BackgroundSubacute combined degeneration (SCD) of the spinal cord is a progressive neurological disorder caused by vitamin B12 deficiency. When initial symptoms present as nonspecific fatigue, dizziness, and affective distress, the condition is frequently misattributed to primary psychiatric disorders. This “diagnostic overshadowing” leads to critical delays in administering definitive therapy, risking irreversible axonal damage.Case presentationA 39-year-old male presented with a nine-month history of progressive paresthesia, dizziness, and emotional distress. Initial medical workups (including brain CT and EEG) were unremarkable, leading to a diagnosis of Somatic Symptom Disorder and anxiety. Despite treatment with multiple psychotropic agents, his condition deteriorated, eventually manifesting as lower limb weakness and significant gait ataxia. Subsequent evaluation at a tertiary center revealed absent patellar reflexes and impaired vibratory sensation. Psychometric testing (SCL-90) showed a high somatization factor (3.00). Investigations confirmed a critically low serum vitamin B12 level (<37 pmol/L) and characteristic longitudinally extensive T2-weighted hyperintensities in the dorsal columns from C3 to T12. Following intramuscular and oral vitamin B12 replacement, supplemented by escitalopram for residual distress, the patient achieved significant recovery. At five-month follow-up, he was fully ambulatory with near-normalization of psychometric scores.ConclusionThis case illustrates the risk of misinterpreting organic neurological deficits as psychogenic somatization. A discrepancy between subjective psychiatric complaints and emerging objective neurological signs-such as absent reflexes or ataxia-should trigger an immediate search for underlying organic etiologies and the initiation of targeted treatment.

Objective:This systematic review and meta-analysis aimed to evaluate the association between the methylenetetrahydrofolate reductase (5,10-methylenetetrahydrofolate reductase, MTHFR) cytosine (C)677thymine (T) polymorphism and cerebral small vessel disease (CSVD), addressing potential sources of heterogeneity and publication bias. Methods:An extensive search of databases, including PubMed, the Excerpta Medical Database, and The Cochrane Database of Systematic Reviews, was conducted to identify studies assessing the prevalence of the MTHFR C677T variant associated with CSVD subtypes in humans. Random or fixed effects models were used to accommodate heterogeneity across the study results. Odds ratios (ORs) and weighted mean differences with 95% confidence intervals (CIs) were used for pooled analyses of the relationships between the MTHFR C677T variant associated and CSVD subtypes. Subgroup analyses and assessments of publication bias were performed using Stata software. Results:Nineteen studies involving 12,441 participants were included. Significant associations were observed across all genetic models: recessive (OR = 1.33; 95%CI = 1.16, 1.52), dominant (OR = 1.25; 95%CI = 1.14, 1.37), allelic (OR = 1.24; 95%CI = 1.14, 1.35), TT vs. CC (OR = 1.42; 95%CI = 1.25, 1.61), and CT vs. CC (OR = 1.20; 95%CI = 1.09, 1.32). Subgroup analyses revealed stronger associations in CSVD-NOS. However, the trim-and-fill method indicated significant publication bias, with adjusted ORs becoming non-significant (recessive model: OR =1.10, 95% CI=0.81, 1.49). Heterogeneity was low to moderate across models (I 2 = 14.2-32.4%). Conclusion:This study highlights the significant association between MTHFR C677T genotyping and CSVD. Early assessment of MTHFR C677T genotyping during the clinical evaluation of elderly patients may improve patient management and reduce the adverse prognostic impact of the CSVD burden. However, further validation of these findings in large-scale, high-quality prospective studies is required. Systematic review registration:https://www.crd.york.ac.uk/prospero/; identifier: CRD42023339320.

Bilateral repetitive transcranial magnetic stimulation (brTMS) has shown promise as a therapeutic approach for depression; however, evidence from existing studies remains inconsistent. To address the concern, a meta-analysis was conducted to examine the efficacy and safety of brTMS in comparison with unilateral repetitive transcranial magnetic stimulation (urTMS) or sham repetitive transcranial magnetic stimulation (srTMS) in treating major depressive disorder (MDD) and bipolar depression (BD). A systematic search covering publications up to May 22, 2024, was performed across four main bibliographic databases (PubMed, EMBASE, Cochrane Library, and PsycINFO) to identify randomized controlled trials (RCTs) assessing the efficacy and safety of brTMS vs. urTMS or srTMS in patients with MDD or BD. Following Cochrane Handbook guidelines, random-effects meta-analyses were employed to derive pooled estimates for primary and secondary outcomes. The analysis included 20 RCTs (8 comparing brTMS to urTMS, 6 comparing brTMS to srTMS, and 6 comparing brTMS to both urTMS and srTMS), encompassing a total of 1666 participants. No significant difference was observed between brTMS and urTMS regarding study-defined response (9 RCTs, 11 study arms, n = 778; RR 1.20, 95

BACKGROUND:The therapeutic efficacy and safety profile of intermittent theta burst stimulation (iTBS) in adolescent patients with major depressive disorder (MDD) or bipolar depression (BD) remain inadequately characterized. This systematic review assesses the efficacy, safety, and tolerability of daily iTBS and accelerated iTBS for adolescents with MDD or BD. METHODS:A comprehensive literature search was conducted in Chinese (WanFang, China National Knowledge Infrastructure) and English (PubMed, EMBASE, PsycINFO, Cochrane Library) databases for randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of daily iTBS or accelerated iTBS in adolescents with MDD or BD. RESULTS:Five RCTs encompassing 264 adolescent patients with MDD or BD were conducted in China and met the inclusion criteria. Two RCTs assessed the antidepressant and neurocognitive effects of adjunctive daily iTBS in MDD, yielding inconsistent findings. Significant superiority of adjunctive daily iTBS over sham stimulation was observed for reducing suicidal ideation (1 RCT), but not for alleviating anxiety symptoms (1 RCT). Four RCTs investigated the antidepressant effects of adjunctive accelerated iTBS in adolescents with MDD or BD, with uncertain findings. No significant advantage of adjunctive accelerated iTBS over sham stimulation was identified for anxiety symptom reduction (2 RCTs), suicidal ideation (1 RCT), or neurocognitive function improvement (2 RCTs). Discontinuation rates did not differ significantly between groups. Only one out of five RCTs systematically reported adverse events. CONCLUSION:Due to the lack of the overall scarcity of high-quality, replicated data, their efficacy in alleviating depressive and anxiety symptoms, suicidal ideation, and neurocognitive deficits remains insufficient to establish clinically meaningful effects. Adverse events were not systematically reported in the majority of studies. Importantly, the efficacy, safety, and tolerability of daily iTBS and accelerated iTBS for adolescents with MDD or BD should be examined in countries other than China.

IntroductionLate-life depression (LLD) is a global public health issue, often accompanied by cognitive impairments that can exacerbate the severity of depression and impair social functioning. Despite being a well-established treatment for LLD, the suitability of problem-solving therapy (PST) for individuals with LLD and varying degrees of cognitive impairments warrants further investigation. This paper presents the protocol for a systematic review and meta-analysis of randomised controlled trials (RCTs) aimed at evaluating the effectiveness and acceptability of PST for this specific demographic.Methods/analysisFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we will conduct a systematic review to synthesise existing research on PST for individuals in this demographic. We will comprehensively search multiple databases and sources, including PubMed, EMBASE, the Cochrane Database and APA PsycNET from inception to October 2023, without language, publication year or type restrictions. Relevant studies will be manually screened from the references. Only RCTs involving PST for LLD will be included. The primary efficacy outcome will be the standardised mean difference in total scores on continuous depression severity scales across different comparison arms. Data extraction will be conducted independently by two reviewers (CH and J-JW), and methodological rigour will be assessed using the Cochrane Risk of Bias assessment tool. Subgroup and sensitivity analyses will be performed to investigate the impact of concomitant cognitive impairments and to evaluate the robustness of the findings.Ethics and disseminationThe meta-analysis project is expected to be ethically unproblematic and does not require approval from a research ethics committee. The results of this study will be shared through articles in scholarly peer-reviewed journals and presentations in various formats, both print and digital.PROSPERO registration numberCRD42023473782

Objectives: As a novel type of theta burst stimulation (TBS), continuous TBS (cTBS) has been shown to have mixed therapeutic effects for major depressive disorder (MDD) or bipolar depression (BD). Thus, we performed a metaanalysis of randomized controlled trials (RCTs) of cTBS for treating major depressive episodes in patients with MDD or BD.Methods: A systematic search of four major bibliographic databases (PubMed, EMBASE, Cochrane Library, and PsycINFO) was conducted from inception dates to February 3, 2023 to identify eligible studies. The data were analyzed using a random-effects model.Results: Three RCTs (n = 78, active cTBS = 37 and sham cTBS = 41) were included the meta-analysis. No significant differences were found in terms of change in Hamilton Depression Rating Scale (HAMD) scores (3 RCTs, n = 78, SMD = -0.09, 95 % CI: -0.53 to 0.36; I2 = 0 %; P = 0.71) and study-defined response (2 RCTs, n = 58, 26.7 % versus 21.4 %, RR = 1.20, 95 % CI: 0.48 to 2.96; I-2 = 0 %; P = 0.70) between active and sham cTBS groups. Similarly, no group differences were found in the rates of adverse events and discontinuation due to any reason (P > 0.05). Limitations: Meta-analysis had small sample sizes and low number of included studies.Conclusions: Although cTBS appeared to be a safe and well-tolerated option for treating major depressive episodes in MDD or BD patients, no advantage in treatment effects was found in this meta-analysis. Future large-scale studies are warranted to assess the efficacy of cTBS for MDD or BD patients with a major depressive episode.

The efficacy and safety of deep transcranial magnetic stimulation (dTMS) in treating treatment-resistant depression (TRD) are unknown. Up to June 21, 2023, we conducted a systematic search for RCTs, and then extracted and synthesized data using random effects models. Five RCTs involving 507 patients with TRD (243 in the active dTMS group and 264 in the control group) were included in the present study. The active dTMS group showed significantly higher study-defined response rate (45.3% versus 24.2%, n = 507, risk ratio [RR] = 1.87, 95% confidence interval [CI]: 1.21-2.91, I2 = 53%; P = 0.005) and study-defined remission rate (38.3% versus 14.4%, n = 507, RR = 2.37, 95%CI: 1.30-4.32, I2 = 58%; P = 0.005) and superiority in improving depressive symptoms (n = 507, standardized mean difference = -0.65, 95%CI: -1.11--0.18, I2 = 82%; P = 0.006) than the control group. In terms of cognitive functions, no significant differences were observed between the two groups. The two groups also showed similar rates of other adverse events and all-cause discontinuations (P > 0.05). dTMS is an effective and safe treatment strategy for the management of patients with TRD.

Objective: This systematic review of randomized controlled studies (RCTs) and observational studies evaluated the efficacy and safety of stanford neuromodulation therapy (SNT) for patients with treatment-resistant depression (TRD).Methods: A systematic search (up to 25 September, 2023) of RCTs and single-arm prospective studies was conducted.Results: One RCT (n = 29) and three single-arm prospective studies (n = 34) met the study entry criteria. In the RCT, compared to sham, active SNT was significantly associated with higher rates of antidepressant response (71.4% versus 13.3%) and remission (57.1% versus 0%). Two out of the three single-arm prospective studies reported the percentage of antidepressant response after completing SNT, ranging from 83.3% (5/6) to 90.5% (19/21). In the three single-arm prospective studies, the antidepressant remission rates ranged from 66.7% (4/6) to 90.5% (19/21). No severe adverse events occurred in all the four studies.Conclusion: This systematic review found SNT significantly improved depressive symptoms in patients with TRD within 5 days, without severe adverse events.

目的 探讨逍遥丸治疗抗精神病药物所致女性精神分裂症患者高泌乳素血症的疗效和安全性.方法 三位研究者系统检索中文数据库(中国知网、万方数据库)和英文数据库(PubMed、Cochrane Library、EMBASE和PsycINFO),纳入关于逍遥丸治疗抗精神病药物所致精神分裂症患者高泌乳素血症的随机对照研究(Randomized Controlled Trials,RCTs),并采用RevMan 5.3软件对结果进行Meta分析.结果 本项Meta分析共纳入3篇RCTs,共计210例女性精神分裂症患者.Meta分析结果显示:逍遥丸组血清泌乳素(Prolactin,PRL)水平明显低于对照组[标准化均数差(Standard Mean Difference,SMD)=-2.71,95％置信区间(Confidence Interval,CI):-3.72～-1.69,P＜0.00001],差异有统计学意义;逍遥丸组阳性与阴性症状量表总分稍高于对照组(SMD=0.04,95％CI:-0.23～0.31,P=0.78),差异无统计学意义.结论 逍遥丸可有效降低抗精神病药物所致女性精神分裂症患者高泌乳素血症的血清PRL水平,改善高泌乳素血症诱导的相关症状.

Objective Intermittent theta-burst stimulation (iTBS), which is a form of repetitive transcranial magnetic stimulation (rTMS), can produce 600 pulses to the left dorsolateral prefrontal cortex (DLPFC) in a stimulation time of just over 3 min. The objective of this systematic review was to compare the safety and efficacy of iTBS and high-frequency (≥ 5 Hz) rTMS (HF-rTMS) for patients with treatment-resistant depression (TRD). Methods Randomized controlled trials (RCTs) comparing the efficacy and safety of iTBS and HF-rTMS were identified by searching English and Chinese databases. The primary outcomes were study-defined response and remission. Results Two RCTs ( n = 474) investigating the efficacy and safety of adjunctive iTBS ( n = 239) versus HF-rTMS ( n = 235) for adult patients with TRD met the inclusion criteria. Among the two included studies (Jadad score = 5), all were classified as high quality. No group differences were found regarding the overall rates of response (iTBS group: 48.0% versus HF-rTMS group: 45.5%) and remission (iTBS group: 30.0% versus HF-rTMS group: 25.2%; all Ps > 0.05). The rates of discontinuation and adverse events such as headache were similar between the two groups (all Ps > 0.05). Conclusion The antidepressant effects and safety of iTBS and HF-rTMS appeared to be similar for patients with TRD, although additional RCTs with rigorous methodology are needed.

ObjectiveTo systematically evaluate the efficacy and safety of Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia， and to provide references for intervention of antipsychotic-induced hyperprolactinemia patients.MethodsEnglish databases （PubMed， Cochrane Library， PsycINFO and Embase） and Chinese databases （CNKI and Wanfang） were systematically searched， with a search time frame of the period from database creation to September 16， 2022. Randomized controlled studies （RCTs） on adjunctive Tianmeng Oral Liquid in the treatment of hyperprolactinemia caused by antipsychotics in female patients with schizophrenia were included. Three investigators independently screened the literatures and extracted data according to PICOS principles and evaluated the quality of including literatures， and the Meta-analysis was performed by using RevMan 5.3.ResultsA total of 3 articles including 256 female schizophrenic patients with hyperprolactinemia were included. Meta-analysis results showed that at the treatment endpoint， the improvement of hyperprolactinemia symptoms reported a significant superiority of the intervention group than the control group （RR=1.73， 95% CI： 1.07~2.79， P˂0.05）. Similarly， the significant superiority of the intervention group than the control group were also found in reducing serum prolactin levels （WMD=-55.17， 95% CI： -68.16~-42.18， P<0.01） and Positive and Negative Syndrome Scale （PANSS） total scores were lower in the intervention group than in the control group （WMD=-7.36， 95% CI： -8.94~-5.77， P<0.01）.ConclusionTianmeng Oral Liquid may help improve clinical efficacy and reduce serum prolactin levels in female schizophrenia patients with hyperprolactinemia. It may improve psychiatric symptoms in female patients with schizophrenia.

Objectives: As a new physical therapeutic technique, magnetic seizure therapy (MST) has established efficacy in the treatment of depression with few cognitive side effects, and thus appears to be a potential alternative to electroconvulsive therapy (ECT). The findings of randomized controlled trials (RCTs) examining the efficacy and safety of MST versus ECT for depression are inconsistent. This systematic review of RCTs was designed with the aim of assessing the safety and efficacy of MST versus ECT for patients with depression. Methods: The WanFang, Chinese Journal Net (CNKI), EMBASE, PubMed, Cochrane Library, and PsycINFO databases were systematically searched by three independent investigators, from their inceptions to July 24, 2021. Results: In total, four RCTs (n = 86) were included and analyzed. Meta-analyses of study-defined response (risk ratio (RR) = 1.36; 95% CI = 0.78 to 2.36; p = 0.28; I2 = 0%), study-defined remission (RR = 1.17; 95% CI = 0.61 to 2.23; p = 0.64; I2 = 0%), and the improvement in depressive symptoms (standardized mean difference (SMD) = 0.21; 95% CI = −0.29 to 0.71; p = 0.42; I2 = 0%) did not present significant differences between MST and ECT. Three RCTs evaluated the cognitive effects of MST compared with ECT using different cognitive measuring tools, but with mixed findings. Only two RCTs reported adverse drug reactions (ADRs), but these lacked specific data. Only one RCT reported discontinuation due to any reason. Conclusions: This preliminary study suggests that MST appears to have a similar antidepressant effect as ECT for depression, but mixed findings on adverse cognitive effects were reported.

Objective We performed a meta-analysis of randomized, double-blind, controlled trials (RCTs) to systematically investigate the therapeutic effects and tolerability of transcranial alternating current stimulation (tACS) for the treatment of patients with major depressive disorder (MDD). Methods Electronic search of PubMed, PsycINFO, EMBASE, Chinese National Knowledge Infrastructure, Wanfang database, and the Cochrane Library up to 1 April 2022. Double-blind RCTs examining the efficacy and safety of tACS for patients with MDD were included. The primary outcome was the improvement of depressive symptoms following a course of tACS treatment. Data were analyzed using Review Manager Version 5.3 (Cochrane IMS, Oxford, UK). Study quality was assessed using the Cochrane risk of bias and Jadad scale. Publication bias was assessed using a funnel plot and the Egger test. Results We identified 883 articles, of which 4 RCTs with 5 active treatment arms covering 224 participants with MDD on active tACS (n = 117) and sham tACS (n = 107) were eligible for inclusion. Meta-analysis of depressive symptoms at post-tACS found an advantage of active tACS over sham tACS (n = 212, standard mean difference (SMD) = −1.14, 95% confidence interval (CI): −2.23, −0.06; I2 = 90%, P = 0.04). The significant superiority of active tACS over sham tACS in improving depressive symptoms remained in a sensitivity analysis. Active tACS was significantly superior to sham tACS regarding depressive symptoms at the 4 week follow-up (SMD = −1.07, 95% CI: −2.05, −0.08; I2 = 88%, P = 0.03) and study-defined remission [risk ratio (RR) = 2.07, 95% CI: 1.36, 3.14, I2 = 9%, P = 0.0006]. The discontinuation rate due to any reason was similar between the two groups (P > 0.05). All included studies were rated as high quality (Jadad score ≥ 3), with funnel plots of primary outcome not suggestive of publication bias. Conclusion tACS appeared to be modestly effective and safe for improving depressive symptoms in patients with MDD, although further studies are warranted.

We aimed to systematically evaluate the clinical efficacy and safety of accelerated intermittent theta burst stimulation (aiTBS) for patients with major depressive disorder (MDD) or bipolar depression (BD). A random -effects model was adopted to analyze the primary and secondary outcomes using the Review Manager, Version 5.3 software. This meta-analysis (MA) identified five double-blind randomized controlled trials (RCTs) comprising 239 MDD or BD patients with a major depressive episode. Active aiTBS overperformed sham stim-ulation in the study-defined response. This MA found preliminary evidence that active aiTBS resulted in a greater response in treating major depressive episodes in MDD or BD patients than sham stimulation.

Background Research is increasingly identifying an overlap between psychosis and immunological dysregulation. Certain autoantibodies are being identified in a small but probably relevant subgroup of patients with psychosis. The term “autoimmune psychosis” (AIP) and its corresponding red-flag signs present the opportunity for a new field in psychiatry to promote diagnostic workup and immunomodulating therapy in individual cases. Objectives The present protocol aims to determine the seroprevalence of autoantibodies in first-episode psychosis (FEPs) using AIP red flag signs, and to explore the frequency of autoantibody subtypes and potential mediating confounders. Methods/design This is a hospital-based case-control study. All participants will be consecutively selected from the main tertiary psychiatric hospital in Shenzhen City, China. Individuals admitted to the psychiatric ward and diagnosed with FEPs will be enrolled. Based on recent consensus, participants with red flags of AIPs will be defined as cases, while the remainder will be matched as controls. Seropositive antibodies will be detected and verified in cerebrospinal fluid (CSF) samples based on the fixed cell-based assay (CBA) method. The propensity score-adjusted odds ratios will be determined to investigate the key mediating confounders regarding autoantibody subtypes and red flag subsets. Discussion The results of this study will facilitate the early identification of AIPs in FEP patients using the red flag sign and help identify key mediators that improve the accuracy of diagnostic algorithms. It will have clinical significance to focus on serum antibodies that have been verified in CSF samples, due to its consistency with clinical practices in current psychiatry.

Objective: Treatment-refractory auditory hallucinations (TRAH) in schizophrenia often do not improve with pharmacotherapy. We performed a meta-analysis of randomized, double-blind, sham-controlled clinical trials (RCTs) that systematically examined the therapeutic effects and tolerability of adjunctive active versus sham active transcranial direct current stimulation (tDCS) for auditory hallucinations as measured by the Auditory Hallucination Rating Scale (AHRS) in schizophrenia patients with TRAH. Methods: Relevant data were extracted, checked and analyzed using the Review Manager, Version 5.3 by three independent investigators. Results: Eight double-blind RCTs covering 329 schizophrenia patients (168 in active tDCS group, 161 in sham tDCS group) were included. Although no advantage of active tDCS on auditory hallucinations [7 RCTs, n = 224; standardized mean difference (SMD): -0.33 (95% confidence interval (CI): -0.71, 0.05), P = 0.09; I-2 = 46%] was found compared to sham, subgroup analyses revealed that active tDCS with twice-daily stimulation [6 RCTs, n = 198; SMD: -0.42 (95%CI:-0.82,-0.02), P = 0.04; I-2 = 44%] and active tDCS with >= 10 stimulation sessions [6 RCTs, n = 198; SMD: -0.42 (95%CI:-0.82,-0.02), P = 0.04; I-2 = 44%] showed a significantly better therapeutic effect than sham in improving auditory hallucinations symptoms. Meta-analyses of total psychopathology and discontinuation due to any reason were not significantly different between the active and sham tDCS groups. Conclusion: This meta-analysis demonstrated that the effects of tDCS for auditory hallucinations symptoms were influenced by the tDCS parameters. Twice-daily stimulation and >= 10 stimulation sessions may be needed to improve auditory hallucinations symptoms in schizophrenia with TRAH.

Objective: The efficacy and safety of adjunctive magnetic seizure therapy (MST) for patients with schizophrenia are unclear. This systematic review was conducted to examine the efficacy and safety of adjunctive MST for schizophrenia.Methods: Chinese (WanFang and Chinese Journal Net) and English (PubMed, EMBASE, PsycINFO, and the Cochrane Library) databases were systematically searched.Results: Two open-label self-controlled studies (n = 16) were included and analyzed in this review. In these studies, the Positive and Negative Syndrome Scale (PANSS) total scores and Brief Psychiatric Rating Scale (BPRS) total scores significantly decreased from baseline to post-MST (all Ps < 0.05), without serious adverse neurocognitive effects. Mixed findings on the neurocognitive effects of adjunctive MST for schizophrenia were reported in the two studies. A discontinuation rate of treatment of up to 50% (4/8) was reported in both studies. The rate of adverse drug reactions (ADRs) was evaluated in only one study, where the most common ADRs were found to be dizziness (25%, 2/8) and subjective memory loss (12.5%, 1/8).Conclusion: There is inconsistent evidence for MST-related adverse neurocognitive effects and preliminary evidence for the alleviation of psychotic symptoms in schizophrenia.

Background Subcortical vascular mild cognitive impairment (svMCI) is one of the most treatable cognitive impairments, but could be hampered by the high clinical heterogeneities. Further classification by Chinese Medicine (CM) patterns has been proved to stratify its clinical heterogeneities. It remains largely unknown of the spontaneous brain activities regarding deficiency patterns (DPs) and excess patterns (EPs) of svMCI patients based on fMRI data. Objective We aim to provide neuroimaging evidence of altered resting-state brain activities associated with DPs and EPs in svMCI patients. Methods Thirty-seven svMCI patients (PAs) and 23 healthy controls (CNs) were consecutively enrolled. All patients were categorized into either the EP group (n = 16) and the DP group (n = 21) based on a quantitative CM scale. The fractional amplitude of low-frequency fluctuation (fALFF) value was used to make comparisons between different subgroups. Results The DP group showed significant differences of fALFF values in the right middle frontal gyrus and the right cerebellum, while the EP group showed significant differences in the left orbitofrontal gyrus and the left cerebellum, when compared with the CN group. When compared with the EP group, the DP group had markedly increased fALFF values in the left superior temporal gyrus, right middle temporal gyrus and brainstem. The decreased fALFF values was shown in the right anterior cingulate and paracingulate gyri. Among the extensive areas of frontotemporal lobe, the Montreal Cognitive Assessment (MoCA) scores were significantly correlated with the reduced fALFF value of the right middle frontal gyrus and the left orbitofrontal gyrus. Conclusion Our results indicated that the DPs and EPs presented the lateralization pattern in the bilateral frontal gyrus, which will probably benefit the future investigation of the pathogenesis of svMCI patients.

Findings of multi-session transcranial direct current stimulation (tDCS) as an adjunctive treatment of neumcognitive dysfunction in schizophrenia have been inconsistent. This meta-analysis of randomized controlled trials (RCTs) investigated the neurocognitive effects of adjunctive multi-session tDCS for schizophrenia. Twelve RCTs covering 418 schizophrenia patients were included and analyzed in this meta-analysis. The RevMan software (Version 5.3) was used to calculate risk ratios (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals (CIs). Adjunctive tDCS outperformed the comparator in improving working memory deficits (SMD = 0.34, 95% CI: 0.03, 0.65; I-2 = 52%; p = 0.03), but no significant effects were found in other cognitive domains. No group differences were found with regard to total psychopathology measured by the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale (SMD =-0.29, 95%CI: -0.61, 0.03; I-2 = 50%, p = 0.07) and discontinuation due to any reason (RR=0.80, 95%CI: 0.39, 1.66; I-2 = 9%, p = 0.56). Adjunctive tDCS appears to have a significant therapeutic effect improving the working memory deficits in schizophrenia.