Introduction
Aggressive behavior in schizophrenia remains one of the most challenging aspects of clinical care. It not only impacts patients’ quality of life but also influences safety and recovery outcomes. Traditional psychiatric assessments often rely on observable symptoms and patient history, which can make it difficult to predict which individuals are at higher risk of aggression. A recent study highlights how transcranial magnetic stimulation (TMS) measures may provide objective insights into brain activity linked to aggression, offering a potential step forward for personalized psychiatry.
TMS measures and aggression in schizophrenia
TMS is a noninvasive brain stimulation method often used in research and treatment of mental health disorders. By applying magnetic pulses to specific brain regions, researchers can measure how the motor cortex responds. These responses reflect how well brain circuits regulate excitability and inhibition—key factors that influence behavior.
The study in question recruited 79 minimally treated patients with schizophrenia. Researchers focused on three main TMS measures:
- Short Interval Cortical Inhibition (SICI): A marker of the brain’s ability to suppress unnecessary activity.
- Cortical Silent Period (CSP): Reflects longer inhibitory processes within motor control.
- Recruitment Gain (SI1mV – RMT): Indicates cortical excitability, or how easily brain cells respond to stimulation.
When compared with aggression levels measured using the Modified Overt Aggression Scale (MOAS), these measures revealed significant associations. Specifically, reduced SICI and altered CSP were linked to higher aggression, while increased excitability also correlated with greater risk.
Predictive potential for clinical care
While no single measure perfectly predicted aggressive outcomes, the combination of SICI, CSP, and recruitment gain explained about 17% of the variation in aggression scores. Importantly, when combined in a predictive model, these measures were able to distinguish individuals with high versus low aggression risk with moderate accuracy (AUC = 0.704).
This suggests that TMS may act as a biomarker-based tool for clinicians. Instead of relying only on observation or patient self-report, doctors could one day integrate neurophysiological data to identify individuals who may require closer monitoring or preventive interventions.
What this means for psychiatry
Although these findings are promising, they also highlight the need for caution. The study had a moderate sample size and a cross-sectional design, meaning it can only show correlations rather than cause-and-effect. Future research will need to include larger, longitudinal studies to confirm whether TMS measures can consistently predict aggression over time.
If validated, these biomarkers could reshape how psychiatrists assess risk in schizophrenia. By combining clinical interviews, behavioral assessments, and TMS data, mental health professionals may be able to design more targeted and effective care plans. This could lead to earlier interventions that improve patient outcomes and reduce risks for both patients and communities.
Looking ahead
The role of TMS in psychiatry is expanding beyond treatment into diagnostics and prediction. Studies like this highlight the growing importance of brain-based biomarkers for guiding clinical decision-making. As interventional psychiatry continues to advance, tools like TMS may help bridge the gap between neuroscience research and real-world mental health care.
References
- Das M, Kumar S, Goyal N, Chowdary KS, Samantaray S. Investigational transcranial magnetic stimulation measures as predictors of aggression in schizophrenia: A cross-sectional study. Journal of Psychiatric Research, 2025. Link: https://pubmed.ncbi.nlm.nih.gov/40972066/
- Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A. Transcranial magnetic stimulation (TMS) for schizophrenia. Cochrane Database of Systematic Reviews, 2015. Link: https://www.cochrane.org/evidence/CD006081_transcranial-magnetic-stimulation-tms-treatment-schizophrenia