Objective: To evaluate the efficacy of EEG neurofeedback (EEG-NF) combined with pharmacological treatment on positive and negative symptoms in schizophrenia.

Methods: Randomized controlled trials (RCTs) were searched in CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane, and Embase databases until January 25, 2025. Literature quality was assessed using the PEDro and CRED-NF checklists. Meta-analysis and publication bias tests were performed using RevMan 5.4.1 and Stata 18.0, respectively, with evidence quality evaluated via GRADEpro.

Results: Fourteen studies (1371 patients) were included. EEG-NF combined with pharmacological treatment significantly improved positive (SMD=-0.87) and negative symptoms (SMD=-1.28). Subgroup analysis showed greater improvement in patients aged ≥45 years (positive: SMD=-1.05; negative: SMD=-1.64). For positive symptoms, better outcomes were observed with intervention periods ≥8 weeks, frequency ≥4 times/week, and disease duration ≥5 years (SMD=-1.04, -0.94, -0.94). For negative symptoms, better outcomes were seen with intervention periods ≥8 weeks, frequency ≥4 times/week, and disease duration <5 years (SMD=-1.34, -1.68, -1.26). Mental and emotional disorders treatment regimens targeting sensorimotor rhythm (SMR) and beta waves showed significant improvement in both positive (SMD=-0.98) and negative symptoms (SMD=-1.49).

Conclusion: EEG-NF combined with pharmacological treatment effectively improves schizophrenia symptoms. A regimen of ≥4 sessions/week for ≥8 weeks, targeting SMR and beta waves, is recommended. However, publication bias may limit the generalizability of findings. Future research should prioritize larger-scale, multicenter studies to evaluate long-term efficacy and mechanisms.

Systematic review registration: www.crd.york.ac.uk, identifier CRD42024593505.

Keywords: EEG neurofeedback; meta-analysis; negative symptoms; pharmacological treatment; positive symptoms; schizophrenia; systematic review.

Copyright © 2025 Duan, Li, Jia, Yu, Wang and Long.

目的: 评估脑电图神经反馈（EEG-NF）联合药物治疗对精神分裂症阳性及阴性症状疗效的评价。

方法: 在CNKI、万方、维普、PubMed、Web of Science、Cochrane和Embase数据库中搜索随机对照试验（RCTs），直至2025年1月25日。文献质量评估采用PEDro和CRED-NF清单，使用RevMan 5.4.1进行元分析及发表偏倚检验，用GRADEpro评价证据质量。

结果: 共纳入14项研究（1371名患者）。EEG-NF联合药物治疗显著改善了阳性症状(SMD=-0.87)和阴性症状(SMD=-1.28)。亚组分析显示，年龄≥45岁的患者有更明显的改善(阳性：SMD=-1.05；阴性：SMD=-1.64)。对于阳性症状，干预期≥8周、频率≥4次/周和病程≥5年的方案表现更好(SMD=-1.04, -0.94, -0.94)。对于阴性症状，干预期≥8周、频率≥4次/周和病程

结论: EEG-NF联合药物治疗有效改善精神分裂症的症状。推荐每周≥4次，持续≥8周的方案，并以SMR和β波为靶点。然而，发表偏倚可能限制了研究结果的普适性。未来的研究应优先进行大规模、多中心的研究来评估长期疗效及机制。

系统综述注册: www.crd.york.ac.uk, identifier CRD42024593505.

关键词: EEG神经反馈；元分析；阴性症状；药物治疗；阳性症状；精神分裂症；系统综述。