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Brunoni AR, Sampaio-Junior B, Moffa AH, Aparício LV, Gordon P, Klein I, Rios RM, Razza LB, Loo C, Padberg F, Valiengo L. Noninvasive brain stimulation in psychiatric disorders: a primer. ACTA ACUST UNITED AC 2018; 41:70-81. [PMID: 30328957 PMCID: PMC6781710 DOI: 10.1590/1516-4446-2017-0018] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Noninvasive brain stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are increasingly being used to treat mental disorders, particularly major depression. The aim of this comprehensive review is to summarize the main advances, limitations, and perspectives of the field. METHODS We searched PubMed and other databases from inception to July 2017 for articles, particularly systematic reviews and meta-analyses, evaluating the use of NIBS in psychiatric disorders. RESULTS We reviewed the mechanisms of action, safety, tolerability, efficacy, and relevant clinical parameters of NIBS. Repetitive TMS is already an established technique for the treatment of depression, and there is theoretically room for further methodological development towards a high-end therapeutic intervention. In contrast, tDCS is a technically easier method and therefore potentially suitable for wider clinical use. However the evidence of its antidepressant efficacy is less sound, and a recent study found tDCS to be inferior to antidepressant pharmacotherapy. Clinical trials using rTMS for other mental disorders produced mixed findings, whereas tDCS use has not been sufficiently appraised. CONCLUSION The most promising results of NIBS have been obtained for depression. These techniques excel in safety and tolerability, although their efficacy still warrants improvement.
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Affiliation(s)
- Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Bernardo Sampaio-Junior
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Adriano H Moffa
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Luana V Aparício
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Pedro Gordon
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Department of Neurology and Stroke, Eberhard Karls University, Tübingen, Germany
| | - Izio Klein
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Rosa M Rios
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais B Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Colleen Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Frank Padberg
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Plewnia C, Brendel B, Schwippel T, Martus P, Cordes J, Hasan A, Fallgatter AJ. Treatment of auditory hallucinations with bilateral theta burst stimulation (cTBS): protocol of a randomized, double-blind, placebo-controlled, multicenter trial. Eur Arch Psychiatry Clin Neurosci 2018; 268:663-673. [PMID: 29224040 DOI: 10.1007/s00406-017-0861-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 12/02/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED Auditory verbal hallucinations (AH) are core symptoms of schizophrenia. They are often severely distressing and refractory to therapy. Their perception is associated with increased activity in temporoparietal areas of the brain. Repetitive transcranial magnetic stimulation (rTMS) can reduce focal brain hyperactivity and has been shown to ameliorate AH. However, controlled multicenter clinical trials are still missing, effect sizes are moderate, and the treatment with rTMS is time consuming. Continuous theta burst stimulation (cTBS) is a quicker and potentially more effective technique to reduce cortical hyperactivity. First case and pilot studies indicate effectiveness in the treatment of AH. In this randomized, sham-controlled, double-blind multicenter clinical trial, 86 patients with schizophrenia spectrum disorder will be randomized to either cTBS or sham to the left and right temporoparietal cortex during three consecutive weeks (15 sessions totally). In each session, both hemispheres will be stimulated sequentially. The order in the first session (left-right or right-left, respectively) will be determined by randomization and alternated in all following sessions. Primary outcome is the reduction of mean PSYRATS-AH score after cTBS as compared to sham treatment. Follow-up measurements will be performed 1, 3 and 6 months after the end of the treatment. Statistical analysis will be based on the intention-to-treat population including all randomized patients using an analysis of covariance. This multicenter-controlled clinical trial will be able to provide decisive evidence for the efficacy of cTBS in the treatment of AH. The results will be suitable to clarify the role of this innovative, pathophysiology-based therapeutic approach in treatment guidelines for AH. TRIAL REGISTRY ClinicalTrials.gov identifier: NCT02670291.
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Affiliation(s)
- Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany.
| | - Bettina Brendel
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany.,Institute of Clinical Epidemiology and Applied Biometry of the University of Tübingen, Silcherstr. 5, 72076, Tübingen, Germany
| | - Tobias Schwippel
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biometry of the University of Tübingen, Silcherstr. 5, 72076, Tübingen, Germany
| | - Joachim Cordes
- LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine Universität Düsseldorf, 40629, Düsseldorf, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
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53
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A Review of the Effects of Transcranial Direct Current Stimulation for the Treatment of Hallucinations in Patients With Schizophrenia. J ECT 2018; 34:164-171. [PMID: 30024458 DOI: 10.1097/yct.0000000000000525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Some 25% to 30% of patients with schizophrenia report auditory verbal hallucinations (AVHs) that fail to respond adequately to antipsychotic treatments. In such cases, transcranial direct current stimulation (tDCS) has been proposed as a therapeutic option. Here, we aim to provide an exhaustive review of the literature examining the clinical effects of tDCS on AVH in patients with schizophrenia. A systematic search in the PubMed and Web of Science databases yielded 14 results, 7 randomized controlled trials (RCTs) and 7 open-label studies. Among them, 4 RCTs and 7 open-label studies reported a significant reduction of AVH after repeated sessions of tDCS, whereas 3 RCTs did not show any advantage of active tDCS over sham tDCS. Altogether, current studies showed an overall decrease of approximately 26% of AVH after active tDCS and 11% after sham tDCS. One suitable approach to decreasing AVH was to deliver twice-daily sessions of tDCS over 5 consecutive days (10 sessions at 20 minutes each, 2 mA) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporoparietal junction. Demographic and clinical parameters such as young age, nonsmoking status, and higher frequencies of AVH occurrence seemed to be predictors of clinical improvement. Further RCTs, with larger sample sizes, are needed to confirm the usefulness of tDCS for AVH.
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Chang CC, Tzeng NS, Chao CY, Yeh CB, Chang HA. The Effects of Add-on Fronto-Temporal Transcranial Direct Current Stimulation (tDCS) on Auditory Verbal Hallucinations, Other Psychopathological Symptoms, and Insight in Schizophrenia: A Randomized, Double-Blind, Sham-Controlled Trial. Int J Neuropsychopharmacol 2018; 21:979-987. [PMID: 30107404 PMCID: PMC6209860 DOI: 10.1093/ijnp/pyy074] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of fronto-temporal transcranial direct current stimulation in treating auditory verbal hallucinations and other psychopathological symptoms of schizophrenia patients has been examined in a small number of clinical trials with limited sample sizes, but the results are mixed. Fronto-temporal transcranial direct current stimulation has also been demonstrated to enhance patients' insight into their mental illness in an open-label pilot study. The current investigation aimed to investigate the therapeutic effects of fronto-temporal transcranial direct current stimulation on the severity of auditory verbal hallucinations, other schizophrenia symptoms, and insight in a large double blind, randomized, sham-controlled trial. METHODS Sixty patients with medication-refractory auditory verbal hallucinations were randomized over 2 conditions: transcranial direct current stimulation with 2-mA, twice-daily sessions for 5 consecutive days, with anodal stimulation to the left prefrontal cortex and cathodal stimulation to the left temporo-parietal junction, and sham treatment. RESULTS Fronto-temporal transcranial direct current stimulation failed to cause significant changes in the severity of auditory verbal hallucinations and other schizophrenia symptoms. The levels of insight into illness (effect size=0.511, P<.001) and positive symptoms (effect size=0.781, P<.001) were largely promoted by 5 days of transcranial direct current stimulation relative to sham treatment. The beneficial effects on the 2 insight dimensions remained 1 month after transcranial direct current stimulation. CONCLUSIONS Fronto-temporal transcranial direct current stimulation is not more effective for auditory verbal hallucinations and other schizophrenia symptoms than sham treatment. But the results of transcranial direct current stimulation-associated improvement in awareness of illness and positive symptoms show promise and provide a new direction for future research into insight promotion interventions in schizophrenia.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Correspondence: Hsin-An Chang, MD, Department of Psychiatry, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, 114, Taiwan, ROC ()
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55
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Koutsouleris N, Wobrock T, Guse B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Musso F, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Dwyer D, Ghaseminejad F, Dechent P, Malchow B, Kreuzer PM, Poeppl TB, Schneider-Axmann T, Falkai P, Hasan A. Predicting Response to Repetitive Transcranial Magnetic Stimulation in Patients With Schizophrenia Using Structural Magnetic Resonance Imaging: A Multisite Machine Learning Analysis. Schizophr Bull 2018; 44:1021-1034. [PMID: 28981875 PMCID: PMC6101524 DOI: 10.1093/schbul/sbx114] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The variability of responses to plasticity-inducing repetitive transcranial magnetic stimulation (rTMS) challenges its successful application in psychiatric care. No objective means currently exists to individually predict the patients' response to rTMS. METHODS We used machine learning to develop and validate such tools using the pre-treatment structural Magnetic Resonance Images (sMRI) of 92 patients with schizophrenia enrolled in the multisite RESIS trial (http://clinicaltrials.gov, NCT00783120): patients were randomized to either active (N = 45) or sham (N = 47) 10-Hz rTMS applied to the left dorsolateral prefrontal cortex 5 days per week for 21 days. The prediction target was nonresponse vs response defined by a ≥20% pre-post Positive and Negative Syndrome Scale (PANSS) negative score reduction. RESULTS Our models predicted this endpoint with a cross-validated balanced accuracy (BAC) of 85% (nonresponse/response: 79%/90%) in patients receiving active rTMS, but only with 51% (48%/55%) in the sham-treated sample. Leave-site-out cross-validation demonstrated cross-site generalizability of the active rTMS predictor despite smaller training samples (BAC: 71%). The predictive pre-treatment pattern involved gray matter density reductions in prefrontal, insular, medio-temporal, and cerebellar cortices, and increments in parietal and thalamic structures. The low BAC of 58% produced by the active rTMS predictor in sham-treated patients, as well as its poor performance in predicting positive symptom courses supported the therapeutic specificity of this brain pattern. CONCLUSIONS Individual responses to active rTMS in patients with predominant negative schizophrenia may be accurately predicted using structural neuromarkers. Further multisite studies are needed to externally validate the proposed treatment stratifier and develop more personalized and biologically informed rTMS interventions.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich,To whom correspondence should be addressed; Professor for Neurodiagnostic Applications in Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstr. 7, D-80336 Munich, Germany; tel: 0049-(0)-89-4400-55885, fax: 0049-(0)-89-4400-55776, e-mail:
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen,County Hospitals Darmstadt-Dieburg, Groß-Umstadt
| | - Birgit Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Francesco Musso
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Georg Winterer
- Experimental & Clinical Research Center (ECRC), Charite – University Medicine Berlin
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Göran Hajak
- European Clinical Research Infrastructure Network (ECRIN), Düsseldorf, Germany,Coordination Centre for Clinical Trials, Heinrich-Heine-University, Düsseldorf
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg
| | - Raees Ahmed
- Referat Klinische Studien Management, Georg-August-University Goettingen
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, Canada
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Farhad Ghaseminejad
- Institute of Mental Health, The University of British Columbia, Vancouver, Canada
| | - Peter Dechent
- Department of Cognitive Neurology, Georg-August-University Goettingen
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Tim B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
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Cognitive effects of bilateral high frequency repetitive transcranial magnetic stimulation in early phase psychosis: a pilot study. Brain Imaging Behav 2018; 13:852-861. [DOI: 10.1007/s11682-018-9902-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Targeted neural network interventions for auditory hallucinations: Can TMS inform DBS? Schizophr Res 2018; 195:455-462. [PMID: 28969932 PMCID: PMC8141945 DOI: 10.1016/j.schres.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Abstract
The debilitating and refractory nature of auditory hallucinations (AH) in schizophrenia and other psychiatric disorders has stimulated investigations into neuromodulatory interventions that target the aberrant neural networks associated with them. Internal or invasive forms of brain stimulation such as deep brain stimulation (DBS) are currently being explored for treatment-refractory schizophrenia. The process of developing and implementing DBS is limited by symptom clustering within psychiatric constructs as well as a scarcity of causal tools with which to predict response, refine targeting or guide clinical decisions. Transcranial magnetic stimulation (TMS), an external or non-invasive form of brain stimulation, has shown some promise as a therapeutic intervention for AH but remains relatively underutilized as an investigational probe of clinically relevant neural networks. In this editorial, we propose that TMS has the potential to inform DBS by adding individualized causal evidence to an evaluation processes otherwise devoid of it in patients. Although there are significant limitations and safety concerns regarding DBS, the combination of TMS with computational modeling of neuroimaging and neurophysiological data could provide critical insights into more robust and adaptable network modulation.
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58
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Bansal S, Ford JM, Spering M. The function and failure of sensory predictions. Ann N Y Acad Sci 2018; 1426:199-220. [PMID: 29683518 DOI: 10.1111/nyas.13686] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 01/24/2023]
Abstract
Humans and other primates are equipped with neural mechanisms that allow them to automatically make predictions about future events, facilitating processing of expected sensations and actions. Prediction-driven control and monitoring of perceptual and motor acts are vital to normal cognitive functioning. This review provides an overview of corollary discharge mechanisms involved in predictions across sensory modalities and discusses consequences of predictive coding for cognition and behavior. Converging evidence now links impairments in corollary discharge mechanisms to neuropsychiatric symptoms such as hallucinations and delusions. We review studies supporting a prediction-failure hypothesis of perceptual and cognitive disturbances. We also outline neural correlates underlying prediction function and failure, highlighting similarities across the visual, auditory, and somatosensory systems. In linking basic psychophysical and psychophysiological evidence of visual, auditory, and somatosensory prediction failures to neuropsychiatric symptoms, our review furthers our understanding of disease mechanisms.
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Affiliation(s)
- Sonia Bansal
- Maryland Psychiatric Research Center, University of Maryland, Catonsville, Maryland
| | - Judith M Ford
- University of California and Veterans Affairs Medical Center, San Francisco, California
| | - Miriam Spering
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Tracy DK, David AS. Clinical neuromodulation in psychiatry: the state of the art or an art in a state? BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.115.014563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
SummaryClinical neuromodulation began in psychiatry with electroconvulsive therapy (ECT), but in recent years several new techniques have been developed: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS), trigeminal nerve stimulation (TNS) and deep brain stimulation (DBS). Each works in a different way, although the principle remains to effect therapeutic change through physically modifying brain activity. Their use in different clinical groups varies between techniques, as does their underlying evidence base. Most support currently exists for rTMS, with a more modest, but growing database for tDCS. Understandably, but problematically, most research in the other techniques has, to date, been in unmasked open trials. This article describes the mechanism of action and current evidence base for each technique, and notes the challenges facing future work in this potentially important field and new clinical avenue.
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60
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Slotema CW, Blom JD, Niemantsverdriet MBA, Sommer IEC. Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review. Front Psychiatry 2018; 9:347. [PMID: 30108529 PMCID: PMC6079212 DOI: 10.3389/fpsyt.2018.00347] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background: Auditory verbal hallucinations (AVH) are experienced more frequently by patients with borderline personality disorder (BPD) than previously assumed. However, consensus is lacking on how to treat them. Objective: To provide a systematic review of studies reporting on AVH in patients with BPD, with a focus on the efficacy of treatment of psychotic symptoms. Methods: For this review a systematic search was made in the PubMed and Ovid databases, and mean weighted prevalence rates, adjusted for sample size, were computed. Results: The search yielded 36 studies describing a total of 1,263 patients. Auditory hallucinations (including AVH) were reported in 27% of hospitalized BPD patients; AVH were reported in 25% of all patients and in 24% of outpatients. Of the hallucinating patients, 78% experienced AVH at least once per day, for a duration of several days to many years. On the whole, patients with BPD regarded their voices as malevolent and omnipotent in nature. Compared to patients with schizophrenia, the phenomenological characteristics of AVH were similar and the ensuing distress was equal or even higher, whereas scores for other positive symptoms were lower. The presence of AVH in BPD was associated with an increase of suicide plans and attempts, and more frequent hospitalization. Moreover, AVH in the context of BPD were associated with higher prevalence rates for post-traumatic stress disorder and emotional abuse. The efficacy of antipsychotics was investigated in 21 studies. Based on these studies, we conclude that both typical and atypical antipsychotics tend to have positive effects on AVH experienced in the context of BPD. The efficacy of cognitive-behavioral therapy and non-invasive brain stimulation has not yet been systematically assessed. Conclusions: These findings indicate that AVH experienced in the context of BPD are in need of proper diagnosis and treatment, and that antipsychotics tend to be beneficial in treating these (and other psychotic) symptoms.There is an urgent need for studies assessing the efficacy of cognitive-behavioral therapy and non-invasive brain stimulation in this underdiagnosed and undertreated group.
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Affiliation(s)
- Christina W Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jan Dirk Blom
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | | | - Iris E C Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Sun Z, Jiang T, Wu Y, Ma C, He Y, Yang J. Low Field Magnetic Stimulation Ameliorates Schizophrenia-Like Behavior and Up-Regulates Neuregulin-1 Expression in a Mouse Model of Cuprizone-Induced Demyelination. Front Psychiatry 2018; 9:675. [PMID: 30574102 PMCID: PMC6291499 DOI: 10.3389/fpsyt.2018.00675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Abstract
White matter and myelin sheath integrity are disrupted in schizophrenia, and non-invasive magnetic brain stimulation targeting these tracts is a promising new therapeutic approach. In particular, deep-brain reachable low field magnetic stimulation (DMS) could alleviate cognitive impairment and depressive-like behaviors in animal models. In this study, we sought to assess the effects of DMS on myelin sheath damage and schizophrenia-like behaviors in the cuprizone-induced demyelination mouse model. Mice were fed cuprizone (copper ion chelating agent, 0.2% w/w mixed with food) for 6 weeks to induce demyelination. During these 6 weeks, mice were stimulated with either sham, low-frequency (LFS, delta frequency) DMS or high-frequency (HFS, gamma Hz) DMS for 20 min each day. Behavioral tests were conducted 24 h after the final DMS session. The myelin sheath was examined by immunohistochemistry and the expression of neuregulin-1 (NRG1)/ErbB4 in the prefrontal cortex was measured with Western blotting. Six weeks of HFS significantly alleviated schizophrenia-like behaviors in cuprizone mice, including improved nesting, social interaction and sensorimotor gating, while LFS improved sensorimotor gating only. HFS and LFS both repaired the myelin sheath and increased the expression of neuregulin-1 and its receptor ErbB4, in the prefrontal cortex of demyelinated mice. Our findings show that DMS is a potential effective neuromodulation technique for the treatment of schizophrenia. One possible mechanism underlying these therapeutic effects could involve the up-regulation of NRG1/ErbB4 signaling in the prefrontal cortex.
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Affiliation(s)
- Zuoli Sun
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Tianhe Jiang
- Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China
| | - Yan Wu
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi He
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jian Yang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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62
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Guo Q, Li C, Wang J. Updated Review on the Clinical Use of Repetitive Transcranial Magnetic Stimulation in Psychiatric Disorders. Neurosci Bull 2017; 33:747-756. [PMID: 29064064 DOI: 10.1007/s12264-017-0185-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/02/2017] [Indexed: 12/28/2022] Open
Abstract
With the ability to modulate cortical activity, repetitive transcranial magnetic stimulation (rTMS) is becoming increasingly important in clinical applications for psychiatric disorders. Previous studies have demonstrated its promising efficacy in depression and schizophrenia, and emerging evidence has also been found in patients with anxiety disorder, obsessive-compulsive disorder, and substance or food craving. However, the overall literature features some conflicting results, varied quality of studies, and a lack of consensus on optimal rTMS parameters. Besides, the efficacy of rTMS in patients with medication-resistant symptoms has drawn most attention from clinicians. Here we review multi-site studies and double-blind randomized controlled trials (RCTs) in single sites, as well as meta-analyses of RCTs in the last three years, in order to update evidence on efficacy and the optimal protocol of rTMS in psychiatric disorders, especially for medication-resistant symptoms.
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Affiliation(s)
- Qian Guo
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China.
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Effects of low frequency rTMS treatment on brain networks for inner speech in patients with schizophrenia and auditory verbal hallucinations. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:105-113. [PMID: 28442422 DOI: 10.1016/j.pnpbp.2017.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/15/2017] [Accepted: 04/16/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) targeting the temporo-parietal junction (TPJ) for the treatment of auditory verbal hallucinations (AVH) remains under debate. We assessed the influence of a 1Hz rTMS treatment on neural networks involved in a cognitive mechanism proposed to subserve AVH. METHODS Patients with schizophrenia (N=24) experiencing medication-resistant AVH completed a 10-day 1Hz rTMS treatment. Participants were randomized to active stimulation of the left or bilateral TPJ, or sham stimulation. The effects of rTMS on neural networks were investigated with an inner speech task during fMRI. Changes within and between neural networks were analyzed using Independent Component Analysis. RESULTS rTMS of the left and bilateral TPJ areas resulted in a weaker network contribution of the left supramarginal gyrus to the bilateral fronto-temporal network. Left-sided rTMS resulted in stronger network contributions of the right superior temporal gyrus to the auditory-sensorimotor network, right inferior gyrus to the left fronto-parietal network, and left middle frontal gyrus to the default mode network. Bilateral rTMS was associated with a predominant inhibitory effect on network contribution. Sham stimulation showed different patterns of change compared to active rTMS. CONCLUSION rTMS of the left temporo-parietal region decreased the contribution of the left supramarginal gyrus to the bilateral fronto-temporal network, which may reduce the likelihood of speech intrusions. On the other hand, left rTMS appeared to increase the contribution of functionally connected regions involved in perception, cognitive control and self-referential processing. These findings hint to potential neural mechanisms underlying rTMS for hallucinations but need corroboration in larger samples.
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Dunn W, Rassovsky Y, Wynn J, Wu AD, Iacoboni M, Hellemann G, Green MF. The effect of bilateral transcranial direct current stimulation on early auditory processing in schizophrenia: a preliminary study. J Neural Transm (Vienna) 2017; 124:1145-1149. [PMID: 28687908 DOI: 10.1007/s00702-017-1752-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/28/2017] [Indexed: 12/16/2022]
Abstract
Transcranial direct current stimulation (tDCS) was applied bilaterally over the auditory cortex in 12 schizophrenia patients to modulate early auditory processing. Performance on a tone discrimination task (tone-matching task-TMT) and auditory mismatch negativity were assessed after counterbalanced anodal, cathodal, and sham tDCS. Cathodal stimulation improved TMT performance (p < 0.03) compared to sham condition. Post-hoc analyses revealed a stimulation condition by negative symptom interaction in which greater negative symptoms were associated with a better TMT performance after anodal tDCS.
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Affiliation(s)
- Walter Dunn
- Department of Veterans Affairs VISN-22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, USA. .,Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA. .,West Los Angeles VA Medical Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
| | - Yuri Rassovsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.,Department of Psychology and Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Jonathan Wynn
- Department of Veterans Affairs VISN-22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Allan D Wu
- Department of Neurology, University of California, Los Angeles, USA
| | - Marco Iacoboni
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, USA
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Michael F Green
- Department of Veterans Affairs VISN-22 Mental Illness Research, Education and Clinical Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Walton E, Hibar DP, van Erp TGM, Potkin SG, Roiz-Santiañez R, Crespo-Facorro B, Suarez-Pinilla P, Van Haren NEM, de Zwarte SMC, Kahn RS, Cahn W, Doan NT, Jørgensen KN, Gurholt TP, Agartz I, Andreassen OA, Westlye LT, Melle I, Berg AO, Mørch-Johnsen L, Færden A, Flyckt L, Fatouros-Bergman H, Jönsson EG, Hashimoto R, Yamamori H, Fukunaga M, Preda A, De Rossi P, Piras F, Banaj N, Piras F, Ciullo V, Spalletta G, Gur RE, Gur RC, Wolf DH, Satterthwaite TD, Beard LM, Sommer IE, Koops S, Gruber O, Richter A, Krämer B, Kelly S, Donohoe G, McDonald C, Cannon DM, Corvin A, Gill M, Di Giorgio A, Bertolino A, Lawrie S, Nickson T, Whalley HC, Neilson E, Calhoun VD, Thompson PM, Turner JA, Ehrlich S. Positive symptoms associate with cortical thinning in the superior temporal gyrus via the ENIGMA Schizophrenia consortium. Acta Psychiatr Scand 2017; 135:439-447. [PMID: 28369804 PMCID: PMC5399182 DOI: 10.1111/acps.12718] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Based on the role of the superior temporal gyrus (STG) in auditory processing, language comprehension and self-monitoring, this study aimed to investigate the relationship between STG cortical thickness and positive symptom severity in schizophrenia. METHOD This prospective meta-analysis includes data from 1987 individuals with schizophrenia collected at seventeen centres around the world that contribute to the ENIGMA Schizophrenia Working Group. STG thickness measures were extracted from T1-weighted brain scans using FreeSurfer. The study performed a meta-analysis of effect sizes across sites generated by a model predicting left or right STG thickness with a positive symptom severity score (harmonized SAPS or PANSS-positive scores), while controlling for age, sex and site. Secondary models investigated relationships between antipsychotic medication, duration of illness, overall illness severity, handedness and STG thickness. RESULTS Positive symptom severity was negatively related to STG thickness in both hemispheres (left: βstd = -0.052; P = 0.021; right: βstd = -0.073; P = 0.001) when statistically controlling for age, sex and site. This effect remained stable in models including duration of illness, antipsychotic medication or handedness. CONCLUSION Our findings further underline the important role of the STG in hallmark symptoms in schizophrenia. These findings can assist in advancing insight into symptom-relevant pathophysiological mechanisms in schizophrenia.
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Affiliation(s)
- Esther Walton
- Department of Psychology, Georgia State University, Atlanta GA 30302,Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany,Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, SE5 8AF, United Kingdom
| | - Derrek P Hibar
- Imaging Genetics Center, Keck School of Medicine, University of Southern California, Marina del Rey, CA, United States
| | - Theo GM van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, USA
| | - Roberto Roiz-Santiañez
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria–IDIVAL, Avda. Valdecilla s/n, 39008, Santander, Spain,Cibersam (Centro Investigación Biomédica en Red Salud Mental), Avda. Valdecilla s/n, 39008, Santander, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria–IDIVAL, Avda. Valdecilla s/n, 39008, Santander, Spain,Cibersam (Centro Investigación Biomédica en Red Salud Mental), Avda. Valdecilla s/n, 39008, Santander, Spain
| | - Paula Suarez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria–IDIVAL, Avda. Valdecilla s/n, 39008, Santander, Spain,Cibersam (Centro Investigación Biomédica en Red Salud Mental), Avda. Valdecilla s/n, 39008, Santander, Spain
| | - Neeltje EM Van Haren
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sonja MC de Zwarte
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rene S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nhat Trung Doan
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Kjetil N Jørgensen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, 0319 Oslo, Norway
| | - Tiril P Gurholt
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway
| | - Ingrid Agartz
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, 0319 Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Akiah O Berg
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Lynn Mørch-Johnsen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, P.O. Box 85 Vinderen, 0319 Oslo, Norway
| | - Ann Færden
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Lena Flyckt
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | - Helena Fatouros-Bergman
- Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | | | - Erik G Jönsson
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, P.O. Box 4956 Nydalen, 0424 Oslo, Norway,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Ryota Hashimoto
- Molecular Research Center for Children’s Mental Development, United Graduate School of Child Development, Osaka University D3, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan,Department of Psychiatry, Osaka University Graduate School of Medicine D3, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine D3, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, 38 Nishigonaka Myodaiji, Okazaki, Aichi, 444-8585, Japan
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, USA
| | - Pietro De Rossi
- NESMOS Department (Neurosciences, Mental Health and Sensory Functions), School of Medicine and Psychology, Sapienza University, Rome, Italy,Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Valentina Ciullo
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, 00179, Rome, Italy,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Menninger Department of Psychiatry and Behavioral Sciences Baylor College of Medicine Houston, TX, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, University of Pennsylvania, Philadelphia PA USA 19104
| | - Ruben C Gur
- Brain Behavior Laboratory, University of Pennsylvania, Philadelphia PA USA 19104
| | - Daniel H Wolf
- Brain Behavior Laboratory, University of Pennsylvania, Philadelphia PA USA 19104
| | | | - Lauren M Beard
- Brain Behavior Laboratory, University of Pennsylvania, Philadelphia PA USA 19104
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne Koops
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Anja Richter
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Bernd Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Sinead Kelly
- Imaging Genetics Center, Keck School of Medicine, University of Southern California, Marina del Rey, CA, United States,Trinity College, Dublin, Ireland
| | - Gary Donohoe
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, H91 TK33 Galway, Ireland
| | | | | | - Annabella Di Giorgio
- Section of Psychiatry and Clinical Psychology, IRCCS Casa Sollievo della Sofferenza, S.G. Rotondo (FG), 71013 Italy
| | - Alessandro Bertolino
- Psychiatric Neuroscience Group, University of Bari ‘Aldo Moro’, Bari, 70124 Italy
| | - Stephen Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside, Edinburgh, EH10 5HF
| | - Thomas Nickson
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside, Edinburgh, EH10 5HF
| | - Heather C Whalley
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside, Edinburgh, EH10 5HF
| | - Emma Neilson
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside, Edinburgh, EH10 5HF
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, NM 87106, United States,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM 87131, United States
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine, University of Southern California, Marina del Rey, CA, United States
| | - Jessica A Turner
- Department of Psychology and Neuroscience Institute, Georgia State University, Atlanta GA 30302
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany,Translational Developmental Neuroscience Section, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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He H, Lu J, Yang L, Zheng J, Gao F, Zhai Y, Feng J, Fan Y, Ma X. Repetitive transcranial magnetic stimulation for treating the symptoms of schizophrenia: A PRISMA compliant meta-analysis. Clin Neurophysiol 2017; 128:716-724. [PMID: 28315614 DOI: 10.1016/j.clinph.2017.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
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67
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Paillère-Martinot ML, Galinowski A, Plaze M, Andoh J, Bartrés-Faz D, Bellivier F, Lefaucheur JP, Rivière D, Gallarda T, Martinot JL, Artiges E. Active and placebo transcranial magnetic stimulation effects on external and internal auditory hallucinations of schizophrenia. Acta Psychiatr Scand 2017; 135:228-238. [PMID: 27987221 DOI: 10.1111/acps.12680] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) over the left temporo-parietal region has been proposed as a treatment for resistant auditory verbal hallucinations (AVH), but which patients are more likely to benefit from rTMS is still unclear. This study sought to assess the effects of rTMS on AVH, with a focus on hallucination phenomenology. METHOD Twenty-seven patients with schizophrenia and medication-resistant AVH participated to a randomized, double-blind, placebo-controlled, add-on rTMS study. The stimulation targeted a language-perception area individually determined using functional magnetic resonance imaging and a language recognition task. AVH were assessed using the hallucination subscale of the Scale for the Assessment of Positive Symptoms (SAPS). The spatial location of AVH was assessed using the Psychotic Symptom Rating Scales. RESULTS A significant improvement in SAPS hallucination subscale score was observed in both actively treated and placebo-treated groups with no difference between both modalities. Patients with external AVH were significantly more improved than patients with internal AVH, with both modalities. CONCLUSIONS A marked placebo effect of rTMS was observed in patients with resistant AVH. Patients with prominent external AVH may be more likely to benefit from both active and placebo interventions. Cortical effects related to non-magnetic stimulation of the auditory cortex are suggested.
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Affiliation(s)
- M-L Paillère-Martinot
- AP-HP, Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Paris, France.,INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Université Paris Descartes, Paris, France.,University Paris-Sud, and University Paris-Saclay, Orsay, France
| | - A Galinowski
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Université Paris Descartes, Paris, France.,University Paris-Sud, and University Paris-Saclay, Orsay, France.,SHU Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - M Plaze
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Université Paris Descartes, Paris, France.,SHU Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - J Andoh
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - D Bartrés-Faz
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Department of Psychiatry and Clinical Psychobiology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - F Bellivier
- AP-HP, Department of Psychiatry, Henri Mondor-Albert Chenevier Hospital, Créteil, France.,INSERM, U1144, Université Paris Diderot, Paris, France
| | - J-P Lefaucheur
- AP-HP, Physiology Department, Henri Mondor - Albert Chenevier Hospital, Créteil, France.,Université Paris 12, Créteil, France
| | - D Rivière
- CEA, LNAO, NeuroSpin, Gif-sur-Yvette, France
| | - T Gallarda
- Université Paris Descartes, Paris, France.,SHU Department of Psychiatry, Sainte-Anne Hospital, Paris, France
| | - J-L Martinot
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Université Paris Descartes, Paris, France.,University Paris-Sud, and University Paris-Saclay, Orsay, France
| | - E Artiges
- INSERM, U 1000, Research unit 'Imaging & Psychiatry', Service Hospitalier Frédéric Joliot, Orsay, France.,Université Paris Descartes, Paris, France.,University Paris-Sud, and University Paris-Saclay, Orsay, France.,Psychiatry Department 91G16, GH Nord Essonne, Orsay, France
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Safety and Efficacy of Adjunctive Θ Burst Repetitive Transcranial Magnetic Stimulation to Right Inferior Parietal Lobule in Schizophrenia Patients With First-Rank Symptoms: A Pilot, Exploratory Study. J ECT 2017; 33:43-51. [PMID: 27428476 DOI: 10.1097/yct.0000000000000343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND First-rank symptoms (FRS) in schizophrenia have been found to be associated with various cognitive and biological markers. Repetitive transcranial magnetic stimulation (rTMS) has been shown to modulate such factors. We hypothesized that rTMS adjunctive to antipsychotics will be safe and effective in treatment of FRS in schizophrenia. METHODS Schizophrenia patients with FRS randomly received either active or sham-magnetic resonance imaging navigated continuous Θ burst stimulation (cTBS)-rTMS to right inferior parietal lobule for 2 weeks; assessments were repeated. While primary outcome variables were safety profile, FRS and overall psychopathology; secondary outcomes were γ oscillatory activity, brain-derived neurotrophic factor levels, and self-monitoring function. RESULTS No significant adverse events were reported in either group. None of the outcome measures showed sufficient power on the time by group analysis. CONCLUSIONS This study fails to demonstrate whether or not adjunctive cTBS to right inferior parietal lobule could significantly alleviate FRS. We also fail to provide evidence for whether this protocol has any effect on brain-derived neurotrophic factor levels, self-monitoring function, and right hemispheric γ oscillations.
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Quinn J, Kolla NJ. From Clozapine to Cognitive Remediation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:94-101. [PMID: 27335156 PMCID: PMC5298523 DOI: 10.1177/0706743716656830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although a minority of persons with schizophrenia (SCZ) commits violent acts, SCZ remains a risk factor for violence. Here, we present a broad overview of evidence-based treatments for violence in SCZ, including biological and psychosocial interventions. METHOD We conducted MEDLINE and PsychINFO literature searches to retrieve articles relating to treatments for violent, hostile, or aggressive behaviours in SCZ. RESULTS Clozapine shows the strongest evidence for treating the acute violence of SCZ. Other atypical antipsychotics also possess antiaggressive effects, although the evidence is not as robust as that for clozapine. Psychosocial treatments can be useful adjuncts to pharmacotherapy once patients' positive symptoms have stabilized. Cognitive behavioural therapy for psychosis and cognitive remediation are 2 psychosocial interventions that have demonstrated positive outcomes for violence in SCZ. Most psychosocial studies that examined violence as an outcome were conducted in forensic psychiatric settings. CONCLUSIONS Effective treatments exist for persons with SCZ who pose a risk for violent and aggressive behaviour, although the overall evidence base remains relatively weak. More randomized controlled trials of programs showing evidence for reduction of violence in SCZ are required. Further research should delineate which patients could benefit from multimodal treatment and where and when such treatments are optimally delivered.
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Affiliation(s)
- Jason Quinn
- 1 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Nathan J Kolla
- 2 Complex Mental Illness Program, Forensic Service, Violence Prevention Neurobiological Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario.,3 Institute of Medical Science, University of Toronto, Toronto, Ontario.,4 Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario
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70
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Abstract
Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in the general population and are considered a psychotic symptom when presented in the context of a psychiatric disorder. Neuroimaging literature has shown that AVH are subserved by a variety of alterations in brain structure and function, which primarily concentrate around brain regions associated with the processing of auditory verbal stimuli and with executive control functions. However, the direction of association between AVH and brain function remains equivocal in certain research areas and needs to be carefully reviewed and interpreted. When AVH have significant impact on daily functioning, several efficacious treatments can be attempted such as antipsychotic medication, brain stimulation and cognitive-behavioural therapy. Interestingly, the neural correlates of these treatments largely overlap with brain regions involved in AVH. This suggests that the efficacy of treatment corresponds to a normalization of AVH-related brain activity. In this selected review, we give a compact yet comprehensive overview of the structural and functional neuroimaging literature on AVH, with a special focus on the neural correlates of efficacious treatment.
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Affiliation(s)
- M M Bohlken
- Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Center Utrecht,3584CX Utrecht,The Netherlands
| | - K Hugdahl
- Department of Biological and Medical Psychology,University of Bergen,Bergen,Norway
| | - I E C Sommer
- Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Center Utrecht,3584CX Utrecht,The Netherlands
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71
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72
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Becker JE, Maley C, Shultz E, Taylor WD. Update on Transcranial Magnetic Stimulation for Depression and Other Neuropsychiatric Illnesses. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160930-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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73
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Hasan A, Wobrock T, Palm U, Strube W, Padberg F, Falkai P, Fallgatter A, Plewnia C. [Non-invasive brain stimulation for treatment of schizophrenic psychoses]. DER NERVENARZT 2016; 86:1481-91. [PMID: 26341690 DOI: 10.1007/s00115-015-4323-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite many different available pharmacological and psychosocial treatment options, an optimal control of symptoms is only partly possible for most schizophrenia patients. Especially, persistent auditory hallucinations, negative symptoms and cognitive impairment are difficult to treat symptoms. Several non-invasive brain stimulation techniques are increasingly being considered as new therapeutic add on options for the management of schizophrenia, targeting these symptom domains. The technique which has been available for the longest time and that is best established in clinical care is electroconvulsive therapy (ECT). New stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) allow a more pathophysiological-based approach. This review article introduces various non-invasive brain stimulation techniques and discusses recent treatment studies on schizophrenia. In total, the novel brain stimulation techniques discussed here can be considered relevant add on therapeutic approaches for schizophrenia. In this context, the best evidence is available for the application of rTMS for the treatment of negative symptoms and persistent auditory hallucinations; however, negative studies have also been published for both indications. Studies using other non-invasive brain stimulation techniques showed promising results but further research is needed to establish the clinical efficacy. Based on a growing pathophysiological knowledge, non-invasive brain stimulation techniques provide new treatment perspectives for patients with schizophrenia.
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Affiliation(s)
- A Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland.
| | - T Wobrock
- Zentrum für seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Darmstadt-Dieburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - U Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - W Strube
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - F Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - A Fallgatter
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - C Plewnia
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
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74
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Kimura H, Kanahara N, Takase M, Yoshida T, Watanabe H, Iyo M. A randomized, sham-controlled study of high frequency rTMS for auditory hallucination in schizophrenia. Psychiatry Res 2016; 241:190-4. [PMID: 27179693 DOI: 10.1016/j.psychres.2016.04.119] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 03/22/2016] [Accepted: 04/30/2016] [Indexed: 01/22/2023]
Abstract
Chronic auditory verbal hallucinations (AVHs) in patients with schizophrenia are sometimes resistant to standard pharmacotherapy. Repetitive transcranial magnetic stimulation (rTMS) may be a promising treatment modality for AVHs, but the best protocol has yet to be identified. We used a double-blind randomized sham-controlled design aimed at 30 patients (active group N=16 vs. sham group N=14) with chronic AVHs that persisted regardless of adequate pharmacotherapy. The protocol was a total of four sessions of high-frequency (20-Hz) rTMS targeting the left temporoparietal cortex over 2 days (total 10,400 stimulations) administered to each patient. After the rTMS session the patients were followed for 4 weeks and evaluated with the Auditory Hallucination Rating Scale (AHRS). The mean changes of AHRS score were 22.9 (baseline) to 18.4 (4th week) in the Active group and 24.2 (baseline) to 21.8 (4th week) in the Sham group, indicating no significant difference by mix model analysis. As regards other secondary end points (each subscore of AHRS, BPRS, GAF and CGI-S), none of these parameters showed a significant between-group difference. The present study's rTMS protocol was ineffective for our patients. However, several previous studies demonstrated that high-frequency rTMS is a possible strategy to ameliorate pharmacotherapy-resistant AVH. It is important to establish a high-frequency rTMS protocol with more reliability.
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Affiliation(s)
- Hiroshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Chiba University Center of Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Masayuki Takase
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Taisuke Yoshida
- Department of Psychiatry, Doujin-kai Kisaradzu Hospital, 2-3-1 Iwane, Kisaradzu-shi, Chiba 292-0061, Japan
| | - Hiroyuki Watanabe
- Division of Medical Treatment and Rehabilitation, Chiba University Center of Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan
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75
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Hasan A, Strube W, Palm U, Wobrock T. Repetitive Noninvasive Brain Stimulation to Modulate Cognitive Functions in Schizophrenia: A Systematic Review of Primary and Secondary Outcomes. Schizophr Bull 2016; 42 Suppl 1:S95-S109. [PMID: 27460623 PMCID: PMC4960427 DOI: 10.1093/schbul/sbv158] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite many years of research, there is still an urgent need for new therapeutic options for the treatment of cognitive deficits in schizophrenia. Noninvasive brain stimulation (NIBS) has been proposed to be such a novel add-on treatment option. The main objective of this review was to systematically evaluate the cognitive effects of repetitive NIBS in schizophrenia. As most studies have not been specifically designed to investigate cognition as primary outcome, we have focused on both, primary and secondary outcomes. The PubMed/MEDLINE database (1985-2015) was systematically searched for interventional studies investigating the effects of repetitive NIBS on schizophrenia symptoms. All interventional clinical trials using repetitive transcranial stimulation, transcranial theta burst stimulation, and transcranial direct current stimulation for the treatment of schizophrenia were extracted and analyzed with regard to cognitive measures as primary or secondary outcomes. Seventy-six full-text articles were assessed for eligibility of which 33 studies were included in the qualitative synthesis. Of these 33 studies, only 4 studies included cognition as primary outcome, whereas 29 studies included cognitive measures as secondary outcomes. A beneficial effect of frontal NIBS could not be clearly established. No evidence for a cognitive disruptive effect of NIBS (temporal lobe) in schizophrenia could be detected. Finally, a large heterogeneity between studies in terms of inclusion criteria, stimulation parameters, applied cognitive measures, and follow-up intervals was observed. This review provides the first systematic overview regarding cognitive effects of repetitive NIBS in schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany;
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Wobrock
- County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany; Department of Psychiatry and Psychotherapy, Georg-August-University, Göttingen, Germany
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76
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Arumugham SS, Thirthalli J, Andrade C. Efficacy and safety of combining clozapine with electrical or magnetic brain stimulation in treatment-refractory schizophrenia. Expert Rev Clin Pharmacol 2016; 9:1245-52. [DOI: 10.1080/17512433.2016.1200971] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
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77
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Blanco-Lopez MJ, Cudeiro-Blanco J, Iglesias G, Gago A, Cudeiro J. A simple, repeated rTMS protocol effectively removes auditory verbal hallucinations in a single patient study. Schizophr Res 2016; 172:224-5. [PMID: 26897475 DOI: 10.1016/j.schres.2016.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Ana Gago
- Psychiatry-Santiago de Compostela, Spain
| | - Javier Cudeiro
- Centro de Estimulación Cerebral de Galicia, A Coruña, Spain; Neuroscience and Motor control Group (NEUROcom) and INIBIC, University of A Coruña, Spain.
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78
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Perera T, George MS, Grammer G, Janicak PG, Pascual-Leone A, Wirecki TS. The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder. Brain Stimul 2016; 9:336-346. [PMID: 27090022 DOI: 10.1016/j.brs.2016.03.010] [Citation(s) in RCA: 344] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Prefrontal Transcranial Magnetic Stimulation (TMS) therapy repeated daily over 4-6 weeks (20-30 sessions) is US Food and Drug Administration (FDA) approved for treating Major Depressive Disorder in adults who have not responded to prior antidepressant medications. In 2011, leading TMS clinical providers and researchers created the Clinical TMS Society (cTMSs) (www.clinicaltmssociety.org, Greenwich, CT, USA), incorporated in 2013. METHODS This consensus review was written by cTMSs leaders, informed by membership polls, and approved by the governing board. It summarizes current evidence for the safety and efficacy of the use of TMS therapy for treating depression in routine clinical practice. Authors systematically reviewed the published TMS antidepressant therapy clinical trials. Studies were then assessed and graded on their strength of evidence using the Levels of Evidence framework published by the University of Oxford Centre for Evidence Based Medicine. The authors then summarize essentials for using TMS therapy in routine clinical practice settings derived from discussions and polls of cTMSs members. Finally, each summary clinical recommendation is presented with the substantiating peer-reviewed, published evidence supporting that recommendation. When the current published clinical trial evidence was insufficient or incomplete, expert opinion was included when sufficient consensus was available from experienced clinician users among the membership of the cTMSs, who were polled at the Annual Meetings in 2014 and 2015. CONCLUSIONS Daily left prefrontal TMS has substantial evidence of efficacy and safety for treating the acute phase of depression in patients who are treatment resistant or intolerant. Following the clinical recommendations in this document should result in continued safe and effective use of this exciting new treatment modality.
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Affiliation(s)
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | | | - Philip G Janicak
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Non-invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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79
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Moseley P, Alderson-Day B, Ellison A, Jardri R, Fernyhough C. Non-invasive Brain Stimulation and Auditory Verbal Hallucinations: New Techniques and Future Directions. Front Neurosci 2016; 9:515. [PMID: 26834541 PMCID: PMC4717303 DOI: 10.3389/fnins.2015.00515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022] Open
Abstract
Auditory verbal hallucinations (AVHs) are the experience of hearing a voice in the absence of any speaker. Results from recent attempts to treat AVHs with neurostimulation (rTMS or tDCS) to the left temporoparietal junction have not been conclusive, but suggest that it may be a promising treatment option for some individuals. Some evidence suggests that the therapeutic effect of neurostimulation on AVHs may result from modulation of cortical areas involved in the ability to monitor the source of self-generated information. Here, we provide a brief overview of cognitive models and neurostimulation paradigms associated with treatment of AVHs, and discuss techniques that could be explored in the future to improve the efficacy of treatment, including alternating current and random noise stimulation. Technical issues surrounding the use of neurostimulation as a treatment option are discussed (including methods to localize the targeted cortical area, and the state-dependent effects of brain stimulation), as are issues surrounding the acceptability of neurostimulation for adolescent populations and individuals who experience qualitatively different types of AVH.
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Affiliation(s)
- Peter Moseley
- School of Psychology, University of Central Lancashire Preston, UK
| | - Ben Alderson-Day
- Science Laboratories, Department of Psychology, Durham University Durham, UK
| | - Amanda Ellison
- Science Laboratories, Department of Psychology, Durham University Durham, UK
| | - Renaud Jardri
- Centre National de la Recherche Scientifique UMR-9193, SCA-Lab & CHU Lille, Fontan Hospital, CURE Platform, Lille University Lille, France
| | - Charles Fernyhough
- Science Laboratories, Department of Psychology, Durham University Durham, UK
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80
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Koops S, van Dellen E, Schutte MJL, Nieuwdorp W, Neggers SFW, Sommer IEC. Theta Burst Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations: Negative Findings From a Double-Blind-Randomized Trial. Schizophr Bull 2016. [PMID: 26221051 PMCID: PMC4681555 DOI: 10.1093/schbul/sbv100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) in schizophrenia are resistant to antipsychotic medication in approximately 25% of patients. Treatment with repetitive transcranial magnetic stimulation (rTMS) for refractory AVH has shown varying results. A stimulation protocol using continuous theta burst rTMS (TB-rTMS) showed high efficacy in open label studies. We tested TB-rTMS as a treatment strategy for refractory AVH in a double-blind, placebo-controlled trial. METHODS Seventy-one patients with AVH were randomly allocated to TB-rTMS or placebo treatment. They received 10 TB-rTMS or sham treatments over the left temporoparietal cortex in consecutive days. AVH severity was assessed at baseline, end of treatment and follow-up using the Psychotic Symptom Rating Scale (PSYRATS) and the Auditory Hallucinations Rating Scale (AHRS). Other schizophrenia-related symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). RESULTS Seven patients dropped out before completing the study. In the remaining 64, AVH improved significantly after treatment in both groups as measured with both PSYRATS and AHRS. PANSS positive and general subscores also decreased, but the negative subscores did not. However, improvement did not differ significantly between the TB-rTMS and the placebo group on any outcome measure. CONCLUSIONS Symptom reduction could be achieved in patients with medication-resistant hallucinations, even within 1 week time. However, as both groups showed similar improvement, effects were general (ie, placebo-effects) rather than specific to treatment with continuous TB-rTMS. Our findings highlight the importance of double-blind trials including a sham-control condition to assess efficacy of new treatments such as TMS.
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Affiliation(s)
- Sanne Koops
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Edwin van Dellen
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands;,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Maya J. L. Schutte
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands;,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Wendy Nieuwdorp
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands;,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Sebastiaan F. W. Neggers
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands;,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Iris E. C. Sommer
- Psychiatry Department, University Medical Center Utrecht, Utrecht, The Netherlands;,Brain Center Rudolf Magnus, Utrecht, The Netherlands
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Abstract
Schizophrenia is a chronic psychiatric disorder with a heterogeneous genetic and neurobiological background that influences early brain development, and is expressed as a combination of psychotic symptoms - such as hallucinations, delusions and disorganization - and motivational and cognitive dysfunctions. The mean lifetime prevalence of the disorder is just below 1%, but large regional differences in prevalence rates are evident owing to disparities in urbanicity and patterns of immigration. Although gross brain pathology is not a characteristic of schizophrenia, the disorder involves subtle pathological changes in specific neural cell populations and in cell-cell communication. Schizophrenia, as a cognitive and behavioural disorder, is ultimately about how the brain processes information. Indeed, neuroimaging studies have shown that information processing is functionally abnormal in patients with first-episode and chronic schizophrenia. Although pharmacological treatments for schizophrenia can relieve psychotic symptoms, such drugs generally do not lead to substantial improvements in social, cognitive and occupational functioning. Psychosocial interventions such as cognitive-behavioural therapy, cognitive remediation and supported education and employment have added treatment value, but are inconsistently applied. Given that schizophrenia starts many years before a diagnosis is typically made, the identification of individuals at risk and those in the early phases of the disorder, and the exploration of preventive approaches are crucial.
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83
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Gaebel W, Zielasek J. Schizophrenia in 2020: Trends in diagnosis and therapy. Psychiatry Clin Neurosci 2015; 69:661-73. [PMID: 26011091 DOI: 10.1111/pcn.12322] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 12/28/2022]
Abstract
Schizophrenia research is providing an increasing number of studies and important insights into the condition's etiopathogenesis based on genetic, neuropsychological and cranial neuroimaging studies. However, research progress has not yet led to the incorporation of such findings into the revised classification criteria of mental disorders or everyday clinical practice. By 2020, schizophrenia will most likely still be a clinically defined primary psychotic disorder. While there is some hope that treatment will be improved with new antipsychotic drugs, drugs addressing negative symptoms, more refined psychotherapy approaches and the introduction of new treatment modalities like transcranial magnetic stimulation, an additional hope is to improve early detection and prevention. As the results of new research into the etiopathogenesis of schizophrenia are promising to improve diagnosis, classification and therapy in the future, a picture of complex brain dysfunction is currently emerging requiring sophisticated mathematical methods of analysis. The imminent clinical challenge will be to develop comprehensive diagnostic and treatment modules individually tailored to the time-variable needs of patients and their families.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Jürgen Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
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84
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Kubera KM, Barth A, Hirjak D, Thomann PA, Wolf RC. Noninvasive brain stimulation for the treatment of auditory verbal hallucinations in schizophrenia: methods, effects and challenges. Front Syst Neurosci 2015; 9:131. [PMID: 26528145 PMCID: PMC4601083 DOI: 10.3389/fnsys.2015.00131] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 09/07/2015] [Indexed: 12/12/2022] Open
Abstract
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Dusan Hirjak
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg Heidelberg, Germany ; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University Homburg, Germany
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85
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Hasan A, Wolff-Menzler C, Pfeiffer S, Falkai P, Weidinger E, Jobst A, Hoell I, Malchow B, Yeganeh-Doost P, Strube W, Quast S, Müller N, Wobrock T. Transcutaneous noninvasive vagus nerve stimulation (tVNS) in the treatment of schizophrenia: a bicentric randomized controlled pilot study. Eur Arch Psychiatry Clin Neurosci 2015. [PMID: 26210303 DOI: 10.1007/s00406-015-0618-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite many pharmacological and psychosocial treatment options, schizophrenia remains a debilitating disorder. Thus, new treatment strategies rooted in the pathophysiology of the disorder are needed. Recently, vagus nerve stimulation (VNS) has been proposed as a potential treatment option for various neuropsychiatric disorders including schizophrenia. The objective of this study was to investigate for the first time the feasibility, safety and efficacy of transcutaneous VNS in stable schizophrenia. A bicentric randomized, sham-controlled, double-blind trial was conducted from 2010 to 2012. Twenty schizophrenia patients were randomly assigned to one of two treatment groups. The first group (active tVNS) received daily active stimulation of the left auricle for 26 weeks. The second group (sham tVNS) received daily sham stimulation for 12 weeks followed by 14 weeks of active stimulation. Primary outcome was defined as change in the Positive and Negative Symptom Scale total score between baseline and week 12. Various other secondary measures were assessed to investigate safety and efficacy. The intervention was well tolerated with no relevant adverse effects. We could not observe a statistically significant difference in the improvement of schizophrenia psychopathology during the observation period. Neither psychopathological and neurocognitive measures nor safety measures showed significant differences between study groups. Application of tVNS was well tolerated, but did not improve schizophrenia symptoms in our 26-week trial. While unsatisfactory compliance questions the feasibility of patient-controlled neurostimulation in schizophrenia, the overall pattern of symptom change might warrant further investigations in this population.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Claus Wolff-Menzler
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - Sebastian Pfeiffer
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Elif Weidinger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Andrea Jobst
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Imke Hoell
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Peyman Yeganeh-Doost
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Silke Quast
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.,Centre of Mental Health, Darmstadt-Dieburg Clinics, Groß-Umstadt, Germany
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Dokucu ME. Neuromodulation Treatments for Schizophrenia. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2015; 2:339-348. [PMID: 28713665 DOI: 10.1007/s40501-015-0055-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Schizophrenia is a psychiatric disorder that causes great suffering and debilitation worldwide. We have a multitude of medications that are effective for psychosis. However, these have not been successful in treating the negative and cognitive symptom domains of schizophrenia. These symptoms are responsible for the larger part of functional impairments that result from schizophrenia. In addition, there are many patients for whom no significant improvement is achieved even in the positive symptom domain. Hence, other treatment modalities have been explored to help these patients. Electroconvulsive therapy and transcranial magnetic stimulation are two of the most promising adjunct treatment methods for medication resistant schizophrenia. Electroconvulsive therapy is the gold standard treatment for catatonias whether associated with schizophrenia, mood disorders or other non-psychiatric disorders. Although not effective for negative symptoms, electroconvulsive therapy provides substantial augmentation to antipsychotic medications in improving positive symptoms and overall severity. Electroconvulsive therapy should be considered more often in patients with inadequate response to antipsychotic medications even when they do not have prominent affective symptoms. Transcranial magnetic stimulation has emerged as a promising useful therapeutic tool in targeting medication resistant auditory hallucinations and negative symptoms. Transcranial magnetic stimulation has proven to be very safe and well-tolerated by the patients in spite of its labor intensiveness. The incorporation of transcranial magnetic stimulation to routine clinical use awaits further studies to substantiate its efficacy and to optimize and customize treatment parameters to individual patients and their symptom patterns. Moreover, combining transcranial magnetic stimulation with electroconvulsive therapy to synergize their likely different mechanisms of action is another exciting possibility.
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Affiliation(s)
- Mehmet E Dokucu
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences 710 North Lake Shore Drive #1324, Chicago, Illinois 60611,
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87
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Donaldson PH, Rinehart NJ, Enticott PG. Noninvasive stimulation of the temporoparietal junction: A systematic review. Neurosci Biobehav Rev 2015; 55:547-72. [DOI: 10.1016/j.neubiorev.2015.05.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 01/15/2023]
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George MS, Baron Short E, Kerns SE, Li X, Hanlon C, Pelic C, Taylor JJ, Badran BW, Borckardt JJ, Williams N, Fox J. Therapeutic Applications of rTMS for Psychiatric and Neurological Conditions. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Abstract
PURPOSE OF REVIEW Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of evaluation and treatment in neurologic and psychiatric practice. The purpose of this review is to define psychosis, communicate recent changes to the classification of and criteria for primary psychotic disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and summarize current evidence-based approaches to the evaluation and management of primary and secondary psychoses. RECENT FINDINGS The DSM-5 classification of and criteria for primary psychotic disorders emphasize that these conditions occur along a spectrum, with schizoid (personality) disorder and schizophrenia defining its mild and severe ends, respectively. Psychosis is also identified as only one of several dimensions of neuropsychiatric disturbance in these disorders, with others encompassing abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances. This dimensional approach regards hallucinations and delusions as arising from neural systems subserving perception and information processing, thereby aligning the neurobiological framework used to describe and study such symptoms in primary psychotic disorders with those used to study psychosis associated with other neurologic conditions. SUMMARY This article provides practicing neurologists with updates on current approaches to the diagnosis, evaluation, and treatment of primary and secondary psychoses.
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Transcranial magnetic stimulation, transcranial direct current stimulation and electroconvulsive therapy for medication-resistant psychosis of schizophrenia. Curr Opin Psychiatry 2015; 28:222-8. [PMID: 25768083 DOI: 10.1097/yco.0000000000000156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Despite adequate antipsychotic treatment, 20-30% of patients with schizophrenia fail to obtain remission from psychosis. Physical stimulation treatments may provide an alternative therapy. In this review, we summarize the most recent studies regarding repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and electroconvulsive therapy (ECT) for medication-resistant psychosis in schizophrenia. RECENT FINDINGS Stimulation techniques in the treatment of medication-resistant psychosis have shown inconsistent results. Initial results of rTMS for auditory verbal hallucinations (AVH) were promising, but three recent large randomized controlled trials (RCTs) show similar results of rTMS as placebo. tDCS has shown initial promise as a treatment for AVH, but only in case studies and in two small RCTs. Larger studies are needed to define its efficacy. Although psychotic symptoms generally decrease after ECT, its efficacy has not been demonstrated in comparison with placebo. SUMMARY Although previous meta-analyses indicate significant mean effect sizes for rTMS for intractable AVH, three recent large RCTs indicate no effect compared with placebo. The use of tDCS for resistant AVH and ECT for intractable psychosis has shown some initial promise, but adequately sized placebo-controlled RCTs are now needed. Taken together, the evidence for physical stimulation techniques to relieve medication-resistant psychosis is currently weak.
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91
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Abstract
PURPOSE OF REVIEW This article reviews the recent evidence for therapeutic strategies for patients with treatment-resistant schizophrenia (TRS) not responding to or only partially responding to clozapine. RECENT FINDINGS A number of pharmacological and nonpharmacological biological approaches for clozapine-resistant TRS have been evaluated in clinical trials. Among these, the evidence supporting clozapine augmentation by pharmacological approaches is weak and the reported benefits were modest at best. However, the results of a recent randomized trial suggest that electroconvulsive therapy (ECT) may be efficacious for the short-term treatment of patients with clozapine-resistant TRS. SUMMARY There is currently insufficient evidence for efficacy of pharmacological augmentation strategies to clozapine. ECT may be a promising option, but further research is necessary to confirm its long-term effects. Moreover, further controlled studies are warranted to clarify the potential of other biological and psychosocial approaches to serve as adjuvant treatments in patients with clozapine-resistant TRS.
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Tortella G, Casati R, Aparicio LVM, Mantovani A, Senço N, D’Urso G, Brunelin J, Guarienti F, Selingardi PML, Muszkat D, Junior BDSP, Valiengo L, Moffa AH, Simis M, Borrione L, Brunoni AR. Transcranial direct current stimulation in psychiatric disorders. World J Psychiatry 2015; 5:88-102. [PMID: 25815258 PMCID: PMC4369553 DOI: 10.5498/wjp.v5.i1.88] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/12/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023] Open
Abstract
The interest in non-invasive brain stimulation techniques is increasing in recent years. Among these techniques, transcranial direct current stimulation (tDCS) has been the subject of great interest among researchers because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in the field. This interest has generated several studies and randomized clinical trials, particularly in psychiatry. In this review, we provide a summary of the development of the technique and its mechanism of action as well as a review of the methodological aspects of randomized clinical trials in psychiatry, including studies in affective disorders, schizophrenia, obsessive compulsive disorder, child psychiatry and substance use disorder. Finally, we provide an overview of tDCS use in cognitive enhancement as well as a discussion regarding its clinical use and regulatory and ethical issues. Although many promising results regarding tDCS efficacy were described, the total number of studies is still low, highlighting the need of further studies aiming to replicate these findings in larger samples as to provide a definite picture regarding tDCS efficacy in psychiatry.
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93
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Koops S, van den Brink H, Sommer IEC. Transcranial direct current stimulation as a treatment for auditory hallucinations. Front Psychol 2015; 6:244. [PMID: 25798123 PMCID: PMC4351567 DOI: 10.3389/fpsyg.2015.00244] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
Abstract
Auditory hallucinations (AH) are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance. Transcranial direct current stimulation (tDCS) is a safe and non-invasive technique that is able to directly influence cortical excitability through the application of very low electric currents. A 1–2 mA direct current is applied between two surface electrodes, one serving as the anode and the other as the cathode. Cortical excitability is increased in the vicinity of the anode and reduced near the cathode. The technique, which has only a few transient side effects and is cheap and portable, is increasingly explored as a treatment for neurological and psychiatric symptoms. It has shown efficacy on symptoms of depression, bipolar disorder, schizophrenia, Alzheimer’s disease, Parkinson’s disease, epilepsy, and stroke. However, the application of tDCS as a treatment for AH is relatively new. This article provides an overview of the current knowledge in this field and guidelines for future research.
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Affiliation(s)
- Sanne Koops
- Psychiatry Department, Brain Center Rudolf Magnus, University Medical Center Utrecht Utrecht, Netherlands
| | - Hilde van den Brink
- Psychiatry Department, Brain Center Rudolf Magnus, University Medical Center Utrecht Utrecht, Netherlands
| | - Iris E C Sommer
- Psychiatry Department, Brain Center Rudolf Magnus, University Medical Center Utrecht Utrecht, Netherlands
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Ray P, Sinha VK, Tikka SK. Adjuvant low-frequency rTMS in treating auditory hallucinations in recent-onset schizophrenia: a randomized controlled study investigating the effect of high-frequency priming stimulation. Ann Gen Psychiatry 2015; 14:8. [PMID: 25699086 PMCID: PMC4333242 DOI: 10.1186/s12991-015-0046-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/27/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train. However, this technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients. METHODS Forty recent onset schizophrenia patients completed the study. Patients were randomized over two groups: one receiving low-frequency rTMS preceded by priming and another receiving low-frequency rTMS without priming. Both treatments were directed at the left temporo-parietal region. The severity of AVH and other psychotic symptoms were assessed with the auditory hallucination subscale (AHRS) of the Psychotic Symptom Rating Scales (PSYRATS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI). RESULTS We found that all the scores of these ratings significantly reduced over time (i.e. baseline through 1, 2, 4 and 6 weeks) in both the treatment groups. We found no difference between the two groups on all measures, except for significantly greater improvement on loudness of AVH in the group with priming stimulation during the follow-ups (F = 2.72; p < .05). CONCLUSIONS We conclude that low-frequency rTMS alone and high-frequency priming of low-frequency rTMS do not elicit significant differences in treatment of overall psychopathology, particularly AVH when given in recent onset schizophrenia patients. Add on priming however, seems to be particularly better in faster reduction in loudness of AVH.
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Affiliation(s)
- Prasenjit Ray
- Department of Psychiatry, Burdwan Medical College, Burdwan, 713101 West Bengal India
| | - Vinod Kumar Sinha
- KS Mani Center for Cognitive Neurosciences and Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, 834006 Jharkhand India
| | - Sai Krishna Tikka
- KS Mani Center for Cognitive Neurosciences and Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, 834006 Jharkhand India
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Kim EJ, Yeo S, Hwang I, Park JI, Cui Y, Jin HM, Kim HT, Hwang TY, Chung YC. Bilateral Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Patients with Schizophrenia: A Randomized Controlled, Cross-over Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:222-8. [PMID: 25598827 PMCID: PMC4293169 DOI: 10.9758/cpn.2014.12.3.222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/06/2014] [Accepted: 09/28/2014] [Indexed: 01/18/2023]
Abstract
Objective A randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition. Methods Twenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham. Results All the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition. Conclusion Our findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.
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Affiliation(s)
- Eun-Ji Kim
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Seonguk Yeo
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Inho Hwang
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Jong-Il Park
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea
| | - Yin Cui
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hong-Mei Jin
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Hyung Tae Kim
- Department of Psychiatry, Chonbuk Provincial Maeumsarang Hospital, Wanju, Korea
| | - Tae-Young Hwang
- Department of Psychiatry, Chonbuk Provincial Maeumsarang Hospital, Wanju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Hospital, Jeonju, Korea. ; Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea. ; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Neuroimaging Effects of 1 Hz Right Temporoparietal rTMS on Normal Auditory Processing. J Clin Neurophysiol 2014; 31:541-6. [DOI: 10.1097/wnp.0000000000000098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Miyamoto S, Jarskog LF, Fleischhacker WW. New therapeutic approaches for treatment-resistant schizophrenia: a look to the future. J Psychiatr Res 2014; 58:1-6. [PMID: 25070124 DOI: 10.1016/j.jpsychires.2014.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/18/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023]
Abstract
Schizophrenia for many patients is a lifelong mental disorder with significant consequences on most functional domains. One fifth to one third of patients with schizophrenia experience persistent psychotic symptoms despite adequate trials of antipsychotic treatment, and are considered to have treatment-resistant schizophrenia (TRS). Clozapine is the only medication to demonstrate efficacy for psychotic symptoms in such patients. However, clozapine is not effective in 40%-70% of patients with TRS and it has significant limitations in terms of potentially life-threatening side effects and the associated monitoring. Accordingly, a number of pharmacological and non-pharmacological biological approaches for clozapine-resistant TRS have emerged. This article provides a brief updated critical review of recent therapeutic strategies for TRS, particularly for clozapine-resistant TRS, which include pharmacotherapy, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation.
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Affiliation(s)
- Seiya Miyamoto
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Bais L, Vercammen A, Stewart R, van Es F, Visser B, Aleman A, Knegtering H. Short and long term effects of left and bilateral repetitive transcranial magnetic stimulation in schizophrenia patients with auditory verbal hallucinations: a randomized controlled trial. PLoS One 2014; 9:e108828. [PMID: 25329799 PMCID: PMC4203691 DOI: 10.1371/journal.pone.0108828] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/15/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation of the left temporo-parietal junction area has been studied as a treatment option for auditory verbal hallucinations. Although the right temporo-parietal junction area has also shown involvement in the genesis of auditory verbal hallucinations, no studies have used bilateral stimulation. Moreover, little is known about durability effects. We studied the short and long term effects of 1 Hz treatment of the left temporo-parietal junction area in schizophrenia patients with persistent auditory verbal hallucinations, compared to sham stimulation, and added an extra treatment arm of bilateral TPJ area stimulation. METHODS In this randomized controlled trial, 51 patients diagnosed with schizophrenia and persistent auditory verbal hallucinations were randomly allocated to treatment of the left or bilateral temporo-parietal junction area or sham treatment. Patients were treated for six days, twice daily for 20 minutes. Short term efficacy was measured with the Positive and Negative Syndrome Scale (PANSS), the Auditory Hallucinations Rating Scale (AHRS), and the Positive and Negative Affect Scale (PANAS). We included follow-up measures with the AHRS and PANAS at four weeks and three months. RESULTS The interaction between time and treatment for Hallucination item P3 of the PANSS showed a trend for significance, caused by a small reduction of scores in the left group. Although self-reported hallucination scores, as measured with the AHRS and PANAS, decreased significantly during the trial period, there were no differences between the three treatment groups. CONCLUSION We did not find convincing evidence for the efficacy of left-sided rTMS, compared to sham rTMS. Moreover, bilateral rTMS was not superior over left rTMS or sham in improving AVH. Optimizing treatment parameters may result in stronger evidence for the efficacy of rTMS treatment of AVH. Moreover, future research should consider investigating factors predicting individual response. TRIAL REGISTRATION Dutch Trial Register NTR1813.
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Affiliation(s)
- Leonie Bais
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN NeuroImaging Center, Groningen, The Netherlands
- Lentis Psychiatric Institute, Groningen, The Netherlands
- * E-mail:
| | - Ans Vercammen
- Australian Catholic University, Strathfield, Australia
| | - Roy Stewart
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, The Netherlands
| | - Frank van Es
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands
| | - Bert Visser
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN NeuroImaging Center, Groningen, The Netherlands
- University of Groningen, Department of Psychology, Groningen, The Netherlands
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and BCN NeuroImaging Center, Groningen, The Netherlands
- Lentis Psychiatric Institute, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands
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Moseley P, Fernyhough C, Ellison A. The role of the superior temporal lobe in auditory false perceptions: a transcranial direct current stimulation study. Neuropsychologia 2014; 62:202-8. [PMID: 25107678 PMCID: PMC4179889 DOI: 10.1016/j.neuropsychologia.2014.07.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/04/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Abstract
Neuroimaging has shown that a network of cortical areas, which includes the superior temporal gyrus, is active during auditory verbal hallucinations (AVHs). In the present study, healthy, non-hallucinating participants (N=30) completed an auditory signal detection task, in which participants were required to detect a voice in short bursts of white noise, with the variable of interest being the rate of false auditory verbal perceptions. This paradigm was coupled with transcranial direct current stimulation, a noninvasive brain stimulation technique, to test the involvement of the left posterior superior temporal gyrus in the creation of auditory false perceptions. The results showed that increasing the levels of excitability in this region led to a higher rate of ‘false alarm’ responses than when levels of excitability were decreased, with false alarm responses under a sham stimulation condition lying at a mid-point between anodal and cathodal stimulation conditions. There were also corresponding changes in signal detection parameters. These results are discussed in terms of prominent cognitive neuroscientific theories of AVHs, and potential future directions for research are outlined. Investigated role of left STG in false perceptions of voices in white noise. Used noninvasive brain stimulation whilst participants listened to white noise. Tested whether number of false perceptions was affected by stimulation of STG. Higher false alarm rate when excitability increased than when decreased.
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Affiliation(s)
- Peter Moseley
- Psychology Department, Durham University, South Road, Durham DH1 3LE, UK.
| | - Charles Fernyhough
- Psychology Department, Durham University, South Road, Durham DH1 3LE, UK
| | - Amanda Ellison
- Psychology Department, Durham University, South Road, Durham DH1 3LE, UK
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