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Spiroiu FI, Minuzzi L, Duarte D, McCabe RE, Soreni N. Neurocognitive effects of transcranial direct current stimulation in obsessive-compulsive disorder: a systematic review. Int J Neurosci 2024:1-14. [PMID: 38913323 DOI: 10.1080/00207454.2024.2371303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
Transcranial direct current stimulation (tDCS) has been used with increasing frequency as a therapeutic tool to alleviate clinical symptoms of obsessive compulsive-disorder (OCD). However, little is known about the effects of tDCS on neurocognitive functioning among OCD patients. The aim of this review was to provide a comprehensive overview of the literature examining the effects of tDCS on specific neurocognitive functions in OCD. A literature search following PRISMA guidelines was conducted on the following databases: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. The search yielded 4 results: one randomized, sham-controlled study (20 patients), one randomized, controlled, partial crossover trial (12 patients), one open-label study (5 patients), and one randomized, double-blind, sham-controlled, parallel-group trial (37 patients). A total of 51 patients received active tDCS with some diversity in electrode montages targeting the dorsolateral prefrontal cortex, the pre-supplementary motor area, or the orbitofrontal cortex. tDCS was associated with improved decision-making in study 1, enhanced attentional monitoring and response inhibition in study 2, improved executive and inhibitory control in study 3, and reduced attentional bias and improved response inhibition and working memory in study 4. Limitations of this review include its small sample, the absence of a sham group in half of the studies, and the heterogeneity in tDCS parameters. These preliminary results highlight the need for future testing in randomized, sham-controlled trials to examine whether and how tDCS induces relevant cognitive benefits in OCD.
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Affiliation(s)
- Flavia I Spiroiu
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Pediatric OCD Consultation Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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2
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Badcock JC, Larøi F, Kamp K, Kelsall-Foreman I, Bucks RS, Weinborn M, Begemann M, Taylor JP, Collerton D, O’Brien JT, El Haj M, Ffytche D, Sommer IE. Hallucinations in Older Adults: A Practical Review. Schizophr Bull 2020; 46:1382-1395. [PMID: 32638012 PMCID: PMC7707075 DOI: 10.1093/schbul/sbaa073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.
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Affiliation(s)
- Johanna C Badcock
- School of Psychological Science, University of Western Australia, Perth, Australia
- Perth Voices Clinic, Murdoch, Australia
- To whom correspondence should be addressed; School of Psychological Science, The University of Western Australia, 35 Stirling Highway, Perth, 6009; tel: 0423123665, fax: 61864881006, e-mail:
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liege, Liege, Belgium
- Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Karina Kamp
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus C, Denmark
| | | | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Marieke Begemann
- Department of Biomedical Sciences of Cells and Systems, University Medical Center, Rijks Universiteit Groningen (RUG), Groningen, The Netherlands
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mohamad El Haj
- Laboratoire de Psychologie des Pays de la Loire (LPPL-EA 4638), Nantes Université, Univ Angers, Nantes, France
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Iris E Sommer
- Rijks Universiteit Groningen (RUG), Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, The Netherlands
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Colmenárez-Raga AC, Díaz I, Pernia M, Pérez-González D, Delgado-García JM, Carro J, Plaza I, Merchán MA. Reversible Functional Changes Evoked by Anodal Epidural Direct Current Electrical Stimulation of the Rat Auditory Cortex. Front Neurosci 2019; 13:356. [PMID: 31031588 PMCID: PMC6473088 DOI: 10.3389/fnins.2019.00356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
Rat auditory cortex was subjected to 0.1 mA anodal direct current in seven 10-min sessions on alternate days. Based on the well-known auditory cortex control of olivocochlear regulation through corticofugal projections, auditory brainstem responses (ABRs) were recorded as an indirect test of the effectiveness and reversibility of the multisession protocol of epidural stimulation. Increases of 20-30 dB ABR auditory thresholds shown after epidural stimulation reverted back to control levels 10 min after a single session. However, increases in thresholds revert 4 days after multisession stimulation. Less changes in wave amplitudes and threshold shifts were shown in ABR recorded contralaterally to the electrically stimulated side of the brain. To assess tissue effects of epidural electric stimulation on the brain cortex, well characterized functional anatomical markers of glial cells (GFAP/astrocytes and Iba1/microglial cells) and neurons (c-Fos) were analyzed in alternate serial sections by quantitative immunocytochemistry. Restricted astroglial and microglial reactivity was observed within the cytoarchitectural limits of the auditory cortex. However, interstitial GFAP overstaining was also observed in the ventricular surface and around blood vessels, thus supporting a potential global electrolytic stimulation of the brain. These results correlate with extensive changes in the distribution of c-Fos immunoreactive neurons among layers along sensory cortices after multisession stimulation. Quantitative immunocytochemical analysis supported this idea by showing a significant increase in the number of positive neurons in supragranular layers and a decrease in layer 6 with no quantitative changes detected in layer 5. Our data indicate that epidural stimulation of the auditory cortex induces a reversible decrease in hearing sensitivity due to local, restricted epidural stimulation. A global plastic response of the sensory cortices, also reported here, may be related to electrolytic effects of electric currents.
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Affiliation(s)
| | - Iván Díaz
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - Marianny Pernia
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - David Pérez-González
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | | | - Juan Carro
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - Ignacio Plaza
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - Miguel A Merchán
- Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
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4
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Ibrahim NM, Abdelhameed KM, Kamal SMM, Khedr EMH, Kotb HIM. Effect of Transcranial Direct Current Stimulation of the Motor Cortex on Visceral Pain in Patients with Hepatocellular Carcinoma. PAIN MEDICINE 2019; 19:550-560. [PMID: 28605527 DOI: 10.1093/pm/pnx087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Hepatocellular carcinoma (HCC) is frequently associated with visceral pain. Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain; however, its effectiveness in malignant visceral pain is unknown. This study aimed to investigate the effects of tDCS in patients with visceral pain due to HCC. Design This is a randomized, sham-controlled, double-blind, prospective study. Forty patients with visceral pain due to HCC were enrolled and randomly assigned into two groups: a real and a sham group; tDCS was applied over the primary motor area (M1) for 10 consecutive days (2 mA, 30 minutes). Patient's pain was evaluated by visual analog scale (VAS) and verbal descriptor scale (VDS) and for depression by Hamilton rating scale (HAM-D). Evaluation was done at prestimulation, after the first, fifth, and 10th sessions, and one month after the end of stimulation sessions. Results Real tDCS showed a reduction of VDS (P = 0.001, F = 4.01) and VAS (P = 0.001, F = 6.817) for HAM-D (P = 0.012, F = 5,077); the effect started from the fifth session and continued to one month after stimulation, while in the sham group the effect persisted for five days only. Percentage reduction in all scales in the real group after the 10th session was as follows: VDS P = 0.008, VAS P = 0.001, HAM-D = 0.001; for one month after the end of stimulation, it was as follows: VDS P = 0.001, VAS P = 0.037, HAM-D = 0.002. Conclusions tDCS proved to be an effective and clinically relevant therapeutic strategy for visceral pain due to HCC.
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Affiliation(s)
- Nagwa Mostafa Ibrahim
- Faculty of Medicine, Anesthesia, Intensive Care and Pain Management, Assiut Universiy, Assiut, Egypt
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5
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Effects and potential mechanisms of transcranial direct current stimulation (tDCS) on auditory hallucinations: A meta-analysis. Psychiatry Res 2019; 273:343-349. [PMID: 30682555 DOI: 10.1016/j.psychres.2019.01.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/14/2022]
Abstract
Auditory hallucinations are the most common psychiatric symptoms of schizophrenia with high recurrence and refractoriness. Transcranial direct current stimulation (tDCS), a novel, non-invasion and affordable brain stimulation technique, has been recently applying on the schizophrenia patients to treat the auditory hallucinations. To analyze the efficacy of tDCS treatment on such symptoms and to reveal its potential working mechanisms, we carried out a structured literature search in PubMed, Embase and Cochrane Library database up to May 12, 2018. Five studies that met inclusion criteria with a total of 137 patients were included in this meta-analysis. After pooling all the data, we found that there was no significant effect between active group and sham group of tDCS (p = 0.18). When we removed one study that did not collaboratively stimulate the frontal-temporal sites, the active tDCS group marks a significant improvement of therapeutic effect compared with sham group (p = 0.007). Our findings suggested that tDCS could be a promising tool to alleviate auditory hallucinations, provided that the simulation sites and protocols are targeting at the sensorimotor frontal-parietal network.
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6
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Rios DM, Correia Rios M, Bandeira ID, Queiros Campbell F, de Carvalho Vaz D, Lucena R. Impact of Transcranial Direct Current Stimulation on Reading Skills of Children and Adolescents With Dyslexia. Child Neurol Open 2018; 5:2329048X18798255. [PMID: 30306098 PMCID: PMC6174647 DOI: 10.1177/2329048x18798255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 07/26/2018] [Accepted: 08/10/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction: Rehabilitation techniques have been used to facilitate reading acquisition in dyslexia. However, many individuals continue to present academic impairment throughout life. New intervention strategies are necessary to further help this population. Objectives: Assess the impact of transcranial direct current stimulation on reading skills in children and adolescents with dyslexia. Methods: The study was conducted with one-group pretest–posttest. Participants received 2 mA transcranial direct current stimulation during 30 minutes for 5 consecutive days. Reading performance was measured by a group of tasks (identification and reading of letters, syllables, words, nonwords, and text). Results: A significant increase in the number of correct answers for nonwords and text tasks was observed after transcranial direct current stimulation (P = .035 and P = .012, respectively). Conclusion: The transcranial direct current stimulation seems to be a promising tool for the treatment of reading problems in dyslexia. Future studies are necessary to confirm the effects of transcranial direct current stimulation and to establish optimal intervention protocol in this population.
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Affiliation(s)
- Débora Medeiros Rios
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | | | - Igor Dórea Bandeira
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Fernanda Queiros Campbell
- Department of Biomorphology, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Daniel de Carvalho Vaz
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Rita Lucena
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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7
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Gupta T, Dean DJ, Kelley NJ, Bernard JA, Ristanovic I, Mittal VA. Cerebellar Transcranial Direct Current Stimulation Improves Procedural Learning in Nonclinical Psychosis: A Double-Blind Crossover Study. Schizophr Bull 2018; 44:1373-1380. [PMID: 29301026 PMCID: PMC6192475 DOI: 10.1093/schbul/sbx179] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The present double-blind crossover study examines the effects of cerebellar transcranial direct current stimulation (tDCS) in controls and in an analogue population to psychosis: individuals reporting elevated symptoms of nonclinical psychosis (NCP). A total of 18 controls and 24 NCP individuals were randomized into conditions consisting of 25 minutes of anodal (active) or sham cerebellar tDCS. Following this, both groups completed a pursuit rotor task designed to measure procedural learning performance. Participants then returned 1-week later and received the corresponding condition (either active or sham) and repeated the pursuit rotor task. Results indicate that in the sham condition, control participants showed significantly greater rates of motor learning when compared with the NCP group. In the active condition, the NCP group exhibited significant improvements in the rate of motor learning and performed at a level that was comparable to controls; these data support the link between cerebellar dysfunction and motor learning. Taken together, tDCS may be a promising treatment mechanism for patient populations and a useful experimental approach in elucidating our understanding of psychosis.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | - Derek J Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | | | - Jessica A Bernard
- Department of Psychology, Texas A&M University, College Station, TX,Institute for Neuroscience, Texas A&M University, College Station, TX
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL,Department of Psychiatry, Northwestern University, Evanston, ILs,Institute of Policy Research, Northwestern University, Evanston, IL,Department of Medical Social Sciences, Northwestern University, Evanston, IL,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL
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8
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Abstract
PURPOSE OF REVIEW Hallucinations are common and often stressful experiences, occurring in all sensory modalities. They frequently complicate many disorders or situations, such as Parkinson's disease, schizophrenia, hearing or vision loss, intoxications and delirium. Although psychoeducation, coping techniques and psychotherapy may be broadly applicable, they do not address a specific underlying brain mechanism. Pharmacotherapy may effectively alleviate hallucinations if the corresponding mechanism is present, whereas in its absence, may only cause harmful side effects. Therefore, pharmacotherapy needs input about underlying brain mechanisms. RECENT FINDINGS Recent findings suggest new underlying neurobiological mechanisms as possible therapeutic targets in selected patients, for example increased glutamate levels. In addition, neuronavigation can guide repetitive transcranial magnetic stimulation treatment of auditory verbal hallucinations to target-specific cortical regions. SUMMARY We propose the use of neuroimaging methods to better understand the interaction of different mechanisms underlying hallucinations and to use this knowledge to guide pharmacotherapy or focal brain stimulation in a personalized manner. In addition, we suggest evidence from various imaging modalities should converge to answer a research question. We believe this 'convergence of evidence' avoids the problem of overreliance on single and isolated findings.
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9
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Bose A, Shivakumar V, Agarwal SM, Kalmady SV, Shenoy S, Sreeraj VS, Narayanaswamy JC, Venkatasubramanian G. Efficacy of fronto-temporal transcranial direct current stimulation for refractory auditory verbal hallucinations in schizophrenia: A randomized, double-blind, sham-controlled study. Schizophr Res 2018; 195:475-480. [PMID: 28866447 DOI: 10.1016/j.schres.2017.08.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
Persistent auditory verbal hallucinations (AVH) that are refractory to antipsychotic medications are reported in about 20-30% of schizophrenia patients. Transcranial Direct Current Stimulation (tDCS), a non-invasive and safe neuromodulatory technique, has attracted significant interest as an add-on treatment for refractory AVH in schizophrenia. Studies examining the efficacy of tDCS for refractory AVH in schizophrenia have reported inconsistent findings. In this study, using a randomized, double-blind, sham-controlled design (RCT), we sought to examine the effect of add-on tDCS [anode corresponding to left dorsolateral prefrontal cortex and cathode to left temporo-parietal junction; 2-mA, twice-daily sessions for 5-days] to treat refractory AVH in schizophrenia patients (N=25); following this RCT phase, patients that had <30% reduction in AVH severity were offered an open-label extension (OLE) active stimulation to evaluate the effect of cross-over to verum tDCS. In the RCT phase, repeated measures ANOVA with tDCS type [verum (N=12) vs. sham (N=13)] as between subjects factor demonstrated a significant tDCS-type X time-point interaction [F=21.5, p<0.001, partial-η2=0.48] with significantly greater reduction of AVH score in verum tDCS group as compared to sham group. In the OLE phase, sham-to-verum crossed over patients (N=13) showed significantly greater reduction in AVH severity than their corresponding change during RCT phase (t=2.9; p=0.01). Together, these observations add further support to the beneficial effects of add-on tDCS to treat refractory AVH schizophrenia.
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Affiliation(s)
- Anushree Bose
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Venkataram Shivakumar
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sri Mahavir Agarwal
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sunil V Kalmady
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sonia Shenoy
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vanteemar S Sreeraj
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Janardhanan C Narayanaswamy
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- WISER Program, Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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10
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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: 22] [Impact Index Per Article: 3.7] [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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11
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Koops S, Sommer IEC. Transcranial direct current stimulation (tDCS) as a treatment for visual hallucinations: A case study. Psychiatry Res 2017; 258:616-617. [PMID: 28412045 DOI: 10.1016/j.psychres.2017.03.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Sanne Koops
- University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands.
| | - Iris E C Sommer
- University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands
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12
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Pondé PH, de Sena EP, Camprodon JA, de Araújo AN, Neto MF, DiBiasi M, Baptista AF, Moura LM, Cosmo C. Use of transcranial direct current stimulation for the treatment of auditory hallucinations of schizophrenia - a systematic review. Neuropsychiatr Dis Treat 2017; 13:347-355. [PMID: 28203084 PMCID: PMC5295799 DOI: 10.2147/ndt.s122016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Auditory hallucinations are defined as experiences of auditory perceptions in the absence of a provoking external stimulus. They are the most prevalent symptoms of schizophrenia with high capacity for chronicity and refractoriness during the course of disease. The transcranial direct current stimulation (tDCS) - a safe, portable, and inexpensive neuromodulation technique - has emerged as a promising treatment for the management of auditory hallucinations. OBJECTIVE The aim of this study is to analyze the level of evidence in the literature available for the use of tDCS as a treatment for auditory hallucinations in schizophrenia. METHODS A systematic review was performed, searching in the main electronic databases including the Cochrane Library and MEDLINE/PubMed. The searches were performed by combining descriptors, applying terms of the Medical Subject Headings (MeSH) of Descriptors of Health Sciences and descriptors contractions. PRISMA protocol was used as a guide and the terms used were the clinical outcomes ("Schizophrenia" OR "Auditory Hallucinations" OR "Auditory Verbal Hallucinations" OR "Psychosis") searched together ("AND") with interventions ("transcranial Direct Current Stimulation" OR "tDCS" OR "Brain Polarization"). RESULTS Six randomized controlled trials that evaluated the effects of tDCS on the severity of auditory hallucinations in schizophrenic patients were selected. Analysis of the clinical results of these studies pointed toward incongruence in the information with regard to the therapeutic use of tDCS with a view to reducing the severity of auditory hallucinations in schizophrenia. Only three studies revealed a therapeutic benefit, manifested by reductions in severity and frequency of auditory verbal hallucinations in schizophrenic patients. CONCLUSION Although tDCS has shown promising results in reducing the severity of auditory hallucinations in schizophrenic patients, this technique cannot yet be used as a therapeutic alternative due to lack of studies with large sample sizes that portray the positive effects that have been described.
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Affiliation(s)
- Pedro H Pondé
- Dynamics of Neuromusculoskeletal System Laboratory, Bahiana School of Medicine and Public Health
| | - Eduardo P de Sena
- Postgraduate Program in Interactive Process of Organs and Systems, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Joan A Camprodon
- Laboratory for Neuropsychiatry and Neuromodulation and Transcranial Magnetic Stimulation Clinical Service, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arão Nogueira de Araújo
- Postgraduate Program in Interactive Process of Organs and Systems, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mário F Neto
- Scientific Training Center Department, School of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Melany DiBiasi
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Biomorphology Department; Postgraduate Program on Medicine and Human Health, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lidia Mvr Moura
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Camila Cosmo
- Postgraduate Program in Interactive Process of Organs and Systems, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory for Neuropsychiatry and Neuromodulation and Transcranial Magnetic Stimulation Clinical Service, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Functional Electrostimulation Laboratory, Biomorphology Department; Center for Technological Innovation in Rehabilitation, Federal University of Bahia; Bahia State Health Department (SESAB), Salvador, Bahia, Brazil
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13
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Szymkowicz SM, McLaren ME, Suryadevara U, Woods AJ. Transcranial Direct Current Stimulation Use in the Treatment of Neuropsychiatric Disorders: A Brief Review. Psychiatr Ann 2016; 46:642-646. [PMID: 27885309 DOI: 10.3928/00485713-20161006-01] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has grown in popularity over the past two decades as an alternative treatment option for various neuropsychiatric disorders. tDCS modulates cortical excitability through the application of a weak direct current to the scalp via electrodes placed over cortical regions of interest. It has been shown to be a promising and relatively safe treatment tool with few adverse events. In this article, we will briefly review the efficacy of tDCS in depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. We will also discuss biomarkers of tDCS efficacy in depression, as it is the most studied neuropsychiatric disorder using tDCS application. We will then offer suggestions for future directions. Although efficacy results show promise, more studies with larger samples and longer treatment periods are needed to better understand the benefits of using tDCS as an alternative treatment option for neuropsychiatric disorders.
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Affiliation(s)
- Sarah M Szymkowicz
- Department of Clinical and Health Psychology at the University of Florida
| | - Molly E McLaren
- Department of Clinical and Health Psychology at the University of Florida
| | - Uma Suryadevara
- North Florida/South Georgia VA Medical Center; and an Assistant Professor, University of Florida College of Medicine
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine
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14
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Gschwind M, Seeck M. Transcranial direct-current stimulation as treatment in epilepsy. Expert Rev Neurother 2016; 16:1427-1441. [DOI: 10.1080/14737175.2016.1209410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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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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16
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Bandeira ID, Guimarães RSQ, Jagersbacher JG, Barretto TL, de Jesus-Silva JR, Santos SN, Argollo N, Lucena R. Transcranial Direct Current Stimulation in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD): A Pilot Study. J Child Neurol 2016; 31:918-24. [PMID: 26879095 DOI: 10.1177/0883073816630083] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/29/2015] [Indexed: 12/22/2022]
Abstract
Studies investigating the possible benefits of transcranial direct current stimulation on left dorsolateral prefrontal cortex in children and adolescents with attention-deficit hyperactivity disorder (ADHD) have not been performed. This study assesses the effect of transcranial direct current stimulation in children and adolescents with ADHD on neuropsychological tests of visual attention, visual and verbal working memory, and inhibitory control. An auto-matched clinical trial was performed involving transcranial direct current stimulation in children and adolescents with ADHD, using SNAP-IV and subtests Vocabulary and Cubes of the Wechsler Intelligence Scale for Children III (WISC-III). Subjects were assessed before and after transcranial direct current stimulation sessions with the Digit Span subtest of the WISC-III, inhibitory control subtest of the NEPSY-II, Corsi cubes, and the Visual Attention Test (TAVIS-3). There were 9 individuals with ADHD according to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. There was statistically significant difference in some aspects of TAVIS-3 tests and the inhibitory control subtest of NEPSY-II. Transcranial direct current stimulation can be related to a more efficient processing speed, improved detection of stimuli, and improved ability to switch between an ongoing activity and a new one.
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Affiliation(s)
- Igor Dórea Bandeira
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - João Gabriel Jagersbacher
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Thiago Lima Barretto
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Jéssica Regina de Jesus-Silva
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Samantha Nunes Santos
- Professor Edgard Santos University Teaching Hospital, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Nayara Argollo
- Department of Pediatrics, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Rita Lucena
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
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17
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Schönfeldt-Lecuona C, Lefaucheur JP, Lepping P, Liepert J, Connemann BJ, Sartorius A, Nowak DA, Gahr M. Non-Invasive Brain Stimulation in Conversion (Functional) Weakness and Paralysis: A Systematic Review and Future Perspectives. Front Neurosci 2016; 10:140. [PMID: 27065796 PMCID: PMC4815435 DOI: 10.3389/fnins.2016.00140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022] Open
Abstract
Conversion (functional) limb weakness or paralysis (FW) can be a debilitating condition, and often causes significant distress or impairment in social, occupational, or other important areas of functioning. Most treatment concepts are multi-disciplinary, containing a behavioral approach combined with a motor learning program. Non-invasive brain stimulation (NIBS) methods, such as electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS) have been used in the past few decades to treat FW. In order to identify all published studies that used NIBS methods such as ECT, TMS and transcranial direct current stimulation (tDCS) for treating FW patients a systematic review of the literature was conducted in PubMed and Web of Science. In a second step, narratives were used to retrospectively determine nominal CGI-I (Clinical Global Impression scale–Improvement) scores to describe approximate changes of FW symptoms. We identified two articles (case reports) with ECT used for treatment of FW, five with TMS with a total of 86 patients, and none with tDCS. In 75 out of 86 patients treated with repetitive (r)TMS a nominal CGI-I score could be estimated, showing a satisfactory short-term improvement. Fifty-four out of seventy-five identified patients (72%) had a CGI-I score of 1 (very much improved), 13 (17%) a score of 2 (much improved), 5 (7%) a score of 3 (minimally improved), and 3 (5%) remained unchanged (CGI-I = 4). In no case did patients worsen after rTMS treatment, and no severe adverse effects were reported. At follow-up, symptom improvement was not quantifiable in terms of CGI-I for the majority of the cases. Patients treated with ECT showed a satisfactory short-term response (CGI-I = 2), but deterioration of FW symptoms at follow-up. Despite the predominantly positive results presented in the identified studies and satisfactory levels of efficacy measured with retrospectively calculated nominal CGI-I scores, any assumption of a beneficial effect of NIBS in FW has to be seen with caution, as only few articles could be retrieved and their quality was mostly poor. This article elucidates how NIBS might help in FW and gives recommendations for future study designs using NIBS in this condition.
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Affiliation(s)
| | - Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de ParisCréteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil UniversityCréteil, France
| | - Peter Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health BoardWrexham, UK; Centre for Mental Health and Society, Bangor UniversityWrexham, UK; Department of Psychiatry, Mysore Medical College and Research InstituteMysore, India
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder Allensbach, Germany
| | | | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg Mannheim, Germany
| | - Dennis A Nowak
- Department of Neurology, Helios-Klinik KipfenbergKipfenberg, Germany; Department of Neurology, University Hospital MarburgMarburg, Germany
| | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University of Ulm Ulm, Germany
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18
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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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