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Besso L, Larivière S, Roes M, Sanford N, Percival C, Damascelli M, Momeni A, Lavigne K, Menon M, Aleman A, Ćurčić-Blake B, Woodward TS. Hypoactivation of the language network during auditory imagery contributes to hallucinations in Schizophrenia. Psychiatry Res Neuroimaging 2024; 341:111824. [PMID: 38754348 DOI: 10.1016/j.pscychresns.2024.111824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/20/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
Auditory verbal hallucinations (AVHs) involve perceptions, often voices, in the absence of external stimuli, and rank among the most common symptoms of schizophrenia. Metrical stress evaluation requires determination of the stronger syllable in words, and therefore requires auditory imagery, of interest for investigation of hallucinations in schizophrenia. The current functional magnetic resonance imaging study provides an updated whole-brain network analysis of a previously published study on metrical stress, which showed reduced directed connections between Broca's and Wernicke's regions of interest (ROIs) for hallucinations. Three functional brain networks were extracted, with the language network (LN) showing an earlier and shallower blood-oxygen-level dependent (BOLD) response for hallucinating patients, in the auditory imagery condition only (the reduced activation for hallucinations observed in the original ROI-based results were not specific to the imagery condition). This suggests that hypoactivation of the LN during internal auditory imagery may contribute to the propensity to hallucinate. This accords with cognitive accounts holding that an impaired balance between internal and external linguistic processes (underactivity in networks involved in internal auditory imagery and overactivity in networks involved in speech perception) contributes to our understanding of the biological underpinnings of hallucinations.
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Affiliation(s)
- Luca Besso
- BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sara Larivière
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meighen Roes
- BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Sanford
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Chantal Percival
- BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matteo Damascelli
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ava Momeni
- BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Katie Lavigne
- Douglas Research Centre, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Branislava Ćurčić-Blake
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Todd S Woodward
- BC Mental Health and Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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2
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Pindi P, Houenou J, Piguet C, Favre P. Real-time fMRI neurofeedback as a new treatment for psychiatric disorders: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110605. [PMID: 35843369 DOI: 10.1016/j.pnpbp.2022.110605] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/12/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
Neurofeedback using real-time functional MRI (RT-fMRI-NF) is an innovative technique that allows to voluntarily modulate a targeted brain response and its associated behavior. Despite promising results in the current literature, its effectiveness on symptoms management in psychiatric disorders is not yet clearly demonstrated. Here, we provide 1) a state-of-art qualitative review of RT-fMRI-NF studies aiming at alleviating clinical symptoms in a psychiatric population; 2) a quantitative evaluation (meta-analysis) of RT-fMRI-NF effectiveness on various psychiatric disorders and 3) methodological suggestions for future studies. Thirty-one clinical trials focusing on psychiatric disorders were included and categorized according to standard diagnostic categories. Among the 31 identified studies, 22 consisted of controlled trials, of which only eight showed significant clinical improvement in the experimental vs. control group after the training. Nine studies found an effect at follow-up on ADHD symptoms, emotion dysregulation, facial emotion processing, depressive symptoms, hallucinations, psychotic symptoms, and specific phobia. Within-group meta-analysis revealed large effects of the NF training on depressive symptoms right after the training (g = 0.81, p < 0.01) and at follow-up (g = 1.19, p < 0.01), as well as medium effects on anxiety (g = 0.44, p = 0.01) and emotion regulation (g = 0.48, p < 0.01). Between-group meta-analysis showed a medium effect on depressive symptoms (g = 0.49, p < 0.01) and a large effect on anxiety (g = 0.77, p = 0.01). However, the between-studies heterogeneity is very high. The use of RT-fMRI-NF as a treatment for psychiatric symptoms is promising, however, further double-blind, multicentric, randomized-controlled trials are warranted.
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Affiliation(s)
- Pamela Pindi
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France
| | - Josselin Houenou
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Campus Biotech, Geneva, Switzerland
| | - Pauline Favre
- Paris Est Créteil University (UPEC), INSERM U955, IMRB, Translational Neuro-psychiatry Team, AP-HP, DMU IMPACT, Mondor University Hospitals, FondaMental Foundation, F-94010 Créteil, France; Paris-Saclay University, Neurospin, CEA, UNIACT Lab, PsyBrain Team, F-91191 Gif-sur-Yvette, France
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3
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Xie Y, He Y, Guan M, Wang Z, Zhou G, Ma Z, Wang H, Yin H. Low-frequency rTMS treatment alters the topographical organization of functional brain networks in schizophrenia patients with auditory verbal hallucination. Psychiatry Res 2022; 309:114393. [PMID: 35042065 DOI: 10.1016/j.psychres.2022.114393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/31/2021] [Accepted: 01/09/2022] [Indexed: 01/10/2023]
Abstract
Auditory verbal hallucinations (AVH) are an important characteristic of schizophrenia. Repeated transcranial magnetic stimulation (rTMS) has been evidence to be effective in treating AVH. We evaluated the topological properties of resting-state functional brain networks in schizophrenia patients with AVH (n = 32) who received 1-Hz rTMS treatment and matched healthy controls (n = 33). The results showed that the psychotic symptoms and certain neurocognitive performances in patients were improved by rTMS treatment. Furthermore, the pretreatment patients showed abnormal global topological metrics compared with the controls, including lower global efficiency (Eglob, represents the relative quality of information transmission between all nodes in the network) and higher characteristic path length (Lp, characterizes the mean shortest distance between any two nodes in the network). The pretreament patients also showed decreased local topological metrics relative to the controls, including the nodal shortest path (NLp, quantifies the mean distance between the given node and the other nodes in the network) and nodal efficiency (Ne, measures the information interchange among the neighbor nodes when one node is removed), mainly located in the prefrontal cortex, occipital cortex, and subcortical regions. While the abnormal global and local topological patterns were normalized in patients after rTMS treatment. The multiple linear regression analysis indicated that the baseline topological metrics could be associated with the clinical responses after treatment in the patient group. The results suggested that the topological organization of the functional brain network was globally and regionally altered in schizophrenia patients with AVH after rTMS treatment and may be a potential therapeutic effect for AVH in schizophrenia.
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Affiliation(s)
- Yuanjun Xie
- School of Education, Xinyang College, Xinyang, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Ying He
- Department of Psychiatry, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Muzhen Guan
- Department of Mental Health, Xi'an Medical University, Xi'an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | | | - Zhujing Ma
- Department of Military Psychology, School of Psychology, Fourth Military Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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4
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Fovet T, Yger P, Lopes R, de Pierrefeu A, Duchesnay E, Houenou J, Thomas P, Szaffarczyk S, Domenech P, Jardri R. Decoding Activity in Broca's Area Predicts the Occurrence of Auditory Hallucinations Across Subjects. Biol Psychiatry 2022; 91:194-201. [PMID: 34742546 DOI: 10.1016/j.biopsych.2021.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) capture aims at detecting auditory-verbal hallucinations (AVHs) from continuously recorded brain activity. Establishing efficient capture methods with low computational cost that easily generalize between patients remains a key objective in precision psychiatry. To address this issue, we developed a novel automatized fMRI-capture procedure for AVHs in patients with schizophrenia (SCZ). METHODS We used a previously validated but labor-intensive personalized fMRI-capture method to train a linear classifier using machine learning techniques. We benchmarked the performances of this classifier on 2320 AVH periods versus resting-state periods obtained from SCZ patients with frequent symptoms (n = 23). We characterized patterns of blood oxygen level-dependent activity that were predictive of AVH both within and between subjects. Generalizability was assessed with a second independent sample gathering 2000 AVH labels (n = 34 patients with SCZ), while specificity was tested with a nonclinical control sample performing an auditory imagery task (840 labels, n = 20). RESULTS Our between-subject classifier achieved high decoding accuracy (area under the curve = 0.85) and discriminated AVH from rest and verbal imagery. Optimizing the parameters on the first schizophrenia dataset and testing its performance on the second dataset led to an out-of-sample area under the curve of 0.85 (0.88 for the converse test). We showed that AVH detection critically depends on local blood oxygen level-dependent activity patterns within Broca's area. CONCLUSIONS Our results demonstrate that it is possible to reliably detect AVH states from fMRI blood oxygen level-dependent signals in patients with SCZ using a multivariate decoder without performing complex preprocessing steps. These findings constitute a crucial step toward brain-based treatments for severe drug-resistant hallucinations.
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Affiliation(s)
- Thomas Fovet
- Plasticity & SubjectivitY team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France; CURE platform, Psychiatry Department, Fontan Hospital, Centre Hospitalier Universitaire de Lille, Lille, France; Centre National de Ressources et de Résilience Lille-Paris, France
| | - Pierre Yger
- Plasticity & SubjectivitY team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France; Institut de la Vision, Sorbonne Université, INSERM, Centre national de la recherche scientifique, Paris, France
| | - Renaud Lopes
- Vascular & Cognitive Deficits team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France; In-vivo Imaging and Functions core facility, Neuroradiology Department, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | | | - Josselin Houenou
- NeuroSpin, Univ Paris Saclay, CEA, Gif-sur-Yvette, France; Neurosurgery, Psychiatry and Addictology Departments, Groupe Hospitalier Universitaire Henri-Mondor, AP-HP, Créteil, France; Faculté de Santé UPEC, Université Paris Est Créteil, Créteil, France
| | - Pierre Thomas
- Plasticity & SubjectivitY team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France; CURE platform, Psychiatry Department, Fontan Hospital, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sébastien Szaffarczyk
- Plasticity & SubjectivitY team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France
| | - Philippe Domenech
- Institut du Cerveau et de la Moelle épinière, Sorbonne Université, INSERM, Centre national de la recherche scientifique, Paris, France; Neurosurgery, Psychiatry and Addictology Departments, Groupe Hospitalier Universitaire Henri-Mondor, AP-HP, Créteil, France; Faculté de Santé UPEC, Université Paris Est Créteil, Créteil, France
| | - Renaud Jardri
- Plasticity & SubjectivitY team, Lille Neuroscience & Cognition Research Centre, University of Lille, INSERM U1172, Lille, France; CURE platform, Psychiatry Department, Fontan Hospital, Centre Hospitalier Universitaire de Lille, Lille, France.
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5
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Blay M, Adam O, Bation R, Galvao F, Brunelin J, Mondino M. Improvement of Insight with Non-Invasive Brain Stimulation in Patients with Schizophrenia: A Systematic Review. J Clin Med 2021; 11:jcm11010040. [PMID: 35011780 PMCID: PMC8745271 DOI: 10.3390/jcm11010040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with schizophrenia are often unaware of their condition and the consequences of their illness. This lack of insight results in impaired functioning, treatment non-adherence and poor prognosis. Here, we aimed to investigate the effects of non-invasive brain stimulation (NIBS) on two forms of insight, clinical and cognitive, in patients with schizophrenia. We conducted a systematic review of the literature registered in the PROSPERO database (CRD42020220323) according to PRISMA guidelines. The literature search was conducted in Medline and Web of Science databases based on studies published up until October 2020 that included pre-NIBS and post-NIBS measurements of clinical and/or cognitive insight in adults with schizophrenia. A total of 14 studies were finally included, and their methodological quality was assessed by using the QualSyst tool. Despite the lack of well-conducted large randomized-controlled studies using insight as the primary outcome, the available findings provide preliminary evidence that NIBS can improve clinical insight in patients with schizophrenia, with a majority of studies using transcranial direct current stimulation with a left frontotemporal montage. Further studies should investigate the effect of NIBS on insight as a primary outcome and how these effects on insight could translate into clinical and functional benefits in patients with schizophrenia.
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Affiliation(s)
- Martin Blay
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
| | - Ondine Adam
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
| | - Rémy Bation
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
- Psychiatric Unit, Wertheimer Neurologic Hospital, F-69500 Bron, France
| | - Filipe Galvao
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
| | - Jérôme Brunelin
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
| | - Marine Mondino
- Centre Hospitalier le Vinatier, F-69500 Bron, France; (M.B.); (O.A.); (F.G.); (J.B.)
- Université Lyon 1, Lyon University, F-69100 Villeurbanne, France;
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, F-69000 Lyon, France
- Correspondence:
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6
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Xie Y, Guan M, Wang Z, Ma Z, Wang H, Fang P, Yin H. rTMS Induces Brain Functional and Structural Alternations in Schizophrenia Patient With Auditory Verbal Hallucination. Front Neurosci 2021; 15:722894. [PMID: 34539338 PMCID: PMC8441019 DOI: 10.3389/fnins.2021.722894] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/12/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Low-frequency transcranial magnetic stimulation (rTMS) over the left temporoparietal cortex reduces the auditory verbal hallucination (AVH) in schizophrenia. However, the underlying neural basis of the rTMS treatment effect for schizophrenia remains not well understood. This study investigates the rTMS induced brain functional and structural alternations and their associations with clinical as well as neurocognitive profiles in schizophrenia patients with AVH. METHODS Thirty schizophrenia patients with AVH and thirty-three matched healthy controls were enrolled. The patients were administered by 15 days of 1 Hz rTMS delivering to the left temporoparietal junction (TPJ) area. Clinical symptoms and neurocognitive measurements were assessed at pre- and post-rTMS treatment. The functional (amplitude of low-frequency fluctuation, ALFF) and structural (gray matter volume, GMV) alternations were compared, and they were then used to related to the clinical and neurocognitive measurements after rTMS treatment. RESULTS The results showed that the positive symptoms, including AVH, were relieved, and certain neurocognitive measurements, including visual learning (VisLearn) and verbal learning (VerbLearn), were improved after the rTMS treatment in the patient group. Furthermore, the rTMS treatment induced brain functional and structural alternations in patients, such as enhanced ALFF in the left superior frontal gyrus and larger GMV in the right inferior temporal cortex. The baseline ALFF and GMV values in certain brain areas (e.g., the inferior parietal lobule and superior temporal gyrus) could be associated with the clinical symptoms (e.g., positive symptoms) and neurocognitive performances (e.g., VerbLearn and VisLearn) after rTMS treatment in patients. CONCLUSION The low-frequency rTMS over the left TPJ area is an efficacious treatment for schizophrenia patients with AVH and could selectively modulate the neural basis underlying psychiatric symptoms and neurocognitive domains in schizophrenia.
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Affiliation(s)
- Yuanjun Xie
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Muzhen Guan
- Department of Mental Health, Xi’an Medical University, Xi’an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Zhujing Ma
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi’an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Peng Fang
- Department of Military Medical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi’an, China,*Correspondence: Peng Fang,
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, China,Hong Yin,
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7
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Thomas F, Bouaziz N, Gallea C, Schenin-King Andrianisaina P, Durand F, Bolloré O, Benadhira R, Isaac C, Braha-Zeitoun S, Moulier V, Valero-Cabré A, Januel D. Structural and functional brain biomarkers of clinical response to rTMS of medication-resistant auditory hallucinations in schizophrenia patients: study protocol for a randomized sham-controlled double-blind clinical trial. Trials 2019; 20:229. [PMID: 31014369 PMCID: PMC6480831 DOI: 10.1186/s13063-019-3311-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The potential of non-invasive repetitive transcranial magnetic stimulation (rTMS) to improve auditory verbal hallucinations (AVH) in schizophrenia patients has been increasingly explored over the past decade. Despite highly promising results, high inter-individual variability of clinical response and ineffective outcomes in a significant number of patients underscored the need to identify factors associated with the clinical response to rTMS. It should help improve the efficacy of rTMS in patients with medication-resistant AVH, and allow a better understanding of its neural impact. Here, we describe an exploratory study protocol which aims to identify structural and functional brain biomarkers associated with clinical response after an rTMS treatment for medication-resistant AVH in schizophrenia. METHODS Forty-five schizophrenia patients with medication-resistant AVH will be enrolled in a double-blind randomized sham-controlled monocentric clinical trial. Patients will be assigned to a regime of 20 sessions of active or sham 1 Hz rTMS delivered twice a day, 5 days a week for 2 weeks over the left temporo-parietal junction. Response will be assessed after rTMS and patients will be classified in responders or non-responders to treatment. Magnetic resonance imaging (MRI) sessions including diffusion weighted imaging and resting-state functional MRI sequences will be recorded before the onset of the rTMS treatment and 3 days following its discontinuation. The primary outcome measure is difference in fractional anisotropy between responder and non-responder patients at baseline. Differences in resting-state functional MRI data at baseline will be also investigated between responder and non-responder groups. Clinical, neuropsychological, neurophysiological, and blood serum BDNF assessments will be performed at baseline, 3 days, 1 month, and 3 months following rTMS. DISCUSSION The aim of this research project is to identify and assess the biomarker value of MRI-based structural and functional biomarkers predicting clinical response to rTMS for AVH in schizophrenia patients. The outcome of the trial should improve patient care by offering them a novel suitable therapy and deepen our understanding on how rTMS may impact AVH and develop more effective therapies adapted to individual patient needs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02755623 . Registered on 22 April 2016.
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Affiliation(s)
- Fanny Thomas
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Cerebral Dynamics, Plasticity and Rehabilitation Group, Frontlab, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, CNRS UMR 7225, INSERM UMRS 1127 and Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013, Paris, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Noomane Bouaziz
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France
| | - Cécile Gallea
- Movement Investigations and Therapeutics, MOV'IT, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, CNRS UMR 7225, INSERM UMRS 1127 and Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013, Paris, France
| | - Palmyre Schenin-King Andrianisaina
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Florence Durand
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Ombline Bolloré
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France
| | - René Benadhira
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Clémence Isaac
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Sonia Braha-Zeitoun
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France.,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France
| | - Virginie Moulier
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, Frontlab, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, CNRS UMR 7225, INSERM UMRS 1127 and Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013, Paris, France. .,Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University School of Medicine, 700 Albany Street, Boston, MA, W-702A, USA.
| | - Dominique Januel
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202 avenue Jean Jaurès, 93332, Neuilly-sur-Marne, France. .,Laboratoire de psychopathologie et de neuropsychologie, Université Paris 8, 2 rue de la Liberté, 93526, Saint-Denis, France.
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8
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Nathou C, Etard O, Dollfus S. Auditory verbal hallucinations in schizophrenia: current perspectives in brain stimulation treatments. Neuropsychiatr Dis Treat 2019; 15:2105-2117. [PMID: 31413576 PMCID: PMC6662171 DOI: 10.2147/ndt.s168801] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This review reports the current perspectives of brain stimulation techniques in the treatment of auditory verbal hallucinations (AVH) in schizophrenia. METHODS A systematic search of the literature in the PubMed database revealed that the most studied techniques are noninvasive techniques (NIBS), including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS). RESULTS The results showed that ECT could have great clinical efficacy but is currently underused in practice perhaps due to the costs associated with its limited implementation and potential associated risks. tDCS is still poorly studied and does not demonstrate sufficiently homogeneous or conclusive results yet to prove its efficacy in the treatment of AVH. However, its safe and simple implementation allows us to recommend it to patients who are refractory to other stimulation techniques. Finally, rTMS seems to be the most efficacious NIBS to offer patients with persistent AVH as an add-on therapeutic strategy. Its implementation has a non negligible cost but can be performed by a single practitioner. Great evolution in these techniques with technological progress, robotics and computer science are currently being tested and will undoubtedly improve the clinical efficacy of these procedures, particularly towards more personalized treatments such as individual rTMS targets and intensities. There are also new techniques for deep brain stimulation based on focused ultrasound that could provide much insight into the treatment of AVH in schizophrenia. CONCLUSION This review suggests that add-on brain stimulation treatments could play a key role among the therapeutic strategies for auditory hallucinations reduction in schizophrenia.
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Affiliation(s)
- Clément Nathou
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
| | - Olivier Etard
- Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France.,Normandie Univ, UNICAEN, CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, CHU de Caen, Caen, F-14000, France
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
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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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Dollfus S, Jaafari N, Guillin O, Trojak B, Plaze M, Saba G, Nauczyciel C, Montagne Larmurier A, Chastan N, Meille V, Krebs MO, Ayache SS, Lefaucheur JP, Razafimandimby A, Leroux E, Morello R, Marie Batail J, Brazo P, Lafay N, Wassouf I, Harika-Germaneau G, Guillevin R, Guillevin C, Gerardin E, Rotharmel M, Crépon B, Gaillard R, Delmas C, Fouldrin G, Laurent G, Nathou C, Etard O. High-Frequency Neuronavigated rTMS in Auditory Verbal Hallucinations: A Pilot Double-Blind Controlled Study in Patients With Schizophrenia. Schizophr Bull 2018; 44:505-514. [PMID: 29897597 PMCID: PMC5890503 DOI: 10.1093/schbul/sbx127] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind sham-controlled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. METHODS Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). RESULTS The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. DISCUSSION This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.
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Affiliation(s)
- Sonia Dollfus
- CHU de Caen, Service de Psychiatrie, Centre Esquirol, Caen, France,Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France,To whom correspondence should be addressed; CHU de Caen, Service de Psychiatrie, Centre Esquirol, Caen F-14000, France, tel: +332 3106 5018; Fax: +332 3106 4789; e-mail: , http://www.ists.cyceron.fr/
| | - Nemat Jaafari
- Centre Hospitalier Henri Laborit, Poitiers, France,Laboratoire expérimental et clinique en Neurosciences, Univ Poitiers, Poitiers, France
| | - Olivier Guillin
- Department of Psychiatry, CH Le Rouvray, Sotteville les Rouen, France,INSERM U 1079, University of Medicine, Rouen, France,CHU Charles Nicolle, Rouen, France
| | - Benoit Trojak
- CHU de Dijon, Service de psychiatrie et d’addictologie, Dijon, France
| | - Marion Plaze
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Ghassen Saba
- Henri Mondor Hospital, Paris-Est Créteil University, Créteil, France
| | | | | | | | - Vincent Meille
- CHU de Dijon, Service de psychiatrie et d’addictologie, Dijon, France
| | - Marie-Odile Krebs
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Samar S Ayache
- Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Paris-Est Créteil University, Créteil, France
| | - Jean Pascal Lefaucheur
- Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Paris-Est Créteil University, Créteil, France
| | - Annick Razafimandimby
- Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France
| | - Elise Leroux
- Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France
| | - Rémy Morello
- CHU de Caen, Unité de biostatistiques et recherche clinique, Caen, France
| | | | - Perrine Brazo
- CHU de Caen, Service de Psychiatrie, Centre Esquirol, Caen, France,Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France
| | | | - Issa Wassouf
- Centre Hospitalier Henri Laborit, Poitiers, France
| | | | | | | | | | - Maud Rotharmel
- Department of Psychiatry, CH Le Rouvray, Sotteville les Rouen, France
| | - Benoit Crépon
- Centre Hospitalier Sainte-Anne, Service de neurophysiologie clinique, Paris, France
| | - Raphael Gaillard
- Centre Hospitalier Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Christophe Delmas
- Department of Psychiatry, CH Le Rouvray, Sotteville les Rouen, France
| | | | - Guillaume Laurent
- Department of Psychiatry, CH Le Rouvray, Sotteville les Rouen, France
| | - Clément Nathou
- CHU de Caen, Service de Psychiatrie, Centre Esquirol, Caen, France,Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France,Department of Psychiatry, CH Le Rouvray, Sotteville les Rouen, France
| | - Olivier Etard
- Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France,CHU de Caen, Service des explorations fonctionnelles du système nerveux, Caen, France
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11
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Leroy A, Foucher JR, Pins D, Delmaire C, Thomas P, Roser MM, Lefebvre S, Amad A, Fovet T, Jaafari N, Jardri R. fMRI capture of auditory hallucinations: Validation of the two-steps method. Hum Brain Mapp 2017; 38:4966-4979. [PMID: 28660668 PMCID: PMC6866805 DOI: 10.1002/hbm.23707] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/08/2017] [Accepted: 06/18/2017] [Indexed: 02/06/2023] Open
Abstract
Our purpose was to validate a reliable method to capture brain activity concomitant with hallucinatory events, which constitute frequent and disabling experiences in schizophrenia. Capturing hallucinations using functional magnetic resonance imaging (fMRI) remains very challenging. We previously developed a method based on a two-steps strategy including (1) multivariate data-driven analysis of per-hallucinatory fMRI recording and (2) selection of the components of interest based on a post-fMRI interview. However, two tests still need to be conducted to rule out critical pitfalls of conventional fMRI capture methods before this two-steps strategy can be adopted in hallucination research: replication of these findings on an independent sample and assessment of the reliability of the hallucination-related patterns at the subject level. To do so, we recruited a sample of 45 schizophrenia patients suffering from frequent hallucinations, 20 schizophrenia patients without hallucinations and 20 matched healthy volunteers; all participants underwent four different experiments. The main findings are (1) high accuracy in reporting unexpected sensory stimuli in an MRI setting; (2) good detection concordance between hypothesis-driven and data-driven analysis methods (as used in the two-steps strategy) when controlled unexpected sensory stimuli are presented; (3) good agreement of the two-steps method with the online button-press approach to capture hallucinatory events; (4) high spatial consistency of hallucinatory-related networks detected using the two-steps method on two independent samples. By validating the two-steps method, we advance toward the possible transfer of such technology to new image-based therapies for hallucinations. Hum Brain Mapp 38:4966-4979, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | - Jack R. Foucher
- Univ Strasbourg, CNRS, UMR 7357 ‐ ICube ‐ Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie and Fédération de Médecine Translationnelle de Strasbourg (FMTS)StrasbourgF‐67000France
- CHU Strasbourg, CEntre de neuroModulation Non Invasive de Strasbourg (CEMNIS)StrasbourgF‐67000France
| | - Delphine Pins
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | | | - Pierre Thomas
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | - Mathilde M. Roser
- Univ Strasbourg, CNRS, UMR 7357 ‐ ICube ‐ Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie and Fédération de Médecine Translationnelle de Strasbourg (FMTS)StrasbourgF‐67000France
- CHU Strasbourg, CEntre de neuroModulation Non Invasive de Strasbourg (CEMNIS)StrasbourgF‐67000France
| | - Stéphanie Lefebvre
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | - Ali Amad
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | - Thomas Fovet
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
| | - Nemat Jaafari
- Henri Laborit Hospital Centre, Unité de recherche clinique intersectorielle en psychiatrie à vocation régionale Pierre DenikerPoitiersF‐86022France
- Univ Poitiers and CHU Poitiers, INSERM, CIC‐P 1402 and U‐1084 Experimental and Clinical Neurosciences LaboratoryPoitiersF‐86022France
| | - Renaud Jardri
- Univ Lille, CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences AffectivesLilleF‐59000France
- CHU Lille, Psychiatry Dpt., CURE platformLilleF‐59000France
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12
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Thomas F, Moulier V, Valéro-Cabré A, Januel D. Brain connectivity and auditory hallucinations: In search of novel noninvasive brain stimulation therapeutic approaches for schizophrenia. Rev Neurol (Paris) 2016; 172:653-679. [PMID: 27742234 DOI: 10.1016/j.neurol.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/10/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
Abstract
Auditory verbal hallucinations (AVH) are among the most characteristic symptoms of schizophrenia and have been linked to likely disturbances of structural and functional connectivity within frontal, temporal, parietal and subcortical networks involved in language and auditory functions. Resting-state functional magnetic resonance imaging (fMRI) has shown that alterations in the functional connectivity activity of the default-mode network (DMN) may also subtend hallucinations. Noninvasive neurostimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) have the ability to modulate activity of targeted cortical sites and their associated networks, showing a high potential for modulating altered connectivity subtending schizophrenia. Notwithstanding, the clinical benefit of these approaches remains weak and variable. Further studies in the field should foster a better understanding concerning the status of networks subtending AVH and the neural impact of rTMS in relation with symptom improvement. Additionally, the identification and characterization of clinical biomarkers able to predict response to treatment would be a critical asset allowing better care for patients with schizophrenia.
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Affiliation(s)
- F Thomas
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202, avenue Jean-Jaurès, 93332 Neuilly-sur-Marne cedex, France.
| | - V Moulier
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202, avenue Jean-Jaurès, 93332 Neuilly-sur-Marne cedex, France
| | - A Valéro-Cabré
- UMR 7225 CRICM CNRS, Université Pierre-et-Marie-Curie, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France; Université Pierre-et-Marie-Curie, CNRS UMR 7225-Inserm UMRS S975, Centre de Recherche de l'Institut du Cerveau et la Moelle (ICM), 75013 Paris, France; Laboratory for Cerebral Dynamics Plasticity & Rehabilitation, Boston University School of Medicine, Boston, MA, USA; Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain
| | - D Januel
- Unité de Recherche Clinique, Établissement Public de Santé Ville-Evrard, 202, avenue Jean-Jaurès, 93332 Neuilly-sur-Marne cedex, France
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13
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Mondino M, Jardri R, Suaud-Chagny MF, Saoud M, Poulet E, Brunelin J. Effects of Fronto-Temporal Transcranial Direct Current Stimulation on Auditory Verbal Hallucinations and Resting-State Functional Connectivity of the Left Temporo-Parietal Junction in Patients With Schizophrenia. Schizophr Bull 2016; 42:318-26. [PMID: 26303936 PMCID: PMC4753593 DOI: 10.1093/schbul/sbv114] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Auditory verbal hallucinations (AVH) in patients with schizophrenia are associated with abnormal hyperactivity in the left temporo-parietal junction (TPJ) and abnormal connectivity between frontal and temporal areas. Recent findings suggest that fronto-temporal transcranial Direct Current stimulation (tDCS) with the cathode placed over the left TPJ and the anode over the left prefrontal cortex can alleviate treatment-resistant AVH in patients with schizophrenia. However, brain correlates of the AVH reduction are unclear. Here, we investigated the effect of tDCS on the resting-state functional connectivity (rs-FC) of the left TPJ. Twenty-three patients with schizophrenia and treatment-resistant AVH were randomly allocated to receive 10 sessions of active (2 mA, 20 min) or sham tDCS (2 sessions/d for 5 d). We compared the rs-FC of the left TPJ between patients before and after they received active or sham tDCS. Relative to sham tDCS, active tDCS significantly reduced AVH as well as the negative symptoms. Active tDCS also reduced rs-FC of the left TPJ with the left anterior insula and the right inferior frontal gyrus and increased rs-FC of the left TPJ with the left angular gyrus, the left dorsolateral prefrontal cortex and the precuneus. The reduction of AVH severity was correlated with the reduction of the rs-FC between the left TPJ and the left anterior insula. These findings suggest that the reduction of AVH induced by tDCS is associated with a modulation of the rs-FC within an AVH-related brain network, including brain areas involved in inner speech production and monitoring.
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Affiliation(s)
- Marine Mondino
- EA4615, Université de Lyon & CH Le Vinatier, F-69678 Bron, France
| | - Renaud Jardri
- Laboratoire de Sciences Cognitives & Affectives (SCA-Lab), UMR CNRS 9193, Université de Lille & CURE, Hôpital Fontan, CHRU de Lille, F-59000, Lille, France
| | | | - Mohamed Saoud
- EA4615, Université de Lyon & CH Le Vinatier, F-69678 Bron, France
| | - Emmanuel Poulet
- EA4615, Université de Lyon & CH Le Vinatier, F-69678 Bron, France
| | - Jérôme Brunelin
- EA4615, Université de Lyon & CH Le Vinatier, F-69678 Bron, France;
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Dollfus S, Lecardeur L, Morello R, Etard O. Placebo Response in Repetitive Transcranial Magnetic Stimulation Trials of Treatment of Auditory Hallucinations in Schizophrenia: A Meta-Analysis. Schizophr Bull 2016; 42:301-8. [PMID: 26089351 PMCID: PMC4753589 DOI: 10.1093/schbul/sbv076] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several meta-analyses have assessed the response of patients with schizophrenia with auditory verbal hallucinations (AVH) to treatment with repetitive transcranial magnetic stimulation (rTMS); however, the placebo response has never been explored. Typically observed in a therapeutic trial, the placebo effect may have a major influence on the effectiveness of rTMS. The purpose of this meta-analysis is to evaluate the magnitude of the placebo effect observed in controlled studies of rTMS treatment of AVH, and to determine factors that can impact the magnitude of this placebo effect, such as study design considerations and the type of sham used.The study included twenty-one articles concerning 303 patients treated by sham rTMS. A meta-analytic method was applied to obtain a combined, weighted effect size, Hedges's g. The mean weighted effect size of the placebo effect across these 21 studies was 0.29 (P < .001). Comparison of the parallel and crossover studies revealed distinct results for each study design; placebo has a significant effect size in the 13 parallel studies (g = 0.44, P < 10(-4)), but not in the 8 crossover studies (g = 0.06, P = .52). In meta-analysis of the 13 parallel studies, the 45° position coil showed the highest effect size. Our results demonstrate that placebo effect should be considered a major source of bias in the assessment of rTMS efficacy. These results fundamentally inform the design of further controlled studies, particularly with respect to studies of rTMS treatment in psychiatry.
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Affiliation(s)
| | - Laurent Lecardeur
- CHU de Caen, Service de Psychiatrie, Centre Esquirol, Caen, F-14000, France;,CNRS, UMR 6301, ISTCT, ISTS Group, GIP Cyceron, Caen, F-14074, France
| | - Rémy Morello
- CHU de Caen, Unité de Biostatistique et de Recherche Clinique, F-14000, France
| | - Olivier Etard
- UCBN, UFR de Médecine, Caen, F-14000, France;,CHU de Caen, Laboratoire d’Explorations Fonctionnelles Neurologiques, Caen, F-14000, France
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15
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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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Fovet T, Orlov N, Dyck M, Allen P, Mathiak K, Jardri R. Translating Neurocognitive Models of Auditory-Verbal Hallucinations into Therapy: Using Real-time fMRI-Neurofeedback to Treat Voices. Front Psychiatry 2016; 7:103. [PMID: 27445865 PMCID: PMC4921472 DOI: 10.3389/fpsyt.2016.00103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Auditory-verbal hallucinations (AVHs) are frequent and disabling symptoms, which can be refractory to conventional psychopharmacological treatment in more than 25% of the cases. Recent advances in brain imaging allow for a better understanding of the neural underpinnings of AVHs. These findings strengthened transdiagnostic neurocognitive models that characterize these frequent and disabling experiences. At the same time, technical improvements in real-time functional magnetic resonance imaging (fMRI) enabled the development of innovative and non-invasive methods with the potential to relieve psychiatric symptoms, such as fMRI-based neurofeedback (fMRI-NF). During fMRI-NF, brain activity is measured and fed back in real time to the participant in order to help subjects to progressively achieve voluntary control over their own neural activity. Precisely defining the target brain area/network(s) appears critical in fMRI-NF protocols. After reviewing the available neurocognitive models for AVHs, we elaborate on how recent findings in the field may help to develop strong a priori strategies for fMRI-NF target localization. The first approach relies on imaging-based "trait markers" (i.e., persistent traits or vulnerability markers that can also be detected in the presymptomatic and remitted phases of AVHs). The goal of such strategies is to target areas that show aberrant activations during AVHs or are known to be involved in compensatory activation (or resilience processes). Brain regions, from which the NF signal is derived, can be based on structural MRI and neurocognitive knowledge, or functional MRI information collected during specific cognitive tasks. Because hallucinations are acute and intrusive symptoms, a second strategy focuses more on "state markers." In this case, the signal of interest relies on fMRI capture of the neural networks exhibiting increased activity during AVHs occurrences, by means of multivariate pattern recognition methods. The fine-grained activity patterns concomitant to hallucinations can then be fed back to the patients for therapeutic purpose. Considering the potential cost necessary to implement fMRI-NF, proof-of-concept studies are urgently required to define the optimal strategy for application in patients with AVHs. This technique has the potential to establish a new brain imaging-guided psychotherapy for patients that do not respond to conventional treatments and take functional neuroimaging to therapeutic applications.
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Affiliation(s)
- Thomas Fovet
- Univ Lille, CNRS, UMR-9193, psyCHIC team & CHU Lille, Psychiatry Dpt (CURE), Fontan Hospital , Lille , France
| | - Natasza Orlov
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London , London , UK
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA-Brain, RWTH Aachen University , Aachen , Germany
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, University of Roehampton, London, UK
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, JARA-Brain, RWTH Aachen University , Aachen , Germany
| | - Renaud Jardri
- Univ Lille, CNRS, UMR-9193, psyCHIC team & CHU Lille, Psychiatry Dpt (CURE), Fontan Hospital , Lille , France
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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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de Weijer AD, Sommer IEC, Lotte Meijering A, Bloemendaal M, Neggers SFW, Daalman K, Boezeman EHJF. High frequency rTMS; a more effective treatment for auditory verbal hallucinations? Psychiatry Res 2014; 224:204-10. [PMID: 25453990 DOI: 10.1016/j.pscychresns.2014.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 09/26/2014] [Accepted: 10/09/2014] [Indexed: 01/31/2023]
Abstract
The great majority of studies on repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool for auditory verbal hallucinations (AVH) have used 1-Hz stimulation with inconsistent results. Recently, it has been suggested that 20-Hz rTMS has strong therapeutic effects. It is conceivable that this 20-Hz stimulation is more effective than 1-Hz stimulation. The aim of this preliminary study is to investigate the efficacy of 20-Hz rTMS compared with 1-Hz rTMS as a treatment for AVH. Eighteen schizophrenia patients with medication-resistant AVH were randomized over two treatment groups. Each group received either 20 min of 1-Hz rTMS or 13 trains of 20-Hz rTMS daily over 1 week. After week 1, patients received a follow-up treatment once a week for 3 weeks. Stimulation location was based on individual AVH-related activation patterns identified with functional magnetic resonance imaging. Severity of AVH was monitored with the Auditory Hallucination Rating Scale (AHRS). Both groups showed a decrease in AVH after week 1 of rTMS. This decrease was significant for the 20-Hz group and the 1-Hz group. When the two treatment types were compared, no treatment type was superior. Based on these results we cannot conclude whether high frequency rTMS is more effective against AVH than is traditional 1-Hz rTMS. More research is needed to optimize stimulation parameters and to investigate potential target locations for stimulation.
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Affiliation(s)
- Antoin D de Weijer
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.
| | - Iris E C Sommer
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Anne Lotte Meijering
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Mirjam Bloemendaal
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Sebastiaan F W Neggers
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Kirstin Daalman
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Eduard H J F Boezeman
- Department of Clinical Neurophysiology, St. Antonius Hospital Nieuwegein, The Netherlands
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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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Matheson SL, Shepherd AM, Carr VJ. How much do we know about schizophrenia and how well do we know it? Evidence from the Schizophrenia Library. Psychol Med 2014; 44:3387-3405. [PMID: 25065407 DOI: 10.1017/s0033291714000166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND True findings about schizophrenia remain elusive; many findings are not replicated and conflicting results are common. Well-conducted systematic reviews have the ability to make robust, generalizable conclusions, with good meta-analyses potentially providing the closest estimate of the true effect size. In this paper, we undertake a systematic approach to synthesising the available evidence from well-conducted systematic reviews on schizophrenia. METHOD Reviews were identified by searching Medline, EMBASE, CINAHL, Current Contents and PsycINFO. The decision to include or exclude reviews, data extraction and quality assessments were conducted in duplicate. Evidence was graded as high quality if reviews contained large samples and robust results; and as moderate quality if reviews contained imprecision, inconsistency, smaller samples or study designs that may be prone to bias. RESULTS High- and moderate-quality evidence shows that numerous psychosocial and biomedical treatments are effective. Patients have relatively poor cognitive functioning, and subtle, but diverse, structural brain alterations, altered electrophysiological functioning and sleep patterns, minor physical anomalies, neurological soft signs, and sensory alterations. There are markers of infection, inflammation or altered immunological parameters; and there is increased mortality from a range of causes. Risk for schizophrenia is increased with cannabis use, pregnancy and birth complications, prenatal exposure to Toxoplasma gondii, childhood central nervous system viral infections, childhood adversities, urbanicity and immigration (first and second generation), particularly in certain ethnic groups. Developmental motor delays and lower intelligence quotient in childhood and adolescence are apparent. CONCLUSIONS We conclude that while our knowledge of schizophrenia is very substantial, our understanding of it remains limited.
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Affiliation(s)
- S L Matheson
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - A M Shepherd
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - V J Carr
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
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Zhang Y, Liang W, Yang S, Dai P, Shen L, Wang C. Repetitive transcranial magnetic stimulation for hallucination in schizophrenia spectrum disorders: A meta-analysis. Neural Regen Res 2014; 8:2666-76. [PMID: 25206578 PMCID: PMC4146020 DOI: 10.3969/j.issn.1673-5374.2013.28.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/24/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders. DATA SOURCES Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Controlled Trials databases from January 1985 to May 2012. Key words were "transcranial magnetic stimulation", "TMS", "repetitive transcranial magnetic stimulation", and "hallucination". STUDY SELECTION Selected studies were randomized controlled trials assessing therapeutic efficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders. Control groups received sham stimulation. MAIN OUTCOME MEASURES The primary outcome was total scores of Auditory Hallucinations Rating Scale, Auditory Hallucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hallucination item, and Hallucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function. RESULTS Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. All data were completely effective, involving 398 patients. Overall mean weighted effect size for repetitive transcranial magnetic stimulation versus sham stimulation was statistically significant (MD = -0.42, 95%CI: -0.64 to -0.20, P = 0.000 2). Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation (OR = 2.94, 95%CI: 1.39 to 6.24, P = 0.005). No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms. Compared with sham stimulation, active repetitive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching. CONCLUSION Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hallucination in schizophrenia spectrum disorders.
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Affiliation(s)
- Yingli Zhang
- Psychological Counseling Center, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Wei Liang
- Department of Clinical Psychology, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
| | - Shichang Yang
- Department of Psychology, Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Ping Dai
- Library of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lijuan Shen
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Changhong Wang
- Department of Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, Henan Province, China
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Fovet T, Amad A, Thomas P, Jardri R. [Schizophrenia and informed consent to research]. Encephale 2014; 41:394-402. [PMID: 25127894 DOI: 10.1016/j.encep.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/05/2013] [Indexed: 12/25/2022]
Abstract
CONTEXT Informed consent to research remains a complex issue, while sometimes staying difficult to obtain, even in the general population. This problem may be maximized with patients suffering from schizophrenia. OBJECTIVE This paper summarizes available data in the literature about informed consent for research involving patients suffering from schizophrenia. METHOD Medline and Google Scholar searches were conducted using the following MESH terms: schizophrenia, informed consent and research. RESULTS Studies using dedicated standardized scales (e.g. MacCAT-CR) revealed a decrease in the capacity to consent of patients with schizophrenia when compared with healthy individuals. Keeping in mind that schizophrenia is an heterogeneous disorder, patients with the lowest insight as well as those with the most severe cognitive symptoms appeared more impaired in their capacity to consent. Such a poor capacity to understand and consent to trials was shown linked with alterations in decision-making. For these specific patients, interventions may be set up to increase their capacity to consent. Various strategies were proposed: enhanced consent forms, extended discussion, test/feedback method or multimedia interventions. Among them, interventions relying on communication and the growing field of information technologies (e.g. web-based tools) seem promising. Finally, associations grouping families and patients (like the French Association UNAFAM) may facilitate the involvement of patients in research programs with safer conditions. CONCLUSION Patients suffering from schizophrenia appear able to consent to research programs when suitable interventions are proposed. Further studies are now needed to optimize and individualize such interventions.
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Affiliation(s)
- T Fovet
- Pôle de psychiatrie, université Lille Nord-de-France, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, 59037 Lille cedex, France.
| | - A Amad
- Pôle de psychiatrie, université Lille Nord-de-France, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, 59037 Lille cedex, France
| | - P Thomas
- Pôle de psychiatrie, université Lille Nord-de-France, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, 59037 Lille cedex, France
| | - R Jardri
- Pôle de psychiatrie, université Lille Nord-de-France, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, 59037 Lille cedex, France
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Review of the efficacy of transcranial magnetic stimulation for auditory verbal hallucinations. Biol Psychiatry 2014; 76:101-10. [PMID: 24315551 DOI: 10.1016/j.biopsych.2013.09.038] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 12/19/2022]
Abstract
With an increase of the number of studies exploring repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations (AVH), an update is provided on the efficacy of different paradigms. A literature search was performed from 1966 through April 2013. Twenty-five randomized controlled trials using the severity of AVH or psychosis as outcome measures were included. Standardized mean weighted effect sizes were computed; a qualitative review of the literature was performed to assess the effects of various rTMS paradigms. rTMS versus sham treatment for AVH yielded a mean weighted effect size of .44. No significant mean weighted effect size was found for the severity of psychosis (i.e., .21). For patients with medication-resistant AVH, the mean weighted effect size was .45. rTMS applied at the left temporoparietal area with a frequency of 1 Hz yielded a moderate mean weighted effect size of .63, indicating superiority of this paradigm. Various other paradigms failed to show superior effects. rTMS applied at the right temporoparietal area was not superior to sham treatment. rTMS, especially when applied at the left temporoparietal area with a frequency of 1 Hz, is effective for the treatment of AVH, including in patients with medication-resistant AVH. The results for other rTMS paradigms are disappointing thus far. A next step should be to explore the effects of rTMS in medication-free individuals, for example, during the initial phases of psychosis, and in patients with diagnoses other than schizophrenia who do not have comorbid psychotic symptoms.
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24
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Jardri R, Bartels-Velthuis AA, Debbané M, Jenner JA, Kelleher I, Dauvilliers Y, Plazzi G, Demeulemeester M, David CN, Rapoport J, Dobbelaere D, Escher S, Fernyhough C. From phenomenology to neurophysiological understanding of hallucinations in children and adolescents. Schizophr Bull 2014; 40 Suppl 4:S221-32. [PMID: 24936083 PMCID: PMC4141307 DOI: 10.1093/schbul/sbu029] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 01/05/2023]
Abstract
Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided.
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Affiliation(s)
- Renaud Jardri
- Child & Adolescent Psychiatry Department,University Medical Centre Lille, Lille, France; Lille Nord de France University, UDSL, Functional Neurosciences & Disorders Lab, Lille, France;
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Martin Debbané
- Adolescence Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jack A Jenner
- Jenner Consult Haren & Audito, Practice for Child & Adolescent Voice Hearers, Ten Boer, The Netherlands
| | - Ian Kelleher
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Yves Dauvilliers
- Sleep unit, Department of Neurology, Hôpital Gui-de-Chauliac, CHU Montpellier & National Reference Network for Narcolepsy, INSERM U1061, Montpellier, France
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bologna, Italy
| | - Morgane Demeulemeester
- Lille Nord de France University, UDSL, Functional Neurosciences & Disorders Lab, Lille, France; Lautréamont Clinic, ORPEACLINEA Group, Loos, France
| | - Christopher N David
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD
| | - Dries Dobbelaere
- National Reference Center for Inherited Metabolic Diseases in Child and Adulthood, University Children's Hospital Jeanne de Flandre, Lille, France
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Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125:2150-2206. [PMID: 25034472 DOI: 10.1016/j.clinph.2014.05.021] [Citation(s) in RCA: 1276] [Impact Index Per Article: 127.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.
| | - Nathalie André-Obadia
- Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
| | - Andrea Antal
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Samar S Ayache
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roberto M Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Dirk De Ridder
- Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France
| | - Vincenzo Di Lazzaro
- Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Saša R Filipović
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France
| | - Simone Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hartwig R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Josep Valls-Sole
- EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
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Brunoni AR, Shiozawa P, Truong D, Javitt DC, Elkis H, Fregni F, Bikson M. Understanding tDCS effects in schizophrenia: a systematic review of clinical data and an integrated computation modeling analysis. Expert Rev Med Devices 2014; 11:383-94. [PMID: 24754366 DOI: 10.1586/17434440.2014.911082] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although recent clinical studies using transcranial direct current stimulation (tDCS) for schizophrenia showed encouraging results, several tDCS montages were employed and their current flow pattern has not been investigated. We performed a systematic review to identify clinical tDCS studies in schizophrenia. We then applied computer head modeling analysis for prediction of current flow. Out of 41 references, we identified 12 relevant studies. The most employed montage was anode and cathode over the left dorsolateral prefrontal and temporoparietal cortex, respectively. Computational model analysis predicted activation and under-activation under the anode and the cathode, respectively, occurring in areas respectively associated with negative and positive symptoms. We also identified tDCS-induced electrical currents in cortical areas between the electrodes (frontoparietal network) and, to a lesser extent, in deeper structures involved in schizophrenia pathophysiology. Mechanisms of tDCS effects in schizophrenia and the usefulness of computer modeling techniques for planning tDCS trials in schizophrenia are discussed.
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Affiliation(s)
- Andre R Brunoni
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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The multimodal connectivity of the hippocampal complex in auditory and visual hallucinations. Mol Psychiatry 2014; 19:184-91. [PMID: 23318999 DOI: 10.1038/mp.2012.181] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/30/2012] [Accepted: 11/12/2012] [Indexed: 11/09/2022]
Abstract
Hallucinations constitute one of the most representative and disabling symptoms of schizophrenia. Several Magnetic Resonance Imaging (MRI) findings support the hypothesis that distinct patterns of connectivity, particularly within networks involving the hippocampal complex (HC), could be associated with different hallucinatory modalities. The aim of this study was to investigate HC connectivity as a function of the hallucinatory modality, that is, auditory or visual. Two carefully selected subgroups of schizophrenia patients with only auditory hallucinations (AH) or with audio-visual hallucinations (A+VH) were compared using the following three complementary multimodal MRI methods: resting state functional MRI, diffusion MRI and structural MRI were used to analyze seed-based Functional Connectivity (sb-FC), Tract-Based Spatial Statistics (TBSS) and shape analysis, respectively. Sb-FC was significantly higher between the HC, the medial prefrontal cortex (mPFC) and the caudate nuclei in A+VH patients compared with the AH group. Conversely, AH patients exhibited a higher sb-FC between the HC and the thalamus in comparison with the A+VH group. In the A+VH group, TBSS showed specific higher white matter connectivity in the pathways connecting the HC with visual areas, such as the forceps major and the inferior-fronto-occipital fasciculus than in the AH group. Finally, shape analysis showed localized hippocampal hypertrophy in the A+VH group. Functional results support the fronto-limbic dysconnectivity hypothesis of schizophrenia, while specific structural findings indicate that plastic changes are associated with hallucinations. Together, these results suggest that there are distinct connectivity patterns in patients with schizophrenia that depend on the sensory-modality, with specific involvement of the HC in visual hallucinations.
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28
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Repetitive transcranial magnetic stimulation (rTMS) in schizophrenia with treatment-refractory auditory hallucinations and major self-mutilation. J Neural Transm (Vienna) 2014; 122 Suppl 1:S19-23. [DOI: 10.1007/s00702-013-1151-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/20/2013] [Indexed: 11/26/2022]
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Kindler J, Homan P, Flury R, Strik W, Dierks T, Hubl D. Theta burst transcranial magnetic stimulation for the treatment of auditory verbal hallucinations: results of a randomized controlled study. Psychiatry Res 2013; 209:114-7. [PMID: 23648282 DOI: 10.1016/j.psychres.2013.03.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 03/10/2013] [Accepted: 03/17/2013] [Indexed: 10/26/2022]
Abstract
One Hertz (1 Hz) repetitive transcranial magnetic stimulation (rTMS) is an effective therapy for auditory verbal hallucinations (AVH). Theta burst protocols (TBS) show longer after-effects. This single-blind, randomized controlled study compared continuous TBS with 1Hz rTMS in a 10-day treatment. Patients were diagnosed with schizophrenia or schizoaffective disorder. TBS demonstrated equal clinical effects compared to 1Hz TMS.
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Affiliation(s)
- Jochen Kindler
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, CH-3000 Bern 60, Switzerland.
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30
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Wang J, Xu Y. Should repetitive Transcranial Magnetic Stimulation (rTMS) be considered an effective adjunctive treatment for auditory hallucinations in patients with schizophrenia? SHANGHAI ARCHIVES OF PSYCHIATRY 2013; 25:254-5. [PMID: 24991163 PMCID: PMC4054564 DOI: 10.3969/j.issn.1002-0829.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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31
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Hoffman RE, Wu K, Pittman B, Cahill JD, Hawkins KA, Fernandez T, Hannestad J. Transcranial magnetic stimulation of Wernicke's and Right homologous sites to curtail "voices": a randomized trial. Biol Psychiatry 2013; 73:1008-14. [PMID: 23485015 PMCID: PMC3641174 DOI: 10.1016/j.biopsych.2013.01.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 12/04/2012] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Auditory/verbal hallucinations (AVHs) are accompanied by activation in Wernicke's and right homologous regions. Efficacy in curtailing AVHs via 1-Hz repetitive magnetic stimulation (rTMS) targeting a site in each region ("W" and "rW") was therefore studied. METHODS Patients with schizophrenia and AVHs (N = 83) were randomly allocated to double-masked rTMS versus sham stimulation, with blocks of five sessions given to W and rW in random order, followed by five sessions to the site yielding greater improvement. The primary outcome measure was the Hallucination Change Score (HCS). Hallucination frequency, total auditory hallucination rating scale score, and clinical global improvement were secondary outcome measures. Attentional salience of AVHs and neuropsychological measures of laterality were studied as predictors of site-specific response. RESULTS After 15 sessions, rTMS produced significant improvements relative to sham stimulation for hallucination frequency and clinical global improvement but not for HCS. After limiting analyses to patients whose motor threshold was detected consistently: 1) endpoint HCS demonstrated significantly greater improvement for rTMS compared with sham stimulation; 2) for high-salience AVHs, rTMS to rW after the first five sessions yielded significantly improved HCS scores relative to sham stimulation, whereas for low salience AVHs, rTMS to W produced this finding. Nondominant motor impairment correlated positively with hallucination improvement following rW rTMS. CONCLUSIONS One-hertz rTMS per our site-optimization protocol produced some clinical benefit in patients with persistent AVHs as a group, especially when motor threshold was consistently detected. Level of hallucination salience may usefully guide selection of W versus rW as intervention sites.
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Affiliation(s)
- Ralph E Hoffman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Jardri R, Bonelli F, Askenazy F, Georgieff N, Delion P. Hallucinations de l’enfant et de l’adolescent. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s0246-1072(13)58150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Maïza O, Hervé PY, Etard O, Razafimandimby A, Montagne-Larmurier A, Dollfus S. Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) on Brain Functional Marker of Auditory Hallucinations in Schizophrenia Patients. Brain Sci 2013; 3:728-43. [PMID: 24961421 PMCID: PMC4061846 DOI: 10.3390/brainsci3020728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/15/2013] [Accepted: 04/09/2013] [Indexed: 11/23/2022] Open
Abstract
Several cross-sectional functional Magnetic Resonance Imaging (fMRI) studies reported a negative correlation between auditory verbal hallucination (AVH) severity and amplitude of the activations during language tasks. The present study assessed the time course of this correlation and its possible structural underpinnings by combining structural, functional MRI and repetitive Transcranial Magnetic Stimulation (rTMS). Methods: Nine schizophrenia patients with AVH (evaluated with the Auditory Hallucination Rating scale; AHRS) and nine healthy participants underwent two sessions of an fMRI speech listening paradigm. Meanwhile, patients received high frequency (20 Hz) rTMS. Results: Before rTMS, activations were negatively correlated with AHRS in a left posterior superior temporal sulcus (pSTS) cluster, considered henceforward as a functional region of interest (fROI). After rTMS, activations in this fROI no longer correlated with AHRS. This decoupling was explained by a significant decrease of AHRS scores after rTMS that contrasted with a relative stability of cerebral activations. A voxel-based-morphometry analysis evidenced a cluster of the left pSTS where grey matter volume negatively correlated with AHRS before rTMS and positively correlated with activations in the fROI at both sessions. Conclusion: rTMS decreases the severity of AVH leading to modify the functional correlate of AVH underlain by grey matter abnormalities.
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Affiliation(s)
- Olivier Maïza
- CHU de Caen, Service Universitaire de Psychiatrie, Centre Esquirol, Caen 14000, France.
| | - Pierre-Yve Hervé
- Université de Bordeaux, GIN UMR 5296 CNRS CEA, Bordeaux 33076, France.
| | - Olivier Etard
- CHU de Caen, Service d'Explorations Fonctionnelles du Système Nerveux, Caen 14000, France.
| | - Annick Razafimandimby
- Université de Caen Basse Normandie, UMR 6301 CNRS CEA, Centre Cyceron, Caen 14074, France.
| | | | - Sonia Dollfus
- CHU de Caen, Service Universitaire de Psychiatrie, Centre Esquirol, Caen 14000, France.
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Corrélats anatomofonctionnels du syndrome d’Ekbom. Presse Med 2013; 42:237-9. [DOI: 10.1016/j.lpm.2012.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 01/08/2012] [Accepted: 01/11/2012] [Indexed: 11/20/2022] Open
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Slotema CW, Aleman A, Daskalakis ZJ, Sommer IE. Meta-analysis of repetitive transcranial magnetic stimulation in the treatment of auditory verbal hallucinations: update and effects after one month. Schizophr Res 2012; 142:40-5. [PMID: 23031191 DOI: 10.1016/j.schres.2012.08.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/20/2012] [Accepted: 08/28/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Several meta-analyses considering repetitive transcranial magnetic stimulation (rTMS) for auditory verbal hallucinations (AVH) have been performed with moderate to high mean weighted effect sizes. Since then several negative findings were reported in relatively large samples. The aim of this study was to provide an update of the literature on the efficacy of rTMS for AVH and to investigate the effect of rTMS one month after the end of treatment. DATA SOURCES A literature search was performed from 1966 through August 2012 using Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Embase Psychiatry, Ovid Medline, PsycINFO and PubMed. Randomized, double blind, sham-controlled studies with severity of AVH or severity of psychosis as an outcome measure were included. STUDY SELECTION Data were obtained from 17 randomized studies of rTMS for AVH. Five studies fulfilled the criteria for the meta-analysis on the effect of rTMS one month after the end of treatment. DATA EXTRACTION Standardized mean weighted effect sizes of rTMS versus sham were computed on pre- and posttreatment comparisons. DATA SYNTHESIS The mean weighted effect size of rTMS directed at the left temporoparietal area was 0.44 (95% CI 0.19-0.68). A separate meta-analysis including studies directing rTMS at other brain regions revealed a mean weighted effect size of 0.33 (95% CI 0.17-0.50) in favor of real TMS. The effect of rTMS was no longer significant at one month of follow-up (mean weighted effect size=0.40, 95% CI -0.23-0.102). Side effects were mild and the number of dropouts in the real TMS group was not significantly higher than in the sham group. CONCLUSIONS With the inclusion of studies with larger patient samples, the mean weighted effect size of rTMS directed at the left temporoparietal area for AVH has decreased, although the effect is still significant. The duration of the effect of rTMS may be less than one month. More research is needed in order to optimize parameters and further evaluate the clinical relevance of this intervention.
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Affiliation(s)
- C W Slotema
- Parnassia Bavo Psychiatric Institute, Lijnbaan 4, 2512 VA The Hague, The Netherlands.
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Cerebral blood flow identifies responders to transcranial magnetic stimulation in auditory verbal hallucinations. Transl Psychiatry 2012; 2:e189. [PMID: 23168989 PMCID: PMC3565757 DOI: 10.1038/tp.2012.114] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Auditory hallucinations comprise a critical domain of psychopathology in schizophrenia. Repetitive transcranial magnetic stimulation (TMS) has shown promise as an intervention with both positive and negative reports. The aim of this study was to test resting-brain perfusion before treatment as a possible biological marker of response to repetitive TMS. Twenty-four medicated patients underwent resting-brain perfusion magnetic resonance imaging with arterial spin labeling (ASL) before 10 days of repetitive TMS treatment. Response was defined as a reduction in the hallucination change scale of at least 50%. Responders (n=9) were robustly differentiated from nonresponders (n=15) to repetitive TMS by the higher regional cerebral blood flow (CBF) in the left superior temporal gyrus (STG) (P<0.05, corrected) before treatment. Resting-brain perfusion in the left STG predicted the response to repetitive TMS in this study sample, suggesting this parameter as a possible bio-marker of response in patients with schizophrenia and auditory hallucinations. Being noninvasive and relatively easy to use, resting perfusion measurement before treatment might be a clinically relevant way to identify possible responders and nonresponders to repetitive TMS.
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Jardri R, Bubrovszky M, Demeulemeester M, Poulet E, Januel D, Cohen D, Lorek C, Goeb JL, Hagnere L, Delion P. Repetitive transcranial magnetic stimulation to treat early-onset auditory hallucinations. J Am Acad Child Adolesc Psychiatry 2012; 51:947-9. [PMID: 22917208 DOI: 10.1016/j.jaac.2012.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/18/2012] [Accepted: 06/11/2012] [Indexed: 12/31/2022]
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