F Fröhlich1, T N Burrello2, J M Mellin2, A L Cordle2, C M Lustenberger2, J H Gilmore2, L F Jarskog2. 1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: flavio_frohlich@med.unc.edu. 2. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Abstract
BACKGROUND:Auditory hallucinations are resistant to pharmacotherapy in about 25% of adults with schizophrenia. Treatment with noninvasive brain stimulation would provide a welcomed additional tool for the clinical management of auditory hallucinations. A recent study found a significant reduction in auditory hallucinations in people with schizophrenia after five days of twice-daily transcranial direct current stimulation (tDCS) that simultaneously targeted left dorsolateral prefrontal cortex and left temporo-parietal cortex. HYPOTHESIS: We hypothesized that once-daily tDCS with stimulation electrodes over left frontal and temporo-parietal areas reduces auditory hallucinations in patients with schizophrenia. METHODS: We performed a randomized, double-blind, sham-controlled study that evaluated five days of daily tDCS of the same cortical targets in 26 outpatients with schizophrenia and schizoaffective disorder with auditory hallucinations. RESULTS: We found a significant reduction in auditory hallucinations measured by the Auditory Hallucination Rating Scale (F2,50=12.22, P<0.0001) that was not specific to the treatment group (F2,48=0.43, P=0.65). No significant change of overall schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale was observed. CONCLUSIONS: The lack of efficacy of tDCS for treatment of auditory hallucinations and the pronounced response in the sham-treated group in this study contrasts with the previous finding and demonstrates the need for further optimization and evaluation of noninvasive brain stimulation strategies. In particular, higher cumulative doses and higher treatment frequencies of tDCS together with strategies to reduce placebo responses should be investigated. Additionally, consideration of more targeted stimulation to engage specific deficits in temporal organization of brain activity in patients with auditory hallucinations may be warranted.
RCT Entities:
BACKGROUND:Auditory hallucinations are resistant to pharmacotherapy in about 25% of adults with schizophrenia. Treatment with noninvasive brain stimulation would provide a welcomed additional tool for the clinical management of auditory hallucinations. A recent study found a significant reduction in auditory hallucinations in people with schizophrenia after five days of twice-daily transcranial direct current stimulation (tDCS) that simultaneously targeted left dorsolateral prefrontal cortex and left temporo-parietal cortex. HYPOTHESIS: We hypothesized that once-daily tDCS with stimulation electrodes over left frontal and temporo-parietal areas reduces auditory hallucinations in patients with schizophrenia. METHODS: We performed a randomized, double-blind, sham-controlled study that evaluated five days of daily tDCS of the same cortical targets in 26 outpatients with schizophrenia and schizoaffective disorder with auditory hallucinations. RESULTS: We found a significant reduction in auditory hallucinations measured by the Auditory Hallucination Rating Scale (F2,50=12.22, P<0.0001) that was not specific to the treatment group (F2,48=0.43, P=0.65). No significant change of overall schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale was observed. CONCLUSIONS: The lack of efficacy of tDCS for treatment of auditory hallucinations and the pronounced response in the sham-treated group in this study contrasts with the previous finding and demonstrates the need for further optimization and evaluation of noninvasive brain stimulation strategies. In particular, higher cumulative doses and higher treatment frequencies of tDCS together with strategies to reduce placebo responses should be investigated. Additionally, consideration of more targeted stimulation to engage specific deficits in temporal organization of brain activity in patients with auditory hallucinations may be warranted.
Authors: Noah S Philip; Brent G Nelson; Flavio Frohlich; Kelvin O Lim; Alik S Widge; Linda L Carpenter Journal: Am J Psychiatry Date: 2017-02-24 Impact factor: 18.112
Authors: Juliann M Mellin; Sankaraleengam Alagapan; Caroline Lustenberger; Courtney E Lugo; Morgan L Alexander; John H Gilmore; L Fredrik Jarskog; Flavio Fröhlich Journal: Eur Psychiatry Date: 2018-03-11 Impact factor: 5.361
Authors: Hyein Cho; Lais B Razza; Lucas Borrione; Marom Bikson; Leigh Charvet; Tracy A Dennis-Tiwary; Andre R Brunoni; Pedro Sudbrack-Oliveira Journal: Focus (Am Psychiatr Publ) Date: 2022-01-25
Authors: Sangtae Ahn; Juliann M Mellin; Sankaraleengam Alagapan; Morgan L Alexander; John H Gilmore; L Fredrik Jarskog; Flavio Fröhlich Journal: Neuroimage Date: 2018-10-24 Impact factor: 6.556
Authors: Pedro H Pondé; Eduardo P de Sena; Joan A Camprodon; Arão Nogueira de Araújo; Mário F Neto; Melany DiBiasi; Abrahão Fontes Baptista; Lidia Mvr Moura; Camila Cosmo Journal: Neuropsychiatr Dis Treat Date: 2017-02-01 Impact factor: 2.570
Authors: J S Gomes; A P Trevizol; D V Ducos; A Gadelha; B B Ortiz; A O Fonseca; H T Akiba; C C Azevedo; L S P Guimaraes; P Shiozawa; Q Cordeiro; A Lacerda; A M Dias Journal: Schizophr Res Cogn Date: 2018-02-20