Abstract
Effective treatment strategies for schizophrenia remain very challenging and many treatment-resistant patients will suffer from persistent auditory verbal hallucinations (AVH). While clozapine is the gold-standard medication for this complex population, many will not respond to this molecule. For these ultra-resistant patients, limited options are available. Cognitive-behavioral therapy (CBT) is the most widely used psychological intervention, though it offers modest effects. With the interpersonal dimension of AVH being recognized, Avatar Therapy (AT), a novel experiential treatment enabling patients to create an avatar of their persecutor and allowing them to gain control over their symptoms, was developed and tested. Results have shown significant improvements in AVH symptomatology. This paper details a case report showcasing the beneficial results of AT for even the most severe and symptomatic cases of schizophrenia. Mr. Smith has been afflicted with the persistency of all his voices for almost 20 years. To our knowledge, this patient tried almost all possible treatments with little efficacy. This case highlights the difficulty of finding an adequate treatment for ultra-resistant patients. Mr. Smith first followed CBT before initiating AT. With AT, he significantly improved in a way that was not observed with any other intervention and these improvements remained afterward. The severity of his positive symptoms as well as his depressive symptoms diminished, and his most distressing persecutory voice disappeared. He was able to regain a life. The effects of AT went well beyond the patient, the morale of the entire family improved. This ultra-resistant case suggests that AT may be a promising intervention for refractory AVH in schizophrenia.
Highlights
Schizophrenia, a chronic and severe psychiatric disorder, poses significant challenges
Notwith standing evidence demonstrating the efficacy of antipsychotic drugs for its treatment (1), there is a high variability in treatment response
We found significant improvements in auditory verbal hallucinations (AVH) sever ity, as well as beliefs of malevolence, depressive symptoms, and quality of life lasting at the 3-month follow-up
Summary
Schizophrenia, a chronic and severe psychiatric disorder, poses significant challenges. Mr Smith followed 27 rTMS treatments, though the effect was minimal After trying these interventions, as of 2014, his treatment included an antipsychotic not yet marketed in Canada, amisulpride, with risperidone, which lightly to moderately controlled his positive symptoms. Clinical assessments administered by a research nurse at baseline, after the therapies (CBTp and AT) and at 3 months following AT, consisted of AVH severity, illness symptomatology as well as depressive symptoms, measured with the Psychotic Symptoms Rating Scale (PSYRATS) (23, 24), the Positive and Negative Syndrome Scale (PANSS) (25), and the Beck Depression Inventory-II (26). The Dr hypothesized that the patient might have Asperger Syndrome, ECT was ended to confirm hypothesis Psychotic symptoms were still very present, changes in medication did not have any success After the treatment, he said the voices were softer, but still present Little improvement, but he said that ECT made him forget his voices. These changes were even noted by friends of the family
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