Abstract
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes.
Highlights
Auditory verbal hallucinations (AVH) are defined as auditive perceptions involving a verbal aspect in the absence of a provoking external stimulus (Aleman and de Haan, 1998)
In the past decade non-invasive brain stimulation techniques became increasingly relevant for the treatment of drug-refractory AVH
It has been suggested that repetitive TMS (rTMS) may reduce aberrant internally generated activity associated with AVH at the site of stimulation
Summary
Auditory verbal hallucinations (AVH) are defined as auditive perceptions involving a verbal aspect in the absence of a provoking external stimulus (Aleman and de Haan, 1998) They represent a core symptom of schizophrenia and related spectrum disorders, but they frequently occur in other psychiatric entities and in the non-psychiatric general population. About 60–80% of patients affected by schizophrenia experience AVH (Aleman and de Haan, 1998; Hugdahl et al, 2008), such as conversing, commenting or imperative spoken speech in distinct voices. These symptoms, especially when the verbal content is experienced as negative, intrusive or persecutory, Non-invasive brain stimulation in hallucinations often induce high levels of distress and lead to significant psychosocial impairment.
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