Symptoms Of Auditory Hallucinations Research Articles

Nursing Care: A Combination of Occupational Therapy and Psycho-Religious Therapy for Changes in Hallucination Symptoms in Schizophrenia Patients at Nur Ilahi Rehabilitation Clinic

Aims: Schizophrenia is a mental disorder that causes hallucinations, delusions, and highly disorganized thinking and behavior that impairs daily functioning, and can be disabling. 90% of people with schizophrenia have hallucinations. This study aimed to determine the effectiveness of occupational therapy and psychoreligious therapy in reducing hallucinations. Objective: This study was to determine the effectiveness of occupational therapy and psychoreligious therapy in reducing hallucinations. Methode : This study used a case study with a nursing care approach that includes assessment to evaluation. Patients with auditory hallucinations were given occupational therapy to shift focus and psycho-religious therapy to provide relaxation for hallucinatory patients. This therapy was given for 10 days with a total of 5 meetings. Results: Problems with sensory perceptual disturbances: reduced auditory hallucinations. Patient get a combination of occupational therapy and psycho-religious therapy which shows changes in behavior such as clients being able to control hallucinations and taking part in activities held by the clinic. This can be seen from the client being able to control his hallucinations, the frequency of hallucinations is reduced, and the client regularly participates in activities held by the clinic. Conclusion: Occupational therapy and psycho-religious therapy can be used for patients with hallucinatory disorders. Therapy is only carried out for 10 days to the patient. so the recommendation for further research is the need to analyze the effectiveness of occupational therapy and psycho-religious therapy to reduce the symptoms of auditory hallucinations. Nursing Implications: This research was conducted to become a basis for nurses in carrying out nursing interventions in patients with sensory perception disorders: auditory hallucinations and can be a guideline for health facilities to make policies regarding interventions for clients with auditory hallucinations.

The effectiveness of application of drawing activity occupational therapy against auditory hallucination symptoms

Auditory hallucinations are the most common hallucinations in schizophrenia, experienced by more than 60% of people with schizophrenia. Patients who have hallucinations often become irrational and lose control of their actions, which can lead to homicide, suicide, and environmental destruction. This study aims to examine the effects of occupational therapy drawing exercises on auditory hallucination symptoms. This study used a quasi-experimental control group technique with a sample size of 40 respondents. The results showed an impact of occupational therapy on drawing activity on auditory hallucinations symptoms, with a p-value of 0.000, and a significant difference in the reduction of auditory hallucinations symptoms between the intervention and control group after occupational therapy with a drawing activity. Patients with auditory hallucinations are advised to engage in occupational therapy drawing activities to alleviate their symptoms.

Classical Music Therapy on Decreasing Auditory Hallucinations for Mental Disorder Patients

Auditory hallucinations are one of the symptoms of mental disorders in which individuals experience sensory-perceptual changes that need to get treatment as soon as possible. To overcome the problem of auditory hallucinations, this can be done through music therapy. The aim of the study was to determine the effect of classical music therapy on reducing auditory hallucinations in patients with mental disorders. The research method used a quasi-experimental pre-post test. The sample in this study were 30 people. The results of statistical analysis using the paired t-test showed a p-value of 0,000, which means that there was an effectiveness of classical music therapy in reducing signs and symptoms of auditory hallucinations. The conclusion is that there is an effect of the effectiveness of classical music therapy on the reduction of signs and symptoms in patients with auditory hallucinations at the Dadi Mental Hospital Makassar.

Nursing Experience Using Motivational Interviewing to Increase Medication Adherence in a Patient With Schizoaffective Disorder

This article describes an experience providing care for non-adherence to medication in a patient with schizoaffective disorder. The patient, a long-term resident of a rehabilitation home, was experiencing auditory hallucination symptoms related to his non-adherence to medication. After being hospitalized, he refused to take oral medications, and had limited ability to effectively deal with the command auditory hallucinations, leading to his self-harm behavior. The nursing period was from April 7th to May 3rd, 2021. Data were collected using observation, in-depth interviews, and a medical history review. The nursing assessment was conducted using the five dimensions of nursing assessment. The authors used empathy, listening, and caring attitudes to establish a trusting and therapeutic interpersonal relationship with the patient. A motivational interview approach was employed to strengthen motivation to take medication, guide and link the value of personal life, and jointly draw up a patient-centered plan to establish rules to which the patient would be able to adhere. Subsequently, the patient achieved reduced interference from auditory hallucinations and close adherence to his medication protocol and attended follow-up appointments regularly in the outpatient department after discharge.

Abstract- Poster

Background:COVID 19 is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease has spread worldwide, leading to ongoing pandemic. Although it is most often linked with respiratory symptoms, it might result in neuropsychiatric complicationsCase description:A 76 year old female patient presented with symptoms of auditory hallucinations since last 9 months. She reported hearing of derogatory voices of multiple persons discussing about her continuously. She developed persecutory delusions few weeks later. She had symptoms of COVID 19 infection 1 month prior to the onset of psychiatric symptoms and was tested positive for the same. She was started on tab. Risperidone 2mg/day later increased to 3mg/day and tab. Trihexiphenidyl 2mg/day. With antipsychotic treatment, there was significant improvement. The delusions resolved and hallucinations reduced by around 80%, according to patient.Discussion:Emerging research indicates that COVID 19 is multi-systemic vascular disease affecting several organs. Numerous influenza virus strains already been implicated in development of mental illnesses such as acute psychosis, schizophrenia, depressive disorders and anxiety disorders.

Penerapan Terapi Psikoreligius : Zikir Terhadap Tanda dan Gejala Serta Kemampuan Mengatasi Halusinasi

Introduction: Mental disorders are brain disorders characterized by disruption of emotions, thought processes, behavior and perceptions. Auditory hallucinations are hearing voices or noises in the form of less loud noises to clear words talking about the client, even to a complete conversation between two or more people where the client is told to do something that is sometimes dangerous. Useful Aim: This study aims to see the signs and symptoms of auditory hallucinations and the ability to overcome hallucinations in schizophrenic patients after being given psychoreligious therapy: dhikr in the Abung Kunang Community Health Center, North Lampung Regency. Research Methods: Using the method of giving nursing actions in the form of psychoreligious therapy: remembrance of 2 schizophrenic patients who experienced auditory hallucinations nursing problems. Reported in the form of case studies. Results: The results obtained were a decrease in signs and symptoms of hallucinations and an increase in the patient's ability to cope with hallucinations. Suggestion: Nurses are expected to provide the optimal application of psychoreligious therapy: dhikr to patients who have auditory hallucinations nursing problems.

Virtual reality based assessment and education tool for auditory hallucination symptoms

This study proposes a method to overcome the limitations of existing tests used to evaluate the symptoms of hallucinations in patients with schizophrenia. Moreover, it aimed to verify whether the disruption to daily life caused by hallucinations can be alleviated by performing a continuous attention task. To verify this, 44 patients with schizophrenia who experienced hallucinations and 22 general control groups were recruited. The patients were randomly assigned to the experimental group and patient control condition, and healthy people were assigned to the normal control condition. The experiment consisted of a total of six sessions: a pretest, four tests, and later tests. The experiment involved a 2-back task and auditory perception recognition, and only the experimental group and patient control group were provided with psychological education. The results of this study confirmed that hallucinations influenced the deterioration of attention-focused tasks. Furthermore, it was confirmed that the interference effect due to hearing loss was reduced by repeating the 2-back task and auditory recognition evaluation. Thus, the proposed hallucination evaluation and education method was effective in objectively evaluating hallucinations and reducing the disruption caused by hallucinations. In addition, the limitations of this study and suggestions for follow-up studies were presented.

A rare case of ganser syndrome presenting with associated symptoms of auditory hallucinations and amnesia

Ganser syndrome (GS) has been found to be rare which was first described by Siegbert Ganser in the year 1897 in prisoners. GS is characterized by, but not always, approximate answers, clouding of consciousness, conversion symptoms and optional auditory or visual hallucinations. Not many cases of GS have been reported till now and diagnosis is difficult. Hence we present such a rare case of Ganser syndrome in a remand prisoner who presented with hearing of voices of an unknown woman and able to see her and sleep disturbances since 1 week and also giving approximate answers. Patient also had amnesia to the presenting symptoms. The diagnosis and treatment of Ganser syndrome being complex and difficult, ruling out possible causes of such presentation is very much important. Since it is rarely reported, prognosis could be uncertain.

Experiences, attitudes, and perceptions of caregivers of individuals with treatment-resistant schizophrenia: a qualitative study

BackgroundTreatment-resistant schizophrenia (TRS) affects about one-third of individuals with schizophrenia. People with TRS do not experience sustained symptom relief and at the same time have the most severe disease-related disability and associated costs among individuals with severe mental disorders. Like caregivers of people with treatment-responsive schizophrenia, caregivers of individuals with TRS experience the disease burden along with their care recipients; however, for those providing care for individuals with TRS, the stress of the burden is unrelenting due to uncontrolled symptoms and a lack of effective treatment options. The objective of this study is to better understand the burden of TRS from the caregiver perspective and to explore their perception of available treatments.MethodsEight focus groups with non-professional, informal caregivers of individuals with TRS were conducted in 5 US locations. TRS was defined as failure of ≥2 antipsychotics and persistent moderate-to-severe positive symptoms of schizophrenia, per caregiver report.ResultsThe 27 caregivers reported an average of 37 h/week providing direct care, and 21 reported being on call “24/7.” Caregivers commonly reported that their care recipients exhibited symptoms of auditory hallucinations (89%), agitation/irritability/hostility (81%), suspiciousness (78%), tangentiality (74%), and cognitive impairment (74%); 70% of caregivers ranked suspiciousness/persecution as the most challenging symptom category. Caring for an individual with TRS impacted many caregivers’ finances, career prospects, social relationships, and sense of freedom. Additionally, multiple medication failures led to a sense of hopelessness for many caregivers.ConclusionsPersistent positive symptoms caused significant perceived burden, feelings of being overwhelmed and having no relief, and substantial negative impacts on caregivers’ emotional and physical health. To address these substantial unmet needs, policy makers should be aware of the need for practical, social, and emotional support for these caregivers and their families. Additionally, new treatment options for TRS should be developed.

Validation of the Indonesian version of psychotic symptom rating scale (Ina-PSYRATS) hallucination subscale

The Psychotic Symptom Rating Scales (PSYRATS) is the most widely used validated scale to measure the specific symptoms of auditory hallucinations and delusions. The purpose of this study was to validate and examine the psychometric properties of the auditory hallucination component of the Indonesian-PSYRATS (Ina-PSYRATS). The study was performed in the outpatient clinic of the Department of Psychiatry, Dr. Cipto Mangunkusumo Hospital, with 50 schizophrenia patients who had experienced or reported verbal auditory hallucinations. We conducted translation and back-translation, panel test, pilot test, and validation test. The psychometric properties of Ina-PSYRATS were studied and a comparison was made between the PSYRATS and the Positive and Negative Syndrome Scale (PANSS). The internal validity was good (95%). The internal consistency of InaPSYRATS was good, as revealed by Cronbach’s alpha value (0.90). Factor analysis replicated three components consisting of emotional, cognitive, and physical factors, similar to the factorial structure of the original auditory hallucination scale. Spearman’s rank-order correlation showed a significant positive relationship between the total auditory hallucination score and PANSSS auditory hallucination item (P3). The auditory hallucination domain of Ina-PSYRATS is a reliable and valid assessment tool suitable for clinical applications.

T43. TRANSCRANIAL DIRECT-CURRENT STIMULATION (TDCS) IN PATIENTS WITH ULTRA-TREATMENT-REFRACTORY AUDITORY HALLUCINATIONS

BackgroundTranscranial direct-current stimulation (tDCS), a noninvasive neurostimulation treatment, has been reported to show improvements in treatment-resistant auditory hallucinations in patients with schizophrenia. tDCS administered over a limited number of sessions effectively produced lasting attenuation of auditory hallucinations in otherwise stable outpatients. It has also been shown that tDCS may be a useful intervention for ameliorating cognitive deficits in patients with chronic schizophrenia. The purpose of this study was to test tDCS for auditory hallucinations in ultra-treatment resistant schizophrenia to assess if this form of neurostimulation can alleviate treatment-refractory auditory hallucination symptoms up to 4 weeks after the final treatment. In addition, we also wanted to examine the effects of tDCS on cognitive functions.Methods28 inpatients with DSM-V schizophrenia and long-standing treatment resistance and persistent auditory verbal hallucinations were recruited. Each individual participated in behavioral assessments at baseline, endpoint and follow-up [PANSS and Auditory Hallucinations Rating Scale (AHRS) and MCCB cognitive battery] and were randomized to receive active vs. sham tDCS treatments. For active treatment, patients had the inhibitory (cathodal) tDCS electrode placed over left auditory cortex relative to an excitatory (anodal) electrode placed over frontal cortex on the right side. tDCS treatments took place for 20 min twice daily for 5 consecutive days. Assessment batteries were repeated following the 4 weeks of treatment. The Chattanooga, dual channel CHA-1335 stimulator with two 7 × 5 cm (35 cm2) sponge electrodes soaked in a saline solution (0.9% NaCl) was used for the delivery of 2 mA current.ResultsA total of 28 subjects were enrolled (tDCS, n = 13; Control, n = 15). 20 subjects completed the trial. 3 subjects dropped out of the active tDCS treatment group, while 4 subjects did not complete the control treatment due to early discharge from the hospital. Most subjects were male (tDCS n = 10, 76.9%; Control n = 6, 40.0%). Length of present psychiatric admission ranged from 1–25 months, with a mode of 2 months (n = 12) and average of 2.9 months. Participating inpatients were on clozapine, haloperidol, paliperidone depot, fluphenazine decanoate, paliperidone, olanzapine, and risperidone as primary medications. Repeated Measures ANOVA showed a significant difference for the auditory hallucination total score, frequency and number of voices over time (p < 0.05) with greater reduction in scores observed for the tDCS group. Improvements were maintained after 4 weeks. There was no significant change over time observed for the PANSS positive symptoms or total score, or for the PANSS Hallucinatory Behavior item score. When assessing cognitive functioning, only Working Memory change was significant (p = 0.048) between the tDCS and the Control group with the tDCS group showing significant improvement in T-Score as compared to the Control group.DiscussionSubjects who received tDCS treatment showed a significant reduction in the frequency, number of voices, and total scores of their auditory hallucination. Additionally, subjects in the tDCS group showed significant improvement in the Working Memory. Our results indicate that patients who have been ultra-resistant to antipsychotic treatments and who received tDCS treatment presented with robust diminution of their auditory hallucinations. We conclude that tDCS seems to be effective not only for ambulatory, higher functioning patients, but also for much lower functioning patients with medication-refractory auditory verbal hallucinations.

Randomized trial of transcranial alternating current stimulation for treatment of auditory hallucinations in schizophrenia

BackgroundApproximately 30% of patients with schizophrenia experience auditory hallucinations that are refractory to antipsychotic medications. Here, we evaluated the feasibility and efficacy of transcranial alternating current stimulation (tACS) that we hypothesized would improve auditory hallucination symptoms by enhancing synchronization between the frontal and temporo-parietal areas of the left hemisphere. Method22 participants were randomized to one of three arms and received twice daily, 20 min sessions of sham, 10 Hz 2 mA peak-to-peak tACS, or 2 mA tDCS over the course of 5 consecutive days. Symptom improvement was assessed using the Auditory Hallucination Rating Scale (AHRS) as the primary outcome measure. The Positive and Negative Syndrome Scale (PANSS) and the Brief Assessment of Cognition in Schizophrenia (BACS) were secondary outcomes. ResultsPrimary and secondary behavioral outcomes were not significantly different between the three arms. However, effect size analyses show that tACS had the greatest effect based on the auditory hallucinations scale for the week of stimulation (1.31 for tACS; 1.06 and 0.17, for sham and tDCS, respectively). Effect size analysis for the secondary outcomes revealed heterogeneous results across measures and stimulation conditions. ConclusionsTo our knowledge, this is the first clinical trial of tACS for the treatment of symptoms of a psychiatric condition. Further studies with larger sample sizes are needed to better understand the effect of tACS on auditory hallucinations.

Spontaneous Gamma Activity in Schizophrenia.

A major goal of translational neuroscience is to identify neural circuit abnormalities in neuropsychiatric disorders that can be studied in animal models to facilitate the development of new treatments. Oscillations in the gamma band (30-100 Hz) of the electroencephalogram have received considerable interest as the basic mechanisms underlying these oscillations are understood, and gamma abnormalities have been found in schizophrenia (SZ). Animal models of SZ based on hypofunction of the N-methyl-d-aspartate receptor (NMDAR) demonstrate increased spontaneous broadband gamma power, but this phenomenon has not been identified clearly in patients with SZ. To examine spontaneous gamma power and its relationship to evoked gamma oscillations in the auditory cortex of patients with SZ. We performed a cross-sectional study including 24 patients with chronic SZ and 24 matched healthy control participants at the Veterans Affairs Boston Healthcare System from January 1, 2009, through December 31, 2012. Electroencephalograms were obtained during auditory steady-state stimulation at multiple frequencies (20, 30, and 40 Hz) and during a resting state in 18 participants in each group. Electroencephalographic activity in the auditory cortex was estimated using dipole source localization. Auditory steady-state response (ASSR) measures included the phase-locking factor and evoked power. Spontaneous gamma power was measured as induced (non-phase-locked) gamma power in the ASSR data and as total gamma power in the resting-state data. The ASSR phase-locking factor was reduced significantly in patients with SZ compared with controls for the 40-Hz stimulation (mean [SD], 0.075 [0.028] vs 0.113 [0.065]; F1,46 = 6.79 [P = .012]) but not the 20- or the 30-Hz stimulation (0.042 [0.038] vs 0.043 [0.034]; F1,46 = 0.006 [P = .938] and 0.084 [0.040] vs 0.098 [0.050]; F1,46 = 1.605 [P = .212], respectively), repeating previous findings. The mean [SD] broadband-induced (30-100 Hz) gamma power was increased in patients with SZ compared with controls during steady-state stimulation (6.579 [3.783] vs 3.984 [1.843]; F1,46 = 9.128 [P = .004]; d = 0.87) but not during rest (0.006 [0.003] vs 0.005 [0.002]; F1,34 = 1.067 [P = .309]; d = 0.35). Induced gamma power in the left hemisphere of the patients with SZ during the 40-Hz stimulation was positively correlated with auditory hallucination symptoms (tangential, ρ = 0.587 [P = .031]; radial, ρ = 0.593 [P = .024]) and negatively correlated with the ASSR phase-locking factor (baseline: ρ = -0.572 [P = .024]; ASSR: ρ = -0.568 [P = .032]). Spontaneous gamma activity is increased during auditory steady-state stimulation in SZ, reflecting a disruption in the normal balance of excitation and inhibition. This phenomenon interacts with evoked oscillations, possibly contributing to the gamma ASSR deficit found in SZ. The similarity of increased spontaneous gamma power in SZ to the findings of increased spontaneous gamma power in animal models of NMDAR hypofunction suggests that spontaneous gamma power could serve as a biomarker for the integrity of NMDARs on parvalbumin-expressing inhibitory interneurons in humans and in animal models of neuropsychiatric disorders.

Transcranial direct-current stimulation as an adjunct to electroconvulsive therapy and clozapine for refractory psychosis.

To the Editor: Twenty-five to 30% of patients with schizophrenia report persistent auditory hallucinations despite an adequate treatment regimen.1 Transcranial direct-current stimulation (tDCS) is a noninvasive method that modulates cortical excitability through electrodes placed directly on the scalp. Anode stimulation subthreshold depolarizes neuronal membranes, while cathode stimulation subthreshold hyperpolarizes neurons.2 The tDCS method has been used to treat major depressive disorder. In patients with major depressive disorder, functional magnetic resonance imaging has shown prefrontal asymmetry with hypoactivity of the left dorsolateral prefrontal cortex (DLPFC) and hyperactivity of the right DLPFC.3 Placement of the anode (excitatory) over the left DLPFC and the cathode (inhibitory) over the right DLPFC is theorized to correct the abnormal frontal activity. Using this model of neuromodulation, it can be hypothesized that similar strategies could be used to target imbalances of neuronal activity in patients experiencing auditory hallucinations. Studies with functional magnetic resonance imaging have shown that hypoactivity in the left prefrontal cortex and left anterior cingulate is associated with auditory hallucinations in patients with schizophrenia.4 Brunelin et al1 showed that tDCS significantly reduced persistent auditory hallucinations in refractory psychosis. Additionally, the effects of tDCS appear to be multifactorial, as it stimulates both local and remote plastic changes mediated by regulation of neurotransmitters including dopamine, acetylcholine, and serotonin.5 We describe a patient who was not responding to treatment with clozapine and ECT and ultimately derived benefit from the addition of tDCS. Case report. Mr A is a 53-year-old man with a 30-year history of schizoaffective disorder, depressed type (per DSM-IV criteria), who suffers from persistent auditory hallucinations. He received an acute course of electroconvulsive therapy (ECT) with maintenance weekly ECT treatments for several months and clozapine 700 mg daily, yet continued to psychiatrically decompensate. Time between weekly ECT treatments could not be lengthened due to worsening auditory hallucinations, leading him to become suicidal and subsequently hospitalized. Mr A was given tDCS adjunctively, and his progress was monitored using the Positive and Negative Syndrome Scale (PANSS), with baseline assessment recorded before treatment initiation and reassessment recorded 1 day posttreatment before subsequent initiation of ECT. Weekly ECT treatments were held during tDCS administration and restarted the following week. Mr A was given the standard regimen of 20-minute tDCS treatments twice daily for 5 consecutive days. The stimulator was set to deliver 2 milliamps with anodal (excitatory) stimulation placed over the left DLPFC and cathodal (inhibitory) stimulation placed over the left temporoparietal cortex. Mr A’s pretreatment PANSS score for positive symptoms was 13 and remained the same posttreatment, but showed a 67% improvement in delusions and a 20% improvement in auditory hallucinations. The negative symptom pretreatment PANSS score of 22 remained static posttreatment; however, blunted affect decreased by 20% and emotional withdrawal decreased by 40%. The general psychopathology pretreatment PANSS score demonstrated overall improvement of 22%, with a 33% decrease in anxiety, 20% decrease in depression, 67% decrease in lack of judgment/insight, and 50% decrease in guilt, tension, and uncooperativeness. Overall, Mr A reported improved mood, feelings of hope, and fewer auditory hallucinations. Discussion. The addition of tDCS, as an adjunctive treatment to ECT and clozapine, provided a beneficial response in Mr A. This case shows a patient who experienced near immediate improvement in positive symptoms of auditory hallucinations, which is consistent with the findings published by Brunelin et al,1 who found tDCS reduces auditory hallucinations refractory to antipsychotic drugs in patients with schizophrenia. This case suggests that tDCS may help reduce severe auditory hallucinations as well as negative symptoms when used in combination with ECT and antipsychotic treatment. The patient presented here demonstrates an overall positive response with the addition of tDCS to his treatment regimen. Further study is warranted to ascertain whether tDCS may be an effective adjunct to ECT and pharmacotherapy in treatment-resistant hallucinations.

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey

Long-range synchrony of gamma oscillations and auditory hallucination symptoms in schizophrenia

Phase locking in the gamma-band range has been shown to be diminished in patients with schizophrenia. Moreover, there have been reports of positive correlations between phase locking in the gamma-band range and positive symptoms, especially hallucinations. The aim of the present study was to use a new methodological approach in order to investigate gamma-band phase synchronization between the left and right auditory cortex in patients with schizophrenia and its relationship to auditory hallucinations. Subjects were 18 patients with chronic schizophrenia (SZ) and 16 healthy control (HC) subjects. Auditory hallucination symptom scores were obtained using the Scale for the Assessment of Positive Symptoms. Stimuli were 40-Hz binaural click trains. The generators of the 40 Hz-ASSR were localized using eLORETA and based on the computed intracranial signals lagged interhemispheric phase locking between primary and secondary auditory cortices was analyzed. Current source density of the 40 ASSR response was significantly diminished in SZ in comparison to HC in the right superior and middle temporal gyrus (p < 0.05). Interhemispheric phase locking was reduced in SZ in comparison to HC for the primary auditory cortices (p < 0.05) but not in the secondary auditory cortices. A significant positive correlation was found between auditory hallucination symptom scores and phase synchronization between the primary auditory cortices (p < 0.05, corrected for multiple testing) but not for the secondary auditory cortices. These results suggest that long-range synchrony of gamma oscillations is disturbed in schizophrenia and that this deficit is related to clinical symptoms such as auditory hallucinations.

Left auditory cortex gamma synchronization and auditory hallucination symptoms in schizophrenia

BackgroundOscillatory electroencephalogram (EEG) abnormalities may reflect neural circuit dysfunction in neuropsychiatric disorders. Previously we have found positive correlations between the phase synchronization of beta and gamma oscillations and hallucination symptoms in schizophrenia patients. These findings suggest that the propensity for hallucinations is associated with an increased tendency for neural circuits in sensory cortex to enter states of oscillatory synchrony. Here we tested this hypothesis by examining whether the 40 Hz auditory steady-state response (ASSR) generated in the left primary auditory cortex is positively correlated with auditory hallucination symptoms in schizophrenia. We also examined whether the 40 Hz ASSR deficit in schizophrenia was associated with cross-frequency interactions.Sixteen healthy control subjects (HC) and 18 chronic schizophrenia patients (SZ) listened to 40 Hz binaural click trains. The EEG was recorded from 60 electrodes and average-referenced offline. A 5-dipole model was fit from the HC grand average ASSR, with 2 pairs of superior temporal dipoles and a deep midline dipole. Time-frequency decomposition was performed on the scalp EEG and source data.ResultsPhase locking factor (PLF) and evoked power were reduced in SZ at fronto-central electrodes, replicating prior findings. PLF was reduced in SZ for non-homologous right and left hemisphere sources. Left hemisphere source PLF in SZ was positively correlated with auditory hallucination symptoms, and was modulated by delta phase. Furthermore, the correlations between source evoked power and PLF found in HC was reduced in SZ for the LH sources.ConclusionThese findings suggest that differential neural circuit abnormalities may be present in the left and right auditory cortices in schizophrenia. In addition, they provide further support for the hypothesis that hallucinations are related to cortical hyperexcitability, which is manifested by an increased propensity for high-frequency synchronization in modality-specific cortical areas.

Maintenance Treatment With Transcranial Magnetic Stimulation in a Patient With Late-Onset Schizophrenia

Back to table of contents Previous article Next article Letters to the EditorFull AccessMaintenance Treatment With Transcranial Magnetic Stimulation in a Patient With Late-Onset SchizophreniaEMMANUEL POULET M.D., Ph.D.JEROME BRUNELIN Ph.D.LASSAD KALLEL M.D.THIERRY D’AMATO M.D., Ph.D.MOHAMED SAOUD M.D., Ph.D.,EMMANUEL POULET M.D., Ph.D.Search for more papers by this authorJEROME BRUNELIN Ph.D.Search for more papers by this authorLASSAD KALLEL M.D.Search for more papers by this authorTHIERRY D’AMATO M.D., Ph.D.Search for more papers by this authorMOHAMED SAOUD M.D., Ph.D.Search for more papers by this author,Published Online:1 Apr 2008https://doi.org/10.1176/appi.ajp.2007.07060868AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: A recent meta-analysis (1) concluded that repetitive transcranial magnetic stimulation (rTMS) efficiently reduces resistant auditory hallucinations in patients with schizophrenia (effect size=0.76). Nevertheless, treatment is presently only provided over short periods of time, and little is known about longer-term impact. Maintenance treatment protocols have been developed, and we previously described a case report involving a maintenance protocol with a weekly, once-a-day stimulation (2) ; however, we failed to demonstrate long-term benefits. To our knowledge, the case presented below is the first report of a twice-daily transcranial magnetic stimulation as efficacious for auditory hallucinations, both in acute and maintenance treatment. “Ms. A,” a 55-year-old right-handed, postmenopausal woman who had DSM-IV late-onset schizophrenia with an illness duration of 2 years, was referred for transcranial magnetic stimulation treatment. She was noted to have benzodiazepine addiction involving the use of lorazepam (9 mg/day). She had been suffering from resistant auditory hallucinations for 2 years (very frequent and loud, with >5 critical and command voices). She was unresponsive to four antipsychotic medication trials lasting >4 months each, including haloperidol (5 mg/day), amisulpride (1200 mg/day), olanzapine (15 mg/day), and risperidone (8 mg/day). A detailed assessment did not reveal any other pathology or transcranial magnetic stimulation contraindications. Auditory hallucinations were assessed using the Auditory Hallucination Rating Scale (3) , and positive symptoms were assessed using the Scale for the Assessment of Positive Symptoms (SAPS). Lorazepam withdrawal was completed without exacerbation of the psychotic symptoms (Auditory Hallucination Rating Scale score: 34). Four months after her initial presentation, the patient gave informed consent and was included in a transcranial magnetic stimulation protocol. Twice-a-day, 1000 low-frequency repetitive stimulations (1 Hz) were administered to the temporoparietal cortex at 100% of motor threshold over a 5-day period. The patient’s current dose of risperidone was maintained during treatment with transcranial magnetic stimulation. After the first course, auditory hallucinations were moderately improved, with a 35% reduction in her Auditory Hallucination Rating Scale score, which did not change over the next several months, as observed in a follow-up assessment. However, the patient’s general SAPS score improved, with a 30% reduction in severity. Six months after the first course of transcranial magnetic stimulation therapy, the patient presented with a relapse of hallucinations. A new transcranial magnetic stimulation course, with the same parameters, was conducted. This second course was followed by a once-per-month, twice-daily maintenance protocol (one session in the morning, the other in the afternoon on the same day). The patient’s auditory hallucinations were greatly improved, by 80%, and her SAPS score decreased from 38 to 16. This maintenance course was associated with a remission of auditory hallucination symptoms, with a stabilization of SAPS scores at 10 over the next 6 months. Presently, more than 1 year later, Ms. A is not receiving any antipsychotic medication, and her Auditory Hallucination Rating Scale and SAPS scores remain at 0.Our case raises the question as to whether twice-daily transcranial magnetic stimulation may be useful in some patients as a possible maintenance intervention. Certainly, further research will help us to understand whether the benefits observed in this single case might also be evident in larger studies.Lyon, France and Bron, FranceThe authors report no competing interests.This letter (doi: 10.1176/appi.ajp.2007.07060868) was accepted for publication in October 2007.

No changes in densities of cannabinoid receptors in the superior temporal gyrus in schizophrenia

In recent years, abnormal changes in the endocannabinoid system have been found in schizophrenia. The superior temporal gyrus (STG) is strongly implicated in the pathophysiology of schizophrenia, particularly with regards to auditory hallucinations. In this study, we investigated the binding density of cannabinoid CB1 receptors in the STG of schizophrenia patients compared to control subjects. Quantitative autoradiography was used to investigate the binding densities of [(3)H]SR141716A (a selective antagonist) and [(3)H]CP-55940 (an agonist) to the CB1 receptors in the STG. Post-mortem brain tissue was obtained from the NSW Tissue Resource Centre (Australia). Contrasting to previous findings in the alterations of CB1 receptor densities in the prefrontal, anterior and posterior cingulate cortex of schizophrenia, which were suggested to be associated to impairment of cognition function, no significant difference was found between the schizophrenia and control cases in both [(3)H]SR141716A and [(3)H]CP-55940 binding. We suggest that CB1 receptors in the STG are not involved in the pathology of schizophrenia and the auditory hallucination symptom of this disease.