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Therapeutic Brain Stimulation in Treatment-Resistant Schizophrenia

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Treatment–Refractory Schizophrenia

Abstract

In the absence of any “gold standard” next step pharmacologic choice for augmentation of clozapine response, it is gratifying that the coming-on-line- of several neuromodulatory strategies now offer viable alternative treatment approaches. There is evidence that repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for persistent auditory hallucinations. Additionally, electroconvulsive therapy (ECT) continues to have some role in managing refractory schizophrenia. This chapter describes the latest information on several modalities and how/when they should be integrated along the clinical decision-making continuum.

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References

  • Andrade C (2013) Once- to twice-daily, 3-year domiciliary maintenance transcranial direct current stimulation for severe, disabling, clozapine-refractory continuous auditory hallucinations in schizophrenia. J ECT 29(3):239–242

    Article  PubMed  Google Scholar 

  • Bersani FS, Minichino A, Enticott PG et al (2013) Deep transcranial mag-netic stimulation as a treatment for psychiatric disorders: a comprehensive review. Eur Psychiatry 28(1):30–39

    Article  CAS  PubMed  Google Scholar 

  • Braga RJ, Petrides G (2005) The combined use of electroconvul-sive therapy and antipsychotics in patients with schizophrenia. J ECT 21:75–83

    Article  CAS  PubMed  Google Scholar 

  • Brunelin J, Mondino M, Gassab L et al (2012) Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am J Psychiatry 169(7):719–724

    Article  PubMed  Google Scholar 

  • Buchanan RW, Kreyenbuhl J, Kelly DL et al (2010) The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 36(1):71–93

    Article  PubMed Central  PubMed  Google Scholar 

  • Chanpattana W, Chakrabhand ML (2001) Combined ECT and neuroleptic therapy in treatment-refractory schizophrenia: prediction of outcome. Psychiatry Res 105:107–115

    Article  CAS  PubMed  Google Scholar 

  • Chanpattana W, Chakrabhand MLS, Sackeim HA et al (1999) Con-tinuation ECT in treatment-resistant schizophrenia: a controlled study. J ECT 15:178–192

    CAS  PubMed  Google Scholar 

  • Cohen E, Bernardo M, Masana J et al (1999) Repetitive transcranial mag-netic stimulation in the treatment of chronic negative schizophrenia: a pilot study. J Neurol Neurosurg Psychiatry 67:129–130

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Demirtas-Tatlidede A, Vahabzadeh-Hagh AM, Pascual-Leone A (2013) Can noninvasive brain stimulation enhance cognition in neuropsychiatric disorders? Neuropharmacology 64:566–578

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Dlabac-de Lange JJ, Knegtering R, Aleman A (2010) Repetitive transcra-nial magnetic stimulation for negative symptoms of schizophrenia: review and meta-analysis. J Clin Psychiatry 71(4):411–418

    Article  PubMed  Google Scholar 

  • Flamarique I, Castro-Fornieles J, Garrido JM et al (2012) Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination? J Clin Psychopharmacol 32(6):756–766

    Article  CAS  PubMed  Google Scholar 

  • Freitas C, Fregni F, Pascual-Leone A (2009) Meta-analysis of the effects of repetitive transcranial magnetic stimulation (rTMS) on negative and positive symptoms in schizophrenia. Schizophr Res 108:11–24

    Article  PubMed Central  PubMed  Google Scholar 

  • Hajak G, Marienhagen J, Langguth B et al (2004) High-frequency repetitive transcranial magnetic stimulation in schizophrenia: a combined treat-ment and neuroimaging study. Psychol Med 34:1157–1163

    Article  CAS  PubMed  Google Scholar 

  • Hoffman RE, Hawkins KA, Gueorguieva R et al (2003) Transcranial magnetic stimulation of left temporoparietal cortex and medication resistant auditory hallucinations. Arch Gen Psychiatry 60:49–56

    Article  PubMed  Google Scholar 

  • Holi MM, Eronen M, Toivonen K et al (2004) Left prefrontal repetitive transcranial magnetic stimulation in schizophrenia. Schizophr Bull 30:429–434

    Article  PubMed  Google Scholar 

  • Jin Y, Kemp AS, Huang Y et al (2012) Alpha EEG guided TMS in schizophrenia. Brain Stimul 5(4):560–568

    Article  PubMed  Google Scholar 

  • Johnson KA, Baig M, Ramsey D et al (2012) Prefrontal rTMS for treating depression: Location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul 6(2):108–117

    Article  PubMed Central  PubMed  Google Scholar 

  • Kindler J, Homan P, Jann K (2013a) Reduced neuronal activity in language-related regions after transcranial magnetic stimulation therapy for auditory verbal hallucinations. Biol Psychiatry 73(6):518–524

    Article  PubMed  Google Scholar 

  • Kindler J, Homan P, Flury R et al (2013b) Theta burst transcranial magnetic stimulation for the treatment of auditory verbal hallucinations: results of a randomized controlled study. Psychiatry Res 209(1):114–117

    Article  PubMed  Google Scholar 

  • Leiknes KA, Jarosh-von Schweder L, Høie B (2012) Contemporary use and practice of electroconvulsive therapy worldwide. Brain Behav 2:283–344

    Article  PubMed Central  PubMed  Google Scholar 

  • Masoudzadeh A, Khalilian AR (2007) Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients. Pak J Biol Sci 10(23):4287–4290

    Article  CAS  PubMed  Google Scholar 

  • Mattai A, Miller R, Weisinger B et al (2011) Tolerability of transcranial direct current stimulation in childhood-onset schizophrenia. Brain Stimul 4(4):275–280

    Article  PubMed Central  PubMed  Google Scholar 

  • Nawani H, Kalmady SV, Bose A et al (2013) Neural basis of tDCS effects on auditory verbal hallucinations in schizophrenia: a case report evidence for cortical neuroplasticity modulation. J ECT (in press)

    Google Scholar 

  • Nicolson R, Rapoport JL (1999) Childhood-onset schizophrenia: rare but worth studying. Biol Psychiatry 46(10):1418–1428

    Article  CAS  PubMed  Google Scholar 

  • Novak T, Horacek J, Mohr P et al (2006) The double-blind sham-controlled study of high-frequency rTMS (20 Hz) for negative symptoms in schizophrenia: negative results. Neuroendocrinol Lett 27:209–213

    PubMed  Google Scholar 

  • Oliveira JF, Zanão TA, Valiengo L et al (2013) Acute working memory improvement after tDCS in antidepressant-free patients with major depressive disorder. Neurosci Lett 537:60–64

    Article  CAS  PubMed  Google Scholar 

  • Palm U, Keeser D, Blautzik J et al (2013) Prefrontal transcranial direct current stimulation (tDCS) changes negative symptoms and functional connectivity MRI (fcMRI) in a single case of treatment-resistant schizophrenia. Schizophr Res 124:159

    Google Scholar 

  • Pascual-Leone A, Vills-Sole J, Wasserman EM et al (1994) Responses to rapid rate transcranial magnetic stimulation of the human motor cortex. Brain 117:847–858

    Article  PubMed  Google Scholar 

  • Petrides G (2012) Electroconvulsive therapy for medication resistant schizophrenia. Schizophr Res 136(Suppl 1):S22

    Article  Google Scholar 

  • Poreisz C, Boros K, Antal A et al (2007) Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Brain Res Bull 72(4–6):208–214

    Article  PubMed  Google Scholar 

  • Rakesh G, Shivakumar V, Subramaniam A et al (2013) Monotherapy with tDCS for Schizophrenia: a case report. Brain Stimul 6(4):708–709

    Article  PubMed  Google Scholar 

  • Sachdev P, Loo C, Mitchell P et al (2005) Transcranial magnetic stimula-tion for the deficit syndrome of schizophrenia: a pilot investigation. Psychiatry Clin Neurosci 59:354–357

    Article  PubMed  Google Scholar 

  • Shiozawa P, da Silva ME, Cordeiro Q et al (2013a) Transcranial direct current stimulation (tDCS) for catatonic schizophrenia: a case study. Schizophr Res 146(1–3):374–375

    Article  PubMed  Google Scholar 

  • Shiozawa P, da Silva ME, Cordeiro Q et al (2013b) Transcranial direct current stimulation (tDCS) for the treatment of persistent visual and auditory hallucinations in schizophrenia: a case study. Brain Stimul 6(5):831–833

    Article  PubMed  Google Scholar 

  • Slotema CW, Aleman A, Daskalakis ZJ et al (2012) Meta-analysis of re-petitive transcranial magnetic stimulation in the treatment of auditory verbal hallucinations: update and effects after one month. Schizophr Res 142(1–3):40–45

    Article  CAS  PubMed  Google Scholar 

  • Tadini L, El-Nazer R, Brunoni AR et al (2011) Cognitive, mood, and electroencephalographic effects of noninvasive cortical stimulation with weak electrical currents. J ECT 27(2):134–140

    Article  PubMed  Google Scholar 

  • Zervas IM, Theleritis C, Soldatos CR (2012) Using ECT in schizophrenia: a review from a clinical perspective. World J Biol Psychiatry 13(2):96–105

    Article  PubMed  Google Scholar 

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Correspondence to Peter B. Rosenquist .

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Rosenquist, P.B., Ahmed, A.O., McCall, W.V. (2014). Therapeutic Brain Stimulation in Treatment-Resistant Schizophrenia. In: Buckley, P., Gaughran, F. (eds) Treatment–Refractory Schizophrenia. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45257-4_8

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  • DOI: https://doi.org/10.1007/978-3-642-45257-4_8

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  • Publisher Name: Springer, Berlin, Heidelberg

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