Repetitive Transcranial Magnetic Stimulation in Persistent Auditory Hallucination in Schizophrenia: Predictors of Respon
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PSYCHOSIS (A AHMED, SECTION EDITOR)
Repetitive Transcranial Magnetic Stimulation in Persistent Auditory Hallucination in Schizophrenia: Predictors of Response Sujita Kumar Kar 1
&
Vikas Menon 2
Accepted: 15 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of the Review This review aims to discuss the role of repetitive Transcranial Magnetic Stimulation (rTMS) in schizophrenia for the management of persistent auditory hallucination, along with the predictors of response. Recent Findings Schizophrenia is a chronic, highly disabling, severe mental illness. Antipsychotic medications are the mainstay of treatment in schizophrenia. Despite adequate pharmacotherapy, a considerable number of patients remain symptomatic, for which brain stimulation (neuromodulation) techniques like electroconvulsive therapy, repetitive transcranial magnetic stimulation and transcranial direct current stimulation are being increasingly used. Persistent auditory hallucination resistant to pharmacotherapy (antipsychotic treatment) is a therapeutic challenge. It is found to be due to abnormal hyperactivity of the neurons at the temporo-parietal junction of dominant hemisphere. Commonly, low-frequency repetitive transcranial magnetic stimulation has been used in the treatment of medication-resistant auditory hallucination. Summary Various factors predict the response to repetitive transcranial magnetic stimulation in the management of resistant auditory hallucination. Identification of various predictors will guide clinicians in the appropriate selection of rTMS to target auditory hallucinations in schizophrenia. Keywords Predictors of response . Repetitive transcranial magnetic stimulation . Auditory hallucination . Schizophrenia
Introduction Auditory hallucination is one of the core positive symptoms of schizophrenia, which produces significant distress and disability in the patient [1]. Auditory hallucinations frequently respond to antipsychotic medications; however, in some patients, it becomes resistant to conventional pharmacotherapy, psychotherapy or electroconvulsive therapy and emerges as a This article is part of the Topical Collection on Psychosis * Sujita Kumar Kar [email protected] Vikas Menon [email protected] 1
2
Department of Psychiatry, King George’s Medical University, Lucknow, UP, India Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education And Research (Jipmer), Dhanvantri Nagar, Puducherry 605006, India
therapeutic challenge for the treating clinician [1]. Antipsychotic resistant auditory verbal hallucinations are seen in one-third of patients with schizophrenia [2]. Various neuromodulation techniques (transcranial magnetic stimulation, transcranial direct current stimulation, deep brain stimulation) have been tried in patients of schizophrenia with resistant auditory hallucinations. Presence of certain parameters can predict the response to transcranial magnetic stimulation (TMS) in depression [3••]. Identifying and understanding such parameters that can predict th
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