Transcranial direct-current stimulation in ultra-treatment-resistant schizophrenia

Area of Science:

• Neuroscience
• Psychiatry
• Medical Technology

Background:

• Transcranial direct-current stimulation (tDCS) is a non-invasive neurostimulation technique.
• Previous studies suggest tDCS efficacy for treatment-resistant auditory hallucinations in ambulatory schizophrenia patients.
• Limited data exists on tDCS effects in hospitalized, low-functioning schizophrenia inpatients.

Purpose of the Study:

• To investigate the efficacy and safety of tDCS for auditory hallucinations in hospitalized ultra-treatment-resistant schizophrenia (TRS).
• To evaluate the impact of tDCS on cognitive functions in this patient population.
• To test the hypothesis that longer stimulation duration may improve tDCS treatment response.

Main Methods:

• A 4-week, sham-controlled, randomized trial involving inpatient participants with DSM-V schizophrenia, treatment resistance, and auditory verbal hallucinations (AVH).
• Participants received twice-daily active or sham tDCS for 4 weeks.
• Assessments included the Positive and Negative Syndrome Scale (PANSS), MATRICS Consensus Cognitive Battery (MCCB), and Auditory Hallucinations Rating Scale (AHRS) at baseline and endpoint.

Main Results:

• Twenty-eight participants were enrolled; 21 completed the trial.
• The tDCS group showed a significant reduction in the AHRS Total Score (21.9% decrease) compared to the sham group (12.6% decrease).
• Significant improvements were observed in hallucination frequency, duration, number of voices, overall psychopathology, and working memory in the tDCS group.

Conclusions:

• tDCS, combined with pharmacological intervention, offers clinical gains over medication alone for hospitalized, ultra-treatment-resistant schizophrenia patients.
• The findings extend the known efficacy of tDCS to a more severely ill inpatient population.
• tDCS appears effective for both ambulatory and hospitalized patients with treatment-resistant auditory hallucinations.