Home-based tDCS for schizophrenia: Exploring the feasibility of a standard operating procedure

Transcranial Direct Current Stimulation (tDCS), a safe and easy-to-administer noninvasive brain stimulation technique, holds promise in managing auditory verbal hallucinations (AVH) in schizophrenia. However, its short-lasting effect often leads to frequent hospital visits for booster/maintenance sessions, posing logistical challenges. Home-based tDCS offers a potential solution that improves accessibility; however, careful standardisation is required to ensure safe and effective application. We present a case of schizophrenia, where add-on home-based tDCS was administered based on a standard operating procedure (SOP) developed to address challenges unique to home administration, like device-related factors, patient and caregiver-related factors, and comprehensive caregiver training protocol. As a part of training, caregivers underwent observational learning, mannequin-based training for electrode placement, and assisted live-patient sessions. Pre and post-training competency assessments were done to ensure proficiency and safe administration. Over ten days, home-based tDCS sustained improvements in AVH without adverse effects. This case report supports the feasibility of home-based tDCS and provides a detailed SOP for implementing a safe and effective home-based tDCS treatment regime. This comprehensive SOP with a training protocol is notedly efficient for enhancing the accessibility and affordability of tDCS treatment protocols.