aDepartment of Psychiatry, University Medical Centre Utrecht bBrain Center Rudolf Magnus, Utrecht, The Netherlands.
Curr Opin Psychiatry. 2015 May;28(3):222-8. doi: 10.1097/YCO.0000000000000156.
Despite adequate antipsychotic treatment, 20-30% of patients with schizophrenia fail to obtain remission from psychosis. Physical stimulation treatments may provide an alternative therapy. In this review, we summarize the most recent studies regarding repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and electroconvulsive therapy (ECT) for medication-resistant psychosis in schizophrenia.
Stimulation techniques in the treatment of medication-resistant psychosis have shown inconsistent results. Initial results of rTMS for auditory verbal hallucinations (AVH) were promising, but three recent large randomized controlled trials (RCTs) show similar results of rTMS as placebo. tDCS has shown initial promise as a treatment for AVH, but only in case studies and in two small RCTs. Larger studies are needed to define its efficacy. Although psychotic symptoms generally decrease after ECT, its efficacy has not been demonstrated in comparison with placebo.
Although previous meta-analyses indicate significant mean effect sizes for rTMS for intractable AVH, three recent large RCTs indicate no effect compared with placebo. The use of tDCS for resistant AVH and ECT for intractable psychosis has shown some initial promise, but adequately sized placebo-controlled RCTs are now needed. Taken together, the evidence for physical stimulation techniques to relieve medication-resistant psychosis is currently weak.
尽管有充分的抗精神病药物治疗，20-30%的精神分裂症患者仍未从精神病中缓解。物理刺激治疗可能提供一种替代疗法。在这篇综述中，我们总结了最近关于重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）和电抽搐治疗（ECT）对精神分裂症药物抵抗性精神病的研究。
刺激技术在治疗药物抵抗性精神病方面的结果不一致。rTMS 治疗听觉言语幻觉（AVH）的初步结果很有希望，但最近三项大型随机对照试验（RCT）显示 rTMS 的结果与安慰剂相似。tDCS 作为 AVH 的治疗方法显示出初步的疗效，但仅限于病例研究和两项小型 RCT。需要更大的研究来确定其疗效。尽管电抽搐治疗后精神病症状通常会减轻，但与安慰剂相比，其疗效尚未得到证实。
尽管以前的荟萃分析表明 rTMS 对难治性 AVH 的平均效应大小显著，但最近三项大型 RCT 表明与安慰剂相比无效果。tDCS 治疗难治性 AVH 和 ECT 治疗难治性精神病有一定的初步疗效，但现在需要进行足够大的安慰剂对照 RCT。综上所述，目前物理刺激技术缓解药物抵抗性精神病的证据较弱。
