每日一次经颅直流电刺激（tDCS）治疗精神分裂症幻听的探索性研究。
Exploratory study of once-daily transcranial direct current stimulation (tDCS) as a treatment for auditory hallucinations in schizophrenia.
机构信息
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
出版信息
Eur Psychiatry. 2016 Mar;33:54-60. doi: 10.1016/j.eurpsy.2015.11.005. Epub 2016 Feb 8.
BACKGROUND
Auditory hallucinations are resistant to pharmacotherapy in about 25% of adults with schizophrenia. Treatment with noninvasive brain stimulation would provide a welcomed additional tool for the clinical management of auditory hallucinations. A recent study found a significant reduction in auditory hallucinations in people with schizophrenia after five days of twice-daily transcranial direct current stimulation (tDCS) that simultaneously targeted left dorsolateral prefrontal cortex and left temporo-parietal cortex.
HYPOTHESIS
We hypothesized that once-daily tDCS with stimulation electrodes over left frontal and temporo-parietal areas reduces auditory hallucinations in patients with schizophrenia.
METHODS
We performed a randomized, double-blind, sham-controlled study that evaluated five days of daily tDCS of the same cortical targets in 26 outpatients with schizophrenia and schizoaffective disorder with auditory hallucinations.
RESULTS
We found a significant reduction in auditory hallucinations measured by the Auditory Hallucination Rating Scale (F2,50=12.22, P<0.0001) that was not specific to the treatment group (F2,48=0.43, P=0.65). No significant change of overall schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale was observed.
CONCLUSIONS
The lack of efficacy of tDCS for treatment of auditory hallucinations and the pronounced response in the sham-treated group in this study contrasts with the previous finding and demonstrates the need for further optimization and evaluation of noninvasive brain stimulation strategies. In particular, higher cumulative doses and higher treatment frequencies of tDCS together with strategies to reduce placebo responses should be investigated. Additionally, consideration of more targeted stimulation to engage specific deficits in temporal organization of brain activity in patients with auditory hallucinations may be warranted.
背景
约 25%的精神分裂症成年患者对药物治疗的听觉幻觉有抵抗作用。非侵入性脑刺激的治疗将为听觉幻觉的临床治疗提供一种受欢迎的额外工具。最近的一项研究发现，在接受为期五天、每天两次的经颅直流电刺激（tDCS）治疗后，精神分裂症患者的听觉幻觉显著减少，该治疗同时针对左背外侧前额叶和左颞顶叶皮层。
假设
我们假设，刺激左额和颞顶区域的电极进行一次性 tDCS 可减少精神分裂症患者的听觉幻觉。
方法
我们进行了一项随机、双盲、假对照研究，评估了 26 名有听觉幻觉的精神分裂症和分裂情感障碍门诊患者连续五天接受相同皮质靶点的每日 tDCS。
结果
我们发现，使用听觉幻觉评定量表（Auditory Hallucination Rating Scale）测量的听觉幻觉显著减少（F2,50=12.22，P<0.0001），但与治疗组无关（F2,48=0.43，P=0.65）。阳性和阴性综合征量表（Positive and Negative Syndrome Scale）测量的整体精神分裂症症状严重程度没有明显变化。
结论
本研究中 tDCS 治疗听觉幻觉的疗效不佳，以及假刺激组的明显反应与之前的发现相反，表明需要进一步优化和评估非侵入性脑刺激策略。特别是，应研究增加 tDCS 的累积剂量和治疗频率，以及降低安慰剂反应的策略。此外，考虑对听觉幻觉患者的大脑活动时间组织的特定缺陷进行更有针对性的刺激可能是必要的。
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