Psychiatry Department, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, the Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB Leiden, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
Schizophr Res. 2018 Nov;201:329-336. doi: 10.1016/j.schres.2018.06.010. Epub 2018 Jun 20.
Transcranial direct current stimulation (tDCS) could be a treatment option for medication-resistant auditory hallucinations (AH), but so far results have been inconclusive, and large sample trials have been missing. This study used tDCS as a treatment method for these hallucinations in a double-blind, placebo-controlled study with a relatively large sample size.
Fifty-four patients of several diagnostic categories with medication-resistant AH were randomized and treated during 10 sessions of 20 min each, with either 2 mA tDCS or placebo, administered on five consecutive days (i.e., two sessions per day). Anodal stimulation was targeted at the left dorsolateral prefrontal cortex, cathodal stimulation at the left temporoparietal junction. AH severity was assessed using the Auditory Hallucination Rating Scale (AHRS). Other outcome measures were assessed with the Positive and Negative Syndrome Scale (PANSS), the Stroop, and the Trail Making Test.
AH frequency and severity decreased significantly over time, as did the scores on the total and general subscales of the PANSS. However, there was no significant interaction effect with the treatment group on any of the main outcome measures.
We found no evidence that tDCS is more effective for medication-resistant AH than placebo, even though AH frequency and severity decreased in both groups. An alternative strategy may be to offer tDCS at an earlier stage of illness. In the light of recent investigations into the neurophysiological mechanisms behind tDCS, we may also have to consider the possibility that tDCS is not able to induce any long-lasting brain changes.
经颅直流电刺激（tDCS）可能是治疗药物难治性听觉幻觉（AH）的一种选择，但迄今为止结果尚无定论，且缺乏大样本试验。本研究采用双盲、安慰剂对照研究，使用相对较大的样本量，使用 tDCS 作为这些幻觉的治疗方法。
54 名患有多种诊断类别的药物难治性 AH 的患者被随机分组，并在 10 次 20 分钟的治疗中接受治疗，每次治疗使用 2 mA 的 tDCS 或安慰剂，连续 5 天（即每天两次）进行。阳极刺激的目标是左背外侧前额叶皮质，阴极刺激的目标是左颞顶联合区。使用听觉幻觉评定量表（AHRS）评估 AH 严重程度。使用阳性和阴性症状量表（PANSS）、斯特鲁普和连线测试评估其他结果测量。
随着时间的推移，AH 频率和严重程度显著降低，PANSS 的总分和一般分量表得分也显著降低。然而，在任何主要结果测量上，治疗组都没有与时间的交互作用效应。
我们没有发现 tDCS 比安慰剂更有效地治疗药物难治性 AH 的证据，尽管两组的 AH 频率和严重程度都有所下降。一种替代策略可能是在疾病的早期阶段提供 tDCS。鉴于最近对 tDCS 背后的神经生理机制的研究，我们也可能不得不考虑 tDCS 不能诱导任何持久的大脑变化的可能性。
