Zöllner Rebecca, Hübener Anne-Friederike, Dannlowski Udo, Kircher Tilo, Sommer Jens, Zavorotnyy Maxim
Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.
Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Marburg, Germany.
Front Psychiatry. 2020 Apr 20;11:294. doi: 10.3389/fpsyt.2020.00294. eCollection 2020.
Treating very-late-onset (>60 years) schizophrenia-like psychosis (VLOSLP) is challenging. Age-related factors in elderly individuals (e.g., metabolism, medication side effects, drug-interaction, somatic morbidity) may adversely affect treatment. Novel therapeutic approaches are needed to ensure the favorable therapeutic outcome in geriatric patients. Previously, theta-burst stimulation (TBS), a novel form of repetitive transcranial magnetic stimulation, was reported being beneficial in the treatment for auditory-verbal hallucination (AVH) in young and middle-aged schizophrenia (SZ) patients.
Here we present a case of a male patient aged 73. His first psychotic episode manifested with paranoid delusions, auditory-verbal and tactile hallucinations at the age of 66, and first remitted following a second-generation antipsychotics (SGA). Years later, after a relapse the AVH did not respond to previously effective olanzapine, whereas its augmentation with an inhibitory TBS over the left temporal lobe led to a stable remission. During his second relapse, TBS was again capable of facilitating therapeutic action of SGA in the same patient. Extending to our clinical observation, a series of functional MRI scans employing a tonal activation paradigm depicted altered auditory processing during AVH as well as brain activation change during remission.
The current case might indicate to favorable effects of combining conventional medicament therapy and non-invasive brain stimulation techniques for elderly patients. Also, we speculate that despite obviously distinct etiologies, the present functional imaging and clinical observation may also demonstrate a possible common pathophysiological pathway underlying AVH in VLOSLP and SZ.
治疗极晚发性（>60岁）精神分裂症样精神病（VLOSLP）具有挑战性。老年人与年龄相关的因素（如新陈代谢、药物副作用、药物相互作用、躯体疾病）可能会对治疗产生不利影响。需要新的治疗方法以确保老年患者获得良好的治疗效果。此前，有报道称，一种新型重复经颅磁刺激形式——theta爆发刺激（TBS），对年轻和中年精神分裂症（SZ）患者的幻听（AVH）治疗有益。
在此，我们报告一例73岁男性患者。他66岁时首次出现精神病性发作，表现为偏执妄想、幻听和幻触，首次缓解是在使用第二代抗精神病药物（SGA）之后。数年后复发，此前有效的奥氮平对其幻听不再起作用，而在左侧颞叶进行抑制性TBS增强治疗后病情稳定缓解。第二次复发时，TBS再次能够促进同一患者SGA的治疗作用。扩展到我们的临床观察，一系列采用音调激活范式的功能磁共振成像扫描显示，幻听期间听觉处理改变，缓解期间大脑激活变化。
目前的病例可能表明，对于老年患者，传统药物治疗与非侵入性脑刺激技术相结合具有良好效果。此外，我们推测，尽管病因明显不同，但目前的功能成像和临床观察也可能表明，VLOSLP和SZ中AVH潜在的病理生理途径可能相同。
