Abstract and Introduction
Abstract
Purpose of review 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.
Recent findings 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.
Summary 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.
Introduction
Schizophrenia-spectrum disorders are among the most invalidating and costly illnesses worldwide. Treatment resistance of invalidating psychotic symptoms occurs in 20–30% of these patients. Chronic psychosis leads to severe problems in both social and professional functioning. Several physical stimulation therapies such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and electroconvulsive therapy (ECT) have been suggested as augmentation to improve medication resistant psychotic symptoms. In this review, we aim to summarize the latest data, focusing on studies published in 2013 and 2014, regarding physical stimulation treatments for medication-resistant psychosis.