Once- to Twice-Daily, 3-Year Domiciliary Maintenance Transcranial Direct Current Stimulation for Severe, Disabling, Clozapine-Refractory Continuous Auditory Hallucinations in Schizophrenia

Abstract

This is the first report in literature of the safe and effective use of daily to twice-daily, domiciliary, 30-min, 1- to 3-mA tDCS sessions across nearly 3 years for the treatment of continuous, disabling, clozapine-refractory auditory hallucinations in schizophrenia. Key learning points emerging from this case are presented and discussed.

Transcranial Direct Current Stimulation for Refractory Auditory Hallucinations in Schizophrenia

“…The treatment gains were apparent by the end of the 5-day tDCS course and were maintained for 3 months. 35 Patients in the case reports 18,31,[33][34][35] showed substantial response to tDCS, whereas those in the RCT 36 showed attenuation of hallucination ratings by only about a third. There are 2 likely explanations for the modest improvement recorded in the RCT.…”

“…Only 1 report 18 has described long-term use of tDCS. In this report, a 24-year-old woman with schizophrenia had severe, antipsychotic-and clozapine-refractory, continuous, psychosocially and cognitively disabling auditory hallucinations that left her almost vegetative.…”

“…Evidence for the successful use of rTMS in patients with refractory auditory hallucinations [10][11][12] encourages the consideration of transcranial direct current stimulation (tDCS) for the same indication. 18 …”

Novel Treatments of Psychosis

“…In neuropsychiatric disorders, non-invasive brain stimulation methods have become increasingly popular given their targeted approach, minimal side effects, and limited drug interactions. Currently, there are no FDA-approved neuromodulation systems for the treatment of schizophrenia [59][60][61][62][63][64]. Off-label use of approved devices, however, has demonstrated promising results, especially in treating the positive symptoms of schizophrenia.…”

Brain Stimulation for Cognitive Enhancement in the Older Person: State of the Art and Future Directions

“…The comparison shows the changes that occur during normal ageing, including the reduction in brain volume and concomitant increase in cerebrospinal fluid, which is especially obvious in the anterior (LVA) and posterior (LVP) parts of the lateral ventricle, the thinning of the bone of the skull and the reduction in white matter scientific attempts that have used brain stimulation in the person's home. TMS would be impractical for this use, but two studies have used tDCS with reasonable success (Andrade 2013;Hagenacker et al 2014). In a less controlled environment, the so-called DIY-tDCS movement has seen people construct and use tDCS devices in their own home.…”