Elsevier

Biological Psychiatry

Volume 76, Issue 2, 15 July 2014, Pages 101-110
Biological Psychiatry

Review
Review of the Efficacy of Transcranial Magnetic Stimulation for Auditory Verbal Hallucinations

https://doi.org/10.1016/j.biopsych.2013.09.038Get rights and content

With an increase of the number of studies exploring repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations (AVH), an update is provided on the efficacy of different paradigms. A literature search was performed from 1966 through April 2013. Twenty-five randomized controlled trials using the severity of AVH or psychosis as outcome measures were included. Standardized mean weighted effect sizes were computed; a qualitative review of the literature was performed to assess the effects of various rTMS paradigms. rTMS versus sham treatment for AVH yielded a mean weighted effect size of .44. No significant mean weighted effect size was found for the severity of psychosis (i.e., .21). For patients with medication-resistant AVH, the mean weighted effect size was .45. rTMS applied at the left temporoparietal area with a frequency of 1 Hz yielded a moderate mean weighted effect size of .63, indicating superiority of this paradigm. Various other paradigms failed to show superior effects. rTMS applied at the right temporoparietal area was not superior to sham treatment. rTMS, especially when applied at the left temporoparietal area with a frequency of 1 Hz, is effective for the treatment of AVH, including in patients with medication-resistant AVH. The results for other rTMS paradigms are disappointing thus far. A next step should be to explore the effects of rTMS in medication-free individuals, for example, during the initial phases of psychosis, and in patients with diagnoses other than schizophrenia who do not have comorbid psychotic symptoms.

Section snippets

Methods and Materials

A search of the literature was performed using the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Embase Psychiatry 1997 through January 2013, Ovid Medline 1966 through January 2013, PubMed 1990 through January 2013, and PsycInfo 1990 through 2013, with the search terms auditory verbal hallucination, auditory hallucination, psychosis, psychotic features, noninvasive treatment, transcranial magnetic

Results

A total of 134 studies were considered, and 115 were excluded. The reasons for exclusion are presented in Table 1. Details of the 19 randomized, sham-controlled studies that were included are presented in Table 2.

Discussion

With an increase in the number of studies exploring the efficacy of rTMS for the treatment of AVH, it is becoming increasingly possible to predict the place that rTMS will deserve in the treatment guidelines for psychosis, and notably AVH.

Treatment with rTMS results in a moderate reduction of the severity of AVH (effect size .44) compared with sham treatment. For medication-resistant AVH, the effect size did not change significantly (i.e., to .45).

The mean weighted effect size on the severity

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