title: Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample.
abstract: BACKGROUND
  Auditory hallucinations are often resistant to treatment and can produce significant distress and behavioral difficulties. A preliminary report based on 24 patients with schizophrenia or schizoaffective disorder indicated greater improvement in auditory hallucinations following 1-hertz left temporoparietal repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation. Data from the full 50-subject sample incorporating 26 new patients are now presented to more comprehensively assess safety/tolerability, efficacy and moderators of this intervention.
  
  
  METHODS
  Right-handed patients experiencing auditory hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 132 minutes of rTMS was administered over 9 days at 90% motor threshold using a double-masked, sham-controlled, parallel design.
  
  
  RESULTS
  Hallucination Change Score was more improved for rTMS relative to sham stimulation (p = .008) as was the Clinical Global Impressions Scale (p = .0004). Hallucination frequency was significantly decreased during rTMS relative to sham stimulation (p = .0014) and was a moderator of rTMS effects (p = .008). There was no evidence of neurocognitive impairment associated with rTMS.
  
  
  CONCLUSIONS
  Left temporoparietal 1-hertz rTMS warrants further study as an intervention for auditory hallucinations. Data suggest that this intervention selectively alters neurobiological factors determining frequency of these hallucinations.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA. ralph.hoffman@yale.edu
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Hoffman
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.forename: Keith A
authors.initials: KA
authors.lastname: Hawkins
authors.forename: Maxine
authors.initials: M
authors.lastname: Varanko
authors.forename: Nash N
authors.initials: NN
authors.lastname: Boutros
authors.forename: Yu-te
authors.initials: YT
authors.lastname: Wu
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carroll
authors.forename: John H
authors.initials: JH
authors.lastname: Krystal
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D004574:Electromagnetic Fields; D005260:Female; D007839:Functional Laterality; D006212:Hallucinations / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012565:Schizophrenic Psychology; D018709:Statistics, Nonparametric; D013702:Temporal Lobe / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000627:therapeutic use*; D016896:Treatment Outcome