title: A pilot double-blind sham-controlled trial of repetitive transcranial magnetic stimulation for patients with refractory schizophrenia treated with clozapine.
abstract: Schizophrenia is a complex and heterogeneous psychiatric disorder. Auditory verbal hallucinations occur in 50-70% of patients with schizophrenia and are associated with significant distress, decreased quality of life and impaired social functioning. This study aimed to investigate the effects of active compared with sham 1-Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left temporal-parietal cortex in patients with schizophrenia treated with clozapine. Symptom dimensions that were evaluated included general psychopathology, severity of auditory hallucinations, quality of life and functionality. Seventeen right-handed patients with refractory schizophrenia experiencing auditory verbal hallucinations and treated with clozapine were randomly allocated to receive either active rTMS or sham stimulation. A total of 384 min of rTMS was administered over 20 days using a double-masked, sham-controlled, parallel design. There was a significant reduction in Brief Psychiatric Rating Scale (BPRS) scores in the active group compared with the sham group. There was no significant difference between active and sham rTMS on Quality of Life Scale (QLS), Auditory Hallucinations Rating Scale (AHRS), Clinical Global Impressions (CGI) and functional assessment staging (FAST) scores. Compared with sham stimulation, active rTMS of the left temporoparietal cortex in clozapine-treated patients showed a positive effect on general psychopathology. However, there was no effect on refractory auditory hallucinations. Further studies with larger sample sizes are needed to confirm these findings.
authors.affiliation: Department of Psychiatry, Federal University of Rio Grande do Sul-RS, Brazil. danilorocha@hotmail.com
authors.forename: Danilo Rocha
authors.initials: DR
authors.lastname: de Jesus
authors.forename: Alexei
authors.initials: A
authors.lastname: Gil
authors.forename: Leonardo
authors.initials: L
authors.lastname: Barbosa
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Lobato
authors.forename: Pedro Vieira da Silva
authors.initials: PV
authors.lastname: Magalhães
authors.forename: Gabriela Pereira de Souza
authors.initials: GP
authors.lastname: Favalli
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
authors.forename: Zafiris Jeffrey
authors.initials: ZJ
authors.lastname: Daskalakis
authors.forename: Paulo da Silva
authors.initials: Pda S
authors.lastname: Belmonte-de-Abreu
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000628:therapy*; D018709:Statistics, Nonparametric; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine