title: The treatment of hallucinations in schizophrenia spectrum disorders.
abstract: This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. Blood levels should be above 350-450 μg/ml for maximal effect. For relapse prevention, medication should be continued in the same dose. Depot medication should be considered for all patients because nonadherence is high. Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated.
authors.affiliation: Neuroscience Division, Psychiatry Department, University Medical Centre Utrecht & Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands. i.sommer@umcutrecht.nl
authors.forename: Iris E C
authors.initials: IE
authors.lastname: Sommer
authors.forename: Christina W
authors.initials: CW
authors.lastname: Slotema
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
authors.forename: Eske M
authors.initials: EM
authors.lastname: Derks
authors.forename: Jan Dirk
authors.initials: JD
authors.lastname: Blom
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004565:Electroconvulsive Therapy / Q000379:methods*; D006212:Hallucinations / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents