title: Transcranial magnetic stimulation, transcranial direct current stimulation and electroconvulsive therapy for medication-resistant psychosis of schizophrenia.
abstract: OBJECTIVE
  Despite adequate antipsychotic treatment, 20-30% of patients with schizophrenia fail to obtain remission from psychosis. Physical stimulation treatments may provide an alternative therapy. In this review, we summarize the most recent studies regarding repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and electroconvulsive therapy (ECT) for medication-resistant psychosis in schizophrenia.
  
  
  RESULTS
  Stimulation techniques in the treatment of medication-resistant psychosis have shown inconsistent results. Initial results of rTMS for auditory verbal hallucinations (AVH) were promising, but three recent large randomized controlled trials (RCTs) show similar results of rTMS as placebo. tDCS has shown initial promise as a treatment for AVH, but only in case studies and in two small RCTs. Larger studies are needed to define its efficacy. Although psychotic symptoms generally decrease after ECT, its efficacy has not been demonstrated in comparison with placebo.
  
  
  CONCLUSIONS
  Although previous meta-analyses indicate significant mean effect sizes for rTMS for intractable AVH, three recent large RCTs indicate no effect compared with placebo. The use of tDCS for resistant AVH and ECT for intractable psychosis has shown some initial promise, but adequately sized placebo-controlled RCTs are now needed. Taken together, the evidence for physical stimulation techniques to relieve medication-resistant psychosis is currently weak.
authors.affiliation: aDepartment of Psychiatry, University Medical Centre Utrecht bBrain Center Rudolf Magnus, Utrecht, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Nieuwdorp
authors.forename: Sanne
authors.initials: S
authors.lastname: Koops
authors.forename: Metten
authors.initials: M
authors.lastname: Somers
authors.forename: Iris E C
authors.initials: IE
authors.lastname: Sommer
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage; D004565:Electroconvulsive Therapy; D006212:Hallucinations / Q000628:therapy; D006801:Humans; D011618:Psychotic Disorders / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents