The treatment of auditory hallucinations

6,328 views
5,942 views

Published on

Presentation made by Dr. Iris Sommer at the SRF live webinar of September 13, 2012.

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,328
On SlideShare
0
From Embeds
0
Number of Embeds
2,162
Actions
Shares
0
Downloads
0
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

The treatment of auditory hallucinations

  1. 1. The Treatment of Auditory Hallucinations Iris Sommer UMC Utrecht
  2. 2. Different Diagnoses need Different Treatments Auditory Hallucinations Psychiatric Disorders:Neurological disorder: SchizophreniaTemporal lobe epilepsy Hearing Disorders: Schizotypal personality Parksinson’s disease Healthy Individuals: Auditory variant of Borderline personality Dementia 10-15% of population Bonnett’s syndrome Affective psychosis Huntington’s disease Dissociative Disorder migraine PTSD
  3. 3. Start treatment with least radical therapy• Psycho-education: explain what happens• Teach coping techniques• Reduce fear and obedience to the voices with cognitive behavioural therapy (CBT)• Anti-psychotic medication• Transcranial Magnetic Stimulation• Electro-Convulsive Therapy (ECT)
  4. 4. Psycho-educationThe language areas are The connections between A few seconds prioractive during AVH. There is the frontal speech to the hallucination,also a lot of activity in the production areas and the the hippocampus islanguage production areas, temporal speech perception activated. Thisindicating that the own areas are of inferior quality. implies that AVHbrain is making these Therefore, self-generated arise from memory,words. sentences are not well just like dreams. recognized.
  5. 5. Coping techniques1. Conversation 73%2. Singing/ humming 70%3. Wissling 60%4. Reading aloud 50%5. Sleeping 43%6. Listening to music 30%7. Shouting 28%8. Reading silently 30%9. Chewing gum 25%10. Hobbies: games, internet, sports, hiking 16%
  6. 6. Cognitive Behavioural Therapy• Reduce belief in the omnipotence of the voices• Stop the patient to carry out commands of the voices• Reduce fear• Increase self esteem
  7. 7. Is CBT really effective?
  8. 8. Antipsychotic medication for hallucinationsDROP-OUT rate after 12 months was 50%!! Data from the EUFEST study Kahn et al, Lancet 2008
  9. 9. Medication• Severity of hallucinations from 4.4 (marked to severe hallucinations), to 2.5 (minimal to mild hallucinations) after 4 weeks.• Severity to 1.5 (absent to minimal hallucinations) after 6 months of treatment• The % patients with at least mild hallucinations from 100% at baseline to 8% after 12 months.• No differences between amisulpride, olanzapine, quetiapine and ziprazidone. Trend towards haloperidol less effective.
  10. 10. TMS for hallucinationsStudy name Subgroup within study Hedgess g and 95% CI Hedgess g p-ValueSlotema b T3P3 0,000 1,000Brunelin T3P3 1,158 0,008Vercammen b T3P3 -0,175 0,613de Jesus T3P3 0,464 0,321Hoffman T3P3 0,552 0,052Rosa PANSS pos T3P3 -0,084 0,880Chibbaro SAH T3P3 1,283 0,014Saba PANSS pos T3P3 -0,053 0,910Lee b frequency T3P3 0,498 0,189Fitzgerald HCS T3P3 0,329 0,344Jandl c PSYRATS T3P3 0,534 0,154Loo c T3P3 0,034 0,916Poulet c T3P3 1,350 0,005McIntoshc PANSS pos T3P3 0,195 0,573Hoffman c hcs T3P3 1,219 0,005 0,437 0,000 -2,00 -1,00 0,00 1,00 2,00 sham rTMSMeta Analysis Slotema et al. Schiz Res in press
  11. 11. Possibility of positive publication bias
  12. 12. TMS usually applied for medication-resistant patients• Psycho-education: explain what happens• Teach coping techniques• Reduce fear and obedience to the voices with cognitive behavioural therapy (CBT)• Anti-psychotic medication• Transcranial Magnetic Stimulation• Electro-Convulsive Therapy (ECT)
  13. 13. ECT for medication-resistant hallucinations A B * * #NOT PLACEBO CONTROLLED!! # * * Mean decrease in PANSS, n=17 Mean decrease in P1 (delusions) P3 (hallucinations) sign. at p<0.05 G6 (depression), G11 (attention)
  14. 14. Thank you very much for your attention!!!!Voices Clinic at the UMC Utrecht

×