The Treatment of Auditory Hallucinations Iris Sommer UMC Utrecht
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
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)
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.
Antipsychotic medication for hallucinationsDROP-OUT rate after 12 months was 50%!! Data from the EUFEST study Kahn et al, Lancet 2008
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.
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
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)
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)
Thank you very much for your attention!!!!Voices Clinic at the UMC Utrecht