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Objectives: Depression is a frequent but potentially treatable clinical dimension in patients with schizophrenia spectrum disorders (PWS). However, there is a lack of consensual recommendations regarding the optimal strategy to manage depression in PWS. In this study, we aimed to compare the various proposed strategies to define a core set of valid care recommendations for depression management in PWS. Methods: After a systematic search of the literature, the methodological quality of 10 international guidelines from four continents was compared using a validated guideline appraisal instrument (AGREE II). Key recommendations for the management of depression in PWS were subsequently reviewed and discussed. Results: The methodological quality of the guidelines was heterogeneous. Although all guidelines proposed pharmacotherapy, psychosocial interventions were a minor concern. Waiting for antipsychotic effects mostly was recommended during the acute phase of schizophrenia. During the postpsychotic phase of the illness, a switch to a second‐generation antipsychotic and/or the adjunction of an antidepressant were the primary recommendations. Cognitive behavioural therapy and other medications were considered with strong variations. Conclusions: Further studies are needed to strengthen the level of evidence for antidepressive approaches in PWS. The inclusion of PWS as stakeholders is also considered to be a major issue for future guideline development. [ABSTRACT FROM AUTHOR]

The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. Therefore, a group of research and clinician experts on tDCS were convened to review the research and clinical use of tDCS. This report reviews the regulatory status of tDCS and summarizes the results according to research, off-label, and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan, and the US. Research use, off label treatment, and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Some 25%-30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. Outcomes in studies of repetitive transcranial magnetic stimulation suggest the possibility that application of transcranial direct-current stimulation (tDCS) with inhibitory stimulation over the left temporo-parietal cortex and excitatory stimulation over the left dorsolateral prefrontal cortex could affect hallucinations and negative symptoms, respectively. The authors investigated the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms. METHOD: Thirty patients with schizophrenia and medication-refractory auditory verbal hallucinations were randomly allocated to receive 20 minutes of active 2-mA tDCS or sham stimulation twice a day on 5 consecutive weekdays. The anode was placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex. RESULTS: Auditory verbal hallucinations were robustly reduced by tDCS relative to sham stimulation, with a mean diminution of 31% (SD=14; d=1.58, 95% CI=0.76-2.40). The beneficial effect on hallucinations lasted for up to 3 months. The authors also observed an amelioration with tDCS of other symptoms as measured by the Positive and Negative Syndrome Scale (d=0.98, 95% CI=0.22-1.73), especially for the negative and positive dimensions. No effect was observed on the dimensions of disorganization or grandiosity/excitement. CONCLUSIONS: Although this study is limited by the small sample size, the results show promise for treating refractory auditory verbal hallucinations and other selected manifestations of schizophrenia. [ABSTRACT FROM AUTHOR]

A genetically mediated abnormal sensitivity to stress is thought to play a role in the onset, exacerbation and relapse of schizophrenia. In a double blind, placebo-controlled crossover study, peak increases in plasma ACTH (Delta ACTH) and homovanillic-acid, a dopamine metabolite, (Delta HVA) following exposure to a metabolic stressor(2DG) were studied in unaffected siblings of patients with schizophrenia (n=15), their patient relatives (n=15) and healthy controls (n=14). Siblings showed a stress response (both Delta ACTH and Delta HVA) that was significantly greater compared to controls and significantly less pronounced compared to patients. The results suggest that the genetic risk for schizophrenia may be characterized by an enhanced sensitivity to stress. [ABSTRACT FROM AUTHOR]

Transcranial Direct Current stimulation (tDCS) has been proposed as a treatment for treatment-resistant auditory verbal hallucinations and negative symptoms in patients with schizophrenia. Despite first clinical studies hold promises, little is known regarding predictive marker of response as well as brain and on cognitive modulation that can underlie beneficial clinical effects in patients with schizophrenia. It was recently observed that tDCS placed with the cathode over of the left temporo-parietal junction (TPJ) coupled with the anode over the left dorsolateral prefrontal cortex (DLPFC) led to decrease the severity of auditory verbal hallucinations, to modulate the functional connectivity of the left TPJ and to improve self recognition in patients with schizophrenia. In these studies, 10 sessions of tDCS (20 min, 2 mA) were delivered twice a day during 5 consecutive days. There was a correlation between the decrease in the severity of hallucinations and the decrease of functional connectivity between the left TPJ and the left insula. There was also a correlation between the decrease in the severity of hallucinations and the increase in source-monitoring performance. These results suggested that tDCS may led to clinical improvement by modulating functional connectivity within a large network involving brain region implicated in language and self-recognition processing. However, evidence also suggested that some patients with schizophrenia failed to respond to this tDCS regimen. Several factors may explain the discrepancies observed between responders and non-responders. Among them, COMT val/met polymorphism or drug intake (including nicotine) were observed to modulate clinical response to tDCS in patients with schizophrenia. Strategies of combination (with medication and or cognitive remediation therapy) and optimization of stimulation parameters (e.g., transcranial alternating current stimulation – tACS) should allow enhancing clinical beneficial effect. [ABSTRACT FROM AUTHOR]

In a double blind controlled study, rTMS results in a similar antidepressant effect to sham in combination with paroxetine. Both groups had the same delay in scale''s scores improvement. rTMS seems not to be efficient as an add-on treatment to pharmacological medication in non-resistant major depression. [Copyright &y& Elsevier]

Introduction About a third of patients with schizophrenia have persistent auditory verbal hallucinations resulting in persistent distress, functional disability, and frequent loss of behavioral control. Objectives To estimate the prevalence of persistent auditory hallucinations in a sample of schizophrenic patients, to specify their characteristics and to identify their clinical associated factors. Methods This was a cross-sectional, descriptive and analytical study carried-on 144 out-patients (101 men and 43 women, mean age 38.24 ± 10.58 years) followed for schizophrenia in the psychiatry department of the university hospital of Monastir. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS). Results The prevalence of persistent auditory hallucinations (score of the AHRS ≥ 5) was 40.3%. The total mean score on the AHRS was 10.7 ± 7.8 for all patients and 19.4 ± 7.7 for patients with persistent auditory hallucinations. The items of the AHRS with higher sub scores were the number, the influence and the reality of the voices. The clinical associated factors with persistent auditory hallucinations after multivariate analysis were the family history of physical illness, the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of prior hospitalization and continuous course. Conclusion Our results support the multidimensional nature of auditory hallucinations and confirm the existence of interindividual differences in these hallucinations. Persistent auditory hallucinations were associated with poor prognosis, requiring more effective therapeutic strategies. [ABSTRACT FROM AUTHOR]