Bilateral Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Patients with Schizophrenia: A Randomized Controlled, Cross-over Study

OBJECTIVE: A randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition. METHODS: Twenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham. RESULTS: All the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition. CONCLUSION: Our findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.

A Case of Lithium Intoxication with Acute Kidney Injury / 대한정신약물학회지

We report a case of 48 years-old male bipolar disorder patient with acute kidney injury due to severe lithium intoxication. He was taking lithium 300 mg per day but suddenly ingested all 30 tablets of lithium 300 mg (total 9,000 mg) at one sitting to commit suicide. On his arrival at the emergency room, the serum lithium concentration was 12.47 mEq/L. Thereafter he was treated with hemodialysis four times for 4-4.5 hour per session and recovered without any prominent sequela. The serum lithium level checked 9 days after hemodialysis was 0.1 mEq/L. Therefore we suggest that clinicians should consider such a strategy as mandatory hemodialysis in a patient with severe kidney intoxication when serum lithium concentrations are very high or rapidly increasing.