Treating auditory hallucinations with transcranial direct current stimulation in a double-blind, randomized trial.

OBJECTIVE: Transcranial direct current stimulation (tDCS) could be a treatment option for medication-resistant auditory hallucinations (AH), but so far results have been inconclusive, and large sample trials have been missing. This study used tDCS as a treatment method for these hallucinations in a double-blind, placebo-controlled study with a relatively large sample size. METHODS: Fifty-four patients of several diagnostic categories with medication-resistant AH were randomized and treated during 10 sessions of 20 min each, with either 2 mA tDCS or placebo, administered on five consecutive days (i.e., two sessions per day). Anodal stimulation was targeted at the left dorsolateral prefrontal cortex, cathodal stimulation at the left temporoparietal junction. AH severity was assessed using the Auditory Hallucination Rating Scale (AHRS). Other outcome measures were assessed with the Positive and Negative Syndrome Scale (PANSS), the Stroop, and the Trail Making Test. RESULTS: AH frequency and severity decreased significantly over time, as did the scores on the total and general subscales of the PANSS. However, there was no significant interaction effect with the treatment group on any of the main outcome measures. CONCLUSIONS: We found no evidence that tDCS is more effective for medication-resistant AH than placebo, even though AH frequency and severity decreased in both groups. An alternative strategy may be to offer tDCS at an earlier stage of illness. In the light of recent investigations into the neurophysiological mechanisms behind tDCS, we may also have to consider the possibility that tDCS is not able to induce any long-lasting brain changes.

Inhibition of return in single and dual tasks: examining saccadic, keypress, and pointing responses.

Two experiments are reported in which inhibition of return (IOR)was examined wit h single-responsetasks (either manual responses alone or saccadic responses alone) and dual-response tasks (simultaneous manual and saccadic responses). The first experiment-using guided limb movements that require considerable spatial information-showed more IOR for saccades than for pointing responses. In addition, saccadic IOR was reduced with concurrent pointing movements, but manual IOR was not affected by concurrent saccades. Importantly, at the time of saccade initiation, the arm movements did not start yet, indicating that the influence on saccade IOR is due to arm-movement preparation. In the second experiment, using localization keypress responses that required only minimal spatial information, greater IOR was again found for saccadic than for manual responses, but no effect of concurrent movements was found. These findings add further support that there is a dissociation between oculomotor and skeletal-motor IOR. Moreover, the results show that the preparation manual responses tend to mediate saccadic behavior-but only when the manual responses require high levels of spatial accuracy-and that the superior colliculus is the likely neural substrate integrating IOR for eye and arm movements.