RESUMEN
INTRODUCTION: Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind sham-controlled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. METHODS: Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). RESULTS: The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. DISCUSSION: This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.
Asunto(s)
Alucinaciones/terapia , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/terapia , Esquizofrenia/terapia , Lóbulo Temporal/fisiopatología , Estimulación Magnética Transcraneal/métodos , Adulto , Método Doble Ciego , Femenino , Alucinaciones/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuronavegación/métodos , Trastornos Psicóticos/complicaciones , Esquizofrenia/complicacionesRESUMEN
Professionals working in emergency departments have an important role to play in assessing and orienting suicidal patients. A patient's suicide risk must be assessed using the 'Risk-Emergency-Dangerousness' grid. The main objective of the initial care is to buy time in order to avoid the patient attempting suicide. Enabling the patient to return home accompanied by a close friend or family member after their visit to the emergency department must be favoured whenever possible, by proposing close monitoring.
