Showing papers by "Iris E. C. Sommer published in 2010"
TL;DR: It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms, as well as for electroconvulsive treatment for depression.
Abstract: Objective: Repetitive transcranial magnetic stimulation (rTMS) is a safe treatment method with few side effects However, efficacy for various psychiatric disorders is currently not clear Data sources: A literature search was performed from 1966 through October 2008 using PubMed, Ovid Medline, Embase Psychiatry, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and PsycINFO The following search terms were used transcranial magnetic stimulation, TMS, repetitive TMS, psychiatry, mental disorder, psychiatric disorder, anxiety disorder, attention-deficit hyperactivity disorder, bipolar disorder, catatonia, mama, depression, obsessive-compulsive disorder, psychosis, posttraumatic stress disorder, schizophrenia, Tourette's syndrome, bulimia nervosa, and addiction. Study selection: Data were obtained from randomized, sham-controlled studies of rTMS treatment for depression (34 studies), auditory verbal hallucinations (AVH, 7 studies), negative symptoms in schizophrenia (7 studies), and obsessive-compulsive disorder (OCD, 3 studies) Studies of rTMS versus electroconvulsive treatment (ECT, 6 studies) for depression were meta-analyzed. Data extraction: Standardized mean effect sizes of rTMS versus sham were computed based on pretreatment-posttreatment comparisons Data synthesis: The mean weighted effect size of rTMS versus sham for depression was 0.55 (P <001). Monotherapy with rTMS was more effective than rTMS as adjunctive to antidepressant medication. ECT was superior to rTMS in the treatment of depression (mean weighted effect size -0 47, P = 004) In the treatment of AVH, rTMS was superior to sham treatment, with a mean weighted effect size of 0.54 (P <001) The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0.39 (P = 11) and for OCD, 0 15 (P = .52) Side effects were mild, yet more prevalent with high-frequency rTMS at frontal locations Conclusions: It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms We do not recommend rTMS for the treatment of OCD J Clin Psychiatry 2010,71(7).873-884 (C) Copyright 2010 Physicians Postgraduate Press, Inc
516 citations
TL;DR: It was shown that higher SPQ scores, lower education, and higher family loading for psychiatric disorders, but not presence of AVH, were associated with lower global functioning, suggesting that AVH in otherwise healthy individuals are part of a general vulnerability for schizophrenia.
Abstract: Epidemiological studies suggest that auditory verbal hallucinations (AVH) occur in approximately 10%–15% of the general population, of whom only a small proportion has a clinically relevant psychotic disorder. It is unclear whether these hallucinations occur as an isolated phenomenon or if AVH in nonclinical individuals are part of a more general susceptibility to schizophrenia. For this study, 103 healthy individuals with frequent AVH were compared with 60 controls matched for sex, age, and education. All participants were examined by a psychiatrist using standardized diagnostic interviews and questionnaires. The individuals with AVH did not have clinically defined delusions, disorganization, or negative or catatonic symptoms, nor did they meet criteria for cluster A personality disorder. However, their global level of functioning was lower than in the controls and there was a pronounced increase on all subclusters of the Schizotypal Personality Questionnaire (SPQ) and the Peters Delusion Inventory, indicating a general increased schizotypal and delusional tendency in the hallucinating subjects. History of childhood trauma and family history of axis I disorders were also more prevalent in these individuals. We showed that higher SPQ scores, lower education, and higher family loading for psychiatric disorders, but not presence of AVH, were associated with lower global functioning. Our data suggest that AVH in otherwise healthy individuals are not an isolated phenomenon but part of a general vulnerability for schizophrenia.
263 citations
TL;DR: Auditory verbal hallucinations in patients with a psychotic disorder are consistently preceded by deactivation of the parahippocampal gyrus, which has been hypothesized to play a central role in memory recollection, sending information from the hippocampus to the association areas.
Abstract: ObjectiveActivation in a network of language-related regions has been reported during auditory verbal hallucinations. It remains unclear, however, how this activation is triggered. Identifying brain regions that show significant signal changes preceding auditory hallucinations might reveal the origin of these hallucinations. MethodTwenty-four patients with a psychotic disorder indicated the presence of auditory verbal hallucinations during 3-Tesla functional magnetic resonance imaging by squeezing a handheld balloon. A one-sample t test was performed to reveal groupwise activation during hallucinations. To enable analysis of brain activation 6 to 0 seconds preceding hallucinations, a tailored 'selective averaging' method, without any a priori assumptions concerning the hemodynamic response profile, was performed. To control for motor-related activation, 15 healthy comparison subjects squeezed a balloon at matched time intervals. ResultsGroupwise analysis during auditory verbal hallucinations revealed brai...
198 citations
TL;DR: A direct relationship between auditory verbal hallucinations and decreased language lateralization can not be established at present, as languageateralization was not significantly reduced in the non-psychotic individuals with auditory verbal hallucination, and group-wise brain activation during verbal fluency was compared between the three groups.
Abstract: Decreased language lateralization is a well-replicated finding in psychotic patients. It is currently unclear, however, whether this abnormality is related to a particular symptom of psychosis or to psychosis in general. It has been argued that decreased language lateralization may be related to auditory verbal hallucinations. To elucidate this, these hallucinations should be studied in isolation. Thirty-five patients with a psychotic disorder, 35 non-psychotic subjects with relatively isolated auditory verbal hallucinations and 35 healthy control subjects participated in this study. All subjects were scanned on a 3T magnetic resonance imaging scanner, while covertly performing a paced verbal fluency task. In order to measure performance on the task, one additional task block was presented during which subjects had to generate words overtly. In addition to calculating language lateralization indices, group-wise brain activation during verbal fluency was compared between the three groups. Task performance was nearly maximal for all groups and did not differ significantly between the groups. Compared with the healthy control subjects and non-psychotic subjects with auditory verbal hallucinations, language lateralization was significantly reduced for the patient group. In addition, the patients displayed significantly greater activity in the right precentral gyrus and left insula when compared with the healthy control subjects and the non-psychotic subjects with auditory verbal hallucinations. Furthermore, the patients showed greater activity in the right superior parietal lobule when compared with the healthy control subjects. Lateralization indices did not differ significantly between the non-psychotic subjects with auditory verbal hallucinations and the healthy control subjects. Moreover, there were no significant differences in brain activation during verbal fluency between the two non-psychotic groups. As language lateralization was not significantly reduced in the non-psychotic individuals with auditory verbal hallucinations, a direct relationship between auditory verbal hallucinations and decreased language lateralization can not be established at present.
63 citations
TL;DR: Socio-demographic risk factors for non-clinical psychotic symptoms in the general population are also risk factorsFor a substantial part explained by an increase in other psychiatric symptoms.
44 citations
TL;DR: The fact that positive FTD (disorganised speech) in schizophrenia patients with AVH is equally high in non-clinical subjects withAVH indicates that these two symptoms tend to co-occur, which may be suggestive of a shared neurobiological substrate.
39 citations
TL;DR: Contrary to expectations, non-psychotic individuals with AVH show increased rather than decreased psychophysiological measures of effortful attention compared to healthy controls, refuting a pivotal role of decreased effortful Attention in the pathophysiology of AVH.
35 citations
TL;DR: In this paper, the authors provide an overview of the nomenclature and classification of auditory hallucinations, and test them empirically with the aid of the structural and functional imaging techniques currently available.
Abstract: Introduction: The literature on the possible neurobiologic correlates of auditory hallucinations is expanding rapidly. For an adequate understanding and linking of this emerging knowledge, a clear and uniform nomenclature is a prerequisite. The primary purpose of the present article is to provide an overview of the nomenclature and classification of auditory hallucinations. Materials and Methods: Relevant data were obtained from books, PubMed, Embase, and the Cochrane Library. Results: The results are presented in the form of several classificatory arrangements of auditory hallucinations, governed by the principles of content, perceived source, perceived vivacity, relation to the sleep-wake cycle, and association with suspected neurobiologic correlates. Conclusions: This overview underscores the necessity to reappraise the concepts of auditory hallucinations developed during the era of classic psychiatry, to incorporate them into our current nomenclature and classification of auditory hallucinations, and to test them empirically with the aid of the structural and functional imaging techniques currently available.
33 citations
26 citations
TL;DR: This study proposes a theoretical framework which dissects auditory verbal hallucinations into 2 essential components: audibility and alienation, which is the failure to recognize the content of AVH as self-generated.
Abstract: This study proposes a theoretical framework which dissects auditory verbal hallucinations (AVH) into 2 essential components: audibility and alienation. Audibility, the perceptual aspect of AVH, may result from a disinhibition of the auditory cortex in response to self-generated speech. In isolation, this aspect leads to audible thoughts: Gedankenlautwerden. The second component is alienation, which is the failure to recognize the content of AVH as self-generated. This failure may be related to the fact that cerebral activity associated with AVH is predominantly present in the speech production area of the right hemisphere. Since normal inner speech is derived from the left speech area, an aberrant source may lead to confusion about the origin of the language fragments. When alienation is not accompanied by audibility, it will result in the experience of thought insertion. The 2 hypothesized components are illustrated using case vignettes.
18 citations
TL;DR: Findings suggest that activity along the contralateral FEF–SC projection is responsible for directly generating anti-saccades, whereas the pathway through the BG might merely have a gating function withholding or allowing a pro- saccade.
Abstract: Almost all cortical areas in the vertebrate brain take part in recurrent connections through the subcortical basal ganglia (BG) nuclei, through parallel inhibitory and excitatory loops. It has been suggested that these circuits can modulate our reactions to external events such that appropriate reactions are chosen from many available options, thereby imposing volitional control over behavior. The saccade system is an excellent model system to study cortico-BG interactions. In this study two possible pathways were investigated that might regulate automaticity of eye movements in the human brain; the cortico-tectal pathway, running directly between the frontal eye fields (FEF) and superior colliculus (SC) and the cortico-striatal pathway from the FEF to the SC involving the caudate nucleus (CN) in the BG. In an event-related fMRI paradigm participants made pro- and anti-saccades. A DTI scan was made for reconstruction of white matter tracts between the FEF, CN and SC. DTI fiber tracts were used to divide both the left and right FEF into two sub-areas, projecting to either ipsilateral SC or CN. For each of these FEF-zones an event-related fMRI timecourse was extracted. In general activity in the FEF was larger for anti-saccades. This increase in activity was lateralized with respect to anti-saccade direction in FEF zones connected to the SC but not for zones only connected to the CN. These findings suggest that activity along the contralateral FEF-SC projection is responsible for directly generating anti-saccades, whereas the pathway through the BG might merely have a gating function withholding or allowing a pro-saccade.
TL;DR: The optimise trial is a large European study, that aims to find the best way to treat people with psychosis, using many options that are available and study new medication.
TL;DR: In this article, a gecombineerde behandelmethode for patienten with auditieve verbale hallucinaties, and bij wie medicatie niet voldoende helpt, beter te leren omgaan met hun stemmen and ze mogelijk doen verdwijnen.
Abstract: Dit artikel beschrijft een gecombineerde behandelmethode om patienten met auditieve verbale hallucinaties, en bij wie medicatie niet voldoende helpt, beter te leren omgaan met hun stemmen en ze mogelijk doen verdwijnen. Er wordt met name gekeken naar een relatief nieuwe techniek: Competitive Memory Training (COMET). Deze nieuwe methode kan op een soms verrassende manier uitkomst bieden, bijvoorbeeld door te zingen of te springen. Dit wordt geillustreerd aan de hand van drie korte gevalsbeschrijvingen. Resultaten laten zien dat de gecombineerde aanpak, dat wil zeggen psycho-educatie, groepsbijeenkomsten en individuele psychotherapie, effectief is. Door vanuit verschillende invalshoeken te focussen op het stemmen horen, helpt de stemmenpoli van het UMC Utrecht patienten met auditieve verbale hallucinaties om de ervaren last van de stemmen voor een groot deel te verminderen en bij sommigen de stemmen te doen verdwijnen.