![]() Likewise, the percentage of subjects with at least mild levels of hallucinations decreased strongly over time from 100% at baseline to 8% after 12 months of treatment. The severity of hallucinations continued to decline with prolonged treatment to mean values of around 1.5, reflecting the presence of absent to minimal hallucinations after 6 months of treatment (see figure 1). A mean reduction in the severity of hallucinations from 4.4 at baseline, indicating marked to severe hallucinations, to a mean value of 2.5, indicating minimal to mild hallucinations, was found after 4 weeks. Even though 54% of the patients discontinued treatment within 12 months, unbiased parameter estimates were obtained under the assumption of Missing at Random. 1 We reanalyzed these data with item P3 (severity of hallucinations) of the Positive and Negative Syndrome Scale, 2 as the primary outcome measure.Īll subjects with a score of 3 or higher at baseline (indicating at least mild hallucinations) were included ( N = 362 73% of the total sample). ![]() The reduction in total symptom severity was virtually the same in all groups, around 60% after 12 months of treatment, but differences were observed in the discontinuation rate, which was higher for haloperidol and lower for amisulpride and olanzapine. The EUFEST study 1 included 498 patients with a first-psychotic episode, who were randomized to receive haloperidol, olanzapine, amisulpride, quetiapine, or ziprasidone. Therefore, we used the data from the European First-Episode Schizophrenia Trial (EUFEST) to assess the potential of 5 antipsychotic agents to reduce the severity of hallucinations. So far, no clinical trials have been published that compare the efficacy of various antipsychotic drugs for the sole and specific indication of hallucinations. The only type of medication known to effectively reduce the frequency and severity of hallucinations in schizophrenia spectrum disorders is antipsychotic medication. Pharmacological Treatment of Hallucinations in Schizophrenia Spectrum Disorders Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. ![]() Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. ![]() Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. Depot medication should be considered for all patients because nonadherence is high. For relapse prevention, medication should be continued in the same dose. Blood levels should be above 350–450 μg/ml for maximal effect. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2–4 weeks of treatment. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. This article reviews the treatment of hallucinations in schizophrenia.
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