Letters to the Editor / Brain Stimulation 8 (2014) 160e167
Department of Psychology and Neuroscience, Duke University, NC 27708, USA David L.K. Murphy Brain Stimulation and Neurophysiology, Psychiatry and Behavioral Science, Duke University, Durham, NC 27710, USA Rebecca J. Price Gwendolyn O’Grady Speech Pathology and Audiology, Department of Surgery, Duke University, Durham, NC 27710, USA Angel V. Peterchev Brain Stimulation and Neurophysiology, Psychiatry and Behavioral Science, Duke University, Durham, NC 27710, USA Department of Biomedical Engineering, Duke University, NC 27708, USA Department of Electrical and Computer Engineering, Duke University, NC 27708, USA * Corresponding
author. Duke University, Box #3620, Durham, NC 27710, USA. Tel.: þ1 919 613 0322. E-mail addresses: [email protected], [email protected] (S.M. Goetz) Received 27 August 2014 Available online 24 November 2014
http://dx.doi.org/10.1016/j.brs.2014.10.010
References [1] Dhamne SC, Kothare RS, Yu C, et al. A measure of acoustic noise generated from transcranial magnetic stimulation coils. Brain Stimul 2014;7:432e4. [2] Counter SA, Borg E. Analysis of the coil generated impulse noise in extracranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 1992;85:280e8. [3] Goetz SM, Murphy DLK, Peterchev A. 2013, unpublished data. [4] Goetz SM, Murphy DLK, Peterchev AV. Transcranial magnetic stimulation device with reduced acoustic noise. IEEE Magn Lett 2014;5:1500104. [5] Nikouline V, Ruohonen J, Ilmoniemi RJ. The role of the coil click in TMS assessed with simultaneous EEG. Clin Neurophysiol 1999;110:1325e8. [6] Stenfelt S, Goode RL. Bone-conducted sound: physiological and clinical aspects. Otol Neurotol Nov 2005;26:1245e61. [7] Henderson D, Hamernik RP. Impulse noise: critical review. J Acoust Soc Am 1986;80:569e84. [8] National Institute for Occupational Safety and Health, www.cdc.gov/niosh. [9] American Conference of Governmental Industrial Hygienists, www.acgih.org. [10] Zangen A, Roth Y, Voller B, Hallett M. Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil. Clin Neurophysiol 2005;116:775e9. [11] Loo C, Sachdev P, Elsayed H, et al. Effects of a 2- to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychologic functioning, electroencephalogram, and auditory threshold in depressed patients. Biol Psychiatry 2001;49:615e23. [12] Pascual-Leone A, Houser CM, Reese K, et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalogr Clin Neurophysiol 1993;89:120e30. [13] Ward WD. Studies on the aural reflex. III. Reflex latency as inferred from reduction of temporary threshold shift from impulses. J Acoust Soc Am 1962;34:1132e7. [14] Tringali S, Perrot X, Collet L, Moulin A. Repetitive transcranial magnetic stimulation (rTMS) noise: a relevance for tinnitus treatment? Brain Stimul 2012;5: 655e6. [15] Personal Communication, Dr Mark Demitrack, Vice President and Chief Medical Officer of Neuronetics, Inc., Oct 1, 2007 and Jul 9, 2014.
163
[16] George MS. Transcranial magnetic stimulation for the treatment of depression. Expert Rev Neurother 2010;10:1761e72. [17] Personal Communication, Dr. Sarah H. Lisanby, Jun 6, 2014. [18] Nondahl DM, Cruickshanks KJ, Wiley TL, et al. The 10-year incidence of tinnitus among older adults. Int J Audiol 2010;49:580e5. [19] Davis A, Davis K, Smith P. The prevalence of deafness and hearing impairment. In: Graham JM, Baguley DM, editors. Ballantyne’s deafness. 4th ed. Chichester, West Sussex: John Wiley & Sons; 2009. p. 6e19. [20] Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med 2010;123:711e8. [21] Siebner HR, Peller M, Willoch F, et al. Imaging functional activation of the auditory cortex during focal repetitive transcranial magnetic stimulation of the primary motor cortex in normal subjects. Neurosci Lett 1999;270: 37e40. [22] Bestmann S, Baudewig J, Siebner HR, Rothwell JC, Frahm J. BOLD MRI responses to repetitive TMS over human dorsal premotor cortex. Neuroimage 2005;28:22e9. [23] Clapp WC, Kirk IJ, Hamm JP, Shepherd D, Teyler TJ. Induction of LTP in the human auditory cortex by sensory stimulation. Eur J Neurosci 2005;22: 1135e40. [24] Zaehle T, Clapp WC, Hamm JP, Meyer M, Kirk IJ. Induction of LTP-like changes in human auditory cortex by rapid auditory stimulation: an FMRI study. Restor Neurol Neurosci 2007;25:251e9. [25] Mears RP, Spencer KM. Electrophysiological assessment of auditory stimulusspecific plasticity in schizophrenia. Biol Psychiatry 2012;71:503e11. [26] Clapp WC, Hamm JP, Kirk IJ, Teyler TJ. Translating long-term potentiation from animals to humans: a novel method for noninvasive assessment of cortical plasticity. Biol Psychiatry 2012;71:496e502. [27] Fastl H, Zwicker E. Psychoacoustics: facts and models. 3rd ed. Berlin, New York: Springer; 2007. [28] Schecklmann M, Volberg G, Frank G, et al. Paired associative stimulation of the auditory system: a proof-of-principle study. PLoS One 2011;6:e27088. [29] Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120: 2008e39.
Transcranial Direct Current Stimulation (tDCS) for Auditory Verbal Hallucinations in Schizophrenia During Pregnancy: A Case Report
To the Editor: Treatment of psychotic symptoms during pregnancy is mandatory since untreated mental illness can adversely impact the mothereinfant pair [1]. However, treatment of a pregnant mother with antipsychotics, the mainstay for schizophrenia treatment, is associated with increased risk for neonatal complications [1]. Transcranial Direct Current Stimulation (tDCS), a re-emerging brain stimulation technique with optimized application parameters, has been proposed as a safe treatment option for pregnant women with psychiatric disorders [2]. Moreover, recent studies offer initial support for its utility in treating schizophrenia [3,4]. In this letter, we report a successful application of tDCS to treat relapse of schizophrenia in a pregnant woman. Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) with the illness being characterized predominantly by auditory verbal hallucinations that were non-responsive to several trials of different antipsychotic medications over the past 9-years. Since 2004, she had been treated with adequate trials of risperidone, olanzapine, clozapine amisulpride and aripiprazole with no significant improvement. She did not tolerate other antipsychotics (quetiapine, paliperidone, haloperidol,
164
Letters to the Editor / Brain Stimulation 8 (2014) 160e167
and flupenthixol). She presented to us in august 2013 with persistent auditory verbal hallucinations and was being treated with 12-mg of iloperidone per day. She was initially treated with addon tDCS as a part of ongoing research study that led to near-total improvement in hallucinations [5]. During the subsequent one year period, she continued to maintain the clinical improvement and was on treatment with iloperidone 12-mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with iloperidone. She reported auditory verbal hallucinations characterized by multiple conversing voices with derogatory content with a score of 29 as assessed by auditory hallucinations subscale [6]. She did not have any medical/obstetric problems as ascertained by a detailed history, comprehensive physical examination and blood investigations (fasting blood sugar, fasting lipid profile, liver/renal function tests). Ultrasound of the abdomen revealed single live intrauterine gestation (18-weeks); overall the pregnancy was without any risks/abnormalities as confirmed by an obstetrician. In view of previous clinical benefit, after a detailed discussion with the patient and her family, she was treated with add-on tDCS with written informed consent. tDCS was delivered using a standard equipment (TCT device model number M101-R-2012-V1.3; www.trans-cranial.com) as per previous description [4] with stringent safety measures [7]. The anode was placed with the middle of the electrode over a point midway between F3 and FP1 (left dorsolateral prefrontal cortex) and the cathode was located over a point midway between T3 and P3 (left temporo-parietal junction) [4]. The stimulation level was set at 2 mA for 20 min. During the tDCS sessions, the patient was comfortably seated and did not perform any activity. The sessions were conducted twice a day (separated by at least 3 h) for 5 consecutive days [4]. The patient tolerated tDCS well without any significant adverse effect as ascertained by a structured questionnaire after each session [7]. Baseline AHRS score was obtained 1 h prior to the first tDCS session. The improvement was measured by periodically interviewing the patient as well as the family members. Immediately after 5-days of add-on tDCS, auditory hallucinations score reduced to 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. During the follow-up assessment at one month after tDCS (last week of September 2014), the auditory hallucination score was 2. Repeat sonography at this time showed healthy fetus (22 weeks) without any abnormalities and the pregnancy was uneventful as ascertained again by an obstetrician. To the best of our knowledge, this is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia. Add-on tDCS in this patient resulted in near-total improvement of the exacerbation of auditory verbal hallucinations during pregnancy. Also, tDCS was tolerated very well by our patient. This is in tune with the encouraging safety profile of tDCS that in laboratories across the world, no major adverse events have been reported so far in 2000 to 3000 human subjects [8]. In addition, tDCS did not cause any significant changes in autonomic function, ventilation rate or core body temperature in healthy volunteers [9]. All these strongly suggest that brain stimulation using tDCS is unlikely to result in any significant risk to fetus; indeed, implicated upon this, a randomized controlled trial has been initiated in July 2014 to evaluate feasibility of a trial for administering tDCS among pregnant women with moderate to severe depression [2]. In this context, similar studies in schizophrenia will help rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients to establish non-invasive and safer alternative to antipsychotic treatment in this special population.
This work is supported by as the Department of Science and Technology (Government of India) Research Grant (SR/CSI/158/2012) to GV. AB and SMA are supported by the Wellcome Trust/DBT India Alliance (500236/Z/11/Z). HC & JCN are supported by the Department of Science & Technology, Government of India (SR/CSI/158/ 2012). VS is supported by the Department of Biotechnology, Government of India (BT/PR5322/COE/34/8/2012). Conflict of interest: There are no potential conflicts of interest to report for any of the authors.
Sonia Shenoy Anushree Bose Harleen Chhabra Damodharan Dinakaran Sri Mahavir Agarwal Venkataram Shivakumar Janardhanan C. Narayanaswamy Palanimuthu T. Sivakumar Ganesan Venkatasubramanian Additional Professor and Wellcome Trust/DBT India Alliance Senior Fellow* The Schizophrenia Clinic, Department of Psychiatry, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India * Corresponding
author. Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India. E-mail addresses: [email protected], [email protected] (G. Venkatasubramanian) Received 3 October 2014 Available online 20 November 2014
http://dx.doi.org/10.1016/j.brs.2014.10.013
References [1] Gentile S. Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophr Bull 2010;36:518e44. [2] Vigod S, Dennis CL, Daskalakis Z, et al. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014;15:366. [3] Bose A, Shivakumar V, Narayanaswamy JC, et al. Insight facilitation with add-on tDCS in schizophrenia. Schizophr Res 2014;156:63e5. [4] Brunelin J, Mondino M, Gassab L, et al. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am J Psychiatry 2012;169:719e24. [5] Agarwal SM, Bose A, Shivakumar V, et al. Impact of antipsychotic medication on tDCS effects in schizophrenia patients. In: International Conference on Schizophrenia (ICONS-VI). Chennai, India; 2014. [6] Haddock G, McCarron J, Tarrier N, Faragher EB. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med 1999;29:879e89. [7] Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol 2011;14: 1133e45. [8] Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Exp Neurol 2009;219: 14e9. [9] Raimundo RJ, Uribe CE, Brasil-Neto JP. Lack of clinically detectable acute changes on autonomic or thermoregulatory functions in healthy subjects after transcranial direct current stimulation (tDCS). Brain Stimul 2012;5: 196e200.
Department of Psychology and Neuroscience, Duke University, NC 27708, USA David L.K. Murphy Brain Stimulation and Neurophysiology, Psychiatry and Behavioral Science, Duke University, Durham, NC 27710, USA Rebecca J. Price Gwendolyn O’Grady Speech Pathology and Audiology, Department of Surgery, Duke University, Durham, NC 27710, USA Angel V. Peterchev Brain Stimulation and Neurophysiology, Psychiatry and Behavioral Science, Duke University, Durham, NC 27710, USA Department of Biomedical Engineering, Duke University, NC 27708, USA Department of Electrical and Computer Engineering, Duke University, NC 27708, USA * Corresponding
author. Duke University, Box #3620, Durham, NC 27710, USA. Tel.: þ1 919 613 0322. E-mail addresses: [email protected], [email protected] (S.M. Goetz) Received 27 August 2014 Available online 24 November 2014
http://dx.doi.org/10.1016/j.brs.2014.10.010
References [1] Dhamne SC, Kothare RS, Yu C, et al. A measure of acoustic noise generated from transcranial magnetic stimulation coils. Brain Stimul 2014;7:432e4. [2] Counter SA, Borg E. Analysis of the coil generated impulse noise in extracranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 1992;85:280e8. [3] Goetz SM, Murphy DLK, Peterchev A. 2013, unpublished data. [4] Goetz SM, Murphy DLK, Peterchev AV. Transcranial magnetic stimulation device with reduced acoustic noise. IEEE Magn Lett 2014;5:1500104. [5] Nikouline V, Ruohonen J, Ilmoniemi RJ. The role of the coil click in TMS assessed with simultaneous EEG. Clin Neurophysiol 1999;110:1325e8. [6] Stenfelt S, Goode RL. Bone-conducted sound: physiological and clinical aspects. Otol Neurotol Nov 2005;26:1245e61. [7] Henderson D, Hamernik RP. Impulse noise: critical review. J Acoust Soc Am 1986;80:569e84. [8] National Institute for Occupational Safety and Health, www.cdc.gov/niosh. [9] American Conference of Governmental Industrial Hygienists, www.acgih.org. [10] Zangen A, Roth Y, Voller B, Hallett M. Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil. Clin Neurophysiol 2005;116:775e9. [11] Loo C, Sachdev P, Elsayed H, et al. Effects of a 2- to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychologic functioning, electroencephalogram, and auditory threshold in depressed patients. Biol Psychiatry 2001;49:615e23. [12] Pascual-Leone A, Houser CM, Reese K, et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalogr Clin Neurophysiol 1993;89:120e30. [13] Ward WD. Studies on the aural reflex. III. Reflex latency as inferred from reduction of temporary threshold shift from impulses. J Acoust Soc Am 1962;34:1132e7. [14] Tringali S, Perrot X, Collet L, Moulin A. Repetitive transcranial magnetic stimulation (rTMS) noise: a relevance for tinnitus treatment? Brain Stimul 2012;5: 655e6. [15] Personal Communication, Dr Mark Demitrack, Vice President and Chief Medical Officer of Neuronetics, Inc., Oct 1, 2007 and Jul 9, 2014.
163
[16] George MS. Transcranial magnetic stimulation for the treatment of depression. Expert Rev Neurother 2010;10:1761e72. [17] Personal Communication, Dr. Sarah H. Lisanby, Jun 6, 2014. [18] Nondahl DM, Cruickshanks KJ, Wiley TL, et al. The 10-year incidence of tinnitus among older adults. Int J Audiol 2010;49:580e5. [19] Davis A, Davis K, Smith P. The prevalence of deafness and hearing impairment. In: Graham JM, Baguley DM, editors. Ballantyne’s deafness. 4th ed. Chichester, West Sussex: John Wiley & Sons; 2009. p. 6e19. [20] Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med 2010;123:711e8. [21] Siebner HR, Peller M, Willoch F, et al. Imaging functional activation of the auditory cortex during focal repetitive transcranial magnetic stimulation of the primary motor cortex in normal subjects. Neurosci Lett 1999;270: 37e40. [22] Bestmann S, Baudewig J, Siebner HR, Rothwell JC, Frahm J. BOLD MRI responses to repetitive TMS over human dorsal premotor cortex. Neuroimage 2005;28:22e9. [23] Clapp WC, Kirk IJ, Hamm JP, Shepherd D, Teyler TJ. Induction of LTP in the human auditory cortex by sensory stimulation. Eur J Neurosci 2005;22: 1135e40. [24] Zaehle T, Clapp WC, Hamm JP, Meyer M, Kirk IJ. Induction of LTP-like changes in human auditory cortex by rapid auditory stimulation: an FMRI study. Restor Neurol Neurosci 2007;25:251e9. [25] Mears RP, Spencer KM. Electrophysiological assessment of auditory stimulusspecific plasticity in schizophrenia. Biol Psychiatry 2012;71:503e11. [26] Clapp WC, Hamm JP, Kirk IJ, Teyler TJ. Translating long-term potentiation from animals to humans: a novel method for noninvasive assessment of cortical plasticity. Biol Psychiatry 2012;71:496e502. [27] Fastl H, Zwicker E. Psychoacoustics: facts and models. 3rd ed. Berlin, New York: Springer; 2007. [28] Schecklmann M, Volberg G, Frank G, et al. Paired associative stimulation of the auditory system: a proof-of-principle study. PLoS One 2011;6:e27088. [29] Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120: 2008e39.
Transcranial Direct Current Stimulation (tDCS) for Auditory Verbal Hallucinations in Schizophrenia During Pregnancy: A Case Report
To the Editor: Treatment of psychotic symptoms during pregnancy is mandatory since untreated mental illness can adversely impact the mothereinfant pair [1]. However, treatment of a pregnant mother with antipsychotics, the mainstay for schizophrenia treatment, is associated with increased risk for neonatal complications [1]. Transcranial Direct Current Stimulation (tDCS), a re-emerging brain stimulation technique with optimized application parameters, has been proposed as a safe treatment option for pregnant women with psychiatric disorders [2]. Moreover, recent studies offer initial support for its utility in treating schizophrenia [3,4]. In this letter, we report a successful application of tDCS to treat relapse of schizophrenia in a pregnant woman. Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) with the illness being characterized predominantly by auditory verbal hallucinations that were non-responsive to several trials of different antipsychotic medications over the past 9-years. Since 2004, she had been treated with adequate trials of risperidone, olanzapine, clozapine amisulpride and aripiprazole with no significant improvement. She did not tolerate other antipsychotics (quetiapine, paliperidone, haloperidol,
164
Letters to the Editor / Brain Stimulation 8 (2014) 160e167
and flupenthixol). She presented to us in august 2013 with persistent auditory verbal hallucinations and was being treated with 12-mg of iloperidone per day. She was initially treated with addon tDCS as a part of ongoing research study that led to near-total improvement in hallucinations [5]. During the subsequent one year period, she continued to maintain the clinical improvement and was on treatment with iloperidone 12-mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with iloperidone. She reported auditory verbal hallucinations characterized by multiple conversing voices with derogatory content with a score of 29 as assessed by auditory hallucinations subscale [6]. She did not have any medical/obstetric problems as ascertained by a detailed history, comprehensive physical examination and blood investigations (fasting blood sugar, fasting lipid profile, liver/renal function tests). Ultrasound of the abdomen revealed single live intrauterine gestation (18-weeks); overall the pregnancy was without any risks/abnormalities as confirmed by an obstetrician. In view of previous clinical benefit, after a detailed discussion with the patient and her family, she was treated with add-on tDCS with written informed consent. tDCS was delivered using a standard equipment (TCT device model number M101-R-2012-V1.3; www.trans-cranial.com) as per previous description [4] with stringent safety measures [7]. The anode was placed with the middle of the electrode over a point midway between F3 and FP1 (left dorsolateral prefrontal cortex) and the cathode was located over a point midway between T3 and P3 (left temporo-parietal junction) [4]. The stimulation level was set at 2 mA for 20 min. During the tDCS sessions, the patient was comfortably seated and did not perform any activity. The sessions were conducted twice a day (separated by at least 3 h) for 5 consecutive days [4]. The patient tolerated tDCS well without any significant adverse effect as ascertained by a structured questionnaire after each session [7]. Baseline AHRS score was obtained 1 h prior to the first tDCS session. The improvement was measured by periodically interviewing the patient as well as the family members. Immediately after 5-days of add-on tDCS, auditory hallucinations score reduced to 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. During the follow-up assessment at one month after tDCS (last week of September 2014), the auditory hallucination score was 2. Repeat sonography at this time showed healthy fetus (22 weeks) without any abnormalities and the pregnancy was uneventful as ascertained again by an obstetrician. To the best of our knowledge, this is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia. Add-on tDCS in this patient resulted in near-total improvement of the exacerbation of auditory verbal hallucinations during pregnancy. Also, tDCS was tolerated very well by our patient. This is in tune with the encouraging safety profile of tDCS that in laboratories across the world, no major adverse events have been reported so far in 2000 to 3000 human subjects [8]. In addition, tDCS did not cause any significant changes in autonomic function, ventilation rate or core body temperature in healthy volunteers [9]. All these strongly suggest that brain stimulation using tDCS is unlikely to result in any significant risk to fetus; indeed, implicated upon this, a randomized controlled trial has been initiated in July 2014 to evaluate feasibility of a trial for administering tDCS among pregnant women with moderate to severe depression [2]. In this context, similar studies in schizophrenia will help rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients to establish non-invasive and safer alternative to antipsychotic treatment in this special population.
This work is supported by as the Department of Science and Technology (Government of India) Research Grant (SR/CSI/158/2012) to GV. AB and SMA are supported by the Wellcome Trust/DBT India Alliance (500236/Z/11/Z). HC & JCN are supported by the Department of Science & Technology, Government of India (SR/CSI/158/ 2012). VS is supported by the Department of Biotechnology, Government of India (BT/PR5322/COE/34/8/2012). Conflict of interest: There are no potential conflicts of interest to report for any of the authors.
Sonia Shenoy Anushree Bose Harleen Chhabra Damodharan Dinakaran Sri Mahavir Agarwal Venkataram Shivakumar Janardhanan C. Narayanaswamy Palanimuthu T. Sivakumar Ganesan Venkatasubramanian Additional Professor and Wellcome Trust/DBT India Alliance Senior Fellow* The Schizophrenia Clinic, Department of Psychiatry, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India * Corresponding
author. Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India. E-mail addresses: [email protected], [email protected] (G. Venkatasubramanian) Received 3 October 2014 Available online 20 November 2014
http://dx.doi.org/10.1016/j.brs.2014.10.013
References [1] Gentile S. Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophr Bull 2010;36:518e44. [2] Vigod S, Dennis CL, Daskalakis Z, et al. Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomized controlled trial. Trials 2014;15:366. [3] Bose A, Shivakumar V, Narayanaswamy JC, et al. Insight facilitation with add-on tDCS in schizophrenia. Schizophr Res 2014;156:63e5. [4] Brunelin J, Mondino M, Gassab L, et al. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am J Psychiatry 2012;169:719e24. [5] Agarwal SM, Bose A, Shivakumar V, et al. Impact of antipsychotic medication on tDCS effects in schizophrenia patients. In: International Conference on Schizophrenia (ICONS-VI). Chennai, India; 2014. [6] Haddock G, McCarron J, Tarrier N, Faragher EB. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med 1999;29:879e89. [7] Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol 2011;14: 1133e45. [8] Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Exp Neurol 2009;219: 14e9. [9] Raimundo RJ, Uribe CE, Brasil-Neto JP. Lack of clinically detectable acute changes on autonomic or thermoregulatory functions in healthy subjects after transcranial direct current stimulation (tDCS). Brain Stimul 2012;5: 196e200.
