Continuous Theta Burst Stimulation for Treating Auditory Verbal Hallucinations in Schizophrenia

For this study, patients with schizophrenia with auditory verbal hallucinations who had inadequate response to at least 1 antipsychotic drug were recruited.

Continuous theta burst stimulation (cTBS) targeting the bilateral temporoparietal cortex (TPC) was safe and effective at treating auditory verbal hallucinations (AVH) in schizophrenia, according to results of a study, published in the Asian Journal of Psychiatry.

Patients with schizophrenia (N=59) with AVH who had inadequate response to at least 1 antipsychotic drug were recruited at Sri Guru Ram Rai Institute of Medical and Health Sciences in India. Patients were randomized to receive cTBS (n=30) or sham therapy (n=29). cTBS was administered during a 2-week hospital stay and delivered using a Mag Ventrue-MagPro R30 device and comprised 3-pulse bursts at 50 Hz every 200 ms.

Each patient received a total of 20 cTBS or sham sessions given twice daily 5 days per week. Symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS), the Auditory Vocal Hallucination Rating Scale (AVHRS), the Psychiatric Symptoms Rating Scale-Auditory Hallucinations Scale (PSYRAT-AH), the Schizophrenia Cognition Rating Scale (SCoRS), and the Calgary Depression Scale for Schizophrenia (CDSS).

The intervention and control cohorts were aged mean 32.17±11.222 and 33.31±11.480 years, the duration of illness was 7.450±7.97 and 7.897±10.09 years, and 21 and 17 of the patients were men, respectively.

Significant group by time interactions were observed for PANSS positive symptoms (F, 32,761; P <.001), PANSS negative symptoms (F, 6.606; P <.001), PANSS general psychopathology (F, 13.658; P <.001), PANSS-total (F, 25.488; P <.001), AVHRS (F, 21.327; P <.001), PSYRAT-AH (F, 13.129; P <.001), CDSS (F, 11.495; P <.001), SCoRS patient scores (F, 5.295; P =.014), SCoRS interviewer scores (F, 18.798; P <.001), SCoRS informant scores (F, 5.268; P =.017).

In the final analysis, however, after covariates were included, PANSS, CDSS, and SCoRS scores were no longer significant.

In total, 16.67% of patients responded to treatment compared with 3.45% of the control group.

A total of 5 in the active and 4 in the sham cohorts reported headache during the initial treatment sessions.

This study was limited by its small sample size and short duration. It remains unclear whether cTBS of the TPC may be an effective long-term therapy for AVH among patients with schizophrenia.

“We conclude that intensive bilateral TPC cTBS in schizophrenia is safe and effective in ameliorating AVH in schizophrenia. Therefore, long-term bilateral TPC inhibitory TBS protocol needs to be considered for AVH in future trials,” stated the study authors.


Tyagi P, Dhyani M, Khattri S, Tejan V, Tikka SK, Garg S. Efficacy of intensive bilateral temporo-parietal continuous theta-burst stimulation for auditory verbal hallucinations (TPC-SAVE) in schizophrenia: a randomized sham-controlled trial. Asian J Psychiatr. 2022;74:103176. doi:10.1016/j.ajp.2022.103176