Clinical Effects of Mindfulness-Based Intervention in Patients With First Episode Psychosis and in Individuals With Ultra-High Risk for Transition to Psychosis: A Review.

Objectives: Recent clinical studies and meta-analyses have reported the clinical effects of mindfulness-based interventions as a complementary treatment for patients with schizophrenia, but their possible efficacy in patients with first episode of psychosis (FEP) and in individuals with ultra-high risk (UHR) of transition to psychosis is less clear. Here, we investigated the current evidence on the usefulness of mindfulness-based interventions in these two populations. Methods: We conducted a systematic search of the literature according to the PRISMA guidelines. Results: Among the 102 references retrieved, 9 responded to the inclusion criteria (8 in FEP patients and 1 in UHR individuals). In FEP patients, mindfulness interventions are well-tolerated and have a satisfactory level of adherence. The clinical benefits consist primarily of reduced anxiety and sadness and improved quality of life. None of the studies reported any increase in positive symptoms. Conclusion: Future sham-controlled studies with large sample sizes are needed to definitively conclude on the clinical interest of mindfulness-based interventions in FEP patients and UHR individuals as well as to understand their underlying mechanisms of action.

Reality-monitoring deficits and visual hallucinations in schizophrenia.

The presence of visual hallucinations in addition to auditory hallucinations (V + AH) is associated with poor prognosis in patients with schizophrenia. However, little consideration has been given to these symptoms and their underlying cognitive bases remain unclear. Based on cognitive models of hallucinations, we hypothesized that V + AH are underpinned by an impairment in reality-monitoring processes. The objective of the present study was to test whether reality-monitoring deficits were associated with V + AH in schizophrenia. This study examined reality-monitoring abilities in two groups of patients with schizophrenia: a group of patients with V + AH (n = 24) and a group of patients with AH only (n = 22). Patients with V + AH were significantly more likely to misremember imagined words as being perceived from an external source, compared to patients with AH only (p = 0.008, d = -0.82). In other words, V + AH patients display a larger externalization bias than patients with AH only. One explanation for these results could be that experiencing hallucinations in two sensory modalities may contribute to increased vividness of mental imagery and, in turn, lead to disruption in reality-monitoring processes. This study helps to refine our understanding of the cognitive processes underlying the presence of both auditory and visual hallucinations in patients with schizophrenia.

[Other therapeutic strategies]. / Dépression résistante : les autres stratégies thérapeutiques.

Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.

Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia.

OBJECTIVE: Some 25%­30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. Outcomes in studies of repetitive transcranial magnetic stimulation suggest the possibility that application of transcranial direct-current stimulation (tDCS) with inhibitory stimulation over the left temporo-parietal cortex and excitatory stimulation over the left dorsolateral prefrontal cortex could affect hallucinations and negative symptoms, respectively. The authors investigated the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms. METHOD: Thirty patients with schizophrenia and medication-refractory auditory verbal hallucinations were randomly allocated to receive 20 minutes of active 2-mA tDCS or sham stimulation twice a day on 5 consecutive weekdays. The anode was placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex. RESULTS: Auditory verbal hallucinations were robustly reduced by tDCS relative to sham stimulation, with a mean diminution of 31% (SD=14; d=1.58, 95% CI=0.76­2.40). The beneficial effect on hallucinations lasted for up to 3 months. The authors also observed an amelioration with tDCS of other symptoms as measured by the Positive and Negative Syndrome Scale (d=0.98, 95% CI=0.22­1.73), especially for the negative and positive dimensions. No effect was observed on the dimensions of disorganization or grandiosity/excitement. CONCLUSIONS: Although this study is limited by the small sample size, the results show promise for treating refractory auditory verbal hallucinations and other selected manifestations of schizophrenia.