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EV1239

Improvement in auditory hallucinations in schizophrenia with neuromodulation: through the lens of source monitoring and the Talk/Listen task

NEUROMODULATION-DRIVEN IMPROVEMENT IN AUDITORY HALLUCINATIONS IN SCHIZOPHRENIA: IN THE LENS OF SOURCE MONITORING AND TALK/LISTEN TASK.

With neuromodulation administered twice daily for fifteen days, tDCS produced greater reductions in auditory hallucination severity and externalizing bias than cTBS-rTMS.

Persistent auditory verbal hallucinations (AVH) may reflect the misattribution of self-generated speech; reality monitoring (RM) and corollary discharge (CD) are complementary markers of this mechanism. The study compared the effects of cTBS-rTMS and tDCS on hallucination severity and examined whether changes in RM or CD tracked clinical improvement. Forty patients with treatment-resistant AVH and 40 healthy controls were recruited for the baseline comparison. The 40 patients were randomized to two arms of 20 participants each and received neuromodulation twice daily for 15 days (1,800 pulses to the left temporoparietal junction plus sham tDCS in the cTBS-rTMS arm; conventional frontotemporal stimulation plus sham intermittent theta burst stimulation in the tDCS arm); 17 cTBS-rTMS and 18 tDCS participants completed post-treatment testing, and the intention-to-treat mixed-model repeated-measures analysis used 75 observations from 40 participants. The primary outcome was the Auditory Hallucination Rating Scale (AHRS); secondary measures were externalizing bias (EB) and internalizing bias (IB) for RM, and N1 amplitude and the corollary discharge index (CDI = N1 Talk minus N1 Listen) in the Talk/Listen task. AHRS scores decreased from 33.50 to 27.70 in the cTBS-rTMS arm (change −5.80, p < 0.001) and from 32.40 to 23.50 in the tDCS arm (change −8.90, p < 0.001); tDCS produced an additional reduction of 3.14 points (SE 0.54; p < 0.001), and post-treatment AHRS scores were 4.24 points lower with tDCS (p < 0.001). EB decreased more with tDCS (group-by-time interaction beta = −0.168, p < 0.001), whereas IB remained unchanged (p = 0.360); the correlation between changes in AHRS and EB was r = 0.599 (p = 0.011) in the cTBS-rTMS arm and r = 0.479 (p = 0.045) in the tDCS arm. N1 amplitude was more negative in the Listen condition than in the Talk condition (beta = −1.44, p < 0.001), but no treatment-related change in CDI was detected (three-way interaction p = 0.368). According to the authors, tDCS produces greater reductions in AVH and EB, with RM reflecting a state-like impairment that tracks symptom improvement and CDI reflecting a trait-like impairment associated with vulnerability.

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