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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO101

An open-label pilot study of a novel theta-burst rTMS protocol targeting treatment-resistant auditory verbal hallucinations

A PILOT OPEN-LABEL STUDY OF A NOVEL THETA BURST RTMS PROTOCOL TARGETING TREATMENT-RESISTANT AUDITORY VERBAL HALLUCINATIONS

All five patients who completed treatment showed improvements in auditory verbal hallucination severity and overall psychopathology both at the end of treatment and at the one-month follow-up; however, given the very small sample, the findings are hypothesis-generating rather than evidence of efficacy.

The aim is to describe preliminary clinical changes and within-person effect sizes associated with a 10-day sequential protocol involving inhibitory continuous theta-burst stimulation (cTBS) to the bilateral temporoparietal junction (TPJ), followed by excitatory intermittent theta-burst stimulation (iTBS) to the left dorsolateral prefrontal cortex (DLPFC), for auditory verbal hallucinations (AVH) resistant to antipsychotic treatment. This is an open-label, single-arm pilot study with pre- and post-treatment assessments and no sham control; although the planned sample was 12 participants, 7 began treatment, 2 withdrew consent after the first session, and the 5 who completed all 20 sessions were included in the current analysis. Treatment consisted of 2 sessions daily for 10 days, with 2,400 pulses per session (48,000 pulses in total): cTBS to the TPJ (900 pulses on the left and 900 on the right, at 90% of the resting motor threshold) and iTBS to the left DLPFC (600 pulses at 120% of the threshold), with targeting based on the EEG 10–20 system, using a MagPro device and a B-70 coil. Assessments were conducted at baseline (T0), the end of treatment (T1), and the one-month follow-up (T2); the primary measure was PSYRATS-AH, and secondary measures were PANSS and SSTICS for subjective cognitive complaints. Within-person standardized changes were reported using Hedges' gz. The PSYRATS-AH total score decreased from 30.8 to 26.0 at T1 and 23.2 at T2 (mean reduction from baseline: 16% at T1 and 25% at T2); gz was 2.14 from T0 to T1 (95% confidence interval 0.55 to 3.71) and 0.94 from T0 to T2 (95% confidence interval −0.03 to 1.85). The PANSS total score decreased from 70.0 to 60.4 at T1 and 62.6 at T2 (gz of 1.19 [0.11; 2.22] and 1.94 [0.46; 3.39], respectively); subscale scores changed from 13.8 to 12.0 and 11.8 for negative symptoms (improvement in 5/5 participants at both assessments), from 18.2 to 16.6 and 17.0 for positive symptoms (3/5), and from 38.0 to 31.8 and 33.8 for general psychopathology (4/5), while SSTICS scores changed from 30.4 to 24.2 at T1 (5/5; no T2 data). Reported effect sizes were 0.62 and 0.87 for PANSS positive symptoms, 1.72 and 1.60 for PANSS negative symptoms, 1.00 and 1.02 for PANSS general psychopathology, and 1.34 for SSTICS. The authors note that, with n=5 paired observations, the smallest attainable p-value in a two-sided exact Wilcoxon signed-rank test is 0.0625; therefore, effect sizes, confidence intervals, and individual trajectories were emphasized rather than significance testing. In conclusion, although the protocol appears feasible, the findings do not provide evidence of efficacy because of the very small completer sample, the open-label uncontrolled design, and the withdrawal of 2 of the 7 participants; they are considered hypothesis-generating for a controlled study. Rather than the preliminary data for n=7 reported in the abstract, the current analysis presented in the poster is based on 5 completers.

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