The release focuses on research presented at a conference that found a third of patients who have schizophrenia and experience auditory verbal hallucinations (AVHs) — meaning they hear voices — responded favorably to transcranial magnetic stimulation (TMS) of a specific region of the brain. The release notes that the finding is valuable for two reasons: because it points to a specific region of the brain associated with AVHs in schizophrenia patients; and because it is a controlled trial for a treatment technique that has been discussed for years but was lacking clinical evidence one way or the other.
The release does a fair job of articulating the importance of the new findings and placing them in context. However, more information on related costs and risks would be valuable. More importantly, the release refers to research that is not published, and is therefore not yet publicly available. The public would be better served if the release had been pushed out only when the relevant research was also publicly available, so that interested parties — including healthcare professionals — could assess the research itself.
According to the National Institute of Mental Health, schizophrenia affects about 1 percent of the U.S. population. And approximately three-quarters of patients with schizophrenia report AVHs. In short, this is a health problem that affects a great many people. New findings that advance our understanding of what causes AVHs, and new treatments to help us address them, are certainly worthy of interest.
It’s important to keep in mind that this research targets just one symptom of schizophrenia — auditory hallucinations (or hearing voices). This symptom may not be the one that causes someone with schizophrenia the most distress or inability to function.
Also, the results were looked at two weeks after treatment so we don’t know how long TMS might help alleviate the voices for those who find the therapy helpful. Schizophrenia is a lifelong disease, and if people have to receive treatment every two weeks, then cost would be an issue, but we don’t have any information yet on what the best treatment schedule is.
Cost is not discussed. TMS therapy is already available for the treatment of other mental health conditions, including depression, so cost estimates should not have been difficult to come by. And since costs can reach into the thousands of dollars, depending on the length of treatment, it is not an insignificant issue for patients and their families.
The release states that “researchers found that 34.6% of the patients being treated by TMS showed a significant response, whereas only 9.1% of patients in the sham group responded.” Of equal importance, the release clearly defined what “significant response” meant: “a more than 30% decrease in the Total Auditory Hallucinations Rating Scale score.” In addition, the release quotes one study author’s qualification of the finding: “treatment with high frequency TMS makes a difference to at least some sufferers, although there is a long way to go before we will know if TMS is the best route to treat these patients in the long-term.” That’s good context.
TMS is generally regarded as a low-risk treatment. That does not, however, make it a no-risk treatment. According to the Mayo Clinic, the use of TMS to treat depression can have side effects ranging from headache and lightheadedness to (in rare cases) seizures and hearing loss. We don’t think the release needs to include a laundry list of potential risks, but it does need to address the risk of potential harms in some meaningful way — even if it is only to highlight that there is a low risk of significant harms.
The release does a good job of explaining the size of the trial and the study design. The release would have been stronger if it had noted that it’s not clear how long the benefits lasted beyond two weeks.
No disease mongering here, and we appreciated the discussion of prevalence of schizophrenia.
The study funders (French Health Ministry (PHRC) and Basse Normandie Regional Council) are listed on a sidebar of the EurekAlert! site, where the release is hosted. We encourage news release writers to include funders in the text as well. The release doesn’t address whether the researchers had any conflicts of interest. To be clear, we are not claiming that such conflicts of interest exist (it’s impossible to tell, since the release doesn’t tell us the names of all the researchers involved). But a release should make clear whether any such conflicts exist. If there are no conflicts, say so.
This is a close one. The release includes a quote from an independent researcher who was not associated with the study. In that quote, the researcher says, “While response rates were moderate, TMS is a welcome addition to the therapeutic repertoire especially for patients who do not respond to medication.” That’s useful information. However, the release would have been far stronger if it had offered even one or two sentences about other treatment options, including medication. For example, do AVHs persist for many patients on medication for schizophrenia?
Other non-drug techniques such as cognitive behavioral techniques are being used for auditory hallucinations as well.
The release does not address availability of TMS for treatment of AVHs specifically. The release does note that TMS “has been shown to be effective in several psychiatric conditions.” However, it’s not clear from the release how widely available TMS is, or even whether it is clinically available at all. This may be because the release is aimed more at practitioners (who are aware of TMS’s availability) than at a more general audience. However, since many reporters and news consumers don’t have that professional background and insight, it would be much better to simply address the issue of availability head on.
The release does a good job here. For example, the release notes that TMS “has been suggested as a possible way of treating the hearing of voices in schizophrenia….However, there is a lack of controlled trials to show that TMS works effectively with AVH sufferers.” The release also quotes an independent source saying that “This work builds on previous studies that have shown a critical role of excessive activity of subregions of the temporal lobe in the generation of voice hallucinations in schizophrenia. To move this into treatment, controlled trial such as the one by Dollfus and coworkers are important.” That’s valuable context.
However, there is one point that raises some confusion. The release notes that this study involved 59 patients in all, and that it has been accepted for publication in a forthcoming issue of the journal Schizophrenia Bulletin. However, a search online finds that a very similar study, by at least one of the same researchers (the only one whose name we know), involving 74 patients, was published online in the journal Neurophysiologie Clinique (Clinical Neurophysiology) in June. Is this part of the same study discussed in the release? If not, how does it differ from the study being discussed in the release? If it is the same, why was there a different number of patients?
This is a close one. In its opening sentence, the release states that “For the first time, scientists have precisely identified and targeted an area of the brain which is involved in ‘hearing voices’, experienced by many patients with schizophrenia.” But there have been previous studies that have tied areas of the brain to hallucinations (e.g., this 2015 Nature Communications paper). That initially gave us pause. However, we’ll give the release the benefit of the doubt given that the opening sentence notes that this study “precisely” identifies an area of the brain associated with AVHs specifically.
It’s a minor point, but we don’t think it was necessary to repeatedly put quotation marks around the phrase “hearing voices.” People with this symptom of schizophrenia hear voices. Period. They’re generated from within their brains, without the benefit of outside sensory input, but they hear them as if they were.
Systematic, Criteria-Driven
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