Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress.
Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. Depot medication should be considered for all patients because nonadherence is high. For relapse prevention, medication should be continued in the same dose. Blood levels should be above 350–450 μg/ml for maximal effect. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2–4 weeks of treatment. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. This article reviews the treatment of hallucinations in schizophrenia.
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