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Ren H, Li J, Zhou J, Chen X, Tang J, Li Z, Wang Q. Grey matter volume reduction in the frontotemporal cortex associated with persistent verbal auditory hallucinations in Chinese patients with chronic schizophrenia: Insights from a 3 T magnetic resonance imaging study. Schizophr Res 2024; 269:123-129. [PMID: 38772324 DOI: 10.1016/j.schres.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Persistent auditory verbal hallucinations (pAVHs) are a fundamental manifestation of schizophrenia (SCZ), yet the exact connection between pAVHs and brain structure remains contentious. This study aims to explore the potential correlation between pAVHs and alterations in grey matter volume (GMV) within specific brain regions among individuals diagnosed with SCZ. METHODS 76 SCZ patients with pAVHs (pAVH group), 57 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group) were investigated using 3 T magnetic resonance imaging. The P3 hallucination item of the Positive and Negative Syndrome Scale was used to assess the severity of pAVHs. Voxel-based morphometry was used to analyze the GMV profile between the three groups. RESULTS Compared to the non-AVH and HC groups, the pAVH group exhibited extensive reduction in GMV within the frontotemporal cortex. Conversely, no significant difference in GMV was observed between the non-AVH and HC groups. The severity of pAVHs showed a negative correlation with GMV in several regions, including the right fusiform, right inferior temporal, right medial orbitofrontal, right superior frontal, and right temporal pole (p = 0.0036, Bonferroni correction). Stepwise linear regression analysis revealed that GMV in the right temporal pole (β = -0.29, p = 0.001) and right fusiform (β = -0.21, p = 0.01) were significantly associated with the severity of pAVHs. CONCLUSIONS Widespread reduction in GMV is observed within the frontotemporal cortex, particularly involving the right temporal pole and right fusiform, which potentially contribute to the pathogenesis of pAVHs in individuals with chronic SCZ.
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Affiliation(s)
- Honghong Ren
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China; Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jinguang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jun Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaogang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zongchang Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Qianjin Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China; Department of Psychiatry, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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2
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Bose A, Agarwal SM, Nawani H, Shivakumar V, Shenoy S, Sreeraj VS, Narayanaswamy JC, Kumar D, Venkatasubramanian G. Effect of add-on tDCS therapy for auditory hallucinations on frequency and duration deviant mismatch negativity in schizophrenia. Schizophr Res 2024; 269:93-95. [PMID: 38759355 DOI: 10.1016/j.schres.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/14/2024] [Accepted: 04/27/2024] [Indexed: 05/19/2024]
Affiliation(s)
- Anushree Bose
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Sri Mahavir Agarwal
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hema Nawani
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Venkataram Shivakumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sonia Shenoy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Janardhanan C Narayanaswamy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Devvarta Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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3
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Su W, Yuan A, Tang Y, Xu L, Wei Y, Wang Y, Li Z, Cui H, Qian Z, Tang X, Hu Y, Zhang T, Feng J, Li Z, Zhang J, Wang J. Effects of polygenic risk of schizophrenia on interhemispheric callosal white matter integrity and frontotemporal functional connectivity in first-episode schizophrenia. Psychol Med 2023; 53:2868-2877. [PMID: 34991756 DOI: 10.1017/s0033291721004840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Schizophrenia is a severely debilitating psychiatric disorder with high heritability and polygenic architecture. A higher polygenic risk score for schizophrenia (SzPRS) has been associated with smaller gray matter volume, lower activation, and decreased functional connectivity (FC). However, the effect of polygenic inheritance on the brain white matter microstructure has only been sparsely reported. METHODS Eighty-four patients with first-episode schizophrenia (FES) patients and ninety-three healthy controls (HC) with genetics, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI) data were included in our study. We investigated impaired white matter integrity as measured by fractional anisotropy (FA) in the FES group, further examined the effect of SzPRS on white matter FA and FC in the regions connected by SzPRS-related white matter tracts. RESULTS Decreased FA was observed in FES in many commonly identified regions. Among these regions, we observed that in the FES group, but not the HC group, SzPRS was negatively associated with the mean FA in the genu and body of corpus callosum, right anterior corona radiata, and right superior corona radiata. Higher SzPRS was also associated with lower FCs between the left inferior frontal gyrus (IFG)-left inferior temporal gyrus (ITG), right IFG-left ITG, right IFG-left middle frontal gyrus (MFG), and right IFG-right MFG in the FES group. CONCLUSION Higher polygenic risks are linked with disrupted white matter integrity and FC in patients with schizophrenia. These correlations are strongly driven by the interhemispheric callosal fibers and the connections between frontotemporal regions.
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Affiliation(s)
- Wenjun Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Aihua Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Lihua Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yanyan Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yingchan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhixing Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Huiru Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhenying Qian
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Xiaochen Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yegang Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tianhong Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Zhiqiang Li
- Affiliated Hospital of Qingdao University & Biomedical Sciences Institute of Qingdao University, Qingdao University, Qingdao 266000, China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Centre for Brain Science, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jie Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai 200031, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200240, China
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4
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Clinical practice guidelines for the use of transcranial direct current stimulation in psychiatry. Indian J Psychiatry 2023; 65:289-296. [PMID: 37063621 PMCID: PMC10096202 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_496_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023] Open
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Mondino M, Janin D, Galvao F, Brunelin J. High-Frequency Transcranial Random Noise Stimulation for Auditory Hallucinations of Schizophrenia: A Case Series. Biomedicines 2022; 10:2698. [PMID: 36359217 PMCID: PMC9687535 DOI: 10.3390/biomedicines10112698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 09/19/2023] Open
Abstract
Transcranial electrical stimulation has been proposed as a noninvasive therapeutic approach for reducing treatment-resistant symptoms of schizophrenia-in particular, auditory hallucinations. However, the high variability observed in the clinical response leaves much room to optimize the stimulation parameters and strengthen its benefits. We proposed to investigate the effects of high-frequency transcranial random noise stimulation (hf-tRNS), which is supposed to induce larger effects than conventional direct current stimulation. Here, we present an initial case series of ten patients with schizophrenia who underwent 10 sessions of 20 min hf-tRNS (2 mA, 100-500 Hz, 1 mA offset), with the anode placed over the left dorsolateral prefrontal cortex and the cathode over the left temporoparietal junction. Patients showed a significant reduction in auditory hallucinations after the hf-tRNS sessions (-36.1 +/- 21.8%, p = 0.0059). In this preliminary, open-label study conducted in ten patients with treatment-resistant symptoms of schizophrenia, frontotemporal hf-tRNS was shown to induce a substantial improvement in auditory hallucinations. Additional sham-controlled studies are needed to further evaluate hf-tRNS as a treatment for schizophrenia.
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Affiliation(s)
- Marine Mondino
- Pôle Est, Centre Hospitalier Le Vinatier, F-69500 Bron, France
- PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, F-69000 Lyon, France
- University Lyon 1, F-69100 Villeurbanne, France
| | - Delphine Janin
- Pôle Est, Centre Hospitalier Le Vinatier, F-69500 Bron, France
- PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, F-69000 Lyon, France
- University Lyon 1, F-69100 Villeurbanne, France
| | - Filipe Galvao
- Pôle Est, Centre Hospitalier Le Vinatier, F-69500 Bron, France
| | - Jérôme Brunelin
- Pôle Est, Centre Hospitalier Le Vinatier, F-69500 Bron, France
- PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, F-69000 Lyon, France
- University Lyon 1, F-69100 Villeurbanne, France
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6
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Paul AK, Bose A, Kalmady SV, Shivakumar V, Sreeraj VS, Parlikar R, Narayanaswamy JC, Dursun SM, Greenshaw AJ, Greiner R, Venkatasubramanian G. Superior temporal gyrus functional connectivity predicts transcranial direct current stimulation response in Schizophrenia: A machine learning study. Front Psychiatry 2022; 13:923938. [PMID: 35990061 PMCID: PMC9388779 DOI: 10.3389/fpsyt.2022.923938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a promising adjuvant treatment for persistent auditory verbal hallucinations (AVH) in Schizophrenia (SZ). Nonetheless, there is considerable inter-patient variability in the treatment response of AVH to tDCS in SZ. Machine-learned models have the potential to predict clinical response to tDCS in SZ. This study aims to examine the feasibility of identifying SZ patients with persistent AVH (SZ-AVH) who will respond to tDCS based on resting-state functional connectivity (rs-FC). Thirty-four SZ-AVH patients underwent resting-state functional MRI at baseline followed by add-on, twice-daily, 20-min sessions with tDCS (conventional/high-definition) for 5 days. A machine learning model was developed to identify tDCS treatment responders based on the rs-FC pattern, using the left superior temporal gyrus (LSTG) as the seed region. Functional connectivity between LSTG and brain regions involved in auditory and sensorimotor processing emerged as the important predictors of the tDCS treatment response. L1-regularized logistic regression model had an overall accuracy of 72.5% in classifying responders vs. non-responders. This model outperformed the state-of-the-art convolutional neural networks (CNN) model-both without (59.41%) and with pre-training (68.82%). It also outperformed the L1-logistic regression model trained with baseline demographic features and clinical scores of SZ patients. This study reports the first evidence that rs-fMRI-derived brain connectivity pattern can predict the clinical response of persistent AVH to add-on tDCS in SZ patients with 72.5% accuracy.
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Affiliation(s)
- Animesh Kumar Paul
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Anushree Bose
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Sunil Vasu Kalmady
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Venkataram Shivakumar
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Vanteemar S Sreeraj
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Rujuta Parlikar
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Janardhanan C Narayanaswamy
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Serdar M Dursun
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Russell Greiner
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ganesan Venkatasubramanian
- Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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7
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Adjunctive tDCS for treatment-refractory auditory hallucinations in schizophrenia: A meta-analysis of randomized, double-blinded, sham-controlled studies. Asian J Psychiatr 2022; 73:103100. [PMID: 35430496 DOI: 10.1016/j.ajp.2022.103100] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Treatment-refractory auditory hallucinations (TRAH) in schizophrenia often do not improve with pharmacotherapy. We performed a meta-analysis of randomized, double-blind, sham-controlled clinical trials (RCTs) that systematically examined the therapeutic effects and tolerability of adjunctive active versus sham active transcranial direct current stimulation (tDCS) for auditory hallucinations as measured by the Auditory Hallucination Rating Scale (AHRS) in schizophrenia patients with TRAH. METHODS Relevant data were extracted, checked and analyzed using the Review Manager, Version 5.3 by three independent investigators. RESULTS Eight double-blind RCTs covering 329 schizophrenia patients (168 in active tDCS group, 161 in sham tDCS group) were included. Although no advantage of active tDCS on auditory hallucinations [7 RCTs, n = 224; standardized mean difference (SMD): - 0.33 (95% confidence interval (CI): - 0.71, 0.05), P = 0.09; I2 = 46%] was found compared to sham, subgroup analyses revealed that active tDCS with twice-daily stimulation [6 RCTs, n = 198; SMD: - 0.42 (95%CI: -0.82, -0.02), P = 0.04; I2 = 44%] and active tDCS with ≥ 10 stimulation sessions [6 RCTs, n = 198; SMD: - 0.42 (95%CI: -0.82, -0.02), P = 0.04; I2 = 44%] showed a significantly better therapeutic effect than sham in improving auditory hallucinations symptoms. Meta-analyses of total psychopathology and discontinuation due to any reason were not significantly different between the active and sham tDCS groups. CONCLUSION This meta-analysis demonstrated that the effects of tDCS for auditory hallucinations symptoms were influenced by the tDCS parameters. Twice-daily stimulation and ≥ 10 stimulation sessions may be needed to improve auditory hallucinations symptoms in schizophrenia with TRAH.
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8
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Hyde J, Carr H, Kelley N, Seneviratne R, Reed C, Parlatini V, Garner M, Solmi M, Rosson S, Cortese S, Brandt V. Efficacy of neurostimulation across mental disorders: systematic review and meta-analysis of 208 randomized controlled trials. Mol Psychiatry 2022; 27:2709-2719. [PMID: 35365806 PMCID: PMC8973679 DOI: 10.1038/s41380-022-01524-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 01/29/2023]
Abstract
Non-invasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS), is a potentially effective treatment strategy for a number of mental conditions. However, no quantitative evidence synthesis of randomized controlled trials (RCTs) of TMS or tDCS using the same criteria including several mental conditions is available. Based on 208 RCTs identified in a systematic review, we conducted a series of random effects meta-analyses to assess the efficacy of NIBS, compared to sham, for core symptoms and cognitive functioning within a broad range of mental conditions. Outcomes included changes in core symptom severity and cognitive functioning from pre- to post-treatment. We found significant positive effects for several outcomes without significant heterogeneity including TMS for symptoms of generalized anxiety disorder (SMD = -1.8 (95% CI: -2.6 to -1), and tDCS for symptoms of substance use disorder (-0.73, -1.00 to -0.46). There was also significant effects for TMS in obsessive-compulsive disorder (-0.66, -0.91 to -0.41) and unipolar depression symptoms (-0.60, -0.78 to -0.42) but with significant heterogeneity. However, subgroup analyses based on stimulation site and number of treatment sessions revealed evidence of positive effects, without significant heterogeneity, for specific TMS stimulation protocols. For neurocognitive outcomes, there was only significant evidence, without significant heterogeneity, for tDCS for improving attention (-0.3, -0.55 to -0.05) and working memory (-0.38, -0.74 to -0.03) in individuals with schizophrenia. We concluded that TMS and tDCS can benefit individuals with a variety of mental conditions, significantly improving clinical dimensions, including cognitive deficits in schizophrenia which are poorly responsive to pharmacotherapy.
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Affiliation(s)
- Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK.
| | - Hannah Carr
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Nicholas Kelley
- Centre for Research on Self and Identity, School of Psychology, University of Southampton, Southampton, UK
| | - Rose Seneviratne
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Claire Reed
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Garner
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
| | - Stella Rosson
- Department of Mental Health, Azienda AULSS 3 Serenissima, Venice, Italy
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
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9
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Kronick J, Sabesan P, Burhan AM, Palaniyappan L. Assessment of treatment resistance criteria in non-invasive brain stimulation studies of schizophrenia. Schizophr Res 2022; 243:349-360. [PMID: 34183208 DOI: 10.1016/j.schres.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 01/17/2023]
Abstract
Novel treatment modalities, such as non-invasive brain stimulation (NIBS), typically focus on patient groups that have failed multiple treatment interventions. Despite its promise, the clinical translation of NIBS in schizophrenia has been limited. One important obstacle to implementation is the inconsistent reporting of treatment resistance in the clinical trial literature contributing to heterogeneity in reported effects. In response, we develop a numerical approach to synthesize quality of assessment of Treatment-Resistant Schizophrenia (TRS) and apply this to studies investigating therapeutic response to NIBS in patients with schizophrenia. Literature search conducted through PubMed database identified 119 studies investigating Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation in treating resistant schizophrenia symptoms. A quality score out of 11 was assigned to each study based on adherence to the international consensus guidelines for TRS developed by the Treatment Response and Resistance in Psychosis (TRRIP) group. Results revealed an overall paucity of studies with thorough assessment and/or reporting of TRS phenomenon, as evidenced by a mean quality score of 3.38/11 (SD: 1.01) for trials and 5.16/11 (SD: 1.57) for case reports, though this improved minimally since the publication of consensus criteria. Most studies considered treatment-resistance as a single dimensional construct by reporting resistance of a single symptom, and failed to establish treatment adherence, resistance time course and functional impairment. We conclude that the current NIBS literature in schizophrenia do not reflect its true effects on treatment-resistance. There is an urgent need to improve assessment and reporting standards of clinical trials that target TRS.
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Affiliation(s)
- Jami Kronick
- Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada.
| | - Priyadharshini Sabesan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Amer M Burhan
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario M5T 1R8, Canada; Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 5S9, Canada; Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Robarts Research Institute, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; Lawson Health Research Institute, 750 Base Line Road East Suite 300, London, Ontario N6C 2R5, Canada.
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10
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Ning Y, Zheng S, Feng S, Zhang B, Jia H. Potential Locations for Non-Invasive Brain Stimulation in Treating Schizophrenia: A Resting-State Functional Connectivity Analysis. Front Neurol 2022; 12:766736. [PMID: 34975725 PMCID: PMC8715096 DOI: 10.3389/fneur.2021.766736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Non-invasive brain stimulation (NIBS) techniques have been widely used for the purpose of improving clinical symptoms of schizophrenia. However, the ambiguous stimulation targets may limit the efficacy of NIBS for schizophrenia. Exploring effective stimulation targets may improve the clinical efficacy of NIBS in schizophrenia. Methods: We first conducted a neurosynth-based meta-analysis of 715 functional magnetic resonance imaging studies to identify schizophrenia-related brain regions as regions of interest. Then, we performed the resting-state functional connectivity analysis in 32 patients with first-episode schizophrenia to find brain surface regions correlated with the regions of interest in three pipelines. Finally, the 10–20 system coordinates corresponding to the brain surface regions were considered as potential targets for NIBS. Results: We identified several potential targets of NIBS, including the bilateral dorsal lateral prefrontal cortex, supplementary motor area, bilateral inferior parietal lobule, temporal pole, medial prefrontal cortex, precuneus, superior and middle temporal gyrus, and superior and middle occipital gyrus. Notably, the 10-20 system location of the bilateral dorsal lateral prefrontal cortex was posterior to F3 (F4), not F3 (F4). Conclusion: Conclusively, our findings suggested that the stimulation locations corresponding to these potential targets might help clinicians optimize the application of NIBS therapy in individuals with schizophrenia.
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Affiliation(s)
- Yanzhe Ning
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sisi Zheng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sitong Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Binlong Zhang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongxiao Jia
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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11
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Stuchlíková Z, Klírová M. A Literature Mini-Review of Transcranial Direct Current Stimulation in Schizophrenia. Front Psychiatry 2022; 13:874128. [PMID: 35530026 PMCID: PMC9069055 DOI: 10.3389/fpsyt.2022.874128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation method that utilizes the effect of low-current on brain tissue. In recent years, the effect of transcranial direct current stimulation has been investigated as a therapeutic modality in various neuropsychiatric indications, one of them being schizophrenia. This article aims to provide an overview of the potential application and effect of tDCS in treating patients with schizophrenia. A literature search was performed using the PubMed, Web of Science, and Google Scholar databases for relevant research published from any date until December 2021. Eligible studies included those that used randomized controlled parallel-group design and focused on the use of transcranial direct current stimulation for the treatment of positive, negative, or cognitive symptoms of schizophrenia. Studies were divided into groups based on the focus of research and an overview is provided in separate sections and tables in the article. The original database search yielded 705 results out of which 27 randomized controlled trials met the eligibility criteria and were selected and used for the purpose of this article. In a review of the selected trials, transcranial direct current stimulation is a safe and well-tolerated method that appears to have the potential as an effective modality for the treatment of positive and negative schizophrenic symptoms and offers promising results in influencing cognition. However, ongoing research is needed to confirm these conclusions and to further specify distinct application parameters.
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Affiliation(s)
- Zuzana Stuchlíková
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia.,Hospital České Budĕjovice, a.s., České Budĕjovice, Czechia
| | - Monika Klírová
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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12
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Guttesen LL, Albert N, Nordentoft M, Hjorthøj C. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation for auditory hallucinations in schizophrenia: Systematic review and meta-analysis. J Psychiatr Res 2021; 143:163-175. [PMID: 34500345 DOI: 10.1016/j.jpsychires.2021.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Through imaging studies, a significant increase in cerebral activity has been detected in fronto-temporal areas in patients experiencing auditory verbal hallucinations. Therefore, non-invasive neuromodulation, in particular transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has been considered as a therapeutic intervention for medication-resistant auditory verbal hallucinations in schizophrenia. We aimed to synthesize results from randomized trials on either rTMS or tDCS versus placebo in patients with schizophrenia by including five recently published trials in the field. A systematic review and meta-analysis of relevant literature was conducted. Studies were included on the basis of pre-defined selection criteria. The quality of the studies was assessed by the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RevMan 5.3 was used to conduct the statistical analysis. Including 465 and 960 patients, respectively, 12 tDCS and 27 rTMS studies were included. Regarding treatment of medication refractory auditory verbal hallucinations, no significant effect of tDCS (-0.23 [-0.49, 0.02], p = 0.08) or rTMS (-0.19 [-0.50, 0,11], p = 0.21) was found compared to sham in this meta-analysis. The current study found that it cannot be concluded that rTMS and tDCS are efficacious in treating medication-resistant auditory verbal hallucinations. Larger randomized controlled tDCS trials of a higher quality should be conducted in the future to establish substantial evidence of tDCS. The interventions appear safe and may have beneficial effects on other outcomes.
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Affiliation(s)
- Liv Liebach Guttesen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Psychiatric Center of Ballerup, Copenhagen University Hospital, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Psychiatry Region Zealand East, Roskilde, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark.
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13
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Bhalerao GV, Sreeraj VS, Bose A, Narayanaswamy JC, Venkatasubramanian G. Comparison of electric field modeling pipelines for transcranial direct current stimulation. Neurophysiol Clin 2021; 51:303-318. [PMID: 34023189 DOI: 10.1016/j.neucli.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Electric field modeling utilizes structural brain magnetic resonance images (MRI) to model the electric field induced by non-invasive transcranial direct current stimulation (tDCS) in a given individual. Electric field modeling is being integrated with clinical outcomes to improve understanding of inter-individual variability in tDCS effects and to optimize tDCS parameters, thereby enhancing the predictability of clinical effects. The successful integration of modeling in clinical use will primarily be driven by choice of tools and procedures implemented in computational modeling. Thus, the electric field predictions from different modeling pipelines need to be investigated to ensure the validity and reproducibility of tDCS modeling results across clinical or translational studies. METHODS We used T1w structural MRI from 32 healthy volunteer subjects and modeled the electric field distribution for a fronto-temporal tDCS montage. For five different computational modeling pipelines, we quantitatively compared brain tissue segmentation and electric field predicted in whole-brain, brain tissues and target brain regions between the modeling pipelines. RESULTS Our comparisons at various levels did not reveal any systematic trend with regards to similarity or dissimilarity of electric field predicted in brain tissues and target brain regions. The inconsistent trends in the predicted electric field indicate variation in the procedures, routines and algorithms used within and across the modeling pipelines. CONCLUSION Our results suggest that studies integrating electric field modeling and clinical outcomes of tDCS will highly depend upon the choice of the modeling pipelines and procedures. We propose that using these pipelines for further research and clinical applications should be subject to careful consideration, and indicate general recommendations.
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Affiliation(s)
- Gaurav V Bhalerao
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bengaluru 560029, India
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14
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Abstract
PURPOSE OF REVIEW To provide an update of recent studies describing the effects of transcranial direct current stimulation (tDCS) on patients with schizophrenia, with particular focus on auditory verbal hallucinations (AVH), cognitive deficits, and negative symptoms. RECENT FINDINGS As a low-cost, easy-to-use neuromodulation technique, tDCS may have clinical implications for those suffering from treatment-persistent AVH, negative symptoms, and cognitive symptoms in schizophrenia. Over the past decade, tDCS has shown no effects for negative symptoms, except when used at a high frequency of sessions, and inconclusive results for AVH and cognitive symptoms. The treatment has little to no adverse effects. SUMMARY The studies reviewed here support the need for further investigation and empirical data regarding the use of tDCS. The underlying mechanisms of tDCS as well as the most effective stimulation parameters must be better understood. Findings support the need for increased duration and frequency of tDCS sessions. One of the next steps is the investigation of effects of concomitant nonpharmacological treatments with tDCS.
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15
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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16
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Rashidi S, Jones M, Murillo-Rodriguez E, Machado S, Hao Y, Yadollahpour A. Transcranial direct current stimulation for auditory verbal hallucinations: a systematic review of clinical trials. Neural Regen Res 2021; 16:666-671. [PMID: 33063718 PMCID: PMC8067931 DOI: 10.4103/1673-5374.295315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/14/2019] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been reportedly beneficial for different neurodegenerative disorders. tDCS has been reported as a potential adjunctive or alternative treatment for auditory verbal hallucination (AVH). This study aims to review the effects of tDCS on AVH in patients with schizophrenia through combining the evidence from randomized clinical trials (RCTs). The databases of PsycINFO (2000-2019), PubMed (2000-2019), EMBASE (2000-2019), CINAHL (2000-2019), Web of Science (2000-2019), and Scopus (2000-2019) were systematically searched. The clinical trials with RCT design were selected for final analysis. A total of nine RCTs were eligible and included in the review. Nine RCTs were included in the final analysis. Among them, six RCTs reported a significant reduction of AVH after repeated sessions of tDCS, whereas three RCTs did not show any advantage of active tDCS over sham tDCS. The current studies showed an overall decrease of approximately 28% of AVH after active tDCS and 10% after sham tDCS. The tDCS protocols targeting the sensorimotor frontal-parietal network showed greater treatment effects compared with the protocols targeting other regions. In this regard, cathodal tDCS over the left temporoparietal area showed inhibitory effects on AVHs. The most effective tDCS protocol on AVHs was twice-daily sessions (2 mA, 20-minute duration) over 5 consecutive days (10 sessions) with the anode over the left dorsolateral prefrontal cortex and the cathode over the left temporal area. Some patient-specific and disease-specific factors such as young age, nonsmoking status, and higher frequencies of AVHs seemed to be the predictors of treatment response. Taken together, the results of tDCS as an alternative treatment option for AVH show controversy among current literatures, since not all studies were positive. However, the studies targeting the same site of the brain showed that the tDCS could be a promising treatment option to reduce AVH. Further RCTs, with larger sample sizes, should be conducted to reach a conclusion on the efficacy of tDCS for AVH and to develop an effective therapeutic protocol for clinical setting.
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Affiliation(s)
- Samaneh Rashidi
- Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Myles Jones
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Eric Murillo-Rodriguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, México
| | - Sergio Machado
- Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói, Brazil
| | - Youguo Hao
- Department of Rehabilitation, Shanghai Putuo People's Hospital, Shanghai, China
| | - Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield, UK
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17
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Mondino M, Fonteneau C, Simon L, Dondé C, Haesebaert F, Poulet E, Brunelin J. Advancing clinical response characterization to frontotemporal transcranial direct current stimulation with electric field distribution in patients with schizophrenia and auditory hallucinations: a pilot study. Eur Arch Psychiatry Clin Neurosci 2021; 271:85-92. [PMID: 32533249 DOI: 10.1007/s00406-020-01149-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/29/2020] [Indexed: 12/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been proposed as a therapeutic option for treatment-resistant auditory verbal hallucinations (AVH) in schizophrenia. In such cases, repeated sessions of tDCS are delivered with the anode over the left prefrontal cortex and the cathode over the left temporoparietal junction. Despite promising findings, the clinical response to tDCS is highly heterogeneous among patients. Here, we explored baseline differences between responders and nonresponders to frontotemporal tDCS using electric field modeling. We hypothesized that responders would display different tDCS-induced electric field strength in the brain areas involved in AVH compared to nonresponders.Using baseline structural MRI scans of 17 patients with schizophrenia and daily AVH who received 10 sessions of active frontotemporal tDCS, we constructed individual realistic whole brain models estimating electric field strength. Electric field maps were compared between responders (n = 6) and nonresponders to tDCS (n = 11) using an independent two-sample t test. Clinical response was defined as at least a 50% decrease of AVH 1 month after the last tDCS session.Results from the electric field map comparison showed that responders to tDCS displayed higher electric field strength in the left transverse temporal gyrus at baseline compared to nonresponders (T = 2.37; p = 0.016; 32 voxels).These preliminary findings suggested that the strength of the tDCS-induced electric field reaching the left transverse temporal gyrus could play an important role in the response to frontotemporal tDCS. In addition, this work suggests the interest of using electric field modeling to individualize tDCS and increase response rate.
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Affiliation(s)
- Marine Mondino
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Clara Fonteneau
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Louis Simon
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
| | - Emmanuel Poulet
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France
- Centre Hospitalier Le Vinatier, Bron, France
- Emergency Psychiatry Unit, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Jerome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center; PSYR2 Team, 95 bd pinel, F-69000, Lyon, France.
- Lyon University, Université Lyon 1, UCBL, 69000, Villeurbanne, France.
- Centre Hospitalier Le Vinatier, Bron, France.
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18
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Gupta T, Mittal VA. Transcranial direct current stimulation and emotion processing deficits in psychosis and depression. Eur Arch Psychiatry Clin Neurosci 2021; 271:69-84. [PMID: 32488523 PMCID: PMC7704557 DOI: 10.1007/s00406-020-01146-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/23/2020] [Indexed: 01/11/2023]
Abstract
Emotional processing deficits (EPDs) are commonly observed among individuals diagnosed with (1) psychotic disorders (2) and depression. Given that EPDs can impact overall functioning and quality of life, the need to identify effective interventions is critical. To date, our current understanding of treatments for these impairments is limited. However, there is increasing interest in investigating the efficacy of transcranial direct current stimulation (tDCS). This neuromodulation technique releases a weak electrical current through the brain. Given research suggesting promise for using tDCS to improve symptoms and cognition across psychopathology, this approach may be useful for improving EPDs and related symptoms in psychosis and depression. In the current review, we provide an overview of the literature determining the effects of tDCS for EPDs and related symptoms in these groups. Furthermore, we highlight methodological advances and pinpoint potential future directions.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA.
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL, 60208, USA
- Department of Psychiatry, Northwestern University, Chicago, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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19
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Cheng PWC, Louie LLC, Wong YL, Wong SMC, Leung WY, Nitsche MA, Chan WC. The effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2020; 53:102392. [PMID: 32956993 DOI: 10.1016/j.ajp.2020.102392] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to examine the effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia. METHODS A literature search was performed for articles published in English using the following databases: MEDLINE, EMBASE, PsycINFO, INSPEC, the Cumulative Index to Nursing & Allied Health Literature Plus (CINAHL Plus), AMED, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, EU Clinical Trials Register, and WHO International Clinical Trials Registry Platform, from their inception to October 2019. The primary outcome variables were the clinical symptoms of schizophrenia including positive symptoms, negative symptoms, and auditory hallucinations. RESULTS 16 randomized controlled trials (RCTs) were included in the meta-analysis, with a sample of 326 patients with active and with 310 sham tDCS. Active tDCS was found to be more effective in improving positive symptoms [standardized mean difference (SMD) = 0.17; 95 % confidence interval (CI) 0.001 to 0.33], negative symptoms [SMD = 0.43, 95 % CI 0.11, 0.75] and auditory hallucinations [SMD = 0.36 95 % CI 0.02, 0.70]. Subgroup analyses showed better results in cases of pure diagnosis of schizophrenia, higher frequency and more sessions of stimulation. CONCLUSION tDCS was effective in improving positive symptoms, negative symptoms and auditory hallucination in schizophrenia. It therefore has potential as a safe and well-tolerated adjunctive intervention for schizophrenia.
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Affiliation(s)
| | | | - Yiu Lung Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | | | | | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, TU Dortmund University, Germany
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
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20
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Kumar PNS, Krishnan AG, Suresh R, Andrade C. Transcranial direct current stimulation for refractory auditory hallucinations in schizophrenia: Acute and 16-week outcomes. Indian J Psychiatry 2020; 62:572-576. [PMID: 33678840 PMCID: PMC7909021 DOI: 10.4103/psychiatry.indianjpsychiatry_182_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 07/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has demonstrated efficacy against antipsychotic-refractory auditory verbal hallucinations (AVH) in schizophrenia. The duration of persistence of benefit is not well characterized. MATERIALS AND METHODS Thirty-one adults with schizophrenia and medication-refractory AVH were treated with 2-3 mA tDCS in 30 min sessions, twice a day, 6 days a week, for 2-4 weeks. The anode was sited over F3 and the cathode midway between T3 and P3 in the 10-20 EEG system. Patients were assessed until a 4-month study endpoint using two auditory hallucination rating scales and the Positive and Negative Syndrome Scale (PANSS-N). RESULTS Auditory hallucinations were moderately reduced by tDCS with 25%-29% improvement evident by the end of the 2nd week and another 10% improvement between week 2 and 4 months. There was no loss of benefit at the end of the 4-month study. There was also a small (11%) but statistically significant improvement in PANSS-N scores. CONCLUSIONS Although this study is limited by the nonblind, uncontrolled design, the results suggest that tDCS, as delivered, holds promise for treating refractory AVH in schizophrenia; the benefits persist beyond the short term.
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Affiliation(s)
| | | | - Rohith Suresh
- Department of Medicine, Government Medical College, Ernamkulam, Kerala, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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21
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Zhuo C, Ji F, Lin X, Tian H, Wang L, Xu Y, Wang W, Jiang D. Global functional connectivity density alterations in patients with bipolar disorder with auditory verbal hallucinations and modest short-term effects of transcranial direct current stimulation augmentation treatment-Baseline and follow-up study. Brain Behav 2020; 10:e01637. [PMID: 32304288 PMCID: PMC7303392 DOI: 10.1002/brb3.1637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the neuroimaging characteristics of auditory verbal hallucinations (AVHs) in patients with bipolar disorder (BP) experiencing depressive episodes with and without AVHs, and alterations in those characteristics after transcranial direct current stimulation (tDCS). METHODS For a baseline pilot study, we recruited 80 patients with BP and depressive status (40 with and 40 without AVHs), and 40 healthy controls (HCs). Their global functional connectivity density (gFCD) was screened by functional magnetic resonance imaging (fMRI). Voxel-wise one-way analysis of covariance (ANCOVA) was conducted to detect intergroup differences in gFCD. In a follow-up study, the effects of 5 weeks of tDCS augmentation treatment on clinical symptoms and gFCD were assessed in the 40 BP patients with AVHs. RESULTS Compared to HCs, BP patients with and without AVHs exhibited increased gFCD in the central parietal lobe, insular lobe, and middle cingulate cortex, with decreased gFCD in the posterior parietal cortex, lateral prefrontal cortex, and occipital lobe (all bilateral). Only patients with AVHs showed increased gFCD in the Broca and Wernicke regions, and decreased gFCD in the hippocampus (all bilateral). After 5 weeks of tDCS, AVHs were slightly alleviated and gFCD abnormalities in the hippocampus were mildly attenuated. CONCLUSIONS Patients with BP and AVHs showed disturbances in the brain's communication capacity mainly in the left frontoparietal network, control network, and memory circuitry. Five weeks of tDCS alleviated AVHs slightly, without improving depressive symptoms, and attenuated hippocampal gFCD alterations in these patients.
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Affiliation(s)
- Chuanjun Zhuo
- School of Mental Health, Jining Medical University, Jining, China.,Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China.,Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China.,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China.,Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen, China
| | - Feng Ji
- School of Mental Health, Jining Medical University, Jining, China
| | - Xiaodong Lin
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Lina Wang
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wenqiang Wang
- Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen, China
| | - Deguo Jiang
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China
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22
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Target specific effects of direct current stimulation in schizo-obsessive disorder: A case report. Brain Stimul 2020; 13:858-860. [DOI: 10.1016/j.brs.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 12/31/2022] Open
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23
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Dondé C, Haesebaert F, Poulet E, Mondino M, Brunelin J. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:237-244. [PMID: 31835905 PMCID: PMC7385421 DOI: 10.1177/0706743719895641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to validate the French version of the 7-item
Auditory Hallucination Rating Scale (AHRS) so as to facilitate fine-grained
assessment of auditory hallucinations (AH) in native French-speaking
patients with schizophrenia (SZ) in clinical settings and studies. Method: Patients (N = 66) were diagnosed with SZ according to the
Diagnostic and Statistical Manual of Mental Disorders.
The French version of the AHRS was developed using a forward–backward
translation procedure. Psychometric properties of the French version of the
AHRS were tested including (i) construct validity with a confirmatory
one-factor analysis, (ii) internal validity with Pearson correlations and
Cronbach α coefficients, and (iii) external validity by correlations with
the Scale for Assessment of Positive Symptoms (SAPS-H1), the Positive and
Negative Syndrome Scale (PANSS-P3; concurrent), the PANSS-Negative subscale
and age of subjects (divergent), and inter-rater intraclass correlation
coefficients (ICCs). Results: (i) The confirmatory one-factor analysis found a root mean square error of
approximation (RMSEA) = 0.00, 90% confidence interval = [0.000 to 0.011],
and a comparative fit index = 0.994. (ii) Correlations between AHRS total
score and individual items were mostly ≥0.4. Cronbach α coefficient was
0.61. (iii) Correlations with PANSS-P3 and SAPS-H1 were 0.42 and 0.53,
respectively. In a subset of participants (N = 16), ICC
values were extremely high and significant for AHRS total and individual
item scores (ICCs range 0.899 to 0.996) Conclusion: The French version of the AHRS is a psychometrically acceptable instrument
for the evaluation of AH severity in French-speaking patients with SZ.
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Affiliation(s)
- Clément Dondé
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Frédéric Haesebaert
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Emmanuel Poulet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Department of Emergency Psychiatry, University Hospital Edouard Herriot, Hospices civils de Lyon, France
| | - Marine Mondino
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Jérôme Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response Team, Lyon, France.,University Lyon 1, Villeurbanne, France.,Centre Hospitalier Le Vinatier, Bron, France
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24
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Chhabra H, Bose A, Shivakumar V, Agarwal SM, Sreeraj VS, Shenoy S, Hazari N, Dinakaran D, Parlikar R, Koparde V, Ramesh V, Biswal J, Murugaraja V, Gowda SM, Chand PK, Sivakumar PT, Kalmady SV, Narayanaswamy JC, Murthy P, Girimaji SC, Venkatasubramanian G. Tolerance of transcranial direct current stimulation in psychiatric disorders: An analysis of 2000+ sessions. Psychiatry Res 2020; 284:112744. [PMID: 31955053 DOI: 10.1016/j.psychres.2020.112744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/05/2019] [Accepted: 01/01/2020] [Indexed: 12/29/2022]
Abstract
Transcranial direct current stimulation (tDCS), a non-invasive, neuromodulatory technique, is being increasingly applied to several psychiatric disorders. In this study, we describe the side-effect profile of repeated tDCS sessions (N = 2005) that were administered to 171 patients (156 adults and 15 adolescents) with different psychiatric disorders [schizophrenia [N = 109], obsessive-compulsive disorder [N = 28], alcohol dependence syndrome [N = 13], mild cognitive impairment [N = 10], depression [N = 6], dementia [N = 2] and other disorders [N = 3]]. tDCS was administered at a constant current strength of 2 mA with additional ramp-up and ramp-down phase of 20 s each at the beginning and end of the session, respectively. Other tDCS protocol parameters were: schizophrenia and obsessive-compulsive disorder: 5-days of twice-daily 20-min sessions with an inter-session interval of 3-h; Mild cognitive impairment/dementia and alcohol dependence syndrome: at least 5-days of once-daily 20-min session; Depression: 10-days of once-daily 30 min session. At the end of each tDCS session, any adverse event observed by the administrator and/or reported by the patient was systematically assessed using a comprehensive questionnaire. The commonly reported adverse events during tDCS included burning sensations (16.2%), skin redness (12.3%), scalp pain (10.1%), itching (6.7%), and tingling (6.3%). Most of the adverse events were noted to be mild, transient and well-tolerated. In summary, our observations suggest that tDCS is a safe mode for therapeutic non-invasive neuromodulation in psychiatric disorders in adults as well as the adolescent population.
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Affiliation(s)
- Harleen Chhabra
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Anushree Bose
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Venkataram Shivakumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Sri Mahavir Agarwal
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Sonia Shenoy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Nandita Hazari
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Damodharan Dinakaran
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Rujuta Parlikar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Vinayak Koparde
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Vinutha Ramesh
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Jitendriya Biswal
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Venkatachalam Murugaraja
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Shayanth Manche Gowda
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Prabhat K Chand
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India; Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Palanimuthu T Sivakumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Sunil V Kalmady
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Janardhanan C Narayanaswamy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Pratima Murthy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India; Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Satish C Girimaji
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
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25
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Zhuo C, Zhou C, Lin X, Tian H, Wang L, Chen C, Ji F, Xu Y, Jian D. Common and distinct global functional connectivity density alterations in drug-naïve patients with first-episode major depressive disorder with and without auditory verbal hallucination. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109738. [PMID: 31442554 DOI: 10.1016/j.pnpbp.2019.109738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 02/07/2023]
Abstract
Auditory verbal hallucination (AVH), defined as the auditory perception of speech in the absence of a real external stimulus, occurs in individuals with and without mental illness. The distribution of functional abnormalities in patients with AVH suggests aberrant brain network connectivity. However, no study has measured the global functional connectivity density (gFCD) associated with AVH in patients with major depressive disorder (MDD); gFCD is used widely to examine the density distribution of whole-brain resting-state functional connectivity and can serve as an index reflecting brain metabolism disturbance. In this study, we involved drug-naïve patients with first-episode MDD with (n = 35) and without (n = 40) AVH and healthy controls (n = 50).Whole-brain resting-state functional magnetic resonance imaging data were acquired and gFCD was calculated and compared among groups. We found the following gFCD alterations that were shared by both MDD groups: (1) decreased gFCD in the bilateral postcentral gyrus, precentral gyrus, insular cortices and occipital lobe; and (2) increased gFCD in the left middle cingulate cortex. More importantly, we found AVH-specific gFCD changes in patients with MDD: increased gFCD in the left Wernicke's brain regions and bilateral hippocampus and thalamus, and decreased gFCD in the bilateral lateral prefrontal lobule. These findings reflect the disturbance of brain information communication and metabolism in patients with MDD and AVH, related mainly to the language and memory processing circuits, and to some extent provide further support for the "VOICE" model of AVH.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, School of Mental Health, Jining University, Jining, Shandong Province 272191, China; Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province 325000, China; Psychiatric-Neuroimaging-Genetics and Comorbidity Laboratory, Tianjin Mental Health Center, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, China, Tianjin 300222, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China.
| | - Chunhua Zhou
- Department of Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province 050000, China
| | - Xiaodong Lin
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province 325000, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics and Comorbidity Laboratory, Tianjin Mental Health Center, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, China, Tianjin 300222, China
| | - Lina Wang
- Psychiatric-Neuroimaging-Genetics and Comorbidity Laboratory, Tianjin Mental Health Center, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, China, Tianjin 300222, China
| | - Ce Chen
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province 325000, China
| | - Feng Ji
- Department of Psychiatry, School of Mental Health, Jining University, Jining, Shandong Province 272191, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Deguo Jian
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province 325000, China
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26
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Zhuo C, Ji F, Lin X, Tian H, Wang L, Liu S, Sang H, Wang W, Chen C. Without insight accompanied with deteriorated brain functional alterations in healthy individuals with auditory verbal hallucinations: a pilot study. Brain Imaging Behav 2019; 14:2553-2558. [PMID: 31834596 PMCID: PMC7647977 DOI: 10.1007/s11682-019-00207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have reported on brain functional differences between healthy individuals with auditory verbal hallucinations (Hi-AVH) with and without insight, so we designed a study to address this knowledge gap. We enrolled 12 Hi-AVH with insight, 15 Hi-AVH without insight, and 15 AVH-free controls (Healthy controls). Global functional connectivity density (gFCD) mapping was used to estimate brain networks. We found that the most common alterations in both Hi-AVH groups were increased gFCD in superior parietal lobule and superior temporal gyrus. We also found that distinct brain functional patterns of Hi-AVH without insight comprised lower gFCD in the frontal lobe oculomotor area, dorsolateral prefrontal cortex, supramarginal gyrus, primary auditory cortex, sensorimotor cortex, ventral anterior, and posterior cingulate Our pilot findings support the hypothesis that abnormal reciprocal action in the circuits for processing perception, memory, language, and attentional control may be pathological features of auditory verbal hallucinations.
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Affiliation(s)
- Chuanjun Zhuo
- School of Mental Health, Jining Medical University, Jining, 272119, Shandong Province, China. .,Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, 325000, Zhejiang Province, China. .,Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, 300222, China. .,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China. .,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China. .,Department of Psychiatry, Changchun Sixth Hospital, Changchun, 130052, Jilin Province, China.
| | - Feng Ji
- School of Mental Health, Jining Medical University, Jining, 272119, Shandong Province, China
| | - Xiaodong Lin
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, 325000, Zhejiang Province, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, 300222, China
| | - Lina Wang
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Tianjin Anding Hospital, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin, 300222, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.,MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Hong Sang
- Department of Psychiatry, Changchun Sixth Hospital, Changchun, 130052, Jilin Province, China
| | - Wenqiang Wang
- Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital and University of Alberta, Xiamen, 361000, China
| | - Chunmian Chen
- Psychiatric-Neuroimaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, 325000, Zhejiang Province, China
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27
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Sharafi E, Taghva A, Arbabi M, Dadarkhah A, Ghaderi J. Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial. Clin EEG Neurosci 2019; 50:375-382. [PMID: 31304775 DOI: 10.1177/1550059419863209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the current study, we tried to evaluate the effect of transcranial direct current stimulation (tDCS) on treatment-resistant major depression. We carried out a double-blind randomized sham-controlled trial was conducted in University Hospitals. Individuals with less than 50% decrease in the intensity of depression after 8 weeks of treatment with selective serotonin reuptake inhibitors were recruited. Thirty patients (16 women) with a mean (SD) age of 47.2 (12.0) years were randomly allocated to 2 groups. For the active group we administered 2-mA stimulation 20 minutes for each session, with 30 seconds ramp-up from 0 and 30 seconds ramp-down. For the sham group we administered 30 seconds ramp-up to 2 mA, 10 seconds stimulation, 30 seconds ramp-down, and 20 minutes no current. The anode was fixed on the center of F3, and the cathode on F4, over the dorsolateral prefrontal cortex. We assessed the Hamilton Depression Rating Scale at the baseline (mean difference = 1.0, P = .630), at the last session of tDCS, and at 1-month postintervention. There were statistically significant differences in the mean Hamilton scores after the intervention, and 1 month later in favor of active group; P < .001, and P = .003, respectively. Mixed analysis of variance showed a significant difference in the mean scores for active group P = .010 and pattern of change during the study P < .001 in favor of active intervention. We concluded that tDCS is an efficient therapy for patients with resistant major depression, and the benefits would remain at least for 1 month.
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Affiliation(s)
- Elham Sharafi
- 1 Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arsia Taghva
- 2 Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Arbabi
- 1 Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Afsaneh Dadarkhah
- 3 Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Jamshid Ghaderi
- 4 Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Islamic Republic of Iran
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28
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Gordon G, Brockmeyer T, Schmidt U, Campbell IC. Combining cognitive bias modification training (CBM) and transcranial direct current stimulation (tDCS) to treat binge eating disorder: study protocol of a randomised controlled feasibility trial. BMJ Open 2019; 9:e030023. [PMID: 31640997 PMCID: PMC6830595 DOI: 10.1136/bmjopen-2019-030023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Binge eating disorder (BED) is a common mental disorder, closely associated with obesity. Existing treatments are only moderately effective with high relapse rates, necessitating novel interventions. This paper describes the rationale for, and protocol of, a feasibility randomised controlled trial (RCT), evaluating the combination of transcranial direct current stimulation (tDCS) and a computerised cognitive training, namely approach bias modification training (ABM), in patients with BED who are overweight or obese. The aim of this trial is to obtain information that will guide decision-making and protocol development in relation to a future large-scale RCT of combined tDCS+ABM treatment in this group of patients, and also to assess the preliminary efficacy of this intervention. METHODS AND ANALYSIS 66 participants with Diagnostic and Statistical Manual-5 diagnosis of BED and a body mass index (BMI) of ≥25 kg/m2 will be randomly allocated to one of three groups: ABM+real tDCS; ABM+sham tDCS or a wait-list control group. Participants in both intervention groups will receive six sessions of ABM+real/sham tDCS over 3 weeks; engaging in the ABM task while simultaneously receiving bilateral tDCS to the dorsolateral prefrontal cortex. ABM is based on an implicit learning paradigm in which participants are trained to enact an avoidance behaviour in response to visual food cues. Assessments will be conducted at baseline, post-treatment (3 weeks) and follow-up (7 weeks post-randomisation). Feasibility outcomes assess recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments. Other outcomes include eating disorder psychopathology and related neurocognitive outcomes (ie, delay of gratification and inhibitory control), BMI, other psychopathology (ie, mood), approach bias towards food and surrogate endpoints (ie, food cue reactivity, trait food craving and food intake). ETHICS AND DISSEMINATION This study has been approved by the North West-Liverpool East Research Ethics Committee. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN35717198.
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Affiliation(s)
- Gemma Gordon
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Gottingen, Goettingen, Niedersachsen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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29
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Kantrowitz JT, Sehatpour P, Avissar M, Horga G, Gwak A, Hoptman MJ, Beggel O, Girgis RR, Vail B, Silipo G, Carlson M, Javitt DC. Significant improvement in treatment resistant auditory verbal hallucinations after 5 days of double-blind, randomized, sham controlled, fronto-temporal, transcranial direct current stimulation (tDCS): A replication/extension study. Brain Stimul 2019; 12:981-991. [PMID: 30922713 PMCID: PMC9896410 DOI: 10.1016/j.brs.2019.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a potentially novel treatment for antipsychotic-resistant auditory verbal hallucinations (AVH) in schizophrenia. Nevertheless, results have been mixed across studies. METHODS 89 schizophrenia/schizoaffective subjects (active: 47; Sham: 42) were randomized to five days of twice-daily 20-min active tDCS vs. sham treatments across two recruitment sites. AVH severity was assessed using the Auditory Hallucination Rating Scale (AHRS) total score. To assess target engagement, MRI was obtained in a sub sample. RESULTS We observed a statistically significant, moderate effect-size change in AHRS total score across one-week and one-month favoring active treatment following covariation for baseline symptoms and antipsychotic dose (p = 0.036; d = 0.48). Greatest change was observed on the AHRS loudness item (p = 0.003; d = 0.69). In exploratory analyses, greatest effects on AHRS were observed in patients with lower cognitive symptoms (d = 0.61). In target engagement analysis, suprathreshold mean field-strength (>0.2 V/m) was seen within language-sensitive regions. However, off-target field-strength, which correlated significantly with less robust clinical response, was observed in anterior regions. CONCLUSIONS This is the largest study of tDCS for persistent AVH conducted to date. We replicate previous reports of significant therapeutic benefit, but only if medication dosage is considered, with patients receiving lowest medication dosage showing greatest effect. Response was also greatest in patients with lowest levels of cognitive symptoms. Overall, these findings support continued development of tDCS for persistent AVH, but also suggest that response may be influenced by specific patient and treatment characteristics. CLINICALTRIALS.GOV: NCT01898299.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Pejman Sehatpour
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Michael Avissar
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Guillermo Horga
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Anna Gwak
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Mathew J Hoptman
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA; Department of Psychiatry, NYU School of Medicine, New York, NY, 10016, USA
| | - Odeta Beggel
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA
| | - Ragy R Girgis
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Blair Vail
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Gail Silipo
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA
| | - Marlene Carlson
- Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Daniel C Javitt
- Schizophrenia Research Center, Nathan Kline Institute, Orangeburg, NY, 10962, USA; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, USA; Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, 10032, USA
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Rapid Amelioration of Clozapine-Resistant Thought Broadcast in Schizophrenia With High-Dose Right Unilateral Ultrabrief Electroconvulsive Therapy-A Single Case Report. J ECT 2019; 35:e16-e17. [PMID: 30531396 DOI: 10.1097/yct.0000000000000561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Parlikar R, Bose A, Venkatasubramanian G. Schizophrenia and Corollary Discharge: A Neuroscientific Overview and Translational Implications. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:170-182. [PMID: 30905117 PMCID: PMC6478093 DOI: 10.9758/cpn.2019.17.2.170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 01/10/2023]
Abstract
Corollary discharge mechanism refers to the suppression of sensory consequences of self-generated actions; a process that serves to distinguish between self and non-self based on discrimination of origination of action. It explains, say for example, why we cannot tickle ourselves. This review discusses how corollary discharge model is an essential neural integration mechanism central to the motor functioning of animal kingdom. In this article, research conducted in the field of corollary discharge has been reviewed to understand the neuroanatomical and neurophysiological basis of corollary discharge and gain insight into the biochemical basis of its dysfunction. This review article also explores the role of corollary discharge and its dysfunction in the presentation of symptoms of schizophrenia, discussing the findings from corollary discharge studies on schizophrenia population. Lastly, the link between schizophrenia psychopathology and corollary discharge dysfunction has been highlighted, and an attempt has been made to establish a case for correction of corollary discharge deficit in schizophrenia through neuromodulation.
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Affiliation(s)
- Rujuta Parlikar
- WISER Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anushree Bose
- WISER Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- WISER Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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32
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Huang J, Zhuo C, Xu Y, Lin X. Auditory verbal hallucination and the auditory network: From molecules to connectivity. Neuroscience 2019; 410:59-67. [PMID: 31082536 DOI: 10.1016/j.neuroscience.2019.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022]
Abstract
Auditory verbal hallucinations (AVHs) frequently occur across multiple psychiatric diseases especially in schizophrenia (SCZ) patients. Functional imaging studies have revealed the hyperactivity of the auditory cortex and disrupted auditory-verbal network activity underlying AVH etiology. This review will firstly summarize major findings from both human AVH patients and animal models, with focuses on the auditory cortex and associated cortical/sub-cortical areas. Besides mesoscale connectivity or activity data, structure and functions at synaptic level will be discussed, in conjunction with molecular mechanisms. We have summarized major findings for the pathogenesis of AVH in SCZ patients, with focuses in the auditory cortex and prefrontal cortex (PFC). Those discoveries provide explanations for AVH from different perspectives including inter-regional connectivity, local activity in specific areas, structure and functions of synapse, and potentially molecular targets. Due to the uniqueness of AVH in humans, full replica using animals seems impossible. However, we can still extract useful information from animal SCZ models based on the disruption of auditory pathway during AVH episodes. Therefore, we will further interpolate the synaptic structures and molecular targets, whose dysregulation in SCZ models may be highly related with AVH episodes. As the last part, implications for future development of treatment strategies will be discussed.
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Affiliation(s)
- Jianjie Huang
- Department of Psychiatric-Neuroimging-Genetics Laboratory(PNG-Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China
| | - Chuanjun Zhuo
- Department of Psychiatric-Neuroimging-Genetics Laboratory(PNG-Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China; Department of Psychiatry, Institute of Mental Health, Jining University, Jining Shandong Province, 272191, China; Department of Psychiatric-Neuroimaging-Genetics and Comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, China, Tianjin, 300222, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China.
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiaodong Lin
- Department of Psychiatric-Neuroimging-Genetics Laboratory(PNG-Lab), Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang Province, 325000, China
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33
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Zhuo C, Jiang D, Liu C, Lin X, Li J, Chen G, Xie Z, Xu Z, Zhou C, Zhu J. Understanding auditory verbal hallucinations in healthy individuals and individuals with psychiatric disorders. Psychiatry Res 2019; 274:213-219. [PMID: 30807972 DOI: 10.1016/j.psychres.2019.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 01/09/2023]
Abstract
Auditory verbal hallucinations(AVHs) are psychiatric manifestations that are common in patients with psychiatric disorders and can occur in healthy individuals. This review summarizes the existing literature on the phenomenological features of auditory verbal hallucinations, imaging findings, and interventions, focusing on patients with schizophrenia who experience auditory verbal hallucinations, in addition to patients with borderline personality disorder, bipolar disorder, major depressive disorder, and posttraumatic stress disorder, as well as healthy individuals. The phenomenological features of AVHs vary in different psychiatric disorders, and the symptoms are associated with changes in specific brain structures and disturbances in brain function, blood flow, and metabolism. Interventions for auditory verbal hallucinations include antipsychotic drugs, neurostimulation, and cognitive behavioral therapy.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China; Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China; Department of Psychiatric-Neuroimaging-Genetics and comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, 300222, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Chuanxin Liu
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China
| | - Xiaodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Jie Li
- Department of Psychiatric-Neuroimaging-Genetics and comorbidity Laboratory (PNGC-Lab), Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, 300222, China
| | - Guangdong Chen
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China
| | - Zuoliang Xie
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China
| | - ZhangJi Xu
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China
| | - Chunhua Zhou
- Department of Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Jingjing Zhu
- Department of Psychiatry, Institute of Mental Health, Jining Medical University, Shandong, Jining, 272191, China
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34
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Effects and potential mechanisms of transcranial direct current stimulation (tDCS) on auditory hallucinations: A meta-analysis. Psychiatry Res 2019; 273:343-349. [PMID: 30682555 DOI: 10.1016/j.psychres.2019.01.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/14/2022]
Abstract
Auditory hallucinations are the most common psychiatric symptoms of schizophrenia with high recurrence and refractoriness. Transcranial direct current stimulation (tDCS), a novel, non-invasion and affordable brain stimulation technique, has been recently applying on the schizophrenia patients to treat the auditory hallucinations. To analyze the efficacy of tDCS treatment on such symptoms and to reveal its potential working mechanisms, we carried out a structured literature search in PubMed, Embase and Cochrane Library database up to May 12, 2018. Five studies that met inclusion criteria with a total of 137 patients were included in this meta-analysis. After pooling all the data, we found that there was no significant effect between active group and sham group of tDCS (p = 0.18). When we removed one study that did not collaboratively stimulate the frontal-temporal sites, the active tDCS group marks a significant improvement of therapeutic effect compared with sham group (p = 0.007). Our findings suggested that tDCS could be a promising tool to alleviate auditory hallucinations, provided that the simulation sites and protocols are targeting at the sensorimotor frontal-parietal network.
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35
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Yoon YB, Kim M, Lee J, Cho KIK, Kwak S, Lee TY, Kwon JS. Effect of tDCS on Aberrant Functional Network Connectivity in Refractory Hallucinatory Schizophrenia: A Pilot Study. Psychiatry Investig 2019; 16:244-248. [PMID: 30836741 PMCID: PMC6444100 DOI: 10.30773/pi.2018.11.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 11/18/2018] [Indexed: 11/27/2022] Open
Abstract
We aim to investigate the effect of fronto-temporal transcranial direct current stimulation (tDCS) on the interactions among functional networks and its association with psychotic symptoms. In this pilot study, we will determine possible candidate functional networks and an adequate sample size for future research. Seven schizophrenia patients with treatment-refractory auditory hallucinations underwent tDCS twice daily for 5 days. Resting-state fMRI data and measures of the severity of psychotic symptoms were acquired at baseline and after completion of the tDCS sessions. At baseline, decreased functional network interaction was negatively correlated with increased hallucinatory behavior. After tDCS, the previously reduced functional network connectivity significantly increased. Our results showed that fronto-temporal tDCS could possibly remediate aberrant hallucination-related functional network interactions in patients with schizophrenia.
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Affiliation(s)
- Youngwoo Bryan Yoon
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.,Department of Psychiatry, Washington University in St. Louis, MO, USA
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang Ik K Cho
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Seoyeon Kwak
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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36
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Kim J, Iwata Y, Plitman E, Caravaggio F, Chung JK, Shah P, Blumberger DM, Pollock BG, Remington G, Graff-Guerrero A, Gerretsen P. A meta-analysis of transcranial direct current stimulation for schizophrenia: "Is more better?". J Psychiatr Res 2019; 110:117-126. [PMID: 30639917 DOI: 10.1016/j.jpsychires.2018.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 01/29/2023]
Abstract
Transcranial direct current stimulation (tDCS) has generated interest in recent years as a potential adjunctive treatment for patients with schizophrenia. The primary objective of this meta-analysis was to evaluate the efficacy of tDCS on positive symptoms, particularly auditory hallucinations, and negative symptoms. A literature search of randomized sham-controlled trials was conducted using the OVID database on October 9, 2018. The standardized mean differences (SMDs) were calculated to examine changes in symptom severity between active and sham groups for the following symptom domains: auditory hallucinations, positive symptoms (including auditory hallucinations), and negative symptoms. Moderator analyses were performed to examine the effects of study design and participant demographics. We identified 10 eligible studies. Main-analyses showed no effects of tDCS on auditory hallucinations (7 studies, n = 242), positive symptoms (9 studies, n = 313), or negative symptoms (9 studies, n = 313). Subgroup analyses of studies that applied twice-daily stimulation showed a significant reduction in the severity of auditory hallucinations (4 studies, n = 138, SMD = 1.04, p = 0.02). Studies that applied ≥10 stimulation sessions showed a reduction in both auditory hallucination (5 studies, n = 186, SMD = 0.86, p = 0.009) and negative symptom severity (7 studies, n = 257, SMD = 0.41, p = 0.04). Meta-regression analyses revealed a negative association between mean age and the SMDs for auditory hallucinations and negative symptoms, and a positive association between baseline negative symptom severity and the SMDs for negative symptoms. Our findings highlight the need to optimize tDCS parameters and suggest twice-daily or 10 or more stimulation sessions may be needed to improve clinical outcomes in patients with schizophrenia.
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Affiliation(s)
- Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Caravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jun Ku Chung
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
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Gowda SM, Narayanaswamy JC, Hazari N, Bose A, Chhabra H, Balachander S, Bhaskarapillai B, Shivakumar V, Venkatasubramanian G, Reddy YCJ. Efficacy of pre-supplementary motor area transcranial direct current stimulation for treatment resistant obsessive compulsive disorder: A randomized, double blinded, sham controlled trial. Brain Stimul 2019; 12:922-929. [PMID: 30808612 DOI: 10.1016/j.brs.2019.02.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 01/28/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A significant proportion of obsessive compulsive disorder (OCD) patients do not respond to specific serotonin reuptake inhibitors (SSRIs). There is a need to evaluate novel treatment options for OCD. OBJECTIVE In this double blinded, randomized, sham controlled study, we investigated the efficacy of add-on transcranial direct current stimulation (tDCS) in reducing the symptoms in SSRI-resistant OCD patients by employing anodal pre-supplementary motor area (pre-SMA) stimulation. METHOD Twenty-five patients with DSM-IV OCD having persistent symptoms despite adequate and stable treatment with at least one SSRI were randomly allocated to receive 20 min of verum (active) 2-mA tDCS or sham stimulation twice daily on 5 consecutive days [anode over Pre-SMA; cathode over right supra-orbital area]. Response to treatment was defined as at least 35% reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score along with a Clinical Global Impression - Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved). RESULTS The response rate was significantly greater in the verum tDCS(4 out of 12) compared to sham-tDCS (0 out of 13) [Fisher's exact test, p = 0.04]. Repeated measures analysis of variance with tDCS type (verum vs. sham) as between subjects factor showed that there was a significant tDCS-type X time-point interaction with significantly greater reduction of YBOCS total score [F (1,22) = 4.95,p = 0.04,partial-η2 = 0.18] in verum-tDCS group. CONCLUSIONS The results of this RCT suggest that tDCS may be effective in treating SSRI-resistant OCD. Future studies should examine the efficacy in larger samples of OCD and explore other potential target regions using randomized sham-controlled designs, in addition to examining the sustainability of the beneficial effects. TRIAL REGISTRATION Clinical Trials Registry India (http://ctri.nic.in/Clinicaltrials/login.php): Registration Number- CTRI/2016/04/006837).
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Affiliation(s)
- Shayanth M Gowda
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Janardhanan C Narayanaswamy
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India; Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India.
| | - Nandita Hazari
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Anushree Bose
- Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Harleen Chhabra
- Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Srinivas Balachander
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Venkataram Shivakumar
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India; Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Ganesan Venkatasubramanian
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India; Translational Psychiatry Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
| | - Y C Janardhan Reddy
- Obsessive Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 560029, India
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38
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Bose A, Nawani H, Agarwal SM, Shivakumar V, Kalmady SV, Shenoy S, Sreeraj VS, Narayanaswamy JC, Kumar D, Venkatasubramanian G. Effect of fronto-temporal transcranial direct current stimulation on corollary discharge in schizophrenia: A randomized, double-blind, sham-controlled mediation analysis study. Schizophr Res 2019; 204:411-412. [PMID: 30076111 DOI: 10.1016/j.schres.2018.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Anushree Bose
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Hema Nawani
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sri Mahavir Agarwal
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Venkataram Shivakumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sunil V Kalmady
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sonia Shenoy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vanteemar S Sreeraj
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Janardhanan C Narayanaswamy
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Devvarta Kumar
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- WISER Neuromodulation Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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39
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Towards artificial intelligence in mental health by improving schizophrenia prediction with multiple brain parcellation ensemble-learning. NPJ SCHIZOPHRENIA 2019; 5:2. [PMID: 30659193 PMCID: PMC6386753 DOI: 10.1038/s41537-018-0070-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/06/2018] [Indexed: 12/16/2022]
Abstract
In the literature, there are substantial machine learning attempts to classify schizophrenia based on alterations in resting-state (RS) brain patterns using functional magnetic resonance imaging (fMRI). Most earlier studies modelled patients undergoing treatment, entailing confounding with drug effects on brain activity, and making them less applicable to real-world diagnosis at the point of first medical contact. Further, most studies with classification accuracies >80% are based on small sample datasets, which may be insufficient to capture the heterogeneity of schizophrenia, limiting generalization to unseen cases. In this study, we used RS fMRI data collected from a cohort of antipsychotic drug treatment-naive patients meeting DSM IV criteria for schizophrenia (N = 81) as well as age- and sex-matched healthy controls (N = 93). We present an ensemble model -- EMPaSchiz (read as ‘Emphasis’; standing for ‘Ensemble algorithm with Multiple Parcellations for Schizophrenia prediction’) that stacks predictions from several ‘single-source’ models, each based on features of regional activity and functional connectivity, over a range of different a priori parcellation schemes. EMPaSchiz yielded a classification accuracy of 87% (vs. chance accuracy of 53%), which out-performs earlier machine learning models built for diagnosing schizophrenia using RS fMRI measures modelled on large samples (N > 100). To our knowledge, EMPaSchiz is first to be reported that has been trained and validated exclusively on data from drug-naive patients diagnosed with schizophrenia. The method relies on a single modality of MRI acquisition and can be readily scaled-up without needing to rebuild parcellation maps from incoming training images.
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Nathou C, Etard O, Dollfus S. Auditory verbal hallucinations in schizophrenia: current perspectives in brain stimulation treatments. Neuropsychiatr Dis Treat 2019; 15:2105-2117. [PMID: 31413576 PMCID: PMC6662171 DOI: 10.2147/ndt.s168801] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This review reports the current perspectives of brain stimulation techniques in the treatment of auditory verbal hallucinations (AVH) in schizophrenia. METHODS A systematic search of the literature in the PubMed database revealed that the most studied techniques are noninvasive techniques (NIBS), including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS). RESULTS The results showed that ECT could have great clinical efficacy but is currently underused in practice perhaps due to the costs associated with its limited implementation and potential associated risks. tDCS is still poorly studied and does not demonstrate sufficiently homogeneous or conclusive results yet to prove its efficacy in the treatment of AVH. However, its safe and simple implementation allows us to recommend it to patients who are refractory to other stimulation techniques. Finally, rTMS seems to be the most efficacious NIBS to offer patients with persistent AVH as an add-on therapeutic strategy. Its implementation has a non negligible cost but can be performed by a single practitioner. Great evolution in these techniques with technological progress, robotics and computer science are currently being tested and will undoubtedly improve the clinical efficacy of these procedures, particularly towards more personalized treatments such as individual rTMS targets and intensities. There are also new techniques for deep brain stimulation based on focused ultrasound that could provide much insight into the treatment of AVH in schizophrenia. CONCLUSION This review suggests that add-on brain stimulation treatments could play a key role among the therapeutic strategies for auditory hallucinations reduction in schizophrenia.
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Affiliation(s)
- Clément Nathou
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
| | - Olivier Etard
- Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France.,Normandie Univ, UNICAEN, CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, CHU de Caen, Caen, F-14000, France
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
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41
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Sreeraj VS, Masali M, Shivakumar V, Bose A, Venkatasubramanian G. Clinical Utility of Add-On Transcranial Direct Current Stimulation for Binge Eating Disorder with Obesity in Schizophrenia. Indian J Psychol Med 2018; 40:487-490. [PMID: 30275626 PMCID: PMC6149297 DOI: 10.4103/ijpsym.ijpsym_551_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Over the recent years, there has been an increasing application of noninvasive brain stimulation techniques such as transcranial direct-current stimulation (tDCS) to modify eating behaviors in healthy population and persons with eating disorders. tDCS is a noninvasive, neuromodulatory intervention which is well-tolerated and safe. In this case report, we describe the successful application of add-on tDCS in a patient with schizophrenia to reduce the craving for food that in turn, helped in reversing the weight gain.
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Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Manjunath Masali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Venkataram Shivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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42
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Moffa AH, Brunoni AR, Nikolin S, Loo CK. Transcranial Direct Current Stimulation in Psychiatric Disorders: A Comprehensive Review. Psychiatr Clin North Am 2018; 41:447-463. [PMID: 30098657 DOI: 10.1016/j.psc.2018.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been gaining favor as a viable tool in Psychiatry. The purpose of this review is to summarize the evidence of tDCS as a treatment of disorders such as depression, schizophrenia, and obsessive-compulsive disorder (OCD). Current findings indicate that tDCS is probably effective in non-treatment-resistant depressive patients. Regarding schizophrenia and OCD, present evidence is not robust enough, although preliminary results indicate that tDCS is a promising technique. Therefore, more trials are needed before using tDCS in a clinical setting.
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Affiliation(s)
- Adriano H Moffa
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia.
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos 785, Sao Paulo, Sao Paulo 01060-970, Brazil; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Leopoldstr. 13, Munich 80802, Germany
| | - Stevan Nikolin
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, Sydney, New South Wales 2031, Australia
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43
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Chang CC, Tzeng NS, Chao CY, Yeh CB, Chang HA. The Effects of Add-on Fronto-Temporal Transcranial Direct Current Stimulation (tDCS) on Auditory Verbal Hallucinations, Other Psychopathological Symptoms, and Insight in Schizophrenia: A Randomized, Double-Blind, Sham-Controlled Trial. Int J Neuropsychopharmacol 2018; 21:979-987. [PMID: 30107404 PMCID: PMC6209860 DOI: 10.1093/ijnp/pyy074] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/08/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of fronto-temporal transcranial direct current stimulation in treating auditory verbal hallucinations and other psychopathological symptoms of schizophrenia patients has been examined in a small number of clinical trials with limited sample sizes, but the results are mixed. Fronto-temporal transcranial direct current stimulation has also been demonstrated to enhance patients' insight into their mental illness in an open-label pilot study. The current investigation aimed to investigate the therapeutic effects of fronto-temporal transcranial direct current stimulation on the severity of auditory verbal hallucinations, other schizophrenia symptoms, and insight in a large double blind, randomized, sham-controlled trial. METHODS Sixty patients with medication-refractory auditory verbal hallucinations were randomized over 2 conditions: transcranial direct current stimulation with 2-mA, twice-daily sessions for 5 consecutive days, with anodal stimulation to the left prefrontal cortex and cathodal stimulation to the left temporo-parietal junction, and sham treatment. RESULTS Fronto-temporal transcranial direct current stimulation failed to cause significant changes in the severity of auditory verbal hallucinations and other schizophrenia symptoms. The levels of insight into illness (effect size=0.511, P<.001) and positive symptoms (effect size=0.781, P<.001) were largely promoted by 5 days of transcranial direct current stimulation relative to sham treatment. The beneficial effects on the 2 insight dimensions remained 1 month after transcranial direct current stimulation. CONCLUSIONS Fronto-temporal transcranial direct current stimulation is not more effective for auditory verbal hallucinations and other schizophrenia symptoms than sham treatment. But the results of transcranial direct current stimulation-associated improvement in awareness of illness and positive symptoms show promise and provide a new direction for future research into insight promotion interventions in schizophrenia.
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan,Correspondence: Hsin-An Chang, MD, Department of Psychiatry, Tri-Service General Hospital, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, 114, Taiwan, ROC ()
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Miyagishi Y, Ikeda T, Takahashi T, Kudo K, Morise H, Minabe Y, Kikuchi M. Gamma-band auditory steady-state response after frontal tDCS: A double-blind, randomized, crossover study. PLoS One 2018; 13:e0193422. [PMID: 29489895 PMCID: PMC5830999 DOI: 10.1371/journal.pone.0193422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/10/2018] [Indexed: 11/19/2022] Open
Abstract
The effects of transcranial direct current stimulation (tDCS) likely depend on cortical N-methyl-D-aspartic acid (NMDA) neurotransmission; however, no previous studies have reported tDCS-mediated modulation of cortical NMDA neurotransmission in humans. The gamma-band auditory steady-state response (ASSR) to a 40 Hz stimulation likely reflects the integrity of cortical NMDA neurotransmission. The present study tested whether the effect of tDCS is reflected in gamma-band ASSRs during a 40 Hz stimulation. Using a double-blind, randomized, crossover study, we performed magnetoencephalography (MEG) and measured the ASSR in 24 healthy participants during 40 Hz of auditory stimulation after prefrontal tDCS (2 mA) or sham (i.e., placebo) treatment. Our results failed to reveal significant differences in any brain between the two conditions after the application of a frequency of approximately 40 Hz. Based on these results, the ASSR is an insufficient method to detect the effect of tDCS on cortical NMDA neurotransmission. Unexpectedly, the results revealed an enhanced beta-band event-related spectral perturbation (ERSP) in the left motor cortex after tDCS compared with that observed after the sham stimuli. Given that beta-band oscillations reflect many functions in motor cortices, the tDCS for the frontal areas had some effect on the left motor cortex while the participants were focusing on not pressing the button with their right index finger. An additional study with an adequate psychological task is necessary to draw a conclusion regarding this unexpected result.
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Affiliation(s)
- Yoshiaki Miyagishi
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
- * E-mail:
| | | | - Kiwamu Kudo
- Ricoh Institute of Future Technology, Research and Development Division, Ricoh Company, Ltd., Kanazawa, Japan
| | - Hirofumi Morise
- Ricoh Institute of Future Technology, Research and Development Division, Ricoh Company, Ltd., Kanazawa, Japan
| | - Yoshio Minabe
- Department of Psychiatry and Neurobiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Mitsuru Kikuchi
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
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