Real time fMRI feedback and auditory processing in schizophrenia

精神分裂症的实时功能磁共振成像反馈和听觉处理

• 批准号: 8509122
• 负责人: MARGARET A NIZNIKIEWICZ
• 金额: $ 18.21万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-10 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8509122
• 关键词: Adopted; Anterior; Antipsychotic Agents; Area; Auditory; Auditory Hallucination; Auditory Perception; Auditory area; Biofeedback; Brain; Brain region; Chronic Schizophrenia; Clinical; Cognition; Computers; DSM-IV; Data; Diagnostic; Educational process of instructing; Effectiveness; Feedback; Frequencies; Functional Imaging; Functional Magnetic Resonance Imaging; Functional disorder; Gender; Grant; Incidence; Individual; Inferior frontal gyrus; Informal Social Control; Intervention; Lead; Literature; Magnetism; Measures; Methods; Modeling; Monitor; Names; Occipital lobe; Outcome; Parietal; Patients; Performance; Pharmaceutical Preparations; Process; Regulation; Relative (related person); Reporting; Resistance; Review Literature; Role; Schizophrenia; Severities; Signal Transduction; Speech; Superior temporal gyrus; Symptoms; Technology; Temporal Lobe; Testing; Therapeutic; Tilia; Time; Training; Verbal Auditory Hallucinations; Voice; auditory feedback; base; cingulate cortex; comparison group; effectiveness measure; experience; improved; improved functioning; language processing; neuropsychological; novel; public health relevance; selective attention

DESCRIPTION (provided by applicant): Auditory verbal hallucinations (AH) have long been a hallmark of schizophrenia (SZ) symptomatology and one of its major diagnostic features (Andreasen and Flaum, 1991; DSM-IV). It has been demonstrated that the brain regions implicated in AH are involved in different aspects of language processing. This brain network includes the temporal cortex and especially the superior temporal gyrus (STG), anterior cingulate (ACC), inferior frontal gyrus (IFG), and temporo-parietal junction (TPJ). Until recently, AH were primarily controlled with antipsychotic medication which was often ineffective. In this application, we propose to use a cutting-edge biofeedback method of real-time functional imaging neuro-feedback (rt-fMRI) to reduce the frequency of AH and to better understand brain processes involved in AH. We adopt the Hugdahl 2009 model of AH according to which AH result from abnormalities in self-monitoring of speech, in selective attention and in auditory perceptual processes. We focus on the role of auditory cortex, specifically the STG, as a target area of neuro-feedback training for the treatment of AH in SZ. Based on existing literature, we posit that that improved function in the STG will normalize the entire network involved in the experience of AH. We predict that the activation in the STG (and regions forming AH network: IFG, ACC, and TPJ) will increase as a result of receiving feedback from that region which will lead to a better performance on the task of recognizing self/other voice as measured by fMRI activation levels pre-and post-rt-fMRI training and by reduction in positive symptoms and especially AH. The rt-fMRI neuro-feedback relies on recent advances in computer technology that allows subjects to see the level of activation in the selected brain region and to regulate ths activation following the training provided. Subjects are taught to up-regulate or down-regulate fMRI signal within a specific brain region selected based on the activation task. Importantly, reported activation changes are possible only if the subject receives a feedback from his/her target area and not when she/he receives it from a different subject or a different area than the target one (sham). It has been recently demonstrated that this approach may be helpful in many clinical conditions, among them schizophrenia (Haller 2010; Sitaran 2011;Linden 2012;Veit 2009; Hartwell 2012; Li 2012, Ruiz 2011). In this study we propose to study 30 chronic SZ patients and 30 normal control (NC) individuals (half of them will receive real and half will receive a sham fMRI feedback). We will use both fMRI (including two measures of connectivity) and clinical measures of the effectiveness of the rt-fMRI feedback. Based on the existing literature and our preliminary data, we predict that we will successfully improve auditory processing within the STG and within the targeted network and that it will lead to improvement in the clinical symptoms and especially in the frequency of AH.

描述（由申请人提供）：听觉言语幻觉（AH）长期以来一直是精神分裂症（SZ）症状学的标志及其主要诊断特征之一（Andreasen和Flaum，1991; DSM-IV）。已经证明，与AH有关的大脑区域与语言处理的不同方面有关。该大脑网络包括颞皮层，尤其是上颞回（STG），前扣带回（ACC），下额回（IFG）和颞顶连接（TPJ）。直到最近， AH主要用抗精神病药物控制，通常无效。在此应用中，我们建议使用实时功能成像神经反馈（RT-FMRI）的最先进的生物反馈方法来降低AH的频率并更好地了解AH涉及的大脑过程。我们采用了Hugdahl 2009 AH模型，根据该模型，AH是由于语音自我监测，选择性关注和听觉感知过程的异常而产生的。我们专注于听觉皮层，特别是STG的作用，是在SZ中治疗AH的神经反馈培训的目标领域。根据现有文献，我们认为，改善STG功能的功能将使与AH体验有关的整个网络正常化。我们预测，由于接收来自该地区的反馈，STG的激活（以及形成AH网络：IFG，ACC和TPJ）将增加，这将导致在识别fMRI激活水平衡量的自我/其他声音的任务上，通过RT-FMRI训练和RT-RT-FMRI训练和降低阳性症状降低阳性症状，尤其是AH。 RT-FMRI神经反馈依赖于计算机技术的最新进展，该技术使受试者能够看到所选大脑区域的激活水平并在提供的训练后调节THS激活。根据激活任务，教导受试者在特定的大脑区域内上调或下调fMRI信号。重要的是，只有当受试者从其目标区域收到反馈时，而不是当她/他从其他受试者或与目标一个区域不同的区域（假）接收到它时，才有可能发生的激活变化。最近已经证明，这种方法在许多临床状况中可能有帮助，其中包括精神分裂症（Haller 2010； Sitaran 2011； Linden 2012； Veit 2009； Hartwell 2009； Hartwell 2012； Li 2012，Ruiz 2011）。在这项研究中，我们建议研究30名慢性SZ患者和30名正常对照（NC）个体（其中一半将获得真实的frim，一半将获得fMRI的反馈）。我们将同时使用fMRI（包括两种连通性的度量）和RT-FMRI反馈有效性的临床度量。根据现有文献和我们的初步数据，我们预测我们将成功改善STG内部和目标网络中的听觉处理，并将导致临床症状，尤其是AH的频率改善。