Real-time fMRI Neurofeedback as a Tool to Mitigate Auditory Hallucinations in Patients with Schizophrenia

实时功能磁共振成像神经反馈作为减轻精神分裂症患者幻听的工具

基本信息

批准号：
10704690
负责人：
MARGARET A NIZNIKIEWICZ
金额：
$ 101.43万
依托单位：
BOSTON VA RESEARCH INSTITUTE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-06-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10704690
关键词：
Adopted Auditory Hallucination Auditory Perception Auditory area Benchmarking Brain Brain region Chronic Schizophrenia Clinical Cognitive DSM-IV Data Delusions Diagnostic Dose Feedback Functional Magnetic Resonance Imaging Functional disorder Future Goals Gur Impaired cognition Intervention Investigation Lead Literature Measurable Measures Medial Mediating Methods Modeling Monitor Motor Cortex Neuropsychology Outcome Paper Patients Pharmaceutical Preparations Phase Prefrontal Cortex Randomized Resistance Rest Sampling Schizophrenia Severities Short-Term Memory Signal Transduction Structure Superior temporal gyrus Symptoms Therapeutic Effect Time Transcranial magnetic stimulation Verbal Auditory Hallucinations Voice arm cingulate cortex cognitive function design disabling symptom group intervention improved neural neurofeedback novel placebo group primary outcome randomized trial response severe mental illness success tool treatment arm trial comparing

项目摘要

This is a resubmission application, originally in response to RFA-MH-16-406 and consists of R61 and R33 phases. Auditory verbal hallucinations (AH) have long been a hallmark of schizophrenia (SZ) and are one of its major diagnostic features Andreasen and Flaum 1991; DSM-IV). They are difficult to manage with existing treatment options. Here, we propose that neurofeedback aimed to regulate the superior temporal gyrus (STG) activation will not only lead to activation changes in the STG, but also to changes in the default mode network (DMN) (R61), as well as to reductions in AH (R33), and that the brain and clinical changes will be correlated (R33). The theoretical framework for the current proposal is an AH model that assumes that AH result from abnormalities in a network of regions including STG, and medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC), the two latter regions are core medial hubs of DMN that are related to self-referential processing. This model is supported by theoretical papers Northoff and Qin 2010, Alderson-Day,2016, and experimental evidence Gur 1995, Liddle 1992, Dierks 1999 as well as our preliminary data (PD). In both R61 and R33 we will study SZ patients with medication resistant AH in the rt-fMRI intervention arm and in the sham-rt-fMRI arm. In both arms, the task and the rt-fMRI session structure will be identical. The SZ-intervention group will receive feedback from the STG while SZ-sham group will receive feedback from the motor cortex. In addition, 2 functional fMRI tasks will examine the effect of rt-fMRI neurofeedback and of sham-rt-fMRI on brain response. In the R61, we will randomly assign 48 SZ patients to either SZ-intervention (n=24) or SZ-sham-rtfMRI (n=24). The STG targeted neurofeedback is predicted to bring changes in brain regions involved in AH (STG and DMN) in SZ-intervention group only. The R61 GO criterion will be BOLD signal reduction in the STG, and resting state connectivity reduction between MPFC-PCC, post rt-fMRI-feedback in SZ-intervention group. In the R33, SZ-intervention group (random n=52) will receive 5 sessions of rt-fMRI feedback targeting STG, while SZ-sham group (random n=52) will receive 5 sham-rt-fMRI sessions. Based on our PD, we predict that rt-fMRI feedback aimed at STG will reduce AH which will be, in turn, associated with reductions in the STG activation and in the DMN connectivity (i.e., brain changes achieved in R61 and replicated in R33) in SZ- intervention group only. Five sessions of rt-fMRI feedback will address the question of dose response at brain and clinical levels. The impact of rt-fMRI neurofeedback and of sham-rt-fMRI on AH (primary outcome), and on delusions, negative symptoms and working memory (WM) (exploratory outcome) will be assessed with clinical and neuropsychological measures. In an exploratory aim, based on the existing literature Garrity 2007; Whitfield-Gabrieli 2009; Rotarska-Jagiela 2010, we predict the improvement in delusions, negative symptoms and in WM score, only post-rt-fMRI neurofeedback targeting the STG and not post-sham-rt-fMRI.

这是一个重新提交申请，最初是针对RFA-MH-16-406的，由R61组成， R33阶段。听觉口头幻觉（AH）长期以来一直是精神分裂症（SZ）的标志，是一个它的主要诊断特征Andreasen和Flaum 1991； DSM-IV）。他们很难管理现有治疗选择。在这里，我们建议神经反馈旨在调节上颞回（STG）激活不仅会导致STG激活变化，还会导致默认模式网络的变化（DMN）（R61），以及AH中的减少（R33），并且大脑和临床变化将相关（R33）。当前建议的理论框架是AH模型，假设AH是由AH产生的包括STG和内侧前额叶皮层（MPFC）和后部的区域网络中的异常扣带皮质（PCC），后两个区域是与自指的核心内侧枢纽加工。该模型得到了理论论文Northoff和QIN 2010，Alderson-Day，2016年的支持以及实验 GUR 1995，Liddle 1992，Dierks 1999以及我们的初步数据（PD）。在R61和R33中，我们将在RT-FMRI干预中研究SZ患者的SZ患者手臂和sham-rt-fmri手臂。在两个武器中，任务和RT-FMRI会话结构将是相同的。这 SZ干预小组将收到STG的反馈，而SZ-SHAM组将收到来自运动皮层。此外，2个功能性fMRI任务将检查RT-FMRI神经反馈和 sham-rt-fMRI关于大脑反应。在R61中，我们将随机分配48名SZ患者，以切入（n = 24）或SZ-SHAM-RTFMRI （n = 24）。预计具有STG的靶向神经反馈会引起涉及AH的大脑区域的变化（STG 和DMN）仅在SZ干预组中。 R61 GO标准将是STG中的大胆信号，并且 SZ干预组的MPFC-PCC，RT-FMRI后反馈之间的静止状态连通性降低。在R33中，SZ干预组（随机n = 52）将获得5个会话RT-FMRI反馈目标 STG，而SZ-SHAM组（随机n = 52）将接受5个Sham-RT-FMRI会话。根据我们的PD，我们预测针对STG的RT-FMRI反馈将减少AH，这又与STG减少有关激活和DMN连接性（即，在R61中实现的大脑变化并在R33中复制）仅干预组。 RT-FMRI反馈的五个会议将解决大脑剂量反应的问题和临床水平。 RT-FMRI神经反馈和Sham-RT-FMRI对AH（主要结果）和关于妄想，负面症状和工作记忆（WM）（探索性结果）将通过临床和神经心理学措施。在探索性目的中，基于现有文献Garrity 2007； Whitfield-Gabrieli 2009； Rotarska-Jagiela 2010，我们预测妄想，负面症状和WM评分的改善，仅针对STG而不是SHAM-RT-FMRI后RT-FMRI神经反馈。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Reducing default mode network connectivity with mindfulness-based fMRI neurofeedback: a pilot study among adolescents with affective disorder history.

DOI：
10.1038/s41380-023-02032-z
发表时间：
2023-06
期刊：
MOLECULAR PSYCHIATRY
影响因子：
11
作者：
Zhang, Jiahe;Raya, Jovicarole;Morfini, Francesca;Urban, Zoi;Pagliaccio, David;Yendiki, Anastasia;Auerbach, Randy P.;Bauer, Clemens C. C.;Whitfield-Gabrieli, Susan
通讯作者：
Whitfield-Gabrieli, Susan