Abstract
Background: Impaired illness awareness or insight into illness (IIA) is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. Neuroimaging studies suggest IIA may arise from interhemispheric imbalance in frontoparietal regions, particularly in the posterior parietal area (PPA) and the dorsolateral prefrontal cortex (dlPFC). In this pilot study, we examined the effects of transcranial direct current stimulation (tDCS) on brain regions implicated in IIA. Methods: Eleven patients with schizophrenia with IIA (≥3 PANSS G12) and 10 healthy controls were included. A crossover design was employed where all participants received single-session bi-frontal, bi-parietal, and sham stimulation in random order. For each condition, we measured (i) blood oxygen level-dependent (BOLD) response to an illness awareness task pre- and post-stimulation, (ii) regional cerebral blood-flow (rCBF) prior to and during stimulation, and (iii) changes in illness awareness. Results: At baseline, patients with schizophrenia showed higher BOLD-response to an illness awareness task in the left-PPA compared to healthy controls. Bi-parietal stimulation reduced the interhemispheric imbalance in the PPA compared to sham stimulation. Relatedly, bi-parietal stimulation increased rCBF beneath the anode (21% increase in the right-PPA), but not beneath the cathode (5.6% increase in the left-PPA). Bi-frontal stimulation did not induce changes in rCBF. We found no changes in illness awareness. Conclusion: Although single-session tDCS did not improve illness awareness, this pilot study provides mechanistic justification for future investigations to determine if multi-session bi-parietal tDCS can induce sustained changes in brain activity in the PPA in association with improved illness awareness.
| Original language | English |
|---|---|
| Pages (from-to) | 63-71 |
| Number of pages | 9 |
| Journal | European Psychiatry |
| Volume | 61 |
| DOIs | |
| Publication status | Published - 2019 Sep 1 |
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Keywords
- Arterial spin labelling
- Functional MRI
- Illness awareness
- Insight
- Regional cerebral blood flow
- Schizophrenia
- Transcranial direct current stimulation
ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Modulation of brain activity with transcranial direct current stimulation : Targeting regions implicated in impaired illness awareness in schizophrenia. / Kim, Julia; Plitman, Eric; Nakajima, Shinichiro; Alshehri, Youssef; Iwata, Yusuke; Chung, Jun Ku; Caravaggio, Fernando; Menon, Mahesh; Blumberger, Daniel M.; Pollock, Bruce G.; Remington, Gary; De Luca, Vincenzo; Graff-Guerrero, Ariel; Gerretsen, Philip.
In: European Psychiatry, Vol. 61, 01.09.2019, p. 63-71.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Modulation of brain activity with transcranial direct current stimulation
T2 - Targeting regions implicated in impaired illness awareness in schizophrenia
AU - Kim, Julia
AU - Plitman, Eric
AU - Nakajima, Shinichiro
AU - Alshehri, Youssef
AU - Iwata, Yusuke
AU - Chung, Jun Ku
AU - Caravaggio, Fernando
AU - Menon, Mahesh
AU - Blumberger, Daniel M.
AU - Pollock, Bruce G.
AU - Remington, Gary
AU - De Luca, Vincenzo
AU - Graff-Guerrero, Ariel
AU - Gerretsen, Philip
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Impaired illness awareness or insight into illness (IIA) is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. Neuroimaging studies suggest IIA may arise from interhemispheric imbalance in frontoparietal regions, particularly in the posterior parietal area (PPA) and the dorsolateral prefrontal cortex (dlPFC). In this pilot study, we examined the effects of transcranial direct current stimulation (tDCS) on brain regions implicated in IIA. Methods: Eleven patients with schizophrenia with IIA (≥3 PANSS G12) and 10 healthy controls were included. A crossover design was employed where all participants received single-session bi-frontal, bi-parietal, and sham stimulation in random order. For each condition, we measured (i) blood oxygen level-dependent (BOLD) response to an illness awareness task pre- and post-stimulation, (ii) regional cerebral blood-flow (rCBF) prior to and during stimulation, and (iii) changes in illness awareness. Results: At baseline, patients with schizophrenia showed higher BOLD-response to an illness awareness task in the left-PPA compared to healthy controls. Bi-parietal stimulation reduced the interhemispheric imbalance in the PPA compared to sham stimulation. Relatedly, bi-parietal stimulation increased rCBF beneath the anode (21% increase in the right-PPA), but not beneath the cathode (5.6% increase in the left-PPA). Bi-frontal stimulation did not induce changes in rCBF. We found no changes in illness awareness. Conclusion: Although single-session tDCS did not improve illness awareness, this pilot study provides mechanistic justification for future investigations to determine if multi-session bi-parietal tDCS can induce sustained changes in brain activity in the PPA in association with improved illness awareness.
AB - Background: Impaired illness awareness or insight into illness (IIA) is a common feature of schizophrenia that contributes to medication nonadherence and poor clinical outcomes. Neuroimaging studies suggest IIA may arise from interhemispheric imbalance in frontoparietal regions, particularly in the posterior parietal area (PPA) and the dorsolateral prefrontal cortex (dlPFC). In this pilot study, we examined the effects of transcranial direct current stimulation (tDCS) on brain regions implicated in IIA. Methods: Eleven patients with schizophrenia with IIA (≥3 PANSS G12) and 10 healthy controls were included. A crossover design was employed where all participants received single-session bi-frontal, bi-parietal, and sham stimulation in random order. For each condition, we measured (i) blood oxygen level-dependent (BOLD) response to an illness awareness task pre- and post-stimulation, (ii) regional cerebral blood-flow (rCBF) prior to and during stimulation, and (iii) changes in illness awareness. Results: At baseline, patients with schizophrenia showed higher BOLD-response to an illness awareness task in the left-PPA compared to healthy controls. Bi-parietal stimulation reduced the interhemispheric imbalance in the PPA compared to sham stimulation. Relatedly, bi-parietal stimulation increased rCBF beneath the anode (21% increase in the right-PPA), but not beneath the cathode (5.6% increase in the left-PPA). Bi-frontal stimulation did not induce changes in rCBF. We found no changes in illness awareness. Conclusion: Although single-session tDCS did not improve illness awareness, this pilot study provides mechanistic justification for future investigations to determine if multi-session bi-parietal tDCS can induce sustained changes in brain activity in the PPA in association with improved illness awareness.
KW - Arterial spin labelling
KW - Functional MRI
KW - Illness awareness
KW - Insight
KW - Regional cerebral blood flow
KW - Schizophrenia
KW - Transcranial direct current stimulation
UR - http://www.scopus.com/inward/record.url?scp=85069205382&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069205382&partnerID=8YFLogxK
U2 - 10.1016/j.eurpsy.2019.06.007
DO - 10.1016/j.eurpsy.2019.06.007
M3 - Article
VL - 61
SP - 63
EP - 71
JO - European Psychiatry
JF - European Psychiatry
SN - 0924-9338
ER -