Treatment of auditory verbal hallucinations in schizophrenia using tDCS Charlotte Chaze1, Vince P. Clark1,2, Jessica Turner1,3, Rose Bigelow2, Jason Long2, Vince Calhoun1,2, Robert Thoma2

1Medical Image Analysis Lab, The Mind Research Network, Albuquerque, United States 2Departments of Psychology & Psychiatry, University of New Mexico, Albuquerque, United States 3Department of Psychology, Georgia State University, Atlanta, United States

cchaze@MRN.org

References:

Brunelin, J. et al. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations

in schizophrenia. Am. J. Psychiatry 2012; 169:719-24.

Drake, R. et al. The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in

first episode psychosis. Schiz. Research 2007; 89:119-122.

Results

Figure 1. Response to real voices before & after tDCS treatment

• There is a decrease in activation in the auditory cortex when listening to real voices

post-treatment

Question

Can transcranial direct current stimulation (tDCS) lessen the severity

of auditory verbal hallucinations (AVH) in schizophrenia by

modulating neural activation in pertinent brain regions?

Background

• Brunelin et al (2012) reported reduction in the severity of AVH in a tDCS

treatment trial

• We use fMRI to measure neural activation before and after treatment

Methods

• Volunteers with schizophrenia underwent a 5-day tDCS treatment program:

• AVH-on and AVH-off were tracked during fMRI scanning using a button-press

paradigm

• Volunteers also completed tasks that involved listening to stories and imagining

scenarios during fMRI scanning

Figure 2. Core PSYRATS Variables: Mean AVH Frequency & Duration Scores

Figure 3. Mean PANSS Scores

• A decrease in PSYRATS and PANSS scores with tDCS treatment is associated with

decreased activation in auditory cortex during a listening task

• A decrease in PSYRATS and PANSS scores are indicative of:

• A decrease in the severity of AVH

• A reduction in positive and negative symptoms of schizophrenia

Conclusions & Applications

• The first 3 participants experienced a decrease in frequency and duration of AVH

following treatment with tDCS

• Atypical function of auditory cortex is associated with the presence and severity of

AVH

• tDCS neurostimulation may be used to affect schizophrenia AVH

Right index finger:

AVH/”voices” on Left index finger:

AVH/”voices” off

Images from:

en.wikipedia.org/wiki/Wernicke's_area, neuroconn.de/dc-stimulator-2 , pixshark.com/duracell-battery-9v.htm,

boundless.com/biology/textbooks/boundless-biology-textbook/the-nervous-system-35/how-neurons-communicate-

200/

http://neurosciencenews.com/fmri-brain-differences-drug-use-889/mri-scan-normal-brain-sagital-view

Future

• Add sham trials

• Analyze listening task for controls

-70

-55

Resting potential

Excitation threshold

Mg+ Ca2+

Na+

-70

-55

e- e-

e-

Cathode

Wernicke’s area:

Language production

Anode

Broca’s area:

Language comprehension

tDCS

e-

Mg+

Ca2+

Na+

Anode: Makes neurons fire more easily Cathode: Makes it more difficult for neurons to fire PSYRATS

PANSS

PSYRATS

PANSS

Day 1

tDCS

Day 2 Day 3 Day 4 Day 5

tDCS tDCS tDCS

tDCS

PSYRATS

PANSS

Neural networks underlying auditory verbal hallucinations in schizophrenia Charlotte Chaze1, Robert Thoma1,2, Rose Bigelow2, Vince P. Clark1,2, Juan Bustillo2, Vince Calhoun1,2, Jessica Turner1,3

1Medical Image Analysis Lab, The Mind Research Network, Albuquerque, United States 2Departments of Psychology & Psychiatry, University of New Mexico, Albuquerque, United States 3Department of Psychology, Georgia State University, Atlanta, United States

cchaze@MRN.org

Question

How are regions involved in auditory verbal hallucinations

(AVH) linked together into networks in the brain?

Background

• Auditory verbal hallucinations are heard, not imagined (Figure 1)

• fMRI studies have identified regions active during auditory verbal

hallucinations (AVH) in schizophrenia

• Little is known about how these regions may be linked together into

networks

Methods

• Volunteers with schizophrenia were scanned in a 3-Tesla Siemens Trio

MRI

• Volunteers pressed buttons to indicate when they were experiencing

AVH (“hearing voices”)

• A minimum of 3 5-minute scans were collected for each volunteer

• Scan data was analyzed using both the general linear model and

independent component analysis

Figure 4. Brain activations during AVH (GLM + ICA)

• Temporal lobe (red): auditory processing and language recognition

• Inferior frontal gyrus (violet): language comprehension and production

• Basal ganglia (green): movement and motivation

• Insula (blue): self awareness, emotions

Discussion

• Activations in presumed auditory/linguistic processing networks show

a strong relationship to AVH

• Multiple networks are activated during AVH

Conclusions

• Each method of analysis has complimentary strengths and

weaknesses

• When combined, the GLM and ICA identify multiple neural networks

underlying the generation of AVH

• Most overlap is on the auditory cortex and temporal

lobes (language regions of the brain)

Applications

• Treatment of schizophrenia using precise techniques focused on

networks implicated in AVH

Right index finger:

AVH/”voices” on

Left index finger:

AVH/”voices” off

Figure 1. Actual hearing vs. “inner speech”

Results

Figure 2. Brain activations during AVH: GLM results

• Activation in auditory cortex and temporal lobes

Figure 3. Brain activations during AVH : ICA results

• Activations in areas previously implicated in AVH

Actual hearing Imagined repeating a sentence

References:

Brunelin, J. et al. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. Am. J. Psychiatry 2012; 169:719-24.

Drake, R. et al. The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis. Schiz. Research 2007; 89:119-122.

PSYRATS

PANSS MRI

MRI

PSYRATS

PANSS

Day 1

tDCS

Day 2 Day 3 Day 4 Day 5

tDCS tDCS tDCS

tDCS