Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.
Int J Neuropsychopharmacol. 2021 Jan 20;24(1):40-53. doi: 10.1093/ijnp/pyaa063.
We previously showed the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over the prefrontal cortex (PFC) regions with extracephalic reference placement in improving negative symptoms in schizophrenia. In this ancillary investigation, the effects of this intervention on insight levels, other clinical outcomes, and cardio-respiratory and autonomic functions were examined and the potential of biomarkers for treatment response was explored.
Schizophrenia patients were randomly allocated to receive 10 sessions of bi-anodal tDCS over the PFC regions with extracephalic reference placement (2 mA, 20 minutes, twice daily for 5 weeks) or sham stimulation. We examined, in 60 patients at baseline, immediately after stimulation and at follow-up visits, the insight levels, other clinical outcomes, blood pressure, respiratory rate, heart rate, and heart rate variability.
Insight levels as assessed by the abbreviated version of the Scale to Assess Unawareness in Mental Disorder in schizophrenia awareness of the disease, positive and negative symptoms dimensions, and beliefs about medication compliance as assessed by Medication Adherence Rating Scale were significantly enhanced by active stimulation relative to sham. No effects were observed on cognitive insight, other clinical outcomes, or cardio-respiratory and autonomic functions. Heart rate variability indices as biomarkers were not associated with the clinical response to the intervention.
Our results provide evidence for bi-anodal tDCS over the PFC regions with extracephalic reference placement in heightening the levels of insight into the disease and symptoms, as well as beliefs about medication compliance in schizophrenia, without impacting other clinical outcomes and cardio-respiratory/autonomic functions.
我们之前已经证明，在前额皮质（PFC）区域使用颅外参考电极位置进行双阳极经颅直流电刺激（tDCS）可以有效地改善精神分裂症的阴性症状。在这项辅助研究中，我们检查了这种干预对洞察力水平、其他临床结果以及心肺和自主功能的影响，并探索了治疗反应的生物标志物的潜力。
精神分裂症患者被随机分配接受 10 次双阳极 tDCS 治疗，电极放置在前额皮质区域，使用颅外参考电极（2 mA，20 分钟，每天两次，持续 5 周）或假刺激。我们在 60 名患者的基线、刺激后立即和随访时检查了洞察力水平、其他临床结果、血压、呼吸频率、心率和心率变异性。
用简明精神分裂症不认同感量表评估的洞察力水平、阳性和阴性症状维度，以及用药物依从性评定量表评估的对药物治疗的信念，在积极刺激后相对于假刺激显著提高。认知洞察力、其他临床结果或心肺和自主功能没有受到影响。作为生物标志物的心率变异性指数与干预的临床反应无关。
我们的结果提供了证据，表明在前额皮质区域使用颅外参考电极位置进行双阳极 tDCS 可以提高对疾病和症状的洞察力水平，以及对药物治疗的信念，而不会影响其他临床结果和心肺/自主功能。
