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首页> 美国卫生研究院文献>Frontiers in Psychiatry >Targeting Treatment-Resistant Auditory Verbal Hallucinations in Schizophrenia with fMRI-Based Neurofeedback – Exploring Different Cases of Schizophrenia
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Targeting Treatment-Resistant Auditory Verbal Hallucinations in Schizophrenia with fMRI-Based Neurofeedback – Exploring Different Cases of Schizophrenia

机译：基于fMRI的神经反馈靶向精神分裂症中的抗拒性听觉幻觉-探索不同情况的精神分裂症

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Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients’ emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region – even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations’ severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state – with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients’ symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for years, experienced symptom changes that may be attributed to the NF training. In order to assess the effectiveness of NF as a therapeutic method, this effect has to be studied systematically in larger groups; further, long-term effects need to be assessed. Particularly in schizophrenia, future NF studies should take into account the individual differences in reward processing, fatigue, and motivation to develop individualized training protocols.
机译：听觉言语幻觉（AVH）是精神分裂症的标志，可能严重损害患者的情绪，社交和职业功能。尽管在心理药理学方面取得了进展，但仍有超过25％的精神分裂症患者遭受难以治疗的幻觉困扰。在寻找替代治疗方法时，神经反馈（NF）成为一种有前途的治疗工具。基于实时功能磁共振成像（rt-fMRI）的NF可以自愿改变选定大脑区域的活动，即使是精神分裂症患者也是如此。这项研究探讨了NF对正在进行的AVH的影响。选定的参与者接受了前扣带回皮质（ACC）中活动自我调节的培训，前扣带回皮质是参与AVHs产生和强度调节的关键监测区域。使用rt-fMRI，三位右撇子患者患有精神分裂症和正在进行的，对治疗有抵抗力的AVH，分别在三天之内学会了控制ACC活性。通过听觉幻觉评定量表（AVHRS）和情感状态-积极和消极影响表（PANAS）评估了NF训练对幻觉严重程度的影响。所有患者的ACC均显着上调，并报告了AVH（AVHRS）某些方面的主观改善，例如骚扰和声音障碍。总体而言，在NF训练过程中，情绪（PANAS）有所改善，尽管两名患者在NF训练后的第三天出现较差的情绪。 NF学习期间的ACC和奖励系统活动以及对情绪和症状的特定影响因参与者而异。他们都没有从延长的三节课培训中受益。此外，在被NF激活的脑网络和症状变化中出现个体差异，这与患者的症状和疾病史有关。基于rt-fMRI的NF似乎是治疗AVH的有前途的工具。患有连续幻觉多年的患者出现症状变化，这可能归因于NF训练。为了评估NF作为一种治疗方法的有效性，必须在较大的人群中系统地研究这种作用。此外，需要评估长期影响。特别是在精神分裂症中，未来的NF研究应考虑奖励过程，疲劳和制定个性化训练方案的动机方面的个体差异。

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