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To be submitted for grant application
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The current research is aimed at using Transcranial Direct Current Stimulation (tDCS) as complementary therapeutic tool in the treatment of schizophrenia. Patients will be randomized into two groups (tDCS-active x tDCS-sham) accordingly to detailed protocol. Main outcome will be measured by specific clinical rating scales based on the assessment of negative symptoms. A total of 40 patients ought to be enrolled as specified in methodology. Secondary outcomes shall include collateral effects evaluation, anxiety and depressive scales as well as clinical monitoring.
Overview
The present study is a double-blind randomized clinical trial in which patients should be allocated from a General Psychiatry Service into two groups (tDCS-active x tDCS-sham). Subjects who fulfilled eligibility criteria will undergo ten days of consecutive stimulation (active or sham) and will return after two to four weeks for final clinical assessment. Patients who shown no response in rating scales and that were allocated to sham intervention group will be able to choose whether or not they want to undergo the active intervention at follow up (partial cross-over)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| tDCS active | Experimental | Active tDCS as foreseen in research protocol: daily sessions for 10 days with 2mA intensity stimulation during 20 minutes. |
|
| tDCS sham | Placebo Comparator | Sham tDCS : as foreseen in research protocol: sham stimulation with initial stimulation followed by turning off the device during the same time of intervention as to guarantee blinding |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transcranial Direct Current Stimulation (tDCS) | Procedure | Transcranial Direct Current Stimulation. Daily sessions with a total of 10 days intervention. Each intervention will take place with a 2mA intensity during 20 minutes. The current will be delivered by "Chattanooga Iontophoresis Dual Channel Delivery Device", that stands for a 2-channels tDCS device in which previous dosage can be set as default to maintain frequently used treatment parameters. Main features include (a) Beeping alerts if electrode fault for open current or high impedance, low battery, treatment completion or power left on; (b)automatic 30 second current ramp up and down during power on/off keeps patient comfortable; (c) Current can be set in 0.1 mA increments between 0.5 mA and 4 mA. |
| Measure | Description | Time Frame |
|---|---|---|
| Negative Symptoms Rates as assessed by the PAANS | Comparison between follow u and baseline PAANS scores with emphasis in negative symptoms scores | Assessment at 0(baseline), 2 weeks and 4 weeks (final outcome) - Positive and Negative Syndrome Scale (PAANS) |
| Measure | Description | Time Frame |
|---|---|---|
| Mental Mini Exam | cognitive evaluation as assessed by the Mental Mini Exam | Assessment at 0(baseline), 2 weeks and 4 weeks (final outcome) - Cognitive Screening assessment as performed by the Mental Mini Exam |
| Moca rating Scale |
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Inclusion Criteria:
Exclusion Criteria:
Regarding medication: all patients should have stable dosology of medications for at least 6 weeks
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| Name | Affiliation | Role |
|---|---|---|
| Andre R Brunoni, PhD | Irmandade da Santa Casa de Misericórdia de São Paulo | Study Chair |
| Pedro Shiozawa, MD | Irmandade da Santa Casa de Misericóridia de São Paulo | Principal Investigator |
| Quirino Jr Cordeiro, PhD | Irmandade da Santa Casa de Misericórdia de São Paulo | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centro de Atenção Integrada à Saúde Mental | São Paulo | São Paulo | 01415001 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 6696597 | Background | Loranger AW. Sex difference in age at onset of schizophrenia. Arch Gen Psychiatry. 1984 Feb;41(2):157-61. doi: 10.1001/archpsyc.1984.01790130053007. | |
| 12830306 | Background | Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC, Kawakami N, Kilic C, Offord D, Ustun TB, Wittchen HU. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res. 2003;12(1):3-21. doi: 10.1002/mpr.138. |
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| ID | Term |
|---|---|
| D012559 | Schizophrenia |
| ID | Term |
|---|---|
| D019967 | Schizophrenia Spectrum and Other Psychotic Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D065908 | Transcranial Direct Current Stimulation |
| ID | Term |
|---|---|
| D004599 | Electric Stimulation Therapy |
| D013812 | Therapeutics |
| D003295 | Convulsive Therapy |
| D013000 | Psychiatric Somatic Therapies |
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|
comparison between follow up and baseline scores in Cognitive evaluation as assessed by MoCa Test
| Assessment at 0(baseline), 2 weeks and 4 weeks (final outcome) - Cognitive assessment by MoCa Test |
| Stroop Victoria | comparison between follow up and baseline scores in atention and inhibitory control as assessed by Stroop Victoria | Assessment at 0(baseline), 2 weeks and 4 weeks (final outcome) - Cognitive assessment by Stroop - Victoria version |
| Neuropsychological Assessment | comparison between follow up and baseline scores in neuropschological evaluations performed by specialist using SuperLab tool | Assessment at 0(baseline), 2 weeks and 4 weeks (final outcome) - neuropsychologial assessment by trained researcher |
| 8782282 | Background | McGlashan TH, Johannessen JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull. 1996;22(2):201-22. doi: 10.1093/schbul/22.2.201. |
| 7637483 | Background | Andreasen NC. Symptoms, signs, and diagnosis of schizophrenia. Lancet. 1995 Aug 19;346(8973):477-81. doi: 10.1016/s0140-6736(95)91325-4. No abstract available. |
| 12581820 | Background | Bressan RA, Chaves AC, Pilowsky LS, Shirakawa I, Mari JJ. Depressive episodes in stable schizophrenia: critical evaluation of the DSM-IV and ICD-10 diagnostic criteria. Psychiatry Res. 2003 Jan 25;117(1):47-56. doi: 10.1016/s0165-1781(02)00298-6. |
| 22305369 | Background | Bensenor IM, Brunoni AR, Pilan LA, Goulart AC, Busatto GF, Lotufo PA, Scazufca M, Menezes PR. Cardiovascular risk factors in patients with first-episode psychosis in Sao Paulo, Brazil. Gen Hosp Psychiatry. 2012 May-Jun;34(3):268-75. doi: 10.1016/j.genhosppsych.2011.12.010. Epub 2012 Feb 2. |
| 18198934 | Background | Awad AG, Voruganti LN. The burden of schizophrenia on caregivers: a review. Pharmacoeconomics. 2008;26(2):149-62. doi: 10.2165/00019053-200826020-00005. |
| 20602051 | Background | Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, Rosa M, Caramelli P, Cohen R, Del Porto JA, Boggio PS, Fregni F. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. Arq Neuropsiquiatr. 2010 Jun;68(3):433-51. doi: 10.1590/s0004-282x2010000300021. |
| 13688369 | Background | BECK AT, WARD CH, MENDELSON M, MOCK J, ERBAUGH J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561-71. doi: 10.1001/archpsyc.1961.01710120031004. No abstract available. |
| 20633386 | Background | Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, Paulus W, Hummel F, Boggio PS, Fregni F, Pascual-Leone A. Transcranial direct current stimulation: State of the art 2008. Brain Stimul. 2008 Jul;1(3):206-23. doi: 10.1016/j.brs.2008.06.004. Epub 2008 Jul 1. |
| 10480273 | Background | Davey NJ, Smith HC, Savic G, Maskill DW, Ellaway PH, Frankel HL. Comparison of input-output patterns in the corticospinal system of normal subjects and incomplete spinal cord injured patients. Exp Brain Res. 1999 Aug;127(4):382-90. doi: 10.1007/s002210050806. |
| 22651961 | Background | Brunoni AR, Ferrucci R, Fregni F, Boggio PS, Priori A. Transcranial direct current stimulation for the treatment of major depressive disorder: a summary of preclinical, clinical and translational findings. Prog Neuropsychopharmacol Biol Psychiatry. 2012 Oct 1;39(1):9-16. doi: 10.1016/j.pnpbp.2012.05.016. Epub 2012 May 28. |
| 17559710 | Background | Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol. 2008 Mar;11(2):249-54. doi: 10.1017/S1461145707007833. Epub 2007 Jun 11. |
| 17337213 | Background | Wagner T, Fregni F, Fecteau S, Grodzinsky A, Zahn M, Pascual-Leone A. Transcranial direct current stimulation: a computer-based human model study. Neuroimage. 2007 Apr 15;35(3):1113-24. doi: 10.1016/j.neuroimage.2007.01.027. Epub 2007 Feb 4. |
| 19348793 | Background | Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A. Treatment of depression with transcranial direct current stimulation (tDCS): a review. Exp Neurol. 2009 Sep;219(1):14-9. doi: 10.1016/j.expneurol.2009.03.038. Epub 2009 Apr 5. |
| 17611487 | Background | Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol. 2007 Jul;3(7):383-93. doi: 10.1038/ncpneuro0530. |
| D004191 | Behavioral Disciplines and Activities |
| D004597 | Electroshock |
| D011580 | Psychological Techniques |