Innovating Care and Discovery |New Treatments and Innovations

Neuromodulation of Social Cognitive Circuitry in People with Schizophrenia Spectrum Disorders (MODSOCCS)

Led by Drs. Aristotle Voineskos and Daniel Blumberger, this multi-centre project is aimed at optimizing a novel therapeutic approach using repetitive transcranial magnetic stimulation (rTMS) to treat social cognitive deficits in people with schizophrenia spectrum disorders. Poor social function is a major cause of disability in people suffering from schizophrenia spectrum disorders. There are no approved treatments for social cognitive deficits and, when left untreated, these deficits tend to persist throughout patients’ lives. This research is aimed at developing an effective, safe treatment for the enhancement of social processes, which are the major determinants of social functioning, and would have considerable health benefits for this population.

Examining a Digital Health Approach for Advancing Schizophrenia Illness Self-Management and Provider Engagement (A4i)

Dr. Sean Kidd is conducting a feasibility RCT funded by CIHR that is examining a digital health approach for schizophrenia illness self-management, App4Independence (A4i). A4i provides customized coping prompts, an auditory “hallucination detector”, peer-to-peer networking, and a portal that facilitates better provider engagement. This research will provide critical information in the development of this new technology to address a key problem in the field - how to enhance care in a resource-limited context where provider-patient contacts are brief, infrequent, and rely on in the moment recall and self-advocacy by patients. This work is at the forefront of international efforts to explore and validate digital health approaches for schizophrenia. Dr. Kidd has also, with a Discovery Fund award, developed a version of A4i for opioid addiction populations that will soon begin testing. 

Treatment of Negative Symptoms in Early Schizophrenia with Transcranial Direct Current Stimulation Coupled with Virtual Reality Training (NEST)

Negative symptoms, including the loss of motivation and reduced emotional expression, have emerged as critical symptoms in schizophrenia that lead to functional disability for affected individuals. Despite advances in treatment, there are no effective treatments for these negative symptoms, which ultimately hinders recovery for patients. To address this critical unmet therapeutic need, Dr. George Foussias is leading a study that aims too investigate the combination of transcranial direct current stimulation (tDCS) with virtual reality motivation training, to treat negative symptoms in schizophrenia. We anticipate the results of this study will provide the first evidence supporting the efficacy of this combined non-invasive brain stimulation and virtual reality treatment, both in terms of improving negative symptoms and community functioning, as well as brain functioning that supports motivated behaviour.

Transcranial Direct Current Stimulation Coupled with Virtual Rehabilitation for Negative Symptoms in At-Risk Youth

Negative symptoms, which include amotivation, social withdrawal and diminished emotional expression, are prominent in youth at clinical high risk (CHR) for psychosis. Negative symptoms lead to significant functional impairment and enduring disability in these youth, regardless of subsequent conversion to psychosis. Recent evidence from independent studies, however, suggests two promising novel treatment approaches for negative symptoms — transcranial direct current stimulation (tDCS), and computerized remediation strategies, both of which have revealed significant therapeutic effects on negative symptoms in schizophrenia. Dr. George Foussias is leading a randomized controlled trial to evaluate if tDCS combined with a virtual reality-based computerized remediation is effective for treating negative symptoms in CHR youth. It is anticipated that the results of this study will provide the first evidence for an effective intervention for negative symptoms and functional impairment in youth at clinical high risk for psychosis. Further, neuroimaging findings will serve to identify the brain changes that are linked to this clinical improvement, and reveal the brain-based predictors of treatment response.

The Effects of Adjunctive Transcranial Direct Current Stimulation on Treatment Adherence in Schizophrenia

Currently, there are no treatments that improve insight in patients with schizophrenia. Common psychological interventions, including CBT and psychoeducation, have shown limited effects, indicating the need for alternative therapeutic options. Dr. Philip Gerretsen, who is also a researcher in CAMH’s Adult Neurodevelopment and Geriatric Psychiatry Program, seeks to explore the effects of transcranial direct current stimulation (tDCS) as an adjunctive treatment to improve antipsychotic medication adherence in patients with schizophrenia, by targeting brain regions implicated in impaired insight, a primary contributor to medication nonadherence. Positive results will indicate if tDCS has the potential to alter patients’ attitudes toward their illness and treatment, and could lead to better antipsychotic medication adherence and clinical outcomes.

Computational Assays for Individual Treatment Predictions in First Episode Psychosis

A key challenge in the treatment of early psychosis is the heterogeneity in treatment response across patients: despite similar initial symptoms, patients often show divergent symptom trajectories over time, and some symptoms persist in spite of treatment. Antipsychotic medication that targets either dopamine or acetylcholine receptors, or both neuromodulatory systems, is used to treat schizophrenia. However, there are no clinical tests to guide treatment and predict which individual patient will benefit from which type of pharmacological intervention. Consequently, treatment decisions rely on a trial-and-error process, which places a severe burden on patients. To overcome this impasse, this new project — led by Dr. Andreea Diaconescu, an Independent Scientist at the Krembil Centre for Neuroinformatics — introduces a neurocomputational approach for understanding the emergence of psychosis symptoms focusing on brain dopaminergic and cholinergic systems using reward and contextual learning paradigms combined with validated mathematical models of cortical computation. This study will investigate the clinical validity of this approach through a longitudinal study in first-episode psychosis (FEP) patients in the early stages of treatment initiation. Through a combination of computerized tasks and brain imaging during the time treatment is being started, coupled with neurocomputation, this study anticipates providing insights into the key cognitive and neurobiological causes of psychosis, and informing personalized treatment intervention strategies for youth and young adults experiencing a first episode of psychosis.