Precision Brain Stimulation to Reduce Cannabis Craving in Schizophrenia
Vanderbilt University Medical Center
Summary
The central hypothesis is this: Brain circuits most relevant to cannabis use in schizophrenia are distinct from pathways identified in healthy controls who use cannabis. This study seeks to provide evidence that targeted stimulation of the DMN leads to both altered network activity and a concomitant behavioral change in cue-induced craving and cognitive performance in individuals with schizophrenia and schizoaffective disorder, while targeted stimulation of the L DLPFC leads to these changes in healthy controls who use cannabis. This study will test a model that integrates brain network pathophysiology and cognition to 1) explain the prevalence of cannabis use in schizophrenia and 2) identify a target for engagement in schizophrenia. This study seeks to establish a neuroscientific framework to guide future treatment-oriented studies aimed at reducing craving and improving cognitive performance in individuals with schizophrenia and schizoaffective disorder. This is a study of the effect of 2 rTMS interventions on functional connectivity and craving in individuals with schizophrenia or schizoaffective disorder and healthy controls who use cannabis. Aim 1: Target Engagement: Determine if rTMS manipulates functional connectivity of each target (DMN, L DLPFC) (n=100). Aim 2: Clinical Efficacy: Determine if rTMS affects cue-induced craving and if craving change correlates with change in functional connectivity (n=100). As an exploratory analysis, the factors that explain individual variance in rTMS-induced connectivity change will also be explored.
Description
Cannabis use is highly prevalent in schizophrenia and has devastating consequences but no current treatments. Psychotic disorders such as schizophrenia are disabling, lifelong illnesses that afflict over three million people in the US. Cannabis is the second-most commonly used substance by people with schizophrenia (SZ) after tobacco. Up to 43% of people with SZ meet criteria for cannabis use disorder (CUD), a rate 15 times that in the general population of 3%. Recent evidence suggests cannabis use and SZ have bidirectional causal relationships. Co-occurring SZ with CUD has a significantly wor…
Eligibility
- Age range
- 18–65 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria for Psychosis Participants: * Age between 18-65 years * Diagnosis of a psychotic disorder according to DSM-5 criteria and confirmed by SCID * Current cannabis use of at least 2/10 on a Visual Analog Scale * Current cannabis use (confirmed by urine cannabis testing) * Must be able to read, speak and understand English * Must be judged by study staff to be capable of completing the study procedures * Participants will be in stable outpatient psychiatric treatment and psychiatrically stable with no recent (within the past 30 days) psychiatric hospitalizations or changes in the…
Interventions
- Device3 Minute iTBS to the L DLPFC
Five daily sessions of TMS (iTBS) to the L DLPFC target.
- DeviceOne-Minute, Personalized, DMN Targeted CTBS
Personalized, DMN Targeted CTBS to the DMN for one minute, five daily sessions.
Location
- Vanderbilt Psychiatric HospitalNashville, Tennessee