Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders

PSYCHIATRY RESEARCH

卷:251

Article

Gerretsen, Philip^1,2,3,4,5  Pothier, David D.^8,9  Falls, Carolyn⁹  Armstrong, Maxine⁹  Balakumar, Thushanthi¹  Uchida, Hiroyuki^2,10  Mamo, David C.^1,3,6,7  Pollock, Bruce G.^1,2,3,4,5  Graff-Guerrero, Ariel^1,2,3,4,5 

[1] Ctr Addict & Mental Hlth, Res Imaging Ctr, Multimodal Imaging Grp, Toronto, ON, Canada

[2] Ctr Addict & Mental Hlth, Geriatr Mental Hlth Program, Toronto, ON, Canada

[3] Univ Toronto, Dept Psychiat, Toronto, ON, Canada

[4] Ctr Addict & Mental Hlth, Res Program, Campbell Mental Hlth Res Inst, Toronto, ON, Canada

[5] Univ Toronto, Inst Med Sci, Toronto, ON, Canada

[6] Univ Malta, Fac Med, Dept Psychiat, Msida, Malta

[7] Univ Malta, Fac Hlth Sci, Msida, Malta

[8] Univ Toronto, Toronto Gen Hosp, Dept Otolaryngol Head & Neck Surg, Toronto, ON, Canada

[9] Toronto Gen Hosp, Ctr Adv Hearing & Balance Testing, Toronto, ON, Canada

[10] Keio Univ, Sch Med, Dept Neuropsychiat, Tokyo, Japan

关键词: Schizophrenia;    Insight into illness;    Illness denial;    Anosognosia;    Vestibular stimulation;   

DOI  :  10.1016/j.psychres.2017.02.020

来源: Elsevier

【 摘 要 】

Impaired insight into illness (IMP-INS) is common among individuals with schizophrenia spectrum disorders (SSD), contributing to medication nonadherence and poor clinical outcomes. Caloric vestibular simulation (CVS) is typically used to assess peripheral vestibular system function. Left cold CVS is also a transiently effective treatment for IMP-INS and hemineglect secondary to right brain hemisphere stroke, and possibly for IMP-INS and mood stabilization in patients with SSD. Participants with SSD and moderate-to-severe IMP-INS participated in an exploratory double blind, crossover, randomized controlled study of the effects of CVS on IMP-INS. Participants sequentially received all experimental conditions left cold (4 degrees C), right cold, and body temperature/sham CVS-in a random order. Repeated measures ANOVA were performed to compare changes in IMP-INS, mood and positive symptom severity pre and 30 min post CVS. A significant interaction was found between CVS condition, time, and body temperature nystagmus peak slow phase velocity (PSPV) for IMP-INS, indicating that single session left cold CVS transiently improved IMP-INS while right cold CVS may have worsened IMP-INS, particularly in participants with greater vestibular reactivity (i.e. higher PSPV) to body temperature CVS. The procedure's effectiveness is attributed to stimulation of underactive right hemisphere circuits via vestibular nuclei projections to the contralateral hemisphere.

【 授权许可】

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