- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04513132
Targeted Intervention Study of dTMS on Impaired Insight in Early Psychosis
April 12, 2023 updated by: Shanghai Mental Health Center
A Study on Targeted Intervention for Insight in Patients With First Episode and Clinical High Risk of Schizophrenia Based on Theta Oscillation in Anterior Cingulate Cortex
Impaired insight is a key factor in the conversion of high-risk individuals to schizophrenia, but there is a lack of targeted interventions.
We found that an electroencephalogram (EEG) signal reflecting the function of self monitoring was a potential objective marker of impaired insight.
And further functional magnetic resonance imaging (fMRI) analysis showed that the functional connectivity between anterior cingulate gyrus (ACC) and medial temporal gyrus (MTG) was related to insight.
Studies have shown that ACC theta oscillation is the key to self monitoring, and theta-alpha phase synchronization between frontotemporal is closely related to cognition.
Therefore, this project hypothesized that targeted regulation of ACC theta oscillations could promote theta-alpha phase synchronization and functional connectivity between ACC and MTG, thereby improving patients' insight.
The first-episode and high-risk subjects were recruited to detect the theta oscillation of ACC, theta-Alpha phase synchronization and functional connectivity between ACC and MTG using EEG-fMRI.
Deep transcranial magnetic stimulation was introduced to regulate ACC theta oscillations.
The high-risk subjects were followed up for two years.
It was estimated that the theta-alpha phase synchronization of ACC-MTG and insight in the active-dTMS group were significantly improved.
And the outcome of the high-risk subjects is better.
The project develops neuroregulatory techniques for impaired insight of schizophrenia and is expected to provide a solution for this clinical pain point.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
Detailed Description
The study will conduct randomized and controlled experimental design, including deep transcranial magnetic stimulation (dTMS) and sham stimulation (SH-dTMS).
Each included participant will be given informed consent and then randomly assigned to different montage of stimulation.
Participants are blind to the dTMS montage.
Researchers in this study will include clinical evaluators, laboratory inspectors, dTMS operators, and statistical analysts.
Before unblinding, each group of researchers will have no access to the information collected by the other groups.
For example, except the dTMS operators, no one knows which stimulus montage any of the participants receive.
The sessions of dTMS will be conducted twice daily for 5 consecutive days, and twice sessions of a day will be separated by 3 hours at least.
Clinical assessments and laboratory tests will be administered at baseline and at the end of the last session.
After the post-intervention tests, first stage unblinding will be conducted.
At this moment, dTMS operators will provide the groups of A and B, but no corresponding montage, to the statistical analysts.
After analyzing the differences between the two groups, second stage unblinding will be performed and the results of the clinical trial will be further analyzed by revealing the corresponding stimulus montage of each group.
This study will be implemented at a single center, the Shanghai Mental Health Center (SMHC).
Study Type
Interventional
Enrollment (Anticipated)
188
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Shanghai
-
Shanghai, Shanghai, China, 200030
- Shanghai Mental Health Center
-
Contact:
- Jingjing Huang, Doctoral
- Phone Number: 3239 021-34773523
- Email: jjhuang_att@163.com
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
14 years to 35 years (Child, Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- 14~35 years old;
- Meet the criteria of clinical high risk for psychosis or meet the DSM-V diagnostic criteria for schizophrenia;
- Meeting the following definition of impaired insight;
- Having completed at least six years of primary education;
- Being able to give informed consent, oral or written. Patients under 18 years old give oral consent and their next of kin or legal guardians give written consent.
Exclusion Criteria:
- Participating in any other clinical intervention research;
- Meeting the diagnostic criteria of psychotic disorders (including affective disorders);
- Threshold symptoms are induced by other mental disorders or psychoactive substances;
- Undergoing anti-psychotic medication for more than 2 weeks;
- Being diagnosed as organic brain diseases, or severe somatic diseases;
- Had Experienced traumatic brain injury, and got scores of 7;
- Dementia, or mental retardation (IQ<70);
- Being a condition of scalp infection;
- A pacemaker or other metal implants in the body, pregnancy, or claustrophobia.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: active-CHR
Participants will be intervened with deep transcranial magnetic stimulation (dTMS).
|
The dTMS using H-coil with 5Hz stimulate ACC.
The sessions of dTMS will be conducted twice daily for 5 consecutive days, and twice sessions of a day will be separated by 3 hours at least.
|
Sham Comparator: sham-CHR
Participants, as a control group, will receive sham stimulation.
|
The sham-dTMS has the same appearance with the real stimulation coil, which can not generate magnetic field.
A sound generator is built in the coil beat to simulate the sound of the real stimulation.
|
Active Comparator: active-FES
Patients with first-episode schizophrenia will be intervened with deep transcranial magnetic stimulation (dTMS).
|
The dTMS using H-coil with 5Hz stimulate ACC.
The sessions of dTMS will be conducted twice daily for 5 consecutive days, and twice sessions of a day will be separated by 3 hours at least.
|
Sham Comparator: sham-FES
Patients with first-episode schizophrenia, as a control group, will receive sham stimulation.
|
The sham-dTMS has the same appearance with the real stimulation coil, which can not generate magnetic field.
A sound generator is built in the coil beat to simulate the sound of the real stimulation.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in clinical insight
Time Frame: Baseline and immediately after the intervention
|
Clinical insight will be assessed using SAI.
SAI is a semi-structured interview tools including seven items, with a total score of 14, 0-6 for recognition of illness, 0-4 for relabeling of psychotic phenomena, and 0-4 for treatment compliance.
Patients, with less than 3 scores on recognition of illness, 2 on relabeling of psychotic phenomena, and 2 on treatment compliance, are considered to be improved on insight.
|
Baseline and immediately after the intervention
|
Change in error-related negativity
Time Frame: Baseline and immediately after the intervention
|
The error-related negativity (ERN) is observed over frontocentral sites within 100 ms following an error response in behavioral tasks, reflecting error-detecting activity, and a reduced ERN indicates reduced error monitoring.
EEG epochs were marked with artifacts and excluded from the following ERN analysis if on any electrode, (i) the maximal peak-to-peak amplitude exceeded 100 μV within any moving window (width: 200 ms; step: 50 ms) or (ii) the absolute amplitude exceeded 100 μV at any time point.
The calculation for the ERN was based on no fewer than five available epochs with erroneous responses.
|
Baseline and immediately after the intervention
|
Change in Resting-state functional brain connectivity between anterior cingulate cortex (ACC) and middle temporal gyrus (MTG)
Time Frame: Baseline and immediately after the intervention
|
Imaging data will be collected on a 3-T Siemens Magnetom Verio syngo MR B17 scanner and a 32-channel head coil, including structural phase and resting stage detection, which will be used to analyze the functional connection between ACC and MTG.
|
Baseline and immediately after the intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in psychopathological symptoms
Time Frame: Baseline and immediately after the intervention
|
This study will also observe the psychopathological symptoms, including positive, negative and general symptoms, using PANSS.The reductive ratio of PANSS points will be calculated after dTMS treatment.
|
Baseline and immediately after the intervention
|
Covariant change of clinical insight and psychopathological symptoms
Time Frame: Baseline and immediately after the intervention
|
Clinical insight will be assessed using SAI, and the psychopathological symptoms will be measured using PANSS.
The correlation of psychopathological symptoms with clinical insight will be analyzed, especially possible covariant change after dTMS treatment.
|
Baseline and immediately after the intervention
|
Change in reality monitoring ability
Time Frame: Baseline and immediately after the intervention
|
Reality monitoring ability refers to distinguish internally self-generated information from externally-derived information.
The test will be carried out by the experimental paradigm of reality monitoring ability.The stimulus materials are easy to be accepted and understood by patients with mental illness.The material consisted of 48 pairs of familiar pictures and was divided into two tests, each consisting of a learning and a testing phase.
In the learning phase, 24 pictures will be presented with different combinations of conditions (four combinations of "perceptive/imaginative × left/right" conditions).
In the testing phase, one object will be presented and the participants will be asked to decide whether the other paired object is perceptive or imaginative, or whether the image is positioned on the left or right side of the screen.
|
Baseline and immediately after the intervention
|
Change in theta oscillation in ACC and theta-alpha phase synchronization between ACC and MTG
Time Frame: Baseline and immediately after the intervention
|
Theta oscillation and theta-alpha phase synchronization will be recorded using using a magnetic resonance compatible 64 electrode cap (BrainAMP MR, Brain Products, Munich, Germany) based on the international society for electroencephala 10/20 standard system.
|
Baseline and immediately after the intervention
|
Convertion rate of transition into psychosis
Time Frame: 2 year
|
This study will use SIPS to identify individuals with CHR and assess the participants' clinical outcomes, including transition into psychosis, symptomatic, remission, and other disorders
|
2 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Anticipated)
January 1, 2024
Primary Completion (Anticipated)
December 31, 2025
Study Completion (Anticipated)
December 31, 2027
Study Registration Dates
First Submitted
August 5, 2020
First Submitted That Met QC Criteria
August 11, 2020
First Posted (Actual)
August 14, 2020
Study Record Updates
Last Update Posted (Actual)
April 18, 2023
Last Update Submitted That Met QC Criteria
April 12, 2023
Last Verified
January 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- DTMS2024
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Impaired Insight
-
Versailles HospitalVersailles Saint-Quentin-en-Yvelines University; Centre National de la Recherche...RecruitingSchizophrenia | Social Skills | Behavior | Insight ImpairedFrance
-
Fundació Institut de Recerca de l'Hospital de la...Hospital Mutua de TerrassaRecruiting
-
Tri-Service General HospitalCompletedQuality of Life | Schizophrenia | Schizoaffective Disorder | Neurocognitive Dysfunction | Psychosocial Impairment | Autonomic Imbalance | Psychotic Symptoms | Insight ImpairedTaiwan
-
Tri-Service General HospitalCompletedQuality of Life | Schizophrenia | Schizoaffective Disorder | Neurocognitive Dysfunction | Psychosocial Impairment | Autonomic Imbalance | Psychotic Symptoms | EEG With Abnormally Slow Frequencies | Insight ImpairedTaiwan
-
University of LiegeCompleted
-
Western Kentucky UniversityEnrolling by invitationDriving ImpairedUnited States
-
Rhode Island HospitalCompleted
-
Public Dental Health, VarmlandKarolinska InstitutetCompleted
-
Maimonides Medical CenterCompletedImpaired ThermoregulationUnited States
-
University of LausanneUniversity Hospital, Geneva; University of Lausanne HospitalsCompleted
Clinical Trials on sham-dTMS
-
Shalvata Mental Health CenterUnknown
-
Shenzhen Kangning HospitalThe National Natural Science Foundation of China (NSFC)Not yet recruitingAnxiety State | Anxiety Disorder
-
Ospedale San DonatoUnknownObesity | Appetite and General Nutritional Disorders | Food CravingItaly
-
Stony Brook UniversityNational Institute on Drug Abuse (NIDA)RecruitingSmoking Cessation | Schizophrenia | Tobacco UseUnited States
-
BrainswayCompletedObsessive Compulsive DisorderUnited States, Canada, Israel
-
Soroka University Medical CenterCompleted
-
Tel-Aviv Sourasky Medical CenterUnknownPremenstrual Dysphoric Disorder
-
BrainswayCompletedSmoking CessationUnited States, Canada, Israel
-
Section for Affective Disorders; Northern Stockholm...Completed
-
BrainswayWithdrawn