Transcranial direct current stimulation improves action-outcome monitoring in schizophrenia spectrum disorder

Abstract

Patients with schizophrenia spectrum disorder often demonstrate impairments in action-outcome monitoring. Passivity phenomena and hallucinations, in particular, have been related to impairments of efference copy-based predictions which are relevant for the monitoring of outcomes produced by voluntary action. Frontal transcranial direct current stimulation has been shown to improve action-outcome monitoring in healthy subjects. However, whether transcranial direct current stimulation can improve action monitoring in patients with schizophrenia spectrum disorder remains unknown. We investigated whether transcranial direct current stimulation can improve the detection of temporal action-outcome discrepancies in patients with schizophrenia spectrum disorder. On 4 separate days, we applied sham or left cathodal/right anodal transcranial direct current stimulation in a randomised order to frontal (F3/F4), parietal (CP3/CP4) and frontoparietal (F3/CP4) areas of 19 patients with schizophrenia spectrum disorder and 26 healthy control subjects. Action-outcome monitoring was assessed subsequent to 10 min of sham/transcranial direct current stimulation (1.5 mA). After a self-generated (active) or externally generated (passive) key press, subjects were presented with a visual outcome (a dot on the screen), which was presented after various delays (0–417 ms). Participants had to detect delays between the key press and the visual consequence. Symptom subgroups were explored based on the presence or absence of symptoms related to a paranoid-hallucinatory syndrome. In general, delay-detection performance was impaired in the schizophrenia spectrum disorder compared to the healthy control group. Interaction analyses showed group-specific (schizophrenia spectrum disorder vs healthy control group) and symptom-specific (with/without relevant paranoid-hallucinatory symptoms) transcranial direct current stimulation effects. Post-hoc tests revealed that frontal transcranial direct current stimulation improved the detection of long delays in active conditions and reduced the proportion of false alarms in undelayed trials of the passive condition in patients. The patients with no or few paranoid-hallucinatory symptoms benefited especially from frontal transcranial direct current stimulation in active conditions, while improvement in the patients with paranoid-hallucinatory symptoms was predominantly reflected in reduced false alarm rates in passive conditions. These data provide some first evidence for the potential utility of transcranial direct current stimulation in improving efference copy mechanisms and action-outcome monitoring in schizophrenia spectrum disorder. Current data indicate that improving efference copy-related processes can be especially effective in patients with no or few positive symptoms, while intersensory matching (i.e. task-relevant in passive conditions) could be more susceptible to improvement in patients with paranoid-hallucinatory symptoms.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

“…Psychological interventions have begun to consider factors which overlap with the self-other distinction theme (e.g., self-awareness; emotion regulation; mentalizing), including metacognitive approaches for psychosis [e.g., ( 304 , 305 )], and personality disorders ( 306 , 307 ). Other emerging interventions combine non-invasive brain stimulation with social cognitive ( 308 ) or sensori-motor ( 309 ) related training. Future related research should seek to first fully define and operationalise the construct of self-other distinction, before identifying reliable measures (e.g., self-other overlap index) that can be used in assessment and evaluation.…”

The impact of cerebellar transcranial direct current stimulation (tDCS) on sensorimotor and inter-sensory temporal recalibration

“…Yet, they were instructed to press the button not immediately after the fixation cross had disappeared but to withhold their button press action for about 700 ms. This was to ensure that the button press was not triggered as a reflex upon a starting signal but as a self-initiated action ( Rohde and Ernst, 2013 ; van Kemenade et al, 2016 ; Straube et al, 2020 ). The same button press latency was applied for passive test trials.…”

“…tDCS is a non-invasive brain stimulation technique that has already been used by a range of previous studies that investigated whether the stimulation of mainly frontal and parietal brain areas can influence the processing of sensory action outcomes. Frontal tDCS for instance facilitated the detection of delays between an action and its sensory outcome ( Straube et al, 2017a , 2020 ) while stimulation of the pre-supplementary motor area ( Cavazzana et al, 2015 ), angular gyrus ( Khalighinejad and Haggard, 2015 ) or dorsolateral prefrontal cortex ( Khalighinejad et al, 2016 ) modulated the intentional binding effect, i.e., an implicit measure for the perceived agency over a sensory event. Furthermore, visual cortex tDCS was able to influence the extent of the visuomotor TRE ( Aytemür et al, 2017 ).…”

Efficacy of Transcranial Direct-Current Stimulation in Catatonia: A Review and Case Series

“…The same montage was previously used to alleviate hallucinations ( 13 , 37 , 38 ) and negative symptoms in schizophrenia ( 18 ). Furthermore, it is interesting to note that tDCS is effective in reducing motor prediction errors in patients with schizophrenia ( 39 ) as motor prediction errors are a hypothesis of the underlying mechanism of catatonia ( 32 , 40 ).…”