The Alternations of Nucleus Accumbent in Schizophrenia Patients With Auditory Verbal Hallucinations During Low-Frequency rTMS Treatment

SOURCE: Frontiers in Psychiatry. 13 (no pagination), 2022. Article Number: 971105.


AUTHORS: Xie Y.; Cai Y.; Guan M.; Wang Z.; Ma Z.; Fang P.; Wang H.

ABSTRACT: Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to reduce the severity of auditory verbal hallucinations (AVH) and induce beneficial functional and structural alternations of the brain in schizophrenia patients with AVH. The nucleus accumbens (NAcc) as an important component of the ventral striatum is implicated with the pathology in AVH. However, the induced characteristic patterns of NAcc by low-frequency rTMS in schizophrenia with AVH are seldom explored. We investigated the functional and structural characteristic patterns of NAcc by using seed-based functional connectivity (FC) analysis and gray matter volume (GMV) measurement in schizophrenia patients with AVH during 1 Hz rTMS treatment. Although low-frequency rTMS treatment did not affect the volumetric changes of NAcc, the abnormal FC patterns of NAcc, including increased FC of NAcc with the temporal lobes and decreased FC of NAcc with the frontal cortices in the pretreatment patients compared to healthy controls, were normalized or reversed after treatment. These FC changes were associated with improvements in clinical symptoms and neurocognitive functions. Our findings may extend our understanding of the NAcc in the pathology of schizophrenia with AVH and might be a biomarker of clinical effect for low-frequency rTMS treatment in schizophrenia.

METHODS AND MATERIALS: Thirty-two patients with AVH were recruited from the Department of Psychiatry, Xijing Hospital of Fourth Military Medical University. The diagnosis of schizophrenia was made by experienced psychiatrists according to the Chinese version of the Structured Clinical Interview for Diagnosis and Statistical Manual of Mental Disorder (DSM-V). The inclusion criteria of the patient group were as follows: (1) AVH daily occurred with at least two antipsychotic medications, and (2) no less than five episodes of AVH per day over the past month. All patients who received a steady dose of antipsychotic medications remained unchanged during the study period. In addition, thirty-five healthy controls matched by age, sex, and education were recruited from the local community through advertising and had no history of psychiatric diseases. For all the participants, the exclusion criteria were as follows: (1) any past or current neurological diseases, (2) history of head injury, (3) alcohol or substance abuse, and (4) contraindications to MRI scans.

CONCLUSION: In summary, our findings revealed abnormal FC and GMV changes of NAcc in patients and suggested an involvement of the striatal pathway in schizophrenia with AVH. Moreover, the abnormal FC patterns of the NAcc were inversed by low-frequency rTMS treatment and could be biomarkers of the clinical effectiveness of low-frequency rTMS treatment in schizophrenia with AVH.