COVID-19 update: We are offering Teletherapy services for all psychotherapy appointments and some neuropsychological testing. Neurofeedback services are open.

 

What is Schizophrenia?

Schizophrenia is a chronic and highly debilitating mental disorder characterized by changes in brain structure and function, most commonly resulting in altered thinking, perception of the self and the world, emotion regulation and language. Overall, schizophrenia is associated with considerable disruption of normal daily life and may affect both educational and occupational performance [1].

What are the symptoms of schizophrenia?

Characteristic symptoms of schizophrenia are hallucinations or psychotic episodes (hearing sounds/voices or seeing things/people that are not real), negative symptoms (e.g., depression, impaired speech and thought, apathy, reduced motivation, and social interest), and delusions (beliefs that cannot be objectively supported, e.g., I think the voice I heard is from a ghost in my house) [1].

While approximately 50% of subjects recover after the first few episodes, in all other cases psychotic episodes persist and may lead to significant disability [2].

Most commonly, schizophrenia is diagnosed using standard psychiatric questionnaires and clinical interviews, however, outcomes often cannot be supported by objective and reliable data gathering methods [3].

Pharmacological Treatment of Schizophrenia

Schizophrenia is generally treated with antipsychotics, with the goal of minimizing hallucinations and also with antidepressants targeting the emotional imbalances often associated with the disease [3].

However, antipsychotic medications have side-effects when used long-term (e.g., anxiety, restlessness/mental distress, anhedonia), are not always effective and their discontinuation highly increases the risk of relapse [4, 5]. Another limitation of antipsychotic medication is that it has no effect on negative symptoms.

Finally, individuals with schizophrenia often do not comply with regular treatment, and discontinuation may be required if side effects cannot be minimized [6].

Use of EEG/QEEG to objectively evaluate brain function anomalies in Schizophrenia

Evidence indicates that altered Electroencephalogram (EEG) is seen in 20% to 60% of patients with schizophrenia [7, 8]. Most importantly, measurable changes in EEG activity have been shown to selectively reflect behavioral changes in patients with schizophrenia and to be predictive of antipsychotic treatment effects [9].

Neurofeedback as a treatment for Schizophrenia

There is evidence that neurofeedback training in subjects with schizophrenia has beneficial effects on both positive and negative symptoms, cognitive functions [10-12], and sleep disruption [13].

Fig.1 Changes in Positive and Negative Syndrome Scale (PANSS) scores after neurofeedback training in patients with schizophrenia [14].

A study by Surmeli et al. [14] has found that after neurofeedback treatment, an improvement on both positive and negative symptom scores (Fig.1) was greater than the 20% seen in most studies with antipsychotics.

In most of the participants, there were gradual improvements in insight (the awareness of being ill), compliance to take medication, self-monitoring, and the ability to seek help if symptoms worsened.

In the same study, over 50% of participants did not need any medication for at least two years after treatment. Moreover, the number of patients who did not require medication increased and the number of drugs needed decreased after neurofeedback training.

A major challenge in schizophrenia is that non-compliance in regularly taking medication is quite high [6], and these results suggest that neurofeedback can solve the problem.

These results also support the idea that neurofeedback should not be a one-size-fits-all intervention [4]. This means that treatment protocols must be personalized to each patient and that effects should be regularly monitored in order to make the appropriate adjustments. QEEG-guided neurofeedback allows to do this as it is based on both EEG data and the symptoms presented by the patient. Clinicians can then tailor treatments selecting the appropriate brain regions/network to target, which can be hardly achieved in pharmacological interventions.

Conclusions

Research supports the use of QEEG for the detection of functional brain anomalies in schizophrenia and indicates that neurofeedback can effectively alleviate both positive and negative symptoms, in many cases significantly reducing the need for pharmacotherapy.

 

References

  1. Organization, W.H. Schizophrenia. 2020; Available from https://www.who.int/news-room/fact-sheets/detail/schizophrenia.
  2. Organization, W.H., Nations for Mental Health Schizophrenia and Public Health. Division of Mental Health and Prevention of Substance Abuse. 1998. p. 3-9.
  3. Gaebel, W. and J. Zielasek, Schizophrenia in 2020: Trends in diagnosis and therapy. Psychiatry Clin Neurosci, 2015. 69(11): p. 661-73.
  4. Clark, S.L., D.E. Adkins, and E.J. van den Oord, Analysis of efficacy and side effects in CATIE demonstrates drug response subgroups and potential for personalized medicine. Schizophr Res, 2011. 132(2-3): p. 114-20.
  5. J.M., K., Pharmacologic advances in the treatment of schizophrenia post-CATIE: an expert interview. Med. Psychiatry Ment. Health, 2006. 11(1).
  6. Phan, S.V., Medication adherence in patients with schizophrenia. Int J Psychiatry Med, 2016. 51(2): p. 211-9.
  7. Small, J.G., et al., Electroencephalographic findings in relation to diagnostic constructs in psychiatry. Biol Psychiatry, 1984. 19(4): p. 471-87.
  8. Ellingson, R.J., The incidence of EEG abnormality among patients with mental disorders of apparently nonorganic origin: a critical review. Am J Psychiatry, 1954. 111(4): p. 263-75.
  9. Czobor, P. and J. Volavka, Pretreatment EEG predicts short-term response to haloperidol treatment. Biol Psychiatry, 1991. 30(9): p. 927-42.
  10. Schneider, F., et al., Self-regulation of slow cortical potentials in psychiatric patients: schizophrenia. Biofeedback Self Regul, 1992. 17(4): p. 277-92.
  11. Gruzelier, J., et al., Learned control of slow potential interhemispheric asymmetry in schizophrenia. Int J Psychophysiol, 1999. 34(3): p. 341-8.
  12. Gruzelier, J., Self regulation of electrocortical activity in schizophrenia and schizotypy: a review. Clin Electroencephalogr, 2000. 31(1): p. 23-9.
  13. Cortoos, A., E. Verstraeten, and R. Cluydts, Neurophysiological aspects of primary insomnia: implications for its treatment. Sleep Med Rev, 2006. 10(4): p. 255-66.
  14. Surmeli, T., et al., Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series. Clin EEG Neurosci, 2012. 43(2): p. 133-44.