SchizophreniaNCT04210557
Models of Auditory Hallucination
A study testing Transcranial Magnetic Stimulation (TMS) in people with Schizophrenia and Schizo Affective Disorder, run by Yale University at 1 site in United States.
Trial summary
The purpose of this study is to address the shortcoming in clinical hallucination research by causally manipulating the neural loci of conditioned hallucination task behavior in-person in patients with psychosis using transcranial magnetic stimulation (TMS), tracking the impact of this manipulation on the number of… Read more about this study
- Who is it for?
- Ages 18 to 45 years
- Conditions the study is for
- Schizophrenia, Schizo Affective Disorder, Auditory Hallucination
- What is being tested?
- Transcranial Magnetic Stimulation (TMS)
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1 participants
- Where
- 1 siteUnited States
- Study dates
- 27 Feb 2020to 1 Apr 2021
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Aged 18 - 45 years
- Voice hearing patients
- Meet diagnostic criteria for DSM-V schizophrenia or schizophreniform disorder
- Report hearing voices at least once a day
- Score > 3 on PANSS P3 (hallucinations item)
Who cannot join
- DSM-V substance use disorder within the past 6 months
- Previous head injury with neurological symptoms and/or unconsciousness
- Intellectual disability (IQ < 70)
- Non-English speaker
- Contraindications for TMS, including:
- History of seizures
Show all 16Show fewer
- Metallic implants
- Pacemaker
- Pregnancy
- Less than 6 weeks of a stable dose of psychotropic medication(s)
- Comorbid mood or anxiety diagnosis
- Clinically/behaviorally instability and unable to cooperate with TMS procedures
- Clinically significant medical condition(s)
- Unstable medical condition(s) based on EKG, medical history, physical examination, and routine lab work
- Personal history of stroke
- Family history of seizures
Trial locations and contacts
1 site in 1 country.
United States1 site
Connecticut Mental Health Center (CMHC)
New Haven, Connecticut, 06519
About this study
The purpose of this study is to address the shortcoming in clinical hallucination research by causally manipulating the neural loci of conditioned hallucination task behavior in-person in patients with psychosis using transcranial magnetic stimulation (TMS), tracking the impact of this manipulation on the number of times participants with hallucinations report hearing tones that were not presented. With such a causal intervention, the veracity of this explanation of hallucinations will be either validated or disconfirmed. If validated, the task can be further developed as a biomarker for predicting the hallucination onset, guiding, developing or tracking the effects of treatments for hallucinations.
Read the detailed description
Hallucinations are percepts without stimulus. 70% of patients with schizophrenia suffer distressing auditory hallucinations. Their mere presence increases the risk of suicide. Most reach remission with D2 dopamine receptor blocking drugs after 1 year of adherence. However, 30% of patients have intractable hallucinations, and 50% are non-adherent to their medications, commonly because of unfavorable side-effects - those intractable and non-adherent patients continue to suffer. There is a clear need for a mechanistic understanding of hallucinations as a prelude to rational treatment design.
This study provides the initial steps towards the development of an interventional biomarker for clinical hallucinations, grounded in computational neuroscience.
Computational psychiatry involves harnessing the power of computational neuroscience to address the clinical needs of those suffering from serious mental illnesses. There has been much discussion of the promise of the approach. There have been few studies thus far and they have largely involved correlative methods like functional neuroimaging. This study will address this shortcoming by causally manipulating the neural loci of computational model parameters in-person in patients with psychosis using transcranial magnetic stimulation (TMS), tracking the impact of this manipulation on behavioral task performance . With such a causal intervention, the veracity of the model's explanation of hallucinations will be either validated or disconfirmed. If validated, the model can be further developed as a biomarker for predicting the hallucination onset, guiding, developing or tracking the effects of treatments for hallucinations. If disconfirmed, the model ought to be discarded and other alternatives should be pursued.
- Being tested
- Transcranial Magnetic Stimulation (TMS)
- Keywords
- TMS, Transcranial Magnetic Stimulation
- Medical subject headings
- Schizophrenia, Psychotic Disorders, Hallucinations
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Transcranial Magnetic Stimulation (TMS)Device
Also called repetitive transcranial magnetic stimulation (rTMS)
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to cause electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil, which in turn is connected to the scalp. The stimulator generates a changing electric current within the coil which induces a magnetic field; this field then causes a second inductance of inverted electric charge within the brain itself.
| Study group | Role | What they receive |
|---|---|---|
| TMS to insula | Active comparator | This study will recruit 30 clinical voice hearers (P+H+). They will complete two parallel forms of the conditioned hallucinations task (with different visual and auditory stimuli) on two occasions, separated by a week.
TMS and sham will be delivered in a randomized counterbalanced order. Hypothesis: Inhibiting the insula will decrease prior over-weighting. If this computational perturbation is responsible for conditioned hallucinations, then ameliorating it with TMS that increases insula engagement will decrease conditioned hallucination responses. Furthermore, the prior weighting parameter will be reduced following active TMS compared with sham. Receives: Device: Transcranial Magnetic Stimulation (TMS) |
| TMS to cerebellum | Active comparator | This study will recruit a further 70 clinical voice hearers. Again, they will complete parallel forms of the conditioned hallucinations task on two occasions, separated by a week. They will receive excitatory TMS over the cerebellum (and sham on the other occasion, in a randomized counterbalanced order). Hypotheses: Exciting the cerebellum will increase belief-updating. If poor belief-updating contributes to conditioned hallucinations, increasing cerebellum engagement should decrease conditioned hallucinations and alter the belief-updating model parameter compared with sham TMS. Receives: Device: Transcranial Magnetic Stimulation (TMS) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Conditioned Hallucinations Task Performance
The primary outcome measure is the number of times participants report hearing tones that were not presented. There are 360 total trials. There are 120 no tone trials. People who hear voices typically report hearing tones on 30% of the no tone trials (approximately 36 times, as compared to 12 times in people who do not hear voices). The investigators anticipate fewer conditioned hallucinations (fewer than 36 reports of tones when none were presented) in the active TMS conditions as compared to the sham.
Measured: approximately 13 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Dec 2019
- Study start27 Feb 2020
- Primary completion1 Apr 2021
- Study completion1 Apr 2021
Why it stopped: Unable to recruit enough suitable participants.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (60)Papers the sponsor has linked to this study.
- Other trials for SchizophreniaStudies of the same condition, open and under way.
- More trials run by Yale UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 1 participants (actual)
Sponsor and investigators
- Lead sponsor
- Yale University
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH)
- Responsible party
- Sponsor
- Investigators
- Philip R Corlett, PhD, Principal investigator, Yale University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04210557
- Sponsor's protocol ID
- 2000023640
- Other IDs
- 1R21MH116258-01A1
- Status last verified
- Jul 2024
- First submitted
- 17 Jun 2019
- Last updated
- 1 Aug 2024
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- No
Publications
Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Munk-Jorgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry. 2007 Mar 16;6:10. doi: 10.1186/1744-859X-6-10.
PubMed 17367524Kelleher I, Lynch F, Harley M, Molloy C, Roddy S, Fitzpatrick C, Cannon M. Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Arch Gen Psychiatry. 2012 Dec;69(12):1277-83. doi: 10.1001/archgenpsychiatry.2012.164.
PubMed 23108974Harkavy-Friedman JM, Kimhy D, Nelson EA, Venarde DF, Malaspina D, Mann JJ. Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry. 2003 Aug;64(8):871-4.
PubMed 12927000Friston K. Hierarchical models in the brain. PLoS Comput Biol. 2008 Nov;4(11):e1000211. doi: 10.1371/journal.pcbi.1000211. Epub 2008 Nov 7.
PubMed 18989391Friston K. The free-energy principle: a rough guide to the brain? Trends Cogn Sci. 2009 Jul;13(7):293-301. doi: 10.1016/j.tics.2009.04.005. Epub 2009 Jun 24.
PubMed 19559644Powers AR, Mathys C, Corlett PR. Pavlovian conditioning-induced hallucinations result from overweighting of perceptual priors. Science. 2017 Aug 11;357(6351):596-600. doi: 10.1126/science.aan3458.
PubMed 28798131Powers AR III, Kelley M, Corlett PR. Hallucinations as top-down effects on perception. Biol Psychiatry Cogn Neurosci Neuroimaging. 2016 Sep;1(5):393-400. doi: 10.1016/j.bpsc.2016.04.003.
PubMed 28626813Helmholtz, H., & Southall, J. P. C. (1924). Helmholtz's treatise on physiological optics. Rochester, N.Y.: Optical Society of America.
Friston K. A theory of cortical responses. Philos Trans R Soc Lond B Biol Sci. 2005 Apr 29;360(1456):815-36. doi: 10.1098/rstb.2005.1622.
PubMed 15937014Rao RP, Ballard DH. Predictive coding in the visual cortex: a functional interpretation of some extra-classical receptive-field effects. Nat Neurosci. 1999 Jan;2(1):79-87. doi: 10.1038/4580.
PubMed 10195184Bayes T. An essay towards solving a problem in the doctrine of chances. 1763. MD Comput. 1991 May-Jun;8(3):157-71. No abstract available.
PubMed 1857193Adams RA, Stephan KE, Brown HR, Frith CD, Friston KJ. The computational anatomy of psychosis. Front Psychiatry. 2013 May 30;4:47. doi: 10.3389/fpsyt.2013.00047. eCollection 2013.
PubMed 23750138Friston, K. (2005). Hallucinations and perceptual inference. Behavioral and Brain Sciences, 28(6), 764-766. doi:10.1017/S0140525X05290131
G. Ellson, D. (1941). Hallucinations produced by sensory conditioning. Journal of Experimental Psychology. 28. 1-20. 10.1037/h0054167.
Mathys C, Daunizeau J, Friston KJ, Stephan KE. A bayesian foundation for individual learning under uncertainty. Front Hum Neurosci. 2011 May 2;5:39. doi: 10.3389/fnhum.2011.00039. eCollection 2011.
PubMed 21629826
Study at a glance
From the registry record, last updated by the sponsor on 1 Aug 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Models of Auditory Hallucination
- ClinicalTrials.gov ID
- NCT04210557
- Acronym / sponsor ID
- 2000023640
- Keywords
- TMS, Transcranial Magnetic Stimulation
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Unable to recruit enough suitable participants.
- Enrolment
- 1 participants (actual)
- Lead sponsor
- Yale UniversityUniversity, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH)
- Study start
- 27 Feb 2020 (actual)
- Primary completion
- 1 Apr 2021 (actual)
- Study completion
- 1 Apr 2021 (actual)
- First posted
- 24 Dec 2019 (actual)
- Results
- Posted 25 May 2023
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to address the shortcoming in clinical hallucination research by causally manipulating the neural loci of conditioned hallucination task behavior in-person in patients with psychosis using transcranial magnetic stimulation (TMS), tracking the impact of this manipulation on the number of times participants with hallucinations report hearing tones that were not presented. With such a causal intervention, the veracity of this explanation of hallucinations will be either validated or disconfirmed. If validated, the task can be further developed as a biomarker for predicting the hallucination onset, guiding, developing or tracking the effects of treatments for hallucinations.
Detailed description
Hallucinations are percepts without stimulus. 70% of patients with schizophrenia suffer distressing auditory hallucinations. Their mere presence increases the risk of suicide. Most reach remission with D2 dopamine receptor blocking drugs after 1 year of adherence. However, 30% of patients have intractable hallucinations, and 50% are non-adherent to their medications, commonly because of unfavorable side-effects - those intractable and non-adherent patients continue to suffer. There is a clear need for a mechanistic understanding of hallucinations as a prelude to rational treatment design.
This study provides the initial steps towards the development of an interventional biomarker for clinical hallucinations, grounded in computational neuroscience.
Computational psychiatry involves harnessing the power of computational neuroscience to address the clinical needs of those suffering from serious mental illnesses. There has been much discussion of the promise of the approach. There have been few studies thus far and they have largely involved correlative methods like functional neuroimaging. This study will address this shortcoming by causally manipulating the neural loci of computational model parameters in-person in patients with psychosis using transcranial magnetic stimulation (TMS), tracking the impact of this manipulation on behavioral task performance . With such a causal intervention, the veracity of the model's explanation of hallucinations will be either validated or disconfirmed. If validated, the model can be further developed as a biomarker for predicting the hallucination onset, guiding, developing or tracking the effects of treatments for hallucinations. If disconfirmed, the model ought to be discarded and other alternatives should be pursued.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| TMS to insula | Active comparator | Device: Transcranial Magnetic Stimulation (TMS)This study will recruit 30 clinical voice hearers (P+H+). They will complete two parallel forms of the conditioned hallucinations task (with different visual and auditory stimuli) on two occasions, separated by a week. TMS and sham will be delivered in a randomized counterbalanced order. Hypothesis: Inhibiting the insula will decrease prior over-weighting. If this computational perturbation is responsible for conditioned hallucinations, then ameliorating it with TMS that increases insula engagement will decrease conditioned hallucination responses. Furthermore, the prior weighting parameter will be reduced following active TMS compared with sham. |
| TMS to cerebellum | Active comparator | Device: Transcranial Magnetic Stimulation (TMS)This study will recruit a further 70 clinical voice hearers. Again, they will complete parallel forms of the conditioned hallucinations task on two occasions, separated by a week. They will receive excitatory TMS over the cerebellum (and sham on the other occasion, in a randomized counterbalanced order). Hypotheses: Exciting the cerebellum will increase belief-updating. If poor belief-updating contributes to conditioned hallucinations, increasing cerebellum engagement should decrease conditioned hallucinations and alter the belief-updating model parameter compared with sham TMS. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Aged 18 - 45 years
- Voice hearing patients
- Meet diagnostic criteria for DSM-V schizophrenia or schizophreniform disorder
- Report hearing voices at least once a day
- Score > 3 on PANSS P3 (hallucinations item)
Key exclusion criteria (16 listed)
- DSM-V substance use disorder within the past 6 months
- Previous head injury with neurological symptoms and/or unconsciousness
- Intellectual disability (IQ < 70)
- Non-English speaker
- Contraindications for TMS, including:
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Transcranial Magnetic Stimulation (TMS)Also: repetitive transcranial magnetic stimulation (rTMS)Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to cause electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil, which in turn is connected to the scalp. The stimulator generates a changing electric current within the coil which induces a magnetic field; this field then causes a second inductance of inverted electric charge within the brain itself. | Device | TMS to cerebellum, TMS to insula |
Primary outcome
Conditioned Hallucinations Task Performance
Time frame: approximately 13 months
The primary outcome measure is the number of times participants report hearing tones that were not presented. There are 360 total trials. There are 120 no tone trials. People who hear voices typically report hearing tones on 30% of the no tone trials (approximately 36 times, as compared to 12 times in people who do not hear voices). The investigators anticipate fewer conditioned hallucinations (fewer than 36 reports of tones when none were presented) in the active TMS conditions as compared to the sham.
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Aug 2024.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 17367524Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Munk-Jorgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry. 2007 Mar 16;6:10. doi: 10.1186/1744-859X-6-10.
- Background: PubMed 23108974Kelleher I, Lynch F, Harley M, Molloy C, Roddy S, Fitzpatrick C, Cannon M. Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Arch Gen Psychiatry. 2012 Dec;69(12):1277-83. doi: 10.1001/archgenpsychiatry.2012.164.
- Background: PubMed 12927000Harkavy-Friedman JM, Kimhy D, Nelson EA, Venarde DF, Malaspina D, Mann JJ. Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry. 2003 Aug;64(8):871-4.
- Background: PubMed 18989391Friston K. Hierarchical models in the brain. PLoS Comput Biol. 2008 Nov;4(11):e1000211. doi: 10.1371/journal.pcbi.1000211. Epub 2008 Nov 7.
- Background: PubMed 19559644Friston K. The free-energy principle: a rough guide to the brain? Trends Cogn Sci. 2009 Jul;13(7):293-301. doi: 10.1016/j.tics.2009.04.005. Epub 2009 Jun 24.
- Background: PubMed 28798131Powers AR, Mathys C, Corlett PR. Pavlovian conditioning-induced hallucinations result from overweighting of perceptual priors. Science. 2017 Aug 11;357(6351):596-600. doi: 10.1126/science.aan3458.
- Background: PubMed 28626813Powers AR III, Kelley M, Corlett PR. Hallucinations as top-down effects on perception. Biol Psychiatry Cogn Neurosci Neuroimaging. 2016 Sep;1(5):393-400. doi: 10.1016/j.bpsc.2016.04.003.
- BackgroundHelmholtz, H., & Southall, J. P. C. (1924). Helmholtz's treatise on physiological optics. Rochester, N.Y.: Optical Society of America.
- Background: PubMed 15937014Friston K. A theory of cortical responses. Philos Trans R Soc Lond B Biol Sci. 2005 Apr 29;360(1456):815-36. doi: 10.1098/rstb.2005.1622.
- Background: PubMed 10195184Rao RP, Ballard DH. Predictive coding in the visual cortex: a functional interpretation of some extra-classical receptive-field effects. Nat Neurosci. 1999 Jan;2(1):79-87. doi: 10.1038/4580.
- Background: PubMed 1857193Bayes T. An essay towards solving a problem in the doctrine of chances. 1763. MD Comput. 1991 May-Jun;8(3):157-71. No abstract available.
- Background: PubMed 23750138Adams RA, Stephan KE, Brown HR, Frith CD, Friston KJ. The computational anatomy of psychosis. Front Psychiatry. 2013 May 30;4:47. doi: 10.3389/fpsyt.2013.00047. eCollection 2013.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Philip R Corlett, PhD principal investigator
Yale University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Transcranial Magnetic Stimulation (TMS) in people with Schizophrenia and Schizo Affective Disorder, run by Yale University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 1 Aug 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 25 May 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Conditioned Hallucinations Task Performance (time frame: approximately 13 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04210557, which also lists 60 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Aug 2024.