141. Real-Time fMRI Feedback Directed at Superior Temporal Gyrus (STG) Reduces Auditory Hallucinations

Abstract

Background: Auditory hallucinations (AH) are one of most debilitating symptoms of schizophrenia, and in some patients they are resistant to medication. We have developed a real-time fMRI (rt-fMRI) protocol targeting STG to reduce the severity and frequency of AH. Methods: We have examined 9 chronic schizophrenia patients (SZ) with AH not amenable to medication and 4 healthy controls (HC; additional data are being collected) over 2 scanning sessions. Structural and functional MRI scans were acquired at Massachusetts Institute of Technology with specialized hardware and software. In the first session, resting state and two functional tasks data were acquired. The passive listening to self-voice and to other-voice task served as functional localizer to identify individual STG for the rt-fMRI session. The self-referential task was designed to examine activation in medial prefrontal cortex (MPFC) associated with self-referential processes. In the rt-fMRI session, subjects were asked to upregulate STG activation to their own voice delivered through the earphones and downregulate STG activation to the other person voice (earphones delivered) with visual feedback provided by a ‘thermometer’ that indicated either successful or not successful STG activation manipulation. The rt-fMRI session was followed by the self-other voice passive listening task and the self-referential task. AH was assessed on the day of the rt-fMRI session and a week later. Results: In SZ, STG activation to other-voice in passive listening task was significantly decreased (P < .05) post- relative to pre-rt-FMRI feedback session. In addition, STG directed fMRI feedback resulted in the MPFC activation increase (P < .014) post- relative to pre-fMRI session, suggesting normalization of MPFC in the self-referential task. Default mode network (DMN) resting state functional hyper-connectivity (P < .05) in SZ relative to HC, pre- rt-fMRI feedback, was significantly reduced post- rt-fMRI (P < .05), suggesting DMN amelioration. AH were significantly reduced post- rt-fMRI (P < .034) and their reduction was correlated with reductions in DMN resting state connectivity (P < .05). Conclusion: We showed for the first time significant reduction in AH as well as changes in brain regions involved in AH as a result of rt-fMRI directed at STG in SZ suffering from medication resistant AH.