Grant: CIHR Fellowship

This novel proof of concept, pilot study seeks to modulate impaired illness awareness or anosognosia in schizophrenia, arguably the most treatment-resistant manifestation of the disorder, using transcranial direct current stimulation (tDCS) during functional magnetic resonance imaging (fMRI). Schizophrenia is ranked 5th among leading causes of disability in industrialized countries and is estimated to cost Canada over $7 billion per year. Impaired illness awareness, occurring in up to 95% of patients with schizophrenia, is associated with medication non-adherence and poor treatment outcomes. Devastatingly, impaired illness awareness is unresponsive to commonly used psychological interventions and psychoeducation. Transcranial DCS is a novel, safe, noninvasive electrical stimulation technique for altering brain function. It has been used to provide evidence for the theory that symptoms associated with damage to one half of the brain, such as neglect due to stroke -- in which the individual ignores the half of the world on their affected side -- derive from the disruption of the normal balance between the brain's hemispheres. In these cases, tDCS's benefit is thought to result from restoring this balance. It is well recognized that neglect and anosognosia frequently co-occur. To our knowledge this is the first study to investigate the effects of tDCS on brain function with fMRI and anosognosia in schizophrenia. During fMRI, we aim to temporarily improve illness awareness in schizophrenia with tDCS by inhibiting left hemisphere regions show by our group to be activated during illness denial. The results of this pilot study would provide evidence to justify a larger treatment-controlled study. If proven effective, tDCS has the potential to alter individuals' attitude towards their illness and need for treatment, leading ultimately to improved capacity for illness recognition and consent to treatment.