Grant: Project Grant

Schizophrenia (SCZ) is a psychiatric illness that affects approximately 1% of the world's population. Medication adherence is critically important to the treatment of SCZ. Non-adherence occurs in up to 60% of patients with SCZ with more than 80% of non-adherent patients discontinuing their medication by 6 months. Medication non-adherence is not only associated with worsening symptoms, but also increased rates of hospitalization, and suicide. A principle predictor of medication nonadherence in patients with SCZ is impaired insight, described as having partial or lack of conscious awareness of one's illness, its symptoms, and need for treatment. Currently, there are no established treatment options to improve insight and medication adherence in patients with SCZ. Transcranial direct current stimulation (tDCS) is a non-invasive device that applies a weak current to the brain. Evidence is accumulating to support tDCS as an efficacious treatment for SCZ, including a recent study by our group indicating that tDCS improves insight into psychosis. The proposed study employs a novel approach to investigate the effects of adjunctive tDCS on antipsychotic medication adherence. Participants will receive twice-daily tDCS for 10 days (20 sessions). Brain scans will be performed before and after 10 days of tDCS. Antipsychotic drug adherence will be assessed monthly based primarily on pill-count, and secondarily, plasma level concentrations and clinician-judgement. The results of this study will provide support for the use of this safe device in out-patient and ambulatory settings as an adjunctive treatment to antipsychotic medication. If proven effective, this intervention would have the potential to improve individual's capacity for illness recognition and engagement in treatment, undoubtedly having a significant impact on the well-being of patients and their families.