Tratamentos Não-Farmacológicos Em Esquizofrenia:Estimulação Elétrica Cerebral E Autorregulação Por Perfusão Sanguínea

Schizophrenia is a heterogeneous disordes with simptoms classified in 5 factors: negative, disorganization/ cognitive, excitement, positive and depressive/ anxiety. Among the refractory symptoms, the negative and cognitive deficits are associated to functionality impairments and low recovery. The frontal lobe is implicated in those deficits and differences on brain functioning are observed in diverse regions, when comparing people with schizophrenia and healthy controls. By now, no pharmacological treatments are recommended for improvement of the negative symptoms nether of the cognitive deficits. On this thesis, I present 4 studies investigating the effects of 3 neuromodulation technique on schizophrenia. OBJECTIVE: Study 1 – to investigate the effects of transcranial direct current stimulation on negative symptoms in schizophrenia. Study 2 - to investigate the effects of transcranial direct current stimulation on working memory (primary outcome and negative symptoms (secundar outcomes) in schizophrenia. Study 3 – to evaluate the effects of trigeminal nerve stimulation on olfactory allucination of 1 patient with schizophrenia. Study 4 – to evaluate the effects of the self-regulation neurofeedback training based on hemoencephalography on cognition and symptoms in schizophrenia. METHOD: We applied 10 sessions of tDCS in schizophrenia subjects. Stimulation used the following parameters: 2mA, for 20 minutes, with electrodes of 25cm2 wrapped in cotton material soaked in saline solution. Anode at F3 and cathode at F4. Fifteen patients were enrolled in a double-blinded, randomized, sham-controlled clinical trial. Negative symptoms were evaluated using PANSS scale, before and after the stimulation. Study 2 – The same parameters described in study 1 were applied. Twenty-four participants were assessed at baseline, after intervention and in a three-months follow-up. For assessment, we evaluated the working memory score from MATRICS (primary outcome) and the negative score from PANSS (secondary outcome). Study 3 – We applied 10 sessions of trigeminal nerve stimulation in a patient with olfactory hallucination. Electroencephalographic data were obtained before and after stimulation. Study 4 – Hemoencephalography neurofeedback training were done along 10 session for 8 people with schizophrenia and 12 health controls in 4 brain sites (F7, Fp1, Fp2 and F8). Cognitive performance were assessed using MATRICS and symptoms with PANSS. RESULTS: Study 1 - patients who received active xix stimulation showed greater reduction on PANSS negative score, compared to controls (p=0.004). Study 2 - We did not find group*time interaction for the working memory (p = 0.720) score or any other cognitive variable (p > 0.05). We found a significant group*time interaction for PANSS negative (p 0.05). Observou-se interação tempo * grupo significante para o escore negativo da PANSS (p < 0.001, d = 0.23, CI.95 = -0.59 – 1.02), escore general (p = 0.011) e PANSS total (p<0.001). Análise exploratória dos 5 fatores da PANSS sugere efeitos para o fator negative (p = 0.012), cognitivo (p =0.016) e depressão (p = 0.029). Estudo 3 – De acordo com a escala analógica visual, a intensidade da alucinação reduziu de 9.4 para 0.3. A potencia de alfa apresentou a maior redução em PZ, reduzindo de 19.68 μV2 para 8.22 μV2 (t=-11.41, p