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Brian A. Coffman, PhD Research Instructor

Department of Psychiatry University of Pittsburgh School of Medicine

UPMC Western Psychiatric Hospital Pittsburgh, PA

Dr. Brian Coffman is a Research Instructor of Psychiatry in the Clinical Neurophysiology Research Lab (CNRL). He earned his BS, MS, and Ph.D. in Psychology at the University of New Mexico, where his primary mentor was Dr. Vincent P. Clark. Dr. Coffman’s current research program focuses on the neurophysiology of sensory and cognitive dysfunction in clinical populations such as schizophrenia, and the therapeutic effects of brain stimulation on these deficits. He has pursued interests in functional magnetic resonance imaging (fMRI), electroencephalography (EEG), magnetoencephalography (MEG), transcranial direct current stimulation (tDCS), and mathematical/computational problems associated with neuroimaging data analysis. Dr. Coffman has published basic science research as well as research in various clinical populations, and he has applied multimodal neuroimaging data to complex problems in clinical diagnosis and treatment. He has published 27 research articles on these topics in peer-reviewed journals, as well as multiple chapters in edited volumes. Dr. Coffman was recently awarded a Young Investigator Award in September of 2018 for his outstanding contributions to the field as an early-career investigator. Abstract: Schizophrenia Treatment with Non-Invasive Brain Stimulation: Using Positive and Negative Currents to Treat Positive and Negative Symptoms (Intermediate) This talk will introduce the methods of transcranial magnetic stimulation and transcranial DC electric stimulation, review studies of the clinical effects of these noninvasive brain stimulation methods in schizophrenia, and present preliminary findings from Dr. Coffman’s lab showing improved cognition and reduced auditory hallucinations in schizophrenia patients following DC electric stimulation paired with cognitive training. Learning Objectives By the completion of this session, participants should be able to: 1. Recognize the difference between magnetic and electrical stimulation methods 2. Recognize positive and negative symptoms of schizophrenia, including auditory hallucinations 3. Discuss noninvasive brain stimulation research studies reported in the literature

References

1. Coffman BA, Clark VP, & Parasuraman R (2014). Battery powered thought: Enhancement of attention, learning, and memory in healthy adults using transcranial direct current stimulation. Neuroimage, 85(3), 895-908.

2. Brunelin, J., Mondino, M., Gassab, L., Haesebaert, F., Gaha, L., Suaud-Chagny, M.F., Saoud, M., Mechri, A. and Poulet, E., 2012. Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia. American Journal of Psychiatry, 169(7), pp.719-724.

3. Mondino, M., Haesebaert, F., Poulet, E., Suaud-Chagny, M.F. and Brunelin, J., 2015. Fronto-temporal transcranial direct current stimulation (tDCS) reduces source-monitoring deficits and auditory hallucinations in patients with schizophrenia. Schizophrenia research.

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University of PittsburghCLINICAL

NEUROPHYSIOLOGY

RESEARCH

LABORATORY

Schizophrenia Treatment with Non-Invasive Brain Stimulation

Using Positive, Negative, and Induced Electric Fields to Treat Positive, Negative, and Cognitive

Symptoms

Brian A. CoffmanDepartment of Psychiatry

University of Pittsburgh School of Medicine

What is brain stimulation?

How can brain stimulation be used therapeutically in schizophrenia?

Ongoing research at UPSOM

Outline

What is Brain Stimulation?

Early Torpedo Fish Brain Stimulation

153 AD – 19th Century AD

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Victorian Era Electrical StimulationCirca 1900 AD




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Electromagnetic Induction Transcranial Magnetic Stimulation

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Thompson, 1910 Barker, 1985 Nexstim, 2015

Therapeutic Brain StimulationA New Avenue for Clinical Translation of

Neuroimaging Research?

• Number and cost of funded proposalsmentioning “fMRI” funded through NIH,2005-‐2016 (from NIH RePORTER)– 14,233 projects and subprojects– Total = $6,152,143,137



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• Neuroimaging correlations can only be used tomake inferences about causality

• Imaging has not provided many treatmentbenefits for community medicine, especially formental health

• Stimulation provides new ways to applyinformation gained by neuroimaging



Therapeutic Brain Stimulation - TMSLasting effects of stimulus frequency

• TMS to motor cortex (single/ repeated pulses)• EMG recording from muscle

TMS Test stimulus

MEP

Baseline

High frequency rTMS increases

excitability

Low frequency rTMS reduces

excitability

10 Hz rTMS

1 Hz rTMS

TMS Test stimulus

MEP

TMS Test stimulus

MEP

Therapeutic Brain Stimulation - TMSChoosing the right dose – the MEP

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ADHDAddictionAlzheimer diseaseAutismBipolar DisorderDepression*Epilepsy

FibromyalgiaLearningMigraine Headache* Multiple SclerosisParkinson's DiseasePTSD

SchizophreniaStroke RecoveryTBITinnitusTourette’s Syndrome

Therapeutic Brain Stimulation - TMS

Therapeutic Brain Stimulation - TMS

What is brain stimulation?

How can brain stimulation be used therapeutically in schizophrenia?

Ongoing research at UPSOM

Outline

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Schizophrenia

Negative SymptomsDiminished speechLack of motivationSocial impairmentDecreased emotional

Cognitive Impairments MemoryAttentionMotor skillsSocial cognitionExecutive skillsDisorganized speech

Positive SymptomsHallucinationsSuspiciousnessDelusions

PrevalentLifetime prevalence: 1-5%

Debilitating

Disease BurdenTop 10 Causes of Premature Mortality and/or Disability for

Adults Age 15-44 years

WHO. The World Health Report 2001. Available at http://www.who.int/whr/2001/en/index.html

Both Sexes%

Total Male%

Total Female%

Total

HIV/AIDS 13.0 HIV/AIDS 12.1 HIV AIDS 13.9

Depressive disorders 8.6 Road traffic accidents 7.7 Depressive disorders 10.6

Road traffic accidents 4.9 Depressive disorders 6.7 Tuberculosis 3.2

Tuberculosis 3.9 Alcohol Use Disorders 5.1 Iron deficiency anemia 3.2

Alcohol Use Disorders 3.0 Tuberculosis 4.5 Schizophrenia 2.8

Self-inflicted Injuries 2.7 Violence 3.7 Obstructed labor 2.7

Iron-deficiency anemia 2.6 Self-inflicted Injuries 3.0 Bipolar disorder 2.5

Schizophrenia 2.6 Schizophrenia 2.5 Abortion 2.5

Bipolar disorder 2.5 Bipolar disorder 2.4 Self-inflicted injuries 2.4

Violence 2.3 Iron deficiency anemia 2.1 Maternal sepsis 2.1

Cloutier, et al (2016) J Clin Psychiatry

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Sommer, et al. (2016) Schizophrenia Research

Course of Schizophrenia

In 25–30% of cases auditory hallucinations are not treated by traditional antipsychotic drugs.

-Shergill et al (1998)

Brain Stimulation in Schizophrenia

Auditory Hallucinations:Overactivation of language perceptual systems in left temporoparietal junction

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• Low frequency (1 Hz, inhibitory) rTMS applied to left TPJ

Therapeutic Brain Stimulation –TMS for Auditory Hallucinations

• Low frequency (1 Hz) rTMS applied to left TPJ

Therapeutic Brain Stimulation –TMS for Auditory Hallucinations

• rTMS and Clozapine are the only treatments with evidence of efficacy for treatment refractory psychotic symptoms

Brain Stimulation in Schizophrenia

Negative Symptoms:Reduced prefrontal cortex metabolism/volume

Sanfilipo et al. (2000) Arch Gen Psychiatry

r = -.70, p<.001 r = -.42, p=.002

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• High frequency (10 Hz) rTMS applied to Prefrontal Cortex

Therapeutic Brain Stimulation –TMS for Negative Symptoms

0

10

20

30

40

50

60

70

80

90

Negative Symptoms (SANS) Positive Symptoms (SAPS)

SCAL

E SC

OR

ES

Prikryl et al. (2013) Schiz. Res.

Baseline Post-TMS

• High frequency (10 Hz) rTMS applied to Prefrontal Cortex

Therapeutic Brain Stimulation –TMS for Negative Symptoms

Ngram

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abstract: schizophrenia treatment with non-invasive brain ...antrios.wpic.pitt.edu/files/file/part...

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