A treatmentstudy for apathy in schizophrenia.

This study is a randomized controlled trial whereby effects of neurostimulative treatment and activation therapy for apathy in schizophrenia are investigated. The main objective is to investigate whether treatment using neurostimulation (tDCS or rTMS) targeting the right dorsolateral prefrontal cortex (rDLPFC) reduces apathy in schizophrenia patients by activating the targeted brain region and whether tDCS is equally effective as rTMS. A secondary aim is to evaluate if a psychosocial intervention, in the form of BAT, in addition to a biological intervention, TMS, further reduces the level of apathy. In addition, we will investigate which patients are more likely to benefit from rTMS treatment by applying near-infrared spectroscopy (NIRS).

1. Repetitive Transcranial Magnetic Stimulation (rTMS), Transcranial Direct-Current Stimulation (tDCS) and Behavioural Activation Therapy (BAT) following rTMS will reduce feelings of apathy, increase goal directed behaviour and might be beneficial for cognitive functioning;

2. Neurostimulative treatment and BAT will increase fronto-striatal circuits;

3. Baseline frontoparietal connectivity is predictive of the clinical response to rTMS.

Directly before intervention, during intervention, immediately after intervention, a follow-up 4 weeks after treatment, and a follow-up three months after treatment.

Prior to treatment, the patients will be asked to complete questionnaires, interviews and neuropsychological tests, and an (f) MRI scan will be made. The neurostimulative treatment, rTMS or tDCS, will be provided to the patients twice a day, for a duration of 20 minutes. This treatment lasts for 3 weeks, 6 days a week. There are two groups of patients that receive placebo rTMS or placebo tDCS treatment (25 persons per group). During the (placebo) treatment all patients wear an Acti-meter (on the wrist like a watch). A portion of the patients (25 persons), get a 6 week behavioral activation therapy (BAT) after finishing the neurostimulatieve treatment. After completion of the treatment the questionnaires, interviews, neuropsychological tests, and scan will be repeated. During two follow-up sessions, four weeks and three months after the treatment, solely the neuropsychological evaluation and one-week Acti-meter assessment will be repeated.