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Stratified Treatment and Recovery for Hallucinations(STAR-H)

Projectomschrijving

Hallucinaties (iets waarnemen dat niemand anders ziet/hoort) compliceren veel verschillende psychische aandoeningen. Deze ‘onwaarnemingen’ zijn vaak beangstigend, kunnen de kwaliteit van leven ernstig verstoren, formele en informele zorg fors verzwaren en agressie uitlokken. Goede uitleg en psychotherapie helpt, maar vaak is er meer nodig. Medicatie kan effectief zijn, maar heeft soms ernstige bijwerkingen. STAR-H introduceert een nieuw concept dat behandeling koppelt aan individuele neurobiologische afwijkingen door biomarkers te identificeren.

Persoonskenmerken

De onderliggende mechanismen van hallucinaties zijn verschillend, en elk mechanisme behoeft zijn eigen aanpak. Daarom dient de behandeling van hallucinaties middels antipsychotica (haldol-achtige middelen), cholinesterase remmers (‘Alzheimer-pleisters’) of magnetische stimulatie (de hersenen lokaal tot rust brengen) nauwkeurig te worden afgestemd op persoonskenmerken.

Doel

STAR-H onderzoekt hoe die persoonskenmerken, via shared decision-making, de leidraad vormen voor behandeling op maat. Dit zorgt dat patiënten snel een werkzame behandeling krijgen en voorkomt ernstige bijwerkingen.

Producten

Titel: Functional brain networks in the schizophrenia spectrum and bipolar disorder with psychosis
Auteur: van Dellen E, Börner C, Schutte M, van Montfort S, Abramovic L, Boks MP, Cahn W, van Haren N, Mandl R, Stam CJ, Sommer I.
Magazine: npj Schizophrenia
Link: https://www.nature.com/articles/s41537-020-00111-6#citeas
Titel: Functional connectome differences in individuals with hallucinations across the psychosis continuum
Auteur: Schutte MJL, Bohlken MM, Collin G, Abramovic L, Boks MPM, Cahn W, Dauwan M, van Dellen E, van Haren NEM, Hugdahl K, Koops S, Mandl RCW, Sommer IEC.
Magazine: Scientific Reports
Link: https://www.nature.com/articles/s41598-020-80657-8
Titel: Auditory Verbal Hallucinations in Schizophrenia From a Levels of Explanation Perspective
Auteur: Hugdahl K, Sommer IE.
Magazine: Schizophrenia Bulletin
Titel: Deafferentation as a cause of hallucinations
Auteur: Marschall TM, Brederoo SG, Curcic-Blake B, Sommer IEC.
Magazine: Current Opinion in Psychiatry
Link: https://journals.lww.com/co-psychiatry/fulltext/2020/05000/Deafferentation_as_a_cause_of_hallucinations.5.aspx?context=LatestArticles
Titel: Deafferentation as a cause of hallucinations.
Auteur: Marschall TM, Brederoo SG, Curcic-Blake B, Sommer IEC.
Magazine: Current Psychiatry Reviews
Titel: Modular-Level Functional Connectome Alterations in Individuals With Hallucinations Across the Psychosis Continuum
Auteur: Schutte MJL, Voppel A, Collin G, Abramovic L, Boks MPM, Cahn W, van Haren NEM, Hugdahl K, Koops S, Mandl RCW, Sommer IEC.
Magazine: Schizophrenia Bulletin
Begin- en eindpagina:
Link: https://academic.oup.com/schizophreniabulletin/article/48/3/684/6530631
Titel: Hallucinations and other psychotic experiences across diagnoses: A comparison of phenomenological features
Auteur: Schutte MJL, Linszen MMJ, Marschall TM, Ffytche DH, Koops S, van Dellen E, Heringa SM, Slooter AJC, Teunisse R, van den Heuvel OA, Lemstra AW, Foncke EMJ, Slotema CW, de Jong J, Rossell SL, Sommer IEC
Magazine: Psychiatry Research
Titel: Cholinesterase Inhibitors for Treatment of Psychotic Symptoms in Alzheimer Disease and Parkinson Disease: A Meta-analysis
Auteur: d'Angremont E, Begemann MJH, van Laar T, Sommer IEC.
Magazine: JAMA Neurology
Begin- en eindpagina:
Link: https://jamanetwork.com/journals/jamaneurology/article-abstract/2806600
Titel: Time varying dynamics of hallucinations in clinical and non-clinical voice-hearers
Auteur: Marschall TM, Koops S, Brederoo SG, Cabral J, Curcic-Blake B, Sommer IEC.
Magazine: NeuroImage: Clinical
Link: https://www.sciencedirect.com/science/article/pii/S2213158223000402
Titel: Spontaneous brain activity underlying auditory hallucinations in the hearing-impaired
Auteur: Marschall TM, Curcic-Blake B, Brederoo SG, Renken RJ, Linszen MMJ, Koops S, Sommer IEC.
Magazine: Cortex
Begin- en eindpagina:
Link: https://www.sciencedirect.com/science/article/pii/S0010945220304469
Titel: Abnormal synaptic pruning during adolescence underlying the development of psychotic disorders.
Auteur: Germann M, Brederoo SG, Sommer IEC.
Magazine: Current Psychiatry Reviews
Titel: Toward personalized treatment of hallucinations.
Auteur: Sommer IE, Kleijer H, Hugdahl K.
Magazine: Current Psychiatry Reviews
Titel: Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness.
Auteur: Slotema CW, Bayrak H, Linszen MMJ, Deen M, Sommer IEC.
Magazine: Acta Psychiatrica Scandinavica
Titel: Hallucinations and other psychotic experiences across diagnoses: A comparison of phenomenological features
Auteur: Schutte MJL, Linszen MMJ, Marschall TM, Ffytche DH, Koops S, van Dellen E, Heringa SM, Slooter AJC, Teunisse R, van den Heuvel OA, Lemstra AW, Foncke EMJ, Slotema CW, de Jong J, Rossell SL, Sommer IEC.
Magazine: Psychiatry Research
Link: https://www.sciencedirect.com/science/article/pii/S0165178120303917?via%3Dihub
Titel: Hallucinations in Hearing Impairment: How Informed Are Clinicians?
Auteur: Marschall TM, van Dijk P, Kluk K, Koops S, Linszen MMJ, Griffiths TD, Toh WL, Malicka AN, Kovacic D, Mulert C, Sommer IEC, Curcic-Blake B.
Magazine: Schizophrenia Bulletin
Begin- en eindpagina:
Link: https://academic.oup.com/schizophreniabulletin/article/49/Supplement_1/S33/7058007
Titel: Hallucinations after Cardiac Surgery: A Prospective Observational Study.
Auteur: Ottens TH, Sommer IEC, Begemann MJ, Schutte M, Cramer MJ, Suyker WJ, Van Dijk D, Slooter AJC
Magazine: Medicine

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Samenvatting van de aanvraag

Hallucinations occur in many psychiatric disorders1. They are highly intrusive for patients, result in low quality of life, high caregiver burden and excess mortality2. Psychoeducation, improving coping skills and cognitive behavioural therapy are the first lines of treatment, but often additional biological treatment is needed 3-5. Biological treatments may be effective, but can also cause major side-effects. Currently, it is not possible to predict who will benefit and who will be harmed by these treatments and clinicians basically have to practice trial-and-error. STAR-H introduces a new concept that matches treatment to individual neurobiological deviation. To accomplish this, we will identify biomarkers with novel combinations of neuroimaging techniques. For the first time, personalized treatment for hallucinations will become feasible by coupling these biomarkers to specific treatments. With the use of transcranial magnetic stimulation (TMS), Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI), we will assess biomarkers in 120 patients who have disstressing and frequent hallucinations with four diagnoses (schizophrenia, borderline personality disorder, bipolar disorder, post-traumatic stress disorder) and compare them to matched controls. Patients receive targeted treatment based on individual Z scores (computed with the use of age-specific normal distributions). Efficacy of treatment based on these biomarkers (personalized treatment arm)will be compared to treatment with the same interventions without information on biomarkers (control arm). In the personalized treatment arm: 1. decreased cholinergic innervation is compensated with rivastigmine; 2. increased dopamine signaling is treated with amisulpride; 3. neuronal network instability (de-afferentation) is reversed with repetitive TMS. In both arms, the choice for treatment will be made in a shared decision process between the patient, his/her partner/relatives and the treating physician, with the important difference that in the personalized treatment arm the treating physician will be provided with information about the patient's biomarker profile. A panel of four people with lived-experience will assist the patients throughout the study and support them in the shared decision process. To facilitate large-scale clinical implementation, we will also assess “psychomarkers” using deep phenotyping with a systematic questionnaire we recently developed together with the International Consortium for Hallucinations Research (ICHR): the Questionnaire for Psychotic Experiences (QPE). If accuracy of psychomarkers is satisfactory, they can replace biomarkers. If these psychomarkers are a valid alternative for neuro-imaging-derived biomarkers, personalized treatment of hallucinations can be provided in all treatment setting without the need for technical facilities or academic know-how. Finally, a data-driven approach is applied to all bio- and psychomarkers to unveil new homogeneous clusters for optimal outcome prediction. This approach may provide new classification concepts for better treatment prediction. In the STAR-H, different scientific elements are put into a chain to translate neuroscientific insight into personalized treatment for hallucinations in day-to-day practice. This is enabled by a unique consortium where all key elements (clinical trials in patient cohorts; deep phenotyping, TMS, MRI; PET; machine learning) can be performed. Our group has done most elements of this project before (assessing F-Dopa uptake18 performing transient-network analyses19 and treating hallucinations with rTMS6), which provides a firm basis for this project. Novelty of STAR-H lies in its potential to radically change treatment of psychiatric symptoms from diagnosis-based to biomarker or psychomarker-based therapy. This approach is the missing link between academic knowledge and clinical practice and can improve outcome for many patients with hallucinations. Most importantly, it will prevent unnecessary and at times severe side-effect of somatic treatment.

Onderwerpen

Kenmerken

Projectnummer:
636310010
Looptijd: 100%
Looptijd: 100 %
2018
2023
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
prof. dr. I.E.C. Sommer
Verantwoordelijke organisatie:
Universitair Medisch Centrum Groningen