Alterations in the mesolimbic dopamine system play a crucial role in the pathophysiology of schizophrenia. However, little is known about potential disturbance in endogenous regulation of neural activity due to cognitive control. Recent research on real-time fMRI (rtfMRI) revealed a novel method to stimulate the substantia nigra and ventral tegmental area (SN/VTA), using positive mental imagery. Importantly, this self-regulation ability could be improved with rtfMRI neurofeedback. For the first time, we applied this innovative method in patients with schizophrenia (SZ) to investigate potential alterations in endogenous regulation of the reward system.

14 (SZ) and 14 healthy controls (HC) were included in this ongoing study. Participants performed a rtfMRI task with abstract visual feedback of neural activity in the SN/VTA. In the active condition, we instructed participants to voluntary up-regulate SN/VTA activity by recalling rewarding scenes. Neurofeedback learning was correlated with the self-reported negative symptoms.

In contrast to HC, SZ were not able to actively self-regulate SN/VTA activity. Furthermore, they failed to improve self-regulation with rtFMRI neurofeedback. Importantly, impaired neurofeedback learning was associated with negative symptoms, in particular diminished expression.

Our preliminary results show that self-regulation of SN/VTA activity is impaired in SZ. Although neurofeedback training improves self-regulation using positive mental imagery in HC, this method might not be suitable as a potential treatment strategy in SZ. The present findings provide new insights to the to the association between negative symptoms and dopaminergic dysfunction and highlight the strengths and limitation for the use of rtfMRI neurofeedback in schizophrenia.

The author has not supplied his declaration of competing interest.