249 research outputs found
Supplementary table -Supplemental material for Altered cortical excitability in persistent idiopathic facial pain
No full textSupplemental material, Supplementary table for Altered cortical excitability in persistent idiopathic facial pain by Ricardo Galhardoni, Daniel Ciampi de Andrade, Mariana YT Puerta, Andre R Brunoni, Bruna LR Varotto, José TT de Siqueira, Manoel J Teixeira and Silvia RDT Siqueira in Cephalalgia</p
Transcranial direct current stimulation for obsessive–compulsive disorder: A randomized, controlled, partial crossover trial
No full textBACKGROUND:
Presupplementary motor area (pre-SMA) hyperactivity has been detected in obsessive-compulsive disorder (OCD) patients. However, it is not understood whether this is a putative primary cause or a compensatory mechanism in OCD pathophysiology. Considering the polarity-dependent effects on cortical excitability of transcranial direct current stimulation (tDCS), we applied cathodal and/or anodal tDCS to the pre-SMA of OCD patients to test which current polarity might better improve symptoms.
METHODS:
Twelve OCD patients received initially 10 anodal (n = 6) or cathodal (n = 6) daily consecutive 2 mA/20 min tDCS sessions with the active electrode placed bilaterally on the pre-SMA. In case of improvement or no change in symptoms severity, the subjects were maintained on the same current polarity for 10 more sessions. In case of symptoms worsening after the first 10 sessions they were switched to the other polarity for 10 more sessions to test the hypothesis of a polarity-dependent effect. Therefore, each subject received 20 tDCS sessions. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Sheehan Disability Scale (SDS) were administered biweekly to assess changes in symptoms severity.
RESULTS:
After 10 sessions, 50% of patients who initially received anodal stimulation were switched to cathodal, while 100% of patients initially assigned to cathodal stimulation continued on the same polarity. At the end of the study, a statistically significant decrease was observed in the mean Y-BOCS scores of those patients who underwent cathodal tDCS. No pre-post difference was found in the scores of patients following anodal tDCS.
CONCLUSIONS:
Cathodal but not anodal tDCS over the pre-SMA significantly improved OCD symptoms
Supplemental Material - Prevalence and patterns of Multimorbidity prevalence and patterns at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
No full textSupplemental Material for Prevalence and patterns of multimorbidity at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) by Larissa Pruner Marques, Odaleia Barbosa Aguiar, Daniela Polessa Paula, Fernanda Esthefane Garrides Oliveira, Dóra Chor, Isabela Benseñor, Antonio Luiz Pinho Ribeiro, Andre R Brunoni, Luciana A C Machado, Maria de Jesus Mendes da Fonseca and Rosane Härter Griep in Journal of Multimorbidity and Comorbidity</p
Transcranial direct current stimulation: challenges, opportunities and impact on psychiatry and neurorehabilitation
No full textVersion of Recor
Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression
No full textTranscranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients
Determinant factors of the COVID-19 pandemic\'s impact on the mental health of the São Paulo population: a multidimensional analysis in the ELSA-Brasil cohort
No full textIntrodução: No decorrer da pandemia da COVID-19, surgiram evidências conflitantes acerca de seu impacto nos transtornos e sintomas psiquiátricos. Esta tese sintetiza os achados do Centro de Pesquisa ELSA-Brasil São Paulo para avaliar a psicopatologia relacionada à pandemia, estruturas de rede de sintomas mentais, trajetórias de transtornos mentais comuns (TMC) e incidência de ideação suicida durante a pandemia. Objetivo: Investigar mudanças nas taxas de sintomas psiquiátricos, a conectividade das redes de sintomas mentais, trajetórias de sintomas de TMC e fatores de risco associados ao aumento da ideação suicida durante a pandemia da COVID-19. Métodos: Foram utilizados dados do centro de São Paulo da coorte ELSA-Brasil, abrangendo avaliações pré-pandêmicas e pandêmicas. As ondas de coleta pré-pandêmicas incluem avaliações de 20082010 (Onda 1), 20122014 (Onda 2) e 20162018 (Onda 3). As avaliações pandêmicas, referidas como Ondas COVID (WC), compreendem quatro ondas: maiojulho de 2020 (WC1), julhosetembro de 2020 (WC2), outubrodezembro de 2020 (WC3) e abriljunho de 2021 (WC4). Foram utilizados o Clinical Interview Scheduled-Revised (CIS-R) e o Depression Anxiety Stress Scale-21 (DASS-21) para medir TMCs e sintomas psiquiátricos. Abordagens analíticas, incluindo modelos lineares generalizados multivariáveis, análise de rede, modelagem de trajetória baseada em grupos e regressão logística, foram aplicadas para comparar taxas de TMCs e sintomas psiquiátricos, examinar estruturas de rede de sintomas mentais, identificar trajetórias de sintomas de TMC e avaliar a incidência de ideação suicida. Resultados: Não foi encontrado um aumento significativo nas taxas de TMCs. Idade mais jovem, sexo feminino, menor nível educacional e etnia não branca foram consistentemente associados a maiores chances de transtornos psiquiátricos e piores trajetórias de sintomas. A análise de rede indicou maior conectividade geral entre os sintomas mentais durante a pandemia, particularmente entre preocupações gerais e preocupações com a saúde. Foi observado um aumento de três vezes na taca de ideação suicida. TMC anterior (OR 7.17; IC 95% 4.43 - 11.58) e eventos adversos na infância (EAI) (OR 1.72; IC 95% 1.09 - 2.72) aumentaram as chances de ideação suicida. Conclusão: Os achados não suportam um agravamento consistente de transtornos e sintomas psiquiátricos nesta amostra durante a pandemia. A conectividade de rede aumentada sugeriu uma interação complexa entre os sintomas psiquiátricos. A identificação de fatores de risco específicos para piores resultados de saúde mental, incluindo desvantagens socioeconômicas e transtornos psiquiátricos anteriores, enfatiza a importancia do suporte e intervenções direcionadasBackground: Amid the COVID-19 pandemic, mixed evidence has emerged regarding its impact on psychiatric disorders and symptoms. This thesis synthesizes findings from the ELSA-Brasil São Paulo Research Center to evaluate pandemic-related psychopathology, network structures of mental symptoms, trajectories of common mental disorders (CMD), and incidence of suicidal ideation during the pandemic. Aim: To investigate changes in psychiatric symptom rates, the connectivity of mental symptom networks, CMD symptom trajectories, and risk factors associated with increased suicidal ideation during the COVID-19 pandemic. Methods: Data from the ELSA-Brasil São Paulo Research Center was used, encompassing pre-pandemic and pandemic assessments. The pre-pandemic waves include assessments from 20082010 (Wave 1), 20122014 (Wave 2), and 20162018 (Wave 3). The pandemic assessments, referred to as Wave COVID (WC), comprise four waves: MayJuly 2020 (WC1), JulySeptember 2020 (WC2), OctoberDecember 2020 (WC3), and AprilJune 2021 (WC4). The Clinical Interview Scheduled-Revised (CIS-R) and the Depression Anxiety Stress Scale-21 (DASS-21) instruments were utilized to measure psychiatric symptoms and common mental disorders across these periods. Analytical approaches, including multivariable generalized linear models, network analysis, group-based trajectory modeling, and logistic regression, were applied to compare psychiatric symptom rates, examine mental symptom network structures, identify CMD symptom trajectories, and assess suicidal ideation incidence. Results: No significant increase in rates of CMDs was found. Younger age, female sex, lower educational level, and non-white ethnicity were consistently linked with increased odds for psychiatric disorders and worsened trajectories of symptoms. Network analysis indicated higher overall connectivity among mental symptoms during the pandemic, particularly between general worries and health concerns. A threefold increase in suicidal ideation was observed. Previous CMD (OR 7.17; 95% CI 4.43 - 11.58) and adverse childhood events (ACE) (OR 1.72 95% CI 1.09 - 2.72) increased the odds of suicidal ideation. Conclusion: Our findings do not support a consistent worsening of psychopathology within the cohort during the pandemic. The increased network connectivity suggested a complex interplay between psychiatric symptoms. The identification of specific risk factors for worsened mental health outcomes, including socioeconomic disadvantages and previous psychiatric disorders, emphasizes the importance of targeted support and intervention
Brain stimulation and other biological non-pharmacological interventions in mental disorders: an umbrella review
No full textBackground: the degree of efficacy, safety, quality, and certainty of meta-analytic evidence of biological non-pharmacological treatments in mental disorders is unclear. Methods: we conducted an umbrella review (PubMed/Cochrane Library/PsycINFO-04-Jul-2021, PROSPERO/CRD42020158827) for meta-analyses of randomized controlled trials (RCTs) on deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electro-convulsive therapy (ECT), and others. Co-primary outcomes were standardized mean differences (SMD) of disease-specific symptoms, and acceptability (for all-cause discontinuation). Evidence was assessed with AMSTAR/AMSTAR-Content/GRADE. Results: we selected 102 meta-analyses. Effective interventions compared to sham were in depressive disorders: ECT (SMD=0.91/GRADE=moderate), TMS (SMD=0.51/GRADE=moderate), tDCS (SMD=0.46/GRADE=low), DBS (SMD=0.42/GRADE=very low), light therapy (SMD=0.41/GRADE=low); schizophrenia: ECT (SMD=0.88/GRADE=moderate), tDCS (SMD=0.45/GRADE=very low), TMS (prefrontal theta-burst, SMD=0.58/GRADE=low; left-temporoparietal, SMD=0.42/GRADE=low); substance use disorder: TMS (high frequency-dorsolateral-prefrontal-deep (SMD=1.16/GRADE=moderate), high frequency-left dorsolateral-prefrontal (SMD=0.77/GRADE=very low); OCD: DBS (SMD=0.89/GRADE=moderate), TMS (SMD=0.64/GRADE=very low); PTSD: TMS (SMD=0.46/GRADE=moderate); generalized anxiety disorder: TMS (SMD=0.68/GRADE=low); ADHD: tDCS (SMD=0.23/GRADE=moderate); autism: tDCS (SMD=0.97/GRADE=very low). No significant differences for acceptability emerged. Median AMSTAR/AMSTAR-Content was 8/2 (suggesting high-quality meta-analyses/low-quality RCTs), GRADE low. Discussion: despite limited certainty, biological non-pharmacological interventions are effective and safe for numerous mental conditions. Results inform future research, and guidelines. Funding: none
Digitalized transcranial electrical stimulation: A consensus statement
No full textObjective
Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES.
Methods
We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided.
Results
The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity.
Conclusions
Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases.
Significance
We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials
Different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms among older adults in Ireland: A prospective community-based study.
No full textBACKGROUND: The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear.
METHODS: Data on 6095 adults aged ≥ 50 years old from the Irish Longitudinal Study on Aging (TILDA) was analyzed. Participants completed the CAGE instrument to screen for problematic alcohol use at baseline between October 2009 and February 2011. Outcomes were incident (assessed by the CES-D scale) and anxiety (assessed by the Hospital Anxiety and Depressive scale) symptoms after a two-year follow-up as well as persistence of probable depression and anxiety among those with a positive screen for those disorders at baseline. Associations were adjusted for potential confounders through multivariable models.
RESULTS: In the overall sample, problem drinking did not predict incident and persistent depression and anxiety in this sample. Among females, problem drinking increased the risk for incident depression (OR = 2.11; 95%CI = 1.12-4.00) and anxiety (OR = 2.22; 95%CI = 1.01-4.86). In addition, problem drinking increased the risk of persistent depressive symptoms (OR = 2.43; 95%CI = 1.05-5.06) among females.
CONCLUSION: Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms
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