Cognitive Function and Treatment Outcomes in Trichotillomania: A Case Series Evaluating the Efficacy of TMS.

Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic

EP 65. Non-invasive brain stimulation for the treatment of Parkinson’s disease – A pilot study

Trichotillomania is a psychiatric disorder characterised by compulsive pulling out of one’s hair resulting in hair loss, which is included in the Diagnostic and Statistical Manual of Mental Disorders 5th edition category ‘obsessive-compulsive disorder and related disorders’. Behavioural therapy and some medications are suggested for the treatment of trichotillomania, though these are not effective for all patients. Therefore, new treatment options are needed. Five female patients diagnosed with trichotillomania applied low-frequency repetitive transcranial magnetic stimulation (rTMS) over bilateral supplementary motor area for 3 weeks. Baseline and after rTMS, patients were given Beck Depres-sion Inventory, Beck Anxiety Inventory and Massachusetts General Hospital Hair Pulling Scale to evaluate the severity of disorder at baseline and post-rTMS. In this case series, three of five patients with trichotillomania obtained a substantial benefit from treatment, while one patient obtained a partial symptom reduction. The last patient experienced a mild increase in severity of disease after rTMS treatment. rTMS treatment can be effective in some patients with trichotillomania and can be a promising option in treatment of trichotillomania.

Hitting the Target of Image-Guided Psychiatry?

A case series of repetitive transcranial magnetic stimulation in the treatment of major depression during pregnancy

IntroductionTranscranial Magnetic Stimulation (TMS) is a Food and Drug Administration (FDA) approved treatment that induces neuronal activity in the left dorsolateral prefrontal cortex. TMS was initially developed to treat major depression after studies of patients with depression revealed hypometabolism in this brain region. Since it was first FDA approved in 2008, several types of TMS have been developed and its clinical indications expanded. Given the dearth of literature guiding clinicians in understanding different forms of TMS and their protocols, this poster will review the common and unique aspects of several forms of TMS in an effort to aid clinicians in appropriately utilizing this safe and effective neuromodulatory treatment.MethodsSpecific keywords were used to conduct a thorough but nonsystematic review of multiple databases, including PubMed, Google Scholar, and PsychInfo. Articles describing protocols rather than direct comparisons were selected. The outcomes regarding protocol guidelines, advantages, disadvantages, safety, and side effects were included in the review.ResultsThe FDA approved types of TMS include repetitive TMS (rTMS), deep TMS (dTMS), intermittent theta burst stimulation (iTBS), and accelerated TMS (aTMS). While rTMS is limited to cortical tissue, other forms of TMS reach subcortical neurons with aTMS using functional magnetic resonance imaging (fMRI) to specifically locate the target area. dTMS was approved in 2013 and its session time is half that of rTMS. Subsequently developed TMS types have even shorter sessions; iTBS sessions are only 3 minutes and aTMS is 9 minutes per session. Most TMS protocols require 8-9 weeks for full treatment, but aTMS only needs 5 days. All TMS protocols stimulate at 120% of resting motor thresholds except for aTMS which adjusts based on the patient using fMRI results. Efficacy is mostly similar with rTMS, dTMS, and iTBS demonstrating remission rates up to 30%, but aTMS had remission rates up to 90.5%. aTMS can also be used for suicidality, patients with severe or refractory depression, as well as those with comorbid anxiety, which have historically shown lower rates of success with other treatments. Overall, all forms of TMS produce minimal and temporary side effects with patients being able to return to normal activities the same day as treatment, although aTMS may cause side effects of greater intensity resulting in sleep dysregulation. Cost remains a barrier, with many insurances covering rTMS but not iTBS or aTMS.ConclusionTMS is an evidence based, efficacious, and safe treatment for depression. Most FDA-approved TMS protocols for depression have similar number of sessions, duration of treatment, common side effects, and remission rates, besides aTMS, which has dramatically greater remission rates and shorter treatment duration, making it a potentially rapid and effective treatment modality for acute and more severe cases of depression.FundingNo Funding

The purpose of this study was to examine the factor structure, validity and reliability of the Massachusetts General Hospital Hair pulling Scale. Participants (304 male and 331 female) selected and the instruments of this study administered on them. Convergent validity of Massachusetts General Hospital Hair pulling Scale with the Obsessive–Compulsive Inventory-Revised, Yale –Brown Obsessive Compulsive Scale modified For BDD, Health Anxiety Inventory—Short Form and Skin Picking Impact Survey respectively were r=0.20, r=0.47, r=0.17 and r=0.47. Confirmatory factor analyses revealed total factor, one assessing impairment and the other symptom severity. The Cronbach's alpha for the total factor was 0.82. It can be concluded that this instrument is a useful measure for assess Hair pulling disorder symptoms in clinical assessment.

Theta-burst rTMS may improve psychomotor retardation in geriatric depression – A case report

Transcranial magnetic stimulation (TMS) for geriatric depression

Over the past two decades, the number of somatic treatments for psychiatric disorders has expanded, leading to new insights into the complex relationship between chemical and electric transmission of signals in the brain. In this article, the authors discuss the different device-based treatments currently available in psychiatry. They review clinical indications; putative mechanism of action; efficacy and adverse effects; the results and limitations of salient clinical trials; and active areas of research into the neurobiology of device-based stimuli.

Background:Numerous studies have reported that transcranial magnetic stimulation (TMS) and fluoxetine is used in the treatment of postpartum depression (PPD). Currently, no study has systematically investigated the efficacy and safety of TMS and fluoxetine for the treatment of patients with PPD. Thus, this study will assess the efficacy and safety of TMS and fluoxetine for treating PPD.Methods:Relevant studies involving TMS and fluoxetine for the treatment of patients with PPD will be comprehensively searched from the electronic databases from inception to the February 1, 2020: Cochrane Library, EMBASE, MEDILINE, CINAHL, AMED, WANGFANG, VIP, and CNKI databases. No language and publication time restrictions will be applied. RevMan 5.3 software will be utilized for data pooling, data analysis, and risk of bias evaluation. If necessary, we will also assess reporting bias using funnel plot and Egger test.Results:This study will comprehensively summarize the existing evidence to assess the efficacy and safety of TMS and fluoxetine for treating PPD.Conclusion:The findings of this study may help to establish a better approach to treat PPD using TMS and fluoxetine.Dissemination and ethics:This study will be disseminated through a peer-reviewed journal. This study does not need ethical approval as no primary patient data will be used.Systematic review registration:INPLASY202040017.

Safety and efficacy of targeting the supplementary motor area with double-cone deep transcranial magnetic stimulation vs figure-eight coil in treatment of obsessive-compulsive disorder with comorbid major depressive disorder

What is the central question of this study? A transcranial magnetic stimulation (TMS)-induced twitch applied on isolated single breaths over the motor cortex somatotopic representation of the tongue briefly recruits submental muscles and improves airflow dynamics of flow-limited respiratory cycles without arousing sleep apnoea patients. However, the mechanical impact of the TMS-induced twitch applied during consecutive breathing cycles on airflow dynamics remains unknown. What is the main finding and what is its importance? Our results show that application of TMS with the stimulator output set at the sleep submental motor threshold intensity on consecutive respiratory cycles increases inspiratory flow and reduces the turbulent airflow component. These results indicate an improvement of airflow pattern after two single consecutive TMS-induced twitches without arousing sleep apnoea patients. Transcranial magnetic stimulation (TMS)-induced twitches applied on isolated breaths briefly recruit upper airway dilator muscles and improve airflow and inspiratory volume without arousing apnoeic patients from sleep, but the effects of applying such twitches consecutively on airflow dynamics is unknown. The objective of this study was to quantify the effects of five consecutive TMS-induced twitches applied on sleep-induced obstructive hypopnoeic breaths in 10 obstructive sleep apnoea patients. Submental muscle motor threshold (SUBMT) and motor-evoked potential were measured during wakefulness and sleep. The TMS-induced twitches were applied during stable non-rapid eye movement (NREM) sleep, at the beginning of inspiration of consecutive flow-limited respiratory cycles, with the stimulator output set at sleep SUBMT. Maximal inspiratory flow, inspiratory volume, inspiratory time, shifts of electroencephalogram frequency and pulse rate variability were assessed. During sleep, SUBMT increased (wakefulness, 25.3 ± 4.9%; NREM sleep, 27.0 ± 6.2%; P = 0.02). During each series of stimulations there was a rise in maximal inspiratory flow (from 306.7 ± 123.2 to 359.8 ± 154.1 ml s(-1); P = 0.0002) and in inspiratory volume (from 346.1 ± 128.1 to 414.9 ± 171.2 ml; P = 0.02) without differences in thoraco-abdominal efforts and inspiratory time. These responses were observed in the absence of arousals and ceased immediately after TMS interruption. Transcranial magnetic stimulation-induced cortical and/or autonomic arousal was observed in 30.2% of all series of stimulation. Consecutive twitch TMS of submental muscles may lead to arousals in a minority of patients but can be applied on consecutive respiratory cycles during sleep and can significantly improve maximal inspiratory flow and inspiratory volume of flow-limited cycles.

Evaluation of cortical excitability by motor and phosphene thresholds in transcranial magnetic stimulation

The number of full-sine cycles per pulse influences the efficacy of multicycle transcranial magnetic stimulation