The current American Heart Association guidelines for acute ischemic stroke reserve Grade 1A recommendation for the use of endovascular thrombectomy (EVT) for patients with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of ≥6.

We aim to determine the safety and efficacy of EVT for large vessel occlusion ischemic stroke patients with low ASPECTS (5 or less).

Medline, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for studies appraising the outcomes of EVT for low ASPECTS ischemic stroke. A meta-analysis of proportions compared the clinical outcomes of patients undergoing EVT and those receiving best medical therapy only.

Nine studies (1,196 patients) were included. There was a trend (p = 0.11) toward a higher rate of symptomatic intracranial hemorrhage (sICH) in the EVT group (9.2%; 95% CI 6.1–13.6; I2 53.37%) compared to the medical group (5.5%; 95% CI 3.7–8.1; I2 0%). There was no difference (p = 0.41) in the pooled 90-day mortality of EVT patients (30.7%; 95% CI 21.7–41.5; I2 84.23%) and medical patients (36.6%; 95% CI 26.4–48.1; I2 76.2%). EVT patients had better (p = 0.001) 90-day outcomes, with 27.7% (95% CI 21.8–34.5; I2 62.08%) of patients attaining a modified Rankin Scale of 0–2 compared to only 3.7% (95% CI 2.3–5.9; I2 87.21%) in the medical group.

This meta-analysis demonstrates a trend in higher sICH among low ASPECTS patients undergoing EVT. Despite this, a significant proportion of this subset of patients still achieved good functional outcomes at 90 days. Randomized trials are necessary to substantiate this result as significant bias is inherent in the observational studies included in this review.

Deep Brain Stimulation (DBS) is a neuromodulation technique that involves the implantation of electrodes into specific parts of the brain. DBS is reversible, nondestructive, and can be modified by adjustment of the stimulator settings after implantation. Since 1998 we investigate DBS as a therapeutic option for severe, treatment-refractory obsessive-compulsive disorder (OCD). DBS in the anterior limbs of the internal capsules induced clinically significant therapeutic benefit in this patient group, not only in severity of OCD symptoms, but also on the patient's mood scores.

Despite advances in biological treatment and psychotherapy for major depression (MD), a substantial number of patients fail to improve.

Based on the results of DBS in OCD, this study investigates the effectiveness, safety, and tolerability of DBS in the same target for treatment-refractory MD.

Three patients with a longstanding history of MD, who failed to improve even after years of pharmacotherapy, psychotherapy, electroconvulsive therapy and even experimental interventions were selected. Bilateral DBS leads were implanted in the ventral part of anterior limb of the internal capsule. Participants underwent standardized and detailed psychiatric assessments on a regularly scheduled basis, both pre- and postsurgically.

After six months of chronic DBS, all three patients showed a clinically significant reduction in depression severity of 50 percent or greater on the Montgomery-Asberg Depression Rating Scale. Two of the three patients were in remission. Quality-of-life measures improved as well.

Further research is warranted, but patients with severe, longstanding, treatment-refractory MD may benefit from DBS.

Research on deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) shows promising effects on symptoms severity.

To compare outcomes between DBS and bilateral capsulotomy on general functioning, personality traits and quality of life.

Consecutive patients with severe and treatment refractory OCD underwent DBS in the anterior limb of the internal capsule (DBS; n = 14) or anterior capsulotomy (CAPS; n = 14). They were tested before surgery (baseline-BL) and after a mean follow-up time (FU) of 19 months (range 14-31 months). Changes in OCD severity were recorded and global assessment of functioning, personality traits, and quality of life were compared between groups.

Statistically significant differential improvements (p < 0.05, Bonferroni corrected) were seen in

*General assessment of functioning (Mn ± 95%CI) GAF: DBS_BL:32.9 ± 3.6; DBS_FU:68.6 ± 7.2; CAPS_BL:35.0 ± 2.7; CAPS_FU:56.4 ± 5.9)

*Personality traits on MMPI (T-score Mn ± 95%CI) Scale 2-depression: DBS_BL:83.7 ± 6.5; DBS_FU:61.9 ± 6.3; CAPS_BL:81.2 ± 8.6; CAPS_FU:77.6 ± 8.7 Scale 9-mania: DBS_BL:48.8 ± 7.3; DBS_FU:57.0 ± 4.2; CAPS_BL:53.8 ± 7.5; CAPS_FU:45.6 ± 6.2 Scale 0-social introversion: DBS_BL:66.8 ± 5.2; DBS_FU:56.1 ± 4.1; CAPS_BL:67.7 ± 7.0; CAPS_FU:66.4 ± 5.8)

* Quality of life: Q-LES-Q Endicott (Mn ± 95%CI) overall score (1-5): DBS_BL:1.2 ± 0.3; DBS_FU:3.4 ± 0.6; CAPS_BL:1.5 ± 0.3; CAPS_FU:2.6 ± 0.4 and in the sub domains feelings (%): DBS_BL:36.8 ± 4.2; DBS_FU:68.6 ± 8.8; CAPS_BL:39.1 ± 5.1; CAPS_FU:54.0 ± 5.9 leisure activities (%): DBS_BL:30.6 ± 5.9; DBS_FU:68.5 ± 7.9; CAPS_BL:40.2 ± 5.4; CAPS_FU:58.3 ± 7.1 social relationships (%):DBS_BL:43.9 ± 5.5; DBS_FU:70.2 ± 8.0; CAPS_BL:46.9 ± 6.8; CAPS_FU:60.1 ± 6.9

These findings suggest a superior impact of DBS over capsulotomy on general functioning, personality traits and quality of life. Limits of this study are the small numbers, the fact that DBS and CAPS patients were from a slightly different OCD population and were not randomized to treatment, and differences in postoperative follow-up.

This study investigates how personality traits, social axioms and therapeutic orientations affect burnout of professionals who work in the area of addictions.

110 psychiatrists, social workers, and counselors participated in the study. They worked in Alcohol and Drugs Treatment and Rehabilitation Clinics. The professionals anonymously completed the following questioners: Social Axioms Survey (Leung et al., 2002), a modernized version of Therapeutic Attitudes Scale (Sandell et al., 2004), and Maslach Burnout Inventory - General Survey (Maslach & Jackson, 1986). Social Axioms Survey measured three basic beliefs regarding world functioning: social cynicism, reward for application, and religiosity. Therapeutic Attitudes Scale measured the professionals’ beliefs of what are the best ways to help the client. They related to three types of therapeutic orientations: cognitive-behavioral, psychodynamic, and systemic. Burnout Inventory measured three aspects of professional burnout: exhaustion, cynicism, and professional efficacy; however, since exhaustion and cynicism scales were highly correlated (r = 71), they were combined into one scale, called emotional weariness.

A stronger belief in social cynicism associated with a higher level of emotional weariness. In addition, a stronger systemic therapeutic orientation was associated with a lower level of emotional weariness. There was a positive relationship between the reward for application belief and the sense of professional efficacy. Therapeutic beliefs were not related to the sense of professional efficacy.

The results of this study may help to identify addiction area professionals who are prone to burnout and would allow the development of burnout prevention and coping programs.

In carefully selected treatment-refractory patients with obsessive compulsive disorder (OCD), deep brain stimulation (DBS) or anterior capsulotomy (AC) might be considered as a possible treatment. However, the direct intervention in the brain can raise questions about autonomy. Do patients still feel like they are in control of their actions when their behavior is changed by a surgical intervention?

To examine in both AC and DBS patients whether these intervention influenced perception of autonomy. We aimed to discover any differences in these perceptions when comparing AC and DBS patients.

We conducted semi-structured interviews with AC and DBS patients. Interviews were recorded digitally and transcribed verbatim. We analyzed interviews in an iterative process based on grounded theory principles.

We interviewed 10 DBS patients and 6 AC patients. Sense of agency (the awareness that one is the author of his/her own actions) did not seem to be diminished by AC or DBS. However, especially DBS patients are aware of their dependency on a device for their well-being. Another important theme is authenticity (in how far patients perceive their actions and thoughts as matching their self-concept). Feelings of authenticity can be disturbed especially in cases of induced hypomania (for DBS) or apathy (for AC). OCD itself also has an impact on autonomy as patients describe a lack of freedom due to their disorder.

Despite extensive changes in emotions, behavior and even personal identity after DBS or AC surgery, perceived autonomy was not greatly altered in these OCD patients.

Medtronic provided grants for research, education, and traveling to B. Nuttin and L. Gabriëls, who hold the Medtronic Chair for Stereotactic Neurosurgery in Psychiatric Disorders at KU Leuven. S. Raymaekers is supported by this Chair. B. Nuttin co-owns a patent on DBS in OCD.

The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”.

In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide.

The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level.

Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.

We previously reported that deep brain stimulation (DBS) in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) is effective in reducing symptoms in severe treatment-resistant obsessive-compulsive disorder patients.

To examine the long-term evolution of obsessive compulsive disorder (OCD) symptoms in 24 patients treated with chronic electrical stimulation in IC/BST.

We aimed to examine the evolution of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to determine if a number of predictors assessed before surgery are significantly related to this evolution.

We used a linear mixed model to investigate the evolution of the Y-BOCS in 24 patients. Data was collected in a naturalistic manner. Seven hundred measurements, taken during a total of 1836 follow-up months, are included in this analysis.

Our analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms stay relatively stable. In addition, results show a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Beside the ON/OFF effect of stimulation, the surgery itself has no additional effect on OCD symptoms. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time.

Electrical stimulation in the IC/BST has a fast and sustained effect on OCD symptoms.

The authors have not supplied their declaration of competing interest.

Disturbed sleep and activity are prominent features of bipolar disorder type I (BP-I). However, the relationship of sleep and activity characteristics to brain structure and behavior in euthymic BP-I patients and their non-BP-I relatives is unknown. Additionally, underlying genetic relationships between these traits have not been investigated.

Relationships between sleep and activity phenotypes, assessed using actigraphy, with structural neuroimaging (brain) and cognitive and temperament (behavior) phenotypes were investigated in 558 euthymic individuals from multi-generational pedigrees including at least one member with BP-I. Genetic correlations between actigraphy-brain and actigraphy-behavior associations were assessed, and bivariate linkage analysis was conducted for trait pairs with evidence of shared genetic influences.

More physical activity and longer awake time were significantly associated with increased brain volumes and cortical thickness, better performance on neurocognitive measures of long-term memory and executive function, and less extreme scores on measures of temperament (impulsivity, cyclothymia). These associations did not differ between BP-I patients and their non-BP-I relatives. For nine activity-brain or activity-behavior pairs there was evidence for shared genetic influence (genetic correlations); of these pairs, a suggestive bivariate quantitative trait locus on chromosome 7 for wake duration and verbal working memory was identified.

Our findings indicate that increased physical activity and more adequate sleep are associated with increased brain size, better cognitive function and more stable temperament in BP-I patients and their non-BP-I relatives. Additionally, we found evidence for pleiotropy of several actigraphy-behavior and actigraphy-brain phenotypes, suggesting a shared genetic basis for these traits.