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Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD.
In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment.
After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests.
rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.
Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19.
This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis.
In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9–59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1–11.4), an affective disorder (OR 4.1; CI 1.6–10.9), and severe respiratory symptoms (OR 4.6; CI 2.2–9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1–0.9) predicted a lower risk of a confusional state.
COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.
The recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.
We assessed the subjective quality of life (QOL) of 30 deficit schizophrenic patients compared to 112 nondeficit schizophrenic patients. The deficit patients did not differ in term of QOL, total score of positive symptoms, general psychopathology from the nondeficit patients. This result suggested an absence of impact of primary negative symptoms on the subjective QOL in schizophrenic patients.
Sinistrality, characterized by an excess of non-right-handedness, has been reported in schizophrenic patients, but the findings are controversial.
As sinistrality could be linked to a failure of hemisphere specialization in schizophrenia that would translate into language disorders, sinistrality was found out in disorganized and positive schizophrenic patients characterized by language disorders.
Seventy-three schizophrenic patients (DSM IV) and 81 controls were evaluated with the Edinburgh Handedness Inventory (EHI). Patients were evaluated and classified into five subtypes (deficit, positive, disorganized, mixed and residual) with the Positive and Negative Syndrome Scale and the Schedule for the Deficit Syndrome.
Disorganized patients had a significantly more severe sinistrality in comparison to the deficit, residual and mixed subtypes and controls. A negative correlation was found between the disorganization and the EHI scores (r = – 0.34; P < 0.01). A significantly more severe sinistrality was also observed in the positive subtype in comparison to controls, but there was no correlation between hallucinatory and EHI scores (r = 0.06).
The findings provided further evidence that the defects in the normal process of lateralization observed in schizophrenia affects primarily disorganized patients.
This chapter provides an overview of animal asymmetries of handedness, spatial orientation, and communication. For all three systems, the chapter provides a detailed knowledge on the behavioral and neural asymmetries in humans. It captures the details into a wider framework of cerebral asymmetries in animals, including humans. The chapter reviews the handedness studies with diverse animal species that make functional asymmetries for spatial cognition likely. It also reviews the spatial orientation studies, which shows that the hemispheres of mammals and birds contribute differentially to spatial cognition, although both sides are to some degree able to utilize the strategy of the other. The experiments with bird species show that spatial navigation requires different computational strategies of the left and the right brain. Experiments on asymmetries in the perception and production of communicatory signals cover a wide range of species from chimpanzees to frogs.
La recurrencia de flashbacks sin consumo de alucinógenos agudo o crónico se ha reconocido en los criterios del DSM-IV como trastorno perceptivo persistente por alucinógenos (TPPA). Las perturbaciones perceptivas pueden durar 5 años o más y representan un sufrimiento psicosocial real. Comunicamos aquí un caso de un joven varón de 18 años que presentaba TPPA después de una intoxicación mixta con psilocibina y cannabis. Este informe muestra recurrencias sintomáticas que persistieron más de 8 meses. Se evocan diagnósticos diferenciales diferentes y se describen nuestras estrategias terapéuticas.
Evaluamos la calidad de vida (CDV) subjetiva de 30 pacientes con esquizofrenia de déficit comparado con 112 pacientes con esquizofrenia no de déficit. Los pacientes de déficit no diferían desde el punto de vista de la CDV, la puntuación total de síntomas positivos y las manifestaciones psicopatológicas generales de los pacientes no de déficit. Este resultado indicaba una ausencia de efecto de los síntomas negativos primarios en la CDV subjetiva en los pacientes esquizofrénicos.
Se ha informado de zurdera, caracterizada por una cantidad mayor de preferencia manual no diestra, en los pacientes esquizofrénicos, pero los hallazgos son polémicos.
Como la zurdera se podría unir a un fallo de la especialización hemisférica en la esquizofrenia que se traduciría en trastornos del lenguaje, se descubrió zurdera en pacientes esquizofrénicos desorganizados y positivos caracterizados por trastornos del lenguaje.
Se evaluó a 73 pacientes esquizofrénicos (DSMIV) y 81 controles con el Inventario de Preferencia Manual de Edimburgo (EHI). Se evaluó y clasificó a los pacientes en cinco subtipos (de déficit, positivo, desorganizado, mixto y residual) con la Escala de los Síndromes Positivo y Negativo y el Inventario para el Síndrome de Déficit.
Los pacientes desorganizados tenían una zurdera significativamente más importante en comparación con los subtipos de déficit, residual y mixto y los controles. Se encontró una correlación negativa entre la desorganización y las puntuaciones del EHI (r = -0,34; P<0,01). Se observó también una zurdera significativamente más importante en el subtipo positivo en comparación con los controles, pero no había correlación entre el subtipo alucinatorio y las puntuaciones del EHI (r=0,06).
Los hallazgos proporcionaron datos adicionales de que los defectos en el proceso normal de lateralización observados en la esquizofrenia afectan principalmente a los pacientes desorganizados.
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