Effectiveness of Repetitive Transcranial Magnetic Stimulation in Depression, Schizophrenia, and Obsessive-Compulsive Disorder: An Umbrella Meta-Analysis.

Objective: To analyze the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder, schizophrenia, and obsessive-compulsive disorder (OCD) via umbrella meta-analysis.Data Sources: Meta-analysis studies were searched in PubMed from inception to May 2021 using the keywords anxiety, depression, ADHD, schizophrenia, mood disorder, OCD, psychiatric disorders, GAD, bipolar disorders, ASD, PTSD, transcranial magnetic stimulation, transcranial, magnetic, stimulation. PRISMA guidelines were followed.Study Selection: Abstracts and full-length articles were reviewed for meta-analysis studies with data on the safety and efficacy of rTMS and sham and were collected for quantitative analysis. The full texts of all identified studies were independently screened and assessed to determine eligibility. Any disagreement was resolved through consensus.Data Extraction: The descriptive variables extracted included the author names, study year, sample size, studies included in the meta-analysis, study period, and type of intervention.Results: 28 meta-analyses were included; 13 were on treatment-resistant depression, 9 on schizophrenia, and 6 on OCD. In treatment-resistant depression, the rTMS group had higher odds of response compared to sham (odds ratio [OR] = 3.27; 95% CI, 2.76-3.87; P < .00001) and higher odds of remission (secondary outcome) (OR = 2.83; 95% CI, 2.33-3.45; P < .00001). rTMS was superior to sham in the reduction of negative symptoms of schizophrenia (mean difference [MD]: 0.47; 95% CI, 0.23-0.7; P < .0001). However, no significant difference was found between the effects of rTMS and sham on auditory hallucinations (MD: 0.24; 95% CI, 0.26-0.74; P = .35), which resulted in 94% heterogeneity. TMS was better than sham in reducing the severity of OCD symptoms (MD: 0.81; 95% CI, 0.53-1.10; P < .00001).Conclusions: The effectiveness of rTMS for symptom reduction in various psychiatric disorders is associated with differences in neuropathology, disease-specific target site, and frequency of rTMS.Prim Care Companion CNS Disord 2023;25(5):22r03423. Author affiliations are listed at the end of this article.

New-Onset Mania and Psychosis in Adolescents in the Context of COVID-19 Infection.

There is a growing body of evidence that coronavirus disease 2019 (COVID-19) is linked with neuropsychiatric complications such as psychosis and delirium in adults. Much less is known about the neuropsychiatric manifestations of this virus in the child and adolescent population. This case series discusses two unique adolescent patients who presented with new-onset mania and psychosis in the context of an otherwise asymptomatic COVID-19 infection, which raises several questions about whether and how the virus precipitates mania and psychosis, whether these symptoms are transient or predisposes patients to a chronic psychiatric disorder, and confounding variables that may have contributed to the symptoms. These questions can then be points for future research and longitudinal follow-up that can better improve our knowledge about the relationship between this complicated virus and how it affects children psychiatrically.

Differentiating Childhood-Onset Schizophrenia From Other Childhood Disorders.

Childhood-onset schizophrenia (COS) is a rare disorder in which symptoms of schizophrenia occur before the age of 13 years. This disorder often has a complicated presentation that can mimic other childhood disorders including post-traumatic stress disorder (PTSD), autism spectrum disorder (ASD), major depressive disorder (MDD) with psychosis, and generalized anxiety disorder (GAD) among others. This is further complicated by the low prevalence rate of COS which limits understanding of the disorder. Accurate and timely diagnosis is crucial as failure to do so has adverse implications for long-term treatment outcomes and prognosis. In this study, a rare case of a 12-year-old girl with childhood-onset schizophrenia and key findings that help differentiate it from other childhood disorders are reviewed to guide diagnosis and treatment.

Emerging Needs and Viability of Telepsychiatry During and Post COVID-19 Era: A Literature Review.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in nationwide stay-at-home orders in an effort to slow the spread severely impacting the healthcare sector. Telepsychiatry provides a platform bridging the gap through advanced technologies connecting mental health providers and patients who need their services, overcoming previous barriers of great distances, lack of transportation, and even time constraints. The most obvious benefit is increased accessibility to mental healthcare, especially in underserved and remote areas where there is no easy access for in-person care. It is important to note that benefits are not limited to patients, but also allow clinicians greater flexibility in scheduling and reduced practice overhead costs, both of which aid with physician burnout and burden. Telepsychiatry during COVID-19 provides its own unique advantages over in-person visits. The risk of exposure to healthcare workers and patients receiving care is reduced, allowing immunocompromised patients to receive much-needed psychiatric care. Without the need to meet in person, self-isolating psychiatrists can still provide care, decreasing strain on their co-workers. Although telepsychiatry is relatively new, it has already exhibited considerable success in its effectiveness at treating psychiatric conditions and widespread corollary benefits. Telepsychiatric consults may be carried out synchronously and asynchronously, each having benefits and setbacks. Different mobile application interventions have been explored, which are available for the purpose of both monitoring/assessing patients and/or providing treatment. The scope of conditions these applications address is broad, from anxiety disorders to schizophrenia to depression. As promising and beneficial telepsychiatry may seem, it is necessary to recognize that building the program can be challenging. It involves adapting to new methods in medicine. We highlighted barriers to general telepsychiatry, the most prominent being technological literacy of both physician and patient, and possible negative effects of eliminating the in-person patient-doctor interaction.

Psychosocial predictors of antenatal stress in Pakistan: perspectives from a developing country.

OBJECTIVE: Antenatal stress is highly prevalent globally and is associated with adverse physical and psychiatric morbidities and adverse neonatal outcomes. However, the burden of antenatal stress and its psychosocial predicators have not been explored in context of the Pakistani sociocultural environment. The present study explores the prevalence of antenatal stress and its association with gender of offspring, socioeconomic background, cultural beliefs, and access to healthcare in the province of Punjab, Pakistan. RESULTS: There was a total of 516 pregnant women. Antenatal stress was measured by the Perceived Stress Scale (PSS). The mean score of the respondents on the Perceived Stress Scale was 7.55 (3.43). A total of 218 (42.2%) respondents reported higher stress levels. Logistic regression analysis (backward method) yielded a significant model predicting high stress levels. According to it, low family income, unplanned pregnancy, increasing number of children, less autonomy in decision making, marital problems, harassment, desire to have a male offspring, and the history of birth complications, attended by midwives were associated with high stress levels.

The therapeutic role of Cannabidiol in mental health: a systematic review.

BACKGROUND: The therapeutic application of cannabidiol (CBD) is gaining interest due to expanding evidence for its use. OBJECTIVE: To summarize the clinical outcomes, study designs and limitations for the use of CBD and nabiximols (whole plant extract from Cannabis sativa L. that has been purified into 1:1 ratio of CBD and delta-9-tetrahydrocannabinol) in the treatment of psychiatric disorders. MATERIALS AND METHOD: A systematic review was conducted including case reports, case series, open-label trials, non-randomized and randomized controlled trials (RCTs). The search resulted in 23 relevant studies on CBD and nabiximols in the treatment of a wide range of psychiatric disorders. The quality of evidence was judged by using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence that ranges from Level 1 to Level 5 based on the quality and study design. These levels of evidence help in grading the recommendations, including Grade A (strong), Grade B (moderate), Grade C (weak), and Grade D (weakest). RESULTS: CBD and CBD-containing compounds such as nabiximols were helpful in alleviating psychotic symptoms and cognitive impairment in patients with a variety of conditions, and several studies provided evidence of effectiveness in the treatment of cannabis withdrawal and moderate to severe cannabis use disorder with Grade B recommendation. There is Grade B recommendation supporting the use of CBD for the treatment of schizophrenia, social anxiety disorder and autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Grade C recommendation exists for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. These recommendations should be considered in the context of limited number of available studies. CONCLUSION: CBD and CBD-containing compounds such as nabiximols were helpful in alleviating symptoms of cannabis-related disorders, schizophrenia, social anxiety disorder, and comorbidities of ASD, and ADHD with moderate recommendation. However, there is weaker evidence for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. The evidence for the use of CBD and CBD-containing compounds for psychiatric disorders needs to be explored in future studies, especially large-scale and well-designed RCTs.

Empathy, Experience and Cultural Beliefs Determine the Attitudes Towards Depression Among Pakistani Medical Students.

The educated echelons of the Pakistani society as well as the medical fraternity have consistently reported poor knowledge of mental illnesses in past surveys. This poor knowledge further translates into poorer attitudes toward psychiatric patients in Pakistani hospitals. However, a paucity of data on predictors of attitude toward depression among Pakistani medical students, warrants further in depth investigations. This cross-sectional study was conducted in two medical colleges in the province of Punjab, Pakistan from January to July 2017. The data were collected conveniently, using a self-administered questionnaire comprising of five parts: (a) demographics, (b) a dichotomous (yes/no) scale exploring biological, psychosocial and religio-magical beliefs about causation of depression, (c) a dichotomous scale (yes/no) assessing knowledge regarding symptomatology of depression, (d) the revised depression attitude questionnaire, (e) Toronto empathy questionnaire. There were a total of 674 respondents. Students with an A-levels/high school diploma, urban background, and aspiration for a career in psychiatry, high empathy levels and endorsement of typical and atypical symptoms of psychiatry had more positive attitudes towards depression. Negative attitudes toward depression were associated with belief in religio-magical causes and false symptoms of depression. Attitude toward depression among Pakistani medical students are shaped by several modifiable and non-modifiable factors. Modifiable factors including exposure toward mentally ill patients and knowledge of depression can be mitigated by in-depth clerkship training in psychiatry.

Validity and reliability of the Urdu version of the Hospital Anxiety & Depression Scale for assessing antenatal anxiety and depression in Pakistan.

This study aims to elucidate the appropriate factor structure for Hospital Anxiety & Depression Scale (HADS) for assessment of anxiety and depression symptoms during pregnancy among Pakistani women. This cross-sectional study was conducted during a 5 month period (2014) in four teaching hospitals of Lahore, Pakistan. Convenience sampling was done to recruit pregnant women availing obstetrics and gynecology services for routine prenatal or perinatal care in the respective departments of the four institutes. Trained interviewers interviewed the consenting participants using a pre-tested scale. All data were analyzed using SPSS v.20. Factor structure of the HADS was explored using Principal Axis Factoring (PAF) method. Goodness of fit of the factor structure was assessed using the Confirmatory Factor Analysis (CFA). Cronbach's alpha value for whole scale was good (α = 0.81). Sensitivity analysis involving assessment of Cronbach's alpha value after removal of each item, did not reveal any major deviations in overall internal consistency of the HADS. Parallel analysis suggested one factor solution to be viable. When one factor was extracted as a uni-dimensional measure of anxiety and depression: item 11 (I feel restless as I have to be on the move) and 14 (I can enjoy a good book or radio or TV program) were deemed problematic for having low communalities and factor loading values.

Conflicts of interest and outcomes of clinical trials of antidepressants: An 18-year retrospective study.

Pharmaceutical sponsorship, funding sources, and investigators' conflicts of interest may be potential influencers in the conduct and results of clinical trials, as well as in the promotion of psychiatric drug therapies. We report the results of an audit of randomized controlled trials (RCTs) of antidepressants conducted from 2000 to 2017. We searched the Web of Science databases with a comprehensive search strategy to identify phase 2 and 3 RCTs. Out of the 1085 articles initially located, a total of 291 RCTs were identified and included in the final analyses. A higher percentage of RCTs conducted by employees of pharmaceutical companies reported favorable results than those with academic or governmental funding (76.90% vs. 60.60%); however, this association was not significant (Χ2 = 2.47, P = 0.18). The data were further analyzed using bivariate and cluster analytical approaches, and the nonsignificant association persisted in both cases. However, analyses of industry-funded placebo-controlled trials (a subgroup of the 291 RCTs) revealed a higher proportion of results that were reported as significant compared to their counterparts with other funding sources (67% vs. 33%). This association was statistically significant (Χ2 = 9.56, P = 0.002), indicating that there is evidence in support of conflicts of interest as a potential bias in the outcomes of RCTs conducted for antidepressants.

Association of bullying experiences with depressive symptoms and psychosocial functioning among school going children and adolescents.

OBJECTIVES: We examined the association of bullying experiences with depressive symptoms and psychosocial functioning among children and adolescents in rural Pakistan. A total of 452 school-going children in Nawabshah, Pakistan were conveniently interviewed to assess rates of bullying experiences and severity of depressive symptoms. Depressive symptoms were assessed using the Patient Health Questionnaire for Adolescents. RESULTS: Experience of victimization was reported by 130 (28.8%) and perpetration by (146, 32.3%). A total of 162 (35.80%) reported mild depressive symptoms, 88 (19.50%) moderate, 33 (7.30%) moderately severe and 19 (4.20%) severe depressive symptoms. Age was not associated with patterns of bullying other than pure bully perpetration (.12, P = .024). Both victims and perpetrators of bullying experienced adverse emotional and social consequences. Bully-perpetrators exhibited the greater severity of depressive symptoms due to distress in psychosocial functioning.

Exploring clusters of defense styles, psychiatric symptoms and academic achievements among medical students: a cross-sectional study in Pakistan.

OBJECTIVE: The clusters of participants with a homogeneous psychological make-up can be identified using sophisticated machine learning techniques such as the two-step clustering algorithm. It can also help us to identify the synergistic and additive effects of a range of psychometric variables. The identification of synergistic effect of this clustering of defense mechanism has significant practical implications as they share a certain variance. This study aims to identify the clusters of ego defenses and their relationship with academic performance and mental health outcome in medical students. RESULTS: The high achievers scored higher on mature and neurotic defense styles and lower on immature than their counter parts. A higher proportion of medical students in high achievers group had normal scores on depressive symptoms than low achievers. While a majority among low achievers suffered from severe anxiety levels than high achievers group. High achievers scored higher on sublimation, humor, anticipation, suppression, pseudo-altruism, idealization, reaction formation, autistic fantasy, denial, and rationalization.