Gut Microbiota and Gastrointestinal Symptoms in the Global Assessment of Obsessive-Compulsive Disorder: A Narrative Review of Current Evidence and Practical Implications.

A growing body of literature suggests a link between bowel syndromes (e.g., irritable bowel syndrome and inflammatory bowel disease), gut microbiome alterations, and psychiatric disorders. This narrative review aims to explore the potential role of the gut microbiome in the pathogenesis and clinical presentation of obsessive-compulsive disorder (OCD) and to explore whether there is sufficient evidence to warrant considering gastrointestinal symptoms and their implication for the gut microbiome during the assessment and treatment of OCD. For this purpose, a PubMed search of studies focusing on OCD, gut microbiota, irritable bowel syndrome, and inflammatory bowel disease was conducted by two independent reviewers. While the current literature on gut microbiome and gastrointestinal issues in OCD remains limited, emerging evidence suggests gut microbiome alterations and high rates of bowel syndromes in this population. These findings emphasize the importance of incorporating comprehensive gastrointestinal assessments into the "global assessment of OCD". Such assessment should encompass various factors, including gastrointestinal physical comorbidities and symptoms, nutritional habits, bowel habits, fluid intake, exercise patterns, and potential microbiome dysfunctions and inflammation. Considering the treatment implications, interventions targeting gut health, such as probiotics and dietary modifications, may hold promise in improving symptoms in OCD patients with comorbid gastrointestinal problems. Further research in this area is warranted to better understand the interplay between gut health and OCD and to explore the effectiveness of targeted interventions in improving clinical outcomes.

Prevalence and clinical phenotypes of adult patients with attention deficit hyperactivity disorder and comorbid behavioral addictions.

Background: Although the correlation between substance use disorder and attention deficit hyperactivity disorder (ADHD) has been largely studied, less is known about the correlation between behavioral addictions and ADHD. Thus, the aim of the present study was to investigate the prevalence of behavioral addictions in a large sample of adult patients with a primary diagnosis of ADHD and to compare the clinical profile of ADHD patients with and without behavioral addictions comorbidity. Methods: 248 consecutive adults newly diagnosed as ADHD patients were assessed through a series of validated scales for gambling disorder, internet, sex, shopping and food addictions. ADHD patients with at least one comorbid behavioral addiction were compared to non-comorbid patients on ADHD symptoms, impulsivity, mood and anxiety symptoms and functional impairment. Results: 58.9% of patients had at least one behavioral addiction comorbidity. Of the whole sample, 31.9% of the patients had a comorbidity with one behavioral addiction while the 27% showed a comorbidity with two or more behavioral addictions. Internet addiction was the most common comorbidity (33.9%) followed by food addiction (28.6%), shopping addiction (19%), sex addiction (12.9%) and gambling disorder (3.6%). ADHD patients with comorbid behavioral addictions showed higher ADHD current and childhood symptoms, higher cognitive and motor impulsivity, higher mood and anxiety symptoms and higher functional impairment. Conclusions: Behavioral addictions are highly frequent in adult ADHD patients. Comorbid patients seem to have a more complex phenotype characterized by more severe ADHD, mood and anxiety symptoms, higher impulsivity levels and greater functional impairment.

Aligning climate scenarios to emissions inventories shifts global benchmarks.

Taking stock of global progress towards achieving the Paris Agreement requires consistently measuring aggregate national actions and pledges against modelled mitigation pathways1. However, national greenhouse gas inventories (NGHGIs) and scientific assessments of anthropogenic emissions follow different accounting conventions for land-based carbon fluxes resulting in a large difference in the present emission estimates2,3, a gap that will evolve over time. Using state-of-the-art methodologies4 and a land carbon-cycle emulator5, we align the Intergovernmental Panel on Climate Change (IPCC)-assessed mitigation pathways with the NGHGIs to make a comparison. We find that the key global mitigation benchmarks become harder to achieve when calculated using the NGHGI conventions, requiring both earlier net-zero CO2 timing and lower cumulative emissions. Furthermore, weakening natural carbon removal processes such as carbon fertilization can mask anthropogenic land-based removal efforts, with the result that land-based carbon fluxes in NGHGIs may ultimately become sources of emissions by 2100. Our results are important for the Global Stocktake6, suggesting that nations will need to increase the collective ambition of their climate targets to remain consistent with the global temperature goals.

Mind the gap: reconciling tropical forest carbon flux estimates from earth observation and national reporting requires transparency.

BACKGROUND: The application of different approaches calculating the anthropogenic carbon net flux from land, leads to estimates that vary considerably. One reason for these variations is the extent to which approaches consider forest land to be "managed" by humans, and thus contributing to the net anthropogenic flux. Global Earth Observation (EO) datasets characterising spatio-temporal changes in land cover and carbon stocks provide an independent and consistent approach to estimate forest carbon fluxes. These can be compared against results reported in National Greenhouse Gas Inventories (NGHGIs) to support accurate and timely measuring, reporting and verification (MRV). Using Brazil as a primary case study, with additional analysis in Indonesia and Malaysia, we compare a Global EO-based dataset of forest carbon fluxes to results reported in NGHGIs. RESULTS: Between 2001 and 2020, the EO-derived estimates of all forest-related emissions and removals indicate that Brazil was a net sink of carbon (- 0.2 GtCO2yr-1), while Brazil's NGHGI reported a net carbon source (+ 0.8 GtCO2yr-1). After adjusting the EO estimate to use the Brazilian NGHGI definition of managed forest and other assumptions used in the inventory's methodology, the EO net flux became a source of + 0.6 GtCO2yr-1, comparable to the NGHGI. Remaining discrepancies are due largely to differing carbon removal factors and forest types applied in the two datasets. In Indonesia, the EO and NGHGI net flux estimates were similar (+ 0.6 GtCO2 yr-1), but in Malaysia, they differed in both magnitude and sign (NGHGI: -0.2 GtCO2 yr-1; Global EO: + 0.2 GtCO2 yr-1). Spatially explicit datasets on forest types were not publicly available for analysis from either NGHGI, limiting the possibility of detailed adjustments. CONCLUSIONS: By adjusting the EO dataset to improve comparability with carbon fluxes estimated for managed forests in the Brazilian NGHGI, initially diverging estimates were largely reconciled and remaining differences can be explained. Despite limited spatial data available for Indonesia and Malaysia, our comparison indicated specific aspects where differing approaches may explain divergence, including uncertainties and inaccuracies. Our study highlights the importance of enhanced transparency, as set out by the Paris Agreement, to enable alignment between different approaches for independent measuring and verification.

Who really hoards? Hoarding symptoms in adults with attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and healthy controls.

Although hoarding disorder (HD) is included in the DSM-5 in the obsessive-compulsive and related disorders chapter, in the last few years, HD has been consistently associated with attention-deficit hyperactivity disorder (ADHD). Some studies on HD patients show higher comorbidity with ADHD than with OCD and some studies on ADHD patients found significant higher rates of HD symptoms compared to the general population. However, the aim of the present study was to be the first direct comparison of the prevalence of HD and HD symptoms across adults with a primary diagnosis of ADHD, OCD and a sample of matched healthy controls (HCs). METHODS: 57 adult patients with a primary diagnosis of ADHD and 50 adult patients with a primary diagnosis of OCD were enrolled and matched with 50 HCs. The presence of hoarding disorder and symptoms were assessed though the Saving Inventory Revised (SI-R). RESULTS: ADHD patients showed significantly higher prevalence of HD comorbidity (32.1%) with respect to both OCD patients (8%) and HCs (4%). The prevalence of HD symptoms was also significantly higher in ADHD patients than in both OCD and HCs. Although OCD patients showed a higher prevalence of HD and HD symptoms with respect to HCs, these differences did not reach statistical significance. CONCLUSION: HD is significantly more comorbid in ADHD patients than in OCD and HCs. A better understanding and definition of the boundaries between HD and the OCD and ADHD spectrum could lead to the development of a more precise treatment approach for hoarding disorder.

Will Transcranial Magnetic Stimulation Improve the Treatment of Obsessive-Compulsive Disorder? A Systematic Review and Meta-Analysis of Current Targets and Clinical Evidence.

BACKGROUND: Although in 2017 a repetitive transcranial magnetic stimulation (rTMS) protocol received Food and Drug Administration approval for the first time for the treatment of obsessive-compulsive disorder (OCD), which neural target and which protocol should be used for OCD are still debated. The aim of the present study was to perform a systematic review and meta-analysis of the available open and sham-controlled trials. METHODS: The primary analysis included a pairwise meta-analysis (over 31 trials), and then subgroup analyses were performed for each targeted brain area. Meta-regression analyses explored the possible moderators of effect size. RESULTS: The pairwise meta-analysis showed a significant reduction in OCD symptoms following active rTMS (g = -0.45 [95%CI: -0.62, -0.29]) with moderate heterogeneity (I2 = 34.9%). Subgroup analyses showed a significant effect of rTMS over the bilateral pre-SMA (supplementary motor area), the DLPFC (dorsolateral prefrontal cortex), the ACC/mPFC (anterior cingulate cortex and medial prefrontal cortex), and the OFC (orbitofrontal cortex). No moderators of the effect size emerged. CONCLUSIONS: TMS of several brain targets represents a safe and effective treatment option for OCD patients. Further studies are needed to help clinicians to individualize TMS protocols and targets for each patient.

The role of forests in the EU climate policy: are we on the right track?

BACKGROUND: The European Union (EU) has committed to achieve climate neutrality by 2050. This requires a rapid reduction of greenhouse gas (GHG) emissions and ensuring that any remaining emissions are balanced through CO2 removals. Forests play a crucial role in this plan: they are currently the main option for removing CO2 from the atmosphere and additionally, wood use can store carbon durably and help reduce fossil emissions. To stop and reverse the decline of the forest carbon sink, the EU has recently revised the regulation on land use, land-use change and forestry (LULUCF), and set a target of - 310 Mt CO2e net removals for the LULUCF sector in 2030. RESULTS: In this study, we clarify the role of common concepts in forest management - net annual increment, harvest and mortality - in determining the forest sink. We then evaluate to what extent the forest sink is on track to meet the climate goals of the EU. For this assessment we use data from the latest national GHG inventories and a forest model (Carbon Budget Model). Our findings indicate that on the EU level, the recent decrease in increment and the increase in harvest and mortality are causing a rapid drop in the forest sink. Furthermore, continuing the past forest management practices is projected to further decrease the sink. Finally, we discuss options for enhancing the sinks through forest management while taking into account adaptation and resilience. CONCLUSIONS: Our findings show that the EU forest sink is quickly developing away from the EU climate targets. Stopping and reversing this trend requires rapid implementation of climate-smart forest management, with improved and more timely monitoring of GHG fluxes. This enhancement is crucial for tracking progress towards the EU's climate targets, where the role of forests has become - and is expected to remain - more prominent than ever before.

Treatment-resistant OCD: Pharmacotherapies in adults.

Serotonin reuptake inhibitor (SRI) medications are well established as first-line pharmacotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). However, despite the excellent safety profile and demonstrated efficacy of these medications, a substantial proportion of individuals with OCD fail to attain sufficient benefit from SRIs. In this narrative review, we discuss clinical features of OCD that have been associated with poorer response to SRIs, and we present pharmacotherapeutic interventions that have been explored as augmenting or alternative treatments for treatment-resistant OCD. We additionally highlight non-SRI interventions for OCD that are currently under investigation. Pharmacotherapeutic interventions were identified via expert consensus. To assess the evidence base for individual pharmacotherapies, targeted searches for relevant English-language publications were performed on standard biomedical research databases, including MEDLINE. Information relevant to ongoing registered clinical trials in OCD was obtained by search of ClinicalTrials.gov. Pharmacotherapies are grouped for review in accordance with the general principles of Neuroscience-based Nomenclature (NbN). Clinical features of OCD that may suggest poorer response to SRI treatment include early age of onset, severity of illness, duration of untreated illness, and the presence of symmetry/ordering or hoarding-related symptoms. Based on evolving pathophysiologic models of OCD, diverse agents engaging serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Medications with dopamine antagonist activity remain the most robustly evidence-based of augmenting interventions, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Interventions targeting glutamatergic and anti-inflammatory pathways are less well evidenced, but may offer more favorable benefit to risk profiles. Ongoing research should explore whether specific interventions may benefit individuals with particular features of treatment-resistant OCD.

Pictograms to aid laypeople in identifying the addictiveness of gambling products (PictoGRRed study).

The structural addictive characteristics of gambling products are important targets for prevention, but can be unintuitive to laypeople. In the PictoGRRed (Pictograms for Gambling Risk Reduction) study, we aimed to develop pictograms that illustrate the main addictive characteristics of gambling products and to assess their impact on identifying the addictiveness of gambling products by laypeople. We conducted a three-step study: (1) use of a Delphi consensus method among 56 experts from 13 countries to reach a consensus on the 10 structural addictive characteristics of gambling products to be illustrated by pictograms and their associated definitions, (2) development of 10 pictograms and their definitions, and (3) study in the general population to assess the impact of exposure to the pictograms and their definitions (n = 900). French-speaking experts from the panel assessed the addictiveness of gambling products (n = 25), in which the mean of expert's ratings was considered as the true value. Participants were randomly provided with the pictograms and their definitions, or with a standard slogan, or with neither (control group). We considered the control group as representing the baseline ability of laypeople to assess the addictiveness of gambling products. Each group and the French-speaking experts rated the addictiveness of 14 gambling products. The judgment criterion was the intraclass coefficients (ICCs) between the mean ratings of each group and the experts, reflecting the level of agreement between each group and the experts. Exposure to the pictograms and their definition doubled the ability of laypeople to assess the addictiveness of gambling products compared with that of the group that read a slogan or the control group (ICC = 0.28 vs. 0.14 (Slogan) and 0.14 (Control)). Laypeople have limited awareness of the addictive characteristics of gambling products. The pictograms developed herein represent an innovative tool for universally empowering prevention and for selective prevention.

Obsessive-compulsive disorder, insulin signaling and diabetes - A novel form of physical health comorbidity: The sweet compulsive brain.

BACKGROUND: While a growing body of research highlights a bi-directional link between diabetes and mood disorders, little is known about the relationship between diabetes and obsessive-compulsive disorder (OCD). The aim of the present review is to investigate current evidence linking OCD, insulin-signaling and diabetes. METHODS: A PubMed search was conducted to review all the available studies assessing diabetes, glucose metabolism and insulin-signaling in OCD patients and vice versa. RESULTS: Some clinical and epidemiological studies show a higher prevalence of diabetes in OCD and vice versa compared to the general population. Animal and genetic studies suggest a possible role of insulin-signaling in the pathophysiology of OCD. Deep brain stimulation (DBS) studies suggest that abnormal dopaminergic transmission in the striatum may contribute to impaired insulin sensitivity in OCD. While DBS seems to increase insulin sensitivity, a possible protective role of serotonin reuptake-inhibitors on diabetic risk needs further studies. CONCLUSION: Despite their preliminary nature, these data highlight the importance of further investigations aimed at assessing metabolic features in OCD patients and OCD symptoms in diabetes patients to understand the impact of each condition on the pathophysiology and course of the other. Understanding the role of insulin in the obsessive-compulsive brain could open new treatment pathways for OCD.

Vegetation-based climate mitigation in a warmer and greener World.

The mitigation potential of vegetation-driven biophysical effects is strongly influenced by the background climate and will therefore be influenced by global warming. Based on an ensemble of remote sensing datasets, here we first estimate the temperature sensitivities to changes in leaf area over the period 2003-2014 as a function of key environmental drivers. These sensitivities are then used to predict temperature changes induced by future leaf area dynamics under four scenarios. Results show that by 2100, under high-emission scenario, greening will likely mitigate land warming by 0.71 ± 0.40 °C, and 83% of such effect (0.59 ± 0.41 °C) is driven by the increase in plant carbon sequestration, while the remaining cooling (0.12 ± 0.05 °C) is due to biophysical land-atmosphere interactions. In addition, our results show a large potential of vegetation to reduce future land warming in the very-stringent scenario (35 ± 20% of the overall warming signal), whereas this effect is limited to 11 ± 6% under the high-emission scenario.

Assessing response, remission, and treatment resistance in patients with obsessive-compulsive disorder with and without tic disorders: results from a multicenter study.

BACKGROUND: Highlighting the relationship between obsessive-compulsive disorder (OCD) and tic disorder (TD), two highly disabling, comorbid, and difficult-to-treat conditions, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) acknowledged a new "tic-related" specifier for OCD, ie, obsessive-compulsive tic-related disorder (OCTD). As patients with OCTD may frequently show poor treatment response, the aim of this multicenter study was to investigate rates and clinical correlates of response, remission, and treatment resistance in a large multicenter sample of OCD patients with versus without tics. METHODS: A sample of 398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from 10 different psychiatric departments across Italy. For the purpose of the study, treatment response profiles in the whole sample were analyzed comparing the rates of response, remission, and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to identify possible factors associated with treatment response. RESULTS: The remission group was associated with later ages of onset of TD and OCD. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts emerged in the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement. CONCLUSIONS: Although remission was associated with later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response with a significant impairment in quality of life for both patients and their caregivers, suggesting a worse profile of treatment response for patients with OCTD.

Land-based measures to mitigate climate change: Potential and feasibility by country.

Land-based climate mitigation measures have gained significant attention and importance in public and private sector climate policies. Building on previous studies, we refine and update the mitigation potentials for 20 land-based measures in >200 countries and five regions, comparing "bottom-up" sectoral estimates with integrated assessment models (IAMs). We also assess implementation feasibility at the country level. Cost-effective (available up to $100/tCO2 eq) land-based mitigation is 8-13.8 GtCO2 eq yr-1 between 2020 and 2050, with the bottom end of this range representing the IAM median and the upper end representing the sectoral estimate. The cost-effective sectoral estimate is about 40% of available technical potential and is in line with achieving a 1.5°C pathway in 2050. Compared to technical potentials, cost-effective estimates represent a more realistic and actionable target for policy. The cost-effective potential is approximately 50% from forests and other ecosystems, 35% from agriculture, and 15% from demand-side measures. The potential varies sixfold across the five regions assessed (0.75-4.8 GtCO2eq yr-1 ) and the top 15 countries account for about 60% of the global potential. Protection of forests and other ecosystems and demand-side measures present particularly high mitigation efficiency, high provision of co-benefits, and relatively lower costs. The feasibility assessment suggests that governance, economic investment, and socio-cultural conditions influence the likelihood that land-based mitigation potentials are realized. A substantial portion of potential (80%) is in developing countries and LDCs, where feasibility barriers are of greatest concern. Assisting countries to overcome barriers may result in significant quantities of near-term, low-cost mitigation while locally achieving important climate adaptation and development benefits. Opportunities among countries vary widely depending on types of land-based measures available, their potential co-benefits and risks, and their feasibility. Enhanced investments and country-specific plans that accommodate this complexity are urgently needed to realize the large global potential from improved land stewardship.

Emerging reporting and verification needs under the Paris Agreement: How can the research community effectively contribute?

Greenhouse gas (GHG) emission inventories represent the link between national and international political actions on climate change, and climate and environmental sciences. Inventory agencies need to include, in national GHG inventories, emission and removal estimates based on scientific data following specific reporting guidance under the United Nation Framework Convention on Climate Change (UNFCCC) and the Paris Agreement, using the methodologies defined in the Intergovernmental Panel on Climate Change (IPCC) Guidelines. Often however, research communities and inventory agencies have approached the problem of climate change from different angles and by using terminologies, metrics, rules and approaches that do not always match. This is particularly true dealing with "Land Use, Land-Use Change and Forestry" (LULUCF), the most challenging among the inventory sectors to deal with, mainly because of high level of complexity of its carbon dynamics and the difficulties in disaggregating the fluxes between those caused by natural and anthropogenic processes. In this paper, we facilitate the understanding by research communities of the current (UNFCCC) and future (under the Paris Agreement) reporting requirements, and we identify the main issues and topics that should be considered when targeting improvement of the GHG inventory. In relation to these topics, we describe where and how the research community can contribute to producing useful inputs, data, methods and solutions for inventory agencies and policy makers, on the basis of available literature. However, a greater effort by both communities is desirable for closer cooperation and collaboration, for data sharing and the understanding of respective and common aims.

Eco-Interactions of Engineered Nanomaterials in the Marine Environment: Towards an Eco-Design Framework.

Marine nano-ecotoxicology has emerged with the purpose to assess the environmental risks associated with engineered nanomaterials (ENMs) among contaminants of emerging concerns entering the marine environment. ENMs' massive production and integration in everyday life applications, associated with their peculiar physical chemical features, including high biological reactivity, have imposed a pressing need to shed light on risk for humans and the environment. Environmental safety assessment, known as ecosafety, has thus become mandatory with the perspective to develop a more holistic exposure scenario and understand biological effects. Here, we review the current knowledge on behavior and impact of ENMs which end up in the marine environment. A focus on titanium dioxide (n-TiO2) and silver nanoparticles (AgNPs), among metal-based ENMs massively used in commercial products, and polymeric NPs as polystyrene (PS), largely adopted as proxy for nanoplastics, is made. ENMs eco-interactions with chemical molecules including (bio)natural ones and anthropogenic pollutants, forming eco- and bio-coronas and link with their uptake and toxicity in marine organisms are discussed. An ecologically based design strategy (eco-design) is proposed to support the development of new ENMs, including those for environmental applications (e.g., nanoremediation), by balancing their effectiveness with no associated risk for marine organisms and humans.

Setting the forest reference levels in the European Union: overview and challenges.

BACKGROUND: The contribution of EU forests to climate change mitigation in 2021-2025 is assessed through the Forest Reference Levels (FRLs). The FRL is a projected country-level benchmark of net greenhouse gas emissions against which the future net emissions will be compared. The FRL models the hypothetical development of EU forest carbon sink if the historical management practices were continued, taking into account age dynamics. The Member States' FRLs have been recently adopted by the European Commission with the delegated Regulation (EU) 2021/268 amending the Regulation (EU) 2018/841. Considering the complexity of interactions between forest growth, management and carbon fluxes, there is a need to understand uncertainties linked to the FRL determination. RESULTS: We assessed the methodologies behind the modelled FRLs and evaluated the foreseen impact of continuation of management practices and age dynamics on the near-future EU27 + UK forest carbon sink. Most of the countries implemented robust modelling approaches for simulating management practices and age dynamics within the FRL framework, but faced several challenges in ensuring consistency with historical estimates. We discuss that the projected 16% increase in harvest in 2021-2025 compared to 2000-2009, mostly attributed to age dynamics, is associated to a decline of 18% of forest sink (26% for living biomass only). CONCLUSIONS: We conclude that the FRL exercise was challenging but improved the modelling capacity and data availability at country scale. The present study contributes to increase the transparency of the implementation of forest-related EU policies and provides evidence-based support to future policy development.

New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease.

INTRODUCTION: A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians. METHODS: We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients. RESULTS: Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials. CONCLUSION: Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.