Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study.

BACKGROUND: Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD. OBJECTIVE: This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD. METHODS: A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8. RESULTS: A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group. CONCLUSIONS: Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.

Adjuvant High-Definition Transcranial Direct Current Stimulation for Negative Symptoms in Schizophrenia: A Pilot Study.

OBJECTIVE: In schizophrenia, negative symptoms account for a substantial amount of the comorbidity resulting in poor performance in social interaction, interpersonal relationships, economic functioning, and recreational activities. Research has implicated hypofrontality in the pathogenesis of negative symptoms of schizophrenia. Conventional transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex has attracted significant interest as an add-on treatment for negative symptoms in schizophrenia. High-definition tDCS (HD-tDCS), an optimized form of tDCS, has the potential for more focalized neuromodulation. Hence, we aimed to evaluate the efficacy of HD-tDCS over the left dorsolateral prefrontal cortex in the improvement of negative symptoms in schizophrenia. METHODS: Fourteen patients with schizophrenia with predominantly negative symptoms were enrolled for this pilot, randomized, sham-controlled, double-blind trial. Each participant received 10 sessions of HD-tDCS at 2 mA for 20 minutes twice daily over 5 days. Negative symptoms were assessed with the Scale for Assessment of Negative Symptoms and Positive and Negative Syndrome Scale for Schizophrenia. The Calgary Depression Scale for Schizophrenia was used to rule out depressive symptoms. Assessments were carried out at baseline and at 2 weeks. RESULTS: The improvement in negative symptoms in the active group was statistically significant at P value of 0.05 as compared with the sham group. CONCLUSION: These results suggest that HD-tDCS may lead to improvement in negative symptoms of schizophrenia. Its use as an adjunct to pharmacological treatment of negative symptoms may be worth considering.

Dermatitis Neglecta Affecting Nose: A Case Report.

Dermatitis neglecta, a relatively uncommon condition, results from inadequate frictional cleansing leading to accumulation of sebum, sweat and corneocytes. It ultimately results in hyper-pigmented patch (or sometimes verrucous plaque). Proper diagnosis is important because recognizing this condition avoids unnecessary diagnostic and therapeutic procedures. Here we report one classical case of dermatitis neglecta in whom the dermatitis developed as a result of neglect of personal hygiene.

Metabolic syndrome-associated cognitive decline in mice: Role of minocycline.

OBJECTIVE: The objective of the study was to characterize the mechanism associated with metabolic syndrome (MetS)-associated cognitive decline and determine the effect of minocycline on the above condition in mice. MATERIALS AND METHODS: We developed a HFHC diet-induced MetS model in mice. Diagnostic characteristics of MetS including waist circumference, lipid levels, blood pressure, and fasting blood glucose were measured in these Swiss albino mice. Cognitive parameters were measured using passive avoidance and elevated plus maze test. Hippocampal acetylcholine esterase (AchE), reduced glutathione (GSH), and cytokine levels were measured and histopathological evaluation conducted. The MetS animals were administered minocycline (50 mg/kg; 10 days) and the above parameters were measured. RESULTS: We successfully induced MetS using HFHC diet in mice. Animals showed significantly higher fasting blood glucose levels (P < 0.001), systolic blood pressure (P < 0.01), waist circumference (P < 0.001), low-density lipoprotein (P < 0.001), and triglyceride (P < 0.01) and reduced high density lipoprotein levels (P < 0.05) compared to control animals. Both scopolamine and MetS significantly lowered (P < 0.01) step-down latency and increased transfer latency (P < 0.001). MetS animals showed significantly higher AchE (P < 0.001) and tumor necrosis factor-α (P < 0.001) and Interleukin-1 ß (P < 0.01) and lower GSH (P < 0.001) levels and reduced both CA1 (P < 0.001) and CA3 (P < 0.01) neuronal density compared to controls. Minocycline treatment partially reversed the above neurobehavioral and biochemical changes and improved hippocampal neuronal density in MetS animals. CONCLUSION: MetS led to hippocampal oxidative stress and neuroinflammatory changes with a corresponding loss of hippocampal neuronal density and cognitive decline. Anti-inflammatory and antioxidant property of minocycline may be responsible for its neuroprotective actions in these animals.

Interrater reliability of the Silverman et al. nomenclature for suicide-related ideations, behaviors, and communications.

BACKGROUND: There is need for a common and uniform nomenclature for suicide and related behaviors. Many nomenclatures exist to address the same. AIMS: Study proposes to assess the inter-rater reliability of Silverman et al. nomenclature on suicide and suicidal behaviors. METHOD: The present study was conducted at the crisis intervention clinic of a tertiary care centre. Case records of patients referred to the centre were evaluated by two trained psychiatrists and were rated according to the Silverman's nomenclature in the domains of suicide related ideation, suicide related communication and suicide related behavior. Inter-rater reliability was measured using kappa coefficient. The relationship of suicide intent item of a structured scale with suicide related ideation, communication and behavior were explored. RESULTS: Inter-rater reliability of the two evaluators using the Silverman's nomenclature on 198 case records was in the moderate range for suicidal related ideation and behavior domains (kappa of 0.476 and 0.502 respectively), but low for communication domain (kappa value of 0.016). The stated intent item of the Pierce Suicide Intent Scale correlated highly with suicide related ideation and behavior as assessed using the Silverman et al. nomenclature (Kendall tau = 0.723 and 0.747 respectively). CONCLUSIONS: Based upon the same case record material, evaluators rate suicide related ideations and behaviors with moderate degree of concordance. However, the concordance is poor for suicide related communication.

Influence of polyphenolic extracts from Enydra fluctuans on oxidative stress induced by acephate in rats.

Acephate, an organophosphorus pesticide, has been proved to play an important role in tissue damage by inducing oxidative stress through the release of free radicals. The aim of this study was to evaluate the protective effect of the plant phenolic compounds present in Enydra fluctuans against acephate toxicity based on lipid peroxidation and antioxidant enzymes profile in rats. An oral dose of acephate at 30 mg/kg of body weight has been given against the extracts containing 20mg of polyphenolic compounds (expressed as gallic acid equivalents)/kg body weight for 14 days. The results showed that under the influence of the pesticides, there was significant decrease in the activities of the antioxidant enzymes SOD, Catalase and Glutathione peroxidase (GPx) and an increase in the non-enzymatic Glutathione, with respect to the normal and the plant extract gavaged groups. Also that there was an increase in the plasma and erythrocyte membrane lipid peroxidation levels in the pesticide treated group compared to the normal or the group treated with the plant extract. The present study thus gives an insight into the ill-effects of this organophosphate and the protective role of plant polyphenols in minimizing those effects.