Establishing an effective TMS protocol for craving in substance addiction: Is it possible?

BACKGROUND AND OBJECTIVES: Repetitive transcranial magnetic stimulation (TMS) is a non-invasive tool with known therapeutic efficacy in various neuropsychiatric disorders, such as depression, schizophrenia, mania, and anxiety disorders. We hereby, briefly present a brief review and meta-analysis on the use of TMS for craving in substance addiction. METHODS: We present our brief review and meta-analysis following the recommendations of the Cochrane group. A total of eight randomized controlled trials fulfilled eligibility criteria and were selected. A total of 199 patients were studied. RESULTS: We found active stimulation to be superior than sham protocols only for trials focused on right DLPFC (with Hedge's g = 1.48; ES (95%CI: 0.126-2.834), p = 0.032. DISCUSSION AND SCIENTIFIC SIGNIFICANCE: Main meta-analysis limitations include small number of studies, high heterogeneity among studies, and high publication bias. However challenging, our exploratory analysis underscored the amelioration of craving in substance addiction for trials using high frequency TMS protocols over the right DLPFC. We hereby, propose the use of this particular TMS protocol as a promising tool in clinical research.

Fatores de risco envolvidos no desenvolvimento da psicopatia: uma atualização / Risk factors involved in the development of psychopathy: an update

O desenvolvimento da personalidade é por si só um assunto complexo que envolve variáveis ambientais, fatores perinatais, genéticos, individuais (incluindo nível intelectual) e familiares. Assim como a definição de personalidade e seus distúrbios, a etiologia da psicopatia ainda não está devidamente esclarecida. O presente estudo objetiva investigar os fatores de risco associados ao desenvolvimento da psicopatia. Os autores realizaram busca sistematizada nas principais bases de dados: Medline (Medical Literature Analysis and Retrieval System Online) via PubMed, Cochrane Library, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Embase. Utilizando como referência o Medical Subject Headings (MeSH), realizou-se uma pesquisa dos termos “antisocial personality disorder and risk factors” entre os anos de 2000 e 2010. A etiologia da psicopatia engloba fatores genéticos, ambientais e sociofamiliares que dificultam estabelecer um fator causal específico. Portanto, o reconhecimento e a intervenção precoces nos fatores de risco poderiam reduzir a probabilidade de desenvolvimento de traços antissociais em indivíduos predispostos.

The development of personality is itself a complex issue that involves environmental variables, perinatal factors, genetic, individual (including intellectual level) and family. Just as the definition of personality and its disorders, the etiology of psychopathy is not yet properly understood. The present study aims to investigate the risk factors associated with the development of psychopathy. The authors conducted systematic search in major databases: MEDLINE (Medical Literature Analysis and Retrieval System Online) via PubMed, Cochrane Library, and LILACS (Latin American and Caribbean Health Sciences) and Embase. Using as reference the Medical Subject Headings (MeSH), there was a search of the terms "antisocial personality disorder and risk factors" between the years 2000 and 2010. The etiology of psychopathy involves genetic, environmental and social-familial difficult to establish a specific causal factor. Therefore, early recognition and intervention in risk factors could reduce the likelihood of developing antisocial traits in predisposed individuals.