Repetitive Transcranial Magnetic Stimulation for Treatment of Trichotillomania: Case Series.

Trichotillomania is a psychiatric disorder characterised by compulsive pulling out of one's hair resulting in hair loss, which is included in the Diagnostic and Statistical Manual of Mental Disorders 5th edition category 'obsessive-compulsive disorder and related disorders'. Behavioural therapy and some medications are suggested for the treatment of trichotillomania, though these are not effective for all patients. Therefore, new treatment options are needed. Five female patients diagnosed with trichotillomania applied low-frequency repetitive transcranial magnetic stimulation (rTMS) over bilateral supplementary motor area for 3 weeks. Baseline and after rTMS, patients were given Beck Depression Inventory, Beck Anxiety Inventory and Massachusetts General Hospital Hair Pulling Scale to evaluate the severity of disorder at baseline and post-rTMS. In this case series, three of five patients with trichotillomania obtained a substantial benefit from treatment, while one patient obtained a partial symptom reduction. The last patient experienced a mild increase in severity of disease after rTMS treatment. rTMS treatment can be effective in some patients with trichotillomania and can be a promising option in treatment of trichotillomania.

Repetitive Transcranial Magnetic Stimulation in the Treatment of Skin Picking Disorder: An Exploratory Trial.

OBJECTIVES: Skin picking disorder (SPD) falls into the category of "obsessive-compulsive disorder and related disorders" in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Repetitive transcranial magnetic stimulation (rTMS) treatment has been reported to be a promising therapy in obsessive-compulsive disorder-related disorders. The purpose of this study was to demonstrate the efficacy of rTMS treatment in patients with SPD. METHODS: Fifteen patients with SPD were assigned to receive 3 weeks' treatment with either active (n = 8) or sham rTMS targeting the pre-supplementary motor area. Patients were evaluated using the Beck Depression Inventory, Beck Anxiety Inventory, Skin Picking Impact Scale, and the Yale-Brown Obsessive Compulsive Scale Modified for Neurotic Excoriation. Response to treatment was defined as a ≥35% decrease on Yale-Brown Obsessive Compulsive Scale modified for Neurotic Excoriation. RESULTS: Treatment response was achieved in 62.5% of patients (5/8) in the active group and 33.3% of patients (2/6) in the sham group. However, there were no significant differences between the groups in terms of primary and secondary outcomes. CONCLUSIONS: In this exploratory study, active rTMS could not be demonstrated to be superior over sham in treatment of SPD. The results of this study indicate the need for further rTMS studies to be conducted with larger sample sizes and subtypes of SPD.

Thioredoxin is not a marker for treatment-resistance depression but associated with cognitive function: An rTMS study.

Elevated oxidative stress is known to play an important role in development of depression and cognitive dysfunction. To date, thioredoxin (TRX), an antioxidant protein, has been investigated as a marker for psychiatric disorders such as schizophrenia, bipolar disorder and autism but its relationship with depression is yet to be unknown. The aim of this study is to detect the TRX levels in patients with treatment-resistant depression (TRD), analyse the effect of rTMS (repetitive transcranial magnetic stimulation) application on TRX levels and display the relationship of TRX with cognitive areas. This study included 27 treatment-resistant unipolar depression patients and 29 healthy subjects. Patients were evaluated by Hamilton Depression Scale (HDRS), Hamilton Anxiety Scale (HARS) and Montreal Cognitive Assessment (MoCA) before and after rTMS application. 23 of TRD patients were applied high-frequency rTMS over left DLPFC for 2 to 4weeks and plasma TRX levels of patients and healthy subjects were measured. No significant difference was determined between the TRX levels of patients and healthy subjects (p>0.05). After rTMS application there were significant decrease in severity of depression (p<0.001) and anxiety (p<0.001), and explicit improvement in cognitive areas (delayed memory, visual-spatial/executive abilities and language points) (all p<0.05). No difference was detected in TRX levels of the patients after rTMS application (p>0.005). High language scores of the patients were found to be associated with high TRX levels (p<0.005). Our study indicates that TRX levels cannot be used as a marker for TRD or rTMS treatment in TRD. In spite of this TRX levels have a positive correlation with language functions of the patients of TRD. More extensive studies are required to clarify the mechanism of action of TRX and the effect of TRX on cognitive functions.