Systematic Review and Meta-analysis: Rates of Violence During First-Episode Psychosis (FEP).

BACKGROUND: Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP. STUDY DESIGN: Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services). STUDY RESULTS: Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services. CONCLUSION: Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.

Psychological Distress Among Parents of Children With Chronic Health Conditions and Its Association With Unmet Supportive Care Needs and Children's Quality of Life.

OBJECTIVE: To assess parent psychological distress in families of children with common chronic health conditions (CHC) and to explore relationships between parent psychological distress, unmet supportive care needs and children's quality of life (QoL). METHOD: Cross-sectional study involving parents of children diagnosed with a common CHC between 0 and 12 years of age and who had received treatment within the last 5 years. Eligible parents completed an online survey, that included the Depression Anxiety Stress Scale (DASS-21) assessing distress in parents and a 34-item assessment of unmet supportive care needs across 6 domains. Parents completed ratings of their child's current functioning (QoL) using the 23-item PedsQL. Multivariable regression models examined the relative association between unmet needs, children's QoL and parents' depression, anxiety, and stress. RESULTS: The sample consisted of 194 parents of children with congenital heart disease (n=97; 50%), diabetes (n=50; 26%), cancer (n=39; 20%), and asthma (n=8; 4%). A significant proportion of parents had moderate-severe symptoms of depression (26%), anxiety (38%), and stress (40%). Of the PedsQL scales, the poorest outcomes were found for emotional and school functioning. Multivariable analyses showed that both higher unmet needs and poorer child emotional functioning were associated with parent depression, anxiety, and stress symptoms. CONCLUSION: Evidence linking parent distress symptoms to higher unmet needs and poorer child emotional functioning suggests these factors may be targets for interventions to alleviate parent distress. Longitudinal research using larger samples is required to replicate findings, and clarify the magnitude and direction of associations.

Cross-National Generalizability of WISC-V and CHC Broad Ability Constructs across France, Spain, and the US.

The Cattell-Horn-Carroll (CHC) model is based on psychometric cognitive ability research and is the most empirically supported model of cognitive ability constructs. This study is one in a series of cross-national comparisons investigating the equivalence and generalizability of psychological constructs which align with the CHC model. Previous research exploring the cross-cultural generalizability of cognitive ability measures concluded that the factor analytic models of cognitive abilities generalize across cultures and are compatible with well-established CHC constructs. The equivalence of the psychological constructs, as measured by the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V), has been established across English-speaking samples. However, few studies have explored the equivalence of psychological constructs across non-English speaking, nationally representative samples. This study explored the equivalence of the WISC-V five-factor model across standardization samples from France, Spain, and the US. The five-factor scoring model demonstrated excellent fit across the three samples independently. Factorial invariance was investigated and the results demonstrated strict factorial invariance across France, Spain, and the US. The results provide further support for the generalizability of CHC constructs across Western cultural populations that speak different languages and support the continued use and development of the CHC model as a common nomenclature and blueprint for cognitive ability researchers and test developers. Suggestions for future research on the CHC model of intelligence are discussed.

Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis.

BACKGROUND: Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI. METHODS: Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings' experience were eligible. The literature search was conducted up until 20th October 2022. RESULTS: Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99-18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09-27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (ß = -16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings' illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings' distress and/or burden. Siblings' experience of wellbeing and caregiving were closely related. CONCLUSION: This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.

Resting state electroencephalography power correlates with individual differences in implicit sequence learning.

Neuroimaging resting state paradigms have revealed synchronised oscillatory activity is present even in the absence of completing a task or mental operation. One function of this neural activity is likely to optimise the brain's sensitivity to forthcoming information that, in turn, likely promotes subsequent learning and memory outcomes. The current study investigated whether this extends to implicit forms of learning. A total of 85 healthy adults participated in the study. Resting state electroencephalography was first acquired from participants before they completed a serial reaction time task. On this task, participants implicitly learnt a visuospatial-motor sequence. Permutation testing revealed a negative correlation between implicit sequence learning and resting state power in the upper theta band (6-7 Hz). That is, lower levels of resting state power in this frequency range were associated with superior levels of implicit sequence learning. This association was observed at midline-frontal, right-frontal and left-posterior electrodes. Oscillatory activity in the upper theta band supports a range of top-down processes including attention, inhibitory control and working memory, perhaps just for visuospatial information. Our results may be indicating that disengaging theta-supported top-down attentional processes improves implicit learning of visuospatial-motor information that is embedded in sensory input. This may occur because the brain's sensitivity to this type of information is optimally achieved when learning is driven by bottom-up processes. Moreover, the results of this study further demonstrate that resting state synchronised brain activity influences subsequent learning and memory.

Unmet supportive care needs of families of children with chronic illness: A systematic review.

BACKGROUND AND AIMS: Unmet supportive care needs (SCN) refer to perceived gaps in the support parents want to manage caregiving activities for children with chronic health conditions (CHC) and the support received. This review aims to systematically identify the unmet SCN of families with children living with five common paediatric CHC and characterise the assessment tools used to measure SCN. DESIGN: Systematic review methodology with narrative synthesis of data. Reporting followed the PRISMA statement guidelines. METHOD: Literature searches were conducted in electronic databases Medline complete, PsycINFO, CINHAL and EMBASE to retrieve relevant articles published between 1990 and July 2022. Eligible studies involved (i) children aged 0-18 years diagnosed with either of cancer, congenital heart disease (CHD), diabetes, asthma, renal disease and (ii) assessment of unmet SCN. Studies involving children with genetic or developmental conditions were excluded. The methodological quality of studies was assessed using JBI assessment tool. RESULTS: Of 6223 articles screened, 34 papers were included (25 quantitative, 5 qualitative and 4 mixed design). Most papers explored unmet needs of families with cancer (n = 26). The remaining articles concerned CHD (n = 5), asthma (n = 2) and mixed CHC (n = 1, renal failure, and diabetes). Information (e.g. treatment, lifestyle, etc.) and health care (e.g. emotional support, practical services, etc.) were the most common unmet need domains across health conditions. A variety of methods and need assessments hampered comparisons between studies both across and within CHC. CONCLUSION: Irrespective of illness, addressing unmet informational or health care needs may help to optimise outcomes and care for children and families living with common CHC. There was considerable variation in reporting styles, study design and need assessments both within and across conditions. RELEVANCE TO CLINICAL PRACTICE: Health care professionals must routinely evaluate the type, quality and quantity of psychoeducation and support that families of children with CHC want and receive. Providing nurses with more effective strategies to assess child and family needs across a broad range of domains may help to increase understanding of where further support for families is required. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution to this study as it involved a systematic review of existing literature.

Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study.

BACKGROUND: The aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool. METHODS: A cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs. RESULTS: One hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support. CONCLUSIONS: Using a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs. Video Abstract.

The Impact of N-acetylcysteine on Major Depression: Qualitative Observation and Mixed Methods Analysis of Participant Change during a 12-week Randomised Controlled Trial.

Objective: N-acetylcysteine (NAC) is a novel therapeutic agent with multiple mechanisms of action in the central nervous system and a favourable side effect profile. Clinical evidence indicates that adjunctive NAC may reduce the severity of depressive symptoms in individuals with major depressive disorder (MDD). Methods: A 12-week randomised controlled trial of 2,000 mg/day adjunctive NAC for MDD found no significant improvement at the primary endpoint (week 12) but did see improvements at the post-discontinuation interview (week 16). Within the context of patient-centered treatment, mixed-methods qualitative analysis was also included to explore factors that may determine individual responses to adjunctive NAC treatment. These data were drawn, under blinded conditions, from clinician notes recorded in the case report form. Using the DSM-5 symptom profile for MDD as the initial framework, themes were developed and explored. Frequencies were compared between placebo and NAC groups. Results: Per protocol analysis of individual themes across the six interviews revealed group differences in favour of NAC for overall depressive affect, optimism, relationships and reduced functional impairment. Conclusion: This study provides further evidence for the utility of the mixed methods approach complimenting the primary findings using traditional quantitative analyses, as well as being able to capture additional, often more subtle, evidence of individual symptom-level change that reflects improvement in functional abilities in response to NAC supplementation. The use of mixed methods to explore outcomes from psychiatric studies should be considered in future to work towards improved patient-centred care and both confirm quantitative findings and generate novel hypotheses.

Measurement invariance of the Wechsler Intelligence Scale for children, fifth edition, in Australian and New Zealand and U.S. standardization samples.

Measurement invariance underlies construct validity generalization in psychology and must be demonstrated prior to any cross-population comparison of means and validity correlations. The purpose of this study was to evaluate the measurement invariance of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) across Australia and New Zealand (A&NZ) versus the U.S. normative samples. The WISC-V is the most widely used assessment of intelligence in children. Participants were census matched, nationally representative samples from A&NZ (n = 528) and the United States (n = 2,200) who completed the WISC-V standardization version. Baseline model estimation was conducted to ensure the same model showed acceptable fit in both samples separately. Measurement invariance was then examined across A&NZ and United States. The five-factor scoring model described in the test manual showed excellent fit in both samples. Results showed that the WISC-V demonstrated strict metric measurement invariance across the A&NZ and U.S. samples. Further, the results were consistent with the Cattell-Horn-Carroll (CHC) framework of cognitive abilities, indicating the generalizability of cognitive abilities across cultures. Small but significant differences in visual spatial latent means were found across females, highlighting the importance of local normative data. These findings suggest that the WISC-V scores can be meaningfully compared across A&NZ and United States and that the constructs, which align with CHC theory, and associated construct validity research, generalize across countries. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological distress in siblings of people with mental illness: A systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to characterise the prevalence and/or severity of psychological distress (namely, depression and anxiety symptoms) in siblings of people with mental illness (MI) and to examine correlates of distress in siblings of people with MI. METHOD: Studies comparing distress in individuals with and without a sibling with MI were eligible. Studies reporting on correlates of distress in siblings were also eligible. A search of MEDLINE Complete, PsycINFO and Embase was conducted up until 17 March 2022. RESULTS: Fifteen studies comprising 2304 siblings and 2263 comparison individuals were included. Meta-analyses indicated individuals with a sibling with MI experience significantly greater depressive symptoms (Hedges's g = 0.53, 95% CI = [0.32, 0.73], siblings n = 1962, comparison individuals n = 2248) and anxiety symptoms (Hedges's g = 0.40, 95% CI = [0.19, 0.61], siblings n = 653, comparison individuals n = 533) than those without. The sibling relationship, siblings' locus of control, interpersonal functioning and their appraisal of the impacts of MI were identified as important and potentially modifiable correlates. CONCLUSION: Individuals with a sibling with MI experience greater depressive and anxiety symptoms than those without and would likely benefit from support. Future studies are required to elucidate the mechanisms underlying distress in siblings.

A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders.

BACKGROUND: Informal primary caregivers provide crucial supports to loved ones experiencing serious mental illnesses with profound outcomes for the caregivers themselves. A comprehensive understanding of how different serious mental illnesses change the caregiving experience may provide important insight into the ways in which caregivers can be better supported in their role. The aim of this review was to synthesize the comparative literature examining caregiver burden and psychological functioning (anxiety, depression, distress, and psychological wellbeing) between caregivers of people with schizophrenia spectrum disorders and bipolar disorder. METHODS: Studies were included if they compared caregivers across both diagnostic groups and used measures assessing either caregiver burden or psychological functioning of caregivers. Databases searched up until 11th of January 2022 included: Medline COMPLETE, Embase, PsycINFO and CINAHL. Reference list scans and grey literature searches across government, organisational and dissertation databases were also conducted. RESULTS: Twenty-eight studies comprising 6166 caregivers were included. Fourteen studies suggested that caregiving burden was comparable across both groups. The effects of caring on caregiver mental health and stress were comparable across both groups. However, methodological limitations were noted, including a reliance on cross-sectional studies, multiple and sometimes competing definitions of caregiving burden, variable sample sizes, and variation in measures used. CONCLUSION AND IMPLICATIONS: The experience of providing care is multidimensional and complex. Symptoms and functional difficulties experienced by people being cared for may affect caregivers more so than diagnosis. Caregivers play a vital role in helping people with serious mental illness. Supporting caregivers by reducing their burden and improving their psychological functioning may help them to continue to provide support, and cope with, the challenges of providing care.

Home Information and Communication Technology Use and Student Academic Performance: Encouraging Results for Uncertain Times.

This study set out to examine the associations of certain information communication technology (ICT) factors in the home environment with academic performance. We employed existing data sets collated by Pearson Clinical Assessment in 2016 which included the WIAT-III A&NZ (Wechsler Individual Achievement Test - Australian and New Zealand Standardised, Third Edition) completed by 714 students aged between 4 and 18 years old, and the home environment questionnaire (HEQ) completed by the parents of those children. Sequential multiple regression models were used to analyze the complex interactions between home ICT factors and measures of student reading, writing, mathematical, and oral ability. The findings of this study indicate that after accounting for the known powerful predictors of household income and parental education: (a) a student's access to an ICT rich home environment, (b) their aptitude in using home ICT, and (c) their recreational use of home ICT, are largely unrelated to academic performance. We observed some small positive correlations between academic performance and child ICT affinity, but also comparably sized negative associations with use of social media and educational TV viewing. Encouragingly, we propose that these findings suggest that increasing levels of ICT use and access in the home are unlikely to be detrimental to academic progress. These results provide important information for parents and educators given the impact of the Coronavirus global pandemic and the near world-wide adoption of ICT for home-schooling.

Assessing cerebellar-cortical connectivity using concurrent TMS-EEG: a feasibility study.

Combined single-pulse transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has been used to probe the features of local networks in the cerebral cortex. Here, we investigated whether we can use this approach to explore long-range connections between the cerebellum and cerebral cortex. Ten healthy adults received single-pulse suprathreshold TMS to the cerebellum and an occipital/parietal control site with double-cone and figure-of-eight coils while cerebral activity was recorded. A multisensory electrical control condition was used to simulate the sensation of the double-cone coil at the cerebellar site. Two cleaning pipelines were compared, and the spatiotemporal relationships of the EEG output between conditions were examined at sensor and source levels. Cerebellar stimulation with the double-cone coil resulted in large artifact in the EEG trace. The addition of SOUND filtering to the cleaning pipeline improved the signal such that further analyses could be undertaken. The cortical potentials evoked by the active TMS conditions showed strong relationships with the responses to the multisensory control condition after ∼50 ms. A distinct parietal component at ∼42 ms was found following cerebellar double-cone stimulation. Although evoked potentials differed across all conditions at early latencies, it is unclear as to whether these represented TMS-related network activation of the cerebellarthalamocortical tract, or whether components were dominated by sensory contamination and/or coil-driven artifact. This study highlights the need for caution when interpreting outcomes from cerebellar TMS-EEG studies.NEW & NOTEWORTHY This is the first study to systematically assess the feasibility of obtaining TMS-evoked potentials from cerebellar stimulation with concurrent EEG. An innovative control condition using electrical stimulation was modified to mimic the sensory aspects of cerebellar stimulation with a double-cone coil, and a state-of-the art cleaning pipeline was trialled. The extent of artifact contamination in signals from stimulation of a cerebellar and an occipital/parietal control site using two TMS coil types was highlighted.

Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis of Mood Effects.

This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.

Non-Invasive Brain Stimulation Does Not Improve Working Memory in Schizophrenia: A Meta-Analysis of Randomised Controlled Trials.

Poor working memory functioning is commonly found in schizophrenia. A number of studies have now tested whether non-invasive brain stimulation can improve this aspect of cognitive functioning. This report used meta-analysis to synthesise the results of these studies to examine whether transcranial electrical stimulation (tES) or repetitive transcranial magnetic stimulation (rTMS) can improve working memory in schizophrenia. The studies included in this meta-analysis were sham-controlled, randomised controlled trials that utilised either tES or rTMS to treat working memory problems in schizophrenia. A total of 22 studies were included in the review. Nine studies administered rTMS and 13 administered tES. Meta-analysis revealed that compared to sham/placebo stimulation, neither TMS nor tES significantly improved working memory. This was found when working memory was measured with respect to the accuracy on working memory tasks (TMS studies: Hedges' g = 0.112, CI95: -0.082, 0.305, p = .257; tES studies Hedges' g = 0.080, CI95: -0.117, 0.277, p = .427) or the speed working memory tasks were completed (rTMS studies: Hedges' g = 0.233, CI95: -0.212, 0.678, p = .305; tES studies Hedges' g = -0.016, CI95: -0.204, 0.173, p = .871). For tES studies, meta-regression analysis found that studies with a larger number of stimulation sessions were associated with larger treatment effects. This association was not found for TMS studies. At present, rTMS and tES is not associated with a reliable improvement in working memory for individuals with schizophrenia.

Immediate Attention Enhancement and Restoration From Interactive and Immersive Technologies: A Scoping Review.

Interactive and immersive technologies such as video games, exergames, and virtual reality are typically regarded as entertainment mediums. They also offer a multitude of health and well-being benefits. They have the capacity to incorporate established well-being techniques (e.g., mindfulness, exercise, and play) and expose users to beneficial environment settings with greater ease, improved access, and a broader appeal. The authors conducted a scoping review to explore whether these technologies could be used to benefit attention in healthy adults, that is, in a regulatory sense such as during periods of cognitive fatigue or attention-critical tasks. Research efforts have typically focused on long-term practice methods for attention enhancement with these technologies. Instead, this review provides the first attempt to unify a broad range of investigations concerned with their immediate impact on attention through state-change mechanisms. This applies the concept of attention state training and a growing evidence base, which suggests that meditative practices, exercise bouts, and nature exposures can provide short-term improvements in attentional performance following brief interactions. A systematic search of MEDLINE, Embase, and PsycINFO databases resulted in 11 peer-reviewed articles (13 experimental trials) each including at least one objective measure of attention directly following the use of an interactive or immersive technology. Most studies involved interactive technologies (i.e., video games and exergames), whereas there were three immersive interventions in the form of virtual reality. The comparisons between baseline and postintervention showed mostly no effect on attention, although there were five cases of improved attention. There were no instances of negative effects on attention. The results are significant considering mounting concerns that technology use could be detrimental for cognitive functioning. The positive effects reported here indicate a need to specify the type of technology in question and bring attention to positive vs. negative technology interactions. Implications for the literature concerning attention state training are discussed considering promising effects of technology exposures geared toward flow state induction. Significant gaps in the literature are identified regarding the implementation of traditional attention state training practices.

Cerebral Cortical Activity Following Non-invasive Cerebellar Stimulation-a Systematic Review of Combined TMS and EEG Studies.

The cerebellum sends dense projections to both motor and non-motor regions of the cerebral cortex via the cerebellarthalamocortical tract. The integrity of this tract is crucial for healthy motor and cognitive function. This systematic review examines research using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to the cerebellum with combined cortical electroencephalography (EEG) to explore the temporal features of cerebellar-cortical connectivity. A detailed discussion of the outcomes and limitations of the studies meeting review criteria is presented. Databases were searched between 1 December 2017 and 6 December 2017, with Scopus alerts current as of 23 July 2019. Of the 407 studies initially identified, 10 met review criteria. Findings suggested that cerebellar-cortical assessment is suited to combined TMS and EEG, although work is required to ensure experimental procedures are optimal for eliciting a reliable cerebellar response from stimulation. A distinct variation in methodologies and outcome measures employed across studies, and small sample sizes limited the conclusions that could be drawn regarding the electrophysiological signatures of cerebellar-cortical communication. This review highlights the need for stringent protocols and methodologies for cerebellar-cortical assessments via combined TMS and EEG. With these in place, combined TMS and EEG will provide a valuable means for exploring cerebellar connectivity with a wide range of cortical sites. Assessments have the potential to aid in the understanding of motor and cognitive function in both healthy and clinical groups, and provide insights into long-range neural communication generally.

The Impact of Stimulation Intensity and Coil Type on Reliability and Tolerability of Cerebellar Brain Inhibition (CBI) via Dual-Coil TMS.

Cerebellar brain inhibition (CBI) describes the inhibitory tone the cerebellum exerts on the primary motor cortex (M1). CBI can be indexed via a dual-coil transcranial magnetic stimulation protocol, whereby a conditioning stimulus (CS) is delivered to the cerebellum in advance of a test stimulus (TS) to M1. The CS is typically delivered at intensities over 60% maximum stimulus output (MSO) via a double-cone coil. This is reportedly uncomfortable for participants, reducing the reliability and validity of outcomes. This feasibility study investigates the reliability and tolerability of eliciting CBI across a range of CS intensities using both a double-cone and high-powered figure-of-8 coil, the D702. It was expected that the double-cone coil would elicit CBI at intensities upwards of 60%MSO. The range for the D702 coil was exploratory. The double-cone coil was expected to be less tolerable than the D702 coil. CBI was assessed in 13 participants (25.92 ± 5.42 years, six female) using each coil (randomized) over intensities 40, 50, 60, 70, 80%MSO. Tolerability was assessed via visual analog scales. Comparisons across intensities and tolerability were assessed non-parametrically and via a linear model. The double-cone coil elicited CBI at intensities 60, 70, and 80%MSO (p < .05), with suppression elicited at 60%MSO not significantly different to that at higher intensities. CBI was not reliably elicited by the D702 coil at any intensity. The double-cone coil was significantly less tolerable than the D702. A CS of 60%MSO with a double-cone coil provides a balance between the reliability and tolerability of CBI.

Intra- and Inter-Regional Priming of Ipsilateral Human Primary Motor Cortex With Continuous Theta Burst Stimulation Does Not Induce Consistent Neuroplastic Effects.

Human responses to non-invasive brain stimulation (NIBS) techniques can be highly variable. Recently, priming protocols involving a conditioning round of NIBS applied to a target brain region prior to the application of a test protocol have shown promise in inducing more reliable effects. We investigated whether intra- or inter-regional priming of the left primary motor cortex (M1) using continuous theta burst stimulation (cTBS) can induce consistent, and reliable modulation of corticospinal excitability. Twenty healthy adults (six males) underwent four cTBS protocols. For intra-regional priming, cTBS was applied twice to the left M1 (M1-M1). For inter-regional M1 priming, cTBS was applied to the ipsilateral (left) dorsal premotor cortex (dPMC-M1), and ipsilateral (left) dorsolateral prefrontal cortex (DLPFC-M1). In the control condition, sham stimulation was applied to left M1, followed by active cTBS also applied to the left M1 (sham-M1). Each round of cTBS was separated by 10 min. Neuroplastic responses were indexed using motor evoked potentials (MEPs) elicited from the left M1 hand region, and measured from the contralateral first dorsal interosseous (right hand). MEP measurements were taken before the first round of cTBS priming, then immediately, 10, 20 and 30 min after the second test round of cTBS. The primary two-way repeated measures ANOVA revealed no significant differences in MEP responses across each condition (no main effects or interaction). Intra- and inter-regional priming of the left M1 using cTBS does not induce consistent neuroplastic effects. Further work is required to identify factors which contribute to such variability in human responses to NIBS.

Cognitive impairment during pregnancy: a meta-analysis.

OBJECTIVES: Many women report declines in cognitive function during pregnancy, but attempts to empirically evaluate such changes have yielded inconsistent results. We aimed to determine whether pregnancy is associated with objective declines in cognitive functioning, and to assess the progression of any declines during pregnancy. STUDY DESIGN: We undertook a meta-analysis, applying a random effects model, of 20 studies that have reported quantitative relationships between pregnancy and changes in cognition. DATA SOURCES: Full text articles indexed by Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, MEDLINE Complete, and PsychINFO. DATA SYNTHESIS: The 20 studies assessed included 709 pregnant women and 521 non-pregnant women. Overall cognitive functioning was poorer in pregnant women than in non-pregnant women (standardised mean difference [SMD], 0.52 [95% CI, 0.07-0.97]; P = 0.025). Analysis of cross-sectional studies found that general cognitive functioning (SMD, 1.28 [95% CI 0.26-2.30]; P = 0.014), memory (SMD, 1.47 [95% CI, 0.27-2.68]; P = 0.017), and executive functioning (SMD, 0.46 [95% CI, 0.03-0.89]; P = 0.036) were significantly reduced during the third trimester of pregnancy (compared with control women), but not during the first two trimesters. Longitudinal studies found declines between the first and second trimesters in general cognitive functioning (SMD, 0.29 [95% CI, 0.08-0.50]; P = 0.006) and memory (SMD, 0.33 [95% CI, 0.12-0.54]; P = 0.002), but not between the second and third trimesters. CONCLUSIONS: General cognitive functioning, memory, and executive functioning were significantly poorer in pregnant than in control women, particularly during the third trimester. The differences primarily develop during the first trimester, and are consistent with recent findings of long term reductions in brain grey matter volume during pregnancy. The impact of these effects on the quality of life and everyday functioning of pregnant women requires further investigation.