Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial.

Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.

Safety and Efficacy of an Intensified and Repeated Transcranial Direct Current Stimulation Targeting Supplementary Motor Area and Dorsolateral Prefrontal Cortex in Trichotillomania (Hair Pulling Disorder): A Case Report.

Trichotillomania (or hair pulling disorder) is a habitual condition in which patients constantly pull their hair. Although psychotherapies such as behavioral therapy and pharmacotherapy have shown relative effectiveness for trichotillomania, some patients fail to respond to these interventions or show only partial responses. Recently, noninvasive brain stimulation techniques such as transcranial direct current stimulation have shown promise in the treatment of psychiatric disorders. We designed a new protocol that included intensified and repeated during 16 sessions, every other day, 2 sessions one day, current intensity of 2 mA for 20 minutes, which regions dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA): Anodal (F3) and cathodal (SMA) were selected as stimulation target areas. The results showed that after the electrical stimulation intervention and also in the follow-up phase, there was a significant improvement in hair pulling behavior and psychiatric evaluations such as depression and anxiety. Therefore, there are many hopes in the effectiveness of the protocol used (intensified and repeated DLPFC and SMA areas) in the treatment of trichotillomania disorder, although there is a need for a future experimental study with a larger group of patients.

The impact of bilateral anodal transcranial direct current stimulation of the premotor and cerebellar cortices on physiological and performance parameters of gymnastic athletes: a randomized, cross-over, sham-controlled study.

Professional sports performance relies critically on the interaction between the brain and muscles during movement. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique which modulates cortical excitability and can be used to improve motor performance in athletes. The present study aimed to investigate the effect of bilateral anodal tDCS (2 mA, 20 min) over the premotor cortex or cerebellum on motor and physiological functions and peak performance of professional gymnastics athletes. Seventeen professional gymnastics athletes participated in a randomized, sham-controlled, crossover study. In this study, we assessed the efficacy of two anodal tDCS protocols (2 mA, 20 min) with stimulation over the bilateral premotor cortex or cerebellum with the return electrodes placed over the opposite supraorbital areas. Power speed, strength coordination, endurance, static and dynamic strength, static and dynamic flexibility, and rating of perceived exertion were measured before and immediately after tDCS interventions (bilateral anodal tDCS over premotor cortices, anodal tDCS over the cerebellum, and sham tDCS). Additionally, physiological muscle performance parameters, including maximum voluntary isometric contraction (MVIC) of upper body muscles, were assessed during tDCS. Bilateral anodal tDCS over the premotor cortex, compared to anodal tDCS over the cerebellum and sham tDCS conditions, significantly improved power speed, strength coordination, and static and dynamic strength variables of professional gymnastics athletes. Furthermore, bilateral anodal tDCS over the cerebellum, compared to sham tDCS, significantly improved strength coordination. Moreover, bilateral premotor anodal tDCS significantly increased MVIC of all upper body muscles during stimulation, while anodal tDCS over the cerebellum increased MVIC in only some muscles. Bilateral anodal tDCS over the premotor cortex, and to a minor degree over the cerebellum, might be suited to improve some aspects of motor and physiological functions and peak performance levels of professional gymnastics athletes.Clinical Trial Registration ID: IRCT20180724040579N2.

Self-care behavior prevention of COVID-19 in the general population based on Pender Health Promotion Model: A cross-sectional study.

Background and Aims: Coronavirus with its sudden and widespread outbreak has obviously imposed devastating consequences in various aspects of human life. The purpose of this study was to determine the predictive value of Pender's Health Promotion Model (HPM) structures in self-care preventive behavior against coronavirus disease 2019 (COVID-19) among the general population of Ardabil, Iran. Methods: The present retrospective descriptive-correlational study was conducted on citizens of Ardabil aged 18 years and over in 2021. After dividing the city of Ardabil into four parts, 50 people from each area of the city and a total of 200 people were selected through the available sampling method through social media. Data collection tools included a demographic profile, perceived self-efficacy scale, perceived emotional questionnaire, perceived social support questionnaire, perceived benefits and barriers questionnaire, researcher-made COVID-19 self-care questionnaire, and commitment to action questionnaire based on Pender's HPM structures in an online manner. Data were analyzed by Amos 22 software and using structural equation modeling. Results: According to the results, direct path analysis to COVID-19 self-care behavior indicated that the variables of perceived self-efficacy (ß = 0.18, p < 0.01), interpersonal effects (ß = 0.19, p < 0.01), positive emotion (ß = 0.15, p < 0.05) and perceived benefits (ß = 0.20, p < 0.01) are able to significantly predict self-care behaviors. Moreover, the bootstrapping test results in the indirect path analysis demonstrated that the variables of perceived self-efficacy (95% confidence interval [CI], 0.012, 0.066), perceived social support (95% CI, 0.002, 0.026), and perceived barriers (95% CI, -0.019, -0.002) and benefits (95% CI, 0.001, 0. 015) through the mediator variable of commitment to action are able to significantly predict COVID-19 self-care behavior. Conclusions: Based on the findings of the present study, it can be claimed that the proposed model of COVID-19 self-care behavior has an acceptable fitness in the general population. This model can be used in developing educational programs and intervention techniques to modify people's attitudes and behaviors.

The Effects of Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex on Reduction of Craving in Daily and Social Smokers.

Objective: Tobacco smoking is an addictive behavior with many psychological side effects, and many smokers are unable to quit it. Despite various treatments for smoking cessation, there is an urgent need to develop and utilize a noninvasive technique with high efficacy. This study aimed to determine the effects of transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on reduction of craving in daily and social smokers. Method : This pretest-posttest quasi-experimental study, in which the participants were randomly assigned into sham and active groups, was performed on 40 daily and social smokers. Stimulation was delivered over the left DLPFC at a 2 m/A during 10 twenty-minute sessions for 5 weeks. The participants filled out the Desire for Drug questionnaire (DDQ) before and after intervention. Analysis of covariance was used for data analysis. Results: A significant decrease was found in the number of cigarette smoking in both daily and social smokers compared to the sham group. Moreover, the results indicated that anodal tDCS on F3 and Cathodal tDCS on F4 has significant effects on nicotine craving (P < 0/000). Conclusion: The results of the present study showed that the current tDCS of DLPFC decreases the craving of smoking. This noninvasive brain stimulation technique targeted at DLPFC area may be a promising method for reducing and treating smoking craving.