Repetitive transcranial magnetic stimulation for cognitive function in adults with bipolar disorder: A pilot study.

BACKGROUND: Cognitive deficits are prevalent in bipolar disorder and are a significant contributor to negative patient-reported outcomes. Herein we conducted a pilot study of repetitive transcranial magnetic stimulation (rTMS) to improve cognitive function in adults with bipolar disorder. METHODS: The study was a triple-blinded, randomized, placebo-control trial. Participants (aged 18 to 60) with a diagnosis of DSM-5-defined bipolar disorder (I or II) were recruited and randomized (N=36) to receive either a sham treatment (n=20) or an active rTMS treatment (n=16). Patients completed the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) at baseline and 1-2 weeks after the rTMS intervention. RESULTS: A significant group by time interaction was observed in the Hopkins Verbal Learning Test-Revised (HVLT-R), (F (1, 34) = 17.0, p < 0.001, partial η2 = 0.33). Post-hoc analysis revealed that although both groups did not significantly differ at baseline (p = 0.58), patients in the active rTMS group significantly improved following neurostimulation (p = 0.02) for HVLT-R. Moreover, within-subject analysis indicated that the active rTMS group significantly improved in score from pre-treatment to post-treatment (p < 0.001), while the sham group did not improve (p = 0.94) for HVLT-R. No significant differences were seen in the other cognitive measures. LIMITATIONS: The study was conducted in a small sample . CONCLUSION: This pilot study, which was intended to establish feasibility, suggests that rTMS may offer benefit in select domains of cognitive functioning in bipolar disorder. None of the measures across subdomains revealed a dyscognitive effect.

A Preliminary Study of Adjunctive Nonconvulsive Electrotherapy for Treatment-Refractory Depression.

Nonconvulsive electrotherapy (NET) defined as electrical brain stimulation administered like standard electroconvulsive therapy (ECT), but below seizure threshold, could be effective for patients with treatment-refractory depression (TRD) with fewer adverse neurocognitive outcomes. However, there is a lack of studies in Chinese patients with TRD. Thus, this study was conducted to examine the efficacy and safety of adjunctive NET for Chinese patients with TRD. Twenty TRD patients were enrolled and underwent six NET treatments. Depressive symptoms, response, and remission were assessed with the 17-item Hamilton Depression Rating Scale (HAMD-17) at baseline and after 1, 3, and 6 NET treatments. Neurocognitive function was assessed by the Wisconsin Card Sorting Test (WCST) at baseline and after the completion of six NET treatments. Mean HAMD-17 scores declined significantly from 26.2 to 10.4 (p < 0.001) after post-NET. The rates of response and remission were 60.0% (95% CI: 36.5-83.5) and 10.0% (95% CI: 0-24.4), respectively. Neurocognitive performance improved following a course of NET. No significant association was found between changes in depressive symptoms and baseline neurocognitive function. Adjunctive NET appeared to be effective for patients with TRD, without adverse neurocognitive effects. Randomized controlled studies were warranted to confirm these findings.

Serum BDNF Levels are Not Associated with the Antidepressant Effects of Nonconvulsive Electrotherapy.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of depression and in the antidepressant response. This study examined whether changes in serum BDNF levels are associated with the antidepressant effects of nonconvulsive electrotherapy (NET). METHODS: For BDNF analyses, serum samples were collected from 20 patients with treatment-refractory depression (TRD) and from 20 healthy controls. Serum samples were also collected from patients following a course of NET. RESULTS: Although significantly lower baseline serum BDNF levels were observed in TRD patients than in healthy controls, no changes in serum BDNF levels were found in TRD patients after a course of NET compared to baseline. No significant association was found between serum BDNF levels and depression severity. CONCLUSION: Serum BDNF levels appear to have no clinical utility in the prediction of the antidepressant effects of NET in patients with TRD. Future studies of higher quality and with larger sample sizes are needed to confirm these findings.

Mental health effects caused by red imported fire ant attacks (Solenopsis invicta).

Susceptible individuals who have suffered painful stings caused by red imported fire ants, Solenopsis invicta, usually experience physical health effects such as fever, dizziness, generalized urticaria, or other systemic reactions such as anaphylactic shock. Whether S. invicta stings also have negative effects on mental health is not clear. In the present study, the psychological impact of S. invicta stings was evaluated using a questionnaire that included a previously published posttraumatic stress disorder (PTSD) checklist, the Patient Health Questionnaire 9-item (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Beck Anxiety Inventory (BAI), and the Pittsburgh Sleep Quality Index, 5th scale (PSQI(5)). A total of 96 valid questionnaires were obtained; 37 participants were placed in the stung group, and 59 participants were placed in the unstung group. Our results showed that symptoms of anxiety, depression and sleep disturbances were not associated with S. invicta stings (for GAD-7 scale, Pearson Chi-Square test, χ2 = 0.152, df = 1, P = 0.697; for the BAI, χ2 = 2.252, df = 1, P = 0.133; for the PHQ-9, χ2 = 0.098, df = 1, P = 0.754; for the PSQI(5), χ2 = 0.536, df = 1, P = 0.453). In total, 2 of 83 individuals stung by S. invicta met the criteria (>50) for PTSD. However, there was no significant difference on PTSD between those stung by S. invicta in the 30-day group and the over 30-day group (χ2 = 0.318, df = 1, P = 0.573). Overall, our data do not show an effect of S. invicta stings on mental health as measured using a range of indicators.