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2 results

  • Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study

  • Aniruddha Mukherjee, Pramod Kumar Kumre, Nishant Goyal, Sourav Khanra
  • Journal:
    CNS Spectrums / Volume 28 / Issue 4 / August 2023
    Published online by Cambridge University Press:
    05 September 2022, pp. 495-504
  • Background

    Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD.

    Objective

    This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD.

    Methods

    A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale–Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8.

    Results

    A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group.

    Conclusions

    Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.

  • Chapter 8 - Legal and Ethical Issues in ASPD and Psychopathy

  • Richard Howard, University of Nottingham, Conor Duggan, University of Nottingham
  • Book:
    Antisocial Personality
    Published online:
    20 January 2022
    Print publication:
    03 February 2022, pp 125-142

  • Summary

    Here, we explore the thorny issue of the involuntary detention of those with ASPD (and those with psychopathic traits) for treatment. We use, as a frame, the recent history in the United Kingdom of attitudes using the changes in the legal designation of ‘psychopathic disorder’ whereby such individuals might be so detained. As there is undeniable evidence that those with the legal designation of psychopathic disorder are at higher risk of re-offending after discharge, psychiatrists were reluctant to admit them for treatment. This filtered down to the community so that those with a PD label were denied treatment. Faced with this dilemma, the government introduced the DSPD programme, whose rationale was underpinned by a defensible notion of both risk and treatability. We believe that, given the wide margin of error associated with both risk estimation and the efficacy of treatment (especially if the latter is imposed rather than consented to), this was unlikely to have a good outcome, and so it proved. We propose an alternative whereby sentencing and treatment of those with PD if convicted are uncoupled, thereby preserving a cordon sanitaire between the custodial and therapeutic realms.