The manuscript calls for establishing a standard for electroconvulsive devices by manufacturers for better regulation in India. This is most relevant in the context of two recent developments, (a) ...Notification of medical devices rules, 2017 with classification of ECT as Class C and (b) Recent change in classification of ECT devices by US-FDA in 2018. The establishment of standards would help in upregulating the standard of ECT devices as well as ECT practices.
•Non-invasive brain stimulation to treat persistent delusions is an under-researched area.•transcranial alternating current stimulation (tACS) (10-Hz) has the potential to alleviate persistent ...delusions.•Add-on tACS targeting the midline cortical structures was administered in schizophrenia patients (N=12) with persistent delusions.•A significant reduction in the severity of delusions was noted following tACS.•10-Hz tACS for treating persistent delusions needs further systematic research.
The utility of non-invasive brain stimulation techniques to alleviate resistant delusions in schizophrenia is an under-researched area. In this study, we report the effectiveness of alpha transcranial alternating current stimulation (tACS) targeting the medial prefrontal cortex in ameliorating persistent delusions. Twelve Schizophrenia patients (N=12) with persistent delusions received add-on treatment with a twice-daily 20-minutes session of 10-Hz tACS. Significant reduction in severity of delusion was noted after 5th day (z=2.67, p<0.01, n=12) with further improvement after 10th day (z=2.52, p=0.01, n=9) of stimulation. Add-on treatment with 10-Hz tACS is a potential therapeutic option for treatment-resistant delusions, which requires further systematic research.
The human gut microbiome regulates brain function through the microbiome-gut-brain axis and is implicated in several neuropsychiatric disorders. However, the relationship between the gut microbiome ...and the pathogenesis of schizophrenia (SCZ) is poorly defined, and very few studies have examined the effect of antipsychotic treatment response. We aim to study the differences in the gut microbiota among drug-naïve (DN SCZ) and risperidone-treated SCZ patients (RISP SCZ), compared to healthy controls (HCs). We recruited a total of 60 participants, from the clinical services of a large neuropsychiatric hospital, which included DN SCZ, RISP SCZ and HCs (n = 20 each). Fecal samples were analyzed using 16s rRNA sequencing in this cross-sectional study. No significant differences were found in taxa richness (alpha diversity) but microbial composition differed between SCZ patients (both DN and RISP) and HCs (PERMANOVA, p = 0.02). Linear Discriminant Analysis Effect Size (LEfSe) and Random Forest model identified the top six genera, which significantly differed in abundance between the study groups. A specific genus-level microbial panel of Ruminococcus, UCG005, Clostridium_sensu_stricto_1 and Bifidobacterium could discriminate SCZ patients from HCs with an area under the curve (AUC) of 0.79, HCs vs DN SCZ (AUC: 0.68), HCs vs RISP SCZ (AUC: 0.93) and DN SCZ vs RISP SCZ (AUC: 0.87). Our study identified distinct microbial signatures that could aid in the differentiation of DN SCZ, RISP SCZ, and HCs. Our findings contribute to a better understanding of the role of the gut microbiome in SCZ pathophysiology and suggest potential targeted interventions.
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•Routine clinical care without objective assessments leads to poor treatment outcomes in schizophrenia patients.•Time constraints and additional work burden are cited as barriers in implementing ...measurement based care (MBC).•Using the brief versions of standard rating scale might be a feasible step in integrating MBC with routine clinical care.
Measurement based care (MBC) implies the utilization of structured objective scales/batteries in the assessment and monitoring of an illness. Patients with schizophrenia with heterogeneous presentation would potentially benefit better through MBC. Time constraints and additional work burden are frequently cited as barriers in implementing objective assessments. In this selective review, the authors discuss the available standard scales for assessment in schizophrenia, the advantages and disadvantages in implementing MBC and a feasible approach to overcome the barriers by adapting shorter versions of structured scales.
Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation technique that is explored as an add-on treatment for the alleviation of symptoms across the diverse symptom ...domains in neuropsychiatric disorders. In psychiatry, data is emerging on the effects of tDCS as an add-on treatment in schizophrenia as well as obsessive-compulsive disorder (OCD). But despite high prevalence, the effectiveness of tDCS in co-morbid schizophrenia and OCD is lacking. This case report for the first time examines the clinical utility with target-specific effects of the add-on tDCS in a patient diagnosed with schizo-obsessive disorder.
A major challenge in Transcranial Magnetic Stimulation trials is that of an inefficient sham protocol. This could potentially amplify the gap in behavioral outcomes following true and control ...treatments. Intermediate theta-burst stimulation (imTBS) is a promising sham alternative since it uses actual TMS pulses, thus mimicking the sensory effects of stimulation without producing physiological aftereffects. Here, we critically review controlled experiments that have examined physiological and behavioral aftereffects following imTBS with the intention to further investigate what appears to be a promising sham control modality for TBS studies.
•Sham stimulation in TMS trials is challenging owing to difficulties in blinding.•Intermediate theta-burst stimulation (imTBS) is a potential sham alternative for TMS trials.•Our review highlights behavioral and neurophysiological after-effects of imTBS.•Five out of nine studies support its feasibility as sham.•Small sample sizes limit our inferences.
Non-invasive brain stimulation techniques such as conventional transcranial direct current stimulation (tDCS) and high definition tDCS (HD-tDCS) are increasingly being used as add-on treatment ...options in schizophrenia and obsessive-compulsive disorder (OCD). This is reporting of the use of a novel accelerated, symptom-specific, add-on tDCS (combining conventional and high definition) protocol in a patient with both schizophrenia and OCD. The intervention showed clinical utility by reducing both schizophrenia and OCD symptoms.
•False alarms had significant positive correlation with auditory hallucinations in schizophrenia.•Discriminability index had significant negative correlation with auditory hallucinations.•Auditory ...signal detection is associated with auditory hallucinations in schizophrenia.•Single-session tDCS did not have significant effect on auditory signal detection in patients.
: Transcranial Direct Current Stimulation (tDCS) has been beneficial for treating auditory verbal hallucinations (AVH) in schizophrenia (SZ). Aberrant auditory signal detection (ASD) is one of the pathogenetic mechanisms for AVH. We investigated the correlates of ASD with AVH and the impact of single-session tDCS on ASD in SZ patients.
: The ASD performance in SZ patients was compared with matched healthy controls (HC) (N = 24). Subsequently, the effect of single-session tDCS on ASD in SZ patients (N = 24) with AVH was examined in a randomized, double-blind, sham-controlled, cross-over design. The true and sham tDCS were administered (anode at the left dorsolateral prefrontal cortex and cathode at the left temporoparietal junction) on two different days. ASD task was performed before and after each session of tDCS.
: Auditory hallucination rating scores correlated significantly with false alarm rate, discriminability index, and response bias. SZ patients had a significantly lesser discriminability index in ASD than HC. Single-session tDCS (true versus sham) did not have any significant effect on ASD in SZ patients.
: The study findings support the pathogenetic role of ASD in AVH in SZ. Lack of effect on ASD following single-session tDCS suggests the need for multi-session studies in the future.
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