No abstract

Background:Repetitive transcranial magnetic stimulation has been explored in patients with obsessive-compulsive disorder, but with negative or conflicting results. This randomized double-blind study was designed to assess the efficacy of 1-Hz repetitive transcranial magnetic stimulation over the presupplementary area.Methods:Forty medication-resistant patients were assigned to 4 weeks of either active or sham repetitive transcranial magnetic stimulation targeting the presupplementary area with the help of a neuronavigation system.Results:According to the Yale-Brown obsessive-compulsive scale, the baseline-week 4 evolution showed no significant differences between groups. Responder rates at week 4 were not different between groups (repetitive transcranial magnetic stimulation 10.5% vs sham 20%; P=.63).Conclusion:Low-frequency repetitive transcranial magnetic stimulation applied to the presupplementary area seems ineffective for the treatment of obsessive-compulsive disorder patients, at least in severe and drug-refractory cases such as those included in this study. Further research is required to determine profiles of responder patients and appropriate repetitive transcranial magnetic stimulation parameters for obsessive-compulsive disorder.

This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients.

A previous study by Nock et al. (2010) suggested that people’s implicit identification with “death” or “suicide” can accurately predict whether they will attempt suicide several months in advance. We report the first direct and independent replication of this promising finding. Participants were 165 patients seeking treatment at a psychiatric unit in France. At baseline, patients completed the Suicide–Implicit Association Test (S–IAT), a semistructured interview, and a self-report measure of suicide ideation. Six months later, we contacted participants by phone and examined their hospital medical records to determine whether they had made a new suicide attempt. Results showed that the S–IAT did not distinguish between patients who were admitted to the hospital following suicide attempts and those who were admitted for other reasons. As in the original study, however, the S–IAT predicted suicide attempts within the 6-month follow-up period beyond well-known predictors. The test correctly classified 85% of patients (95% confidence interval = [76.91, 91.53]), supporting its diagnostic value for identifying who will make a suicide attempt.

Obsessive-Compulsive Disorder (OCD) is characterized by intrusive, anxious thoughts with repetitive, ritualized behaviors, and has negative impacts on family relationships and social life. Its lifetime prevalence is estimated to be 2-3% [1]. Cognitive and behavioral therapy and selective serotonin reuptake inhibitors are the standard treatments for OCD; nevertheless, despite these treatments, between 25 and 40% of patients display persistent symptoms leading to severe functional disability [2]. Neurosurgical treatment targeting different parts of the orbito-fronto-striato-thalamo-cortical circuit has been proposed for the most severe and refractory forms, including both gamma knife non-invasive stereotactic lesions and invasive deep brain stimulation (DBS) [3] (Supplementary Information). However, the longterm efficacy (> 3 years) and safety of DBS for OCD is not fully reported. We prospectively followed 14 OCD patients treated with subthalamic DBS (STN-DBS, STOC study) for 46 months [4] (ClinicalTrials.gov Number: NCT00169377) (Supplementary Information). The primary outcome was the change in the total Yale Brown Obsessive Compulsive Scale (Y-BOCS) score between inclusion (baseline) and month 46 with STN-DBS, or month 34 in the case of missing data at month 46 (Supplementary Figure 1). We also assessed others psychiatric symptoms, global functioning and tolerance (Supplementary Information) [4].Twelve patients completed the follow-up study ( Supplementary Figure 1). The Y-BOCS total score between inclusion (baseline) and the end of the follow up period showed a median decrease of 15.5 points (IQR=-31 to -6), with a median change of 50% (IQR=-86.1 to -19.4%, Table 1). At the final follow-up, 11 patients (92%) were considered at least partial responders (>25% of Y-BOCS decrease) and 9 (75%) full responders (>35% of Y-BOCS decrease) ( Table 1). The Y-BOCS score was also significantly improved at month 46 compared to month 16 (Table 1) and decreased by an average of 1 (SE=.04) point per year between month 16 and month 46 (Time effect p=0.027, Supplementary Figure 2). At the end 4 of the follow-up period (month 46), the compulsion, obsession, anxiety and depression scores, but also global functioning and social and family life subscores were significantly improved ( Supplementary Table 1). We found a significant positive relationship between the severity of OCD at month 46 and the age at onset (r=0.61, p=0.045, Supplementary Figure 3) with early onset patients having fewer OCD symptoms with STN stimulation. During the follow-up, the medication had not changed significantly (not shown) but stimulation voltage was significantly increased (p=0.042, Supplementary Table 2). Twenty-three serious adverse events occurred, 5 being transient and related to STN-DBS (hypomania, impulsivity, dysarthria or fall) and 18 related to the disease (increased anxiety and obsessive and compulsive symptoms, and major depressive episodes with suicide attempts, Supplementary Table 3). Our results show that STN-DBS can effectively treat OCD...

Research has suggested that implicit identification with death/suicide can accuratelypredict a suicide attempt several months in advance (Nock et al., 2010). We report thefirst direct and independent replication of this promising finding. Participants included165 patients seeking treatment at a psychiatric unit in France. At baseline, patientscompleted the Suicide-Implicit Association Test (S-IAT), a semistructured interview,and a self-report measure of suicide ideation. Six months later, we contacted the patientsby phone and examined their hospital medical records, to determine whether they hadmade a new suicide attempt. Results showed that the S-IAT did not discriminatepatients who presented for suicide attempts (vs. other reasons). As in the original study,however, the S-IAT predicted suicide attempts within the 6-month follow-up periodbeyond well-known predictors. The test correctly classified 85% of patients, 95% CI[76.91, 91.53], supporting its diagnostic value for identifying who will make a futuresuicide attempt.

No abstract

Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessivecompulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuospatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.