Transcranial Direct Current Stimulation for the Treatment of Depression: a Comprehensive Review of the Recent Advances

Preclinical and clinical studies have shown promising therapeutic effects of tDCS for treatment of depressive disorders (DDs). However, the clinical applications of the technique are in still in the initial phase. This paper aims to review the therapeutic applications of tDCS for the treatment of DDs, to discuss its safety, and current clinical challenges of the technique. The databases of PubMed (1985–2016), EMBASE (1980–2016), Web of Sciences (1980–2016), and Google Scholar (1980–2016) were searched using the search terms “transcranial direct current stimulation” or “tDCS”, “depressive disorder” or “DD”, “depression”, “safety”, “clinical application”, and “treatment”. Current evidence shows tDCS is effective in reducing depressive symptoms. In addition to the potential clinical utility and minimal adverse-effects of tDCS, it appears to improve cognitive performance. Furthermore, the interesting clinical importance of tDCS is its therapeutic efficacy for both treatment-resistant and non-treatment-resistant patients with mild to moderate depression. tDCS has been reportedly associated with no serious adverse effects with the most frequent adverse effects being headaches, itchiness, and redness at the site of stimulation.     

The Interpersonal Legacy of Chestnut Lodge

This article addresses the context in which Chestnut Lodge Sanatorium evolved its legendary status. Early years of interpersonal psychoanalysis (1920s–1950s) locate the Washington, DC, and Baltimore areas as crucial contexts, both for the professional support they provided to the beginnings of an interpersonal viewpoint, and for the derisive, dismissive attitudes targeting the early proponents of the interpersonal perspective. Chestnut Lodge and the developing White Institute evolved along parallel organizational lines. The development of a compatible clinical sensibility is noted, conceptually linking those identifying as “interpersonal.” Both organizations (“The Lodge” and “White”) share a common intellectual ancestry and a comparable approach to clinical technique. Likewise, both organizations share an emphasis on rejecting dogma and managing to resist organizational pressures in favor of nonconformity and defiance of rigidity. Both organizations are shaped by theorists who are drawn to work intensively with “difficult” patients, as well as with facing powerful personal and political challenges and credible threats of professional exclusion.     

Histrionic Personality and Antisocial Personality: Caricatures of stereotypes?

The proposal that the diagnoses Histrionic personality and Antisocial Personality represent sex-role caricatures of the concepts “woman” and “man”, respectively, was examined utilizing the semantic differential technique for the assessment of connotative meanings. Twenty-eight psychiatric residents and 21 academic psychiatrists rated the concepts “woman”, “man”, “histrionic personality”, and “antisocial personality” on each of 15 bipolar adjectival scales. No important differences were found between the ratings made by male or female psychiatrists or by resident and faculty psychiatrists. The subjects clearly distinguished between the connotative meanings of “woman” and “histrionic personality” and between “man” and “antisocial personality”, though there was a greater resemblance between the first pair of concepts than between the second. The linkages in meaning between women and the diagnosis Histrinic Personality are discussed, and it is proposed that the concept of sex-role caricatures be abandoned since the political overtones of the term “caricature” tend to undermine the empirical work needed to validate or reject clinical diagnoses.     

Culture and Psychoanalysis

Abstract. This article explores ghosts–-defined as internalizations gone awry and experienced as inchoate absent presences–-that haunt our patients and that can be profoundly disruptive to clinical process. The case of a patient whose traumatic “ghosts” communicated by way of the bodies of both patient and analyst, via a process the author calls “interpsychic-intersomatic” transmission, is presented and linked to theory. How the analyst's personal ghosts became involved with those of the patient, in both facilitating and interfering ways, is also illustrated. Some of the clinical challenges of “laying ghosts to rest as ancestors” (Loewald, 1960/2000b) are explored.     

Dream as Transaction: An Exercise in Interpersonal Theory

The author explores the multiple meanings for her of analyst disclosures and the application of a fixed analytic frame. She challenges the idea that most analytic rules, outside of the context of a particular and ever-changing clinical situation, can universally hold true. She believes that questions pertaining to “right” and “wrong” are, perhaps, an inapt line of inquiry in this regard. Drawing material from reflections on her own developmental history in relation to disclosure and risk, as these factors play out in the dyadic interactions of a particular, out-of-the-ordinary, highly charged clinical case, she highlights a distinction between a potentially inappropriate application of generic analytic “rules” and a necessary steadying personal connection with a hierarchy of ethical principles.     

Is Anticonvulsant Treatment of Mania a Class Effect? Data from Randomized Clinical Trials

Our aim was to evaluate the efficacy and tolerability of anticonvulsant agents for the treatment of acute bipolar mania and ascertain if their effects on mania are a “class” effect. We conducted a systematic review of randomized controlled trials (RCTs) with placebo or active comparator, in acute bipolar mania in order to summarize available data on anticonvulsant treatment of mania/mixed episodes. We searched (PubMed/MEDLINE) with the combination of the words “acute mania” and “clinical trials” with each one of the following words: “anticonvulsants/antiepileptics,”“valproic/valproate/divalproex,”“carbamazepine,”“oxcarbazepine,”“lamotrigine,”“gabapentin,”“topiramate,”“phenytoin,”“zonisamide,”“retigabine,”“pregabalin,”“tiagabine,”“levetiracetam,”“licarbazepine,”“felbamate,” and “vigabatrin.” Original articles were found until November 1, 2008. Data from 35 randomized clinical trials suggested that not all anticonvulsants are efficacious for the treatment of acute mania. Valproate showed greater efficacy in reducing manic symptoms, with response rates around 50% compared to a placebo effect of 20–30%. It appears to have a more robust antimanic effect than lithium in rapid cycling and mixed episodes. As valproate, the antimanic effects of carbamazepine have been demonstrated. Evidences did not support the efficacy of the gabapentin, topiramate as well as lamotrigine as monotherapy in acute mania and mixed episodes. Oxcarbazepine data are inconclusive and data regarding other anticonvulsants are not available. Anticonvulsants are not a class when treating mania. While valproate and carbamazepine are significantly more effective than placebo, gabapentin, topiramate, and lamotrigine are not. However, some anticonvulsants may be efficacious in treating some psychiatric comorbidities that are commonly associated to bipolar illness.     

Supported decision making for people with mental health disorders in clinical practice: a systematic review

Abstract

Objectives: The Convention on the Rights of Persons with Disabilities (CRPD) was adopted at the United Nations Assembly in 2006. The main aim of the convention is to ensure equal rights for people with disabilities including the expression of people’s own “will and preferences” concerning health treatment. Article 12 demands the respect of a person’s “rights, will and preferences” (CRPD) and suggests supported decision making (SDM) when possible. The aim of this review was to gather information regarding the SDM implementation from a clinical perspective for people with mental health disorders.

Methods: A systematic literature search was performed on electronic databases MEDLINE, PsycARTICLES, and PsycINFO using the keywords “supported decision making” and “UN convention on the rights of persons with disabilities” in March 2018.

Results: Eleven articles were included in the final review, which focussed on three themes: (1) different models of SDM, (2) stakeholder views, and (3) challenges for implementation. A limited number of papers described clinical models that had good theoretical consistency with SDM. The main challenges of implementation related to critical situations when “will and preferences” are poorly understood or appear contradictory. Future studies should assess specific models of SDM implementation, including related outcomes and process measures.     

Challenges in detecting disease modification in Parkinson's disease clinical trials

Despite the wealth of encouraging data from numerous compounds that demonstrate “neuroprotection” in pre-clinical studies of Parkinson's disease, and despite numerous clinical trials, to date, no intervention has been demonstrated to able to modify the course of disease progression. While this “failure to translate” is likely due to numerous factors including our incomplete understanding of the pathogenic mechanisms underlying PD together with excessive reliance on data from the toxin-based animal models of PD, here we will discuss the “structural issues” pertaining to inadequate clinical trial design, selection of inappropriate endpoints and poor patient selection which are often not addressed following failed disease modification trials. Future directions to overcome these challenges such as reducing the heterogeneity of patient cohorts, identifying and utilising a pre-diagnostic population, embracing a personalised medicine approach and utilising novel trial designs may be required to ultimately fulfil the goal of conclusively demonstrating evidence of disease modification.     

Sexotic therapy: embracing the exotic,irrational and paradoxical experience of living and loving

This paper seeks to shed light on an extraordinary therapeutic approach that I refer to as “exotic sex therapy” or “sexotic therapy”. This approach originated out of my fascination with the irrational aspects of the “living and loving” experience, developed through my understandings of the scientific and non-scientific literature (particularly Persian love poetry) in this regard, and established through my clinical work. Central to sexotic therapy is a conceptual framework that acknowledges and celebrates the erotic life as a complex, ambiguous, exotic and paradoxical journey. It recognises the inherent challenges and paradoxes of maintaining a balanced passionate and intimate long-term relationship and invites embracing obstacles as potentially constructive and excitement enhancing. In this paper, I start with sharing my experiences and understandings of the relevant literature in Part One, proceed with some clinical discussions in Part Two, and finish by illustrating sexotic therapy with a case study in Part Three.     

Les « Drive for » dans la dysmorphie musculaire : critique de la littérature internationale

IntroductionCurrent differences about muscle dysmorphia nosography belonging have led to new researches. Which where plural and rich concepts on development of muscle dysmorphia and associate factors. Despite its categorization among DSM-5 as specific body disorder, a transnosographic determinant to eating behavior disorder and body images is used as a decisive diagnostic criteria or whether comorbidly. “Drive for” also known as a successful way to express inherent motivations with the aim to fit society standards.MethodologyBased on Prisma methodology and keywords: “muscle dysmorphia”, “Drive for”, “Drive for Muscularity”, “Drive for Thinness”, “Drive for Leanness”, “Drive for Size”, “Dive for Power”, “Drive for Tone”, “Drive for Bulk”, we had studied bibliographic databases Cochrane, Ebsco, PsycInfo, Pubmed, Science Direct, Web of science between 1993 and 2018.ResultsWe have selected 58 articles about these subjects. Studies analysis have led to show significant links between muscle dysmorphia and the “Drive for” there selves. It seems relevant to consider the “Drive for” as roots of muscle dysmophia, and around which they are factors that will define each symptomatical expression. However, some “Drive for” are showcases faces to others. These have reduced the way muscle dysmorphia should be considered as a nosography entity, in which we can identify specificities influenced by one or another “Drive for”.DiscussionFollowing our work some questions have emerged. After showing a rightful position on current research about muscle dysmorphia regarding its nosography belonging. Regarding the importance to re-examine muscle dysmorphia subcategories we should include “Drive for” influence. It can be useful information to identify early signs appearance but also starting to developed specific treatment for each type of “Drive for” meeting through clinical approach.     

Observations on the synaptic organization of the retina of the albino rat: a light and electron microscopic study

An electron microscopic study of the retina of the albino rat, with particular emphasis on the synaptic organization of the inner and outer plexiform layers, has been correlated with specimens impregnated with a modified Golgi technique. The central element of the photoreceptor “triad” in the outer plexiform layer is a bipolar cell dendrite. Two types of synaptic contacts were observed in the inner plexiform layer, the “dyad” ribbon synapse and the conventional synapse. The postsynaptic elements of the “dyad” consisted of an amacrine process and a ganglion cell dendrite. Conventional synapses were made by amacrine processes which were usually presynaptic to bipolar terminals. Reciprocal synapses between processes making ribbon synapses and those making conventional synapses were seen. Golgi technique revealed the presence of two types of bipolar cells, three types of amacrine cells, and one type each of horizontal and ganglion cell. These findings are discussed in relation to reported receptive field organization.     

Defining biotypes for depression and anxiety based on large-scale circuit dysfunction: a theoretical review of the evidence and future directions for clinical translation

Complex emotional, cognitive and self-reflective functions rely on the activation and connectivity of large-scale neural circuits. These circuits offer a relevant scale of focus for conceptualizing a taxonomy for depression and anxiety based on specific profiles (or biotypes) of neural circuit dysfunction. Here, the theoretical review first outlines the current consensus as to what constitutes the organization of large-scale circuits in the human brain identified using parcellation and meta-analysis. The focus is on neural circuits implicated in resting reflection (default mode), detection of “salience,” affective processing (“threat” and “reward”), “attention,” and “cognitive control.” Next, the current evidence regarding which type of dysfunctions in these circuits characterize depression and anxiety disorders is reviewed, with an emphasis on published meta-analyses and reviews of circuit dysfunctions that have been identified in at least two well-powered case:control studies. Grounded in the review of these topics, a conceptual framework is proposed for considering neural circuit-defined “biotypes.” In this framework, biotypes are defined by profiles of extent of dysfunction on each large-scale circuit. The clinical implications of a biotype approach for guiding classification and treatment of depression and anxiety is considered. Future research directions will develop the validity and clinical utility of a neural circuit biotype model that spans diagnostic categories and helps to translate neuroscience into clinical practice in the real world.     

A novel method for systematic analysis of rigidity in Parkinson's disease

We propose a novel system that analyzes the components of rigidity in Parkinson's disease (PD) usually perceived by physicians, in a very simple and systematic way for routine clinical practice. Our system is composed of two compact force sensors, a gyroscope, and EMG surface electrodes. Muscle tone was assessed in 24 healthy elderly subjects and 27 PD patients by passive extension and flexion of the elbow joint with ramp‐and‐hold trajectory. Torque and angle data in the dynamic phase were used to calculate “elastic coefficients” in extension and flexion, and the mean value of torque in each dynamic phase at each joint angle (defined as “Bias”) was also calculated. The muscle activity index in the static phase (EMG Index) was obtained for both biceps brachii (BB) and triceps brachii (TB) muscles. “Elastic coefficients,” sum of the “difference of Bias” and “EMG Index” for BB all correlated well with UPDRS score. Based on our results, Parkinsonian rigidity consists of both an “elastic” component and a “difference of Bias” component, and neurologists may assess greater rigidity when either one or both components are high in value. The EMG index was useful for differentiating PD patients with slight rigidity from healthy elderly adults. © 2009 Movement Disorder Society     

A qualitative investigation of the nature of “informal supervision” among therapists in training

Objective: This study investigated how, when, why, and with whom therapists in training utilize “informal supervision”—that is, engage individuals who are not their formally assigned supervisors in significant conversations about their clinical work. Method: Participants were 16 doctoral trainees in clinical and counseling psychology programs. Semi-structured interviews were conducted and analyzed using the Consensual Qualitative Research (CQR) method. Results: Seven domains emerged from the analysis, indicating that, in general, participants believe that informal and formal supervision offer many of the same benefits, including validation, support, and reassurance; freedom and safety to discuss doubts, anxieties, strong personal reactions to patients, clinical mistakes and challenges; and alternative approaches to clinical interventions. However, several differences also emerged between these modes of learning—for example, formal supervision is seen as more focused on didactics per se (“what to do”), whereas informal supervision is seen as providing more of a “holding environment.” Conclusions: Overall, the findings of this study suggest that informal supervision is an important and valuable adjunctive practice by which clinical trainees augment their professional competencies. Recommendations are proposed for clinical practice and training, including the need to further specify the ethical boundaries of this unique and essentially unregulated type of supervision.

Clinical or Methodological Significance of this article: This is the first study to detail the wide-ranging uses and impact of “informal supervision,” with significant clinical implications for psychotherapy training, education, and development, including a proposal for legitimizing and integrating informal supervisory practice into doctoral training programs, and an important discussion of ethics. Thus, this paper highlights the diverse range of important ways that trainees use “informal supervision” throughout their training to enhance their clinical and professional development. Results of our study show that “informal supervision” is a ubiquitous and often secretive practice that is a valuable complement to, rather than replacement for, formal supervision. Several important differences between these modes of learning (formal versus informal supervision) are also discussed.     

Parentification and Related Processes: Distinction and Implications for Clinical Practice

ABSTRACT

With the emergence of what can be called “new families,” the place and the role of the child are increasingly questioned. If a child helps a parent or takes care of them, the terms “parentified child,” “parental child,” or “adult child” are used equally. However, these concepts hide different processes that have different impacts on the child’s development. In the present article, based on the current doctoral research and clinical practice experience, the author will try to make the distinction between these concepts and to illustrate them. By a better identification of each process the author is convinced that therapists and social workers can be helped in their interventions with children and their families.     

Caregivers’ perception of factors associated with a healthy diet among people with intellectual disability living in community residences: A Concept mapping method

BackgroundMany people with intellectual disabilities (ID) living in community-based residences have been found to have unhealthy diet and weight disturbances. In Norway, a majority of people with ID live in such residences.AimsThe aim of the study was to examine factors affecting the caregivers’ opportunity to promote a healthy diet among the residents.Methods and proceduresA concept mapping methodology was adopted, including group-based brainstorming, idea synthesising, sorting, rating and analysis of the results. Informants were caregivers in four different community residences for people with mild to moderate ID in the southeast of Norway. A total of 13 informants were recruited (12 females and 1 male), and 10 informants completed two sessions.ResultsEight clusters were identified as affecting the caregivers’ ability to promote a healthy diet: “Availability and accessibility”, “Guidance and autonomy”, “Competence among staff”, “Planning and involvement”, “Customization”, “External conditions affecting staff”, “Legislation, rules and structure” and “Everyday challenges”, each including both barriers and facilitators.Conclusions and implicationsMultiple factors affect the caregivers’ ability to promote a healthy diet. Caregivers’ opportunity to promote a healthy diet is complex. Availability and accessibility of healthy food is crucial, but a healthy diet also requires time and competence among the caregivers.     

Frontal versus dysexecutive syndromes: relevance of an interactionist approach in a case series of patients with prefrontal lobe damage

The concepts of “frontal” and “dysexecutive” syndromes are still a matter of debate in the literature. These terms are often used interchangeably but can be distinguished when considering specific frontal behavioural deficits which occur during social interaction. Despite being of interest for the clinical assessment and care management of patients with anterior brain damage, few studies have tried to disentangle the specificity of each syndrome. We report the case of eight patients with frontal lobe damage who were assigned to one of two groups based on whether or not they showed a dysexecutive syndrome. The nondysexecutive group differed from the dysexecutive group in showing environmental dependency phenomena, behavioural disorders triggered by social interaction. By adopting an interactionist perspective, this pilot study contributes to defining more precisely the distinction between “frontal” and “dysexecutive” syndromes. The discussion focuses on the potential interest of the interactionist approach in designing appropriate methodologies of assessment and rehabilitation of patients with frontal lobe syndrome.     

Evidence‐based guidelines for interpretation of the Panic Disorder Severity Scale

Background: The Panic Disorder Severity Scale (PDSS) is promising to be a standard global rating scale for panic disorder. In order for a clinical scale to be useful, we need a guideline for interpreting its scores and their changes, and for defining clinical change points such as response and remission. Methods: We used individual patient data from two large randomized controlled trials of panic disorder (total n=568). Study participants were administered the PDSS and the Clinical Global Impression (CGI)—Severity and —Improvement. We applied equipercentile linking technique to draw correspondences between PDSS and CGI‐Severity, numeric changes in PDSS and CGI‐Improvement, and percent changes in PDSS and CGI‐Improvement. Results: The interpretation of the PDSS total score differed according to the presence or absence of agoraphobia. When the patients were not agoraphobic, score ranges 0–1 corresponded with “Normal,” 2–5 with “Borderline,” 6–9 with “Slightly ill,” 10–13 with “Moderately ill,” and 14 and above with “Markedly ill.” When the patients were agoraphobic, score ranges 3–7 meant “Borderline ill,” 8–10 “Slightly ill,” 11–15 “Moderately ill,” and 16 and above “Markedly ill.” The relationship between PDSS change and CGI‐Improvement was more linear when measured as percentile change than as numeric changes, and was indistinguishable for those with or without agoraphobia. The decrease by 75–100% was considered “Very much improved,” that by 40–74% “Much improved,” and that by 10–39% “Minimally improved.” Conclusion: We propose that “remission” of panic disorder be defined by PDSS scores of five or less and its “response” by 40% or greater reduction. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

L’hypnose,expérience ecmnésique,ou l’ecmnésie,expérience hypnotique ?

Hypnosis is a therapeutic tool which accompanies medicine since always, in varied forms. One of its characteristics is the core use associated with a technique with induction, which produces a “reviviscence” of the memory different from a simple “Re-memorizing”. This experiment is carried by the neurological phenomenon of synesthesia. A clinical example illustrates this proposal.     

A Useful Electrophysiologic Test For Diagnosis Of Minimal Conduction Block

The concept of motor nerve conduction block has gained more importance with the identification of new disease entities. In fact, the presence of motor conduction block greatly influences the diagnostic and therapeutical approach of neuropathies. In spite of the generally good sensitivity of the conventional nerve conduction evaluation, normal findings are still observed in a number of patients with clinical data strongly suggesting the presence of conduction block. We have developed a simple technique for the detection of conduction block by using SFEMG electrode. This test is based on the concept that from stimulation proximal and distal to a partial conduction block, several registrations from few muscle fibers could show some “blocked” fibers (innervated by “blocked” axons). To evaluate the usefulness, sensitivity and specificity of a new neurophysiological test for partial conduction block we studied 17 patients (17 nerves) with clinical picture strongly suggesting the presence of motor conduction block and 20 healthy subjects (40 nerves). Motor nerve conduction studies were performed with conventional surface technique and with the new technique we developed. Moreover, we also evaluated patients with other neurological diseases. According to recent AAEM consensus criteria, 5/17 cases presented “definite” partial conduction block and 6 presented “probable” partial conduction block. In contrast, 16/17 cases (94%) presented an evidence of conduction block at SFEMG conduction block test. The 5/6 cases that were not filled in the AAEM criteria and that presented abnormal findings at SFEMG nerve conduction test could be considered affected by “minimal conduction block.” The sensitivity of this new test was greater than the conventional test. The specificity was 100% (no abnormal findings in healthy subjects or patients with other diseases than neuropathy). SFEMG conduction block test is a sensitive, complementary technique for diagnosis of minimal conduction block in patients with normal findings in standard nerve conduction studies.