反社会型人格障碍共病边缘型人格障碍特质的影响因素

目的:探讨反社会型人格障碍(ASPD)共病边缘型人格障碍(BPD)的人口学及心理环境影响因素。方法:对1 804名服刑人员使用人格障碍诊断问卷(PDQ-4)进行评估,筛选出反社会型、边缘型及共病人群,采用自编一般资料问卷、患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)、儿童期虐待量表(CTQ-SF)、冲动性量表(BIS-11)、自杀意念量表(SIOSS)进行问卷调查。结果:ASPD共病BPD组在冲动性、儿童期虐待、焦虑、抑郁、自杀意念各个维度和因子的得分均高于ASPD组和BPD组,除儿童虐待中躯体虐待和性虐待外,其他维度和因子均存在显著差异(P0.05或P0.01)。Logstic回归显示,情感忽视、抑郁、绝望对ASPD形成共病人格产生影响。结论:童年期情感忽视和情绪问题可能是ASPD患者发展成ASPD共病BPD患者的影响因素。     

边缘型人格障碍患者儿童期虐待、冲动及与自杀意念的关系

目的:探讨边缘型人格障碍(BPD)患者儿童期虐待、冲动与自杀意念的关系。方法:对1 864名服刑人员应用人格障碍诊断问卷第4版(PDQ-4)进行评估,对筛选出的BPD患者应用儿童期虐待问卷(CTQ-SF)、Barratt冲动性量表第11版(BIS-11)和自杀意念自评量表(SIOSS)进行问卷调查。结果:共有163名服刑人员符合BPD;其中90人有自杀意念(SIOSS≥12分)。结构方程模型显示,儿童期情感忽视对自杀意念具有直接效应,并通过无计划冲动对自杀意念产生间接效应;儿童期情感虐待通过注意力冲动对自杀意念产生间接效应。结论:BPD患者自杀意念的形成与儿童期虐待、冲动性的部分因子相关。     

男性服刑人员冲动性与心理健康的相关性研究

目的:探讨男性服刑人员的冲动性水平、心理健康状况及其相关性。方法:采用Barratt冲动性量表第11版(BIS-11)、症状自评量表(SCL-90)对456名男性服刑人员(研究组)及年龄及受教育程度匹配的178名健康男性(对照组)进行评估。结果:研究组BIS-11总分、运动冲动性及无计划冲动性评分明显高于对照组(P0.05或P0.01);SCL-90总分及各因子分明显高于对照组(P0.05或P0.01)。研究组SCL-90总分及各因子分与BIS-11总分及因子分呈正相关(P均0.01);回归分析显示注意力冲动性对SCL-90总分(b=0.295,P=0.000)有较好的预测作用。结论:男性服刑人员具有冲动性人格特质,心理健康状况较差;冲动性尤其注意力冲动性对其心理健康有明显的影响。     

童年期受虐经历与躯体形式障碍患者认知情绪调节策略、述情障碍及抑郁的关系

目的:探讨躯体形式障碍(SFD)童年期受虐经历与认知情绪调节策略、述情障碍及抑郁的关系。方法:采用儿童期受虐经历问卷(CTQ-SF)、贝克抑郁问卷(BDI)、认知情绪调节问卷-中文版(CERQ-C)、多伦多述情量表(TAS)对109例SFD患者进行评定;以CTQ-SF得分均数为界,将SFD患者分为CTQ-SF高分组与低分组,分析CTQ-SF得分与CERQ-C、BDI、TAS的关系。结果:分别有48例及61例患者归入CTQ-SF高分组与低分组。与CTQ-SF低分组比较,CTQ-SF高分组在CERQ-C中积极重新评价因子分偏低,灾难化、责难他人因子及不适应性策略总分明显偏高,差异有统计学意义(P均0.05);BDI总分及TASII因子分偏高,差异有统计学意义(P均0.05)。CERQ-C中的不适应性策略总分与CTQ-SF的情感虐待因子及总分呈正相关(r=0.414,0.217;P0.05或P0.01)。BDI总分与CTQ-SF的情感虐待、性虐待、情感忽视、躯体忽视因子及总分呈正相关(r=0.220,0.230,0.204,0.281,0.298;P0.05或P0.01);TAS总分与CTQ-SF的情感虐待及躯体忽视因子呈正相关(r=0.188,0.254;P均0.05)。结论:童年期受虐经历与SFD患者认知情绪调节、抑郁情绪及述情障碍有较密切的关系。童年期受虐越严重,认知情绪调节能力越差,更易出现严重的抑郁情绪与述情障碍。     

成年男性暴力犯罪人员的三维人格特征及其与童年期创伤的关系

目的探讨暴力犯罪人员的三维人格特征和童年期创伤经历的特点及两者间的关系,为暴力犯罪的心理矫治及其犯罪行为的预防提供科学依据。方法采用三维人格问卷、童年期创伤史问卷（CTQ）及自行编制的在押服刑罪犯一般情况登记表对符合纳入、排除标准的400名对象的资料进行收集、整理。根据是否暴力犯罪者分为两组,对两组资料进行比较;最后将TPQ与CTQ各因子进行相关分析。结果暴力犯罪组寻求刺激维度及NS4因子高于非暴力犯罪组,奖赏依赖维度及RD1、RD3因子低于非暴力犯罪组,差异均有统计学意义（P〈0.05或0.01）,余维度及因子差异无统计学意义。暴力犯罪组童年期创伤史中的情感虐待、躯体虐待、性虐待、情感忽视及躯体忽视等因子分均高于非暴力犯罪组,差异均有统计学意义（P〈0.05或0.01）。三维人格量表寻求刺激维度和躯体虐待、情感虐待、性虐待、躯体忽视均呈正相关（P〈0.05或0.01））,躲避伤害维度和躯体忽视、情感忽视因子呈正相关（P〈0.05或0.01）,而奖赏依赖维度则和童年期创伤的五个因子均呈负相关（P〈0.05或0.01）。结论暴力犯具有冲动、探索、易变、兴奋、脾气急躁、外向和不守陈规等人格特征。童年遭受虐待可增加个体的冲动、攻击性,从而增加暴力犯罪的几率,因而暴力犯心理矫治时要了解其人格特征,结合其童年期的经历才能更加有的放矢。     

童年期虐待、应对方式、自尊与青少年社交恐惧症的相关研究

目的 探讨童年期虐待、应对方式、自尊与青少年社交恐惧症的相关性,并探讨其与青少年社交恐惧症的起病年龄、病程及严重程度的关系.方法 对符合CCMD-3诊断标准的110例青少年社交恐惧症患者(病例组)以及142例健康对照(对照组)进行童年期虐待问卷(Childhood Trauma Questionnaire-28 item Short Form,CTQ-SF)、简易应对方式量表(Simplified Coping Style Questionnaire,SCSQ)、自尊量表(Self-Esteem Scale,SES)评估,并对青少年社交恐惧症患者进行临床资料、社交回避及苦恼量表(Social Avoidance and Distress Scale,SAD)的评定.结果 相对于对照组,病例组CTQ-SF总分及其各维度分、积极应对和消极应对分更高(P＜0.05),SES 评分更低(P＜0.05).相关分析结果表明:青少年SAD分与CTQ-SF总分及其各维度分、消极应对分存在显著正相关(P＜0.01),与积极应对分、SES分呈显著负相关(P＜0.01).非条件Logistic回归分析发现,童年期虐待水平、情感虐待(EA)、情感忽视(EN)、消极应对、自尊为影响青少年社交恐惧症发病的因素,且CTQ-SF总分、EA分、EN分与青少年社交恐惧症患者的起病年龄成显著负相关(P＜0.01),EA、EN的严重程度与病程呈显著正相关(P＜0.05).结论 青少年社交恐惧症患者有更多的童年期虐待经历.童年期虐待水平、情感虐待、情感忽视、消极应对、自尊为影响青少年社交恐惧症发病的危险因素,积极应对是青少年社交恐惧症发病的保护因素,且童年期虐待经历越多,其起病年龄越早,经历的情感虐待、情感忽视越多,其病情越严重、病程越长.     

青少年冲动攻击行为与应激及下丘脑-垂体-肾上腺轴活性的关系初探

目的初步探讨青少年冲动性攻击行为与生活应激水平及基础状态时下丘脑-垂体-肾上腺皮质(hypothalamic-pituitary-adrenal,HPA)轴活性的关系。方法采用修订版外显攻击行为量表(modified overt aggression scale,MOAS)和冲动性量表(barratt impulsivity scale-11,BIS-11)对某所工读学校的男性初中生近半年内的攻击行为和冲动性进行评估,纳入其中51名有冲动性攻击行为(体力攻击次数≥3、MOAS总分≥5分、BIS-11总分≥70分)的学生为研究组,对照组为53名无冲动性攻击行为(体力攻击次数为0、MOAS总分4分、BIS-11总分70分)的学生,使用青少年生活事件量表(adolescent self-rating life events checklist,ASLEC)调查受试者近半年内的生活应激水平,同时采用酶联免疫吸附试验法测定血清皮质醇、血浆促肾上腺皮质激素(adrenocorticotrop hichormone,ACTH)水平。结果研究组近半年内的ASLEC应激总分(P0.05)、"人际关系"因子(P0.01)、"受惩罚"因子(P0.05)、"健康适应"因子(P0.01)分值均高于对照组,而血清皮质醇浓度(P0.01)、血浆ACTH浓度(P0.05)均低于对照组。相关分析结果显示,冲动性与ASLEC应激水平呈弱正相关(r=0.26,P0.01),与ACTH浓度呈弱负相关(r=-0.20,P0.05);攻击性与ASLEC应激水平呈弱正相关(r=0.26,P0.01),与皮质醇浓度呈弱负相关(r=-0.21,P0.05)。结论青少年冲动性攻击行为可能与较高的环境应激水平、机体HPA轴活性异常有关。     

青少年女性非自杀性自伤行为及相关因素北大核心CSCD

目的探讨青少年女性非自杀性自伤(non suicidal self-injury,NSSI)行为特点及相关因素。方法纳入64例存在《精神障碍诊断与统计手册第5版》中NSSI行为的青少年女性患者(NSSI组)和57名青少年女性健康对照(对照组)。NSSI组采用渥太华自伤量表(Ottawa self-injury inventory,OSI)评估NSSI情况,两组对象使用童年期创伤问卷-简版(childhood trauma questionnaire,CTQ-SF)、情绪调节困难量表(difficulties in emotion regulation scale,DERS)、Barratt冲动人格问卷(Barratt impulsiveness scale,BIS)评估NSSI行为的相关因素。结果NSSI组患者最早于7岁开始出现自伤行为,近1年中的自伤次数中位数为34(11,62)次。常见的自伤部位是前臂/腕部(81.3%)、头面部(57.8%)、手(50.0%),最常用的自伤方式为切割(75.0%)、搔抓(53.1%)、啃咬(48.4%)、击打(45.3%)。NSSI组患者暴露于躯体虐待(21.9%vs.0)、情感虐待(45.3%vs.1.8%)、情感忽视(60.9%vs.19.3%)和性虐待(12.5%vs.1.8%)的比例高于对照组(P<0.05),DERS各维度评分、BIS各维度评分高于对照组(P<0.01)。线性回归分析显示,饮酒史(β=77.31,P<0.01)、情感虐待(β=14.81,P<0.01)、情绪知觉(β=6.84,P=0.01)、情绪感受(β=3.07,P=0.04)、认知冲动(β=6.92,P<0.01)与NSSI组1年中的自伤频率呈正相关,文化程度(β=-61.31,P=0.04)、躯体虐待(β=-19.47,P<0.01)、行为冲动(β=-5.93,P<0.01)与NSSI组1年中的自伤频率呈负相关,该模型可以解释自伤频率43%的变异(F=3.36,P<0.01)。结论青少年女性患者常见的自伤部位是前臂/腕部、头面部和手,最常用的自伤方式为切割、搔抓、啃咬和击打,并且儿童期情感虐待、情绪调节和冲动与NSSI相关。     

儿童期虐待对成人自杀可能性的影响

目的 了解儿童期虐待对于成年后自杀可能性的影响.方法 分层随机抽取≥18岁的天津市区居民564例,使用儿童期虐待问卷（CTQ-SF）、自制自杀态度量表作为工具进行调查.结果 男性被调查者儿童期躯体虐待评分高于女性（P＜0.01）,女性被调查者儿童期情感忽视评分高于男性（P＜0.05）.男性有自杀意念人数显著低于女性（P＜0.05）.相关分析显示儿童期躯体虐待、情感虐待、性虐待及情感忽视与被调查者的自杀意念呈负相关（P＜0.01）;儿童期躯体虐待、情感虐待及性虐待与被调查者自杀未遂呈负相关（P＜0.05,P＜0.01）;而儿童期躯体虐待、情感虐待、性虐待及情感忽视与被调查者的自杀接受程度呈正相关（P＜0.05,P＜0.01）.回归分析显示情感虐待、性虐待和情感忽视为被调查者自杀意念的独立影响因素（P＜0.05）.结论 成年人的自杀意念、自杀未遂及自杀接受态度与其儿童期虐待有关.     

男性暴力罪犯的冲动、攻击性人格特点及其与童年期受虐待的关系

目的 探讨暴力犯罪人员的冲动、攻击性人格特点,及其与童年期受虐待关系,为减少或预防暴力犯罪提供科学依据.方法 采用冲动性和攻击性量表、童年期创伤史问卷(Childhood Tmuma Questionnaire.CTQ)及自行编制的在押服刑罪犯一般情况登记表,对符合纳入、排除标准的400名犯人的资料进行收集、整理,然后对资料进行统计分析.结果 暴力犯组的运动冲动性、冲动总水平、躯体攻击性、言语攻击性、愤怒水平、敌意水平、自我攻击水平及攻击性总分等因子得分高于非暴力犯组,差异均有统计学意义(P<0.01).暴力犯中无计划冲动性、认知冲动性、冲动总水平和童年期创伤各因子均呈正相关;敌意水平、自我攻击水平、攻击总水平与童年期创伤的五个因子均呈正相关,而躯体攻击性、言语攻击性、愤怒水平与情感虐待、躯体虐待和性虐待呈正相关.结论 暴力犯有明显的冲动及攻击性,更容易失去理智,产生暴力攻击行为;童年遭受虐待可增加个体的冲动、攻击性,从而增加暴力犯罪的可能.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.