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Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)

  • Derek K. Tracy (a1), Sukhwinder S. Shergill (a2) (a3), Anthony S. David (a4), Peter Fonagy (a5), Rashid Zaman (a6), Jonathan Downar (a7), Emma Eliott (a8) and Kamaldeep Bhui (a8)...
Summary

Suicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing ‘suicidality-by-proxy’ through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype – from any number of causative gene-environment interactions – primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification from repetitive transcranial magnetic stimulation (rTMS). The current evidence base for this is undoubtedly extremely limited, but the societal and clinical burden self-harm and suicide pose warrants such investigation.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Derek Tracy, Consultant Psychiatrist, and Associate Clinical Director, Green Parks House, Princess Royal University Hospital, BR6 8NY, London, UK. Email: derek.tracy@oxleas.nhs.uk
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Declaration of interest

K.B. is the Editor of BJPsych Open, but had no editorial involvement in the review or decision process regarding this paper.

Footnotes
References
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Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)

  • Derek K. Tracy (a1), Sukhwinder S. Shergill (a2) (a3), Anthony S. David (a4), Peter Fonagy (a5), Rashid Zaman (a6), Jonathan Downar (a7), Emma Eliott (a8) and Kamaldeep Bhui (a8)...
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