Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulation technique for managing obsessive-compulsive disorder (OCD). Early intervention with tDCS may lead to improved treatment outcomes for individuals with OCD, offering hope for more effective and timely intervention strategies. This study aimed to evaluate the safety and efficacy of tDCS as an early augmentation strategy in adults with OCD.

Drug-free adult patients with OCD were randomized into active and sham groups and received fluoxetine 20 mg (up to 60 mg). The protocol involved placing the cathode over the left supplementary motor area and the anode over the left dorsolateral prefrontal cortex, using a 2-mA current for 20 minutes, with a ramp time of 10 seconds. A total of 10 sessions were given over 2 weeks. Following the baseline assessment, both illness severity and side effects were measured periodically at 2, 4, and 6 weeks.

A total of 40 patients completed this study (20 in each group). The active group demonstrated a significant reduction in Yale-Brown Obsessive-Compulsive Scale scores at 2, 4, and 6 weeks compared with the sham group, with a number needed to treat of 2.5. Additionally, the effect size of the intervention at 2 weeks was calculated to be 0.58, indicating a moderate effect according to Cohen’s d. Side effects were milder, tolerable, and uncommon.

Early augmentation with tDCS is a safe and effective method for rapidly reducing symptom severity in adult patients with OCD.

The literature on persistent antidepressant withdrawal symptoms is sparse. This systematic review is the first to examine the prevalence, duration, severity, risk/protective factors and treatment strategies for post-acute withdrawal syndrome (PAWS) following the discontinuation of antidepressant medications.

We searched PubMed, Web of Science and PsycInfo, focusing on newer-generation antidepressants. The electronic database search was complemented with handsearching reference lists of pivotal studies. We included original studies in adults reporting on PAWS and providing data about epidemiology and clinical management of withdrawal symptoms persisting for at least 6 weeks.

The literature search yielded 1286 results, with 26 records assessed for eligibility, and seven studies fulfilled our selection criteria. Prevalence data were sparse, with one small cohort study reporting a 15% prevalence rate for PAWS in patients with panic disorder and agoraphobia. The duration of PAWS varied considerably across studies, ranging from 1.5 to 166 months. Long-term paroxetine use emerged as a potential risk factor for the development of PAWS. There was no reliable evidence to support the effectiveness of various treatment strategies, including the reinstatement of antidepressant medication, the use of benzodiazepines and the provision of cognitive-behavioral therapy.

The current evidence on PAWS is sparse and predominantly of low certainty. The presence of withdrawal symptoms, lasting several months and possibly even years in some patients, underscores the need for further research with rigorous methodology. Large prospective cohort studies are needed to assess the epidemiology of PAWS, while randomized controlled trials are quired to test the efficacy of clinical interventions to treat PAWS.

CRD42023461793

New developments in neuro-navigation and machine learning have allowed for personalised approaches to repetitive transcranial magnetic stimulation (rTMS) to treat various neuropsychiatric disorders. One specific approach, known as the cingulum framework, identifies individualised brain parcellations from resting state fMRI based on a machine-learning algorithm. Theta burst stimulation, a more rapid form of rTMS, is then delivered for 25 sessions, 5 per day, over 5 days consecutively or spaced out over 10 days. Preliminary studies have documented this approach for various neurological and psychiatric ailments. However, the safety and tolerability of this approach are unclear.

We performed a retrospective study on 165 unique patients (202 target sets) treated with this personalised approach between January 2020 and December 2023.

Common side effects included fatigue (102/202, 50%), local muscle twitching (89/202, 43%), headaches (49/202, 23%), and discomfort (31/202, 17%), all transient. The top 10 unique parcellations commonly found in the target sets included L8av (52%), LPGs (28%), LTe1m (21%), RTe1m (18%), LPFM (17%), Ls6–8 (13%), Rs6–8 (9%), L46 (7%), L1 (6%), and L6v (6%). Fatigue was most common in target sets that contained R6v (6/6, 100%) and L8c (5/5, 100%). Muscle twitches were most common in target sets that contained RTGv (5/5, 100%) and LTGv (4/4, 100%).

These side effects were all transient and well-tolerated. No serious side effects were recorded. Results suggested that individualised, connectome-guided rTMS is safe and contain side-effect profiles similar to other TMS approaches reported in the literature.

This study explores how we can improve the government’s research and technology for disasters and safety.

This study employs the Structural Equation Model (SEM) based on 268 experts’ perspectives.

R&D performance exerts a directly significant impact on R&D achievement with the coefficient of 0.429. Second, while professionality and environment of R&D do not show a direct effect on achievement, they exhibit an indirect effect on it with the coefficient of 1.124 and 0.354, respectively. Third, R&D professionality exerts a significant impact on the R&D environment (0.964), and R&D environment has a positive effect on R&D performance (0.827).

Governments and policymakers should develop disaster and safety policies by understanding direct and indirect effects and the relationship of factors related to R&D for improving R&D achievement.

This position paper focuses on healthy ageing for the frailest and institutionalized older adults in the context of the recent pandemic. The paper aims to identify and discuss hindering and promoting factors for healthy ageing in this context, taking both health safety and a meaningful social life into account, in a pandemic situation and beyond.

The recent COVID-19 pandemic has highlighted the vulnerability of frail older adults residing in long-term care institutions. This is a segment of the older population that does not seem to align well with the recent policy trend of healthy and active ageing. The need for healthy ageing in this population has been voiced by professionals and interest organizations alike, alluding to inadequate support systems during the pandemic, conditioned by both previous and newly emerging contextual factors. Supporting healthy ageing in older adults in nursing homes and other residential care settings calls for attending to meaningful social life as well as to disease control.

Findings and early conclusions leading up to the position paper were presented with peer discussions involving healthcare professionals and researchers at two joint EFPC PRIMORE workshops 2021 and 2022, as well as other international research seminars on long-term care. The following aspects of long-term care and COVID-19 were systematically discussed in those events, with reference to relevant research literature: 1. Long-term care policies, 2. pre-COVID state of long-term care facilities and vulnerability to the pandemic, 3. factors influencing the extent of spread of infection in long-term care facilities, and 4. the challenge of balancing between strict measures for infection control and maintaining a meaningful social life for residents and their significant others.

A policy shift towards ageing at home and supporting the healthiest of older adults seems to have had unwarranted effects both for frail older adults, their significant others, and professional care staff attending to their needs. Resulting insufficient investment in primary health care staff and in the built environment for frail older adults in nursing homes were detrimental both for the older adults living in nursing homes, their significant others, and staff. More investment in staff and in physical surroundings might improve the quality of care and the social life of older adults in nursing homes in a non-pandemic situation and be a resource for primary health care staff ensuring both protection from health hazards and a meaningful social life for frail older adults in a pandemic or epidemic situation. As for investing in the physical surroundings, smaller nursing homes are advantageous, with singular resident rooms and for developing out-and indoor spaces for socializing and for meeting with families and other visitors. Regarding investment in staff, there is a documented need for educated staff in full-time positions. Use of part-time or temporary staff should be limited.

Access to psychedelic drugs is liberalizing, yet responses are highly unpredictable. It is therefore imperative that we improve our ability to predict the nature of the acute psychedelic experience to improve safety and optimize potential therapeutic outcomes. This study sought to validate the ‘Imperial Psychedelic Predictor Scale’ (IPPS), a short, widely applicable, prospective measure intended to be predictive of salient dimensions of the psychedelic experience.

Using four independent datasets in which the IPPS was completed prospectively – two online surveys of ‘naturalistic’ use (N = 741, N = 836) and two controlled administration datasets (N = 30, N = 28) – we conducted factor analysis, regression, and correlation analyses to assess the construct, predictive, and convergent validity of the IPPS.

Our approach produced a 9-item scale with good internal consistency (Cronbach's α = 0.8) containing three factors: set, rapport, and intention. The IPPS was significantly predictive of ‘mystical’, ‘challenging’, and ‘emotional breakthrough’ experiences. In a controlled administration dataset (N = 28), multiple regression found set and rapport explaining 40% of variance in mystical experience, and simple regression found set explained 16% of variance in challenging experience. In another (N = 30), rapport was related to emotional breakthrough explaining 9% of variance.

Together, these data suggest that the IPPS is predictive of relevant acute features of the psychedelic experience in a broad range of contexts. We hope that this brief 9-item scale will be widely adopted for improved knowledge of psychedelic preparedness in controlled settings and beyond.