The use of selectiveserotonin reuptake inhibitors (SSRIs) is an independent risk factor for bleeding events. Antidepressants and oral anticoagulants (OACs) are often prescribed together as depression and anxiety often coexist with cardiovascular diseases, atrial fibrillation and thromboembolic disorders. Serotonin is released from platelets in response to vascular injury, promoting aggregation. Inhibition of serotonin transporter (responsible for the uptake of serotonin into platelets) can lead into a reduced ability to form clots and a subsequent increase in the risk of bleeding. Direct oral aticoagulants (DOACs), rivaroxaban, apixaban and edoxaban are primarily metabolized via CYP3A4. The co-administration of antidepressants with inhibitory effects on CYP3A4 may theoretically interact with them.

Presentation of a case of upper gastrointestinal bleeding after initiation of Apixaban in a patient taking Sertraline and literature review.

We carried out a literature review in Pubmed electing those articles focused on bleeding risk between newer direct oral antigulants and selective serotinin reuptake inhibitors.

A 66-year-old woman sought medical assistance for generalized ecchymosis and melena. She was diagnosed with atrial fibrillation treated with apixaban 7 days ago. Concomitant treatment between apixaban and sertraline was the possible cause of upper gastrointestinal bleeding and ecchymosis. We had to switch sertraline into vortioxetine (with less dregree of serotonin reuptake inhibition) and add proton-pump inhibitor (Omeprazole) in order to decrease the risk of bleeding.

SSRIs increase the risk of gastrointestinal bleeding, much more in case of concomitant use of oral anticoagulants. If SSRI use cannot be avoided, monitor closely and prescribe proton pump inhibitors.

Benzodiazepines (BZD) are psychotropic drugs prescribed in psychiatry for their anxiolytic, hypnotic and sedative properties. Several guidelines aimed to limit the chronic use of BZDs. However, BZDs prescribing that does not comply with international recommendations remains widespread, estimated in France at 30% for anxiolytic BZDs.

The aims of our study were to evaluate BZDs prescribing practices in the treatment of anxiety and to assess their compliance with international recommendations.

This is a cross-sectional study conducted through a Google-forms self-administered questionnaire,intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. The most prescribed BZD for anxiolytic purposes was Prazepam (76.2%). Clonazepam was prescribed for anxiolytic purposes in 10.5% of cases. Of the 105 participants, 48 indicated that they prescribed BZDs for anxiolytic purposes in states of acute stress (45.7%), 28.6% prescribed them for the treatment of mild to moderate anxiety manifestations in anxiety disorders. For the treatment of anxiety without panic attacks, 20% indicated that they prefer a short half-life BZD, 80% a long half-life BZD. The maximum duration of BZDs prescription for anxiolytic purposes was 12 weeks (62%), and 6 months in 10% of cases.

BZDs are often prescribed in psychiatry for their anxiolytic property, sometimes in a way that does not comply with the recommendations of good practice, with regard to the prescribed molecules, their indications and the duration and modalities of prescription.

Skin and subcutaneus tissue disorders are common type of adverse drug reactions reported with a wide variety of both typical and atypical antipsychotics. Aripiprazole is a quinolinone antipsychotic that is a partial agonist at the D2 and 5-HT1A receptors and antagonist at the 5-HT2A receptors. We report a case of rosacea that developed after starting aripiprazole in a patient with schizophrenia and which remitted after the drug was stopped.

To present a case of rosacea that developed in a schizophrenic patient after starting aripiprazole. Review of literature and search for the total number of cases reported in the european database of suspected adverse drug reactions (EudraVigilance).

We carried out a literature review in Pubmed electing those articles focused on skin ad subcutaneous skin disorders in those patients that have been taking aripiprazole. Review number of cases of skin reactions reported by the European database of suspected adverse drug reactions.

A 43-year-old man previously diagnosed with schizophrenia with low adherence to different treatments. He came to our service seeking for help in order to decrease delusions with a treatment with minimun adverse reactions. We started aripirazole 10 mg every day and, after 7 days appeared signs of rosacea in his face. After discontinuation of aripiprazol, after 5 days, rosacea remitted.

Rosacea in our case posibly point aripiprazole as the agent that produced the skin reaction. After stopping the treatment the signs disapeared. Awareness of skins manifestations produced by aripiprazole is essential to prevents worse skin reactions.

Efficacy of lithium is well documented in the literature, making it the gold standard treatment. However, its use declines with the advent of anticonvulsants. This raises the question about monitoring of mood stabilizers in practice.

The aims of this study were to determine the prophylactic lithium response in patients followed for bipolar disorder and compared to those of anticonvulsants and assess the mood stabilizers monitoring procedures in clinical practice.

A retrospective study was conducted, over a period of six months, with patients followed for bipolar disorder stabilized under the same mood stabilizer (lithium or anticonvulsant) for at least one year. The participants were divided into two groups according to the mood stabilizing treatment. The two groups were compared according to socio-demographic, clinical and evolutionary profiles as well as the prophylactic response to treatment.

Patients included were 64 in the study, 28 received lithium and 36 received anticonvulsants. The socio-demographic profile and clinical characteristics were similar in two groups, except for the average total number of mood episodes. Retrospective evaluation of the prophylactic response by ALDA scale showed a significantly higher mean total score in patients receiving lithium (5.9 ± 2.8 versus 2.58 ± 2.4, p = 0.025).). Ten of them were in compliance with the recommendations; while 19.44% received anticonvulsants had all the monitoring parameters within the recommended time frame.

Thymoregulators significantly modify the disease’s prognosis. Practitioners will attach particular special attention to distinguish the therapeutic efficacy of the side effects which are numerous and sometimes serious.

Benzodiazepines (BZD) are psychotropic drugs prescribed in psychiatry for their anxiolytic, hypnotic and sedative properties. Since anxiety, agitation and insomnia are common in psychoses and mood disorders, BZDs are frequently prescribed in the treatment of these pathologies. Guidelines remain rare with regard to the use of BZDs in the treatment of psychosis and bipolar disorder.

Our study aimed to evaluate BZDs prescribing practices in psychoses and bipolar disorder and to assess the specific risks related to the use of these molecules in the population suffering from severe mental disorder.

This is a descriptive cross-sectional study conducted through a Google-forms self-administered questionnaire, intended for psychiatrists and psychiatric residents, over a period of two months, from April 1 to May 31, 2019.

One hundred physicians practicing in psychiatry answered our questionnaire. The response rate was 28%. BZDs were prescribed during thymic or psychotic relapses by 88.6% of the participants. During relapses, the main indication for BZDs was anxiety (81.3%), insomnia (80.2%), and catatonia (59.4%). Among the participants, 24.8% indicated that they maintained a long-term treatment with BZDs in patients with psychosis, and 11.4%in patients with bipolar disorder. The participants estimated that the long-term use of BZDs in patients with severe mental disorder represented an increased risk of : dependence (94.3%), behavioral disinhibition (30.5%), suicide (22.9%), anger, hostility and violence (31.4%).

Few guidelines concern the use of BZDs in psychosis and bipolar disorder. However, this prescription remains very frequent in current practice, with clinical and therapeutic features specific to this population.

The recognition of the conditioned-unconditioned stimulus (CS-US) association in classical conditioning is referred to as contingency awareness. The neural underpinnings of contingency awareness in human fear conditioning are poorly understood.

We aimed to explore the EEG correlates of contingency awareness.

Here, we recorded electroencephalography (EEG) from a sample of 20 participants in a semantic conditioning experiment. In the acquisition phase the participants were presented with sequences of words from two semantic categories paired with tactile stimulation followed by presentation of a neutral sound (US-) ((e.g., animals -> left hand vibration -> US-, clothes -> right hand vibration -> US-). In the test phase the association violated in 50% of trials which followed by a presentation of a loud noise (US+). The participants were only instructed to listen carefully. On the basis of self-reported contingency awareness, twenty participants were divided in aware (N=12) and unaware (N=8) group.

The aware group expressed a non-lateralized effect of alpha-beta (12-23 Hz) suppression along with a more negative CNV at central channels preceding presentation of the vibration (main effect of Group). Also, CNV was more negative in expectation of US+ comparing with expectation of US- in the aware group but not in the unaware group.

The results indicate that contingency awareness is accompanied by neural patterns reflecting expectation as can be seen in the suppression of somatosensory alpha-beta activity before expected presentation of the vibration as well as in CNV in expectation of an aversive event.

The autonomic nervous system (ANS) plays a key role in maintenance of the homeostasis and adaptability of the body to different stimuli. The disturbances of ANS, especially sympathetic dysregulation in stress response, are associated with various disorders.

Thus, we aimed to study the sympathetic arousal in response to negative emotional stress and during recovery using heart rate variability (HRV) nonlinear analysis (symbolic dynamics parameter 0V%) and skin conductance level (SCL) as sympathetically-mediated indices in healthy students.

Seventy students (age: 23.1±0.2yr., 39 females) were examined during complex stress response: baseline – negative emotional stress – recovery. RR intervals (for HRV analysis) and electrodermal activity were continuously recorded during each period lasting six minutes. Evaluated parameters: HRV nonlinear analysis - symbolic dynamics index 0V% as cardiac sympathetic index, skin conductance level (SCL) as sympathetic cholinergic index.

Regarding electrodermal activity, the parameter SCL significantly increased in response to negative emotional stress (p<0.001) and remained higher after stress (recovery phase, p<0.001). Symbolic dynamics index 0V% was without significant changes.

Our findings revealed increased sympathetically-mediated index SCL in response to negative emotional stress and in recovery phase indicating higher sympathetic arousal during complex stress response in young people. Surprisingly, cardiac sympathetic index 0V% was not sensitive to detect discrete changes in sympathetic arousal to negative emotion. We suggest that detailed knowledge about complex sympathetic regulatory mechanisms to emotional stress in healthy probands represents the first step for understanding of pathomechanisms leading to abnormal stress response in mental disorders.

This study was funded by the Slovak Scientific Grant Agency under grants VEGA 1/0044/18; VEGA 1/0190/20 and Ministry of Health of the Slovak Republic under the project registration number 2018/20-UKMT-16.

Age-related differences in the processing speed have been observed in a great variety of tasks. In spite of the great amount of researches in this area, we know relatively little about the nature of this developmental tendency.

The aim of this study was to assess whether age-related differences in reaction time (RT) can be explained satisfactorily in terms of a global age-related differences in processing speed alone.

The sample consisted of 48 4-year-olds, 50 5-year-olds, 46 6-year-olds children, and 35 adults. To investigate processing speed in children and adults we used the test battery consisted of three types of RT tasks: simple, discrimination, and choice.

We have revealed clear age-related differences in processing speed not only between children and adults but also between three age groups of children. However, using transformation method proposed by Madden et al. (2001) and Ridderinkhoff & van der Molen (1997) we have revealed that there are not only global age-related differences but also process-specific age-related differences in processing speed. Among children, age-related differences larger than predicted by the global difference hypothesis were evident when tasks required spatial orientation discrimination and stimulus–response rule complexity, but not for response suppression or reversal of stimulus–response contingencies.

It can be assumed that the observed process-specific, age-related differences in processing speed generally can be explained by the principle of heterochronicity of human brain development (Casey et al., 2005).

It is well established that reaction time and IQ test scores are correlated, although the strength of this relationship is a matter of debate (Neisser et al., 1996). It was proposed that processing speed is a component of intelligence (Deary, Penke, & Johnson, 2010; Hunt, 2011). In our previous research we have not revealed the relationship between IQ and reaction time in children (Kiselev et al., 2000). However, it is possible that reaction time can predict intelligence test scores in the developmental perspective.

This study investigated whether visuomotor reaction time in 5 year-old children predicts intelligence test scores in 8 year-old children using the longitudinal approach.

The participants were 35 children (17 males and 18 females) at the age of 5 years (5,34±0,45). We used computerized sensorimotor technique (Kiselev et al., 2009) to investigate visuomotor reaction time in children. Children completed simple, discrimination and choice reaction time tasks. The IQ of 8-year children was assessed by the WISC.

The regression analysis has revealed the significant (p≤0,05) relationships between discrimination and choice reaction time tasks in 5 years-old children and non-verbal IQ performance in these children at 8 years of age. However, we did not find this relationship for simple reaction time task.

In view of obtained results it can be assumed that visuomotor reaction time in preschool children can predict non-verbal intelligence test scores in the developmental perspective. The received data can give new perspective in the understanding the interrelation between reaction time and IQ in children.

Psychiatry is fundamental interdisciplinary medical science with essential importance for enormous health-problems of humanity. Creation of integrative-psychiary in context of multidimensional&holistic medicine, founded by HIPPOCRATES-GALENUS-HUA T’UA-AVICENA-PARACELSUS is necessary to counteract disastrous human health-situation. Psychiatry needs new integrative therapy-models considering application of psychopharmacotherapy as well as practices of psycho-somatic (Th.v.UEXKÜLL) and somato-psychic theories (Y.IKEMI). Emperor AKIHITO during Opening-Ceremony of ICPM-2005-Kobe appointed to consider “total symptoms of mind-body, seeking ways of holistic care”.

REFERENCES. PSYCHIATRY: EPA-2020-virtual/Madrid, Eur.Psychiatry 63S, EPP0834/5+EPV0581/1470; EPA-2019-Warsaw, Eur. Psychiatry 56S,S689; EPA-2018-Nice, Eur.Psychiatry 48/S1, S623&567&662. WPA-2019-Lisbon, E-Poster WCP19-2137, -1822, -1839; 2018-Mexico-City, Abs.-Book WCP18-0584/-0625/-0643/-0654. 2011-Buenos-Aires,AB:PO1.200. PSYCHOLOGY: EFPA-2019-Moscow, Abs.-Book 1529,1530,1549. IUPsyS-2012-Cape-Town, IntJPsychol 47:407; -2008-Berlin, 43/3-4:154, 248,615,799; -2004-Beijing, AB:49,587. PSYCHOSOMATICS: ICPM-2017-Beijing, AB:ID: 648493,648895,648749,648878; -2005-Kobe, J.Psychosom.Res. 58:85-86.

Evaluation of psychic-“polar-attitude-list”/physiological-parameters: heart-rate, blood-pressure,etc. from patients/probands after training by occidental/oriental practices (Music-/Yogatherapy/others) (ref.).

Observations demonstrate strong positive influence after music[1], respiratory[2], hatha-yoga[3] therapies. Items of psycho-physiological (relaxed), emotional (tranquil/happy), cognitive (few/ordered thoughts), voluntary (active/spontaneous), social (open/assertive), consciousness (clear/sleepy) categories are significantly positive changed 25-50%. The 3-therapies have specific psychic-effects,e.g. items “relaxed/tranquil” after respiratory- (+45/50%) and music- (+20/5%), also item “open” after music-therapy (+25%) are positive, but negative after respiratory-therapy (-20%). Psychic-effects are correlated with positive physiological-ones,e.g. heart/respiratory-frequency decreased 25-30%, voluntary-apnoea prolonged 55%. Mountain-altitude (>2000-3000m), hypothermia (<20 to 0°C) influenced positively psychic/physiological-parameters,e.g. heart-rate/blood-pressure decrease (n=125,P<0.05-0.01).

Different methods of integrative psychiatric therapy are with preference,e.g. for depression is suitable respiratory/physical-training, also hypothermia&high-mountain therapy (activation-euphoria), for mania:music-therapy (inhibitory-effect). Systematically research about single/combined therapies is necessary,e.g. for epilepsy: Respiratory-therapy/hypothermia,etc. could help patients (hypo-/hypercapnia: inhibitory/excitatory effects on CNS-structures).

Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation technique allowing to induce changes in oscillatory activity. Theta activity has been reported to play a major role in maintenance of information in working memory (WM).

The current study had the initial goal to check the effect of theta tACS on accuracy and resting state EEG in a set of match-to-sample WM tasks.

In the first experiment, we tested 31 participants in the WM task after 20-min tACS applied at Fpz and CPz at 6 Hz, 1 mA.). In the second experiment, we compared the after-effects and online effects of the stimulation in a sample of 25 individuals. Five similar 25-min blocks filled with the same working memory task were distributed over 3 days. We assessed the same group of participants in all three sessions. On the Training day, the participants performed one block without stimulation. On the Sham-Verum day (SV), the first block with Sham stimulation followed by the second block with Verum stimulation. On the Verum-Sham day (VS), the blocks order reversed.

After-effects of the stimulation did not produce any significant changes either in behavior (accuracy in the task) or resting-state EEG (theta frequency band spectral power in the first experiment. In the second experiment, 6 Hz tACS delivered before the WM task was not able to produce any observable changes in working memory performance. The same hold true for online stimulation.

Theta frequency tACS applied to Fpz-CPz electrodes is not an efficient method to improve WM.

The quality of life is a multidiimensional and subjective construct, based on the patient’s experience.

The objective of this study is to observe if at the HIV - positive patient the quality of life in relation to health is a consequence of disease and treatment and if his perception about the disease changes his ability to have a full and useful life.

We centralized the data coming from a number of 600 patients registered in the Iasi Regional Center, for a period of 12 months. The side effects reported by the patients emerged from discussions with the infectious diseases specialist and the psychologist.

From 600 pacients, 59% of them were male with mean age of 21.1 years old. Approximately 14% of the patiens had stable jobs, the rest were unemployed or had part-time jobs. 38% came from foster care units of from broken homes. The average number of days of hospitalization was 4 days, 25% of them were at their first scheme, 10% in the seventh-eighth scheme. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea in 15% of the cases; regarding the psychological aspects, 65% of patients showed an above level of anxiety, 40% had depressive manifestations, 10% had specific obsessions-compulsions and 10% neurotic and hysterical tendencies.

We need a close collaboration between the infectious diseases specialist and the psychologists in order to enhance the quality of life of the HIV patient.

SSRI-treated psychiatric disorders (STPD), such as general anxiety disorder and major depression disorder, are common psychiatric diagnoses. Serotonin-mediated effects of solar insolation are an active topic of research. Artificial intelligence (AI) could help to better examine that complex relation.

To investigate whether AI could predict the STPD relying primarily on average ambient temperature and annual solar insolation.

Data of age, average ambient temperature and annual solar insolation were employed to predict STPD status in 7,587 subjects using an AI. To simplify the data analysis, only individuals with white ethnicity were assessed. SPTD prevalence was 17.1%. The AI was conservatively tuned to maximize the positive likelihood ratio considering predicted and real STPD statuses. The free and open source programming language R was used for all the analyses. Dataset source: Wortzel, Joshua; Kent, Shia; Avery, David; Al-Hamdan, Mohammad; Turner, Brandon; Norden, Justin; Norden, Michael; Haynor, David (2018), “Data for: Ambient temperature and solar insolation are associated with decreased prevalence of SSRI-treated psychiatric disorders”, Mendeley Data, V1, doi: 10.17632/trs43ybh92.1

Predictions obtained a positive likelihood ratio of 4.850. The results were indicative of fair performance.

AI might be useful to predict STPD. Furthermore, the results of this study might indicate a moderate effect of age, average ambient temperature and annual solar insolation on the probability of STPD occurrence. Finally, the AI used in this study is freely available, allowing anyone to experiment.

ECT is a potentially life-saving treatment for patients with severe or treatment resistant depression. Cognitive function disturbances following ECT are generally transient, but could be of longer duration in some cases

To assess the cognitive side effects in patients with affective disorders treated with a course of electroconvulsive therapy (ECT).

Cognitive functions of patients who undergo ECT was assessed prior to start of treatment, midway of the course of treatment and after end of the course of treatment using Montreal Cognitive Assessment (MoCA). We did a retrospective analysis of MoCA scores of 15 patients who received bilateral ECT in 2017-2018. In order to assess the efficacy of ECT in the treatment of their illness, we did a retrospective analysis of Montgomery Asberg Depression Rating Scale (MADRS) scores of 18 patients who received bilateral ECT in 2017-2018

Only 7% of the patients who underwent ECT in our sample did have significant cognitive decline as per their MoCA scores. 28% of patients achieved complete remission in their depressive symptomes. 22% of patients continued on maintenance treatment. 95% of patients showed significant improvement in their symptoms following treatment with ECT where there symptoms reduced to either mild or minimal depressive symptoms.

Cognitive side effect was not a significant side effect in our sample of patients. We did see an improvement in cognitive function in a significant number of the sample of patients as they progressed with treatment, which coincided with improvement in their affective symptoms.

Despite being one of the oldest treatments in the field of Psychiatry, Electroconvulsive therapy (ECT) is used worldwide for various severe and treatment-resistant psychiatric disorders, establishing itself as one of the fastest and most effective treatments.

The primary aim of this study was to describe a nationwide epidemiological perspective of the use of ECT in hospitalized psychiatric patients. The secondary aims were to characterize clinical and sociodemographic trends of hospitalized patients who needed ECT.

A retrospective-observational study was conducted using an administrative database which gathered all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 - Other electroshock therapy defined by the International Classification of Diseases version-9, Clinical Modification.The variables included in the study were birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status from each single hospitalization episode.

There were a total of 879 hospitalizations with ECT during the 8-year period of the study. Most of the hospitalizations occurred in female patients (53.4 vs 46.6%), belonging to the age group of 51-70 years old, with a mean age of 50.5 years old. The median LoS was 43.0 days with an IQR of 27.0-68.0 days. The specific primary diagnosis most frequent in all hospitalizations was Major depressive disorder, recurrent episode representing 19.6% of all ECT related hospitalizations.

In Portugal most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication.

Vagus Nerve Stimulation (VNS) is a neuromodulatory intervention which involves attaching an electrode to the vagus nerve. Studies investigating VNS as an acute treatment method for treatment resistent depression have shown very limited results, however there are data suggesting that VNS might have a beneficial effect on a longer term. There are also studies that suggest that a history of response to ECT might indicate a higher response rate to VNS. VNS was suggested as treatment for a patient who received maintenance ECT for treatment resistant unipolar depression during 9 years. 3 months after VNS was implanted, ECT was stopped due to the Covid-19 pandemic. In this case study we will review the patient’s response to treatment with VNS and the sudden stop of long-term ECT treatment.

To review the response to acute and maintenance ECT and VNS in this patient diagnosed with treatment resistant unipolar depression, and to compare this to the data suggesting VNS as an alternative treatment method for maintenance ECT in patients with treatment resistant depression.

Using the extensive data collected during the patient’s treatment, we will review the clinical response and side-effect burden of this patient to acute and maintenance ECT and to VNS.

The patient showed a vast improvement in depressive symptoms a few months after start of VNS treatment, while long-term maintenance ECT was stopped.

This patient’s response to VNS supports the data suggesting VNS as an alternative treatment method for maintenance ECT in patients with treatment resistant depression.

This patient received VNS treatment as part of a study conducted in our centre (UPC KULeuven) with support of Livanova. Me nor my supervisor (prof. Sienaert Pascal) are directly involved in this study. I have received no financial or other compensation fr

Tourette’s syndrome is a neuropsychiatric disorder marked by motor and phonic tics frequently associated with psychiatric comorbidities, beginning in childhood. While most cases improve or resolve with age, some are refractory.

To review new strategies for the management of Tourette’s Syndrome, following an outpatient clinical vignette.

We performed a review based on the PubMed® database.

A 50-years-old female patient with a long-term outpatient psychiatric follow-up presented with motor tics appearing in adolescence, including winking and facial grimacing, as well as episodes of coprolalia. Over the years, she developed an anxiety disorder and social isolation. In addition to psychological therapy, pharmacological therapy had already been approached with the use alpha-adrenergic agonists and several antipsychotics, such as risperidone and aripiprazole, with the patient showing only partial response to pimozide. In Tourette’s syndrome, the therapy must be adequate to the patient’s individual needs. Emerging treatments for refractory cases, such as anticonvulsants, cannabinoids or antiglutamatergic drugs have been the target of several studies. Botulinum toxin injections are particularly effective in patients with focal motor tics and complex phonic tics. Non-pharmacological treatment options, such as electroconvulsive therapy and deep brain stimulation may prove effective in some cases.

A significant proportion of patients fail to respond to conventional strategies. Thus, new pharmacological and non-pharmacological therapies are on the horizon and may represent an important step in treatment algorithms for refractory cases in the future.

Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.

To emphasize the importance of defining predictors of response to ECT in OCD.

The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.

Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.

Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.

Obsessive-Compulsive Disorder (OCD) is an incapacitating Neuropsychiatric condition characterized by the presence of obsessions and/or compulsions. Although the disorder’s phenotype is well described, its pathophysiology remains elusive (Aouizerate et al, 2004). Over the last decade, techniques to noninvasively study the brain’s neurophysiology, such as Transcranial Magnetic Stimulation (TMS), have found widespread use in psychiatric research. For OCD, single- and paired-pule TMS protocols have been used to explore abnormalities in motor cortex excitability and cortical neuroplasticity. Here we propose to systematically review and, where possible, metanalyse existing case-control studies that compared such measures in patients and healthy subjects.

To systematically review and meta-analyse published case-control studies comparing cortical excitability measures, as measured by single- or paired-pulse TMS, in subjects with OCD and healthy controls.

We have conducted a systematic review of published literature (PROSPERO registration CRD42020201764) reporting measures of cortical excitability as measured by single or paired-pulse TMS, in patients with OCD and healthy controls. We searched 4 different electronic libraries (PubMed, Web of Science, EMBASE, PsycINFO). The resulting list of articles was reviewed, separately, by two researchers. Disagreements were discussed and resolved by consensus, until a final list of eligible articles was obtained.

13 studies reporting motor cortex excitability measures were included in our final list. The total number of participants included in our analyses is 615 (349 OCD; 180 healthy subjects; 86 other conditions)

A sufficient number of studies was found to allow for metanalyses, currently ongoing.

The electroconvulsive therapy is an ancient therapeutic technique used in the traitment of certain psychiatric diseases.

discuss the technical aspects, indications, therapeutic response and tolerance of ECT

This was a descriptive retrospective study that interested all patients who were hospitalized in the psychiatric department of the Mahdia University Hospital in 2017 and 2018 and were benefited from ECT sessions

The number of patients who received ECT was 34, representing 4.33% of patients, 25 men and 9 women with an average age of 39, the number of ECT sessions was 785. The major diagnosis was bipolar disorder in 47,1% of patients, followed by schizophrenia in 35,3% and major depressive disorder in 14,7 %. Resistance to treatment and major suicidal risk were the main indications. All sessions were performed in a bilateral temporal mode. the initial energy delivered varied between 50 and 101 millicoulombs. The duration of the crise obtained was predominantly between 21 and 30 seconds. The average number of sessions during the attack phase was 13.88, whereas it was 2.5 sessions during the consolidation phase. The mean scores of the psychometric evaluations showed a marked improvement, especially in the mania scores (65.89%) and the beck depression inventory (63.55%). Only four incidents were reported in all patients. Only five patients (14,7%) had side effects and the most marked effect was anterograde amnesia.

Mental health programs in Tunisia should promote the generalization of this method throughout the Tunisian territory, given the efficacy demonstrated in mood disorder, several psychoses and other psychiatric pathologie.