The role of estrogen in the treatment of men with schizophrenia.

Schizophrenia is a debilitating and pervasive mental illness with devastating effects on many aspects of psychological, cognitive and social wellbeing. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women, suggesting that estrogen plays a "protective" role . Adjunctive estrogen therapy has been shown to be effective in enhancing the treatment of schizophrenia in women.

An investigation of medial temporal lobe changes and cognition following antidepressant response: a prospective rTMS study.

Background: Major depressive disorder (MDD) is often resistant to treatment with standard approaches. Repetitive transcranial magnetic stimulation (rTMS) is a new treatment that has proven antidepressant efficacy in treatment resistant MDD (TRD). Preliminary evidence also raises the possibility of rTMS enhancing neuronal plasticity; with demonstrated increases in serum levels of brain derived neurotrophic factor (BDNF) found.

Cognitive and volumetric predictors of response to repetitive transcranial magnetic stimulation (rTMS) - a prospective follow-up study.

As the prevalence of treatment resistant depression (TRD) continues to rise, it remains a clinically important issue to identify neurobiological-, patient- and treatment-related factors that could potentially predict response to treatment. Medial temporal lobe (MTL) structures, in particular the hippocampus and amygdala have been implicated in inferior treatment response. The role of related structures such as the entorhinal cortex and the impact of MTL abnormalities on neurocognitive function, however, have not been systematically examined.

Assessing cortical network properties using TMS-EEG.

The past decade has seen significant developments in the concurrent use of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) to directly assess cortical network properties such as excitability and connectivity in humans. New hardware solutions, improved EEG amplifier technology, and advanced data processing techniques have allowed substantial reduction of the TMS-induced artifact, which had previously rendered concurrent TMS-EEG impossible. Various physiological artifacts resulting from TMS have also been identified, and methods are being developed to either minimize or remove these sources of artifact.

Investigating the relationship between cognitive change and antidepressant response following rTMS: a large scale retrospective study.

Background: The use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression has been studied extensively over the last 15 years. In this time the vast majority of trials included assessment of cognition to determine whether the technique is cognitively safe. However, recent evidence suggests that the assessment of cognition could also have an important role to play in the prediction of antidepressant response.

Hormones and schizophrenia.

Purpose Of Review: It is a well established fact that many serious mental illnesses, in particular psychoses such as schizophrenia, may have a significant hormonal aetiological component. This study aims to discuss the oestrogen protection hypothesis of schizophrenia in particular, with an emphasis on findings from the recent literature in support of this theory.

Recent Findings: Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women, suggesting a protective role of oestrogen.

The emerging use of brain stimulation treatments for psychiatric disorders.

Objective: The aim of this study was to review the current state of development and application of a wide range of brain stimulation approaches in the treatment of psychiatric disorders.

Method: The approaches reviewed include forms of minimally invasive magnetic and electrical stimulation, seizure induction, implanted devices and several highly novel approaches in early development.

Results: An extensive range of brain stimulation approaches are now being widely used in the treatment of patients with psychiatric disorders, or actively investigated for this use.

A practical guide to the use of repetitive transcranial magnetic stimulation in the treatment of depression.

Background: Repetitive transcranial magnetic stimulation (rTMS) is currently emerging as a new treatment for patients with mood disorders. Research into the use of rTMS for the treatment of patients with depression has been conducted now for a period of greater than 15 years and a considerable body of knowledge has accumulated informing its use.

Objective: The aim of this paper was to review the use of various rTMS techniques for the treatment of depression and to provide practical suggestions to address the common issues encountered in the prescribing and administration of rTMS treatment.

Magnetic seizure therapy for treatment-resistant depression.

Approximately 30% of people with depression do not respond to standard treatments. Currently, the standard treatment for patients with treatment-resistant depression is electroconvulsive therapy (ECT). ECT, while effective, has a number of common side effects that limit its use - in particular the occurrence of memory impairment.

Intensity dependent repetitive transcranial magnetic stimulation modulation of blood oxygenation.

Background: Repetitive transcranial magnetic stimulation (rTMS) is increasingly being investigated in clinical settings for the treatment of neurological and psychiatric disorders such as dystonia, schizophrenia, and major depressive disorder (MDD). Using near infra-red spectroscopy (NIRS), very short trains of rTMS have previously been shown to modulate cortical blood oxygenation.

Methods: In order to investigate the effect of longer, clinically relevant trains of 1 Hz rTMS on oxy-hemoglobin (HbO) at prefrontal cortex, the current study applied ten minute trains of rTMS at both subthreshold and suprathreshold intensities.

A randomized controlled trial of sequentially bilateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of negative symptoms in schizophrenia.

Background: Repetitive transcranial magnetic stimulation (rTMS) has been investigated for its treatment efficacy for the negative symptoms of schizophrenia. Previous studies have targeted the dorsolateral prefrontal cortex (DLPFC), which is associated with the pathophysiology of this disorder. Several rTMS parameters have been explored in the treatment of negative symptoms and include stimulating the left and bilateral DLPFC at several different frequencies and number of sessions.

Blood oxygenation changes resulting from suprathreshold transcranial magnetic stimulation.

The hemodynamic response to low-intensity transcranial magnetic stimulation (TMS) has previously been demonstrated at motor cortex using near infrared spectroscopy (NIRS). To investigate the effect of TMS on oxy-hemoglobin (HbO) at prefrontal cortex, both subthreshold and suprathreshold TMS relative to resting motor threshold (rMT) were applied at typical intensities used in experimental settings. Although there was no significant change after 90% and 110% rMT TMS, there was a significant drop in HbO after 130% rMT TMS.

Individualized alpha activity and frontal asymmetry in major depression.

Lateralized differences in frontal alpha power in individuals with major depressive disorder (MDD) are thought to reflect an aberrant affective processing style. However research into anterior alpha asymmetry and MDD has often produced conflicting results. The current study aimed to investigate whether individualized alpha bandwidths provide a more sensitive measure of anterior alpha asymmetry in MDD than the traditional fixed 8-13 Hz alpha band.

The effects of repetitive transcranial magnetic stimulation in the treatment of depression.

Repetitive transcranial magnetic stimulation (rTMS) is currently emerging as one of the first fundamentally new treatments in psychiatric practice for a considerable number of years. Research into the use of rTMS for the treatment of patients with depression has now been conducted for over 15 years. The aim of this article was to review the development of rTMS treatment for depression and the current state of evidence supporting its use.

Can a behavioral intervention enhance the effect of repetitive transcranial magnetic stimulation on mood?

Background: One of the few novel treatments developed for major depression in recent years has been repetitive transcranial magnetic stimulation (rTMS). Despite mostly promising results, 50-60% of patients do not respond to rTMS. Therefore, it is important to investigate ways of enhancing the effectiveness of this treatment.

A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression.

Background: Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres.

Method: A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions.

Hippocampal volumetrics in treatment-resistant depression and schizophrenia: the devil's in de-tail.

Studies of patients with major depressive disorder (MDD) and schizophrenia (SCH) have revealed reduced hippocampal volumes, but findings have been inconsistent due to sample and measurement differences. The current study sought to measure this structure in a large sample of MDD, SCH, and healthy subjects, using a strict measurement protocol, to elucidate morphological-specific volumetric differences. Patients with treatment-resistant MDD (N = 182) and treatment-resistant SCH with auditory-verbal hallucinations (N = 52), and healthy controls (N = 76) underwent psychiatric assessments and brain MRI.

A near infra-red spectroscopy study of the effects of pre-frontal single and paired pulse transcranial magnetic stimulation.

Objective: Concentration changes in hemoglobin following single and paired pulse (2 and 15 ms inter-stimulus interval) transcranial magnetic stimulation (TMS) was investigated using near infra-red spectroscopy (NIRS).

Methods: TMS was delivered to left pre-frontal cortex at typical intensities used in neuroscience research and concentrations of deoxyhemoglobin (Hb), oxyhemoglobin (HbO) and total hemoglobin (HbT) were measured.

Results: Significant drops in concentration of HbO and HbT were observed and while there was no effect of the different pulse types on amplitude, there was a difference in the time taken to return to baseline.

Exploring the optimal site for the localization of dorsolateral prefrontal cortex in brain stimulation experiments.

Background: Dorsolateral prefrontal cortex (DLPFC) is a common target for repetitive transcranial magnetic stimulation (rTMS) experiments and therapeutic protocols.

Objective: The aim of this study was to investigate the optimal method for the localization of DLPFC for use in these studies.

Methods: Twelve healthy subjects underwent a structural magnetic resonance imaging (MRI) scan, a TMS procedure to establish the location of the motor cortex and a neuronavigational procedure to assess the relative position of the DLPFC.

Upper alpha activity during working memory processing reflects abnormal inhibition in major depression.

Background: EEG studies examining 'resting' state (i.e. non-task) state brain activity in major depressive disorder (MDD) have reported numerous abnormalities within the alpha bandwidth.

Introducing magnetic seizure therapy: A novel therapy for treatment resistant depression.

Objective: Electroconvulsive therapy (ECT) remains the only established therapy for the large percentage of patients with depression who fail to respond to standard treatments. It is commonly used but has substantial problems including the occurrence of cognitive side effects that are often highly distressing for patients. One highly promising potential alternative is magnetic seizure therapy (MST).

Traumatic brain injury, major depression, and diffusion tensor imaging: making connections.

Unlabelled: It is common for depression to develop after traumatic brain injury (TBI), yet despite poorer recovery, there is a lack in our understanding of whether post-TBI brain changes involved in depression are akin to those in people with depression without TBI. Modern neuroimaging has helped recognize degrees of diffuse axonal injury (DAI) as being related to extent of TBI, but its ability to predict long-term functioning is limited and has not been considered in the context of post-TBI depression. A more recent brain imaging technique (diffusion tensor imaging; DTI) can measure the integrity of white matter by measuring the directionality or anisotropy of water molecule diffusion along the axons of nerve fibers.

Brain stimulation in psychiatry and its effects on cognition.

From the advent of electroconvulsive therapy in the 1930s to the emergence of magnetic seizure therapy in the 2000s, the refinement of brain stimulation in psychiatry has been largely motivated by a desire to achieve clinical efficacy and eliminate cognitive adverse effects. As a result of these efforts, a clinically efficacious brain stimulation technique that does not negatively affect cognition could soon be available. In the course of developing a 'cognitively safe' brain stimulation technique, potential methods to enhance various aspects of cognition have also emerged.

Piloting the effective therapeutic dose of adjunctive selective estrogen receptor modulator treatment in postmenopausal women with schizophrenia.

Estrogen treatment may enhance the recovery of schizophrenia in women. However, adverse effects on uterine and breast tissue and other physical side effects may limit the long-term therapeutic use of estrogen. Raloxifene hydrochloride is a selective estrogen receptor modulator that acts as an estrogen antagonist in breast tissue and may have agonistic actions in the brain, potentially offering mental health benefits with few estrogenic side effects.

GABA and cortical inhibition in motor and non-motor regions using combined TMS-EEG: a time analysis.

Objective: The induction of long interval cortical inhibition (LICI) in motor cortex with paired pulse transcranial magnetic stimulation (ppTMS) is an established paradigm for the assessment of cortical inhibition, proposed to be related to GABA(B) receptor inhibitory neurotransmission. This study aimed to further evaluate recent methods of the assessment of LICI in non motor regions with ppTMS and electroencephalography (EEG).

Methods: ppTMS was applied using a single coil to the motor and dorsolateral prefrontal cortex (DLPFC) in 14 healthy subjects, and in the parietal lobe in 5 of those subjects.