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Objectives: To explore whether facial emotion recognition (FER), impaired in both schizophrenia and alcohol and substance use disorders (AUDs/SUDs), is additionally compromised among comorbid subjects, also considering the role of catechol‐O‐methyltransferase (COMT) Val158Met. Methods: We conducted a cross‐sectional study, randomly recruiting 67 subjects with a DSM‐IV‐TR diagnosis of schizophrenia, and rigorously assessing AUDs/SUDs and COMT Val158Met polymorphism. FER was assessed using the Ekman 60 Faces Test‐ EK‐60F. Results: As a whole, the sample scored significantly lower than normative data on EK‐60F. However, subjects with comorbid AUDs/SUDs did not perform worse on EK‐60F than those without, who had a better performance on EK‐60F if they carried the COMT Val/Met variant. Conclusions: This study is the first to date examining the impact of AUDs/SUDs and COMT variants on FER in an epidemiologically representative sample of subjects with schizophrenia. Our findings do not suggest an additional impairment from comorbid AUDs/SUDs on FER among subjects with schizophrenia, whilst COMT Val158Met, though based on a limited sample, might have a role just among those without AUDs/SUDs. Based on our results, additional research is needed also exploring differential roles of various substances.

Background: A functional polymorphism in the catechol-O-methyltransferase (COMT) gene (Val158Met) appears to influence cognition in people with alcohol/substance use disorders (AUD/SUD) and in those with psychosis. Methods: To explore the potential moderating effect of these factors, a cross-sectional study was conducted, randomly recruiting subjects with DSM-IV diagnosis of schizophrenia. AUD/SUD was rigorously assessed, as well as COMT Val158Met polymorphism. Executive control functioning was measured using the Intra-Extra Dimensional Set Shift (IED). The effect of a possible interaction between comorbid AUD/SUD and COMT Val158Met polymorphism on IED scores was explored. Results: Subjects with schizophrenia, comorbid AUD/SUD, and MetMet carriers for SNP rs4680 of the COMT gene showed worse performance on IED completed stages scores, as compared with individuals with ValVal genotype. However, among subjects without AUD/SUD, those with the MetMet variant performed better than people carrying ValVal genotype. Conclusions: This study is the first to date examining the impact of COMT on cognition in a highly representative sample of people with schizophrenia and comorbid AUD/SUD. Differential moderating effects of COMT Val/Met genotype variations may similarly influence executive functions in people with schizophrenia and comorbid AUD/SUD.

Anxiety disorders are common, comorbid, and disabling conditions, often underdiagnosed and under-treated, typically with an early onset, chronic course, and prolonged duration of untreated illness. The present study aimed to explore the influence of sociodemographic and clinical factors in relation to onset and latency to treatment in patients with generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD). A total of 157 patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM-IVTR) diagnosis of PD (n=49), GAD (n=68), and OCD (n=40) were recruited, and epidemiological and clinical variables were collected through a specific questionnaire. Statistical analyses were carried out to compare variables across diagnostic groups. PD, GAD, and OCD patients showed a duration of untreated illness of 53.9 ±81.5, 77.47 ±95.76, and 90.6± 112.1 months, respectively. Significant differences between groups were found with respect to age, age of first diagnosis, age of first treatment, family history of psychiatric illness, onset-related stressful events, benzodiazepine prescription as first treatment, antidepressant prescription as first treatment, and helpseeking (self-initiated vs. initiated by others). Patients with GAD, PD, and OCD showed significant differences in factors influencing onset and latency to treatment, which may, in turn, affect condition-related outcome and overall prognosis. Further studies with larger samples are warranted in the field.

INTRODUZIONE: La Schizofrenia è una patologia cronica caratterizzata dalla presenza di sintomi positivi, negativi, disorganizzazione del pensiero e del comportamento con una progressiva compromissione delle funzioni socio­ cognitive(1). In particolare, il deficit nel riconoscimento delle emozioni può rappresentare uno degli aspetti più gravi alla base dei problemi interpersonali dei soggetti affetti da schizofrenia(2). Inoltre questi pazienti presentano spesso in comorbidità una condizione di abuso di alcol e sostanze(3). SCOPO DEL LAVORO: confrontare la FEP in pazienti affetti da Schizofrenia che utilizzano sostanze (SKZ+SUD) rispetto agli schizofrenici senza SUD in comorbilità (SKZ­SUD). Materiali e Metodi: si tratta di uno studio descrittivo­osservazionale. Sono stati reclutati 53 soggetti (M=40; F=13) con diagnosi di Schizofrenia secondo il DSM­IV (valutata attraverso la Structured Clinical Interview for DSM­IV, SCID I). Il campione è stato suddiviso a seconda della presenza o meno dell’abuso di alcol e sostanze correlato (valutato con l’Alcohol e la Drug Use Scale ­AUS e DUS­ in due gruppi, che sono stati poi confrontati per quanto riguarda le caratteristiche socio­demografiche e cliniche (Positive and Negative Syndrome Scale ­PANSS­ e derivati indici di Bell: sintomi positivi, negativi e disorganizzazione). E’ stata analizzata quindi l’associazione tra condizione di abuso e risultati ottenuti al test di Ekman, che valuta la FEP, controllando per variabili socio­demografiche e cliniche. RISULTATI: I due gruppi SKZ+SUD (n=20; M=16, F=4) e SKZ­SUD (n=33; M=24, F=9) presentano una differenza statisticamente significativa per età con media (SD) pari a 38,4 (10,5) negli abusatori e 46,0 (8,7) nei non abusatori (p= 0,006) e per pendenze legali (p=0,03). Al test di Ekman il gruppo degli abusatori (media=43,1; SD=6,9) mostra un punteggio statisticamente più alto (p=0,006) rispetto ai non abusatori (media=34,6; SD=12,0). La differenza di punteggio è risultata p

BACKGROUND: le caratteristiche cognitive e genetiche sono sempre più centrali nello studio della Schizofrenia. La compromissione delle Funzioni Esecutive (FE), definite come un complesso di abilità cognitive superiori attribuibili alle regioni della corteccia prefrontale, e della Facial Emotion Recognition (FER) rappresentano elementi centrali nel disturbo schizofrenico. Ad oggi, però, il paradigma del (dis)funzionamento cognitivo nella Schizofrenia poggia su studi che hanno escluso i soggetti schizofrenici con storia di abuso di sostanze (SUD), che ha mostrato un impatto peggiorativo sulla cognitività nella popolazione con disturbo da uso di sostanze. La letteratura ha inoltre negli anni definito polimorfismi potenzialmente implicati sia nella Schizofrenia sia nei disturbi da uso di alcol e sostanze, come quello (rs4680) relativo al gene della catecol-O-metiltransferasi (COMT). Viste la prevalenza del fenomeno e l’associazione fra cognition, outcome funzionale e le polimorfismi genetici, lo studio di tali correlati nei pazienti schizofrenici con abuso di sostanze costituisce una questione imprescindibile per una più puntuale stratificazione diagnostica, prognostica e dei trattamenti. SCOPO DEL LAVORO: valutare l’impatto del polimorfismo del COMT e dell’abuso di alcol e sostanze sulle performance cognitive in una popolazione di soggetti con schizofrenia. MATERIALI E METODI: si tratta di uno studio descrittivo­osservazionale. Sono stati reclutati 62 soggetti (M=50; F=12) con diagnosi di Schizofrenia secondo il DSM-IV (valutata attraverso la Structured Clinical Interview for DSM­IV, SCID I). Il campione è stato suddiviso a seconda della presenza o meno dell’abuso di alcol e sostanze correlato (valutato con l’Alcohol e la Drug Use Scale -AUS e DUS­) in due gruppi, che sono stati poi confrontati per quanto riguarda le caratteristiche socio­demografiche e cliniche (Positive and Negative Syndrome Scale - PANSS­). È stata analizzata quindi l’associazione tra condizi, BACKGROUND: cognitive and genetic features are increasingly important in the study of schizophrenia. The impairment of executive function (FE) and facial emotion recognition, are central issues in schizophrenic disease. To date, however, the paradigm of the (dis) cognitive functioning in schizophrenia is based on studies that excluded subjects with schizophrenia and a history of substance abuse (SUD)(5), which is actually a phenomenon that showed a derogatory impact on cognition in the population with substance use disorder. The literature has also over the years defined polymorphisms potentially implicated in both schizophrenia and in alcohol and substance use disorders, such as the one (rs4680) related to the gene of catechol-O-methyltransferase (COMT). Given the prevalence of the phenomenon and the association between cognition, functional outcome and genetic polymorphisms, the study of these related in schizophrenic patients with substance abuse is an important issue for a more precise stratification diagnosis, prognosis and treatment. AIM: to evaluate the impact of the COMT polymorphism and alcohol and substance abuse on cognitive performance in a population of subjects with schizophrenia. MATERIALS AND METHODS: this is a observational study. We recruited 62 subjects (M = 50, F = 12) diagnosed with schizophrenia according to DSM-IV (assessed by the Structured Clinical Interview for DSM-IV, SCID I). The sample was subdivided according to the presence or not of alcohol abuse and related substances (evaluated with the Alcohol and Drug Use Scale -Aus and DUS) into two groups (SKZ+SUD and SKZ-SUD), which were then compared with regard to socio-demographic and clinical characteristics (Positive and Negative Syndrome Scale - PANSS). It was then analysed the association between the condition of abuse, COMT polymorphism and score on Intra-Extra Dimensional Shift September (IED), which evaluates the FE and on test Ekman, evaluating the FER, controlling for socio-demograp

People with alcohol and substance use disorders (AUDs/SUDs) show worse facial emotion recognition (FER) than controls, though magnitude and potential moderators remain unknown. The aim of this meta-analysis was to estimate the association between AUDs, SUDs and FER impairment. Electronic databases were searched through April 2015. Pooled analyses were based on standardized mean differences between index and control groups with 95% confidence intervals, weighting each study with random effects inverse variance models. Risk of publication bias and role of potential moderators, including task type, were explored. Nineteen of 70 studies assessed for eligibility met the inclusion criteria, comprising 1352 individuals, of whom 714 (53%) had AUDs or SUDs. The association between substance related disorders and FER performance showed an effect size of -0.67 (-0.95, -0.39), and -0.65 (-0.93, -0.37) for AUDs and SUDs, respectively. There was no publication bias and subgroup and sensitivity analyses based on potential moderators confirmed core results. Future longitudinal research should confirm these findings, clarifying the role of specific clinical issues of AUDs and SUDs.

Latency to first pharmacological treatment [duration of untreated illness (DUI)] in psychiatric disorders can be measured in years, with differences across diagnostic areas and relevant consequences in terms of socio-occupational functioning and outcome. Within the psychopathological onset of a specific disorder, many factors influence access and latency to first pharmacotherapy and the present study aimed to investigate such factors, through an ad-hoc developed questionnaire, in a sample of 538 patients with diagnoses of schizophrenia-spectrum disorder (SZ), mood disorder (MD), and anxiety disorder (AD). Patients with SZs showed earlier ages at onset, first diagnosis and treatment, as well as shorter DUI compared with other patients (43.17 months vs. 58.64 and 80.43 months in MD and AD; F=3.813, P=0.02). Patients with MD and AD reported more frequently onset-related stressful events, benzodiazepines as first treatment, and autonomous help seeking compared with patients with SZs. In terms of first therapist, psychiatrist referral accounted for 43.6% of the cases, progressively decreasing from SZ to MD and AD (57.6, 41.8, and 38.3%, respectively). The opposite phenomenon was observed for nonpsychiatrist clinician referrals, whereas psychologist referrals remained constant. The present findings confirm the presence of a relevant DUI in a large sample of Italian patients with different psychiatric disorders (5 years, on average), pointing out specific differences, in terms of treatment access and latency, between psychotic and affective patients. Such aspects are relevant for detection of at-risk patients and implement early intervention programs.

Introduzione: La schizofrenia è una patologia psichiatrica con sintomi positivi, negativi e compromissione delle funzioni neuro e socio-cognitive1. Tale patologia si associa frequentemente al disturbo da uso di sostanze2. Disegno Studio descrittivo-osservazionale Metodologia Sono stati reclutati 25 soggetti con diagnosi di Schizofrenia secondo il DSM-IV (Structured Clinical Interview for DSM-IV, SCID I) presso la Clinica Psichiatrica Universitaria dell’Azienda Ospedaliera San Gerardo di Monza. Per ogni paziente sono stati raccolti i dati socio-demografici e clinici e ad ognuno sono stati somministrati l’Alcohol e la Drug Use Scale (AUS e DUS), la Positive and Negative Syndrome Scale (PANSS) e il Test di Ekman (per la valutazione delle funzioni socio-cognitive tramite il riconoscimento delle emozioni faciali). Il campione è stato quindi suddiviso in due gruppi: con abuso di sostanze (Ab+) e senza (Ab-); i gruppi sono stati confrontati per quanto riguarda le caratteristiche cliniche e le capacità socio-cognitive (social cognition). Risultati Al test di Ekman il gruppo Ab+ mostra minor compromissione delle capacità socio-cognitive (Ab+: 47.8 ± 5,3; Ab-: 40.5 ± 8,3; p<0.007). Inoltre all’aumento della gravità clinica si associa un peggioramento della performance nel riconoscimento delle espressioni (p=0.03). L’abuso incide sull’esito al test di Ekman maggiormente rispetto alla gravità clinica (coeff di regressione 7.45 p=0,006 vs coeff di regressione -0.20 p=0.013). Conclusioni Nei soggetti affetti da schizofrenia la social cognition è meno compromessa se tale condizione è associata ad abuso di sostanze. Bibliografia (1) Bora E, Yucel M, Pantelis C. Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study. Br J Psychiatry. 2009 Dec;195(6):475-82. (2) Yücel M, Bora E, Lubman DI, Solowij N, Brewer WJ, Cotton SM, Conus P, Takagi MJ, Fornito A, Wood SJ, McGorry PD, Pantelis C. The impact of cannabis use on cognit

Introduzione: i disturbi psichiatrici subiscono frequentemente un ritardo nella diagnosi e nel trattamento e le cause che maggiormente influenzano tali variabili rimangono in gran parte sconosciute, non essendovi strumenti specificamente volti a indagare tale fenomeno (1) (2). A tal proposito, il nostro Dipartimento ha recentemente sviluppato un questionario focalizzato sull’esordio e sulla latenza ai trattamenti: il questionario sull’esordio psicopatologico (QEP). Scopo del presente studio è stato analizzare le principali variabili cliniche e socio-demografiche correlate all’esordio psicopatologico e alla latenza al trattamento, confrontandole tra gruppi diagnostici. Metodi: il questionario è stato somministrato a 256 pazienti, affetti da qualsiasi disturbo psichiatrico e suddivisi in: Disturbi dell’Umore (n=135), Disturbi d’Ansia (n=83), Disturbi Psicotici (n=38). Sono state successivamente effettuate analisi statistiche demografiche e di confronto tra gruppi tramite SPSS. Risultati: il campione di pazienti con Disturbi dell’Umore ha mostrato le seguenti variabili: età d’esordio 33.2 anni ±15.8, eventi stressanti precedenti l’esordio nel 67%, latenza alla prima visita>6 mesi nel 41% dei casi. Il campione dei Disturbi d’Ansia ha riportato invece: età d’esordio 29.6 anni ±14.7, eventi stressanti precedenti l’esordio nel 66%, una latenza alla prima visita>6 mesi nel 47%. Infine, i Disturbi Psicotici hanno mostrato: esordio 29.5 anni±12.9, eventi stressanti precedenti l’esordio nel 54, latenza alla prima visita>6 mesi nel 48% dei casi. Sono emerse differenze significative tra gruppi, in termini di motivazione alla prima visita: più della metà dei pazienti con Disturbi dell’umore (55%) e la maggior parte dei pazienti con Disturbi Psicotici (72%) sono stati inviati su consiglio dei familiari, percentuale ridotta al 39% nei pazienti con Disturbi d’Ansia, nei quali, invece, sembrerebbe prevalere una decisione autonoma. In tutti i gruppi, la familiarità psichiatrica

Introduzione: La Schizofrenia è una patologia psichiatrica complessa, in grado di alterare in modo significativo la qualità di vita e il funzionamento globale delle persone affette. Essa coinvolge diverse dimensioni psicopatologiche, tra cui quella cognitiva (1), largamente studiata negli ultimi anni, ed è molte volte associata a condotte di abuso di sostanze (2). Disegno: Studio descrittivo-osservazionale. Metodi: Saranno reclutati 50 soggetti (18-50 anni) con diagnosi di Schizofrenia con e senza abuso di sostanze secondo il DSM- IV (Mini International Neuropsychiatric Interview, MINI) presso la Clinica Psichiatrica Universitaria dell’Azienda Ospedaliera San Gerardo di Monza. Saranno raccolti i dati clinici e socio-demografici e ad ogni paziente saranno somministrati il Wisconsin Card Sorting Test (WCST) per valutare le funzioni esecutive, la Positive And Negative Syndrome Scale (PANSS) per la valutazione della sintomatologia psicotica, l’Alcohol Use Scale (AUS) e la Drug Use Scale (DUS) per la definizione delle condotte d’abuso di alcol e sostanze, rispettivamente. Il campione totale, sulla base della presenza di abuso di sostanze, sarà diviso in due gruppi, che saranno confrontati per quanto riguarda le funzioni esecutive, al fine di delinearne eventuali differenze. Discussione: Nella valutazione della schizofrenia un aspetto considerevole è rappresentato dal concomitante uso di sostanze, e di cannabis in particolare, stimato intorno al 64% lifetime (3), il cui ruolo sulle performances cognitive è ancora dubbio. Il nostro studio ha lo scopo di valutare le funzioni esecutive in un campione di soggetti affetti da schizofrenia con e senza abuso di sostanze, al fine di comparare i risultati nei 2 gruppi. Bibliografia (1) Bora E, Yucel M, Pantelis C. Cognitive functioning in schizophre- nia, schizoaffective disorder and affective psychoses: meta-analytic study. Br J Psychiatry 2009;195:475-82. (2) Yücel M, Bora E, Lubman DI, et al. The impact of cannabis use on

Introduzione: in Italia sono pochi gli studi volti ad attestare la prevalenza delle malattie psichiatriche negli Istituti Penitenziari. Uno dei problemi fondamentali nelle carceri italiane è costituito dalle condotte autolesive. Il suicidio rappresenta infatti la prima causa di morte in carcere e conta per circa la metà di tutti i decessi. Metodi: il nostro è uno studio descrittivo osservazionale prospettico. Il campione è costituito da 119 detenuti; si è rilevata in primo luogo l’incidenza delle condotte autolesive in un periodo di osservazione di 6 mesi. Sono state inoltre somministrate 6 scale di valutazione psicopatologica, tra cui la Barrat Impulsiveness Scale (BIS-11). Risultati: il 16% del campione ha compiuto gesti autolesivi e il 3,4% ha compiuto un TS. Il 77,8% dei paziente che ha compiuto gesti autolesivi aveva già commesso un tentativo simile in passato. Il 44,2% dei soggetti è risultato ad alta impulsività (BIS-11 > 72). Il 66,6% dei soggetti del gruppo considerato soffriva di un disturbo della personalità a fronte del 22% dei pazienti del resto del campione. Questi ultimi risultavano colpiti nel 31,8% dei casi da un disturbo dell’adattamento che interessava invece solo il 13,3% dei self-harmer (p = 0,037). Conclusioni: il presente studio s’inserisce nel contesto poco esplorato della psichiatria penitenziaria italiana, con lo scopo di dare un contributo per quanto riguarda la gestione delle condotte autolesive e dell’impulsività nella popolazione carceraria.

Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that modifies cortical excitability in a polarity-dependent way that has been increasingly investigated for the treatment of major depression (MD) during recent years. Stimulation for few minutes can induce plastic alterations of cortical excitability and improve cognitive performance. Even if the available evidence, including randomized clinical trials, has generally reported encouraging results in treatment of major depression and treatment-resistant depression, the use of tDCS in mood disorders should still be considered experimental. In fact, further research is needed to better define the optimal stimulation parameters, duration of treatment, durability of clinical effect and predictors of response. Nevertheless, to date, tDCS has shown a favourable tolerability profile, is easy to apply, portable and inexpensive. Taken together, increased use of the technique in the treatment of depressive disorders may be expected in the near future.

Transcranial direct current stimulation (tDCS) is a selective, painless, brain stimulation technique that allows the electric stimulation of specific cortical regions. TDCS has been recently used as investigational intervention for major depression and treatment resistant depression (TRD) with encouraging results. The present study was aimed to investigate the efficacy and tolerability of tDCS in major depressives with poor response to pharmacological treatment. Twenty-three depressed patients, with a diagnosis of major depressive disorder or bipolar disorder, were treated with augmentative tDCS for 5 days, two sessions per day in a blind-rater trial. The course of depressive symptoms was analyzed using repeated measures ANOVA for HAM-D and MADRS total scores. A qualitative analysis on the basis of the HAM-D response was performed as well. Both analyses were conducted at three time-points: T0 (baseline), T1 (endpoint tDCS) and T2 (end of the first week of follow-up). All patients completed the trial without relevant side-effects. A significant reduction of HAM-D and MADRS total scores was observed during the study (P<0.0001). Treatment response (endpoint HAM-D reduction ≥50%) was obtained by four patients (17.4%) at T1 and by seven patients (30.4%) at T2 and remission (endpoint HAM-D. <8) by three patients (13.0%) at T1 and by four subjects (17.4%) at T2. Present findings support the efficacy and good tolerability of tDCS in the acute treatment of patients with TRD with clinical benefit being progressive and extended to the first week of follow-up. Further sham-controlled trials with longer follow-up are needed to confirm present results. © 2011 Elsevier Masson SAS.

Introduction: There are more than 10 million inmates worldwide. Recent studies show that, compared with general population, prisoners have about 2-10-fold higher rate of mental disorders. In order to evaluate severity symptomatology of psychiatric inmates as well as clinical and sociodemographic characteristics, we performed a research on a sample of prisoners secluded in Casa Circondariale di Monza referred for a clinical psychiatric assessment. Materials and methods: Cross-sectional study of consecutive prisoners secluded in Casa Circondariale di Monza referred, over a six-month period, for a clinical psychiatric assessment. For whole sample, clinical and sociodemographic characteristics were collected, a clinical diagnosis in according with DSM-IV-TR was formulated and Clinical Global Impressions (CGI), Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAM-D), Mania Rating Scale (MRS), Hamilton Anxiety Scale (HAM-A) and Barratt Impulsiveness Scale, version 11 (BIS-11) were administered. Moreover, all patients were prospectively followed until the end of the study and main clinical variables were recorded. Results: In our sample prevalence for a mental disorders was: personality disorders 33.6%; adjustment disorders 26.1%; psychotic disorders 4.2%; mood disorders 10.9%; anxiety disorders 6.7%. Mean total scores obtained at psychometric scales were: GAF 70.5; MRS 3.4; HAM-D 9.1; HAM-A 7.9; BIS-11 68.8; PANSS 42.1; CGI 3.2. Conclusions: Mainly, prisoners affected by mental disorder showed a moderate symptomatic severity. Psychometric scales have been found useful to identify a subgroup of subjects with an increased risk to make self harm. © 2012 Elsevier Srl. Tutti i diritti riservati.

Background: Major Depression (MD) and treatment-resistant depression (TRD) are worldwide leading causes of disability and therapeutic strategies for these impairing and prevalent conditions include pharmacological augmentation strategies and brain stimulation techniques. In this perspective, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with a favorable profile of tolerability which, despite being recently approved by the Food and Drug Administration (FDA) for the treatment of patients with medication-refractory unipolar depression, still raises some doubts about most effective parameters of stimulation. Methods: A literature search was performed using PubMed for the years 2001 through February 2011 in order to review meta-analytic studies assessing efficacy and safety issues for rTMS in depressive disorders. Fifteen meta-analyses were identified and critically discussed in order to provide an updated and comprehensive overview of the topic with specific emphasis on potentially optimal parameters of stimulation. Results: First meta-analyses on the efficacy of rTMS for the treatment of MD and TRD have shown mixed results. On the other hand, more recent meta-analytic studies seem to support the antidepressant efficacy of the technique to a greater extent, also in light of longer periods of stimulation (e.g. > 2 weeks). Conclusion: rTMS seems to be an effective and safe brain stimulation technique for the treatment of medication refractory depression. Nevertheless, further studies are needed to better define specific stimulation-related issues, such as duration of treatment as well as durability of effects and predictors of response. © Dell'Osso et al.

BACKGROUND: The efficacy of repetitive transcranial magnetic stimulation (rTMS) has been poorly investigated in the long-term. The present follow-up study was aimed to assess the long-term efficacy and the discontinuation effects of rTMS in a sample of depressed bipolar patients. METHODS: After the completion of an acute trial with augmentative, low-frequency, navigated rTMS, 11 drug-resistant depressed bipolar subjects (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [Text Revision] criteria) entered a naturalistic follow-up with monthly evaluations through the Hamilton Depression Rating Scale and the Young Mania Rating Scale. RESULTS: After 1 year of follow-up, results showed that the achievement of remission after acute rTMS was predictive of maintenance of response at 1 year. On the other hand, the absence of acute rTMS response predicted the absence of subsequent response in the long-term. CONCLUSIONS: This first report on the long-term discontinuation effects after acute rTMS suggests that immediate remission is predictive of sustained benefit after 1 year. Larger controlled studies are needed to confirm present preliminary findings. © 2011 Lippincott Williams & Wilkins, Inc.