The measurement of the physiological coherence, the order and the quality of the connection of complex systems such as the cardiac and the respiratory system, varies in situations of stress and relaxation.

We aim to assess changes in physiological coherence and perception of stress during mental stress and directed breathing exercises.

Repeated-measures study in healthy adults without prior training in breathing techniques, aged between 18 and 65 years of both sexes who were evaluated in three situations: baseline, mental stress (Stroop test and successive subtractions), and directed breathing, during which were captured heart rate and respiratory signals to estimate physiological coherence and the participants rated the perceived stress at each moment.

34 participants were analyzed, 59% women, with a median age of 36 years (Rq = 13). During mental stress tasks, the median for physiological coherence was similar to baseline coherence but increased significantly with five minutes of directed breathing exercises (38% vs. 63% p <0.0001). The highest perception of stress was during successive subtractions (Me 7, Rq = 4) and the lowest during directed breathing exercises (Me 2 Rq = 3.0). The correlation was sought between physiological coherence and perception of stress during each of the four moments of the study. Basal (Rho Spearman -0.05, p 0.54); Stroop (Rho -0.17, p 0.03); successive subtractions (Rho 0.50, p 0.77); and directed breathing (Rho -0.28, p 0.09).

A correlation was found between physiological coherence and perception of stress during the Stroop test; however, no association was found.

No significant relationships.

Vagus nerve stimulation produces therapeutic effects for the treatment of psychiatric disorders, heart failure, and others.

The aim of the current study was to evaluate the effects of the non-invasive vagus nerve stimulation on emotional burnout.

6 right-handed male volunteers aged 18-22 years participated in study. We used the combination of pleasant meditative classical music and a slow bi-polar wave (0.1-0.2 Hz) of electrical non-invasive transcutaneous auricular vagus nerve stimulation for 5 minutes. The set of 4 VNS was performed at intervals of 3 days. EEG was registered during the rest state (3 min, closed eyes condition). To measure the severity of emotional burnout in students, we used the 22-item Maslach Burnout Inventory (MBI).

VNS significantly improve the depersonalization and reduction of personal achievements (components of the emotional burnout). Changes in the psychoemotional state of the respondents were accompanied by the increase in the theta-Fz/alpha-Pz ratio, that reflects an enhancement of the activation level. A set of non-invasive stimulation of the auricular branch of the vagus nerve leads to an increase in the level of activation (the ratio of beta / alpha rhythms). The changes in the power of the alpha rhythm may relate to improving of mental process, creativity, creative thinking. An increase in alpha rhythm may reflect internally oriented attention in creative activities.

The preliminary data suggests that the novel mastoid stimulation device may have a prolonged stimulating effect on the brain processes while attenuating the burnout at the same time.

No significant relationships.

It has been suggested that dysregulation of sex hormones is associated with schizophrenia. However, obesity and metabolic syndrome are very common between schizophrenic patients, and it can also dysregulate sex hormones so they could act as confounders.

To determine if estradiol and progesterone are abnormally elevated regardless of obesity or metabolic syndrome in men with SCZ.

We measured serum levels of progesterone and estradiol in 56 schizophrenic male patients at treatment with a depot antipsychotic. Subsequently, we studied the association or independence of our results with obesity or metabolic syndrome by a Chi Square Test.

66.07% of our patients elevated progesterone levels, 19.64% of our patients elevated estradiol levels, and 16.07% of our patients elevated both, progesterone and estradiol, simultaneously. We found no relationship between increased estradiol and / or progesterone with obesity and / or metabolic syndrome.

Estradiol and progesterone are abnormally elevated regardless of obesity and / or metabolic syndrome in male schizophrenic patients on depot treatment.

No significant relationships.

Oxytocin, also known as the love molecule, was discovered in 1906 because of its effects on uterine contractions. It exists in all mammals and is partly responsible for delivery. Nonetheless, it seems that oxytoxin also takes part in something as important to nursing as the physical changes in childbirth – the behavioural predisposition to form human bonds and to care for others.

Present a review on Oxytocin and its functions in human behaviour and possible clinical implications

Pubmed and Google Scholar search using the keywords “oxytocin”, “behaviour”, “oxytocin in humans” and “psychiatry”.

Besides acting as a peripheral hormone following posterior hypophisis secretion, oxytocin can be diffused through several brain areas, acting as a neuropeptide in neurochemical circuits that promote sexual behaviour, maternal and caring behaviour towards newborns, and other subtle social processes like vinculation, social memories formation, aggressiveness towards strangers and anxiety reduction. These evolutionary advantages constitute the roots for feelings of love and social phenomena like solidarity and affection. Oxytocin is increased in response to sex hormones, during pregnancy and social interactions, especially mother-child contact; additionally, is associated with endorphin release and feelings of well-being. Several studies associate the oxytocinergic system to multiple clinical implications, such as Anxiety Disorders, PTSD, Depression, Autism, Borderline and Anti-social Personality Disorder.

Oxytocin has an important role in shaping social behaviours and in the development of secure interpersonal bonds. In the future, it can be a possible target for some psychiatric conditions; however, more research is required to prove therapeutic outcomes.

No significant relationships.

To understand the way chemistry influences human communication is important since the reaction to chemosignals has many implications for science and society. For instance, previous research showed a connection between olfaction and affective psychiatric disorders. Olfactory processing may be impaired in subject presenting depression symptoms (DEP). Furthermore, a heightened sensitivity to social odours has been shown in subject with social anxiety symptoms (SAD). This may be due to the partial overlap of brain areas which are involved in olfactory processing and the pathophysiology of these disorders. Yet, more detailed research on the olfactory processing is required.

POTION is an EU funded project within the Horizon2020 initiative that aims to understand the nature of chemosignals in humans and their sphere of influence on social interaction. Within this project, we conducted a preliminary exploratory study examining whether the odours may be utilized to support positive outcomes of psychological therapy. It evaluates the catalyst effect of the odour conditions on the effectiveness of mindfulness meditation for SAD and DEP.

Thirty subjects per patient group (total=60) are randomly allocated to one exposure group (happy or fearful human body odour or clean air) and follow the intervention while being exposed to the odour. Psychological outcome is measured before and after the intervention through the State-Trait Anxiety Inventory and the Profile of Mood State questionnaires. Analysis of variance is performed to assess outcome differences between groups.

Preliminary results on a subsample of 32 patients show a trend of deeper reduction of anxiety symptoms at post-treatment among odour-exposed groups compared to clean air (F(1,17)=11.08, p=0.004).

Final results on the complete sample will be available and presented at the time of the congress.

No significant relationships.

Fear is an unpleasant emotional response to perceiving a threat causing physiological changes. Humans feel fear for positive motives, as it plays a crucial role in our survival. Just as the right balance in life is ideal, pathological fear is often described in one of its exaggerations, of having too much. However, lack of fear or “hypophobia” can be just as devastating and debilitating. This can be demonstrated in the analogy between those who feel no pain who also demonstrate increased risk and decreased life expectancy.

The authors aim to explore the concept of fear, discussing currently known physiological mechanisms in order to explain the effects that alterations of these mechanisms can have on fear responses, namely lack of fear, and subsequently the consequence of this on mental health.

A brief non-systematized literature review was performed based on works most pertinent to the topic discussed.

Muted fear responses have been mentioned in the literature, principally associated with medical conditions affecting the physiological fear pathways, including Urbach-Wiethe disease. Amygdala damage provokes abnormal fear reactions and reduced fear experience. This appears to be similar to what is seen in psychopathy, where abnormalities in the limbic system produce abnormal fear responses.

Any extreme can cause havoc on a well-balanced machine. Just as the excess of fear results in mental issues such as anxiety, a lack of fear can also be debilitating. Those demonstrating less fear could help investigators better understand mental health disorders that have been demonstrated to be mediated by similar processes.

No significant relationships.

Electroconvulsive therapy (ECT) is administered following general anaesthetic induction with methohexital, thiopental, etomidate, alfentanil, remifentanil, propofol or ketamine. One approach for idealizing the induction anaesthesia for ECT is combining two agents (e.g. ketamine-propofol) with synergistic anaesthetic properties and non-additive anticonvulsive and hyperdynamic effects.

To establish any superiority between ketamine-propofol (ketofol) combination and etomidate in terms of seizure characteristics and hemodynamic measures.

We have combined our previous case series (etomidate vs thiopental) with new data regarding propofol and ketofol. ECT stimulus duration, stimulus frequency, the stimulus charge applied, duration of central seizure time, number of stimulation trials, plus anaesthetic used in the individual sessions were retrieved. A total number of 1092 sessions (239 sessions with etomidate, 233 with thiopental, 275 with propofol, and 345 with ketofol induction) were included in the linear mixed-effects model analysis.

Etomidate was superior in terms of seizure duration compared with thiopental. There was no significant difference in seizure durations between ketofol, propofol and thiopental, however, number of failed stimulation trials within a session increased significantly with propofol use compared with etomidate and ketofol. The required amount of charge (stimulation dosage) was significantly lower when ketofol was used, compared with thiopental. Additionally, within the ketofol sessions only the propofol dose significantly increased the amount of required dose.

Etomidate and ketofol displayed certain superiorities in terms of seizure characteristics when used as induction anaesthetics for ECT. Therefore, both etomidate and ketamine used in combination with propofol may be considered to be the gold standards of ECT anaesthesia.

No significant relationships.

Late life depression is a major global health issue, with an estimated 7% of older adults suffering from this mental disorder. Depression is one of the most important predictors for suicide in the elderly. However, it is often difficult to recognize and manage, making treatment-resistance a common occurrence. Treatment-resistant depression itself is also a known risk factor for suicide. Recently, non-invasive neuromodulation techniques have been used as a new treatment for depression and suicidality with promising results.

This study aims to investigate the effect of adTMS (accelerated deep Transcranial Magnetic Stimulation) and tDCS (transcranial Direct Current Stimulation) on the suicidality of elderly, therapy-resistant depressed patients. The hypothesis is that suicidal ideation and risk of suicide will decrease after a treatment with adTMS and tDCS.

In this randomized double-blinded sham-controlled clinical trial, geriatric therapy-resistant depressive patients will receive adTMS treatment (See: Figure 1). Suicidality will be assessed before and after the active or sham treatment, through the Columbia Suicide Severity Rating Scale (C-SSRS) and Beck Scale for Suicide Ideation (BSI). After one week of rest, all patients will receive an at-home tDCS treatment for 3 weeks. Likewise, the suicide risk will be estimated before and after the tDCS. During the screening period, the severity of the patients’ depressive symptoms will be determined by using the 17-item Hamilton Depression Rating Scale (HDRS-17). In total, the trial will last for 5 weeks, and suicidality will be examined at five different time points (during screening, at T0, T1, T2 and T3).

Not applicable

Not applicable

No significant relationships.

Insufficient efficacy of conventional treatment of auditory hallucinations (AH) in schizophrenia supports rising interest to brain stimulation techniques including transcranial magnetic stimulation (TMS). Left temporo-parietal cortex (TP3) is involved in emergence of AH, thus neuromodulation of this area might be reasonable.

Comparison of efficacy and tolerability of 2 protocols of TMS (1 Hz and cTBS) over TP3 and sham-TMS for treatment resistant AH in schizophrenia.

76 schizophrenia (ICD-10 - F20) patients with prominent AH (PANSS P3 ≥ 4, AHRS ≥ 15), who had failed to respond to previous antipsychotic treatment, were randomized into 3 groups: 1) 1 Hz TMS (30 patients); 2) cTBS (25 patients); 3) Sham-TMS (21 patients). Sessions were performed 5 days a week for 3 weeks. Antipsychotic medication was continued throughout the study. Patients were assessed weekly with PANSS, AHRS, CDSS, CGI-S by blinded raters. The criterion of efficacy was 30% AHRS score reduction after 3 weeks of treatment.

The number of responders were 13 (43,3%) in 1 Hz TMS group, 14 (56%) – in cTBS group, 4 (19,1%) in sham-TMS group. There was no statistically significant difference in efficacy between 1 Hz TMS and cTBS, but each of the active protocols was more effective than sham-TMS. Treatment was generally well tolerated in all groups, nobody was discontinued the study due to adverse events.

Both protocols of TMS (1 Hz and cTBS) over TP3 are safe and effective in the treatment of schizophrenic patients with pharmacotherapy resistant AH. Further studies are needed.

No significant relationships.

The use of Electroconvulsive therapy (ECT) during pregnancy and in the post-partum period is a critical decision for both providers and their patients. ECT utilization during this critical period needs to be better understood to assess the need and allocate resources for this valuable treatment option.

1) To evaluates baseline characteristics and analyze ECT utilization trends for pregnant and post-partum patients hospitalized in the US. 2) To provide insight into ECT use among inpatient pregnant women with different age groups with various comorbid psychiatric disorders.

The study used the 2002-2015 National (Nationwide) Inpatient Sample (NIS) data. Descriptive statistical and trend analyses were conducted to evaluate data.

A study found that a total of 924 pregnancy-related hospitalizations required ECT treatment; 92.2% of these ECTs were conducted in urban hospitals. The mean age of women was 30.3 years, and the majority (71%) were of the White race. Mood disorders (major depressive disorder- 51.9% and bipolar disorder- 37.9%) accounted for the most common comorbid psychiatric illnesses. The payer source (Medicare/Medicaid vs. Private Insurance) was almost equal (47.9 vs. 46.8). Though not statistically significant, the trend analysis showed that the proportion of ECTs during pregnancy out of the total ECT performed for the year almost doubled (0.24% to 0.47%) from 2008 to 2015.

Though not statistically significant, the use of ECT in pregnant women has increased in 2015 compared to 2002. Results will help clinicians, policymakers, and various stakeholders to optimize ECT utilization, reimbursement and ultimately improve clinical outcomes.

No significant relationships.

The Department of Psychiatry at Semmelweis University is the largest electroconvulsive therapy (ECT) centre in Hungary, where a total number of around 300 treatments are conducted every year. Certain changes were administered in 2018 and 2019 in our logistics and internal protocols that helped to increase the number of treated patients and improve quality of care. The COVID-19 pandemic caused serious disruptions in the Hungarian mental health care system , therefore there was a realistic fear that many patients who required ECT would not receive this form of tretament.

Our goal was to assess the effects of the pandemic on our ECT service, and to analyse whether patients were able to receive treatment, despite the logistical difficulties.

We retrospectively gathered data from our internal documentation to compare the number of ECT treatments with the previous years. We also had to take into account the fluctuation in our general caseload of psychiatric patients, since our Department acted as a COVID-19 treatment centre for several months.

Total number of ECT treatments decreased in 2020 after a peak in 2019, however the numbers were not much lower compared to the years before changes in 2018. Unfortunately, we see a more direct effect of the 3rd wave of the pandemic.

We can conlude that there is a decrease in the number of ECT treatments due to the pandemic, however, the fact that we still provided service in most parts of 2020 and 2021 for patients with the most severe conditions is a serious achivement.

No significant relationships.

Anorexia nervosa has an important burden on both patients and families, with important comorbidities such as depression and obsessive symptoms. These are more resistant to pharmacological treatment than in non-anorexia patients, due to both biological and psychological mechanisms. Electroconvulsive therapy is the best available therapy for treatment resistant depression making it a treatment to consider in treatment resistant depression in anorexia though only case reports exist.

To review the current evidence for electroconvulsive therapy of depression in patients with anorexia nervosa as well as it’s ethical challenges

Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “anorexia nervosa”.

Electroconvulsive therapy in anorexia has no controlled trials with mostly case reports available on scientific databases. It presents important challenges due to patient age, medical status and ethical challenges. Even less evidence exist for electroconvulsive therapy in children and adolescents than for adults, anorexia can complicate medical status presenting an anesthetic and life-support challenge and it’s egosyntonicity can place a legal and ethical challenge when patient refuses treatment.

Anorexia has a dramatic burden on patients and families affected, with integrated evidence-based treatment being necessary both for treating the current episode and for remission prevention. Case-reports show that electroconvulsive therapy can play a role on treatment resistant depression in anorexia.

No significant relationships.

Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder that affects 2-3% of the population. Pharmacological or cognitive behavioral therapy can reduce symptoms. Deep brain stimulation is emerging for treatment-resistant patients.

We measured neuronal activity in two patients with treatment-resistant OCD, who had DBS electrodes implanted bilaterally in the BNST. Local field potentials were recorded directly from the BNST during and without symptom provocation and without electrical stimulation.

In two patients with a diagnosis of treatment resistant OCD (TR-OCD) local field potentials (LFP) were recorded as part of their clinical follow up post-implantation. In both patients, the diagnosis of TR-OCD was confirmed by a neuropsychiatric examination and a multidisciplinary committee comprising both experienced psychiatrists and neurosurgeons from different medical centers in Belgium. We used BrainSense recording technology in the Percept PC to record the LFPs. The LFP recordings in the first patient were acquired on the 15th day after DBS surgery. In the second patient, the interval between implantation and recording was 18 days. Symptom provocation was performed using the MOCCS image set, developed by Mataix-Cols.

At rest, relative power peaks in the BNST were highest in the theta (4-8 Hz) frequency band for both patients. In both patients switching DBS ON during provocation images appears to cause the LFP signal to closely resemble that recorded during neutral images.

The main finding of this pilot study is that switching stimulation ON in the BNST during provocation images causes the LFP signal to more closely resemble the LFP recorded during neutral images.

No significant relationships.

Trans-cranial magnetic stimulation (TMS) as a non-invasive method of altering brain activity (1) has widened the array of therapeutic options available for various psychiatric disorders.

Trans-cranial Magnetic stimulation (TMS) as a non-invasive method of altering brain activity has widened the array of therapeutic options available for various psychiatric disorders. •A large number of studies have shown therapeutic benefits in a wide range of patient population with majority of studies in adults. •TMS is used increasingly for the treatment of child and adolescent depression. •Yet, the scarcity of studies and lack of published guidelines for this population is notable. •As TMS use is expanding in this population, an overview of the use of TMS in children and adolescents with depression may provide much needed and timely perspective on this neuropsychiatric intervention.

We searched all published studies using PubMed database, on TMS use in depressive disorders in children and adolescents. A total of 13 studies were found to have reported use of TMS in depression in children and adolescents.

We found various case series, open label studies as well as sham controlled blind studies indicating that TMS has been effective in treating depression in children and adolescents. No significant side effects were found in our review.

Studies have shown that TMS is an effective treatment option for depressive disorders in children and adolescents. Initial studies look promising but implications in large pediatric population may be different and there is a need for more double blind, controlled trials with larger sample size.

No significant relationships.

Deep Brain Stimulation is an increasingly viable, well-established treatment for medication refractory obsessive-compulsive disorder. Yet, its neuromodulatory effects on the brain have led to varying and opposing neuroethical debates about its potential influence on a range of phenomena such as human agency, sense of nonauthenticity and identity.

Establish the importance of maintaining the psychotherapeutic alliance in a long-term DBS patient who reported minimal device side effect and no brain-technology interface interpersonal issues; yet struggled with a paradoxical phenomenon of psychic distress surrounding issues of agency and identity, not through device implantation, but through morphology of cognitions from negativistic interpersonal dynamics and spousal victim-blaming due to the necessity for such a device.

Case-report of a 60+-year-old gentleman with a history of childhood-onset, treatment refractory OCD with a 15-year history of bilateral DBS lead placed via a ventral caudate/ ventral striatum trajectory through the anterior limb of the internal capsule to the nucleus accumbens.

Years later he was only minimally improved above baseline; yet now with a few-years increasing degree of distress over a perceived atrophy of his capabilities that he felt was validated through what he described as his failure of artificial bionics. Extensive device setting re-optimization did not improve efficacy and with supportive therapy, the DBS device was weaned, and turned off.

The following year the therapeutic foci were on interpersonal identity, existential acceptance of breakthrough symptoms, and engagement of spouse into marital counseling leading to subsequent resolution of distress with improved quality of life.

No significant relationships.

Postpartum and peripartum depression are debilitating disorders that impact the mother and their ability to care for their children’s emotional, social, and physical needs. Current treatments include psychotherapy, pharmacotherapy, and electroconvulsive therapy. These treatments are moderately effective or come with side effects that can negatively impact mother and child. As a result, many mothers view some treatments as unacceptable while pregnant or breastfeeding. Over the last decade, repetitive transcranial magnetic stimulation (rTMS) has shown promise as an effective and safe treatment option for postpartum and peripartum depression. However, little is known regarding people’s knowledge and attitudes towards this emerging technology, with no research assessing this in Canada.

We aim to identify gaps in knowledge and to assess attitudes toward rTMS as a treatment for postpartum and peripartum depression in mental health professionals, patients, and the general public living in Canada.

A mixed methods study design will be employed. The qualitative portion will consist of individual semi-structured interviews. An inductive thematic analysis will be completed. The quantitative portion will consist of an anonymous, self-administered survey shared through REDCap. Focus groups with rTMS experts will be conducted to inform survey creation.

No resulst at this time.

Understanding gaps in knowledge and attitudes toward rTMS is the first step toward ensuring that everyone is well informed and able to access safe and effective treatments. With limited treatment options available to a postpartum and/or peripartum depression patients being well informed on all treatments is crucial towards accessing treatments that best suit their needs.

No significant relationships.

Catatonia is one of the most common severe motor syndromes, with an estimated prevalence among psychiatric inpatients of about 15 %. Benzodiazepines and electroconvulsive therapy (ECT) are the most widely studied treatment methods recommended as first-line therapy. We present the case of a 55-year-old female patient with paranoid schizophrenia and severe life-threatening catatonia who remitted under a short series of rTMS.

s. Introduction

The point of resting motor threshold (RMT) for the musculus rectus femoris was determined for the left hemisphere. A straight line 3 cm anterior and parasagittal from that point defined the SMA. A total of three sessions, each with 1000 pulses at intensity 66 % of the RMT, were performed within 24 and 120 hours apart. Stimulation protocol was set to 1Hz in the area of the left SMA with 25 series of 40 pulses, pulse width 25 ms, angle of attack 45°. Hardware: MagVenture, 8-coil “cool-B65 butterfly-shaped coil from Medtronic.

Within 24 hours after the first session, a marked improvement of catatonic symptoms like independent locomotion and verbal communication was recognized. One week after the whole rTMS treatment, a food intake without a gastric tube was possible.

The present case demonstrates that pronounced catatonia may be successfully treated with inhibitory rTMS. Our results underline the importance of non-invasive brain stimulation as a valuable addition to the existing treatment spectrum for catatonia. Future research is empowered to path the way for a significant expansion of treatment.

No significant relationships.

Electroconvulsive therapy (ECT) is a medical treatment for those patients with high suicide risk or refractory psychiatric disorders. It is currently a safe technique, and its effectiveness has been widely demonstrated.

Presentation of a clinical case about a patient with drug-resistant delusional disorder and high suicide risk, who eventually received ECT treatment.

Bibliographic review including the latest articles in Pubmed about ECT procedure, effects and use.

We present a 45-year-old man, who visited different doctors several times by reporting he had the feeling of “having a brain tumor or a vascular disorder”, so he requested imaging tests (computed tomography and magnetic resonance). These tests were absolutely normal, but he kept thinking something was wrong, and eventually attempted suicide by hanging (his family founded him before it was too late). The patient was admitted to hospital, and started psychopharmacological treatment, with minimal response. He desperately insisted that he had “something inside his head”. At this point, it was proposed to start ECT, and the patient accepted. After 6 bilateral ECT sessions, he was visibly more relaxed and less worried, and he no longer presented autolytic ideation. He was still a little bit suspicious about the feeling of having a neurological disease. Currently, the patient runs a follow-up consultation.

Electroconvulsive therapy is a safe and effective technique for those patients with high suicide risk. It may be useful to perform imaging tests in certain cases, for detecting intracranial pressure, acute hemorrhage, tumors… A follow-up of these patients must be performed

No significant relationships.

Intelectual disability is an illness with an important burden on patients and caregivers, especially when severe and when comorbidities such as other psychiatric disorders are present. There are case reports of treatment resistant self-aggression, agitation, epilepsy, catatonia and psychosis successfully treated with electroconvulsive therapy although controlled studies were not found.

This work reviewed the current evidence for the use of electroconvulsive therapy in the management of patients with intellectual disability as well as its ethical and methodological implications.

Non-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “intellectual disability”.

Patients with intellectual disability can have incapacitating comorbilities that greatly impair quality of life, and may require withdrawl from the community Treatment often differs from the general population as psychotropic medication can worsen other comorbilities. Electroconvulsive therapy can be a relevant treatment option for comorbidities in this population due to its safety profile. Ethical considerations should be taken into account, especially with non-verbal patients or when adequate representatives have not been chosen or cannot be reached. Different legal challenges may be present on different countries.

Electroconvulsive therapy and intellectual disability share the burdens of heavy stigma and low investment. Intellectual disability and it’s commorbidites present both a diagnostic and treatment challenge. Electroconvulsive therapy is an important weapon capable of restoring patients to their families and diminishing the burdens of caregivers and healthcare systems

No significant relationships.

Depressive symptoms are common in individuals with tinnitus, however, the mechanisms of their interaction are not fully understood. There is neurobiological evidence that might help understanding the interplay between tinnitus and depression which, in turn, helps in making the right choice for treating both conditions.

This case report describes a 70-year old female patient that presented with tinnitus and depressive symptoms lasting for the past 5 years.

The patient showed limited treatment results with different antidepressants. The otorhinolaryngologist ruled out any possible somatic causes of her tinnitus. Tinnitus was causing her sleep disturbances, which worsened her everyday functioning that was already quite poor even further.

After being administered with 30 rounds of TMS, her symptoms either completely resolved or at least reached a level that was adequate for her to start functioning normally on a day-to-day basis.

TMS is a technique that provides non-invasive cortical stimulation, more specifically, when used for depression treatment it stimulates the left dorsolateral prefrontal cortex, a brain region synaptically connected to the limbic system involved in mood regulation that is proven to be hypoactive in depression. The limbic system is where tinnitus-related brain networks and regions involved in the pathophysiology of depression overlap. Further research is needed to deepen the understanding of this topic.

No significant relationships.