The Effects of rTMS on Impulsivity in Normal Adults: a Systematic Review and Meta-Analysis

Impulsivity is a multi-dimensional construct that is regarded as a symptom of many psychiatric disorders. Harm resulting from impulsive behaviour can be substantial for the individuals concerned, for their social network, and for wider society. Therefore, the importance of developing therapeutic interventions to target impulsivity is paramount. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline, and PsycINFO databases on the use of repetitive transcranial magnetic stimulation (rTMS) in healthy adults to modulate different subdomains (motor, temporal and reflection) of impulsivity. The results indicated that rTMS has distinct effects on different impulsivity subdomains. It has a significant, albeit small, effect on modulating motor impulsivity (g?=?0.30, 95% CI, 0.17 to 0.43, p?<?.001) and a moderate effect on temporal impulsivity (g?=?0.59, 95% CI, 0.32 to 0.86, p?<?.001). Subgroup analyses (e.g., excitatory vs. inhibitory rTMS, conventional rTMS vs. theta burst stimulation, analyses by stimulation sites, and type of outcome measure used) identified key parameters associated with the effects of rTMS on motor and temporal impulsivity. Age, sex, stimulation intensity and the number of pulses were not significant moderators for effects of rTMS on motor impulsivity. Due to lack of sufficient data to inform a meta-analysis, it has not been possible to assess the effects of rTMS on reflection impulsivity. The present findings provide preliminary evidence that rTMS can be used to modulate motor and temporal impulsivity in healthy individuals. Further studies are required to extend the use of rTMS to modulate impulsivity in those at most risk of engaging in harmful behaviour as a result of impulsivity, such as patients with offending histories and those with a history of self-harming behaviour.     

Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis

Comorbidity rates between ADHD and anxiety disorders (AD) are high, but little is known about the nature of this co-occurrence. A dominant idea is that AD may intensify some (i.e., attention and working memory) and attenuate other (i.e., inhibition) ADHD symptoms. Results are mixed, potentially because of between-study differences. To investigate this further we performed a meta-regression analysis on 11 studies (n ‘ADHD-only’ = 695; n ‘ADHD + AD’ = 608), containing 35 effect sizes on attention, inhibition and working memory. Main results were: (1) no evidence of a negative effect of AD on attention and working memory; (2) better response inhibition in children with ADHD with AD than those with only ADHD (medium ES g = ? .40); (3) medication moderated this association: the effect seemed limited to studies that included medication-naïve participants; (4) the difference between the two groups increased with age for attention and with proportion of boys for working memory ability. There was no effect of comorbid disruptive behavior disorder. In conclusion, AD seems to be a protective factor for inhibition problems as assessed with laboratory tasks in ADHD, especially in children who are medication naïve. Further, AD may have a protective function for attention in older children, and for working memory in boys with ADHD. It is therefore important to screen for AD when diagnosing ADHD, and to educate those with comorbid AD about the possible positive function of feeling anxious. Potential negative effects of ADHD medication on inhibition in children with comorbid AD should be considered.     

Der Facharzt für Psychotherapeutische Medizin: Realisierung in der Praxis

Ohne Zusammenfassung     

Anxiety and Threat Perception Abnormalities in Normal Children

The current study examined the relationship between childhood anxiety and threat perception abnormalities. Children (N = 105) were exposed to stories reflecting three types of anxiety: social anxiety, separation anxiety, and generalized anxiety. From children's reactions to the stories, a number of threat perception indices were derived. Children's level of anxiety was assessed by means of questionnaires and a structured diagnostic interview. Results indicated that high levels of anxiety, as measured by questionnaires and interview, were accompanied by a high frequency of threat perception, high ratings of threat, a high frequency of threatening interpretations, high levels of negative feelings and cognitions, and an early detection of threat. Furthermore, results seemed to suggest that threat perception abnormalities were mediated by children's general level of anxiety rather than by levels of specific anxiety symptoms.     

Causes As Difference‐Makers For Processes

It is natural to think of causes as difference‐makers. What exact difference causes make, however, is an open question. In this paper, I argue that the right way of understanding difference‐making is in terms of causal processes: causes make a difference to a causal process that leads to the effect. I will show that this way of understanding difference‐making nicely captures the distinction between causing an outcome and helping determine how the outcome happens and, thus, explains why causation is not transitive. Moreover, the theory handles tricky cases that are problematic for competing accounts of difference‐making.     

Psychological Well-Being as an Additional Outcome Parameter in the Treatment of Patients with Gambling Disorder: Results from a Clinical Multicenter Follow-Up Study

According to the World Health Organization well-being has been defined as one outcome parameter indicating successful recovery from diseases. One disease causing significant psychosocial problems and distress is Gambling Disorder that is being characterized as a poorly controlled excessive engagement in gambling activities. While there are several studies investigating treatment-effects in patients with Gambling Disorder, the role of well-being as a complementary treatment outcome has not been studied so far. In our research project it was aimed to fill this gap by gathering data on changes of eudaimonic dimensions of well-being from 76 patients with Gambling Disorder before and 1 year after receiving inpatient treatment. At both waves (pretreatment and follow-up) we collected data regarding well-being (Ryff Scales of Well-being), psychopathological symptoms (SCL-9), and diagnostic criteria for Gambling Disorder (Lie/Bet-Questionnaire). We found some dimensions of well-being changing 1 year after treatment and that patients recovered from Gambling Disorder displayed significant increments in Autonomy and Environmental Mastery. In contrast, patients still meeting criteria for Gambling Disorder displayed well-being increments only in Environmental Mastery and decreases in Personal Growth and Positive Relations with Others. Only changes in Environmental Mastery and Self-Acceptance were significantly associated with decreases in psychosocial distress indicating that well-being is an additional indicator for treatment outcome. It was also intended to identify factors predicting increments in well-being. However, no relationships were found regarding demographics, clinical variables, or treatment parameters. It is proposed to acknowledge well-being as an additional indicator for treatment effects and suggested to implement therapeutic strategies for an early enhancement of well-being.