General Psychiatry最新文献

{"title":"Navigating personal recovery: multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals","authors":"Jutharat Thongsalab, Jintana Yunibhand, Penpaktr Uthis","doi":"10.1136/gpsych-2023-101325","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101325","url":null,"abstract":"Background Schizophrenia is a chronic mental disorder affecting individuals globally, emphasising the significance of personal recovery in mental healthcare. Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions. Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage. Methods A multistage sampling technique was employed, selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals. Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires—Stage of Recovery Scale, Beck Cognitive Insight Scale, Brief Resilience Scale, Family Support, Therapeutic Relationship-Patients Version and Social Support Questionnaire—along with personal data sheets. Pearson correlation and multinomial logistic regression were performed. Results The predominant personal recovery stage among participants was stage 3, ‘living with disabilities’, comprising 42.4% of the participants. Key factors contributing to personal recovery, explaining approximately 38.4% of the variance, included resilience, family support, therapeutic alliance, hospitalisations since onset and recovery-oriented nursing service utilisation. Logit equations for stages 3 and 4 are as follows: stage 3 (living with disability): logit=−4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation; stage 4 (living beyond disability): logit=−11.57–0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance. Conclusion The findings emphasise the significance of mental health nursing interventions. In conjunction with recovery-oriented nursing services, strengthening resilience, therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia. Data may be obtained from a third party and are not publicly available.","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"97 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain-wide activation involved in 15 mA transcranial alternating current stimulation in patients with first-episode major depressive disorder","authors":"Jie Wang, Wenfeng Zhao, Huang Wang, Haixia Leng, Qing Xue, Mao Peng, Baoquan Min, Xiukun Jin, Liucen Tan, Keming Gao, Hongxing Wang","doi":"10.1136/gpsych-2023-101338","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101338","url":null,"abstract":"Background Although 15 mA transcranial alternating current stimulation (tACS) has a therapeutic effect on depression, the activations of brain structures in humans accounting for this tACS configuration remain largely unknown. Aims To investigate which intracranial brain structures are engaged in the tACS at 77.5 Hz and 15 mA, delivered via the forehead and the mastoid electrodes in the human brain. Methods Actual human head models were built using the magnetic resonance imagings of eight outpatient volunteers with drug-naïve, first-episode major depressive disorder and then used to perform the electric field distributions with SimNIBS software. Results The electric field distributions of the sagittal, coronal and axial planes showed that the bilateral frontal lobes, bilateral temporal lobes, hippocampus, cingulate, hypothalamus, thalamus, amygdala, cerebellum and brainstem were visibly stimulated by the 15 mA tACS procedure. Conclusions Brain-wide activation, including the cortex, subcortical structures, cerebellum and brainstem, is involved in the 15 mA tACS intervention for first-episode major depressive disorder. Our results indicate that the simultaneous involvement of multiple brain regions is a possible mechanism for its effectiveness in reducing depressive symptoms. Data are available upon reasonable request.","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"1 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140072992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"J-shaped association between dietary thiamine intake and the risk of cognitive decline in cognitively healthy, older Chinese individuals.","authors":"Chengzhang Liu, Qiguo Meng, Yuanxiu Wei, Xinyue Su, Yuanyuan Zhang, Panpan He, Chun Zhou, Mengyi Liu, Ziliang Ye, Xianhui Qin","doi":"10.1136/gpsych-2023-101311","DOIUrl":"10.1136/gpsych-2023-101311","url":null,"abstract":"<p><strong>Background: </strong>The prospective association of dietary thiamine intake with the risk of cognitive decline among the general older adults remains uncertain.</p><p><strong>Aims: </strong>To investigate the association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals.</p><p><strong>Methods: </strong>The study included a total of 3106 participants capable of completing repeated cognitive function tests. Dietary nutrient intake information was collected through 3-day dietary recalls and using a 3-day food-weighed method to assess cooking oil and condiment consumption. Cognitive decline was defined as the 5-year decline rate in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified.</p><p><strong>Results: </strong>The median follow-up duration was 5.9 years. There was a J-shaped relationship between dietary thiamine intake and the 5-year decline rate in global and composite cognitive scores, with an inflection point of 0.68 mg/day (95% confidence interval (CI): 0.56 to 0.80) and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake. Before the inflection point, thiamine intake was not significantly associated with cognitive decline. Beyond the inflection point, each unit increase in thiamine intake (mg/day) was associated with a significant decrease of 4.24 (95% CI: 2.22 to 6.27) points in the global score and 0.49 (95% CI: 0.23 to 0.76) standard units in the composite score within 5 years. A stronger positive association between thiamine intake and cognitive decline was observed in those with hypertension, obesity and those who were non-smokers (all p<0.05).</p><p><strong>Conclusions: </strong>This study revealed a J-shaped association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals, with an inflection point at 0.68 mg/day and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake.</p>","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"37 1","pages":"e101311"},"PeriodicalIF":5.3,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiota-derived short-chain fatty acids and depression: deep insight into biological mechanisms and potential applications","authors":"Junzhe Cheng, Hongkun Hu, Yumeng Ju, Jin Liu, Mi Wang, Bangshan Liu, Yan Zhang","doi":"10.1136/gpsych-2023-101374","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101374","url":null,"abstract":"The gut microbiota is a complex and dynamic ecosystem known as the ‘second brain’. Composing the microbiota-gut-brain axis, the gut microbiota and its metabolites regulate the central nervous system through neural, endocrine and immune pathways to ensure the normal functioning of the organism, tuning individuals’ health and disease status. Short-chain fatty acids (SCFAs), the main bioactive metabolites of the gut microbiota, are involved in several neuropsychiatric disorders, including depression. SCFAs have essential effects on each component of the microbiota-gut-brain axis in depression. In the present review, the roles of major SCFAs (acetate, propionate and butyrate) in the pathophysiology of depression are summarised with respect to chronic cerebral hypoperfusion, neuroinflammation, host epigenome and neuroendocrine alterations. Concluding remarks on the biological mechanisms related to gut microbiota will hopefully address the clinical value of microbiota-related treatments for depression.","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"2 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional and national burdens of bipolar disorders in adolescents and young adults: a trend analysis from 1990 to 2019","authors":"Yunxi Zhong, Yifan Chen, Xiaoying Su, Meiqi Wang, Qixiu Li, Ziming Shao, Long Sun","doi":"10.1136/gpsych-2023-101255","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101255","url":null,"abstract":"Background Bipolar disorder is identified as a cause of severe damage to the physical, psychological and social functioning of adolescents and young adults. Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10–24 years at global, regional and national levels from 1990 to 2019. Methods The data analysed in this study were from the Global Burden of Diseases 2019. The numbers, rates per 100 000 population, average annual percentage changes (AAPCs) of incidence, prevalence and years lived with disability (YLDs) of bipolar disorder are reported at the global, regional and national levels among individuals aged 10–24 years. Global trends by age, sex and Social Development Index (SDI) were further analysed. Results Globally, the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100 000 population (95% uncertainty interval (UI): 58.13 to 105.15) in 1990 to 84.97 per 100 000 population (95% UI: 61.73 to 113.46) in 2019, AAPC 0.24 (95% confidence interval (CI): 0.22 to 0.26). In the past three decades, there has been an increase in incidence, prevalence and YLDs in both males and females. The largest increase in incidence between 1990 and 2019 was observed in those aged 20–24 years old (from 51.76 per 100 000 population (95% UI: 26.81 to 87.20) in 1990 to 58.37 per 100 000 population (95% UI: 30.39 to 98.55) in 2019; AAPC 0.42 (95% CI: 0.38 to 0.47)). By the SDI quintile, the largest increase in incidence was observed in the middle SDI; however, the high SDI countries had the highest incidence. Regionally, the largest increase in incidence was observed in southern Latin America. At the national level, the most pronounced increase in the incidence was in Greenland. Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised. Data are available in a public, open access repository. Data in this article were collected from the Global Health Data Exchange (<https://vizhub.healthdata.org/gbd-results/>).","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"29 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide, self-injury and violence","authors":"Kexin Zhang, Ziyang Wang, Xin Yu","doi":"10.1136/gpsych-2023-101387","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101387","url":null,"abstract":"To the editor: Non-suicidal self-injury (NSSI) is defined as direct, repetitive self-injury to bodily tissues without suicidal intent.1 The estimated prevalence of NSSI among adolescents is 17.2% worldwide2 with a comparable rate observed in China.3 As a behavioural addiction,4 NSSI poses a significant suicide risk,5 and is emerging as a major mental health problem among adolescents. To unravel this puzzle, the four-function model (FFM) distinguishes between interpersonal and intrapersonal functions, as well as positive and negative reinforcement functions,6 proving relatively comprehensive among various theoretical models. Despite its high prevalence rates and serious influences, adolescents and young adults with NSSI often seek information and social support online rather than offline from doctors or other professionals. One-third of young people with a history of self-injury report online help-seeking for self-injury.7 As of June 2023, China has a huge adolescent internet user base of close to 150 million.8 However, a limited number of studies have explored NSSI and online information-seeking and help-seeking in the Chinese context. Social media sites have raised concerns due to the presence of NSSI-related content.9 10 As one of the most commonly used social media platforms among Chinese users, Sina Weibo (Weibo hereafter) has a large user base with a large amount of user-generated content. The content on Weibo is mostly the self-expression of users, with pictures and text as the main focus, and the text content is limited to 140 Chinese characters, fostering an open content ecosystem. This study investigates ambiguous NSSI-related terms on Weibo. To our knowledge, this is the first published study to explore NSSI-related terms on a Chinese-language social network. The purposes of the current study are (1) to explore the meaning and consistency of ambiguous language use; (2) to explore the general social opinions towards NSSI …","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"34 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparisons of transcranial alternating current stimulation and repetitive transcranial magnetic stimulation treatment therapy for insomnia: a pilot study","authors":"Ziqiang Shao, Yongjian Guo, Lirong Yue, Xiaoyang Liu, Jiayi Liu, Xumeng Zhao, Xiaona Sheng, Dahua Yu, Yifei Zhu, Kai Yuan","doi":"10.1136/gpsych-2023-101184","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101184","url":null,"abstract":"To the editor: Insomnia disorder has a serious and widespread detrimental effect on humans with comorbidity with other mental or physical health problems.1 2 In recent years, non-invasive brain stimulation (NIBS) techniques, especially transcranial magnetic stimulation (TMS) and transcranial electrical stimulation, have been increasingly used for the treatment of brain diseases, including insomnia disorder. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proven to reduce neuronal excitability to modulate the abnormal hyperarousal of patients with insomnia. The efficacy of rTMS for insomnia has been observed, and rTMS may be a safe and effective option for insomnia treatment.3 However, the stimulation effects of rTMS have varied substantially across studies and individuals. rTMS was found to produce region-specific effects that critically depend on the connectivity profile of target regions, and an extended, trans-scale model has been developed.4 Unfortunately, it could not simply generalise across different protocols, which hindered the development of more precise and effective regulation for brain abnormalities. A previous review indicated that dorsolateral prefrontal cortex (DLPFC) stimulation by rTMS could modulate the release of key neurotransmitters in the sleep–awake cycle. Even though the proposed mechanisms were still speculative, the review indicated that the stimulation of DLPFC (right, left and bilaterally) with low frequencies (1 Hz) could improve sleep architecture and quality.5 Continued research into better rTMS protocols for treating insomnia disorder and further study of the mechanisms of efficacy were still warranted. It is also worth noting that transcranial alternating current stimulation (tACS) has received much attention in recent years. tACS was able to modulate neural oscillations of specific frequencies through entrainment.6 Such frequency specificity facilitated the precise modulation of the brain, leading to a better therapeutic effect. Currently, tACS has been showing results for initial sleep regulation and insomnia treatment.7 8 Since the role …","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"29 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the influences of education, intelligence and income on mental disorders","authors":"Ancha Baranova, Hongbao Cao, Fuquan Zhang","doi":"10.1136/gpsych-2023-101080","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101080","url":null,"abstract":"Background Previous studies have shown that educational attainment (EA), intelligence and income are key factors associated with mental disorders. However, the direct effects of each factor on major mental disorders are unclear. Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders. Methods Using genome-wide association study summary datasets, we performed Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to assess potential associations between the 3 factors (EA, N=766 345; household income, N=392 422; intelligence, N=146 808) and 13 common mental disorders, with sample sizes ranging from 9907 to 807 553. Inverse-variance weighting was employed as the main method in the MR analysis. Results Our MR analysis showed that (1) higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa, obsessive-compulsive disorder (OCD), bipolar disorder (BD) and autism spectrum disorder (ASD); (2) higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD; (3) higher household income protected against 10 mental disorders but confers risk for anorexia nervosa. Our MVMR analysis showed that (1) higher EA was a direct protective factor for attention-deficit/hyperactivity disorder (ADHD) and insomnia but a direct risk factor for schizophrenia, BD and ASD; (2) higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder (MDD) and ASD; (3) higher income was a direct protective factor for seven mental disorders, including schizophrenia, BD, MDD, ASD, post-traumatic stress disorder, ADHD and anxiety disorder. Conclusions Our study reveals that education, intelligence and income intertwine with each other. For each factor, its independent effects on mental disorders present a more complex picture than its overall effects. No data are available.","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"12 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140003965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive–behavioural therapy (CBT) intervention","authors":"Yunxiang Sun, Soim Park, Abid Malik, Najia Atif, Ahmed Zaidi, Atif Rahman, Pamela J Surkan","doi":"10.1136/gpsych-2023-101136","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101136","url":null,"abstract":"Background Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety. Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive–behavioural therapy (CBT) had a regulatory effect. Methods Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model. Results Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=−0.82, 95% CI: −1.46 to –0.18) and anxiety (B=−0.70, 95% CI: −1.25 to –0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes. Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences. Trial registration number [NCT03880032][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03880032&atom=%2Fgpsych%2F37%2F1%2Fe101136.atom","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"127 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140004176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological considerations of priming repetitive transcranial magnetic stimulation protocols in clinical populations","authors":"Jack Jiaqi Zhang, Zhongfei Bai, Kenneth N K Fong","doi":"10.1136/gpsych-2023-101237","DOIUrl":"https://doi.org/10.1136/gpsych-2023-101237","url":null,"abstract":"To the editor: Repetitive transcranial magnetic stimulation (rTMS) is a neuroplasticity-enhancing technique that modifies brain responsiveness to various therapeutic modalities in clinical psychiatric and neurological applications.1 Furthermore, its effect can be attributed to long-term potentiation (LTP) or long-term depression (LTD)-like neuroplasticity. However, responsiveness to rTMS is largely variable in healthy and pathological brains2 and is mediated by complex biological mechanisms. Metaplasticity refers to a higher-order plasticity mechanism in which the direction and magnitude of synaptic plasticity are modified by prior neuronal activity and is believed to be a significant factor leading to the response variability of rTMS.3 According to its mechanism of action, the threshold for induction of LTP and LTD is dynamically adjusted to the level of prior neuronal activity: a low level of prior neuronal activity slides down the threshold to preferentially induce LTP. By contrast, a high level slides up the threshold to preferentially induce LTD.4 The induction of metaplasticity has been demonstrated in the human cortex using rTMS. Successively applying two identical rTMS protocols may lead to the reversal of the aftereffect of the protocol owing to the saturation of LTP/LTD and homeostatic regulation via metaplasticity. By contrast, pairing two non-identical stimulation protocols appears to induce additive neuroplastic effects through therapeutically beneficial metaplasticity induction.4 Therefore, researchers have used priming protocols to stabilise and increase the aftereffects of the subsequent conditioning session (figure 1A). A total of two kinds of priming protocols for inducing therapeutically beneficial metaplasticity, ‘preceding excitation enhances subsequent inhibition’ and ‘preceding inhibition amplifies subsequent excitation’, have been tested with conventional high-frequency/low-frequency rTMS as well as intermittent/continuous theta burst stimulation (iTBS/cTBS) in the M1 of healthy individuals, measured using motor-evoked potential (MEP).5 Figure 1 (A) Design of priming rTMS protocol and its underlying sliding threshold model: a low level of neuronal …","PeriodicalId":12549,"journal":{"name":"General Psychiatry","volume":"22 1","pages":""},"PeriodicalIF":11.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139666342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}