RESUMO
BACKGROUND: Bipolar depression (BD) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness. Pharmacological treatments for BD might further aggravate cognitive impairment, highlighting the need of developing interventions that present cognitive safety. In this study, we evaluated the cognitive effects of H1-coil (deep) transcranial magnetic stimulation (TMS) in patients with treatment-resistant bipolar depression. METHODS: Fourty-three patients were randomized to receive 20 sessions of active (55 trains, 18â¯Hz, 120% resting motor threshold intensity) or sham rTMS within a double-blind, sham-controlled trial. A battery of 20 neuropsychological assessments, grouped in 6 domains (attention and processing speed, working memory and executive function, inhibitory control, language, immediate verbal memory, and long-term verbal memory) was performed at baseline and after 4 and 8 weeks of trial onset. Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression. RESULTS: Cognitive improvement was shown for all cognitive domains. It occurred regardless of intervention group and depression improvement. For the language domain, greater improvement was observed in the sham group over time. No correlations between depression (at baseline or during treatment) and cognitive improvement were found. LIMITATIONS: Absence of healthy control group. CONCLUSION: The results of this exploratory study provide evidence on the cognitive safety of H1-coil TMS for BD patients. Putative pro-cognitive effects of rTMS in BD were not observed and thus should be further investigated.
Assuntos
Transtorno Bipolar/terapia , Transtornos Cognitivos/etiologia , Transtorno Depressivo Resistente a Tratamento/terapia , Estimulação Magnética Transcraniana/métodos , Adulto , Transtorno Bipolar/psicologia , Cognição , Transtorno Depressivo Resistente a Tratamento/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Resultado do TratamentoRESUMO
O transtorno afetivo bipolar causa incapacitação e isolamento social, podendo levar ao suicídio. Tratou-se de estudo clínico de casos múltipos com uso de: Inventário de Depressão (BDI) e Suicídio (BSI) de Beck, Escala de Depressão de Hamilton (HAM-D) e Rorschach, Sistema Compreensivo. O objetivo foi analisar os aspectos afetivos, cognitivos e interpessoais das pacientes. Quatro pacientes foram estudadas. Foram atendidas em ambulatório público e préviamente diagnosticadas com depressão bipolar, segundo Entrevista Psiquiátrica (SCID-I/CV-DSM-IV). Resultados indicaram sentimentos depreciativos na autoimagem, conteúdos eufóricos e falta de insight sobre a auto-tolerância ao estresse. Aspectos emocionais e cognitivos influenciaram no contexto interpessoal, acentuando o sofrimento. Outros dados qualitativos clínicos foram observados e comentados.
The bipolar affective disorder induces incapacitation and social isolation, and might lead to suicide. It was a clinical study of multiple cases using the following instruments: Beck Depression Inventory (BDI), Beck Suicide Inventory (BSI), Hamilton Scale of Depression (HAM-D) and the Rorschach, by Exner's Comprehensive System (CS). The objective was to analyze the affective, cognitive and interpersonal aspects of the patients. Four female out-patients who were previously diagnosed as bipolar depressive, by the Psychiatry Interview according to Diagnostic and Statistical Manual of Mental Disorders (SCIDI/CV-DSM-IV) criteria were studied. Results had indicated undervalued feelings about themselves, euphoric contents and lack of insight about the self-tolerance related to stress controls. Emotional and cognitive aspects have influenced the interpersonal context leading to increased suffering. Other qualitative and clinic data have been observed and commented.