The interest in non-invasive brain stimulation techniques is increasing in recent years. Among these techniques, transcranial direct current stimulation (tDCS) has been the subject of great interest among researchers because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in the field. This interest has generated several studies and randomized clinical trials, particularly in psychiatry. In this review, we provide a summary of the development of the technique and its mechanism of action as well as a review of the methodological aspects of randomized clinical trials in psychiatry, including studies in affective disorders, schizophrenia, obsessive compulsive disorder, child psychiatry and substance use disorder. Finally, REVIEWSubmit a

Background Neuromodulation techniques for obsessive–compulsive disorder (OCD) treatment have expanded with greater understanding of the brain circuits involved. Transcranial direct current stimulation (tDCS) might be a potential new treatment for OCD, although the optimal montage is unclear. Objective To perform a systematic review on meta-analyses of repetitive transcranianal magnetic stimulation (rTMS) and deep brain stimulation (DBS) trials for OCD, aiming to identify brain stimulation targets for future tDCS trials and to support the empirical evidence with computer head modeling analysis. Methods Systematic reviews of rTMS and DBS trials on OCD in Pubmed/MEDLINE were searched. For the tDCS computational analysis, we employed head models with the goal of optimally targeting current delivery to structures of interest. Results Only three references matched our eligibility criteria. We simulated four different electrodes montages and analyzed current direction and intensity. Conclusion Although DBS, rTMS and tDCS are not directly comparable and our theoretical model, based on DBS and rTMS targets, needs empirical validation, we found that the tDCS montage with the cathode over the pre-supplementary motor area and extra-cephalic anode seems to activate most of the areas related to OCD.

16 revista debates em psiquiatria -Nov/Dez 2014 zar, é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, manifestando caracteristicamente delírios, alucinações, pensamento e/ou comportamento desorganizado. A etapa inicial de manifestação dos sintomas psicóticos, em que a intensidade dos mesmos leva uma quebra evidente do funcionamento, define o primeiro episódio psicótico (PEP FIRST-EPISODE PSYCHOSIS: EMERGENCY ASSISTANCEResumo O termo psicose é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, e a etapa inicial de manifestação dos sintomas psicóticos define o primeiro episódio psicótico (PEP). Este artigo apresenta conceitos e dados gerais sobre PEP, apresenta fatores de risco e provê orientações sobre o diagnóstico (inclusive diagnósticos diferenciais), tratamento e acompanhamento de pacientes com PEP, com destaque para o papel das emergências psiquiátricas. As diferentes fases das psicoses também são descritas. Como conclusão, os autores salientam a importância da identificação e investigação dos casos, o início precoce do tratamento e o acompanhamento aproximado e individualizado dos pacientes.Palavras-chave: Psicoses, primeiro episódio psicótico, emergência psiquiátrica. AbstractThe term psychosis is used to describe a mental state in which the individual loses contact with reality, and the first step in the manifestation of psychotic symptoms is referred to as first-episode psychosis. This article presents general concepts and data on first-episode psychosis, describes risk factors, and provides guidance on the diagnosis (including differential diagnosis), treatment, and follow-up of these patients, with special attention to the role played by psychiatric emergency centers. The different phases of psychoses are also described. The authors conclude by underscoring the importance of identifying and investigating cases of first-episode psychosis, beginning treatment as early as possible, and maintaining a close, individualized follow-up regimen.

O termo psicose é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, e a etapa inicial de manifestação dos sintomas psicóticos define o primeiro episódio psicótico (PEP). Este artigo apresenta conceitos e dados gerais sobre PEP, apresenta fatores de risco e provê orientações sobre o diagnóstico (inclusive diagnósticos diferenciais), tratamento e acompanhamento de pacientes com PEP, com destaque para o papel das emergências psiquiátricas. As diferentes fases das psicoses também são descritas. Como conclusão, os autores salientam a importância da identificação e investigação dos casos, o início precoce do tratamento e o acompanhamento aproximado e individualizado dos pacientes.