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neuroleptic sensitivity with a higher risk for neuroleptic malignant syndrome and extrapyramidal adverse effects. 1 Furthermore, studies on antidepressant use in patient with DLB found that selective serotonin reuptake inhibitors are not efficacious in the treatment of depressive symptoms in patients with DLB and may have adverse effects including the worsening of REM sleep behavior disorder symptoms. 2 As such, there is a significant need for nonpharmacologic management of depressive symptoms in patients with DLB.However, despite reassuring results from case reports, there are no randomized trials evaluating nonpharmacologic methods like ECT in DLB. In one small, uncontrolled study, all 7 enrolled patients had improvement in depressive symptoms with variable resolution of motor complaints, delusions, and hallucinations. 4 The longevity of improvement was also varied, with some patients achieving several months of depressive symptom resolution and others reporting only 2 weeks of relief. 4 A second study demonstrated that in 8 patients with DLB and an average HAM-D score of 38, there was a significant reduction in depressive symptoms after ECT. 5 The average posttreatment HAM-D score was 15, with no additional follow-up data presented. 5 Similarly, Mr A did not experience complete resolution of depression ECT, citing continued difficulties across domains such as psychomotor retardation. However, there was improvement in mood, suicidality, and agitation, the symptoms that most contributed to the acute need for hospitalization. As such, it is possible that ECT alleviated symptoms associated with the affective component of an MDE, but could not target neurovegetative symptoms chronically present in patients with DLB.In conclusion, the experience presented in this case, when considered alongside the existing data on ECT for DLB, provides a compelling argument for this treatment modality.

Purpose of Review The aim of this article was to review current research regarding social cognition (SC) in gambling disorder (GD), to (i) compile and synthetize the current state of existing literature on this topic, and (ii) propose cognitive remediation therapy approaches focused on SC for clinicians. Recent Findings It is well known that disordered gamblers show impairment regarding non-social cognitive functions such as inhibition, attention, and decision-making. Furthermore, patients with substance use disorders also present certain deficits regarding social information processing which are difficult to differentiate from the intrinsic toxic effects linked to drugs or alcohol consumption. Summary To date, relatively little research has been undertaken to explore SC in gambling disorder (GD) with neuropsychological tasks. Preliminary results suggest impaired non-verbal emotion processing, but only one study has directly measured SC in GD. As a consequence, future research on this framework should propose diverse measures of SC, while controlling for other factors such as personality traits and subtypes of disordered gamblers.

IntroductionDepression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments.Methods and analysisThis paper, based on the DISCO study protocol, focuses on the design of a prospective, randomised, controlled, open-label multicentre economic study to be conducted in France. It will include 214 patients with unipolar or bipolar depression, assigning them to two parallel arms: group A (tDCS-TAU) and group B (TAU alone). The primary outcome is the incremental cost-effectiveness ratio, that is, the ratio of the difference in cost between each strategy to the difference in their effects. Their effects will be expressed as numbers of quality-adjusted life-years, determined through administration of the EuroQol Five-Dimension questionnaire over a 12-month period to patients (EQ-5D-5L). Expected benefits are the reduction of treatment resistance and suicidal ideation as well as social and professional costs of depression. Should depression-related costs fall significantly, tDCS might be considered an efficient treatment for depression.Ethics and disseminationThis protocol has been approved by a French ethics committee, the CPP-–Est IV (Comité de Protection des Personnes–Strasbourg). Data are to be published in peer-reviewed medical journals.Trial registration numberRCB 2018-A00474-51;NCT03758105