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Background: Maladaptive neuroplasticity-related learned response in substance use disorder (SUD) can be ameliorated using noninvasive brain stimulation (NIBS); however, inter-individual variability needs to be addressed for clinical translation. Objective: Our first objective was to develop a hypothesis for NIBS for learned response in SUD based on a competing neurobehavioral decision systems model. The next objective was to develop the theory by conducting a computational simulation of NIBS of the cortico-cerebello-thalamo-cortical (CCTC) loop in cannabis use disorder (CUD)-related dysfunctional “cue-reactivity”—a construct closely related to “craving”—that is a core symptom. Our third objective was to test the feasibility of a neuroimaging-guided rational NIBS approach in healthy humans. Methods: “Cue-reactivity” can be measured using behavioral paradigms and portable neuroimaging, including functional near-infrared spectroscopy (fNIRS) and electroencephalogram (EEG) metrics of sensorimotor gating. Therefore, we conducted a computational simulation of NIBS, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) of the cerebellar cortex and deep cerebellar nuclei (DCN) of the CCTC loop for its postulated effects on fNIRS and EEG metrics. We also developed a rational neuroimaging-guided NIBS approach for the cerebellar lobule (VII) and prefrontal cortex based on a healthy human study. Results: Simulation of cerebellar tDCS induced gamma oscillations in the cerebral cortex, while transcranial temporal interference stimulation induced a gamma-to-beta frequency shift. A preliminary healthy human study (N = 10) found that 2 mA cerebellar tDCS evoked similar oxyhemoglobin (HbO) response in the range of 5 × 10−6 M across the cerebellum and PFC brain regions (α = 0.01); however, infra-slow (0.01–0.10 Hz) prefrontal cortex HbO-driven phase–amplitude-coupled (PAC; 4 Hz, ±2 mA (max)) cerebellar tACS evoked HbO levels in the range of 10−7 M that were statistically different (α = 0.01) across these brain regions. Conclusion: Our healthy human study showed the feasibility of fNIRS of cerebellum and PFC and closed-loop fNIRS-driven ctACS at 4 Hz, which may facilitate cerebellar cognitive function via the frontoparietal network. Future work needs to combine fNIRS with EEG for multi-modal imaging for closed-loop NIBS during operant conditioning.

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<p class="abstract"><strong>Background:</strong> Expressed emotions (EE) are the critical, hostile and emotionally over- involved attitude of relatives towards a family member who is suffering from a disorder. It is a measure of the expressed attitude of the relatives towards their psychological patient in their absence. As, in bipolar affective disorder (BPAD) alternating/recurring periods of depression and elevated mood occurs which leads to varied levels of stress and expressed emotions in the patient as well as their caregivers.</p><p class="abstract"><strong>Methods:</strong> An exploratory study was conducted in psychiatry ward and psychiatry outpatient department (OPD) of PGIMER, Chandigarh on BPAD patients and their caregivers (N=50 each) using purposive sampling technique. Data was collected in the month of March for 10 days. Interviews were conducted using the modified perceived stress scale by Sheldon Cohen and Hooley’s expressed emotions scale for assessing expressed emotions levels, respectively.  </p><p class="abstract"><strong>Results:</strong> Data analysis done with the help of statistical package for the social sciences (SPSS) 22 version 16.0 through descriptive and inferential statistics. The study revealed that 64% of caregivers face criticism from their patients whereas 62% of patients receive criticism from their caregivers. The study also showed that 68% of caregivers were given emotional support by their patients. 66% of caregivers and patients, both displayed moderate level of perceived stress.</p><p class="abstract"><strong>Conclusions:</strong> It can be concluded that both EE and perceived stress are significant stressors for the BPAD patients and their caregivers.</p>