Kathy Aleixo dos Santos Marcolin
◽
Ângelo Batista Miralha Cunha
◽
Beatriz Capparros Yoneyama
◽
Tiango Aguiar Ribeiro
Abstract
BackgroundVictims of disasters can develop post-traumatic stress disorder (PTSD) in 30-40% of cases. Application of repetitive transcranial magnetic stimulation (rTMS) shown promising results in PTDS. Transcranial direct current stimulation (tDCS) similar to rTMS, which is a neuromodulation technique, has shown promise in treatment of neuropsychiatric disorders.MethodA clinical trial conducted from March/2015-July-2016 in “KISS nightclub fire” disaster patients diagnosed with PTSD without complete remission of symptoms, over 18-years and who maintained pharmacological treatment. Electrodes positioned as cathode (right DLPFC) and extra-cephalic anode (contralateral deltoid muscle.) A current of 2mA used for 25cm² area (0.08mA/cm² current density) 30min once a day, for 10 continuous days. Patients were assessed pre-intervention, post-intervention, 30-days’ and 90-days’ post-intervention. PTSD Checklist-Civilian version (PCL-C); Montreal Cognitive Assessment (MoCA); Hamilton Depression and Anxiety Rating Scale (HAM-D and HAM-A) were used.Results145 subjects were initially screened and eight analysed. 87,5% were female. 30.88±7.74 years were the mean age (ranging 23-44). post-intervention results demonstrate: no cognitive impairment (MoCA); 60% reduction in HAM-D scale (patients diagnose as moderate depression turns normal diagnosis) (p <0.001); 54.39% reduction in HAM-A scale (moderate to severe symptoms of anxiety patients turns mild symptoms) (p<0.001) and 20% decrease in PCL-C scale values (patients with high severity symptoms of PTSD turns moderate to moderately high severity symptoms) (p<0.001). Improvement in PTSD symptoms were maintained 30-days post-intervention (PCL-C, p= 0.025) and improvement in symptoms of depression (HAM-D, p=0.006) and anxiety (HAM-A, p= 0.028) in 90-days post-intervention.ConclusionDespite decrease over time, this improvement in PTSD, depression and anxiety symptoms was maintained throughout the first month after treatment. tDCS adjuvant can be an alternative treatment to refractory PTSD, either as a monotherapy or as a treatment enhancement strategy. They can also be an option for patients who do not want or do not tolerate pharmacological management.RBR-2qpv74b, 01/07/2021, “retrospectively registered” 03/03/2015.
Rationale, design, and implementation of a clinical trial of a mindfulness-based relapse prevention protocol for the treatment of women with comorbid post traumatic stress disorder and substance use disorder
