To evaluate the efficacy of transcranial magnetic stimulation (TMS), including repetitive TMS (rTMS) and deep TMS (dTMS), in patients with severe, treatment-resistant obsessive-compulsive disorder (OCD), specifically examining target- and phenotype-specific outcomes as well as predictors of treatment response. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251003027) searching PubMed and ProQuest (January 2017-April 2024). Methodological quality was appraised using design-specific tools, and certainty of evidence was evaluated using the GRADE framework. Twenty-seven articles representing 23 distinct clinical studies were included (14 high, 12 moderate, and 1 low quality). Active TMS significantly reduced OCD severity on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), with secondary gains in depressive and anxiety symptoms assessed by Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A). Evidence certainty varied substantially by anatomical target: Deep TMS (mPFC/ACC) and prefrontal targets (OFC/DLPFC) demonstrated moderate certainty, supported by multiple randomized controlled trials (RCTs). Pre-supplementary motor area (pre-SMA) showed low-to-moderate certainty due to RCT outcome heterogeneity and genetic moderation (SLC6A4 genotype). Supplementary motor area (SMA) evidence was limited to uncontrolled open-label, while VMPFC and PPC targets exhibited very low certainty. Key predictors of enhanced therapeutic response included higher baseline OCD severity (Y-BOCS ≥ 28), older age, lower functional disability, and baseline amygdala hyper-activation during symptom provocation. TMS represents a promising neuromodulation approach for treatment-resistant OCD, with the most robust evidence supporting dTMS and prefrontal targets. Tailoring protocol parameters and stratifying patients based on clinical, genetic, and neurophysiological predictors are critical to optimizing individualized outcomes.
In this study, it was aimed to examine the role of optimistic-pessimistic thinking style in the relationship between social support perceived from family, peers and teachers in adolescence and developmental problems that may be frequently encountered in adolescence. This cross-sectional study, conducted in Türkiye, employed a correlational research design with a convenience sample of 475 adolescents (241 girls and 234 boys) aged 14–17. Participants completed the Optimism-Pessimism Scale for Adolescents, the Social Support Appraisals Scale, and the Developmental Problem Areas Scale. The correlation analysis results showed that there were significant relationships between perceived social support from family, peers and teachers, optimistic-pessimistic thinking style and developmental problems. The mediation analysis results indicated that optimism and pessimism mediated the relationship between perceived social support and developmental problems, showing both partial and full mediation patterns depending on the source of social support. Taken together, the findings suggest that social support received from various sources in adolescence may facilitate coping with developmental problems by increasing adolescents’ optimistic thinking style or decreasing their pessimistic thinking style. The results were discussed in the light of the literature and some suggestions based on the findings were presented.
Self-care and illness perception are key determinants of adaptation to inflammatory bowel disease (IBD), but their relationship may be heterogeneous and poorly captured by average-level associations. This multicenter cross-sectional study examined whether self-care behaviors were associated with illness perception and explored whether distinct patient profiles could be identified from their combined behavioral and cognitive-emotional patterns. Between April and June 2024, adult patients were recruited consecutively from nine Italian IBD units and completed validated measures of self-care, illness perception, self-care self-efficacy, and psychological distress. Structural equation modeling was used to test the association between self-care domains and illness perception, followed by unsupervised cluster analysis. Among 450 participants with complete data, the structural equation model showed satisfactory fit, but no self-care domain was significantly associated with illness perception. Four clinically interpretable profiles emerged: Engaged Copers, Overwhelmed and Passive, Detached and Vulnerable, and Minimizers with Functional Engagement. The profiles differed markedly in illness perception and self-care behaviours, with large effect sizes, whereas anxiety and self-care self-efficacy showed statistically significant but small between-profile differences. No statistically significant omnibus differences were observed in generational distribution, exercise habits, or disease activity. These findings suggest that self-care and illness perception are not related through a simple linear association. Person-centered profiling may support tailored self-management education and psychological assessment in routine IBD care.
Attention-deficit/hyperactivity disorder (ADHD) is associated with behavioral, cognitive, and motor impairments that may negatively affect children’s academic and social functioning. The present study examined the effects of cognitively enriched handball training and conventional handball training on behavioral symptoms, working memory, and motor competence in girls with ADHD. A total of 45 girls aged 7–9 years with ADHD participated in this parallel-group randomized controlled trial and were randomly assigned to cognitively enriched handball training (n = 15), conventional handball training (n = 15), or a control condition (n = 15). Behavioral symptoms, working memory, and motor competence were assessed using the Child Behavior Checklist (CBCL), the Wechsler Digit Span Test, and the MOBAK-3, respectively. Data were analyzed using multivariate analysis of covariance (MANCOVA). After controlling for baseline scores, the multivariate group effect was significant (partial η² = 0.56), with large omnibus effects for behavioral symptoms (partial η² = 0.82), working memory (partial η² = 0.66), and motor competence (partial η² = 0.65). Both exercise interventions significantly improved behavioral symptoms, working memory, and motor competence compared with the control group (p < .05). Furthermore, cognitively enriched handball training produced significantly greater improvements in behavioral symptoms and motor competence than conventional handball training (p < .05), whereas no significant difference was observed between the two exercise groups for working memory. These findings suggest that cognitively enriched handball training may provide short-term complementary benefits for behavioral regulation and motor competence in girls with ADHD. However, the small sample size and absence of follow-up assessments warrant cautious interpretation and limit conclusions regarding the generalizability and long-term maintenance of these effects.
Objectives: To investigate the relationship between sleep (nocturnal sleep and total 24-hour sleep) and depressive symptoms in middle-aged and elderly people using data from the China Health and Retirement Longitudinal Study (CHARLS). Study Design: Cross-sectional study. Methods: A total of 13,718 middle-aged and elderly people aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS 2020) were included. A multivariate logistic regression model was used to analyze the correlation between sleep and depressive symptoms, and a random forest model was used to rank the importance of variables. Furthermore, the nonlinear relationship between sleep duration and depressive symptoms risk was fitted using a restricted cubic spline (RCS) model. Results: Compared with the group with 24-hour sleep duration of > 7 to ≤ 9 h, the adjusted odds ratio (OR) for depressive symptoms in the group with 24-hour sleep duration of ≤ 7 h (OR = 1.649) and > 9 h (OR = 1.166) was higher. Random forest results showed that total 24-hour sleep ranked above average among variables affecting depressive symptoms. The RCS curve showed that a total 24-hour sleep time of > 7 to ≤ 9 h was associated with the lowest adjusted odds for depressive symptoms. Conclusions: There is a significant correlation between sleep duration and depressive symptoms in middle-aged and elderly people. Those who slept > 7 to ≤ 9 h per night had a lower incidence of depressive symptoms, and total 24-hour sleep of > 7 to ≤ 9 h showed a stronger OR value. Life satisfaction also emerged as an important factor influencing depressive symptoms.
