A Systematic Review of Neuromodulation Treatment Effects on Suicidality.
A Systematic Review of Neuromodulation Treatment Effects on Suicidality.
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DOI：
10.3389/fnhum.2021.660926
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发表时间：
2021
影响因子：
2.9
通讯作者：
Croarkin PE
中科院分区：
文献类型：
--
作者：
Kucuker MU;Almorsy AG;Sonmez AI;Ligezka AN;Doruk Camsari D;Lewis CP;Croarkin PE
前言：神经调节是治疗神经精神障碍的一组重要方法。以前的研究主要集中在与神经调节相关的疗效和不良反应上。关于神经调节治疗对自杀的影响，我们知之甚少。这项系统性的综述试图检验各种神经调节技术对自杀的影响。方法：按照系统综述和荟萃分析指南的首选报告项目，对1940~2020年的文献进行系统综述。报告中任何与自杀相关的结果，包括自杀意念、自杀意图、自杀未遂、完全自杀，都被认为是自杀治疗效果的推定标准。结果：综述确定了129项相关研究。一项比较舍曲林和经颅直流电刺激(TDC)治疗抑郁症效果的随机对照试验的探索性分析报告称，倾向于tDCS的自杀意念比安慰剂和tDCS联合舍曲林和安慰剂的自杀意念减少。几项研究报告了重复的经颅磁刺激与自杀意念的改善之间的联系。在12项研究中，自杀是主要结果，其中10项研究显示自杀意念有显著改善。电惊厥治疗(ECT)和磁惊厥治疗也被证明与较低的自杀意念和完全自杀率有关。有11项研究以自杀为主要结果，其中7项研究表明，接受ECT治疗的患者的自杀意念或自杀意图有所改善，自杀企图或完全自杀事件减少。关于迷走神经刺激对自杀意念的潜在保护作用的文献有限。关于脑深部刺激对自杀的潜在影响，数据喜忧参半。结论：未来迫切需要对神经调节进行前瞻性研究，重点关注自杀的主要结果。系统评审注册：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599，标识：CRD42019125599。
Introduction: Neuromodulation is an important group of therapeutic modalities for neuropsychiatric disorders. Prior studies have focused on efficacy and adverse events associated with neuromodulation. Less is known regarding the influence of neuromodulation treatments on suicidality. This systematic review sought to examine the effects of various neuromodulation techniques on suicidality. Methods: A systematic review of the literature from 1940 to 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was conducted. Any reported suicide-related outcome, including suicidal ideation, suicide intent, suicide attempt, completed suicide in reports were considered as a putative measure of treatment effect on suicidality. Results: The review identified 129 relevant studies. An exploratory analysis of a randomized controlled trial comparing the effects of sertraline and transcranial direct-current stimulation (tDCS) for treating depression reported a decrease in suicidal ideation favoring tDCS vs. placebo and tDCS combined with sertraline vs. placebo. Several studies reported an association between repetitive transcranial magnetic stimulation and improvements in suicidal ideation. In 12 of the studies, suicidality was the primary outcome, ten of which showed a significant improvement in suicidal ideation. Electroconvulsive therapy (ECT) and magnetic seizure therapy was also shown to be associated with lower suicidal ideation and completed suicide rates. There were 11 studies which suicidality was the primary outcome and seven of these showed an improvement in suicidal ideation or suicide intent and fewer suicide attempts or completed suicides in patients treated with ECT. There was limited literature focused on the potential protective effect of vagal nerve stimulation with respect to suicidal ideation. Data were mixed regarding the potential effects of deep brain stimulation on suicidality. Conclusions: Future prospective studies of neuromodulation that focus on the primary outcome of suicidality are urgently needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=125599, identifier: CRD42019125599.
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