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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2019.tde-16102019-151043
Document
Author
Full name
Gabriel Tortella de Souza
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Brunoni, Andre Russowsky (President)
Pereira Junior, Bernardo de Sampaio
Benseñor, Isabela Judith Martins
Fraguas Junior, Renerio
Title in Portuguese
Segurança cognitiva no tratamento da depressão bipolar com estimulação transcraniana por corrente contínua: um ensaio clínico randomizado, duplo-cego, placebo-controlado
Keywords in Portuguese
Avaliação cognitiva
Cognição
Depressão
Estimulação transcraniana por corrente contínua
Transtorno afetivo bipolar
Abstract in Portuguese
A depressão bipolar é um quadro psiquiátrico que tem entre seus sintomas o comprometimento das habilidades cognitivas. Os tratamentos farmacológicos usados para essa condição podem agravar os déficits cognitivos do paciente. Nesse contexto, surge a necessidade de uma opção terapêutica que preserve a cognição. O objetivo deste estudo foi investigar se a Estimulação Transcraniana por Corrente Contínua (ETCC) é uma ferramenta terapêutica que apresenta segurança cognitiva no tratamento de pacientes com depressão bipolar. Foi realizado um estudo randomizado, controlado por placebo, duplo-cego (Bipolar Depression Electrical Treatment Trial [BETTER]). Cinquenta e nove pacientes (40% mulheres), com transtorno bipolar em um episódio depressivo maior (pontuação superior a 17 para a Escala de Depressão de Hamilton - HDRS17) foram randomizados em dois grupos. Eles foram seguidos por uma bateria de avaliações neuropsicológicas, antes do tratamento, após duas e seis semanas. A ETCC foi aplicada diariamente por dez dias consecutivos, exceto aos finais de semana, e depois 1 sessão a cada quinzena até a semana 6, na região do córtex pré-frontal dorsolateral, por de 30 minutos (2-mA, ânodo a esquerdo e cátodo a direita). Não houve diferença significativa entre o grupo placebo e o grupo tratado com ETCC no início e no final do estudo, para as características cognitivas. Não foi encontrado comprometimento cognitivo para pacientes tratados com ETCC. Este é um achado importante quando comparado a técnicas farmacológicas que podem apresentar efeitos colaterais cognitivos durante o tratamento. Estudos adicionais devem examinar a segurança cognitiva da técnica com amostras maiores
Title in English
Cognitive safety in the treatment of bipolar depression with transcranial direct current stimulation: a randomized, double-blind, placebo-controlled trial
Keywords in English
Bipolar affective disorder
Cognition
Cognitive evaluation
Depression
Transcranial direct current stimulation
Abstract in English
Bipolar depression is a psychiatric condition that has among its symptoms the impairment of cognitive abilities. The pharmacological treatments used for this condition may aggravate the patient's cognitive deficits. In this context, the need for a therapeutic option that preserves cognition arises. The aim of this study was to investigate if Transcranial Direct Current Stimulation (tDCS) is a therapeutic tool that presents cognitive safety in the treatment of patients with bipolar depression. A randomized, placebo-controlled, double-blind study (Bipolar Depression Electrical Treatment Trial [BETTER]) was performed. Fifty-nine patients (40% women) with bipolar disorder in a major depressive episode (score above 17 for the Hamilton Depression Scale - HDRS17) were randomized into two groups. They were followed by a battery of neuropsychological assessments, before treatment, after two and six weeks. The ETCC was applied daily for 10 consecutive days, except on weekends, and then 1 session every fortnight until week 6, in the region of the dorsolateral prefrontal cortex, for 30 minutes (2-mA, anode to left and cathode on the right). There was no significant difference between the placebo group and tDCS at the beginning and end of the study for all cognitive characteristics. No cognitive impairment was found for patients treated with tDCS. This is an important finding when compared to pharmacological techniques that may present cognitive side effects during treatment. Additional studies should examine the cognitive safety of the technique with larger samples
 
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Publishing Date
2019-11-01
 
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