Somatic Symptom disorders (SSDs) are characterised by the presence of persistent somatic symptoms associated with excessive thoughts, feelings and behaviours related to the symptoms. However, current treatment modalities are non-specific with modest effects. We aim to explore the safety and outcome of high-frequency transcranial magnetic stimulation at medial Prefrontal Cortex in ten such patients. Patient Health Questionnaire-15, Hamilton Rating Scale for Depression and Hamilton Anxiety Rating Scale were applied to ten patients with Somatic Symptom Disorder. 15 sessions of 15Hz TMS using a double cone coil with 2500 pulses/session were administered. All patients completed their sessions except one. Eight of the nine patients reported significant improvement with a reduction of 33%-80% from their baseline PHQ-15 scores. One patient reported significant adverse effects. Double cone coil TMS at medial Prefrontal Cortex appears to be a safe therapeutic intervention with potentially good outcomes in SSDs.

Clonidine, an alpha-2 adrenergic agonist, has been proposed as an antimanic agent that acts by reducing noradrenergic transmission. We conducted a systematic review to examine the efficacy and safety of clonidine for acute mania/hypomania. A comprehensive literature search was performed to identify randomized controlled trials (RCT) and non-randomized studies investigating the efficacy and safety of monotherapy/adjuvant treatment with clonidine for acute mania/hypomania in patients with bipolar disorder (BD). Nine studies (n = 222) met our inclusion criteria, including five RCTs (n = 159) and four non-randomized studies (n = 63). Non-randomized studies showed clonidine to help reduce symptoms of mania. However, data from placebo controlled RCTs were inconsistent. One RCT showed adjuvant clonidine as superior to placebo, whereas another RCT reported that clonidine was not better than placebo. In individual RCTs, lithium and valproate offered better antimanic effects compared to clonidine. Studies reported hypotension, depression, and somnolence as common adverse effects. Significant differences in study design and sample size contributed to high heterogeneity. This systematic review suggests low-grade evidence for clonidine as an adjuvant treatment for acute mania with mood stabilizers and inconclusive efficacy as monotherapy, warranting further well-designed RCTs.

Objective: Brain-derived neurotrophic growth factor (BDNF) which mediates neural plasticity, survival, and growth is associated with several psychiatric disorders. However, its role in the pathogenesis of Obsessive-Compulsive Disorder (OCD) has not been systematically studied in patients and their unaffected first-degree relatives (FDR). Ours is the first study to compare serum BDNF levels in OCD patients and their FDR with controls in the Indian population. Methodology: Thirty drug naïve/unmedicated patients diagnosed with OCD were enrolled with parents, siblings or children as FDR. Age-sex matched controls were also recruited. Any participant with comorbid medical or psychiatric illness was excluded from the study. Serum BDNF levels were measured by collecting blood samples in anticoagulant-free tubes and using enzyme-linked immunosorbent assay. Results: No significant difference in BDNF levels was seen between the OCD and healthy control group (p=0.750), or FDR group (p=0.134) but a significantly higher level was found in the FDR group compared to age-sex matched controls (p=0.025). Conclusion: BDNF may have a protective role in the pathogenesis of OCD.