Non-invasive brain stimulation techniques (NIBS) have been widely used in both clinical and research contexts in neuropsychiatry. They are safe and well-tolerated, making NIBS an interesting option for application in different settings. Transcranial magnetic stimulation (TMS) is one of these strategies. It uses electromagnetic pulses for focal modulate ion of neuronal activity in brain cortical regions. When pulses are applied repeatedly (repetitive transcranial magnetic stimulation—rTMS), they are thought to induce long-lasting neuroplastic effects, proposed to be a therapeutic mechanism for rTMS, with efficacy and safety initially demonstrated for treatment-resistant depression (TRD). Since then, many rTMS treatment protocols emerged for other difficult to treat psychiatric conditions. Moreover, multiple clinical studies, including large multi-center trials and several meta-analyses, have confirmed its clinical efficacy in different neuropsychiatric disorders, resulting in evidence-based guidelines and recommendations. Currently, rTMS is cleared by multiple regulatory agencies for the treatment of TRD, depression with comorbid anxiety disorders, obsessive compulsive disorder, and substance use disorders, such as smoking cessation. Importantly, current research supports the potential future use of rTMS for other psychiatric syndromes, including the negative symptoms of schizophrenia and post-traumatic stress disorder. More precise knowledge of formal indications for rTMS therapeutic use in psychiatry is critical to enhance clinical decision making in this area.

Repetitive transcranial magnetic stimulation (rTMS) is cleared by the Food and Drug Administration for major depression, and recently received breakthrough status for bipolar depression (BDep). However, evidence on its efficacy and safety and optimal protocols for BDep remains limited. We conducted a systematic review to synthesize available data on rTMS for BDep. We systematically searched 4 literature databases for studies published between 1995 and 2025 treating participants with acute BDep (1097 articles). The primary outcome for the meta-analysis was change in mean depression severity scores from baseline. Determinants of treatment response were assessed using meta-regression and subgroup meta-analyses. Fifty-six articles were included, representing a total of 1709 patients with BDep. Active TMS had superior antidepressant efficacy relative to sham in randomized controlled trials (RCTs) (Cohen’s d = 0.40). Rates of treatment-emergent mania or hypomania were low and equivalent to those found for sham (odds ratio = 1.3; 95% CI, 0.7–2.4). A large effect size for antidepressant effectiveness was found when pooling active arms of RCTs with data from uncontrolled studies (Cohen’s d = 1.4), with rates of response (46.81%) and remission (28.25%) similar to those described for MDD and preserved in subanalyses for high-frequency protocols, including intermittent theta burst stimulation (iTBS) delivered to the left dorsolateral prefrontal cortex (DLPFC) and low-frequency protocols delivered to the right DLPFC. Higher baseline illness severity and more treatment sessions were predictors of greater antidepressant effect. TMS is efficacious and safe in BDep, with response and remission rates on par with rates for unipolar depression. High- and low-frequency protocols on the left and right DLPFC, respectively, are robustly associated with positive outcomes, with left DLPFC iTBS showing noninferiority to more widely used high-frequency rTMS protocols.

The prevalence of autism spectrum disorders (ASD) is increasing, and the correlates of involvement of this population in the criminal justice system have been reported. People with ASD have specific deficits such as difficulties in social communication and behavior, impulsivity, misinterpretation of rules, obsessions, and restricted interests, increasing their vulnerability to becoming victims and offenders. Herein, we report the case of a male 40 high-functioning ASD patient accused of stalking. This paper highlights clinical and forensic challenges when assessing patients with ASD prosecuted for stalking behaviors.

Background Deficits in social cognition are significant barriers to functional living for individuals with schizophrenia. Although these symptoms have garnered increasing research attention, an effective treatment remains elusive. This systematic review evaluates the use of neuromodulation techniques in treating social cognition deficits in schizophrenia. Methods We conducted a literature search in MEDLINE/PubMed, Web of Science, The Cochrane Library, and Embase databases, adhering to PRISMA guidelines. We included randomized, sham-controlled trials, non-controlled and/or open-label trials that assessed the efficacy of neuromodulation in patients diagnosed with schizophrenia (as per the DSM-III or later editions, or ICD equivalents), aged over 18 years. Results Thirteen papers (1 on ECT, 4 on rTMS, and 8 on tES), including 11 RCTs, met the inclusion criteria. Seven of the thirteen analyzed studies indicated improvements in certain domains of social cognition associated with neuromodulation treatments. Conclusions Neuromodulation techniques improved some domains of social cognition in individuals with schizophrenia. Further research is required to develop robust treatment protocols with proven efficacy in improving social cognition.

STRUCTURED Background: Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory treatment cleared by Food and Drug Administration (FDA) for use in major depressive disorder (MDD). Recently, FDA granted breakthrough status for rTMS as a therapeutic option for bipolar depression (BDep). Nonetheless, efficacy and safety for BDep are not yet sufficiently established and there is no guidance regarding patient and protocol selection. Here, we systematically reviewed the literature on TMS for BDep, to synthesize the evidence on efficacy, effectiveness and safety. Methods: We systematically searched four literature databases for studies published between 1995-2024 treating participants with acute bipolar depression. The primary outcome for meta-analysis was change in mean depression severity scores from baseline. Determinants of treatment response were assessed using meta-regression and sub-group meta-analyses. Results: Forty-nine articles were included, representing a total of 1593 patients with BDep. Active TMS had superior antidepressant efficacy relative to sham in RCTs (Cohen’s d=0.43; 95%CI 0.21-0.64; p<0.001; N=18). Rates of treatment-emergent mania or hypomania were low and equivalent to those found for sham (OR=1.3; 95%CI 0.7-2.5). A large effect size for antidepressant effectiveness was found when pooling active arms of RCTs with data from non-controlled studies (Cohen’s d=1.40 95%CI 1.2-1.6; p<0.001; N=39), with rates of response (47.2%, 95%CI 35.3-59.1) and remission (27.1%, 95%CI 22.1-32.2) similar to those described for MDD, and preserved in sub-analyses for high frequency protocols, including iTBS, delivered to the left DLPFC, and low frequency protocols delivered to right DLPFC. Baseline illness severity, shorter illness duration and longer treatment courses were predictors of greater antidepressant effect. Conclusions: TMS is efficacious and safe in BDep, with response and remission rates on par with unipolar depression. Longer protocols, namely with high-frequency or iTBS to the L-DLPFC and low-frequency to the R-DLPFC, have the best results, and patient selection may further improve clinical outcomes.