Papers by Nicolas Bukowski
Brain Stimulation
Background: Recently intermittent theta burst stimulation (iTBS) proved to be non-inferior to con... more Background: Recently intermittent theta burst stimulation (iTBS) proved to be non-inferior to conventional repetitive transcranial magnetic stimulation (10 Hz rTMS) in unipolar depression after failure of one antidepressant trial, but to date no randomized control trial assessed the ability of iTBS to improve depression level and quality of life in more resistant features of depression with a long-term (6 month) follow-up in comparison to 10 Hz rTMS. Objectives/Hypothesis: The aim of our study was to compare the efficacy of 10 Hz rTMS and iTBS in treatment-resistant unipolar depression on response rates (50% decrease of MADRS scores at one month from baseline) and change in quality of life during a 6-month follow-up. In addition, we investigated whether some clinical features at baseline were associated with the response in the different groups. Method: Sixty patients were randomized in a double-blind, controlled study at the University Hospital Center of Nantes, and received 20 sessions of either rTMS or iTBS applied to the left dorsolateral prefrontal cortex targeted by neuronavigation. Statistical analysis used Fischer's exact test and Chi-square test as appropriate, linear mixed model, and logistic regression (occurrence of depressive relapse and factors associated with the therapeutic response). Results: Included patients showed in mean more than 3 antidepressants trials. Response rates were 36.7% and 33.3%, and remission rates were 18.5% and 14.8%, in the iTBS and 10 Hz rTMS groups respectively. Both groups showed a similar significant reduction in depression scores and quality of life improvement at 6 months. We did not find any clinical predictive factor of therapeutic response in this sample. Conclusion: Our study suggests the clinical interest of iTBS stimulation (which is more time saving and cost-effective as conventional rTMS) to provide long-lasting improvement of depression and quality of life in highly resistant unipolar depression.
French Journal of Psychiatry, 2019
Trials, 2020
Background Depression is a debilitating and costly disease for our society, especially in the cas... more Background Depression is a debilitating and costly disease for our society, especially in the case of treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy in treatment-resistant unipolar and non-psychotic depression. It can be applied according to two therapeutic strategies after an initial rTMS cure: a further rTMS cure can be performed at the first sign of relapse or recurrence, or systematic maintenance rTMS (M-rTMS) can be proposed. TMS adjuvant to treatment as usual (TAU) could improve long-term prognosis. However, no controlled study has yet compared the cost-effectiveness of these two additional rTMS therapeutic strategies versus TAU alone. Methods/design This paper focuses on the design of a health-economic, prospective, randomized, double-blind, multicenter study with three parallel arms carried out in France. This study assesses the cost-effectiveness of the adjunctive and maintenance low frequency rTMS ...
BMJ Open, 2020
IntroductionDepression is among the most widespread psychiatric disorders in France. Psychiatric ... more IntroductionDepression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments.Methods and analysisThis paper, based on the DISCO study protocol, focuses on the design ...
Current Addiction Reports, 2019
The original article unfortunately contained a mistake. Some references mentioned in Table 1 have... more The original article unfortunately contained a mistake. Some references mentioned in Table 1 have been misplaced and not included in the final bibliography. The original version has been corrected. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Current Addiction Reports, 2019
Purpose of Review The aim of this article was to review current research regarding social cogniti... more Purpose of Review The aim of this article was to review current research regarding social cognition (SC) in gambling disorder (GD), to (i) compile and synthetize the current state of existing literature on this topic, and (ii) propose cognitive remediation therapy approaches focused on SC for clinicians. Recent Findings It is well known that disordered gamblers show impairment regarding non-social cognitive functions such as inhibition, attention, and decision-making. Furthermore, patients with substance use disorders also present certain deficits regarding social information processing which are difficult to differentiate from the intrinsic toxic effects linked to drugs or alcohol consumption. Summary To date, relatively little research has been undertaken to explore SC in gambling disorder (GD) with neuropsychological tasks. Preliminary results suggest impaired non-verbal emotion processing, but only one study has directly measured SC in GD. As a consequence, future research on th...
The Journal of ECT, 2011
The authors concluded that the efficacy and safety of electroconvulsive therapy in patients with ... more The authors concluded that the efficacy and safety of electroconvulsive therapy in patients with bipolar disorder had been poorly investigated and the evidence had methodological limitations. However, high response rates were observed in patients who received electroconvulsive therapy. Given the limited quality of the evidence presented and the significant heterogeneity between trials, the authors' concluding statement seems appropriate. Authors' objectives To assess the safety and efficacy of electroconvulsive therapy (ECT) in the treatment of bipolar disorder. Searching MEDLINE, PsycINFO and Web of Science databases were searched through to March 2010; search terms were reported. Reference lists of retrieved articles were searched manually. There was no search for unpublished data. Study selection Clinical trials that assessed the safety and efficacy of ECT in the treatment of at least 10 patients with bipolar disorder were eligible for inclusion. Patients diagnosed with schizoaffective disorder (bipolar type) were considered as having a form of bipolar disorder. Studies were eligible if they compared ECT to a placebo or no treatment, or alternative treatment (such as pharmacological medication). Before-and-after studies that assessed the effects of ECT were eligible for inclusion. Included studies were of patients with bipolar mania, bipolar depression, mixed states or compared bipolar versus unipolar depression or manic versus bipolar depressed patients. Some patients were medication resistant. Intervention patients received ECT with or without antipsychotics or chlorpromazine. Controls included simulated ECT plus chlorpromazine or antipsychotics or an antidepressant, lithium with or without haloperidol, other medications (not specified) or no treatment. Where reported, most studies used bilateral ECT. Various diagnostic criteria were used, including versions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. Outcome measures varied across studies and included non-operational clinical criteria, Young Mania Rating Scale and Clinical Global Impressions scale. Two reviewers screened studies for inclusion. Assessment of study quality The authors did not state that they assessed trial quality, although blinding was reported for controlled/comparative trials. Data extraction The authors did not state how many reviewers performed the data extraction. Methods of synthesis Data were presented as a narrative synthesis, grouped by type of bipolar disorder. Results of the review Fifty-one trials were included in the review. ECT in bipolar mania: There were 28 clinical trials (1,651 participants). The three controlled/comparative prospective trials (one double blind) showed that ECT with or without chlorpromazine was more effective than simulated ECT or lithium. Of the six controlled/comparative retrospective trials, two reported significant benefit from ECT compared to no treatment or lithium. Overall, the non-comparative studies showed significant improvements with ECT.
Journal of the American College of Cardiology, 2020
Background: Takotsubo cardiomyopathy (TCM) occurs after an emotional or physical stressor. There ... more Background: Takotsubo cardiomyopathy (TCM) occurs after an emotional or physical stressor. There have been case reports of patients undergoing electroconvulsive therapy (ECT) who have developed TCM. Prior reports were mainly female patients who developed TCM after their first treatment. This is a report of a male patient undergoing third round of ECT while on ACE-inhibitor who developed TCM and was able to resume ECT. Case: A 73 yo male with a history of depression, hypertension on enalapril, and diabetes presented to the hospital with depression and admitted for the initiation of ECT. The patient previously completed ECT without complication. The patient developed chest pain during the fourth round. Troponin was elevated, ekg with anterolateral ST depressions. Pt started on aspirin, clopidogrel, and heparin. An echocardiogram showed a reduced ejection fraction (EF) of 25% with anterior hypokinesis with an InterTAK Diagnostic score of 54 (29% chance of having TCM). Coronary angiogram showed no significant obstruction. Repeat echocardiogram one week later showed an EF of 30%, and a new apical thrombus. Warfarin was initiated and a cardiac MRI four weeks later showed normal EF and resolution of the apical thrombus. Patient resumed ECT. Decision-making: Given echocardiogram results, negative angiogram, and high InterTAK score, patient was diagnosed with TCM. Pt was started on Metoprolol Succinate, Aspirin, Atorvastatin and continued on Enalapril. Given that patient had resolution of his TCM and had continued refractory depression, the patient restarted his ECT treatment. The patient had no recurrence of his symptoms. Conclusion: This is a rare case of ECT induced TCM in a male patient who had both already undergone multiple full rounds of ECT treatment as well as having already been on an ACEi. Despite ACEi being used to treat TCM, patients can develop ECT induced cardiomyopathy while on an ACEi. While the majority of reported cases of ECT induced cardiomyopathy occur in women, male patients are susceptible making it difficult to predict those at risk. However with appropriate identification and treatment patients with ECT induced cardiomyopathy patients can make a full recovery and resume ECT treatments.
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Papers by Nicolas Bukowski