European Psychiatry - Volume 41 - April 2017

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S374 25th European congress of psychiatry / European Psychiatry 41S (2017) S365–S404
2 Inserm U1094, Tropical Neuroepidemiology, Limoges, France
3 Esquirol Hospital Center, University Pole of Elderly Psychiatry,
Limoges, France
4 University of Limoges, UMR S 1094, Tropical Neuroepidemiology,
Institute of Neuroepidemiology and Tropical Neurology, CNRS FR
3503 GEIST, Limoges, France
∗ Corresponding author.
Introduction Repetitive transcranial magnetic stimulation
(rTMS) is a neurostimulation technique used in many indications,
especially in psychiatry in the treatment of mood disorders.
Although its efficacy in this treatment has been demonstrated,
the study of predictive response factors currently remains a major
challenge.
Method We conducted a retrospective study from the cohort
of treatment-resistant depressed patients that received rTMS
treatment in Esquirol Hospital in Limoges in order to identify
response predictors at three months. Of the 416 patients treated
between January 2007 and November 2015, 107 subjects have
been included. The clinical characteristics of responders and non-
responders at three months after treatment, but also at the end of
treatment and after one month were compared. Predictors of clin-
ical improvement objectified by the Hamilton Depression Rating
Scale (HDRS) were identified using a logistic regression model.
Results In our cohort, the response rates were 52% at the end of
treatment, 61% at 1 month and 57% at 3 months. Psychiatric family
history and the recurrence of thymic episodes were found to be
negative predictors of response to rTMS treatment. Similarly, high
subscore of depression core symptoms in HDRS could also predict
a poorer response.
Conclusion Our data from a naturalistic cohort tended to prove
that a number of clinical features should be taken into account
in determining the profile of the treatment-resistant depressed
patients that could respond to rTMS treatment.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0777
Prolonged theta burst stimulation:
A novel rTMS paradigm in
neuropsychiatry
M. Klírová ∗, M. Hejzlar , T. Novák , R. Rokyta
1 National Institute of Mental Health, Neurostimulation Department,
Klecany, Czech Republic
2 3rd Faculty of Medicine, Charles University, Department of Normal,
Pathological and Clinical Physiology, Prague, Czech Republic
∗ Corresponding author.
Introduction Repetitive transcranial magnetic stimulation
(rTMS) has important role in treatment of neuropsychiatric disor-
ders. Theta burst stimulation (TBS), a modification of rTMS, seems
to produce greater changes in cortical excitability (CE) than those
observed in conventional rTMS protocols. TBS is used in different
protocols: intermittent TBS (iTBS) and continuous TBS (cTBS).
While iTBS facilitates CE, cTBS leads to CE inhibition. However, a
prolonged cTBS produces facilitatory effect similar to that of iTBS.
Prolonged TBS (pTBS), a novel rTMS paradigm, is of great clinical
interest for its short duration, but also because it may induce
stronger effect.
Aim To prove the effect of pTBS of motor cortex on changes of
motor threshold (MT), CE and pain threshold (PT) in healthy volun-
teers (HV). To compare the effects of two different forms of active
pTBS (pcTBS, piTBS) with placebo.
Methods A double-blind, placebo-controlled, cross-over study
compared the effects of different pTBS of contralateral M1 area on
MT, CE and PT. We enrolled 24 HV to the study, who underwent all
types of pTBS in randomized order and were assessed before and
after each pTBS application. We usedMagPro R30 (with coil focused
to contralateral M1 area, 1200 pulses/session, 90% MT).
Results A significant changes inCE andMTwere found after appli-
cation of continuous pTBS. Intermittent and placebo pTBS did not
confirm the effect. There were no significant changes on PT after
pTBS. Continuous pTBSwas better tolerated than intermittent pTBS.
Conclusion pTBS should be considered as an effective and safe
treatment option for neuropsychiatric disorders.
Disclosure of interest Supported by AZV 16-31380A.
EW0778
Transcranial direct current
stimulation: Adverse effects and the
efficacy of a commonly utilised sham
protocol
A. Kortteenniemi ∗, T. Ali-Sisto , J. Wikgren , S. Lehto
1 Institute of Clinical Medicine, University of Eastern Finland,
Department of Psychiatry, Kuopio, Finland
2 Centre for Interdisciplinary Brain Research, University of Jyväskylä,
Department of Psychology, Jyväskylä, Finland
∗ Corresponding author.
Introduction Transcranial direct current stimulation (tDCS) is a
promising neuromodulation method that has, for example, been
used to treat depression. Nevertheless, the adverse effects of tDCS
and the validity of the current standard tDCS sham protocols have
received limited attention.
Objectives To evaluate the extent and types of tDCS adverse
effects and to assess the reliability of sham stimulation as a control
procedure for tDCS in a double-blind setting.
Aims To compare adverse effects between tDCS and sham stim-
ulation groups, and to determine howwell the participants and the
experimenter are able to distinguish tDCS from sham stimulation.
Methods A sample of healthy volunteers received a 20-minute
session of either tDCS (n = 41; 2mA) or sham stimulation (n = 41;
ramp up 15 s, ramp down 15 s; no current in between). The
anode was placed over F3 and cathode over F4. Both the par-
ticipants and the experimenter reported immediate adverse
effects and the perceived likelihood for the participant to
receive tDCS. Analyses were conducted using the Mann–Whitney
U-test.
Results The tDCS group reported more erythema compared with
the sham group (P = 0.016, Cohen’s D = 0.444). No other significant
differences in adverse effects were observed. In the tDCS group,
both the participants (P = 0.034, Cohen’s D = 0.612) and the exper-
imenter (P = 0.006, Cohen’s D = 0.674) reported a higher perceived
likelihood of the participant receiving tDCS than in the sham group.
Conclusions tDCS has only modest adverse effects. Nevertheless,
the current standard sham protocol appears insufficient.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EW0779
From theory to practice:
The contribution of John Farquhar
Fulton (1899–1960) to psychosurgery
P. Michielsen ∗ e Jonge etryki Arts
1 Mental Health Western Northern Brabant, Department Clinical
Psychiatry, Halsteren, The Netherlands
2 Mental Health Western Northern Brabant, Department
Neuropsychiatry and Old Age Psychiatry, Halsteren, The Netherlands
3 University of Groningen, University Medical Center Groningen,
Department of Clinical Pharmacy and Pharmacology, Groningen, The
Netherlands