Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
Journal of affective disorders
Assessing symptom severity in patients with markedly treatment-resistant depression: Insights from the RECOVER trial
BACKGROUND: The performances of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) and Self-Report (QIDS-SR) ratings have never been evaluated in markedly treatment-resistant depression (TRD). RECOVER, a 12-month randomized, controlled trial, compared adjunctive active to adjunctive sham vagus nerve stimulation, provided data to address this knowledge gap, and to examine the basis for the differential sensitivities of these scales in detecting overall and between-treatment-group symptom changes. METHODS: We employed classical test and item response theory methods to characterize each scale. Effect sizes identified items that were most sensitive to change over time across treatments, best discriminated between the two treatments, and best detected at least a partial symptom response in clinician global ratings. RESULTS: All three inventories were unidimensional, with high retest reliability and strong internal consistency. MADRS total scores were less sensitive in detecting overall and between-treatment-group symptom differences. On each scale, five symptom domains-mood, energy/lassitude, interest/inability to feel, negative self-view/pessimism, and concentration-covaried most strongly with overall depression severity and had the largest effect sizes in detecting overall therapeutic change and between-group difference in efficacy. LIMITATIONS: These findings may not generalize to less treatment-resistant populations or to different treatments. The relative insensitivity of suicidal ideation, sleep, and appetite items may be due to study design or concomitant medications. CONCLUSION: The MADRS, QIDS-C, and QIDS-SR are suitable for use in markedly TRD. Whether sadness, energy, interest, guilt, and concentration are "core" symptoms that are especially sensitive to change deserves further study.
16 June 2026
Read appraisal →Behavioural brain research
Influences of high-definition transcranial direct current stimulation (HD-tDCS) and cognitive reappraisal on emotions and aggression following social exclusion
Social exclusion can trigger negative emotions and aggressive behavior, while emotion regulation strategies and neuromodulation techniques may mitigate these effects. This study employed a 2 × 2 factorial design to investigate the impacts of high-definition transcranial direct current stimulation (HD-tDCS) and cognitive reappraisal on emotions and aggression following social exclusion. Thirty-two university students were randomly assigned to four groups: active HD-tDCS + cognitive reappraisal, sham HD-tDCS + cognitive reappraisal, active HD-tDCS + no reappraisal, and sham HD-tDCS + no reappraisal. Results showed that active HD-tDCS significantly reduced aggressive behavior in both the Competitive Reaction Time Task and Job-relevant Evaluations Task, likely by enhancing prefrontal regulatory control. Cognitive reappraisal significantly decreased negative emotions but did not directly reduce aggressive behavior, suggesting a dissociation between emotional and behavioral regulation pathways. No significant interaction was found between HD-tDCS and cognitive reappraisal, possibly due to their independent neural mechanisms. These findings highlight the potential of HD-tDCS and cognitive reappraisal as interventions for social exclusion-induced aggression and emotional dysregulation.
1 May 2026
Read appraisal →Behavioural brain research
Targeting the prefrontal-supplementary motor network with online and offline tDCS to modulate disgust: A single-blind and sham-controlled study
In certain individuals, disgust experience is abnormally high. This heightened sensitivity serves as a cognitive component that can lead to dysfunction in neural circuits related to emotion processing and psychological disorders such as contamination-based obsessive-compulsive disorder. In this single-blind study, 36 individuals with high disgust sensitivity were randomly assigned to three groups: online, offline, and sham. The online group received intensified and repetitive transcranial direct current stimulation (tDCS) while performing a disgust image watching task, whereas the offline and sham groups performed the task at two time points: immediately before (pre-test) and immediately after (post-test) the stimulation session. The offline group received active tDCS, whereas the sham group received placebo tDCS to control for the interval duration. Anodal and cathodal stimulation was applied to the left dorsolateral prefrontal cortex (l-DLPFC; F3) and pre-supplementary motor area (pre-SMA; FC2), respectively. The intervention consisted of 10 sessions of tDCS (2 sessions per day) over 5 days, with a stimulation intensity of 2 mA for 20 min and a 20-minute interval between sessions. The results showed a significant decrease in disgust experience in the online group compared to the offline group, while there was no significant difference between the online and sham groups. Although these findings suggest potential effects of tDCS combined with a task, further studies are necessary to confirm its efficacy.
1 May 2026
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