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Torous J, Stern AP, Padmanabhan JL, Keshavan MS, Perez DL. A proposed solution to integrating cognitive-affective neuroscience and neuropsychiatry in psychiatry residency training: The time is now. Asian J Psychiatr 2015; 17:116-21. [PMID: 26054985 DOI: 10.1016/j.ajp.2015.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/05/2015] [Indexed: 01/07/2023]
Abstract
Despite increasing recognition of the importance of a strong neuroscience and neuropsychiatry education in the training of psychiatry residents, achieving this competency has proven challenging. In this perspective article, we selectively discuss the current state of these educational efforts and outline how using brain-symptom relationships from a systems-level neural circuit approach in clinical formulations may help residents value, understand, and apply cognitive-affective neuroscience based principles towards the care of psychiatric patients. To demonstrate the utility of this model, we present a case of major depressive disorder and discuss suspected abnormal neural circuits and therapeutic implications. A clinical neural systems-level, symptom-based approach to conceptualize mental illness can complement and expand residents' existing psychiatric knowledge.
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Affiliation(s)
- John Torous
- Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA; Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Adam P Stern
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Berenson Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Jaya L Padmanabhan
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Department of Behavioral Neurology and Neuropsychiatry, Belmont, MA, USA
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA.
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Ahmari SE, Dougherty DD. DISSECTING OCD CIRCUITS: FROM ANIMAL MODELS TO TARGETED TREATMENTS. Depress Anxiety 2015; 32:550-62. [PMID: 25952989 PMCID: PMC4515165 DOI: 10.1002/da.22367] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/18/2015] [Accepted: 02/28/2015] [Indexed: 01/08/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic, severe mental illness with up to 2-3% prevalence worldwide. In fact, OCD has been classified as one of the world's 10 leading causes of illness-related disability according to the World Health Organization, largely because of the chronic nature of disabling symptoms.([1]) Despite the severity and high prevalence of this chronic and disabling disorder, there is still relatively limited understanding of its pathophysiology. However, this is now rapidly changing due to development of powerful technologies that can be used to dissect the neural circuits underlying pathologic behaviors. In this article, we describe recent technical advances that have allowed neuroscientists to start identifying the circuits underlying complex repetitive behaviors using animal model systems. In addition, we review current surgical and stimulation-based treatments for OCD that target circuit dysfunction. Finally, we discuss how findings from animal models may be applied in the clinical arena to help inform and refine targeted brain stimulation-based treatment approaches.
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Affiliation(s)
- Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15219 USA
| | - Darin D. Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
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Senço NM, Huang Y, D'Urso G, Parra LC, Bikson M, Mantovani A, Shavitt RG, Hoexter MQ, Miguel EC, Brunoni AR. Transcranial direct current stimulation in obsessive-compulsive disorder: emerging clinical evidence and considerations for optimal montage of electrodes. Expert Rev Med Devices 2015; 12:381-91. [PMID: 25982412 DOI: 10.1586/17434440.2015.1037832] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neuromodulation techniques for obsessive-compulsive disorder (OCD) treatment have expanded with greater understanding of the brain circuits involved. Transcranial direct current stimulation (tDCS) might be a potential new treatment for OCD, although the optimal montage is unclear. OBJECTIVE To perform a systematic review on meta-analyses of repetitive transcranianal magnetic stimulation (rTMS) and deep brain stimulation (DBS) trials for OCD, aiming to identify brain stimulation targets for future tDCS trials and to support the empirical evidence with computer head modeling analysis. METHODS Systematic reviews of rTMS and DBS trials on OCD in Pubmed/MEDLINE were searched. For the tDCS computational analysis, we employed head models with the goal of optimally targeting current delivery to structures of interest. RESULTS Only three references matched our eligibility criteria. We simulated four different electrodes montages and analyzed current direction and intensity. CONCLUSION Although DBS, rTMS and tDCS are not directly comparable and our theoretical model, based on DBS and rTMS targets, needs empirical validation, we found that the tDCS montage with the cathode over the pre-supplementary motor area and extra-cephalic anode seems to activate most of the areas related to OCD.
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Affiliation(s)
- Natasha M Senço
- Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Kisely S, Chang A, Crowe J, Galletly C, Jenkins P, Loi S, Looi JC, Macfarlane MD, McVie N, Parker S, Power B, Siskind D, Smith G, Merry S, Macfarlane S. Getting started in research: systematic reviews and meta-analyses. Australas Psychiatry 2015; 23:16-21. [PMID: 25504401 DOI: 10.1177/1039856214562077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Systematic reviews are one of the major building blocks of evidence-based medicine. This overview is an introduction to conducting systematic reviews and meta-analyses. CONCLUSIONS Systematic reviews and meta-analyses of randomised controlled trials (RCTs) represent the most robust form of design in the hierarchy of research evidence. In addition, primary data do not have to be collected by the researcher him/herself, and there is no need for approval from an ethics committee. Systematic reviews and meta-analyses are not as daunting as they may appear to be, provided the scope is sufficiently narrow and an appropriate supervisor available.
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Affiliation(s)
- Stephen Kisely
- Committee for Research, Royal Australian and New Zealand College of Psychiatrists (RANZCP), Melbourne, VICUniversity of Queensland School of Medicine, Wooloongabba, QLD, Australia
| | - Alice Chang
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Jim Crowe
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | | | - Peter Jenkins
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Samantha Loi
- Committee for Research, RANZCP, Melbourne, VICAcademic Unit for Psychiatry of Old Age, Saint Vincent's Health, Saint George's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Jeffrey C Looi
- Committee for Research, RANZCP, Melbourne, VICAcademic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACTACT Health Directorate, Mental Health Service, Canberra Hospital, Woden, ACT, Australia
| | - Matthew D Macfarlane
- Committee for Research, RANZCP, Melbourne, VICGraduate School of Medicine, University of Wollongong, Wollongong, NSWIllawarra Shoalhaven Local Health District, NSW, Australia
| | - Ness McVie
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Stephen Parker
- Committee for Research, RANZCP, Melbourne, VIC, Australia
| | - Brian Power
- Committee for Research, RANZCP, Melbourne, VICSchool of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WASouth Metropolitan Area Health Service, Perth, WA, Australia
| | - Dan Siskind
- Committee for Research, RANZCP, Melbourne, VICSchool of Medicine, University of Queensland, Wooloongabba, QLD, Australia
| | - Geoff Smith
- Committee for Research, RANZCP, Melbourne, VICWA Centre for Mental Health Policy Research, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WACentre for Research into Disability and Society, Curtin University, Perth, WA Australia
| | - Sally Merry
- Committee for Research, RANZCP, Melbourne, VIC, AustraliaPsychological Medicine, University of Auckland, Auckland, New Zealand
| | - Stephen Macfarlane
- Committee for Research, RANZCP, Melbourne, VICAged Psychiatry Service, Alfred Health, Caulfield, VIC, Australia
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