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Chen J, Chen Z, Zhang Y, Fan X, Zhang C, Zhu J, Song C, Zhang S, Zhang D, Tang L, Li B, Yang W, Hu Q. Effective alleviation of depressive and anxious symptoms and sleep disorders in benzodiazepine-dependent patients through repetitive transcranial magnetic stimulation. Addict Biol 2024; 29:e13425. [PMID: 39051484 PMCID: PMC11270051 DOI: 10.1111/adb.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/15/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
Benzodiazepine (BZD) dependence poses a significant challenge in mental health, prompting the exploration of treatments like repetitive transcranial magnetic stimulation (rTMS). This research aims to assess the impact of rTMS on alleviating symptoms of BZD dependence. A randomized control trial was employed to study 40 BZD-dependent inpatients. Their symptoms were quantified using the Hamilton Anxiety Rating Scale (HAMA), Montgomery-Åsberg Depression Rating Scale (MADRS) and Pittsburgh Sleep Quality Index (PSQI). Participants were divided into a conventional treatment group (daily diazepam with gradual tapering) with supportive psychotherapy and another group receiving the same treatment supplemented with rTMS (five weekly sessions for 2 weeks). Significant improvements were observed in both groups over baseline in MADRS, HAMA and PSQI scores at the 2nd, 4th, 8th and 12th week assessments (p < 0.05). The group receiving rTMS in addition to conventional treatment exhibited superior improvements in all measures at the 8th and 12th weeks. The addition of rTMS to conventional treatment methods for BZD dependence significantly betters the recovery in terms of depression, anxiety and sleep quality, highlighting the role of rTMS as an effective adjunct therapy.
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Affiliation(s)
- Jinbo Chen
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Zixuan Chen
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Yanli Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Xiaohe Fan
- Department of PsychiatryHongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiangChina
| | - Changchun Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Jun Zhu
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Chuanfu Song
- Department of PsychiatryThe Fourth People's Hospital of WuhuWuhuChina
| | | | - Danwei Zhang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Lijuan Tang
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Benhan Li
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
| | - Weibian Yang
- Department of PsychiatryHongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiangChina
| | - Qiang Hu
- Department of PsychiatryZhenjiang Mental Health CenterZhenjiangChina
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Galanis C, Neuhaus L, Hananeia N, Turi Z, Jedlicka P, Vlachos A. Axon morphology and intrinsic cellular properties determine repetitive transcranial magnetic stimulation threshold for plasticity. Front Cell Neurosci 2024; 18:1374555. [PMID: 38638302 PMCID: PMC11025360 DOI: 10.3389/fncel.2024.1374555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a widely used therapeutic tool in neurology and psychiatry, but its cellular and molecular mechanisms are not fully understood. Standardizing stimulus parameters, specifically electric field strength, is crucial in experimental and clinical settings. It enables meaningful comparisons across studies and facilitates the translation of findings into clinical practice. However, the impact of biophysical properties inherent to the stimulated neurons and networks on the outcome of rTMS protocols remains not well understood. Consequently, achieving standardization of biological effects across different brain regions and subjects poses a significant challenge. Methods This study compared the effects of 10 Hz repetitive magnetic stimulation (rMS) in entorhino-hippocampal tissue cultures from mice and rats, providing insights into the impact of the same stimulation protocol on similar neuronal networks under standardized conditions. Results We observed the previously described plastic changes in excitatory and inhibitory synaptic strength of CA1 pyramidal neurons in both mouse and rat tissue cultures, but a higher stimulation intensity was required for the induction of rMS-induced synaptic plasticity in rat tissue cultures. Through systematic comparison of neuronal structural and functional properties and computational modeling, we found that morphological parameters of CA1 pyramidal neurons alone are insufficient to explain the observed differences between the groups. Although morphologies of mouse and rat CA1 neurons showed no significant differences, simulations confirmed that axon morphologies significantly influence individual cell activation thresholds. Notably, differences in intrinsic cellular properties were sufficient to account for the 10% higher intensity required for the induction of synaptic plasticity in the rat tissue cultures. Conclusion These findings demonstrate the critical importance of axon morphology and intrinsic cellular properties in predicting the plasticity effects of rTMS, carrying valuable implications for the development of computer models aimed at predicting and standardizing the biological effects of rTMS.
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Affiliation(s)
- Christos Galanis
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lena Neuhaus
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicholas Hananeia
- 3R-Zentrum Gießen, Justus-Liebig-Universitat Giessen, Giessen, Germany
| | - Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Jedlicka
- 3R-Zentrum Gießen, Justus-Liebig-Universitat Giessen, Giessen, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center BrainLinks-BrainTools, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Liu J, Guan J, Xiong J, Wang F. Effects of Transcranial Magnetic Stimulation Combined with Sertraline on Cognitive Level, Inflammatory Response and Neurological Function in Depressive Disorder Patients with Non-suicidal Self-injury Behavior. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:28-36. [PMID: 38454900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Depressive disorder is a chronic mental illness characterized by persistent low mood as its primary clinical symptom. Currently, psychotherapy and drug therapy stand as the primary treatment modalities in clinical practice, offering a certain degree of relief from negative emotions for patients. Nevertheless, sole reliance on drug therapy exhibits a delayed impact on neurotransmitters, and long-term usage often results in adverse side effects such as nausea, drowsiness, and constipation, significantly impeding medication adherence. This study aims to investigate the impact of combining transcranial magnetic stimulation with sertraline on the cognitive level, inflammatory response, and neurological function in patients with depressive disorder who engage in non-suicidal self-injury (NSSI) behavior. METHODS A total of 130 depressive patients NSSI behavior, who were admitted to our hospital from December 2020 to February 2023, were selected as the subjects for this research. The single-group (65 cases) received treatment with oral sertraline hydrochloride tablets, while the combination group (65 cases) underwent repetitive transcranial magnetic stimulation (rTMS) in conjunction with sertraline. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was utilized to assess the depression status and cognitive function levels of both groups. Additionally, the enzyme-linked immunosorbent assay (ELISA) was employed to measure serum levels of inflammatory factors, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6). Furthermore, serum levels of neurotransmitters (norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT)) and neuro-cytokines (brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glial fibrillary acidic protein (GFAP)) were assessed. The clinical effects of the interventions on both groups were then evaluated. RESULTS Following the treatment, the combination group exhibited significantly higher levels of immediate memory, delayed memory, attention, visual function, and language function compared to the single group, with statistically significant differences (p < 0.05). Additionally, the serum levels of TNF-α, IL-1β, IL-6, and GFAP in the combination group were lower than those in the single group, while the levels of BDNF and NGF were higher in the combination group compared to the single group. These differences were also statistically significant (p < 0.05). Simultaneously, the total clinical effective rate in the combination group reached 95.38%, surpassing the 84.61% observed in the single group, and the disparity between the two groups was statistically significant (p < 0.05). CONCLUSIONS The combined use of rTMS and sertraline in treating patients with depressive disorder exhibiting NSSI behavior has proven to be effective in enhancing cognitive function, mitigating inflammatory responses, and elevating levels of neurotransmitters and nerve cytokines in the patients.
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Affiliation(s)
- Jun Liu
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Juan Guan
- Early Intervention Ward 1, Wuhan Mental Health Centre, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Jie Xiong
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Fang Wang
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
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Tesfa A, Petrosyan H, Fahmy M, Sexton T, Arvanian V. Spinal magnetic stimulation to treat chronic back pain: a feasibility study in veterans. Pain Manag 2024; 14:75-85. [PMID: 38314568 DOI: 10.2217/pmt-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Aim: Chronic low back pain represents a significant societal problem leading to increased healthcare costs and quality of life. This study was designed to evaluate the feasibility and effectiveness of non-invasive spinal electromagnetic simulation (SEMS) to treat nonspecific chronic low back pain (CLBP). Methods: A single-site prospective study was conducted to evaluate SEMS in reducing pain and improving disability. A total of 17 patients received SEMS two to three sessions a week. The Numeric Rating Scale and the Modified Oswestry Disability Questionnaire were used to assess pain and disability. Results: Participants receiving SEMS exhibited statistically significant reductions in pain and disability. Conclusion: Current results suggest that non-invasive SEMS can be an effective treatment in reducing pain and improving disability associated with CLBP.
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Affiliation(s)
- Asrat Tesfa
- Research & Development Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
| | - Hayk Petrosyan
- Department of Physical Medicine & Rehabilitation, Hackensack Meridian, JFK Johnson Rehabilitation Institute, Edison, 08820, NJ, USA
| | - Magda Fahmy
- Physical Medicine & Rehabilitation Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
| | - Thomas Sexton
- College of Business, Stony Brook University, Stony Brook, 11790, NY, USA
| | - Victor Arvanian
- Research & Development Service, Department of Veterans Affairs Medical Center, Northport, 11768, NY, USA
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Zhao M, Liu A, Wu J, Mo L, Lu F, Wan G. Il1r2 and Tnfrsf12a in transcranial magnetic stimulation effect of ischemic stroke via bioinformatics analysis. Medicine (Baltimore) 2024; 103:e36109. [PMID: 38277520 PMCID: PMC10817048 DOI: 10.1097/md.0000000000036109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/23/2023] [Indexed: 01/28/2024] Open
Abstract
Ischemic stroke refers to ischemic necrosis or softening of localized brain tissue. Transcranial magnetic stimulation (TMS) is a painless, noninvasive and green treatment method, which acts on the central nervous system through a pulsed magnetic field to assist in the treatment of central nervous system injury diseases. However, the role of Il1r2 and Tnfrsf12a in this is unknown. The ischemic stroke datasets GSE81302 and TMS datasets GSE230148 were downloaded from Gene Expression Omnibus database. Differentially expressed genes (DEGs) were screened and weighted gene co-expression network analysis (WGCNA) was performed. The construction and analysis of protein-protein interaction (PPI) network and functional enrichment analysis were performed. Draw heat map gene expression. Through the Comparative Toxicogenomics Database (CTD) to find the most relevant and core gene diseases. TargetScan was used to screen miRNAs regulating DEGs. A total of 39 DEGs were identified. According to gene ontology (GO) analysis results, in biological process (BP) analysis, they were mainly enriched in the positive regulation of apoptosis process, inflammatory response, positive regulation of p38MAPK cascade, and regulation of cell cycle. In cellular component (CC) analysis, they were mainly enriched in the cell surface, cytoplasm, and extracellular space. In Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, they were mainly enriched in nf-κB signaling pathway, fluid shear stress and atherosclerosis, P53 signaling pathway, TNF signaling pathway, and apoptosis. Among the enrichment items of metascape, negative regulation of T cell activation, hematopoietic cell lineage, positive regulation of apoptotic process, fluid shear stress and atherosclerosis were observed in GO enrichment items. Five core genes (Socs3, Irf1, Il1r2, Ccr1, and Tnfrsf12a) were obtained, which were highly expressed in ischemic stroke samples. Il1r2 and Tnfrsf12a were lowly expressed in TMS samples. CTD analysis found that the core gene (Socs3, Irf1 and Il1r2, Ccr1, Tnfrsf12a) and ischemic stroke, atherosclerosis, hypertension, hyperlipidemia, thrombosis, stroke, myocardial ischemia, myocardial infarction, and inflammation. Il1r2 and Tnfrsf12a are highly expressed in ischemic stroke, but lowly expressed in TMS samples.
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Affiliation(s)
- Man Zhao
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Aixian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Jiaojiao Wu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Linhong Mo
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Fang Lu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
| | - Guiling Wan
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing
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Ikawa H, Takeda Y, Osawa R, Sato A, Mizuno H, Noda Y. A Retrospective Case-Control Study on the Differences in the Effectiveness of Theta-Burst Stimulation Therapy for Depression with and without Antidepressant Medication. J Clin Med 2024; 13:399. [PMID: 38256534 PMCID: PMC10816069 DOI: 10.3390/jcm13020399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Transcranial magnetic stimulation (TMS) therapy has few side effects and comparable therapeutic effects to antidepressant treatment, but few studies have introduced TMS therapy as an initial treatment for MDD. The objective of this study was to retrospectively compare the clinical outcomes between 50 MDD patients without antidepressants (i.e., TMS monotherapy) and 50 MDD patients with antidepressants plus TMS therapy, matched for age, sex, and depression severity. The presence or absence of antidepressant therapy in first-line treatment was determined via a detailed interview by psychiatrists. The study design was a retrospective observational case-control study using the TMS registry data. The key inclusion criteria were adult patients who met the diagnosis of MDD and received 20-30 sessions of intermittent theta-burst stimulation (iTBS) therapy to the left dorsolateral prefrontal cortex (DLPFC). In this study, the Montgomery-Åsberg Depression Rating Scale (MADRS) was used as the primary outcome measure. No significant group differences existed in the baseline MADRS total score between the unmedicated and medicated patient groups. Following TMS therapy, no significant group differences in response rate, remission rate, or relative total score change in the MADRS were observed. The main limitations were the retrospective design and the use of registry data as a source. Our findings suggest that TMS monotherapy may be as effective as TMS add-on therapy to antidepressants when used as the first-line therapy for MDD, but randomized controlled trials are needed.
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Affiliation(s)
- Haruki Ikawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Yuya Takeda
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Ryota Osawa
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | - Akiko Sato
- Tokyo Yokohama TMS Clinic, Kawasaki 211-0063, Japan
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
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Munot S, Kim N, Huang Y, Keller CJ. Direct cortical stimulation induces short-term plasticity of neural oscillations in humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.15.567302. [PMID: 38014071 PMCID: PMC10680685 DOI: 10.1101/2023.11.15.567302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Patterned brain stimulation is commonly employed as a tool for eliciting plasticity in brain circuits and treating neuropsychiatric disorders. Although widely used in clinical settings, there remains a limited understanding of how stimulation-induced plasticity influences neural oscillations and their interplay with the underlying baseline functional architecture. To address this question, we applied 15 minutes of 10Hz focal electrical simulation, a pattern identical to 'excitatory' repetitive transcranial magnetic stimulation (rTMS), to 14 medically-intractable epilepsy patients undergoing intracranial electroencephalographic (iEEG). We quantified the spectral features of the cortico-cortical evoked potential (CCEPs) in these patients before and after stimulation. We hypothesized that for a given region the temporal and spectral components of the CCEP predicted the location and degree of stimulation-induced plasticity. Across patients, low frequency power (alpha and beta) showed the broadest change, while the magnitude of change was stronger in high frequencies (beta and gamma). Next we demonstrated that regions with stronger baseline evoked spectral responses were more likely to undergo plasticity after stimulation. These findings were specific to a given frequency in a specific temporal window. Post-stimulation power changes were driven by the interaction between direction of change in baseline power and temporal window of change. Finally, regions exhibiting early increases and late decreases in evoked baseline power exhibited power changes after stimulation and were independent of stimulation location. Together, these findings that time-frequency baseline features predict post-stimulation plasticity effects demonstrate properties akin to Hebbian learning in humans and extend this theory to the temporal and spectral window of interest. These findings can help improve our understanding of human brain plasticity and lead to more effective brain stimulation techniques. Significance Statement Brain stimulation is increasingly used to treat neuropsychiatric disorders by inducing changes in neural activity at specific brain regions. Despite their effectiveness, how these changes occur, specifically in the spectral domain, is unknown. To better understand how brain oscillations change after patterned stimulation, we performed focused stimulation in epilepsy patients and measured intracranial brain recordings. We found strong and predictable changes in brain oscillations (plasticity) after patterned stimulation. Specifically, low frequencies showing widespread effects and high frequencies exhibiting a greater magnitude of change. These changes were directly related to the temporal and spectral structure of brain responses prior to stimulation. Our study reveals that baseline brain activity patterns can predict how stimulation will induce plasticity in the spectral domain. These findings can help improve our understanding of human brain plasticity and lead to more effective brain stimulation techniques. Highlights We applied 15 minutes of repetitive 10Hz focal electrical stimulation and assessed the evoked brain-wide spectral changes with intracranial EEG.10Hz stimulation induced short-term plasticity in low frequency alpha evoked power broadly across regions and time windows and high frequency (beta, gamma) power specifically in early evoked time windows (10-50ms).Across patients, frequency bands, and time windows, brain regions with stronger baseline evoked power were more likely to undergo greater spectral changes after 10Hz stimulation.Post-stimulation spectral changes were specific; that is, for a given frequency band in a specific time window, baseline evoked power predicted post-stimulation change in the same frequency band and time window.Post-stimulation spectral change was driven by an interaction between direction of change and temporal window of baseline power; that is, regions exhibiting baseline evoked early (10-100ms) increases and late (100-200ms) decreases in power correlated with observed post-stimulation spectral changes.These results were independent of stimulation location.
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El-Khoury BB, Ray KL, Altchuler SI, Reichard JF, Dukes CH. Selective Serotonin Reuptake Inhibitors and Other Treatment Modalities for Deep Space Missions. Aerosp Med Hum Perform 2023; 94:843-851. [PMID: 37853590 DOI: 10.3357/amhp.6272.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION: As humankind ventures further into the depths of space, planning is already underway for long-duration exploration missions that will test the bounds of human performance. Deep space travel will include added risk related to stressors from the isolated, confined, and extreme environment that lies outside the boundaries of low Earth orbit. Currently, selective serotonin reuptake inhibitors (SSRIs) are considered the standard of care for many mental health diagnoses, including anxiety and depression; however, SSRIs are also associated with several undesired side effects. The utility of nonpharmacological therapies for the management of behavioral health conditions has not yet been fully explored.METHODS: A comprehensive literature search was performed using PubMed. Relevant articles pertaining to the psychological impacts of isolated, confined, and extreme environments, use of SSRIs in spaceflight, side effects associated with SSRIs, and nonpharmacological treatments for anxiety and depression were reviewed. Over 70 studies were reviewed in total.RESULTS: Reduced bone mineral density, impaired hemostatic function, significant individual variability resulting from gene polymorphisms, and drug-drug interactions are well described adverse effects of SSRIs that may complicate their operational use in the deep space environment. Four alternative therapies for the treatment of anxiety and depression may show promise for long duration missions.DISCUSSION: Although SSRIs have long been considered standard of care treatment for many behavioral health conditions, we cannot trivialize the risk that prolonged pharmacological therapy may pose. The need to mitigate these risks by exploring alternative therapies has never been more relevant.El-Khoury BB, Ray KL, Altchuler SI, Reichard JF, Dukes CH. Selective serotonin reuptake inhibitors and other treatment modalities for deep space missions. Aerosp Med Hum Perform. 2023; 94(11):843-851.
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Galanis C, Neuhaus L, Hananeia N, Turi Z, Jedlicka P, Vlachos A. Axon morphology and intrinsic cellular properties determine repetitive transcranial magnetic stimulation threshold for plasticity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.25.559399. [PMID: 37808716 PMCID: PMC10557586 DOI: 10.1101/2023.09.25.559399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used therapeutic tool in neurology and psychiatry, but its cellular and molecular mechanisms are not fully understood. Standardizing stimulus parameters, specifically electric field strength and direction, is crucial in experimental and clinical settings. It enables meaningful comparisons across studies and facilitating the translation of findings into clinical practice. However, the impact of biophysical properties inherent to the stimulated neurons and networks on the outcome of rTMS protocols remains not well understood. Consequently, achieving standardization of biological effects across different brain regions and subjects poses a significant challenge. This study compared the effects of 10 Hz repetitive magnetic stimulation (rMS) in entorhino-hippocampal tissue cultures from mice and rats, providing insights into the impact of the same stimulation protocol on similar neuronal networks under standardized conditions. We observed the previously described plastic changes in excitatory and inhibitory synaptic strength of CA1 pyramidal neurons in both mouse and rat tissue cultures, but a higher stimulation intensity was required for the induction of rMS-induced synaptic plasticity in rat tissue cultures. Through systematic comparison of neuronal structural and functional properties and computational modeling, we found that morphological parameters of CA1 pyramidal neurons alone are insufficient to explain the observed differences between the groups. However, axon morphologies of individual cells played a significant role in determining activation thresholds. Notably, differences in intrinsic cellular properties were sufficient to account for the 10 % higher intensity required for the induction of synaptic plasticity in the rat tissue cultures. These findings demonstrate the critical importance of axon morphology and intrinsic cellular properties in predicting the plasticity effects of rTMS, carrying valuable implications for the development of computer models aimed at predicting and standardizing the biological effects of rTMS.
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Abstract
Major depressive disorder (MDD) is a leading contributor to disability worldwide and is associated with increased morbidity and mortality. Current pharmacologic treatment options may be ineffective for some patients and can pose several limitations and challenges, including suboptimal response and slow onset of action. Many of these therapies can take 6 to 8 weeks for patients to achieve response and 12 weeks or longer to demonstrate full clinical benefit. Delays in depressive symptom resolution are associated with poor symptomatic and functional outcomes, decreased quality of life, and increased burden on the healthcare system. Achieving response and remission of symptoms soon after diagnosis and treatment is associated with lower rates of relapse and a greater likelihood of functional recovery. An unmet need exists for innovative treatments that offer rapid and sustained effects. This editorial discusses the benefits of rapid improvement in depressive symptoms with available and investigational agents for patients with MDD.
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Ziesel D, Nowakowska M, Scheruebel S, Kornmueller K, Schäfer U, Schindl R, Baumgartner C, Üçal M, Rienmüller T. Electrical stimulation methods and protocols for the treatment of traumatic brain injury: a critical review of preclinical research. J Neuroeng Rehabil 2023; 20:51. [PMID: 37098582 PMCID: PMC10131365 DOI: 10.1186/s12984-023-01159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of disabilities resulting from cognitive and neurological deficits, as well as psychological disorders. Only recently, preclinical research on electrical stimulation methods as a potential treatment of TBI sequelae has gained more traction. However, the underlying mechanisms of the anticipated improvements induced by these methods are still not fully understood. It remains unclear in which stage after TBI they are best applied to optimize the therapeutic outcome, preferably with persisting effects. Studies with animal models address these questions and investigate beneficial long- and short-term changes mediated by these novel modalities. METHODS In this review, we present the state-of-the-art in preclinical research on electrical stimulation methods used to treat TBI sequelae. We analyze publications on the most commonly used electrical stimulation methods, namely transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS) and vagus nerve stimulation (VNS), that aim to treat disabilities caused by TBI. We discuss applied stimulation parameters, such as the amplitude, frequency, and length of stimulation, as well as stimulation time frames, specifically the onset of stimulation, how often stimulation sessions were repeated and the total length of the treatment. These parameters are then analyzed in the context of injury severity, the disability under investigation and the stimulated location, and the resulting therapeutic effects are compared. We provide a comprehensive and critical review and discuss directions for future research. RESULTS AND CONCLUSION: We find that the parameters used in studies on each of these stimulation methods vary widely, making it difficult to draw direct comparisons between stimulation protocols and therapeutic outcome. Persisting beneficial effects and adverse consequences of electrical simulation are rarely investigated, leaving many questions about their suitability for clinical applications. Nevertheless, we conclude that the stimulation methods discussed here show promising results that could be further supported by additional research in this field.
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Affiliation(s)
- D Ziesel
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria
| | - M Nowakowska
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - S Scheruebel
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
| | - K Kornmueller
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
| | - U Schäfer
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - R Schindl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Biophysics Division, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - C Baumgartner
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - M Üçal
- Research Unit of Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - T Rienmüller
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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Caparelli EDC, Abulseoud OA, Gu H, Zhai T, Schleyer B, Yang Y. Low frequency repetitive transcranial magnetic stimulation to the right dorsolateral prefrontal cortex engages thalamus, striatum, and the default mode network. Front Neurosci 2022; 16:997259. [PMID: 36248660 PMCID: PMC9565480 DOI: 10.3389/fnins.2022.997259] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/16/2022] [Indexed: 11/25/2022] Open
Abstract
The positive treatment outcomes of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) when applied over the right dorsolateral prefrontal cortex (DLPFC) in treatment-refractory depression has been verified. However, the mechanism of action behind these results have not been well-explored. In this work we used simultaneous functional magnetic resonance imaging (fMRI) during TMS to explore the effect of LF rTMS on brain activity when applied to the right [RDLPFC1 (MNI: 50, 30, 36)] and left DLPFC sites [LDLPFC1 (MNI: -50, 30, 36), LDLPFC2 (MNI: -41, 16, 54)]. Seventeen healthy adult volunteers participated in this study. To identify brain areas affected by rTMS, an independent component analysis and a general linear model were used. Our results showed an important laterality effect when contrasting rTMS over the left and right sites. Specifically, LF rTMS increased brain activity at the striatum, thalamus, and areas of the default mode network when applied to the right, but not to the contralateral left DLPFC. In contrast, no site differences were observed when evaluating the effect of LF rTMS over the two left sites. These findings demonstrate that LF rTMS to the right DLPFC was able to stimulate the cortico-striato-thalamo-cortical pathway, which is dysregulated in patients with major depressive disorder; therefore, possibly providing some neurobiological justification for the successful outcomes found thus far for LF rTMS in the treatment of depression.
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Affiliation(s)
- Elisabeth de Castro Caparelli
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
- *Correspondence: Elisabeth de Castro Caparelli,
| | - Osama A. Abulseoud
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Phoenix, AZ, United States
| | - Hong Gu
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Tianye Zhai
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Brooke Schleyer
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
- Department of Psychology, College of Liberal Arts, Temple University, Philadelphia, PA, United States
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
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13
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Levenberg K, Cordner ZA. Bipolar depression: a review of treatment options. Gen Psychiatr 2022; 35:e100760. [PMID: 36035376 PMCID: PMC9358943 DOI: 10.1136/gpsych-2022-100760] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Bipolar depression (BD-D) is both common and incredibly challenging to treat. Even treated individuals with BD-D experience depression approximately 19% of the time, and subsyndromal depression an additional 18%. This stands in clear contrast to the approximately 10% of time spent in hypomania and 1% of time spent in mania. Despite this high illness burden, there remain relatively few treatment options approved by the US Food and Drug Administration for BD-D. Of the approved medications, four are second-generation antipsychotics (SGAs) and one is an SGA combined with an antidepressant. However, particularly when used long-term, antipsychotics can pose a significant risk of adverse effects, raising the clinical conundrum of weighing the risks associated with long-term antipsychotic use versus the risk of relapse when patients are off medications. Here, we review commonly used treatments for BD-D, including antipsychotics, classic mood stabilisers, electroconvulsive therapy and psychotherapy. We then address the somewhat controversial topic of antidepressant use in BD-D. Finally, we summarise emerging treatment options and highlight ongoing clinical trials. We hope this review will help compare the risks and benefits of several common and novel options for the treatment of patients with BD-D. In doing so, we also hope this review will aid the individualised selection of treatments based on each patient’s history and treatment goals.
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Affiliation(s)
- Kate Levenberg
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Zachary A Cordner
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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14
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Somaa FA, de Graaf TA, Sack AT. Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Front Neurol 2022; 13:793253. [PMID: 35669870 PMCID: PMC9163300 DOI: 10.3389/fneur.2022.793253] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Transcranial Magnetic Stimulation (TMS) has widespread use in research and clinical application. For psychiatric applications, such as depression or OCD, repetitive TMS protocols (rTMS) are an established and globally applied treatment option. While promising, rTMS is not yet as common in treating neurological diseases, except for neurorehabilitation after (motor) stroke and neuropathic pain treatment. This may soon change. New clinical studies testing the potential of rTMS in various other neurological conditions appear at a rapid pace. This can prove challenging for both practitioners and clinical researchers. Although most of these neurological applications have not yet received the same level of scientific/empirical scrutiny as motor stroke and neuropathic pain, the results are encouraging, opening new doors for TMS in neurology. We here review the latest clinical evidence for rTMS in pioneering neurological applications including movement disorders, Alzheimer's disease/mild cognitive impairment, epilepsy, multiple sclerosis, and disorders of consciousness.
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Affiliation(s)
- Fahad A. Somaa
- Department of Occupational Therapy, Faculty of Medical Rehabilitation, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tom A. de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander T. Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Center of Integrative Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Brain + Nerve Centre, Maastricht University Medical Centre+, Maastricht, Netherlands
- *Correspondence: Alexander T. Sack
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15
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Jivraj J, Ameis SH. Is Repetitive Transcranial Magnetic Stimulation (rTMS) Ready for Clinical Use as a Treatment Tool for Mental Health Targets in Children and Youth? JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:93-99. [PMID: 35614951 PMCID: PMC9084373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/10/2022] [Indexed: 06/15/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with potential for broad application in individuals with neuropsychiatric conditions. As in adults, most rTMS research in youth has focused on treatment-resistant depression. A limited number of rTMS studies have also been conducted in children and youth with primary diagnoses of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) or Tourette's syndrome. Across the available rTMS literature, rTMS appears to be well tolerated with few adverse effects reported when applied to child and youth research samples. However, the potential efficacy of rTMS treatment for a variety of targets in children and youth remains unclear, due in part to limitations of the current literature, including studies using diverse protocols, potential for bias in existing clinical trial designs, variability in the research samples, and the use of heterogenous outcome measures. While rTMS is unlikely to take the place of more accessible treatments (e.g., psychopharmacological, psychosocial, psychotherapeutic), rTMS may provide a valuable alternative treatment option, particularly for those individuals where conventional treatments are inaccessible, poorly tolerated, or ineffective. A more robust body of well-designed, controlled trials, is needed in order to clarify rTMS treatment efficacy across relevant neuropsychiatric conditions, optimize treatment protocols, and meet the critical need for novel mental health interventions in children and youth.
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Affiliation(s)
- Jamil Jivraj
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephanie H Ameis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Brain and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
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16
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Taşdemir Yiğitoğlu G, Çunkuş N, Özgün Öztürk F, Sarıçay K. Identification of the sociodemographic and clinical characteristics of the patients who have undergone transcranial magnetic stimulation in a psychiatry clinic: A retrospective descriptive design. Perspect Psychiatr Care 2022; 58:682-690. [PMID: 33955016 DOI: 10.1111/ppc.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aim of this study, which is the first in this field in Turkey, is to determine the sociodemographic and clinical characteristics of patients who have undergone transcranial magnetic stimulation (TMS) in a psychiatry clinic. DESIGN AND METHODS This study has a retrospective descriptive design. Data of 513 psychiatric patients who have undergone TMS between 2015 and 2018 in a university hospital were reviewed. FINDINGS Significant differences were found between psychiatric diagnoses of the patients, based on their sex, marital status, and the number of courses of treatment with TMS (p < 0.05). PRACTICAL IMPLICATIONS It was suggested that nurses who would practice this procedure were required to be educated for TMS and nursing care to provide well and effective care.
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Affiliation(s)
- Gülay Taşdemir Yiğitoğlu
- Departmant of Psychiatric Nursing, Faculty of Health Science, Pamukkale University, Denizli, Turkey
| | - Nesrin Çunkuş
- Departmant of Psychiatric Nursing, Faculty of Health Science, Pamukkale University, Denizli, Turkey
| | - Fatma Özgün Öztürk
- Departmant of Psychiatric Nursing, Faculty of Health Science, Pamukkale University, Denizli, Turkey
| | - Kıymet Sarıçay
- Psychiatric Nurse, Pamukkale University Habib Kızıltaş Psychiatric Hospital, Denizli, Turkey
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17
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Koike S, Uematsu A, Sasabayashi D, Maikusa N, Takahashi T, Ohi K, Nakajima S, Noda Y, Hirano Y. Recent Advances and Future Directions in Brain MR Imaging Studies in Schizophrenia: Toward Elucidating Brain Pathology and Developing Clinical Tools. Magn Reson Med Sci 2021; 21:539-552. [PMID: 34408115 DOI: 10.2463/mrms.rev.2021-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Schizophrenia is a common severe psychiatric disorder that affects approximately 1% of general population through the life course. Historically, in Kraepelin's time, schizophrenia was a disease unit conceptualized as dementia praecox; however, since then, the disease concept has changed. Recent MRI studies had shown that the neuropathology of the brain in this disorder was characterized by mild progression before and after the onset of the disease, and that the brain alterations were relatively smaller than assumed. Although genetic factors contribute to the brain alterations in schizophrenia, which are thought to be trait differences, other changes include factors that are common in psychiatric diseases. Furthermore, it has been shown that the brain differences specific to schizophrenia were relatively small compared to other changes, such as those caused by brain development, aging, and gender. In addition, compared to the disease and participant factors, machine and imaging protocol differences could affect MRI signals, which should be addressed in multi-site studies. Recent advances in MRI modalities, such as multi-shell diffusion-weighted imaging, magnetic resonance spectroscopy, and multimodal brain imaging analysis, may be candidates to sharpen the characterization of schizophrenia-specific factors and provide new insights. The Brain/MINDS Beyond Human Brain MRI (BMB-HBM) project has been launched considering the differences and noises irrespective of the disease pathologies and includes the future perspectives of MRI studies for various psychiatric and neurological disorders. The sites use restricted MRI machines and harmonized multi-modal protocols, standardized image preprocessing, and traveling subject harmonization. Data sharing to the public will be planned in FY 2024. In the future, we believe that combining a high-quality human MRI dataset with genetic data, randomized controlled trials, and MRI for non-human primates and animal models will enable us to understand schizophrenia, elucidate its neural bases and therapeutic targets, and provide tools for clinical application at bedside.
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Affiliation(s)
- Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo.,University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM).,University of Tokyo Center for Integrative Science of Human Behavior (CiSHuB).,The International Research Center for Neurointelligence (WPI-IRCN), Institutes for Advanced Study (UTIAS), The University of Tokyo
| | - Akiko Uematsu
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences.,Research Center for Idling Brain Science (RCIBS), University of Toyama
| | - Norihide Maikusa
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences.,Research Center for Idling Brain Science (RCIBS), University of Toyama
| | - Kazutaka Ohi
- Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine
| | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University.,Institute of Industrial Science, The University of Tokyo
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18
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Greenberg BD, Philip NS, Fortin-Ashburne K, Carpenter LL. The COBRE Center for Neuromodulation (CCN) at Butler Hospital: Clinical-Translational Research in Human Brain Stimulation. RHODE ISLAND MEDICAL JOURNAL (2013) 2021; 104:30-33. [PMID: 33648316 PMCID: PMC8211205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COBRE Center for Neuromodulation (CCN) at Butler Hospital supports clinical research in neuromodulation and investigators' career development in this field. The work couples brain stimulation methods with readouts of brain activity (e.g., using various neuroimaging, behavioral, and physiological assessment methods) in clinical or clinically relevant populations. Its guiding principle is that for noninvasive brain stimulation to gain efficacy and implementation, it is essential to better characterize clinically relevant target circuits and mechanisms of action. The CCN includes a Design and Analysis Core (DAC) to support rigorous and innovative experimental design and data analytic strategies and a Neuromodulation and Neuroimaging Core (NNC) to facilitate the acquisition and processing of high-quality data using noninvasive neurostimulation and neuroimaging methods. This article will describe the CCN's research focus and how it enhances research capacity in neuromodulation in our state. It will introduce our current investigator Project Leaders, their projects, and our pilot project program. It will also detail the CCN's links to Centers and research cores in Rhode Island researching allied areas of clinical neuroscience, neurology, psychiatry, and psychology, current collaborative efforts across those centers, and opportunities to collaborate in research and training.
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Affiliation(s)
- Benjamin D Greenberg
- Butler Hospital, Providence RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center
| | - Noah S Philip
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center
| | | | - Linda L Carpenter
- Butler Hospital, Providence RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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19
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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20
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Petrosino NJ, Zandvakili A, Carpenter LL, Philip NS. Pilot Testing of Peak Alpha Frequency Stability During Repetitive Transcranial Magnetic Stimulation. Front Psychiatry 2018; 9:605. [PMID: 30515110 PMCID: PMC6256033 DOI: 10.3389/fpsyt.2018.00605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/29/2018] [Indexed: 01/13/2023] Open
Abstract
Over half of those diagnosed with post-traumatic stress disorder (PTSD) have comorbid major depressive disorder (MDD), and rates are even higher among military veterans. Transcranial magnetic stimulation (TMS) may be a safe and efficacious treatment for PTSD, both with and without comorbid MDD. Still, the mechanism of action of TMS is not fully understood, and it remains unclear which stimulation techniques (e.g., target regions, pulse strength/frequency, waveform) optimize treatment for these patients. Recent research indicated that a patient's unique individualized alpha frequency (IAF) may be used to guide brain stimulation treatment, and emerging data suggests that stimulation synchronized to the IAF may be efficacious for MDD. However, to our knowledge there are no studies to date that evaluate the stability of IAF over time in patients with comorbid PTSD and MDD. To this end, we used an eight-lead electroencephalography (EEG) system to record IAF before and after a course of TMS. Stimulation parameters were informed by prior studies of TMS for comorbid PTSD and MDD and included 5 Hz TMS to the left dorsolateral prefrontal cortex, at 120% of motor threshold, 3,000-4,000 pulses per session for up to 40 sessions. We tested whether IAF was changed with a course of TMS therapy and evaluated whether IAF predicted clinical outcomes. We observed no significant changes in IAF from baseline to post-treatment, and there was no relationship between IAF and clinical symptom change. These data demonstrate the stability of IAF with TMS and indicate its utility as a trait marker for future brain stimulation studies. This work does not support the use of IAF as predictor of clinical response to TMS as administered.
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Affiliation(s)
- Nicholas J. Petrosino
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, United States
| | - Amin Zandvakili
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, United States
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, United States
| | - Noah S. Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Butler Hospital, Alpert Medical School of Brown University, Providence, RI, United States
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