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3 episodes with rtms
3 episodes with rtms
2 episodes with rtms
11 episodes with rtms
2 episodes with rtms
2 episodes with rtms
2 episodes with rtms
3 episodes with rtms
2 episodes with rtms
In this fascinating second instalment of our "Beyond the Veil" series, we explore the revolutionary idea that your brain might not be creating consciousness but rather filtering it. Discover how the "Reducing Valve Hypothesis" proposed by William James and Aldous Huxley is finding support in modern neuroscience, especially through research using repetitive transcranial magnetic stimulation (rTMS) that shows inhibiting certain brain regions may enhance psychic abilities.Key TopicsThe origins of the "Reducing Valve Hypothesis" in psychology and philosophyHow neuroplasticity and altered states challenge traditional brain modelsGroundbreaking rTMS research showing enhanced psi abilities when inhibiting specific brain regionsThe science behind why meditation, flow states, and hypnosis may access expanded consciousnessNotable MentionsWilliam James' pioneering theories on consciousness filtrationAldous Huxley's "The Doors of Perception" and consciousness theories2024 Cortex study using rTMS to enhance psi phenomenaConnections to "The Telepathy Tapes" podcast findings on nonverbal autisticsHypnosis research demonstrating suggestion's effect on sensory perceptionComing NextJoin us next time as we explore how epigenetics and environmental influences shape our ability to access spiritual states. Is consciousness inherited or cultivated?Series ContextThis episode builds on our previous discussion exploring genetic links to mediumistic abilities. We recommend listening to Episode 1 in the series- 'Is Spiritual Perception in our DNA?' first for full context.FREE Guide: 20 Client Conversation Starters Guide https://www.integratedwisdom.com.au/20conversationstarters Connect With UsEmail: hello@integratedwisdom.com.auInstagram: @Integrated_Wisdom https://www.instagram.com/integrated_wisdom/Be sure to SHARE this episode to anyone you feel may be interested or benefit from this content.And please don't forget to hit SUBSCRIBE to keep up to date with our episodes and give us a RATING below. ⭐️⭐️⭐️⭐️⭐️Intro and Outro music: Inspiring Morning by PlaysoundDisclaimer: This podcast is intended for educational purposes only. It is not intended to be treated as psychological treatment or to replace the need for psychological treatment.
In this episode, we're talking about why traditional account plans might be slowing you down and how to replace them with a streamlined approach: Reasons to Meet (RTMs). Jason walks you through how to ditch the exhaustive research and focus on the minimum you need to land that critical first meeting—because you don't need a full account strategy before making contact. RTMs take just 15 to 30 minutes to create, saving you hours of prep time while keeping your outreach sharp and targeted. Check out the show notes, more free content, and get coaching at https://outboundsquad.com
Tous savoir sur la dépression pour bien la soigner. Coup de blues, déprime ou dépression on en parle dans EMPATHIE le podcast ! Antidépresseurs, RTMS, eskétamine, on aborde les traitements qui marchent et toutes les nouvelles pistes. Abonnez-vous aussi à la chaîne de https://tinyurl.com/CHRouvray !
（解 説）東京慈恵会医科大学 精神医学講座 准教授 小髙文聰氏 （ききて）防衛医科大学校教授 池脇克則氏
En el episodio de hoy, describimos el modelo de competición interhemisférica, base de algunas técnicas de estimulación cerebral no invasiva y exponemos las críticas y modelos alternativos en la actualidad para explicar esa relación entre hemisferios cerebrales y la relación con la recuperación motora tras un ictus. 1. Di Pino, G., Pellegrino, G., Assenza, G., Capone, F., Ferreri, F., Formica, D., Ranieri, F., Tombini, M., Ziemann, U., Rothwell, J. C., & Di Lazzaro, V. (2014). Modulation of brain plasticity in stroke: a novel model for neurorehabilitation. Nature reviews. Neurology, 10(10), 597–608. https://doi.org/10.1038/nrneurol.2014.162 (https://pubmed.ncbi.nlm.nih.gov/25201238/). 2. Brancaccio, A., Tabarelli, D., & Belardinelli, P. (2022). A New Framework to Interpret Individual Inter-Hemispheric Compensatory Communication after Stroke. Journal of personalized medicine, 12(1), 59. https://doi.org/10.3390/jpm12010059 (https://pubmed.ncbi.nlm.nih.gov/35055374/). 3. Lee, H. S., Kim, D. H., Seo, H. G., Im, S., Yoo, Y. J., Kim, N. Y., Lee, J., Kim, D., Park, H. Y., Yoon, M. J., Kim, Y. S., Kim, H., & Chang, W. H. (2024). Efficacy of personalized rTMS to enhance upper limb function in subacute stroke patients: a protocol for a multi-center, randomized controlled study. Frontiers in neurology, 15, 1427142. https://doi.org/10.3389/fneur.2024.1427142 (https://pubmed.ncbi.nlm.nih.gov/39022726/). 4. Xu, J., Branscheidt, M., Schambra, H., Steiner, L., Widmer, M., Diedrichsen, J., Goldsmith, J., Lindquist, M., Kitago, T., Luft, A. R., Krakauer, J. W., Celnik, P. A., & SMARTS Study Group (2019). Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation. Annals of neurology, 85(4), 502–513. https://doi.org/10.1002/ana.25452 (https://pubmed.ncbi.nlm.nih.gov/30805956/). 5. Murase, N., Duque, J., Mazzocchio, R., & Cohen, L. G. (2004). Influence of interhemispheric interactions on motor function in chronic stroke. Annals of neurology, 55(3), 400–409. https://doi.org/10.1002/ana.10848 (https://pubmed.ncbi.nlm.nih.gov/14991818/). 6. Ferbert, A., Priori, A., Rothwell, J. C., Day, B. L., Colebatch, J. G., & Marsden, C. D. (1992). Interhemispheric inhibition of the human motor cortex. The Journal of physiology, 453, 525–546. https://doi.org/10.1113/jphysiol.1992.sp019243 (https://pubmed.ncbi.nlm.nih.gov/1464843/).
In this episode, I am joined by Wolfgang Croskey for an in-depth discussion on hiring and our Crane community. We discuss: (00:00:00) - Intro (00:03:40) - Hiring executives (00:12:05) - Integrating the new hire (00:20:46) - The WHO scorecard (00:25:18) - Using recruiters (00:27:48) - Hiring front-line and remote labor (00:40:08) - Crane Learn more & connect with me here: Crane, the private community for property management business owners. My Free PM Newsletter RL Property Management The content of this podcast is for informational purposes only and does not constitute professional advice. I may have consulting agreements with, or financial interests in, companies mentioned in this podcast. Additionally, some of the links included may be affiliate links, meaning I may earn a commission if you purchase through these links. Always perform your own due diligence before making any financial or business decisions.
Viele von euch werden wahrscheinlich an Gesprächstherapie oder Medikamente wie Anti-Depressiva zur Behandlung psychischer Erkrankungen denken. Dabei gibt es mit der Neurostimulation noch einen ganz eigenen und besonderen Bereich in der medizinischen Behandlung psychischer Erkrankungen, den wir bei uns seit kurzem in unserem Neurostimulationszentrum unter Leitung von Prof. Dr. Dr. Sprick anbieten. Unser Oberarzt Dr. York Christoph Vogel ist buchstäblich seit seinen Kindertagen fasziniert von Physik, Strom und seinen vielfältigen Möglichkeiten: In dieser Podcast-Folge lernt ihr nicht nur ihn ganz persönlich kennen, sondern darüber hinaus erfahrt ihr, was es mit EKT (Elektrokonvulsionstherapie), rTMS (repetitiver transkranieller Magnetstimulation) und der TPS (Transkranielle Pulsstimulation) auf sich hat, wie sie funktionieren, was es dabei zu beachten gilt und wie die Behandlungsverfahren bei diversen psychischen Erkrankungen und sogar Alzheimer Demenz (hier kommt die TPS zum Einsatz) erfolgreich helfen können. Übrigens: Ihr lernt in dieser Folge auch, dass die von uns im Neurostimulationszentrum angewendeten Verfahren absolut nichts mit den destruktiven Verfahren zu tun haben, die einige von euch aus Hollywood-Filmen wie "Einer flog über das Kuckucksnest" - vielmehr sind sämtliche Verfahren extrem nebenwirkungsarm. Viel Spaß beim Hören und wie immer freuen wir uns über Eure Kommentare und Fragen zum Thema! Ihr wollt uns Feedback geben?Dann schreibt uns einfach an podcast-ajk@ak-neuss.de Wir freuen uns auf eure Anregungen und Kommentare!
Welcome to another episode of Quick Takes Essentials, our summer series. This essential episode was released just this past May and is on the newly released CANMAT Depression Guidelines update. If you haven't had time to review the update, well, you can start by listening to this episode, which outlines all the major changes in that update in a quick, concise format. The update draws on eight clinically relevant questions, which we explore akin to following a patient's journey. Here I interview first co-author Doctor Raymond Lam of the University of British Columbia. Please enjoy. THANKS FOR LISTENING!Quick Takes is a production of the Center for Addiction and Mental Health. You can find links to the relevant content mentioned in the show and accessible transcripts of all the episodes we produce online at CAMH.ca.Follow CAMH Education on X (formerly known as Twitter) @camhEduFollow and subscribe to Reading of the Week where, every week, Dr. David Gratzer reviews research papers from the world of psychiatry.
“As far as medical treatments go, ECT is the safest medical procedure in all of medicine.”Will the stigma around ECT fade? Will ECT simply grow less relevant in the age of ketamine and MST? What's the future of neuromodulation?Join Dr. David Gratzer as he speaks to Dr. Daniel Blumberger, scientific director of the Temerty Centre for Therapeutic Brain Intervention and professor at the University of Toronto to find out.During their discussion, we learn about:the 20-30 active clinical trials at the Temerty Centrethe impact and efficacy of some of the newer treatments like ketamine, rTMS, and MSTthe latest in the literature on ECT and suicide preventionand that ECT isn't being replaced any time soon. THANKS FOR LISTENING!Quick Takes is a production of the Center for Addiction and Mental Health. You can find links to the relevant content mentioned in the show and accessible transcripts of all the episodes we produce online at CAMH.ca.Follow CAMH Education on X (formerly known as Twitter) @camhEduFollow and subscribe to Reading of the Week where, every week, Dr. David Gratzer reviews research papers from the world of psychiatry.
“They really are the most widely used guidelines in the world.”Much has changed over the past eight years. In 2016, singer Olivia Rodrigo was just starting high school; quarterback Tom Brady seemed ageless; none of us were talking about pandemics. Recently the Canadian Network for Mood and Anxiety Treatments (CANMAT) released its first major depression update in eight years. How has depression management changed, and what does it mean for you and your practice? Join Dr. David Gratzer as he speaks to Dr. Raymond Lam, the co-first author and the executive chair of CANMAT and find out.In this episode you will learn:when to recommend exercise (and how to discuss it with your patients)about the role of pharamacogenetic testinghow to think about neuromodulationand the reason for the format update to these guidelines. THANKS FOR LISTENING!Quick Takes is a production of the Center for Addiction and Mental Health. You can find links to the relevant content mentioned in the show and accessible transcripts of all the episodes we produce online at CAMH.ca.Follow CAMH Education on X (formerly known as Twitter) @camhEduFollow and subscribe to Reading of the Week where, every week, Dr. David Gratzer reviews research papers from the world of psychiatry.
Throughout the world, across numerous cultures, elongated skulls have been revered. Whether it's a small isolated island in the middle of the Pacific or an ancient culture, the practice of elongating skulls is as mystifying as it is unexplained. The practice has led some to speculate that it was done to enhance consciousness and psychic abilities. For the very same reason, trepanning has been conducted from Neolithic times to the modern day. We explore this strange practice and hear reports of people who have attempted to alter their consciousness by drilling holes in their heads. Sometimes with incredible improvements, though usually the person ends up in a love affair with a pigeon. Listen to find out more. Then, for our Plus+ Members, we take a look at a new angle on Bigfoot encounters and consider how they are more similar to poltergeist encounters than you might think. Is it possible that Bigfoot is being mimicked by some other unknown force? Links New Dawn Special Issue Vol.18 No.2 New DNA Testing on 2,000-Year-Old Elongated Paracas Skulls Changes Known History The Mystery of Peru's Elongated Skulls – Science vs Myth Head Space: Behind 10,000 Years of Artificial Cranial Modification Enhanced mind-matter interactions following rTMS induced frontal lobe inhibition Bart Huges over zijn trepanatie Bore Hole Joey Mellen - The Psychedelic Science of Bart Hughes The Beckley Foundation Heartbeat in the Brain partial My LSD-Induced Love Affair With a Pigeon An Interview with the Woman Who Drilled a Hole in Her Head to Open Up Her Mind Plus+ Extension The extension of the show is EXCLUSIVE to Plus+ Members. To join, click HERE. BFRO Samurai Chatter The Forest Poltergeist: Class B Encounters and the Paranormal Class B Incident in Michaux State Forest, Pennsylvania, early November 2005 Christopher Noel Impossible Visits: The Inside Story of Interactions with Sasquatch at Habituation Sites Mysteries in the Mist: Mist, Fog, and Clouds in the Paranormal Bigfoot Unveiled: Scientific Answers to Bigfoot Mysteries Learn more about your ad choices. Visit megaphone.fm/adchoices
Joining us for this episode was Mr. Ken Mariash, the CEO at Sinaptica Therapeutics. For over 20 years Ken has been leading & growing new business ventures on both the 'Buy Side' and the 'Build Side.' He started his career in management consulting at Charles River Associates then jumped to industry at CLS, then Baxter BioScience (acquired by Takeda) and then Boston Scientific with leadership roles in marketing, strategy & corporate development. Ken holds degrees in both Biochemistry & Business Economics from Brown University.Today, Ken is leading the team at Sinaptica to advance their personalized closed-loop neuromodulation therapy for Alzheimers which has generated unprecedented Phase 2 sham-controlled clinical data that was recently published in the Oxford journal, 'Brain.' Sinaptica has FDA Breakthrough status for its novel proprietary approach which combines rTMS, EEG, and Neuronavigation with a sophisticated ML-derived personalization engine based on a novel brain target--the precuneus, the central hub of the Default Mode Network, a brain network involved in episodic memory. The company has completed all clinicals to date with non-dilutive funding and is now in-process of obtaining financing to complete the clinical product (SinaptiStim-AD) ** and prepare to initiate a pivotal study in one year's time.Some of the major highlights we discussed:-How Ken's upbringing shaped his early & future career days-Pivotal roles that were instrumental in Ken's career development to becoming a CEO-How Ken manages stress, especially during difficult times-Ken's perspective on the toughest part of being a CEO-Career advice for others coming up behind him...and so much moreKey Takeaways:Early interests and experiences can provide clues to future career paths.Pivotal roles and responsibilities can shape a career and provide valuable skills and experiences.Opportunities and the belief of others can play a significant role in career progression.Being a MedTech CEO requires managing time and maintaining focus amidst numerous demands. Maintaining focus is crucial for productivity. Techniques like taking short walks, facing the sun, and prioritizing tasks can help regenerate focus.Managing stress involves letting go of outcomes, maintaining an optimistic outlook, and imagining a future where goals are achieved.Establishing a daily routine that includes meditation, setting intentions, exercise, and prioritizing sleep can contribute to mental and physical well-being.Building a high-performance team requires individuals with an all-in mentality, personal responsibility, and a focus on winning together.Culture is a system of unspoken values that determine the behaviors that get rewarded. Leaders must actively shape and reinforce the desired culture.Leadership involves pushing others to achieve their best, providing honest feedback, and being open to personal growth.Career and life advice includes becoming excellent in your area of focus, being curious and hungry to learn about other areas, and seeking new opportunities.The future of Synaptic and their work in Alzheimer's therapy is exciting, with promising data showing the potential for significant impact.Find Ken Mariash on LinkedIn:https://www.linkedin.com/in/kenmariash/Sinaptica Therapeutics on the web:https://sinapticatx.com/Note: (SinaptiStim is a trade mark of Sinaptica Therapeutics)
Join Ryan on this transformative episode of From Darkness to Life as he sits down with Dr. Kent Comeau, the compassionate psychiatrist at Reconnect Mental Health in the heart of Medicine Hat, Alberta.Explore the diverse range of services offered at Reconnect Mental Health, where Dr. Comeau, driven by his passion for mental wellness, discusses innovative treatments such as repetitive transcranial magnetic stimulation (rTMS). This non-invasive, painless therapy utilizes magnetic pulses to stimulate specific brain regions associated with mood regulation, offering hope and relief for conditions like depression and anxiety.In addition to rTMS, delve into the integral role of process groups and shared-care at Reconnect Mental Health. Dr. Comeau sheds light on how these services foster a collaborative approach to mental health, providing individuals with a supportive community to navigate their unique journeys.Listeners will be captivated by Dr. Comeau's insights into the transformative impact of these services. Whether you're seeking information on cutting-edge mental health treatments or inspired by tales of resilience, this episode promises to be a compelling journey from darkness to life.Tune in and let Dr. Kent Comeau guide you through the corridors of mental wellness on this illuminating episode of From Darkness to Life.Explore Reconnect Mental Health at https://reconnectmentalhealth.com/
In this episode of Better Thinking, Nesh Nikolic speaks with Paul Fitzgerald about the development of novel brain stimulation treatment options including repetitive transcranial magnetic stimulation (rTMS) for patients with depression, schizophrenia, obsessive compulsive disorder, PTSD, autism and Alzheimer's disease. Paul Fitzgerald is the Head of the School of Medicine and Psychology at the Australian National University. He is a qualified psychiatrist, has a MBBS degree, Masters of Psychological Medicine and research PhD from Monash University. He has conducted an extensive range of more than 20 clinical trials, especially focussed on the development of novel brain stimulation treatment options including repetitive transcranial magnetic stimulation (rTMS) for patients with depression, schizophrenia, obsessive compulsive disorder, PTSD, autism and Alzheimer's disease. He has had continual NHMRC grant support for over 20 years and over $10 million in research support in the last 5 years. He has published several books, over 500 journal articles and been cited over 20,000 times. He has established multiple clinical rTMS services, founded several device and clinical service companies and the first rTMS training program in Australia. He led a national application to the Department of Health at the Federal Government level and this resulted in Medicare funding $283 million in year 1 of rTMS therapy for patients with depression in 2021. Episode link at https://neshnikolic.com/podcast/paul-fitzgeraldSee omnystudio.com/listener for privacy information.
Psychiater en onderzoeker Nienke Vulink vertelt over de nieuwste ontwikkelingen in de psychiatrie. Wat kan diepe hersenstimulatie (DBS) betekenen voor mensen met een hevige dwangstoornis of depressie? Wat zijn de verschillen met rTMS, waarvoor geen operatie nodig is? En waarom zijn deze veelbelovende behandelmethoden nog zo onbekend? Nienke pleit voor meer samenwerking tussen academische ziekenhuizen en ggz-instellingen. Presentatie door Maaike Kooijman en Tabe Bakker.
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In deze aflevering praten we verder over hardnekkige depressie, en hoe Martijn daarmee omgaat. In de vorige aflevering vertelde hij al hoe het is om te leven met een persistente depressie. Hoe gaat het met rTMS-therapie en de impact op zijn leven. - Meer informatie over rTMS. Ook praten we over mijn eigen gestoordheid: hoe kwam ik uit mijn diepste depressie ooit? Wat was mijn weg? Kyara kletst met Martijn over alternatieve en reguliere therapieën. Graag hoor ik ook jouw ervaringen met depressie, en wat jij voor behandelingen hebt gekozen. Wat werkt voor jou? Mail ons , of reageer en volg mij op Instagram Heb je het momenteel zo moeilijk dat je het even niet meer weet, en dat destructieve gedachten je lijken over te nemen? Je bent niet alleen! Echt! Bel (gratis) 0800-0113 , of chat anoniem met een van de hulpverleners. Ze zijn er altijd voor je. Volg Kyara Kletst door ons toe te voegen aan je Spotify-bibliotheek. Dan zie je vanzelf wanneer we weer een aflevering online hebben. Als je ons beluistert op Apple iTunes, geef ons wat sterren, schrijf dan een recensie, en volg ons (als je dat leuk vindt. Of niet. Moet je echt zelf weten! :-) ) Wil je meepraten? Email ons dan op KyaraKletst@gmail.com, en deel jouw schaamtevolle topics en taboe-vragen. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kyara-skura/message
Deze aflevering praat ik met tafelheer en -voor deze keer- gast Martijn over mental health in het onderwerp ‘Ik ben totaal gestoord! Wat nu?'. Dit wordt een thema dat ik vaker ga behandelen, omdat ik het ontzettend belangrijk vind, en omdat het helaas nog steeds omgeven is met een gevoel van taboe, en vooral van veel schaamte. In deze aflevering -de eerste van een tweeluik- praat ik met Martijn over depressie. Martijn lijdt hier al sinds zijn jeugd aan, en dat is echt wat anders dan ‘ns een keertje somber zijn. We praten over zijn ervaring, over hoe moeilijk het kan zijn om “gewoon” mee te doen in de maatschappij, en over hoe reëel zijn angsten zijn voor oordelen en veroordeling van buiten. Dit onderwerp raakt veel punten die voor sommigen pijnlijk, angstwekkend of triggerend kunnen zijn. Let dus alsjeblieft goed op jezelf, en laat als je twijfelt deze aflevering even staan totdat je je goed genoeg voelt. Hoe voelen jullie je over mental health? Makkelijk onderwerp voor je? Lastig? Schaam je je? Juist niet? Reageer via mijn instapost op https://instagram.com/kyara_skura Mijn boekentip deze keer is Ga Gewoon Wat Leuks Doen, van Aafke Romeijn. Bestel 'm bij je lokale boekhandel. Wil je meer over rTMS weten? De organisatie waar Martijn zijn huidige behandeling volgt heet Neurocare, en die heeft een informatieve website. Heb je het momenteel zo moeilijk dat je het even niet meer weet, en dat destructieve gedachten je lijken over te nemen? Je bent niet alleen! Echt! Bel (gratis) 0800-0113 , of chat anoniem met een van de hulpverleners. Ze zijn er altijd voor je. Vond je het leuk om naar Kyara te luisteren?Volg Kyara Kletst dan door ons toe te voegen aan je Spotify-bibliotheek. Dan zie je vanzelf wanneer we weer een aflevering online hebben.Als je ons beluistert op Apple iTunes, geef ons wat sterren, schrijf een recensie, en volg ons (als je dat leuk vindt. Of niet. Moet je lekker zelf weten! :-) ) Wil je meepraten? Email ons dan op kyarakletst@gmail.com, en deel jouw schaamtevolle topics en taboe-vragen. --- Send in a voice message: https://podcasters.spotify.com/pod/show/kyara-skura/message
睡得好是孩子發育關鍵，換季溫差大，你家過敏兒睡得好嗎？別讓過敏影響孩子的成長！LP33機能優酪乳含專利LP菌，榮獲國家健康食品認證，能輔助調整過敏體質！天天喝LP33，換季過敏不用怕！全聯、家樂福熱賣中！ https://youtu.be/noxu6E4FBkw －－－－以上訊息由 SoundOn 動態廣告贊助商提供－－－－ 「你已經做得很好了，今天也活得輕鬆一些吧。」 今天要來分享的身心相關選書是《今天也活得輕鬆一些》，雖然小小一本，看起來很像是散文的封面，可是裡面就像是一本小的百科全書一樣，所有有關於身心疾患的種種問題，你幾乎都可以在這裡得到解答。今天就特別邀請到本書的作者李旻珊，一起來討論很少被談及的主題「高功能焦慮」！ 1. 「高功能焦慮」有哪些特徵？ 2. 如何用藥物和非藥物治療焦慮？ 3. 藥物治療並不像電視上看到的樣子？ 4. 什麼是rTMS經顱磁刺激？能夠治療憂鬱？ 5. 怎麼面對發現自己能力有限的無力感？ 6. 除了藥物，女生可以試試看芳療 7. 不同問題有不同的推薦精油配方 8. 拯救一個人的情緒帶來的改變非常強大 9. 解釋不同強度的抗焦慮劑、情緒穩定劑 10. 如何逐漸減少安眠藥的使用？ 11. 給「高功能焦慮者」的建議：放過自己 12. 從《美少女戰士》談母女的競爭關係 《今天也活得輕鬆一些：身心科醫師給「高功能焦慮者」，關於心理健康的全面方案》 https://www.books.com.tw/products/0010950873 Website｜捷思身心醫學診所 Facebook｜身心科 李旻珊醫師 Instagram｜dr.minshan -- - - - -
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.20.533396v1?rss=1 Authors: Anil, S., Lu, H., Rotter, S., Vlachos, A. Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique used to induce neuronal plasticity in healthy individuals and patients. Designing effective and reproducible rTMS protocols poses a major challenge in the field as the underlying biomechanisms remain elusive. Current clinical protocol designs are often based on studies reporting rTMS-induced long-term potentiation or depression of synaptic transmission. Herein, we employed computational modeling to explore the effects of rTMS on long-term structural plasticity and changes in network connectivity. We simulated a recurrent neuronal network with homeostatic structural plasticity between excitatory neurons, and demonstrated that this mechanism was sensitive to specific parameters of the stimulation protocol (i.e., frequency, intensity, and duration of stimulation). The feedback-inhibition initiated by network stimulation influenced the net stimulation outcome and hindered the rTMS-induced homeostatic structural plasticity, highlighting the role of inhibitory networks. These findings suggest a novel mechanism for the lasting effects of rTMS, i.e., rTMS-induced homeostatic structural plasticity, and highlight the importance of network inhibition in careful protocol design, standardization, and optimization of stimulation. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
My guest is Jan Ellison Baszucki, founder of MetabolicMind.org. Jan is also a parent, author, mental health advocate and aspiring citizen scientist. Her husband, David Baszucki and Jan Ellison Baszucki launched MetabolicMind.org, an initiative of Baszucki Group, to share information and resources about the emerging field of metabolic psychiatry. Their family experienced the challenges of a mental health crisis firsthand when the eldest of their four children, their son, Matt, was diagnosed with bipolar disorder at age 19. After battling bipolar illness for five years, Matt achieved a full recovery from his condition using a metabolic ketogenic diet therapy. I invited Jan on the podcast to share her personal journey as a parent with a child who was struggling with a serious mental health crisis. She shares her insights and learned know-how with us. Even though her son isn't diagnosed with ADHD, there is so much education, insight and resources packed in this episode to support a parent or expert who is supporting a person with ADHD. In this episode, Jan and I discuss the following: - Jan's personal family story navigating her son who was diagnosed with bipolar 1 - They tried everything from functional medicine, supplements, RTMS, DBT, CBT, sobriety, meds, exercise, mediation, weekly therapy. - Then came trying a Keto Diet - Introduction to Dr. Chris Palmer and his findings - Keto diet helped resolve son's Bi-Polar - Differences in diets- what makes Keto work for improved metabolic & mental health - Georgia Ede's work and her findings - How mood is effected by brain running on glucose vs. ketones - Keto Diet is low carb, keeping track of carbs - What foods are considered carbs? - How does Keto Diet calm the brain? - What healing your gut really means when it comes to eating? - Metabolic Mind's mission - Resources to learn more at metabolicmind.org, Nichole Laurent at mentalhealthketo.com and dietdoctor.com. - Jan's shared wisdom to parents who are raising a child who is struggling with mental health. Brought to you by ADHDKidsCanThrive.com. Thank you for listening and please share! #adhd #adhd parent support #anxiety #depression #keto #metabolicpsychiatry #ketones #ketodiet #bipolar #dysregulation #mentalhealth
https://psychiatry.dev/wp-content/uploads/speaker/post-12061.mp3?cb=1677678412.mp3 Playback speed: 0.8x 1x 1.3x 1.6x 2x Download: Functional Connectivity Mapping for rTMS Target Selection in Depression – Immanuel G Elbau et al. American Journal of Psychiatry. 2023. Repetitive transcranialFull EntryFunctional Connectivity Mapping for rTMS Target Selection in Depression –
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.24.528183v1?rss=1 Authors: Petrov, P. I., Vink, J., Mandija, S., van den Berg, N. A. T., Dijkhuizen, R. M., Neggers, S. F. W. Abstract: The adoption of transcranial magnetic stimulation (TMS) has steadily increased in research as a tool capable to safely and non-invasively stimulate both the central and peripheral nervous systems. Initial clinical applications were limited to diagnostic use of TMS and readout signals such as electromyograms (EMG). Subsequently, repetitive TMS (rTMS) was appreciated for its therapeutics benefits as well. However, even after a decade of use of rTMS as an alternative treatment of major depression disorder in psychiatry, the mechanism of action is still not well understood. Computer models predicting the induced electric field distribution in the brain have been suggested before in the hope to resolve at least some of the uncertainty and resulting variable treatment response associated with the clinical use of TMS. We constructed a finite element model (FEM) of the head using individual volumetric tissue meshes obtained from an MRI scan and a detailed model of a TMS coil that together can predict the current induced in the head of a patient at any given location with any given coil position and orientation. We further designed several potential metrics of how a TMS induced current induced neuronal activation in the motor cortex, and added this to the model. We validated this model with motor evoked potentials (MEPs), EMG responses of the hand muscles after TMS on the motor cortex, in an experiment on 9 healthy subjects. We adopted a tailored MEP mapping protocol for model validation, which unlike traditional grid mappings, varies the TMS machine output intensity between stimulation locations. We further varied coil orientation on each point stimulated to allow exploration of the angular dependency of the model MEPs. Taken together, this approach covers a wide domain and scope of the modeled and measured responses, which are optimally suited for model validation. For each subject the motor hotspot was carefully identified using individual cortical anatomy and BOLD fMRI measurements. Modeled activation in the motor cortex did not show a good correlation to the observed magnitude of the observed MEPs, for none of the neuronal activation metrics adopted. For an activation metric that was asymmetric, taking into account induced current direction with respect to the motor cortex sulcal wall, was marginally better than other metrics. Generally all activation metrics based on induced currents performed better than a control metric agnostic of induced electric field magnitude. Our results suggest that one should take into account components of the injected currents and their relationship to the morphology of the underlying motor cortex, but the coarse metrics we used to model the relationship between induced current and neuronal activation probably did not do justice to the complex neuronal circuitry of the cortical sheet. Furthermore, it seemed MEP magnitudes in our experiment are too variable over subsequent stimulations, which could be mitigated by more repetitions per stimulation location and orientation. Further efforts to construct validated models predicting TMS effects in individual patients brains should incorporate microcircuits interactions in the cortical sheet, in addition to induced electrical field models, and take into account inherent trial to trial variability of MEPs. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.02.06.527256v1?rss=1 Authors: Manassero, E., Concina, G., Caraig, M. C. C., Sarasso, P., Salatino, A., Ricci, R., Sacchetti, B. Abstract: Down-regulating emotional overreactions toward threats is fundamental for developing treatments for anxiety and post-traumatic disorders. The prefrontal cortex (PFC) is critical for top-down modulatory processes, and despite previous studies adopting repetitive Transcranial Magnetic Stimulation (rTMS) over this region provided encouraging results in enhancing extinction, no studies have hitherto explored the effects of stimulating the medial PFC (mPFC) on threat memory and generalization. Here we showed that rTMS applied before threat memory retrieval abolishes implicit reactions to learned and novel stimuli in humans. These effects were not due to inhibition of electrodermal reactivity and enduringly persisted one week later in the absence of rTMS. No effects were detected on explicit recognition. Critically, we observed stronger attenuation of defensive responses in subjects stimulated over the mPFC than the dlPFC. Our findings uncover a prefrontal region whose modulation can permanently hamper implicit reactions to learned dangers, representing an advance to long-term deactivating overreactions to threats. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.01.30.526374v1?rss=1 Authors: Ross, J. M., Cline, C. C., Sarkar, M., Truong, J., Keller, C. J. Abstract: Despite adoption of repetitive TMS (rTMS) for the treatment of neuropsychiatric disorders, a lack of understanding of its neural effects limits our ability to monitor, personalize, and adapt treatments. Here we address the methodological limitations in capturing the neural response to a single TMS train, the fundamental building block of treatment. We developed methods to measure these effects noninvasively and evaluated the acute neural response to single and sequential TMS trains. In 16 healthy adults, we applied 10 Hz trains to the dorsolateral prefrontal cortex (dlPFC) in a randomized, sham-controlled, event-related design and assessed changes to the TMS-evoked potential (TEP), a measure of local cortical excitability. We hypothesized that single TMS trains would induce changes in the local TEP amplitude that would accumulate across trains, but we found no evidence in support of this hypothesis. However, exploratory analyses demonstrated modulations non-locally and in phase and source space. Single and sequential TMS trains may not be sufficient to modulate the local TEP amplitude, but induce acute neural changes measured in alternative ways. This work should be contextualized as methods development for the monitoring of transient neural changes during rTMS and contributes to a growing understanding of the neural effects of rTMS. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.10.28.514217v1?rss=1 Authors: Tomar, M., Rodger, J., Moretti, J. Abstract: Overreliance on habit is linked with disorders such as drug addiction and obsessive-compulsive disorder and there is increasing interest in the use of repetitive transcranial magnetic stimulation (rTMS) to alter neuronal activity in the relevant pathways and reduce relapse or accelerated shift towards habit formation. Here we studied the brains of ephrin-A2A5-/- mice, which previously showed perseverative behaviour in progressive-ratio tasks, associated with low cellular activity in nucleus accumbens. We investigated if rTMS treatment had altered the hierarchical recruitment of brain regions from ventral to dorsal striatum associated with abnormal habit formation in these mice. Brain sections of mice that underwent progressive-ratio tasks with and without LI-rTMS were taken from a previous study. Striatal regions were stained for neuronal activation with c-Fos and for medium spiny neurons with DARPP32. Qualitative analysis was carried out for other neuronal subtypes in the striatum - GABAergic, parvalbumin-expressing and cholinergic interneurons. Contrary to our hypothesis, we found neuronal activity in ephrin-A2A5-/- mice still reflected goal-directed behaviour. However, we saw that the dorsolateral striatum contributed more to total striatal activity in untreated ephrin-A2/A5-/- mice. This supported our hypothesis that ephrin-A2/A5-/- mice have greater c-Fos activity in habit-associated striatal regions. LI-rTMS in ephrin-A2A5-/- mice also appeared to delay the shift from goal-directed to habitual behaviour as suggested by increased activation in dorsomedial striatum and nucleus accumbens. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC
As technology advances, many things are made more manageable, especially in healthcare. Care strategies and delivery become more effective with easier access to health data that's been automatically recorded and reported to the care team. Remote Therapeutic Monitoring (RTM) became accepted by the Center for Medicare Services as of 2022. Thus, Physical Therapists can now bill for apps and "wearables" that monitor patient motion (HEPs) between PT sessions. James Heathers, the Chief Science Officer for Cipher Skin, joins the podcast to explain how RTMs can be utilized to benefit patients and providers during the episodes of care. Tune in to this episode for a more comprehensive discussion with James Heather!Love the show? Subscribe, rate, review, and share! https://ptoclub.com/
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.09.08.507012v1?rss=1 Authors: Duprat, R. J., Linn, K. A., Satterthwaite, T. D., Sheline, Y. I., Liang, X., Bagdon, G., Flounders, M. W., Robinson, H., Platt, M., Kable, J., Long, H., Scully, M., Deluisi, J. A., Thase, M., Cristancho, M., Reber, J., Shinohara, R. T., Oathes, D. Abstract: Depression alleviation following treatment with repetitive transcranial magnetic stimulation (rTMS) tends to be more effective when TMS is targeted to cortical areas with high resting state functional connectivity (rsFC) with the subgenual anterior cingulate cortex (sgACC). However, it has not yet been confirmed that rsFC-guided TMS coil placement leads to TMS modulation of the sgACC. For each participant (N=115, 34 depressed patients), a peak rsFC cortical hotspot for the sgACC and control targets were prospectively identified. Single pulses of TMS interleaved with fMRI readouts were then administered to these targets and established significant downstream fMRI BOLD responses in the sgACC. We then marked an association between TMS-evoked BOLD responses in the sgACC and rsFC between the stimulation site and sgACC. This effect was qualified by a difference between healthy and patient participants: only in depressed patients, positively connected sites of stimulation led to the strongest evoked responses in the sgACC. Our results highlight rsFC-based targeting as a viable strategy to causally modulate sgACC subcortical targets and further suggest that cortical sites with high positive rsFC to the sgACC might represent an alternative target for the treatment of depression. Copy rights belong to original authors. Visit the link for more info Podcast created by PaperPlayer
Subscribe for more: www.nobu.ai/podcastFollow us on Instagram: https://www.instagram.com/nobuappFollow us on Spotify: https://open.spotify.com/show/3NMIEgjblqmhwT6Uy3l0NmSubscribe to Dear Mind You Matter Podcast: https://podcasts.apple.com/us/podcast/dear-mind-you-matter/id1573642046Leave us a review: https://podcasts.apple.com/us/podcast/dear-mind-you-matter/id1573642046Interested in attending our Educational Events? https://bit.ly/eventsandeducation____Dr. Williams is an Assistant Professor within the Department of Psychiatry and Behavioral Sciences and the Director of the Stanford Brain Stimulation Lab. Dr. Williams has a broad background in clinical neuroscience and is triple board-certified in general neurology, general psychiatry, as well as behavioral neurology & neuropsychiatry. In addition, he has specific training and clinical expertise in the development of brain stimulation methodologies under Mark George, MD. Themes of his work include (a) examining the use of spaced learning theory in the application of neurostimulation techniques, (b) development and mechanistic understanding of rapid-acting antidepressants, and (c) identifying objective biomarkers that predict neuromodulation responses in treatment-resistant neuropsychiatric conditions. He has published papers in high impact peer-reviewed journals including Brain, American Journal of Psychiatry, and the Proceedings of the National Academy of Science. Results from his studies have gained widespread attention in journals such as Science and New England Journal of Medicine Journal Watch as well as in the popular press and have been featured in various news sources including Time, Smithsonian, and Newsweek. Dr. Williams received two NARSAD Young Investigator Awards in 2016 and 2018 along with the 2019 Gerald R. Klerman Award. Dr. Williams received the National Institute of Mental Health Biobehavioral Research Award for Innovative New Scientists in 2020.Social Media Handle: NolanRyWilliamsPublications: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20101429Memorable Moments: 4:17 I've been very focused on specifically trying to help develop rapid acting interventions with you know, with a lot of a lot of work in the, in the kind of emergence emerging psychedelic space with some, you know, with with drugs like Ibogaine and ketamine being explored in the lab. And that's, that's part of it. And those studies are definitely important in trying to understand the mechanism of those drugs and trying to understand what we can use those drugs for. Where we've been very focused is using and kind of engineering a rapid acting form of for repetitive transcranial magnetic stimulation.5:47 So we've been very focused on trying to develop rTMS and kind of re-engineer rTMS into an approach that allows for us to treat people over a very short period of time. 7:25 The idea there is this is a way of treating rapidly by rearranging the stimulation in space, and time and dose.13:25 The highest risk of completed suicide is in the period right after psychiatric hospital discharge. [That's] rate of the whole lifetime. So we were very interested in that particular population, because we wanted to be able to treat people in these high emergency settings. 22:42 To me, the problem of really getting TMS in particular out there has been an educational problem.Dear Mind, You Matter is brought to you by NOBU, a new mental health, and wellness app. To download NOBU, visit the app store or Google Play. This podcast is hosted by Allison Walsh and Dr. Angela Phillips. It is produced by Allison Walsh, Savannah Eckstrom, and Nicole LaNeve. For more information or if you're interested in being a guest on this podcast, please visit www.therecoveryvillage.com/dearmindyoumatter.
Have you ever imagined using rTMS for patients who struggle to quit smoking? This episode discusses a double-blind RCT that assessed the efficacy of rTMS in patients with tobacco use disorder who had at least 1 prior failed attempt to quit. Faculty: Jim Phelps, M.D. Host: Jessica Diaz, M.D. Learn more about Premium Membership here Earn 0.5 CMEs: Quick Take Vol. 37 Repetitive Transcranial Magnetic Stimulation for Smoking Cessation: A Pivotal Multicenter Double‐Blind Randomized Controlled Trial
Join James & Kay as Kay ask James questions to kick off Real talk Monday weekend
Depression:The most important thing anyone reading this needs to know is that everyone with depression will get better. The sooner you treat it the quicker and better the results.LIfe time prevalence 4%, in fact in the USA up to 10% struggle with depression.280 million people world-wide suffer from depression.20% risk of suicide in untreated depression.Used to be the 5th commonest cause of illness and death, now it is the commonest.It is not because we have all become genetically susceptible to clinical depression, rather we have become more and more unhappy and stressed with modern life. What has risen is social media with the pressure to be perfect compare and online bullying and economic uncertainty as well as recent lockdown and health hysteria and vaccine mandates and most recently Ukraine War and spiralling energy prices. Mental health referrals are at all time highs.Neuroscience New and Research July 2022 Ruairi J Mackenzie: Serotonin theory has been seen for years as an oversimplification. SSRI medications do often work in depression but depression is multifactorial and likely more than one illness. The Biopsychosocial model of depression is preferred.Even Epicurus 2,500 years ago and before him Buddha both said that seeking of pleasure would cause unhappiness as pleasure is transient and leads to more seeking of it hence is not only meaningless but destructive. Yet as a society that is exactly what we have become: cyclical reflex dopamine seekers especially with social media.Furthermore the teaching of socialisation has been reversed with smart phone hunched pleasure seekers. We are all becoming depressed children with no effective parental supervision apart from the social media CEOs temping us ever further down the rabbit hole of instant gratification..One of the definitions of the most dysfunctional members of our society namely personality disorders is self obsession as this is not tribe compatible yet the rest of us are rapidly heading that way pulling apart the integrity of our society and even civilisation itself if it continues. Close on the heals of self obsession is loss of boundaries and rules aka political correctness which is a Marxist view of demanding the same outcome for everyone despite the fact that everyone is different.Without boundaries we are lost because we have evolved to function in tribes with structure hierarchy and leadership. Now we are led by self serving politicians who will say anything that gets them elected which is what they think the voters want but voters are influenced by mass and social media. Add into that that 98% of what we do and think is emotional and not logical which means that currently we are being led by media driven hysteria which the politicians respond to. Even more dangerous is that media controls the masses on a global scale now almost instantly.Diagnosis of clinical depression:Diagnostic and Statistical Manual 5th Edition Americal Psychiatric Association and International Classification of Diseases 11th Edition 296. And F32 codes respectively:Require are certain number of symptoms for a certain period of time typically 5 symptoms for at least 2 weeks although this can be altered according to severity.Symptoms making up depression include:Low mood typically worse in the morning improving as the day goes on (diurnal mood variation)- said to be due to raised levels of cortisol in depression with the coritsol peak being in the morning and lowest in the middle of the night- I have seen severely depressed people walking around the ward at 2am feeling fine. This is one the reasons metyrapone is used with is a cortisol synthesis inhibitor in a resistant depressionL Ted Dinan et al.Disturbed sleep typically waking early in the morning unable to get back to sleepReduced appetite and weight loss (although people can comfort eat) reduced energy concentration enjoyment motivation confidence libido and suicidal thoughts.Treatment of depression:Firstly there needs to be a risk assessment of suicide . in 2005 1.5% of all deaths were suicide and the commonst cause was depression and it is going up.Investigation:Biological:Thyroid , metabolic, autoimmune, dietary, epileptic , raised indices of inflammation. Females my have hormonal issues including sensitivity to progesterone in oral contraceptives.Psychological:Aristotle argued that virtue is functioning according to you values and beliefs . A blunt knife is not a vrituous knife as knives are designed to cut. A virtuous human being is a human able to function according to their values and beliefs which is socialisation and reproduction. However in todays goal oriented society the pressure is one of endless goal seeking and perfectionism. That alone severely raises stress and cortisol levels but also makes you more unhappy as you not functioning according to your values and beliefs. It also means that if you achieve something at the cost of your values and beliefs you value it less in any case. Hence it is impossible to ever be happy with he result that more and more of us are depressed.Note that chronic sleep deprivation causes clinical depression.Treatment of depression:Classically it is a combination of medication and psychological treatment eg cognitive behaviour therapy.However one third of patients have raised indices of inflammation and those are likely to be resistant to antidepressants and can respond to aspirin.Furthermore for moderate depression regular exercise is as effective as antidepressant.Antidepressants: Currently they all work on a combination of serotonin noradrenaline and dopamine and a couple work additionally on melatonin receptors. None are better than the other although the newer ones have less side effects.The new generation coming through are going to be based on psychedelics and glutamate receptor antagonists . In fact the latter has a drug licensed in the UK for 3rd line treatment of depression s ketamine nasal spray.Treatment resistant depression:Requires a review of diagnosis and physical investigations then switching to a different antidepressant and raising the dose according to plasma levels , combining antidepressants and adding in thyroid hormone, lithium or antipsychotic such as risperidone.-Electro Convulsive Therapy-rTMS daily for 4 weeks.-Neurofeedback can be an alternative to antidepressants.Sleep Deprivation and Depression: National Library of Medicine Jan 2021Why is ECT becoming a preferred treatment for depression March 2022 Maclean Hospital Harvard Medical School AffiliateUsing neurofeedback as a means of reducing self blame in depression: Dr Zahn Kings College News Centre Sept 2021Review of social participation interventions for those with mental health problems Social Psychiatry Psychiatric Epidemiology March 2017 Martin WebberExercise is an all natural treatment to fight depression: Harvard Health Publishing Dr Miller February 2021The relationship between excessive internet use and Depression:Morrison Gore Psychopathology 2010 43: 121-126Treatment Resistant Depression: Web Med: Dr Bruce May 2022Esketamine For Treatment Resistant Depression: BMJ Sept 2019 JauharAn evidence based approach for augmentation and combination strategies for treatment resistant depression Psychiatry July 2006 BarowskiKey differences between Venlafaxine XR and Desvenlafaxine: An analysis of pharmacokinetic and clinical data Michelle D. Colvard, PharmDMental Health Clinician (2014) 4 (1): 35–39. A Popular Theory About Depression Wasn't "Debunked" by a New ReviewPublished: July 22, 2022 | Ruairi J MackenzieA Popular Theory About Depression Wasn't "Debunked" by a New ReviewPublished: July 22, 2022 | Ruairi J MackenzieA Popular Theory About Depression Wasn't "Debunked" by a New ReviewPublished: July 22, 2022 | Ruairi J Mackenzie
My guests are Will Schmitz and Sal Marcello. They are the founders of Real-Time Management Strategies. RTMS was launched in April 2022. It is a program to help men kick the porn habit. We discuss what RTMS is, how it works, who it is for and how you can connect with Will and Sal. RTMS Resources Discord Channel: https://discord.gg/fnGuyNpjQ6 Twitter: https://twitter.com/RTmgmtS Share the podcast with your friends and family. Follow us on Facebook and Instagram. Help us to reach more people by leaving a rating and review on the show on iTunes. Check out the YouTube page . Thank you for your support. God bless! The Regular Catholic Guy
Thank you Thomas Chandy III (Sort of IV) for developing this podcast. Thank you Ryne Peters OMS III and Andrew Collyer OMS III for joining us in the endeavor. This podcast is loaded with helpful information for the shelf with attention to high yield content around treatment of depressioin. Thomas does a great job introducing everybody from the casual listener and beyond to the topic of rTMS. I was particiularly impressed with his should to his parents and to his thoughts about how iTBS may supplant rTMS eventually. We enjoyed our discussion and hope you find it as interesting as we did! Thank you Jordan Turner for creating the perfect bumper music!
Listen to a blog summary of a trending editorial published in Volume 14, Issue 9 of Aging (Aging-US), entitled, "Cognitive training and neuromodulation for Alzheimer treatment." ______________________________________ Many neurodegenerative disorders among elderly populations share common characteristics. In dementias, for example, neurons and glial cells undergo a progressive loss of structure or function in the brain and spinal cord. Alzheimer's disease (AD) is the most common form of dementia and the main cause of cognitive impairment. Studies have confirmed that cognitive treatments, such as cognitive stimulation, training and rehabilitation, can improve brain function by increasing brain plasticity. Recently, researcher Fabrizio Vecchio, from IRCCS San Raffaele Roma‘s Brain Connectivity Laboratory, discussed innovative treatment options for Alzheimer's disease. On April 27, 2022, Dr. Vecchio published his new editorial paper in Volume 14, Issue 9, of Aging (Aging-US), entitled, “Cognitive training and neuromodulation for Alzheimer treatment.” “Neuromodulation techniques are having a growing consensus as a therapeutic approach of incipient and mild to moderate dementia because of their capability to be modulated both in space, i.e. in different cortical and subcortical areas of the brain, and time.” Full blog -https://aging-us.org/2022/05/trending-with-impact-neuromodulation-in-alzheimers-disease-treatment/ DOI - https://doi.org/10.18632/aging.204044 Corresponding author - Fabrizio Vecchio - fabrizio.vecchio@uniecampus.it Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.20404 Keywords - aging, EEG, Small World, cognitive training, rTMS, Alzheimer About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at http://www.Aging-US.com and connect with us: SoundCloud - https://soundcloud.com/Aging-Us Facebook - https://www.facebook.com/AgingUS/ Twitter - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/agingus LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Aging-US is published by Impact Journals, LLC: http://www.ImpactJournals.com Media Contact 18009220957 MEDIA@IMPACTJOURNALS.COM
Members of our Real Estate Disputes Team discuss recent cases of interest to those dealing with residential property, including on service charge demands, statutory consultations and RTMs. We also review some of the significant changes which the government has in mind for residential tenancies, as well as the recent introduction of the Leasehold Reform (Ground Rent) Act 2022. Cases covered include: Aviva Investors Ground Rent GP Limited & Anr v Williams and Ors Kensquare Limited v Boakye Aster Communities v Chapman No. 1 West India Quay (Residential) Limited v East Tower Apartments Limited Wynne v. Yates & Anr. Firstport Property Services Ltd v Settlers Court RTM Company Limited
"Un ejercicio muy práctico para reconfigurar tu mente para que puedas crear un mejor pasado, presente y futuro en este nuevo episodio. Únete a RTM → https://hotm.art/RTMS
Tim Keane, photographer, founder of RTMS, Golden Angels Investors, and Keane Consultants and former board member of First Business Financial Services, Inc., joins us to discuss his career, accomplishments, advice for entrepreneurs, and provide his perspectives about investing, risk, and his next chapter in life. Listen to this episode of the First Business Bank Podcast for a dynamic conversation about facing challenges and finding joy with an entrepreneurship and investing expert.
"Sabes lo que quieres y tienes que hacer, sin embargo, no lo haces. Hoy te voy a compartir una práctica personal que me ha impulsado a crecer y que si te hace sentido puedes tomarla. Estructuras psicológicas y ejercicios prácticos para Recodificar tu Mente aquí→ https://hotm.art/RTMS"
"Necesitas gente que quiera aportar a tus negocios, pero ¿Cómo atraerlos? ¿Cuáles son los puntos que debes mostrar y presentar de tu negocio? Descúbrelo en este nuevo episodio de Recodifica tu Mente. Pasa de la teoría a la práctica aquí → https://hotm.art/RTMS"
Guest: Ayesha Samia Niazi This testimonial is in English by one of the attendees in a training workshop in Lahore in January 2022. And she also received a session. You can visit my website where you can find all the options and information. She spoke about her therapy experience, her rTMS comparison to her Self Healing & Transformation - Reiki Therapy. Who is the founder & Owner of LUWS ACADEMY LLC ? visit: lightupwithshua.com I am a student of knowledge of multiple disciplines, a mentor, and an intercultural & Interfaith practitioner, who wants to help heal and solve problems by bringing awareness to conscious living and conscious parenting to people with flexible mindset. Currently hosting a weekly podcast on LightupwithShua podcast on conscious living and parenting. Additionally, actively conducting Self - Healing & Transformation Training Workshops in Pakistan and soon in the USA. You can connect with me here: Shua@lightupwithshua.com *Remember to LIKE, SHARE, RATE and REVIEW. Thank you. Shua - شعا ع https://linktr.ee/Shuakhan Copyright © 2017-2022 LUWS ACADEMY LLC & LightupwithShua Podcast All Rights Reserved Attribution-NonCommercial-NoDerivs This work is licensed under a Creative Commons Attribution 4.0 International License
Guest: Ayesha Samia Niazi This testimonial is in English by one of the attendees in a training workshop in Lahore in January 2022. She also received a Self Healing Training session. She spoke about her therapy experience, her rTMS comparison to her Self Healing & Transformation - Reiki Therapy. You can visit my website where you can find all the options and information. Who is the founder & Owner of LUWS ACADEMY LLC ? visit: lightupwithshua.com I am a student of knowledge of multiple disciplines, a mentor, and an intercultural & Interfaith practitioner, who wants to help heal and solve problems by bringing awareness to conscious living and conscious parenting to people with flexible mindset. Currently hosting a weekly podcast on LightupwithShua podcast on conscious living and parenting. Additionally, actively conducting Self - Healing & Transformation Training Workshops in Pakistan and soon in the USA. You can connect with me here: Shua@lightupwithshua.com *Remember to LIKE, SHARE, RATE and REVIEW. Thank you. Shua - شعا ع https://linktr.ee/Shuakhan Copyright © 2017-2022 LUWS ACADEMY LLC & LightupwithShua Podcast All Rights Reserved Attribution-NonCommercial-NoDerivs This work is licensed under a Creative Commons Attribution 4.0 International License
SUMMARY In Part 2 of this podcast on Schizophrenia, we're joined again by Katrina Tinman (peer support worker with lived experience of schizophrenia), Chris Summerville (CEO of the Canadian Schizophrenia Society), and Dr. Phil Tibbo (clinical/research psychiatrist who specializes in psychosis-related illnesses). They dig deep into emerging holistic recovery approaches that integrate biological, psychological, social, vocational, and spiritual supports. They also explore stigma, impacts of COVID-19, needed changes to public policy and the mental healthcare system, and the world of schizophrenia 20-30 years from now. TAKEAWAYS This Part 2 podcast will help you understand: Emerging diagnostic practices and medications Integrated healing that incorporates biological, psychological, social, vocational, and spiritual recovery supports Benefits of meditation/mindfulness and positive lifestyle choices Benefits of creative therapies that use art, music, drama, and writing Advances in personalized/precision medicine Advances in technology and the Internet to support recovery Effects of COVID-19 Stigma's impact on recovery Challenges for families of people with schizophrenia What medical professionals need to know about schizophrenia What public policy changes would support recovery Why changes should be made to the mental healthcare system What the world of schizophrenia could look like in the future SPONSORS RESOURCES RECOVERY: Research Into Recovery Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care A National Framework for Recovery in Mental Health Recovery-oriented Practice − An Implementation Toolkit PEER SUPPORT: Peer Support The Future is Peer Support Using Peer Support in Developing Empowering Mental Health Services MENTAL HEALTH STIGMA: Fighting Stigma and Discrimination Is Fighting for Mental Health Stigma and Discrimination Addressing Stigma Five Ways to End Mental Health Stigma SCHIZOPHRENIA: Hope and Recovery Schizophrenia Treatment and Self-help GUESTS Katrina Tinman Katrina Tinman is a peer support worker for Peer Connections Manitoba, formerly the Manitoba Schizophrenia Society, and is located at the Mental Health Crisis Response Centre in Winnipeg, Manitoba. Katrina is currently working toward formal peer support worker certification with Peer Support Canada, though she already has peer support certification through the Ontario Peer Development Initiative. Katrina received a university education in journalism and political science in 1998, from North Dakota State University in Fargo, North Dakota. Since then, she's had a wide range of life experiences from working in the professional arena, extensive travel, motorcycle riding, alpine skiing, and SCUBA diving, to homelessness and mental illness. Regardless of some negative life experiences, Katrina's greatest achievement was a sense of fearlessness that carried her through along with hope for the future. Now she's able, through her peer support work, to use her life's insights to help others in their recovery from crisis and mental illness. Email: k.tinman@peerconnectionsmb.ca Website: www.peerconnectionsmb.ca Facebook: www.facebook.com/katrina.tinman.5 Twitter: https://twitter.com/tinman_katrina Linkedin: www.linkedin.com/in/katrinatinman Chris Summerville, BA, MDiv, M.Miss, D.Min, LLD (Honorary) Chris Summerville is from a family with mental health challenges (father and brother with bi-polar disorder, a brother with schizophrenia, siblings living with depression, and two suicides). He has also received mental health care himself, which has informed and inspired his work as CEO of the Schizophrenia Society of Canada since 2007. Chris has been involved with the schizophrenia-recovery movement for nearly 30 years, having served on the boards of the Mental Health Commission of Canada, Mood Disorders Society of Canada, National Network for Mental Health, and Psychosocial Rehabilitation Canada. Chris earned a doctorate from Dallas Theological Seminary, is a certified psychosocial rehabilitation recovery practitioner (CPRRP), and received an honorary Doctor of Laws from Brandon University in 2014. He is a regional, provincial, and national leader and advocate for a transformed, person-centered, recovery-oriented mental healthcare system, and believes mental health concerns should be addressed using integrated bio-psycho-social-spiritual-vocational approaches. Email: Chris@schizophrenia.ca Website: www.schizophrenia.ca Facebook: https://www.facebook.com/SchizophreniaSocietyCanada Twitter: https://twitter.com/SchizophreniaCa LinkedIn: https://www.linkedin.com/company/schizophrenia-society-of-canada Phil Tibbo, MD, FRCPC Phil Tibbo was named the first Dr. Paul Janssen Chair in Psychotic Disorders, an endowed research chair, at Dalhousie University in Halifax, Nova Scotia, Canada. He is a professor in the Department of Psychiatry with a cross-appointment in psychology at Dalhousie University, and an adjunct professor in the Department of Psychiatry at the University of Alberta. He is also director of the Nova Scotia Early Psychosis Program (NSEPP) and co-director of the Nova Scotia Psychosis Research Unit (NSPRU). Dr. Tibbo is funded by local and national peer reviewed funding agencies and well published in leading journals. His publications are primarily around schizophrenia, and his current foci of study include individuals at the early phase of, and individuals at risk for, a psychotic illness. Dr. Tibbo's areas of research include application of in vivo brain neuroimaging techniques, to study psychosis as well as research interests in co-morbidities in schizophrenia, psychosis genetics, addictions and psychosis, stigma and burden, pathways to care, education, and non-pharmacological treatment options. Dr. Tibbo is president of the Canadian Consortium for Early Intervention in Psychosis (CCEIP), helping to advance early intervention care at the national level. He is a recipient (2015) of the Michael Smith Award from the Schizophrenia Society of Canada for research and leadership in schizophrenia, recipient of the Canadian Alliance on Mental Illness and Mental Health's Champion of Mental Health Research/Clinician award in 2017 and, most recently, recipient of the 2018 Regional Prix d'excellence – Specialist of the Year – Region 5 by the Royal College of Physicians and Surgeons of Canada. Email: phil.tibbo@nshealth.ca LinkedIn: https://www.linkedin.com/in/phil-tibbo-62170b18/ HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797 PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter. HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Katrina Tinman, Chris Summerville, Phil Tibbo Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK 0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO 0:32 Hey, Jo here. Thanks for joining me again with my three incredible guests as we continue our conversation about schizophrenia, this time focusing on integrated recovery support, emerging science, and advancing technology. We'll also touch on the stigma faced by people with the illness, and gaps in the current mental health care system. But before we dig back in, a big shout out to our amazing sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafe BC, and AECOM Engineering Canada. We celebrate them as their continued support is fueling our passion for improving mental health literacy. Again, my three guests are Katrina Tinman, a peer support worker with Peer Connections Manitoba, Chris Summerville, Executive Director of the Schizophrenia Society of Canada, and Dr. Phil Tibbo, a Canadian psychiatrist who studies, treats, and advocates for people with psychosis and schizophrenia. In Part 1 of this podcast, we heard personal stories and learned about signs of the illness, myths, and recovery movements. Dr. Phil Tibbo also talked about past diagnostic practices. To start this episode, we'll connect with Phil again about diagnostic practices today, and what research is telling us about them. PHIL 2:06 It's a big area of research. And I think I mentioned earlier, we're still not at a point where we can do a blood test similar to other medical illnesses, and from that result in a diagnosis. So there's still a lot of work going on here, and especially at early phases of illness as well. And so a lot of the research is looking at multimodal or multifaceted approaches to diagnosis, that can include not only from interview and behavioral, looking at symptoms, but as well as what we call the biological markers, biological indices, which can be some of the neuroimaging research. Some very exciting work going on even EEG type of research within brainwaves, but as well as in genetics too. The one difficulty with schizophrenia, and again, different from some other medical illnesses where it's a single gene, and something wrong with that gene causes a medical illness. We know that's not the case for psychosis and schizophrenia. And often what it's called is an illness with multiple genes of small effect. Research is active in here, but really that focus is to really help us to identify early. But it'll probably be, like I say, multifaceted or a multimodal sort of approach to diagnosis. I wish I can kind of drop in in 20 30 years time and see what the approach is going to be. I think we're going to see a difference from how we're approaching things now to what it will be in the future, which is of course, the way that it should be. I mean, we're doing things differently than what we were doing 20 30 years ago as well. JO 3:38 Let's now hone in on current treatment strategies that focus on integrating biological, psychological, social, and vocational support, as well as psychosocial rehabilitation. And we're gonna break that down, so don't worry about all those big terms. Starting with biological support, Phil from what I understand, biological or brain-related effects are still best treated with anti-psychotic medications, which ideally, are only one part of an overall treatment plan. Is that what you're seeing? PHIL 4:17 Yes, you still have to consider that schizophrenia is a brain illness which needs to be treated, and medication can be a cornerstone of that treatment. But as a result of the illness, there are other things that may be needed when we were looking at other non-biological therapies. Definitely have psychotic medications are a cornerstone. Now that said, the amount of medication or the length that somebody is on a medication really depends on the individual and really what their needs are as well. Because I have individuals that I see that may need medications for actually a fairly short period of time, and they've been doing well with no medications at this point. It really is kind of individual, but yet yes from biological standpoint, the anti-psychotic medications are a cornerstone treatment. JO 5:04 Kat and Chris, in your personal experience and as shared by your peers, what are the pros and cons of anti-psychotic medication? And are people's responses changing over time as the medications change? KATRINA 5:21 It gets to symptoms versus side effects. As I went through the process of finding what medication would work, it was a journey that lasted about 10 years. And I'd ran the gamut of, well, three I can remember Lexapro, Risperdal, and Zyprexa. But nothing really fit. Remember the description of the spectrum, and trying to find where things fit. And for me, it wasn't until 2013 when I ended up fortunate enough to have a doctor to work with me at length, to find the right medication that would actually be the best fit for me, in communication with me. And it turned out it was one of those that hadn't even been invented until right around that timeframe. Abilify turned out to be the right one for me. CHRIS 6:15 Well, certainly, antipsychotics and antidepressants can address the symptoms of psychosis and mood disorders and minimize them. But as one of our former chiefs of psychiatry here in Manitoba said, "If only the medications did everything that we hoped that they would do." Unfortunately, as Katrina stated, there can be significant side effects. And there are many side effects that we don't have time to go into. But the two that I would mention most pronounced are cardiovascular illnesses and metabolic illnesses. And that's one reason why many people don't want to take the medications or discontinue after a while, because of that fear. JO 6:57 Phil, what advances are being made to make these medications more accessible and effective with fewer side effects? PHIL 7:05 There's a lot of research and development going into newer medications. And I think we always have to be careful in our discussion around this. Because while there may be cardiovascular, may be metabolic side effects, it's not a given. Significant number of individuals that I see that do not have any side effects with their medications. That's with our open and honest discussions. But we have to be mindful of when that can occur, and just be able to catch it early. I know we'll talk about stigma, but there is a stigma about medication that has resulted and it's probably from the older medication. The research and development these days, the focus is on developing an effective medication with little to no side effects. With a better understanding of the illness, with better understanding of brain receptors, there's more targeted, more focused research on the development of these types of medications. I have to agree that there was a period of time where there's a lot of sort of what I call 'me to' medications being developed, very similar to ones that are already out there. But what we're seeing now is just that more focused, more targeted development. JO 8:14 Phil, what about options for people who might forget to take their medications, or choose not to take them for whatever reason? PHIL 8:21 We've had, I'll use the term LAI's, long-acting injectable medication. We've had them for a while. But for similar reasons Katrina and Chris mentioned, you know, they've kind of fell out of favor because of their side effect profile. But recent developments have allowed us to have newer medications in that particular format with much fewer side effects. People can just be on a once-a-month injection medication, or once every three months. And there's product and development for other medications for once every two months. I have this conversation with individuals that I see. It allows them to focus on their recovery, because they don't have to remember to take their medication. And I think that's an important piece. What some of young adults tell me is that they have to take a pill every day that just reminds them that they have an illness. But if they just need to come into the clinic once a month, or every three months for an injection, that helps them focus on their recovery as well. JO 9:18 And Phil, while doing research for this episode, I came across information about using cannabis to treat psychosis. Is that legitimate? PHIL 9:27 No. First of all, a couple of points around that. When we talk about cannabis, keep in mind if we're talking about just overall cannabis plant, there's over 100 active compounds within that. The two most common compounds people hear about, of course, are THC and CBD. And we know that THC is actually more of the risk factor with respect to psychosis development, and poor outcomes after the development of psychosis. There have been some studies trying to look at CBD, cannabidiol, and its potential role within a psychosis, but honestly, there's not a lot. And we just recently published a position statement for the Canadian Psychiatric Association as well as a systematic review and meta-analysis, examining this literature and looking at randomized, controlled trials of different cannabis or cannabinoid products. There's actually only six studies in schizophrenia where they've looked at cannabinoid products, really not much effect. I'm not being negative about it. But just highlighting that we do need a lot more research into this area. And we have to be very clear on what sort of cannabinoid product that we're talking about. JO 10:39 Let's talk about another piece of the recovery puzzle, which is psychological support. Psychological or mental and emotional effects associated with schizophrenia can include depression, anxiety, substance-use, suicidal ideation, and others. These often respond well to treatments such as cognitive behavior therapy, and other emerging approaches such as reality therapy and cognitive remediation. Phil, how do these work? And how can they be integrated with biological solutions? PHIL 11:16 Well first of all, our approach is integrated. We look at, say, medication plus as well as the psychotherapy and psychosocial treatments as well. Having more tools in our toolkit to be able to address the illness. We will have some people who will definitely benefit from cognitive behavioral therapy for psychosis. And that really allows an individual to learn how to adapt, and respond, and develop strategies to work with their symptoms, for example, so that an individual is not as stressed by their symptoms or able to manage them so that they can do what they want to do, basically, in their day-to-day lives. There's a number of different strategies and therapies along these lines. Some are more similar to each other than not. We have a sort of service and commitment therapy as well, ACT, plus as you mentioned, CBT. But they're really there to help augment that individual's experience with their symptoms, or for example, with comorbid symptoms as well, such as depression and anxiety. JO 12:17 So Chris and Kat, are your peers ever hesitant to add these therapies to their recovery plans? KATRINA 12:25 I know I wasn't. In talking with peers, we usually do touch on some of these possibilities. And there's usually enthusiasm at the idea. Oh yeah, I heard of that, or along those lines where they are willing to engage. CHRIS 12:43 I don't think there would be a hesitancy in general, if people were aware of what their various therapies are. There are many what I call, talk therapies that we can utilize today. Some have been mentioned, cognitive remediation, cognitive behavioral therapy, dialectical behavioral therapy, and acceptance commitment therapy, and family therapy. People in general, I think, have a fear of going into therapy because someone's going to try to fix me, and I have to expose them to, and I have to reveal all of my problematic thinking or what have you. So, I think the goal of these therapies have to be clearer for the patient or the client, and that is helping one to manage difficulty in the area of cognition and their thinking, helping them in their executive skills, helping them to improve their communication skills and relationships. So, the therapy has to be explained to people that it will be more than a supplement to the medication, where the medication is not able to address certain issues. Talk therapies have been demonstrated to promote the recovery process. JO 13:47 What are the biggest barriers to people not receiving the psychological support they need? CHRIS 13:53 Well number one, here in Canada, psychological support services are not covered by our health care system unless you're a patient in the hospital. But once you're out in the community, you have to shell it out of your own pocket, and most people can't afford psychological support therapies. And also, the lack of awareness about the role that trauma can play in psychosis and recovery. A lot of people don't know about that. And many service providers may not actually be trained in trauma informed care, due to the lack of trauma informed services. So all those things that I've just mentioned, can be great barriers to people receiving the appropriate psychological supports that they need. PHIL 14:32 I'll have to step in and agree with that. Access and availability is a big thing. The other thing to consider as a barrier. Families talk to me about this kind of at the beginning, when is psychotherapy going to start? And sometimes the barrier, of course, is the illness itself and that person to be able to engage and work within some of these therapies, they have to get to a certain cognitive level to be able to do that. And that's where sometimes we have to wait a little bit of time until we get some better control on some of those symptoms, so that people are then able to engage in some of the psychosocial and talk therapies that would be helpful. JO 15:08 What about creative therapies that use art, music, drama, and writing? KATRINA 15:14 Those, speaking from a person of lived experience and pure perspective, can be very, very useful for meditations and journaling, because really it helps somebody walk through and process thoughts, feelings, and experiences. And I personally think that can be very valuable, as it's really helped me in many ways. PHIL 15:40 I'd have to agree. We've been researching areas of this as well, and we published on this too in a number of different formats and looking at mindfulness-based support groups for families looking at self compassion, and mindfulness, in relation to depression and anxiety. And interestingly too, we've even published on claymation art therapy in our youth and young adult population and the benefits of that. One person may do well with claymation art therapy, and another person not interested at all. So, it helps to be able to investigate and to know that these types of therapies and creative therapies can be helpful. JO 16:14 In your stories and insights, I'm hearing that social support is also vital for people recovering from schizophrenia, this being available through peer support, self-help programs, and family education and support. Chris, what are the biggest barriers to people receiving the social support they need? CHRIS 16:35 Society in general and the media as well, they tend to think that it's just all about medication. You wouldn't believe how many times I've been asked this question through the over 1500 media interviews that I've done, in which I will be asked, "well, how do we make sure these people stay on their medication?" As if medication was the cure all? Again, education is needed that, quote, the treatment of mental illness, and particularly schizophrenia that we're talking about today, is very holistic, so a holistic approach. And that means, what do we do to help people when they're in the community, back at home, back in the community? What kinds of social supports do they need? Whether it's peer support, support groups, whether it's accommodations in pursuing education, accommodation and getting a job, adequate housing, decent income, all those factors. As a society, I think we get it with most other illnesses. These kinds of questions didn't come up when my wife was experiencing breast cancer. There was pure support, there was family engagement, there was family education. There was not just attempts but helping her to connect with various community agencies. One of the things that perhaps gets in the way, which we'll talk about later, is that this profound stigma and prejudice towards people who have a mental illness that live in our community, that affects our policies, that affects our funding. It's a great misconception out there that to address mental illnesses is just a matter of the medical. But as we've listened to Dr. Tibbo and Katrina, they've articulated well that psychological, social, the communal aspects involved in recovery are equally important. JO 18:35 Kat, can you share a story of how important social support is? KATRINA 18:40 The way I'll share it is actually to state that sometimes we hear feedback as peer support workers from our peers, as we're going through the process and discussing with them where they're at and where they're going, and what they're working on, and what they're trying to accomplish. And one of my peers sent back the message, for instance, that I made them feel comfortable, and that I connected with her, that I was nurturing, and calming, and helped that peer make their own decisions that were right for them. And that's, I think, an important piece, that connection to the recovery process and that non-aloneness. And I think that is something that peer support is demonstrating. What we're doing right now at the Mental Health Crisis Response Center is a pilot program. The feedback that we're getting is huge, phenomenal to positive that, yes, this is worth it. JO 19:41 I know you're researching the effectiveness of non-pharmaceutical treatment options like therapy and peer support. What have you learned so far? PHIL 19:52 Well, I think the high-level approach to this question is really important. And that we need to continue with our research in looking at non-pharmaceutical options, and the different types of therapy and peer support. Specifically finding out what we can use, what has the best effect, will be important for the population that we work with as well. We have researched peer support and we have found, yes definitely, it is needed and people, as Katrina mentioned, do benefit from it in many varieties of ways. JO 20:21 Chris as a recovery practitioner, you're very familiar with psychosocial rehabilitation, which I've learned among other things, includes case management, advocacy, structured living residences, and rehab centers, for example. Tell us more about that. And what are the biggest barriers to people receiving the rehabilitation they do need? CHRIS 20:46 We have here in Canada, what's called Psychosocial Rehabilitation Canada, an organization that promotes psychosocial rehabilitation of all mental health service providers. So it's not just limited, let's say, to social workers or mental health workers. So let me just define it. First of all, psychosocial rehabilitation, also sometimes called psychiatric rehabilitation, it promotes personal recovery, successful community integration, the satisfactory quality of life for persons who have a mental health problem or mental illness. Psychosocial rehabilitation services and supports, they're what we call collaborative, person directed, individualized, and we believe they're essential element of human service prospective. And so the goal of psychiatric rehabilitation, or psychosocial rehabilitation is focused on helping individuals develop skills, and access the resources needed to increase their capacity to be successful and satisfied, in what we would call living, working, learning, and social environments of their choice. And so you need a wide continuum of services and supports. The approaches, they are evidence based. And they are promising practices in key life domains of, let's say, employment, education, leisure, wellness, and basic living skills. And family involvement, family peer support, individual peer support are very important aspects of psychosocial rehabilitation. JO 22:18 Chris, what needs to be in place for this to happen? CHRIS 22:22 Truly integrated comprehensive mental health services in which the various sectors are endorsing and creating relationships with each other. So whether that's psychiatrists, social worker, a mental health worker, spiritual health care director. The team of support around the patient, they're not in competition with each other. They are to be working as a team when they have their meetings, and hopefully, with the patient there, listening to the patient. Again, that's that question. What do you feel would help you? What do you feel you need at this point? And as well as offering, what I want to say as wisdom through listening, offering a wisdom back to the patient in helping them to find the various supports and services in and outside of the hospital, that can promote the recovery experience. JO 23:15 Let's expand upon that and look at vocational rehabilitation, and or training that prepares people with schizophrenia for work that best meets their individual wants and needs. Chris, can you tell us more about that? CHRIS 23:31 So let me just tell you a story to illustrate this point about vocational training. This individual's true-life story who had schizophrenia and he had gone through four mental health workers. Well, what happened with the fourth mental health worker? Began to listen to the individual because he was always very persistent with his mental health workers, that he wanted to be an astronaut. They would just dismiss that, "There's no way you can do that, because you have schizophrenia." Well, the fourth mental health worker began to listen to him and ask him, let's just assume that his name is Joe, and said, "Joe, why would you like to be an astronaut?" And he had seen the first moon landing and other things, and he was very enchanted that he wanted to be an astronaut. So, she asked him then in the course of not just in one conversation, but as they developed their relationship. "Well Joe, what do you think would help you to be able to reach that goal?" And they talked about that, and perhaps hygiene could be a problem. Of course, they began to focus on education. "And so what school do you think there might be, and where would you like to go to school to learn more about this?" And so she encouraged him. "Well, why don't you try for one course?" And he took the course and guess what happened? He failed. But that's not the end of the story. She continued to encourage him about other options, and again, a true-life story. He eventually found work and began to work in a space aeronautics museum, welcoming guests and introducing them to the museum. So did he fulfill his goal and his dream? Yes, but it had to be adjusted. But she didn't give up hope on him in terms of his vocational desire. JO 25:06 What a great story. In my research, I continually came upon the term personalized medicine. Phil, what is personalized medicine? And how could it revolutionize diagnosis and treatment strategies for schizophrenia? PHIL 25:24 Personalized medicine, and sometimes people refer to it as precision medicine as well. So sometimes you hear those terms interchangeably. And really what it is, is the tailoring of the medical treatment to the individual, to the individual characteristics of each patient. It does rely on research, it does rely on an understanding of a person's own unique, molecular, and genetic profile as well, and how that can influence treatment. If you think about a personalized medicine, it is really what's going to be appropriate, what's going to work for you specifically based on who you are, both biologically and otherwise. And really, this sort of came out of the advent of trying to figure out from a genetic perspective, how can we use an individual's unique genetic makeup to guide treatment decision? We're not quite there yet, in that respect, but it allowed us to be able to step back, though, and still think about, okay, what is appropriate for this person that's sitting in front of me. And I think that's a little bit more of a holistic approach to our treatment, and that is truly personalized. Now, if we get to that stage where we can do a cheek swab, get a genetic makeup, and then say, okay, this particular treatment, either medication or otherwise, this is specific to you and will work the best. Obviously, that's a great outcome. Are we there yet? No. But research is going in that direction. JO 26:46 One topic I didn't come across in my research is the role of lifestyle choices in recovery. Healthy habits, like getting enough sleep, eating well, and exercising regularly. Kat, how important have lifestyle choices been in your recovery? And do you teach life skills as part of your work with peers? KATRINA 27:09 Lifestyle choices are very important in my recovery. It's something I pay very close attention to. As far as teaching life skills, we do workshops that do some form of teaching, but teaching as an agenda. It's more of an exploration type discussion. JO 27:30 Phil, what do you see in your research and hear from your patients about the importance of lifestyle choices? PHIL 27:36 Research obviously has shown that it's very important, these lifestyle choices. What are lifestyle choices? These could be anything from smoking, cannabis use, to sedentary lifestyle, activity, diet, a number of different choices. We know that individually each of those, and accumulatively each of those can have an effect on outcomes. And the research is pretty solid with respect to that. And so a lot of our focus, so once we get to some of the early sort of phases is, okay really, how can we improve lifestyle, what kind of healthy choices we can help people with lived experience make. We do things, we have a project where we got some funding currently from our Mental Health Foundation, where we're trying to target our rural population. So we got Fitbits. So that allows us to measure and monitor some things along the lines of sleep and steps and exercise. But to be able to send that to their clinicians and to be able to have those discussions, that's sort of great talking points about lifestyle. CHRIS 28:36 Let me combine that question about lifestyle choices and the previous one about personal medicine. Personal medicine, in terms of consumer movement or people who live with mental illnesses, it was really first introduced in early 2003 as a result of qualitative research conducted by Dr. Patricia Deegan. Now, Patricia Deegan is a psychologist, PhD, has lived experience of schizophrenia and experience of recovery. And so personal medicine along with what Dr. Tibbo said, is also about what we do that's medicinal for us in managing, let's say, my depression. What are those lifestyle choices that I know helped me in terms of managing all the stress associated with living with a mental illness? And stress can lead to relapse, we know. So it's not necessarily something prescribed by a doctor or nurse. It comes from within, and it's finding that right balance of what to do and what we take in our pathway to recovery. So that can be mindfulness, can be spirituality, it can be running and exercise. Those things that you know help you to manage your illness in terms of stress management, increasing your resiliency, and your mental health as well, because people with a mental illness can have positive mental health. We know that. And so that word as Patricia Deegan has written about it, personalized medicine has to do with those things that we know that are uniquely medicinal for us, and helping us move forward in our recovery. JO 30:16 Thanks Chris, great comments. Phil, is there any science to support the role of practices such as meditation in recovery? PHIL 30:26 Yes, there is research on this. It's not necessarily for everyone. But for people who can do mindfulness-based practices and meditation, it definitely has been shown to be quite helpful in a number of different ways. I don't say for individuals with lived experience, but we published actually on mindfulness-based techniques for family members, and definitely see the benefits within that group as well. JO 30:50 Advancing technology is another thing I'm hearing a lot about for diagnostic and treatment purposes. Phil, from your perspective and in your practice, can you bring us up to speed on that? PHIL 31:02 Our advances of technology, we're trying to utilize those as best as we can, as quickly as we can as well. And also moving from research to clinical applications, of course, is really quite important. Kind of alluded to this a little bit earlier. We have had advances in the various brain imaging techniques to help us with diagnosis. And there's a lot of different types of brain imaging techniques that are focused either on brain structure, but as well as brain function, and of course, the different parts of the brain, white matter and gray matter. And then other types of diagnostic technologies are there, treatments as well, such as rTMS. There's a lot of this that's happening. And I don't want to minimize that there's a lot of research that have gone into the development and use of smartphone apps as well, and their utility within helping people move forward with their lives and on their treatment to recovery goals. JO 31:56 Chris, what about that technology for social support services? CHRIS 32:01 Well, there are two things that COVID has surfaced for us. Number one has placed mental health definitely on the radar. Ninety-eight percent of Canadians are more concerned about the impact of mental health. Secondly, the use of virtual technology, and that will not go away after the pandemic. In fact, about a year and a half ago, I had my first FaceTime experience with my GP. I never thought that would happen. So use of Zoom and other technology to offer peer support individually, to offer support groups. Many of the schizophrenia societies across Canada are doing education with family members through virtual technology. So that's not going to go away after the pandemic. It is all in a state of development. I think Dr. Tibbo, when he and I've had discussions on this, we have to look at safety, confidentiality issues, privacy, and having good standards. And then, are the various apps that have been developed and ought to be developed, are they evidence based and effective? So I'm excited about where virtual technology can lead us, especially for people who live outside of urban areas. But the great challenge is that many people with mental illnesses, especially if they're on income security, they don't have access to internet, they can't afford a laptop or an iPhone. JO 33:24 Kat, how willing are your peers to take advantage of advancing technologies? KATRINA 33:30 It's hard to conjecture, because every peer is different. As Chris pointed out, even the ability of some might be limited. But from what I'm hearing as we compare notes, peers and I, now hey I have that app, this app that works really good for me. It comes up. So I think, for the most part, it's very favorable in that direction. JO 33:53 Chris mentioned COVID-19, and just a very quick question. Phil, how has COVID affected your patients with schizophrenia? PHIL 34:03 Keep in mind that for my particular patients that I see, it's mainly youth and young adults, and actually the resilience there is really quite high. And the adaptation to virtual technologies, such as Zoom and having meetings along those lines, they're actually fairly quick to adapt to. However, what is also interesting is that a lot of the youth and young adults that I see actually didn't want to have their meetings via Zoom. They'd rather be in person. So we've tried our best to work with that. We obviously want to make sure that nobody is going to have relapse or have any ill effects because of COVID. I think we did a pretty good job of pivoting and shifting service delivery and care to accommodate that. COVID-19 overall in the general population, there's a lot of research that has gone into that and we have seen an increase in, for example, substance use in this population. We've also studied acute care admissions to the inpatient units, and I've seen a shift during the height of COVID in states of emergency declarations, where the substances have played a role, a more significant role in admissions than they did before, as well as in a little bit older age group than what we would normally see in a non-COVID year. JO 35:15 Chris, what are you seeing with your peers and their families as a result of COVID? CHRIS 35:22 Each of my workdays, two to three hours now, have been devoted to taking phone calls and answering emails since the pandemic began, by individuals and family members who are looking for additional help. There is evidence that people with schizophrenia are more likely to develop the illness resulting from COVID-19, as opposed to the general population. I think fundamentally, what some recent reports have indicated is that it's become somewhat harder for people with pre-existing mental illnesses to consistently get not only psychiatric care, but also primary health care. JO 36:02 Kat has the pandemic been difficult for you? KATRINA 36:07 It's been challenging in ways for myself and for my peers. For instance, some describe that it slammed them when they were in healthy spaces. It actually slammed them right back into illness because it looked the same. Now, we were isolating, so they were isolated, again, or still. And that just took them back into it. Just as one example alone. For me, I have to admit riding buses to commute to and from work is a challenge because of what I see. And it causes me a little stress. The people that pull their masks down on the bus when they're supposed to have it up, and stuff like that. But for the most part, I think it's, we're just all hanging in there. JO 36:57 Before moving on to talk about stigma, I'd like to thank our major sponsors again, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering Canada. As a registered charity, we rely on support from sponsorships, grants, and donations. If you'd like to support our HEADS UP programming, please visit freshoutlookfoundation.org/donations. As I say on every podcast, you can't have a conversation about mental health, without talking about stigma. Phil, how does stigma affect people you've researched and treated biologically and psychologically? PHIL 37:40 Stigma can be a huge part of the illness. There are a number of elements to stigma as well. And I'm sure Chris and Katrina will elaborate on these as well, and some we've already alluded to as well within our discussion. Because stigma can affect people's entry into care. And that because of the stigma around the illness, or stigma actually even towards mental health, either themselves or even within their family members as well, can actually affect their pathways to care. And we've done some research on that and have been able to show that. And then when somebody is in care too, and we do have to work with what we sometimes call self stigma, people's perceptions and ideas of what a diagnosis of schizophrenia means and what it can mean. And so there's those elements as well. And of course, we're trying to be the best advocates that we can for patients and our families. And that's where we try to work with the stigma in other areas around society towards the illness, towards mental health, of course, in general. Being those advocates and supports towards vocational or educational pursuits as well. We've definitely gotten a lot better with respect to that over the last number of years, but there still exists some of that stigma out there. JO 38:54 Kat, how would you describe stigma from the perspective of a person with schizophrenia? KATRINA 38:59 I would describe it as a belittlement. And a discreditation is a way of writing somebody off to make them not count. It's even, now how many times do you see it on TV used in a court of law, theoretically, to discredit somebody so much that that witness doesn't even count. It's a write off, and that's not fair. JO 39:21 Chris, what about the impacts of social and vocational stigma on the people you're advocating for? CHRIS 39:28 Well, first of all, we need to understand that all stigmas are built on the same formula. And that is misconceptions and myths, plus lack of education multiplied by fear, results in prejudice, and none of us are immune from prejudice. We all as a human experience. And what we need to do is to be able to look at our attitudes, confront them, and be willing to grow up, to change. Because there is societal stigma, and then when an individual with a mental illness internalizes society's stigma, we call that self stigma. So they think, well, I must have a broken brain and I'm not deserving. And then there's structural stigma in terms of laws, and policies, and practices that result in unfair treatment of people with a mental illness. Now, what does it all result in? It's not just about hurt feelings. Stigma results in a reluctance to seek out treatment. It delays treatment, it increases morbidity and mortality, it results in social rejection, avoidance, and isolation. It results in worse psychological well-being for individuals living with a mental illness. There's poor understanding amongst friends and families. Stigma can lead to harassment, violence, and bullying, poor quality of life, increased socio-economic burden. That's above and beyond the shame and the self doubt that the individual may face. That is perhaps our greatest enemy in promoting comprehensive mental health services and recovery oriented mental health services. That's why we have to advocate as Martin Luther King did, as other leaders and various other movements did, to claim our voice and to identify injustices where they are, and what impedes our being able to see people with mental illnesses as our brothers and sisters, our neighbor, and the fact that we should love one another as we love ourselves. JO 41:33 Kat, you and Chris have both experienced the mental health care system. Just wondering what you've seen, as far as stigma goes within that system. CHRIS 41:43 Well, the Mental Health Commission did a study a number of years ago amongst mental health service providers, and it found that stigma is alive and well within our mental health system, and those who provide psychiatric supports and services. So that might be surprising to people. None of us are immune to stigma, it has to be addressed. And whether you're a doctor, a psychiatrist, a police officer, a correctional guard in one of our prisons, people have to receive supportive education, which helps them to identify their attitudes, which leads to actions of discrimination, or improper behavior, or working with clients, patients, prisoners, etc. So this is a huge issue. JO 42:36 So we're on the homestretch. Now, given what you've learned over the years, what would you say to give hope to people who are early in their recovery journeys? CHRIS 42:48 What I would say is, I want you to meet Katrina. Katrina has lived experience of psychosis. But she also has found ways to move forward and live beyond the limitations of mental illness. She's a peer support worker. And so Katrina, through her lived experience, she will listen. And she will give you realistic hope. Because the hope for recovery is possible. I know this is a difficult time for you right now. And the next couple of years, it may seem like you're not coming out of this deep, dark hole. So what I'm saying here is that I think introducing patients to a peer support worker as soon as possible, can help with the depression and the forlornness that a person may be experiencing by receiving a diagnosis of psychosis or schizophrenia. We need to be realistic, but also, we need to communicate hope that things can get better. And the person who can communicate that the best is a peer support worker who's been down that road and knows what helps and hinders recovery. JO 43:53 Kat, what have you learned about hope? KATRINA 43:56 I've learned that it is the most wondrous and beautiful thing in existence to have hope, and that life without hope, isn't life at all. JO 44:06 Chris, what would you say to family members who are confused, fearful, and frustrated? CHRIS 44:13 I would say that it's normal. It's very normal to be confused, and frustrated, and fearful, and to feel shame. It's normal. And that is not your fault. But that help is available. We know more than we've ever known before about schizophrenia, psychosis, treatment modalities, what helps in the recovery process. And so I would encourage the family who's new at all of this, that there are individuals known as family navigators, or family peer support workers, and that there's family education. There are support groups because the family is in recovery too. The individual with schizophrenia or psychosis, they're not the only one in recovery. But the family is also on a recovery journey, in terms of dealing with their stigma. Dealing with their fears and their frustration, learning communication skills with their loved one who has a mental illness, and that there's hope for the entire family. And things can get better, but not minimizing the barriers and the frustrations that are there. JO 45:17 Phil, what would you say to medical and mental health professionals to help them better understand schizophrenia, and to respond more compassionately? PHIL 45:26 A lot of it is that storytelling, and a lot of what we're doing here tonight too, as well, and just appreciate that a diagnosis of schizophrenia is not necessarily a negative diagnosis, and that people can have great outcomes. And its outcomes based on the individual and what they perceive that their own personal sense of well-being and psychological well-being. And so appreciating and having them appreciate the various outcomes that can exist within schizophrenia and psychosis. So it really comes down to still a lot of that education, that's important. It's not necessarily education, for example, from me from the medical community. It's also education for family members. It's education from people with lived experience, as well. And these are very important stories for the medical community to hear. JO 46:08 How would you pitch the need for wholesale change in mental health care to the people making those policy and funding decisions, Chris? CHRIS 46:18 Well, in terms of policymakers and politicians, I think that we not only point out to them, and most the time they know this already, that our current mental health system is not adequate. And it fails many people. And that most people struggling with a mental health problem or mental illness, are not getting the kinds of supports and services that we've talked about on this podcast today. But then I would move forward, promoting transformation of the mental health system through the recovery philosophy. Australia, New Zealand, Scotland, England, has moved towards recovery oriented mental health services. In fact, the fastest growing occupation in the mental health system in England is that of peer support workers, embedding peer support workers in the mental health system, which can help transform the mental health system. We have to educate those who make policy, in politicians. And we have to get to administrators and hospitals and other domains, and not just write recovery into policies, but develop toolkits to help practitioners to move towards a recovery environment. We have to be patient, but we have to be persistent. And we have to be consistent in our advocacy. And we have to speak with one voice. The best advocacy is collaborative advocacy. Unfortunately, there is still much debate within the mental health community about the medical model versus the recovery philosophy. But we have to persist, we have to be determined we can overcome. PHIL 47:57 So it's a great question. And I guess I kind of go back to some of a little bit what I mentioned earlier, it shouldn't be me doing this pitch for wholesale change. And sometimes I really think it needs to come from those individuals who are living it, both the individuals with lived experience, and their family members. And oftentimes, our major changes in either service delivery, or funding, or policy have come because of the advocacy of family and individuals with lived experience as well. We can be there in the medical community to help support, and give that research, and give the data, and look at cost analysis. But the pitch needs to be unified with all the important stakeholders. JO 48:38 And what would you say to those of us who may not know enough about schizophrenia, but who are willing to explore our ignorance and our conscious and or unconscious biases? CHRIS 48:50 Well, it's all about contact-based education. So what I would say to a person is get to know someone, get to know that relative who has schizophrenia, and get to know that neighbour who is experiencing psychosis the same way I had to do when I was a racist in the deep south. In the first part of my life, as a child, as a teenager and young adult, I had to confront my racism. And the way I did that was by moving out of my supposed circle of safety. And that was getting to know people different from me, people of colour. Eating with them, praying with them, interacting, listening to their hopes and dreams. And then you see a person. So we have to do the same thing in terms of going beyond our comfort zones, to learning the truth about the reality of people who live with psychosis or any mental illness. JO 49:44 Kat, any comments? KATRINA 49:46 To those who are willing to explore, you'll find a whole new world because you'll rediscover people that were there the whole time. JO 49:56 What I've discovered is a whole new world of potential. So, not only for people with schizophrenia, but for collaborative change. CHRIS 50:06 Exactly. You mentioned a wonderful word, their potential. In fact, that is the mission of the Schizophrenia Society of Canada. Build a Canada, where people living with psychosis and schizophrenia achieve their potential. And that's what recovery is all about. JO 50:26 So in closing, I have just one more question for each of you. Given what you've learned, personally and professionally, and what we're collectively learning through research and advancing technology, how do you envision the world of schizophrenia changing over the next 20 or 30 years? Kat, let's start with you. KATRINA 50:48 That there won't be the fear of the illness to stop people from finding out if they need help, how to do it. That there won't be this belittlement that can lead to the self stigma, which feels horrible. That there will be treatments that encompass the wholeness of who you are, working together in greater capacity than where we're at now. We have made some progress, but we're not there yet. JO 51:23 Chris, your vision? CHRIS 51:24 We will live in a society in which no one is left behind. Not because they have schizophrenia or psychosis. That stigma will basically be a thing of the past, and it will not be our big albatross. That in fact, that treatments will go beyond anti-psychotics and won't even have to use antipsychotics. And that the recovery philosophy will be fully ingrained within our mental health system. That's what I hope for. PHIL 51:56 I think we'll have a better understanding of the illness and understanding, for example, from the biological underpinnings of the illness. That will in itself help us to understand the best treatments for schizophrenia. So I think we'll see some advancement there within the biological treatments, but as well as the psychosocial or psychotherapy type of treatments, as well. And I think really what we're seeing as well, is just that better understanding and appreciation. I think in 20 or 30 years, we'll see some of the stigma being reduced as well. I think what will continue to happen is that understanding of illness, and it's really getting back to that early intervention piece. And people understanding that if things aren't really quite right, they should get it checked out. And I do make that analogy when I do some public speaking about skin cancer, and that we've had enough education at this point to realize, okay, if we have a funny looking mole, we should get it checked out. May not be anything, but it may be something that needs a little bit more attention. Hopefully, we will be in 20 or 30 years with mental health and wellness as well, is that enough education there to say, okay, if things aren't really quite right, then we should get it checked out. Again, maybe nothing, but it may be something that needs attention. The earlier that attention is there and the treatment than the better the outcomes. JO 53:10 Thanks so much to all of you for your profound insights, ideas, and passions for making the world a much better place for people with schizophrenia, their families and friends, their employers, and society at large. Phil, I so admire and applaud your attention to the ever-changing details of diagnosis, and both pharmaceutical and non-pharmaceutical treatment options. Your boundless curiosity will certainly make schizophrenia less mysterious, and perhaps one day even curable or preventable. PHIL 53:46 Thank you so much for that. And importantly, as these venues, these educational opportunities, these podcasts, are really going to help us to those eventual goals as well. Thank you very much for this opportunity. JO 53:58 Kat and Chris, your willingness to be vulnerable so that others might be helped, is truly inspiring. And I'm sure will help to inform and transform the evolving conversation around social support and advocacy. KATRINA 54:14 It's a pleasure to help. I know, if I would have had peer support years ago, things would have been different. And that's why I'm working so hard to be a peer support worker is to make that difference. JO 54:31 Chris? CHRIS 54:31 I hope that the listeners of this podcast will be inspired and motivated to take a different approach to seeing people who have a mental illness. And here's the statement, ask not what illness a person has, ask what person the illness has. See a person, not an illness. JO 54:53 Thank you both. This is one of the most robust and powerful discussions I've had. The three of you, what you bring to the conversation individually is astounding, but how well you blended your experiences and insights is really truly remarkable. This has been a wonderful, wonderful experience for me. That's a wrap on Part 2 of our podcast on schizophrenia. Be sure to catch Part 1, which focuses on stories, signs, myths, and recovery philosophy. Huge thanks again to our guests for sharing their amazing minds and spirits. To connect with Kat, Chris, or Phil, check out the episode show notes at freshoutlookfoundation.org/podcasts where you'll find contact info, complete bios, and a transcript. I'd appreciate you leaving a review as well. I'm also grateful for all you listeners and hope this information inspires and mobilizes you along the rapidly changing road to recovery. If you haven't already signed up for monthly HEADS UP e-blasts about new episodes, please visit freshoutlookfoundation.org. And for ongoing information, follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be healthy and let's connect again soon. Episode Reviews
When patients with severe depression don't respond to medication, psychiatrists sometimes turn to a treatment known as repetitive transcranial magnetic stimulation (rTMS). The non-invasive therapy uses pulses of magnetic activity to stimulate the brain, and about half of patients see their symptoms improve. Now, researchers at Stanford say they have developed a new and improved version of rTMS, tailored to each patients' neurocircuitry. In one study, nearly 80 percent of severely depressed patients experienced a normal mood within five days. We'll talk to the lead researcher on the Stanford study and other experts in the field about the latest developments in rTMS and other methods of treating depression and mental illness.
In this episode of Psych Matters, Professor Colleen Loo and Dr Brett Simpson discuss Electro Convulsive Therapy.Professor Colleen Loo is a clinical psychiatrist and Professor of Psychiatry at the University of New South Wales, Sydney; Australia. She is an internationally recognised clinical expert and researcher in the field of ECT, ketamine and novel brain stimulation treatments (rTMS, tDCS) for depression. Her research spans laboratory neuroscience, clinical research and clinical trials. She has contributed to Australian and international treatment guidelines and policy. Dr Brett Simpson is an old-age psychiatrist practicing in Sydney. He has extensive clinical experience in ECT and directs both a public and private ECT service. He is a member of the NSW ECT working party responsible for the production and revision of the NSW ECT Minimum Standards. He has taught ECT courses for more than 10 years.Links:Gold Coast Health video https://www.youtube.com/watch?v=HEot7ow3yfkFeedback:If you have a topic suggestion or would like to participate in a future episode of Psych Matters, we'd love to hear from you.Please contact us by email at: psychmatters.feedback@ranzcp.orgDisclaimer:This podcast is provided to you for information purposes only and to provide a broad public understanding of various mental health topics. The podcast may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). The podcast is not to be relied upon as medical advice, or as a substitute for medical advice, does not establish a doctor-patient relationship and should not be a substitute for individual clinical judgement. By accessing The RANZCP's podcasts you also agree to the full terms and conditions of the RANZCP's Website. Expert mental health information and finding a psychiatrist in Australian or New Zealand is available on the RANZCP's Your Health In Mind Website.
《會談地圖》最新版上市了！這次的改版總共更新的一萬多字，這次新增了更多重複經顱磁刺激（rTMS）、二代抗精神病藥長效針劑比較等最新的治療方式、covid-19以及更多會伴隨精神科症狀的內外科疾病。在內容上也把許多重要的知識的實證更新為最新的參考文獻。 這集podcast我們也向讀者們介紹幾個朋友們經常詢問的問題： 《會談地圖》的全書架構還有內容是如何編排的？怎麼樣會比較好找到相關的知識？ 《會談地圖》可以怎麼搭配podcsst、粉絲專頁的資源？ 精神醫學的知識日新月異，哪些新的內容會收錄到《會談地圖》中呢？ 哪些部分是讀者很少注意，但是作者推薦大家一定要讀的部份？
Dr. Spencer Zimmerman is a Nurse Practitioner and Chiropractor. His goal is to help patients achieve better health. His clinic is located in Meridian, Idaho. Having received both degrees he combines the best of both worlds and brings an approach rarely seen. He takes a brain based approach to identifying why the brain isn't functioning optimally. An area of common concern for many patients with brain based issues is poor sleep quality or quantity. Having extensively studied peptides, functional neurology, functional medicine, and functional immunology he utilises a unique approach to evaluate the brain. Having a wide range of tools he utilises rTMS, neuro feedback, QEEG, hyperbaric, vision therapy, vestibular therapy, supplements, peptides and more to allow his patients to break through barriers in their recovery. His practice is an integrative practice that sees individuals suffering a wide range of neurological and autoimmune based conditions. This may include insomnia, concussions, TBI, vertigo, stroke, neuro degeneration, autoimmunity, and neuro developmental disorders. Going to the source: A brain based approach of evaluating and restoring sleep Is the brain directly the cause of poor sleep or is it being impacted by something else? How can we use functional neurology to evaluate the brain? How is Functional Neurology used to balance the brain to promote sleep? What is a brain healing diet? Do head injuries, whiplash, traumatic brain injury, and concussions play a role in poor sleep? What is trans cranial magnetic stimulation to promote sleep? How can you safely use ketamine to heal the brain? What are the symptoms that you need to look at your brain health? What are the supplements for brain health? For more on Dr Spencer Zimmerman, you can follow him: Website: http://idahobrainandbody.com Facebook: https://www.facebook.com/IdahoBrainandBody Instagram: https://www.instagram.com/drszimmerman/ Linked In: https://www.linkedin.com/in/spencer-zimmerman-1474b354/ Course: TheBrainBodyReset.com Related Episodes: 065 - Vitamin D, Microbiome & Sleep With Dr Stasha Gominak, Neurologist 061 - Micronutrients & Sleep With Dr Smita Patel, Integrative Neurologist 052 - The Right Breath For Better Sleep With Elif Clarke, Breath Psychologist 048 - Sleep & Memory With Dr Manvir Bhatia 043 - From Blindness, Paralysis & Insomnia To Author with Vanessa Potter 036 - Essential Oils To Boost The Brain & Heal Your Body with Jodi Sternoff Cohen -For more on Deepa: Deepa is a Yoga therapist for over two decades and a Functional Nutritionist for five. She brings together her experience in therapeutic & transformational yoga and deep learning in nutrition based on the principles of functional medicine to her practice Phytothrive. The focus has been on merging together the deep science of the functional world with the deep symbolism of ancient wisdom. She has a masterful understanding of the human anatomy with cohesive understanding of physiology to offer what can be classified as true bio-individual mind, body & spirit nutrition. Having a son with a rare adrenal condition gave her a deep insight into the working of the adrenals and the stress response, as it relates to all health and sleep. Her articles have been shared by Dr Mark Hyman, MD, a 13 times NY Times Bestselling Author twice. She also gave the opening speech on Health Hacks at Amazon Web Services & YourStory HeathTech 2019 to heads of healthcare start-ups in India. Deepa has twenty years of experience in wellness, where she has focus on sleep nutrition, women's health, detoxification, skin health and adrenal function. She is in the YourStory100 Digital Influencers Of 2020. Weekly Newsletter:
In this episode, I talk with Roy Hamilton, Associate Professor of Neurology at the University of Pennsylvania, about his work using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (TDCS), and in particular the application of these neuromodulatory techniques to enhance recovery from aphasia.Laboratory for Cognition and Neural StimulationPenn Brain Science, Translation, Innovation, and Modulation CenterHamilton RH, Pascual-Leone A. Cortical plasticity associated with Braille learning. Trends Cogn Sci 1998; 2: 168-174. [doi]Naeser MA, Martin PI, Treglia E, Ho M, Kaplan E, Bashir S, Hamilton R, Coslett HB, Pascual-Leone A. Research with rTMS in the treatment of aphasia. Restor Neurol Neurosci 2010; 28: 511-529. [doi]Hamilton RH, Chrysikou EG, Coslett B. Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation. Brain Lang 2011; 118): 40-50. [doi]Price AR, Peelle JE, Bonner MF, Grossman M, Hamilton RH. Causal evidence for a mechanism of semantic integration in the angular gyrus as revealed by high-definition transcranial direct current stimulation. J Neurosci 2016; 36: 3829-3838. [doi]Carr RM, Lane-Fall MB, South E, Brady D, Momplaisir F, Guerra CE, Montoya-Williams D, Dalembert G, Lavizzo-Mourey R, Hamilton R. Academic careers and the COVID-19 pandemic: Reversing the tide. Sci Transl Med 2021; 13: eabe7189. [doi]
What do we do better? Decommissioning aircraft or decommissioning people? This episode will explore how well we do the latter. Dr Richard Magtengaard is a psychiatrist with near 20 years of clinical experience, working extensive with veterans and first responders. But he's pretty different to who and what you might expect... Firstly, Richard served for 10 years as an officer in the Royal Australian Navy, before retiring to complete his Postgraduate Degree within Medicine (MBBS) and then into psychiatry. Secondly, Richard prefers to use non-conventional therapies over medication. We ask Richard about the merit of art therapy, animal therapy, forgery, the use of psychedelics and much more. What can we do NOW so we don't need to end up seeing a psych!? Richard is currently the Director of the Military Trauma Recovery Programme. This programme remains dedicated to assisting Defence Personnel, our Veterans, First Responder Organisations and their families who have sustained physical and psychological traumas during the performance of their duties. Richard is passionate about the future of disruptive health technologies to improve outcomes in care, including neurostimulation with rTMS (repetitive transcranial magnetic stimulation). Intelligence Summary (INTSUM) 00:30 Please excuse the echo in the introduction as we tested our new non sound. proofed studio…. Don't ask why!? Just ask Ben! 03:55 Richard's surname…. And how it translated into a nickname! 08:20 Joining the Navy from a Wheatbelt town. 12:00 Summarising Richard's Navy service, and transferrable lessons learned into psychiatry. 14:30 Why psychiatrists are bad are decompressed. 16:20 Rights of individuals….. versus collective responsibility. 18:50 Has Richard ever crashed a boat? 21:00 The most confronting professional sights for Richard. 22:20 Out of the Navy whites and into the Scrubs. 24:15 Combat operations- fascinating science or difficult treatment? 26:00 Therapies other than medication. 28:00 Tim's opinion on the role of ‘forgery'. 29:20 Mammalian brains…. why we have challenges. 31:00 Did we prepare people well for 20 years of combat operations? 35:30 Mark Wales and his brain being more lizard than human! 42:30 Art therapy- how (and does) it work? 47:20 Animal therapy… gimmick or effective? 52:00 Is there a place for psychedelics? 56:50 Set and settings…. dose and environment. Loving yourself and removing stress. 59:10 Richard talks disruptive health technologies and transcranial magnetic stimulation. 1:03:20 What can we do so we don't need to end up seeing a psych!? 1:05:50 On breathing. 1:07:50 On victimhood, diagnoses, power and control …. Richard's thoughts. 1:12:15. Caring for the carers www.unforgiving60.com Email us at debrief@unforgiving60.com Social Media (Instagram, Twitter): @Unforgiving60 External Links More information on Richard is available here. Music The Externals – available on Spotify Mitchell Martin- available on Spotify
A fascinating discussion with Dr. Jason Keifer (BrainHealthHawaii.com)that will both educate and excite you about today's available technology of TMS - Transcranial Magnetic Stimulation and its undeniable brain healing results. Yes, much like the electrical system in the heart, the brain can be in a state of arrhythmia associated with symptoms. Brain arrhythmia is at the root of many conditions - such as anxiety, depression, post-concussion, PTSD, sleep problems, ADHD, headaches, and more. Enjoy knowing there are tremendous possibilities with our brain once it becomes synchronized once again.
Fifth of our fan campaign series featuring RCB fans - Sreekar, Rishi, Sai and Pratik who played it bold Kohli the opener, what changed? Truimph trio of ABD - Kohli - Maxi The secret behind RCB's bid for Steve Smith Miyaan magic Siraj and his transformation What happened to the loopy Chahal? Retentions, RTMs and many more.. Tune in for exciting content and follow us on (https://twitter.com/StraightDrive_)
There is an invisible string that holds the modern woman back from lasting weight loss and the success she desires. Struggling with consistently, grappling with the urge to people-please, and feeling drained are all good indicators that Enlitened can help. This work releases the weight from the body, mind, and shoulders through Melissa's Integrative Transformation Practices TM system which combines hypnotherapy practices that reprogram the subconscious mind, self-reflection tools, and stress-reducing breathwork to release the grip that plagues the woman who feels like she has to do it all. It's time for her to thrive, guilt-free, and unapologetically. Free Audio RTM: https://www.subscribepage.com/rtm Join the Facebook Community: https://www.facebook.com/groups/451215386044331 Melissa's Instagram: https://www.instagram.com/melissamronda/ Melissa's Tiktok: https://vm.tiktok.com/ZMex975vF/
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers ketamine for treatment-resistant depression (TRD) with Dr. Sandhya Prashad, a psychiatrist and the founder and medical director of Houston Ketamine Therapeutics. She has extensive expertise using ketamine and is one of the most experienced ketamine psychiatrists in the United States, with her clinical practice focusing on TRD and incorporating transcranial magnetic stimulation (TMS), sometimes in conjunction with ketamine. Dr. Prashad is also a founding member and current president of the American Society of Ketamine Physicians (ASKP), a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy. We’re also experimenting with something new for this episode — providing a transcript of the entire interview! The transcript can be found at psychedpodcast.org/transcripts/ketamine. We’d love to hear your feedback as listeners on this as a feature, including whether it’s something you’d be interested in seeing for other episodes moving forward! The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Describe ketamine and how it came to be used in the field of psychiatry. Develop an appreciation for benefits and potential harms associated with ketamine and how this compares to other treatments for depression. Understand how ketamine fits into the treatment of depression and suicidality, patient characteristics to consider before initiation, potential mechanisms of action, different models of administration, and incorporation of psychotherapy. Guest expert: Dr. Sandhya Prashad Hosts: Jimmy Qian (MS2), Dr. Nikhita Singhal (PGY2), Dr. Chase Thompson (PGY3) Audio editing by: Dr. Chase Thompson Show notes by: Gray Meckling (MS4) Interview transcript by: Gray Meckling 00:00 – Introduction 03:00 – Learning objectives 03:30 – History of ketamine 06:20 – Recreational use of ketamine, phenomenology of the ketamine experience 09:45 – Where does ketamine fall in the algorithm for treatment of depression? 11:50 – Ketamine’s use in acute suicidality 13:40 – Ketamine contraindications 14:40 – Ketamine efficacy 19:00 – Combining ketamine with rTMS 21:15 – Limitations to ketamine 24:35 – Ketamine mechanism of action 26:05 – Ketamine formulations, and integrating ketamine into psychotherapy 33:10 – Combining ketamine with traditional antidepressant treatment 37:30 – Practicalities of administering ketamine 39:40 – Ketamine as treatment for OCD and PTSD 41:40 – Closing remarks Resources: American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP) Sandhya Prashad, MD (Website) NEJM interview with Dr. Roy Perlis: Esketamine for Treatment-Resistant Depression — First FDA-Approved Antidepressant in a New Class References: Berman, R., Cappiello, A., Anand, A., Oren, D., Heninger, G., Charney, D.. (2000) Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 47: 351–354. Daly, E. J., Trivedi, M. H., Janik, A., Li, H., Zhang, Y., Li, X., ... & Thase, M. E. (2019). Efficacy of esketamine nasal spray plus oral antidepressant treatment for relapse prevention in patients with treatment-resistant depression: a randomized clinical trial. JAMA psychiatry, 76(9), 893-903. J.W. Murrough, D.V. Iosifescu, L.C. Chang, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two site randomized controlled trial. Am. J. Psychiatry, 2013 (170) (2013), pp. 1134-1142 Kim, J., Farchione, T., Potter, A., Chen, Q., & Temple, R. (2019). Esketamine for treatment-resistant depression-first FDA-approved antidepressant in a new class. N Engl J Med, 381(1), 1-4. McIntyre, R. S., Rosenblat, J. D., Nemeroff, C. B., Sanacora, G., Murrough, J. W., Berk, M., ... & Stahl, S. (2021). Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. American Journal of Psychiatry, appi-ajp. Muetzelfeldt L, Kamboj SK, Rees H, Taylor J, Morgan CJA, Curran HV. Journey through the K-hole: Phenomenological aspects of ketamine use. Drug and Alcohol Dependence [Internet]. 2008 Jun 1;95(3):219–29. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB. A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA psychiatry. 2017 Apr 1;74(4):399-405. Williams NR, Heifets BD, Blasey C, Sudheimer K, Pannu J, Pankow H, Hawkins J, Birnbaum J, Lyons DM, Rodriguez CI, Schatzberg AF. Attenuation of antidepressant effects of ketamine by opioid receptor antagonism. American Journal of Psychiatry. 2018 Dec 1;175(12):1205-15. Williams NR, Heifets BD, Bentzley BS, Blasey C, Sudheimer KD, Hawkins J, Lyons DM, Schatzberg AF. Attenuation of antidepressant and anti suicidal effects of ketamine by opioid receptor antagonism. Molecular psychiatry. 2019 Dec;24(12):1779-86. Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., Luckenbaugh, D.. (2006a) A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch Gen Psychiatry 63: 856–864. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association (CPA). For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.
After several years an MRI finally reveals brain abnormalities in Black Mouth Cur Darwin's brain. Rather than give up and accept the status quo, Vanessa keeps trying out new training ideas and management strategies to improve quality of life for everyone in the multi-dog (and cat!) household.Strap in for another long episode people. Follow along as Vanessa recounts how a perfectly behaved puppy changed to an anxious adult dog after puberty.We discuss how assumptions can lead to blind spots. For the longest time, Vanessa and Ryan had assumed that the move from the US to The Netherlands and the plane ride over had been the triggering event for the decline in Darwin's behavior.Going through old photographs looking for clues in Darwin's body posture, they realized that assumption was false as the signs had been there earlier. Vanessa tells us what it took for her to gain confidence in her own knowledge of dog behavior.A short improvement in behavior after quitting Darwin's anxiety medication gave them hope briefly, as did the possibility of maybe being able to participate in an RTMS trial at the Belgian University of Ghent, but none of it was meant to be.Darwin's anxiety is such that having to make simple decisions such as “Should I get on the couch?” are stress inducing for him.Muzzle training turned out to be a blessing in disguise. As a bonus side effect to the muzzle training, it became a tool to help Darwin relax.You can find Vanessa on Instagram: @overseas.with.petsAs soon as her dog training business website officially launches, you will be able to find it here too.A link to the scientific article that got Vanessa to contact the university of Ghent is here:TMS improves anxious aggressive behaviour in dogs: A case studyA link to the show notes with photos of Vanessa, Ryan, and their dogs is here:http://www.vanoverbeekfotografie.com/2021/03/004-ruff-around-the-edges-with-vanessa-osullivan-darwin/The FREE mindset-mini course "THINK Your Way to a Better Relationship With Your Dog" is available here:https://kajsavanoverbeek.com/think-mini-course/
Eric Berg has had seizures due to epilepsy since he was 12 years old. This past year, his seizures increased in frequency, affecting his day-to-day life and his ability to work. With encouragement from his fiancee, Eric sought treatment at Mayo Clinic. At Mayo Clinic, experts are using a new way to treat some seizure disorders: repetitive transcranial magnetic stimulation, or rTMS. This treatment uses a magnetic field to stimulate certain areas of the brain. While often used to treat depression, repetitive transcranial magnetic stimulation also is showing promise in treating seizures. On the Mayo Clinic Q&A podcast, Eric Berg shares his story. His physician, Dr. Jeffrey Britton, a neurologist and chair of the Division of Epilepsy at Mayo Clinic, also joins the podcast and explains how repetitive transcranial magnetic stimulation is used to treat seizure disorders.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.11.11.378117v1?rss=1 Authors: Zmeykina, E., Turi, Z., Antal, A., Paulus, W. Abstract: Sensorimotor mu-alpha rhythm reflects the state of cortical excitability. Repetitive transcranial magnetic stimulation (rTMS) can modulate neural synchrony by inducing periodic electric fields (E-fields) in the cortical networks. We hypothesized that the increased synchronization of mu-alpha rhythm would inhibit the corticospinal excitability reflected by decreased motor evoked potentials (MEP). In seventeen healthy participants, we applied rhythmic, arrhythmic, and sham rTMS over the left M1. The stimulation intensity was individually adapted to 35 mV/mm using prospective E-field estimation. This intensity corresponded to ca. 40% of the resting motor threshold. We found that rhythmic rTMS increased the synchronization of mu-alpha rhythm, increased mu-alpha/beta power, and reduced MEPs. On the other hand, arrhythmic rTMS did not change the ongoing mu-alpha synchronization or MEPs, though it increased the alpha/beta power. We concluded that low intensity, rhythmic rTMS can synchronize mu-alpha rhythm and modulate the corticospinal excitability in M1. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.28.358986v1?rss=1 Authors: Zmeykina, E., Mittner, M., Paulus, W., Turi, Z. Abstract: This study was conducted to provide a better understanding of the role of electric field strength in the production of aftereffects in resting state scalp electroencephalography by repetitive transcranial magnetic stimulation (rTMS) in humans. We conducted two separate experiments in which we applied rTMS over the left parietal-occipital region. Prospective electric field simulation guided the choice of the individual stimulation intensities. In the main experiment, 16 participants received rhythmic and arrhythmic rTMS bursts at between ca. 20 and 50 mv/mm peak absolute electric field intensities. In the control experiment, another group of 16 participants received sham rTMS. To characterize the aftereffects, we estimated the alpha power (8-14 Hz) changes recorded in the inter-burst intervals, i.e., from 0.2 to 10 seconds after rTMS. We found aftereffects lasting up to two seconds after stimulation with ca. 35 mV/mm. Relative to baseline, alpha power was significantly reduced by the arrhythmic protocol, while there was no significant change with the rhythmic protocol. However, we found no significant long-term, i.e., up to 10-second, differences between the rhythmic and arrhythmic stimulation, or between the rhythmic and sham protocols. Weak arrhythmic rTMS induced short-lived alpha suppression during the inter-burst intervals. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.13.338483v1?rss=1 Authors: Beynel, L., Campbell, E., Naclerio, M., Galla, J. T., Ghosal, A., Michael, A. M., Kimbrel, N. A., Davis, S. W., Appelbaum, L. G. Abstract: Repetitive transcranial magnetic stimulation (rTMS) has fundamentally transformed how we treat psychiatric disorders, but is still in need of innovation to optimally correct dysregulation that occurs throughout the fronto-limbic network. rTMS is often applied over the prefrontal cortex, a central node in this network, but less attention is given to subcortical areas because they lie at depths beyond the electric field penetration of rTMS. Recent studies have demonstrated that the effectiveness of rTMS is dependent on the functional connectivity between deep subcortical areas and superficial targets, indicating that leveraging such connectivity may improve dosing approaches for rTMS interventions. The current preliminary study, therefore, sought to test whether task-related, fMRI-connectivity-based rTMS could be used to modulate amygdala activation through its connectivity with the medial prefrontal cortex (mPFC). For this purpose, fMRI was collected on participants to identify a node in the mPFC that showed the strongest negative connectivity with right amygdala, as defined by psychophysiological interaction analysis. To promote long-lasting Hebbian-like effects, and potentially stronger modulation, 5Hz rTMS was then applied to this target as participants viewed frightening video-clips that engaged the fronto-limbic network. Post-rTMS fMRI results revealed promising increases in both the left mPFC and right amygdala, for active rTMS compared to sham. While these modulatory findings are promising, they differ from the a priori expectation that excitatory 5Hz rTMS over a negatively connected node would reduce amygdala activity. As such, further research is needed to better understand how connectivity influences TMS effects on distal structures, and to leverage this information to improve therapeutic applications. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.28.316190v1?rss=1 Authors: Turi, Z., Lenz, M., Paulus, W., Mittner, M., Vlachos, A. Abstract: Background: Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used, non-invasive brain stimulation technique in neuroscience research and clinical practice with a broad spectrum of suggested applications. Among other parameters, the choice of stimulus intensity and intracranial electric field strength substantially impact rTMS outcome. This review provides a systematic overview of the intensity selection approaches and stimulation intensities used in human rTMS studies. We also examined whether studies report sufficient information to reproduce stimulus intensities in basic science research models. Methods: We performed a systematic review by focusing on original studies published between 1991 and 2020. We included conventional (e.g., 1 Hz or 10 Hz) and patterned protocols (e.g., continuous or intermittent theta burst stimulation). We identified 3,784 articles in total, and we manually processed a representative portion (20%) of randomly selected articles. Results: The majority of the analyzed studies (90% of entries) used the motor threshold (MT) approach and stimulation intensities from 80 to 120% of the MT. For continuous and intermittent theta burst stimulation, the most frequent stimulation intensity was 80% of the active MT. Most studies (92% of entries) did not report sufficient information to reproduce the stimulation intensity. Only a minority of studies (1.03% of entries) estimated the rTMS-induced electric field strengths. Conclusion: We formulate easy-to-follow recommendations to help scientists and clinicians report relevant information on stimulation intensity. Future standardized reporting guidelines may facilitate the use of basic science approaches aiming at better understanding the molecular, cellular, and neuronal mechanisms of rTMS. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.23.310219v1?rss=1 Authors: Shirinpour, S., Hananeia, N., Rosado, J., Galanis, C., Vlachos, A., Jedlicka, P., Queisser, G., Opitz, A. Abstract: Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique widely used in research and clinical applications. However, its mechanism of action and the neural response to TMS are still poorly understood. Multi-scale modeling can complement experimental research and provide a framework between the physical input parameters and the subcellular neural effects of TMS. At the macroscopic level, sophisticated numerical models exist to estimate the induced electric fields in whole-brain volume conductor models. However, multi-scale computational modeling approaches to predict TMS cellular and subcellular responses, crucial to understanding TMS plasticity inducing protocols, are not available so far. Here, we develop a multi-scale Neuron Modeling for TMS toolbox (NeMo-TMS) that enables researchers to easily generate accurate neuron models from morphological reconstructions, couple them to the external electric fields induced by TMS, and to simulate the cellular and subcellular responses of the neurons. Both single-pulse and rTMS protocols can be simulated and results visualized in 3D. We openly share our toolbox and provide example scripts and datasets for the user to explore. NeMo-TMS toolbox (https://github.com/OpitzLab/NeMo-TMS) allows researchers a previously not available level of detail and precision in realistically modeling the physical and physiological effects of TMS. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.09.288910v1?rss=1 Authors: Hendrikse, J. J., Thompson, S., Suo, C., Yucel, M., Rogasch, N. C., Coxon, J. Abstract: Working memory (WM) refers to the capacity to temporarily retain and manipulate finite amounts of information; a critical process in complex behaviours such as reasoning, comprehension, and learning. This cognitive function is supported by a parietal-prefrontal network and linked to the activity of key brain neurotransmitters, such as gamma-aminobutyric acid (GABA). Impairments in WM are seen in a range of psychiatric and neurological disorders, and there are currently no effective methods of remediating WM deficits. In this study, we analysed secondary outcome measures from a trial investigating the effects of multi-day rTMS on cognition. Participants received four days of 20 Hz rTMS to an individualised region of left parietal cortex in one week, and an individualised region of pre-supplementary motor area (pre-SMA) in a separate week. We assessed changes to WM function before and after each week of stimulation (N = 39), and changes to GABA concentration before and after stimulation in week one using MR spectroscopy (N = 18 per stimulation condition). We hypothesised that multi-day parietal rTMS would enhance WM and reduce GABA concentration, but this was not observed. Instead, we report some evidence of improved WM function and increased GABA concentration following pre-SMA rTMS, although this effect was variable across individuals. Additionally, we found that higher cardiorespiratory fitness was associated with greater WM improvement following pre-SMA stimulation. While there are a number of factors known to influence the response to rTMS, increasing cardiorespiratory fitness may provide a novel approach to enhance cognitive outcomes. Given the clinical utility of both exercise and rTMS, future studies are required to determine whether additive effects may be achieved when applied in tandem. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.08.287896v1?rss=1 Authors: Fatakdawala, I., Ayaz, H., Safati, A., Sakib, M. N., Hall, P. Abstract: The dorsolateral prefrontal cortex (dlPFC) and dorsomedial prefrontal cortex (dmPFC) are important nodes for self-control and decision-making, but through separable processes (cognitive control versus evaluative processing). This study aimed to examine the effects of excitatory brain stimulation (intermittent theta-burst stimulation; iTBS) targeting the dlPFC and dmPFC on food choice. iTBS was hypothesized to decrease consumption of appetitive snack foods, via enhanced interference control for dlPFC stimulation and reduced delay discounting for dmPFC stimulation. Using a single-blinded, between-subjects design, participants (N = 43) were randomly assigned to of the three conditions: 1) iTBS targeting the left dlPFC, 2) iTBS targeting bilateral dmPFC, or 3) sham. Participants then completed two cognitive tasks (delay discounting (DD) and Flanker), followed by a taste test. fNIRS imaging revealed increases in medial PFC activity were evident in the dmPFC stimulation group during the DD task; likewise, a neural efficiency effect was observed in the dlPFC stimulation group during the Flanker. Gender significantly moderated consumption during the taste test, with females in the dmPFC showing paradoxical increases in food consumption compared to sham. Findings are consistent with possible amplification of positive evaluative processing in the presence of dietary restraint, vis-a-vis excitation of the mPFC. Copy rights belong to original authors. Visit the link for more info
EDDIE BROWN JR / BIOOwner/ Graphic Designer / Photographer / FilmmakerEddie Brown, Jr. is an award-winning Graphic designer/ Photographer and Filmmaker and began studying film in Orlando in 1997. Upon obtaining a degree in Film, Eddie moved on to assist with several projects. In 2005, he was co-founder of the Central Nebraska Film Festival and acted as a key player in the Estes Park Film Festival development. In the following years he became involved in professional photography, film editing and entertainment-oriented web page development and deployment. Eddie’s focus on working on the front lines with talent along with industry power players enables him to keep striving for bigger and better film productions. In 2009, Eddie founded the Florida Panhandle Film Festival in Perry, FL he will continue developing and helping students in this industry.Eddie has been trained in many technical applications for marketing, sales, printing, and graphic development. An extensive knowledge using Salesforce, A-CRM, and RTMS software production applications for marketing and sales tracking. These applications are used by AT&T and YP.com for maintaining advertiser’s information and products. In designing Eddie is advanced in Adobe Photoshop, InDesign, Premiere, After Effects, and Illustrator. Eddie has been using these applications for media design, video production, and commercial printing.He is key in working with screen writers, producers, and musicians with marketing and SEO for their marketing campaigns. The designer has over 20 years’ experience in the design world and entertainment industry.
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.08.19.257295v1?rss=1 Authors: Thomson, A. C., de Graaf, T. A., Schuhmann, T., Kenis, G., Sack, A. T., Rutten, B. P. F. Abstract: Repetitive Transcranial Magnetic Stimulation (rTMS) is an established neuromodulation technique, using electromagnetic pulses that, depending on the precise parameters, are assumed to lead to lasting neural excitability changes. rTMS has widespread applications in both research and therapy, where it has been FDA approved and is considered a first-line treatment for depression, according to recent North American and European guidelines. However, these assumed excitability effects are often difficult to replicate, and highly unreliable on the single subject/patient level. Given the increasing application of rTMS, especially in clinical practice, the absence of a method to unequivocally determine effects of rTMS on human neuronal excitability is problematic. We have taken a first step in addressing this bottleneck, by administering excitatory and inhibitory rTMS protocols, iTBS and cTBS, to a human in vitro neuron model; differentiated SH-SY5Y cells. We use live calcium imaging to assess changes in neural activity following stimulation, through quantifying fluorescence response to chemical depolarization. We found that iTBS and cTBS have opposite effects on fluorescence response; with iTBS increasing and cTBS decreasing response to chemical depolarization. Our results are promising, as they provide a clear demonstration of rTMS after-effects in a living human neuron model. We here present an in-vitro live calcium imaging setup that can be further applied to more complex human neuron models, for developing and evaluating subject/patient-specific brain stimulation protocols. Copy rights belong to original authors. Visit the link for more info
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.06.05.137067v1?rss=1 Authors: Tang, D.-l., Mottonen, R., Asaridou, S. S., Watkins, K. E. Abstract: Speech processing relies on interactions between auditory and motor systems and is asymmetrically organized in the human brain. The left auditory system is specialized for processing of phonemes, whereas the right is specialized for processing of pitch changes in speech that affect prosody. In speakers of tonal languages, however, processing of pitch (i.e., tone) changes that alter word meaning is left-lateralized. This indicates that linguistic function and language experience shape auditory speech processing asymmetries; their effect on auditory-motor speech processing remains unknown, however. Here, we investigated the asymmetry of motor contributions to auditory speech processing in speakers of tonal and non-tonal languages. We temporarily disrupted the left or right speech motor cortex using repetitive transcranial magnetic stimulation (rTMS) and measured the impact of these disruptions on auditory processing of phoneme and tone changes in sequences of syllables using electroencephalography (EEG). We found that disruption of the speech motor cortex in the left, but not the right hemisphere, impaired processing of phoneme changes in both language groups equally. In contrast, the effect of motor disruptions on processing of tone changes differed in tonal and non-tonal language groups: disruption of the left speech motor cortex significantly impaired processing of tone changes in tonal language speakers, whereas disruption of the right speech motor cortex modulated processing of tone changes in non-tonal speakers. We conclude that the contribution of the left and right speech motor cortex to auditory speech processing is determined by the functional role of the acoustic cues in the listener's native language. Copy rights belong to original authors. Visit the link for more info
Shauna Hahn is a Psychiatric Mental Health Nurse Practitioner who practices at Framework TMS, which is part of Northwest Functional Neurology. For most of her career, she worked in community mental health and is an alumnus of the National Health Service Corps. She believes passionately in public health: access for all and more client-centered services for those struggling with brain injury recovery. Shauna is on the Board of Directors for the Oregon Brain Injury Alliance (BIAOR) and is brain injury certified. She has spoken on the subject of brain injury for the Nurse Practitioners of Oregon and BIAOR. She runs a support group for brain injury survivors. www.frameworkTMS.com
Dr. Fidel Vila-Rodriguez is a clinical scientist at the University of British Columbia's NINET Lab studying repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression, Parkinson's disease, and OCD. In the second episode of the Capture Queue podcast, he explains what rTMS is, how it functions, and the work he's doing to push for wider access to rTMS and similar treatments. View the accompanying photographs taken during our conversation in the lab at CaptureQueue.com
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.04.23.056655v1?rss=1 Authors: Hendrikse, J. J., Coxon, J. P., Thompson, S., Suo, C., Fornito, A., Yucel, M., Rogasch, N. Abstract: Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique with the capacity to modulate brain network connectivity and cognitive function. Recent studies have demonstrated long-lasting improvements in associative memory and resting-state connectivity following multi-day repetitive TMS (rTMS) to individualised parietal-hippocampal networks. We aimed to assess the reproducibility and network- and cognitive-specificity of these effects following multi-day rTMS. Participants received four days of 20 Hz rTMS to a subject-specific region of left lateral parietal cortex exhibiting peak functional connectivity to the left hippocampus. In a separate week, the same stimulation protocol was applied to a subject-specific region of pre-supplementary motor area (pre-SMA) exhibiting peak functional connectivity to the left putamen. We assessed changes to associative memory before and after each week of stimulation (N = 39), and changes to resting-state functional connectivity before and after stimulation in week one (N = 36). We found no evidence of long-lasting enhancement of associative memory or increased parieto-hippocampal connectivity following multi-day rTMS to the parietal cortex, nor increased pre-SMA-putamen connectivity following multi-day rTMS to pre-SMA. Instead, we observed some evidence of site-specific modulations of functional connectivity lasting ~24 hours, with reduced connectivity within targeted networks and increased connectivity across distinct non-targeted networks. Our findings suggest a complex interplay between multi-day rTMS and network connectivity. Further work is required to develop reliable rTMS paradigms for driving changes in functional connectivity between cortical and subcortical regions. Copy rights belong to original authors. Visit the link for more info
اپیزود شش در ششمین اپیزود از پادکست پرتو آگاهی نگاهی خواهیم داشت به درمانهای غیر دارویی بیماری افسردگی. در این اپیزود مهمترین و متداولترین روشهای روانشناختی درمان افسردگی از قبیل شناخت درمانی، رفتار درمانی و روان تحلیلی را معرفی خواهیم کرد. علاوه بر این مطالب سایر روشهای درمانی از قبیل ECT, RTMS, TDCS, و نوروفیدبک را نیز بررسی می کنیم. --- Send in a voice message: https://anchor.fm/partoagahi/message
Today we chatted with Shelley about her experience on Talk11 and everything in between.Shelley Hofer is a mental health advocate who began sharing her 45 year battle with Major Depressive Disorder when her teenage son, Zach, stepped up and raised over $130,000 for youth mental health initiatives. Shelley now speaks about her illness, hospitalizations, Electro-convulsive Therapy treatments (ECT), rTMS and brain stimulation to help reduce the shame and stigma associated with Mental Illness that often keeps others from seeking treatment. Despite the life sentence of her illness, Shelley's story is full of hope, connection and resilience. She has a very loving and accepting partner in Derek and loves parenting an empathetic and very moody (but oh so wonderful!) teenage boy.
Wenceslao Pérez Gómez entrevista al Sales Manager de EMEA, Eneko Arostegui, para la 16ª edición de TRAFIC. La empresa ha desarrolado un sistema no intrusivo de radar a través de RTMS que ha presentado en la Feria. No sólo es aplicable al exceso de velocidad sino también a los atascos circulatorios, por ejemplo
Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers repetitive transcranial magnetic stimulation (rTMS) with Dr. Jonathan Downar, a world expert and leading researcher on rTMS, and clinical fellow Dr. Jean-Phillippe Miron. In addition to learning the basics about rTMS, you will also be listening to Henry Barron’s first-hand experience with non-therapeutic rTMS treatment to help bring some of the learning principles to life. The learning objectives for this episode are as follows: By the end of this episode, you should be able to… Understand generally how rTMS is conducted and some of the theory behind how it works Understand where rTMS fits in the treatment algorithm for depression and what kind of patient characteristics should be considered before initiating rTMS Appreciate the benefits, side effects and drawbacks of rTMS and how it compares to other depression treatments Guest staff psychiatrist: Dr. Jonathan Downar, Associate Professor at the University of Toronto and Co-Director of the MRI-Guided rTMS Clinic at University Health Network. CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
Dr. Dan Engle lectures and consults globally and is the Medical Director of The Revive Treatment Centers of America, as well as medical advisor to Onnit Labs, The True Rest Float Centers and several international treatment centers using indigenous plant medicines for healing and recovery. He published his fist book, The Concussion Repair Manual, in October 2017, which has received praise from countless figures in the medical arena. His other programs include B.O.L.D., Freedom From Meds and Full Spectrum Medicine. He is the Medical Director of Revive Treatment Centers in Colorado, a leading neurological rehabilitation center that treats traumatic brain injury (TBI), stroke, PTSD, and other neurodegenerative disorders by combining functional neurology, metabolics, and psychology. In addition to a whole-body approach, Revive has the most innovative and progressive suite of treatment modalities currently available in the neurological rehabilitation space. These state-of-the art testing and therapeutic modalities include: gene testing, cellular therapy, hyperbaric oxygen therapy (HBOT), low level laser therapy (LLLT), transcranial magnetic stimulation (rTMS), rotational therapy, and much more. He also medically consults with Onnit Labs in Austin, Texas, a company leading the industry in peak performance methods and Total Human Optimization, as well the most visited and regarded ayahuasca healing center in the world – The Temple of the Way of Light Ayahuasca Healing Center in Peru. https://drdanengle.com http://eastforest.org
Cont.
Dr. Engle is the Medical Director of Revive Treatment Centers in Colorado, a leading neurological rehabilitation center that treats traumatic brain injury (TBI), stroke, PTSD, and other neurodegenerative disorders by combining functional neurology, metabolics, and psychology. In addition to a whole-body approach, Revive has the most innovative and progressive suite of treatment modalities currently available in the neurological rehabilitation space. These state-of-the art testing and therapeutic modalities include: gene testing, cellular therapy, hyperbaric oxygen therapy (HBOT), low level laser therapy (LLLT), transcranial magnetic stimulation (rTMS), rotational therapy, and much more.Dr. Dan Engle:https://drdanengle.comRonnie's Inner Circle Membership www.ronnieinnercircle.comRonnie's Official Website www.hhphealth.com
Dr. Engle is the Medical Director of Revive Treatment Centers in Colorado, a leading neurological rehabilitation center that treats traumatic brain injury (TBI), stroke, PTSD, and other neurodegenerative disorders by combining functional neurology, metabolics, and psychology. In addition to a whole-body approach, Revive has the most innovative and progressive suite of treatment modalities currently available in the neurological rehabilitation space. These state-of-the art testing and therapeutic modalities include: gene testing, cellular therapy, hyperbaric oxygen therapy (HBOT), low level laser therapy (LLLT), transcranial magnetic stimulation (rTMS), rotational therapy, and much more.Dr. Dan Engle:https://drdanengle.comRonnie's Inner Circle Membership www.ronnieinnercircle.comRonnie's Official Website www.hhphealth.com
Elaina Love interviews Dr. Dan Engle on a variety of topics. We discuss Random Acts of Kindness, Social media and the impact on our children and on increasing depression Psilocybin (magic mushrooms) has to be one of the more exciting areas of research because the medicines that are being studied and utilized today are very good for improving the five primary psychiatric conditions- five big epidemics are chronic depression anxiety PTSD addiction and pain. Using Float Tanks for Neurological Recovery and Brain Optimization as an alternative to psychaelic self-exploration. Dr. Dan is the Medical Director of Revive Treatment Centers in Colorado, a leading neurological rehabilitation center that treats traumatic brain injury (TBI), stroke, PTSD, and other neurodegenerative disorders by combining functional neurology, metabolics, and psychology. In addition to a whole-body approach, Revive has the most innovative and progressive suite of treatment modalities currently available in the neurological rehabilitation space. These state-of-the art testing and therapeutic modalities include: gene testing, cellular therapy, hyperbaric oxygen therapy (HBOT), low level laser therapy (LLLT), transcranial magnetic stimulation (rTMS), rotational therapy, and much more. He also medically consults with Onnit Labs in Austin, Texas, a company leading the industry in peak performance methods and Total Human Optimization, as well the most visited and regarded ayahuasca healing center in the world – The Temple of the Way of Light Ayahuasca Healing Center in Peru. Dr. Dan Engle lectures and consults globally and is the Medical Director of The Revive Treatment Centers of America, as well as medical advisor to Onnit Labs, The True Rest Float Centers and several international treatment centers using indigenous plant medicines for healing and recovery. He publisehdt book, The Concussion Repair Manual, in October 2017, which has received praise from countless figures in the medical arena. His other programs include B.O.L.D., Freedom From Meds and Full Spectrum Medicine. REFERENCES: http://www.planetaryculture.info/ Collaborate with scholars, technologists, independent researchers, visionaries, and activists on our Regenerative Society Wiki. This ongoing project provides a road map for re-organizing society into more equitable and just relationships, while harmonizing human activity with our planet's ecology. https://thethirdwave.co/podcast/ Reframing Psychedelics https://thethirdwave.co/ (podcast on microdosing) Maps.org http://reset.me/ First Ever Human Trials finds Magic Mushrooms Beats severe depression https://heffter.org/ advancing studies on psilocybin for cancer distress and addiction with the highest standards of scientific research BOOK:Theconcussionrepairmanual.com How to Change your Mind by Michael Pollen WEBSITESPsychedelic therapy: http://fullspectrummedicine.com/ http://drdanengle.com/about-dr-dan-engle/ http://revivecenters.com/
Dr. Jonathan Downar, neuroscientist and psychiatrist, and Dr. Don Vaughn, neuroscientist and behavioral consultant, share their thoughts on the future of mental health, and how Neuroscience is helping us solve complex human problems.
Many of us have experienced depression or have loved ones who have. Reaching out for help is never easy, and when frontline treatments don’t work, the effect on quality of life can be devastating. On this week’s episode, Kat sits down with MRI-Guided rTMS Clinic Co-Director Dr. Jonathan Downar from the Toronto Western Hospital. Dr. Downar shares his insights on rTMS as an intervention for treatment-resistant depression and other mental illnesses, and discusses recent transformative developments in rTMS procedures that could greatly increase accessibility to those who need it most. Kat and Grace poll the public about their knowledge of alternative treatments for depression and the challenges faced by those who suffer from it. Until next time, keep it raw!
Many of us have experienced depression or have loved ones who have. Reaching out for help is never easy, and when frontline treatments don’t work, the effect on quality of life can be devastating. On this week’s episode, Kat sits down with MRI-Guided rTMS Clinic Co-Director Dr. Jonathan Downar from the Toronto Western Hospital. Dr. Downar shares his insights on rTMS as an intervention for treatment-resistant depression and other mental illnesses, and discusses recent transformative developments in rTMS procedures that could greatly increase accessibility to those who need it most. Kat and Grace poll the public about their knowledge of alternative treatments for depression and the challenges faced by those who suffer from it. Until next time, keep it raw!
Kan magnetstimulering av hjärnan bota alkoholism? Kjell, som varit alkoholist i många år, hoppas på att bli hjälpt av en ny teknik. Repris från våren. Forskningsprojektet pågår vid Linköpings universitetssjukhus och metoden som används kallas rTMS, repetitiv transkraniell magnetstimulering. Den går ut på att stimulera delar av hjärnan som ger sug efter alkohol. Vi har träffat Kjell som deltar i studien, gång på gång har han försökt sluta dricka men alltid trillat dit igen. Nu sätter han sitt hopp till den nya behandlingen, kan den få honom att sluta dricka en gång för alla? I studion: Markus Heilig, professor i psykiatri vid Linköpings universitet och Anders Hammarberg, beteendevetare och psykoterapeut.
Welcome to PsychED, the educational psychiatry podcast for medical learners, by medical learners. This episode covers the approach to treating Major Depressive Disorder, as described by the CANMAT (Canadian Network for Mood and Anxiety Treatments) Guidelines. We discuss with Dr. Sid Kennedy, the founding chair of CANMAT, the past president of International Society for Affective Disorders, as well as a staff psychiatrist and scientist at Toronto Western and St. Michael’s Hospitals in Toronto. In this episode, Dr. Kennedy discusses the origins of the CANMAT and how the guidelines are structured and constructed. We talk briefly about consideration of specifiers and symptoms in tailoring treatment. We then approach psychotherapy, pharmacotherapy, electrostimulation, and complementary and alternative therapies as treatment options, using the case from the previous episode on the diagnosis of depression. Evidence-based psychotherapies for depression include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based cognitive therapy (MBCT). We explain briefly the theoretical underpinnings of each. Patient suitability and availability of quality therapy are considered. Some evidence demonstrate a superiority of combining psychotherapy with pharmacotherapy (Cuijpers 2009). The first-line pharmacotherapy includes antidepressant classes SSRI (selective serotonin reuptake inhibitor), SNRI (serotonin and norepinephrine reuptake inhibitor), NDRI (norepinephrine and dopamine reuptake inhibitor), and NaSSA (norepinephrine and specific serotonergic antidepressant). We discuss side effects with a focus on SSRIs, and understanding them from serotonin receptor profiles. We talk about the delayed onset of antidepressants, using validated tools to measure improvement, and strategies to optimize dosage, or using adjuncts with partial responses. We explore results from STAR*D (Trivedi et al, 2006) regarding response rates to medications.We touch briefly on antidepressant selection and the limited evidence of superiority of one medication/class over another (Cipriani et al 2009). Brain stimulation includes electro-convulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and Deep Brain Stimulation (DBS). Dr. Kennedy discusses the cultural origins of misconceptions around ECT and explores the current practice of ECT today, which includes general anesthesia for the comfort of patients. We explain briefly the practice of rTMS and DBS. Complementary and alternative therapies are briefly explored, including light therapy which has increasing evidence not only for seasonal patterns of depression. Dr. Kennedy discusses the limited evidence available to support any complementary therapies including nutraceuticals and exercise. The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to: Demonstrate an approach to the treatment of depression based on severity of illness and other clinical features Apply the CANMAT Guidelines in discussing treatment options for MDD Identify psychotherapy, pharmacotherapy, brain stimulation, and complementary and alternative therapies as treatment options for MDD Psychotherapy Identify CBT, IPT, and MBCT as evidence-based psychotherapies for depression Explain factors for choosing psychotherapy versus pharmacotherapy as first-line treatment Describe the efficacy of psychotherapy in relation to pharmacotherapy Pharmacotherapy Identify SSRI, SNRI, NDRI, and NaSSA as classes of antidepressants that are first-line for depression Explain the time of onset and side effect profile of SSRIs Apply the guideline to either optimize, switch, or add adjunctive therapies with limited or partial responses to medication Identify some factors to consider in choice of antidepressants Brain Stimulation Identify ECT, rTMS, and DBS as brain stimulation treatments for depression Criticize the cultural origins of stigma around ECT Describe the current practice of ECT, rTMS, and DBS Complementary and Alternative Therapies Describe Light Therapy as the only evidence-based complementary treatment strategy Recognize the limited data in support of other therapies including nutraceuticals and exercise Guest Staff Psychiatrist: Dr. Sid Kennedy (Toronto Western Hospital and St. Michael’s Hospital, Toronto) For more PsychEd, follow us on Twitter (@psychedpodcast) and Facebook. You can provide feedback by email at psychedpodcast@gmail.com For more information visit our website: psychedpodcast.org.
Kan magnetstimulering av hjärnan bota alkoholism? Kjell, som varit alkoholist i många år, hoppas på att bli hjälpt av en ny teknik. Forskningsprojektet pågår vid Linköpings universitetssjukhus och metoden som används kallas rTMS, repetitiv transkraniell magnetstimulering. Den går ut på att stimulera delar av hjärnan som ger sug efter alkohol. Vi har träffat Kjell som deltar i studien, gång på gång har han försökt sluta dricka men alltid trillat dit igen. Nu sätter han sitt hopp till den nya behandlingen, kan den få honom att sluta dricka en gång för alla? I studion: Markus Heilig, professor i psykiatri vid Linköpings universitet och Anders Hammarberg, beteendevetare och psykoterapeut.
Multiple Sclerosis Discovery: The Podcast of the MS Discovery Forum
Full transcript: [intro music] Host – Dan Keller Hello, and welcome to Episode Eighty-eight of Multiple Sclerosis Discovery, the podcast of the MS Discovery Forum. I’m Dan Keller. You may have heard of transcranial magnetic stimulation, a treatment for migraine, neuropathic pain, and treatment-resistant depression using an electromagnet positioned on the scalp. Dr. John Hart, a professor of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center in Dallas, is now testing another electrical technique called transcranial direct current stimulation, or tDCS, as well as alternating current to improve cognition in brain disorders, potentially including MS. An even more directed form, called high definition tDCS, allows more precise targeting of brain areas. The experimental procedure involves placing electrodes strategically on the outside of the head. We spoke in his office about how he's going about developing the technique and how it may eventually be combined with other therapeutic modalities. Interviewer – Dan Keller You're working in transcranial direct current stimulation. Basically, what is it; how does it work or be applied? Interviewee – John Hart tDCS is short for that. You'll have an electrode – actually it's a sort of small doughnut, so it's not such electrodes that people think of tiny little electrodes – and you place one on one part of the scalp area, and then another part, and you're basically going to pass current through the head in a sort of diffuse, generalized way, not very specific, from that one electrode to the other. Recently, a new sort of area has been developed, a new cap system approach called high definition transcranial direct current stimulation. It's an EEG cap with EEG electrodes on them, and you can pass current out one electrode and draw it in a variety of other electrodes. So you can target it to specific areas where it's coming out, and you can also direct it as to where it goes through to multiple, depending on how specific or not, brain regions that you're going to have the electrode come out. So if you want to hit one spot, you can go out one and bring it in its surrounders and keep all the current there, or you can go from one place to another. And in some instances, we're able to throw it – sort of like throwing your voice – down the deep structures and sort of hit those as a way of stimulating. The other part about it is the direct current part. We also do alternating currents, or HD TACS, and we can do frequencies and other things, too. So I feel that this has got a fair amount of promise and flexibility as a way to externally stimulate brain areas pretty safely. It does a little tingling to your scalp kind of side effects in terms of application. MSDF What kind of currents and voltages does it involve? Dr. Hart Right now normally in tDCS in the big things, we do 2 milliamps ballpark. We find that 1 milliamp is about where we're functioning now at the high definition, and right now we're doing studies with it where we're playing around with the amps and different frequencies to see – since it's relatively a new technique – what sort of effects you get. So … it's so new there's not a ton of papers out about it for me to tell you where we're going to land, will there be a dose-response curve? We're doing those studies right now. MSDF You've said that you’re interested, in general, in cognition across all sorts of brain disorders—Alzheimer's, MS, others. What's the hypothesis for using this kind of stimulation? Dr. Hart Well, in my primary research area I do word retrieval and knowledge retrieval and storage, so we've mapped out in that example a circuit of the pre-SMA, the pre-supplementary motor area, and the caudate and the thalamus that's involved in retrieving a memory. So when I say desert and humps, does that make you think of a specific object? When camel pops into your head, we mapped out with fMRI, EEG depth, and electrodes this sort of electrical pattern of that retrieval circuit to effectively pull up that memory. So the way we've been doing it, we came up with this circuit in normal people, and we've seen certain disease states where it's dysfunctional, and MS happens to be one of them. So we're directing, right now, our current to the pre-SMA and trying to stimulate that circuit to hopefully have a less functional circuit become more functional, where it can pull out the signal to noise and fire off the right rhythms or get their rhythms in a correct pattern that are not there. Psychiatry's done a lot better in terms of treatments, because a lot of the disorders are based on neurotransmitters and neurotransmitter states, that a drug will affect those neurotransmitters, and it hits all the areas, because it's more the transmitter than the place. Cognition has a lot to do with place and connectivity. Drugs, we've not got a ton of them as the primary cognitive treatment because they don't go to a specific place, and they don't effectively change that specific area's connectivity and/or its links. I have a big study we just finished with RTMS [repetitive transcranial magnet stimulation] in PTSD [posttraumatic stress disorder]. I look at the fact that having worked as an electrician of cognition for years, that that's what the circuit is, and the best way for me to change cognitive status in the way that it's lined up its focal networks is probably not showering a brain with drug that won’t go to specific areas but maybe targeting things like electrical and magnetic current. MSDF In terms of MS or other diseases, have you done any clinical studies so far? Dr. Hart So we're right in the middle of doing some MS patients preliminarily. And I don't get excited easily – I'm normally a pessimist, I think, at heart for these things. We've had some encouraging results in having people not on meds or who have failed meds or not had a response to meds that we've looked at retrieving memory in both word retrieval and in episodic memory retrieval and seen some improvements that have been relatively reasonably long-lasting from my point of view, lasting over months. But we've only at this point done about 5 or 6 people and we're enrolling more folks. We had a grant proposal in and we needed to get more folks to do a bigger trial. We're doing some placebo and then add people later to also see how much of this is a fair sort of setup as a placebo effect versus not. So we're advancing getting more and more folks into those stages now. And we've tried a few folks with TBI [traumatic brain injury]. MSDF How long do you apply the treatment. Is it a one-shot deal and what's the residual effect? You said you've had benefit up to months, is that from a series or from just once? Dr. Hart We're doing one-shot now as a way of figuring out dosing and effectiveness, since it's a relatively new device. The way we're doing the treatments for folks is to do 20-minute sessions and 10 of those over a 2-week period. So once a day, 20 minutes, for a total of 10 sessions. And that has seem to have been from animal studies and some other folks in the literature reasonable time and reasonable number of sessions at this point. We're going to figure out and look at more about adjusting dose, dose response, will we need boosters if it starts fading, and things like that. Its affect fades, because in essence these folks are not treated with modafinil or stimulants that we're doing this, so we're not doing it in conjunction with that. So they're not receiving what are typical cognitive treating medications in MS. So that's a plus side, and that we haven't had any serious any sort of residual side effect things at this point. So if it lasted several months and you had to reapply a booster thing, compared to taking amphetamines or some of the other pro-amphetamine drugs, I think the upside is reasonable enough to say that compared to that, it would be a reasonable issue if you came in 4 times a year if that's what we need to do. But we'll see as we keep following folks. MSDF If it works as you said, kind of separates out the signal from noise, essentially boosts the signal, the signal is gone when you turn it off or when someone leaves the treatment room. So what do you think, something's happening biochemically, or what's it doing that gives you a long-lasting effect? Dr. Hart When we just finish our RTMS trial for post-traumatic stress disorder, one of our interesting findings was the length of time, or the time when the effect lasts, or how long it lasts and continues. So there are some studies on electrical stimulation in animal models that suggests that what it does is set up a state called meta-plasticity. And the meta-plasticity in the animal models support the fact that long-term potentiation and synaptic potentials that can be set up down the road are actually benefited from the electrical stimulation. And that's what's encouraged us a little bit looking at stuff to see why these things last, because the first thing always like a single-shot, it fades off, it fades away. Luckily, for some of this stuff we have some guidance from animal models. And this meta-plasticity phenomena has been noted for a continue – or delayed almost – effect of when you see improvement because of this. I think it's a state potential change that long-term potentiation can occur down the road. That's our best guess at this point. MSDF You said besides direct current stimulation, you're also trying alternating current. With a direct current, you probably would not get anything analogous to a magnetic stimulation because you wouldn’t set up a magnetic field. Do you see differences between your direct current stimulation and your alternating current stimulation? Dr. Hart We sure have – and I must admit none of this has been published yet because we're trying to set parameters. Initially, the enthusiasm for alternate current stimulation waned a lot, I think, for folks for any of these things, because it didn't seem to be nearly as effective as direct current. And I think as a lot of this stuff initially was done in normals. And I'm not so sure that when you have patients with a disease state, depending on what the disease state is, that I'm willing to sort of say that alternating current is not necessarily going to be useful or not. Also, this is very directional, so here's anode and cathode. So you can take the same current, same electrodes, change the directionality and get different effects. And typically people that found those things in the motor system were pretty noticeable. In cognitive systems, we haven't seen that as much, that when we flip the direction of the current, that we're getting the opposite effects—so instead of enhancing a performance in something, that we're knocking it out. So I think once we look at sort of these things, every new approach has to be taken really as a start from scratch, do the hard work of just what we're doing, change the amplitudes, change the parameters, change the direction in a nice, safe way in single shots, and which we've been doing, and then record pre- and post. We do a lot of electophys measures, but also cognitive measures and other sorts of measures to see how each one of these effects things, and do we have something that I would hope one day I'll be writing electrical prescriptions. And I'll say you should get F4 to CZ current at 1 milliamp or 0.5 milliamps, or whatever I wind up doing, for 10 sessions, 20 minutes. Or, no, my god, look at this, we've got to go from here to here at a different milliamp. Once we start looking at that, I think to me also frequencies are very important; can I send different frequencies instead of milliamps. We're going to discover a lot of different things work differently, especially in diseases that are not a homogeneous thing. Brain disease is not like liver cancer. Hepatocytes, it's like how many hepatocytes are not working and how big is the tumor? No, not having a good thalamus is very different than not having a functional motor cortex, you just see entirely different results. So I think it's going to be a lot more complicated, but I think doing it in a systematic way in normals, and then applying it to certain disease states gives us our best chance at coming up with primary or as adjunct treatments to other ways we're going to be treating diseases that have cognitive problems. MSDF It doesn't seem surprising that the polarity wouldn't matter, because not all the neurons, dendrites, and synapses are lined up in one direction; they're going in all different directions, so even their polarity is different. It seems like zapping it in one direction for one, but the opposite direction for the other anyway. Dr. Hart We've actually done stuff with EEG measures and fMRI measures, and done these things called Granger causality models. So how much does, say, one time point predict an activation or a change in the other time point? And in an area that we thought was really this guy is telling that guy what to do, we found that most of those were predominantly a lot of two-way interactions that are constantly going on, and there's a lot of feedback between these systems. And I always try to think like neurons and think electrically, and I can do it for about a couple hours and then my head starts really hurting. And in reality, I think the simplistic: Turn this light switch on and that you have a serial processing circuit is not really how electrically two neurons are always working together, or talking to each other, or keeping a tone or a level up. So I think you're right, I learn a lot every day. It's been sort of a cool job to figure out, yeah, that makes sense, because really it's an interactive set of neuronal firings. MSDF Do you see any role for combining it with drugs that have ionotropic effects? Dr. Hart Yeah, I do. And the other part of that is going to be really, to me, which I think has been a problem with a lot of approaches to cognition and treating them, the timing of when and how you add different therapies together are going to be very, very important. Even now to say, all right, let's say I want to do a behavioral therapy with HD [high definition?] tDCS, well do you do it during it, do you do the HD tDCS continually? Do you pre-prep the brain by doing that first, and then doing cognitive rehabilitation strategies and therapies? I think we glibly just put things together without thinking that there might be an order to this. So right now we're looking at what's called state changes. We're not the first folks to do this, but some people say before you do tDCS, and that's before this HD stuff, you do a little RTMS first to set the state of the neurons in that area so they're more receptive to whatever you're going to do with the tDCS. MSDF Just to be clear on it, RTMS is repetitive transcranial magnet stimulation. Dr. Hart So I think we're looking at kind of like, you know what, you get your pre-meds before you get your chemo so you don't vomit or do this or that. We might be finding ways that electrically how we're going to, or even you use meds prior to a treatment electrically, or vice versa, that that timing is going to be where the money is in terms of working out what are going to be the most effective therapies. MSDF What have we missed? I realize it's still pretty early, but is there anything important to add? Dr. Hart I think the way we've done it is not going to always be available, in that we came from a circuit that we worked out, and we have an idea as to what we were trying to do. And we're measuring all these brain rhythms as outcome measures, so I know when I'm supposed to see alpha and beta rhythms to do that. And I think what's going to happen is we're not always going to have these circuits, we're going to have a spot. Like we've talked a little bit, shall we try to hit the hippocampus? And what other diseases would you do these things in? And the question's going to be when you're doing that, or doing that as a general approach, how do you smartly do it, when you really are not sure about the circuit? We don't have a ton of really well worked out cognitive circuits in an active state of doing things. We have a lot of functional connectivity rest states, and you say I'd like to amp up that connectivity. I don't know what that does functionally, if you electrically take a rest state that normally is when your eyes close and add current to it. So I think while we've targeted this in the two areas that we're using electrical therapy in, post-traumatic stress disorder and this, and the things we've chosen, we built it off of normal studies. The things we've got to be careful about, thoughtful about, and open-minded to at the same time about, is what if we want to treat something different than this? We want to do working memory, we want to do episodic memory, we want to do frontal behavioral problems. And if we don't have a circuit, try our best to get the most reasonable pre/post measures. Do single shots just to see what it does in a transient state, and then sort of work our way through the fact that at least a reasonable pre/post model and start thinking of this not as one-size-fits-all, but may be 0.5 milliamps, maybe TACS, maybe pink noise, maybe whatever sort of way you want to deal with it. It's going to take a lot more thought, I think, than people might casually say, hey, got some electrodes? I mean, what bugs me right now is you can set up your own tDCS device off the internet, one of them using a car battery – 2 pieces of metal and some wire. And I highly would tell all those out there, which I know none of your listeners, don't do that. So when people started sort of exploring around in what they're going to do, I hope as we take this field further that we need to do it in a systematized fashion and a thoughtful way, because there's a lot of information you can get when something doesn't work. So you know what, I didn't change a thing here when I did this. Well, I would like to know that, you know, is somebody else trying to do it, and try to collect this information that might be useful to other people trying to do things. Saying, you know what, we did this electrodes, these are these things in normals or whatevers and didn't get a response, to try to come up with a way that we've got to take it for the fact that it's like a med. It's going to have schedules, it's going to have doses. So if you're taking it twice a day at 5 mg or 6 times a day at 40 mg, working all that out is going to clearly need to be done in a reasonable, thoughtful way. MSDF I appreciate it, thanks. Dr. Hart Oh, thank you so much, I really appreciate your interest. [transition music] MSDF Thank you for listening to Episode Eighty-eight of Multiple Sclerosis Discovery. This podcast was produced by the MS Discovery Forum, MSDF, the premier source of independent news and information on MS research. MSDF’s executive editor is Carol Cruzan Morton. Msdiscovery.org is part of the nonprofit Accelerated Cure Project for Multiple Sclerosis. Robert McBurney is our President and CEO, and Hollie Schmidt is Vice President of Scientific Operations. Msdiscovery.org aims to focus attention on what is known and not yet known about the causes of MS and related conditions, their pathological mechanisms, and potential ways to intervene. By communicating this information in a way that builds bridges among different disciplines, we hope to open new routes toward significant clinical advances. [outro music] We’re interested in your opinions. Please join the discussion on one of our online forums or send comments, criticisms, and suggestions to editor@msdiscovery.org. For Multiple Sclerosis Discovery, I'm Dan Keller.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 19/19
Die Wirkung der repetitiven transkraniellen Magnetstimulation (rTMS) auf die Stimmung gesunder Probanden wurde bereits vielfach in Studien untersucht. Ziel solcher Untersuchungen ist einerseits, die neurophysiologischen Grundlagen der Emotionsregulation zu erforschen und andererseits einen Beitrag zur Entwicklung von Hirnstimulationsverfahren zu therapeutischen Interventionen bei affektiven Erkrankungen zu leisten. Die Ergebnisse der Studien zum Effekt der rTMS auf die Stimmung gesunder Probanden sind in der Gesamtschau allerdings weitgehend inkonsistent. Grund dafür könnten methodische Unterschiede, eine interindividuelle Variabilität der präfrontalen Konnektivität oder andere Faktoren, die das Paradigma rTMS-induzierter Stimmungsänderung beeinflussen, wie etwa interindividuelle Unterschiede der Persönlichkeit der Probanden, sein. Die vorliegende Dissertation befasst sich mit der Untersuchung dieses möglichen Einflussfaktors der Persönlichkeit auf die Art und Ausprägung der Stimmungsänderung nach rTMS. In zwei Studien wurden insgesamt 41 gesunde Probanden eingeschlossen. Die Ergebnisse wurden im Hinblick auf die Annahme, dass die Persönlichkeit einen Einfluss auf die Stimmungsänderung nach rTMS hat, ausgewertet. In der Studie A erhielten 17 Probanden eine 1 Hz rTMS (600 Stimuli, Intensität: 120% der rMT) im Crossover-Design an drei Loci auf der Großhirnrinde (medialer präfrontaler Kortex - mPFC, linker dorsolateraler präfrontaler Kortex - LDLPFC und auditorischer Kortex als Plazebo-Bedingung mit der Spule um 45° abgewinkelt). In der Studie B wurden 12 Probanden ausschließlich am mPFC, weitere 12 Probanden nur am LDLPFC stimuliert. Beide Gruppen erhielten jeweils im Crossover-Design drei Stimulationseinheiten (iTBS, cTBS, imTBS als Plazebo-Bedingung). Bei jeder Einheit wurden 600 Stimuli mit einer Intensität von 80% der motorischen Schwelle bei den beiden aktiven Stimulationsbedingungen und mit 10% der Geräteleistung bei der Plazebobedingung, appliziert. Der Stimulationsort wurde in beiden Studien mit dem internationalen 10/20 EEG-System bestimmt (mPFC: Fz; LDLPFC: F3, auditorischer Kortex: T3). Die Stimulationen wurden jeweils binnen eines Tages und in randomisierter Reihenfolge durchgeführt. Zwischen den Stimulationen war eine Pause von 50 min. Vorher wurden Persönlichkeitstests (NEO-FFI, Sensation Seeking Skale, Version 5 = SSS-V), sowie eine Stimmungsmessung mit der Eigenschaftswörterliste (EWL) von Janke und Debus gemacht, die nach jeder Stimulation wiederholt wurde. Es wurde zunächst ein möglicher Effekt der rTMS auf die Stimmung, sowie ein zeitlicher Effekt ohne die Berücksichtigung des Faktors der Persönlichkeit untersucht. Dabei ergaben sich in beiden Studien keine signifikanten rTMS-spezifischen Effekte auf die Stimmung. Wie in der Mehrzahl der Vorstudien, konnten weder für die unterschiedlichen Modi, noch für die unterschiedlichen Stimulationsorte signifikante Unterschiede hinsichtlich der Stimmungsänderung gezeigt werden. Auch für die Stimmungsänderungen zu den jeweiligen Messzeitpunkten zeigte sich bis auf einen signifikanten Unterschied, kein durchgängiger Effekt. Als Hauptergebnis zeigte sich, dass der Effekt der rTMS auf die Stimmung maßgeblich von der Persönlichkeit der Probanden abhing. Korrelationsanalysen ergaben in der 1 Hz Studie einen signifikanten Zusammenhang zwischen der Ausprägung des Merkmals „Sensation Seeking“ (SS) und einer Stimmungsverschlechterung nach allen Stimulationen (auch nach der Plazebo-Bedingung). Im Extremgruppenvergleich konnte das Ergebnis durch signifikante und hochsignifikante Unterschiede zwischen den Gruppen „hohes SS“ und „niedriges SS“ bezüglich der Stimmungsänderung nach den Stimulationen bestätigt werden. In der TBS-Studie konnten gleichermaßen Zusammenhänge festgestellt werden. Es ergaben sich Korrelationen zwischen einer Stimmungsverbesserung nach cTBS und iTBS über dem mPFC und höheren Punktwerten in der SSS-V, sowie ein Zusammenhang zwischen einer Stimmungsverschlechterung nach imTBS über dem LDLPFC und höheren Punktwerten in der SSS-V. Korrelative Zusammenhänge zwischen der Ausprägung einzelner Persönlichkeitsfaktoren des NEO-FFI und der Stimmungsänderung konnten nur für die TBS-Studie gezeigt werden. Dabei ergaben sich signifikante Korrelationen für die Faktoren „Neurotizismus“, „Extraversion“, „Verträglichkeit“ und „Gewissenhaftigkeit“ mit der Stimmungsänderung nach rTMS. In der 1 Hz Studie wurde außerdem ein Zusammenhang zwischen dem zeitlichen Faktor der Stimmungsänderung und SS Score festgestellt. Die Ergebnisse weisen auf eine besondere Bedeutung der Persönlichkeit als Einflussfaktor für Art und Ausprägung des Effektes einer rTMS-Intervention auf die Stimmung gesunder Probanden hin. Weiterführende Studien sind notwendig, um Persönlichkeitsvariablen als festen Einflussfaktor auf die Wirkung von Stimulationsverfahren auf die Emotionsregulation zu charakterisieren. In Studien könnte durch ein Screening nach Persönlichkeitsvariablen homogenere Gruppen gebildet und so konsistentere Ergebnisse erzielt werden.
RTMS is an industry-led, voluntary self-regulation scheme that encourages consignees, consignors and transport operators engaged in the road logistics value chain to implement a vehicle management system that preserves road infrastructure, improves road safety and increases the productivity of the logistics value chain. This scheme also supports the Department of Transport’s National Freight Logistics Strategy. All stakeholders in the road logistics value chain are aware of the problems concerning road logistics that affect their industries. The road infrastructure is deteriorating rapidly due to overloading and poor maintenance. Furthermore, the large number of accidents attributed to heavy trucks is unacceptable. Both road safety and road infrastructure are public concerns subject to strict regulation by governments, particularly when abused. Overregulation, road deterioration and high accident rates pose a significant threat to the long term sustainability and global competitiveness of the road logistics value chain. This has prompted users of road haulage (consignors and consignees) and providers of road haulage (hauliers) to jointly develop strategies aimed at protecting the road network, improving road safety and transport productivity for the benefit of the country’s citizens and the industry itself. The industry also recognises that poor compliance to transport regulations creates an unfair competitive environment. It is therefore felt that a self-regulation scheme is required to create standard rules for the industry, and that these rules should become the “business norm” – supporting principles of good corporate governance. It is for this reason that industry is leading this initiative, to ensure its quick adoption by all businesses participating in the road logistics value chain. Furthermore, industry recognises its critical role in the economy’s growth. Efficient movement of goods between a country’s centres of production and its shipping ports boosts competitiveness in international markets. RTMS is one of the innovative and pro-active initiatives that will make this possible.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 12/19
Thu, 9 Dec 2010 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/12511/ https://edoc.ub.uni-muenchen.de/12511/1/Troegele_Dirk.pdf Trögele, Dirk
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 10/19
Die präfrontale repetitive transkranielle Magnestimulation (rTMS) wird seit den 90er Jahren angewendet, um einerseits die Bedeutung des präfrontalen Kortex für verschiedene kognitive und affektive Prozesse zu erforschen und andererseits die Pathophysiologie psychiatrischer Erkrankungen zu untersuchen und therapeutisch zu modulieren. Von neuen Stimulationsprotokollen, wie der Theta Burst Stimulation (TBS), die analog zum Tiermodell zur Induktion von Langzeitpotenzierung beim Menschen entwickelt wurde, werden stärkere und länger anhaltende therapeutische Effekte erhofft. Im Gegensatz zur Stimulation des Motorkortex wurde die präfrontale rTMS bislang kaum neurophysiologisch untersucht. In dieser Arbeit werden daher zwei Experimente beschrieben, in denen eine niederfrequente 1 Hz-rTMS und TBS bezüglich ihrer Effekte auf ereigniskorrelierte Potentiale (EKP) in GoNogo-Aufgaben charakterisiert wurden. Sie verfolgten die Fragestellungen, ob EKP analog zu motorisch evozierten Potenzialen (MEP) geeignet sind die Wirkungsweise einer präfrontalen rTMS einzuschätzen und ob sich die TBS qualitativ oder quantitativ von herkömmlichen rTMS-Protokollen unterscheidet (Experiment 1 und 3). In einem Vorexperiment zu Experiment 3 (Experiment 2) wurde erstmals die Sicherheit verschiedener präfrontaler TBS-Formen mittels EEG und kognitiver Tests untersucht. In Experiment 1 wurden 18 gesunde Probanden mit einer als inhibitorisch geltenden 1 Hz rTMS über dem linken dorsolateralen präfrontalen Kortex (DLPFC), dem medialen präfrontalen Kortex (mPFC) und einer Kontrollregion stimuliert. Bei der nachfolgenden Bearbeitung einer GoNogo-Aufgabe, zeigte sich eine Vergrößerung der P3-Amplitude nach Stimulation des mPFC bei zeitgleich größerer parietaler Aktivität. Hypothesenkonform konnte eine Reduktion der N2-Amplitude bei Stimulation des linken DLPFC gefunden werden. Während der rTMS-Effekt auf die P3-Amplitude am besten durch die Initiierung von Aufmerksamkeitsprozessen erklärt werden kann, spricht der Einfluss der 1 Hz-rTMS über dem linken DLPFC für einen inhibitorischen Effekt auf kortikaler Ebene (Experiment 1). Im Hinblick auf die vorbeschriebenen nachhaltigeren Effekte von TBS-Protokollen am Motorkortex wurde in Experiment 2 die TBS am präfrontalen Kortex bei 24 gesunden Probanden plazebo-kontrolliert bezüglich ihrer Sicherheit untersucht, um diese als innovative Stimulationsform für weitere Experimente einsetzbar zu machen. Die Ergebnisse dieses Experimentes zeigten, dass eine präfrontale, als inhibitorisch geltende TBS (continuous TBS - cTBS) und eine als exzitatorisch geltende TBS (intermittent TBS - iTBS) keine epilepsietypischen Potenziale im EEG oder epileptische Anfälle triggerten. Es kamen jedoch bei drei von 25 Probanden vagale Reaktionen vor, deren Auftreten beachtet und deren Ursache in weiteren Studien erforscht werden sollte. In den neuropsychologischen Untersuchungen wurde eine verminderte Leistung im Arbeitsgedächtnis und in einer frontalen Testbatterie (Trend) nach iTBS des linken DLPFC und in der Anzahl der ‚false alarms’ einer GoNogo-Aufgabe nach cTBS des mPFC festgestellt. Diese Veränderungen spiegelten sich auch in neurophysiologischen Parametern wider. Eine Analyse der EEG-Daten mittels standardized low resolution brain electromagnetic tomography (sLORETA) ergab eine Zunahme der Aktivität im Alpha 2-Band links präfrontal nach iTBS des linken DLPFC, die bis zu einer Stunde nachweisbar blieb und einen Zusammenhang mit den Leistungen im Arbeitsgedächtnis und der frontalen Testbatterie zeigte. In Experiment 3 wurden dann 1 Hz rTMS, cTBS und eine Plazebostimulation bei 9 gesunden Probanden miteinander verglichen. Alle Stimulationen erfolgten neuronavigiert bezogen auf eine Aktivierung im individuellen funktionellen Magnetresonanztomographie (fMRT) Bild, die während der Entscheidungskomponente (Volition) einer modifizierten GoNogo-Aufgabe gefunden wurde. Hierbei konnte die in Experiment 1 beobachtete inhibitorische Wirkung der 1 Hz rTMS auf eine relevante EKP-Komponente (N2P2-peak-to-peak-Amplitude) analog repliziert werden (Trend). Bei einer zeitlichen Betrachtung der Stromdichten mittels sLORETA ließ sich deskriptiv eine Verminderung nach 1 Hz rTMS beobachten, während sich der Verlauf der Stromdichten in der cTBS-Bedingung abhängig vom Aktivierungszustand des Kortex zu ändern schien. In einer für ‚conflict monitoring’ relevanten region of interest (ROI) konnte in dem für die N2P2-Amplitude relevanten Zeitfenster eine Verminderung (Trend) der Stromdichte in der 1 Hz-Bedingung gefunden werden, die mit der N2P2-Amplitude korrelierte. Desweiteren waren in Experiment 1 und 3 keine Effekte auf Verhaltensdaten und EKP-Latenzen nachweisbar. Die Ergebnisse dieser Arbeit sprechen dafür, dass die gemeinsame Betrachtung von Verhaltensdaten, EKP- und Stromdichteanalysen eine neurophysiologische Interpretation der rTMS erlaubt. Die alleinige Verwendung von EKP zur Beurteilung der Wirkungsweise einer präfrontalen rTMS hingegen ist methodisch und inhaltlich begrenzt. Am präfrontalen Kortex zeigten cTBS und iTBS andere Effekte als für den Motorkortex vorbeschrieben. Insgesamt betrachtet sprechen die Ergebnisse dafür, dass sich die TBS nicht nur quantitativ sondern auch qualitativ von einer 1 Hz rTMS unterscheidet. Nach diesen Pilotexperimenten stellt die Untersuchung rTMS-vermittelter Effekte auf präfrontal generierte EKP einen vielversprechenden Untersuchungsansatz dar, um die Bedeutung präfrontaler Regionen als Generatoren spezifischer EKP-Komponenten zu erforschen, die Wirkung verschiedener rTMS Protokolle neurophysiologisch zu untersuchen und diese Protokolle für experimentelle oder therapeutische Anwendungen weiter zu entwickeln. So könnte die Wirkung spezifischer TBS-Protokolle durch eine pathologisch veränderte Grundaktivität bei Patienten mit psychiatrischen Erkrankungen im Gegensatz zu gesunden Probanden verändert sein. Dies könnte in einem nächsten Schritt mit dem oben beschriebenen Untersuchungsansatz näher erforscht werden.
Guest: Charles Epstein, MD Host: Mark Nolan Hill, MD Is rTMS a more effective treatment for depression than drugs therapy? Join Dr. Charles Epstein as he explains rTMS, how it is implemented and what type of results can be expected.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 06/19
Angst- und Panikstörungen sind in der Bevölkerung häufig auftretende Krankheitsbilder, von denen zu großem Teil auch junge Menschen betroffen sind. Es stehen mit der Verhaltenstherapie und der Pharmakotherapie bereits etablierte Therapiestandards zur Verfügung. Jedoch kommt es bei den behandelten Patienten langfristig in bis zu 25% der Patienten zu einer Therapieresistenz bzw. zu belastenden Nebenwirkungen durch die Pharmakotherapie. Es besteht daher weiterhin der Bedarf an neuen alternativen Therapiestrategien. Mit der Transkraniellen Magnetstimulation (TMS) steht ein interessantes Paradigma bereit, welches vor dem Hintergrund der postulierten Wirksamkeit bei depressiven Störungen auch in der Behandlung von Angststörungen ein mögliches Potential besitzt. In einer placebo-kontrollierten cross-over-Studie wurde bei 11 gesunden Probanden eine 1-Hz-Verum- oder Placebo-rTMS an zwei verschiedenen Tagen über dem rechten dorsolateralen präfrontalen Kortex durchgeführt. Unmittelbar nach der Stimulation wurde durch die Gabe eines Cholezystokinin-Tetrapeptids (CCK-4) eine experimentelle Panik-Auslösung durchgeführt. Die Panik-Reaktion nach CCK-4-Gabe wurde durch Anwendung klinischer Skalen, Messung der Herzfrequenz und Untersuchung der Blutspiegel auf ACTH und Cortisol ermittelt. Alle Probanden zeigten sowohl nach Verum-rTMS als auch nach Placebo-rTMS eine der CCK-4-Gabe folgende deutliche Panik-Reaktion. Eine ANOVA-durchgeführte Analyse zeigte keine signifikanten Unterschiede in einer der untersuchten Parameter zwischen beiden Bedingungen. Im Gegensatz zu vorherigen Untersuchungen an Patienten mit Angststörungen wurde die durch CCK-4 ausgelöste Panik an gesunden Probanden nicht durch eine niedrigfrequente rTMS beeinflusst. Zukünftige Studien sollten untersuchen, ob eine rTMS vielleicht bei Patienten mit Panikstörungen die Reaktion auf CCK-4-Gabe beeinflusst.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 05/19
In der vorliegenden Dissertation untersuchten wir mit Hilfe des psychopathologischen Tiermodells der HAB- und LAB-Ratten, welche sich nicht nur bezüglich ihrer genetisch determinierten Emotionalität und ihrer Stressbewältigungsstrategien, sondern auch hinsichtlich der Reaktivität der HPA-Achse unterscheiden, Effekte des Serotonin-Wiederaufnahmehemmers Paroxetin und von rTMS auf Verhalten und die neuroendokrine Regulation. Mit Hilfe des kombinierten DEX/CRH-Tests gelang es uns nachzuweisen, dass sich ein hohes Maß an angeborenem Angstverhalten in einer profunden Fehlregulation des Stresshormonsystems widerspiegelt. HAB-Tiere zeigten nach Verabreichung von Dexamethason einen verminderten Suppressionseffekt und die periphere Injektion von CRH führte zu einem deutlichen Anstieg der Plasmakonzentrationen von ACTH und Kortikosteron. Hierfür scheint intrahypothalamisch überexprimiertes und sezerniertes AVP verantwortlich zu sein, folglich führte auch die periphere Verabreichung eines V1-Rezeptorantagonisten zu einer Normalisierung des bei HAB-Tieren dysregulierten HPA-Systems im DEX/CRH-Test. Bindungskapazität und Bindungsaffinität von Glukokortikoid- und Mineralokortikoidrezeptoren unterschieden sich nicht zwischen den Zuchtlinien, so dass die durch Kortikosteron vermittelte Feedbackregulation des HPA-Systems auf der Ebene der intrazellulären Signalkaskade gestört zu sein scheint. Die mehrwöchige Behandlung mit dem selektiven Serotonin-Wiederaufnahmehemmer Paroxetin induzierte bei HAB-Tieren nicht nur eine durch die Verminderung der intrahypothalamischen AVP-Genexpression vermittelte Normalisierung des dysregulierten Hormonfreisetzungsprofiles im DEX/CRH-Test, sondern auch profunde Verhaltensänderungen im Forced Swim-Test, der als guter Prädiktor für die klinische Wirksamkeit einer antidepressiven Therapie angesehen wird. HAB-Tiere, welche eine passive Stressbewältigungsstrategie im Forced Swim-Test zeigen, struggelten nach Behandlung mit Paroxetin signifikant länger und verbrachten signifikant weniger Zeit mit Floating als unbehandelte HAB-Kontrolltiere. Sie waren in ihrem Verhalten von LAB-Tieren, auf die die Behandlung mit Paroxetin keinen Einfluss hatte, nicht mehr zu unterscheiden. Mit Hilfe von in vivo Mikrodialyse untersuchten wir den Einfluss von chronisch verabreichtem Paroxetin auf die stressinduzierte Freisetzung von Serotonin im dorsalen Hippocampus. Bei HAB-Tieren, welche eine angeborene verminderte Empfindlichkeit der raphé-hippocampalen Neurotransmission zeigen und den bei LAB-Tieren zu beobachtenden stressinduzierten Anstieg der Serotoninfreisetzung vermissen lassen, führte die Behandlung zu einer Normalisierung der serotonergen Neurotransmission. Dieser Effekt könnte mit der gezeigten Verminderung von SERT-Bindungsstellen im Hippocampus bei HAB- im Vergleich zu LAB-Tieren zusammenhängen, während die Expression von 5-HT1A-Rezeptoren in dieser Hirnregion unbeeinflusst blieb. Somit konnten wir erstmals zeigen, dass eine Normalisierung der Stresshormonregulation durch Paroxetin mit einem Anstieg der stressinduzierten Freisetzung von Serotonin im Hippocampus assoziiert ist. Dass rTMS der linken frontalen Hirnregionen antidepressive Effekte hat, konnte bereits in mehreren klinischen Untersuchungen an Patienten, die an Major Depression leiden, beobachtet werden. Unsere im psychopathologischen Modellorganismus der HAB/LAB-Tiere nach Langzeitbehandlung mit rTMS erzielten Ergebnisse gewähren neue Einblicke in die der antidepressiven Wirkung zugrundeliegenden neurobiologischen Mechanismen. Wie auch die Behandlung mit Paroxetin, wandelte rTMS die angeborene passive Stressbewältigungsstrategie der HAB-Tiere in eine signifikant aktivere Stressbewältigungsstragie im Forced Swim-Test um und dämpfte die endokrine Stressantwort der HPA-Achse. Die frontalen Hirnregionen partizipieren durch efferente Projektionen zum perinukleären Bereich des PVN an der Regulation der neuroendokrinen Reaktion auf Stressstimuli und kann die Synthese und Freisetzung von CRH und somit die Antwort des HPA-Systems hemmen. Wir konnten ebenfalls zeigen, dass rTMS auch während chronischem psychosozialem Stress eine dämpfende Wirkung auf die basale Aktivität der HPA-Achse hat. Allerdings ließ sich kein anregender Effekt auf die Neurogenese im Hippocampus nachweisen: rTMS erhöhte zwar leicht die Proliferationsrate hippocampaler Vorläuferzellen, verminderte jedoch die Überlebensrate BrDU-markierter Neurone. Daher scheinen andere Faktoren, neben den Glukokortikoiden, eine mindestens genauso große Rolle bei der Regulation der Anzahl und der Ausreifung der Vorläuferzellen im Hippocampus zu spielen. Wir folgern daraus, dass die Dämpfung des HPA-System wahrscheinlich ein wichtiger, der klinisch beobachteten antidepressiven Wirkung von rTMS zugrundeliegender Mechanismus ist, es mit unserem experimentellen Design jedoch nicht gelang, einen stimulierenden Effekt von rTMS auf die Neurogenese im adulten Hippocampus nachzuweisen.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 05/19
In vorliegender Arbeit wurde anhand von Fremd- und Selbstbewertungsskalen umfassend explorativ untersucht, wie sich eine zweiwöchige Therapie mit präfrontaler rTMS (repetitiver transkranieller Magnetstimulation) auf die Symptomatik depressiver Patienten auswirkt und inwieweit es potentielle klinische Prädiktoren gibt, die ein Ansprechen auf rTMS vorhersagen können. In der offenen Studie wurden 39 Patienten eingeschlossen. Die Patienten erhielten eine Behandlung mit 10 Hz rTMs des linken dorsolateralen präfrontalen Kortex (100% Intensität bezogen auf die individuelle motorische Schwelle, 1500 Stimuli/d, 10 rTMS-Behandlungen). Alle Patienten waren während der Studie medikamentenfrei. Im Gesamtkollektiv wiesen die Summenscores der Hamilton Rating Skala für Depressionen (HRSD) und Montgomery-Asperg Depressions Rating Skala (MADRS) eine signifikante Besserung der klinischen Symptomatik um 30% auf. Die Abnahme der Summenscores der Selbstbeurteilungsskalen war nicht signifikant. Die depressive Kernsymptomatik besserte sich signifikant unter rTMS. Eine spezifische Wirkung der rTMS auf Angstsymptomatik und psychomotorische Hemmung konnte im Gesamtkollektiv nicht bestätigt werden. Anhand der Einzelitemanalyse der HRSD fand sich eine signifikante Besserung der Schlafitems. Die HRSD-Subskalen zeigten ebenfalls eine Besserung von etwa 30%. Patienten mit psychotischer Depression zeigten signifikant weniger Response.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 01/19
Die repetitive transkranielle Magnetstimulation (rTMS) findet seit einigen Jahren zunehmende Beachtung als potentielle Behandlungsform für eine Reihe von neurologischen und psychiatrischen Erkrankungen. Die umfangreichste Datenbasis liegt bisher für die behandlung depressiver Störungen vor. In früheren rTMS-Studien wurde ein antidepressiver Effekt nach hochfrequenter Stimulation des linken dorsolateralen präfrontalen Kortex (DLPFC) und nach niederfrequenter Stimulation des rechten DLPFC nachgewiesen. In den ersten Studien mit hochfrequenter rTMS bei gesunden Probanden wurde über hemisphärisch lateralisierte Effekte berichtet, mit einer Stimmungsverschlechterung nach Stimulation des linken DLPFC und Stimmungsverbesserung nach Stimulation des rechten DLPFC. Weitere Studien mit ähnlichen Stimulationsparameter konnten diese Ergebnisse jedoch nicht verifizieren. Stimmungseffekte nach niederfrequenter Stimulation wurden bei gesunden Probanden bislang nur in einer Studie untersucht. Effekte nach Stimulation des anteromedialen präfrontalen Kortex (AMPFC) wurden bislang nicht systematisch untersucht. Weitere, nicht stimmungsbezogene Befindlichkeitsqualitäten wurden bisher kaum einbezogen. Fragestellung der Arbeit war, ob sich auch bei niederfrequenter rTMS signifikante lateralisierte Stimmungseffekte nachweisen lassen. In einem explorativen Teil wurde zusätzlich untersucht, ob sich Veränderungen weiterer Befindlichkeitsqualitäten zeigen. Zusätzlich wurde explorativ der Einfluß bestimmter Persönlichkeitszüge auf die Reagibilität der Probanden bei den einzelnen Untersuchungsbedingungen untersucht. In einem randomisierten cross-over Design erhielten 16 rechtshändige Probanden eine niederfrequente rTMS (0,5 Hz, 150 Stimuli pro Sitzung, 120% der individuellen motorischen Schwelle) des rechten und linken DLPFC, rechten und linken AMPFC sowie des occipitalen Kortex. Die Messung der Stimmung und der Befindlichkeit erfolgte mit einer standardisierten Selbstrating-Skala (Eigenschaftswörterliste, Globalform) mit 15 Subskalen sowie mit 8 visuellen Analogskalen. Zur Messung der Persönlichkeitszüge wurden der NEO-FFI und der Sensation-Seeking-Test (SSS, Globalskala) eingesetzt. Bei allen Skalen zeigten sich deutliche individuelle Unterschiede und inkonsistente Reaktionen. Bei den Stimmungsskalen ergaben sich nach α-Korrektur keine signifikanten Effekte, Tendenzen waren jedoch erkennbar. Auch im direkten Vergleich zwischen den einzelnen Regionen fanden sich keine signifikanten Unterschiede. Bei den Befindlichkeitsskalen waren die Effekte z.T. stärker als bei den Stimmungsskalen. Nach rechts dorsolateraler Stimulation kam es vor allem zu einer Abnahme von Extravertiertheit, Vertrautheit, Konzentriertheit und des globalen Zustandes. Links dorsolateral fand sich im Wesentlichen eine Abnahme der Erregtheit sowie eine Zunahme der Verträumtheit und der Ruhe. Nach rechts anteromedialer Stimulation kam es vor allem zu einer Zunahme der Selbstsicherheit und von Ärger. Links anteromedial war eine Zunahme von Introvertiertheit und Benommenheit sowie eine Abnahme von Aktiviertheit, Empfindlichkeit und der Angst zu verzeichnen. Nach occipitaler Stimulation fanden sich kaum Änderungen. Im Vergleich zur occipitalen Kontrollbedingung zeigten sich rechts dorsolateral eine Zunahme der Empfindlichkeit und eine Abnahme der Aktiviertheit und der Vertrautheit, links dorsolateral eine Abnahme der Aktiviertheit und der Konzentriertheit. Rechts anteromedial fand sich eine Abnahme der Ängstlichkeit, links anteromedial eine Abnahme der Extravertiertheit und der Aktiviertheit. Im Direktvergleich rechts vs. links ergaben sich dorsolateral signifikante Seitenunterschiede in den Skalen „Extravertiertheit“, „Erregtheit“ und „Verträumtheit“, anteromedial bei den Skalen „Aktiviertheit“, “Benommenheit“ und „Extravertiertheit“. Auch im Vergleich dorsolateral vs. anteromedial ergaben sich signifikante Unterschiede: rechts bei den Skalen „Extravertiertheit“ und „Globaler Zustand“, links bei „Aktiviertheit“ und „Empfindlichkeit“. Bei der explorativen Untersuchung des Einflusses von Persönlichkeitsfaktoren fanden sich im Bereich der Stimmungsskalen keine signifikanten Korrelationen mit dem NEO-FFI. Bei der Persönlichkeitseigenschaft „Sensation Seeking“ (SS) ergaben sich Hinweise auf eine Beteiligung des linken AMPFC: In einem Extremgruppenvergleich kam es nach rTMS des linken AMPFC bei der Gruppe mit hohem SS zu einer leichten Stimmungsverbesserung, bei Probanden mit niedrigem dagegen eher zu einer Stimmungsverschlechterung. Tendenziell kam es nach rTMS im Vergleich beider Gruppen zu einer Angleichung der Stimmungslage. Der SSS könnte damit ein Prädiktor für ein unterschiedliches Ansprechen von Probanden auf niederfrequente rTMS des linken AMPFC sein. Die auf der Basis des explorativen Teils der vorliegenden Arbeit generierten Hypothesen müssen in zukünftigen kontrollierten Probandenuntersuchungen spezifisch getestet werden. Von zunehmender Bedeutung dürften dabei die Kombination mit weiteren Verfahren wie z.B. funktionelle Bildgebung, Neuronavigation, brain-mapping sein. Insgesamt zeigt sich, daß die Methode der rTMS ein wertvolles Forschungsinstrument zur Untersuchung der komplexen Funktion des prä-frontalen Kortex darstellt und damit zu einem verbesserten Verständnis der Regulation von Stimmung, Emotionen und Befindlichkeit beitragen kann.
Eric Berg has had seizures due to epilepsy since he was 12 years old. This past year, his seizures increased in frequency, affecting his day-to-day life and his ability to work. With encouragement from his fiancee, Eric sought treatment at Mayo Clinic. At Mayo Clinic, experts are using a new way to treat some seizure disorders: repetitive transcranial magnetic stimulation, or rTMS. This treatment uses a magnetic field to stimulate certain areas of the brain. While often used to treat depression, repetitive transcranial magnetic stimulation also is showing promise in treating seizures. On the Mayo Clinic Q&A podcast, Eric Berg shares his story. His physician, Dr. Jeffrey Britton, a neurologist and chair of the Division of Epilepsy at Mayo Clinic, also joins the podcast and explains how repetitive transcranial magnetic stimulation is used to treat seizure disorders. Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.04.24.059337v1?rss=1 Authors: Lukas, M., Oberhänsli, S., Buri, M., Le, N. D., Grandgirard, D., Bruggmann, R., Müri, R. M., Leib, S. L. Abstract: Pneumococcal meningitis (PM) causes damage to the hippocampus, a brain structure critically involved in learning and memory. Hippocampal injury - which compromises neurofunctional outcome - occurs as apoptosis of progenitor cells and immature neurons of the hippocampal dentate granule cell layer thereby impairing the regenerative capacity of the hippocampal stem cell niche. Repetitive transcranial magnetic stimulation (rTMS) harbours the potential to modulate the proliferative activity of this neuronal stem cell niche. In this study, specific rTMS protocols - namely continuous and intermittent theta burst stimulation (cTBS and iTBS) - were applied on infant rats microbiologically cured from PM by five days of antibiotic treatment. Following two days of exposure to TBS, differential gene expression was analysed by whole transcriptome analysis using RNAseq. cTBS provoked a prominent effect in inducing differential gene expression in the cortex and the hippocampus, whereas iTBS only affect gene expression in the cortex. TBS induced polarisation of microglia and astrocytes towards an inflammatory phenotype, while reducing neurogenesis, neuroplasticity and regeneration. cTBS was further found to induce the release of pro-inflammatory cytokines in vitro . We conclude that cTBS intensified neuroinflammation after PM, which translated into increased release of pro-inflammatory mediators thereby inhibiting neuroregeneration. Copy rights belong to original authors. Visit the link for more info
"A Show of Strength is a movement, where I try to encourage courage" Today, Jamie sits with Dr. Yuliya Knyahnytska and Dr. Colin Hawco to better understand rTMS (repetitive transcranial magnetic stimulation therapy) in the hopes that it will inspire others to seek the help they so richly deserve. Special Thanks to Dean Rainey, Karen Cleveland and the Temerty Centre for Therapeutic Brain Intervention. Brought to you by Try Thai Tonight Support this podcast at — https://redcircle.com/a-show-of-strength/donations
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