Interventional Psychiatry

Road to Novel Therapeutics

1st Edition - April 16, 2024
Editors: Joao Quevedo, André R. Brunoni, Clement Hamani
Language: English
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 8 4 9 7 - 0

Recent advances in pharmacology and brain stimulation have led to the development of novel treatments for psychiatric disorders. These new advances have led to the development of… Read more

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Recent advances in pharmacology and brain stimulation have led to the development of novel treatments for psychiatric disorders. These new advances have led to the development of a new subspecialty, Interventional Psychiatry.

Interventional Psychiatry: Road to Novel Therapeutics reviews all specialized treatments including device-based interventions such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS). This book discusses the procedure-based pharmacologic interventions including ketamine infusion therapy and psychedelic therapies. Internationally contributed, this book outlines the state of the field, as well as implications for training and the role of the interventional psychiatrist in treatment teams.

Cover image
Title page
Table of Contents
Copyright
Contributors
Foreword
Chapter 1. Interventional therapeutics in psychiatry: Beyond psychopharmacology and psychotherapy?
Introduction
Theoretical conceptualization
Targets and mechanisms of action
Personalizing treatment
Challenges for evidence-based medicine
Training and collaboration
Perspectives
Chapter 2. Proposed curriculum for an interventional psychiatry fellowship program
Background
The emergence of interventional psychiatry
Why is it important to have an interventional psychiatry fellowship?
Overview of current interventional psychiatry training
Proposed curriculum for an interventional psychiatry fellowship
Alternatives to an interventional psychiatry fellowship
Moving toward board certification
Chapter 3. Mechanisms of action of transcranial magnetic stimulation
How does TMS work?
How does TMS depolarize neuronal structures?
Which neurons are depolarized by TMS?
TMS effects depend on the state of the neuronal structures
Possible clinical uses of single- and paired-pulse TMS
Modulation of cortical responses by repetitive TMS
Chapter 4. Transcranial magnetic stimulation in psychiatric disorders
Introduction
rTMS for major depressive disorder
rTMS for obsessive-compulsive disorder
rTMS for other disorders
Summary
Chapter 5. Therapeutic use of repetitive transcranial magnetic stimulation (rTMS) in neurological disorders
Introduction
Chronic neuropathic pain
Fibromyalgia
Other chronic pain syndromes
Parkinson's disease
Other movement disorders
Motor stroke
Poststroke aphasia
Poststroke neglect
Amyotrophic lateral sclerosis
Multiple sclerosis
Epilepsy
Disorders of consciousness
Cognitive impairment and Alzheimer's disease
Tinnitus
Functional neurological disorders
Conclusion
Chapter 6. Mechanisms of action of transcranial direct current stimulation
Introduction
Neurophysiological effects of tDCS
tDCS effects on cortical regions other than M1
The impact of tDCS on brain functional connectivity and topological functional organization
Non-neuronal effect of tDCS
Chapter 7. Transcranial direct current stimulation in psychiatric disorders
Introduction
Technical aspects
The clinical uses of tDCS for psychiatric disorders
Chapter 8. Transcranial Direct Current Stimulation in neurological disorders
Introduction
tDCS principles and mechanisms
tDCS in neurological disorders
Future directions
Chapter 9. Mechanism of action of electroconvulsive therapy
Introduction
Structural effects
Functional effects
Molecular effects
Conclusion
Chapter 10. Convulsive therapy for psychiatric disorders
What is convulsive therapy?
Modern ECT delivery
Who is a suitable candidate for ECT?
Adverse effects of ECT
How to manage the ECT course
Comparison of ECT with other interventional psychiatry approaches
Advances in convulsive therapy
Conclusion
Chapter 11. Cognitive effects of convulsive therapies
Introduction
Cognitive effects of ECT
Effects of treatment techniques on cognitive outcomes
Effects of patient factors on cognitive outcomes
Monitoring cognition across the ECT treatment course
Future directions
Chapter 12. Mechanisms of action of vagus nerve stimulation
Introduction
Anatomical and functional pathways of the vagus nerve
Vagal nerve stimulation
Mechanism of action of vagal nerve stimulation
Brain imaging studies
Conclusion
Chapter 13. VNS for mood disorders
Introduction
Principle of VNS therapy
Safety and tolerability
Indications and efficacy
Patient selection
Patient education and shared decision-making
Pathway development
Summary
Chapter 14. Ketamine in psychiatry
Introduction
The pharmacology of ketamine
Routes of administration and common formulations
Moderators/predictors of response
Continuation/maintenance approaches
Safety, tolerability, and side effects
Conclusion
Chapter 15. Psychedelics in psychiatry
Serotoninergic psychedelics or classic hallucinogens
Major depressive disorder
Cancer-related depression and/or anxiety
Anxiety disorders
Substance use disorders
Other psychiatric disorders
Possible mechanisms
Conclusions
Chapter 16. The use of inhaled gases in psychiatry
Introduction
Treatment-resistant major depression
Nitrous oxide
Isoflurane
Xenon
Chapter 17. Mechanisms of deep brain stimulation for psychiatric disorders
Introduction
History of DBS in psychiatry
Mechanisms of deep brain stimulation: From micro to macro
Future directions
Summary
Chapter 18. Deep brain stimulation for obsessive-compulsive disorder
Introduction
Indication for DBS and contraindications
Deep brain stimulation and procedure
Targets in deep brain stimulation
Outcomes of DBS
Predictors of response
Neurobiological effects of DBS in OCD patients
Implementation of DBS in clinical practice
Discussion
Chapter 19. Deep brain stimulation for depression
Introduction
Psychosurgery
The modern DBS procedure
Anatomical targets of DBS for treatment-refractory depression
Conclusions
Chapter 20. Radiofrequency lesions for psychiatric disorders
Introduction
Historical perspective
Patient selection
Radiofrequency lesioning techniques
Results
Discussion
Conclusions
Chapter 21. Gamma Knife for psychiatric indications
Background and history
Main indications
Neuropsychological and personality aspects
Radiobiological aspects
Discussion
Conclusion
Chapter 22. Focused ultrasound for psychiatric indications
Introduction
Focused ultrasound
Obsessive-compulsive disorder
Major depressive disorder
Limitations and future directions
Index

Joao Quevedo

Dr. João Luciano de Quevedo, MD, PhD, is a Professor of Psychiatry at the McGovern Medical School, the University of Texas Health Science Center at Houston, where he is the Vice-Chair for Faculty Development and Outreach, Director of the Translational Psychiatry Program, and Director of the Treatment-Resistant Depression Clinic. Before moving to Houston, he was a Dean at the University of Southern Santa Catarina Medical School, Criciúma, SC, Brazil, where he is still an Adjunct Professor of Psychiatry. He is also Editor-in-Chief of the Brazilian Journal of Psychiatry and Director of the Continuous Medical Education Program in Psychiatry (PROPSIQ) of the Brazilian Psychiatric Association. Dr. Quevedo’s research interest is neurobiology of psychiatric disorders, particularly mood disorders, and he is a specialist in both unipolar and bipolar treatment–resistant depression. He is author of nearly 600 publications and 10 scientific books.

Affiliations and expertise

Professor of Psychiatry at the McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA

André R. Brunoni

Dr. André Brunoni graduated in Medicine in 2004 and specialized in Internal Medicine and Psychiatry in 2007 and 2010. Dr. Brunoni did his PhD from 2010 to 2012 in the University of São Paulo, Brazil, with a 4-month fellowship at Spaulding Rehabilitation Hospital, Harvard Medical School. Currently, Dr. Brunoni is the Director of two clinical and research centers in leading university hospitals of the University of São Paulo—the Institute of Psychiatry in the Clinics Hospital and the University Hospital. He supervises postgraduate and graduate students as well as medical residents and students. His research involves the use of noninvasive brain stimulation techniques, such as transcranial direct current stimulation, transcranial magnetic stimulation, and “deep” transcranial magnetic stimulation in the treatment of mental disorders, such as mood disorders, obsessive-compulsive disorder, and schizophrenia. He is a very productive and active researcher, with more than 100 published articles in PubMed peer-reviewed journals.

Affiliations and expertise

University of São Paulo Brazil

Clement Hamani

Dr. Clement Hamani is the Research Director of the Hurvitz Brain Sciences Program, Senior Scientist at the Sunnybrook Research Institute, Full Professor in Surgery/Neurosurgery at the University of Toronto, preclinical lead of the Harquail Centre for Neuromodulation, and neurosurgeon at the Sunnybrook Health Sciences Centre in Toronto, Canada. Dr. Hamani’s research focus is the development of new ways of modulating the function of the nervous tissue, and discovering new applications for techniques that stimulate the brain and spinal cord to treat neurological and psychiatric disorders. His work ranges from basic research in preclinical models to clinical trials.

Affiliations and expertise

Sunnybrook Research Institute, Toronto, Canada