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Novel Neurostimulation Therapeutic Approaches for Treatment-Resistant Psychiatric Disorders

  • Ralph J. KoekEmail author
  • Janine Roach
  • Nicholas Athanasiou
  • Arkady Korotinsky
Chapter

Abstract

Direct electrical alteration of brain circuitry—neuromodulation—is the oldest somatic treatment still used in psychiatry since the arrival of ECT in 1938. This chapter reviews the expansive literature on neuromodulatory strategies that are either clinically available (ECT, rTMS, VNS) or under investigation (TNS, tDCS, DBS) for the treatment of psychiatric disorders refractory to standard (psychotherapy or pharmacotherapy) treatments. Rather than attempt a full review of each modality, this chapter will focus on the current (September 2017) state of knowledge on how each modality may contribute to relieving the tremendous suffering of individuals afflicted with refractory psychiatric conditions and what the future may hold. In particular, this section will address treatment-refractory addiction, anxiety disorders, bipolar disorder, depression, OCD, PTSD, and schizophrenia but, because of space limitations, will exclude cognitive, eating, or developmental disorders even though neuromodulation has been tried experimentally for these other conditions.

Keywords

Neuromodulation Psychiatric disorders Electroconvulsive therapy (ECT) Transcranial magnetic stimulation (TMS) Transcranial direct current stimulation (tDCS) Trigeminal nerve stimulation (TNS) Vagal nerve stimulation (VNS) Deep brain stimulation (DBS) 

Abbreviations

BD

Bipolar disorder

BDI

Beck depression inventory [1]

CAPS

Clinician administered posttraumatic stress disorder rating scale [2]

CBT

Cognitive-behavioral therapy

CGI

Clinical global impressions [3]

DLPFC

Dorsolateral prefrontal cortex

HDRS

Hamilton depression rating scale [4]

MADRS

Montgomery-Asberg depression rating scale [5]

NAc

Nucleus accumbens

OCD

Obsessive-compulsive disorder

OFC

Orbitofrontal cortex

PTSD

Post-traumatic stress disorder

SCG

Subgenual cingulate gyrus

SZP

Schizophrenia

TRD

Treatment-resistant depression

vALIC

Ventral anterior limb of the internal capsule

VC/VS

Ventral internal capsule/ventral striatum

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Ralph J. Koek
    • 1
    • 2
    Email author
  • Janine Roach
    • 1
    • 2
    • 3
  • Nicholas Athanasiou
    • 1
    • 2
  • Arkady Korotinsky
    • 1
    • 2
  1. 1.Mood Disorders Clinic, Sepulveda Amublatory Care CenterVA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of PsychiatryOlive View-UCLA Medical CenterSylmarUSA

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