Brain Stimulation in Psychiatry

Transcription

1 Brain Stimulation in Psychiatry ECT, DBS, TMS, and Other Modalities

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3 Brain Stimulation in Psychiatry ECT, DBS, TMS, and Professor, Department of Psychiatry, and Chief, Division of Geriatric Psychiatry, Mount Sinai School of Medicine, New York, NY, USA

4 cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Mexico City Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York Information on this title: / This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2012 Printed in the United Kingdom at the University Press, Cambridge A catalog record for this publication is available from the British Library Library of Congress Cataloging in Publication data Kellner, Charles H., 1952 Brain stimulation in psychiatry : ECT, DBS, TMS, and other modalities /. p. ; cm. Includes bibliographical references and index. ISBN (pbk.) I. Title. [DNLM: 1. Electroconvulsive Therapy. 2. Deep Brain Stimulation. 3. Mental Disorders therapy. 4. Patient Selection. 5. Transcranial Magnetic Stimulation. 6. Vagus Nerve Stimulation. WM 412] dc ISBN Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet Websites referred to in this publication, and does not guarantee that any content on such Websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

5 This book is dedicated to my wife, Andrea, with appreciation for her unending patience and support.

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7 Contents Acknowledgments List of contributors page ix x 1 Introduction 1 2 Electroconvulsive Therapy (ECT): Basic Concepts 3 Basic Concepts 3 Overview 3 Theories of Mechanism of Action 5 Basics of Electricity 8 Medical Physiology 10 3 Electroconvulsive Therapy (ECT): Patient Selection and Preparation 17 Indications 17 The Pre-ECT Evaluation 19 ECT in Specific Medical Conditions 21 Concurrent Medications 25 Informed Consent 30 4 Electroconvulsive Therapy (ECT): Technique 37 Electrode Placement 37 Stimulus Dosing 41 Electrode Site Preparation 46 Physiological Monitoring 50 Anesthetics and Muscular Relaxation 56 Cardiovascular Agents 61 Missed, Short, and Prolonged Seizures 63 Treatment Procedure 67 5 Electroconvulsive Therapy (ECT): Treatment Course 73 Treatment Schedule 73 Clinical Monitoring 74 Continuation/Maintenance ECT 75 6 Electroconvulsive Therapy (ECT): Common Adverse Effects 79 Cognition 79 Headache, Muscle Aches, and Nausea 81 7 Electroconvulsive Therapy (ECT): The ECT Service 83 Staffing and Administration 83 The ECT Suite 84 Record Keeping 84 8 Electroconvulsive Therapy (ECT): Special Issues 87 Stigma 87 Malpractice Litigation and Insurance 87 Research 87 9 Deep Brain Stimulation (DBS) Wayne K. Goodman and Ron L. Alterman 89 Basic Concepts 89 Pre-operative Evaluation 90 vii

8 viii Contents The DBS Device 91 The Surgical Procedure 91 Activation and Programming of the DBS Devices 94 DBS in Obsessive-Compulsive Disorder (OCD) 94 DBS in Depression 95 Adverse Effects 96 Conclusions Transcranial Magnetic Stimulation (rtms) Eran Chemerinski 103 Basic Concepts 103 Patient Selection and Preparation 105 Technique 113 Common Adverse Effects 116 The rtms Service 119 Conclusions Magnetic Seizure Therapy (MST) 127 Introduction 127 MST in Depression 128 Future Directions Vagus Nerve Stimulation (VNS) 131 Introduction 131 Background and Neurobiology 131 Studies in Depression 132 Patient Selection 132 Conclusions Transcranial Direct Current Stimulation (tdcs) 135 Transcranial Direct Current Stimulation 135 Overview and Theoretical Background 135 Clinical Uses Epidural Cortical Stimulation (EpCS) 139 Introduction 139 Technique 139 Clinical Trials in Depression 139 Conclusions 140 Index 143

9 Acknowledgments I would like to acknowledge the skillful assistance of Rosa Pasculli and Mimi Briggs in the preparation of the manuscript. ix

10 Contributors Ron L. Alterman, MD Department of Neurosurgery, Friedman Brain Institute of the Mount Sinai School of Medicine, New York, NY, USA Eran Chemerinski, MD Assistant Professor, Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA Wayne K. Goodman, MD Esther and Joseph Klingenstein Professor and Chair of Psychiatry, Professor of Neuroscience, Mount Sinai School of Medicine, New York, NY, USA, MD Professor, Department of Psychiatry, Chief, Division of Geriatric Psychiatry, Mount Sinai School of Medicine, New York, NY, USA x