rTMS

[solumanculver]

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Hey,
I'm really interested in psychiatry and have a few questions for you guys, if you care to answer. First of all, what kind of training do you get in rTMS in residency, and what are your opinions on it as a therapy for depression. And also, is there a future for this therapy in other psychiatric and/or neurologic diseases?

Also, as a more general question, how is psychodymanic theory related to a biological view of psychiatric disease? Don't they give entirely different explanations for the same diseases? Do most psychiatrists embrace a kind of philosophical dualism regarding the brain and mind that's reflected in the two different modes of treatment, or is there an underlying assumption that psychodynamic relations are metaphors for relations between different brain modules? I might be displaying my ignorance here, I've read a lot of Freud and Jung, but not much after them. I'm assuming, though, that there still has to be an element of interaction between the ego, superego, and id in the theory...

Thanks for your help

 

[Doc Samson]

Hey,
I'm really interested in psychiatry and have a few questions for you guys, if you care to answer. First of all, what kind of training do you get in rTMS in residency, and what are your opinions on it as a therapy for depression. And also, is there a future for this therapy in other psychiatric and/or neurologic diseases?

Also, as a more general question, how is psychodymanic theory related to a biological view of psychiatric disease? Don't they give entirely different explanations for the same diseases? Do most psychiatrists embrace a kind of philosophical dualism regarding the brain and mind that's reflected in the two different modes of treatment, or is there an underlying assumption that psychodynamic relations are metaphors for relations between different brain modules? I might be displaying my ignorance here, I've read a lot of Freud and Jung, but not much after them. I'm assuming, though, that there still has to be an element of interaction between the ego, superego, and id in the theory...

Thanks for your help

rTMS is still fairly experimental, and isn't widely recognized (or covered by insurance) as a current treatment for anything, so as of now residents are not trained in rTMS.

Speaking only for myself, I believe that intrapsychic conflicts can manifest as physical disordrs through effects on neurotransmitters, so no... psychiatrists don't need to maintain a theoretical dualism.

 

[nortomaso]

There is a large multi-centered trial of rTMS vs sham in the treatment of depression that is currently wrapping up. The data should be released in June and will determine whether it is approved by the FDA for the treatment of depression. I interviewed at a dozen programs and two of them (WashU and UPENN) had rotations in TMS built into the residency.

 

[nortomaso]

And also, is there a future for this therapy in other psychiatric and/or neurologic diseases?
.

Ralph Hoffman at Yale has published good data on the use of slow freq TMS for treatment resistant auditory hallucinations in schizophrenia. sarah Lisanby at Columbia is studying the potential of high freq TMS for the treatment of negative symptoms.

 

[PublicHealth]

Tons of well-written reviews on rTMS out there: http://www.ncbi.nlm.nih.gov/entrez/...uids=16097402&query_hl=54&itool=pubmed_DocSum

 

[solumanculver]

Hey,
Thanks a lot for all of your responses. I'm not sure whether it's justified or not, given the lack of strong data on its efficacy, but the concept of rTMS has made me really excited about psychiatry. Is there any sense that the field of psychiatry might be changed in any radical way by this kind of technology? It's almost like being able to turn different parts of a persons brain on and off.

Back on the subject of psychodynamic therapy, or any therapy really, what do neuroimaging studies show the results to be, and how are they theoretically achieved? Are there specific trends in the imaging after the therapy regardless of the specific disorder, such as "Psychodynamic therapy increases brain activity in X region", or is it a more general trend, like "Therapy makes all patients imaging look more like normal images"? I'm assuming that most psychiatric diseases make some imprint on neuroimaging, so you can correct me if I'm wrong.

 

[PublicHealth]

Hey,
Thanks a lot for all of your responses. I'm not sure whether it's justified or not, given the lack of strong data on its efficacy, but the concept of rTMS has made me really excited about psychiatry. Is there any sense that the field of psychiatry might be changed in any radical way by this kind of technology? It's almost like being able to turn different parts of a persons brain on and off.

Back on the subject of psychodynamic therapy, or any therapy really, what do neuroimaging studies show the results to be, and how are they theoretically achieved? Are there specific trends in the imaging after the therapy regardless of the specific disorder, such as "Psychodynamic therapy increases brain activity in X region", or is it a more general trend, like "Therapy makes all patients imaging look more like normal images"? I'm assuming that most psychiatric diseases make some imprint on neuroimaging, so you can correct me if I'm wrong.

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16164763&query_hl=9&itool=pubmed_docsum

 

[solumanculver]

http://www.ncbi.nlm.nih.gov/entrez/..._uids=16164763&query_hl=9&itool=pubmed_docsum

Thank you for your very informative, and concise, replies...

 

[needinformation]

There is quite a bit of research going on at Stanford about various stimulation type treatment for depression. There is a new thought that dep is a pathway disease, instead of just neurotransmitter stuff. Therefore, I think it is up and coming. It is the age of the brain, after all.
As for Freud/Jung, check out Dr. Mitchell's writing, Freud and Beyond, there is much more than ego psychology. The Kleinian thought and the object relations thought are both very important.
The reason I love psychiatry is that nothing is ever so black and white. There are multiple ways of understanding a person's difficulty, and that there are multiple ways of making a person better, let it be ECT, or meds, or CBT, or psychodynamic therapy. Keeps me on my toes and l enjoy the intellectual stimulation.