Ruhsal Bozuklukların Tedavisinde Somatik Tedavi Seçenekleri
Özet
Ruhsal bozuklukların tedavisinde, psikofarmakoloji ve psikoterapinin yanı sıra özellikle dirençli durumlarda somatik tedavi yöntemlerine başvurulmaktadır. Noninvazif beyin uyarım tekniklerinden Elektrokonvulsif Terapi (EKT), suisid riski yüksek ve tedaviye dirençli majör depresyon ile katatoni gibi durumlarda en sık kullanılan, anestezi altında uygulanan etkin bir yöntemdir. Son dönemde kullanımı artan Tekrarlayan Transkraniyal Manyetik Uyarım (rTMS) ise bilişsel yan etki riski olmaksızın depresyon, OKB ve bağımlılık tedavisinde FDA onaylı olarak tercih edilmektedir. Diğer noninvazif yöntemler arasında transkraniyal doğru akım uyarımı (tDCS), deneysel aşamada olan manyetik nöbet terapisi (MNT) ve odaklanmış ultrason (FUS) yer alır. İnvazif yöntemlerden Derin Beyin Uyarımı (DBS), Parkinson'un yanı sıra dirençli OKB ve depresyonda belirli beyin çekirdeklerinin elektrotlarla uyarılması esasına dayanırken, Vagal Sinir Uyarımı (VNS) dirençli epilepsi ve depresyonda sol vagus sinirinin elektriksel stimülasyonunu içerir. Kronoterapötik yaklaşımlardan parlak ışık tedavisi (fototerapi) mevsimsel ve mevsimsel olmayan depresyonda sirkadiyen ritmi düzenlerken, uyku yoksunluğu tedavisi özellikle bipolar depresyonda hızlı antidepresan etki sağlar. Son olarak, tarihsel lobotomi uygulamalarından modern stereotaktik singulotomiye evrilen psikocerrahi, en dirençli vakalarda anatomik yolları modüle etmek için bir seçenek olarak varlığını sürdürmektedir.
In the treatment of mental disorders, somatic treatment methods are utilized alongside psychopharmacology and psychotherapy, particularly in treatment-resistant cases. Among non-invasive brain stimulation techniques, Electroconvulsive Therapy (ECT) is a highly effective method administered under anesthesia, most commonly used in major depressive disorder with high suicidal risk, treatment resistance, and conditions like catatonia. Repetitive Transcranial Magnetic Stimulation (rTMS), which has seen increased usage recently, is FDA-approved for depression, OCD, and addiction treatment without the risk of cognitive side effects. Other non-invasive methods include transcranial direct current stimulation (tDCS), and the experimental magnetic seizure therapy (MST) and focused ultrasound therapy (FUS). Among invasive methods, Deep Brain Stimulation (DBS) relies on stimulating specific brain nuclei via electrodes for resistant OCD and depression as well as Parkinson's disease, whereas Vagal Nerve Stimulation (VNS) involves electrical stimulation of the left vagus nerve for resistant epilepsy and depression. Regarding chronotherapeutic approaches, bright light therapy (phototherapy) regulates circadian rhythms in seasonal and non-seasonal depression, while sleep deprivation therapy provides a rapid antidepressant effect, especially in bipolar depression. Lastly, psychosurgery, which has evolved from historical lobotomy practices to modern stereotactic cingulotomy, remains an option to modulate anatomical pathways in the most refractory cases.
Referanslar
Lefaucheur J-P, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology. 2014;125(11):2150-206.
Milev RV, Giacobbe P, Kennedy SH, J, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments. The Canadian Journal of Psychiatry. 2016;61(9):561-75.
Dell’Osso B, Di Lorenzo G. NIBS 2020: How TMS and tDCS Acquisitions Have Set New Standards in Clinical Neuroscience. Non Invasive Brain Stimulation in Psychiatry and Clinical Neurosciences: Springer; 2020. p. 1-3.
Sadock BJ. Sadock’s compr. textbook of psych. Lippincott ; 2017.
Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. The Lancet. 1985;325(8437):1106-7.
Fitzgerald PB, Daskalakis ZJ. Repetitive transcranial magnetic stimulation treatment for depressive disorders: a practical guide: Springer Science 2013.
Anderson RJ, Hoy KE, Daskalakis ZJ. Repetitive transcranial magnetic stimulation for treatment resistant depression: Re-establishing connections. Clinical Neurophysiology. 2016;127(11):3394-405.
McClintock SM, Reti IM, Carpenter LL, et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. The Journal of clinical psychiatry. 2017;79(1):3651.
Blumberger DM, Vila-Rodriguez F,et al. Effectiveness of theta burst versus high-frequency rTMS in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet. 2018;391(10131):1683-92.
Mutz J, Vipulananthan V, Carter B, Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. bmj. 2019;364.
Wang H-N, Wang X-X, Zhang R-G, et al. Clustered repetitive transcranial magnetic stimulation for the prevention of depressive relapse/recurrence: a randomized controlled trial. Translational psychiatry. 2017;7(12):1-9.
Bikson M, Inoue M, et al. Effects of uniform extracellular DC electric fields on excitability in rat hippocampal slices in vitro. J. of phys.. 2004;557(1):175-90.
Woods AJ, Antal A, Bikson M, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Cli. neurophysology. 2016;127(2):1031-48.
Brunoni AR, Sampaio-Junior B, Moffa AH,, et al. Noninvasive brain stimulation in psychiatric disorders. Brazilian Journal of Psyc. 2018;41:70-81.
Hunter MA, Coffman BA, Gasparovic C, Baseline effects of transcranial direct current stimulation on glutamatergic neurotransmission and large-scale network connectivity. Brain research. 2015;1594:92-107.
Grimm S, Beck J, Schuepbach D,et al.Imbalance between left and right DLPFC in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Bio. psyc.. 2008;63(4):369-76.
Brunoni AR, Moffa AH, Fregni F, et al. tDCS for acute MD episodes: meta-analysis of individual patient data. The British J. of Psyc. 2016;208(6):522-31.
Cretaz E, Brunoni AR, Lafer B. Magnetic seizure therapy for unipolar and bipolar depression: a systematic review. Neural Plasticity. 2015
Semkovska M, McLoughlin DM. Objective cognitive performance associated with ECT for depression: a systematic review. Bio. psyc. 2010;68(6):568-77.
Toccaceli G, Barbagallo G, Peschillo S. Low-intensity focused ultrasound for the treatment of brain diseases: safety and feasibility. Theranostics. 2019;9(2):537.
Lee W, Kim H, Lee S,. Creation of various skin sensations using pulsed focused ultrasound: evidence for functional neuromodulation. International journal of imaging systems and technology. 2014;24(2):167-74.
Tyler WJ. Noninvasive neuromodulation with ultrasound? A continuum mechanics hypothesis. The Neuroscientist. 2011;17(1):25-36.
Min B-K, Bystritsky A, Jung K-I, et al. FUS suppression of chemically-induced acute epileptic EEG activity. BMC neuroscience. 2011;12(1):1-12.
Staudt MD, Herring EZ, Gao K, Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation. Frontiers in neuroscience. 2019;13:108.
Dougherty DD. Deep brain stimulation: clinical applications. Psychiatric Clinics of North America. 2018;41(3):385-94.
Nuttin B, Cosyns P, Demeulemeester H, ES in anterior limbs of internal capsules in patients with OCD. The Lancet. 1999;354(9189):1526.
Greenberg B, Gabriels L, Malone D, et al. DBS of the ventral internal capsule/ventral striatum for OCD: worldwide. Mol. psyc. 2010;15:64
Goodman WK, Price LH, Rasmussen SA, et al. The YBOCS: I. Development, use, and reliability. Archives of general psychiatry. 1989;46(11):1006-11.
Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe OCD. New England Journal of Medicine. 2008;359(20):2121-34.
Mayberg HS, Lozano AM, Voon V, McNeely HE, et al. DBS for treatment-resistant depression. Neuron. 2005;45(5):651-60.
Bewernick BH, Hurlemann R, Matusch A, et al. Nucleus accumbens DBS decreases ratings of depression and anxiety in TRD. Bio. psyc. 2010;67(2):110-6.
Ruffoli R, Giorgi FS, Pizzanelli C, The chemical neuroanatomy of VNS. Journal of chemical neuroanatomy. 2011;42(4):288-96.
Zagon A. Does the vagus nerve mediate the sixth sense? Trends in neurosciences. 2001;24(11):671-3.
Krahl SE. VNS for epilepsy: A review of the peripheral mechanisms. Surgical neurology international. 2012;3(Suppl 1):S47.
Howland RH. VNS. Currentbehav.neurosciencereports. 2014;1(2):64
Özdemir PG, Yilmaz E, Selvi Y, Boysan M. Psikiyatride Parlak Işık Tedavisi. Psikiyatride Güncel Yaklaşımlar. 2017;9(2):177-88.
Pail G, Huf W, Pjrek E, et al. Bright-light therapy in the treatment of mood disorders. Neuropsychobiology. 2011;64(3):152-62.
Selvi Y, Besiroglu L, Aydin A. Chronobiology and Mood Disorders /Current Approaches to Psychiatry. 2011;3(3):368-87.
Carskadon MA, Dement WC. Normal human sleep: an overview. Principles and practice of sleep medicine. 2005;4(1):13-23.
Avery DH, Khan A, Dager SR,Morning or evening BLT of winter depression? The significance of hypersomnia.Biological Psychiatry. 1991
Eastman CI, Young MA, Fogg LF, BLT of winter depression: a placebo-controlled trial. Archives of general psychiatry. 1998;55(10):883-9.
Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS spectrums. 2005;10(8):647-63.
Westrin Å, Lam RW. Seasonal affective disorder: a clinical update. Annals of Clinical Psychiatry. 2007;19(4):239-46.
Rosenthal NE, Sack DA, Carpenter CJ, LENGTH: 5520 words TITLE: Antidepressant Effects of Light in Seasonal Affective Disorder. Am J Psychiatry. 1985
Wirz-Justice A, Benedetti F, Terman M. Chronotherapeutics for Affective Disorders: A Clinician's Manual for Light and Wake Therapy, 2nd: Karger Medical and Scientific Publishers; 2013.
Benedetti F, Colombo C. Sleep deprivation in mood disorders. Neuropsychobiology. 2011;64(3):141-51.
Ramirez-Mahaluf JP, Rozas-Serri E, Ivanovic-Zuvic. Effectiveness of sleep deprivation in treating acute bipolar depression as augmentation strategy: a systematic review and meta-analysis. Frontiers in psychiatry. 2020;11:70.
Stone JL. Dr. Gottlieb Burckhardt the pioneer of psychosurgery. Journal of the History of the Neurosciences. 2001;10(1):79-92
Fulton JF, editor The functions of the frontal lobes: a comparative study in monkeys, chimpanzees, and man. Abstracts of the second international neurological congress; 1935.
Rekate HL. Occipital plagiocephaly: a critical review of the literature. Journal of neurosurgery. 1998;89(1):24
Whitty C, Duffield J, Tow P, Anterior cingulectomy in the treatment of mental disease. The Lancet. 1952
Brinegar W, editor Psychosurgery in a state hospital: clinical evaluation of results. The Third World Congress of Psychiatry; 1961
