Journal of the American Psychiatric Nurses Association current issue

Transcranial Magnetic Stimulation (TMS): An Entirely Novel Form of Treatment in Psychiatry and a Groundbreaking Opportunity for Psychiatric Mental Health Nursing

Rosedale, M. — Wed, 11 Nov 2009 15:46:51 PST

Focus Issue Reviewer Acknowledgment

Wed, 11 Nov 2009 15:46:51 PST

A Review of Studies Comparing Methods for Determining Transcranial Magnetic Stimulation Motor Threshold: Observation of Movement or Electromyography Assisted

Anderson, B. S., George, M. S. — Wed, 11 Nov 2009 15:46:51 PST

BACKGROUND: Early in the development of transcranial magnetic stimulation (TMS) as a research tool, scientists developed the concept of motor threshold (MT) as a method of quantifying dose and establishing safety. Neurophysiologists determined the MT with the aid of peripheral electromyography (EMG). More recently, clinicians started substituting the EMG with observed movements (OM) of the hand or digits. It is unclear whether the two approaches (EMG and OM) reach similar conclusions about an individual’s cortical excitability and when best to use each approach. OBJECTIVE: To review TMS studies directly comparing the EMG and OM MT methods. DESIGN: A systematic search of the literature on Medline from January 1995 through April 2008. RESULTS: Four articles directly compared the two approaches, reaching different and opposing findings. CONCLUSION S: The evidence supporting the substitution of EMG with OM is sparse and conflicting. Clinicians stimulating at or near safety guidelines should use the EMG method.

Effective Utilization and Future Directions for Repetitive Transcranial Magnetic Stimulation: A Guide for Psychiatric Nurses

Fitzsimons, L., Disner, S. G., Bress, J. N. — Wed, 11 Nov 2009 15:46:51 PST

Repetitive transcranial magnetic stimulation (rTMS) and magnetic seizure therapy (MST) represent new and promising avenues for treating mild and severe treatment-resistant depression, respectively. A further understanding of these modalities and the contribution of psychiatric nurses in the emerging field of brain stimulation would be of great use to the nursing community. This article serves as a primer for those who are interested in participating in or referring patients for research or treatment with rTMS or MST. Of particular emphasis is the role of certified psychiatric nurses as clinical rater, patient liaison, and evidence-based practitioner:

A Psychiatric Nurse's Perspective: Helping Patients Undergo Repetitive Transcranial Magnetic Stimulation (rTMS) for Depression

Bernard, S., Westman, G., Dutton, P. R., Lanocha, K. — Wed, 11 Nov 2009 15:46:51 PST

With the October 2008 Food and Drug Administration approval of repetitive transcranial magnetic stimulation (rTMS) for depression treatment, the establishment and administration of rTMS clinical treatment programs are critically important and emerging areas for psychiatric nursing leadership. There is growing recognition that many patients are unable to tolerate antidepressant medications and require alternative antidepressant treatment approaches. The enormous growth in the field of brain stimulation creates exciting new therapeutic options for patients with treatment-resistant depression. As with any clinical breakthrough, new treatments offer exciting possibilities but also require growth in psychiatric nursing knowledge, different practice competencies, and new ways of organizing care. This article discusses current practice guidelines, psychiatric nursing qualifications, and essential details about developing an rTMS clinical service. This is the first article to describe the role of a psychiatric nurse establishing a clinical rTMS service, administering rTMS, and helping patients undergo the treatment. The authors share the progress made and the lessons learned.

The Structure of the Lived Experience for Persons Having Undergone rTMS for Depression Treatment

Rosedale, M., Lisanby, S. H., Malaspina, D. — Wed, 11 Nov 2009 15:46:51 PST

OBJECTIVE: This phenomenological research study reports preliminary findings about experiences of persons undergoing repeated transcranial magnetic stimulation (rTMS) for depression treatment. METHODS: Giorgi’s phenomenology was the method used to describe the structure of the lived experience for persons having undergone rTMS treatment for depression. Participants were recruited from the OPT-TMS pivotal depression study that resulted in the October 2008 FDA approval of rTMS. Thus far, nine persons comprise the purposive sample. Each participant was asked to describe the experience of undergoing rTMS for depression treatment and encouraged to provide as much details as possible. RESULTS: Four preliminary themes emerged to describe participants’ experiences of rTMS for depression treatment: (a) a narrative of frustration and helplessness with medication treatment resistance, (b) the sensory experience of rTMS, (c) mindfulness— an enhanced awareness of the content of consciousness, and (d) the importance of connection with clinicians. CONCLUSIONS: Preliminary results of this phenomenological study make the struggle of persons with treatment-resistant depression more visible and should assist clinicians to understand how rTMS is experienced by depressed persons undergoing treatment. Moreover, results shed new light on the changes participants observe and describe with rTMS and the high value they place on a therapeutic relationship with clinicians administering treatment.