Focus Live Sessions Delve into Cutting-Edge Neurotherapeutics, Obsessive-Compulsive Disorders

For many years, advances in psychiatry were centered around new synaptic-based treatments, chiefly psychotropic medications aimed at regulating neurotransmitters in the brain. In the last decade, however, approval of new medications with novel mechanisms of action has proved elusive.

Now new circuit-based treatments, such as repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation, are leading the pack when it comes to psychiatric advances, Alexander Bystritsky, M.D., Ph.D., professor emeritus at University of California, Los Angeles, and CEO of BrainSonix Corp., told Psychiatric News.

“The benefits are clear for these types of neuromodulation treatments. We’re moving from administering treatments globally to the brain toward circuit-specific treatments,” he said. “These can improve symptoms of refractory depression when other treatments have failed.” Bystritsky served as guest editor of the most recent Focus issue on the same subject. He will lead the Focus Live session, delving into how these novel neurotherapeutics tools work and how they are being used to study and treat mental illness.

Replacing other technologies that required surgery or the implantation of electrodes, rTMS is a noninvasive procedure with fewer side effects than electroshock therapy, Bystritsky said. It is well accepted by patients, and health insurance companies have started approving coverage of these treatments in certain circumstances, he added. In addition to refractory depression, the Food and Drug Administration has now approved rTMS for obsessive-compulsive disorder, anxiety, and smoking cessation. Research is also underway for its potential use in treating patients with substance use disorders.

“I have seen amazing results in some patients and not so amazing results in others,” said Bystritsky, who conducted clinical trial work for rTMS. “We haven’t yet learned how to predict who will have the best response to these treatments.” He added that initial targeting was primitive, and recent refinements using guided imaging are poised to change that.

Other approaches that will be discussed at the session include deep brain stimulation as well as noninvasive vagus nerve stimulation. Recent research data for the latter has renewed interest in its use for treatment-resistant depression, Bystritsky said. The session will also review advances in focused ultrasound/low intensity focused ultrasound pulsation.

Focus Editor-in-Chief Mark Hyman Rapaport, M.D., CEO of the Huntsman Mental Health Institute, the William H. and Edna D. Stimson Presidential Endowed Chair, and the chair of psychiatry at the University of Utah School of Medicine, will also give a presentation at the session. He told Psychiatric News the goal is to inform psychiatrists about the many potential new approaches for treatment now available.

“There’s a tremendous opportunity in refining these techniques, for example, using approaches that combine MRI imaging with rTMS or focused ultrasound to develop more precise, guided approaches to care that enhance results,” he said. “It’s a really exciting time when we think about what the future may bring to the field of psychiatry. Within the next decade we expect to see tremendous advances in neuromodulation treatment approaches for our patients. This session will give a glimpse into the future.”

Focus Live on OCRD

With the publication of DSM-5 in 2013, obsessive-compulsive and related disorders (OCRD) were granted their own diagnostic classification, separate from anxiety disorders, as well as new specifiers for the presence of tics and the degree of the patient insight.

“Since that time a flurry of literature has advanced understanding of these conditions, particularly for body dysmorphic disorder, hoarding, trichotillomania, and skin picking,” Michele T. Pato, M.D., director of the Center for Genomics of Psychiatric Health and Addictions and a professor of psychiatry at Rutgers Robert Wood Johnson Medical School and New Jersey Medical School, told Psychiatric News.

“These conditions have important distinctions from anxiety disorder and do not respond the same way to treatment. … This session will be valuable for all levels of psychiatrists and faculty who treat OCRD, especially for those who have completed their training before 2013,” she said.

The Focus Live session will delve into the latest advances in diagnosing these conditions along with their genetic underpinnings, frequent comorbid conditions, neurobiology, and treatment protocols, both pharmacologic and psychotherapeutic. Attendees will have the opportunity to learn from some of the foremost OCRD experts, including Pato, who has focused on OCRD since meeting her first patient with the disorder as a resident 38 years ago. As well as serving as guest editor for two Focus issues on OCRD, Pato has written extensively on the phenotypic data on patients with OCD and is now working with the Genomic Psychiatry Cohort to complete a genomewide association study of 5,000 individuals with the illness.

“This is a really exciting session and one that will allow us to take advantage of the knowledge of the experts who will be presenting. They’re all friends, and there will undoubtedly be a lot of repartee between them,” Rapaport said.

Fun, Quiz-Style Session Formats

Focus Live sessions give psychiatrists a chance to put their knowledge of novel neurotherapeutics and OCDR to the test.

Participants can respond using audience response keypads; the correct answer will then be displayed, along with an explanation of why that answer is best. Pato said that the sessions will be highly interactive, based on audience response to the quiz questions. “If many attendees fail to get a particular answer correct, the panelists will be prepared with an extra slide or two on that concept to enhance understanding.”

Members who attend will be able to later test their knowledge and earn self-assessment credit for MOC Part II. ■