Program Schedule

12:00pm     Lunchtime Discussion Tables – Seating is limited, but we will do our best to accommodate your request for a seat at a Discussion Table.    General lunchtime seating is available if we are unable to assign you to a Discussion Table and for all other attendees.

    1. Practical Steps to Setting Up a TMS Study - Facilitator: Brian Coffman, PhD
    2. Regulatory Processes Involving the IRB and FDA Associated with TMS Studies - Facilitator: Fabio Ferrarelli, MD, PhD

1:00pm    Welcome & Introduction - David A. Lewis, MD

1:10pm    Session 1: Non-Invasive Brain Stimulation via Induced Electric Fields, an Introduction to the Biophysics and Neurophysiology and     of Transcranial Magnetic Stimulation (TMS)     Brian Coffman, PhD
Over the past two decades, therapeutic use of Transcranial Magnetic Stimulation (TMS) has expanded in interventional psychiatry, with FDA-approved indications for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), and potential for treatment and diagnosis of many other psychiatric disorders. TMS is performed as an outpatient procedure, typically five times a week for four to six weeks and does not require anesthesia or sedation. During TMS, brief and strong magnetic fields are generated by an electric coil that is placed on the scalp, and these magnetic fields induce focal electric currents in the brain that are strong enough to stimulate neurons. Specific brain areas can be targeted using neuroimaging guided TMS; however, target selection is limited by coil distance, among other considerations. This talk will briefly delve into these and other methodological considerations for TMS in interventional psychiatry. 

1:25pm    Session 2: Theta Burst Stimulation to Frontostriatal Reward Circuitry in Young Adults with Depression    Erika Forbes, PhD

Depression disrupts positive and negative affect, yet traditional rTMS treatment for depression targets the cognitive regulation of negative affect only. Young adults with depression present a unique opportunity for intervention because they are early in their clinical course and at a developmental point of plasticity in reward circuitry. Based on the hypothesis that the mechanism of disrupted positive affect is altered frontostriatal reward circuit function, which occurs through over-regulation of the ventral striatum (VS) by the dorsomedial prefrontal cortex (dmPFC), we used an experimental, within-subjects approach to target dmPFC with theta burst stimulation (TBS), a condensed form of TMS. Young adults with depression underwent 1 session each of intermittent, continuous, and sham TBS in counterbalanced order, plus fMRI and mood assessment pre/post TBS. Resting functional connectivity between VS and dmPFC decreased only with continuous TBS, a technique postulated to reduce cortical activity through long-term-depression-type effects. Young people with greater functional connectivity decreases experienced greater increases in positive affect, indicating the value of targeting reward circuitry to enhance positive affect and possibly improve depression.
 
1:40pm    Session 3: Targeting Reward Circuitry with TBS in Bipolar Disorder: Toward a Novel Intervention for Mania    Mary Phillips,  MD, MD (CANTAB)
This presentation focuses on how the Mood and Brain Lab’s research has identified specific abnormalities in the reward neural network that are associated with predisposition to mania/ hypomania. Dr. Phillips will discuss how researchers  have begun to target these neural abnormalities with TBS as a first step toward developing a new intervention to help reduce mania/ hypomania risk in individuals with bipolar disorder and in individuals at risk for future mania/ hypomania and thus bipolar disorder. 
1:55pm    Discussion and Q&A - Moderator: Helmet Karim, PhD
2:15pm    Session 4: iTBS and the Schizophrenia Spectrum: Existing Evidence and Ongoing Research    Deepak Sarpal, MD
iTBS has emerges as an effective strategy for the delivery of TMS to treat MDD. However. It’s utility as a treatment option in schizophrenia spectrum disorders is an active area of research. In this talk, Dr. Sarpal will briefly review the existing literature on iTBS for schizophrenia, and will introduce more recent evidence supporting an accelerated method of iTBS delivery. He will also discuss ongoing work in the Department of Psychiatry focused on accelerated iTBS as an adjunctive treatment in clozapine treated individuals with treatment-resistant schizophrenia. 

2:30pm    Session 5: TMS-assessed and TMS-modulated Prefrontal Oscillatory Abnormalities in Schizophrenia Patients    Fabio Ferrarelli, MD, PhD
Transcranial Magnetic Stimulation (TMS) is a technique that can be utilized to both assess and modulated the activity of neuronal circuits in healthy and psychiatric populations. Specifically, single pulse TMS with simultaneous EEG can be used the examine the neurophysiological properties of human cortical neurons, whereas repetitive TMS, including theta burst stimulation (TBS), can be employed to increase, or decrease, cortical excitability. Dr. Ferrarelli will present findings from TMS-EEG studies demonstrating reduced prefrontal oscillatory activity in patients with schizophrenia (SCZ) relative to healthy controls. He will also share preliminary data from an ongoing NIMH-funded project aiming to reverse these prefrontal deficits in SCZ patients using TBS. 

2:45pm    Session 6: Experimental Manipulation of the Orbitofrontal Cortex Impacts Short-Term Markers of Human Compulsive Behavior:    Developing a Synergistic Biobehavioral Approach    Rebecca Price, PhD 
Compulsive behaviors (CBs) are core features of obsessive-compulsive disorders. CBs suggest a failure of goal-directed behavior to override habitual behaviors “stamped in” through repeated practice and short-term distress reduction. Animal models provide compelling evidence for a possible causal role of the orbitofrontal cortex (OFC) in CBs, but human studies have largely been limited by a correlational design (e.g., cross-sectional comparisons). Dr. Price will describe methods to experimentally manipulate OFC function in human patients through Theta Burst Stimulation (a form of TMS), within the behavioral context of a digital “habit override training.” The resulting impacts observed on short-term markers of CB vulnerability help us to delineate a causal translational model, serving as an initial precursor to mechanistic intervention development.

3:00pm    Discussion and Q & A Session - Moderator: Helmet Karim, PhD

3:15pm    Wrap Up and Adjourn