Active

University of Iowa Interventional Psychiatry Service Patient Registry

The purpose of this study is to examine the effects of interventional/procedural therapies for treatment-resistant depression (TRD). These treatments include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), racemic ketamine infusion and intranasal esketamine insufflation. The investigators will obtain various indicators, or biomarkers, of a depressed individuals' state before, during, and/or after these treatments. Such biomarkers include neurobehavioral testing, neuroimaging, electroencephalography, cognitive testing, vocal recordings, epi/genetic testing, and autonomic nervous system measures (i.e. "fight-or-flight" response). The results obtained from this study may provide novel antidepressant treatment response biomarkers, with the future goal of targeting a given treatment to an individual patient ("personalized medicine").

ClinicalTrials.gov Identifier: NCT04480918

If interested in participating, follow this link to express interest. 

Cerebellar Stimulation and Cognitive Control

The purpose of the study is to explore cerebellar stimulation as a potential new treatment to restore frontal activity and cognitive function in autism, schizophrenia, bipolar disorder, and Parkinson's disease. Subjects will be brought in for 5 to 6 separate visits, with cerebellar or sham TMS stimulation twice per day for 5 days, as well as 3 follow-up visits. During these visits, the patient will have cognitive, disease-specific and emotional testing, including EEG testing and MRI imaging. For those participants that received sham stimulation, we will again use EEG to record how single pulses of magnetic or electrical stimulation influences other regions of the cerebellum and downstream brain regions. These data will provide insight into how the cerebellum may influence downstream brain regions and play a role in cognitive and motor performance. All data will be analyzed offline to determine if performance on the interval timing task and/or frontal brain rhythms change following transcranial magnetic stimulation as compared to the pre-stimulation blocks of trials. Additionally, we will analyze changes in their cognitive function, symptom ratings, functional and structural MRI, and mood following stimulation. Controls will receive both active and sham treatment for comparison.

ClinicalTrials.gov Identifier: NCT03217110

If interested in participating, please email Ben Pace at benjamin-pace@uiowa.edu or call 319-384-9302. Additionally, follow this link to express interest. 

DBS for OCD

Completed

TMS Targeting

The purpose of this study is to investigate the reliability and accuracy of inter-treater targeting and dosing of rTMS as it is applied for major depressive disorder. As it currently stands, rTMS is non-invasively targeted to the left prefrontal cortex of the brain for the treatment of MDD, its primary application in clinical psychiatry. The exact location in the prefrontal cortex used for stimulation is identified in different manners at different locations. There are primarily two different methods for localizing the left prefrontal cortex clinically in the United States, which rely on certain scalp measurements being performed by the treatment technician or physician. This study aims to evaluate the reliability between technicians for identifying the same treatment target, as well as the ability of a technician to identify the same target from one day to the next. In terms of dosing, TMS is dosed based on a technician's or physician's ability to determine a patient's motor threshold, which involves delivering single pulses of electromagnetic stimulation over the motor cortex of the brain to determine the minimal amount required to induce a motor movement in the subject's hand. This study will also evaluate different methods of determining motor threshold to determine inter- and intra-treater reliability and accuracy for the purposes of optimizing treatment targeting and dosing. Notably, this study will NOT involve the active treatment of patients with depression but focuses solely on the reliability of targeting and dosing methods used through investigation in healthy control subjects. Additional studies will take place looking at whether motor threshold changes based on several factors including caffeine intake, use of electromyography (EMG), and neuronavigation guidance in target localization.

Publications from this project: click

rTMS for MDD: 5.5cm Rule vs. F3Targeting

Currently, there is little standardization between rTMS treatment programs as to what is the best way to localize the left dorsolateral prefrontal cortex, which is the FDA-approved treatment location for clinical rTMS for major depressive disorder (MDD). Different targeting methods yield locations that can vary by up to a few centimeters. By comparing different treatment locations and obtaining neurobehavioral, neuroimaging, cognitive, and neuropsychological measures, this study would provide the opportunity to identify the optimal treatment targeting method when using rTMS for major depressive disorder in a clinical setting. This study will specifically be focusing on comparing the two most common targeting methods: a target 5.5cm anterior to the motor strip on the left prefrontal scalp and the F3 target location on the left prefrontal scalp as identified using the 10-20 EEG system nomenclature.

ClinicalTrials.gov Identifier: NCT03378570

Transcranial Magnetic Stimulation Pilot Study for Methamphetamine Use Disorder

This is a pilot study to test the feasibility of a recruitment strategy and study protocol to examine the effects of a dual target transcranial magnetic stimulation treatment in methamphetamine use disorder. The study will test intermittent theta burst stimulation (TBS) targeting the dorsolateral prefrontal cortex (DLPFC) combined with continuous TBS targeting the medial prefrontal cortex (MPFC) in people with methamphetamine use disorder (MAUD) who are engaged in psychosocial treatment. Intermittent TBS targeting the DLPFC is approved by the Food and Drug Administration for major depressive disorder, and continuous TBS targeting the MPFC has been studied in cocaine use disorder. We will administer this dual target TBS daily for 2 weeks, followed by three times weekly for 2 weeks, and monitor depressive symptoms, anxiety, sleep, craving, quality of life, and methamphetamine use for three months. Changes in functional connectivity of brain circuits will be evaluated with functional magnetic resonance imaging (fMRI) before and after treatment. We expect to observe changes in connectivity between the DLPFC, MPFC, and other regions implicated in addiction and impulsivity. Furthermore, we will evaluate if baseline differences in functional connectivity can be used to predict response. Psychological tests focusing on state impulsivity and risk taking will be administered, and we expect to observe reductions in these characteristics after treatment. We will test this protocol in 20 patients recruited from clinical care settings at University of Iowa Hospitals and Clinics, University of New Mexico Health System, and University of Utah Health to illustrate the feasibility of recruitment and completing the protocol, to support an external funding proposal.

ClinicalTrials.gov Identifier: NCT04449055