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Chapter 27. Nonpharmacological Somatic Treatments

Mark S. George, M.D.; Ziad H. Nahas, M.D., M.S.C.R.; Jeffrey J. Borckardt, Ph.D.; Berry Anderson, B.S.N., R.N.; Milton J. Foust, M.D.
DOI: 10.1176/appi.books.9781585623402.338825

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Psychiatry is now developing a third realm of treatment modalities, complementing the well-established realms of psychopharmacology (medications) and psychotherapy. Various names are used to describe these treatments—ranging from "neuromodulation" to "brain stimulation techniques" to the hard-to-understand and cumbersome "nonpharmacological somatic treatments." As a class, these methods involve focal electrical brain stimulation of some sort and vary widely in their invasiveness and methods of delivery. Table 27–1 lists the current methods. In this chapter we review only those treatments that are U.S. Food and Drug Administration (FDA) approved for treatment of traditionally defined psychiatric disorders, such as electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS), or treatments that have substantial Class I randomized controlled trial (RCT) data supporting their use, such as transcranial magnetic stimulation (TMS). These techniques are also being used in traditionally defined neurological disorders (e.g., deep brain stimulation [DBS] in dystonia or Parkinson's disease). We will mention their uses where appropriate, but a complete review of these treatments is found in the references listed in "Suggested Readings."

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Sample questions:
1.
Electroconvulsive therapy (ECT) is the prototype for nonpharmacological somatic treatments in psychiatry. Which of the following statements regarding the clinical use of ECT is true?
2.
Which of the following statements regarding transcranial magnetic stimulation (TMS) is true?
3.
Transcranial magnetic stimulation (TMS) may have a role in the treatment of anxiety disorders, particularly obsessive-compulsive disorder (OCD). Which of the following statements regarding the treatment of OCD with TMS is true?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
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