The Case for Adaptive Neuromodulation to Treat Severe Intractable Mental Disorders

Mental disorders are a leading cause of disability worldwide, and available treatments have limited efficacy for severe cases unresponsive to conventional therapies. Neurosurgical interventions, such as lesioning procedures, have shown success in treating refractory cases of mental illness, but may have irreversible side effects. Neuromodulation therapies, specifically Deep Brain Stimulation (DBS), may offer similar therapeutic benefits using a reversible (explantable) and adjustable platform. Early DBS trials have been promising, however, pivotal clinical trials have failed to date. These failures may be attributed to targeting, patient selection, or the “open-loop” nature of DBS, where stimulation parameters are chosen ad hoc during infrequent visits to the clinician’s office that take place weeks to months apart. Further, the tonic continuous stimulation fails to address the dynamic nature of mental illness; symptoms often fluctuate over minutes to days. Additionally, stimulation-based interventions can cause undesirable effects if applied when not needed. A responsive, adaptive DBS (aDBS) system may improve efficacy by titrating stimulation parameters in response to neural signatures (i.e., biomarkers) related to symptoms and side effects. Here, we present rationale for the development of a responsive DBS system for treatment of refractory mental illness, detail a strategic approach for identification of electrophysiological and behavioral biomarkers of mental illness, and discuss opportunities for future technological developments that may harness aDBS to deliver improved therapy

ENGL 151-01, First Year Seminar in Critical, Thinking, and Writing, Fall 2001

This syllabus was submitted to the Office of Academic affairs by the course instructor.English 151 is intended to help students develop the skills of critical reading and thinking, skills that enable them to write effectively. A basic assumption underlying the course is that reading, writing, and thinking are vitally related. The topic clusters challenge us to consider the ways in which argument informs the world around us and to examine how writers form and support their claims. Discussion of the arguments in textbook readings and classmates’ papers will help students to analyze the choices writers make as they draft and revise

An Innovative Intervention for Obsessive Compulsive Disorder: A Web-Based Self-Help Program for OCD

Obsessive Compulsive Disorder (OCD) is a mental illness characterized by unwanted intrusive thoughts followed by repetitive rituals. 50.6% of adult cases of OCD are considered severe according to the National Institute of Mental Health. Interventions based on evidence based modalities for OCD in the United States are difficult to access and are extremely costly. The OCD Challenge (OCDC) is an interactive Internet based self-help program for OCD. This website allows participants to engage in an evidence-based intervention (CBT, specifically exposure with response prevention) for their OCD. The OCD Challenge is an online intervention that guides participants through the website, prompting them to climb their personal “OCD Mountain” with step-by-step direction along the way. The OCDC is a novel approach that will afford many individuals with OCD the opportunity to receive an evidence-based intervention that may not otherwise be available. This research study describes the development of the online interactive program and the demographics of participants who are accessing the program. Future studies should examine the feasibility of the website on OCD, disability, depression, anxiety and stress symptom reduction.Social Work, Graduate College o

Rethinking Unacceptable Thoughts: Validation of an Expanded Version of the Dimensional Obsessive-Compulsive Scale (DOCS)

The Dimensional Obsessive-Compulsive Scale (DOCS) is widely used to measure obsessive-compulsive disorder (OCD) severity across four broad symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, symmetry). Despite its proven utility, there is reason to suspect that the unacceptable thoughts subscale conflates different types of unacceptable thoughts that are meaningfully distinct from one another. In the current study, we first evaluated the psychometric properties of a newly developed DOCS violent and/or aggressive thoughts subscale. We then examined the factor structure, psychometric properties, and diagnostic sensitivity of a seven-factor version of the DOCS that includes the four original DOCS subscales and three more-specific versions of the unacceptable thoughts scale (i.e., sexually intrusive thoughts, violent and/or aggressive thoughts, and scrupulous or religious thoughts). The sample included 329 residential and intensive outpatients, the majority of which had a diagnosis of OCD (75.2%). The new unacceptable thoughts subscales demonstrated convergent and discriminant validity with unique associations between the subscales and depression, suicide, and perceived threat from emotions that were not present in the broader unacceptable thoughts subscale. The seven-factor version of the DOCS demonstrated slightly lower levels of diagnostic sensitivity than the original DOCS. Thus, the four-factor version of the DOCS is recommended for screening purposes. A score of 40 of higher on the seven-factor version of the DOCS best predicted a diagnosis of OCD. Overall, the three additional unacceptable thoughts subscales appear to be distinct dimensional categories that have potential value in research and clinical settings