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经颅磁刺激治疗强迫症的症状激发:专业培训分步指南

Symptom provocation for treatment of obsessive-compulsive disorder using transcranial magnetic stimulation: A step-by-step guide for professional training.

作者信息

Maia Ana, Almeida Sílvia, Cotovio Gonçalo, Rodrigues da Silva Daniel, Viana Francisco Faro, Grácio Jaime, Oliveira-Maia Albino J

机构信息

Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.

Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.

出版信息

Front Psychiatry. 2022 Aug 3;13:924370. doi: 10.3389/fpsyt.2022.924370. eCollection 2022.


DOI:10.3389/fpsyt.2022.924370
PMID:35990054
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9382110/
Abstract

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that was cleared by the Food and Drug Administration (FDA) for the treatment of Obsessive-Compulsive Disorder (OCD) in 2018. The approved protocol includes individualized symptom provocation before each stimulation session, to elicit a moderate level of obsessional distress. Although symptom provocation can be a delicate, demanding, and uncomfortable procedure, structured training methods for those who are going to apply it are not available. Here, we describe a model for training in symptom provocation for TMS technicians, developed at the Champalimaud Clinical Centre in Lisbon, Portugal. Our programme includes two-sessions dedicated to clinical communication and symptom provocation techniques from a theoretical and practical perspective. Additionally, supervision meetings are conducted during treatment of patients, allowing regular case discussion and redefinition of symptom provocation hierarchy, as needed. In addition to having a strong practical component, our training program is short and pragmatic, allowing for easy implementation and fluid transition to clinical practice. By sharing our experience, we hope to contribute to systematize training procedures required for symptom provocation in the context of TMS, and to qualitatively describe a methodology that can be used for implementation of TMS programmes for the treatment of OCD.

摘要

经颅磁刺激(TMS)是一种非侵入性脑刺激技术,2018年美国食品药品监督管理局(FDA)批准其用于治疗强迫症(OCD)。获批方案包括在每次刺激疗程前进行个体化症状激发,以引发中等程度的强迫性困扰。尽管症状激发可能是一个微妙、要求高且令人不适的过程,但目前尚无针对即将实施该操作的人员的结构化培训方法。在此,我们描述了一种在葡萄牙里斯本尚帕利莫德临床中心开发的TMS技术人员症状激发培训模式。我们的课程包括两部分,从理论和实践角度专门讲解临床沟通和症状激发技术。此外,在患者治疗期间会举行督导会议,以便根据需要定期进行病例讨论并重新确定症状激发等级。除了具备很强的实践部分外,我们的培训项目简短且务实,便于实施并能顺利过渡到临床实践。通过分享我们的经验,我们希望有助于使TMS背景下症状激发所需的培训程序系统化,并定性描述一种可用于实施治疗OCD的TMS方案的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fc0/9382110/79c34317b425/fpsyt-13-924370-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fc0/9382110/89f8ca81a483/fpsyt-13-924370-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fc0/9382110/79c34317b425/fpsyt-13-924370-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fc0/9382110/89f8ca81a483/fpsyt-13-924370-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7fc0/9382110/79c34317b425/fpsyt-13-924370-g0002.jpg

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引用本文的文献

[1]
Symptom Provocation and Clinical Response to Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis.

JAMA Psychiatry. 2025-6-4

[2]
Targeting VMPFC-amygdala circuit with TMS in substance use disorder: A mechanistic framework.

Addict Biol. 2025-1

[3]
Advances in Brain Stimulation, Nanomedicine and the Use of Magnetoelectric Nanoparticles: Dopaminergic Alterations and Their Role in Neurodegeneration and Drug Addiction.

Molecules. 2024-7-29

[4]
Toward personalized circuit-based closed-loop brain-interventions in psychiatry: using symptom provocation to extract EEG-markers of brain circuit activity.

Front Neural Circuits. 2023

[5]
Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders.

Brain Sci. 2023-7-5

[6]
Accelerated TMS - moving quickly into the future of depression treatment.

Neuropsychopharmacology. 2024-1

本文引用的文献

[1]
Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation.

Evid Based Complement Alternat Med. 2021-7-2

[2]
A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions.

Front Psychiatry. 2019-11-11

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The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: an integrative review.

Adv Med Educ Pract. 2019-6-18

[4]
Obsessive-compulsive disorder.

Nat Rev Dis Primers. 2019-8-1

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Am J Psychiatry. 2019-5-21

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