Transcranial magnetic stimulation for treatment resistant depression: six case reports and review.

BACKGROUND: Depressive disorder is a common, recurrent, and chronic disorder that is a leading cause of functional impairment and disability An estimated 20-40% of patients do not benefit sufficiently from existing therapies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for psychiatric illness. Evidences support its use in depression, either alone or combined with antidepressants. During rTMS, a time-varying current is discharged in an insulated coil attached to the scalp surface, generated a brief dynamic magnetic field that can freely, non-invasively penetrate the skull and induce the eddy current in the neural tissue. The rTMS works as a neuro-stimulator and neuro-modulator at the same time, which can modify the functionality of the brain circuits involved in the pathophysiology of mental illness especially in depressive disorder. MATERIAL AND METHOD: The authors reported six cases of various types of depressive disorder, double depression, borderline personality disorder with depression, psychotic depression with nihilistic delusion, post-schizophrenic depression, and treatment resistant depression non-respond to electroconvulsive therapy (ECT). RESULTS: Four in six cases responded well with 10 daily sessions of rTMS. However, a patient with psychotic depression yielded no response. Five patients with moderate depression reached the remission criteria of Hamilton Depression Rating Scale-17 items (HAM-D-17). The means HAM-D-17 of rTMS responders were decreased from 22.4 (SD = 4.1) to 5.2 (SD = 2.9). A patient with psychotic depression did not show any benefit from rTMS and got subsequent modified ECT. CONCLUSION: This is the first cases report of using rTMS for the treatment of depression in Thailand. The rTMS gave promising results in various forms of depression. Due to its safety needing no anesthesia, suitable for out-patient care, rTMS might be a treatment alternative in the acute phase of moderate non-psychotic depression. The authors also reviewed the current evidence.

Validity and reliability study of the Thai version of WHO Schedules for Clinical Assessment in Neuropsychiatry version 2.1.

OBJECTIVE: To determine the validity and reliability of the Thai version of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview book version 2.1 was translated from English into Thai. The content validity of the translation was verified by examining the back-translation. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions of Thailand for comprehensibility of the relatively technical language. Re-edition of the Thai version was made in accordance with suggestions from the field trial. The complete SCAN Thai version was put into the computerized I-Shell program for inter and intra-rater reliability study. RESULTS: Based on the response from Thai subjects and consultations with competent and well SCAN-trained psychiatrists, content validity was established. The inter- and intra-rater agreement of somatoform and dissociative symptoms module were 0.77, 0.85; anxiety: 0.79, 0.84; mood: 0.80, 0.86; eating disorders: 0.73, 0.76; use of alcohol: 0.66, 0.82; stress and adjustment disorders: 0.90, 0.94; psychosis: 0.68, 0.76; cognitive impairment: 0 72, 0.78 and observed behavior, affect and speech module were 0.45 and, 0.51 respectively. CONCLUSION: The SCAN version 2.1 Thai version proved to be a reliable tool for assessing psychiatric illness among Thais.