Assessing the synergistic effectiveness of intermittent theta burst stimulation and the vestibular ocular reflex rehabilitation protocol in the treatment of Mal de Debarquement Syndrome: a randomised controlled trial.

INTRODUCTION: Mal de Debarquement Syndrome (MdDS) is a rare central vestibular disorder characterised by a constant sensation of motion (rocking, swaying, bobbing), which typically arises after motion experiences (e.g. sea, air, and road travel), though can be triggered by non-motion events. The current standard of care is non-specific medications and interventions that only result in mild-to-moderate improvements. The vestibular ocular reflex (VOR) rehabilitation protocol, a specialised form of rehabilitation, has shown promising results in reducing symptoms amongst people with MdDS. Accumulating evidence suggests that it may be possible to augment the effects of VOR rehabilitation via non-invasive brain stimulation protocols, such as theta burst stimulation (TBS). METHODS: The aim of this randomised controlled trial was to evaluate the effectiveness of intermittent TBS (iTBS) over the dorsolateral prefrontal cortex in enhancing the effectiveness of a subsequently delivered VOR rehabilitation protocol in people with MdDS. Participants were allocated randomly to receive either Sham (n = 10) or Active (n = 10) iTBS, followed by the VOR rehabilitation protocol. Subjective outcome measures (symptom ratings and mental health scores) were collected 1 week pre-treatment and for 16 weeks post-treatment. Posturography (objective outcome) was recorded each day of the treatment week. RESULTS: Significant improvements in subjective and objective outcomes were reported across both treatment groups over time, but no between-group differences were observed. DISCUSSION: These findings support the effectiveness of the VOR rehabilitation protocol in reducing MdDS symptoms. Further research into iTBS is required to elucidate whether the treatment has a role in the management of MdDS. TRN: ACTRN12619001519145 (Date registered: 04 November 2019).

An interdisciplinary psychoeducation program for schizophrenic patients and their families in an acute care setting.

A psychoeducation program in an acute care inpatient psychiatric setting involves schizophrenic patients and their families in a range of educational interventions that are responsive to their particular strengths and vulnerabilities. Patients receive one-on-one instruction about their illness from a psychiatrist and the nursing staff and learn community living skills in classes and tutorials conducted by occupational therapists. Families discuss ways of coping with the patients' illness in a series of meetings with a social worker, and they attend workshops led by a team of clinicians and an administrator, who advise them of current perspectives on the illness and its management and about how to negotiate the mental health system. A mental health library keeps staff, family, and patients abreast of recent literature about schizophrenia. The authors believe the program prepares patients to live in the community better than do programs whose goals are limited to symptom reduction or crisis intervention.