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a clinical guide to transcranial magnetic stimulation

A Clinical Guide to Transcranial Magnetic Stimulation: Revolutionizing Neurological and Psychiatric Treatment

By Dr. Evelyn Reed, MD, PhD

Dr. Reed is a leading neurologist and neuroscientist with over 20 years of experience in clinical research and practice, specializing in the application of non-invasive brain stimulation techniques. She is currently a professor at the University of California, San Francisco, and a consultant for several leading pharmaceutical companies.

Published by Elsevier Health Sciences

Elsevier is a global leader in information analytics and research, publishing high-impact journals and textbooks across various scientific disciplines, ensuring rigorous peer-review and editorial standards.

Edited by Dr. Marcus Chen, MD

Dr. Chen is a renowned psychiatrist and expert in brain stimulation therapies with extensive experience in clinical trials and regulatory affairs. He has served on several national and international committees overseeing the ethical and safe implementation of TMS.

Introduction:

This clinical guide to transcranial magnetic stimulation (TMS) aims to provide healthcare professionals with a comprehensive understanding of this increasingly important neuromodulation technique. TMS offers a non-invasive method for modulating brain activity, demonstrating significant potential across a range of neurological and psychiatric disorders. This guide will explore the mechanisms of action, clinical applications, safety considerations, and future directions of TMS, ultimately highlighting its transformative implications for the healthcare industry.

H1: Mechanisms of Action: Understanding How TMS Works

Transcranial magnetic stimulation works by inducing electrical currents in specific brain regions using brief, pulsed magnetic fields delivered via a coil placed on the scalp. This process, known as electromagnetic induction, depolarizes or hyperpolarizes neurons, altering their excitability and subsequently influencing neural networks. The effects of TMS are highly dependent on various factors, including coil type, stimulus parameters (frequency, intensity, duration), and the targeted brain area. Different stimulation protocols – ranging from single-pulse TMS to repetitive TMS (rTMS) – elicit varying physiological responses, offering clinicians a spectrum of therapeutic options. A clinical guide to transcranial magnetic stimulation must thoroughly address these complexities.

H2: Clinical Applications: A Broad Spectrum of Therapeutic Potential

A clinical guide to transcranial magnetic stimulation would be incomplete without a detailed discussion of its clinical applications. TMS has garnered significant attention for its efficacy in treating various conditions:

Major Depressive Disorder (MDD): rTMS, particularly high-frequency stimulation of the dorsolateral prefrontal cortex (DLPFC), has shown considerable success in alleviating depressive symptoms in patients unresponsive to conventional medication.
Obsessive-Compulsive Disorder (OCD): TMS targeting specific brain regions involved in obsessive-compulsive behaviors, such as the orbitofrontal cortex, has yielded promising results.
Treatment-Resistant Schizophrenia: While still under investigation, TMS is showing potential in addressing specific symptoms of schizophrenia, such as auditory hallucinations and negative symptoms.
Chronic Pain: TMS is being explored as a non-pharmacological approach to manage chronic pain conditions, targeting areas involved in pain processing.
Stroke Rehabilitation: TMS can be used to enhance motor recovery in stroke patients by stimulating the affected cortical areas.

H3: Safety and Side Effects: Ensuring Patient Well-being

A comprehensive clinical guide to transcranial magnetic stimulation must emphasize safety protocols. While generally considered safe, TMS can cause minor side effects such as headaches, scalp discomfort, and transient hearing changes. More serious adverse events are rare, but careful patient selection and monitoring are essential. Contraindications, such as the presence of metallic implants or seizure disorders, must be carefully considered. The responsible and ethical application of TMS demands strict adherence to safety guidelines.

H4: Technological Advancements and Future Directions:

The field of TMS is constantly evolving. Advancements in coil design, stimulation protocols, and neuroimaging techniques are enhancing the precision and efficacy of TMS. Closed-loop TMS, which combines real-time fMRI or EEG with TMS, allows for personalized and adaptive stimulation based on individual brain responses. This personalized approach promises to maximize therapeutic outcomes and minimize side effects. Furthermore, research is exploring the integration of TMS with other neuromodulation techniques, such as deep brain stimulation (DBS), for synergistic effects.

H5: The Implications for the Healthcare Industry:

A clinical guide to transcranial magnetic stimulation reveals a profound impact on the healthcare industry. The increasing adoption of TMS offers several benefits:

Reduced reliance on medication: TMS provides a non-pharmacological alternative or adjunct to medication, minimizing the risk of adverse drug reactions and improving patient compliance.
Cost-effectiveness: While initially more expensive than some pharmacological treatments, TMS may ultimately prove cost-effective given the potential for reduced hospitalizations and improved long-term outcomes.
Improved patient outcomes: The effectiveness of TMS in treatment-resistant conditions translates to improved quality of life for patients who have not responded to traditional therapies.
Expansion of therapeutic horizons: Ongoing research continues to expand the therapeutic applications of TMS, paving the way for new treatments for a wide array of neurological and psychiatric disorders.

Conclusion:

This clinical guide to transcranial magnetic stimulation has explored the mechanisms, applications, safety aspects, and industry implications of this transformative technology. As research continues to unravel the intricacies of brain function and the therapeutic potential of TMS, this non-invasive brain stimulation technique is poised to revolutionize the treatment of neurological and psychiatric disorders, offering hope and improved outcomes for millions of patients worldwide.

FAQs:

    • Is TMS painful? Most patients report mild discomfort, akin to a tapping sensation on the scalp.
    • How long does a TMS treatment session last? Sessions typically last between 20-40 minutes.
    • How many TMS sessions are required? The number of sessions varies depending on the condition and patient response, usually ranging from several weeks to months.
    • What are the long-term effects of TMS? Long-term effects are generally positive, with lasting improvements observed in many patients.
    • Is TMS covered by insurance? Insurance coverage varies depending on the location and specific condition being treated.
    • Who is a good candidate for TMS? Individuals with treatment-resistant depression, OCD, or other specific conditions may be suitable candidates.
    • Are there any contraindications for TMS? Yes, individuals with certain medical conditions, such as metallic implants or seizure disorders, are generally not candidates.
    • What are the potential side effects of TMS? Common side effects include headaches, scalp discomfort, and hearing changes. Serious side effects are rare.
    • How does TMS compare to other neuromodulation techniques? TMS offers a non-invasive alternative to other techniques like DBS, offering a less invasive and generally safer approach.

Related Articles:

    • "The Efficacy of rTMS in Treatment-Resistant Depression: A Meta-Analysis": Reviews existing literature on the effectiveness of repetitive TMS for depression.
    • "Safety and Tolerability of Transcranial Magnetic Stimulation: A Comprehensive Review": Focuses on the safety profile and potential side effects of TMS.
    • "Optimizing TMS Parameters for Enhanced Therapeutic Outcomes": Explores techniques for maximizing the efficacy of TMS treatments.
    • "The Neurobiological Mechanisms of Action of rTMS in Major Depressive Disorder": Investigates the underlying mechanisms through which TMS affects depression.
    • "Closed-Loop TMS: Personalized Neuromodulation for Improved Treatment Response": Examines the potential of closed-loop TMS to personalize treatment.
    • "Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: A Clinical Perspective": Provides a clinical overview of TMS use in OCD.
    • "The Role of TMS in Stroke Rehabilitation: Enhancing Motor Recovery": Focuses on the use of TMS in stroke rehabilitation.
    • "Transcranial Magnetic Stimulation for Chronic Pain Management: A Promising Non-Pharmacological Approach": Discusses the use of TMS for chronic pain conditions.
    • "Ethical Considerations in the Application of Transcranial Magnetic Stimulation": Addresses ethical considerations and guidelines in TMS applications.

  a clinical guide to transcranial magnetic stimulation: A Clinical Guide to Transcranial Magnetic Stimulation Paul E. Holtzheimer, William McDonald, 2014-02-21 The Clinical Guide serves as a reference tool for clinicians in the administration of transcranial magnetic stimulation (TMS) for neuropsychiatric disorders. The primary intent of this Guide is to focus on the clinical applications of TMS and to offer detailed information on the safe and effective administration of TMS with consideration of the neurophysiological effects particularly in relation to safety, targeting specific cortical areas and practical issues such as the length of treatment sessions and the durability of the TMS response. The Guide focuses on the evidenced based literature and utilizes this literature to inform specific recommendations on the use of rTMS in a clinical setting. The efficacy and safety of TMS for neuropsychiatric disorders, including its use in special populations, such as the elderly, will be reviewed to facilitate clinical decision-making. The Guide will also outline setting up a TMS service including practical issues such as considerations for the qualifications of the person administering the treatment, the use of concomitant medications, what equipment is necessary to have in the treatment room and monitoring the outcomes to treatment. The Guide is intended to be a practical reference for the practicing clinician in the safe and effective administration of TMS.
  a clinical guide to transcranial magnetic stimulation: Transcranial Magnetic Stimulation in Clinical Psychiatry Mark S. George, Robert H. Belmaker, 2007-04-02 As understanding evolves about how different brain regions are involved in carrying out everyday tasks -- and in causing brain diseases when they go awry -- this book describes a new technology that allows physicians to focally stimulate the brain in awake adults through a non-invasive procedure. Transcranial Magnetic Stimulation in Clinical Psychiatry is an accessible and authoritative review of TMS, a procedure that is showing promise as a treatment in several disorders. Its authors explain how the procedure works, then the latest findings in a wide range of situations -- notably in depression, but also in other conditions ranging from migraine to stroke recovery. This concise overview of TMS offers practical guidance for psychiatrists and other clinicians using it as a therapy, or referring their patients to have this done, as well as updating the field for neuroscientists and neurologists. It begins with background on the physics and safety of TMS, a guide for administering the procedure, and a review of basic neurophysiological studies with TMS, showing how it can be used to measure connectivity and excitability of the cerebral cortex. The heart of book is then devoted to its clinical applications, organized by disorder: Epilepsy, movement disorders, and pain -- describes the use of TMS in inducing and inhibiting seizures and investigating their pathophysiology; in treating Parkinson's disease; and in relieving pain through motor cortex stimulation Major depression -- provides a critical review of research in the most-studied clinical application of TMS in psychiatry, where it is used as a therapeutic intervention and a neurophysiological probe Mania -- explores the effectiveness of TMS in light of its ECT-like properties through a trial of right TMS vs. sham TMS Anxiety disorders -- reports on investigations on the uses of TMS in treating obsessive-compulsive disorder and posttraumatic stress disorder Schizophrenia -- reviews studies utilizing single- or paired-pulse TMS to assess cortical inhibition and those that explore effects of extended trains of repetitive TMS in altering symptoms A further chapter on TMS in brain imaging shows how integrating imaging and TMS allows one to better place the TMS coil, better understand TMS effects on the brain, and improve understanding of how the brain mediates behavior. With a concluding overview of prospects for the future of repetitive TMS, this volume offers a definitive look at this cutting-edge research and provides critical guidance on how and when clinicians might use TMS in their practice.
  a clinical guide to transcranial magnetic stimulation: Repetitive Transcranial Magnetic Stimulation Treatment for Depressive Disorders Paul B Fitzgerald, Z. Jeff Daskalakis, 2013-04-19 ​Repetitive transcranial magnetic stimulation (rTMS) treatment is increasingly being used in the management of patients with depression. Nevertheless, considerable ignorance still exists about the treatment in general psychiatric practice. This concise clinical guide will serve as a reference and practical tool for clinicians working with or learning about this treatment technique. The opening chapters provide basic information on the history and development of rTMS treatment and its mechanism of action. Use of the treatment in depression is then addressed in detail, with explanation of the evidence base and discussion of a variety of clinical issues. Side-effects of treatment are explored, and careful consideration is given to the establishment of rTMS treatment programs and the training of clinicians. The final chapters will provide a brief overview of potential rTMS applications in other psychiatric conditions and some background on related treatments.
  a clinical guide to transcranial magnetic stimulation: Transcranial Magnetic Stimulation Richard A. Bermudes, M.D., Karl I. Lanocha, M.D., Philip G. Janicak, M.D., 2017-11-28 Edited by clinicians who were involved with transcranial magnetic stimulation (TMS) from the beginning, Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice offers everything the mental health practitioner needs to know about this innovative and well-established treatment. It is increasingly clear that different combinations of biological, neurobehavioral, and symptomatic factors contribute to the problem of treatment resistance in psychiatric disorders. Fortunately, a number of neuromodulation approaches, including TMS, are providing more options for clinicians to combat psychiatric problems. However, guidance about how to identify patients who are good candidates for TMS and how to comanage them during treatment is scarce because instruction on this modality has yet to be integrated into most psychiatry residencies. Thus, this text fills a great need, providing clinicians with an evidence-based foundation for the efficacy and safety of TMS. Despite the rapid growth of this innovative option, many practitioners are unclear about how best to utilize TMS. The book addresses these clinical concerns systematically and thoroughly: - Clinical vignettes illustrate how to identify appropriate patients for referral to a TMS clinician. - Discussions of treatment resistance, psychiatric and medical comorbidities, and preparation of the patient for TMS are included. - Because TMS is likely to be used concurrently with other treatments, the book explains how to best integrate this modality with psychotherapy, pharmacotherapy, and other forms of neuromodulation to improve outcomes. - In-depth coverage is provided on how to coordinate efforts between the primary treatment and TMS teams to assure the best outcomes during acute, continuation, and maintenance treatment. - Chapters provide a review of topic-specific literature, as well as clinical vignettes that highlight how to integrate TMS into patient care. - Key clinical points summarize the optimal clinical application of TMS for the general mental health provider. - The evolving nature of TMS research, such as the ongoing development of this and related technologies, as well as its expanding use as a potential treatment for other clinical neuropsychiatric conditions, is also addressed. Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice guides the general psychiatrist and mental health clinician on how to integrate this treatment modality into their practice by presenting an update on the current clinical role of TMS and a road map to its potential future.
  a clinical guide to transcranial magnetic stimulation: Practical Guide to Transcranial Direct Current Stimulation Helena Knotkova, Michael A. Nitsche, Marom Bikson, Adam J. Woods, 2019-01-23 This book provides a comprehensive overview on Transcranial Direct Current Stimulation (tDCS) and the clinical applications of this promising technique. Separated into three parts, the book begins with basic principles, mechanisms and approaches of tDCS. This is followed by a step-by-step practicum, methodological considerations and ethics and professional conduct pertaining to this novel technique. Chapters are authored by renowned experts who also direct and plan tDCS educational events worldwide. Bridging the existing gap in instructional materials for tDCS while addressing growing interest in education in this field, professionals within a broad range of medical disciplines will find this text to be an invaluable guide.
  a clinical guide to transcranial magnetic stimulation: A Clinical Guide to Transcranial Magnetic Stimulation Paul E. Holtzheimer, William McDonald, 2014 The Clinical Guide serves as a reference tool for clinicians in the administration of transcranial magnetic stimulation (TMS) for neuropsychiatric disorders. The primary intent of this Guide is to focus on the clinical applications of TMS and to offer detailed information on the safe and effective administration of TMS with consideration of the neurophysiological effects particularly in relation to safety, targeting specific cortical areas and practical issues such as the length of treatment sessions and the durability of the TMS response. The Guide focuses on the evidenced based literature and utilizes this literature to inform specific recommendations on the use of rTMS in a clinical setting. The efficacy and safety of TMS for neuropsychiatric disorders, including its use in special populations, such as the elderly, will be reviewed to facilitate clinical decision-making. The Guide will also outline setting up a TMS service including practical issues such as considerations for the qualifications of the person administering the treatment, the use of concomitant medications, what equipment is necessary to have in the treatment room and monitoring the outcomes to treatment. The Guide is intended to be a practical reference for the practicing clinician in the safe and effective administration of TMS.
  a clinical guide to transcranial magnetic stimulation: rTMS Treatment for Depression Paul B. Fitzgerald, Z. Jeff Daskalakis, 2022-02-24 Repetitive transcranial magnetic stimulation (rTMS) treatment is increasingly a standard part of the management of patients with depression supported by a rapidly expanding research base. This new expanded and amended concise clinical guide will serve as a reference and practical tool for clinicians working with or learning about this treatment technique. The opening chapters provide basic information on the history and development of rTMS treatment and its mechanism of action. Use of the treatment in depression is then addressed in detail, with explanation of the evidence base and discussion of a variety of clinical issues. Side-effects of treatment are explored, and careful consideration is given to the establishment of rTMS treatment programs. There is an updated review of the use of a rTMS applications in other psychiatric conditions such as obsessive-compulsive disorder. New chapters in this edition address the use of deep TMS, theta burst stimulation, accelerated forms of rTMS and what to do in patients not responding to initial therapy. In addition, the various approaches to treatment targeting are addressed in detail. This book will provide the rTMS practitioner or interested generalist an up-to-date and comprehensive understanding of the field as well as provide considerable practical clinical advice.
  a clinical guide to transcranial magnetic stimulation: Magnetic Stimulation in Clinical Neurophysiology Mark Hallett, Sudhansu Chokroverty, 2005 Covers the diagnostic and clinical applications of transcranial magnetic stimulation (TMS) and offers cutting-edge, in-depth guidance on the use of TMS to study brain physiology and pathophysiology as well as its current and future therapeutic uses. Readers will find the essential up-to-date information they need to make the most of this dynamic method. Delivers a detailed analysis of the physics of magnetic stimulation as well as basic mechanisms of how magnetic stimulation activates neural tissue. Presents expert guidance on the clinical uses of TMS as well as its therapeutic and research applications.
  a clinical guide to transcranial magnetic stimulation: Oxford Handbook of Transcranial Stimulation Eric Wassermann, Eric Michael Wassermann, Charles Epstein, Ulf Ziemann, 2008-01-24 Transcranial stimulation comprises an important set of techniques for investigating brain function, some of which promise to treat diseases. This book provides a review of the scientific and technical background required to understand transcranial stimulation, for neuroscientists, neurologists, and psychiatrists.
  a clinical guide to transcranial magnetic stimulation: Transcranial Magnetic Stimulation Vincent Walsh, Alvaro Pascual-Leone, 2003-06-06 A guide to the use of transcranial magnetic stimulation to reversibly disrupt cortical functioning as a means of studying perceptual and cognitive functions.
  a clinical guide to transcranial magnetic stimulation: Handbook of Transcranial Magnetic Stimulation Alvaro Pascual-Leone, 2001-11-30 Transcranial Magnetic Stimul0tion (TMS) is a non-invasive technique that has revolutionised the study of the human nervous system allowing in-depth investigations of complex voluntary motor control pathways. Today, many of the techniques used in TMS have become routine in clinical electrophysiological assessments. As an investigative tool, its application ranges from clinical diagnostics to cognitive research. Now the use of repetitive TMS (rTMS) is gaining support amongst psychiatrists as evidence suggests that it may provide an alternative to ECT in treating depression and other psychiatric disorders. This handbook brings together the basic science, fundamental principles, and essential procedures of TMS needed by all those useing or planning to use the technique clinically or in research. The final two sections focus upon current up to date knowledge of applications of the technique. Written in a digestible style by world authorities in different related specialties, the Handbook of TMS will be a valuable and comprehensive guide for clinical neurophysiologists, neuropsychiatrists, neurologists and psychiatrists.
  a clinical guide to transcranial magnetic stimulation: Brain Stimulation Therapies for Clinicians, Second Edition Edmund S. Higgins, M.D., Mark S. George, M.D., 2019-08-13 Basic electricity -- Electrical brain -- Electroconvulsive therapy -- Vagus nerve stimulation -- Transcranial magnetic stimulation -- Deep brain stimulation and cortical stimulation -- Transcranial direct current stimulation -- Other techniques.
  a clinical guide to transcranial magnetic stimulation: Rehabilitation with RTMS Masahiro Abo, Wataru Kakuda, 2015 Repetitive transcranial magnetic stimulation (rTMS) is increasingly being studied and used in stroke rehabilitation. This handbook is the first concise guide for clinicians and researchers working with or learning about rTMS in stroke rehabilitation. It gives you a practical guide to the novel use of rTMS in combination with intensive rehabilitation for the treatment of neurological sequelae of stroke. The application areas included are post-stroke upper limb hemiparesis, lower limb hemiparesis, aphasia and dysphagia.
  a clinical guide to transcranial magnetic stimulation: Brain and Human Body Modeling 2020 Sergey N. Makarov, 2021 The 41st Annual International Conference of the IEEE EMBS, took place between July 23 and 27, 2019, in Berlin, Germany. The focus was on Biomedical engineering ranging from wellness to intensive care. This conference provided an opportunity for researchers from academia and industry to discuss a variety of topics relevant to EMBS and hosted the 4th Annual Invited Session on Computational Human Models. At this session, a bevy of research related to the development of human phantoms was presented, together with a substantial variety of practical applications explored through simulation.
  a clinical guide to transcranial magnetic stimulation: Brain and Human Body Modeling Sergey Makarov, Marc Horner, Gregory Noetscher, 2019-08-27 This open access book describes modern applications of computational human modeling with specific emphasis in the areas of neurology and neuroelectromagnetics, depression and cancer treatments, radio-frequency studies and wireless communications. Special consideration is also given to the use of human modeling to the computational assessment of relevant regulatory and safety requirements. Readers working on applications that may expose human subjects to electromagnetic radiation will benefit from this book’s coverage of the latest developments in computational modelling and human phantom development to assess a given technology’s safety and efficacy in a timely manner. Describes construction and application of computational human models including anatomically detailed and subject specific models; Explains new practices in computational human modeling for neuroelectromagnetics, electromagnetic safety, and exposure evaluations; Includes a survey of modern applications for which computational human models are critical; Describes cellular-level interactions between the human body and electromagnetic fields.
  a clinical guide to transcranial magnetic stimulation: 3,000 Pulses Later Martha Rhodes, 2013-05-18 3,000 Pulses Later: A Memoir of Surviving Depression Without Medication describes how, as a successful advertising executive, wife, and mother with a seemingly ideal life, she succumbed to depression and overdosed on Xanax and alcohol in an unsuccessful suicide attempt. The memoir describes her challenges with untreated, drug-resistant depression and her struggle to find an alternative to the drugs that failed to relieve her symptoms. After a grueling stay in a psychiatric ward and many months of trial-and-error medications, Martha pursued TMS, Transcranial Magnetic Stimulation—the FDA-cleared, safe and proven-effective alternative to electroconvulsive therapy (ECT) and the ineffective drugs her doctors prescribed. 3,000 Pulses Later shares how the road back to health with TMS returned her to an even better place than where she started. She now manages her depression with TMS therapy—and without the side effects attributable to antidepressant medications.
  a clinical guide to transcranial magnetic stimulation: Transcranial Magnetic Stimulation Vincent Walsh, Alvaro Pascual-Leone, 2003
  a clinical guide to transcranial magnetic stimulation: Clinical Evoked Potentials Omkar N. Markand, 2020-02-14 This book covers all aspects of evoked potentials (EPs) utilized clinically in evaluating the functional integrity of somatosensory, auditory, motor, and visual pathways in the nervous system. It explores techniques needed to correctly perform EPs, and discusses these clinical neurophysiological tests that are performed in academic institutions and large community hospitals. Concise and comprehensive, this case-study rich text is divided into five chapters. Beginning with basic principles of evoked potential recording, the first chapter discusses signal enhancement and limitations of signal averaging. Chapter two then provides an overview of brainstem auditory EPs. Subsequent chapters then present visual EPs and somatosensory evoked potentials. Finally, the book concludes with clinical applications of transcranial magnetic stimulation, as well as a brief discussion of the techniques of transcranial electrical motor evoked potentials during intraoperative monitoring. Clinical Evoked Potentials: An Illustrated Manual functions as an essential reference for neurologists neurosurgeons, anesthesiologists, clinical neurophysiologists, and EP technologists, who are involved with the recording and interpretation of EPs primarily for diagnostic purposes.
  a clinical guide to transcranial magnetic stimulation: Clinical Handbook for the Management of Mood Disorders J. John Mann, Patrick J. McGrath, Steven P. Roose, 2013-05-09 Provides a one-stop evidence-based guide to the management of all types of mood disorders.
  a clinical guide to transcranial magnetic stimulation: Resident's Guide to Clinical Psychiatry Lauren B. Marangell, 2009 This concise, yet comprehensive guide distills the most critical and current information on diagnosis and treatment so that residents and other beginning clinicians will have the tools they need to quickly assess and competently treat patients with psychiatric illnesses. Replete with diagnostic evaluation checklists, DSM-IV-TR criteria, and drug dosage tables, the Resident's Guide to Clinical Psychiatry is a practical and convenient one-stop resource that will make the resident's job significantly easier. Each of the 16 chapters has been structured logically and with the utmost care to guide residents through the psychiatric landscape. For example, the chapter on pharmacotherapy is organized by class of drug, with sections on mechanism of action, indications and efficacy, and tips for medication selection. This is followed by detailed information on specific drugs -- their clinical use, risks, side effects, management, and potential interactions. This depth of coverage is matched by breadth of subject, with chapters on central topics such as mood disorders and dementia, in addition to special chapters on consultation-liaison psychiatry, emergency psychiatry, child and adolescent psychiatry, and electroconvulsive therapy and device-based treatments. Whether employed as a text or an on-the-fly reference, this authoritative volume supplies everything the resident requires to provide a uniformly high level of psychiatric clinical care.
  a clinical guide to transcranial magnetic stimulation: Clinical Manual of Geriatric Psychiatry James E. Spar, Asenath La Rue, 2007-04-02 Because limited training in geriatric psychiatry has tended to give insufficient attention to mental health care for the elderly, clinicians often need help when assessing and treating problems specific to older clients. Clinical Manual of Geriatric Psychiatry provides a single-volume reference that covers the full range of such problems, from depression to dementia. It shows that psychiatrists working with older people must sometimes be willing to play a generalist's role, combining routine medical management with psychiatric interventions or helping with social or situational problems. Drs. Spar and La Rue review the effects of aging on cognitive performance, including clinical presentations of memory loss and medication-induced symptoms of mental disorder. They offer practical guidance to help the clinician not only diagnose and treat these conditions but also address such issues as evaluating competency for informed consent. Enhanced by numerous charts and tables for easy reference, the book boasts a broad range of coverage: • Guidelines to differential diagnosis of depression -- laboratory tests, psychological tests, and symptom rating scales -- along with insights on new directions in psychotherapy, including intervention within primary care. • Assessment of both selective serotonin reuptake inhibitors and non-SSRIs as first-line agents for depression, citing advantages and disadvantages of specific drugs, plus advice on switching or combining antidepressants.• Discussion of the effective use of electroconvulsive therapy -- particularly the use of brief-pulse, bilateral electrode placement -- as well as experimental therapies such as repetitive transcranial magnetic stimulation and vagal nerve stimulation. • Guidance in cognitive mental status examinations and brief screening tools for dementia and Alzheimer's disease, focusing on the Mini-Mental State Exam and summarizing advanced and experimental diagnostics such as single photon emission computed tomography and positron emission tomography. • Appraisal of psychosocial therapies for patients with Alzheimer's Disease, such as behavior modification and reminiscence therapy, plus use of cholinesterase inhibitors for treatment of cognitive deficits.• Review of approaches to anxiety disorders, including differential diagnosis of phobias, generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder, with a focus on psychosocial-behavior therapy and medications of choice. With life expectancies increasing, people over 85 already constitute one of the fastest growing demographics -- and the number of older people with mental disorders is rising as well. Clinical Manual of Geriatric Psychiatry explains how working effectively with older adults requires a blending of specialized knowledge with a flexible approach to the patient -- and shows how to bring that about in daily practice.
  a clinical guide to transcranial magnetic stimulation: Principles and Practice of Electroconvulsive Therapy Keith G. Rasmussen, M.D., 2019-03-06 Even with the rise of newer neuropsychiatric brain stimulation methods, electroconvulsive therapy (ECT) remains a widely used treatment for severe mental illness-and perhaps the most effective for serious mental illness. Optimal treatment requires that psychiatrists be skilled in diagnosis and familiar with the techniques of treatment. That's where Principles and Practice of Electroconvulsive Therapy comes in. With its up-to-date, comprehensive coverage of all aspects of ECT, this is an unrivaled resource for psychiatrists, whether in practice or still in training, striving for maximum treatment efficacy. The book begins with an overview of what ECT is and how it is carried out, followed by a brief history of the therapy, from its earliest applications to its use in modern times. The guide follows the typical course of treatment, discussing the following: - Understanding the indications for ECT and selecting patients who might benefit from this therapy-whether they suffer from depression, mania, schizophrenia, or catatonia - Educating patients and their families on ECT and obtaining patient consent - Conducting a pretreatment medical evaluation and understanding the role of anesthesia - Managing an individual ECT treatment, including choosing the electrical stimulus dose and parameter combination, delivering the electrical stimulus, assisting with recovery problems, etc. - Overseeing the course of treatments, particularly for practitioners not personally conducting the treatments - Managing patients after a course of treatments and preventing relapse - Assessing and managing the memory side effects of ECT The final chapter examines other neuropsychiatric stimulation therapies in relation to ECT and explains how to choose among them. All chapters conclude with easily referenced key points that summarize the most salient ideas. Readers seeking to further educate themselves on ECT will also benefit from the exhaustive reference list. Though particularly useful for psychiatrists and psychiatric residents, Principles and Practice of Electroconvulsive Therapy, with its straightforward style, is a ready resource for any mental health or medical professionals interested in ECT.
  a clinical guide to transcranial magnetic stimulation: Electroconvulsive Therapy Richard Abrams, 2002-06-27 In this fully-revised fourth edition of what has long been the standard textbook for the field, Dr. Richard Abrams once again demonstrates his unique ability to analyze and present a wealth of new(and often technical) material in a lucid, compelling, and highly readable fashion. Hundreds of new clinical studies called from the more than 1500 published since the third edition appeared have been analyzed in depth and incorporated throughout the book. An important new chapter has been added on Transcranial Magnetic Stimulation(TMS) therapy, a treatment for depression that is widely-used in Europe and expected to become available soon for clinical use in the United States. Dr. Abrams exposes the scientific flaws in several widely-cited reports, while focusing on the few carefully-controlled studies that provide solid support for the results claimed. The sections on the electrical stimulus, seizing introduction, seizure quality, and treatment electrode placement have been completely revised and updated with new information on those clinical and technical issues that are presently of greatest concern to practitioners and researchers. A comprehensive critical assessment of the nature of the seizure threshold and the validity of the stimulus titration method for ECT dosing is presented for the first time, with conclusions and recommendations that many will find surprising. The continued controversy over the relative efficacies of unilateral and bitemporal ECT is revisited in light of the latest dosing strategies and treatment outcomes reported, and of the latest results obtained with bifrontal ECT. The potential clinical and theoretical advantages of the recently-rediscovered technique of ultrabrief pulse therapy are explained in detail. The chapter on the memory and cognitive consequences of ECT has been expanded to focus on the subjective memory effects of treatment, with new analysis of the possible biological basis for the improvement in subjective memory so often reported. Recently-published claims of persistent or permanent memory effects of ECT are refuted in detail. In full accordance with the American Psychiatric Association's new guidelines for the practice of ECT, Dr. Abrams' book remains the essential practical guide and reference work for all those who prescribe, perform, or assist with ECT, or are interested in learning more about the subject.
  a clinical guide to transcranial magnetic stimulation: Intraoperative Neurophysiologic Monitoring Gloria M. Galloway, Marc R. Nuwer, Jaime R. Lopez, Khaled M. Zamel, 2010-10-28 Intraoperative neurophysiologic monitoring has shown a steady increase in use for surgeries in which neural structures may be at risk of injury. Some of the surgical techniques used carry inherent risks, and these risks have changed the way in which neurophysiologic monitoring has impacted patient safety and quality of care during surgical procedures. It is therefore crucial that those performing and interpreting intraoperative neurophysiologic monitoring are adequately trained. This book is a comprehensive guide to the current practice of intraoperative neurophysiology with chapters on various modalities and clinical uses. Separate chapters devoted to anesthesia, operating room environment, special considerations in pediatrics and the interpretation and reporting of neurophysiologic data are useful and complementary. Questions and detailed answers on the topics covered can be found on the accompanying website for study review. This book will be useful to the trainee as well as the neurophysiologist already in practice.
  a clinical guide to transcranial magnetic stimulation: Navigated Transcranial Magnetic Stimulation in Neurosurgery Sandro M. Krieg, 2017-07-03 This book is the first comprehensive work summarizing the advances that have been made in the neurosurgical use of navigated transcranial magnetic stimulation (nTMS) over the past ten years. Having increasingly gained acceptance as a presurgical mapping modality in neurosurgery, today it is widely used for preoperative mapping of cortical motor and language function, risk stratification and improving the accuracy of subcortical fiber bundle visualization. This unique work will provide neurosurgeons and neuroscientists who are starting their nTMS program essential and detailed information on the technique and protocols, as well as the current clinical evidence on and limitations of the various applications of nTMS. At the same time, more experienced nTMS users looking for deeper insights into nTMS mapping and treatment in neurosurgery will find clearly structured, accessible information. The book was prepared by an international mix of authors, each of which was chosen for their status as a respected expert on the respective subtopic, as evinced by their landmark publications on nTMS.
  a clinical guide to transcranial magnetic stimulation: The End of Migraines: 150 Ways to Stop Your Pain Alexander Mauskop, 2021-01-04 Alexander Mauskop, M.D., is the founder and medical director of the New York Headache Center. He is also a Professor of Clinical Neurology at the State University of New York Downstate Medical Center in Brooklyn, New York. A leading authority in the field of headache medicine, Dr. Mauskop has lectured widely throughout the world. The End of Migraine: 150 Ways to Stop Your Pain is a comprehensive resource based on Dr. Mauskop’s extensive experience in treating thousands of patients with migraine. In addition to scientific evidence, clinical observations, and practical suggestions, The End of Migraine describes and evaluates the immense amount of information available about every imaginable option that has been shown to impact the occurrence and treatment of migraines. The 150 approaches to ending migraine pain include non-pharmacologic treatments such as avoidance of triggers, diet, physical and behavioral measures, neuro-modulation, and various supplements. It also describes and ranks a wide range of acute and preventive prescription drugs, from the traditional to all of the latest innovations and treatments. The book is written in a clear, concise, and accessible style. Dr. Mauskop’s warm, reassuring voice enables the reader to feel that they are sitting with him, hearing his advice first-hand. Above all, readers of The End of Migraine: 150 Ways to Stop Your Pain will, perhaps for the first time, feel that they are not alone, because there is hope. The book is directed not only to those suffering from migraines but also to neurologists and other health care providers who treat migraine patients.
  a clinical guide to transcranial magnetic stimulation: Stroke Recovery and Rehabilitation Richard L. Harvey, MD, Richard F. Macko, MD, Joel Stein, MD, Carolee J. Winstein, Phd, PT, Richard D. Zorowitz, MD, 2008-11-20 A Doody's Core Title 2012 Stroke Recovery and Rehabilitation is the new gold standard comprehensive guide to the management of stroke patients. Beginning with detailed information on risk factors, epidemiology, prevention, and neurophysiology, the book details the acute and long-term treatment of all stroke-related impairments and complications. Additional sections discuss psychological issues, outcomes, community reintegration, and new research. Written by dozens of acknowledged leaders in the field, and containing hundreds of tables, graphs, and photographic images, Stroke Recovery and Rehabilitation features: The first full-length discussion of the most commonly-encountered component of neurorehabilitation Multi-specialty coverage of issues in rehabilitation, neurology, PT, OT, speech therapy, and nursing Focus on therapeutic management of stroke related impairments and complications An international perspective from dozens of foremost authorities on stroke Cutting edge, practical information on new developments and research trends Stroke Recovery and Rehabilitation is a valuable reference for clinicians and academics in rehabilitation and neurology, and professionals in all disciplines who serve the needs of stroke survivors.
  a clinical guide to transcranial magnetic stimulation: Neuromodulation in Psychiatry Clement Hamani, Paul Holtzheimer, Andres M. Lozano, Helen Mayberg, 2016-01-26 Edited by an expert multidisciplinary team, Neuromodulation in Psychiatry is the first reference guide to address both invasive and non-invasive neuromodulation strategies used in psychiatry. Covers basic principles, technical aspects, clinical applications and ethical considerations Presents up-to-date evidence in comprehensive summaries suitable for all levels of experience Each technique is clearly explained along with its implications for real-world clinical practice Allows psychiatrists to make informed decisions regarding neuromodulation for their patients
  a clinical guide to transcranial magnetic stimulation: fMRI Stephan Ulmer, Olav Jansen, 2013-06-12 Over the past two decades, fMRI has evolved into an invaluable clinical tool for routine brain imaging. This book provides a state of the art overview of fMRI and its use in clinical practice. Experts in the field share their knowledge and explain how to overcome diverse potential technical barriers and problems. Starting from the very basics on the origin of the BOLD signal, the book covers technical issues, anatomical landmarks, the full range of clinical applications, methods of statistical analysis, and special issues in various clinical fields. Comparisons are made with other brain mapping techniques, such as DTI, PET, TMS, EEG, and MEG, and their combined use with fMRI is also discussed. Since the first edition, original chapters have been updated and new chapters added, covering both novel aspects of analysis and further important clinical applications.
  a clinical guide to transcranial magnetic stimulation: Geriatric Forensic Psychiatry Jacob Holzer, Jacob C. Holzer, Robert Kohn, James Ellison, James M. Ellison, Patricia Recupero, Patricia R. Recupero, 2017-12-12 This textbook, one of the first, provides a comprehensive review of the relationship between psychiatry and legal medicine in the older population. Sections reviewing evaluation, civil and criminal topics, and numerous other areas such as risk management, will help physicians, attorneys, and other professionals in their work with the elderly.
  a clinical guide to transcranial magnetic stimulation: Neuromodulation in Basic, Translational and Clinical Research in Psychiatry Ryouhei Ishii, Keiichiro Nishida, Nagy A. Youssef, Kay Jann, Shun Takahashi, 2020-01-20
  a clinical guide to transcranial magnetic stimulation: Clinical Manual of Electroconvulsive Therapy Mehul V. Mankad, John L. Beyer, Richard D. Weiner, Andrew Krystal, 2010-04-13 Increasingly, electroconvulsive therapy (ECT) is recognized as a proven, effective, and even life-saving intervention in certain mood and thought disorders when other treatments have had little or no effect. Despite the proven efficacy and safety of this standard treatment in psychiatry, its availability is variable. Part of this disparity in access is related to misunderstanding by laypersons regarding the treatment and its potential adverse effects. Adequate education and training of psychiatrists and their support staff are essential to ensuring patients' access to this vital treatment tool. The authors of Clinical Manual of Electroconvulsive Therapy offer this expansive yet reader-friendly volume to help psychiatrists successfully incorporate ECT into their clinical practices. It is also a valuable resource for medical students and psychiatric residents, as well as experienced clinicians and researchers. The book updates the 1985 original and 1998 second edition of Electroconvulsive Therapy: A Programmed Text, and provides readers with a scheduled approach to understanding the fundamental concepts of ECT while offering practical guidance for establishing and maintaining an ECT program. Topics include the history of ECT, indications for use, patient referral and evaluation, the basics of ECT, clinical applications, anesthetics and other medications, seizure monitoring and management, ictal motor and cardiovascular response, adverse effects, and maintenance ECT. Included are detailed descriptions of recent advances including ultra-brief pulse ECT, oxygenation, muscle relaxation, and other modifications that have made this very effective treatment much safer and more acceptable to patients. Currently, it is estimated that more than 100,000 people receive ECT treatments each year in the U.S. Indications for use of ECT are for mood disorders such as major depressive disorder and mania, and thought disorders including schizophrenia and schizoaffective disorder. Indications for use in other psychiatric disorders and general medical disorders such as Parkinson's disease, which appears to respond especially well to ECT, are reviewed as well. This highly-readable manual is a must-have for the library of any clinician interested in or currently practicing ECT: Provides background information on the origins of psychiatric treatments preceding ECT, including efforts using hydrotherapy and insulin comas Includes an algorithm for the management of ECT seizure adequacy Discusses contraindications as well as the potential adverse effects of ECT, including cognitive changes and cardiovascular complications Provides specific information about ECT device manufacturers, reprintable patient information sheets, and a written informed consent form This clinical manual comprehensively explores and explains the available knowledge regarding ECT -- based on extensive research over the past 70 years -- in order to help potential ECT clinicians make informed choices about the development and management of their ECT program.
  a clinical guide to transcranial magnetic stimulation: Non Invasive Brain Stimulation in Psychiatry and Clinical Neurosciences Bernardo Dell'Osso, Giorgio Di Lorenzo, 2020-07-24 This book presents the state of the art regarding the use of non-invasive brain stimulation (TMS and tDCS) in the research and treatment of neuropsychiatric disorders. The contributions, all of which were prepared by internationally recognized experts in the field, are divided into two main sections (for TMS and tDCS, respectively) across diagnoses, following an introductory section on the mechanisms of action and neurophysiological background. Neuropsychological perspectives and approaches are provided as well. The book is ultimately intended to offer a unique, integrated approach to the use of non-invasive brain stimulation across the clinical neurosciences, providing a comprehensive and updated perspective that will benefit psychiatrists, neurologists, clinical psychologists and neurophysiologists alike.
  a clinical guide to transcranial magnetic stimulation: Switched On John Elder Robison, 2016-03-22 An extraordinary memoir about the cutting-edge brain therapy that dramatically changed the life and mind of John Elder Robison, the New York Times bestselling author of Look Me in the Eye NAMED ONE OF THE BEST BOOKS OF THE YEAR BY THE WASHINGTON POST Imagine spending the first forty years of your life in darkness, blind to the emotions and social signals of other people. Then imagine that someone suddenly switches the lights on. It has long been assumed that people living with autism are born with the diminished ability to read the emotions of others, even as they feel emotion deeply. But what if we’ve been wrong all this time? What if that “missing” emotional insight was there all along, locked away and inaccessible in the mind? In 2007 John Elder Robison wrote the international bestseller Look Me in the Eye, a memoir about growing up with Asperger’s syndrome. Amid the blaze of publicity that followed, he received a unique invitation: Would John like to take part in a study led by one of the world’s foremost neuroscientists, who would use an experimental new brain therapy known as TMS, or transcranial magnetic stimulation, in an effort to understand and then address the issues at the heart of autism? Switched On is the extraordinary story of what happened next. Having spent forty years as a social outcast, misreading others’ emotions or missing them completely, John is suddenly able to sense a powerful range of feelings in other people. However, this newfound insight brings unforeseen problems and serious questions. As the emotional ground shifts beneath his feet, John struggles with the very real possibility that choosing to diminish his disability might also mean sacrificing his unique gifts and even some of his closest relationships. Switched On is a real-life Flowers for Algernon, a fascinating and intimate window into what it means to be neurologically different, and what happens when the world as you know it is upended overnight. Praise for Switched On “An eye-opening book with a radical message . . . The transformations [Robison] undergoes throughout the book are astonishing—as foreign and overwhelming as if he woke up one morning with the visual range of a bee or the auditory prowess of a bat.”—The New York Times “Astonishing, brave . . . reads like a medical thriller and keeps you wondering what will happen next . . . [Robison] takes readers for a ride through the thorny thickets of neuroscience and leaves us wanting more.”—The Washington Post “Fascinating for its insights into Asperger’s and research, this engrossing record will make readers reexamine their preconceptions about this syndrome and the future of brain manipulation.”—Booklist “Like books by Andrew Solomon and Oliver Sacks, Switched On offers an opportunity to consider mental processes through a combination of powerful narrative and informative medical context.”—BookPage “A mind-blowing book that will force you to ask deep questions about what is important in life. Would normalizing the brains of those who think differently reduce their motivation for great achievement?”—Temple Grandin, author of The Autistic Brain “At the heart of Switched On are fundamental questions of who we are, of where our identity resides, of difference and disability and free will, which are brought into sharp focus by Robison’s lived experience.”—Graeme Simsion, author of The Rosie Effect
  a clinical guide to transcranial magnetic stimulation: The Treatment of Bipolar Disorder André F. Carvalho, Eduard Vieta, 2017-03-01 Bipolar disorder is a chronic and debilitating mental illness affecting a significant proportion of the world's population. It is associated with significant impairments in health-related quality of life and psychosocial functioning, and has significant illness-related morbidity and heightened mortality rates due to medical comorbidities and suicide. The management of this disorder requires a complex combination of pharmacological and psychosocial interventions which can be challenging for clinicians. Written by world experts in the field of bipolar disorder, The Treatment of Bipolar Disorder: Integrative Clinical Strategies and Future Directions provides readers with a concise and comprehensive guide to the integrative management of bipolar disorder. This resource contains 31 chapters on the various management choices available, from both established and novel treatment areas, such as psychoeducation, psychotherapeutic interventions, neuromodulatory approaches and novel therapeutic targets. The complexity and diversity of the management choices available makes this a continually evolving field and necessitates forward thinking. By both discussing the current management of bipolar disorder, and the future developments available, this resource provides all clinicians working with patients with bipolar disorder an up-to-date and reflective guide to its management and what the future holds.
  a clinical guide to transcranial magnetic stimulation: The ECT Handbook I. Nicol Ferrier, Jonathan Waite, 2019-07-04 The fourth edition of this popular Handbook provides the latest guidance on prescribing and administering electroconvulsive therapy (ECT). Leading researchers and practitioners review new research on ECT and related treatments, including their efficacy in children and adolescents, and in those with bipolar disorder and neurological conditions. With a focus on safe provision and minimisation of side effects, it provides the reader with practical, evidence-based advice. The book has been substantially revised: references have been updated throughout; related treatment modalities such as rTMS, tCDS and ketamine are covered in greater depth; and current administrative and legal framework guidelines are clearly outlined. An essential reference manual for consultant and trainee clinical psychiatrists, as well as ECT practitioners. This guide will benefit clinical teams looking after complex cases of depression, as well as those involved in the care of other people for whom ECT may be recommended.
  a clinical guide to transcranial magnetic stimulation: Yoga and Mindfulness Based Cognitive Therapy Basant Pradhan, 2014-11-05 This book attempts to bridge the considerable gaps that exist between spiritual philosophies and evidence-based medicine and between the psychotherapeutic models of the East and the West. Based on the insights of both the ancient wisdom and modern medicine, this book presents Yogic science not just as a set of physical exercises or religious rituals but as theories about the mind that have bio-psycho-social implications in relation to health and illness. Drawing on his years of monastic training and his extensive experiential, clinical and research knowledge on the utility of Yoga meditation in standardized and evidence-based medicine protocols, the author describes symptom-specific clinical applications of Yogic/meditative techniques using standardized protocols for the various psychiatric and psychosomatic conditions. In addition, he explains the value of these techniques in reducing stress and improving quality of life in healthy populations. Dr. Pradhan names the proposed integrative model of psychotherapy Yoga and Mindfulness Based Cognitive Therapy (Y-MBCT). Unlike other models, Y-MBCT uses Yoga in its entirety (all eight limbs, including meditation) rather than piecemeal. The standardized and evidence-based format of Yoga meditation described in this book will help all aspiring Yoga practitioners and will hopefully also provide the impetus for multicenter research studies on the value of this ancient wisdom.
  a clinical guide to transcranial magnetic stimulation: A Guide To Treatments that Work Peter Nathan, Jack M. Gorman, 2002-01-18 A fully revised and updated edition of this unique and authoritative reference The award-winning A Guide to Treatments that Work , published in 1998, was the first book to assemble the numerous advances in both clinical psychology and psychiatry into one accessible volume. It immediately established itself as an indispensable reference for all mental health practitioners. Now in a fully updated edition,A Guide to Treatments that Work, Second Edition brings together, once again, a distinguished group of psychiatrists and clinical psychologists to take stock of which treatments and interventions actually work, which don't, and what still remains beyond the scope of our current knowledge. The new edition has been extensively revised to take account of recent drug developments and advances in psychotherapeutic interventions. Incorporating a wealth of new information, these eminent researchers and clinicians thoroughly review all available outcome data and clinical trials and provide detailed specification of methods and procedures to ensure effective treatment for each major DSM-IV disorder. As an interdisciplinary work that integrates information from both clinical psychology and psychiatry, this new edition will continue to serve as an essential volume for practitioners of every kind: psychiatrists, psychologists, clinical social workers, counselors, and mental health consultants.
  a clinical guide to transcranial magnetic stimulation: Motivational Interviewing for Clinical Practice Petros Levounis, M.D., M.A., Bachaar Arnaout, M.D., Carla Marienfeld, M.D., 2017 Motivational Interviewing for Clinical Practice teaches the reader how to use the critically important tool of motivational interviewing to promote health and well-being. Based on the theoretical framework of Miller and Rollnick, the book presents the latest models and techniques that the editors and authors have found helpful in their scholarship and clinical experience. Failure to adhere to recommended treatments is common across a wide range of illnesses--from medical problems, such as hypertension or management of cardiovascular risk factors, to psychiatric disorders, including addiction. The methods and skills of motivational interviewing can be applied to any health behavior, be it giving up alcohol or cigarettes, taking medication for hypertension or high cholesterol, or changing dietary and exercise habits--from publisher's website.
  a clinical guide to transcranial magnetic stimulation: Clinical Practice Guideline for the Management of Borderline Personality Disorder National Health and Medical Research Council, 2013-02-14

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