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Psychiatry > TMS > Flashcards

TMS Flashcards

1
Q

How deep does the electric field penetrate the heads surface?

A

2-4 cm

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2
Q

What does the train represent?

A

The number of repetitive pulses in a quick succession.

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3
Q

Why do we get the motor threshold?

A

It is used to determine the goal treatment intensity and we base it on the level of tolerability

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4
Q

What is the goal of mapping?

A

To locate the motor cortex and the motor threshold so that we can use the motor threshold to determine the intensity of the treatment.

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5
Q

What is the nasion and inion?

A

Nasion is the point where the nasal and frontal bone connect

Inion is the projecting part of the occipital bone at the base of the skull.

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6
Q

What should the measurements for the nasion to cap be between

A

Between 1 to 2.5 cm. No greater than 2.5 cm.

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7
Q

What does c3 and f3 represent

A

C3 is left side motor cortex for right hand

F3 is left dorsolateral prefrontal cortex

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8
Q

Why is the motor cortex important?

A

It helps us find the dlpfc!

The goal is to move the index finger (but any finger moment is sufficient)

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9
Q

What are the steps involved in the BEAM method?

A

Measure the distance from nasion to onion and Tragus to tragus (making sure it is going through the cz/vertex)

Then take 20% of the tragus to tragus and measure laterally from the vertex and that gives you c3

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10
Q

In the 5 cm rule, where do you place your marks on the diagonal line

A

4.5 cm, 5 cm, and 5.5 cm

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11
Q

What amplitude do you start at when testing for motor threshold?

A

40% or 50%

Keep going until you see a response and then

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12
Q

Where do you usually start treatment intensity at?

A

80% of MT

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13
Q

If the patients MT is between 20 and 40 what should your treatment intensity goal range be?

A

100 to 120%

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14
Q

If the patient motor threshold is between 40 to 50, the treatment intensity goal should be?

A

100 to 110% of the motor threshold 

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15
Q

How much time do you want to take to increase to the goal Treatment intensity

A

Do you want to slowly increase over the course of 3 to 5 days

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16
Q

If having difficulty finding the motor threshold, what amplitude should you not go over?

A

60 

17
Q

What are the two most important things when it comes to TMS treatment?

A

Making sure the patient can tolerate the treatment and making sure that we can get the patient the most pulses throughout the course of their treatment 

18
Q

On the brains way device, what amplitude do you not want to exceeded?

A

40, patients typically tolerate 25 to 35 

19
Q

At what point should you do remapping

A

Close to the 15th treatment

20
Q

At what point should you do remapping

A

Close to the 15th treatment

21
Q

How much of a gap should there be when the coil is placed on the head?

A

It should not go beyond your distal, interphalangeal point 

22
Q

When doing rem mapping, which side should you start on?

A

You should start on the right side and complete the birth and then complete the left side. 

23
Q

During re-mapping, if the motor threshold is 35 or lower what percentage can you go up to?

A

Can go higher than 120 if tolerated 

24
Q

During remapping if the motocross hold is 35 or higher, what goal percentage should you shoot for?

A

Do not go over 110% unless as a psychiatrist, you see that they can tolerate it and will benefit from a higher intensity 

25
Q

What is the machine average for a mag venture?

A

40

26
Q

What is the machine average for brains way?

A

About 30

27
Q

At remapping, if depression symptoms have not improved. What can you do?

A

You can double down by adding left sided theta. 

28
Q

How many sessions are included in a TMS treatment?

A

36 sessions typically done over six weeks and the patient should show up about five days out of the week 

29
Q

What should you do if you have double down on the left side to help with depression treatment and there is still no improvement?

A

You can either consider changing devices or a violate for other aspects that may be contributing to their poor progress (bio, psycho,social, spiritual)

30
Q

Went to consider brains way

A

When the patient has OCD, patient with personality disorders, patients who are doing a second round of TMS and they responded well but the effects were not long lasting from magventure 

31
Q

What to do when giving treatment and depression is improving but anxiety has gotten worse

A

You can add the default 10 Hz protocol to the right side

If there is time constraints- then you can switch theta bursts to the left and 10hz to the right but only if depression has improved 

32
Q

What to do if depression and anxiety has gotten worse at remapping?

A

Consider adding left sided theta and right sided 10 hz

Or if they already have 10hz on the right side- then consider adding left sided theta burst or a device change

33
Q

What is the ideal improvement we want to see in MDD

A

50% decrease in phq9 or at least 5 point reduction in depressive scale

Typically will see improvement in sleep

34
Q

When to consider the 1 Hz protocol?

A

When anxiety is the main concern.

There is a 10 min option for less severe anxiety and a 20 min option (double the pulses but more of a time commitment)

35
Q

Ideal improvement for anxiety ?

A

50 % decrease on GAD7

36
Q

How would you add the 1 hz protocol?

A

You would do the default bilateral protocol and then add 1 Hz protocol to the right side.

37
Q

What can you do if the primary concern is ptsd/trauma?

A

Do the standard and add 10Hz to the right side (addds 15 minutes)

38
Q

Time required for each part of the protocol

A

10hz- 15 minutes
Theta burst- 3 minutes
1 hz - 10-20 minutes

Psychiatry (5 decks)

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