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Article ; Online: Deciphering deep brain stimulation for depression.

Bhati, Mahendra T / Halpern, Casey H

The lancet. Psychiatry

2017 Volume 4, Issue 11, Page(s) 820–821

MeSH term(s)	Deep Brain Stimulation ; Depression ; Depressive Disorder, Treatment-Resistant ; Humans
Language	English
Publishing date	2017-10-04
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2215-0374
ISSN (online)	2215-0374
DOI	10.1016/S2215-0366(17)30396-6
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Article ; Online: Defining psychosis: the evolution of DSM-5 schizophrenia spectrum disorders.

Bhati, Mahendra T

Current psychiatry reports

2013 Volume 15, Issue 11, Page(s) 409

Abstract: Descriptions of mental illness exist throughout recorded history. However, until the mid-twentieth century, there was no standard nosology or diagnostic standard for mental disorders. This limited understanding of these disorders and development of ... ...

Abstract	Descriptions of mental illness exist throughout recorded history. However, until the mid-twentieth century, there was no standard nosology or diagnostic standard for mental disorders. This limited understanding of these disorders and development of better treatments. As conditions such as dementia praecox and schizophrenia were being described, collaborative efforts were made in the twentieth century to develop the first Diagnostic and Statistical Manual of Mental Disorders (DSM). This review provides an overview of the history of psychiatric diagnosis with a focus on the history of schizophrenia as a diagnosis in the DSM. DSM-5 updates to diagnostic criteria for schizophrenia and related disorders are provided. Limitations to diagnostic validity and reliability are discussed in addition to changes in diagnostic approaches to schizophrenia spectrum and other psychotic disorders in an effort to improve diagnostic validity and reliability. The DSM-5 reflects the culmination of an ongoing collaborative effort to improve the diagnosis of mental disorders, and future research in Research Domain Criteria (RDoC) will help provide convergent validity when understanding and treating mental illnesses.
MeSH term(s)	Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychotic Disorders/classification ; Psychotic Disorders/diagnosis ; Schizophrenia/classification ; Schizophrenia/diagnosis
Language	English
Publishing date	2013-09-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055376-6
ISSN	1535-1645 ; 1523-3812
ISSN (online)	1535-1645
ISSN	1523-3812
DOI	10.1007/s11920-013-0409-9
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Article ; Online: Deep Brain Stimulation of the Ventral Capsule/Ventral Striatum for Treatment-Resistant Depression: A Decade of Clinical Follow-Up.

Hitti, Frederick L / Cristancho, Mario A / Yang, Andrew I / O'Reardon, John P / Bhati, Mahendra T / Baltuch, Gordon H

The Journal of clinical psychiatry

2021 Volume 82, Issue 6

Abstract: Objective:: Methods:: Results:: Conclusions:: Trial Registration: ...

Abstract	Objective: Methods: Results: Conclusions: Trial Registration:
MeSH term(s)	Cognition ; Deep Brain Stimulation/methods ; Depressive Disorder, Major/therapy ; Depressive Disorder, Treatment-Resistant/psychology ; Depressive Disorder, Treatment-Resistant/therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; Outcome Assessment, Health Care ; Psychiatric Status Rating Scales ; Quality of Life/psychology ; Secondary Prevention/methods ; Time ; Treatment Outcome ; Ventral Striatum
Language	English
Publishing date	2021-10-19
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	716287-x
ISSN	1555-2101 ; 0160-6689
ISSN (online)	1555-2101
ISSN	0160-6689
DOI	10.4088/JCP.21m13973
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Article ; Online: Deep Brain Stimulation for Alzheimer's Disease: Ethical Challenges for Clinical Research.

Siegel, Andrew M / Barrett, Marna S / Bhati, Mahendra T

Journal of Alzheimer's disease : JAD

2017 Volume 56, Issue 2, Page(s) 429–439

Abstract: Deep brain stimulation (DBS) is an invasive neuromodulation modality that has shown early promise as a novel treatment of Alzheimer's disease (AD). Further clinical research is warranted on the basis of positive results from animal and human studies, as ... ...

Abstract	Deep brain stimulation (DBS) is an invasive neuromodulation modality that has shown early promise as a novel treatment of Alzheimer's disease (AD). Further clinical research is warranted on the basis of positive results from animal and human studies, as well as the inadequacy of existing treatments in reducing the enormous medical and financial costs of untreated AD. Nevertheless, unique ethical challenges require particular attention to elements of subject enrollment and informed consent. Study protocols should specify robust assessment and regular monitoring of subject decision-making capacity to consent to trial participation. Investigators should also assess for and mitigate therapeutic misconception (the phenomenon whereby a research participant conflates the goals of research with those of clinical treatment) and ensure that all prospective trial participants have adequate post-trial access to treatment and DBS device maintenance. In the following discussion, each issue is summarized and followed by recommendations for proper ethical procedure. We conclude by assimilating relevant ethical considerations into a decision-making algorithm designed to aid future clinical investigators of DBS for AD with the task of ethical subject enrollment.
Language	English
Publishing date	2017
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-160356
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Article: A Commentary on Attitudes Towards Deep Brain Stimulation for Addiction.

Lee, Karen E / Bhati, Mahendra T / Halpern, Casey H

Journal of neurology & neuromedicine

2016 Volume 1, Issue 8, Page(s) 1–3

Abstract: Deep brain stimulation (DBS) has proven to be an effective treatment for neurologic disorders such as Parkinson's disease, and is currently being investigated as a therapy for psychiatric diseases such as addiction, major depressive disorder, and ... ...

Abstract	Deep brain stimulation (DBS) has proven to be an effective treatment for neurologic disorders such as Parkinson's disease, and is currently being investigated as a therapy for psychiatric diseases such as addiction, major depressive disorder, and obsessive compulsive disorder. In this commentary, we review and discuss the findings presented in the Letter to the Editor entitled "Attitudes towards treating addiction with deep brain stimulation," written by Ali et al
Language	English
Publishing date	2016-11-15
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2572-942X
ISSN	2572-942X
DOI	10.29245/2572.942x/2016/8.1093
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Article: The brain, language, and schizophrenia.

Bhati, Mahendra T

Current psychiatry reports

2005 Volume 7, Issue 4, Page(s) 297–303

Abstract: Language is a defining and prominent feature in humans. This faculty is impaired in those with schizophrenia. Individuals with schizophrenia show numerous abnormalities in language function, including symptoms of disorganized speech, auditory ... ...

Abstract	Language is a defining and prominent feature in humans. This faculty is impaired in those with schizophrenia. Individuals with schizophrenia show numerous abnormalities in language function, including symptoms of disorganized speech, auditory hallucinations, thought disorders, and verbal memory impairments. Structural and functional brain imaging with neurocognitive testing shows various aspects of brain structure and function associated with language that also are abnormal in schizophrenia. This article comparatively reviews this research and relates it to understanding the symptoms and pathophysiologic features of schizophrenia. Understanding the neural basis of language and its disruption in schizophrenia provides a guide for diagnosis, subtyping, treatment, and future research.
MeSH term(s)	Brain/abnormalities ; Brain/physiopathology ; Cognition Disorders/epidemiology ; Humans ; Language Disorders/epidemiology ; Schizophrenia/epidemiology ; Schizophrenia/physiopathology
Language	English
Publishing date	2005-08-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	2055376-6
ISSN	1523-3812
ISSN	1523-3812
DOI	10.1007/s11920-005-0084-6
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Article ; Online: Responsive deep brain stimulation guided by ventral striatal electrophysiology of obsession durably ameliorates compulsion.

Neuron

2023 Volume 112, Issue 1, Page(s) 73–83.e4

Abstract: Treatment-resistant obsessive-compulsive disorder (OCD) occurs in approximately one-third of OCD patients. Obsessions may fluctuate over time but often occur or worsen in the presence of internal (emotional state and thoughts) and external (visual and ... ...

Abstract	Treatment-resistant obsessive-compulsive disorder (OCD) occurs in approximately one-third of OCD patients. Obsessions may fluctuate over time but often occur or worsen in the presence of internal (emotional state and thoughts) and external (visual and tactile) triggering stimuli. Obsessive thoughts and related compulsive urges fluctuate (are episodic) and so may respond well to a time-locked brain stimulation strategy sensitive and responsive to these symptom fluctuations. Early evidence suggests that neural activity can be captured from ventral striatal regions implicated in OCD to guide such a closed-loop approach. Here, we report on a first-in-human application of responsive deep brain stimulation (rDBS) of the ventral striatum for a treatment-refractory OCD individual who also had comorbid epilepsy. Self-reported obsessive symptoms and provoked OCD-related distress correlated with ventral striatal electrophysiology. rDBS detected the time-domain area-based feature from invasive electroencephalography low-frequency oscillatory power fluctuations that triggered bursts of stimulation to ameliorate OCD symptoms in a closed-loop fashion. rDBS provided rapid, robust, and durable improvement in obsessions and compulsions. These results provide proof of concept for a personalized, physiologically guided DBS strategy for OCD.
MeSH term(s)	Humans ; Deep Brain Stimulation/methods ; Treatment Outcome ; Obsessive-Compulsive Disorder/therapy ; Ventral Striatum ; Obsessive Behavior
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	808167-0
ISSN	1097-4199 ; 0896-6273
ISSN (online)	1097-4199
ISSN	0896-6273
DOI	10.1016/j.neuron.2023.09.034
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Zs.MG 92: Show issues

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Article ; Online: Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating.

Shivacharan, Rajat S / Rolle, Camarin E / Barbosa, Daniel A N / Cunningham, Tricia N / Feng, Austin / Johnson, Noriah D / Safer, Debra L / Bohon, Cara / Keller, Corey / Buch, Vivek P / Parker, Jonathon J / Azagury, Dan E / Tass, Peter A / Bhati, Mahendra T / Malenka, Robert C / Lock, James D / Halpern, Casey H

Nature medicine

2022 Volume 28, Issue 9, Page(s) 1791–1796

Abstract: Cravings that precede loss of control (LOC) over food consumption present an opportunity for intervention in patients with the binge eating disorder (BED). In this pilot study, we used responsive deep brain stimulation (DBS) to record nucleus accumbens ( ... ...

Abstract	Cravings that precede loss of control (LOC) over food consumption present an opportunity for intervention in patients with the binge eating disorder (BED). In this pilot study, we used responsive deep brain stimulation (DBS) to record nucleus accumbens (NAc) electrophysiology during food cravings preceding LOC eating in two patients with BED and severe obesity (trial registration no. NCT03868670). Increased NAc low-frequency oscillations, prominent during food cravings, were used to guide DBS delivery. Over 6 months, we observed improved self-control of food intake and weight loss. These findings provide early support for restoring inhibitory control with electrophysiologically-guided NAc DBS. Further work with increased sample sizes is required to determine the scalability of this approach.
MeSH term(s)	Deep Brain Stimulation ; Eating ; Humans ; Nucleus Accumbens ; Obesity, Morbid ; Pilot Projects ; Synaptic Transmission
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-022-01941-w
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Article: Natural language processing methods are sensitive to sub-clinical linguistic differences in schizophrenia spectrum disorders.

Tang, Sunny X / Kriz, Reno / Cho, Sunghye / Park, Suh Jung / Harowitz, Jenna / Gur, Raquel E / Bhati, Mahendra T / Wolf, Daniel H / Sedoc, João / Liberman, Mark Y

NPJ schizophrenia

2021 Volume 7, Issue 1, Page(s) 25

Abstract: Computerized natural language processing (NLP) allows for objective and sensitive detection of speech disturbance, a hallmark of schizophrenia spectrum disorders (SSD). We explored several methods for characterizing speech changes in SSD (n = 20) ... ...

Abstract	Computerized natural language processing (NLP) allows for objective and sensitive detection of speech disturbance, a hallmark of schizophrenia spectrum disorders (SSD). We explored several methods for characterizing speech changes in SSD (n = 20) compared to healthy control (HC) participants (n = 11) and approached linguistic phenotyping on three levels: individual words, parts-of-speech (POS), and sentence-level coherence. NLP features were compared with a clinical gold standard, the Scale for the Assessment of Thought, Language and Communication (TLC). We utilized Bidirectional Encoder Representations from Transformers (BERT), a state-of-the-art embedding algorithm incorporating bidirectional context. Through the POS approach, we found that SSD used more pronouns but fewer adverbs, adjectives, and determiners (e.g., "the," "a,"). Analysis of individual word usage was notable for more frequent use of first-person singular pronouns among individuals with SSD and first-person plural pronouns among HC. There was a striking increase in incomplete words among SSD. Sentence-level analysis using BERT reflected increased tangentiality among SSD with greater sentence embedding distances. The SSD sample had low speech disturbance on average and there was no difference in group means for TLC scores. However, NLP measures of language disturbance appear to be sensitive to these subclinical differences and showed greater ability to discriminate between HC and SSD than a model based on clinical ratings alone. These intriguing exploratory results from a small sample prompt further inquiry into NLP methods for characterizing language disturbance in SSD and suggest that NLP measures may yield clinically relevant and informative biomarkers.
Language	English
Publishing date	2021-05-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2813844-2
ISSN	2334-265X
ISSN	2334-265X
DOI	10.1038/s41537-021-00154-3
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Article: MR-Guided Focused Ultrasound Versus Radiofrequency Capsulotomy for Treatment-Refractory Obsessive-Compulsive Disorder: A Cost-Effectiveness Threshold Analysis.

Kumar, Kevin K / Bhati, Mahendra T / Ravikumar, Vinod K / Ghanouni, Pejman / Stein, Sherman C / Halpern, Casey H

Frontiers in neuroscience

2019 Volume 13, Page(s) 66

Abstract: Meta-analytic techniques support neuroablation as a promising therapy for treatment-refractory obsessive-compulsive disorder (OCD). This technique appears to offer a more favorable complication rate and higher utility than deep brain stimulation. ... ...

Abstract	Meta-analytic techniques support neuroablation as a promising therapy for treatment-refractory obsessive-compulsive disorder (OCD). This technique appears to offer a more favorable complication rate and higher utility than deep brain stimulation. Moreover, these pooled findings suggest that bilateral radiofrequency (RF) capsulotomy has marginally greater efficacy than stereotactic radiosurgery or cingulotomy. MR-guided focused ultrasound (MRgFUS) capsulotomy is an emerging approach with a potentially more favorable profile than RF ablation and radiosurgery, with preliminary data suggesting safety and efficacy. As a clinical trial is being developed, our study examined the cost and clinical parameters necessary for MRgFUS capsulotomy to be a more cost-effective alternative to RF capsulotomy. A decision analytical model of MRgFUS with RF capsulotomy for OCD was performed using outcome parameters of percent surgical improvement in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score, complications, and side effects. The analysis compared measured societal costs, derived from Medicare reimbursement rates, and effectiveness, based on published RF data. Effectiveness was defined as the degree to which MRgFUS lowered Y-BOCS score. Given that MRgFUS is a new therapy for OCD with scant published data, theoretical risks of MRgFUS capsulotomy were derived from published essential tremor outcomes. Sensitivity analysis yielded cost, effectiveness, and complication rates as critical MRgFUS parameters defining the cost-effectiveness threshold. Literature search identified eight publications (162 subjects). The average reduction of preoperative Y-BOCS score was 56.6% after RF capsulotomy with a 22.6% improvement in utility, a measure of quality of life. Complications occurred in 16.2% of RF cases. In 1.42% of cases, complications were considered acute-perioperative and incurred additional hospitalization cost. The adverse events, including neurological and neurobehavioral changes, in the other 14.8% of cases did not incur further costs, although they impacted utility. Rollback analysis of RF capsulotomy yielded an expected effectiveness of 0.212 quality-adjusted life years/year at an average cost of $24,099. Compared to RF capsulotomy, MRgFUS was more cost-effective under a range of possible cost and complication rates. While further study will be required, MRgFUS lacks many of the inherent risks associated with more invasive modalities and has potential as a safe and cost-effective treatment for OCD.
Language	English
Publishing date	2019-02-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2411902-7
ISSN	1662-453X ; 1662-4548
ISSN (online)	1662-453X
ISSN	1662-4548
DOI	10.3389/fnins.2019.00066
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