Explored in this presentation is the efficacy of treatments used in psychiatry such as ketamine infusion therapy, neurofeedback, and psychological testing. Those interested can learn more about the services and assessments that are used to diagnose and treat patients suffering from a wide range of illnesses and disorders such as depression, anxiety, PTSD, learning disabilities, insomnia, etc.

1. EFFICACY OF
TREATMENTS/ASSESSMENTS
KETAMINE INFUSION,
NEUROFEEDBACK, AND
PSYCHOLOGICAL TESTING
SOPHIA RODRIGUEZ
PSYC 390
ELEMENTAL CENTER LTD.
FALL 2020

2. KETAMINE
• KETAMINE INFUSION- WHAT IS IT?
• INVOLVES THE ADMINISTRATION OF A SINGLE INFUSION OR A SERIES OF INFUSIONS FOR THE MANAGEMENT
OF PSYCHIATRIC DISORDERS
• I.E., MAJOR DEPRESSIVE DISORDER, POST-TRAUMATIC STRESS DISORDER, ACUTE SUICIDALITY)
• NONCOMPETITIVE N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONIST THAT HAS TRADITIONALLY
BEEN USED FOR THE INDUCTION AND MAINTENANCE OF ANESTHESIA
• GLUTAMATE AND NMDA RECEPTOR MRNA EXPRESSION ARE ABNORMAL IN INDIVIDUALS WITH MAJOR
DEPRESSIVE DISORDER AND BIPOLAR AFFECTIVE DISORDER
• KETAMINE BINDS TO NMDA RECEPTORS
• WHICH INCREASES THE AMOUNT OF GLUTAMATE IN THE SPACES BETWEEN NEURONS
• GLUTAMATE —> ACTIVATES CONNECTIONS IN ANOTHER RECEPTOR (AMPA RECEPTOR)
• TOGETHER, THE INITIAL BLOCKADE OF NMDA RECEPTORS AND ACTIVATION OF AMPA RECEPTORS
LEAD TO THE RELEASE OF OTHER MOLECULES THAT STRENGTHEN NEURONAL COMMUNICATION
ALONG NEW PATHWAYS
• SYNAPTOGENESIS: THIS PROCESS LIKELY AFFECTS MOOD, THOUGHT PATTERNS, AND COGNITION
Lee, Della Selva, Liu, &
Himelhoch, 2015; Meisner, 2019

3. KETAMINE (CONT.)
• SIGNIFICANTLY REDUCES DEPRESSIVE SYMPTOMS (LEE, DELLA SELVA, LIU, & HIMELHOCH, 2015)
• EFFECTS SUSTAINED AT 7 DAYS POST-INFUSION
• RAPID ANTI-DEPRESSANT EFFECT
• STUDIES
• LEE ET. AL., 2015
• SHOWED ROBUST RATE RESPONSIVENESS TO KETAMINE
• 50% OR GREATER REDUCTION IN MONTGOMERY-ASBERG DEPRESSION RATING SCALE (MADRS) AS
COMPARED TO BASELINE MADRS SCORE
• 50% OR GREATER REDUCTION IN HAMILTON DEPRESSION RATING SCALE (HDRS) AS COMPARED TO
BASELINE HDRS SCORE
• WILKINSON, BALLARD, BLOCH, MATHEW, MURROUGH, FEDER, SOS, WANG, ZARATE, & SANACORA, 2018
• SUICIDE IS AMONG THE TOP 3 CAUSES OF MORTALITY WORLDWIDE FOR INDIVIDUALS AGED 15-44
• STUDY: COLLECTED BASELINE DATA ON DAY 1 USING MADRS, HDRS, QUICK INVENTORY OF DEPRESSIVE
SYMPTOMOLOGY-SELF REPORT (QIDS-SR), AND BECK DEPRESSION INVENTORY (BDI)
• COLLECTED ON DAY 1,2,3, AND 7
• PATIENTS WHO HAD NO SUICIDAL IDEATION AT BASELINE WERE EXCLUDED FROM ANALYSIS
• RESULTS
• REDUCED SUICIDAL IDEATION MORE RAPIDLY THAN WAS OBSERVED WITH CONTROL TREATMENTS
• MEAN MADRS SCORES
• KETAMINE GROUP
• BASELINE: 33.8 (SD=6.8)
• DAY 1: 19.5 (SD=12.3)
• DAY 2: 19.4 (SD=12.1)
• DAY 3: 20.1 (SD=12.2)
• DAY 7: 22.0 (SD=11.5)
• RESULTS (CONT.)
• CONTROL GROUP
• BASELINE: 32.9 (SD=6.5)
• DAY 1: 29.2 (SD=9.3)
• DAY 2: 29.1 (SD=10.5)
• DAY 3: 27.3 (SD=9.8)
• DAY 7: 27.5 (SD=10.0)
• SELF REPORT MEASURES
• WHEN EACH SELF-REPORT MEASURE WAS ANALYZED, IT WAS SHOWN THAT KETAMINE
MORE RAPIDLY REDUCED SUICIDAL IDEATION THAN CONTROL GROUPS ON THE QIDS-
SR (P< 0.001) BUT NOT THE BDI (P=0.08)
• KETAMINE WAS ASSOCIATED WITH GREATER PROPORTION OF PEOPLE FEELING FREE
FROM SUICIDAL IDEATION COMPARED TO CONTROL TREATMENTS AT POST-INFUSION
DAYS 1,2,3 (P<0.05) BUT NOT ON DAY 7 (P=0.238)
• TAKEAWAYS:
• KETAMINE HAS A HALF-LIFE OF 3 HOURS AND IS “EXTENSIVELY HEPATICALLY
METABOLIZED” (LEE ET AL., 2015) SO IT MAKES SENSE WHY THE EFFECT SIZE WAS
REDUCED TO MEDIUM ON DAY 7
• DATA SUGGEST WEEKLY DOSING OF IV KETAMINE
• CAN BE BURDENSOME; TAKEN ORALLY WOULD BE PREFERABLE BUT RUN THE
RISK OF ABUSE

4. NEUROFEEDBACK
• WHAT IS NEUROFEEDBACK?
• KIND OF BIOFEEDBACK
• TEACHES SELF-CONTROL OF BRAIN FUNCTION
TO INDIVIDUALS BY MEASURING BRAIN WAVES
AND PROVIDING A FEEDBACK SIGNAL
• PROVIDES AUDIO OR VISUAL FEEDBACK
• POSITIVE OR NEGATIVE FEEDBACK IS
PRODUCED FOR DESIRABLE OR
UNDESIRABLE BRAIN ACTIVITIES
• USED TO TREAT A VARIETY OF DISORDERS AND PROBLEMS
• ADHD, ANXIETY, DEPRESSION, EPILEPSY, INSOMNIA,
ASD, DRUG ADDICTION, SCHIZOPHRENIA, LEARNING
DISABILITIES, DYSLEXIA AND DYSCALCULIA, AND
OTHER APPLICATIONS SUCH AS PAIN MANAGEMENT
AND IMPROVEMENT OF MUSICAL AND ATHLETIC
PERFORMANCE
• NEUROFEEDBACK (NF) IS MOSTLY IMPLEMENTED USING
NON-INVASIVE TECHNIQUES SUCH AS FMRI OR EEG
• WHAT HAPPENS DURING TREATMENT?
• INDIVIDUAL BECOMES AWARE OF CHANGES
• IE. SUBJECT WILL TRY TO IMPROVE BRAIN
PATTERNS BASED ON THE CHANGES THAT
OCCUR IN THE SOUND OR MOVIE
• IF THE AUDIO OR VISUAL STOPS, THE
PERSON WILL REASSESS THEIR THOUGH
PATTERNS IN ORDER TO CONTINUE ON
WITH THE STIMULUS
www.elementalcenter.com/neurofeedback Marzbani, Marateb, & Mansourian, 2016

5. NEUROFEEDBACK (CONT.)
• WHEN NEURONS ARE ACTIVATED, THEY PRODUCE ELECTRICAL PULSES
(MARZBANI, 2016)
• BRAIN PATTERN DIFFERENCES CAN BE OBSERVED BY THEIR
AMPLITUDES AND FREQUENCIES
• AMPLITUDE: POWER OF THE WAVES (MEASURED IN
MICROVOLTS)
• FREQUENCY: HOW FAST THE WAVE OSCILLATES (MEASURED
BY THE #WAVES/SECOND [HERTZ])
• DIFFERENT FREQUENCY COMPONENTS:
• DELTA (LESS THAN 4 HERTZ)
• THETA (4-8 HZ)
• ALPHA (8-13 HZ)
• BETA (13-30 HZ)
• GAMMA (30-100 HZ)
• CLINICAL APPLICATIONS (MARZBANI ET AL., 2016)
• EXAMPLES
• ADHD
• EFFECTIVE IN REDUCING HYPERACTIVITY, INCREASING FOCUS/GRADES,
AND IMPROVING INDICATORS OF SUSTAINED ATTENTION
• DECREASES BRAIN ACTIVITY IN THE THETA BAND AND INCREASES
ACTIVITY IN THE BETA BAND
• ASD
• IMPROVEMENT IN FOCUS, ATTENTION, HELPS INDIVIDUALS RELAX,
IMPROVEMENT IN SOCIAL BEHAVIORS, INCREASE IN APPROPRIATE EYE-
CONTACT, REDUCTION IN SELF-STIMULATION
• INSOMNIA
• HELPS PEOPLE TO PREPARE THEIR BODY AND MIND FOR SLEEP/GO TO
SLEEP FASTER
• SCHIZOPHRENIA
• PEOPLE SUFFERING ARE ABLE TO ADJUST THEIR BRAIN ACTIVITY
• HELPS WITH ILLUSIONS OF AUDITORY DISORDERS,
RESTLESSNESS, CONFUSION, DEPRESSION
Each
represent
s a
specific
physiolog
ical
function

6. PSYCHOLOGICAL TESTING
• PURPOSE OF PSYCHOLOGICAL TESTS AND ASSESSMENTS
• SIMILAR TO MEDICAL TESTS
• HELPS PSYCHOLOGISTS MEASURE AND OBSERVE A CLIENT’S BEHAVIOR IN ORDER TO ARRIVE AT A
DIAGNOSIS AND CREATE A TAILORED TREATMENT PLAN
• EXAMPLES
• A CHILD WHO HAS PROBLEMS IN SCHOOL MAY TAKE AN APTITUDE TEST OR TESTS FOR LEARNING
DISABILITIES
• IF A PERSON IS HAVING RELATIONSHIP PROBLEMS, THESE TESTS CAN EVALUATE IS THE PERSON IS
EXPERIENCING EMOTIONAL DISORDERS
• IE. DEPRESSION OR STRUGGLING WITH ANGER MANAGEMENT/INTERPERSONAL SKILLS
• TESTING/ASSESSMENTS INCLUDE:
• USAGE OF FORMAL TESTS CALLED “NORM-REFERENCED” TESTS
• IE. QUESTIONNAIRES OR CHECKLISTS
• TESTS HAVE BEEN STANDARDIZED SO INDIVIDUALS ARE ANALYZED IN A SIMILAR WAY
• IE. A CHILD WHO TAKES A TESTS ON READING ABILITIES— THESE SCORES WILL BE
COMPARED TO OTHER CHILDREN OF SIMILAR AGE OR GRADE LEVEL
• NORM-REFERENCED TESTS HAVE BEEN PROVEN TO BE EFFECTIVE FOR MEASURING A PARTICULAR TRAIT
OR DISORDER
• COGNITIVE VS NON-COGNITIVE QUALITIES
• COGNITIVE: INTELLIGENCE, LANGUAGE, ATTENTION AND VIGILANCE, EXECUTIVE FUNCTIONING,
PROCESSING SPEED, MEMORY
• NON-COGNITIVE: EMOTIONAL, BEHAVIORAL, PERSONALITY
• PSYCHOMETRICS
• RELIABILITY (CONSISTENCY)
• TEST-RETEST: DETERMINE WHETHER SCORES REMAIN STABLE OVER TIME
• INTER-RATER: CAN TEST SCORES BE AGREED UPON BY INDEPENDENT JUDGES
• INTERNAL CONSISTENCY: ITEMS MEASURE THE SAME THING
• VALIDITY (ACCURACY OF INTERPRETATIONS AND USE)
• INTERPRETATIONS OF SCORES MUST BE ROOTED IN PSYCHOLOGICAL THEORY AND
EMPIRICAL EVIDENCE
• ENSURE STRUCTURE OF TEST MATCHES THE THEORY BEHIND CREATING IT
• STANDARDIZATION
• PROVIDES SET OF SCORES FROM DESIGNATED POPULATIONS
• INDIVIDUAL SCORES CAN BE COMPARED TO ONE ANOTHER
• WITHOUT STANDARDIZED ASSESSMENT, AN INDIVIDUALS PERFORMANCE MIGHT NO
REFLECT HIS/HER ABILITY OR PRESENTING ISSUE
www.apa.org/topics/psychological-testing-
assessment
https://www.ncbi.nlm.nih.gov/books/
NBK305233/#!po=1.21951

7. PSYCHOLOGICAL TESTING (CONT.)
• TESTING/ASSESSMENTS INCLUDE (CONT.)
• INFORMAL TESTS AND SURVEYS
• INTERVIEWS— (WITH CLIENT’S TEACHER, COWORKERS, FAMILY MEMBERS, FRIENDS,
ETC— NEED WRITTEN CONSENT)
• CLINICAL INTERVIEW: WHEN A PSYCHOLOGIST SPEAKS TO A PERSON ABOUT
THEIR CONCERNS AND HISTORY; IN THIS INTERACTION, THE PSYCHOLOGIST IS
ABLE TO OBSERVE HOW THE CLIENT THINKS, REASONS, AND INTERACTS WITH
OTHERS
• SCHOOL OR MEDICAL RECORDS
• MEDICAL EVALUATIONS
• OBSERVATIONAL DATA
• THE PSYCHOLOGIST WILL DETERMINE WHICH INFORMATION TO USE BASED ON
WHAT QUESTION IS TRYING TO BE ADDRESSED
• IMPLICATIONS
• CAN BE USED TO DETERMINE IF A PERSON HAS ANY SORT OF DISABILITY OR DISORDER,
IS COMPETENT TO STAND TRIAL, OR HAS TRAUMATIC BRAIN INJURY
• IE. ANXIETY DISORDERS, DEPRESSION, EATING DISORDERS, LEARNING DISABILITY,
PERSONALITY DISORDER, ETC,
• IN MANY CASES, AFTER THE TEST(S) IS/ARE ADMINISTERED,
THE PSYCHOLOGIST WILL TREAT THE PATIENTS
• SOME REFER THEIR CLIENTS TO OTHER SPECIALISTS FOR
TREATMENT AFTER A DIAGNOSIS HAS BEEN MADE
www.apa.org/topics/psychological-testing-
assessment
https://jflowershealth.com/psychological-diagnostic
testing/

8. VIDEOS/PICTURES
• HTTPS://YOUTU.BE/JQEJ53DWGNY
• HTTPS://YOUTU.BE/ZTL6LCLNKXG
• NEUROFEEDBACK
Where electrodes may be
placed:
Brain lobes and their corresponding functions
and areas
 NF on Depression:
 Increase alpha and theta
 Inhibit faster beta frequencies
 Produces significant
improvements in depression
 NF on epilepsy:
 Continuous sensorimotor
rhythm therapy reduces rates
of seizures in severe and
uncontrolled epilepsy
 NF on learning disabilities, dyslexia,
and dyscalculia
 Increasing alpha wave
activity
 Helps individuals to better
understand and solve
problems (ie. math problems)
Marzbani et al., 2016

9. VIDEOS/PICTURES (CONT.)
• https://youtu.be/YHOmXnNf1A0
• https://youtu.be/ddOSOBvKWqU (how
it’s administered)
• Ketamine

10. VIDEOS/PICTURES (CONT.)
• PSYCHOLOGICAL TESTING
Example of a Personality
Assessment

11. REFERENCES
• LEE, E. E., DELLA SELVA, M. P., LIU, A., & HIMELHOCH, S. (2015). KETAMINE AS A NOVEL TREATMENT FOR MAJOR DEPRESSIVE DISORDER AND BIPOLAR DEPRESSION: A
SYSTEMATIC REVIEW AND QUANTITATIVE META-ANALYSIS. GENERAL HOSPITAL PSYCHIATRY, 37(2), 178–184. HTTPS://DOI.ORG/10.1016/J.GENHOSPPSYCH.2015.01.003
• MARZBANI, H., MARATEB, H. R., & MANSOURIAN, M. (2016). NEUROFEEDBACK: A COMPREHENSIVE REVIEW ON SYSTEM DESIGN, METHODOLOGY AND CLINICAL
APPLICATIONS. BASIC AND CLINICAL NEUROSCIENCE, 7(2), 143–158. HTTPS://DOI.ORG/10.15412/J.BCN.03070208
• WILKINSON, S. T., BALLARD, E. D., BLOCH, M. H., MATHEW, S. J., MURROUGH, J. W., FEDER, A., SOS, P., WANG, G., ZARATE, C. A., JR., & SANACORA, G. (2018). THE EFFECT OF A
SINGLE DOSE OF INTRAVENOUS KETAMINE ON SUICIDAL IDEATION: A SYSTEMATIC REVIEW AND INDIVIDUAL PARTICIPANT DATA META-ANALYSIS. THE AMERICAN JOURNAL OF
PSYCHIATRY, 175(2), 150–158. HTTPS://DOI.ORG/10.1176/APPI.AJP.2017.17040472
• HTTPS://WWW.APA.ORG/TOPICS/PSYCHOLOGICAL-TESTING-ASSESSMENT
• HTTPS://WWW.ELEMENTALCENTER.COM/NEUROFEEDBACK
• HTTPS://WWW.NCBI.NLM.NIH.GOV/BOOKS/NBK305233/#!PO=1.21951
• HTTPS://JFLOWERSHEALTH.COM/PSYCHOLOGICAL-DIAGNOSTIC-TESTING/
• HTTPS://WWW.HEALTH.HARVARD.EDU/BLOG/KETAMINE-FOR-MAJOR-DEPRESSION-NEW-TOOL-NEW-QUESTIONS-2019052216673