The Effect of Rapid Transcranial Magnetic Stimulation (rTMS) on Aggression in Forensic Patients

Study Overview
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Brief Summary
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Forensic patients will undergo 30 rTMS treatments, once per day each business day using a 1Hz frequency at the right dorso-lateral pre frontal cortex, located using modified BEAM F3. Patients will be assessed before and after the study with a battery of assessments and using 2 computer tasks: a ball passing task, and the Point Subtraction Aggression Paradigm (PSAP). The investigators will also monitor and record aggressive incidents that take place on the unit.

Official Title
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The Effect of Rapid Transcranial Magnetic Stimulation (rTMS) on Aggression in Forensic Patients

Conditions
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Aggression

Intervention / Treatment
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* Device: rTMS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: are voluntary and competent to consent to treatment are a current Forensics inpatient at St. Joseph's West 5th Campus demonstrate aggressive behavior as confirmed by a psychologist or psychiatrist including verbal and physical aggression are between the ages of 18 and 65 have had no changes in dose or initiation of any psychotropic medication in the 4 weeks prior to motor threshold are willing and able to adhere to the treatment schedule pass the TMS adult Safety-Screening (TASS) Questionnaire Exclusion Criteria: Withdraw consent to participate in the study fail the TASS Safety Screening Questionnaire have a concomitant major unstable medical illness, cardiac pacemaker or implanted medication pump, or a significant history of seizures have active suicidal intent are pregnant as confirmed by pregnancy test completed as part of pre-study screening have any significant neurological disorder or insult including, but not limited to: any condition likely to be associated with increased intracranial pressure, space occupying brain lesion, any significant history of seizure except those therapeutically induced by electroconvulsive therapy (ECT), cerebral aneurysm, Parkinson's disease, Huntington's chorea, multiple sclerosis have an intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed currently (or in the last 4 weeks) take more than lorazepam 2 mg daily (or equivalent) due to seizure risk or any dose of an anticonvulsant due to the potential to limit rTMS efficacy non-correctable clinically significant sensory impairment (i.e., cannot hear well enough to cooperate with interview).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: rTMS<br>treatment with repetitive transcranial magnetic stimulation for 30 days | Device: rTMS<br>* repetitive transcranial magnetic stimulation, 1Hz protocol to right dorsolateral pre frontal cortex (R_DLPFC)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Aggressive Incident Scale (AIS) | ranking scale of aggressive incidents | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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rTMS, Repetitive Transcranial Magnetic Stimulation, Brain Stimulation