Community implementation of TMS for smoking cessation
Interventional psychiatric treatments, such as neuromodulation, have been available for decades or more yet often remain unfamiliar or not considered in many patient settings. This lecture will provide a general overview of three neuromodulation modalities with a particular focus on TMS (Transcranial Magnetic Stimulation) and mentions of ECT (Electroconvulsive Therapy) and VNS (Vagus Nerve Stimulation), with information on typical treatment course, mechanism of action, and patient selection considerations. After the overview, we will look at ways that these treatments can be appropriate for managing patients diagnosed with Substance Use Disorders.
Objectives:
- Review Evidence Based Interventional/Neuromodulation Treatments for MDD with a particular focus on TMS
- Review treatment course and mechanism of action for TMS
- Discuss the role of these treatments in the setting of substance use disorders
Elizabeth Shultz CV
Dr. Shultz completed her undergraduate degree at Indiana University Bloomington before starting her osteopathic medical degree at Kansas City University of Medicine and Biosciences in Kansas City, MO. Upon graduation from medical school, she completed her Adult Psychiatry residency training at Cleveland Clinic in Ohio serving as Chief resident during her PGY-3 year. From 2013-2023, she worked as a faculty psychiatrist at Vanderbilt University Medical Center. During her time at Vanderbilt, she ran inpatient teams, joined the Neuromodulation team serving as the medical director from 2021-2023 where she helped grow the ECT, TMS, and educational experiences. Additionally, she developed a passion for working with marginalized populations such as those living with HIV and members of the LGBTQIA community. Since November 2023, Dr. Shultz practices at Neuroscience and TMS Treatment Centers in Nashville, TN where she provides medication management and interventional services outpatient. She continues to maintain a voluntary faculty appointment with Vanderbilt University and engages in teaching opportunities with trainees.
Education
Undergraduate:
August 2001-May 2005 B.S. Psychology (minors in Spanish, Chemistry & Biology, honors distinction)
Indiana University—Bloomington
Graduate:
August 2005- May 2009 Doctor of Osteopathic Medicine, Kansas City University of Medicine &
Biosciences
32 Day gap of vacation between end of medical school and start of residency
Postgraduate:
July 2009-June 2013 Resident, General Adult Psychiatry
Cleveland Clinic, Cleveland, OH
Program Director: George Tesar, M.D.
Licensure and Certification
2009-2013 Ohio State Medical Board, Training Certificate, OH/58.003203
August 2012-January 1, 2014 Ohio State Medical Board, OH/34.010648 (did not renew)
January 2013- Tennessee State Medical Board, TN/DO0000002460; renewed October 2014,
November 2016, November 2018
May 2012 Electroconvulsive Therapy Certification, International Society for ECT and
Neurostimulation
February 13, 2011 Collaborative Institutional Training Initiative (CITI), completed with Cleveland
Clinic
May 22, 2014- Collaborative Institutional Training Initiative (CITI), completed with Vanderbilt
University; renewed 5/2015, 6/2019, 9/2020
September 2013- Diplomate, American Board of Psychiatry and Neurology, General Psychiatry,
#67163, Expiration: 12/2024
January 1, 2018- Diplomate, American Board of Preventive Medicine, Addiction Medicine,
#61-3317, Expiration: 1/31/2028
October 2020- Perinatal Mental Health Certification through Postpartum Support International
Academic Appointments
October 2011- June 2013 Clinical Instructor, Cleveland Clinic Lerner College of Medicine at Case Western
Reserve University
June 2013-July 2023 Assistant Professor of Clinical Psychiatry, Vanderbilt University School of Medicine
July 2023-October 2024 Associate Professor of Clinical Psychiatry, Vanderbilt University School of
Medicine
November 2024- Voluntary faculty of Clinical Psychiatry, Vanderbilt University School of Medicine
Hospital Appointments
June 2013-October 2024Attending Psychiatrist, Adult Inpatient Psychiatry, Vanderbilt Psychiatric
Hospital, Vanderbilt University Medical Center, Nashville, TN
March 2021-October2024Medical Director of Neuromodulation Services, Vanderbilt Psychiatry Hospital,
Vanderbilt University Medical Center, Nashville, TN
Employment
October 2012-May 2013 Psychiatric Emergency Department House Officer, St. Vincent’s Charity Hospital,
Cleveland, OH.
December 2012-May 2013 Internal Moonlighting Physician, Marymount Hospital, Cleveland Clinic,
Garfield Heights, OH.
Professional Organizations
2009- American Psychiatric Association, member
2009-2013 Ohio Psychiatric Physicians Association, member
2013- Tennessee Psychiatric Association, member
2005-May 2015 American Osteopathic Association, member
Professional Activities
Intramural:
June 2011-June 2012 Psychiatry Department Education Committee, Cleveland Clinic, member
July 2011-June 2012 Neurological Institute Education Committee, Cleveland Clinic, member
June 2014-July 2024 Physician Advisor for the Utilization Management (UM) Committee at Vanderbilt
Psychiatric Hospital and Vanderbilt University Medical Center
-Review and update Vanderbilt Behavioral Health UM Plan and Charter
-Physician lead and co-run quarterly Vanderbilt Behavioral Health (VBH) UM
Committee meeting
-Co-developed and steer VBH Complex Patient Review Committee
-Physician lead for VPH Complex Patient Review Committee meetings
March 2014-2015 Call Schedule workgroup at Vanderbilt Psychiatric Hospital
July 2018-January 2023 Educational Policy Committee
July 2018-July 2024Clinical Competency Committee for Adult Psychiatry Residency
May 2019 Committee Member for Suspensory Advisory Committee to Medical Center Medical
Board
July 2019-February 2020 Admission & Discharges Workgroup, Vanderbilt Psychiatric Hospital
November 2020- Sexual Orientation and Gender Identity Data Implementation Workgroup
August 2021-2022Transgender Workgroup for inpatient practices at Vanderbilt Psychiatric Hospital
November 2021-2022 Clinical Practice Committee, Vanderbilt Psychiatric Hospital
Awards and Honors
2011-2012 Chief Resident, Adult Psychiatry, Cleveland Clinic, Cleveland, OH.
May 2005 Phi Beta Kappa, Indiana University, Bloomington, IN.
April 2017 VBH Impact Award
Teaching Activities
Medical School Courses
Title Required or
Elective
Number of Contact
Hours
Dates offered Role
“Cannabis Use
and Psychosis”
Department of
Psychiatry
Chairman’s
Journal Club,
Cleveland Clinic
Required Lecture: 1
Conference:
Lab:
May 20, 2010 Presenter
Medical Student
didactics (varied
topics)
Required Lecture: 8
Weekly during core
psychiatry rotation
at Cleveland Clinic
Conference:
Lab:
July 2010-2011 Presenter
“A Second Opinion
for Bipolar
Disorder”
Case Conference
for Psychiatry
resident didactics,
Cleveland Clinic
Required Lecture: 1
Conference:
Lab:
February 23, 2011 Presenter
“Electroconvulsive
Therapy”
Required Lecture: 1
Conference:
October 2014 Presenter
Lab:
Primary Care
Week Discussion
Panel
Vanderbilt
University School
of Medicine
(VUSM)
Elective Lecture:
Conference: 1
Lab:
October 27, 2014 Panelist
Observed
Interviews and
Physical
Examination Skills
Medical students,
VUSM
Required Lecture:
Conference:
Lab: 2
December 2014 Evaluator
Brain, Behavior,
and Movement
VUSM MSI
Required Lecture: 1
Conference:
Lab: 12, 2 hours per
session
March 2015-July
2016
Revised
curriculum for
psychiatry
portion with
co-director
Co-teacher for
lectures
Small group
facilitator for
clinical
experience
“LGBTQ+ Mental
Health”
Sexual Medicine
and Reproduction
Integrated Science
Course, VUSM
Elective Lecture: 2
Conference:
Lab:
September 2021- Developed
curriculum
with small
team and
co-led the
sessions and
panel
discussions
“Brain Stimulation
Therapies”
Brain, Behavior,
and Movement
Course, VUSM,
Foundations of
Medical
Knowledge Phase
(MSI students)
Required Lecture: 1
Conference:
Lab:
July 2021-July
2022
Presenter
Graduate School Courses
Title Required or
Elective
Number of
Contact Hours
Dates Offered Role
“Atypical Antipsychotics in
the Outpatient Population”
PGY-2 psychiatry resident
didactics, Cleveland Clinic
Required Lecture: 1
Conference:
Lab:
August 2011 Presenter
“Case Correlation” (Mood
Disorders)
Adult Psychiatry Resident
Didactics, Cleveland Clinic
Required Lecture: 1
Conference:
Lab:
January 2012 Presenter
Observed Structured
Clinical Evaluation (OSCE)
PGY-1 Adult Psychiatry
Residents, Vanderbilt
University Medical Center
(VUMC)
Required Lecture:
Conference:
Lab: 4
July 2014-2019 Evaluator
“Borderline Personality
Disorder in the Elderly”
Case Conference with Beto
Arriola-Vigo, MD PGY-1
Psychiatry Resident, VUMC
Required Lecture:
Conference: 1
Lab:
July 22, 2014 Faculty Discussant
“Substance Use Disorders:
Other Considerations”
PGY-2 Psychiatry resident
didactics, VUMC
Required Lecture: 1
Conference:
Lab:
March 2015-,
annual
Presenter
“Mental Status
Examination”
PGY-2 Psychiatry resident
didactics, VUMC
Required Lecture: 1
Conference:
Lab:
August 2015-,
annual
Presenter
“Depression in Pregnancy”
Case Based Learning with
Shakevia Johnson, MD
PGY-1 Psychiatry Resident,
VUMC
Required Lecture:
Conference: 1
Lab:
October 31,
2017
Faculty Discussant
Observed Structured
Teaching Examination
Required Lecture:
Conference:
Lab: 2
June 2017- Evaluator
Rising PGY-3 Psychiatry
Residents, VUMC
“Navigating Discharges”
PGY-1 Psychiatry resident
psychotherapy didactics,
VUMC
Required Lecture: 1
Conference:
Lab:
August
2019-2020
Presenter
“Akathisia”
Case Conference with
Barrington Hwang, MD
PGY-1, Psychiatry Resident,
VUMC
Required Lecture:
Conference: 1
Lab:
November 12,
2019
Faculty Discussant
“Neuromodulation”
Geriatric Psychiatry Fellow
didactics, VUMC
Required Lecture: 1
Conference:
Lab:
August 2020-,
annual
Presenter
“ECT and TMS”
PGY-1 Psychiatry Resident
Biomedical Didactics,
VUMC
Required Lecture: 1
Conference:
Lab:
November
2020-2022
Presenter
“Dissociative Identity
Disorder”
Case Conference with
Joshua Streicher, MD PGY-1
Psychiatry Resident, VUMC
Required Lecture:
Conference: 1
Lab:
December 10,
2020
Faculty Discussant
“Insomnia and CBT-I”
Case Conference with Seth
Christman, MD, PGY-4
Psychiatry Resident, VUMC
Required Lecture:
Conference: 1
Lab:
January 6, 2021 Faculty Discussant
“Psychiatric Care of
Transgender Patients”
Case Conference with
Julian Raffoul, MD, PhD,
MBA, PGY-3 Psychiatry
Resident, VUMC
Required Lecture:
Conference: 1
Lab:
April 4, 2022 Faculty Discussant
“OCD-Psychosis Interface”
Case Conference with
Kristina Alton, MD, PGY-2
Psychiatry Resident, VUMC
Required Lecture:
Conference: 1
Lab:
November 11,
2022
Faculty Discussant
“ECT in Acute Mania” Required Lecture:
Conference: 1
January 1, 2023 Faculty Discussant
Case Conference with Paige
Mergaman, PGY-1
Psychiatry Resident, VUMC
Lab:
“Treatment Resistant
Depression”
Psychiatry Grand Rounds
General Psychiatry Case
Conference , Vanderbilt
Department of Psychiatry &
Behavioral Sciences
Required Lecture:
Conference: 1
Lab:
February 3,
2023
Presenter
“Memantine & ECT
Cognitive Effects”
Resident Journal Club with
Raza Sagarwala, MD PGY-3
Psychiatry Resident, VUMC
and Amir
Mohammadzadeh, MD
PGY-2, Psychiatry Resident
VUMC
Required Lecture:
Conference: 1
Lab:
April 18, 2023 Faculty Discussant
Continuing Medical Education
Title Number of Contact Hours Dates Offered Role
“Working with Patients with
Borderline Personality
Disorder”
Vanderbilt Nurse Residency
Program, VUMC
Lecture: 1
Conference:
Lab:
March 7, 2022,
February 20,
2023
Presenter
“Social Media in Psychiatry”
Social Work Month CME/CEU,
VUMC
Lecture: 1
Conference:
Lab:
March 31, 2015 Panelist
“Resilience”
Social Work Grand Rounds,
VUMC
Lecture: 1
Conference:
Lab:
May 2016 Presenter
“An Overview of
Electroconvulsive Therapy and
Transcranial Magnetic
Stimulation”
National Alliance on Mental
Illness (NAMI) Davidson County,
Vanderbilt Educational Session,
Virtual
Lecture: 1
Conference:
Lab:
April 20, 2022 Presenter
“Electroconvulsive Therapy and
TMS”
BACH for Fort Campbell CME,
Virtual
Lecture: 1
Conference:
Lab:
April 27, 2022 Presenter
Clinical Teaching
Activity Dates Description
Inpatient Rotation Clinical
Supervisor
(Adult Inpatient Psychiatric
Units at Vanderbilt
Psychiatric Hospital)
2013-present
At least 5 months
annually
Daily supervision & teaching of medical
students and psychiatry residents on Mood or
Psychotic Disorder teams.
Small group facilitator
(Brain, Behavior, &
Movement Course, VUSM)
2013- present Led small groups on MSI or MSII students
during their initial psychiatric interviewing
experience
Clinical Electroconvulsive
Therapy Experience
(Psychiatry Core Clerkship,
VPH)
2014- present Clinical teaching for medical students during
their morning at Electroconvulsive Therapy
during the Psychiatry Core Clerkship
Electroconvulsive Therapy
Elective Rotation
(Psychiatry residents and
fellows elective, VPH)
2014- present Clinical teaching for psychiatry trainees
(residents, clinical fells in Geriatric Psychiatry,
Child & Adolescent Psychiatry, and
Consultation-Liasion Psychiatry) for ECT
procedures and consultations
Alpha Epsilon Delta clinical
shadowing
(Vanderbilt Undergraduate
students, VPH)
February 2015- June
2015
Clinical supervisor for shadowing experience of
inpatient psychiatry for interested pre-medical
undergraduate students
Clinical Preceptor for
External PMHNP students
(Inpatient Psychiatry
Clerkship, VPH)
January 2016-June
2016 (A. Zanoni)
August
2017-December 2017
(K. Anderson)
January 2019-April
2019 (C. Paramore)
September
2021-November 2021,
Clinical preceptor for inpatient psychiatry
clerkship for PMH-NP students from external
schools
January 2023-April
2023 (A. Wittenburg)
Clinical Preceptor for VUSN
PMHNP Students
(Inpatient Psychiatry
Clerkship, VPH/VUSN)
August 2020-Sept
2020
January 2022- present
Clinical preceptor for VUSN PMHNP students
rotating on the Mood Disorder teams at VPH
Clinical Supervisor, HIV
Psychiatry Outpatient
Elective
(Vanderbilt Comprehensive
Care Center, VUMC)
July 2019- June 2023 Faculty clinical supervisor for 1-2 PGY-3 or 4
psychiatry residents participating in weekly
half-day outpatient elective clinic providing
longitudinal psychiatric medication
management to patients who are seropositive
for HIV
Clinical Supervisor,
Transgender Psychiatry
Outpatient Elective
July 2021- June 2023 Faculty Clinical supervisor for PGY-4 psychiatry
residents participating in half-day outpatient
elective seeing transgender or non-binary
patients for pre-surgical consultation, brief
psychiatric consultation & management, or
longitudinal psychiatric medication
management
Clinical Preceptor VUSM
PMHNP student
(Outpatient psychiatry,
Vanderbilt Comprehensive
Care Center, VUSN)
February
2022-present
Clinical preceptor for PMHNP student during
weekly VCCC Psych team case conference
Formal Supervision of Trainees:
2014-2015 Margarita Abi Zeid Daou, Resident in Psychiatry, Faculty advisor, 1hr/week
2015-2016 Nataly Summariva, Resident in Psychiatry, Faculty advisor, 1hr/week
2016-2017 Reema Dedania, Resident in Psychiatry, Faculty advisor, 1hr/week
2017-2018 Luis Rosas-Vidal, Resident in Psychiatry, Faculty advisor, 1hr/week
2018-2019 Jessica Diehl, Resident in Psychiatry, Faculty advisor, 1hr/week
2019-2020 Katerin Sudol, Resident in Psychiatry, Faculty advisor, 1hr/week
2020-2021 Nathaniel Allen-Slaba, Resident in Psychiatry, Faculty advisor, 1hr/week
2020-2022 Brent Necaise, Resident in Psychiatry, Faculty Advisor, 1hr/week
2021-2022 Katie Termini, Resident in Psychiatry, Faculty Advisor 1hr/week
2022-2023 Sean Bowman, Resident in Psychiatry, Faculty Advisor 1hr/week
Other Significant Activities:
July 2016- June 2022 Portfolio Coach, Vanderbilt University School of Medicine
-Supervise 10-12 medical students during medical school career to provide coaching on
development in multiple domains, areas of strength, and areas for improvement
Research
2012-2013 Pilot study involving the use of Second Life multi-user virtual environment in teaching
medical students, Cleveland Clinic.
Publications
Shultz, E., Malone, DA Jr. “A practical approach to prescribing antidepressants.” Cleveland Clinic Journal
of Medicine. 2013 Oct; 80(10): 625-31.
Shultz, E., Pandya M., Mehta, N. “Technology and teaching: suicide risk assessment” Medical Education.
2013 Nov; 47 (11): 1132-3.
Becker J, Maley C, Shultz E, Taylor W. Update on Transcranial Magnetic Stimulation for Depression and
Other Neuropsychiatric Illnesses. Psychiatr Ann. 2016; 46: 637-641.
Becker JE, Maley CT, Shultz EKB, Peters TE. Neuromodulation: Past, Present, and Future. Child Adolesc
Psychiatr Clin N Am. 2019 Jan;28(1):xi-xii. Epub 2018 Sep 18.
Maley CT, Becker JE, Shultz EKB. Electroconvulsive Therapy and Other Neuromodulation Techniques for
the Treatment of Psychosis. Child Adolesc Psychiatr Clin N Am. 2019 Jan;28(1):91-100. Epub 2018 Aug 31.
Becker JE, Shultz EKB, Maley CT. Transcranial Magnetic Stimulation in Conditions Other Than Major
Depressive Disorder. Child Adolesc Psychiatr Clin N Am. 2019 Jan;28(1):45-52. Epub 2018 Sep 20.
Presentations at Scientific Meetings:
“Inadvertent Multi-drug Overdose Including the Novel Drug 4-ACO-DMT”. November 17, 2011. Poster
presentation. Academy of Psychosomatic Medicine Annual Conference. Phoenix, AZ.
-Also presented at the Cleveland Clinic Neurological Institute Research Day. May 24, 2012.
Cleveland, OH.
“A Case of Creutzfeldt-Jakob Disease Presenting as Psychotic Depression”. November 15, 2012. Poster
presentation. Academy of Psychosomatic Medicine Annual Conference. Atlanta, GA.
-Also presented at the Cleveland Consultation-Liaison Society Meeting. May 1, 2013. Cleveland,
OH.
“Exploring the Use of Technologies in Teaching Medical Students Suicide Risk Assessment”. March 7-9,
2013. Poster presentation. American Association of Directors of Psychiatric Residency Training Annual
Conference. Fort Lauderdale, FL.
-Also presented at the Cleveland Clinic Neurological Institute Research Day. May 23, 2013
Cleveland, OH.
“Exploring the Use of Technologies in Teaching Medical Students Suicide Risk Assessment”. February 27,
2013. PGY-4 “Academic Initiative” at Cleveland Clinic for Adult Psychiatry Residents. Cleveland, OH.
“Systemic Challenges for the Early Career Consultation Psychiatrist: Correcting Communication
Breakdowns in the Academic Medical Center”. November 12, 2015. Academy of Psychosomatic Medicine
Annual Meeting. New Orleans, LA.
“Identifying Problems and Solutions Part I: The Problems”. March 16, 2024. Tennessee Psychiatric
Association Annual Meeting. Fall Creek Falls, TN.