The Future of Training and Practice in Neuromodulation: An Interventional Psychiatry Perspective.

Abstract

Psychiatrists have been proceduralists dating back almost 100 years, nearly to psychiatry's inception as a medical specialty. Electroconvulsive therapy (ECT) was developed as a procedure in the 1930s and refined over time, with impressive efficacy and response rates (1). However, due to a lack of understanding of the pathophysiology of many psychiatric conditions, combined with disastrous outcomes from premature adoption of other procedural treatments such as transorbital lobotomy (2), procedural options for psychiatric treatment have been limited. In recent years this landscape is changing, again introducing the potential for procedural therapies in neuropsychiatric disease management. The subspecialty focused on procedure-based psychiatric care, specifically utilization of neurotechnologies to treat psychiatric disorders has become known as “interventional psychiatry.” Interventional psychiatry frequently employs treatments under the umbrella of “psychiatric neuromodulation,” which we define as the collection of nervous system stimulation therapies focused on modulating dysfunctional brain circuitry for therapeutic benefit, including use of electrical, magnetic, ultrasonic, and photic stimulation (see Table 1 for examples). As practically applied, interventional psychiatry also often incorporates procedure-based pharmacologic interventions such as ketamine infusion therapy and psychedelic therapies, which similarly involve a medical intervention applied to a treatment-refractory patient population and require familiarity with procedural consent and monitoring. Here we outline the state of the field, as well as implications for training and the role of the interventional psychiatrist in the treatment team. Table 1 Proposed competency areas for trans-disciplinary fellowship in interventional psychiatry or psychiatric neuromodulation.