Interventional Psychiatry Research Articles

A Model for Formal Residency Training in Interventional Psychiatry.

A Model for Formal Residency Training in Interventional Psychiatry.

Facilitating routine data collection to improve clinical quality and research in Interventional Psychiatry: The CARE Network.

Facilitating routine data collection to improve clinical quality and research in Interventional Psychiatry: The CARE Network.

The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part II.

This is the second part of the Brazilian S20 mental health report. The mental health working group is dedicated to leveraging scientific insights to foster innovation and propose actionable recommendations for implementation in Brazil and participating countries. In addressing the heightened mental health challenges in a post-pandemic world, strategies should encompass several key elements. This second part of the S20 Brazilian Mental Health Report will delve into some of these elements, including: the impact of climate change on mental health, the influence of environmental factors on neurodevelopmental disorders, the intersection of serious mental illness and precision psychiatry, the co-occurrence of physical and mental disorders, advancements in biomarkers for mental disorders, the utilization of digital health in mental healthcare, the implementation of interventional psychiatry, and the design of innovative mental health systems integrating principles of innovation and human rights. Reassessing the treatment settings for psychiatric patients within general hospitals, where their mental health and physical needs are addressed should be prioritized in mental health policy. As the S20 countries prepare for the future, we need principles that stand to advance innovation, uphold human rights, and strive for the highest standards in mental health care.

Effects of TMS on anhedonia and suicidal ideation in treatment-resistant depression: Outcomes from the University of Minnesota Interventional Psychiatry Program

BackgroundA developing literature suggests that transcranial magnetic stimulation (TMS) can target anhedonia and suicidal ideation (SI), core symptoms of treatment-resistant depression (TRD). This present naturalistic study extends the existing literature by investigating the connection between changes in anhedonia and suicidal ideation (SI) related to transcranial magnetic stimulation (TMS), independent of any overall changes in depression. MethodsPre and post treatment PHQ-9 and IDS-SR data were collected from 181 TRD patients who received dorsolateral prefrontal cortex ( dlPFC) TMS using the Figure-8 or H1-coil. Changes in overall depression symptoms, anhedonia, and SI were analyzed using chi square tests, repeated measure ANOVAS, and linear regression for repeated measures. ResultsTMS yielded changes in overall depression symptoms (PHQ-9 Cohen’s d = 1.02; IDS-SR Cohen’s d = 1.05), with 23.9 % and 41.7 % of patients experiencing response as measured by IDS-SR and PHQ-9, respectively. TMS treatment was also associated with large changes in both anhedonia (d = 1.03) and SI (d = 0.88), which were similar in magnitude to changes in all other depression symptoms (d = 0.97). Importantly, changes in anhedonia predicted changes in SI, even after controlling for baseline depression severity and change in other depression symptoms. LimitationsThe lack of a control arm and a neuroimaging measure temper mechanistic conclusion. ConclusionOur results reinforce the effectiveness of TMS in TRD and provide new evidence that anhedonia and SI may belong to a broader symptom cluster potentially undergirded by a shared circuitry accessible to dlPFC TMS.

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023.

We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.

Psychiatry: what's new in 2023

Resistance to treatment in psychiatry can arise from a variety of causes, and here we look at two strategies that can improve this problem. First, we discuss the role of patients' relatives; in addition to family therapy interventions, setting up groups of relatives makes it possible to increase their skills in helping their sick relative and to help each other in this process. And finally, we look at the option of interventional psychiatry. These methods, which have been greatly enriched in recent years, are now available in the interventional psychiatry unit recently opened in the new Cery psychiatric hospital in Lausanne.

Suicide Assessment and Prevention in Bipolar Disorder: How Current Evidence Can Inform Clinical Practice.

Bipolar disorder is associated with a considerable risk of suicide, and this fact must be incorporated into management of all patients with the condition. This article highlights the importance of a more nuanced understanding of the factors associated with the increased risk of suicidal behavior in people diagnosed as having bipolar disorder and interventions that could mitigate it. Several sociodemographic, clinical, environmental, and other variables have been associated with suicide attempts or deaths in bipolar disorder. Youths with bipolar disorder are a particularly vulnerable group, and their trajectory of illness could be modified by early interventions. Several medications have been studied regarding their relationship to suicide risk in bipolar disorder, and interventional psychiatry is a newer area of research focus. Finally, community-based approaches can be incorporated into a comprehensive approach to suicide prevention. This article summarizes the current understanding of key variables that can help inform a clinical risk assessment of individuals and interventions that can be employed in suicide prevention in bipolar disorder.

More on interventional psychiatry

More on interventional psychiatry

Improving Flow of Out of OR Interventional Psychiatry Procedures using a Collaborative Model of Care

Improving Flow of Out of OR Interventional Psychiatry Procedures using a Collaborative Model of Care

Interventional psychiatry: What are the next steps?

Interventional psychiatry: What are the next steps?

Interventional psychiatry (Part 2)

Interventional psychiatry (Part 2)

Interventional Psychiatry and Neurotechnologies: Education and Ethics Training.

The last two decades have seen dramatic growth in the application of procedurally based interventions for treating refractory psychiatric conditions, leading to interest in developing the foundations for the subspecialty of "Interventional Psychiatry." However, there is cause for concern that the rate of expansion of clinical advances in this field may be outpacing the ability of postgraduate curricula to provide sufficient exposure to and teaching and supervision of these treatments. The paucity of adequately trained practitioners in Interventional Psychiatry further exacerbates inequities in the ability of eligible patients to access and benefit from these approaches. This paper explores the rates of utilization of Interventional Psychiatry treatments, the current state of education in these treatments, and the role that training can play in translating scientific advances in this area to ensure equitable access and maximum impact at a population level. The majority of the discussion is centered on electroconvulsive therapy (ECT), the most established and available of these treatments, highlighting how enhancing education and training in ECT can reduce barriers to its utilization. It is argued that innovations in pedagogical approaches for disseminating the learning of these procedures are needed to increase the current low rates of competency in these treatments and can facilitate the more rapid dissemination of other Interventional Psychiatry approaches and neurotechnologies, such as repetitive transcranial magnetic stimulation, ketamine, deep brain stimulation, and focused ultrasound.

Interventional Psychiatry Comes of Age: How Do We Define the Practice?

Back to table of contents Previous article Next article ViewpointsFull AccessInterventional Psychiatry Comes of Age: How Do We Define the Practice?Richard A. Bermudes, M.D.Richard A. BermudesSearch for more papers by this author, M.D.Published Online:25 Apr 2023https://doi.org/10.1176/appi.pn.2023.05.3.50AbstractOver the last few years, I’ve engaged in several discussions regarding the state and direction of interventional psychiatry. It is exciting to see this area of psychiatry develop, and the interest in “interventions,” both within psychiatry and from other medical professionals, is exploding.A quick search on the internet for services in metropolitan areas indicates that various providers from different medical and nonmedical specialties offer transcranial magnetic stimulation (TMS), ketamine infusions, and, now in specific urban areas, “legal psychedelics.”Do all of these treatments belong under one tent? Why is one treatment considered a psychiatric “intervention” when all treatments constitute an intervention in one form or another? What should this emerging area of specialization be labeled? (For further reading, see “Interventional Treatments Expand Psychiatrists’ Treatment Options”). Should we call it “interventional brain medicine or perhaps “procedural psychiatry”? Although a name for this subspecialty is critical, defining what an interventional psychiatrist does and what qualifications are required to perform these treatments are essential.What does an interventional psychiatrist do? Some would argue an interventional psychiatrist is someone who likes to do procedures. However, interventional psychiatrists integrate procedures with medications, psychotherapy, and psychosocial therapies to treat the whole patient.During a recent private-practice internal quality review (unpublished), we found that physicians whose patients had the highest remission rates exhibited four critical qualities in their clinical work:They had extramural training and experience in psychotherapy and regularly combined TMS with psychotherapeutic interventions.They provided longitudinal psychiatric care with their TMS patients (many referrals were from their long-term patient caseload).They typically had experience and training in administering ECT, esketamine, or IV ketamine in addition to TMS.They participated in journal clubs and bimonthly conferences reviewing patients who did not achieve remission.The top-performing physicians had two or more years of experience and achieved remission rates in the 40% to 60% range (the average published rate is 30%).Thus, interventional psychiatrists perform procedures, actively monitor the therapeutic relationship, and incorporate medications and psychotherapy into treatment. In addition, because they completed a psychiatry residency, they contribute and often lead treatment teams responsible for the patients’ overall biopsychosocial treatment plan.Who should perform interventional procedures for psychiatric conditions, and what training is required? As someone who completed a combined residency in family medicine and psychiatry, I am open-minded and sensitive to patient access problems. I have contemplated this question for a while and thought that anyone with a license to prescribe and proper training should be able to do interventional psychiatry procedures. However, I am concerned about the number of TMS centers, ketamine infusion centers, and psychedelic clinics that do not have a psychiatrist involved in any meaningful way. For example, during a recent discussion with an anesthesiologist setting up a ketamine infusion center, they asked, “Why do I need a psychiatrist? My malpractice is not requiring it, and we know how to dose IV ketamine for depression.”Suppose a psychiatrist is not involved in evaluating and managing the psychiatric condition during the interventional treatment. How do we know if the patient receives the proper treatment at the right time?I believe it is time for professional organizations such as the Clinical TMS Society and the American Society of Ketamine Physicians, Psychotherapists, and Practitioners to engage and inform the public about the risks of receiving psychiatric treatment for complex or treatment-resistant psychiatric conditions without a psychiatrist involved. Furthermore, as an evolving area of specialization, we must have well-thought-out guidelines for training, certification, and credentialing. We owe it to our patients. ■Richard A. Bermudes, M.D., is the founder and board member at Mindful Health Solutions in San Francisco and a volunteer assistant clinical professor of psychiatry at the University of California, San Francisco. He is also the co-editor of Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice from APA Publishing. ISSUES NewArchived

Interventional psychiatry (Part 1)

Interventional psychiatry (Part 1)

Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process.

Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.

Cautious optimism regarding the use of home-based neuromodulation to treat depression

Weak-intensity neuromodulation involves the use of targeted transcranial stimulation to treat neuropsychiatric disorders, including depression. This type of neuromodulation has more favourable tolerability profiles1,2 than higher intensity neuromodulation techniques, such as repetitive transcranial magnetic stimulation and electroconvulsive therapy. As weak-intensity neuromodulation is delivered by portable, battery-driven devices, it can potentially be administered to patients at home. Such home-based neuromodulation is likely to play an increasing role in the treatment of psychiatric disorders in the near future,3 and neuromodulation is gaining rapid traction as an effective tool in interventional psychiatry.

Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation.

The deep brain stimulation (DBS) Think Tank X was held on August 17-19, 2022 in Orlando FL. The session organizers and moderators were all women with the theme women in neuromodulation. Dr. Helen Mayberg from Mt. Sinai, NY was the keynote speaker. She discussed milestones and her experiences in developing depression DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging DBS technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank X speakers was that DBS has continued to expand in scope however several indications have reached the "trough of disillusionment." DBS for depression was considered as "re-emerging" and approaching a slope of enlightenment. DBS for depression will soon re-enter clinical trials. The group estimated that globally more than 244,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia, and Australia; cutting-edge technologies, closed loop DBS, DBS tele-health, neuroethics, lesion therapy, interventional psychiatry, and adaptive DBS.

Treatment-Resistant Depression – What is the Effective Maintenance Treatment

IntroductionTreatment-resistant depression (TRD) presents a significant challenge in clinical practice. Besides antidepressant medications, neurostimulation methods (ECT, rTMS) and ketamine are viable treatment options.ObjectivesTo objectively evaluate the real effectiveness of treatments within interventional psychiatry in the maintenance treatment.MethodsThe extensive literature review of the efficacy of ECT, rTMS, and ketamine treatment in the maintenance treatment of TRD and the author’s clinical and research experience will be included in this presentation.ResultsNeurostimulation, particularly ECT and ketamine treatment are usually effective treatments for patients with TRD. However, both of these treatment modalities do not have sustained benefits and after discontinuing treatment the majority of patients relapse. Ketamine has rapid therapeutic effects in depression, but these effects are short-lived. Continuation treatment with ketamine in the form of intranasal ketamine is an option, but concerns over cognitive impairment, interstitial cystitis and significant addictive potential related to longer use of ketamine are significant limiting factors. rTMS is a first-line treatment option for patients with TRD according to the Canadian CANMAT guidelines. However, the majority of patients may relapse following the course of rTMS. The maintenance rTMS over an extended period of time is usually not feasible as it may significantly affect the waiting time for newly referred patients. Portable TMS machine for home use would be an alternative option for a limited number of patients.ConclusionsMaintenance treatment has been always a big clinical challenge in mood disorder psychiatry. Only well-established multimodal treatment is a realistic option for getting long-term benefits in treating patients with TRD.DisclosureNo significant relationships.

Interventional psychiatry: Why an umbrella term is useful?

Interventional psychiatry: Why an umbrella term is useful?

A New Role for Interventional Psychiatrists: Ambassadors for Recovery

A New Role for Interventional Psychiatrists: Ambassadors for Recovery