Interventional Psychiatry: How Should Psychiatric Educators Incorporate Neuromodulation into Training?

Published in final edited form as:

Acad Psychiatry. 2014 April ; 38(2): 168–176. doi:10.1007/s40596-014-0050-x.

Nolan R. Williams, Joseph J. Taylor, Jonathan M. Snipes, E. Baron Short, Edward M. Kantor, and Mark S. George

Medical University of South Carolina, Charleston, SC, USA

Abstract

Objective – Interventional psychiatry is an emerging subspecialty that uses a variety of procedural neuromodulation techniques in the context of an electrocircuit-based view of mental dysfunction as proximal causes for psychiatric diseases.

Methods – The authors propose the development of an interventional psychiatry-training paradigm analogous to those found in cardiology and neurology.

Results – The proposed comprehensive training in interventional psychiatry would include didactics in the theory, proposed mechanisms, and delivery of invasive and noninvasive brain stimulation.

Conclusions – The development and refinement of this subspecialty would facilitate safe, effective growth in the field of brain stimulation by certified and credentialed practitioners within the field of psychiatry while also potentially improving the efficacy of current treatments.Brain stimulation technologies are becoming increasingly common in the treatment of psychiatric illness. Psychiatrists who employ these methods have been described in procedure-specific terms such as ECT practitioner, TMS provider, or somatic therapist. Unfortunately, these labels fail to encompass the scope and procedural nature of brain stimulation. In order to facilitate the training and certification of those who perform these highly specialized interventions, we propose the term “interventional psychiatrist” and offer a plan to develop training paradigms for this blossoming subspecialty within the field of psychiatry [1] and alongside the emerging training milestone project [2].

Summary
Interventional psychiatry, though still in its infancy, is an exponentially growing subspecialty within psychiatry that needs to be recognized and developed. Although many brain stimulation tools are currently in the realm of research, the FDA has approved at least three brain stimulation treatments (ECT, VNS, TMS) as therapeutic interventions in traditional psychiatric illnesses. Currently the target population of these experimental treatments primarily consists of treatment-resistant psychiatric patients, but this is likely to change. It is important to recognize formally and promote the training of interventional psychiatrists because the field of brain stimulation is rapidly becoming more clinically relevant, more widely available, and more complex. The dearth of physicians who are trained to implement brain stimulation for treatment-resistant patients with psychiatric disorders is troubling. These training deficits are compounded with the reality that invasive treatment of psychiatric disorders is one of the most controversial subjects in medicine, a topic that raises significant moral, ethical, and socioeconomic issues [41]. As a field, we need to make sure these methods are used thoughtfully and appropriately integrated into person-centered care and mental health recovery paradigms. Through ethical and procedural pairing, we can avoid the missteps and abuses of treatment from previous generations.