Interventional Psychiatry-An Emerging Subspecialty

Interventional Psychiatry is one of the fastest growing subspecialty in the field of Psychiatry. In the past two decades, there is improved understanding of various brain circuitry. There have been disease specific models of possible explanation to the dysfunctions in the brain circuitry.

An example could be major depressive disorder. Since there is a high rate of treatment resistant depression clinically, option in such resistant and difficult to treat cases often include modalities that target brain circuitry in various parts of brain. The long known treatment Electro Convulsive Therapy (ECT) and comparatively newer modality Transcranial Magnetic Stimulation (TMS), both target areas of brain involved with depression. The ECT and the TMS are considered interventions and their use in Psychiatry is viewed as examples of interventional psychiatry.

The neuromodulation techniques can be broadly classified into two categories:

(1) “Invasive”: The techniques that have invasive component to the modality, for example, Vagal Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS)

(2) “Non-Invasive”: The techniques that do not involve invasion of brain areas and there is no penetration at the level of skin or beyond, for example, ECT, Magnetic Seizure Therapy (MST), and TMS.

There is an abundant evidence for ECT however other relatively newer modalities such as TMS and DBS are having robust evidences in the treatment of numerous psychiatry disorders. The formal training in interventional psychiatry has also become available, but at a very few places at this time. There is a tremendous growth potential for the field of interventional psychiatry and structured curriculum, such as fellowships may enhance the growth of this field.

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by Dr. Ramkrishna Makani, MD, MPH

Child and Adolescent Fellow, Children’s Hospital of Philadelphia (Philadelphia, PA)

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