Bret S. Stetka, MD; Edward M. Kantor, MD; Nolan R. Williams, MD

Disclosures

May 30, 2013

In This Article

Editor's Note: While onsite at the 2013 Annual Meeting of the American Psychiatric Association, Medscape spoke with Drs. Edward M. Kantor and Nolan R. Williams about the emerging new field of interventionalist psychiatry and their initiative to develop a training program.[1]

Background

Medscape: What is interventional psychiatry?

Dr. Williams: Interventional psychiatry is an emerging subspecialty that uses brain stimulation techniques to modulate the dysfunctional circuitry underlying medically resistant psychiatric diseases. Physicians who deliver procedures in the spectrum between standard care and surgery are sometimes referred to as "interventionalists" in other areas of medicine (eg, cardiology, radiology, and neurology). Currently, the field of psychiatry does not recognize interventionalists or offer formal training and certification. Our group is proposing the concept of "interventional psychiatrist" in place of procedure-specific terms such as "somatic therapist" or "ECT (electroconvulsive therapy) practitioner," which fail to encompass the scope of brain stimulation strategies. It is not meant to replace current psychiatric therapies (medication and psychotherapy) but rather to enhance the practice of psychiatry with an additional set of tools. This can be viewed much in the same way that interventional cardiologists do not replace general cardiologists.

Dr. Kantor: I also see this bringing great opportunity for collaboration across neurology, neurosurgery, and psychiatry, which rarely occurs in other settings. This alone may advance our liaison activities and communication and, more than anything else, will facilitate better care between the disciplines and really help focus us on the whole person -- mind, body, and brain -- as opposed to one at a time, in isolation.

Medscape: How do you recommend that interventional psychiatry be incorporated into clinical training?

Dr. Kantor: It's an emerging area of our field, where older techniques like ECT are being adapted for better efficacy with fewer side effects, and new techniques are coming of age. It's not currently accredited on the training side, but my guess is that as it formalizes over the next 2-3 years, that process will naturally evolve. As a residency director, I support an educational plan that outlines minimum competencies, experience, and oversight. We already have begun exploring the paradigm with the American Association of Directors of Psychiatric Residency Training (AADPRT) and relevant specialty societies. I think the education has to begin with programs like ours at Medical University of South Carolina (MUSC), where the resources are more established, there are enough cases and mentors, and we can train practitioners and research scientists within psychiatry, in a way best suited to work within the existing graduate medical education framework.

A component of basic understanding and clinical exposure in residency would likely be the minimum expectation. On top of that, an optional, more formal track, using senior elective time, would be fairly easy to plan for within the existing training structure. Currently, not all programs have the expertise, but I believe that there is a desire among those that do to collaborate with needed tools like shared guidelines, online and remote learning, and course-based experiences. That said, I imagine that there will never be a one-size-fits-all plan that works in every institution.

Dr. Williams: Psychiatry is rapidly changing. New methods for noninvasively and invasively stimulating the brain have powerful therapeutic potential, but they require background knowledge (eg, circuits, physics of electricity) that is foreign to most psychiatrists. Interventional psychiatry is an emerging subspecialty that needs to be formally recognized and developed at various levels of psychiatric training. Academic centers will have to adapt to ensure adequate training to those who will be providing these neuromodulatory interventions, in order to avoid mistakes of an earlier era and to make sure that psychiatrists are the ones to perform the procedures, rather than other specialists who are clinically unfamiliar with the psychiatric disease management. Establishing formal training programs will ensure that psychiatry is ready to meet the challenges of treatment-resistant psychiatric illness with a properly trained cohort of interventional psychiatrists. We have an interventional psychiatry fellowship program at MUSC, and there are a few others starting around the country.

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