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 Table of Contents    
EDITORIAL  
Year : 2020  |  Volume : 62  |  Issue : 1  |  Page : 1-2
Need to develop “Interventional Psychiatry” as a subspecialty in India


Professor of Psychiatry, WBMES and Consultant Psychiatrist, AMRI Hospitals, Kolkata, West Bengal, India

Click here for correspondence address and email

Date of Submission24-Dec-2019
Date of Acceptance24-Dec-2019
Date of Web Publication3-Jan-2020
 

How to cite this article:
Singh OP. Need to develop “Interventional Psychiatry” as a subspecialty in India. Indian J Psychiatry 2020;62:1-2

How to cite this URL:
Singh OP. Need to develop “Interventional Psychiatry” as a subspecialty in India. Indian J Psychiatry [serial online] 2020 [cited 2021 Apr 21];62:1-2. Available from: https://www.indianjpsychiatry.org/text.asp?2020/62/1/1/274835




Interventional psychiatry is a subspecialty which uses the technologies available in neuroscience to understand and identify the dysfunctional neurocircuitry underlying the psychiatric disorders and applies these techniques of neuromodulation to modify and treat these disorders. It is an area which lies as a connecting link between traditional psychotherapy, pharmacotherapy, and surgery. Practice of interventional psychiatry has existed even before the advent of psychopharmacological revolution and has time and again proven to be highly effective in managing severe mental disorders. Surprisingly, due to reasons unknown, mental health professionals never got the distinction of being “Interventional Psychiatrists” unlike specialists in other contemporary fields such as cardiology, neurology, and radiology. There has always been an attempt by psychiatrists to understand the physiology of brain activity and to modify it to manipulate certain behaviors. This is evident from the fact that electroencephalography (EEG), a neurophysiological study of brain, was developed by a psychiatrist Hans Berger in 1924,[1] and electroconvulsive therapy (ECT) is the earliest and one of the most effective treatment modalities for modifying brain activity through alteration of electrical activity. ECT, the “Gold Standard” intervention, has endured the test of time and remains one of the most efficacious “interventions” which is being practiced since its inception, both in the Western world and in India. Its usage in India dates as far back as 1953 at Central Institute of Psychiatry (CIP) using the “Ediswan System” developed by Wilcox and Friedman, which was the most commonly used system in the world at that time. Even the father of psychoanalysis Sigmund Freud, who was a neurophysiologist by training, attempted to define psychological functions in terms of neurological activities and wrote the “The Project for a Scientific Psychology” in 1895 taking a turn from mind to brain which was published posthumously in 1950. The project was essentially a neurological model of the mind.[2] Freud was unable to complete his “project” due to inadequate knowledge and understanding of brain biology, physiology, structure, and function at that time. Despite historical evidences of such initiatives, stigma attached to psychosurgery and ECT desisted psychiatrists from exploring these options and there has been a strange reluctance on the part of psychiatrists from embracing the newer developments in neuroscience.

With the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) initiative of the US Government and Defense Advanced Research Projects Agency's $70 million project called Systems-Based Neurotechnology and Understanding for the Treatment of Neuropsychological Illnesses (SUBNETS), which is part of the BRAIN Initiative, there is now an explosion of knowledge about brain functioning and neurocirciutiry.[3] SUBNETS seeks to develop intelligent closed-loop neuromodulation technologies that modulate dysfunctional circuits in neuropsychiatric disorders.[4]

These scientific programs have modified our perception of brain and different modalities are being used to modulate neuronal functioning. Different methods of brain modulation that have evolved include noninvasive methods such as repetitive transcranial magnetic stimulation (rTMS); transcranial direct current stimulation; and invasive ones such as vagus nerve stimulation (VNS), epidural cortical stimulation, and deep brain stimulation (DBS). The United States Food and Drug Administration has approved rTMS, DBS, and VNS for the treatment of various psychiatric disorders.[3]

India does not lag behind in adoption of these techniques. The National Institute of Mental Health and Neurosciences, Bengaluru (NIMHANS); All India Institute of Medical Sciences (AIIMS), New Delhi; CIP, Ranchi; and many other institutes of national repute across the country have been instrumental in spreading awareness and knowledge for growth of interventional psychiatry in India. NIMHANS and CIP have been using modern neuromodulation techniques including transcranial magnetic stimulation for more than 15 years for various investigative and therapeutic purposes. They have recently added newer methods of brain stimulation including direct current stimulation and hybrid stimulation keeping pace with the most advanced techniques emerging in the field of interventional psychiatry. CIP and NIMHANS have been successfully running Centre for Cognitive Neurosciences and Translational Psychiatry Laboratory, respectively, where most advanced neuromodulation and neuroinvestigative research is carried out using techniques which include functional magnetic resonance imaging (MRI), volumetric MRI, special imaging modalities such as diffusion tensor imaging, high-resolution EEG, and infrared spectroscopy which is constantly providing translational inputs for further delineating the derangement in physiology of brain. Most recently, the Department of Psychiatry, AIIMS, New Delhi, has been accorded ICMR Grant for developing a Centre for Advanced Research and Excellence in Neuromodulation (CARE) which would bring further strength to the growing field of interventional psychiatry.

However, there is still a lack of formal training and standardization of care and procedural requirements for these techniques. It is high time that we acknowledge the impact of interventional psychiatry and take appropriate measures to suitably train our mental health-care providers. Inclusion of interventional psychiatry as a subspecialty in PG curriculum and introduction of post-PG courses for specialized training in this subspecialty are the needs of the hour. Proper training in various modalities of intervention psychiatry and laying down standards of care and best practice guidelines would go a long way in promoting optimal utilization of these advanced modalities for improving patient care and research. We must work upon the foundation laid by our institutes and take a lead in establishing interventional psychiatry as a subspecialty.



 
   References Top

1.
La Vaque TJ. The history of EEG Hans Berger. J Neurother 1999;3:1-9.  Back to cited text no. 1
    
2.
McCarley RW, Hobson JA. The neurobiological origins of psychoanalytic dream theory. Am J Psychiatry 1977;134:1211-21.  Back to cited text no. 2
    
3.
Williams NR, Taylor JJ, Kerns S, Short EB, Kantor EM, George MS. Interventional psychiatry: Why now? J Clin Psychiatry 2014;75:895-7.  Back to cited text no. 3
    
4.
Gorman J. Agency Initiative will Focus on Advancing Deep Brain Stimulation. New York Times; 24 October, 2013. Available from: https://www.nytimes.com/2013/10/25/science/. [Last accessed on 2019 Dec 20].  Back to cited text no. 4
    

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Correspondence Address:
Prof. Om Prakash Singh
AA 304, Ashabari Apartments, O/31, Baishnabghata, Patuli Township, Kolkata - 700 094, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_800_19

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