Year : 2020  |  Volume : 62  |  Issue : 5  |  Page : 600--601

Comments on, “need to develop 'interventional psychiatry' as a subspecialty in India”

Mukesh Samani 
 Department of Psychiatry, PDU Government Medical College, Rajkot, Gujarat, India

Correspondence Address:
Mukesh Samani
Department of Psychiatry, PDU Government Medical College, Rajkot, Gujarat

How to cite this article:
Samani M. Comments on, “need to develop 'interventional psychiatry' as a subspecialty in India”.Indian J Psychiatry 2020;62:600-601

How to cite this URL:
Samani M. Comments on, “need to develop 'interventional psychiatry' as a subspecialty in India”. Indian J Psychiatry [serial online] 2020 [cited 2020 Nov 27 ];62:600-601
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The editorial by Singh[1] is thought provoking and needs further considerations on the part of other senior psychiatrists regarding the need for the development of the subspecialty of interventional psychiatry. The editorial has made interesting statement, “It is an area which lies as a connecting link between traditional psychotherapy, pharmacotherapy, and surgery.” Some of the important historical and recent developments in this regard will be of interest to the readers. Historically, there have been several pioneering attempts. Julius Wagner-Jauregg was awarded Nobel Prize for physiology or medicine in 1927 for “The Treatment of Dementia Paralytica by Malaria Inoculation.” He was the first psychiatrist to be awarded Nobel Prize. Egas Moniz was awarded Nobel Prize for physiology or medicine in 1949 for the development of frontal leucotomy for some psychiatric disorders. Other historical interventional psychiatric treatment had been chemical convulsive therapy and insulin coma therapy (ICT). The ICT era, roughly 1933–1960 was a key moment in the development of the American psychiatry. Developed only 10 years after insulin had been embraced as a “miracle drug” for the treatment of diabetes, ICT was perceived by psychiatrists as a means of bringing their field closer to mainstream medicine, particularly to neurology.[2]

Several recent attempts to integrate neuroscience and psychotherapy are also worth noting. Neuropsychoanalysis considers neuroscience as basic science of psychoanalysis. An integrative perspective can create dialogues leading to better conceptualizations and techniques to be applied in the clinical situation.[3] Neuropsychotherapy[4] offers neuroscientifically guided techniques for psychotherapy. The author emphasizes that all experiences lead to learning with correlated brain changes including changes in the form of increased or decreased synaptic connections. “Neurons that fire together wire together.” This well-known principle of Hebb is emphasized as a key to understand how experiences lead to brain changes. Positive emotional experiences lead to the strengthening of the pathways responsible for the processing of positive emotions. Negative emotional experiences lead to the strengthening of the pathways responsible for the processing of negative emotions. If a person has more negative emotional experiences, brain changes in the person make it difficult to experience positive emotions and easy to experience negative emotions. In this way, a vicious cycle is set. For example, in a case of depression, there may be hyperfunctional amygdala with right-sided hyperfunctional brain pathways which process negative emotions and activate avoidance goals. Left-sided pathways may be hypofunctional which process positive emotions and activate approach goals. Because of the nature of the patient's brain, initially, the patient will not be able to take initiative and engage in goal-directed approach behaviors. In initial phase, family members should be explained about the patient's condition in a brain-based manner and they are counseled to involve the patient in pleasurable activities and interrupt the patient from ruminating. Family members are counseled that sustained effort for several weeks may be required for noticeable change, because remolding of synaptic connections will take time. Once pathways for positive emotions have been sufficiently strengthened, the patient will become capable of initiating goal fulfilling activities.

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1Singh OP. Need to develop “Interventional Psychiatry” as a subspecialty in India. Indian J Psychiatry 2020;62:1-2.
2Doroshow DB. Performing a cure for schizophrenia: Insulin coma therapy on the wards. J Hist Med Allied Sci 2007;62:213-43.
3Johnson B, Flores Mosri D. The neuropsychoanalytic approach: Using neuroscience as the basic science of psychoanalysis. Front Psychol 2016;7:1459.
4Grawe K. Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy. New York: Psychology Press; 2007.