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Interventional Psychiatry
Interventional Psychiatry is a subspecialty within the field of psychiatry, focusing on the use of procedural and device-based treatments to manage mental health disorders, particularly those resistant to conventional therapies such as pharmacotherapy and psychotherapy. This field integrates neuromodulation methods with targeted pharmacological interventions, providing options for patients who have not responded to traditional treatments. Historical background The origins of interventional psychiatry can be traced to the historical use of procedural treatments for psychiatric disorders, with Electroconvulsive Therapy (ECT) being a notable early example. Introduced in 1938 by Ugo Cerletti and Lucio Bini, ECT involves applying electrical currents to the brain to induce seizures, which can alleviate symptoms of severe depression, catatonia, and other psychiatric conditions. Despite its effectiveness, ECT has been subject to stigma due to concerns over side effects, particularly co ...
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Psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. Initial psychiatric assessment of a person begins with creating a Medical history, case history and conducting a mental status examination. Laboratory tests, physical examinations, and psychological tests may be conducted. On occasion, neuroimaging or neurophysiological studies are performed. Mental disorders are diagnosed in accordance with diagnostic manuals such as the ''International Classification of Diseases'' (ICD), edited by the World Health Organization (WHO), and the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM), published by the American Psychiatric Association (APA). The fifth edition of the DSM (DSM-5) was published in May 2013. Treatment may include psychotropics (psychiatric medicines), psychotherapy, su ...
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Focused Ultrasound
High-intensity focused ultrasound (HIFU), or MR-guided focused ultrasound surgery (MR-guided focused ultrasound ablation), is an incisionless therapeutic technique that uses non-ionizing ultrasonic waves to heat or ablate tissue. HIFU can be used to increase the flow of blood or lymph or to destroy tissue, such as tumors, via thermal and mechanical mechanisms. Given the prevalence and relatively low cost of ultrasound generation mechanisms, the premise of HIFU is that it is expected to be a non-invasive and low-cost therapy that can at least outperform care in the operating room. The technology is different from that used in ultrasonic imaging, though lower frequencies and continuous, rather than pulsed, waves are used to achieve the necessary thermal doses. However, pulsed waves may also be used if mechanical rather than thermal damage is desired. Acoustic lenses are often used to achieve the necessary intensity at the target tissue without damaging the surrounding tissue. Th ...
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Academic Disciplines
An academic discipline or academic field is a subdivision of knowledge that is taught and researched at the college or university level. Disciplines are defined (in part) and recognized by the academic journals in which research is published, and the learned societies and academic departments or faculties within colleges and universities to which their practitioners belong. Academic disciplines are conventionally divided into the humanities (including philosophy, language, art and cultural studies), the scientific disciplines (such as physics, chemistry, and biology); and the formal sciences like mathematics and computer science. The social sciences are sometimes considered a fourth category. It is also known as a ''field of study'', ''field of inquiry'', ''research field'' and ''branch of knowledge''. The different terms are used in different countries and fields. Individuals associated with academic disciplines are commonly referred to as ''experts'' or ''specialists''. Other ...
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Psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. Initial psychiatric assessment of a person begins with creating a Medical history, case history and conducting a mental status examination. Laboratory tests, physical examinations, and psychological tests may be conducted. On occasion, neuroimaging or neurophysiological studies are performed. Mental disorders are diagnosed in accordance with diagnostic manuals such as the ''International Classification of Diseases'' (ICD), edited by the World Health Organization (WHO), and the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM), published by the American Psychiatric Association (APA). The fifth edition of the DSM (DSM-5) was published in May 2013. Treatment may include psychotropics (psychiatric medicines), psychotherapy, su ...
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Esketamine
Esketamine, sold under the brand names Spravato (for depression (mood), depression) and Ketanest (for anesthesia) among others, is the ''S''(+) enantiomer of ketamine. It is a dissociative hallucinogen drug used as a general anesthetic and as an antidepressant for treatment of depression (mood), depression. Esketamine is the biological activity, active enantiomer of ketamine in terms of NMDA receptor antagonist, NMDA receptor antagonism and is more potency (pharmacology), potent than racemic ketamine. It is specifically used as a therapy for treatment-resistant depression (TRD) and for major depressive disorder (MDD) with co-occurring suicidal ideation or Suicide, behavior. Its efficacy for depression is modest and similar to that of other antidepressants. Esketamine is not used by Intravenous therapy, infusion into a vein for depression as it is only Food and Drug Administration, FDA-approved in the form of a nasal spray under direct medical supervision for this indication (th ...
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Ketamine
Ketamine is a cyclohexanone-derived general anesthetic and NMDA receptor antagonist with analgesic and hallucinogenic properties, used medically for anesthesia, depression, and pain management. Ketamine exists as its S- (esketamine) and R- (arketamine) two enantiomers and has antidepressant action likely involving additional mechanisms than NMDA antagonism. At anesthetic doses, ketamine induces a state of dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia. Its distinguishing features as an anesthestic are preserved breathing and airway reflexes, stimulated heart function with increased blood pressure, and moderate bronchodilation. As an anesthetic, it is used especially in trauma, Emergency medical services, emergency, and Pediatrics, pediatric cases. At lower, sub-anesthetic doses, it is used as a treatment for pain and treatment-resistant depression. Ketamine is legally used in medicine but is also tightly controlled due to ...
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Magnetic Seizure Therapy
Magnetic seizure therapy (MST) is a proposed form of electrotherapy and electrical brain stimulation. It is currently being investigated for the treatment of major depressive disorder, treatment-resistant depression (TRD), bipolar depression, schizophrenia and obsessive-compulsive disorder. MST is stated to work by inducing seizures via magnetic fields, in contrast to ECT which does so using alternating electric currents. Additionally, MST works in a more concentrated fashion than ECT, thus able to create a seizure with less of a total electric charge. In contrast to (r)TMS, the stimulation rates are higher (e.g. 100 Hz at 2 T) resulting in more energy transfer. Currently it is thought that MST works in patients with major depressive disorder by activating the connection between the subgenual anterior cingulate cortex and the parietal cortex. Medical uses Magnetic seizure therapy is a new treatment modality that is being studied for the treatment of multiple psychiatric ...
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Transcranial Direct-current Stimulation
Transcranial direct current stimulation (tDCS) is a form of neuromodulation that uses constant, low direct current delivered via electrodes on the head. This type of neurotherapy was originally developed to help patients with brain injuries or neuropsychiatric conditions such as major depressive disorder. It can be contrasted with cranial electrotherapy stimulation, which generally uses alternating current the same way, as well as transcranial magnetic stimulation. Research shows increasing evidence for tDCS as a treatment for depression. There is mixed evidence about whether tDCS is useful for cognitive enhancement in healthy people. There is no strong evidence that tDCS is useful for memory deficits in Parkinson's disease and Alzheimer's disease, non-neuropathic pain, nor for improving arm or leg functioning and muscle strength in people recovering from a stroke. There is emerging supportive evidence for tDCS in the management of schizophreniaespecially for negative symptoms. ...
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Deep Brain Stimulation
Deep brain stimulation (DBS) is a type of neurostimulation therapy in which an implantable pulse generator is stereotactic surgery, surgically implanted subcutaneous tissue, below the skin of the chest and connected by Lead (electronics), leads to the brain to deliver controlled electrical charge, electrical impulses. These charges therapeutically disrupt and promote dysfunctional nervous system circuits bidirectionally in both ante- and retrograde signaling, retrograde directions. Though first developed for Parkinsonian tremor, the technology has since been adapted to a wide variety of chronic neurologic disorders. The usage of electrical stimulation to treat neurologic disorders dates back thousands of years to ancient Greece and Early Dynastic Period (Egypt), dynastic Egypt. The distinguishing feature of DBS, however, is that by taking advantage of the portability of lithium-ion battery technology, it is able to be used long term without the patient having to be Electrical wir ...
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Neuromodulation
Neuromodulation is the physiological process by which a given neuron uses one or more chemicals to regulate diverse populations of neurons. Neuromodulators typically bind to metabotropic, G-protein coupled receptors (GPCRs) to initiate a second messenger signaling cascade that induces a broad, long-lasting signal. This modulation can last for hundreds of milliseconds to several minutes. Some of the effects of neuromodulators include altering intrinsic firing activity, increasing or decreasing voltage-dependent currents, altering synaptic efficacy, increasing bursting activity and reconfiguring synaptic connectivity. Major neuromodulators in the central nervous system include: dopamine, serotonin, acetylcholine, histamine, norepinephrine, nitric oxide, and several neuropeptides. Cannabinoids can also be powerful CNS neuromodulators. Neuromodulators can be packaged into vesicles and released by neurons, secreted as hormones and delivered through the circulatory system ...
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Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. Initially developed by James Leonard Corning to compress or stimulate the carotid sheath, VNS typically refers to an implantable electrode. However, non-invasive VNS delivered transcutaneously via the auricular branch of the vagus nerve, or through the skin to the cervical nerve, is being investigated in clinical research. Invasive VNS is used as an adjunct treatment for certain types of intractable epilepsy, cluster headaches, migraine, treatment-resistant depression and stroke rehabilitation. Medical use Epilepsy VNS is used to treat drug-resistant epilepsy. For refractive epilepsy, cervical VNS on the left side is FDA-approved. In the United States, VNS is approved as adjunctive therapy for those 4 years of age or older with refractory focal onset seizures. In the European Union, VNS is approved as an adjunctive therapy for patients with either generalized or ...
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Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a noninvasive neurostimulation technique in which a changing magnetic field is used to induce an electric current in a targeted area of the brain through electromagnetic induction. A device called a stimulator generates electric pulses that are delivered to a magnetic coil placed against the scalp. The resulting magnetic field penetrates the skull and induces a secondary electric current in the underlying brain tissue, modulating neural activity. Repetitive transcranial magnetic stimulation (rTMS) is a safe, effective, and FDA-approved treatment for major depressive disorder (approved in 2008), chronic pain (2013), and obsessive-compulsive disorder (2018). It has strong evidence for certain neurological and psychiatric conditions—especially depression (with a large effect size), neuropathic pain, and stroke recovery—and emerging advancements like iTBS and image-guided targeting may improve its efficacy and efficiency. A ...
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