The below editorial, "interventional Psychiatry" appeared on PubMed today:
Postgrad Med, 1-2 Interventional Psychiatry
- PMID: 32053020
The url for the pdf is:
https://drive.google.com/file/d/1a0r5NAqw3fDJlMmQ5o8wqlc9Aq79vMQb/view?usp=sharing
The premise of the editorial is that psychiatric residents should be broadly educated in emerging psychiatric treatments and that "interventional psychiatry" should include not just neuromodulation techniques (ECT, rTMS, VNS, DBS), but also "implants, intramuscular, subcutaneous or intravenous medications and treatments requiring utilization of Risk, Evaluation and Mitigation Strategy (REMS) protocols." They suggest that futures additions to the list might be acupuncture and botulinum toxin injections.
The authors cite evidence that 37% of psychiatry residency programs do not meet the (very minimal) APA recommendation of participation in 10 ECT procedures.
Who can argue against more and better eduction?
The risk here is that education/training in ECT will get further diluted in the rush to include other treatments, many of which have a much smaller evidence base for efficacy or public health impact.
In these lists of psychiatric treatments, ECT is not an equal among peers: it is the best established and a critical part of care for our most severely ill patients.
In a future that embraces education and training in broadly defined "Interventional Psychiatry," I hope that ECT training is adequately comprehensive to insure that there will be a next generation of expert ECT providers.
Lumping ECT as a "neuromodulation" therapy, among the popular scalp tickling, reimbursable dainty "procedures" loses its unique quality and efficacy. The core of ECT is the induced grand mal seizure, not any aspect of electricity.
ReplyDeleteWe lack evidence for behavioral effects beyond placebo for the neuromodulations, while the efficacy of induced seizures for the ill with catatonia, mania, melancholia, and delirium is well documented over the 80+ years of its use.
That psychiatry residents are poorly trained in ECT is a continuing shame in the profession; denigrating seizure inductions as "neuromodulation" furthers this shame.