Table 1.
Proposed competency areas for trans-disciplinary fellowship in interventional psychiatry or psychiatric neuromodulation.
| CORE COMPETENCIES: |
| Invasive neuromodulation |
| - Indications, Evaluation, Procedure, Periprocedural Care (DBS, VNS, RNS, SCS, epCS) - In depth knowledge of treatment approaches, pharmacologic and psychotherapeutic treatment alternatives, risks/benefits/side effects of each procedure - Demonstrated skill and knowledge for seeking and obtaining patient consent, answering patient and family questions about treatment options - Demonstrated proficiency in device management including initial programming, impedance checks, troubleshooting device issues, intraoperative neuropsychiatric assessments of patients during awake DBS procedures - Knowledge of how and when to interface with neurology, neurosurgery, and device manufacturers - Troubleshooting treatment failures or lack of response to standard settings - Communication of expectations pre-procedure, patient education, follow-up care, maintenance, and augmentation strategies |
| Non-invasive neuromodulation |
| - Modalities:
Electrical = tES, ECT, TNS, PNS; Magnetic = TMS, MST; Pharmacologic = ketamine, esketamine, psychedelics; Ultrasonic = FUS; Photic = photobiomodulation, gamma light therapy, optogenetics; Haptic = micromotor stimulation- Indications, Evaluation, Procedure, Periprocedural Care - In depth knowledge of treatment approaches, pharmacologic and psychotherapeutic treatment alternatives, risks/benefits/side effects of each procedure - Demonstrated skill and knowledge for seeking and obtaining patient consent, answering patient and family questions about treatment options - Demonstrated skill in administration of each treatment modality, troubleshooting issues and managing side effects and complications - Troubleshooting treatment failures and lack of response to standard protocols or settings - Skill in procedure-specific techniques such as reading/interpreting EEG in ECT treatments, achieving motor threshold in TMS procedures, delivering provocation in TMS for OCD - Knowledge of techniques currently used off-label or without an FDA-approved indication, including potential research applications and future clinical potential - Communication of expectations pre-procedure, patient education, follow-up care, maintenance and augmentation strategies |
| Neuroimaging-diagnostic and functional |
| - Demonstrated proficiency in localization of neuroanatomical structures and white matter tracts, especially those of relevance for neuromodulation targeting and therapy |
|
Neuropsychiatric evaluations with a focus on treatment refractory OCD, depression, and other conditions amenable to neuromodulation
intervention |
| - Knowledge of common psychiatric symptom rating scales to quantify disease characteristics and treatment response - Knowledge of proposed neurocircuitry involved in neuropsychiatric diseases and proposed therapeutic options |
| Cross-disciplinary neuropsychiatric evaluations for patients with conditions amenable to neuromodulation intervention |
| - Knowledge of indications/contraindications for neuromodulation, necessary work-up and evaluation, treatment alternatives, differential diagnostic considerations |
| Subspecialty evaluations may include |
| - Movement Disorder Evaluations with a focus on Tourette's, Parkinson's Disease, Essential Tremor, Dystonia |
| - Epilepsy Evaluations, Epilepsy Monitoring Unit Patient Management with a focus on reading EEG or qEEG, cortical mapping procedures in EMU - Pain Evaluations- Neurorehabilitation Evaluations- Neurosurgical Evaluations with a focus on medical contraindications to surgical intervention, surgical approaches and ability to weigh risks and benefits of different surgical interventions, necessary preoperative and perioperative work-up and management, post-operative care and device/wound management |
| Professionalism and communication skills especially with multidisciplinary care and interfacing with other specialties |
| Active learning demonstrated by contributions to the field such as scientific publication, quality improvement project, reading and interpreting new relevant journal articles |
| Cross-disciplinary fellowship options with potential for disease-specific procedural focus |
| - Psychiatry track with emphasis on TMS, ECT, VNS, ketamine - Neurology track emphasizing DBS, FUS, VNS - Pain management track emphasizing SCS, tES, TMS, ketamine - Neurorehab/PM&R track emphasizing TMS, intrathecal baclofen, SCS |
DBS, deep brain stimulation; VNS, vagus nerve stimulation; RNS, responsive neurostimulation; SCS, spinal cord stimulation; epCS, epidural cortical stimulation; tES, transcranial electrical stimulation; ECT, electroconvulsive therapy; TNS, trigeminal nerve stimulation; PNS, peripheral nerve stimulation; TMS, transcranial magnetic stimulation; MST, magnetic seizure therapy; FUS, focused ultrasound.