介入精神病学:为什么一个总括性的术语是有用的?

A. Pouchon, M. Polosan, C. Dondé
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引用次数: 1

摘要

“介入精神病学”一词于2014年首次被创造出来,用来描述基于神经科学的脑调节设备的精神病学领域的发展(Williams et al., 2014)。从那时起,新的介入治疗方法出现了,并成为大量令人鼓舞的已发表和正在进行的试验的主题。其中一些治疗方法随后获得了美国食品和药物管理局(fda)、欧洲药品管理局(European Medicines Agency for Europe)和法国高级医疗机构(Haute autorit de sant)的批准。经颅聚焦超声刺激、肉毒杆菌毒素注射装置、用于长期精神药物输送的皮下植入物、输注和鼻内治疗(氯胺酮、布雷沙诺酮)是过去几年发展起来的最具创新性的介入技术。临床实践中对介入方法的使用和需求日益增长,导致了许多国家的个体化和“介入精神病学中心”的标签,包括美国、加拿大、澳大利亚、德国和瑞士。因此,我们强烈支持开发和实施“介入精神病学”标签,用于提供有关这些治疗选择的一系列服务和专业知识的单位。我们认为,使用这一总括性术语将导致以下两个进展。首先是减少围绕介入方法的污名和错误信息,特别关注神经调节技术。尽管有安全和道德的实践框架,但这些技术仍然受到歧视,导致限制和降低可及性。例如,电休克疗法的名称已被证明对其可接受性和有效性都有影响(Andrade和Thyagarajan, 2007)。“介入性精神病学”标签的系统化,通过向介入性医学的一般、较少的框架靠拢,可以更好地应对介入性——污名化——技术利用不足的挑战。这可能会提高介入方法在患者、护理人员和卫生工作者眼中的可信度和可接受性。第二,使用介入性精神病学总括术语可能会导致介入性精神病学实践的协调改进,达到国际公认的创新和卓越水平。从这个角度来看,介入精神病学的专业课程,包括神经科学教学和实践经验,必须在住院医师课程中进行推广。目前,大多数使用介入技术的精神科医生的训练方式非常不一致。很少有这样的项目存在,但据我们所知,这样的培训并不是强制性的。推广这些项目将有助于识别高度专业化的从业人员,特定干预精神病学单位和资源的实施和可见性,并促进干预技术的更好改进(Nikayin et al., 2022)。
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Interventional psychiatry: Why an umbrella term is useful?
The term ‘interventional psychiatry’ was coined for the first time in 2014 to describe the growing field of psychiatry based on neuroscience-informed brain modulation devices (Williams et al., 2014). Since then, new interventional treatments have emerged and have been the subject of a large amount of encouraging published and ongoing trials. Some of these treatments were subsequently approved by the US Food and Drug Administration, the European Medicines Agency for Europe and the French Haute Autorité de Santé. Transcranial focused ultrasound stimulation, botulinum toxin injection devices, subcutaneous implants for prolonged psychotropic drugs delivery, infusion and intranasal therapies (Ketamine, Brexanolone) are among the most innovative interventional techniques that have been developed in the last few years. A growing use and demand for interventional approaches in clinical practice has led to individualization and labeling of ‘Interventional Psychiatry Centers’ in many countries, including the United States, Canada, Australia, Germany and Switzerland. Hereby, we strongly support the development and implementation of the ‘Interventional Psychiatry’ label for units that offer a range of services and expertise about these treatment options. We posit that the use of this umbrella term will lead to two following advances. First is stigma and misinformation reduction around interventional approaches with a special focus on neuromodulation techniques. Despite safe and ethical practice frameworks, these techniques continue to be stigmatized resulting in restriction and reduced accessibility. As an example, the name of electroconvulsive therapy has been demonstrated as having itself an impact on both its acceptability and effectiveness (Andrade and Thyagarajan, 2007). System atization of the ‘Interventional Psychiatry’ label would better meet the challenges of the underutilization of interventional – stigmatized – techniques by moving closer to the general, less-stigmatized, framework of interventional medicine. This is likely to improve the credibility and acceptability of interventional approaches in the eyes of patients, caregivers and health workers. Second, the use of interventional psychiatry umbrella term might lead to harmonized improvement of interventional psychiatric practice to a level of innovation and excellence that is recognized internationally. In this perspective, specialty tracks in interventional psychiatry including both neuroscience didactics and hands-on experiences must be generalized within residency curricula. Currently, most psychiatrists who use interventional techniques are trained in a very inconsistent manner. Few programs exist, but to our knowledge, such training is not mandatory to practice this subspecialty. Generalizing these programs will facilitate the identification of highly specialized practitioners, the implementations and visibility of specific Intervention Psychiatry Units and resources, and promote better improvement of interventional techniques (Nikayin et al., 2022).
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