Interventional Neuropsychiatry & Neuromodulation Fellowship

Program Overview

Interventional neuropsychiatry and neuromodulation is a rapidly evolving clinical subspecialty that uses device-based neuromodulation to treat patients with brain disorders. Despite its growing relevance, there is no established path for clinicians to train in this technical and highly specialized space. This fellowship provides a one-year post-residency training curriculum to address this important gap.

Neuromodulation techniques are generally divided into three categories:

• Noninvasive Neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS)
• Convulsive Neuromodulation, such as electroconvulsive therapy (ECT)
• Invasive or Surgical Neuromodulation, such as deep brain stimulation (DBS) and vagal nerve stimulation (VNS)

Given the strong history and current clinical and research presence of all three neuromodulation categories at the Massachusetts General Hospital, the Interventional Neuropsychiatry and Neuromodulation Fellowship aims to uniquely provide comprehensive clinical training (theoretical and procedural) in the full spectrum of techniques. In addition, fellows will develop expertise in novel emerging modalities such as transcranial Photobiomodulation (tPBM) and low intensity focused ultrasound (LIFUP), as well as relevant non-device modalities such as Ketamine infusions.

Despite the many modality-specific knowledge areas, we believe there is a shared neurobiological and clinical framework across all neuromodulation therapies. Neurotherapeutic devices intervene at the level of circuits, and therefore, it is important for interventional neuropsychiatrists to be very familiar with circuit pathophysiological models, and more practically, comfortable generating circuit-based clinical formulations of individual patients (not just the conditions they have). Hence, a critical goal of the fellowship is to teach trainees a clinical circuit-based approach to anamnesis, exam, differential diagnosis, clinical formulation and, of course, treatment planning.

While this is a clinical fellowship, it takes place in an environment where the research and clinical missions are uniquely integrated so that the traditional boundaries between science and patient care are very fluid: the lab is in the clinic and the clinic in the lab. Fellows will be able to train and practice in this translational environment, learn from clinician-scientist mentors and develop their unique identity and niche of expertise with protected research time.

We are aiming to train the next generation of interventional neuropsychiatrists who will shape the growth of the field and impact the development and application of individualized device therapeutics.

Research

Given the relative early stage of development of the field of interventional neuropsychiatry, it is critical that master clinicians not only become excellent practitioners able to critically adopt fast evolving technical and clinical innovations, but that they are part of the process of catalyzing such innovations through their own impactful research. Towards this end, fellows will have protected research time and ample opportunities to develop clinical, translational and/or basic research projects in neuromodulation and circuit neuroscience throughout Mass General and Harvard research environments.

Every fellow will be paired with a research mentor and will be expected to complete a research project leading to a publishable manuscript during the course of the fellowship. There will be opportunities to present original work at scientific or clinical meetings. Fellows will have access to educational resources from Mass General and Harvard University, including libraries and online resources, in addition to professional meetings and trainings. While a strong research background is not required to apply to our program, trainees motivated to become clinician-scientists (independent of their previous research experience) will find our program particularly appealing.

Curriculum

Scheduled Rotations

Fellows will participate in year-long longitudinal rotations within the Interventional Neuropsychiatry and Neuromodulation Fellowship core clinics, as well as have dedicated research time to complete a clinical or scholastic research project.

Core clinics

• Transcranial Magnetic Stimulation
• Electroconvulsive Therapy
• Ketamine
• Invasive Neuromodulation/Psychiatric Neurosurgical Clinics: DBS and VNS

Additional Curriculum Elements

As part of your educational experience, you will attend hour-long, weekly formal didactics on topics related to the core clinical experiences as well as circuit-based neuroscience.

Sample Lecture Topics

TMS Topics

• TMS basics
• TMS initial evaluation and general follow-up
• TMS Clinical Pearls
• TMS equipment: Parts, set-up and troubleshooting
• TMS technique I: Motor threshold
• Practice I: MT and neurophysiology
• TMS Protocols I: Single and paired-pulse
• TMS Protocols II: rTMS and theta burst stimulation (TBS)
• TMS Safety I: General principles
• Patient management during TMS treatment series
• TMS applications I: Diagnostic
• TMS application II: Therapeutic (MDD, OCD and beyond)
• TMS technique II: Alternative targets
• TMS Practice II: Target identification and neuronavigation
• Potentiating TMS treatment: Theory and evidence
• Maintenance and Duration: TMS

Transcranial Direct Current Stimulation Topics

• Introduction to tDCS
• Current evidence for tDCS in neuropsychiatric disorders

Invasive Neuromodulation Topics

• Ablative limbic system procedures
• Vagus nerve stimulation for TRD
• Deep brain stimulation for psychiatric illness

Electroconvulsive Therapy Topics

• ECT basics
• History of ECT
• ECT evaluations, indications and relative contraindications
• ECT safety and working in a multidisciplinary team
• ECT anesthetic options and integration into care
• ECT physics
• ECT dosing strategies: Ultra-brief vs. brief pulse
• ECT electrode placement: Evidence for right unilateral vs. bilateral vs. bifrontal
• ECT: Balancing treatment efficacy with side effects
• Maintenance and duration: ECT

Ketamine Topics

• Ketamine basics and indications
• Treatment-resistant depression: Pharmacology strategies
• Ketamine: Pharmacodynamics and pharmacokinetics
• Ketamine safety
• Ketamine: Monitoring and treating side effects during and after treatment
• Ketamine: Regulations and documentation
• Maintenance and duration: Ketamine

Circuit Neuroscience: Behavioral Neuroanatomy

• Mesulam 1: Parts of the cerebral cortex and cortical organization
• Mesulam 2: Primary sensory-motor and unimodal association areas
• Mesulam 2: Heteromodal association areas and their classical neuropsychological syndromes
• Mesulam 4: Paralimbic and Limbic regions
• Mesulam 5: Basal Ganglia, Cerebellum and Thalamus
• Mesulam 6: Hemispheric specialization and network dynamics
• Novel models of cortical organization

Circuit Neuroscience: Circuit Pathophysiology

• Normal development of brain circuits
• Neurocircuitry of mood disorders
• The neurocircuitry of fear, stress and anxiety disorders
• Changing fear: The neurocircuitry of emotion regulation
• Phasic vs. sustained fear in rats and humans: Role of the extended amygdala in fear vs. anxiety
• Amygdalocortical circuitry in schizophrenia: From circuits to molecules
• The reward circuits: Linking primate anatomy and human imaging
• Cortico-basal ganglia reward network: Microcircuitry
• Neurocircuitry of addiction
• The episodic memory system: Neurocircuitry and disorders
• Executive function and dysexecutive syndromes
• The neural circuitry of executive functions in healthy subjects and Parkinson’s disease
• Attention-deficit/hyperactivity disorder and attention networks
• Executive function, neural circuitry and genetic mechanisms in schizophrenia
• Human and rodent homologies in action control: Corticostriatal determinants of goal-directed and habitual action
• Impulsivity and compulsivity
• Graph theory and connectomics
• Introduction to Rich hubs

How to Apply

Application Requirements

To apply to the Interventional Neuropsychiatry and Neuromodulation Fellowship, send your personal statement, CV and 3 letters of recommendation to Tracy Barbour (tbarbour@partners.org) and Joan Camprodon (jcamprodon@mgh.harvard.edu).

Application Timeline

Applications will be accepted on a rolling basis. Interviews will occur between July and January for the following academic year. Offers will be given to candidates by February for the following academic year.