Yale continues to pioneer advances in brain stimulation treatment, and a new training opportunity at Yale New Haven Psychiatric Hospital is exposing more psychiatry residents to therapy that offers hope to patients who don’t respond to traditional psychotherapies and medication.
The Yale Department of Psychiatry last year created the part-time position of Chief Resident of the Yale Interventional Psychiatry Service, where neuro-technologies like electroconvulsive therapy (ECT) and ketamine infusion therapy are used to treat brain circuitry problems that contribute to complex psychiatric disorders.
The Chief Resident post became full-time this year, allowing the Chief more time to interface with patients and attending physicians, and to help train and teach other psychiatry residents how to use the technologies. Second-year residents do a rotation through the clinic to train on ECT.
“I’m a face of continuity for the service when there are different attendings day-to-day,” said Chief Resident Rachel Katz, MD, who is in her fourth year in the Yale Psychiatry Residency Program. “It has really provided me to the opportunity to be exposed to the breadth of acute psychiatric illnesses.”
Katz will spend a year training with a multi-disciplinary team of experts in a clinic that is renowned for its groundbreaking research and delivery of care to patients who range in age from 15 to 90 years old.
The Yale Department of Psychiatry has been at the forefront of studies into the use of brain stimulation therapy to treat disorders like depression, schizophrenia, and bipolar disease. In the late-1990s, Yale researchers were the first to discover that the drug ketamine, which is primarily used to induce and maintain anesthesia, provided immediate relief to chronically depressed patients who did not respond to traditional medication.
The U.S. Food and Drug Administration has yet to approve the drug for use as an antidepressant, but the Yale clinic offers ketamine therapy to people who suffer from severe mood disorders.
The Chief Resident assists in the ketamine infusion area, but Katz said she spends about 90 percent of her time administering ECT. The treatment is offered to patients diagnosed with severe depression and other psychiatric illnesses, including bipolar disease and schizophrenic affective disorder.
Patients are given low-voltage electrical brain stimulation by electrodes placed on their scalp. The treatment is highly regulated, and is considered safe. The Yale clinic performs as many as 100 ECT treatments a week.
It is patient care in an academic setting. It's a fascinating opportunity for learning.
Rachel Katz, MD, Chief Resident, Yale Interventional Psychiatry Service
“We’re one of the most robust programs in the country,” Katz said. “We continue to grow very quickly.”
She and Samuel Wilkinson, MD, the program’s first Chief Resident, marvel at the speed at which most patients respond to treatment in the clinic.
Wilkinson said ECT tamps down the intensity of a person’s negative thoughts, at least temporarily. For patients who struggle to perform the most basic of tasks, like getting out of bed in the morning, the results can be profoundly life-altering.
“You can just see it on their faces,” Wilkinson said. “I think there is a reactivity that people gain when they are well. Some patients who come in say, ‘I wish I would have known about this earlier.’”
As part of her training, Katz spends time with patients and their families, helping them to understand how the treatments work, and how they can manage the transition between having a chronic illness, to maintenance of their condition and wellness.
Among the many aspects of the job that she enjoys is seeing patients’ health improve so they are able to spend more time with their families.
“It is patient care in an academic setting. It’s a fascinating opportunity for learning,” she said. “I think this is one of the only places in the country where one can get such intense exposure to interventional psychiatry.”