Neuromodulation in clinical psychiatry ; its history, present, and future

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  • Nakamura Motoaki
    Kinkou Hospital, Kanagawa Psychiatric Center Department of Psychiatry, Yokohama City University School of Medicine Department of Psychiatry, Showa University School of Medicine

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  • 精神科医療におけるニューロモデュレーションの歴史と現在，そして未来
  • セイシンカ イリョウ ニ オケル ニューロモデュレーション ノ レキシ ト ゲンザイ,ソシテ ミライ

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Neuromodulation is derived from a concept of slow synaptic transmission in the field of neurophysiology. Recently, the term has been used as a therapeutic methodology in clinical medicine. This article reviews history of neuromodulation in clinical psychiatry and then introduces trends of neuromodulation and their future directions. Neuromodulation in clinical psychiatry could be classified into three categories; 1) exogenous and highly-invasive, 2) exogenous and mildly-invasive, and 3) endogenous and non-invasive. Highly-invasive neuromodulation includes seizure induction or neurosurgical procedures, such as electroconvulsive therapy, psychosurgery, and deep brain stimulation. Endogenous neuromodulation, such as cognitive behavioral therapy and neurofeedback, is independent of external stimuli having electromagnetic or neurochemical actions on the central nervous system. It is important to understand merits and demerits of each type of neuromodulation, and to place neuromodulation techniques properly in a treatment algorithm. From a viewpoint of negative history of prefrontal lobotomy and electroconvulsive therapy, neuromodulation must be applied to clinical psychiatry in future, based on the neuroscience and neuroethics.

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