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The Psychiatric Neuromodulation Unit

Implementation and Management

Sauvaget, Anne, MD, PhD*†; Poulet, Emmanuel, MD, PhD‡§; Mantovani, Antonio, MD, PhD∥¶; Bulteau, Samuel, MD*#; Damier, Philippe, MD, PhD, MBA**; Moutaud, Baptiste, PhD††; Paternoster, Mariano, MD, PhD‡‡; de Bartolomeis, Andrea, MD, PhD§§; D'Urso, Giordano, MD, PhD§§

doi: 10.1097/YCT.0000000000000513

The proven effectiveness of neuromodulation and stimulation techniques for the management of psychiatric disorders has brought strongly needed innovation in psychiatry, given the high prevalence and high costs of treatment resistance. Although evidence-based guidelines in neuromodulation have been implemented to improve the clinical efficacy, safety, and research procedures, practical suggestions on how to design a psychiatric neuromodulation unit (PNU) are not available in the scientific literature. In this contribution, we have combined the results of a literature search with the suggestions of clinical psychiatrists, managers, and bioethicists who have had firsthand experience in building a PNU. Eleven key issues concerning the implementation and management of a PNU were identified: general context, team composition, environment, basic technical equipment, clinical versus research activities, target clinical population, education and training, interdisciplinarity, ethical aspects, regulatory and reimbursement issues, fund-raising, and partnership development. Moreover, a business plan comprising pragmatic solutions and recommendations for designing an efficient PNU was laid out.

From the *CHU de Nantes, Psychiatric Neuromodulation Unit, Addictology and Liaison-Psychiatry Department, Nantes University Hospital;

Laboratory “Movement, Interactions, Performance” (E.A. 4334), Faculty of Sport Sciences, University of Nantes, Nantes;

Université de Lyon, Université Claude Bernard Lyon I, EA 4615, Centre Hospitalier le Vinatier, Bron, France;

§CHU de Lyon, Groupement Hospitalier Edouard Herriot, Pavillon N, Service de Psychiatrie des Urgences Lyon, Lyon, France;

Department of Physiology, Pharmacology & Neuroscience, Sophie Davis School of Biomedical Education, City University of New York, NY;

Division of Experimental Therapeutics, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY;

#EA 4275 SPHERE bioStatistics, Pharmacoepidemiology and Human sciEncesREsearch, Faculties of Medicine and Pharmaceutical Sciences, Nantes University;

**CHU de Nantes, CIC0004, Nantes & Université de Nantes, UFR Médecine, Nantes;

††CNRS, Cermes3, Research Center on Sciences, Health, Mental Health and Society, Paris, France; and Departments of

‡‡Advanced Biomedical Sciences and

§§Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.

Received for publication November 8, 2017; accepted April 26, 2018.

Reprints: Giordano D'Urso, MD, Via Pansini N.5, Edificio 18, 80131 Napoli, Italy (e-mail:

G.d.U. has participated in speaker educational activity (CME) with unrestricted grant from Otsuka; A.B. has received unrestricted grants from Lundbeck Italia and Otsuka Italia for preclinical studies; acted as paid consultant in advisor boards for Takeda, Otsuka, Janssen, and Lundbeck; and received honoraria as speaker for unrestricted CMEs supported by Chiesi, Takeda, Otsuka, Lundbeck, FB Health, and Janssen. The remaining authors have no conflicts of interest or financial disclosures to report.

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