Neuropsychiatry
Encyclopedia
Neuropsychiatry is the branch of medicine
dealing with mental disorders attributable to diseases of the nervous system
. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training.
However, neurology and psychiatry subsequently split apart and are typically practiced separately. Nevertheless, neuropsychiatry has become a growing subspecialty of psychiatry
and it is also closely related to the field of behavioral neurology
, which is a subspecialty of neurology
that addresses clinical problems of cognition and/or behavior caused by brain injury or brain
disease. "Behavioral Neurology & Neuropsychiatry" fellowships are jointly accredited through the United Council for Neurologic Subspecialties (UCNS), in a manner similar to how the specialties of psychiatry
and neurology
in the United States have a joint board for accreditation, the American Board of Psychiatry and Neurology
(ABPN).
Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor
Joseph B. Martin, former Dean of Harvard Medical School
and a neurologist
by training, has summarized the argument for reunion: "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.
nervous system pathology
, especially of the brain
, whereas psychiatrists have laid claim to illnesses of the mind
. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it is argued that this division is simply not veridical; a plethora of evidence from the last century of research has shown that our mental life has its roots in the brain
. Brain and mind are argued not to be discrete entities but just different ways of looking at the same system (Marr, 1982). It has been argued that embracing this mind/brain monism
is important for several reasons. First, rejecting dualism logically implies that all mentation is biological and so immediately there is a common research framework in which understanding—and thus treatment—of mental suffering can be advanced. Second, it removes the widespread confusion about the legitimacy of mental illness: all disorders should have a footprint in the brain-mind system.
In sum, one reason for the division between psychiatry
and neurology
was the difference between mind or first-person experience and brain. That this difference is artificial is taken as good support for a merge between these specialties.
traditionally looks at the causes of disorders from an "inside-the-skin" perspective (neuropathology
, genetics
) whereas psychiatry
looks at "outside-the-skin" causation
(personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of etiology
will be enriched, in particular between brain
and environment
. One example is eating disorders, which have been found to have some neuropathology (Uher and Treasure, 2005) but also show increased incidence in rural Fijian school girls after exposure to television
(Becker, 2004). Another example is schizophrenia
, the risk for which may be considerably reduced in a healthy family environment (Tienari et al., 2004).
Secondly, it is argued that this augmented understanding of etiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. Indeed, it may be that non-organic interventions, like cognitive behavioral therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden's (2006) demonstration of how psychotherapy
has neurobiological commonalities with pharmacotherapy
is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while self-efficacy is increased.
In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate (Koch and Laurent, 1999). Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering.
(Sabshin, 1990). A good example of this is Tourette syndrome
, which Ferenczi (1921), although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation
caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms (Shapiro, Shapiro and Wayne, 1973) the syndrome has gained pathophysiological support (e.g. Singer, 1997) and is hypothesized to have a genetic basis too, based on its high inheritability (Robertson, 2000). This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology
and psychiatry
because both are dealing with disorders of the same system.
and rehabilitation
strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like Parkinson's disease
, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis
and depression
(Lerner and Whitehouse, 2002). These symptoms, which are largely ignored in neurology
, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.
or genome
is used to suggest that psychiatric disorders are not bona fide
and should thus be kept separate (e.g. Baughman and Hovey, 2006). On this issue, it is worth remembering that research into the neural correlates of psychiatric disorders is in its infancy: the answers may still be to come. One reason why they may not have been found so far is that complex mental disorders may result from minute and intricate brain-wide damage and complicated gene-environment interactions, which are only beginning to be understood. Disorders may not exist as tidy, localized neurodysfunction or genetic abnormalities but multi-factorial brain-wide disorders with complex interactions between environment and genetics (e.g. Green, 2001). Such distributed dysfunction may not be resolvable in the living brain with current technology. E.g. disparate behavioral disorders have been linked to identical neurodysfunction with imaging but show significant organic differences following neurohistological analysis (Rempel–Clower et al., 1996). Where physiopathology is extremely small and distributed or neural tissue is actually healthy it may be the disturbed information-processing that should be studied. E.g. Bell, Halligan and Ellis' (2006) work on cognitive deficits in delusions.
management strategies, which are skills honed by years of experience:
Sachdev suggests to join them may be to dilute them both. Further, the ability to maintain a competent knowledge and skill base for both neurology and psychiatry with the advent of the inexorable increase in scientific knowledge may not be possible.
and psychiatry
's aim was to show that this was the case. Psychiatry
departed the union preferring ideology
over empiricism
, including very environmentally-based etiology as well as espousing that the mind was something fundamentally different from the brain. Neurologists, however, finding no physiopathology for certain disorders left them to the psychiatrists, while themselves pursuing the diseases with clear physiopathology.
However, the cleavage between mind
and brain
and the causal dichotomies are argued not to be veridical. Psychiatric disorders are increasingly showing organic manifestation and demonstrate causation from something as distant as culture. Thus the reasons for the initial division are argued not to be useful or real ones. The two specialties are both dealing with disorders of the same system. Biological psychiatry and behavioral neurology show how the boundaries are being blurred. It is argued that there can be no objection to a reunion on philosophical or scientific grounds. However, there may be reasons to question whether neuropsychiatry would be practically possible. The differences in patient management, knowledge base and skill competency between neurology
and psychiatry
mean that being proficient in both may be impossible.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
dealing with mental disorders attributable to diseases of the nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training.
However, neurology and psychiatry subsequently split apart and are typically practiced separately. Nevertheless, neuropsychiatry has become a growing subspecialty of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and it is also closely related to the field of behavioral neurology
Behavioral neurology
Behavioral neurology is a subspecialty of neurology that studies the neurological basis of behavior, memory, and cognition, the impact of neurological damage and disease upon these functions, and the treatment thereof. Two fields associated with behavioral neurology are neuropsychiatry and...
, which is a subspecialty of neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
that addresses clinical problems of cognition and/or behavior caused by brain injury or brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
disease. "Behavioral Neurology & Neuropsychiatry" fellowships are jointly accredited through the United Council for Neurologic Subspecialties (UCNS), in a manner similar to how the specialties of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
in the United States have a joint board for accreditation, the American Board of Psychiatry and Neurology
American Board of Psychiatry and Neurology
The American Board of Psychiatry and Neurology, Inc. is a nonprofit corporation that was founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, and the then Section on Nervous and Mental Diseases of the American...
(ABPN).
The case for the rapprochement of neurology and psychiatry
Given the considerable overlap between these subspecialities, there has been a resurgence of interest and debate relating to neuropsychiatry in academia over the last decade.Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
Joseph B. Martin, former Dean of Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
and a neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
by training, has summarized the argument for reunion: "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.
Mind/brain monism
Neurologists have focused objectively on organicOrganic (model)
Organic describes forms, methods and patterns found in living systems such as the organisation of cells, to populations, communities, and ecosystems.Typically organic models stress the interdependence of the component parts, as well as their differentiation...
nervous system pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, especially of the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
, whereas psychiatrists have laid claim to illnesses of the mind
Mind
The concept of mind is understood in many different ways by many different traditions, ranging from panpsychism and animism to traditional and organized religious views, as well as secular and materialist philosophies. Most agree that minds are constituted by conscious experience and intelligent...
. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it is argued that this division is simply not veridical; a plethora of evidence from the last century of research has shown that our mental life has its roots in the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
. Brain and mind are argued not to be discrete entities but just different ways of looking at the same system (Marr, 1982). It has been argued that embracing this mind/brain monism
Monism
Monism is any philosophical view which holds that there is unity in a given field of inquiry. Accordingly, some philosophers may hold that the universe is one rather than dualistic or pluralistic...
is important for several reasons. First, rejecting dualism logically implies that all mentation is biological and so immediately there is a common research framework in which understanding—and thus treatment—of mental suffering can be advanced. Second, it removes the widespread confusion about the legitimacy of mental illness: all disorders should have a footprint in the brain-mind system.
In sum, one reason for the division between psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
was the difference between mind or first-person experience and brain. That this difference is artificial is taken as good support for a merge between these specialties.
Causal pluralism
Another broad reason for the divide is that neurologyNeurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
traditionally looks at the causes of disorders from an "inside-the-skin" perspective (neuropathology
Neuropathology
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery...
, genetics
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
) whereas psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
looks at "outside-the-skin" causation
Causation
Causation may refer to:* Causation , a key component to establish liability in both criminal and civil law* Causation in English law defines the requirement for liability in negligence...
(personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
will be enriched, in particular between brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
and environment
Social environment
The social environment of an individual, also called social context or milieu, is the culture that s/he was educated or lives in, and the people and institutions with whom the person interacts....
. One example is eating disorders, which have been found to have some neuropathology (Uher and Treasure, 2005) but also show increased incidence in rural Fijian school girls after exposure to television
Television
Television is a telecommunication medium for transmitting and receiving moving images that can be monochrome or colored, with accompanying sound...
(Becker, 2004). Another example is schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, the risk for which may be considerably reduced in a healthy family environment (Tienari et al., 2004).
Secondly, it is argued that this augmented understanding of etiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. Indeed, it may be that non-organic interventions, like cognitive behavioral therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden's (2006) demonstration of how psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
has neurobiological commonalities with pharmacotherapy
Pharmacotherapy
Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....
is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while self-efficacy is increased.
In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate (Koch and Laurent, 1999). Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering.
Hitherto psychiatric disorders have organic basis
To further sketch psychiatry's history shows a departure from structural neuropathology, relying more upon ideologyIdeology
An ideology is a set of ideas that constitutes one's goals, expectations, and actions. An ideology can be thought of as a comprehensive vision, as a way of looking at things , as in common sense and several philosophical tendencies , or a set of ideas proposed by the dominant class of a society to...
(Sabshin, 1990). A good example of this is Tourette syndrome
Tourette syndrome
Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical tics and at least one vocal tic; these tics characteristically wax and wane...
, which Ferenczi (1921), although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...
caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms (Shapiro, Shapiro and Wayne, 1973) the syndrome has gained pathophysiological support (e.g. Singer, 1997) and is hypothesized to have a genetic basis too, based on its high inheritability (Robertson, 2000). This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
because both are dealing with disorders of the same system.
| Psychiatric symptoms | E.g. Traditional psychiatric (psychoanalytic) explanation | E.g., Neural correlates | Source |
|---|---|---|---|
| Depression Depression (mood) Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless... |
Narcissistic | Limbic-cortical dysregulation | Mayberg (1997) |
| Obsessive Compulsive Disorder | Poor maternal parenting | frontal-subcortical circuitry, right caudate activity | Saxena et al. (1998), Gamazo-Garran, Soutullo and Ortuno (2002) |
| Schizophrenia Schizophrenia Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social... |
Narcissistic/escapism | NMDA receptor activation in the human prefrontal cortex | Ross et al. (2006) |
| Visual hallucination Hallucination A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,... |
projection | retinogeniculocalcarine tract, ascending brainstem modulatory structures | Mocellin, Walterfang, Velakoulis, 2006 |
| Auditory hallucination Hallucination A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,... |
projection | frontotemporal functional connectivity | Shergill et al., 2000 |
| Eating disorder Eating disorder Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific... |
Atypical serotonin Serotonin Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans... system, right frontal and temporal lobe Temporal lobe The temporal lobe is a region of the cerebral cortex that is located beneath the Sylvian fissure on both cerebral hemispheres of the mammalian brain.... damage |
Kaye et al. (2005), Uher and Treasure (2005) | |
| Bipolar disorder Bipolar disorder Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or... |
Narcissistic | Prefrontal cortex Prefrontal cortex The prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior... and hippocampus Hippocampus The hippocampus is a major component of the brains of humans and other vertebrates. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. Humans and other mammals have two hippocampi, one in... , anterior cingulate, amygdala Amygdala The ' are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae are considered part of the limbic system.-... |
Barrett et al. (2003), Vawter, Freed, & Kleinman (2000) |
Improved patient care
Further, it is argued that this nexus will allow a more refined nosology of mental illness to emerge thus helping to improve remediationTherapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
and rehabilitation
Psychiatric rehabilitation
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and usually simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual who has a psychiatric disability...
strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
and depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
(Lerner and Whitehouse, 2002). These symptoms, which are largely ignored in neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.
Better management model
Schiffer et al. (2004) argue that there are good management and financial reasons for rapprochement.No psychiatric disorder has been completely "mapped"
The fact that no complete syndrome has been mapped in the brainBrain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
or genome
Genome
In modern molecular biology and genetics, the genome is the entirety of an organism's hereditary information. It is encoded either in DNA or, for many types of virus, in RNA. The genome includes both the genes and the non-coding sequences of the DNA/RNA....
is used to suggest that psychiatric disorders are not bona fide
Bona Fide
Bona Fide is a studio album from rock band Wishbone Ash. It is the first studio album in six years and is the only studio album to feature guitarist Ben Granfelt...
and should thus be kept separate (e.g. Baughman and Hovey, 2006). On this issue, it is worth remembering that research into the neural correlates of psychiatric disorders is in its infancy: the answers may still be to come. One reason why they may not have been found so far is that complex mental disorders may result from minute and intricate brain-wide damage and complicated gene-environment interactions, which are only beginning to be understood. Disorders may not exist as tidy, localized neurodysfunction or genetic abnormalities but multi-factorial brain-wide disorders with complex interactions between environment and genetics (e.g. Green, 2001). Such distributed dysfunction may not be resolvable in the living brain with current technology. E.g. disparate behavioral disorders have been linked to identical neurodysfunction with imaging but show significant organic differences following neurohistological analysis (Rempel–Clower et al., 1996). Where physiopathology is extremely small and distributed or neural tissue is actually healthy it may be the disturbed information-processing that should be studied. E.g. Bell, Halligan and Ellis' (2006) work on cognitive deficits in delusions.
Pragmatic issues
The extent to which neuropsychiatry is practically possible has been questioned. As Sachdev (2005) has noted, psychiatrists and neurologists operate very different patientPatient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
management strategies, which are skills honed by years of experience:
- NeurologistNeurologistA neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
: Clinical examination skills; empiricismEmpiricismEmpiricism is a theory of knowledge that asserts that knowledge comes only or primarily via sensory experience. One of several views of epistemology, the study of human knowledge, along with rationalism, idealism and historicism, empiricism emphasizes the role of experience and evidence,...
; objectivityObjectivity (science)Objectivity in science is a value that informs how science is practiced and how scientific truths are created. It is the idea that scientists, in attempting to uncover truths about the natural world, must aspire to eliminate personal biases, a priori commitments, emotional involvement, etc...
; surgerySurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical... - PsychiatristPsychiatristA psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
: Rich description of mental phenomena, well developed interviewing skills; understanding multiple causation; appreciation of individual differences; interpersonal context; psychological and behavioral therapies
Sachdev suggests to join them may be to dilute them both. Further, the ability to maintain a competent knowledge and skill base for both neurology and psychiatry with the advent of the inexorable increase in scientific knowledge may not be possible.
Summary of the arguments for neuropsychiatry
Diseases of the body have a physical manifestation that can often be caused by internal factors, external factors, or a combination of the two. Mental disorders should be no different and when together neurologyNeurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
's aim was to show that this was the case. Psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
departed the union preferring ideology
Ideology
An ideology is a set of ideas that constitutes one's goals, expectations, and actions. An ideology can be thought of as a comprehensive vision, as a way of looking at things , as in common sense and several philosophical tendencies , or a set of ideas proposed by the dominant class of a society to...
over empiricism
Empiricism
Empiricism is a theory of knowledge that asserts that knowledge comes only or primarily via sensory experience. One of several views of epistemology, the study of human knowledge, along with rationalism, idealism and historicism, empiricism emphasizes the role of experience and evidence,...
, including very environmentally-based etiology as well as espousing that the mind was something fundamentally different from the brain. Neurologists, however, finding no physiopathology for certain disorders left them to the psychiatrists, while themselves pursuing the diseases with clear physiopathology.
However, the cleavage between mind
Mind
The concept of mind is understood in many different ways by many different traditions, ranging from panpsychism and animism to traditional and organized religious views, as well as secular and materialist philosophies. Most agree that minds are constituted by conscious experience and intelligent...
and brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
and the causal dichotomies are argued not to be veridical. Psychiatric disorders are increasingly showing organic manifestation and demonstrate causation from something as distant as culture. Thus the reasons for the initial division are argued not to be useful or real ones. The two specialties are both dealing with disorders of the same system. Biological psychiatry and behavioral neurology show how the boundaries are being blurred. It is argued that there can be no objection to a reunion on philosophical or scientific grounds. However, there may be reasons to question whether neuropsychiatry would be practically possible. The differences in patient management, knowledge base and skill competency between neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
mean that being proficient in both may be impossible.
See also
- Cognitive neuropsychiatryCognitive neuropsychiatryCognitive neuropsychiatry is a sub-discipline of psychology and psychiatry that aims to understand mental illness and psychopathology in terms of models of normal psychological function. It is also a way of uncovering normal psychological processes by studying the effects of their change or...
- NeurologyNeurologyNeurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
- PsychiatryPsychiatryPsychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
- NeuropsychologyNeuropsychologyNeuropsychology studies the structure and function of the brain related to specific psychological processes and behaviors. The term neuropsychology has been applied to lesion studies in humans and animals. It has also been applied to efforts to record electrical activity from individual cells in...
- PsychoneuroimmunologyPsychoneuroimmunologyPsychoneuroimmunology is the study of the interaction between psychological processes and the nervous and immune systems of the human body...
Subspecialty Certification
Journals
- The Journal of Neuropsychiatry and Clinical Neurosciences
- Neuropsychiatric Disease and Treatment
- Clinical Neuropsychiatry: Journal of Treatment Evaluation
- Cognitive Neuropsychiatry
International/National Organizations
- Neuropsychiatric forum, Czech Republic
- American Neuropsychiatric Association
- The British Neuropsychiatry Association
- Royal College of Psychiatrists, Special Interest Group in Neuropsychiatry (SIGN)
- International Neuropsychiatric Association
- Neuropsychiatry in New Zealand
- Society for Behavioral and Cognitive Neurology