Tuesday, June 16, 2009

Neurology & Psychiatry

Here's another question from a visitor to the site:

"Neurology and Psychiatry: ...I continue to read the scientific literature and I find it somewhat arbitrary how different fields are divided up. What do you think of joining psychiatry and neurology?"

The field of "neuropsychiatry" is extremely interesting. At UBC there is a specialized ward devoted to helping patients who suffer from a combination of neurological diseases (such as epilepsy, head injuries, etc.) and psychiatric illnesses. Some "neuropsychiatrists" have completed specialty training in both neurology and psychiatry. At UBC a particular focus in neuropsychiatry has been the treatment of severe somatization and conversion disorders: these are psychiatric illnesses which present with severe physical or neurological symptoms (such as paralysis, blindness, or seizures). In conversion disorders, symptoms such as paralysis, blindness, or seizures, are not caused by neurologic problems such as stroke or epilepsy, but by severe, complicated depression in most cases. Treatment of the underlying psychiatric illness causes the neurological symptoms to disappear.

So, neurology and psychiatry do have an intersection in current practice. However, many neurologists may not be predisposed to dealing with psychiatric problems, or may not be willing to offer the type of regular follow-up which I believe is a healthy standard of care in psychiatry (unfortunately, the same could be said of some psychiatrists). Conversely, most psychiatrists would be uncomfortable dealing with acute or esoteric neurological problems.

So, in practice, while neurology and psychiatry have an overlap, the areas outside of the overlap are sufficiently large for the specialties to exist separately.


L said...

Hi Dr. K,

The "questioner's" question, from my perspective was referring to (all or most of) psychiatric symptoms BEING biological symptoms, thereby making the division of psychiatry and neurology a mistake.

Given the seemingly obvious material nature of at least a large portion of psychiatric symptoms (i.e. the genetic cause and the neurobiological cause...why else would we bother with taking meds?):

Doesn't it make sense that psychiatrists and neurologists join hands...perhaps becoming one specialty...to treat the many other illnesses (depression, bipolar disorder, schizophrenia, etc.)... currently in the realm of psychiatry alone?

I always wondered why the division given some neurological conditions have more than just biology triggering them (eg. perhaps some neurological illnesses triggered by stress, or where a person lives, or other things outside biolical causes,


GK said...

I agree with you, regarding the neurobiological roots of both psychiatric and neurological problems.

Neurologists are in short supply as well, and are busy seeing patients with epilepsy, peripheral nerve diseases, autoimmune conditions, etc. Many neurologists specializing in these areas are not comfortable attempting to help with emotional problems.

In this way, I suppose it could be fair to consider neurology and psychiatry different branches of "nervous system" medicine, just as immunology and endocrinology are different branches of internal medicine.

I do agree that neurologists and psychiatrists ought to interact more with each other professionally, and to learn from each other, especially since most neurological conditions have a substantial risk of psychiatric comorbidity.