Neuro/Psych . . . is this a good combo?

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Hello! I'm a newly minted 4th year medical student who has only three months to decide between the following career paths: Psychiatry followed by neuropsychiatry fellowship, Neurology followed by behavioral neurology fellowship, or a combined Neurology/Psychiatry residency program. In theory, I could apply to all three residency types (psych, neuro, neuro/psych combo), but I would rather not, it seems like a good way to confuse my recommendation letter writers and interviewers alike. I am fascinated by the brain in all its aspects, neurological and psychiatric diseases alike. I've had a little more experience in psychiatry prior to medical school, and therefore am currently better at psych than neuro, but I'm not convinced that one would be much easier for me than the other. Any advice from someone who has made a similar choice, or someone who is in one of these specialties? Thank you!

50 years ago I decided not to go into psychiatry because it seemed to me that psychiatry was really neurology without demonstrable pathology, given the tools of the time. After an internal medicine residency I spent a year with an early behavioral neurologist and then finished a neurology residency. Subsequently I worked with rehabilitation psychologists, neuropsychologists and a neuropsychiatrist in brain injury rehabilitation, pain rehabilitation and headache. You can go at it from several directions, but behavioral neurology might be the most direct and it's lots of fun. The way functional MRI and other investigative tools are working out, psychiatry and neurology may ultimately come back together again.

Cinnameg,

I am currently a 4th med student and am also consider Neuro, Psych, and Neuro/Psych programs. I'm curious to know what you ultimately decided upon? Any advice for a 4th year looking into these programs? Thanks!

I eventually decided psychiatry and plan to do a neuropsych fellowship. It was a tough decision and I think I would have been almost as happy in neurology. It was such a hard choice that it came down to things like how many months of medicine I really wanted to do during residency.

Exactly my dilemma. Behavioral Neurology is fascinating, the neurological basis of psychiatric diseases is where it's at for me. Is there a benefit to a combined residency? I'm more inclined to do psych save 1 year of residency and move on to what I really want to focus on after that. I'd love to hear some advice

I am 90% going to apply to Psych residencies (current MS4), but I am also wondering about combined programs and fellowships in the same way. I love the research aspects of psych, and while I feel my heart is in psychiatry, neurology satisfies the empiricist in me too. I was told that the Neuropsychiatry fellowships deal with the psychiatric sequalae of TBI and such pretty specifically, and that what I was actually interested in was really "Biological Psychiatry". I suppose these are subtle differences, so I was wondering if someone could elaborate on this.

Neuropsychiatry, in a clinical sense, deals with psychiatric conditions that result from neurological disorders (and TBI, as you mentioned). For example, mood changes and depression associated with Alzheimer's, Parkinson's, etc; dementia, autism, fragile X syndrome, and the like can fall into this category. Generally, the demographic for this subspecialty is an older population. From what I've gathered, neuropsychiatry deals with a very specific subset of the patient population.

Biological psychiatry is not necessarily a clinical field - it's more of a perspective or a research field. Basically, biopsychiatry believes that all psychiatric disorders ultimately stem from abnormalities in the brain, be it neurochemical dysregulation, neuronal signaling gone awry, or malformations of certain parts of the brain. This is the predominant viewpoint in psychiatry, as far as I am aware, and is the reason for the increased use of pharmacotherapy as opposed to psychotherapy. Research in this area is progressing at a fast rate but the ultimate result of it has yet to be seen.

Originally Posted by vaillant

Neuropsychiatry, in a clinical sense, deals with psychiatric conditions that result from neurological disorders (and TBI, as you mentioned). For example, mood changes and depression associated with Alzheimer's, Parkinson's, etc; dementia, autism, fragile X syndrome, and the like can fall into this category. Generally, the demographic for this subspecialty is an older population. From what I've gathered, neuropsychiatry deals with a very specific subset of the patient population.

Thank you for explaining that for us. Would you mind explaining what the difference is between neuropsych and behavioral neurology?

I'm just starting third year, but I'm also extremely interested in a combined residency or a fellowship following residency.