Behavioral Neurology vs. Psychiatry

solumanculver said:

Hey,
This may be a very naive question, but what is the difference between behavioral neurology and psychiatry? If a person wanted to deal with mental illness, why would they go through the trouble of doing a neurology residency, and then an unrecognized fellowship in behavioral neurology instead of just becoming a psychiatrist? What do behavioral neurologists do that psychiatrists don't? For that matter, what is the difference between behavioral neurology and neuropsychiatry? They're portrayed as being essentially the same thing, as far as I can tell...

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Good question. I'm bumping this post up this list in the hopes that somebody will answer you. I'm debating neurology vs. psychiatry vs. both, so I'm interested.

solumanculver said:

Hey,
This may be a very naive question, but what is the difference between behavioral neurology and psychiatry? If a person wanted to deal with mental illness, why would they go through the trouble of doing a neurology residency, and then an unrecognized fellowship in behavioral neurology instead of just becoming a psychiatrist? What do behavioral neurologists do that psychiatrists don't? For that matter, what is the difference between behavioral neurology and neuropsychiatry? They're portrayed as being essentially the same thing, as far as I can tell...

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There are obviously a lot of similarities between behavioral neurology and psych. Both are interested in human behavior and the brain/mind. I think the main difference comes down to philosophy. Neurologist see the brain as connections of synapses and disease as dysfunction of these synapses (sort of a mechanistic point of view), while Psychiatrist although may hold these opinions see other contributing factors that cause disease (ie Freudian factors, emotional, etc).

Also the patients you see are different. Neurobehavior usually mostly deals with dementias (ie the structural defects of the brain) and the psychiatric sequelae of dementias (and usually do not see schizophrenics, manics, etc).

Psychiatrists obviously see bipolar, depression, schizophrenia.

I think it is interesting to note that most people, at least most that I've spoken to, who go into Neurology are drawn to it because they find human behavior very fascinating.

As for whether to chose Behavior Neuro vs. Psych, 3rd year clerkships will clue you in.

Cinnameg said:

Good question. I'm bumping this post up this list in the hopes that somebody will answer you. I'm debating neurology vs. psychiatry vs. both, so I'm interested.

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Simply put, the paths to get there are very different.

You could, as a behavioral neurologist, end up having a similar practice to what you could get as a practicing psychiatrist who focused on neuro. Methyldopa summed up the patient population nicely. As a psychiatrist you can choose or shape your practice in a certain direction though.
I did a rotation with a psych doc who was really into the neurology stuff and most of his patients were on the neuro or neuropsych floor. His office work was more broad though.
So maybe the core patients could end up being the same but the other stuff would differ a lot between a behavioral neurologist and a psychiatrist. Also, the road to get there and the philosophy is quite different. I don't know if that makes sense.
Methyldopa is right, I think it will be a more obvious choice as you rotate through them.
Good Luck

Do a combined Neuro/Psych residency and get the best of both worlds.

mysophobe said:

Do a combined Neuro/Psych residency and get the best of both worlds.

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The problem with that is that you end up doing either Psych or Neuro, rarely do you do both. And although it might make you a better Psychiatrist to know Neurology (or vice versa), a little extra reading can do the same trick. There are a few programs out there that combine the fields. And one of my Psych attendings was in fact double boarded (both in Psych and Neuro), but he told me that he rarely uses his Neuro training, except for reading the odd EEG.

I think in general combined programs are a waste of time (whether Neuro/Med, Neuro/Psych). I think the only advantage is that you get a broader experience.

solumanculver said:

Is there a principled reason that a behavioral neurologist wouldn't see a patient with schizophrenia, or is it simply that not enough is known about the neurologic development of the disease?

Also, do behavioral neurologists have any different methods of treatment that psychiatrists lack, or are the differences between the two specialties best though of in terms of personal preference for certain kinds of disease models, i.e. behavioral neurologists preferring dementias?

Soluman

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As for the first question, the cause of schizophrenia is indeed theoretical (but so the cause of many other dementias). As Neurologist you don't get much training in Psychiatry, you get a month nowadays. Although most well trainined Neurologists could deal with demented patients who develop schizophrenia (even then referals to psychiatrists become inevitable), I doubt many Neurologist would want to treat straight up schizophrenics.

For your second question, I don't think that the specialties have different methods of treatments necessarily. Indeed the difference does lie in personal pereferance for disease models and the approach to those diseases.

Though there are large overlaps between behavioral neurology and psychiatry, there is a lot of area covered by one or the other, but not both. Behavioral neurologists may have dementia clinics, but the field also includes functional imaging, the effects of neurologic diseases such as stroke and seizures on the functionality of the brain, and the like.

Methyldopa said:

The problem with that is that you end up doing either Psych or Neuro, rarely do you do both. And although it might make you a better Psychiatrist to know Neurology (or vice versa), a little extra reading can do the same trick. There are a few programs out there that combine the fields. And one of my Psych attendings was in fact double boarded (both in Psych and Neuro), but he told me that he rarely uses his Neuro training, except for reading the odd EEG.

I think in general combined programs are a waste of time (whether Neuro/Med, Neuro/Psych). I think the only advantage is that you get a broader experience.

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Yeah, it was a less serious suggestion than it prolly appears. The only combined residency program I can think of that would be beneficial is med/peds so that you have access to the fellowships for both specialties.

Methyldopa said:

The problem with that is that you end up doing either Psych or Neuro, rarely do you do both. And although it might make you a better Psychiatrist to know Neurology (or vice versa), a little extra reading can do the same trick. There are a few programs out there that combine the fields. And one of my Psych attendings was in fact double boarded (both in Psych and Neuro), but he told me that he rarely uses his Neuro training, except for reading the odd EEG.

I think in general combined programs are a waste of time (whether Neuro/Med, Neuro/Psych). I think the only advantage is that you get a broader experience.

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I got the same repeated opinion from my neuro and psych attendings. You end up picking one and you can always read up on the other.

Nerdoscience said:

Though there are large overlaps between behavioral neurology and psychiatry, there is a lot of area covered by one or the other, but not both. Behavioral neurologists may have dementia clinics, but the field also includes functional imaging, the effects of neurologic diseases such as stroke and seizures on the functionality of the brain, and the like.

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Are you saying neuropsychiatrists wouldn’t order brain imaging, or EEG’s? And furthermore, if I would like to incorporate these kinds of diagnostics into my approach to mental illness, should I choose neuro over psych and then go into cognitive neurology? Also, would a neuropsychiatrist investigate neurovascular problems that might account for the pt’s cognitive problem?

Methyldopa said:

The problem with that is that you end up doing either Psych or Neuro, rarely do you do both. And although it might make you a better Psychiatrist to know Neurology (or vice versa), a little extra reading can do the same trick. There are a few programs out there that combine the fields. And one of my Psych attendings was in fact double boarded (both in Psych and Neuro), but he told me that he rarely uses his Neuro training, except for reading the odd EEG.

I think in general combined programs are a waste of time (whether Neuro/Med, Neuro/Psych). I think the only advantage is that you get a broader experience.

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Do you think this only about residency combinations, or do you also think that combined degree programs like MD/MPH are a waste of time (yes, this is a serious question)?

Kulak Bondiced said:

Are you saying neuropsychiatrists wouldn’t order brain imaging, or EEG’s? And furthermore, if I would like to incorporate these kinds of diagnostics into my approach to mental illness, should I choose neuro over psych and then go into cognitive neurology? Also, would a neuropsychiatrist investigate neurovascular problems that might account for the pt’s cognitive problem?

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With behavioral neurology, its unlikely your patients would have 'mental illness' in the classical sense. You would probably be seeing patients with either dementia or (presumably identifiable) brain lesions that lead to cognitive sequelae, such as speech, communicative, or higher functional impairment. The range of the neuropsychiatrist also includes mood, anxiety, aggression and perceptual disorders. I think the Freudian philosophy is diminishing and continuing to diminish in psychiatry. The focus increasingly is on an evidence-based, empirical, atheoretic perspective rather than a 'theoretical' perspective.