APA urging neurology and psychiatry to rejoin?

[masterofmonkeys]

Given the topic of this thread, did many/any of you psych residents and attendings consider neurology?

I was undergrad in neurobio and have been a neuro patient for 11 years. I briefly considered neuro in high school but it didn't last very long.

As you can probably tell from my above rant, what most interests me in biology is the capacity for the human body and brain to adapt. That translates into a strong interest in physical and mental health promotion in making the 'healthy' healthier and helping the 'sick' to rehabilitate.

While there are specialists in neurorehab, I have found that neuro in general has a pretty limited interest in the capacity of people to adapt and overcome, whereas psychiatry seems to come at it from so many angles, from psychotherapy to social support to exercise to nutrition, with the latter two being the aspects of mental health I'm most interested in researching.

---

Members don't see this ad.

 

[howelljolly]

Can I ask why?

During my psychology and neuro "career" I was also an EMT and then a paramedic mostly in-hospital, with teaching responsabilities.... so throw that into my bag of interests.

Basically, to me there was an irreconsilable (sp?) divide between the academic vs. the clinical sides of both fields.... more so with psychiatry, I thought... but I have more clinical experience with psych as opposed to neuro - from undergrad, and med school.

For neuro, it wasnt so much that we cant do anything for patients, rather its that we dont have any good answers. An example that sticks out in my mind... a bichemistry professor came in for a followup after a stroke. He was in is 40s, and had no identifiable risk factors. He wanted to know how the stroke might have happened, and what he can do to prevent another one. The attending neurologists answer was "you have no risk factors, so I dont know" That was all. Maybe because I have very limited clinical neuro experience to balance out the good and bad... but after all that research, and problem solving, not having a simple answer like that didnt sit well with me.

With psych... my core rotation was really malignant, thanks to the attending I was assigned to. Whether its related, Im not sure... All of the "thinking" that we psych people like to do, all seemed useless. When I admitted the patient, I would have to write my differentlal diagnoses on the chart. During the patients stay, the attending wouldnt even bother trying to narrow down a diagnosis.... no attempt at all.
If the patient was somewhere on the depressed side of things... MDD, disthymic, adjustment d/o... didnt matter. They got an SSRI.
If they came in with any hint of mania... impulsivity. regardless of profound social stressors, or an organic brain disorder.... depakote.
That was it... the dosage was titrated to to pont were the patient couldnt feel depressed or elated because they could not feel or think at all.
The patients were just medicated. Any complaints thereafer were attributed to "attention seeking behavior"

It was horrible, and I had reverse vegetative symptoms myself by the end of the rotation.

So add to this neuro-psych mix, the paramedic thing, plus an insatiable interest in physiology, plus loads of learning, and thinking, and applying, and seeing results, asking questions and getting answers, on my medicine core and electives...

either emergency or internal medicine for me, thanks

 

[michaelrack]

The only places that action potentials actually ORIGINATE are in sensory organs. Without a body, there is no mind.

What about PGO waves?? http://en.wikipedia.org/wiki/PGO_waves

 

[michaelrack]

Why do you think that? Do you think we have more in common with medicine than with neurology? I'm just curious. I feel like with medicine, you can remove a lot of organs one by one and the body can keep working--even the heart and lungs (ie. bypass machine)--but you can't get by without the brain. You also CAN'T separate the brain FROM the mind which is why I'd lean toward neurology. People talk about the mind and the body being inseparable, but really, they're not. I can at least imagine separating the two, because, as I said, you can take one organ away at a time and the person remains alive. But if there is no mind, there is no behavior except coma or death.
.

From a practical standpoint, medical issues are gaining more prominence in psychiatry as compared to neurologic- with the newer antipsychotics, it becomes more important to monitor for metabolic complications than TD (though you still have to monitor for TD). There are inherent metabolic abnormalities in the major psychiatric syndromes- dexamethasone supression test in MDD, higher rates of metabolic abn in unmedicated schizophrenics and bipolar pts.

I am interested in the interface between psychiatry, neurology, and Internal medicine, which is one of the reasons that I did a sleep disorders fellowship.

I think it is important for a psychiatrist to have a good grasp of both IM and neuro, but since I am also an internist, I have a bias towards IM.