Child Psychiatry

I am an MPH student and plan to apply to medical school or graduate school next summer. I am interested in pursuing either neuropsychiatry or clinical neuropsychology, depending on which route I choose -- MD/DO or PhD.

I am interested in psychiatry because of its inherent challenge and mystery. While I have considered pursuing child psychiatry or child clinical neuropsychology, I would rather be in adult practice. As you know, child psychiatrists deal mostly with problems such as ADHD, conduct disorder, oppositional defiant disorder, and rarely, more extreme Axis II psychopathology. With regard to adults, however, a psychiatrist will see a wider variety of psychopathology, including schizophrenia, more Axis II disorders, as well as impulse control disorders such as pathological gambling and pyromania. While there is much overlap between child and adult psychiatry, I simply find the adult side to be more varied and challenging, both of which add to the mystery which drives me to pursue this field.

Are you planning to pursue child psychiatry?

neuropsych

 

hey neuropsych,
I'm college student trying to make the same decision and I'm hoping that you'd willing to inform about practice differences between these two fields as well as the future outlook. I posted a thread in the neurology forum about this, thanks. I apologize to the original poster for getting off the topic.

 

Hi Sanman,

Thanks for your interest. Feel free to e-mail me if you have more specific questions. I would be more than happy to answer them. I address some of your concerns below.

I have heard opinions from both sides -- psychiatry (MD/DO) and clinical neuropsychology (PhD) -- and have come to the conclusion that it all depends on which profession suits YOU the best.

Behavioral Neurology and Neuropsychiatry both require the MD or DO degree in addition to 4-5 years of residency and anywhere between 1-3 years of fellowship training. This varies depending on your desire for subspecialization.

Clinical Neuropsychology requires the PhD degree. These programs are typically PhD programs in Clinical Psychology, which include a predoctoral internship in a clinical setting and may include courses in and applied training in clinical neuropsychology. Nearly all graduates from such programs go on to do fellowships in their area of specialization -- e.g., child clinical neuropsychology.

A major difference between medical training and graduate training is that graduate training in neuropsychology requires you to complete a dissertation which is usually based on original research. Such research is typically in some area of clinical psychology or clinical neuropsychology -- e.g., "attentional deficits in obsessive-compulsive disorder." Neuropsychologists are particularly interested in the relationship between brain and behavior and spend a good part of their time conducting neuropsychological evaluations of patients to assess cognitive capacities such as memory, executive function, attention, and language. Some also work in rehabilitation hospitals where they conduct evaluations of brain-injured patients and some may work in neurosurgical settings in which they perform cortical mapping.

As far as salary is concerned, behavioral neurologists and neuropsychiatrists can make anywhere between $120,000-$200,000/year, although the median tends to hang around $140,000/year. Clinical neuropsychologists can make anywhere between $50,000 and $75,000/year with the median around $60,000/year. All of these estimates are based on statistics from the U.S. Dept of Labor and from my many interactions among such professionals.

Regarding the future of neuropsychology, here's an e-mail I recently received from Dr. Michael Westerveld, a clinical neuropsychologist in the Dept. of Neurosurgery at the Yale University School of Medicine:

"The challenges that face the profession are not scientific,
but economic. Unfortunately, the reality is that reimbursement for clinical neuropsychological services are declining, as they are in every other medical and mental health specialty. The profession will, in my opinion, continue to flourish as a science, but as a clinical specialty I think the gravity of the danger is real. I would truly like to believe that in ten years these issues
will be largely resolved, but as the economic pressures on the Medicare system increases with the aging of the population, neuropsychology will be hard hit. The sad reality is that private insurance companies are leading the decline, whereas they used to provide a respite from the lower government reimbursement
systems. This is a somewhat pessimistic view, to be sure, but one that, if ignored, will become reality.

As far as the biological basis of behavior, I think that it depends more on the area you are interested in. If you are interested in Psychiatric disorders and pharmacalogical interventions, Psychiatry is a more logical discipline although Psychologists are gaining a foothold in this area and have successfully gained
prescription priveleges in some domains (New Mexico, and the DOD, with more poised to follow). However if you are more interested in the neurological basis of normal behavior and the impact of neurological injury or disease, then I would pursue either Clinical Neuropsychology or Behavioral Neurology."

Hope this helps!

neuropsych

 

Hi,

Thanks for the insights, neuropsych. Raj, sorry this is deviating a bit. Anyway, i posted this earlier in other forums, but never got a good answer.

I want to understand all MD proffesions like psych/neuropsych. I want to know more about what they entail (i'm post BS, pre MD). I'm not that interested in psychology. I most definetly want research tied in with my career... maybe MD PhD. You ask me the most fascinating thing for research is to understand the cellular basis of addiction, learning and memory, etc. Though inititially drawn to neuroscience because of it's hard science nature, i loved everything about it, especially how it could explain the intricate complexities and invention bodies for things we are always seeing in everyday life.

I've seriously considered psychiatry, b ut don' t want to be prescribing meds all day. Also, i'm thinking, technically, it can get very boring. But some pe ople say that it is very academically stimulating... but I don 't see how. A lot of people are driven purely because they see as it a lot of counseling people. I do like that, but I th ink any medical proffesion (outside like anesth/radiology) has enough. There is an unusualness of neuro/ psych diseases that partially attracts me. The mystery of behavior /speech or someone with aprosodia (or maybe it was apahsia) or schizophrenia. Also, i'm driven because, the patient sometimes feel so helpless, when they're is a lot that can be done. Maybe very little compared to other specialties, but a lot more than the public realizes. Also, you can make a very big impact on the patient.

I'm a very strong believer that one can control their mind, and they're should be lot less reliance on drugs. They have their place, but psychology and counseling have a place everywhere with all psychiatric (or all medical.. periord) conditions, even ones people consider "purely" biological, like schizophrenia.

A reason i don't admit, is that i've seen personally too much the effect of neuro and psych diseases.

I'd really like to understand more about all MD profs related to and between Neuro and Psych. I just don't what specifically my questions are, they are very general. What do you like/dislike about different such specialties? What do they entail? What do you feel you are missing? Anygood books to consider that could be fun and informative?

Thanks,
Sonya

 

Does anyone know anything about combined Neurology/Psychiatry residency training.

 

Sonya,

Psychiatry is certainly a fascinating field, and although many psychiatrists today are seen as "pill-pushing, drug cowboys" there are ample opportunities in psychiatric research. Unfortunately, you have to endure four years of medical training and an additional four years of residency before you can begin building a research program.

Clinical psychology and clinical neuropsychology programs, on the other hand, require that you carry out a research project that will ultimately result in a dissertation. You also spend quite a bit of time in clinical training and teaching. Thus, such programs are a more balanced if you're interested in research, clinical work, and teaching.

Of course, there are trade-offs in both fields. You simply have to decide what fits you the best and then go for it!

I highly recommend shadowing a psychiatrist and clinical neuropsychologist to see what their work entails. If possible, shadow more than one of each type of professional. Ask them how they enjoy their jobs and what they see as the future of their field.

I'm post-BA, pre-med, and currently an MPH student. While public health is not directly related to psychiatry or clinical neuropsychology, I am currently volunteering in various clinical arenas -- psychology and psychiatry -- and working on my Master's thesis which will explore medical and psychosocial correlates of elderly problem gambling from a public health perspective, all while taking a full-time load of MPH classes.

In sum, there are several opportunities out there. You seem to have a deep interest in psychiatry and psychology. These are disparate, yet related fields. In order to get a full appreciation of both fields, go out and ask people who are currently practicing in these areas, read about both fields, get a rich understanding of what both fields entail, and then pursue the one you know suits you the best.

Recommended reading:

"Brave New Brain: Conquering Mental Illness in the Era of the Genome" by Nancy Andreasen

"Out of its Mind: Psychiatry in Crisis" by J. Allan Hobson and Jonathon Leonard.

"Fundamentals of Human Neuropsychology" by Bryan Kolb and Ian Whishaw

"Neuropsychological Assessment" by Muriel Lezak

Hope this helps. Feel free to PM or e-mail me.

neuropsych

"The subject of gambling is all encompassing. It combines man's natural play instinct with his desire to know about his fate and his future."

-Franz Rosenthal, Gambling in Islam (1975)

 

Neuropsych,
Thanks for the info. I was wondering about lifestyle issues in clinical practice if you have any experience with this. Also, you mentioned that you looked into child neuropsych, do they assess learning disorders? As far as behavioral neurology goes, I understood that it isn't a recognized neurology specialty, but can be studied at some of the larger university programs.

 

sonya--

some books that might a little fluffier but can really give you insight into neurology/psychiatry:

The Man Who Mistook His Wife for a Hat (Oliver Sacks)...it's a classic

Why Michael Couldn't Hit (i don't remember the author, and the title might be a little off, but you should be able to find it by searching this title)


Also, V.S. Ramachandran is a guy who has done a lot of work in this field and has had several PBS specials (maybe it was series or mini-series??) talking about his work. he keeps things very simple but it will give you a taste of what people in neuropsych do and the intriguing findings you can come up with.

If you want more technical readings, I have a list somewhere from a class last semester.....


chops

 

Hi,

Thanks for the suggestions about books, and other info.

I'm not really considering neuropsychology, and am quite confident I want to do MD and all that. I'm not sure I wa nt to specialize in psychiatry, but something related to nerology/neuropsych seems the most appealing right now.

I don't think neuropsychology would interst me because, i'm not that much into psychology... it's not really science, i guess. (my opinion). I'm still really into the hard core science (in terms of what i like, academically.. bioeng major, want to do biophysics research, but if it relates to psych disease or cognition, all the more interesting).

I do want to be involved with research... i need that mental challenge, and i know i can make good contributions a nd will enjoy it. But, still want to be involved with practice to.

Sonya

 

Neuropsych,

Just wanted to update everyone on something you wrote about in your 9-18-02 regarding psychologists and prescription writing priveleges.

The DOD program was discontinued 5 years ago per an article I read on the American Psychiatric Association website. It is listed under psychiatric news in the section labeled viewpoints. The title of the article is Lessons from New Mexico written by Neil Arnet, MD.

Just wanted to clarify this, only because I read the article. I am interested in psychiatry and I am personally against psychologist acquiring these priveleges.

Thanks,

FutureMD/DO

 

That was actually an e-mail I received from Dr. Westervald, who is a clinical neuropsychologist at Yale. Thanks for clarifying.

I, too, am opposed to psychologists prescribing. Passing legislation which allows them to do so takes away from their profession as well as from psychiatry.

 

I love psychiatry. I went into the field knowing that I would plan to subspecialize. I interviewed all over and was very pleased with what Washington University had to offer. I love the supportive staff, endless learning opportunities and variety of patient populations.