Combined Neuro/Psych, Neuro w/ Neuropsych, or Psych w/ Neuropsych

[vaillant]

Hi all,

I wasn't really sure where to put this thread and ended up deciding on the Neurology forum. Please don't shoot me.

Anyways, I was wondering what the difference would be between a physician trained in a combined Neuro/Psych residency, a Neuro residency w/ Behavioral Neuro and Neuropsych fellowship, and a Psych residency w/ Behavioral Neuro and Neuropsych fellowship. My main interests are patients with Alzheimer's disease, epilepsy, bipolar disorder, major depressive disorder, and schizophrenia, especially bipolar disorder. I am also interested in research pertaining to the development of novel therapeutics for treatment of neurologic and neuropsychiatric disorders.

Which of the above paths would best suit my interests? Which of them would provide the largest patient base? Would a Neuro w/ Neuropsych fellowship be able to treat psychiatric patients also?

Thank you.

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[Missdetermined]

I'm curious about this also. I hope someone has an answer to this soon.

 

[95439]

Which of the above paths would best suit my interests? Which of them would provide the largest patient base? Would a Neuro w/ Neuropsych fellowship be able to treat psychiatric patients also?

Thank you.

I'm almost positive you can treat psych patients with a Neurology residency and Neuropsych fellowship. Especially considering there are Neuropsychiatry, Behavioral Neurology, and Neuropsychology fellowships...

http://www.aan.com/education/fellowships/

 

[RenegadeSynapse]

I'm in a similar boat re: trying to decide how I want to get to this area of clinical neuroscience. I'm just starting MS3, so I'm obviously not there yet and still trying to decide for certain, but here is my two cents. Anyone more in the know, please feel free to correct me

As far as behavioral/cognitive neuro and neuropsych go, I imagine it depends on where and who you do your fellowship with. Some programs seem more memory disorder heavy, while others may give you more involvement with bipolar/schizo and other traditionally psychiatric disorders. My thought process has generally been that I enjoy interacting with neurologists more, I prefer the way that (in my experience) neurologists tend to think about neuropsychiatric problems.

Also, I could see myself deciding upon other subspecs in neuro, but I'm not so certain that I'd like other areas of psychiatry on a daily basis. This is subject to change when I actually do the rotation, of course. But the thought process is nontheless important. I think you can get to the same end place through either specialty, so it might make sense to think about the other subject matter associated with each path.

I don't know if that's helpful or not. I certainly sympathize since I'm going through a similar process of trying to figure out what I want to do when I grow up.

RS

 

[Mattchiavelli]

I also went through some of this train of thought when trying to decide residencies, and I'll share what I've found out-

First off, this article gives some good backstory into the birth of the subspecialty/fellowship http://neuro.psychiatryonline.org/cgi/content/full/18/2/146

To go along with professional distinctions, neuropsychology is an allied health field that comes out of psychology. When you do things like behavioral fellowships, or traumatic brain injury fellowships, some stroke fellowships heavy on the rehab etc you get some neuropsychology time because you will need to know when to bring the neuropsychologist in, how to interpret results of their studies and incorporate it into treatment plans, things like that. A good comparison would be how a neurologist needs to know about neurosurgery to refer to a neurosurgeon appropriately and work in conjunction with a neurosurgeon while not doing any of the actual surgery.

As to the specific interests the OP had, Alzheimer's and epilepsy are typically more seen by neurologists, whereas MDD, bipolar d/o and schizophrenia are more the territory of psychiatry. One thing to consider when comparing the two is the general neurology vs psychiatry residency and whether you would enjoy the other things involved (so addiction disorders, personality disorders, anxiety disorders, suicide, the DSM, more focus on neurotransmitters with psych; neuromuscular disorders, strokes, MS, movement, much more neurophysiology and neuroanatomy with neuro). I ended up choosing neurology because I like the neurophys and neuroanatomy, also because I am not a huge fan of the DSM and I predict a bit of a hot mess happening with the transition of DSM-IV to DSM-V which would happen toward the end of my residency. There's still enough behavioral stuff in neurology to pique my interest- frontal lobe epilepsy, rehabilitation of brain injury, mood disorder manifestations in MS, psychogenic movement disorders, behavioral neurology the specialty, cognitive manifestations of stroke, and many more. It's also nice to sometimes be able to say "your EMG was XXX so you have YYY and here's what we're going to do about it" which is a kind of definitiveness that isn't as prevalent in psychiatry. Your mileage may vary. Cheers!

 

[vaillant]

Thank you, Mattchiavelli. Your post offered considerable insight and allowed me to have a better grasp of the choice at end. After reading the article you posted, as well as examining what the subspecialty of Behavioral Neurology and Neuropsychiatry really entailed, I realized that, in light of my interests, I would be better off pursuing a residency in Psychiatry.

I was confused at first due to my preconception that neuropsychiatry was essentially synonymous with biological psychiatry. Often, the term is used as such, but clinically speaking, neuropsychiatry deals with behavioral and cognitive deficits as a result of neurological disorders.

 

[Mattchiavelli]

Glad it helped!

Honestly, with the way psychiatry is nowadays neuropsychiatry is a little redundant because there is much focus on neurotransmitters and functional neuroimaging. It's not really the same psychiatry of Dr Freud. Do a couple of rotations in both as neither are so competitive that you MUST have your 3rd and 4th year in a specific way or you won't match.