Future of psychiatry and neurology

[vmc303]

I'm very interested in the brain in general, both its functioning as a biological organ as well as the higher level "mind" processes that psychiatrists typically focus on. While I'm drawn to psychiatry because of its intellectualism, I'm not sure I agree with its foundations. I'm a firm materialist and think that psychiatric problems are ultimately neurological problems. I don't have much interest in psychoanalysis other than a passing intellectual one, and I'd much rather study pharmacology and neurosciences than conventional therapy. Frankly, counseling depressed people for hours on end seems like hell to me, but then so does the opposite extreme of 15 minute med checks all day long.

At the same time though, neurology seems constrained by its focus on "low level" diseases. Alzheimer's and Parkinson's are fascinating, but mostly as objects of research; as a practitioner, I imagine it would get frustrating never having good treatment prospects.

So my question is, where are the two fields heading? Are they due to converge? If I want to be a brain "generalist," an expert in both the biological and mental aspects of the brain, which direction should I go in? I know that in the neurosciences, they don't really differentiate between the two, so maybe there's hope for an integrated approach in medicine as well.

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[Gfunk6]

A very interesting topic and I'll give you my two cents as a mere MS-III

One of the things that kind of unnerved me during my Psych and Medicine clerkships was that there was a very clear distinction between psychiatric problems and medical problems. As we all know this is ultimately a false dichotomoy as all psychiatric problems are technically biological and therefore, medical, phenomena.

That said, I don't think that Psychiatry and Neurology will converge anytime soon. Psychiatry problems are ultimately problems in behavior whereas neurology encompasses more motor and specific functional deficits. There are some diseases like Alzeimher's and Parkison's where both fields overlap, but not too many.

In your specific case you may be more interested in doing a Neurology residency followed by a Behavioral Neurology fellowship. If you are more interested in research, there is no shortage of Psych programs that can provide an integrated post-doc to allow you to do research.

In Pysch we often know how to treat problems but the etiology eludes us. So research into the causes of psychotic, mood, and anxiety disorders will probably bring about the next great leap in psychitary. In contrast, Neurology often provides a good understanding of the mechanism of diseases but therapeutics is lagging behind.

 

[vmc303]

A very interesting topic and I'll give you my two cents as a mere MS-III

One of the things that kind of unnerved me during my Psych and Medicine clerkships was that there was a very clear distinction between psychiatric problems and medical problems. As we all know this is ultimately a false dichotomoy as all psychiatric problems are technically biological and therefore, medical, phenomena.

That said, I don't think that Psychiatry and Neurology will converge anytime soon. Psychiatry problems are ultimately problems in behavior whereas neurology encompasses more motor and specific functional deficits. There are some diseases like Alzeimher's and Parkison's where both fields overlap, but not too many.

In your specific case you may be more interested in doing a Neurology residency followed by a Behavioral Neurology fellowship. If you are more interested in research, there is no shortage of Psych programs that can provide an integrated post-doc to allow you to do research.

In Pysch we often know how to treat problems but the etiology eludes us. So research into the causes of psychotic, mood, and anxiety disorders will probably bring about the next great leap in psychitary. In contrast, Neurology often provides a good understanding of the mechanism of diseases but therapeutics is lagging behind.

Interesting. You're right in that I'm more interested in research, although ideally I'd like to strike a balance between research and practice.

What do you think about dual psych/neurology residencies? Would the extra time simply be wasted, if there's no real way to combine them in practice? And would this even be necessary? It sounds like if I did behavioral neurology, I might be able to perform many of the same duties as a psychiatrist anyway.

 

[pr.usmle]

hello gfunk6,
can you tell me more about the combined psyc/ doctoral programs.. or give me some links.. it is kinda difficult to start blindly for an img ...do we also have integrated psyc residencies - fellowships in the US?

i am from india and will soon give my USMLE steps.

 

[Gfunk6]

What do you think about dual psych/neurology residencies? Would the extra time simply be wasted, if there's no real way to combine them in practice? And would this even be necessary? It sounds like if I did behavioral neurology, I might be able to perform many of the same duties as a psychiatrist anyway.

I think a Neurology/Psych residency is very interesting, albeit relatively long at six years (including a PGY-1 preliminary year). Since the fields are relatively close I think there is a lot of information would be synergistic. Necessary? No, I don't think so but I think it would be desirable for some.

In your case, if you are really not interested in psychoanalysis you probably would be interested in Neurology alone or a Psych program with a heavier emphasis on research and psychopharmacology. My two cents.

 

[Gfunk6]

hello gfunk6,
can you tell me more about the combined psyc/ doctoral programs.. or give me some links.. it is kinda difficult to start blindly for an img ...do we also have integrated psyc residencies - fellowships in the US?

i am from india and will soon give my USMLE steps.

Combined Psychiatry/Post-Doc programs provide you with the clinical exposure of a psychiatry residency along with ~18 months of protected research time. Here are is an example:

University of Michigan
http://www.med.umich.edu/psych/education/genres/aboutres.htm

It won't be too hard to Google a few more such programs.

AFAIK, the only integrated Psychiatry Residency/Fellowship is the Triple board of Psychiatry/Pediatrics/Child and Adolescent Psychiatry.

Psych is a relatively IMG-Friendly speciality in the US. Though you may have a hard time matching to a major academic center, community programs are well within the realm of possibility.

 

[PublicHealth]

I think a Neurology/Psych residency is very interesting, albeit relatively long at six years (including a PGY-1 preliminary year). Since the fields are relatively close I think there is a lot of information would be synergistic. Necessary? No, I don't think so but I think it would be desirable for some.

In your case, if you are really not interested in psychoanalysis you probably would be interested in Neurology alone or a Psych program with a heavier emphasis on research and psychopharmacology. My two cents.

An artificial barrier separates neurology and psychiatry. There are certainly overlaps between the fields, but purists tend to want to retain their identity as psychiatrists or neurologists, not some combination of both. There is a small literature on both sides of this issue. This article from the Am J of Psychiatry provides a concise overview:

That being said, I think psychosomatic psychiatry has a promising future.

The Integration of Neurology, Psychiatry, and Neuroscience in the 21st Century (Am J Psychiatry 159:695-704, May 2002)

Joseph B. Martin, M.D., Ph.D.
OBJECTIVE: This article examines the historical basis for the divergence of neurology and psychiatry over the past century and discusses prospects for a rapprochement and potential convergence of the two specialties in the next century. METHOD: The author presents a brief historical overview of developments in neurology and psychiatry from the late 19th century. The histories of research and prevailing scientific opinion on two neuropsychiatric disorders, Alzheimer?s disease and Tourette?s syndrome, are compared to illustrate the effects of viewing a disease process from, respectively, the neurologic/organic and psychiatric/functional perspectives. RESULTS: Research on Alzheimer?s disease, because of its early pathologic demonstration, moved rapidly toward identification of associated synaptic abnormalities and genetic mutations. In Tourette?s syndrome, the absence of evident brain pathology resulted in vacillation between organic and functional explanations and persistent controversy about the nature of the illness. CONCLUSIONS: Neurology and psychiatry have, for much of the past century, been separated by an artificial wall created by the divergence of their philosophical approaches and research and treatment methods. Scientific advances in recent decades have made it clear that this separation is arbitrary and counterproductive. Neurologic and psychiatric research are moving closer together in the tools they use, the questions they ask, and the theoretical frameworks they employ. The interests of neurology and psychiatry converge within the framework of modern neuroscience. Further progress in understanding brain diseases and behavior demands fuller collaboration and integration of these fields. Leaders in academic medicine and science must work to break down the barriers between disciplines.

 

[Thewonderer]

I am not a purist but I just don't see how neurology and psychiatry can mix. There is simply too large of a personality difference! Psychiatrists like me are fascinated by behaviors. However, neurologists are interested in lesions and the underlying mechanisms. I have absolutely no interest. Even in behavioral neurology, they try to tie behaviors with specific lesions and that absolutely drives me nuts. It is like, frontal lobe dementia has this list of 15 symptoms, some of which overlap with lewy body dementia which has a list of 13 symptoms. And in the end, we are not sure but let's put them on aricept. Well, we could have put them on aricept without this mental exercise, couldn't we?

Yes, psychiatry will advance a lot quicker once we understand the underlying mechanisms or genetics of schizophrenia, depression, etc. But let's allow the basic scientists (it seems that all neurologists have some basic scientist mind-set) to figure it out. In the meantime, I know that antipsychotics work for controlling aggressive behaviors and other psycotic features so let me treat them clinically now.

 

[pr.usmle]

Combined Psychiatry/Post-Doc programs provide you with the clinical exposure of a psychiatry residency along with ~18 months of protected research time. Here are is an example:

University of Michigan
http://www.med.umich.edu/psych/education/genres/aboutres.htm

It won't be too hard to Google a few more such programs.

AFAIK, the only integrated Psychiatry Residency/Fellowship is the Triple board of Psychiatry/Pediatrics/Child and Adolescent Psychiatry.

Psych is a relatively IMG-Friendly speciality in the US. Though you may have a hard time matching to a major academic center, community programs are well within the realm of possibility.

thanks,so do you think that i, being a img, will get these residencies as these are academic centres.. should i be dreaming of being at such places or will my img status act as my handicap?
do community programs also offer such courses?
if you let me know i can start searching...
you're spoiling me ..

 

[Gfunk6]

thanks,so do you think that i, being a img, will get these residencies as these are academic centres.. should i be dreaming of being at such places or will my img status act as my handicap?
do community programs also offer such courses?
if you let me know i can start searching...
you're spoiling me ..

You can certainly get a Psych residency at an academic medical center. Just be aware that the standard is generally higher for IMGs. There is not a lot of interest among US grads to go into Psych, hence programs use IMGs to fill out their programs. That's the good news. The bad news is that there are a ton of IMGs vying for these spots so programs can pick or choose which ones the want.

Community programs do not generally offer research exposure that are as broad as academic centers.