movement disorders in psych?

[nancysinatra]

Edit Note: I don't know how that mad face got there! Sorry!

I came across an interesting comment in another thread, one of the eternal neuro vs. psych threads. It said that movement disorders are an area of overlap between neuro and psych. I was kind of surprised to read this. How true is it? I can see how they might be-- there's tardive dyskinesia, tics, Huntington's, etc. But what is the real life role of psychiatrists in treating or researching these conditions? It also seems like the turf is pretty clearly defined between the two specialties.

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[Faebinder]

That doesn't sound right. Occasionally a consult is made for psychosis as one of the differential for the movement behavior and paralysis but no overlap there.

 

[Anasazi23]

Theoretically, much or most of neurology overlaps with psychiatry. At least from an academic standpoint. But I agree with Faebinder in the sense that at least for the "hard" movement disorders, you'll have a hard time finding a psychiatrist treating these as a stand-alone physician.

Things like TD, withdrawal dyskinesias, tic disorders, in the context of psychiatric illness, is treated very commonly by psychiatrists. Psychiatrists commonly adjust medications to treat, for example, the bradykinesia in a parkinson's patient, but this is normally done from an antipsychotic standpoint. Much like how a neurologist may give an antidepressant to his depressed stroke patient, but won't usually see a patient with a complaint solely of depression.

 

[Doc Samson]

Lewy body dementia is about the only movement-involving DO that I'd see as a primary treater.

 

[nancysinatra]

Who usually treats patients with Tourette's Syndrome? I remember on a call night in the psych ER, we admitted a child with this. But since then, even during a C&A elective, I haven't heard a word about it, until now, on my neuro clerkship.

I know it's in the DSM, but do most people think it is a neurological disorder or a psychiatric one?

 

[Faebinder]

Tourette's Syndrome is usually psych, but they dont usually get admitted...maybe that's why you haven't heard about it. It's sorta the same reason why you don't admit everyone with a flu...except that it's much less common than the flu.

 

[billypilgrim37]

I imagine this is quite institution dependent. I saw many more tic disorders on peds neuro rotation than I ever did in child psych. If there are significant psych comorbidities, you would expect a psychiatrist would be involved. If mom brings Billy to the pediatrician because he's blinking too much, he'll probably get referred to a neurologist.

A lot of children with autism see pediatric neurologists, and a lot see child psychiatrists, and a lot see both, and some of the care readily overlaps. Plenty of neurologists prescribe antipsychotics they probably have too little experience to actually prescribe, and psychiatrists order lots of diagnostics they can't personally interpret worth a lick (yes, DS, we know YOU can ). So it goes.

So yeah, there's overlap, and both sides think they are uniquely qualified to provide the best care, and some patients are probably best served by one or the other, while quite a few would be appropriately managed in either environment.

 

[liquidshadow22]

Is it very uncommon for a psychiatrist to be accepted into a movement disorders fellowship? Is it generally only exclusive to neurology applicants?

 

[st2205]

Is it very uncommon for a psychiatrist to be accepted into a movement disorders fellowship? Is it generally only exclusive to neurology applicants?

I've never heard of anyone doing it. I couldn't tell you the requirements but I'd imagine you'd really need to have a background in neuro for that specialty as there'd be too much you wouldn't know related to peripheral (generally speaking, not referring to PNS) issues that are pertinent in workups and treatment and such. Anyway, behavioral neurology / neuropsychiatry encompasses the relevant portions of movement disorders and from what I recall of the fellowships most of them have you spending some time there. I've heard of people who have done neurophysiology but that almost makes even less sense.