Neurology / Psychiatry distinction

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toby jones

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I'm trying to grapple with the distinction between neurology and psychiatry at the moment. I'm sort of trying to grasp the intuitive distinction before going to to think about whether the distinction is principled or whether it is more a function of accidents of history. In another thread someone posted a list of some specialities within neurology:

1. General (Most expect proficiency in EMG and EEG)
2. EMG (Neurophysiology or Neuromuscular)
3. Sleep (The majority are not 100% sleep)
4. Stroke
5. Epilepsy
6. Pediatric
7. Movement Disorders
8. Headache/Pain
9. MS
10. Neurointensivist
11. Neurorehab
12. Neurobehavioral/Dementia
13. Neuropsychiatry
14. Neuro-imaging
15. Neuro-opthalmology

So I suppose that gives me some idea. Um... What is 'Neuropsychiatry' and how does that differ from psychiatry?

There are people working on developing models of what is going wrong in the Capgras delusion, for example (people say 'my wife has been replaced by an impostor) or whatever. Sometimes this arises within a context of a psychotic episode such as schizophrenia, othertimes this arises within a context of acquired cerebral injury. Is the thought that the first is psychiatric whereas the second is neuropsychiatric? Is neuropsychiatric about psychiatric disorders that arise in response to acquired cerebral injury? Um... In such cases are people given anti-psychotics? Do they seem to help.

Any thoughts on the distinction between psychiatry and neurology would be welcome. In particular on whether people think these disciplines will be merged eventually or on whether there is a principled distinction there. How about social practices? Will the distinction remain because the day to day stuff of the two fields is typically different?

Thanks.

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Neurology and Psychiatry are similar fields.. classicaly, the difference is supposed to be that neurologist would see patients who have physical signs/symptoms (related to CNS) alongwith an identifiable CNS lesion upon investigation (i.e. after autopsy, EMG, CT, EEG) while psychiatrist mostly see patients who have mental signs/symptoms (without an identifiable CNS lesion). Mind was thought to be a separate entity. That was 100 years ago. Past decades have proven that all mental/neurological illness are organic in origin and the distinction between a neurologist and psychiatrist is blurred at the moment. You can train in Psychiatry and then obtain fellowship experience and eventually work in a setting very similar to the neurologist.

'Neuro-psychiatry' is the eventual future of these two fields... my 2 cents ;)
 
Neuropsychiatry is actually a relatively recently approved fellowship with certain official guidelines. Check the Psychiatry forum sticky's for more details.
 
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Neuropsychiatry is actually a relatively recently approved fellowship with certain official guidelines. Check the Psychiatry forum sticky's for more details.

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Can anyone take a stab at telling me the practical differences between the study of Neuropsychiatry vs. Neuropsychology except for the degree obtained?
 
My understanding: Neuropsychiatry: started as a subspecialty of Psychiatry, but now is part of both Neuro and psych -- deals with things that overlap between the two like pseudoseizures, somatoform disorder, depression in Parkinson's, effect of mood on pain circuits.

Neuropsychology: a field dealing witht he quantification of cognition in a clinical or research setting. Deals with things like measuring loss of function in dementia, lateralizing neurologic deficits before epilepsy surgery, mapping out language circuits.
 
Neuropsychiatry is actually a relatively recently approved fellowship with certain official guidelines. Check the Psychiatry forum sticky's for more details.
there are way too many different fellowships today... I learned the other day when flexner re-designed med school there were only three required clerkships?
 
My understanding: Neuropsychiatry: started as a subspecialty of Psychiatry, but now is part of both Neuro and psych -- deals with things that overlap between the two like pseudoseizures, somatoform disorder, depression in Parkinson's, effect of mood on pain circuits.

Neuropsychology: a field dealing witht he quantification of cognition in a clinical or research setting. Deals with things like measuring loss of function in dementia, lateralizing neurologic deficits before epilepsy surgery, mapping out language circuits.

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Nerdo, thanks again for the helpful info...your comments are giving me more avenues to research then I may have time for...

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Psychiatry = neurology without physical findings

Is that right? It seems like psychiatry does have physical findings, they just aren't necessarily diagnostic. Larger ventricular volume in schizophrenia, for instance...

It seems like a plausible conceptual difference between neurology and psychiatry isn't the absence of physical findings but the nature of the symptoms presented. In psychiatry the symptoms are best described in behavioral or cognitive terms, while in neurology they're best described in other ways... with seizures and shaking and whatnot.

Also, I guess that there is a persuasive reason to consider psychiatry and neurology separately, and that's because of the vast difference between the psychiatric and neurologic exams...
 
Psychiatry = neurology without physical findings

Is that right? It seems like psychiatry does have physical findings, they just aren't necessarily diagnostic. Larger ventricular volume in schizophrenia, for instance...

It seems like a plausible conceptual difference between neurology and psychiatry isn't the absence of physical findings but the nature of the symptoms presented. In psychiatry the symptoms are best described in behavioral or cognitive terms, while in neurology they're best described in other ways... with seizures and shaking and whatnot.

Also, I guess that there is a persuasive reason to consider psychiatry and neurology separately, and that's because of the vast difference between the psychiatric and neurologic exams...

I'm impressed that you can pick up increased ventricular volume on physical exam!

The quote, of course, refers to findings on the classic neurologic exam, which I guess isn't taught any more . . . you know, Babinski signs, increased tone, visual field defects . . . little stuff like that.

And believe me, there are plenty of "seizures and shaking" going on in psychiatry -- just visit any epilepy monitoring unit!
 
2nd commonest reason for a neuro consult= abnormal MRI

3rd commonest reason for a neuro consult= normal MRI

The commonest reason for a neuro consult= patient needs a neuro exam

:D
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ps. don't mean to lower the tone of a good thread... I'm compensating for a rough day at work ;)
 
Academically, you can squabble about the similarities between the specialties, but unless you are highly specialized in a particular area that overlaps, the practice of Psych and the practice of Neuro are totally different.

Just try it and see. Yeah, there is the exception of dementia. And there are psych pts in neuro, and vice versa. But day to day, they are just not at all the same.
 
I found Psychiatry rotations to be overwhelmingly subjective. Much of your diagnosis and criteria for pharmacological therapy are based solely on what the patient tells you...often without the ability to objectively confirm what you are hearing. Many patients learn the "right" things to say in order to escape hospitalization...or merit it.

Neurology is more like traditional Internal Medicine specialties in that there is more objectivity to physical examination and imaging results.
 
I found Psychiatry rotations to be overwhelmingly subjective. Much of your diagnosis and criteria for pharmacological therapy are based solely on what the patient tells you...often without the ability to objectively confirm what you are hearing. Many patients learn the "right" things to say in order to escape hospitalization...or merit it.

Neurology is more like traditional Internal Medicine specialties in that there is more objectivity to physical examination and imaging results.

Wrong. A huge chunk of neurology deals with subjective symptoms without clinical exam findings: headache and other chronic pain. Just as with psych, "much of your diagnosis and criteria for pharmacological therapy are based solely on what the patient tells you . . . often without the ability to objectively confirm what you are hearing." And believe me, plenty of patients "learn the 'right' thing to say" in order to get the meds they want. I have to confess that whenever I see any chronic headache/pain patient, the question of "is this a drug seeker" is always kicking around my mind. Sad, perhaps, but that's just how it is.
 
A huge chunk of neurology deals with subjective symptoms without clinical exam findings: headache and other chronic pain.

I have to confess that whenever I see any chronic headache/pain patient, the question of "is this a drug seeker" is always kicking around my mind. Sad, perhaps, but that's just how it is.

Elevated heart rate and blood pressure aside, I understand that pain is subjective. It is also something that all specialties and primary care physicians would have to deal with.

My own personal experience with Psychiatry is that it is much more subjective than Neurology.
 
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