Neuropsychiatry after psychiatry or neurology?

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Yoyomama88

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If you want to focus your practice on neuropsychiatry patients (is this only possible at academic medical centers?), what are the pros/cons of doing this fellowship as a psychiatrist vs. neurologist?
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gopens67 said:
is it that much harder than a psych residency?
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Depends on what you mean by much harder.

Since you have posed this in the psychiatry forum, you will hear from people who are committed to psychiatry, from pre meds through attendings. I am an MS4, and I have decided on psychiatry. I also thought I would be interested in neurology, but my rotation in it taught me otherwise.

Wait until you go to med school, specifically 3rd year rotations, and it will become more obvious to you which path is better for you.
 
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gopens67 said:
is it that much harder than a psych residency?
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That depends on what non-neuropsych issues you like more...

Neuromuscular pathology vs. personality disorders
Strokes vs. suicide attempts
EMGs vs. psychotherapy
Etc...

For me, I think some of the CNS aspects of neuro are interesting, particularly the cross-over issues. The peripheral pathology, hemorrhages, intensive care, IM and surgery crossovers? Not really.
 
There are neuropsychology fellowships out there but they are not accreditted from what I understand.

A problem with this field is there is a very limited number of people that will need your services, though contradicting myself, we need people in this field because there are very few people specializing in this and head traumas causing psychiatric problems is an increasing problem due to more people surviving TBIs thanks to improved military medicine.

The VA has several TBI patients but a problem there is it may be difficult to do what you'd like in a specialized neuro-psych manner because, frankly, state systems tend to operate in terms of state bureaucracy. They might, for example, just make you a regular psychiatrist in terms of position, you'll have to ask for the neuropsych patients and people might not offer you anything special on top of what they already offer psychiatrists.

Academic centers would be a better fit (in general). There are exceptions. If the right people at the VA aren't brain dead, they may help you to treat outside the box.
 
And I should mention that they might not be accredited but that doesn't mean they're not good. It's so cutting edge that it could be they're not accredited because it hasn't become mainstream enough.
 
To be good at "Neuropsychiatry" you will need to be good at both Psychiatry and Neurology. That sounds a bit to glib, but it's also true. For better or for worse (and I think worse), the training of Psychiatrists and Neurologists has not been as unified as it ought to be. Both specialities deal with disorders of the brain and nervous system. Neurology has had a more "organic" emphasis than Psychiatry. Most Neurologists learn about neuroanatomy and neuropathology and are taught to diagnose disease in terms of "lesions" to the nervous system. Most Psychiatrists learn about "psychopathology" and are taught to diagnose "mental illness" in terms of "behavioral psychology," with a heavy emphasis upon DSM diagnostic "criteria" of mental illness.
 
st2205 said:
For me, I think some of the CNS aspects of neuro are interesting, particularly the cross-over issues. The peripheral pathology, hemorrhages, intensive care, IM and surgery crossovers? Not really.
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+1. If neuro was all about treating brain problems, I'd be all about it. But in reality, you spend more time treating peripheral problems and referring people with brain problems (mostly strokes) to rehab. The only specialties in which you can actually treat brain problems are psychiatry and neurosurgery. And I'm most certainly not a surgeon.
 
How is treating someone with a stroke (tpa) or Status Epilepticus (antiseizure) or Multiple Sclerosis or Alzheimer's/Parkinsons or Headaches ...not treating the CNS?
 
shan564 said:
+1. If neuro was all about treating brain problems, I'd be all about it. But in reality, you spend more time treating peripheral problems and referring people with brain problems (mostly strokes) to rehab. The only specialties in which you can actually treat brain problems are psychiatry and neurosurgery. And I'm most certainly not a surgeon.
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Obviously many neurologists dont do acute stroke, but I think a lot of people dont really realize how tPA has changed the possible practice environments for neurologists. Everyone has this stereotype of neurology being the lets stand around and talk for hours and then not do anything specialty, but it was kind of eye opening to see the stroke neurologists sometimes running to the parking lot to meet the ambulance, doing NIH scales on people as they are rolling to CT, reading the scans and then tPA-ing them within like 20 minutes of the ambulance pulling up. If thats not treating brain problems, I dont know what is.
 
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Armadillos said:
Obviously many neurologists dont do acute stroke, but I think a lot of people dont really realize how tPA has changed the possible practice environments for neurologists. Everyone has this stereotype of neurology being the lets stand around and talk for hours and then not do anything specialty, but it was kind of eye opening to see the stroke neurologists sometimes running to the parking lot to meet the ambulance, doing NIH scales on people as they are rolling to CT, reading the scans and then tPA-ing them within like 20 minutes of the ambulance pulling up. If thats not treating brain problems, I dont know what is.
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Do you really need a neurologist to do that? Sounds like emergency medicine territory..
 
Armadillos said:
Obviously many neurologists dont do acute stroke, but I think a lot of people dont really realize how tPA has changed the possible practice environments for neurologists. Everyone has this stereotype of neurology being the lets stand around and talk for hours and then not do anything specialty, but it was kind of eye opening to see the stroke neurologists sometimes running to the parking lot to meet the ambulance, doing NIH scales on people as they are rolling to CT, reading the scans and then tPA-ing them within like 20 minutes of the ambulance pulling up. If thats not treating brain problems, I dont know what is.
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its treating a vascular/plumbing problem, not a brain problem.
 
splik said:
its treating a vascular/plumbing problem, not a brain problem.
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I obviosuly see what your getting at, but this is a very strange distinction, by this logic an MI is not a heart problem? Rentinal artery occlusion not an eye problem? Ischemic bowel,etc,etc
 
shan564 said:
Do you really need a neurologist to do that? Sounds like emergency medicine territory..
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I don't know how it is everywhere, but I know around here at the stroke centers tPA is generally given by a neurologist or at more rural hospitals ER physicians will consult a neurologist via telemedicine who will examine the patient via webcam and then make the call for tPA
 
sorry once the brain is infarcted or swelling, it becomes a brain problem.
 
splik said:
at which point it is no longer something that can be treated with tPA.
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I dont really understand your arguement here, saving the penumbra around the infarcted area is the whole point of tPA.

I really don't know where you all are trying to go with this argument that neurologists don't treat the brain, I mean I'm interested in psych, but saying neurology doesn't treat the brain just makes the forum seem silly.
 
Somebody said that, sorry if it wasn't you. Just seemed like you were picking up their argument where they left off
 
I didn't say that neurologists don't treat the brain, I said that neurologists don't spend enough time actually treating the brain for my own tastes. Psychiatry is 100% brain.

And that's why I like psychiatry better than neurology. In neurology, you spend most of your time doing peripheral examinations, treating plumbing problems, etc. Stroke is a cardiovascular problem that affects the brain, MS is an immune problem that affects the brain, etc. Epilepsy and Parkinson's are primary brain problems, but that'll be a minority of what you see as a neurologist. Alzheimer's is a primary brain problem, but you can't really treat that effectively.

In psychiatry, we spend most of our time actually examining the nuances of what happens when something goes wrong in the brain. You get trained in how to track the progress of a mental status exam, when the rest of the doctors just circle the box that says "crazy" or "not crazy."

I think I might have oversimplified when I said that "the only specialties that actually treat brain problems are psychiatry and neurosurgery." I'll admit that neurologists do treat brain problems sometimes. But more commonly, their everyday practice involves examining PNS problems, peripheral manifestations of CNS problems, vascular/immunological/other problems that affect the brain, or untreatable illnesses. In psychiatry, you mostly see actual brain problems, and you mostly see actual treatable conditions. So psychiatrists treat more brain problems (it was a 2-part statement). That doesn't mean that psychiatry is superior... it's just the reason why I prefer it.
 
shan564 said:
I didn't say that neurologists don't treat the brain, I said that neurologists don't spend enough time actually treating the brain for my own tastes. Psychiatry is 100% brain.

And that's why I like psychiatry better than neurology. In neurology, you spend most of your time doing peripheral examinations, treating plumbing problems, etc. Stroke is a cardiovascular problem that affects the brain, MS is an immune problem that affects the brain, etc. Epilepsy and Parkinson's are primary brain problems, but that'll be a minority of what you see as a neurologist. Alzheimer's is a primary brain problem, but you can't really treat that effectively.

In psychiatry, we spend most of our time actually examining the nuances of what happens when something goes wrong in the brain. You get trained in how to track the progress of a mental status exam, when the rest of the doctors just circle the box that says "crazy" or "not crazy."

I think I might have oversimplified when I said that "the only specialties that actually treat brain problems are psychiatry and neurosurgery." I'll admit that neurologists do treat brain problems sometimes. But more commonly, their everyday practice involves examining PNS problems, peripheral manifestations of CNS problems, vascular/immunological/other problems that affect the brain, or untreatable illnesses. In psychiatry, you mostly see actual brain problems, and you mostly see actual treatable conditions. So psychiatrists treat more brain problems (it was a 2-part statement). That doesn't mean that psychiatry is superior... it's just the reason why I prefer it.
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so you want to treat primary diseases of the brain- which I guess would be genetic and/or psychosocial in origin for the most part. That's cool.

But neurologists are still the brain doctors. They evaluate all manifestations of brain dysfunction (motor, sensory, emotional). Of course, the emotional evaluation is more limited than a psychiatrist would do. Neuologists are a lot better at examining the nuances of what happens when something goes wrong with the brain- evaluating for aphasia, apraxia, motor deficits, sensory deficits, etc.
Psychiatrists do sometimes screen for aphasia/apraxia, but a neurologist is usually much better at evaluation of these.
 
michaelrack said:
But neurologists are still the brain doctors. They evaluate all manifestations of brain dysfunction (motor, sensory, emotional). Of course, the emotional evaluation is more limited than a psychiatrist would do. Neuologists are a lot better at examining the nuances of what happens when something goes wrong with the brain- evaluating for aphasia, apraxia, motor deficits, sensory deficits, etc.
Psychiatrists do sometimes screen for aphasia/apraxia, but a neurologist is usually much better at evaluation of these.
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Yeah, I agree. Neurologists are brain doctors. The purpose of this discussion wasn't to decide who treats more of the brain, the purpose was to decide whether one should pursue neuropsychiatry as a subspecialty of neurology or psychiatry. I was simply listing some of the reasons why I chose psychiatry over neurology. Others will have completely different reasons. I'm not trying to argue that psychiatry is somehow a better field than neurology... that would be silly.

The point is, as somebody mentioned earlier, you make the choice mainly based on what sorts of diseases you want to treat. I like doing mental status exams because it makes me feel like I'm examining the brain/mind, and I don't really like doing neurological exams because it makes me feel like I'm examining peripheral stuff. I prefer working with my head rather than working with my hands. For that reason, I'd also rather be doing psychotherapy than manual procedures. The whole psych vs. neuro thing is carrying this thread away from the actual point.
 
To overgeneralize the three brain doctors:

brain surgeon = surgery on brain/cord masses and vasculature

neurologist = treatment of disorders/diseases that are closely linked to brain/cord lesions and vasculature

psychiatrist = treatment disorders/diseases that are not (yet) clearly linked to brain/cord lesions, primarily mood and psychiatric disorders

There is no single brain doctor. My $0.02
 
So, what I have learned from this thread, as long as you alter the definition of the words you are saying to meet whatever personal bias you may have, anything can be true. Sweet!
 
billypilgrim37 said:
So, what I have learned from this thread, as long as you alter the definition of the words you are saying to meet whatever personal bias you may have, anything can be true. Sweet!
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More just that I have a tendency to go on pointless tangents. I think there's a diagnosis for that.
 
shan564 said:
More just that I have a tendency to go on pointless tangents. I think there's a diagnosis for that.
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It's called working in the mental health field.
 
Leo Aquarius said:
To overgeneralize the three brain doctors:

brain surgeon = surgery on brain/cord masses and vasculature

neurologist = treatment of disorders/diseases that are closely linked to brain/cord lesions and vasculature

psychiatrist = treatment disorders/diseases that are not (yet) clearly linked to brain/cord lesions, primarily mood and psychiatric disorders

There is no single brain doctor. My $0.02
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Like heck there isn't!
 
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