Neuropsychiatry Timeline

[Engineering2MD]

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Hello and thank you for reading my message.
I am interested in neurology and psychiatry for a profession. I was wondering what the time line was from the point of entry being medical school until I was a full neuropsychiatrist practicing medicine.

Also I was interested in what schools are best to get into in order to study the brain and its function in a neurological view. What schools are best to get into to set me up with a high quality residency program.

Thank You,
Engineering2MD

 

[aspiringdoc09]

Hello and thank you for reading my message.
I am interested in neurology and psychiatry for a profession. I was wondering what the time line was from the point of entry being medical school until I was a full neuropsychiatrist practicing medicine.

Also I was interested in what schools are best to get into in order to study the brain and its function in a neurological view. What schools are best to get into to set me up with a high quality residency program.

Thank You,
Engineering2MD

I am interested in this field and would like to know.

 

[cbrons]

4 years undergrad, 4 years med school, at least 4 years residency. There are some combined neuro/psychiatry residencies out there, not sure exactly how long they are. Perhaps its closer to 5 years, I don't know if they make you do a year of medicine first.

 

[aSagacious]

To add to the above, it looks like there are 7 combined programs in the US (or at least that are listed through the ACGME), the majority of which are 6 years.

 

[GoSpursGo]

Allo is a forum for med students, not for pre-meds to ask questions. Med students frequently post in pre-allo to answer these kinds of questions, which is where I'm moving this thread.

 

[splik]

When you do your psychiatry and neurology clerkships you can decide which you want to do. There are three routes to what you call 'neuropsychiatry'. One is to do a combined 6-year neurology/psychiatry residency (the first year is mainly internal medicine followed by 2.5 years of post-internship training in both neurology and psychiatry). This route is best for those who are interested in both neurology and psychiatry, and not just cognitive neuroscience or behavioral neurology but everything - peripheral nervous system disorders, epilepsy, stroke, headache, movement disorders and so on. You will not get very good psychotherapy training, which is fairly important in neuropsychiatry depending on what you want to do, and there is some really interesting research on the neural basis of psychotherapy. These have largely fallen out of favor for various reasons (most neurologists dont like psychiatry, most psychiatry wannabes dont like neurology, it is 6 years, they are keen on neuroscience PhDs, it is not clear what the job opportunities are, it is clearly the biomedical approach to psychiatry is not the future, there has been an upswing in psychotherapy etc). These programs frequently go unfilled.

If you are predominatly interested in training in neurology you can do a 4-year neurology residency followed by a 1-2 year cognitive neurology or behavioral neurology fellowship. This is not a ACGME approved fellowship, and it is not a recognised subspecialty by the American Board of Neurology and Psychiatry. A major part of this is dementias, neurodegenerative disease, and cognitive and behavioral aspects of stroke, traumatic brain injury, epilepsy, movement disorders etc.

The 3rd pathway is to do a 4 year psychiatry residency followed by a 1-2 year fellowship in neuropsychiatry or behavioral neurology. If you are primarily interested in the mind, and emotional, cognitive and behavioral dysfunction from a cognitive neuroscience perspective then this is the way to go. You will become proficient in diagnosis and management of common mental disorders (schizophrenia, bipolar, depression, PTSD, personality disorders), au fait with psychopharmacology, psychodynamic therapy, cognitive behavior therapy, and supportive psychotherapy, and ECT. This route will be good for dealing with conversion disorders, depersonalization, cognitive deficits in psychiatric illness, dementia, traumatic brain injury, psychiatric aspects of epilepsy, Tourette's syndrome, Parkinson's disease etc.

Neuropsychiatry is a predominantly academic field and most are based in academic centers with faculty positions, often doing research. Many are MD PhDs (but this is not necessary, and you do not have to research necessarily). It is a niche area and hard but possible to carve out a private practice (and doing so would usually require a strong academic reputation).

As for where to go for medical school- well go to the best school you can without bankrupting yourself. Neurology, psychiatry, and neuropsychiatry are ridiculously uncompetitive fields (except at the top top programs) you will be fine. It is too early for you to know what you really want to do, but it would be useful to go somewhere that could support your interests in this area (so you could do research etc) but certainly not necessary. Harvard and Hopkins spring to mind, and I think NYU, Brown, Dartmouth and UCSF are also strong here.

 

[aspiringdoc09]

When you do your psychiatry and neurology clerkships you can decide which you want to do. There are three routes to what you call 'neuropsychiatry'. One is to do a combined 6-year neurology/psychiatry residency (the first year is mainly internal medicine followed by 2.5 years of post-internship training in both neurology and psychiatry). This route is best for those who are interested in both neurology and psychiatry, and not just cognitive neuroscience or behavioral neurology but everything - peripheral nervous system disorders, epilepsy, stroke, headache, movement disorders and so on. You will not get very good psychotherapy training, which is fairly important in neuropsychiatry depending on what you want to do, and there is some really interesting research on the neural basis of psychotherapy. These have largely fallen out of favor for various reasons (most neurologists dont like psychiatry, most psychiatry wannabes dont like neurology, it is 6 years, they are keen on neuroscience PhDs, it is not clear what the job opportunities are, it is clearly the biomedical approach to psychiatry is not the future, there has been an upswing in psychotherapy etc). These programs frequently go unfilled.

If you are predominatly interested in training in neurology you can do a 4-year neurology residency followed by a 1-2 year cognitive neurology or behavioral neurology fellowship. This is not a ACGME approved fellowship, and it is not a recognised subspecialty by the American Board of Neurology and Psychiatry. A major part of this is dementias, neurodegenerative disease, and cognitive and behavioral aspects of stroke, traumatic brain injury, epilepsy, movement disorders etc.

The 3rd pathway is to do a 4 year psychiatry residency followed by a 1-2 year fellowship in neuropsychiatry or behavioral neurology. If you are primarily interested in the mind, and emotional, cognitive and behavioral dysfunction from a cognitive neuroscience perspective then this is the way to go. You will become proficient in diagnosis and management of common mental disorders (schizophrenia, bipolar, depression, PTSD, personality disorders), au fait with psychopharmacology, psychodynamic therapy, cognitive behavior therapy, and supportive psychotherapy, and ECT. This route will be good for dealing with conversion disorders, depersonalization, cognitive deficits in psychiatric illness, dementia, traumatic brain injury, psychiatric aspects of epilepsy, Tourette's syndrome, Parkinson's disease etc.

Neuropsychiatry is a predominantly academic field and most are based in academic centers with faculty positions, often doing research. Many are MD PhDs (but this is not necessary, and you do not have to research necessarily). It is a niche area and hard but possible to carve out a private practice (and doing so would usually require a strong academic reputation).

As for where to go for medical school- well go to the best school you can without bankrupting yourself. Neurology, psychiatry, and neuropsychiatry are ridiculously uncompetitive fields (except at the top top programs) you will be fine. It is too early for you to know what you really want to do, but it would be useful to go somewhere that could support your interests in this area (so you could do research etc) but certainly not necessary. Harvard and Hopkins spring to mind, and I think NYU, Brown, Dartmouth and UCSF are also strong here.

What you said (in bold) do you mean that neuropsychiatrist aren't properly trained in psychotherapy training or neurology by itself isn't? I know in the end when it comes to jobs that you will only be able to choose one or the other, but for now my interests span in both psychiatric illnesses and primarily neurodegenerative diseases. I'm open-minded, and I'm not saying I want change my mind in medical school.

 

[splik]

If you do a dual neurology-psychiatry residency you will be doing both in a fraction of the time (6 years instead of 8). Something has to go. That thing is psychotherapy training. Obviously if someone did a psychiatry residency where there was good psychotherapy training (this is highly variable) and then did a neuropsychiatry fellowship that would be different, and if you did neurology and then trained in behavioral and cognitive neurology you would have zero psychotherapy training.

It is possible to practice both neurology and psychiatry but this is not the norm. In reality most of the patients in neurology clinics have neurological symptoms that are likely psychiatric in origin or do not conform to any known pattern of neurological abnormality. These patients will never see a psychiatrist so a neurologist who is psychiatrically trained is helpful. It is no accident that many neurologists practiced psychotherapy in the former half of the 20th century, that military neurologists treated psychopathology, and even Freud was a neurologist, not a psychiatrist.

Neurodegenerative diseases fall at the interface of neurology and psychiatry - primarily the dementias (though dementia is much better managed by geriatric psychiatry than neurology) but also Parkinsons' - sleep disorders, depression, frank psychosis all very common in PD, and the meds cause dopamine dysregulation syndrome which often causes neuropsychiatric problems such as pathological gambling.

There are some really fascinating areas of cognitive neuroscience, but most of it is nothing like an Oliver Sacks book.

 

[aspiringdoc09]

]If you do a dual neurology-psychiatry residency you will be doing both in a fraction of the time (6 years instead of 8). Something has to go. That thing is psychotherapy training.[/B] Obviously if someone did a psychiatry residency where there was good psychotherapy training (this is highly variable) and then did a neuropsychiatry fellowship that would be different, and if you did neurology and then trained in behavioral and cognitive neurology you would have zero psychotherapy training.

It is possible to practice both neurology and psychiatry but this is not the norm. In reality most of the patients in neurology clinics have neurological symptoms that are likely psychiatric in origin or do not conform to any known pattern of neurological abnormality. These patients will never see a psychiatrist so a neurologist who is psychiatrically trained is helpful. It is no accident that many neurologists practiced psychotherapy in the former half of the 20th century, that military neurologists treated psychopathology, and even Freud was a neurologist, not a psychiatrist.

Neurodegenerative diseases fall at the interface of neurology and psychiatry - primarily the dementias (though dementia is much better managed by geriatric psychiatry than neurology) but also Parkinsons' - sleep disorders, depression, frank psychosis all very common in PD, and the meds cause dopamine dysregulation syndrome which often causes neuropsychiatric problems such as pathological gambling.

There are some really fascinating areas of cognitive neuroscience, but most of it is nothing like an Oliver Sacks book.

You make a solid point. I never thought about it like that; however, I did wonder how MD-PhDs could be good as either physicians/scientists if they decrease the time it takes to get the Ph.D. (normally 5-7 yrs) or have such a gap between their medical basic science and clinical years. If you don't mind me asking, what type of resident are you?

 

[splik]

You make a solid point. I never thought about it like that; however, I did wonder how MD-PhDs could be good as either physicians/scientists if they decrease the time it takes to get the Ph.D. (normally 5-7 yrs) or have such a gap between their medical basic science and clinical years. If you don't mind me asking, what type of resident are you?

In my experience the MD-PhDs I have worked with have been some of the most intelligent people I have met and they are great scientists (at least have top quality research published in high impact factor journals) but in general they don't to be as good clinically. That is a generalization of course but being a good clinician has nothing to do with running PCRs etc and more to do with having good communication skills, working well with others, and having the balls to make decisions rather than mentally masturbate about the nuances of diagnosis/management.

I am doing psych by way of IM and public health.