should I even consider psychiatry?

[soul21]

Hi everybody I dont know whether I should go into neurology or psychiatry. I find neuroscience very exciting and love the fact that a lot of advances are being made in the last frontier of medicine. I am fascinated by the biological aspect of psychiatry but i am not to interested in psychotherapy. My qeustion to you all is should I even consider psychiatry as a profession if I like only the biological aspect of psychiarty or should I go into neurology even though i find psychiatric illness more interesting?

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[Anasazi23]

I had the same problem a couple years back. I had this feeling that I should go into neurology, since I like the neurosciences so much. But, my real love was with psychiatric illness.

As far as choosing which field, nobody can decide but yourself. But, consider that there are many psychiatrists that focus heavily on the biological aspect of psychiatric illness, and do no psychotherapy at all. Many are researchers that don't even see patients at all. In the fellowships sticky above, you can see that as a psychiatry resident, you are eligible for either behavioral neuroscience fellowships, as well as neuropsychiatry fellowship training. This will allow you to study both psychiatry and neurology in depth.

Remember that psychiatrists are boarded by the American Board of Psychiatry and Neurology. 40% of our boards is neurology. 40% of their boards is psychiatry. The fields are heavily intertwined. Think about what kind of patients you want to see primarily, keeping in mind that there is often overlap. When doing this, think of the kinds of treatment you'd rather be giving. i.e. stroke patients with tpa, neuro-rehab and the like; along with migraines, neuropathic pain, spinal cord diseases, etc. This is in contrast to psychiatry, with schizophrenia, personality disorders, mood disorders, neuropsychiatric syndromes, psychiatric manifestations of medical illness, being treated with ECT, antipsychotics, older neuroleptics, and in the near future, VNS or TMS.

If you're truly a glutton for punishment, do a combined residency in Neuropsychiatry. It's 6 years though, I think. Details can be found also in the fellowships thread sticky.

 

[OldPsychDoc]

Hi everybody I dont know whether I should go into neurology or psychiatry. I find neuroscience very exciting and love the fact that a lot of advances are being made in the last frontier of medicine. I am fascinated by the biological aspect of psychiatry but i am not to interested in psychotherapy. My qeustion to you all is should I even consider psychiatry as a profession if I like only the biological aspect of psychiarty or should I go into neurology even though i find psychiatric illness more interesting?

Everything Anasazi said is true, but keep in mind that most of neuro is "plumbing and packaging"--i.e. cardiology of the brain. I just didn't find seizures, Parkinson's and dementia nearly as interesting as psychosis and depression and their respectiv pharmacologies. Plus, in psych you don't have to stay up all night in the ICU giving TPA or dealing with stroked out pts on vents or status epilepticus...

 

[Anasazi23]

Everything Anasazi said is true, but keep in mind that most of neuro is "plumbing and packaging"--i.e. cardiology of the brain. I just didn't find seizures, Parkinson's and dementia nearly as interesting as psychosis and depression and their respectiv pharmacologies. Plus, in psych you don't have to stay up all night in the ICU giving TPA or dealing with stroked out pts on vents or status epilepticus...

True, true, true. The seizure thing gets old kinda quick. And the movement disorders, while interesting, are just sort of timid compared to the psych stuff.

You'll see enough of it in your practice to keep it interesting, and have a good time thinking of the complicating factors in your treatment options - all the while doing a lot of good for your patients.

I'm glad I made the decision I did.

 

[soul21]

Thanks for all the advice. I am definitely leaning more towards pyschiatry then neurology since psychiatric illness is just so darn interesting but my concern is that I am going to dread psychotherapy sessions during residency.
I would definitely like to do research in psychiatric illness in the future. Have you guys heard of neurologist doing psychiatric research?

 

[Anasazi23]

Yes, but usually in the context of neurological influence.

i.e. adverse psychiatric effects of antiseizure medications.

 

[Hurricane]

Thanks for all the advice. I am definitely leaning more towards pyschiatry then neurology since psychiatric illness is just so darn interesting but my concern is that I am going to dread psychotherapy sessions during residency.
I would definitely like to do research in psychiatric illness in the future. Have you guys heard of neurologist doing psychiatric research?

Some of the disorders overlap. When I did my peds neuro rotation, I worked with a neurologist who did research in tourettes - a disorder which is "claimed" by both psych and neuro. And there is a lot of comorbidity with ADHD and OCD, so he saw a lot of psych in his practice.

Conversely, when I was on one of my interviews, I met with a psychiatrist who is interested in dopamine, and he had projects involving schizophrenia and parkinson's.

As far as not doing psychotherapy, you will have to learn it and practice it during residency and pass the boards, but after that it's up to you. I know a very well respected psychiatrist/researcher who thinks psychodynamic stuff is crap, and she doesn't do it at all. Also, keep in mind that we're not really exposed to psychotherapy as 3rd year medical students, and so you might not have the clearest idea of exactly what psychotherapy entails. It's not all psychodynamic "tell me about your mother" stuff. What I thought was just good beside manner and good advice is actually supportive psychotherapy and interpersonal psychotherapy.

 

[Manochikitsak]

Thanks for all the advice. I am definitely leaning more towards pyschiatry then neurology since psychiatric illness is just so darn interesting but my concern is that I am going to dread psychotherapy sessions during residency.
I would definitely like to do research in psychiatric illness in the future. Have you guys heard of neurologist doing psychiatric research?

While It would be great if you could do Psych, even as a Neurologist, you could do a Behavioral Fellowship after Neuro residency. This way, u could avoid "giving TPAs" after residency, similar to choosing not to do Psychotherapy after finishing Psych residency.

 

[OldPsychDoc]

True, true, true. The seizure thing gets old kinda quick. And the movement disorders, while interesting, are just sort of timid compared to the psych stuff.

You'll see enough of it in your practice to keep it interesting, and have a good time thinking of the complicating factors in your treatment options - all the while doing a lot of good for your patients.

I'm glad I made the decision I did.

Actually, I get paid for CAUSING seizures!
Did it four times just this morning.
And the patients thanked me for it!!

Now there's a twisted concept!

 

[Anasazi23]

Good point. I asked a neurologist the other day why ect has a protective effect against seizures. It seems contrary to common knowledge. He gave me an answer but it didn't really make sense and was disjointed.

 

[willow212]

To the OP:

Can you give more details on your thoughts about being a therapist?

I know quite a few residents who don't want to do therapy after residency, but who nonetheless find it helpful with building skills for talking with patients, finding out what people's resistances are to treatment. If you are worried about being competent as a therapist, I think beginning therapists all struggle with those feelings (part of the process!), and I've found that 95% of the work is just showing up and being willing to listen to someone who often hasn't felt "heard" in a long time.