What a neurologist can do

[MellowYellowCA]

I know similar things have been asked, but I have looked in multiple threads and I haven't been able to answer my question. Like many others, I am interested in both psych and neuro. At the moment, I am leaning towards applying to a neuro residency. However, I am wondering, as a neurologist, would I still be able to see patients that are usually seen by psychiatrists (eg ADHD, OCD, autism, schizophrenia) for diagnosis and med treatment? If not, are there any extra board certification or fellowships that would allow me to, after I complete a neurology residency? I am not so interested in doing a joint neuro/psych residency because of geographic limitations. Thanks in advance.

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[neurologist]

I know similar things have been asked, but I have looked in multiple threads and I haven't been able to answer my question. Like many others, I am interested in both psych and neuro. At the moment, I am leaning towards applying to a neuro residency. However, I am wondering, as a neurologist, would I still be able to see patients that are usually seen by psychiatrists (eg ADHD, OCD, autism, schizophrenia) for diagnosis and med treatment? If not, are there any extra board certification or fellowships that would allow me to, after I complete a neurology residency? I am not so interested in doing a joint neuro/psych residency because of geographic limitations. Thanks in advance.

Any doctor can treat anything within the limits of:
1. Their competence
2. Their best judgement
3. Their hospital privileges (on the inpatient side)

As a neurologist, I've given patients rxs for anti-fungal cream for their ringworm, and antibiotics for their strep throats and ear infections.

Many neurologists treat their moderately depressed or anxious patients with antidepressants or anxiolytics. If a primary care doc can do it, why shouldn't a neurologist?

Many others (myself included) prefer not to deal too much with psych issues. But there's no hard and fast rule that says we "can't."

If you want to do this, just make sure you know the limits of your knowledge and when to refer.

And since at least half the patients we see in neuro are crazy anyway, you'll have plenty of opportunity to develop your skills.

 

[MellowYellowCA]

Any doctor can treat anything within the limits of:
1. Their competence
2. Their best judgement
3. Their hospital privileges (on the inpatient side)

As a neurologist, I've given patients rxs for anti-fungal cream for their ringworm, and antibiotics for their strep throats and ear infections.

Many neurologists treat their moderately depressed or anxious patients with antidepressants or anxiolytics. If a primary care doc can do it, why shouldn't a neurologist?

Many others (myself included) prefer not to deal too much with psych issues. But there's no hard and fast rule that says we "can't."

If you want to do this, just make sure you know the limits of your knowledge and when to refer.

And since at least half the patients we see in neuro are crazy anyway, you'll have plenty of opportunity to develop your skills.

Thanks a lot neurologist

So it sounds like it is up to the physician to set the limits. I never knew this - does this mean that if, for example, a radiologist for some reason feels comfortable writing prescriptions to treat diabetes or hypertension, he or she can?

I am wondering though, to what degree of overlap would a typically trained neurologist feel comfortable with treatment of disorders typically treated by psychiatrists? Does neurology residency cover some of these psych areas? Would a neurologist feel more comfortable than, for example, a primary care doc in treating these things?

Also, would anyone have any fellowship recommendations for overlap with some psych / behavioral issues associated with things like MR, autism, OCD, etc?

 

[neurologist]

Thanks a lot neurologist

So it sounds like it is up to the physician to set the limits. I never knew this - does this mean that if, for example, a radiologist for some reason feels comfortable writing prescriptions to treat diabetes or hypertension, he or she can?

LOL, why do you think they went into radiology to begin with?!?! Rads don't even know what a prescription pad looks like.

Sure, they could, but it would be a pretty stupid thing to do . . .

I am wondering though, to what degree of overlap would a typically trained neurologist feel comfortable with treatment of disorders typically treated by psychiatrists? Does neurology residency cover some of these psych areas? Would a neurologist feel more comfortable than, for example, a primary care doc in treating these things?

Neuro residents typically do some rotation on psychiatry during their training. You will definitely learn mechanisms of most psych meds. Plus, as I alluded to in my first post, there is an awful lot of comorbidity between psych and neuro patients. And remember, we are certified by the American Board of Psychiatry AND Neurology . . . and there is a fair amount of overlap on the board exam. (hint: for any psych question on the neuro board, the answer is "depression." For any neuro question on the psych board, the answer is probably "migraine." )

Also, would anyone have any fellowship recommendations for overlap with some psych / behavioral issues associated with things like MR, autism, OCD, etc?

Peds neuro, if you like kiddies. You can probably build an entire practice around autism and ADHD. Maybe a neurobehavioral fellowship/subspecialty, but those seem to emphasize dementia rather than what I suspect you are looking for.

 

[MellowYellowCA]

LOL, why do you think they went into radiology to begin with?!?! Rads don't even know what a prescription pad looks like.

Sure, they could, but it would be a pretty stupid thing to do . . .




Neuro residents typically do some rotation on psychiatry during their training. You will definitely learn mechanisms of most psych meds. Plus, as I alluded to in my first post, there is an awful lot of comorbidity between psych and neuro patients. And remember, we are certified by the American Board of Psychiatry AND Neurology . . . and there is a fair amount of overlap on the board exam. (hint: for any psych question on the neuro board, the answer is "depression." For any neuro question on the psych board, the answer is probably "migraine." )



Peds neuro, if you like kiddies. You can probably build an entire practice around autism and ADHD. Maybe a neurobehavioral fellowship/subspecialty, but those seem to emphasize dementia rather than what I suspect you are looking for.

Great, thanks neurologist. Peds neuro sounds good, but are there any shorter end fellowships (1 year?).

Also, typically, do psychiatrists or neurologists treat autism? Do you think that there are parents who due to things like the "stigma" in psych, would prefer going to a neurologist for treating their child's autism?

Lastly, what are the implications of psychiatrists and neurologists being boarded under the same category "American Board of Psychiatry and Neurology" - does it simply indicate that there are similar responsibilities and overlap in knowledge, or more than this?

 

[PhakeDoc]

OP - read this thread: http://forums.studentdoctor.net/showthread.php?t=735363

Also, if you are still in pre-med (and just didn't forget to switch your status), it's probably a bit premature, IMHO, to get this detailed at this time. Undoubtedly, you'll change your mind several times in med school. Most people do.

 

[MellowYellowCA]

OP - read this thread: http://forums.studentdoctor.net/showthread.php?t=735363

Also, if you are still in pre-med (and just didn't forget to switch your status), it's probably a bit premature, IMHO, to get this detailed at this time. Undoubtedly, you'll change your mind several times in med school. Most people do.

You're right - I forgot to change my status. I am in the middle of med school by now

 

[MellowYellowCA]

Great, thanks neurologist. Peds neuro sounds good, but are there any shorter end fellowships (1 year?).

Also, typically, do psychiatrists or neurologists treat autism? Do you think that there are parents who due to things like the "stigma" in psych, would prefer going to a neurologist for treating their child's autism?

Lastly, what are the implications of psychiatrists and neurologists being boarded under the same category "American Board of Psychiatry and Neurology" - does it simply indicate that there are similar responsibilities and overlap in knowledge, or more than this?

I would like to know more on this.

Any other opinions on to what extent the neuro training makes you comfortable treating things often treated in the realm of psychiatry - autism, depression, anxiety, ADHD, MR?

Would love insight from any neurologists or neurologists in training.

 

[dl2dp2]

I would like to know more on this.

Any other opinions on to what extent the neuro training makes you comfortable treating things often treated in the realm of psychiatry - autism, depression, anxiety, ADHD, MR?

Would love insight from any neurologists or neurologists in training.

autism, ADHD and MR are usually treated by child psychiatrist, which is a further subspecialty of psychiatry. Some are co-managed by a child neurologist, for instance if they have a seizure disorder.

Depression and anxiety, especially in their more severe forms, are almost exclusively managed by psychiatrists. As a neurologist you would not be well versed in the nuances of antidepressants and anxiolytics, or have any training in psychotherapy as an additional (and especially effective, in case of anxiety disorders) tool. Furthermore, neurologists have no training in somatic techniques such as ECT, DBT, TMS etc.

I think if you want to primarily see the patients as you described, you should become a psychiatrist.

 

[bluntdissector]

I know similar things have been asked, but I have looked in multiple threads and I haven't been able to answer my question. Like many others, I am interested in both psych and neuro. At the moment, I am leaning towards applying to a neuro residency. However, I am wondering, as a neurologist, would I still be able to see patients that are usually seen by psychiatrists (eg ADHD, OCD, autism, schizophrenia) for diagnosis and med treatment? If not, are there any extra board certification or fellowships that would allow me to, after I complete a neurology residency? I am not so interested in doing a joint neuro/psych residency because of geographic limitations. Thanks in advance.

Have you rotated through either? That tends to change one's perspective quite a bit.

 

[Mattchiavelli]

My $0.02 as someone that came into med school thinking Psych, bounced around A LOT in school, and now I'm interviewing Neurology.

There is some overlap, but I don't think specifically in the ways you're asking about. For patients with some of the psych disorders you talk about (anxiety d/o, schizophrenia, etc) it'd be pretty odd for you to manage primarily by yourself. A lot of neurologists inadvertently end up dealing with behavioral issues (neurodegen disease, movement d/o, etc) and to tell you the honest truth I have seen some neurologists that could probably treat the primary psych disorders better than the patient's psychiatrist but that's the start of a tangent I'm not getting into. Here are some of the big points-

Behavioral neurology. I've only worked with people in this field that have worked with neurodegenerative disease. They worked with neuropsychologists to do testing of some higher cortical functions which I thought was interesting. Sometimes they give psych meds to help with behavioral aspects (agitation, sleep disturbance, etc). Also like psychiatrists they put a lot of emphasis on function and helping coordinate care for patients which while having nothing to do with pathophysiology it helps patients and their caregivers tons.

Somatization disorder- this can include psychogenic seizures, psychogenic movement disorders. They will come for you to evaluate or rule out. I know it's a psych disorder masquerading as a neurological one but they can be fascinating to deal with (I'm probably one of the few that feel this way).

Epilepsy. There are some patients that present like psych patients and end up just having simple or complex partial seizures that were missed or poorly diagnosed. Epileptic patients also give some of the "you had to have heard it to believe it" types of histories that can be appealing to psych practice- the auras and experiences some people have are nuts (no pun intended)

Regardless, if you are a good physician you will give of yourself for supportive psychotherapy at the bedside (no formal training needed). All the good clinicians do.

 

[cyneuron]

regardless, if you are a good physician you will give of yourself for supportive psychotherapy at the bedside (no formal training needed). All the good clinicians do.

+1...

 

[medc]

there are combined neurology/psychiatry programs which lead to board certification in both.