Will Neurology ever Rejoin with Psychiatry?

[Averroes]

It seems like psychiatry is going more and more toward neuropsychiatry. Will neurology ever join again with psychiatry?

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[billypilgrim37]

Probably not. While psychiatry increasingly has more in common with neurology, neurology increasingly has more in common with internal medicine. And, except for maybe some of the epileptologists and those who privy themselves headache experts, neurologists hold particular contempt for psychiatric patients.

It's not impossible to imagine a future in which neurology is torn apart and its parts given to (neuro)psychiatry, interventional radiology, neurosurgery, orthopedics, and pm&r. But it's also not impossible to imagine a future in which psychiatry is torn apart and handed over to the Texas Board of Education, with our state hospitals being set out into the Gulf of Mexico in a big boat with nothing but microwave popcorn and Dr. Pepper and a few Wii games.

So, yeah, my imagination is pretty robust.

 

[nancysinatra]

Will neurology ever join again with psychiatry?

no

 

[Faebinder]

Probably not. While psychiatry increasingly has more in common with neurology, neurology increasingly has more in common with internal medicine. And, except for maybe some of the epileptologists and those who privy themselves headache experts, neurologists hold particular contempt for psychiatric patients.

It's not impossible to imagine a future in which neurology is torn apart and its parts given to (neuro)psychiatry, interventional radiology, neurosurgery, orthopedics, and pm&r. But it's also not impossible to imagine a future in which psychiatry is torn apart and handed over to the Texas Board of Education, with our state hospitals being set out into the Gulf of Mexico in a big boat with nothing but microwave popcorn and Dr. Pepper and a few Wii games.

So, yeah, my imagination is pretty robust.

I have yet to see a neurologist (even epileptologists) say a good thing about psychiatry... they hate it intensely. I never met one of those migraine masters.

Psychiatry and neurology are not going to join back.. first they gotta come up with some diagnostic tests in psychiatry before rejoining.

 

[jettavr6]

Rather than merge together, there will be some ever increasing cross-over between the two specialties. There will be some major advances on the horizon in the field of neurosciences which will benefit both psychiatry and neurology. However, there is enough work for each group alone.

What I do see happening is more training for psychiatrists in neurology. I tend to agree with billypilgrim in that neurology may be parsed out to other specialties including psychiatry.

And yes, I've noticed that many neurologists, at best, tolerate psychiatric patients. More often than not, they can't stand dealing with them. Even in the field of pain, they are often pretty harsh. I've literally seen more empathy towards patients from neurosurgeons. Sad, but true.

 

[Manicsleep]

I would agree with Bpilgrims thought to a large degree in that neurology is headed the way of radiology, surgery and generally more invasive methods of treatment. I also think that psychiatry is also headed that way however, although we will generally lag behind a few years.

Of course the turf war for psychiatry could make psychiatry go another direction altogether. If you want to imagine...psychiatry could be done by computer modeling, nanobots and the person treating you could be an IT guy in India.

Another topic that will occur of course is the multimodal specialties such as sleep. There probably will be a greater place for psychiatry in endocrine, radiology and perhaps a new field of invasive psychiatry. I anticipate that the next generation of psychiatrists will be learning how to read imaging on a regular basis as well as ordering genetic testing.

Google Karl Deisseroth if you want to see how engineering and psychiatry are merging.

 

[nancysinatra]

And yes, I've noticed that many neurologists, at best, tolerate psychiatric patients. More often than not, they can't stand dealing with them. Even in the field of pain, they are often pretty harsh. I've literally seen more empathy towards patients from neurosurgeons. Sad, but true.

Well, I wonder why that is? One reason I could see is that in neuro they do get a lot of psychiatric comorbidity, often tending to be frustrating Axis II stuff. Also, there is an inherent unfairness between our fields. If a psychiatric patient turns out to have a neurological problem, psychiatry will transfer the patient to neuro in a flash, claiming "medical instability." But if a neuro patient turns up with a psych problem (very common situation)--neuro can't transfer the patient to us until the neurological issue is cleared. Meanwhile all they can do is get a psych consult. And I'm noticing more and more that psych consults for neuro patients don't always offer much in the way of effective short term treatment. Plus, psychiatric problems sort of defy the logical way that neurologists look at things.

 

[billypilgrim37]

Well, I wonder why that is? One reason I could see is that in neuro they do get a lot of psychiatric comorbidity, often tending to be frustrating Axis II stuff. Also, there is an inherent unfairness between our fields. If a psychiatric patient turns out to have a neurological problem, psychiatry will transfer the patient to neuro in a flash, claiming "medical instability." But if a neuro patient turns up with a psych problem (very common situation)--neuro can't transfer the patient to us until the neurological issue is cleared. Meanwhile all they can do is get a psych consult. And I'm noticing more and more that psych consults for neuro patients don't always offer much in the way of effective short term treatment. Plus, psychiatric problems sort of defy the logical way that neurologists look at things.

While these things are true, I think we're discounting the fact that neurology, like all medical specialties, attracts certain personality types. And I'm pretty sure the hyperanalytic, Occam's-razor-or-die mentality that attracts med students into neurology explains this relationship much better than systems issues. And I blame the system for everything!