Will Neurology ever Rejoin with Psychiatry?

[Averroes]

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


I don't know if it is OK to post this on the psychiatry and neurology forums, so I just did anyways! lol. lock it if you must. I thought that there would be different opinions from both sides maybe.

 

[neurolddoc]

Sure.. The psychiatrist can ask "so Mr Jones, how do you feel about the TPA?"

 

[typhoonegator]

What do you mean by "rejoin"?

I think you may have an overly simplistic view of things. They are separate specialties, managed by separate departments, with separate residencies and separate credentialling. Their research funding sources are different, all the way up to the NIH level. The ABPN oversees both specialties, but the board examinations are different.

There is a heck of a lot more to both specialties than the very small regions of overlap. Why would a psychiatrist want to have to learn about the differential diagnosis for cauda equina syndrome in the immunocompromised host? Why would I want to have to learn about the diagnosis of Axis II disorders?

Don't get me wrong, I like psychiatrists, but the ones I know don't know much about secondary stroke prevention. Or ventilator management. Or status epilepticus. Just like I don't know much about the inclusion criteria for ECT. I think we're both probably OK with this. They are separate for a reason.

 

[neurologist]

Why would I want to have to learn about the diagnosis of Axis II disorders?

Because so many of your patients have them and they can significantly influence the approach you need to take to the patient?

"The brain is the organ of behavior."

Psychiatry = neurology without physical findings

 

[bustbones26]

There is certainly some overlap but enough distinct differences to keep them separate.

In some hospitals, they prefer to consult the psychiatrist more so than the neurologist for altered mental status. And yes, the do consider medical and non-psychiatric etiologies into their differential diagnosis.

I have seen some psychiatrist manage Alzheimers and dementia in their clinics and do it just as well as a neurologist.

As much as I have resisted it over the years, concepts of sleep medicine have just become a part of neurology training. We focus on the neurophysiology and pharmacology, not the CPAP stuff (unless you go and do a formal fellowship of course). A number of psychiatrist take in interest in these areas too and are very good at the psychopharmacology of sleep medicine.

Neurologists seem to focus on the organic etiologies of psych disorders. The reason that man is running down the street with his pants down screaming "I'm a chicken" is because he is having a frontal lobe seizure, not because he is nuts!! While psychiatrist focus on non-organic, the reason he does that is due to his repressed feelings of lust toward his second cousin as a child.

I suppose in either specialty, you can go to a University center and do a neurobehavior or neuropsychiatry fellowship. But at the end of the day, you are going really be a dementia specialist if you do so.

 

[Averroes]

What do you mean by "rejoin"?

I was under the impression that historically, psychiatrists were neurologists and vice versa. for example, freud was a neurologist. But, I may be misinformed.

 

[neurologist]

I was under the impression that historically, psychiatrists were neurologists and vice versa. for example, freud was a neurologist. But, I may be misinformed.

Wow, you must have been a bad boy to get banned in just 20 posts . . .

But yes, you're right, many of the early psychiatrists started out in neurology.

As much as I have resisted it over the years, concepts of sleep medicine have just become a part of neurology training.

Bite your tongue. Sleep is one of the very, very few things that even keep me in neurology. 😡

 

[typhoonegator]

Because so many of your patients have them and they can significantly influence the approach you need to take to the patient?

Well, I don't have to know the criteria for histrionic personality disorder to know that my patient is acting in a histrionic fashion and approach him/her thusly. I also don't need to quibble about the subjective overlap between histrionic and antisocial personality disorders.

I have never learned the six subtypes in the sub-classification of histrionic personality disorder, because I don't offer (or refer for) long-term intensive psychotherapy to treat it, and it is unlikely to change my management of neurologic disease.

Fortunately for me, this is all moot as one cannot act in a histrionic fashion from behind their endotracheal tube. Although perhaps I could place this in my differential for failure to wean...

 

[markglt]

Well, I don't have to know the criteria for histrionic personality disorder to know that my patient is acting in a histrionic fashion and approach him/her thusly. I also don't need to quibble about the subjective overlap between histrionic and antisocial personality disorders.

I have never learned the six subtypes in the sub-classification of histrionic personality disorder, because I don't offer (or refer for) long-term intensive psychotherapy to treat it, and it is unlikely to change my management of neurologic disease.

Fortunately for me, this is all moot as one cannot act in a histrionic fashion from behind their endotracheal tube. Although perhaps I could place this in my differential for failure to wean...

 

[michaelrack]

Don't get me wrong, I like psychiatrists, but the ones I know don't know much about secondary stroke prevention. Or ventilator management. Or status epilepticus. Just like I don't know much about the inclusion criteria for ECT. I think we're both probably OK with this. They are separate for a reason.

I agree with you regarding status epilepticus and secondary stroke prevention. However, it has been my experience that most neurologist don't know that much about vent management and usually consult IM/pulm for this.

 

[typhoonegator]

I agree, most neurologists don't need to know anything about vents, and so they don't.

I need to, though. Sorry, I was speaking from the perspective of a neurointensivist.