Psychiatry for Neurologists

Behavior—the things that our patients do and say and think—remains inevitably balanced between the parallel universes of Psychiatry and Neurology. Language is the means by which we communicate with the people who come to see us. Emotional states determine their quality of life far more robustly than motor and sensory functions. Their cognitive status determines their vocational success more powerfully than vision or hearing. The relationships that we develop with them bring satisfaction and meaning to our lives as physicians, whether psychiatrists or neurologists.

We take the measure of our patients' behaviors continuously, both in psychiatry and neurology, yet we look at them through strangely different glasses. Neurologists see neural circuits and neurochemistry. Psychiatrists look to subjective states, and life's historical determinants as the platforms for healing. Both sides are partly right, and partly wrong.[1]

Certain long-term pressures are at work in medicine to produce convergence between these separate universes of the Brain and the Mind.[2] But the convergence is not uniform across the several domains of the clinical neurosciences.

In the laboratory neurosciences, the trends for convergence are strong, rendering psychiatric investigators indistinguishable from neurological investigators.

In the educational arenas, strong entrenchments and territorial pressures from accreditation agencies work to maintain boundaries from long ago.

In clinical practice, the areas of overlap between psychiatry and neurology are patchy. Our patients are not nearly as interested in the neurology/psychiatry boundaries as we are. They come to us with illness, and they seek to be made well. They do not appreciate it when they are told, “This is all in your brain—not in your mind—and you must go elsewhere,” … or vice versa. Certain large healthcare institutions are integrating all clinical neurosciences in new ways.[3]

In this issue of Seminars in Neurology, we have tried to put together a series of practical essays on the recognition and management of behavioral syndromes for neurological practitioners. We have tried to make these essays useful, relevant for neurologists who carry out the work of practice in our field, without which there would be no field. We are indebted to the Academy of Neurology, which has allowed us to modify certain texts from our annual course, “Psychiatry for Neurologists,” to include in this Seminars issue. We hope that the readers find the work interesting and enjoyable.

REFERENCES

• 1 Schiffer R B, Rao S M, Fofel B S. Neuropsychiatry. 2nd ed. Philadelphia, PA; Lippincott Williams & Wilkins 2003
• 2 Josiah Macy, Jr. Foundation .2005 Proceedings of the Conference on Convergence of Neuroscience, Behavioral Science, Neurology, and Psychiatry Scottsdale, AZ; January
• 3 Cleveland Clinic .Neurological Institute Annual Report. Cleveland, OH; Cleveland Clinic Foundation 2008