Neuropsychiatry for the Neurologist

Aneeta Saxena, MD

David L. Perez, MD, MMSc, FAAN, FANPA

In 2002, Joseph Boyd Martin, the Edward R. and Anne G. Lefler Professor of Neurobiology at Harvard University and Dean of Harvard Medical School, wrote a transformative article highlighting the need for a re-convergence of the fields of neurology, psychiatry, and neuroscience.[1] As he looked toward the 21st century, Prof. Martin wrote “The ‘brain problem’ is arguably the most difficult we will ever encounter. It is a challenge that will excite and test the limits of our creativity and imagination…. Leaders in academic medicine and the sciences at each of our institutions and at a national and international level must work to break down the barriers between disciplines to remove the obstacles for fuller collaboration and integration.”

This issue of Seminars in Neurology on Neuropsychiatry is our contribution to breaking down the artificial walls that divide neurology and psychiatry, providing readers with an interdisciplinary framework for a range of complex brain-based disorders that promotes shared expertise across the clinical neurosciences.[2] [3] [4]

Throughout the late 20th century, the field of neurology was driven by a biomedical approach, examining specific diagnoses and understanding disease pathologies through physiological biomarkers such as those obtained from electroencephalography, magnetic resonance imaging, cerebrospinal fluid, and genetics amongst other modalities. As neuroimaging techniques advance, and genetic-epigenetic research moves forward, a more sophisticated characterization of the disease processes occurs with the aid of computing power and large-scale databases. Nonetheless, a singular focus on neurobiology fails to deliver the promise of precision medicine. Our perspective is that a patient-centered approach for a range of neurological conditions can be advanced today by embracing the biopsychosocial model, one that allows underlying pathophysiology to be considered alongside relevant psychological and sociocultural considerations.

As such, this issue has clinical assessment and treatment articles on the following topics: (1) the biopsychosocial formulation; (2) the neuropsychiatric approach to clinical assessments; (3) how to leverage psychotherapy principles to enhance neurologist–patient encounters; (4) harnessing social networks therapeutically; (5) cognitive behavioral therapy; (6) mindfulness-based psychotherapies; (7) neuromodulation; and (8) pharmacology. These treatments expand the therapeutic toolkit in neurology. Furthermore, we provide disorder-specific articles as examples of how to utilize a neuropsychiatry perspective for the following conditions; (9) functional neurological disorder; (10) mild traumatic brain injury; (11) epilepsy; (12) Parkinson's disease; and (13) mild cognitive impairment.

As an epileptologist with a focus on functional (nonepileptic) seizures (A.S.) and a dual trained neurologist–psychiatrist and research scientist (D.L.P.), we are deeply indebted to the contributing authors for sharing their expertise and to the journal editors for providing us this platform to bring a neuropsychiatric perspective to the practice of clinical neurology. It is our steadfast hope that these articles will energize the next generation of neurologists and psychiatrists to develop shared expertise across the clinical neurosciences.[5]

Publication History

Article published online:
08 June 2022

• References

• 1 Martin JB. The integration of neurology, psychiatry, and neuroscience in the 21st century. Am J Psychiatry 2002; 159 (05) 695-704
• 2 Perez DL, Keshavan MS, Scharf JM, Boes AD, Price BH. Bridging the great divide: what can neurology learn from psychiatry?. J Neuropsychiatry Clin Neurosci 2018; 30 (04) 271-278
• 3 Price BH, Adams RD, Coyle JT. Neurology and psychiatry: closing the great divide. Neurology 2000; 54 (01) 8-14
• 4 Cowan WM, Kandel ER. Prospects for neurology and psychiatry. JAMA 2001; 285 (05) 594-600
• 5 Keshavan MS, Price BH, Martin JB. The convergence of neurology and psychiatry: the importance of cross-disciplinary education. JAMA 2020; 324 (06) 554-555