Neuropsychiatry/Behavioral Neurology
Neuropsychiatry/Behavioral Neurology
Definition
Neuropsychiatry is an integrative, collaborative discipline that deals with the psychiatric aspects of neurological disease. The terms “neuropsychiatry” and “behavioral neurology” are frequently used interchangeably.
Description
Neuropsychiatry lies in the interface between the disciplines of neurology and psychiatry. For many centuries, neurology and psychiatry formed a single unified field. Even in the late nineteenth century, many medical practitioners and researchers, like Sigmund Freud, Jean-Martin Charcot, and Eugen Bleuler, did not distinguish between the study of the mind and the brain. In the twentieth century, however, neurology and psychiatry became separate, distinct disciplines. Neurology focused on disorders, such as stroke, multiple sclerosis, and Parkinson’s disease, which were clearly characterized by disease of, or damage to, the brain, and resulted in behavioral and cognitive problems, and also somatic symptoms related to movement and sensation. Psychiatry, on the other hand, concerned itself with behavioral, cognitive, personality and emotional disorders, such as depression, schizophrenia, and anxiety disorders. Initially, these conditions were not typically seen as problems related to sensory or motor dysfunction, and consequently revealed few or no pathologic symptoms during standard neurologic examinations.
The impetus for a change in this divide between neurology and psychiatry has come from the advances made in neuroscience during the second half of the twentieth century. With the advanced understanding of the underlying biology of psychiatric disorders advances, it has become difficult to draw a clear line between the mind and the brain, the psychological and physical manifestations of disease. Because of these advances, scientists and clinicians are now able to assess the structure and functioning of the brain in new ways. Many new techniques developed in the latter half of the twentieth century and the beginning of the twenty-first century have shown that behavioral, emotional and cognitive disorders are often accompanied by changes in the brain. For example, magnetic resonance imaging studies have revealed structural abnormalities in the brains of patients who suffer from schizophrenia, and functional magnetic resonance imaging and positron emission tomography techniques have demonstrated that brain function is abnormal in such patients. Researchers and clinicians are also now more cognizant of the fact that disorders that were traditionally in the domain of neurology, such as Parkinson’s disease, are often accompanied by emotional and cognitive symptoms like depression and even dementia.
In addition, treatments that target the brain, such as pharmacotherapy, transcranial magnetic stimulation, vagus nerve stimulation and deep-brain stimulation are being used or are being investigated for their potential to alleviate disorders that have traditionally been considered psychiatric, such as depression and obsessive-compulsive disorder. Disorders that are currently recognized as being within the purview of neuropsychiatry include, but are not limited to, neurocognitive disorders, drug-induced movement disorders, Tourette’s syndrome, stroke and head injury, chronic fatigue syndrome, Parkinson’s disease, attention-deficit/hyperac-tivity disorder, and dementia.
Territorial struggles between psychiatry and neurology continue. Modern neuropsychiatry, which has emerged only in the last two decades, is still a discipline with ill-defined boundaries, frequently psychiatry and neurology. Training programs in neuropsychiatry are still being developed.
See also Biological psychiatry; Liaison psychiatry.
Resources
BOOKS
Butcher, James N., Susan Mineka, and Jill M. Hooley Abnormal Psychology. Boston, MA: Pearson Education, 2007.
Kalat, James W. Biological Psychology. 9th ed. Belmont, CA: Thomson Wadsworth. 2007.
PERIODICALS
Agrawal, Niruj. “Neuropsychiatry.” BMJ Career Focus 328 (2004).
Baker, Mary G., Rajendra Kale, and Matthew Menken. “Editorial: The Wall Between Neurology and Psychiatry.” BMJ 324 (22 June 2002): 1468–69.
Mitchell, Alex J. and Niruj Agrawal. “Editorial: Training in Neuropsychiatry: Is it Time to Reintegrate into Mainstream Psychiatry?” Psychiatric Bulletin 29 (2005): 361–64.
Sachdev, Perminder S. “Whither Neuropsychiatry?” Journal of Neuropsychiatry and Clinical Neurosciences 17 (May 2005): 140–41.
KEY TERMS
Attention-deficit/hyperactivity disorder —A condition characterized by difficulties relating to impulsiveness, excessive activity and distractibility.
Chronic fatigue syndrome —A debilitating condition characterized by severe chronic fatigue and other symptoms such as memory problems, pain, or tender lymph nodes.
Deep-brain stimulation —A surgical procedure used to treat disabling neurological symptoms such as those of Parkinson’s disease. It involves implanting a device that electrically stimulates specific areas of the brain.
Dementia —A condition characterized by deficits in memory, cognition, personality, behavior, learning, and motor control. These manifestations impair an individual’s ability to function and interact socially.
Functional magnetic resonance imaging —A scanning technique that involves measuring variations in magnetic fields, and that is used to determine which areas of the living brain are most active. Magnetic resonance imaging—A scanning technique that involves measuring variations in magnetic fields, and is used to examine the structure of internal organs like the brain.
Multiple sclerosis —An inflammatory demyelinating disease of the central nervous system resulting in injury to the myelin sheath, oligodendrocytes and, to some extent, the axons and nerves. Multiple sclerosis is characterized by symptoms such as problems with movement, sensation, and speech.
Neurocognitive disorders —Neurological disorders characterized by cognitive problems.
Obsessive-compulsive disorder —An anxiety disorder characterized by intrusive thoughts or images of an unpleasant or frightening nature, and often by compulsive, ritualistic behaviors designed to ward off anxiety.
Parkinson’s disease —A progressive condition characterized by neurological symptoms such as tremors, rigidity of the limbs and trunk, slowness of movement, and problems with balance and coordination.
Pharmacotherapy —Treatment with drugs.
Positron emission tomography —A technique that involves recording radioactive emissions from injected chemicals, and that is used to examine the activity of the living brain.
Stroke —A temporary loss of normal blood flow to an area of the brain
Tourette ’s syndrome—A neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations.
Transcranial magnetic stimulation —A technique that involves application of an intense magnetic field to a part of the scalp in order to stimulate neurons in a particular part of the brain.
Vagus nerve stimulation —A technique that involves electrically stimulating the vagus nerve by means of a surgically implanted device.
Silver, Jonathan M. “Behavioral Neurology and Neuro-psychiatry Is a Subspecialty.” Journal of Neuropsy-chiatry and Clinical Neurosciences 18 (May 2006): 146–48.
Yudofsky, Stuart C. and Robert E. Hales. “Editorial: Neu-ropsychiatry and the Future of Psychiatry and Neurology.” American Journal of Psychiatry 159.8 (Aug. 2002): 1261–64.
ORGANIZATIONS
American Neuropsychiatric Association, 700 Ackerman Road, Suite 625, Columbus, OH 43202. (614) 447-2077. E-mail: [email protected]
International Neuropsychiatric Association, INA Secretariat Office, Neuropsychiatric Institute, Euroa Centre, The Prince of Wales Hospital, Randwick NSW 2031, Australia. 61-2-93823763. E-mail: [email protected]
Ruvanee Pietersz Vilhauer, PhD