Neuropsychiatry or Organic Psychiatry is a branch of

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...

that deals with

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial p ...

as it relates to

neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...

, in an effort to understand and attribute behavior to the interaction of

neurobiology Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, developme ...

and

social psychology Social psychology is the scientific study of how thoughts, feelings, and behaviors are influenced by the real or imagined presence of other people or by social norms. Social psychologists typically explain human behavior as a result of the ...

factors. Within neuropsychiatry, the mind is considered "as an emergent property of the brain", whereas other behavioral and neurological specialties might consider the two as separate entities. Neuropsychiatry preceded the current disciplines of

and

, which previously had common training, however, those disciplines have subsequently diverged and are typically practiced separately. Currently, neuropsychiatry has become a growing subspecialty of psychiatry as it closely relates the fields of

neuropsychology Neuropsychology is a branch of psychology concerned with how a person's cognition and behavior are related to the brain and the rest of the nervous system. Professionals in this branch of psychology often focus on how injuries or illnesses of t ...

and

behavioral neurology Behavioral neurology is a subspecialty of neurology that studies the impact of neurological damage and disease upon behavior, memory, and cognition, and the treatment thereof. Two fields associated with behavioral neurology are neuropsychiatry an ...

, and attempts to utilize this understanding to better treat illnesses that fall under both neurological and mental disorder classifications (e.g.,

autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...

ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...

Tourette's syndrome Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) ...

The case for the rapprochement of neurology and psychiatry

Given the considerable overlap between these subspecialities, there has been a resurgence of interest and debate relating to neuropsychiatry in academia over the last decade. Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor Joseph B. Martin, former Dean of

Harvard Medical School Harvard Medical School (HMS) is the graduate medical school of Harvard University and is located in the Longwood Medical Area of Boston, Massachusetts. Founded in 1782, HMS is one of the oldest medical schools in the United States and is cons ...

and a

neurologist Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

by training, has summarized the argument for reunion: "the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway." These points and some of the other major arguments are detailed below.

Mind/brain monism

Neurologists have focused objectively on

organic Organic may refer to: * Organic, of or relating to an organism, a living entity * Organic, of or relating to an anatomical organ Chemistry * Organic matter, matter that has come from a once-living organism, is capable of decay or is the product ...

nervous system

pathology Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in ...

, especially of the

brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...

, whereas psychiatrists have laid claim to illnesses of the

mind The mind is the set of faculties responsible for all mental phenomena. Often the term is also identified with the phenomena themselves. These faculties include thought, imagination, memory, will, and sensation. They are responsible for various m ...

. This antipodal distinction between brain and mind as two different entities has characterized many of the differences between the two specialties. However, it has been argued that this division is fictional; evidence from the last century of research has shown that our mental life has its roots in the

. Brain and mind have been argued not to be discrete entities but just different ways of looking at the same system (Marr, 1982). It has been argued that embracing this mind/brain

monism Monism attributes oneness or singleness (Greek: μόνος) to a concept e.g., existence. Various kinds of monism can be distinguished: * Priority monism states that all existing things go back to a source that is distinct from them; e.g., i ...

may be useful for several reasons. First, rejecting dualism implies that all mentation is biological, which provides a common research framework in which understanding and treatment of mental disorders can be advanced. Second, it mitigates widespread confusion about the legitimacy of mental illness by suggesting that all disorders should have a footprint in the brain. In sum, a reason for the division between

and

was the distinction between mind or first-person experience and the brain. That this difference is taken to be artificial by proponents of mind/brain monism supports a merge between these specialties.

Causal pluralism

One of the reasons for the divide is that

traditionally looks at the causes of disorders from an "inside-the-skin" perspective (

neuropathology Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of anatomic pathology, but work closely with the clini ...

genetics Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar work ...

) whereas

looks at "outside-the-skin" causation (personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of

etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, ...

will be enriched, in particular between

and

environment Environment most often refers to: __NOTOC__ * Natural environment, all living and non-living things occurring naturally * Biophysical environment, the physical and biological factors along with their chemical interactions that affect an organism or ...

. One example is

eating disorders An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating ...

, which have been found to have some neuropathology (Uher and Treasure, 2005) but also show increased incidence in rural Fijian school girls after exposure to

television Television, sometimes shortened to TV, is a telecommunication medium for transmitting moving images and sound. The term can refer to a television set, or the medium of television transmission. Television is a mass medium for advertising, ...

(Becker, 2004). Another example is

schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...

, the risk for which may be considerably reduced in a healthy family environment (Tienari et al., 2004). It is also argued that this augmented understanding of etiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. It may be that non-organic interventions, like

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...

(CBT), better attenuate disorders alone or in conjunction with drugs. Linden's (2006) demonstration of how

psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...

has neurobiological commonalities with

pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...

is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while

self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura. Self-efficacy affects every area of human end ...

is increased. In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate (Koch and Laurent, 1999). Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering.

Organic basis

To further sketch psychiatry's history shows a departure from structural neuropathology, relying more upon

ideology An ideology is a set of beliefs or philosophies attributed to a person or group of persons, especially those held for reasons that are not purely epistemic, in which "practical elements are as prominent as theoretical ones." Formerly applied pri ...

(Sabshin, 1990). A good example of this is

Tourette syndrome Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) ...

, which Ferenczi (1921), although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of

masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinat ...

caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms (Shapiro, Shapiro and Wayne, 1973) the syndrome has gained pathophysiological support (e.g. Singer, 1997) and is hypothesized to have a genetic basis too, based on its high inheritability (Robertson, 2000). This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting

and

because both are dealing with disorders of the same system.

Improved patient care

Further, it is argued that this nexus will allow a more refined

nosology Nosology () is the branch of medical science that deals with the classification of diseases. Fully classifying a medical condition requires knowing its cause (and that there is only one cause), the effects it has on the body, the symptoms that ...

of mental illness to emerge thus helping to improve remediation and

rehabilitation Rehabilitation or Rehab may refer to: Health * Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished * Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...

strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms beco ...

, are being recognized for their high incidence of traditionally psychiatric symptoms, like

psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavi ...

and depression (Lerner and Whitehouse, 2002). These symptoms, which are largely ignored in

, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.

Better management model

Schiffer et al. (2004) argue that there are good management and financial reasons for rapprochement.

US institutions

"Behavioral Neurology & Neuropsychiatry" fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS
www.ucns.org
, in a manner analogous to the accreditation of

and

residencies in the United States by the

American Board of Psychiatry and Neurology The American Board of Psychiatry and Neurology, Inc. (ABPN) is a not-for-profit corporation that was founded in 1934 following conferences of committees appointed by the American Psychiatric Association, the American Neurological Association, a ...

(ABPN). The American Neuropsychiatric Association (ANPA) was established in 1988 and is the American medical subspecialty society for neuropsychiatrists. ANPA holds an annual meeting and offers other forums for education and professional networking amongst subspecialists in behavioral neurology & neuropsychiatry as well as clinicians, scientists, and educators in related fields. American Psychiatric Publishing, Inc. publishes the peer-reviewed '' Journal of Neuropsychiatry and Clinical Neurosciences'', which is the official journal of ANPA.

International organizations

The International Neuropsychiatric Association was established in 1996. INA holds congresses biennially in countries around the world and partners with regional neuropsychiatric associations around the world to support regional neuropsychiatric conferences and to facilitate the development of neuropsychiatry in the countries/regions where those conferences are held. Prof. Robert Haim Belmaker is the current President of the organization whereas Prof. Ennapadam S Krishnamoorthy serves as President-Elect with Dr. Gilberto Brofman as Secretary-Treasurer. The British NeuroPsychiatry Association (BNPA) was founded in 1987 and is the leading academic and professional body for medical practitioners and professionals allied to medicine in the UK working at the interface of the clinical and cognitive neurosciences and psychiatry. Recently, a new non-profit professional society named Neuropsychiatric Forum (NPF) was founded. NPF aims to support effective communication and interdisciplinary collaboration, develop education schemes and research projects, organize neuropsychiatric conferences and seminars.

References

* Arciniegas DB, Kaufer DI; Joint Advisory Committee on Subspecialty Certification of the American Neuropsychiatric Association; Society for Behavioral and Cognitive Neurology. Core Curriculum for Training in Behavioral Neurology and Neuropsychiatry. J Neuropsychiatry Clin Neurosci. 2006 Winter;18(1):6-13. * Barrett, T.B., Hauger, R.L., Kennedy, J.L., Sadovnick, A.D., Remick, R.A. & Keck, P.E, McElroy, S L, Alexander, L., Shaw, S.H., & Kelsoe, J. (2003) Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder" ''Molecular Psychiatry'' 8, 546−557. * Becker, A.E. (2004) Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity During Rapid Social Change. Culture, Medicine and Psychiatry, 28(4): 533–559. * Bell, V., Halligan, P.W., Ellis, H.D. (2006). Explaining delusions: a cognitive perspective. Trends in Cognitive Sciences,10(5), 219–26. * Ferenczi, S. (1921) Psychoanalytical observations on tic. ''

International Journal of Psychoanalysis ''The International Journal of Psychoanalysis'' is an academic journal in the field of psychoanalysis. The idea of the journal was proposed by Ernest Jones in a letter to Sigmund Freud dated 7 December 1918. The journal itself was established in ...

'', 2: 1-30. * Gamazo-Garran, P., Soutullo, C.A. & Ortuno, F. (2002) Obsessive compulsive disorder secondary to brain dysgerminoma in an adolescent boy: a positron emission tomography case report. Journal of Child and Adolescent Psychopharmacology, 12, 259–263. * Green, M.F. (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. * Kaye, W.H., Bailer, U.F., Frank, G.K., Wagner, A., & Henry, S.E. (2005). Brain imaging of serotonin after recovery from anorexia and bulimia nervosa. Physiology & Behaviour, 86(1-2), 15-7 * Koch, C. & Laurent, G. (1999). Complexity and the nervous system" ''Science'' 284(5411), 96–8. * Lerner, A.J., & Whitehouse, P.J. (2002) Neuropsychiatric aspects of dementias associated with motor dysfunction. Washington, DC: American Psychiatric (pp 931–937) * Linden, D. E. J. (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging" ''Molecular Psychiatry'' 11, 528–38. * Marr, D. (1982). Vision: A Computational Approach. San Francisco: Freeman & Co. * Mayberg, H.S. (1997). Limbic-cortical dysregulation: a proposed model of depression. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 471–481. * Mocellin, R., Walterfang, M., & Velakoulis, D. (2006) Neuropsychiatry of complex visual hallucinations. Australian and New Zealand Journal of Australian and New Zealand Journal of Psychiatry, 40, 742-751 * Rempel-Clower, N.L., Zola, S.M., Squire, L.R., & Amaral, D.G. (1996). Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation" ''Journal of Neuroscience'' 16, 5233–5255 * Robertson, M.M. (2000). Tourette syndrome, associated conditions and the complexities of treatment" ''Brain'' 123(3), 425–462. * Ross, C.A., Margolis, R.L., Reading, S.A.J., Pletnikov, M., & Coyle, J.T (2006). Neurobiology of Schizophrenia" ''Neuron'' 52, 139–153. * Sabshin, M. (1990). Turning points in twentieth-century American psychiatry" ''American Journal of Psychiatry'' 147(10),1267-1274. * Sachdev, P.S. (2005). Whither Neuropsychiatry? Journal of Neuropsychiatry and Clinical Neurosciences,17,140-141. * Saxena, S., Brody, A.L., Schwartz, T.M., & Baxter, L.R. (1998). Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. British Journal of Psychiatry,173(35), 26–37. * Schiffer, R.B, Bowen, B., Hinderliter, J., Hurst, D.L., Lajara-Nanson, W.A., & Packard, R.C. (2004). Neuropsychiatry: A Management Model for Academic Medicine. Journal of Neuropsychiatry and Clinical Neurosciences, 16, 336–341. * Shapiro, A.K., Shapiro, E., Wayne, H., & Clarkin, J. (1973). Organic factors in Gilles de la Tourette's syndrome. British Journal of Psychiatry, 122, 659–664. * Shergill, S. S., Brammer, M. J., Williams, S., Murray, R.M., & McGuire, P.K. (2000). Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging" ''Archives of General Psychiatry'' 57, 1033 -1038. * Singer, H.S. (1997). Neurobiology of Tourette syndrome. Neurologic Clinics, 15, 357–379. * Tienari, P., Wynne, L. C., Sorri, A., Lahti, I., Läksy, K., Moring, J., Naarala., M, Nieminen, P., & Wahlberg K. (2004) Genotype–environment interaction in schizophrenia-spectrum disorder: long-term follow-up study of Finnish adoptees. British Journal of Psychiatry, 184, 216–222. * Uher, R., & Treasure, J. (2005) Brain lesions and eating disorders. Journal of Neurology, Neurosurgery & Psychiatry, 76, 852–7. * Vawter, M.P., Freed, W.J., & Kleinman, J.E. (2000). Neuropathology of bipolar disorder" ''Biological Psychiatry'' 48, 486–504.