Neuropsychiatry is a branch of medicine that deals with mental
disorders attributable to diseases of the nervous system. It preceded
the current disciplines of psychiatry and neurology, which had common
training, however, psychiatry and neurology have subsequently split
apart and are typically practiced separately. Nevertheless,
neuropsychiatry has become a growing subspecialty of psychiatry and it
is also closely related to the fields of neuropsychology and
1 The case for the rapprochement of neurology and psychiatry
1.1 Mind/brain monism
1.2 Causal pluralism
1.3 Organic basis
1.4 Improved patient care
1.5 Better management model
2 US institutions
3 International organizations
4 See also
6 External links
6.1 Subspecialty Certification
6.3 International/National Organizations
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 and a neurologist 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.
Neurologists have focused objectively on organic nervous system
pathology, especially of the brain, whereas psychiatrists have laid
claim to illnesses of the mind. 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.
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 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 psychiatry and neurology 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.
One of the reasons for the divide is that neurology traditionally
looks at the causes of disorders from an "inside-the-skin" perspective
(neuropathology, genetics) whereas psychiatry 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
will be enriched, in particular between brain and environment. One
example is eating disorders, 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
(Becker, 2004). Another example is schizophrenia, 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 (CBT), better attenuate disorders alone
or in conjunction with drugs. Linden's (2006) demonstration of how
psychotherapy has neurobiological commonalities with pharmacotherapy
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 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.
To further sketch psychiatry's history shows a departure from
structural neuropathology, relying more upon ideology (Sabshin, 1990).
A good example of this is Tourette syndrome, which Ferenczi (1921),
although never having seen a patient with Tourette syndrome, suggested
was the symbolic expression of masturbation 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 neurology and psychiatry because both are dealing
with disorders of the same system.
Linking traditional psychiatric symptoms or disorders to brain
structures and genetic abnormalities.
(This table is in not exhaustive but provides some neurological bases
to psychiatric symptoms.)
Anger turned inward
Limbic-cortical dysregulation, monoamine imbalance
Prefrontal cortex and hippocampus, anterior cingulate, amygdala
Barrett et al. (2003), Vawter, Freed, & Kleinman (2000)
NMDA receptor activation in the human prefrontal cortex
Ross et al. (2006)
Projection, cold distant mother causing a weak ego
retinogeniculocalcarine tract, ascending brainstem modulatory
Mocellin, Walterfang, Velakoulis, (2006)
Projection, cold distant mother causing a weak ego
frontotemporal functional connectivity
Shergill et al., 2000
Harsh parenting leading to love-hate conflict
frontal-subcortical circuitry, right caudate activity
Saxena et al. (1998), Gamazo-Garran, Soutullo and Ortuno (2002)
Attempted control of internal anxiety
Atypical serotonin system, right frontal and temporal lobe
dysfunction, changes to mesolimbic dopamine pathways
Kaye et al. (2005), Uher and Treasure (2005), Olsen (2011), Slochower
Improved patient care
Further, it is argued that this nexus will allow a more refined
nosology of mental illness to emerge thus helping to improve
remediation and rehabilitation strategies beyond current ones that
lump together ranges of symptoms. However, it cuts both ways:
traditionally neurological disorders, like Parkinson's disease, are
being recognized for their high incidence of traditionally psychiatric
symptoms, like psychosis and depression (Lerner and Whitehouse, 2002).
These symptoms, which are largely ignored in neurology, 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.
Neurology & Neuropsychiatry" fellowships are
accredited by the United Council for Neurologic Subspecialties (UCNS;
www.ucns.org), in a manner analogous to the accreditation of
psychiatry and neurology residencies in the United States by the
American Board of
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.
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
The British Neuro
Psychiatry 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
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.
American Neuropsychiatric Association
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Neuropsychiatry and the
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^ a b c Martin, J.B. (2002). "The integration of neurology,
psychiatry, and neuroscience in the 21st century". American Journal of
Psychiatry. 159 (5): 695–704. doi:10.1176/appi.ajp.159.5.695.
^ Berrios, G.E.; Marková, I.S. (2002). "The concept of
neuropsychiatry: a historical overview". Journal of Psychosomatic
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^ Price, B.H.; Adams, R.D.; Coyle, J.T. (2000). "
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Neurologic Subspecialties, USA
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Neuropsychiatry and Clinical Neurosciences
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Clinical Neuropsychiatry: Journal of Treatment Evaluation
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