Neuropsychiatry: Definitions, Concepts, and Patient Types

Exploring Neuropsychiatry: Contemporary Challenges, Breakthroughs, and Philosophical Perspectives

This editorial provides a concise and updated overview of neuropsychiatry, emphasizing its definitional challenges and profound implications for education, training, research, and the integration of phenomenology and philosophy of mind. Neuropsychiatry, situated at the crossroads of neurology and psychiatry, grapples with complex definitional issues that impede research progress. Establishing a unified conceptual framework is essential for focused research and delving into fundamental questions regarding topics like "consciousness." Nevertheless, the integration of philosophical perspectives into neuropsychiatry, while valuable, faces hurdles due to conceptual ambiguities and the fluid boundaries of the field. These obstacles disrupt research and hinder progress in effectively addressing neuropsychiatric conditions. This editorial advocates for a systematic approach to defining neuropsychiatry to mitigate these concerns. Additionally, as neuropsychiatry evolves, it necessitates an integrative approach. Recent advancements in neuroscience, propelled by technologies like artificial intelligence and advanced neuroimaging, reshape our comprehension of brain-behavior interactions, offering potential biomarkers and comprehensive treatment approaches.

Dual Residency Training in Neurology and Psychiatry: History and Current Practice

In the early 20th century, neurology training included more experience in psychiatry, and psychiatry training included more training in neurology than what is currently required. After World War I, the increased need for differential diagnosis of what might now be called functional neurological disorders resulted in the military encouraging combined residency training in neurology and psychiatry and the promulgation of the term "neuropsychiatry" for this specialty. Thirty-six percent of physicians certified by the American Board of Psychiatry and Neurology in its first decade (1935-1945) held certification in both neurology and psychiatry. However, the term neuropsychiatry gradually became used interchangeably with general psychiatry-to distinguish it from psychoanalysis-and lost its specificity. It is widely held that the popularity of psychoanalysis resulted in psychiatrists perceiving less need for neurological knowledge, and inclusion of neurology content in psychiatry training decreased. Dual residency training programs in neurology and psychiatry began to increase in popularity again in the 1980s as advances in neuroscience, neuroimaging, and pharmacology, paired with the growth of behavioral neurology, laid the foundation for meaningful practice of neuropsychiatry. The author surveyed 207 physicians who graduated from both a neurology and psychiatry residency and 18 current trainees in combined neuropsychiatry residency programs to collect information on their current practice, academic activity, and opinions about their training. The response rate was 64%. Respondents' attitudes toward the value of their dual neurology and psychiatry training were overwhelmingly positive. Reasons for the lack of growth of combined residency programs in neurology and psychiatry are examined.