Neuropsychiatry: Part 1
Although a biological basis for psychiatric disorders has now been firmly entrenched into psychiatric training, research, and clinical care, a strong understanding of the neuropsychiatric syndromes—both psychiatric manifestations of neurological diseases, and functional neurological disorders—has eluded standard psychiatric practice. The ACGME (Accreditation Council for Graduate Medical Education) sought to rectify this with the psychiatry milestones project, which identifies neuropsychiatry and neuroscience as among the score knowledge and skillset for psychiatrists.1
Unfortunately, our burgeoning understanding of neuropsychiatric disorders has escaped a generation. Moreover, even though neuropsychiatry is now recognized as a core of psychiatric residency training, most programs lack the faculty and resources for basic neuropsychiatric education.
This Special Report goes some way to rectify these deficiencies by providing state of the art overviews of some of the common neuropsychiatric syndromes. Unfortunately, many important neuropsychiatric topics such as autoimmune limbic encephalitis, behavioral variant frontotemporal dementia, the neuropsychiatry of epilepsy, rapidly progressive dementias, movement disorders and so on, could not be included. The neuropsychiatry of TBI was previously featured as its own special report.2
The recent discoveries of a variety of antibodies such as the NMDA-R antibody that can cause neuropsychiatric symptoms, and the various neuropsychiatric symptoms including delusions, hallucinations, and mania associated with the C9orf72 hexanucleotide repeat expansion, have focused our attention on the need to identify neurological causes of “psychiatric presentations.”3,4 As neurobiological research into psychiatric disorders has become the predominant model of inquiry, there have been calls for psychiatry to be reformulated as a “clinical neuroscience discipline” while some of my colleagues argue that all psychiatry is neuropsychiatry.5-7 I disagree.
To be sure, clinical neuroscience is a fundamental discipline for psychiatry. However, the social, cultural, political, and economic context is just as important to psychiatry. Furthermore, not all of the problems that psychiatrists treat are best explained in a neurobiological paradigm. Indeed, we are now learning that even for neuropsychiatric disorders, a narrow focus on the brain alone does not yield the secrets to our conundrums.
Dr Datta is Assistant Clinical Professor, University of California, San Francisco, CA. He reports no conflicts of interest concerning the subject matter of this Special Report.
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