Introduction: Neuropsychiatry Is Thriving

February 27, 2015
Fred Ovsiew, MD
Volume 32, Issue 2

Neuropsychiatry is thriving, and the articles in this Special Report demonstrate its breadth and depth while providing the opportunity to characterize and delimit its scope.

Neuropsychiatry is thriving, and the articles in this Special Report demonstrate its breadth and depth while providing the opportunity to characterize and delimit its scope.

Neuropsychiatry-now with a credential it shares with behavioral neurology (www.ucns.org/go/subspecialty/behavioral)-is the subspecialty of psychiatry devoted to understanding the mental and behavioral consequences of brain diseases and to providing care for persons with these diseases. That this care often critically depends on psychological and environmental management, rather than on altering the brain itself, testifies to the intractability of many brain diseases and to the need for neuropsychiatry to remember its psychiatric roots. Being a neuropsychiatrist does not mean a one-sided commitment to organic explanations or treatments of behavior disorders.

[[{"type":"media","view_mode":"media_crop","fid":"32174","attributes":{"alt":"Neuropsychiatry","class":"media-image media-image-right","id":"media_crop_1420619059243","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3402","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 175px; height: 204px; float: right;","title":"Shutterstock.com","typeof":"foaf:Image"}}]]“The Neural Basis of Bipolar Disorder,” by Dr James Phelps, offers a perspective from neuroscience on a core problem of clinical general psychiatry. To what extent neuropsychiatry, as defined above, provides help in understanding the phenomena of general psychiatric illness is uncertain. On the one hand, the momentum of general psychiatry for many years has been toward a biological take on schizophrenia, affective disorders, and other psychiatric illnesses. The neuropsychiatric knowledge gained from analyzing the relation of known brain lesions to clinical symptoms naturally seems highly relevant to the neuroscientific understanding of psychiatric symptoms. On the other hand, similarity in clinical phenomena offers no guarantee of similarity in underlying mechanisms. Indeed, the mechanism of symptom production in acquired brain disease-the core of the neuropsychiatric enterprise-may be quite different from the mechanism operating in idiopathic disorders that develop over the life span and depend, presumably to a greater degree, on genetic factors.

Transcranial Magnetic Stimulation in Neuropsychiatry: An Update,” by Jonathan Hsu and Dr Daniel M. Blumberger, addresses one of many fascinating aspects of this new technology. The capacity of transcranial magnetic stimulation (TMS) to produce temporary functional lesions means that it has potential as a tool to understand brain function. Its potential as a treatment for depression is being actively investigated. The potential of TMS as a treatment for cognitive disorders, fatigue, pain, and other manifestations of brain disease is discussed, as is the encouraging prospect for neuropsychiatric management of many patients.

Drs Jason Brandt and Antonio N. Puente address, so to speak, the inverse of neuropsychiatry in their article “Update on Psychogenic Nonepileptic Seizures.” There is precisely no organic basis to the spells, sometimes called pseudoseizures, that are the focus of treatment, even though these spells mimic a cardinal manifestation of brain disease. Why then is the problem of pseudoseizures so important to neuropsychiatrists? Because, we believe, the clinician trained to understand the manifestations of epilepsy and experienced in the variability and oddness of such manifestations is particularly well suited to provide psychiatric care to patients with nonepileptic seizures.

Management of Mild Traumatic Brain Injury,” by Drs Adam M. Willis, Jon P. Williams, John H. Sladky, and Jeffrey C. McClean, the most centrally neuropsychiatric article in this Special Report, addresses the nature and consequences of traumatic brain injury (TBI). TBI, especially mild TBI, is common and is a risk factor for many psychiatric syndromes. Psychiatrists are often called on to treat the consequences of TBI, sometimes without fully realizing that they are doing so.

The articles in this Special Report show, each from a different angle, the excitement, way of thinking, and progress of the field of neuropsychiatry.