Neuropsychiatry and the Future of Psychiatry and Neurology

Abstract

Editorial Neuropsychiatry and the Future of Psychiatry and NeurologyWhat is psychiatry? Psychiatry is a continuously evolving concept that has, historically, conveyed widely varying meanings for patients, physicians, and the general public. Joseph B. Martin (1) traced the specialty's conceptual evolution in America from one predominant theoretical and therapeutic model to another over the course of the 19th and 20th centuries. Melvin Sabshin (2) reviewed these successive transitions and indicated that, by the middle of the 20th century, psychiatry had moved from a field based on structural neuropathology to psychoanalysis to community and social psychiatry. He summarized the deleterious effects of these conceptual changes as follows: "The combination of psychiatry's boundary expansion, the predominance of ideology over science, and the field's demedicalization began to produce a vulnerability. Many decision makers became skeptical about psychiatrists' capacity to diagnose and treat patients" (2, p. 1270). Nancy C. Andreasen (3) has written that the revolutionary advances in psychopharmacology, molecular biology, functional brain imaging, and genetics that have been occurring since the end of the 20th century raise the antipodal concern, i.e., that psychiatry could overcorrect with an increasingly narrow biological focus that would endanger the humanism of the field. A potential result of such biological reductionism would be the fragmentation of psychiatric care to a point that the psychiatrist would solely diagnose illnesses and prescribe medications, with a concomitant de-emphasis on the psychological and social aspects of causation and remediation of mental illnesses. Although we do not agree, many concerned psychiatrists and neurologists contend that such a state, wherein there is a neurobiological localization for every illness and the equivalent of "a pill for every problem" has already arrived for psychiatry's sister specialty, neurology. The psychobiology model of Adolf Meyer is nearly 100 years old (4), and George L. Engel articulated the biopsychosocial approach to the practice of psychiatry over a quarter century ago (5). We must now ask why neither of these potentially unifying and integrating paradigms for psychiatry has resulted in substantially reduced stigmatization of the mentally ill (6) or sufficient acceptance of psychiatric treatment by patients (7). The answer is clear: neither psychiatry nor its companion field neurology can escape or surmount the fundamental flaw that lies at their very foundations, i.e., the arbitrary and baseless cleavage of brain-based disorders into two disparate medical specialties.Two reports in this issue of the Journal highlight the conceptual disintegration of separating brain-based disorders into neurological or psychiatric conditions. Koponen et al. evaluated over a period of 30 years the occurrence of psychiatric disorders in patients who had experienced a traumatic brain injury. Each patient had experienced brain trauma of sufficient severity to result in neur...

O sujeito cerebral

“…A popularidade da abordagem naturalista encontra uma justificativa no tema da luta contra a estigmatização dos distúrbios mentais que o dualismo corpo-espírito e a distinção orgânico-funcional favoreciam. Um editorial recente de uma grande revista americana de psiquiatria destrincha o argumento: um dos problemas postos pela separação entre neurologia e psiquiatria é que ela "perpetua o dualismo corpo-espírito [...], fonte de estigmatização das doenças mentais que conduzem a uma falta de equidade na devolução dos tratamentos psiquiátricos em relação às outras condições médicas" (Yudofsky & Hales, 2002: 1262.…”

Training in neuropsychiatry: is it time to reintegrate into mainstream psychiatry?

“…Training programmes should be redesigned to allow exposure to all the neuroscience-based disciplines together with the introduction of common core concepts related to neurosciences in an integrated manner. This will foster more coherent brain-based learning and allow future clinicians to have a much wider perspective than the currently prevalent specialty-driven reductionistic categorisations (Yudofsky & Hales, 2002).…”

Limitations of Neurobiological Approach in Neuropsychiatry: DCD and the Two Visual Systems Theory

“…Thus, neuropsychiatry has become a special subdivision of psychiatry and it is also related to a subdivision of neurology, which is neuropsychology and behavioral neurology that work on clinical problems of cognition and/or behavior caused by brain injury or brain disease. Among debates relating to neuropsychiatry, most of work agrees that mind and brain are not separable and neuropsychiatry could be more effective approach collaborating with neuropsychology, cognitive neuroscience, and neurosurgery in the field of psychiatry [1][2][3][4]. There is no doubt that these neurobiological approaches in psychiatry could help to develop new possible assessment and treatment using many tools (e.g., brain imaging, genetics, neurophysiology, neuropsychology, and neuro-psychopharmacology), but we should be cautious in focusing too much on discrete anatomical brain areas because it is hard to find unique brain areas associated with individual disorders.…”