Talk:Neuropsychiatry

May 2007 update

Done quite a big update of the article, not so much in the definition of Neuropsychiatry - that seems fine to me - but with regards to the move towards neuropsychiatry as a mainstream speciality in medicine, as opposed to a subspeciality of psychiatry. Put complete references in too, for those wishing to check statements or add more detail (e.g. year of split etc). --Neuropsychology 12:29, 6 May 2007 (UTC)

In the table the e.g. psychiatric causes are unsourced. I got these from pers. comm. with a University of Bristol Neuropsychology lecturer, who didnt source them either. If anyone knows of the hypothesized causes of these disorders from an old psychiatric point of view, then please add them.Neuropsychology 16:29, 10 May 2007 (UTC)

Copied from email

(I am) new to this. (I'm) not sure what is going on with my edit of (Neuropsychiatry). Please advise. many thanks, mp mp*****@**t.*** (*=blanking to protect privacy)

Here is my commentary on what you had added to the article, and why I believe it was a problem: Historically, all neurologists were fully trained in psychiatry, and all psychiatrists were also neurologists (see Freud, who originally was a child neurologist, and Charcot). This were the classic "neuropsychiatrists".

I believe your use of the word "all" and "fully" give this statement a non-neutral point of view, because to disprove it one would only need to find 1 psychiatrist who was lacking anay one facet of training in eather subject.

For reasons perhaps more related to academic politics than to science, the two disciplines split into "neurology" and "psychiatry", as if one could understand (and diagnose and treat) the brain and the emotional mind independently.

This statement appears to be in response to another party's point of view on an argument, even though the other side of the argument is not presented. If you simply state the fact that the disciplines were split, and perhaps add the year that this occurred, without providing your own commentary on why the split ocurred and why it was wrong to do so, it might be includable.

Recent scientific advances - e.g., the possibility to "visualize" if ever so primitively certain emotional processes as they are taking place in the brain - as well as the realization that this hyperspecialization may be harmful to patients suffering from complex mind-brain disorders (e.g., epilepsy, chronic pain), may have contributed to a certain rapprochement.

This statement perports to state one side of an argument as being "obvious", while acknowledging that there is another side of the argument. This is clearly not a "neutral pioint of view".

A small, but now again increasing number of physicians are both fully trained neurologists and psychiatrists, and arguably most qualified to diagnose and treat patients suffering from these "overlap" disorders: Epilepsy with co-morbid mood disorders, the differential diagnosis of non-epileptic seizures, Parkinson disease with depression or dementia, psychosomatic disorders, chronic pain, and others.

You are here pushing the same point of view as above, and stating that it is a low percentage of professionals who believe this way, but seem to be stating that these are the progressive or righteous few.

Currently defined by many psychiatrists as a subspecialty of Psychiatry, for a number of reasons alluded to above, Neuropsychiatry, is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It is closely related to the field of Behavioral Neurology, which is a subspecialty of Neurology that addresses clinical problems of cognition and/or behavior caused by brain injury or brain disease. Indeed, Behavioral Neurology / Neuropsychiatry is recognized as a single subspecialty by the United Council for Neurologic Subspecialties (UCNS).

Here is the first paragraph that provides any non-neutral point of view, although it is also polluted with weasel words ("many psychiatrists"), and seems to include a greater context not cited ("alluded-to"). This paragraph does provide good content which could be preserved, however.

OVERALL SUGGESTION:

Find an authoritative reference which discusses this classical professional argument, and simply state in the article that both points of view exist, and reference the external document, allowing the reader to do his own research and come to his own opinion on the subject.

Jerry lavoie 22:04, 28 January 2007 (UTC)

very helpful. i wonder how you are able to keep track of all these entries.. ;-)

re content:

neuropsychiatry has a long history and is much more than a "subspecialty of psychiatry

My edit was at least in part a response to what I feel is an overly simplistic article whose knowledgebase seems limited to party line publications of ONE professional organization in ONE country of the world.

so i wonder, why was this acceptable?

not sure how to resolve this issue.

your thoughts...

best, mp mp*****@**t.*** (*=blanking to protect privacy)

I would suggest something to the effect of:

Neuropsychiatry has been a medical discipline since ____. The medical community combined this into psychiatry in ____. Neuropsychiatry itself dealt with (aspect a) as well as (aspect b) and (aspect c) of (medical generality), where psychiatry in its strictest form dealt solely with (aspect a) and (aspect b). This occurred amidst some controversy in the medical community, as described in the book _______________________ by ___________, published in ____. In recent years, new developments, such as (develoment a) and (development b) has given rise to a renewed discussion over the two disciplines and wether they should again be split. This is described in book _________________________ by ________________ published in ____.

You may wish to review and cite Neuropsychiatry Online; it seems to discuss the issue at hand. This is far beyond my PATC (Electrical Engineering), so I don't think I can help you with context, but I am willing to help with formatting, citation, and achieving neutrality.

You may also want to reference This White Paper. Jerry lavoie 23:36, 28 January 2007 (UTC)

I just have a problem about the statement, "Neurologists have focussed objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind." This makes it sound like Psychiatrists are dualists. I am not an expert, but given what I know about biological psychology, we assume that the brain is material and behavior manifests itself from material causes - not an ethereal mind-brain interaction. --Sweaterman (talk) 19:24, 9 February 2008 (UTC)

OR and necessity of POV tag?

Looks like a fair bit of Original Research and Synthesis happening on the page. Should the article get a POV tag?--scuro 15:40, 25 October 2007 (UTC)

Citations and general cleanup of this article

I removed the cleanup tag: the actual layout of the article looks somewhat tidy, except for the possible overlap between the first section, "rapprochement of neurology and psychiatry," and the third section, "summary of arguments for neuropsychiatry." I also replaced the unreferenced tag with a 'citation style' tag, because there are several sources attributed in the article; they just don't have a uniform citation style, and they aren't wikified. Bry9000 (talk) 01:34, 9 December 2007 (UTC)

Neurology and psychiatry

I think both the similarities and the differences have been overstated. That mental phenomena have their origin in the brain is not a discovery of the last century: it was known to Hippocrates and Galen, but oddly enough not accepted by Aristotle. Sigmund Freud, who had training in neurology as well as neuroscience, but not much in psychiatry, expressed this as "no psychosis without neurosis," by which he meant that nothing happens in the mind without first happening in the brain.

However, dealing with the same organ is not enough to allow neurology and psychiatry to be practiced together: neurosurgeons also deal with the brain, and for that matter so do psychoanalysts, counsellors, therapists of many kinds (occupational, physical, speech and language), not to mention teachers and priests. There are differences in approach, which would make it difficult to combine these professions.

On the other hand, the extent to which neurologists deal with objective pathology has possibly been overemphasised. That may be more true of neurosurgeons. Neurologists deal with large numbers of people who never have a clear diagnosis, whether or not they have physical signs, and whatever form of words may be used to placate them. Think of the people with headaches and migraine, dizzy spells or "funny turns" who throng their clinics. Recall also the "new" psychosomatic illnesses such as myalgic encephalomyelitis, fibromyalgia and chronic fatigue, which are managed by various kinds of physician rather than psychiatrists. Whereas psychiatrists no longer claim a role in the management of the "old" psychosomatic diseases (asthma, rheumatoid arthritis, ulcerative colitis, etc) now that physicians no longer run from the psychological and social aspects of disease. All medical specialties have their share of conditions where the management requires more than scientific skill.

I doubt that many doctors ever had full training in both neurology and psychiatry, as they used to be practiced in very different kinds of institution. The few psychiatric patients treated in general hospital units or outpatient clinics were not the same as those in the old mental hospitals.

It is true that in the UK, many neurologists used to have a Diploma in Psychological Medicine (DPM), just like the psychiatrists: the examinations required two years work in psychiatric units, and asked psychiatrists to show more knowledge of neuroanatomy and neurology than is expected of them now, but the DPM faded out around 1975. The replacement, the Membership examination of the Royal College of Psychiatrists, requires three years work: which is too long away from hands-on medicine for a neurology trainee.

The Maudsley Hospital, the temple of British psychiatry, used to encourage its psychiatric trainees to get the Membership of the Royal College of Physicians before applying, but that used to be a hard slog, with not very much neurology, and may have been intended to discourage those of a psychoanalytic bent. Nowadays specialist trainees in psychiatry in the UK are much more likely to have been trained in general practice first.

The one field where neuropsychiatry is routinely practiced in the UK, but usually without the name, is the psychiatry of learning disability, known elsewhere as mental retardation, intellectual disability, etc. As well as having IQs well below average, these patients are much more likely to have mental illness, autism and epilepsy (occasionally all three). Unlike other psychiatrists, LD specialists usually manage their patients' epilepsy themselves. In keeping with their inmates' low status in society, the old institutions had few facilities, and “care in the community” has now to be practiced on a shoestring, often without access to an examination couch, let alone scans and EEGs.

However, it seems that the reasons for bringing neurology and psychiatry together are philosophical rather than practical. Medicine has never owed much to philosophy, and thousands of years of reasoning about disease and treatment got us nowhere, as did prolonged scholastic education (seven years study for a BA and MA and possibly also Holy Orders was the norm at Oxford and Cambridge before one started to study medicine, prior to the reforms of 1570) until physicians and surgeons started looking at the evidence from practice instead. NRPanikker (talk) 02:45, 8 July 2008 (UTC)

I agree with the issue of overstating (and the section above, re possible OR/argumentation). The article seems to portray psychiatry as it was in part decades ago, psychoanalytic, blaming parents, social causes etc, rather than how it predominantly is now (based ideologically on what the APA president called the biobiobio model, related to massive pharma compnay influence). EverSince (talk) 17:42, 4 October 2008 (UTC)

Fred M. Levin

I created a page on the neuropsychiatrist Fred M. Levin. But he may not be influential in this field. Mwalla (talk) 22:57, 26 February 2009 (UTC)mwalla

Why no mention of ANPA?

This article has many problems, and the tag "reads like a term paper" seems appropriate...and not even a good term paper at that. Why is there no mention of the American Neuropsychiatric Association (ANPA) in this article? There is a link to their webpage at the bottom, of course, but no mention of the organization in the article's main body. This is the medical specialty society for neuropsychiatry, just as we have the American Academy of Neurology, the American Psychiatric Association, or the American Academy of Pediatricians. The fact that there is a medical subspecialty society for the field of Neuropsychiatry certainly deserves mention in the article itself...they even give out fellowships just like any other respectable society.

Also, while there are citations to the Journal of Neuropsychiatry and Clinical Neurosciences, it would be highly informative for the reader to mention that this is the official publication of ANPA (most medical societies publish their own journals). In fact, ANPA's webpage, which is linked at the bottom of this page, states in the second paragraph, right on their front page, that The Journal of Neuropsychiatry and Clinical Neurosciences (JNP) is the official publication of the organization. The existence of a medical society for this specialty that publishes an official journal would be one of the more pertinent pieces of information that a reader would want to find in this article, right?

ANPA's webpage goes on to mention that ANPA has taken an active role in the creation of subspecialty certification for neuropsychiatry including developing a core curriculum and setting up guidelines for training in neuropsychiatry. As a result, Behavioral Neurology & Neuropsychiatry was approved as a subspecialty by the Unified Council for Neurologic Subspecialties (UCNS) in 2004. I mean, this is all very pertinent information that was discovered through about 5 minutes of research from the front page of their website, easily verifiable.

Here's the basic information that I would want in an article on any medical field (with the answers in parentheses):

1. Is there an official medical society for this specialty/subspecialty? (yes)

2. What is the name of this society (ANPA)

3. When was this society founded (1988)

4. Do they publish an academic, peer-reviewed journal (yes)

5. Do they offer official Fellowships and CME accreditation? (yes)

6. Is the field recogized by ABMS (if a specialty) or by an ABMS-accredited society (if a subspecialty) (yes, subspecialty recognized by UCNS, a board composed of ABMS-accredited specialty societies).

7. Is there an official core curriculum for training in this field (yes)

From there, it might be useful to delve into the training involved, the history of the society, and the field's ties to other societies (ie APA, AAN). Notable neuropsychiatrists might be mentioned, along with seminal publications if applicable. ANPA's website has ample resources in this regard, as does their journal. Obviously other sources may be useful as well.

Historical disputes between the fields of neurology and psychiatry strike me as fairly parochial (and irrelevant, given that both specialties are certified by the same ABMS board).

Unfortunately, this article needs a complete rewrite. I'd start with the questions I've outlines above as a template. This is an encyclopedic article, not a term paper, Op/Ed piece, or historical analysis. Look at it from the perspective of a person who is looking up information on the subject, and start by considering the questions that they might want answered first. Work at it from there, keep the stuff verifiable from reputable sources, and it should improve greatly.

I apologize if my comment is a bit US-specific, but I am more intimately familiar with the American medical system than those in other countries. However, the ANPA website does also mention the International Neuropsychological Society, the British Neuropsychiatry Association, and the International Neuropsychiatry Congresses, so those organizations may also be able to provide useful information about this field in other countries. ~ Hyperion35 (talk) 14:32, 22 January 2010 (UTC)

Hyperion, all fair comments. Wikipedia encourages users to be bold, so if you have an interest in this area you are a suitable candidate to edit the page! I too have an interest (and am a member of the BNPA) but sadly I don't have as much knowledge in this area. All the best, --PaulWicks (talk) 01:52, 23 January 2010 (UTC)

Please edit this

I wish to observe that the table named "Linking traditionally psychiatric symptoms to brain structures and genetic abnormalities" is not only totally outdated, but also factually inaccurate, especially since the title is talking about symptoms, but in the table one does not see any symptoms, but rather diseases being presented.

Please see the wikipedia own definition of symptoms, syndromes, and diseases:

http://en.wikipedia.org/wiki/Symptoms

http://en.wikipedia.org/wiki/Syndrome

http://en.wikipedia.org/wiki/Disease

I do not wish to enter into the details of the poorly supported blatant inaccuracies of the psychoanalytic interpretation of various psychiatric disorders listed in that table.

In my opinion that table does a great disservice to the entire article, which is otherwise written quite well, and contributes in an obviously painful way to the diminuation of the credibility of the entire article, which is sad, given the wonderful and exciting advances that are being made each day in the study of the field of consciousness and the rich scientific literature that already exists.

Please, please, just scrap that table altogether !

Rudolph Aspirant (aka Eugen Craciun), 10th August, 2011 17:09, Oslo 84.210.21.34 (talk) 15:09, 10 August 2011 (UTC)

Well, I disagree with you about the overall quality of the article, but I tend to agree with you about the table. I'll leave it for the moment though in case anybody else wants to comment. Looie496 (talk) 15:26, 10 August 2011 (UTC)

Too little about the field of neuropsychiatry, too much about history/philosophy

This article reads like a history of a specific part of the neurology/psychiatry borderline rather than an article about the modern medical field of neuropsychiatry. The introduction and the (short) very last section talk about the modern medical field, but the rest of the article is about historical and philosophical differences between neurology and psychiatry. In short, if somebody is looking to Wikipedia to understand the job of a neuropsychiatrist, this article will be useless in answering that question.

I can think of a few different options for cleaning up the article:

• Reduce the size of the history section in comparison with sections about the medical field.
• Place much of the history/philosophy in a different article and link to that article.
• Provide more details about the role of modern neuropsychiatrists in medical treatment.
• Explain a bit of the distinction between neuropsychiatrists and neuropsychologists.

Thoughts? Techielaw (talk) 16:44, 4 January 2015 (UTC)

I think your critique and suggested solutions are great overall. I encourage you to improve the coverage however you're able. I wish I could offer help, but like most people, as someone who doesn't work in any of the fields, I don't know enough about the fields' details to take the next steps that you identify. And actually, that's the explanation of how gaps like this arise in many Wikipedia articles. The content and its gaps, to date, reflect the contributorship and its gaps, to date. It takes a new and more knowledgeable addition to the contributorship (such as you, in the post above) to move to the next level of coverage quality. My only caveat about the suggested improvements is that it's usually best not to wipe out any valid info that has already been contributed, even if it is out of proportion because the other areas are underdeveloped. Instead, preserve that info but relegate it to a section or to a separate article. If the size of the section just bugs you, better to move it to a separate article than to delete it. One of the reasons this is important is that it prevents dysfunction and atrophy of the contributor community, which threatens the health of the project (the whole encyclopedia as an ongoing project that relies on continual volunteer efforts). By refraining from wiping out the useful contributions of whichever few people wrote that portion of coverage, it avoids causing worthwhile contributors from thinking, "Well, they deleted most of the valid writing that I worked on, so screw it, Wikipedia can rot without me from now on." Anyhow, if you get any time, I encourage you to make the improvements that you are able to make. Regards, — ¾-10 18:08, 4 January 2015 (UTC)