Bridging the Great Divide: What Can Neurology Learn From Psychiatry?

• Published in: The journal of neuropsychiatry and clinical neurosciences 2018-10, Vol.30 (4), p.271-278
• Main Authors: Perez, David L, Keshavan, Matcheri S, Scharf, Jeremiah M, Boes, Aaron D, Price, Bruce H
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brain - physiology; Brain - physiopathology; Brain Diseases - physiopathology; Brain Diseases - psychology; Child; Humans; Mental Disorders - physiopathology; Mental Disorders - psychology; Neurology; Neurosciences; Psychiatry; Young Adult
• ISSN: 0895-0172; 1545-7222
• DOI: 10.1176/appi.neuropsych.17100200

Neurology and psychiatry share common historical origins and rely on similar tools to study brain disorders. Yet the practical integration of medical and scientific approaches across these clinical neurosciences remains elusive. Although much has been written about the need to incorporate emerging systems-level, cellular-molecular, and genetic-epigenetic advances into a science of mind for psychiatric disorders, less attention has been given to applying clinical neuroscience principles to conceptualize neurologic conditions with an integrated neurobio-psycho-social approach. In this perspective article, the authors briefly outline the historically interwoven and complicated relationship between neurology and psychiatry. Through a series of vignettes, the authors then illustrate how some traditional psychiatric conditions are being reconceptualized in part as disorders of neurodevelopment and awareness. They emphasize the intersection of neurology and psychiatry by highlighting conditions that cut across traditional diagnostic boundaries. The authors argue that the divide between neurology and psychiatry can be narrowed by moving from lesion-based toward circuit-based understandings of neuropsychiatric disorders, from unidirectional toward bidirectional models of brain-behavior relationships, from exclusive reliance on categorical diagnoses toward transdiagnostic dimensional perspectives, and from silo-based research and treatments toward interdisciplinary approaches. The time is ripe for neurologists and psychiatrists to implement an integrated clinical neuroscience approach to the assessment and management of brain disorders. The subspecialty of behavioral neurology & neuropsychiatry is poised to lead the next generation of clinicians to merge brain science with psychological and social-cultural factors. These efforts will catalyze translational research, revitalize training programs, and advance the development of impactful patient-centered treatments.