Neuropsychiatry
BMJ 2004; 328 doi: https://doi.org/10.1136/sbmj.0403110 (Published 01 March 2004) Cite this as: BMJ 2004;328:0403110
- Niruj Agrawal, consultant neuropsychiatrist and honorary senior lecturer1
- 1St George's Hospital Medical School, London
Doctors often think of neuropsychiatry as an exciting new discipline; it may be exciting, but it is far from new. In the 18th and 19th centuries most eminent clinicians and researchers working in the field of neurosciences were in fact neuropsychiatrists. They were working with disorders of the brain, which included both neurological and psychiatric disorders. The 20th century, however, saw a gradual separation of these two fields. The focus of psychiatry shifted gradually from structural neuropathology to psychoanalysis and then to community and social psychiatry.1
Artificial boundaries
During the past few decades, the advent of newer pharmacological treatments and advances in fields such as neuroimaging, genetics, and molecular biology have resulted in a growing recognition of brain pathology as the basis for psychiatric illnesses. At the same time, people have begun to address properly the psychological problems that can accompany neurological illnesses. All this has shown how closely interwoven neurology and psychiatry really are and that any boundaries between the two are largely artificial.
BSIP DUCLOUX/SPLA
coloured MRI scan of a coronal section through the brain of a person with Parkinson's disease
What is neuropsychiatry?
Fundamental to any definition of neuropsychiatry is the inseparability of mind and body. It is an integrative and collaborative field, not a specialist category that recognises only circumscribed features of specific brain disease.2 So the focus of neuropsychiatry is all the brain symptoms (neurological and psychiatric) that patients present with.
However, the emphasis is on the psychological features associated with a neurological condition rather than pure neurological presentations. Neuropsychiatry also focuses on the patients who fall between the boundary of neurology and psychiatry. Overall, neuropsychiatry attempts to bridge the theoretical and clinical schisms between neurology …
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