Psychiatry and Neurology

Neurology and psychiatry: East and West, and the Twain shall never meet.  However, the two specialties do have a common root. The main difference has been that disorders with behavioral disturbances came to be regarded as mainly “functional” without a structural basis, while neurology concerned itself with symptoms having an origin in organic changes.

Neurology has matured as a separate clinical specialty with close contacts with biology and similarities with internal medicine. At the same time, the influence of socioeconomic, familial, and interpersonal relationship brought a new dimension to clinical psychiatry. The two specialties drifted away from each other. Neurology developed from a mainly diagnostic, descriptive specialty with few possibilities for therapeutic interventions into an active discipline based upon therapeutic manipulation of biological systems. The progress in functional MRI, improved imaging techniques, development in genetics, and the revolution in molecular medicine with its understanding of signal transmission in brain gave neurology a new image.

The development of behavioral neurology has effaced the border between neurology and psychiatry. With the development of imaging techniques it became possible to study the morphological correlates to personality traits and neuro-psychiatric symptoms and relate these to genetic, biochemical, and neuroreceptor characteristics that serve to expand and modify the diagnostic classification. Psychiatry and neurology share a common basis in neuroscience. This development accelerated during the last decade and is now firmly established in basic research.

This does not mean that neurologists will be able to manage psychiatric disorders such as schizophrenia and depression. Nor will psychiatrists take over the care of patients with multiple sclerosis, epilepsies, or hereditary ataxias. Neurology and psychiatry may have developed from two sides of the earth, but there is much more that brings us together than which separates us. The two specialties are strong enough to stand face to face.

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