A combination of neurology and psychiatry has been at the forefront in the study of the brain and its disorders for 2000 years in the west. The two branches were thought to be a single unified branch of the medical field, neuropsychiatry, studying the brain and the mind.
Pioneers like Bleuler, Jackson, Freud, and Charcot propagated the school of thought where the brain and the mind were considered to be unified, despite their research and clinical interests.
A psychiatrist specializing in this field used to treat patients with behavioral or psychological symptoms with their roots in neurology, like brain injuries. Although both neurology and psychiatry look into the central nervous system’s disorders, there is an eternal debate surrounding the relationship between them.
A Brief Overview on Neurology and Psychiatry
Neurology is a specialty in the field of medicine, which is concerned with the diagnosis and treatment of disorders of the central nervous system, i.e., the brain, spinal cord, and the nerves connecting them.
A neurologist is a highly trained clinician who is capable of diagnosing and treating complex neurological issues including, but not limited to, Parkinson’s disease, multiple sclerosis, migraine, epilepsy, concussion, amyotrophic lateral sclerosis (ALS), Alzheimer’s disease, stroke, and more.
Detailed case history and several physical tests are conducted to diagnose the gait, reflexes, coordination, sensation, strength, speech, and mental status. Some commonly used neurological tests include Lumbar puncture for cerebrospinal fluid analysis (LP), Electromyography (EMG), Electroencephalography (EEG), Magnetic Resonance Imaging (MRI), Computed tomography scans (CT), etc.
Psychiatry is a branch of medical science that focuses on the prevention, diagnosis, and treatment of behavioral, emotional, and mental disorders. A psychiatrist is a medical doctor trained to work with mental health issues, including substance abuse disorders.
They assess both physical and mental aspects of the psychological issues presented. They perform a range of medical and psychological assessments, including mental status examination, to understand the complex relationship between genetics, family history, emotions, and other medical illnesses.
Their diagnosis would be based on the criteria under APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). They provide various therapies and treatments, including medications like stimulants, mood stabilizers, hypnotics, antidepressants, antipsychotic medications, etc.
Although the two fields started on the same grounds, the two parted ways in the 20th century. Neurologists mainly focused on the brain-related disorders associated with cognitive and behavioral abnormalities with prominent somatic signs.
In contrast, psychiatrists focused on thought and mood disorders with little to no physical manifestations or causes found in the neurological examinations.
There were conflicting theories and approaches when it came to specific illnesses that had both psychological and physical origins and implications. This has led to the current understanding and approach to bridge the gap between the two fields.
The neuroscience field’s current development has made it difficult to find and draw a line between neurological and psychiatric disorders as both have symptoms and causes with biopsychosocial origins.
For example, it is a known fact that people with stroke and Parkinson’s disease develop symptoms of dementia and depression. Results from MRI and PET tests show more evidence regarding the interrelation between the two fields.
Obsessive-compulsive disorder has been characterized by unwanted, recurrent, intrusive thoughts, ideas, and images that are performed to decrease the discomfort caused due to the obsessions.
Evidence shows that increasing the level of selective reuptake inhibitors and serotonin in the brain can help control the disorder’s symptoms. There is also evidence of structural abnormalities in the brain and genetic predispositions that suggest that Schizophrenia is a brain disorder.
Because of consistent research about neurobiological and psychological disorders, the ones that were thought to be psychopathological were found to be of neuropathological origins. One of the best examples to indicate the shift is conversion disorder.
Conversion disorder was previously assumed in the broad category of hysteria by propagators of psychoanalysis. However, recent studies show neurological symptoms such as paralysis, blindness, and weakness without a biological cause.
But looking at it merely from the perspective of neurology would not account for the traumatic and other psychological causal factors that contributed to the disorder’s development.
Aiming for a Merger between Psychiatry and Neurology
Instead of reorienting themselves into fields of the specialty of brain and mind, a psychiatrist specializing in neuropsychology and psychiatry must focus on orienting the medical field towards merging the two.
The focus must be shifted towards operating as a multi-level science to help patients dealing with complex mental problems and neurological problems with a cohesive approach of biopsychosocial perspective.