The spring meetings dedicated to neurology, neuropsychiatry, and geriatric psychiatry have just passed:
American Academy of Neurology
American Neuropsychiatric Association
American Association of Geriatric Psychiatry
These meetings bring to the forefront the centuries-old question of the separation of neurology and psychiatry. Much has been written recently regarding the dearth of neurology education and the need to better integrate basic and clinical neurosciences curricula into psychiatry residency training (1, 2). So how far along have we gotten in this journey? In a survey of program directors, Reardon and Walaszek (3) found that, on average, neurosciences constituted approximately 13% of residency curricula, although program directors felt it should comprise 20%. Topics taught included stroke/vascular disorders, epilepsy, dementia, movement disorders, and headache. The greatest number of neurology didactic hours were offered during postgraduate years 1 and 4. This survey also pointed out many areas of growth for psychiatry residency curricula. For example, residents commonly encounter patients with multiple sclerosis and other white matter diseases during their outpatient rotations, and the number of genetic mutations known to be associated with fronto-temporal lobar degeneration grows continuously (4). The Diagnostic and Statistical Manual for Psychiatric Disorders, 5th edition (DSM-5), has done well by our patients with cognitive deficits, changing the nomenclature from dementia to major neurocognitive disorder, which shows a better grasp of the biological underpinnings of cognitive impairment. Mild neurocognitive disorder still remains a conundrum, however, and it has morphed into a mostly clinical diagnosis, without the need to show deficits in performance on standardized memory testing, as was required in the DSM-IV-TR. This probably reflects the state of psychiatric practice around the United States (and the world), where it is still difficult to obtain neuropsychological testing and know how to interpret the results. The time will come when we will be able to better delineate psychiatric conditions on the basis of diagnostic testing and perhaps uncover phenotypes that respond to treatment differentially. Until then, neuropsychiatry and geriatric psychiatry are the areas that provide most support to the idea that neurology and psychiatry are, after all, not that separate. To those who attended the above spring meetings: we hope you enjoyed them and learned new things. Please remember to teach your students and residents what you learned. It all starts in the hippocampus.
References
AAP Bulletin – Spring 2016, Page 6 of 7
