Psychiatry and Neurology

To the Editor: I read with interest the editorial by Stuart C. Yudofsky, M.D., and Robert E. Hales, M.D. (1). I was encouraged by their attention to the overlap between psychiatry and neurology and the arbitrary line of distinction that is drawn between these two fields. I agree that the developing field of neuropsychiatry provides us an opportunity for addressing this issue and that these areas are theoretically related and should be conceptualized in a theoretically integrated framework.

However, I disagree with their main conclusion that psychiatry and neurology should be integrated into a single specialty of neuropsychiatry. The reasons for this are merely practical. Specialties in medicine are based not only on theoretical but also practical reasons. Accordingly, physicians who treat patients with brain disorders typically are interested only in treating a subset of patients with these disorders using a subset of the available treatment options. For this reason, we currently have the specialties of psychiatry, neurology, and neurosurgery. It is a rare physician who chooses to specialize in more than one of these areas, with the obvious extensive training requirements. Given the advances made in the understanding of brain disorders, this need to specialize in a subset of brain disorders probably will become more important—not less.

Therefore, I predict that, eventually, neuropsychiatry will develop as an area of specialty between neurology and psychiatry. It will include disorders such as schizophrenia, dementia, mental retardation, and Parkinson’s disease. Psychiatry will attract physicians who are more interested in psychodynamics and treating patients with psychotherapy, social interventions, and integration of medication and psychosocial treatments. The lines between these areas will be flexible ones. Specialists in brain disorders will have an integrated model within which they can understand their patients, practice their specialties, and communicate with other specialists.