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Contemporary neuropsychiatry has come of age. After a flourish at the interface of neurology and psychopathology in the late 19th century, a decline during the era of psychoanalysis, and precursors in the forms of psychopharmacology and biological psychiatry, a substantial neuropsychiatric evidence and experience base has accrued, and the field has been defined. Localization of brain functions has extended beyond sensory-motor and even cognitive processes to emotional, social, and complex behavioral processes. The interactions among nodes within brain networks that mediate higher-order human mental function are being elucidated. Interdisciplinary clinical teams, like that of the Center for Brain/Mind Medicine at Brigham and Women’s Hospital, are being formed. The American Neuropsychiatric Association and the Journal of Neuropsychiatry and Clinical Neurosciences have played a major role in bringing together the neuropsychiatric community and advancing the field. Specialized training programs have been developed.
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These developments have resulted in a convergent, evolving understanding of the neurobiology of psychiatric conditions and the psychiatric aspects of neurologic conditions. Systems-level functional and structural neuroimaging is identifying brain circuits as final common pathways of clinical phenotypic expression of psychiatric phenomena. This work is elucidating the brain regions, circuits, and connectivity underlying the full range of human experience and behavior (including social interactions). Such findings are often consistent with the brain-behavior, structure-function relationships that had been identified through case studies of patients with focal neurologic lesions. This convergence reinforces our confidence in a fundamental neuropsychiatric knowledge base. At the same time, cellular and molecular research is identifying pathophysiological mechanisms that disrupt signaling pathways within the implicated circuits across a range of disease processes.
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A neuropsychiatrist combines this knowledge with clinical acumen in both psychiatry and neurology. This integration occurs through combined residency training in psychiatry and neurology, or through a UCNS-approved fellowship in behavioral neurology and neuropsychiatry after a single residency in either field. The neuropsychiatrist is thus ideally suited to evaluate and treat patients who have abnormalities in perception, cognition, emotion, and/or behavior due to a known psychiatric or neurologic disorder; due to the simultaneous presence of, or interaction between, psychiatric and neurologic disorders (or their treatments, and associated psychosocial elements); or due to an unknown underlying brain condition.
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Patients who come to, or are referred to, a neuropsychiatrist have often seen multiple psychiatrists and neurologists (and internists) and have received multiple diagnoses or continue to suffer despite treatment prescribed. Psychiatrists or neurologists may feel uncomfortable ruling in or out a diagnosis that is outside of their core expertise, or may not know what they don’t know within the vast span of neurobehavioral medicine. In some cases, patients and families may be reluctant to see a psychiatrist due to stigma, misunderstanding, and residual dualism in society. In all these instances, the neuropsychiatrist can provide a synthetic, “buck-stops-here,” “one-stop-shopping” evaluation of tremendous value to all concerned.
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Indeed, in many cases a comprehensive neuropsychiatric evaluation may itself have significant ...