Neurology and psychiatry: “Oh, East is East and West is West …”

Neurology and psychiatry: " Oh, East is East and West is West … " " …and never the twain shall meet ". However far removed, 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 same development in psychiatry revealed how closely connected neurology and psychiatry really are. The artificial divide between structural and functional became unclear. For example, many dystonias that were regarded as " functional " and of psychogenic origin turned out to have a biological basis. 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. Although evaluation of the mental status should be an integral part of a neurological examination, it has by tradition become the weakest part. A neurologist may spend more time examining motor disturbances than analyzing behavioral elements because he/she knows that the analysis of motor disturbances will give crucial information about the localization and extent of the process. The psychiatrist may leave much of the visual, auditive, motor, and sensory examination as being of lesser relevance. Although there is …