The Hindu : Tamil Nadu / Chennai News : Psychiatrists, neurologists need to work together: expert

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Psychiatrists, neurologists need to work together: expert

Special Correspondent

Call for team approach and communication between members for research

Concurrence among the two on disorders of brain could change conceptions of mental illness
Patients deserve a change in the stigmatised perception about brain, behavioural disorders

CHENNAI: Better communication between psychiatrists and neurologists is vital for improving patient care and ending the stigma of psychological illnesses, David W. Dunn, international neuropsychiatry expert, said on Saturday.

Delivering the sixth MV Arunachalam Endowment Oration 2008, Dr. Dunn, professor of neurology and psychiatry, Indiana University and Riley Hospital for Children, Indianapolis, US, said concurrence among psychiatrists and neurologists on disorders of the brain could change conceptions of mental illness.

“Mental illness should not imply blame or weakness.” Patients deserved a change in the stigmatised perception about brain and behavioural disorders, he said.

The theme of the oration was, “When the mind meets the brain! Why Neurologists, Psychiatrists and Psychologists must talk to one another”. It was jointly organised by the MV Arunachalam Centre for Information and Education in Neurosciences, The Institute of Neurological Sciences (INS), Voluntary Health Services and Neurosciences India Group.

According to Dr. Dunn, though there was significant overlap between psychiatry and neurology towards the start of the 1900s, the union between the specialities proved to shortlived.

He said while psychiatrists took “the mind, the ghost and the invisible,” the neurologists adopted “the brain, the machine and the visible”. One group used the bio-psychosocial model, studied the symptoms and accepted the ambiguous, the other adopted a bio-medical model, studied physical signs and insisted on the concrete and the measurable.

However, more recently the specialities had come closer mainly owing to advances in genetics, psychopharmacology, and functional magnetic resonance imaging. Constant advances in the neural sciences had dispelled doubts that mental illnesses were brain-based, biological disorders. There had also been recognition by neurologists that behavioural and emotional changes were a critical component of most central nervous system disorders, Dr. Dunn said.

According to the expert, the blending of psychiatry and neurology into neuropsychiatry continued to be challenged by divergent interests of the respective specialities; neurologists mostly dealt with spinal cord problems, peripheral neuropathies and myopathies, while psychiatry’s obsession was more with personality disorders, family dynamics and psychodynamic therapies.

The exponential expansion of medical knowledge only widened the chasm between the disciplines.

By way of illustration, Dr. Dunn pointed out that if a modern psychiatry textbook ran into 4,480 pages, one on neuropsychiatry and behavioural neurosciences spanned 1,360 pages and involved 82 contributors while a book on epilepsy alone consumed 2,985 pages.

Dr. Dunn pointed out that the biggest worry for the patient in this segmented approach to treatment was the fragmentation of care. The remedy lies in communication between specialist and patient and between specialists of different disciplines.

“The strength of the team approach and need for communication between team members is essential for research as well as patient care.”

Dr. Dunn pointed to the experience at his hospital where the involvement of psychiatrists, neurologists, psychologists, nurses and statisticians led to a vastly improved understanding of the cognitive and behavioural co-morbidities of childhood epilepsy.

False dichotomy

“An increase in communication between psychiatrists and neurologists…may finally end the false dichotomy between brain and mind.”

E.S. Krishnamoorthy, director, INS, VHS, Prof. Krishnamoorthy Srinivas, chairman-emeritus, N.S. Murali, honorary secretary, VHS hospital, M.V. Murugappan, chairman, Vellayan Chettiar Trust, A. Vellayan, trustee and S. Janaki, medical superintendent, VHS, participated.

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