My cerebellar neuro told me that some people may think or comment that my condition is all in my head, but to remember how ridiculous a statement that is because his entire job deals with what's in the head and that technically the entire subjective experience (including all feelings and sensations) is in the head. You're absolutely right in your assessment there, and it really seems like psychiatry is almost a subfield of neurology (especially for psychs who use and study through Stahl's various books and approach). I'm curious what would be different if it was treated like that more.
Most psychiatric and psychological issues stem from social science issues mixed with early childhood education but are individualized based on personal neurology.
Most recent evidence shows that psychiatric medicine is not as beneficial as psychological breakthroughs. The reality is that many mental health issues are a result of thoughts, habits and behvaiors.
Your brain condition is all in your head, and my respiratory condition is all in my chest. The fact that it is all in your head doesn't mean that it isn't real.
"It's just in your head" is such a pet peeve of mine. If you break your leg, no one would say "it's just in your leg", when you can literally be totally fine having had both your legs amputated, but you go and amputate a head...
He is absolutely right on several levels: 1) psychiatric symptoms arise from the brain 2) the brain is a physical organ intensely linked to the circulation, the immune system and the gut 3) numerous infections are known to cause severe neuropsych disorders: toxoplasmosis and psychosis/schizophrenia; Strep and "OCD" like symptoms; Bartonella and intense basal ganglia and amygdala symptoms; many others 4)Psychiatrists and their DSM too often classify and approach diseases by their symptoms instead of searching for Etiology (causative process like infections and or inflammatory response). For true understanding and treatment of especially the most severe "psychiatric" disturbances, psychiatry needs to return to its organic neurologic and medical roots.
The Problem is, as far as I know for almost all psychological disorders we have no idea what the cause is. We don't even have Biomarkers, thats why the DSM focuses on Symptoms. It's the only viable option for classification at the moment.
Most of Psychiatric disorders are multifactorial and the root cause cannot be pinpointed nor directly addressed. That's where the line gets draw, Psychiatry gets the patients that Neurology cannot tackle the organic cause directly because the pathologic chain is not fully understood (measureable), their patients have behavioural and mood disorders that need to have an farmacology approach tailored to their individual symptomatic response and the psychoterapy that has some level of evidence for the patient's diagnose. In a lot of the disorders in psychiatry, the meds are there to help the psychoterapy or treat the most problematic symptons, they do not work on the root cause because of the multifactorial nature of the psychopathology. Neurology will get the patient that have disorders with somewhat well understood pathogenesis and the treatment works somewhere in the chain of the pathologic proccess, whether treating the cause if possible or minimizing the damages by intervene in the chain, here it is a bit like psychiatry but usually the treatment is mostly for physical symptoms or slowing disease progression, very rarely they treat mood and behaviour problems. Therefore you need to know the organic mechanisms behind the disease, of course there are exceptions both ways and some disorders like ADHD can be treated by both specialties, but that is the gross difference from my understanding and my personal opinion is that we will never be able to understand all the things that go wrong in the mind from a fully "neurologic/ medicine" approach.
Glad you brought this up. I always thought it was peculiar that when an etiology is found, psych doesn't tend to embrace it and instead a disease gets shipped off to a different specialty - like dementia and anti-NMDA like you said. Everything else has to be "ruled out" before it's considered a primary psych disorder which feels murky. As a neuro resident it's two sides of the same coin. I feel like we should be embracing psych more in neuro, and vice versa.
This is one of the most important conversations to be had in contemporary neuro and psych. The handwaving response to the divide between brain and mind, usually delivered with some meaningless platitude about monism vs dualism, has always been a convenient, imperfect lens to this field of health. Starting to question why the divide continues to exist is the best way to approach possibly ending it.
@@itspresromy psych and neuro skills are both incomplete and rusty. Please keep talking about these issues. Your star is rising, Psych Resident - and you're placed to stand a better chance of making positive change than I ever did.
I totally agree with you. I’ve been a psychologist for quite a while and even in my internship when I saw my first schizophrenic I thought there must be something wrong with their brain function. At that time the disorder was attributed to bad mothering! Ugh
@@patriciasavant9121 the Cluster A Personality Disorders are poster children for this entire case. They're so easily thrown in the research too hard basket because of how complex and wild they are to approach from both a neurobiology and a pure psychology standpoint. Just because it's one of the most difficult, least lucrative challenges in medicine, doesn't make it less worthwhile in my opinion. Though I'm not the one who has to live off the minimum-wage-level research stipend, so I'm gonna take the coward's option and simply point to a systemic issue I have no chance to fix.
Sir! I'm an Exercise Physiologist on an acute psych ward in Australia... And my specialty interest area is chronic pain! I highly recommend looking into Professor Lorimer Moseley's findings around chronic pain and how we use a biopsychosocial framework to understand it and treat it. I'm currently leading a study evaluating attitudes, knowledge and treatment practices of chronic pain in acute mental health on our ward. We know that the biomedical framework many physicians rely on is impeding recovery rather than promoting it, particularly when we consider the intersection between serious mental illness and substance use disorders. Just some food for thought! Thanks for sharing your thoughts 🙂
I have an ultra-rare cancer. It can affect any part of my body. It can damage any organ. It causes inflammation. It is a blood cancer and an autoimmune disease. Yes, it has caused two short psychotic episodes before I started a targeted chemotherapy. There are lots of symptoms, including cognitive issues. The problem is that doctors know virtually nothing about Erdheim-Chester Disease, my cancer. Worse yet, I see over a dozen specialists and most say they do not treat it. A Pulmonologist advertised his services, and I get my prescription that keeps me alive from him. I no longer have any lung problems. I plan to travel to see a Erdheim-Chester Disease specialist, but that does not help me get proper medical care once I leave his office. If they had studied my disease and symptoms, so much would be better understood. Doctors cannot be bothered to learn.
Thank you for sharing this part your journey with us. I hope you receive all the care and medical intervention you need and deserve to help release you from this back and forth with doctors. I know it can be overwhelming to have a condition that requires so much from you...especially emotionally because it does take such an intense toll...to feel like you're fighting by yourself. Please rest assured that there _are_ many competent and capable doctors that are eager to help patients with rarer and lesser known medical conditions. The toughest part is what you have already proven to have tackled, which is, to fight and advocate for yourself. I know it can feel heavy and exhausting, but you're doing great. Keep fighting for the treatment that will help and heal your body. You deserve tailored healthcare, and I hope the universe connects you to someone that will finally treat your condition consistently and properly. Also, I'm happy to hear you are not having trouble with your lungs ❤. When it's hard to breathe, every easy breath feels like a gift. Sending many positive thoughts your way...may you be blessed always 🙏🏼.
Hey man. Just thought I'd say I love your content - skits and this style. Skits are obviously hilarious, but I like these as well because I can get exposed to different topics or questions in healthcare and perspectives I haven't thought of. Thanks.
I love this video so much. I'm neurology but I'm specializing in FND, CRPS, phantom limbs, non-epileptic seizures and behavioral neurology. Now I think there are correlates you can find on imaging for a lot of this but for sure we don't have a clear definition. But I really like how fuzzy that line is. Some of my favorite colleagues are in the department of psychiatry and I look forward to continuing to work very closely with them in my career. TL;DR psych and neuro have been the same field before and have merged again and then split again and then merged again throughout history. I think the merger is in order again. Neurologists absolutely need more training in behavioral aspects of the field and I think psychiatry people these days do just as much neuro anatomic and physiologic research so perhaps a little bit more foundation in neurology and neuroanatomy is in order? Great question was asked and a great answer Preston
Please see my detailed ecperiment using keto and gaba for non epileptic freezing.... invthe comment, I just happened to have scientific/nutrition training and get sick, and trouble shoot scientifically. I hope my experience can be a starting point for others. I cry when I see anyone going through this, let alone youth. Thank you for you, and your path. Thanks so much for helping others.
I'm a 30 year old pre-med student that just restarted classes after dropping out of an engineering program nearly 10 years ago. The catalyst for that change was going to therapy for depression, getting diagnosed with ADHD instead, and accepting stimulant medication for it several months later. The more I learn about my condition, the more I realize how blurry the line between neurology and psychiatry is. Some people might see this as frustrating, but I see it as interesting. It's so cool how everything interacts, and its amazing how far we've come despite having such a long way to go and having so much to learn. We know ADHD causes physical changes in the brain, that it's a dopaminergic disorder, and that it impacts how the firing of neurons are timed, which does make it neurological in nature. What keeps it in psychiatry scope of practice is that those things can largely be treated non-medically with therapy, as it's mostly behavioral, and the medication is just a tool to make it easier to learn how to cope with how differently my brain works compared to the brains that created the increasing demands of our society. I had no issues functioning day to day, but that's all I could do because of how fast-paced and stressful society is now. Once I started medication, it took about 3 weeks to start filling out paperwork to go back to school because I suddenly had the ability to keep functioning after I got home from work. My goal is to learn to function efficiently without my meds through therapy, and try to get off of them in a year or so after I learn to strengthen my focus and regulate my internal state. Then go back on them for med school and residency when the system tries working me into an early grave again. Hopefully at a lower dose than I'm on now, but that doesnt matter as long as the medication works without causing side effects. It sounds weird, but I feel like the way I'm looking at it is significantly healthier and more realistic than any other view I've taken. I will say, I'm very thankful I have a supportive family medicine physician thats willing to try things that I ask for as long as its safe, and a quality therapist that pushes me to be better without beating myself up. The first time I sought mental health help shortly after dropping out of school, I ended up going through a variety of SSRI's and benzos that just made things worse. I won't say that physician didn't care, because I believe they did, they tried treating the depression and anxiety I was reporting. I just feel like our system is broken, and doesn't teach how to effectively treat and diagnose certain things. That gives me hope because we can define that problem, and that's the first step to solving any problem. It shows that we can do better, it's just a matter of time until we figure out how.
I've been a patient since birth for a stack of medical issues and a psych patient since grade school. From the patient chair it always seemed like neuro and psych are like, fraternal twins, and ive been in the best hands when my doctors felt similarly.
I see it as a separation between structure and function. Neurologists limit themselves to disorders of the nerves which is the structure of the CNS (& PNS). Psychiatrists deal with disorders of function of the CNS. I see it like the difference between the hardware and software of the a computer. If a part like the motherboard or CPU is broken then that's the neurologists job. If there's a problem of software like being unable to install programs, that's the psychiatrists job. Although the lines are definitely blurred there is a clear difference. For example if someone has a stroke the neurologist will help treat the neurological defects. However from a loss of independence that same person may become depressed and adopt maladaptive strategies. In this case it's the loss of function of the CNS (through mood dysregulation) that manifests as the depression, with the loss of structure (ie neurones) only being an indirect cause. Ultimately though the problem with these blurry lines, as you highlighted, is the entire field of psychiatry essentially exists as a diagnosis of exclusion. The problem is the brain is so complex and to avoid this problem we would need to understand 100% of neurology/endocrinology/rheumatology/toxicology etc... Which is obviously not going to happen any time soon. Very thought provoking topic I have thought about this for a while myself.
I want to become a neuropsychiatrist and this is one of the first times I’ve ever seen anyone have my exact same view on this subject. Whenever people ask which type of medicine I want to practice, and I reply neuropsychiatry, they look at me like I have 3 heads.
I talk about this quite a lot with my patients. I take the philosophical position of embodied cognition, which collapses the Cartesian divide, and I think jives better with neuroscience and subjectivities. I think a lot my patients appreciate that I understand the arbitrary nature of the categorical system, and the history of psychiatry and neurology that got us to this point. Then we can turn towards treatment in a more fulsome way, and they’re less worried about their psychiatrist missing something that the medical model does not recognize.
The neuro-opthhalmic dynamic interaction is fascinating as well. I wish access was more prevalent. My ocular migraines are a particularly fascinating overlap and I'd have to go probably 4 hours for access. ☠️
As imaging helps to improve diagnostic accuracy, I think that may be a good thing if it does happen. Those guys need to be working more closely together anyway.
I work in closed-loop deep-brain neuromodulation, and I can say we have already stopped thinking of there being any difference other than the end clinical customer
I have been lucky to experience an autoimmune issue that impaired certain neurological functions in a physical way. I have a health and engineering science background. Troubleshoot the symptoms cause and effect one at a time, using bought known substances. FYI nerve damage is treatable, do all conditions are potentially treatable. Please please stop poisoning people and start healing or correcting the nerve damage. Thanks for your insight and work. Please keep questioning
Autoimmune, age, stroke, dementia, alzheimers, adhd, concussion, etc, you know what nerves, generally, are damaged, and one could treat that damage and hopefully negate the other symptoms.... I have experienced really good results from treating my known autoimmune damage and I would like to get the word out. I took my premeds in nutritional science, but couldn't finish because I became a stay at home mom for awhile. Went back to school for engineering and was working in that field when I got my autoimmune disorder. After years of reading pub med and having difficulty swallowing, I was able to find the concoctions to a) allow possible regeneration through feeding the mitochondria in the dendrites - I was initially reluctant to do keto because I was taught it was dangerous back in the 90s, but my body reacted very badly to sugar, grains and animal products, and I was starving, so pub med and a prayer.... the brain fog cleared. If I had added electrical stimulation the dendrite regrowth might have taken less than 2.5 years? An important aspect is that I have medical sensitivities to steroids and other drugs, but treatment with glatiramir acetate seemed to slow enough of the autoimmune that healing could occur. B) manage symptoms and deal with the muscle wasting of being bedridden for so long. Especially since I have extreme reactions to animal products now I take extra supplementation of various neurotransmitters. Through this trial error, I have found off the counter solutions that I can give many pub med or other reputable references for each substance and what it does. C) swelling, allergy, and exacerbation, what do do and how to avoid it. I got a good tropical antiinflamatory for the migraines. (Luckily) I eventually found the pathway in full that was effected by my type of nerve damage, and it can be evidenced in other pathologies as well. These are new developments in these fields. I was 3 years keto begore science released had studies of these treatments. most of my dosages I have had to adjust as eventually the studies were catching up with me, and the doses were supposed to be more, sometimes even triple, what I has been taking. Since I switched to the studied doses, I have seen quicker gains. NAC, taurine, also only the correct amount of hydration, D3, methylated bs, etc But GABA itself has been extremely important, hands stopped freezing up. The first day I took GABA I took only 200mg orally, is a very small amount. I literally felt like an iceberg was melting. Luckily, I had already adressed stress and trauma, and the emotional release was just vague and teary occasionally. I cried occasionally first week of taking only 200 mg of GABA because I felt a random release. If one had untreated trauma I would hope that they should not be left alone, and possibly treat it as it arises (EFT etc). My hands stopped freezing up, which was good. Some people take faba to sleep or relax, to me it's stimulating because I can finally move, its like being untethered. I could try to walk further if I unfreeze my legs, because with my condition, when the dendrites have damage,They are the ones that make the gaba. So stretching makes my legs tighten. A well person would call me lazy, but I was a lifelong sports person and aerobic instructor in the 90s, stayed very active and strong until this ailment. Healthy people think exercise helps. I'm not saying it doesn't, I'm saying that I take a lot of things while trying to walk, so that my legs don't freeze up on me. Exercising without caring for my electrolytes, gaba, neurotransmitters and Krebs cycle, to name a few, would be disasterous. It would be a like a fish tangling more and more in a net until its completely paralyzed. That's what nerve damage can feel like, but that's just the movement. I still also address neurotransmitter precursors on that pathway, as well as other systems and cycles. It's a learning process exacerbated by the fact that my esophagus and stomach take limited volume with much effort. Regardless, I feel very grateful that God is with me, forging a new path. For whatever reason I have outlined my processes and discoveries here, to get the forward thinking medical professionals to start in a helpful place. Please please remove bias about age and ability. I have sometimes trouble speaking due to what nerves show damage . It's not a sign of alzheimers or dementia, my brain gets smarter everyday, I can do multidimensional math and matrix math. If there's a weather system moving in or other similar stressor, I may or may not be able to say the things I'm doing but I could still do the smart things and also my brain gets continuously smarter, My speech gets slurred some days but my brain is getting smarter (and possibly younger?) every minute. .Especially on this corrective diet. Speech is not necessarily diagnostic of my brain and state being, its only related to others being able to understand me... so if you see me at an emergency room and my speech is slurred, please don't "Narcan" me, I'm totally sober, do a blood test if you want to prove it. I probably just need some intravenous hydration to start.... Please have a wonderful blessed day, and please be considerate of these simple nerve disorders that are so easily rectified . If I had known these things sooner I would have prevented so much damage... Thank you so much for caring about people , and trying to do the best for them.
Disclaimer, please get your health advice from your medical practionner I have not taken more than 1000mg orally of gaba at à time i dont know what it would do, I take my gaba throughout the day as needed. That may or may notvwork for you dépendent on your conditions and medications. Please seek medical advice Hope you are having a good day Hope there are more medical people like these helpful ones😊
Thank you for this💜. I have ptsd and I it's a brain injury. My wires have been disrupted in how they communicate in my brain! I have worked to rewire it via emdr& other methods of bilateral stimulation in conjunction with therapy. I absolutely hate when it's only referred to as a mental illness.
Psych can also be Neuro, and probably shouldn't be considered separately. There are many Neuropsych illnesses. Dementias are one type (Alzheimer's, Parkinson's, Lewy Body, Vascular, Fronto temporal and any combination of those). Mood disorders like Depression can greatly resemble Dementias and are often misdiagnosed in patients who are older.
I’ve had chronic migraines since I was a kid, depression and PTSD that I was able to manage with therapy until the grave’s disease hit. Not only did that turn me floridly manic for 4 months, but I lost a significant amount of cognitive functioning that never returned. Finally ended up seeking a psychiatrist when I was so depressed that I couldn’t think and return to the life I once had. Eventually ended up in the psych ward because psych meds do wacky things to my brain. I had a 9 month migraine from hell that started the day I was admitted, but because I was a psych patient they refused to believe that triptans had stopped working years earlier. I got imitrex two days in a row and it never touched the migraine. Several months later after I started having vision blackouts, I was finally diagnosed with intracranial hypertension. When that’s not stable, my mental health gets worse. Newest neuro-ophth says it has something to do with brain inflammation. But the newest psychiatrist won’t even listen to my history of brain and cognitive impairment in considering a diagnosis. Decided that having been disabled for 15 years is really a sign that I have dependent personality disorder and I’m asking for treatment and accommodations I don’t really need. And got fired pretty quickly. Seriously people, talk to each other or at least listen to the crazy but not that crazy person!
Hey, love your vids. Current rads residents. Do your psychs use fmri often? At my institution it's the opinion of ours that it's pretty meh in all but the most extreme cases. Neurosurg loves it though. For complex regional pain, there are actually some bone density changes we can see on xr/ ct that can suggest the dx. Autonomic dysfunction and altered blood flow leads to a change in bone density. Pretty cool stuff!!
I'm just a med student but I feel like this relates to the relatively arbitrary nature of what is determined as normal or non-pathological function - and how much of psychiatric illnesses such as anxiety and depression are "Normal" brains at a biochemical level, but are only experiencing pathological symptoms due to socioeconomic pressures. Can someone's depression really only be reduced to biological function, or is it a natural consequence of a Normal brain being exposed to constant chasing tigers - of financial stress, of stress over the future, of stress over the world. I mean you could do a rough analogy to asbestos, you treat your patient's lungs, the symptoms and pathology they experience, but still they go back into the asbestos mine. Does it really serve someone's depression (caused mainly due to extreme environmental factors), if you treat it at a neurological or biochemical levels - reducing it to lab results and chemicals.
You can acknowledge that asbestos causes shortness of breath due to lung damage on a molecular level AND still agree the best solution is to change the environment. Social issues causes biologic issues and vice versa. Within the bio/psycho/social model, pathology and cure can come from any of the three
@@itspresro Yeah absolutely that make sense. I just feel sometimes like doctors (speaking specifically in Australia where I'm from) are actively encouraged to be apolitical - not acknowledging the systemic structures that ultimately cause pathology, only treating the symptoms for some kind of cure. From what I've seen, this sorta comes as cursing out admin or management or EPIC or any other system which is just the manifestation of wider societal pressures that ultimately harm patients. And doctors are actively discouraged from making political stances or encouraging any sorta change at a higher level - of the root causes. And so it just resorts to treating the shortness of breath, with doctors being actively discouraged from talking about why the patient needs to be sent into the asbestos mine in the first place.
Super interesting conversation. Also today I learned that asbestos is naturally occurring. I had no idea. I thought it was synthetic and made in a factory. I should have known given how old it is. Anyway, I don't think that the two are mutually exclusive. There's definitely an importance in being reductionist sometimes because it helps us find biomarkers and medications to fix the sequelae of the bad environment. You still fix and treat the burn (and the downstream electrolyte abnormalities that it caused) even while acknowledging that the burn wouldn't be there if they weren't in a fire. Could the burn doctor advocate for more fire safety protocols? Absolutely they should and could but I'm also glad that some of them are spending time figuring out what the best artificial graft technology is or researching medications that can improve skin healing. Both are important but I recognize with your asbestos example we should have more control over it than a random fire. Equating the forces that cause depression and anxiety to a fire is a bit apologist because we can stop a lot of the socio-economic pressures if we put our minds to it. I will still say though that some people who live perfectly happy wonderful lives are anxious and depressed. Not everyone has to have a trigger that everyone would consider adequate to cause depression. There are people who are neurochemically more or less resilient. For example, I'm a happy resident LOL I actually like my job and life. 😊 People in the same residency program as me can't necessarily say the same haha. 😢
Exactly this. A major function of psychiatry in a miserable capitalist society where if you do not succeed you’re out on the street - a terrifying possibility - is to subdue people who are the collateral of all the abuse we are facing. So those who have experienced sexism, unhappy marriages, abusive childhoods, racism, military violence, homophobia, rape, etc. are all medicated with the hope that their productivity in the workforce will increase and thus the productivity of the nation. It’s far more important that we tackle the root causes rather than making the whole field of psychiatry about bandaids for the end consequences of abuse and injustice. That’s why we have the highest rates of depression ever yet most access to the drugs!
A lot of my time with patients is spent normalizing grief, anxiety, depression, etc. as human in nature & depathologizing their reported symptoms. (Instead of I'm broken, something's wrong with me, try my body is sending a message, maybe I could listen, understand and act on that.) To the original point in the video, we have been conditioned to think of humans as a collection of concrete/ finite systems leading to a 'stay in your lane' mentality that often causes more harm than good. We can focus on what we know/ specialize in with respect to a system only if we keep in mind that a human being is a unified whole - psychological (cognitive and emotional), physiological, spiritual aspects can't truly be separated. We're dynamic and ALL systems interact with and effect the other. Research findings on the efficacy of positive thought, meditation, prayer, or the placebo/nocebo effects make sense when we consider that a thought, at its most basic level, is a series of electrochemical reactions resulting in action potentials/ neural firing culminating in physiological, cognitive, emotional reactions. It's not rocket science, but simultaneously more simple and more complex.
I agree-neurological and physiological. Addiction is now being treated by targeted brain ultrasound; Obsessive compulsive-DBS; Depression and anxiety-TMS; Schizophrenia-keto diet,etc. Previously lobotomies…
Terrific insights Gabor Mate covers this thoroughly in The Myth of Normal re stress HPA Psycho Neuro immunology History of psychiatry reveals this in syphilis Tx pre and post penicillin Most exciting and frustrating area of medicine!
Wow ok……I’m actually gearing up to take my MCAT here in the states next year. I’ve been working as a social worker/licensed therapist for the past 14 years. I’m interested into going into Psych. But after watching this, should I go into NEURO?? Any advice would be great. I’m Polynesian and I see in my community that there’s a great need for MH services. Culturally I’ve been given privileges and blessings that enable me to serve my community. Thank you so much for this wonderful topic of discussion
Psychiatry and Neurology are medical specialties and you will need an MD degree which requires pre med courses. Psychology is a social science, and depending what jurisdiction you are in you will need either a master's degree or Ph'd to practise.
A conversation I've had many times throughout training. It's always interesting to hear everyone's two cents on it. Thanks for putting yours out there!
I'm afraid , historically, the profession of psychiatry as only treated the symptoms of disorders such as schizophrenia ( with antipsychotics) Instead of treating the etiology of the disoder.The Schizophrenia Psychosis Action Alliance is attempting to reclassify psychotic disorders as a neurological illness.The diagnosis of schizophrenia would no longer have such a stigma as a "mental health" disorder. In addition, there would be rehabitation services like OT after a psychotic issue.In the cases of other neurological diseases ( stroke, Parkinson's...) there are rehabilitation services such as PT, OT.....Disappointing to see individuals suffer with psychotic episodes (many homeless in San Francisco...) who would never choose that lifestyle in their pre-psychotic health. Once psychotic most individuals are not capable of making rational decisions to accept treatment.(Especially if paranoid) There needs to be more advocacy for this population. Thank you for your video.
Thank you so much for this dialogue I would like to add I am a family nurse practitioner and see mental health issues daily.I see patients who see psychiatry who will provide cognitive behavioral therapy ( essentially reframing things in a positive way.) Even though CBT is important for everyone individuals after psychosis need cognitive remediation therapy ( working on memory, attention, visual spatial skills...) This is the therapy stroke patients receive and I believe those suffering from psychosis would receive if reclassified as a neurological illness.Again thank you for this video & respectful dialogue.Lets advocate for this underserved population.
So, this is coming from a CompSci/Computational Cognitive Science guy. People at MIT CBMM (Center for Brains, Minds, and Machines) and many others have been trying to draw that line between the brain and the mind. This question is extremely hard, and there is a legitimate possibility that we cannot answer it, ever. The line boils down to the definition of consciousness in the end. If we accept the existence of qualia, then the self-referential nature of our "conscious experience" makes it impossible to come up with causal explanations. Under this argument, if there are psychiatric disorders that relate to conscious experience, then neuroscience can only detect the correlates of this and can never treat the cause. Even if you accept the fact that consciousness is due to neurological activity and there is only the brain, it is possible that it happens at the level of microtubules, not the neuronal level, which again makes it impossible for us to do causal inference because of quantum effects at that level. TLDR; There is a strong possibility that the Mind is inexplicable (causally) by empirical science. Even it is, there is a strong possibility that we still cannot do causal inference due to quantum effects. In those cases, neurology will not be the whole answer for mental health.
Regardless Neurology will never be the sole answer for mental health. When I was assert that all consciousness is due to neurologic activity I was essentially refuting mind body dualism
It's because despite what some people might say, nobody really understands what's different about the brains of people with bipolar disorder which makes them have that condition
I have struggled with the disorder myself since I was a teenager. I have family history of relatives with mental illness. Seems like most people who are diagnosed bipolar have the same situation. But the best scientists in the world haven't yet been able to establish a certain aspect of the brain that causes it. It would certainly make things easier for people if they could easily identify it
Same here,but there's many researches going on in the UK,where they can do all the examination for you .There's one going on until April, at King's London college. You need to be in a depressive episode to take part in.Try to Google it,there's one going on in Edinburgh.
My favorite experience this year was seeing a neurologist react to getting a patient with conversion disorder. The split between neurology and psychiatry likely has more to do in the fact that people who enjoy treating ‘neurological’ disorders hate treating ‘psychiatric’ disorders and vice versa
They are, but mainly in cellular level... And that is why there is a term called neuroscience actually, as an umbrella discipline that includes neuropsychiatric diseases too. Most psychiatric disorders have a genetic component in the form of, mainly but not exclusively, variation in neurotransmitter transporter and/or enzyme involved in production, or break down of a given signalling molecule expression. In organism level, differences in single nucleotide level genetic expression of, say 5-hydroxytryptamine receptor, could make you more susceptible to, for example mood swings. Population level studies almost everyday are shedding light on this aspect of neuro/psychiatric diseases. Cheers from Oxford Uni, Dept. of Pharmacology!
The neurology board is governed by “The American Board of Psychiatry and Neurology”. Notice how it’s not Neurology and Psychiatry despite N being before P
YES - etiological exploration is *so* needed in mental health. I think it's very much both historical lived experiences (especially in childhood) influencing emotional well-being as well as potential pathophysiological imbalances, which may have a neuro or other etiology. For example, there's growing evidence for the gut-brain connection & microbiome influence on mental health, so depression/anxiety etc could have a partially GI root cause. I think there's an urgent need to shift *all* specialities towards a more holistic paradigm.
The problem with this is that: 1. Psychiatric syndromes are purely based off symptoms and most of them likely have multiple different causes. For example things like hypothyroidism can present as a depression, so it's not unlikely depression has hundreds/thousands of aetiologies 2. Even if specific aetiologies existed diagnosing them would be extremely hard. When someone has dynamic ST elevation on an ECG with chest pain, 90% of the time you can find a lesion in a coronary artery. In psychiatry, what does it mean to find subtle changes on fMRI in someone with subtle behavioural changes over decades eventually manifesting as depression? It's never going to be as easy as other fields because there's just too many unknown factors and the system is too complex.
One could argue that this separation is from philosophy and the idea of mind-body dualism, popularized by Descartes. I would say that separating the two is more harmful than good. Why draw a line, when clearly these things are related and may not even be separate at all? A more holistic approach is obviously needed. Medicine likes to think of itself as an empirical science, but there is a lot of philosophy and ideology in how things are approached. This is something people should be cognizant of and seek to improve.
Depression (the diagnosis) is the diagnosis given when all other known causes of depression (the symptom) have been excluded - Normal TFTs, normal Hb, normal HbA1c, normal electrolytes, no neurological red flags etc.
What does a "re-merger" of psychiatry and neurology look like, practically speaking? Currently if one wants to do "both," they have to become a double-boarded neuropsychiatrist. Do you think a "soft merger" would be a little more realistic, where training programs for psych simply begin to incorporate more neuroanatomy/neuroscience and neurology training programs incorporate more behavioral management?
Soft merger is more realistic. Currently psychiatrist do 2 months of neuro in their 4 years of psych and neurologists do one month of psych. I think you could use a lot of electives and other rotations to split the training more evenly, like 70/30 (% of time training) rather than 95/5
Neuropsychiatry is a rapidly growing field for this very reason. Our ability to image psychiatric disorders and more importantly, to intervene in them with various neurotechnologies is expanding by leaps and bounds.
It's not just mental illnesses that are mislabeled or rather, left in limbo... Seems to be most types of chronic disease. The Drs want to treat each individual symptom by itself (and usually by a different specialist altogether 🙄) but there's no Dr to treat the entire person as a whole. This has been my lifelong struggle with metabolic disease featuring neuromuscular presentation. Even the Cleveland clinic couldn't decide whether to send me to the nerve disease clinic or the muscular disease clinic - I was also sent to neurology/rheumatology where they both refused to treat me - claiming to not have the proper knowledge 😅 So, now I have one Dr treating my seizures, one Dr treating my muscle spasms, another that treats my pain completely separately (even though it's directly related to the muscle spasms/nerve damage 🤦)... None of it makes sense. Feels like they just want to squeeze as much money from my insurance companies while doing the least amount of work possible
It also makes me wonder about what end points we are interested in as physicians and as a society; the focus on physiology instead of subjective outcomes. How much money has been spent on lipitor to lower LDL levels with only minimal changes in quality of life for large patient cohorts? We use epinephrine in cardiac arrest because we understand the physiology that leads to ROSC, but study after study shows no improvements in neurological status at discharge.
I was diagnosed with conversion disorder in 2004 in the ER after having an episode with extreme tremors and passing out in the church. I heard the resident say that he thinks it's conversion disorder bc the MIR and ultrasound came back normal. The interesting part the doctors never told me what conversion is?? I was sent to many psychiatrist and neurologist in which I was sent back and forth for years. thank you sir for making my medical nightmare make sense. These doctors need to work together for better results for patients. patients are tired of hearing ' it's ALL IN YOUR HEAD 🗣️.
@@itspresro it is in mine as well, just by Oliver Sacks' books, who in my humble opinion is the best specimen of a hybrid neurologist/psychiatrist. Let's just put it thus: you psych guys are software engineers and neuro geeks are hardware ones. 🤔
I’ve realized the boundaries in medical fields are defined by what the doctors in each field can *do*, and not the diseases themselves. It’s why consultants always get annoyed and ask “what do you want us to do, cath/admit/scope/operate/etc?” Same distinction between neuro and psych. Neurologists diagnose what they think are neurological diseases and treat with neuro meds, and psychiatrists diagnose what they think are psych diseases and treat with psych meds. Obviously oversimplified but I think that’s really what separates any two areas of medicine.
It's funny that people with epilepsy experience symptoms like mania, that is present with - mentally sick people with Bipolar Disorder. Yet only those with bipolar are called mentally ill. How does medication for seizures works also for people with BD? Like lamotrigine?
I tell every one of my patients- what is the difference between schizophrenia and Parkinsons? How can you say it isn't a physical issue, but prescribe a med? Should we treat it with therapy and medication? Do we treat hypertension with medication and lifestyle? I could relate many examples....
I'm studying neuroscience at university, and I agree with the ideal of psychiatry and neurology merging. I used to think, "well if everything has a physical cause, then why not just find the physical/chemical causes of all disorders - psychology must be redundant." But, even with growing technology and computational power, we are very far from explaining all disorders from a purely biological perspective. Some disorders have so many potential genes that are implicated in it (schizophrenia), that studying it from a psychological perspective is more useful for now. Psychology will never "cure" these disorders, but it is key for understanding and managing them. Similarly, the metric of the subjective improvement in a patient is always going to be important, and will go hand in hand with quantifiable, objective measures of improvement. Neurological disorders of the brain are more complex since they can sometimes affect our perception of the world. The best way to measure improvement would be to ask the patient (i.e., subjective report). However, I definitely agree the two disciplines should work more closely together. While they are not ever going to become the same field, some disorders need both perspectives for effective treatment. Until our understanding is sufficient (which I don't think will be in the near future), there is a place for a psychiatric view of neurological disorders.
I stopped pursuing my psych degree because of all the red tape that stopped a person from truly having a well rounded work up on what could be going on. I argued that between psych (symptoms), neurological (spinal/brain), OBGYN/Urology (hormone), dietitian (nutrition) etc... The village needs to come together to truly understand and succeed in "mental illness." Young Children get "treated" but you are not allowed to "treat" the parents that have (in many cases but not all) created the environment for the mental instability. Creating an even more unbalanced situation for the child with opposition and no true choices they can make to change their living situation. They learn to cope and adjust to others. This can essentially worsen their state of mind and being. 😢😢 Along with not being able to get the proper work ups to narrow down it's cause with other specialties. I've seen Children with behavioral issues go to the Chiropractor to correct their spine and their behavior changes. Messages throughout are able to get through properly. No medications needed! Yet, other specialties would tell parents that isn't possible and dangerous for them. 😒
Because we neurologist in our fuctional autism love things that make sense, our focus is on functional systems an the deduction of how the disfuction of said systems manifest clinicaly. The psichiatric patient requieres another type of expertise; one more based en soft skills and intuition. In the end the medical specialities are not olnly based on the organ or system, but also in the kind of patient you are able to help.
Because know ne takes the time too listen and look at patients history family history, mental health is all of our health i was greatly discriminated and had to ho through legal issues because of mental illness later to be also sarcoidosis
I love this channel but have a strong difference of an opinion here. I am no medical professional, just a high school chemistry teacher who also has the misfortune of suffering from fairly treatment-resistant depression (at least to the 5 different kinds of medication I have tried over the course of my 30 years). I was pre-med in college, and when younger deeply believed in the biological explanations of behavior and mental illness. Today, not so much. Of course we are made of atoms and cells, so of course there is a biological cause of behavior (and mental illness). We have known this for a long time from things like strokes, and more recent developments like fMRI. However, I believe the “true” etiology of mental illness is much more psychological, cultural, environmental, and dare I say, “spiritual.” The word “etiology” can be tricky. The etiology of COPD is exposure to aerosolized irritants and mutagens. The etiology of this exposure is cigarette and nicotine addiction. The etiology to this? Psychological addiction and cultural availability. For the purposes of mental illness, despite how little we know now and how ineffective many treatments are, I am fully willing to purchase that some day in the future we will know how every sodium gate contributes to every ripple of anxiety as we become more precise in our understanding. And, thank god for some of the treatments cooked up by psychiatry in the last 100 years, I have a very close relative who would likely not be alive today without invega. However, most people I know (myself deeply included) do not have some crippling form of schizophrenia or daily suicidal depression. People seem to live with a constant unease and disquiet, manifesting for some more anxiously, while others are more disconnected and numb. Some live, quite brightly and seemingly joyfully, but with full addiction to substances, or their work, or sex and love, or external markers of status and productivity. Happy on a hamster wheel and strangers to themselves. It seems, and I believe the literature backs me up, that for these quietly despairing masses, psychiatry and the heft of discoveries in neuroscience and NIH funding have done little help. I do know some people, of this ilk, who claim that their medications (mainly SSRIs) have saved their lives. I know far more who live in ambivalence to these treatments, constantly rotating on and off, doubting their efficacy, still depressed, and suffering side-effects that often seem equal to their afflictions. There seems to be a disconnect between the shrinks I know and their total confidence in better living through chemistry, and their patients, who may be alleviated through the medical treatments but seems stuck in depressive loops, arising temporarily, only to be subsumed again when life circumstances negatively shift, as life is ought to do. Talk therapy similarly seems like a useful tool for some, but often fails to manifest in real, enduring change. For myself, I have found meditation and plant medicine (psychedelics like ayahuasca taken ceremonially with much respect and humility) by far the most effective things, this is in comparison to the various kinds of medication, talk therapies, exercise, and major lifestyle changes I have attempted. Despite all our wisdom and research dollars, and the destigmatization of psychiatry, we are a deeply depressed society. While suicide rates in the US have only slightly increased in the last 20 years, if we look at raw rates of depression, and other indicators of mental unwellness, like anxiety, ADHD, addiction, overdose, obesity, or loneliness, it seems the philosophy of care we have been operating on is inadequate to stem the suffering of this society. This isn’t psychiatry's fault, I often feel we are not raising our children right. Not to fault parents either, there are a host of cultural, economic, and technological changes that have left us feeling more inadequate, competitive, narcissistic, and severed from human communities, the natural world, and our own sense of the mystic or spiritual. I’m really not trying to make any “unscientific” claims by using these words, hoping only to convey that there are some experiences, and ways of being, that involve a different part of ourselves than our very logical, intelligent, discerning minds that solve problems and make decisions. There is a way to be that involves surrendering more to the circumstances of our lives (both material AND psychological) and stop trying to control everything. I think this is where true freedom resides. Ultimately all our treatments, including even meditation and psychedelics, I believe are just tools to teach us how better to live with and forgive ourselves. World religions have perpetrated grotesquely horrible acts, but still, there is real wisdom, of a different sort, in the thousands of years humans have lived, and learned about what life is before fMRIs and iphones. This can be communicated spiritually by llamas, rabbis, and imams, through myth and legend and spiritual practice like prayer or meditation. Depression is a biological condition, sure, we are biological entities. But it is a deeply spiritual affliction, relating more to our ways of being, our childhoods, our families, our egos, our perspectives, than, say, hypertension or a ring avulsion. I think we need modalities of treatment that embrace this, rather than continuing to pour money searching endlessly for some magical serotonin analogue, or training our healers to medicalize what is fundamentally a human experience.
DUDE TOTALLY. as someone who was sent to neuro for aytipical migraines (I was told,) and in remission from bipolar type 1 (psych) but told by neuro that it was a high correlation... yeah. As someone who's history of mania and psychosis is TREATED with an anti-convulsant most often used by neuro...YEAH. Soon, it'll just be about HEALTH and specialties will be reclassified into more cohesive systems, so students of certain health systems in the human form can also know more about environmental factors impacting those systems, too. Like, literally living with imdoor mold toxins can dramatically change behavior (neuro? psych? ...epidemiology??). Just sayin!
The big mistake was taking social and environmental problems, and peoples responses to these problems, as illnesses and diseases. Basically none of the issues Psychiatry has ownership of are issues they can actually resolve in the restricted environment of an office setting. The medications, at best, sedate people into oblivion to the point where their baseline worries about how terrible their life and trauma are become a jumbled mess. Why solve social issues when we can just sedate everyone who complains?
As a psychiatrist, I can safely say that psychiatric disorders are considered neurologic and vice versa. You may not know this if you are not in the medical field, but there is a sub-specialty in psychiatry known as 'consult-liaison psychiatry' that deals specifically with this. Psychiatrists work hand-in-hand with neurologists and other medical specialties. We get consulted all the time in a hospital setting especially at the geriatric wards where dementia is commonplace.. The reasons for the split are historical, philosophical, and sociopolitical. Sigmund Freud was one of the pioneers of modern-day psychiatry, and he was a neurologist. He discovered that there were neurological symptoms that could not be explained organically, hence started psychoanalysis. It was simply an alternative model to describe what we could not understand then. We now know that Freud was not entirely accurate on many things, but the ship has sailed and he inspired many modern WESTERN concepts of mental illness. There are entirely different explanatory models in non-western cultures. Philosophically speaking, every psychiatrist is asked to ponder De Cartes's mind-body dualism dilemma during their training. The quote "I think, therefore I am" has led thinkers to believe that the mind is different from regular matter like atoms. Again, although we now accept that the mind and body are linked, science still cannot explain what exactly consciousness (aka the mind) is or where it comes from. This makes it difficult to bridge the gap entirely. Finally, neurologists (and other medical specialists) and psychiatrists fulfil very different societal roles. Psychiatrists are state agents, and we enforce the laws of the state (unless we work in the private sector), not unlike your average judge or police officer. We are prone to abuse ranging from the pathologizing of homosexuality to the political killings and eugenics in the Soviet Union. Most doctors prefer to be politically neutral, but this responsibility is thrust upon psychiatrists. After all, society needs someone to tell them what is considered 'normal' human behaviour versus what is considered 'insanity'. The DSM has evolved five times in less than a century, primarily due to changing views, stigma, and lobbying, even though the treatments have remained similar. The idea of 'trauma', for example, was hugely politicized, which has gone on to spur an entire industry of self-help gurus and pseudoscientific treatments, except 'trauma' cannot be measured scientifically and is entirely subject to the mind and its perceptions. Psychiatrists are at the forefront of medical ethics because some of the most gnarly medical scenarios are psychiatric. Although I don't speak for every psychiatrist, I can safely say that I am not interested in turf wars with any other medical specialty. The weight of my profession is heavy enough, and I'd appreciate someone carrying it for me. We help each other out as colleagues, but sometimes, we disagree, which is a normal and healthy part of healthcare. I hope this helps. Spread the word.
Yay, a young psychiatrist! Your kind are thin on the ground, my friend. Also, I blame Freud... Just like everyone else. The first actual brain surgery was performed in 1884 (if you don't count drilling holes in the skull to balance the humours), which was right around the time Freud was gaining popularity. His theories were much.. sexier, if you will, and got all the press. Also, neuroscience had their heyday in the 90s, and it seems like they have intentionally separated themselves from psychiatry, which has been seen (by some, not me of course) as a crack science. So neuroscience, I think, wanted to say "oh no, we're real scientists, not like those psychiatrists ::hiss::!"
I believe they're considered a culmination of neurological issues along with many other contributeing factors. So if u have a neurological disorder it can definitely contribute to psychiatric disorders. But having a neurological disorder doesn't necessarily mean you have a psychiatric disorder.
Ich habe das auch noch nie so recht verstanden. Verhält sich nicht neurologie zu psychologie wie physik zu Chemie? Klar, quantenprozesse sind kompliziert, genauso wie neuronale Netze, aber diese netze sind doch die Grundlage jedes psychologischen prozesses. Psychologie ist doch eigentlich nur der Versuch, noch ohne die notwendige technologie, die neuronalen netze zu verstehen und durch annahmen und näherungen trotzdem Menschen zu helfen. Grüße
My personal experience has been that women and gender minorities may be more prone to tactile hallucinations in relationship to the spectrum of psychoses.
OK I think I need to go to medical school where this is the kind of stuff people are thinking about all the time....because ordinary conversation just isn't it.
I spent the last 1.5 years trying different doses of antidepressant/anti-anxiety medications, making little to no progress on them. Finally, the psych PA tells me I probably have a personality disorder and that's why medications aren't helping, and that therapy is the only real treatment. I feel like they did any sort of functional imaging on the brain this would have been discovered sooner. It's baffling that psychiatry doesn't image the organ it is treating.
You can’t detect a personality disorder on a scan. That’s pseudoscience. Please also be careful because psychiatrists and other people working in mental health commonly diagnose people as having personality disorders when they fail to respond to the drugs, which most people don’t have a full response to anyway. NNT for an SSRI is about 9 for full recovery and 4.5 for partial recovery, IIRC.
@@user-xy4ff5yp7b Do you have a source for this? I'm genuinely interested, it conflicts with research I've down which showed benefit only in cases of severe depression.
@@itspresro Dualism and Physicalism aren't the only theories of mind. You know that, don’t be naive. Idealism is as epistemically reasonable as Physicalism, at least on the level of how many ontological categories it postulates, and I would argue even more so. I encourage you to at least theoretically consider an Idealistic viewpoint, where the brain is simply a representation of what's going on in our minds, and nothing more, and where medications are foreign bits of consciousness, entering and interfering with our field of consciousness, and the metabolic changes we see, are once again, just representations. The reason I argue idealism has more explanatory power, not only metaphysically, but pragmatically for psychiatry as well, is because it can better and more simply explain things like the placebo effect, psychedelic experiences, and NDEs/SEs.
Yeah, I think psychiatric disorders are all ultimately neurologic. We just don't know enough things yet to localize and manage. The phenomenological approach from psych will have to do for now.
In 300 year it could be (how I think it should be) shared training for two- three years and then it splits off into fellowships (neuro already has some of the most I think)
It sure is hard to not feel smarter than your provider and suffer communication breakdownswhen you're a mere BS in bio and try to operate on this simple principle of mind=brain. Each professional guild has a somewhat vested interet in keeping these things separate - if only from an intellectual fragility standpoint. Add to that being a brown middle aged woman and I am pretty sure it's impossible for many of them to even hear the words coming out my mouth let alone appreciate them. sighhhh so this is the age of information huh
Hi I’m Preston I’m a psychiatry resident in the US. You should have a healthy dose of skepticism for my content regardless of my credentials tho. If I ever use facts or pull stats I will include sources as much as I can remember
Preston, love your videos, but I think you're missing an important point here. Psychiatric disorders ARE and CAN be considered neurologic. Interventional psychiatrists and the people completing neurology residencies and BNNP fellowship training think about things differently than say a patient presenting with general anxiety disorder and seeing their psychiatrist.
