A Career in Neuropsychiatry

"We are currently experiencing a renaissance in neuropsychiatry" - Niruj Agrawal

Neuropsychiatry (also known as behavioral neurology) incorporates both neurology and psychiatry in the diagnosing of illnesses. Neuropsychiatry is not an entirely new concept; it emerged in the nineteenth century and has blossomed along with advancing technology. Researchers are beginning to recognize the fact that neurology and psychiatry have many similarities; in both fields, patients display symptoms that are often linked to neurological dysfunctions. Some patients who display psychiatric symptoms are in reality suffering from a neurological illness. Often times, symptoms from neurological conditions such as dementia, head injury, and brain tumors, are mistaken for psychological illnesses. In this situation, the patient might be referred to a therapist when they should be getting immediate medical care. On the other hand, a psychological illness is mistaken for a physical disease and a patient who is in a very fragile mental state is put through numerous unnecessary physical examinations.

Neuroimaging techniques have enabled psychiatric and medical researchers to locate specific problematic areas in the brain that are responsible for mental and physical illness. New emerging neuroimaging tools, such as optical imaging machines, allow clinical researchers to observe and track specific changes in chemical function and structure in relation to a patient's behavior. MRI's, EEGs and MEGs have been used to track illnesses in medical hospitals for years, but neuroimaging researchers are in need of new perspectives and are eager to hear, specifically, those of clinical psychiatrists. Most clinical psychiatrists, however, have little to no education on how to use neuroimaging tools. A neuropsychiatrist would be the one to provide the skills needed to incorporate these techniques into clinical research. Unfortunately, the field of neuropsychiatry does not yet have a universally established collegiate curriculum.

The only true neuropsychiatry program at this time is at The Royal College of Psychiatrists in London. Organizations such as the American Neuropsychiatric Association (ANPA), and the United Council for Neurologic Subspecialties collaborate with leading psychological and neurological associations in gaining funds for the growth of the field of neuropsychiatry/behavioral neurology. The UCNS has created a list of objectives that must be covered and courses that need be completed to become a qualified neuropsychiatrist. These courses focus on clinical training, research, assessment, diagnosis and treatment.

The Occupational Outlook Handbook: Physicians and Surgeons, explains that before specializing in neuropsychiatry, a student must earn an M.D. in psychiatry. This involves the average four years of undergraduate school, four years of medical school, and up to eight years of internship and residency.. Courses required for all medical students include: anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing medicine. Students interested in practicing neuropsychiatry should participate in additional courses such as: structural and functional neuroanatomy, neurobehavioral assessment, neuropsychiatric syndromes, neuropsychopharmacology, and research methodology. Extensive knowledge of literature pertaining to these subjects is also crucial. Towards the end of medical school, students are required to observe varying types of practicing physicians at work; a student studying psychiatry would focus on clinical observation. Intense residency experience is the final requirement needed in order to receive a license to practice medicine in the United States. At this point, a qualified individual can decide whether they want board certification in a specialty. If a person is interested in practicing clinical neuropsychiatry, for example, he or she has to complete a specialty final examination immediately following residency.

A career in any field of medicine means working long irregular hours; one third of full time physicians worked 60 hours or more a week in 2004. It is becoming more common for physicians to practice in groups or health care organizations that provide back up coverage and more time off. Many physicians start their career in debt from medical school tuition; however, they can expect to eventually have a very substantial salary. After one year of employment in a specialized field of psychiatry, compensation added up to an average of $180,000 in 2004.

A career in neuropsychiatry does not look to be an easy one. A successful, practicing neuropsychiatrist must have developed expertise in all areas of clinical assessment including: diagnostics, test administration (neurological, cognitive and electrophysiological), and counseling. Clinician-scientists are often forced to act as fundraisers so as to support research and education within emerging fields such as neuropsychiatry. Development in these areas is continuously stunted by changes in health-care funding and diminishing research budgets. With all that said, it must be understood that the possibilities in this field enormously outnumber the hurdles.