The disciplines of neurology and psychiatry have been inextricably intertwined since their origins in the 19th century. In fact, once upon a time little distinction existed between the two; hence the origin of the American Board of Psychiatry and Neurology. As medical knowledge advanced in the mid-20th century, practice of the two specialties diverged. With psychiatry dominated by the psychoanalytic theories of Sigmund Freud, his disciples, and later rivals, and with psychoses such as schizophrenia "explained" by a variety of psychodynamic theories, the fields sometimes seemed at odds with one another.
Recent decades, however, have produced an explosion of neuroscience, which has moved the fields ever closer to one another. Better understanding of neurochemistry, including elucidation of neurotransmitters and their receptors, insights gained from advances in neuroimaging, and shared use of many neuropharmacological agents, have once again strengthened the bond between the two specialties.
Better understanding of psychiatry is critically important for practicing neurologists. An inordinate number of patients presenting to neurologists have complaints that defy a neuroanatomical or neurophysiological explanation and fall under the broad rubric of somatoform disorders. Psychiatric symptoms, such as depression and anxiety, are extremely common among patients with neurological disorders, especially those with a chronic course. Neurologists do their patients a severe disservice if they do not recognize these symptoms and address them properly. Cognitive disorders, exemplified in this issue by delirium, interest both neurologists and psychiatrists alike. For these and other reasons, CONTINUUM readers should welcome this issue on psychiatry for neurologists. We are indebted to Dr James Bourgeois and his colleagues in the Psychiatry Department at the University of California, Davis, for having enthusiastically embraced the assignment. Dr Bourgeois has also provided additional introductory material, which follows this preface.
I also remind readers to solidify their gains by tackling the multiple-choice questions, ably crafted for this issue by Drs Steven Lewis and Joanne Lynn. Dr James Russell has added a provocative discussion of issues related to psychiatric status in the imminently dying patient in the newly featured ethics section of CONTINUUM. I am confident that after reading this issue of CONTINUUM neurologists will not only have enhanced their skills, but will also have reaffirmed their kinship with our psychiatric colleagues.
Aaron E. Miller, MD, FAAN