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What is a Neuropsychiatrist?

Stephen M. Raffle, M.D.

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Curriculum Vitae

By Stephen M. Raffle, M.D.

A Neuropsychiatrist is a psychiatrist with special training in Neuropsychiatry, the medical specialty which diagnoses and treats mental disorders attributed to identifiable physical causation, for example a Traumatic Brain Injury (TBI).  (On this website see TBIs and Other Dementias).  A Neuropsychiatrist is not a neurologist.

In previous times a neuropsychiatrist assumed the role of both neurologist and psychiatrist but that hybridization officially ended in 1969 when the American Board of Psychiatry and Neurology (ABPN) ceased Board Certification in Neuropsychiatry.

In the days of my father‑in‑law, Professor Ibrahim Chehrazi, M.D., an esteemed neuropsychiatrist, all psychiatrists were trained as neuropsychiatrists by neurologists and psychiatrists.  Sigmund Freud, M.D., was more a neurologist by training but also had training in behavioral neurology/neuropsychiatry.  In the days of each of them, “pure” behaviorists were the non‑medical practitioners of psychology.

The training of a psychiatrist includes specific training in neurology just as the training of a neurologist includes training in psychiatry.  When I was taking my Boards, the written Board Exam in Psychiatry by the American Board of Psychiatry and Neurology (ABPN), was 2/3 Psychiatry and 1/3 Neurology and included two one‑hour oral exams, one in Psychiatry and one in Neurology, by a panel of 3 specialists in each specialty.

When I began practice in 1970, no specialty of Neuropsychiatry existed.  If a psychiatrist wanted to include in his practice the treatment of mental disorders attributable to the nervous system, because his training permitted it, he did so.  Some psychiatrists also obtained additional training in neurology, sat for the neurology Boards and became double‑Boarded in neurology and psychiatry, and were thus a psychiatrist and a neurologist.  But it was not, and is not necessary to do so to be a Neuropsychiatrist.

Here, an example may clarify the distinction: assume a person has an identifiable traumatic brain injury.  The neurologist focuses on the diagnosis and treatment of the organic nervous system pathology and the neuropsychiatrist is concerned with the diagnosis and treatment of the behavioral changes in the patient’s mind caused by the physical injury or the creation or reawakening of non‑organic psychopathology caused by the brain injury.

Insofar as I have diagnosed and treated many patients who have either had mental disorders caused by organic nervous system pathology, or have had non‑organic psychopathology created or reawakened by organic brain injury, I consider myself a neuropsychiatrist by training and experience.

 

Additional suggested reading:

YudofskyS.C., & Hales E.H. (2002).  “Neuropsychiatry and the Future of Psychiatry and Neurology.”  American Journal of Psychiatry, 159(8), 1261‑1264

Berrios G.E., Marková I.S. (2002) “The Concept of Neuropsychiatry.  A Historical Overview.”  Journal of Psychosomatic Research 53 : 629‑638

Price, B.H., Adams, R.D., & Coyle, J.T. (2000).  “Neurology and Psychiatry: Closing the Great Divide.”  Neurology, 54(1), 8‑14

Martin, J.B. (2002).  “The Integration of Neurology, Psychiatry, and Neuroscience in the 21st Century.”  American Journal of Psychiatry, 159(5), 695‑704

Kendler, K.S. (2005).  “Toward a Philosophical Structure for Psychiatry.”  American Journal of Psychiatry, 162, 433‑440

DISCLAIMER: The information provided on this website does not constitute legal or medical advice. Readers should consult with their own legal counsel or physician for the most current information and to obtain professional legal advice or medical advice before acting on any of the information presented.

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