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Redalyc.What Is Neuropsychiatry? Revista Colombiana de Psiquiatría ISSN: 0034-7450 [email protected] Asociación Colombiana de Psiquiatría Colombia Berríos, Germán E. What is Neuropsychiatry? Revista Colombiana de Psiquiatría, vol. XXXVI, núm. 1, 2007, pp. 9-14 Asociación Colombiana de Psiquiatría Bogotá, D.C., Colombia Available in: http://www.redalyc.org/articulo.oa?id=80615418002 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative What is Neuropsychiatry? ArtículosArtículos What is Neuropsychiatry?* Germán E. Berríos1 Abstract Introduction: Neuropsychiatry is based on social and scientifi c narratives developed since the XIX century in order to understand and deal with “mental symptoms” found in the context of neurological diseases. Objective: This is an effort to answer this question: Are mental symptoms in neurology the same ones as those found in general psychiatry? Method: Analysis of the diverse symptoms found in some diseases so that the neuropsychiatrist can develop a current and refi ned descriptive psychopathology without trying to “naturalize” these symptoms in a simplistic way, reducing them to putative biological markers. Conclusions: Frequently, neurological symptoms are not psychiatric, for instance, hallucinations in severe melancholia are only superfi cially similar to “organic” hallucinations in Parkinson’s disease. In this sense, the possibility that some symptoms are not only functional copies of other symptoms (behavioral phenocopies) should be seriously considered, since such differences could have important therapeutic implications. Keywords: Neurology, psychiatry, psychopathology, nervous system diseases. Título: ¿Qué es la neuropsiquiatría? Resumen Introducción: la neuropsiquiatría está basada en narrativas sociales y científi cas que se de- sarrollaron desde el siglo XIX para entender y manejar los “síntomas mentales” encontrados en el contexto de la enfermedad neurológica. Objetivo: intentar responder a la pregunta ¿los síntomas mentales de la neurología son los “mismos” que aquellos encontrados en la psiquia- tría general? Método: análisis de algunos de los diversos síntomas evidenciados en algunas enfermedades para que el neuropsiquiatra desarrolle una psicopatología descriptiva refi nada y actualizada sobre éstas y no trate de “naturalizar” de manera simplista los síntomas, redu- ciéndolos a marcadores biológicos putativos. Conclusión: se sugiere que con frecuencia los síntomas neurológicos no son psiquiátricos, por ejemplo, las alucinaciones de la melancolía grave son sólo superfi cialmente similares a las alucinaciones “orgánicas” de la enfermedad de Parkinson. En este sentido, la posibilidad de que algunos síntomas sean únicamente copias funcionales de otros síntomas (fenocopias conductuales) debe ser considerada seriamente, pues tales diferencias pueden tener importantes implicaciones terapéuticas. Palabras clave: neurología, psiquiatría, psicopatología, enfermedades del sistema nervioso. * The Editors express their gratitude to the Asociación Peruana de Déficit de Atención. 1 M. D. and philosopher of Universidad de San Marcos, Perú. Psychiatrist of Oxford Uni- versity. Teacher of Epistemology of Psychiatry in University of Cambridge and director of Neuropsychiatry, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom. Rev. Colomb. Psiquiat., vol. XXXVI, Suplemento No. 1 / 2007 9 S Berríos G. The Word and its Referents The Context Names help or hinder in all walks of Whether there is ‘neuropsychiatry’ life, particularly when they behave in a particular country, and whether as drifting signifi ers. For example, it has a broad or narrow meaning since it first appeared in fin de will depend, to a large extent, upon siècle France as a double-barre- the structure of its health services lled word (‘neuro-psychiatrie’), the and on the quality of the rela- meaning of ‘neuropsychiatry’ has tionship between neurology and repeatedly changed. By the inter- psychiatry. bellum period, and now converted in ‘neuropsychiatrie’, it referred to This is interesting and ironical as the clinical doings of medics trained both specialisms are new. Alienism both in neurology and psychiatry. (the original name for psychiatry) By 1918, the word appeared in the and neurology developed by the Anglo-Saxon to name a form of: 1830s and 1860s respectively as the “Psychiatry which relates mental or direct result of the fragmentation of emotional disturbance to disordered the old grand Cullean category of brain function”. My own defi nition ‘Neurosis’, and of the broadening is narrower: “discipline that deals of the notion of ‘lesion’ which by with the psychiatric complications the end of the century indistinctly of neurological disease”. On the referred to failures and solutions of other hand, American usage is continuity in putative ‘structural’, broader and tantamount to “biolo- ‘physiological’ or ‘psychological’ gical psychiatry”. domains. Currently, and fi rst and fore most In Germany and France, the for- “neuropsychiatry” refers to overla- mation of alienists included neuro- pping clinical disciplines sha ring logical training and this facilitated the belief that mental symptoms the use of the term ‘neuropsychia- are produced at disorde red brain trist’. In Great Britain, on the other sites. It is also used to ma ke a hand, and due to important socio- professional claim vis-à-vis rival economic reasons (which there is views of mental disorder such as no space to discuss), neurology psychoanalysis. Lastly, it creates and psychiatry had fully diverged a social and economic space whe- by the 1880s. This means that for rein like-minded researchers safely more than 90 years there was little congregate to usufruct their fashio- communication between the two nable ideas. and that during the 1970s ‘neurop- sychiatry’ had to be reinvented. It is not altogether surprising that those 10 S Rev. Colomb. Psiquiat., vol. XXXVI, Suplemento No. 1 / 2007 What is Neuropsychiatry? of us who were involved in such etc. do so on account of a variety re-creation had both neurological of mechanisms. On the one hand, and psychiatric training. This also there are the causal aetiologies. explains why to this day we do not have in the UK a unifi ed defi nition As my work on musical hallu- of neuropsychiatry. cinations and irritability states in Huntington’s disease patients The American defi nition has become showed years ago, a direct link popular and this has encouraged can be demonstrated between psychiatrists holding a biological symptom and brain site or CAG orientation au outrance to call repeat, respectively. On the other themselves ‘neuropsychiatrists’. hand, neurological patients have Others (like myself) continue defi - reasons for their symptoms, that is, ning neuropsychiatry in a narrow neurological diseases happen to real way. The former can be found in all people and hence have semantic venues of psychiatric care, the latter contexts. This adds an entire new work in general hospitals and do a layer of meaning, hermeneutics and great deal of ‘neuro-liaison’ work (I therapeutic response. Patients may introduced this term in a lecture show behavioural copies of mental given in Wellington, New Zealand symptoms and these do not have some years ago). the same brain representation as the conventional symptoms. Neuropsychiatry Neuropsychiatric clinical work ge- in Cambridge, UK nerates clinical templates which can be translated into research In keeping with the above, my own paradigms. There is nothing new ‘neuropsychiatric’ clinical service in this and each university will is organize on the narrow view use a different rhetoric to sell what that neuropsychiatry is a branch they do. Some sell themselves as of psychiatry that deals with the top-to-bottom research institutions mental complications of neurolo- (i.e. grand ideas governing action), gical disease. I do not believe that others, are bottom-up ones (piece- such practice should in any way be meal, low level research converging interpreted as a statement about upwards). This is the case of the the nature of mental disorders in Cambridge University Neuroscience general. Even within the confi nes Campus (the largest in the UK) whi- of my narrow defi nition, it seems ch includes research institutes and clear that neurological patients who a neuroimaging suite with inter alia develop delusions, hallucinations, 12 MRI magnets. My Neuropsychia- obsessions, sadness, anxiety, etc., try Service (6 clinics) is linked with Rev. Colomb. Psiquiat., vol. XXXVI, Suplemento No. 1 / 2007 11 S Berríos G. most of the research centres in the nied by psychiatric appurtenances. campus. For example, the PD Clinic The psychiatric component of some, provides patients for the large pro- like Parkinson’s disease, Multiple jects on receptor expression, fMRI, Sclerosis, Huntington’s disease, pharmacology, and neurosurgery. Wilson’s disease, Binswanger’s disease, etc. has been known for a The HD Clinic is held in the ‘Bra- long time, and in some cases the in Repair Centre’ where about 12 severity and management of that patients who have already received component is more important for fetal cell implants in their caudate social re-entry than any motor or nuclei are followed up at 3 months sensory disorder. In other cases, intervals. The Traumatic Brain Da- however, such as the taupathies, mage clinic
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