A neuroscience perspective on incidental imaging findings and diagnostic and therapeutic silos.

Abstract

Traditionally, psychiatry and clinical psychology have understood behavior as separate from brain function and have avoided referring neurobehavioral patients, particularly those carrying a Diagnostic Statistical Manual (DSM) diagnosis, for additional studies such as neuroimaging. Current psychiatric training programs continue to permit this dichotomous misunderstanding by neglecting neuroscience courses that elucidate the relationship between behavior and brain function. Psychiatrists and psychologists have learned to interpret and manage behavior without a clear picture of brain physiology and function (1). Moreover, with the exception of some neuropsychologists, most psychologists and psychiatrists neglect standard neurological exams and only consider behavioral symptoms. When it concerns neurobehavioral disorders, psychiatric and psychological standards of practice disregard objective imaging for assessing brain function and primarily reserve this technique for research. This omission confirms a meager understanding of brain physiology and function and their influences on behavior. Therefore, psychological and psychiatric theories have become stuck in unsubstantiated data. For example, the DSM defines disorders purely from observational data. To be fair, those diagnostic theories evolved during an era that lacked the necessary technology for objective brain evaluation, yet despite neuro-imaging and neuro-scientific advances, clinical psychology and psychiatry training programs still disregard introducing neuroscience to their students trained to be clinicians. Consequently, this omission has caused competition and isolation between clinical specialties and the development of practical and intellectual silos. Didactic programs that ignore neuroscience perspectives hinder clinical mental health students by denying them a holistic view of the patient. This incomplete picture begins the process of pseudo-specialization, a process that has little to do with developing optimal person centered therapeutics for the patient. In an ideal world, all behavioral fields would pursue a common neuroscientific language and education that permits seamless understanding of biology, behavior, sociology, and pathology.