Training in neuropsychiatry: is it time to reintegrate into mainstream psychiatry?

Alex J Mitchell,Niruj Agrawal

doi:10.1192/pb.29.10.361

Abstract

In 1988, Yorke highlighted a growing separation between training in psychoanalysis and neuroscience. With recent developments in medical education in the UK, now is an ideal time to review the position on neuropsychiatric training. In the subsequent 17 years there has been a tremendous increase in

Highlights

In the UK, neuropsychiatry as a discipline is much misunderstood
It should be of no surprise that neuropsychiatry overlaps hugely with liaison psychiatry, old age psychiatry, learning disability and clinical neurology/neuroscience
Current deficiencies in neuropsychiatry training. Given this striking impact of neuropsychiatric conditions on the population, what are the recommendations for neuropsychiatric services from the Royal College of Psychiatrists in the UK? The college recommends 0.1 whole time equivalents for a Mental Illness Needs Indexweighted population of 100 000 aged 18-64 years (Royal College of Psychiatrists, 2001)

Summary

Importance of training in neuropsychiatry

In the UK, neuropsychiatry as a discipline is much misunderstood. It has gained the reputation of being highly esoteric and exotic, something away from the mainstream clinical practice. From an epidemiological perspective approximately 10 million people across the UK have a neurological condition and nearly 2 million care for someone either with a chronic neurological or mental health problem (Neurological Alliance, 2003) Of all disorders these have the greatest impact on the quality of life of both patients and carers (Sprangers et al, 2000; Arnold et al, 2004; Agrawal & Mitchell, 2005). From a clinical perspective up to half of new referrals to neurology clinics meet criteria for a neuropsychiatric diagnosis (Carson et al, 2000a; Fink et al, 2003) and an additional third have medically unexplained symptoms (Carson et al, 2000b) It should be of no surprise that neuropsychiatry overlaps hugely with liaison psychiatry, old age psychiatry, learning disability and clinical neurology/neuroscience. It is the psychiatric complications of neurological disease that cause most distress and burden to patients and their carers (Teri, 1997; Aarsland et al, 1999; Coen et al, 1999; Chipchase & Lincoln, 2001)

Current deficiencies in neuropsychiatry training

Recommendations for training in neuropsychiatry

Postgraduate training

Higher specialist training in neuropsychiatry

Findings

Conclusions