why study neurology?

James Teo james at teoth.fsnet.co.uk
Sun Jan 13 10:53:11 EST 2002


On Sun, 13 Jan 2002 04:22:23 +0000, Nick Medford
<nick at hermit0.demon.co.uk> wrote:
>>Also, I feel that effective treatments that I can give
>>patients (cognitive disorders or not) are more realistically available
>>in my lifetime for neurology than in psychiatry. 
>
>This statement surprises me though- treatments in psychiatry are far from
>ideal but at least one can usually do *something*, which is often not the
>case in neurology, at the present time anyway. This difference was
>another thing I found refreshing when I switched.

Oops, you caught me there. Yeah, you are right now that I think back
on it: motor neurone disease vs. depression . I suppose what I don't
like about is that psychiatry feels like groping in the dark. Not a
fair criticism since modern psychiatry is a constantly changing field.
Probably more a reflection of myself than psychiatry.

>>And at heart, I am
>>more comfortable approaching things biologically rather than
>>psychologically, although that does not mean I would totally discard
>>one for the other. Not to forget that the most common diseases of the
>>nervous system (strokes, Alzheimer's) have a distinct cognitive
>>component.
>>
>>However, I do think that the subspecialty of neuropsychology might
>>take off 
>
>Neuropsychology is a branch of psychology, not medicine. Sorry if that
>seems like nit-picking, but it's a very well established field in its own
>right and its practitioners would probably be surprised to read that "it
>might take off". The doyenne of UK neuropsychology is Prof. Elizabeth
>Warrington, who has been pushing the field forward for some 40 years
>now.

Yeah, I know. Hey, I'm from Oxford, the place is reeking with PPPists
and Warrington Rooms. I meant it in the context of medicine and
clinical practice since this is the premise of the thread.
Neuropsychologists at this moment in time is not a clinical
subspecialty. 

>>on its own (cognitologists or something like that) in the
>>next 1-2 decades if progress in neuroscience keeps going, and attract
>>people from neurology and psychiatry (rather like how the A&E
>>specialty was born and now attracts both surgeons and medics).
>
>It is my hope that this will happen, but there will need to be some
>flexibility on the part of the Royal Colleges. Currently neuropsychiatry is
>not  a recognised subspecialty and the only way to practise it is to train
>in psychiatry (prior experience in general medicine and neurology is
>obviously an asset) and try to get jobs that have the right "flavour" as one
>moves up the ladder. There are very few places that have bona fide
>neuropsych departments. 

I once attended a seminar by Prof Anthony Gnolan (spelling?) and he
spent most of it ranting about the myopia of british neurologists.
Well, with time (and some Susan Greenfields) hopefully things will
change.

>Similarly, if coming at it from the neurology angle, one needs to train
>within general neurology and try to get the appropriate placements and
>hook up with an interested research supervisor.
>
>I believe the situation is very different in the US where there are
>dedicated training schemes in both neuropsych and behavioural
>neurology.

Interesting. I never realised there was a difference. I wonder why?
Heading of for my neurology elective in US next week, and will eagerly
anticipate this different environment.

>>Basic background, so that you know how much salt to take with my above
>>views: Final year medical student, 
>>trained at Oxford and Royal Free.
>
>Well good luck for finals, I presume they're coming up in summer. I
>trained at Charing Cross. I worked at the Free some years ago, excellent
>neuro dept. there (nice part of town too... ). 

And filled with psychiatrists. ;-)
I remember our paediatrics department. Paediatrics at the Royal Free
is decent but was in the midst of turmoil during my attachment with
all that scandal on Wakefield, we didn't get much formal teaching on
it (although loads of clinical exposure). However, as the Royal Free
has a Child Psychiatry department with lots of free time, we got 3
tutorials a week on Child Psychiatry. Very amusing as that department
was filled with Continental Freudists, unlike the Adult Psychiatry
department which had a more Anglo-Saxon flavour.

>Anyway I see that no-one has taken up any of the gauntlets in my
>previous post, so I await replies with interest. 

They don't call this newsgroup BIOnet.neuroscience for nothing.
Lots of computational and bench people here methinks.

I'll just add that I find it curious that a lot of schizophrenic
patients have marked religious fervour during their attacks. Very
interesting and I wonder if there is any epidemiological study looking
into which is cause and which is effect.




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