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As we enter the next millennium, neurology and psychiatry are trying to define their future roles.1-5 In this context, we review the initially common, then divergent relationship between neurology and psychiatry. We trace the emergence of neuroscience over the last two decades that has informed both disciplines. We illustrate those recent advances that have fundamentally changed brain science, requiring the abandonment of several central dogmas while compelling improvement in reciprocal relationships. Based on these changes, we call for the introduction of new training curricula and accreditation criteria for both neurology and psychiatry and recommend more effective collaborations with neuropsychology, cognitive neuroscience, and neurosurgery.
Brief history.
The scientific study of the brain and its relationship to complex behaviors began with Gall in the early 19th century.6 The anatomic studies of aphasia by Broca in 1861 and Wernicke in 1874 persuaded a number of scientists that the brain was the seat of intellectual competence as well as the potential site of mental problems.6 During the last half of the 19th century through World War II, figures from the ranks of European academia who engaged in the study of higher order mental dysfunction included Meynert, Liepmann, Pick, Oppenheim, Charcot, Korsakoff, von Monakow, Babinski, Janet, Freud, Jackson, Bleuler, Kraepelin, Bonhoeffer, and Alzheimer. All were considered to be neuropsychiatrists, interested in both neurology and psychiatry. Many held dual academic posts in neurology and psychiatry.6 Neuropathology arose from efforts, primarily based in Germany, to correlate changes in brain structure with mental illness.6
By the 1930s, many neurologic syndromes had been clinically defined and their neuropathologic bases identified.6 The elementary neurologic examination was refined with objective, consistent, and reproducible findings. Diagnostic tests such as CSF analysis and instruments such as the EEG were in place.2,6 These developments, as …
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