Neuropsychiatry - Linking the Mind and Matter

Some ailments - especially in the elderly - that have been previously thought to be psychiatric disturbances are actually illnesses with an organic cause. Alzheimer's disease, for example, we know now is caused by actual changes in the brain: lesions called "senile plaques" develop and nerve fibers become tangled. Prior to the early 1900's, Parkinson's disease was thought to be a mental disease.

It is generally believed that about 15 percent of people over the age of 65 have a psychiatric disease, and it is generally accepted that about 25 percent of people over the age of 75 have an organic mental impairment. Furthermore, many neurological disorders have psychiatric symptoms.

Dementia, a disease caused by structural changes within the brain, typically presents itself with short-term memory loss (those things most recently learned are forgotten); concurrently, depression is noticed. As the dementia progresses, the most outward signs might be the person's agitation and anti-social behavior.

Similarly, delirium - which can be caused by head injury, stroke, high fever, drug reaction or prolonged stress or exhaustion - can be marked by hallucinations, delusions and panic which are symptoms common in schizophrenia.

The field of neuropsychiatry bridges the boundaries of the two separate fields of neurology and psychiatry. Basic in neuropsychiatry is the link between psychopathology and brain defects. Neuropsychiatry reduces the stigma long associated with psychiatric symptoms such as delusions, hallucinations, mood changes and bizarre behavior.

"The elderly are more prone to neuropsychiatric disorders," says Dr. Stuart C. Yudofsky, chairman of the department of psychiatry and behavioral sciences at Baylor College of Medicine, and co-editor of The American Psychiatric Press Textbook of Neuropsychiatry, the most read text on the subject. "They tend to be on several medications, and there may well be medical disorders such as cardiovascular disease. So you have to look at all aspects - mood, organic problems, memory, sleep patterns.

"The advantage of neuropsychiatry is the acknowledgement that there are few boundaries between some illnesses that we may previously have wanted to categorize as either psychiatric or neurologic," he says.

- ROGER WIDMEYER

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©2006 Texas Medical Center

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