Epilepsy & Behavior 40 (2014) 102
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor Between neurology and psychiatry To the Editor First of all, I would like to congratulate you for the 15th anniversary of Epilepsy & Behavior (E&B)! I think that the fact that the Journal existed for 15 years eloquently confirms the importance of this edition. Now, I would like to present my own thoughts about the scientific significance of the problems that are regularly presented and discussed on the pages of E&B. I would like to commence with remembrance of my early practice when I was a young psychiatrist and frequently asked myself about the principal discrepancies between neurology and psychiatry. After many years of practice in psychiatry, it seemed clear to me that the basic method (the so-called general psychopathology) psychiatrists use in their everyday practice is based upon the search of connections between different symptoms. Moreover, an experienced psychiatrist is able to predict the appearance of other symptoms after he or she has already found and qualified some symptoms. The mutual tropism between some symptoms helps to depict the syndrome that is regarded as the principal element in psychopathology. Here, it must be stressed that the diagnostic process in the mind of a psychiatrist is quite similar to a correlation matrix which can be depicted as positive or as negative connections between different signs. Nevertheless, the cause of symptoms in terms of their cerebral substrate as a rule remains beyond the scope of the diagnostic process, and an experienced psychiatrist is able to suggest the organic or endogenous origin of disorder regardless of the localization of pathological process responsible for this disorder. In neurology, quite the contrary, the search for a cerebral substrate, explaining the appearance of different symptoms, represents the principal task, and such approach can be achieved if an experienced neurologist properly used the method of topical diagnostics. In other words, the principal aim of neurological assessment is focused on the finding of pathological locus, and some additional objective methods, i.e., MRI, CT, and EEG, may be effectively used for this purpose. At first glance, a definite gap seems to exist between two disciplines that can cause misunderstanding between neurology and psychiatry. However, there are some disorders and diseases that present an object of study both for neurologists and for psychiatrists at the same time. Epilepsy seems to represent such an example, and generally speaking for many years, it was the so-called apple of discord between two
http://dx.doi.org/10.1016/j.yebeh.2014.09.004 1525-5050/© 2014 Elsevier Inc. All rights reserved.
disciplines because neurologists and psychiatrists used their specific algorithms for the diagnostics of epilepsy. The situation has become much better as a new intermediate discipline cementing neurology and psychiatry has appeared, which has been called behavioral neurology or neuropsychiatry. Since this time, the unique possibility has appeared to explain all forms of behavior in neurological patients from the point of view of concrete local dysfunction of certain brain regions. However, from my point of view, the circle of tasks of neuropsychiatry is much broader, and its final aim may be designed as an attempt to explain the origin of all psychopathological symptoms and syndromes (including affective symptoms, delusion, hallucinations, catatonic symptoms, and many others) based upon data of local destruction or dysfunction of certain brain regions. Here, it should be added that the journal E&B during its 15 years of existence helped to form the unique neuropsychiatric approach to assessment and understanding of multifarious forms of behavior in epilepsy. The journal has helped to create and establish the modes of diagnostics and treatment of patients with epilepsy. Speaking for myself, I may say that I was really enchanted by the ideas of Professor Norman Geschwind whom I have known from the pages of E&B. It seems that the so-called présence d'esprite of Norman Geschwind may be continuously perceived upon reading the articles in E&B. In conclusion, I would like to express my sincere gratitude to the Editor-in-Chief, Professor Steven Schachter, for the publication of several works from our department. For myself and my coauthors, publication in E&B is very prestigious and signifies the quality of our performed work. Conflict of interest The authors declare that there are no conflicts of interest.
Vladimir V. Kalinin Department of Brain Organic Disorders and Epilepsy, Moscow Research Institute of Psychiatry of Ministry of Healthcare, Russia
Contents lists available at ScienceDirect
Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh
Letter to the Editor Between neurology and psychiatry To the Editor First of all, I would like to congratulate you for the 15th anniversary of Epilepsy & Behavior (E&B)! I think that the fact that the Journal existed for 15 years eloquently confirms the importance of this edition. Now, I would like to present my own thoughts about the scientific significance of the problems that are regularly presented and discussed on the pages of E&B. I would like to commence with remembrance of my early practice when I was a young psychiatrist and frequently asked myself about the principal discrepancies between neurology and psychiatry. After many years of practice in psychiatry, it seemed clear to me that the basic method (the so-called general psychopathology) psychiatrists use in their everyday practice is based upon the search of connections between different symptoms. Moreover, an experienced psychiatrist is able to predict the appearance of other symptoms after he or she has already found and qualified some symptoms. The mutual tropism between some symptoms helps to depict the syndrome that is regarded as the principal element in psychopathology. Here, it must be stressed that the diagnostic process in the mind of a psychiatrist is quite similar to a correlation matrix which can be depicted as positive or as negative connections between different signs. Nevertheless, the cause of symptoms in terms of their cerebral substrate as a rule remains beyond the scope of the diagnostic process, and an experienced psychiatrist is able to suggest the organic or endogenous origin of disorder regardless of the localization of pathological process responsible for this disorder. In neurology, quite the contrary, the search for a cerebral substrate, explaining the appearance of different symptoms, represents the principal task, and such approach can be achieved if an experienced neurologist properly used the method of topical diagnostics. In other words, the principal aim of neurological assessment is focused on the finding of pathological locus, and some additional objective methods, i.e., MRI, CT, and EEG, may be effectively used for this purpose. At first glance, a definite gap seems to exist between two disciplines that can cause misunderstanding between neurology and psychiatry. However, there are some disorders and diseases that present an object of study both for neurologists and for psychiatrists at the same time. Epilepsy seems to represent such an example, and generally speaking for many years, it was the so-called apple of discord between two
http://dx.doi.org/10.1016/j.yebeh.2014.09.004 1525-5050/© 2014 Elsevier Inc. All rights reserved.
disciplines because neurologists and psychiatrists used their specific algorithms for the diagnostics of epilepsy. The situation has become much better as a new intermediate discipline cementing neurology and psychiatry has appeared, which has been called behavioral neurology or neuropsychiatry. Since this time, the unique possibility has appeared to explain all forms of behavior in neurological patients from the point of view of concrete local dysfunction of certain brain regions. However, from my point of view, the circle of tasks of neuropsychiatry is much broader, and its final aim may be designed as an attempt to explain the origin of all psychopathological symptoms and syndromes (including affective symptoms, delusion, hallucinations, catatonic symptoms, and many others) based upon data of local destruction or dysfunction of certain brain regions. Here, it should be added that the journal E&B during its 15 years of existence helped to form the unique neuropsychiatric approach to assessment and understanding of multifarious forms of behavior in epilepsy. The journal has helped to create and establish the modes of diagnostics and treatment of patients with epilepsy. Speaking for myself, I may say that I was really enchanted by the ideas of Professor Norman Geschwind whom I have known from the pages of E&B. It seems that the so-called présence d'esprite of Norman Geschwind may be continuously perceived upon reading the articles in E&B. In conclusion, I would like to express my sincere gratitude to the Editor-in-Chief, Professor Steven Schachter, for the publication of several works from our department. For myself and my coauthors, publication in E&B is very prestigious and signifies the quality of our performed work. Conflict of interest The authors declare that there are no conflicts of interest.
Vladimir V. Kalinin Department of Brain Organic Disorders and Epilepsy, Moscow Research Institute of Psychiatry of Ministry of Healthcare, Russia
