Introduction: Understanding the Links Between Neuroscience and Behavior

[[{"type":"media","view_mode":"media_crop","fid":"23947","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4666532534707","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2005","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 224px; height: 109px; float: right; margin: 2px 4px;","title":" ","typeof":"foaf:Image"}}]]Behavioral Neurology & Neuropsychiatry (BN & NP) is a medical specialty “committed to better understanding links between neuroscience and behavior and to the care of individuals with neurologically based behavioral disturbances.”¹ Neuropsychiatrists specialize in the assessment and treatment of the cognitive, emotional, and behavioral symptoms from disorders such as traumatic brain injury, epilepsy, Parkinson disease, and Alzheimer disease. The CME article in this issue and 4 articles in this Special Report are devoted to several important topics in this field.

In their CME article, John J. Campbell III, MD, and Annya Tisher, MD, describe subtypes of deficits in executive functioning. They suggest a practical guide to its assessment, including pertinent history, and easy to perform office evaluations.

Hal S. Wortzel, MD, offers a balanced perspective on a “hot topic” that we are frequently asked about-chronic traumatic encephalopathy (CTE)-and urges caution before prematurely concluding that we know more than what we do about the prevalence and risk factors for this disorder. The most accurate perspectives about CTE may not be gleaned from reports in the media.

Marco Mula, MD, PhD, reviews the evaluation and treatment of patients with epilepsy. His article highlights that patients with epilepsy not only have seizures, but they also experience depression, affective instability, and psychosis that significantly impair quality of life.

In patients with Parkinson disease, neuropsychiatric problems often develop in addition to the “movement” disorder. Psychosis is the most difficult to treat, since medications used to improve movements may produce psychosis, and antipsychotic medications can exacerbate parkinsonian symptoms. Howard D. Weiss, MD, and Sam Adler, MD, focus on psychosis in Parkinson disease and Parkinson-related disorders (eg, dementia with Lewy bodies, Parkinson disease dementia). They provide a review of the pros and cons of treatment and discuss what makes a patient with these disorders susceptible to psychosis.

There are several ways to assess a patient’s cognitive status, ranging from brief screening tests to comprehensive neuropsychological evaluations. C. Thomas Gualtieri, MD, provides his perspective on the potential value of computerized cognitive testing.

Although excellent, these articles offer only a brief exposure to the issues that we confront. The American Neuropsychiatric Association² is an exciting multidisciplinary organization devoted to this specialty. In 2004, the United Council for Neurologic Subspecialties,¹ an organization composed of all of the major neurology organizations, recognized the subspecialty status of BN & NP.³ Since 2006, 23 accredited fellowship training programs have emerged, and we now have 321 diplomates who have passed the certification examination. After May 2014, you will be required to complete a fellowship training program in order to take the examination. Thus, if you wish to be certified, and are not currently a fellow, you must apply now to take the next examination offered in October 2014.

There are many excellent journals (eg, Journal of Neuropsychiatry and Clinical Neurosciences and Journal of Neurosurgery, Neurology, and Psychiatry) and books (eg, Behavioral Neurology & Neuropsychiatry,⁴ Management of Adults With Traumatic Brain Injury,⁵ Textbook of Traumatic Brain Injury,⁶ and Textbook of Neuropsychiatry and Clinical Neurosciences⁷) that provide clinically relevant information to help you treat your patients with these disorders. I hope that these Special Report articles are practical and informative and stimulate your interest in our field.

Disclosures:

Dr Silver is Clinical Professor in the department of dsychiatry at the NYU Medical Center in New York, Past President and Fellow of the American Neuropsychiatric Association, and Diplomate in Behavioral Neurology & Neuropsychiatry. He reports no conflicts of interest concerning the subject matter of this Special Report.

References:

1. American Neuropsychiatric Association. http://www.anpaonline.org. Accessed March 5, 2014.

2. United Council for Neurologic Subspecialties. http://www.ucns.org. Accessed March 5, 2014.

3. Silver JM. Behavioral neurology and neuropsychiatry is a subspecialty. J Neuropsychiatry Clin Neurosci. 2006;18:146-148.

4. Arciniegas DB, Anderson CA, Filley CM, eds. Behavioral Neurology & Neuropsychiatry. Cambridge, UK: Cambridge University Press; 2013.

5. Arciniegas DB, Zasler ND, Vanderploeg RD, Jaffee MS. Management of Adults With Traumatic Brain Injury. Washington, DC: American Psychiatric Publishing; 2013.

6. Silver JM, McAllister TW, Yudofsky SC, eds. Textbook of Traumatic Brain Injury. 2nd ed. Washington, DC: American Psychiatric Publishing; 2011.

7. Yudofsky SC, Hales RE, eds. Textbook of Neuropsychiatry and Clinical Neurosciences. 5th ed. Washington, DC: American Psychiatric Publishing; 2008.