Neurology and schizophrenia

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NeuroKlitch

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MS3 here . I've been struggling for the past weeks and months trying to make a decision between neurology and psychiatry . My question is whether a neurologist with a great deal of interest in schizophrenia would be able to set up a practice in which he would also treat them in addition to the regular neurology patients. I am completely fascinated by schizophrenia/schizoaffective disorder and has been one of the main things that have been holding me back from committing myself completely to neurology. While In neurology there is not one single pathology that I am deeply as fascinated with, I love the brain , neuroanatomy , and the puzzle of correlating brain lesions/regions with pt presentation. and Any advice ? Has anyone else went through this same struggle.


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You would need fellowship training because neurology residency will not prepare you to manage schizophrenic patients long-term in the clinic. That's not to say it is impossible, but you will always be something of an outsider. Also, you have to think about how you would want your practice to be structured. You aren't going to see four dizzy patients, a migraine, and a chronic schizophrenic in the clinic on Monday morning. In private practice, the referral patterns would send all those patients to a psychiatry clinic. In academia, you would be a subspecialist who would probably have a joint appointment in psychiatry and see those patients through the psychiatry clinic. Imagine being a clinic administrator and trying to synchronize PROMs data collection practices on 95% neurology patients and 5% schizophrenic patients. Not going to happen. Clinic intake procedures would be very different as well.

I know several neurology trained MD-PhD scientists who specialize in schizophrenia and tic disorders. But they see very few patients. They study these diseases. You see a lot more overlap in neurodegenerative disorders with behavioral neurologists who manage neuropsychiatric components and manifestations.
 
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MS3 here . I've been struggling for the past weeks and months trying to make a decision between neurology and psychiatry . My question is whether a neurologist with a great deal of interest in schizophrenia would be able to set up a practice in which he would also treat them in addition to the regular neurology patients. I am completely fascinated by schizophrenia/schizoaffective disorder and has been one of the main things that have been holding me back from committing myself completely to neurology. While In neurology there is not one single pathology that I am deeply as fascinated with, I love the brain , neuroanatomy , and the puzzle of correlating brain lesions/regions with pt presentation. and Any advice ? Has anyone else went through this same struggle.


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You may want to think about a combined Neurology/Psychiatry residency which takes 6 years to complete. There are only a few programs in the country but it would allow you to be able to care for neuro and psych patients. The few people who I know who are trained in both tend to have a unique approach to both patient populations. They can manage a lot of the psychiatric diseases seen in neurodegenerative disorders while dealing with the neurological consequences of treatment for certain psychiatric disorders (tardive dyskinesia, neuroleptic-induced parkinsonism).
 
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MS3 here . I've been struggling for the past weeks and months trying to make a decision between neurology and psychiatry . My question is whether a neurologist with a great deal of interest in schizophrenia would be able to set up a practice in which he would also treat them in addition to the regular neurology patients. I am completely fascinated by schizophrenia/schizoaffective disorder and has been one of the main things that have been holding me back from committing myself completely to neurology. While In neurology there is not one single pathology that I am deeply as fascinated with, I love the brain , neuroanatomy , and the puzzle of correlating brain lesions/regions with pt presentation. and Any advice ? Has anyone else went through this same struggle.


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If you love hard data and imaging, then psychiatry is not for you. As a psychiatrist, I think I can safely say that neurology is still light-years ahead of psychiatry in terms of objective laboratory data that can be used in treatment. Also, if you love procedures, then do neurology over psychiatry.

If you don't mind not doing procedures, are ok with dealing in shades of grey rather than black/white diagnosis, and are OK with managing mood and anxiety disorders in addition to psychosis, then choose psychiatry. Talk to as many people as you can, and you'll figure it out. Good luck!
 
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I would second what Jimmy B said. I'm in a combined Neurology/Psychiatry residency, and recommend you look into it further. Feel free to shoot me a message if you have any questions!

-A
 
While In neurology there is not one single pathology that I am deeply as fascinated with, I love the brain , neuroanatomy , and the puzzle of correlating brain lesions/regions with pt presentation.
You sound like a neuropsychiatrist/behavioral neurologist in the making, which means either psychiatry residency + neuropsychiatry fellowship or neurology residency + behavioral neurology fellowship. To choose your original point (i.e. psychiatry vs. neurology residency), heed PistolPete's advice on choosing between hard data, imaging and procedures in neurology vs. more ambiguity and more interpersonal focus in psychiatry. Also consider which "bread and butter" cases you would rather see for a large part of your practice: eg, migraines and strokes vs. mood disorders and suicidality. Consider which aspects of each specialty you can't do without. Consider which aspects of each specialty you dislike and whether you see yourself dealing with those for years to come.

Combined neuro/psych residency sounds like a good option to look into, though there are very few programs/training positions unfortunately and you have to be fairly competitive/well-connected/have very well-defined career goals to get into one of those.

Alternatively, if you're interested in neuroanatomy, neuroimaging and functional correlations, you can do neuroimaging based psychiatry research. In fact, you can do functional neuroimaging psychiatry research on schizophrenia - e.g. studying auditory circuits in people with schizophrenia and what not. In other words, even though clinical psychiatry rarely turns to neuroanatomy/neuroimaging, it doesn't mean that you'll have to give up these interests if you go into psychiatry. In fact, if anything, with the booming research on brain stimulation approaches to psychiatric disorder treatments there are plenty of psychiatry research opportunities that involve neuroanatomy/neuroimaging.

(I like neuro and neuroanatomy/neuroimaging a lot as well; however, I don't care as much about the nervous system outside of the brain - no offense to anyone! - and I'm really interested in some aspects of psychiatry that neurology doesn't have like psychotherapy, so I had no difficulty choosing psychiatry. I've been doing - and plan to keep doing - neuroimaging based research of depression, different aspects of which are relevant to brain stimulation techniques or to psychotherapy - so I won't miss brain neuroanatomy/neuroimaging!)
 
Do psychiatry and a neuropsychiatry fellowship, do some reading and go to neurology meetings and you will know more about neurology than 90% of psychiatrists anyway.

Even though neuro and psych use the same medications and treat some of the same conditions, the approach is very very different; neurologists do focused detailed physical exams and order lots of tests, psychiatrists... not so much.
 
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