The Inseparable Nature of Neurological and Psychiatric Disorders
People’s Medical Publishing House has produced a set of “national higher-education organ-system integrated textbooks” for clinical-medicine students. It is an excellent set; used together with the classic clinical-medicine textbooks (now in their tenth edition), it greatly benefits clinical-medicine students. I have gradually bought nearly the whole set, and I have recently been reading the volume on Neurological and Psychiatric Disorders, with much to gain.
Traditional subject classification separates the three clinical disciplines of neurology, neurosurgery, and psychiatry, but this set unites them. I think this integration is excellent, because from my own practice I have deeply felt that common neurological diseases and some common psychiatric conditions are strongly linked, even causally related; the traditional division makes it hard for clinicians to build a systematic understanding of all three.
For example, patients after cerebral hemorrhage or cerebral infarction usually have a series of psychiatric disorders. In the past, we mainly had neurologists treating these conditions, and they tended to relieve symptoms with the usual neurology approach—often with unsatisfactory results.
In recent years, leading international studies have shown that some antipsychotic drugs (such as carbamazepine) can relieve the “three hemipareses”—hemiplegia, hemianopia, and hemisensory deficit—of patients with stroke sequelae. In the past we would have attributed these symptoms mainly to damage of the internal capsule, which is hard to recover, and so had little to offer.
Some leading brain-science studies also show that several psychiatric disorders are accompanied by organic changes in the nervous system that were simply not detected before, because the medicine of the time was limited. In reality, most psychiatric disorders relate to abnormalities or damage of brain tissue. So if we split neurological and psychiatric disorders apart, we can hardly truly understand the link between them.
Organ-system-based, multidisciplinary integrated curricula were pioneered in the 1950s by Case Western Reserve University in the United States. This medical-education reform quickly drew the attention of medical schools in Europe and America and, because of its excellent teaching outcomes, gradually spread. In recent years many Chinese medical schools have adopted it too. The “national higher-education organ-system integrated textbooks” were compiled for this reform and are now in their second edition.
The human body is an organic system in which one part’s loss affects all; the traditional medical division is too fine-grained, with both advantages and drawbacks. This integrated curriculum is a correction to that model. I recommend this set to clinical-medicine students who have not yet encountered it, and recommend the Neurological and Psychiatric Disorders volume to readers interested in neurology, neurosurgery, and psychiatry, so as to understand common neurological disorders more deeply.