Psychiatric and neurological illnesses: Converging paths in the brain
The brain being the seat of both psychiatric and neurological illnesses, the boundaries are getting increasingly blurred with better understanding of the brain.
Representative image
Dr Srinivas Singisetti
22nd July each year is marked as World Brain Day, the theme of which this year is "Brain Healthand Disability: Leave No One Behind". It emphasizes the importance of brain health, ensuring inclusivity and equal opportunities for all individuals with brain disabilities.
While brain disorders traditionally would refer to illnesses such as stroke, Parkinson’s disease, and brain tumors that come under the remit of neurologists; brain health concerns the overall well-being and functioning of the brain, encompassing mental, emotional, behavioral and cognitive aspects. Some of the illnesses representing these aspects of brain function such as depression, anxiety and psychosis would traditionally fall under the remit of psychiatrists. The brain being the seat of both psychiatric and neurological illnesses, the boundaries are getting increasingly blurred with better understanding of the brain.
It is not uncommon for individuals to have both psychiatric and neurological symptoms or conditions simultaneously. For instance, a person with Parkinson's disease (neurological) may also experience depression (psychiatric) as a result of the neurological changes and the impact of living with a chronic condition. A third to half of all patients suffering from stroke develop depressive symptoms. Postictal psychosis, a psychiatric condition can occur after a seizure in individuals with epilepsy, and presents with psychotic symptoms, such as hallucinations and delusions.
Advances in brain science increasingly recognize the occurrence of structural and neurochemical changes within the brain in the causation of ‘psychiatric’ illnesses. There is also increasing recognition of environmental stress effecting subtle brain changes. Neuroplasticity, the brain's ability to reorganize and form new neural connections can be impaired by chronic stress. Chronic stress can also trigger inflammatory responses in the brain, and is the new area for research in various psychiatric and neurological illnesses. Similarly, counselling, an important aspect of treatment in psychiatry brings about positive changes in the brain neurochemistry.
While psychiatry and neurology are distinct medical specialties with different training and expertise, collaboration between these specialties is often necessary for cases where there is an overlap or when a condition presents with both neurological and psychiatric symptoms. The 2016 biographical movie "Brain on Fire" draws inspiration from the real-life account of a New York Post writer who undergoes a painful and inexplicable journey of several medical evaluations, misdiagnosis with psychosis, and confinement in a psychiatric hospital, before reaching the hands of a compassionate and skillful Syrian-American neurologist, Souhel Najjar who diagnosed her with autoimmune encephalitis and enabled treatment for her rare ailment.
"Brain Health and Disability: Leave No One Behind" hopefully is a step towards commitment to research and progress in neuroscience and medical technology that will likely lead to a deeper understanding of the relationships between psychiatric and neurological conditions, ultimately improving diagnosis and treatment approaches for all patients with brain disability.
The author Dr Srinivas Singisetti is Associate Professor, GIMSR, Visakhapatnam.