Division of Cognitive Neurology, Department of Neurology, Brigham & Women's Hospital Center for Brain Mind Medicine, Harvard Medical School, Boston, Massachusetts.
Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cogn Behav Neurol. 2023 Dec 1;36(4):199-201. doi: 10.1097/WNN.0000000000000353.
Dividing the brain-mind into the specialized fields of neurology and psychiatry has produced many granular advantages, but these silos have imposed barriers to comprehensively understanding and contextualizing the fundamentals governing mental life and its maladies. Scientific inquiry into these fundamentals cannot reach its full potential without interdigitating the boundaries of two specialties of the same organ for both scholarship and clinical practice. We propose that to truly integrate disorders of the brain and the mind for research and clinical care, we must carefully reexamine the classification of its disorders (nosology) as an instrument to develop a coherent pathological and psychological framework. We call on professional organizations from neurology, psychiatry, behavioral neurology, neuropsychiatry, neuropsychology, and other relevant subspecialties (eg, geriatric psychiatry) to convene a multidisciplinary task force to define the current classification principles of their subspecialties and work toward developing an integrated nosology. The effect of a shared classification system, which we acknowledge is a difficult proposition philosophically and politically, would have transformative potential across educational, clinical, scientific, programmatic, and sociocultural realms. If accomplished, this initiative would provide a definitive step toward reducing stigma (and promoting reimbursement parity) for the full spectrum of complex brain disorders (regardless of traditional neurologic vs psychiatric conceptualizations).
将大脑-思维划分为神经学和精神病学的专业领域,产生了许多细致的优势,但这些隔阂给全面理解和上下文中的精神生活及其疾病的基本原理造成了障碍。如果不将同一器官的两个专业的边界相互交错,用于学术和临床实践,那么对这些基本原理的科学研究就无法充分发挥其潜力。我们提出,为了真正将大脑和思维的障碍整合到研究和临床护理中,我们必须仔细重新审视其障碍的分类(疾病分类学),将其作为发展连贯的病理和心理框架的工具。我们呼吁来自神经病学、精神病学、行为神经病学、神经精神病学、神经心理学和其他相关专业领域(如老年精神病学)的专业组织召集一个多学科工作组,以确定其亚专业的当前分类原则,并努力制定一个综合的疾病分类学。我们承认,一个共享的分类系统的效果在哲学和政治上是一个困难的命题,但它将在教育、临床、科学、项目和社会文化领域产生变革性的潜力。如果这一倡议得以实现,它将为广泛的复杂脑部疾病(无论传统的神经学还是精神病学概念如何)提供一个减少污名(并促进报销均等化)的明确步骤。