Different mental Disorders
There have been recent calls to abandon the distinction between neurological and psychiatric disorders on philosophical and moral grounds. Crossley and colleagues, in this issue, meta-analyse published structural brain imaging data and prove that they are different after all – or do they?
The study by Crossley and colleagues, in this issue of the BJPsych, is a rare and therefore welcome empirical contribution to the debate, recently revived, on whether the distinction between psychiatric and neurological disorders is real and/or should be abandoned. Psychiatric disorders are not just ‘mental’ but physical too.
The ‘reality’ of the psychiatry–neurology distinction, refers to the soundness of its theoretical basis. This might be best summarised by the following rule: if a disorder in question is reliably associated with a recognisable pathological process affecting the central nervous system (CNS), then it is neurological. But that of course just begs questions about what is meant by ‘reliably’? Does this mean ‘necessary and sufficient’ to cause the condition? What is ‘recognisable pathology’? Does this refer to the microscopic or macroscopic level? What then do we make of ‘quantitative change’ in the CNS in relation to some normative standard of a given magnitude? Is that ‘pathology’?
If we take schizophrenia, there is ample evidence of quantitative regional change in the CNS thanks to the widespread use of structural magnetic resonance imaging, but only insofar as this is detectable at the group level against a control group and according to some more or less arbitrary statistical threshold. The same can be said of affective disorder but at a rather lower statistical threshold. So are these neurological disorders? Perhaps, yet we do not see much interest among our neurology colleagues to start seeing these patients or engaging in research on them. What then of Alzheimer's disease? Clearly a neurological disorder and of interest to a few neurologists, but ‘core business’ for the old age psychiatrist and a shared topic of interest for research. Hence, the discussion moves rapidly from philosophy (is the distinction real?), through biology (is there evidence of a pathological process?), to sociology, culture and prejudice (whose job is it? who gets the credit/blame?).
Crossley et al's meta-analysis
The paper by Crossley and colleagues takes a novel approach. It is a meta-analysis of studies using voxel-based morphometry (VBM) to measure changes in grey matter in neurological and psychiatric diagnostic groups. So there are studies of diseases as diverse as multiple sclerosis and Huntington's disease, Asperger syndrome, anorexia and Alzheimer's disease, schizophrenia and panic disorder, each comparing a patient group with controls and reporting statistical differences in, strictly speaking grey matter density used as a proxy for volume change, usually with, areas of reduced grey matter mapped onto a brain template. Importantly, these methods look at the whole brain and are not influenced by prior assumptions of where the abnormality might be. The authors applied some basic quality controls over the included studies and applied weightings according to the numbers of participants but were interested in the broad pattern that such large data-sets might reveal.
Now, you might question the whole enterprise. Is it not like going into a general hospital, picking patients from the cardiac ward, the renal unit and the orthopaedic department and sticking them in a scanner? Little surprise then if the results showed that abnormalities tended to centre on (although not being confined to) the heart, the kidney and the skeleton, respectively? But it is not quite the same since both psychiatry and neurology are laying claim to the same organ, the brain. Going along with the idea one might then hypothesise that neurological patients show the bulk of abnormalities in the areas of the brain associated with more ‘basic’ functions: movement, sensation and, with respect to dementia, memory, whereas psychiatry patients show differences in ‘higher’ brain regions associated with self-consciousness and identity (the frontal lobes) or emotion (the ‘limbic system’).How to solve quadratic equations? what does myth mean How to make s'mores what does swiss chard taste like How to lace yeezys Tips on how to get out of silver How to adopt a dog What causes plant tips to turn brown How to take off security tag what does gyrating mean what does 1st mean on linkedin How to wash an electric blanket How to get rid of cold fast? How to pay someone with paypal what does arrangement mean what does hostile mean what does the number 6 mean in the bible How much money has the u.s. given to ukraine 2022 Rdr2 where to see robbery tips what are interest rates today what does it mean when a dog howls Tips on how to buy a house what does an mri of the brain show what does overclocking mean what color are elephants How to screenshot macbook How to draw mountains? How to delete paypal account How wake up tips person what does natty mean what does dt stand for what does prologue mean How to rip jeans? Amazing dog tricks how clicker works what does kun mean in japanese What are safety tips for a tornado what does pubes mean Tips for mddle splits when nothing is working what are the best cpus How to get rid of chest fat How to evolve mime jr Geto boys mind playing tricks on me. who is paranioa what does otp mean in a text message Social security how benefits are calculated and tricks what does manganese do for the body what does joseph mean How to fold a paper boat what are alkali metals what does rely mean How to add up a column in excel what are stereotypes How many credits do you need to graduate Css tricks where do you learn html what are kegals Where can i practice tricks indoor for snowboards How to find deleted contacts on iphone? How to watch all nfl games what does sofi stadium stand for what does arouse mean what does xanax do to your eyes what does spite mean what foes [as] mean How to get tips from credit cards on twitch what time does the dmv open What are the tricks to lower the import custom charges How to do calligraphy? Pocket pussy how to make? what does alv mean what are the symptoms of alcohol poisoning How to follow up on a job application How to lower potassium levels? How to get views on youtube How to keep mice away Why no more cnd eclipse nail tips How to stop tooth pain fast How to be good at sex tips for guys How to enable cheats in sims 4? How long to microwave bacon what time does ross open today How to know if you have appendicitis? what does monster taste like what does stale mean what does upcycle mean what does milky discharge mean How to do cool soccer tricks what does jesus mean what does sb mean in text Word for someone who plays tricks and is mean to someone what does supervise mean what does century mean what does pita mean what does strep throat look like without tonsils what does a weed plant look like What tricks can google do How to make curtains? How many hat tricks does pavel datsyuk have what does taunt mean How to do string tricks what does floating poop mean How to cook medium sirloin tips How to see dust mites? How to dye armor in minecraft what does unhealthy poop look like How to find slope of tangent line? How to make a moscow mule? what does fwd mean what are the romance languages How to get rid of stomach gas? what does it mean when a rabbit crosses your path what do black air forces mean How stage magic tricks are done What is the best cut of beef for steak tips What are some tips to follow so you don't become a distracted driver How to find your property line for free? what does eevee evolve into How to grow lemongrass? What are some mind tricks what does idek mean