CPCP: Neurology and Psychiatry: Divided or United?

“When you learn, teach, when you get, give”–Maya Angelou

I’m particularly proud of today’s Clinical Problems in Consultation Psychiatry (CPCP), “Neurology and Psychiatry: Divided Or United?” Partly that’s because one of the trainees who worked on it is a Neurology resident, Dr. Abdel Wahed, and I always enjoy their participation on the Consultation-Liaison Psychiatry service. That said, the medical student, Nicoll, and the Family Medicine resident Dr. True, both made outstanding contributions to this group effort. The picture shows them (including an excellent senior, Dr. Chhatlani) holding up the C-L Psychiatry mascots–good sports.

Dr. Bill Yates

I’ve posted about neuropsychiatry before and the hope that some clinically oriented physicians have that someday psychiatry and neurology will merge into one neuroscience division. My former teacher, Bill Yates, MD, has been an articulate supporter of this position. He was also the architect of the CPCP, which began in the mid-1990s:

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144. Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

Incidentally, the importance of the CPCP probably was first identified a half-century ago by Dr. Z.J. Lipowski in one of his classic papers, Lipowski, Z. J. (1967). “Review of consultation psychiatry and psychosomatic medicine. I. General principles.” Psychosom Med 29(2): 153-171.: “Whatever the number of the members of the consultation service, they should function as a team and share their experiences in a formal weekly case conference.”

The debate about whether neurology should combine with psychiatry will no doubt go on, possibly indefinitely, although the presentation below gives us an illuminating and often startling view of the debate. In many ways, it’s analogous to what has been going on for many years with Consultation-Liaison Psychiatry as a way to reintegrate mind and body.

In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

One of the major efforts to reintegrate mind and brain is underway at the National Neuroscience Curriculum Initiative. One of the leaders in our psychiatry department (see Wonder Women below), Dr. Hanna Stevens, MD, PhD, is on the advisory board. You can find many fascinating and neuroscience-based tools, such as the Talking Pathways to Patients. Registration for login is free.

This is also about learners and teachers, and often reminds me of one my favorite teachers in undergraduate college, Dr. Jenny Lind Porter. Incredibly, I just received another comment on my blog post, “Spotlight on Jenny Lind Porter, A Favorite Teacher for So Many.” The comment is evidently from yet another admirer named Anita and is copied below:

“Jenny Lind Porter Scott was a lifetime member and past president of Austin AAUW (American Association of University Women). We have lost touch. We believe her house on Summit View was demolished, but we wonder if there is a plaque to celebrate her fame. Who knows where she now resides? Didn’t she write a poem about WOMEN? What is the best book of her poetry? I don’t find any in my Westbank library.”

As many readers know, I’ve chronicled my role as student to Dr. Porter on this blog and my reply to this latest “fork-in-the-road” reminder of her influence on my own career as a teacher is below:

“Hello, Anita. I am always astonished by the messages I get about Dr. Porter. They seem to turn up like signposts or forks in the road. Just when I think her story has truly ended, someone like you reminds me her legacy runs deeper than any of us knows.

The last I heard in September 2016, Casa Magni, which is what she called the house on Summit View, was to be demolished. The architect and project designer was planning a small project to honor her memory, to be erected in the Old Enfield neighborhood. A new house with architecture similar to the original was planned for someone who bought the property. I thought the ground-breaking was supposed to have been sometime earlier this year. I haven’t heard anything since. By now, I’m sure the projects are probably well underway or nearing completion. See my blog post, “Farewell Casa Magni,” posted September 26, 2016.

Your question about whether she ever wrote a poem about women is excellent, but I’m such a poor scholar of her works that I wouldn’t know the answer. All I have is “The Lantern of Diogenes and Other Poems.” I could speculate that “The Vinegar Hymn” or “Madame Bovary” might be about the role of women in society, but I wouldn’t flatter myself about my interpretation. Her subjects often had classical or spiritual themes. I’m biased of course because my knowledge of her work is so meager–but I would choose the “The Lantern of Diogenes and Other Poems” as her best work. You can order a copy of it on line.

The only biography I could find was on line. It’s a Prabook profile and I occasionally catch myself hoping that someone will write a proper biography. I believe she has had a guardian since 2015. I don’t know where she lives and I’m fine with that. All I know is that I’ve not yet seen an obituary next to that of her husband, Lawrence E. Scott.

May it be that something of her spirit burns in me.

Thank you for writing.”

I really am not sure if Dr. Porter ever wrote something about women, specifically, but she was clearly a leader as a teacher, literary scholar, and writer. It was probably coincidental, but just yesterday I found out about the book “Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space Race.” One of our staff members was actually able to order this book for me! And time for a plug for the “Wonder Women” leading the University of Iowa Department of Psychiatry.

Of course, the line about her spirit burning in me is from her poem “The Lantern of Diogenes’

The Lantern of Diogenes

All maturation has a root in quest.

How long thy wick has burned, Diogenes!

I see thy lantern bobbing in unrest

When others sit with babes upon their knees

Unconscious of the twilight or the storm,

Along the streets of Athens, glimmering strange,

Thine eyes upon the one thing keeps thee warm

In all this world of tempest and of change.

Along the pavestones of Florentian town

I see the shadows cower at thy flare,

In Rome and Paris; in an Oxford gown,

Men’s laughter could not shake the anxious care

Which had preserved thy lantern. May it be

That something of thy spirit burns in me!–Jenny Lind Porter

The trainees have made an excellent presentation and I’ve learned from it. I always learn something from my students. I can tell you that their talents are certainly not going to waste.

 

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Comments

  1. “I’ve posted about neuropsychiatry before and the hope that some clinically oriented physicians have that someday psychiatry and neurology will merge into one neuroscience division.”

    My hope as well Jim. Insel has talked about including Neurosurgery.

    Great post.

    George

    George Dawson, MD, DFAPA

    Liked by 1 person

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