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In the post war years of the 20th century, the divide between neurology and psychiatry seemed nearly complete. Such a separation between the “organic” biologically based disorders with florid neurological physical signs, and the “functional” mentally ill behaviourally, affectively or psychotically disturbed with minimal physical neurological abnormalities on examination would have seemed extraordinary a couple of centuries earlier. Freud himself was an expert in cerebral palsy and the minutiae of its description. For paediatric neurologists it has been the rare psychiatrist who has been a regular participant in their meetings and whose writings have proved educational and inspirational. Similarly, it is rare for neurologists to be involved in teaching child psychiatrists and few have had training in the psychosocial aspects of patient management. It is to be hoped that in the present century paediatric neurology and child and adolescent psychiatry will come even closer with a new generation of neuropsychiatrists.1 Training in paediatric neurology and paediatric neurodisability currently reflects this with a requirement for psychiatry modules and placement.
BIOLOGICAL BASIS OF BEHAVIOUR DISORDERS
Neurobiology, genetic research, and particularly modern imaging technology have prompted re-evaluation of disorders of behaviour assumed to have little biological basis. Several major mental illnesses would now be thought of as having a significant biological basis—for example, obsessive compulsive disorder (OCD), schizophrenia, autism, and addiction. Attention deficit hyperactivity disorder (ADHD), dyslexia, and OCD are examples where functional neuroimaging of subjects compared with controls have shown consistent differences. In OCD, pre- and post-treatment paradigms demonstrate attenuation of hypermetabolism in orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex, with reduction of OCD symptoms, as a consequence of effective treatment, irrespective of whether the treatment modality was behaviour therapy or medication.
It is often commented in jest that psychiatry is one of the medical disciplines that is striving towards its own extinction, through systematic …