Beyond Broca’s and the MOCA: Teaching Neuropsychiatry Across the C-L Spectrum of Clinical Care

Neuroscience has immeasurably advanced in the last several decades, with progressive emphasis on understanding disturbances in thought, emotion and behavior in the context of their neuroscientific underpinnings. Though both psychiatry and neurology have an established standing as distinct disciplines, there has been an increasing need to have a combined neuropsychiatric approach to treat a wide array of conditions and disorders, particularly on consultation-liaison (CL) psychiatry services. While CL fellowship training often does not embed a standardized curriculum in neuropsychiatry, a foundational understanding of a comprehensive neuropsychiatric assessment and neurocircuitry of brain-behavior relationships is paramount for patient care on CL services. This workshop will address the evolution of neuropsychiatry within CL psychiatry, and current neuropsychiatric challenges and dilemmas facing clinicians on CL psychiatry services:

Overview of neuropsychiatry: Neuropsychiatry focuses on the psychiatric expressions of neurologic disease and the biological bases of idiopathic psychopathology. The neuropsychiatric approach places behavior at the center of study by broadly assessing clinical problems that transcend the usual neurology-psychiatry divide. Dr. Kontos will review the history of psychiatry’s relationship with neuroscience and the importance of incorporating neuropsychiatry into CL psychiatry educational training.

The bedside neuropsychiatric exam: Comprehensive clinical assessments of higher cortical functioning can be challenging to ascertain in patients with particular neuropsychiatric diseases, such as dementia, stroke, or focal cerebral lesions. Dr. Nicolson will review the bedside neurocognitive exam in the CL setting by focusing on the frequent misconceptions of its execution, challenging educational pearls for learners, and common clinical dilemmas by providing "high yield" tips for educators.



Neurocircuitry of Common Clinical Syndromes: Recent advances in structural and functional brain imaging, experimental psychology and clinical electrophysiology have advanced our understanding of clinical neurosciences. Psychiatric evaluations in the inpatient medical settings involve understanding the etiology of an array of both psychiatric and neurological signs and symptoms when clinical diagnoses may often be in flux. Dr. Quinn will review neuropsychiatric nosology in the context of neural circuits and networks implicated in the most common neuropsychiatric disorders encountered on CL services, with focus on the salience, central executive and default mode networks.



Neuropsychiatry Education in the era of COVID-19: The impact of the SARS-CoV-2 (COVID-19) pandemic on medical education is well described. The loss of opportunities for bedside teaching, in-person clinical instruction and didactics have disrupted the continuity of quality education for trainees, particularly in honing the skills required for the neurocognitive exam and comprehensive neuropsychiatric assessments. Dr. Roy will review the dilemmas and controversies of teaching neuropsychiatry in the inpatient and outpatient settings in the context of the COVID-19 pandemic. She will focus the ethical implications of continued bedside neuropsychiatry teaching and how to navigate these challenges across the clinical spectrum of care.