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We believe that all neurologists in training would benefit from spending some time with a neuropsychiatrist or with a liaison psychiatrist who is experienced in dealing with “neurological” patients, and should equip themselves to perform at least a basic neuropsychiatric assessment. While the title of this article draws attention to the risk of mistaking “neurological” disorders for psychiatric ones, the opposite mistake is almost certainly more common. There is much to be gained from joint work with interested psychiatric colleagues. Judging how far we neurologists can trust our own psychiatric acumen, and when we should ask for help, is necessary but tricky.

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As you will have gathered, we are not really trying to teach you how to “rescue” neurological patients from the psychiatrists: on the contrary we believe that both psychiatrists and neurologists have much to gain by sharing and exchanging their complementary skills.

We then pick out a number of neurological disorders which are particularly liable to give rise to “discipline confusion” by turning up in the psychiatry clinic, grouping these disorders in terms of the neuropsychiatric function which they most conspicuously disturb (for example, memory in the case of transient global amnesia). In this article we first drive home the general point that CNS disorders tend to give rise to cognitive and behavioural as well as “neurological” manifestations by considering some of the neuropsychiatric associations of the major classes of neurological disease, highlighting some specific examples and case histories as we do so. Moreover, this type of assessment is essential if one is to do justice to the symptoms of dementia which most bother patients: these are more often “psychiatric” than “neurological”. The importance of a wide ranging approach to assessment is well illustrated by the example of dementia, a primarily cognitive and behavioural disorder: the clue to diagnosis may come from general medical examination (revealing, for example, the testicular tumour causing limbic encephalitis or the bradycardia of hypothyroidism), from traditional neurological examination (subtle chorea in early Huntington’s disease), from cognitive assessment (isolated anterograde memory impairment in early Alzheimer’s disease), or from observation of behaviour (the patient with a frontal lobe dementia who leans over your desk and takes apart your pen). The physical and psychological symptoms of disease can therefore be related in the following ways: (1) physical symptoms come to light by way of complex psychological processes (2) psychological upset can manifest itself in physical symptoms (3) physical diseases commonly cause a secondary psychological reaction (4) one category of physical disease, affecting the brain, can give rise, more or less directly, to psychological manifestations. Cognitive and behavioural involvement is the rule, not the exception, among patients with disorders of the central nervous system (CNS).

The notion many of us bring to neurology-that only a minority of neurological disorders has a significant psychological or psychiatric dimension-is almost certainly wrong. The main targets of the traditional British “neurological examination” may be elementary motor and sensory processes, but any adequate assessment of “brain function” must take account of cognition and behaviour.

Neurology has an especially close relationship with psychology and psychiatry, as all three disciplines focus on the functions and disorders of a single organ, the brain.