Evolving a new neuropsychiatry

Clinical neuroscience struggles with poor scientific validity of neuropsychiatric diagnosis and its negative impact on management. Sydenham's ancient conformity of type approach to nosology with its assumption that the symptom cluster and course of a disorder are due to a common etiology, has proven no match for the complicated comorbidities faced in neuropsychiatry. In the absence of accurate pathological biomarkers there is a challenge in finding a solid foundation for modern neuropsychiatry. We find standard psychiatric nosology to be of limited benefit at the general hospital bedside in evaluating and treating neuropsychiatric disorders. Consequently, we have developed over the years a neuro-circuitry-based training for our psychosomatic medicine fellows. In this commentary, we will introduce a strategy for understanding patients with neuropsychiatric disorders that may advance our ability to diagnose and treat them in accordance with neuroscientific evidence anchored in evolutionary neurocircuitry and attachment neurobehavior.