Neuropsychiatric Constructs as Bridges Between Psychopathology and Neuropathology: A Medical Perspective

This essay provides an analysis of the clinical problems that arise at the borderline between neurology and psychiatry. We postulate that psychopathological and neuropathological constructs have distinct referents and conceptual fields, but they are not mutually exclusive categories. After establishing criteria for defining neuropsychiatric constructs, we outline rules for identifying cases where a significant relationship exists between neuropathological and psychopathological patterns. We propose three approaches to establishing this relationship: a clinical epidemiology approach, a clinical neuroscience approach offering a mechanistic model, and a longitudinal study of individual cases incorporating idiographic perspectives. We discuss the logic of brain-behavior relationships and emphasize the need for closer academic feedback between neuroscientific research and clinical practice to better understand the causality of psychopathological phenomena in the context of neuropsychiatry. While precise demarcation may be challenging in some cases, we provide two types of examples: first, straightforward cases where neuropathology explains psychopathological patterns; second, complex cases that require studying the causal interactions between neuropathological factors, psychological factors, and sociocultural contexts, leading to intricate clinical patterns that demand cognitive neuropsychiatry resources, and a multidisciplinary approach to clinical care.