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Neurologist vs Psychiatrist: Know the Difference

Neurologist vs Psychiatrist: Know the Difference

Since the brain is the center of body control, any malfunction has an impact on everything, including emotions and bodily activity. Psychiatrists and neurologists both study the brain, yet they specialize in distinct fields. You can find the proper professional more quickly if you are aware of these differences.
A neurologist is a medical doctor who specializes in diagnosing and treating disorders related to the nervous system. This includes the brain, spinal cord, and peripheral nerves. Conditions like epilepsy, Parkinson's disease, migraines, and multiple sclerosis often require neurological care. Neurologists use advanced imaging, clinical assessments, and lab tests to identify the root cause of symptoms. While they don't perform surgeries, they often work alongside neurosurgeons when surgical intervention is needed.
Psychiatrists are trained medical doctors who specialize in mental health. They assess, diagnose, and treat emotional and behavioral disorders such as depression, bipolar disorder, schizophrenia, and anxiety. What sets psychiatrists apart from psychologists is their ability to prescribe medication. They often combine pharmacological treatment with psychotherapy or refer patients to clinical psychologists when needed.
Both neurologists and psychiatrists begin their journeys in medical school. Afterward, neurologists complete residency programs focused on the nervous system, while psychiatrists undergo specialized training in mental health. Although their foundations are similar, their residency experiences shape their clinical perspectives. Neurologists focus on physical symptoms and disease mechanisms, whereas psychiatrists are trained to explore thought patterns, behavior, and emotions.
Neurologists manage a wide range of neurological issues. Common conditions include: Stroke and transient ischemic attacks (TIAs)
Epilepsy and seizure disorders
Parkinson's disease
Migraines and cluster headaches
Neuropathy and nerve pain
Multiple sclerosis
These conditions can be chronic and progressive, requiring lifelong monitoring.
Psychiatrists handle mental, emotional, and behavioral disorders. Major depressive disorder
Generalized anxiety disorder
Schizophrenia
Bipolar disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
They often assess how these conditions affect daily functioning and relationships, and develop a treatment plan that might include medications, talk therapy, or hospitalization in severe cases.
Neurologists rely heavily on diagnostic imaging such as MRI, CT scans, EEGs, and lumbar punctures to visualize brain and nerve function. These tools help pinpoint physical causes of neurological symptoms. Psychiatrists, on the other hand, focus on detailed clinical interviews, psychological questionnaires, and observation to identify emotional and behavioral patterns. They may also order blood tests to rule out hormonal or metabolic issues affecting mental health.
Neurologists typically treat conditions with medications, physical therapy, and sometimes nerve stimulation techniques. For instance, anti-seizure medications are prescribed for epilepsy. Psychiatrists may use medications like antidepressants or antipsychotics, but therapy also plays a large role. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychoanalysis are common tools in psychiatric care.
Consider seeing a neurologist if you experience persistent or unexplained: Seizures or blackouts
Frequent headaches/migraines
Memory loss or confusion
Muscle weakness or numbness
Coordination issues
If your symptoms suggest something affecting your nerves or brain physically, a neurologist is the right choice.
Ahmedabad has become a destination for neurological and psychiatric care in India. Whether it's for long-term care or second opinions, finding a qualified neurologist in Ahmedabad allows you to get comprehensive care.
You might need a psychiatrist if you're dealing with: Long-standing depression or anxiety
Panic attacks
Hallucinations or delusions
Sudden changes in mood or personality
Difficulty coping with daily life
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Misdiagnosing and Overdiagnosing AxSpA: An ‘Imaging Crisis?'
Misdiagnosing and Overdiagnosing AxSpA: An ‘Imaging Crisis?'

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  • Medscape

Misdiagnosing and Overdiagnosing AxSpA: An ‘Imaging Crisis?'

TORONTO — MRI is central to the early detection and diagnosis of axial spondyloarthritis (axSpA), but years-long diagnostic delays are still common. However, experts are warning that misinterpretation of MRI findings is contributing to significant increases in false-positive diagnoses in patients presenting with back pain that may be caused by other, noninflammatory conditions. The good news is that studies show that diagnostic accuracy in the interpretation of MRI findings can be significantly improved when rheumatologists provide radiologists with all the clinical information relevant to a diagnosis of axSpA. 'There is a high risk of misdiagnosis and overdiagnosis of axSpA in clinical practice,' said Denis Poddubnyy, MD, PhD, professor in the Division of Rheumatology, Temerty Faculty of Medicine at the University of Toronto, Toronto, Ontario, Canada. Denis Poddubnyy, MD, PhD 'In 2025, evidence of SpA-compatible active inflammatory and structural changes on MRI of the sacroiliac joints is needed for a diagnosis of axSpA,' he said in a presentation at the Spondyloarthritis Research and Treatment Network (SPARTAN) 2025 Annual Meeting. 'There's been a paradigm shift.' Evidence for this paradigm shift comes from the ongoing Improve-axSpA project, Poddubnyy said. The telemedicine initiative, which involves rheumatologists and orthopedists at 40 centers across Germany and Austria, is focused on enhancing the diagnosis of axSpA. Interim findings showed that clinicians misinterpreted the MRI findings in 35% of 476 cases of suspected axSpA submitted for central evaluation. These cases could be explained by noninflammatory conditions that mimic the symptoms of axSpA, said the investigators, led by Poddubnyy. These axSpA-like conditions include degenerative or mechanical changes in the sacroiliac joint (SIJ), degenerative disk disease, and osteitis condensans ilii — a mechanical condition that is often associated with bone marrow edema in the SIJs. 'I believe this [35%] figure is very accurate, not only for Europe — or Germany and Austria — but for anywhere that physicians are trying to apply MRI findings to make an early diagnosis,' Poddubnyy told Medscape Medical News . This finding could also account for a significant proportion of the 40%-50% of patients with axSpA who don't respond to treatment, he said. In the study, central evaluation ruled out axSpA in a whopping 75% of the 183 cases with an inconclusive local diagnosis. In the other 25% of these cases, the diagnosis could not be confirmed by central assessment because of insufficient imaging. This disturbing trend provides evidence of an 'imaging crisis' in axSpA, said Torsten Diekhoff, MD, PhD, a radiologist and associate professor, Charité — Universitätsmedizin Berlin, Berlin, Germany, in an editorial published on May 16, 2025, in The Lancet Rheumatology . Poddubnyy was a co-author. 'The prevailing dilemma in imaging of axial spondyloarthritis lies in the incongruence between early detection and the confidence of the imaging assessment,' they wrote. 'Although clinical work-around strategies have been developed to address this issue, they frequently fail to resolve the fundamental concern of achieving an early diagnosis before the manifestation of structural lesions.' When asked to comment, Jonathan Chan, MD, clinical associate professor, University of British Columbia, Vancouver, British Columbia, Canada, said there are 'definitely some major changes that we all agree are important.' One of them is acknowledging that MRI is a better tool than x-ray and that there is heavier weighting for MRI than for x-ray. 'We know that structural lesions are important, and we know that sometimes bone marrow edema can be intermittent, whereas the presence of multiple erosions will not reverse. That is something you can hang your hat on.' The consequences of diagnostic delay in patients with axSpA are well known and include less favorable treatment response and worse clinical outcomes. In 2019, an analysis of health insurance data in Germany from 1677 patients with axSpA revealed that diagnostic delay was common, with a mean of 5.7 years. The factors associated with longer time to diagnosis included female gender, negative HLA-B27 status, the presence of psoriasis, and a younger age at symptom onset. 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'The specificity of x-rays is not great,' Poddubnyy said. 'If you have to perform x-rays first in your clinical setting, that's okay, but be extremely critical in terms of interpreting this imaging. If you have any doubts about whether axial disease is present, order a cross-sectional image.' When MRI is not readily available, CT may be a good alternative, he suggested. In the Improve-axSpA study, for instance, CT had higher specificity and produced fewer false-positive results than MRI. CT also captured more specific lesions, including erosions and ankylosis. Sharing clinical information can vastly improve MRI interpretation, a 2024 study showed. The results demonstrated that when rheumatologists gave radiologists essential clinical information relevant to the diagnosis of axSpA — not just patient age and gender — the precision and specificity of imaging interpretation significantly improved. When clinical information was available along with conventional radiographs, the precision of SIJ radiograph interpretation — meaning the percentage agreement between diagnosis by a rheumatologist and the radiology report confirming or excluding a diagnosis of axSpA — jumped from 70% to 78%. This kind of information-sharing doesn't happen routinely in clinical practice, said the investigators, led by Tim Pohlner, Charité — Universitätsmedizin Berlin. Some clinicians think that sharing essential clinical information will cause bias on the part of the radiologist, explained Poddubnyy. The expertise of both rheumatologists and radiologists is needed to diagnose axSpA, he added, and that means all information on clinical and imaging outcomes must be accessible. 'This is something that should be done in daily clinical practice, in every radiology setting,' Poddubnyy emphasized. 'Rheumatologists should be initiating this, bringing the radiologist to this idea.' The 2024 ASAS recommendations on clinical information to include on imaging referrals provide support for differentiating inflammatory from noninflammatory changes in patients with suspected or known axSpA. A downloadable checklist that can be shared with the radiologist includes information such as patient history, back pain characteristics, HLA-B27 status, physical activity level, pregnancy history, and SpA parameters. For Chan, who is also a clinical investigator at Arthritis Research Canada, Vancouver, British Columbia, Canada, the importance of sharing clinical information became evident while he was working on the CLASSIC study to revise classification criteria for axSpA in adults. 'We would meet every five scans and do a calibration with two or three central reader radiologists and then our local reader radiologist, who was using the 2009 [ASAS] classification criteria. 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