International Neuropsychiatric Association

International Neuropsychiatric Association As professional organizations go, the International Neuropsychiatric Association (INA) is young, having been formed in 1998 when a group of neuropsychiatrists met in Toronto, Canada, to consider the status of their profession. There was a shared sense of optimism, with a feeling that their time had come. They seemed ready to proclaim their professional identity in the form of an association and to meet the immediate challenges. Defining neuropsychiatry and thereby the legitimate territory for a neuropsychiatrist was the first and most difficult challenge. This generated much discussion and eventually a compromise: “Neuropsychiatry is a field of scientific medicine that concerns itself with the complex relationship between human behavior and brain function, and endeavors to understand abnormal behavior and behavioral disorders on the basis of an interaction of neurobiological and psychological–social factors. It is rooted in clinical neuroscience and provides a bridge between the disciplines of Psychiatry, Neurology and Neuropsychology”. The definition emphasizes the scientific underpinnings of the profession and its hybrid origin. The INA was therefore mandated to admit professionals from a diverse range of backgrounds, and was seen as a forum for interaction between these overlapping disciplines. The second challenge was to define the clinical and research territory that neuropsychiatry could lay claim to. Some would consider this unnecessary, being content with the establishment of a neuropsychiatric approach that could be applied to all brain disorders. However, a profession needs to fence in a territory to be able to establish an identity and a raison d’etre for its existence. There are many disorders that currently fit the bill of being “neuropsychiatric”. What characterizes them is that the principles of either psychiatry or neurology are unable to fully encapsulate these disorders, and the neuropsychiatric approach is needed for their diagnosis and management. The diagnoses that come to mind are neurocognitive disorders (including the dementias and mild cognitive impairment), drug-induced movement disorders, Tourette’s syndrome, psychiatric disorders associated with other movement disorders such as Parkinson’s disease and dystonia, those associated with epilepsy, cerebrovascular disease, and head injury, chronic fatigue syndrome and other psychoneuroimmunological disorders, attention deficit hyperactivity disorder, and other conditions in which cognitive, behavioral, or affective disturbance results directly from brain insult. Together, these disorders comprise a body of clinical work that can underpin a robust discipline. While some neuropsychiatrists claim schizophrenia, bipolar disorder, melancholic depression, and obsessive compulsive disorder, these disorders remain the province of general psychiatrists with perhaps some input from neuropsychiatrists in the management of resistant cases with novel treatment techniques such as transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, leukotomy, and in the future, genetic and stem cell therapies. The third challenge was to make the INA truly international. This had an auspicious start with the interim executive committee comprising 12 countries. Many countries already had fully established neuropsychiatric associations, which included the United Perminder Sachdev