Neuropsychiatry and behavioural neurology are often considered sister disciplines and involve the treatment, prevention and research of problems at the interface of psychiatry and neurology. Reference Arciniegas and Kaufer1 Psychiatric and neurological disorders frequently co-occur and co-present to clinical services. The incidence and prevalence of neurological disorders is markedly raised in people with psychiatric disorders. Reference Hesdorffer2,Reference Nuyen, Schellevis, Satariano, Spreeuwenberg, Birkner and van den Bos3 Conversely, up to half of people referred to neurology clinics meet the diagnostic criteria for a neuropsychiatric diagnosis. Reference Carson, Ringbauer, MacKenzie, Warlow and Sharpe4,Reference Jabbar, Doherty, Duffy, Aziz, Casey and Sheehan5 Although some co-occurring difficulties may be easily managed by specialists in either discipline, consultation with, or direct management by, clinicians with specialist training in neuropsychiatry is considered best practice or, where best practice is not defined, desirable. Reference Agrawal, Fleminger, Ring and Deb6–Reference Sachdev8 We note here that the term ‘neuropsychiatry’ is sometimes used in a wider sense to mean the equivalent of ‘biological psychiatry’ – a field that emphasises neurobiological explanations for psychiatric disorders more widely. Here, however, we are using the term in its more common meaning to refer to the field that deals with conditions that lie at the intersection of psychiatry and neurology. Reference Lishman9,Reference Ramírez-Bermúdez, Juarez and Aliseda10
This interface occurs at both the pathological level and the level of clinical practice. Pathologically, neuropsychiatry concerns conditions in which disturbances of brain structure give rise to symptoms traditionally categorised as psychiatric, for example post-stroke mood disorders, Reference Ferro, Caeiro and Figueira11 the psychoses of epilepsy Reference Mula, Kanner, Young, Giorgio, Schulze-Bonhage and Trinka12 and in autoimmune encephalitis, Reference Pollak, Coutinho, Palmer-Cooper, Vincent, Agrawal, Faruqui, Bodani, Agrawal, Faruqui and Bodani13 or where functional disorders give rise to presentations traditionally categorised as neurological – for example functional neurological disorders. Reference Perez, Aybek, Popkirov, Kozlowska, Stephen and Anderson14 At the level of clinical practice, neuropsychiatry reflects an integrative approach that draws on neurological, psychiatric and cognitive assessment, often in settings where a single specialty in isolation would not sufficiently capture the complexity of the presentation. Reference Trapp, Martyna, Siddiqi and Bajestan15
One challenge in recommending specialist training is that there is no consensus about the components of neuropsychiatry and behavioural neurology training, with different authors and organisations citing different requirements for what they consider adequate training. Reference Perez16 Some have emphasised an approach that prioritises psychiatric complications of traditionally neurological disorders, Reference Agrawal17 whereas others highlight a wider scope, including areas such as functional neurological disorder, neurodevelopmental disorders and cognitive impairment. Reference Arciniegas and Kaufer1,Reference Bateman, Josephy-Hernandez, Apostolova, Benjamin, Barrett and Boeve18 Some have argued for research training as core to education in the discipline, Reference Molina-Ruiz, Nakagami, Mörkl, Vargas, Shalbafan and Chang19,Reference Sachdev and Mohan20 whereas others have focused largely on clinical competencies. Reference Shalev and Jacoby21
There have been a variety of proposals for the place of neuropsychiatry training within medical training as a whole. Suggestions have ranged from encouraging specialists in neuropsychiatry to fully qualify as both psychiatrists and neurologists, Reference Benjamin7 formalising the field as a subspecialty Reference Silver22 and integrating the content as a core competency in residency training, Reference Benjamin, Widge and Shaw23,Reference Torous, Stern, Padmanabhan, Keshavan and Perez24 to a complete ‘vertical integration’ at all stages of medical training. Reference Mitchell and Agrawal25
Understanding shared and common components of neuropsychiatry and behavioural neurology training programmes would outline a core curriculum as it is currently structured and taught. However, an important obstacle to doing this is that although some curriculum components are published in the peer-reviewed literature, others exist solely as grey literature – either online as part of public-facing course documentation or, in some cases, solely as internal institutional documents.
One way of addressing these obstacles is to conduct a scoping review, which uses a systematic literature search and grey literature searches to map existing literature on the topic. Reference Munn, Peters, Stern, Tufanaru, McArthur and Aromataris26 Consequently, we used a scoping review to understand the common components of neuropsychiatry and behavioural neurology syllabuses across the world to better understand what defines neuropsychiatry as taught to trainees. We deliberately selected an inclusive approach that included academic and clinical neuropsychiatry syllabuses, the latter regardless of target profession, with the aim of clearly distinguishing these characteristics in the analysis.
Method
This scoping review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Reference Tricco, Lillie, Zarin, O’Brien, Colquhoun and Levac27
Protocol and registration
The scoping review protocol was pre-registered with INPLASY in September 2023 (registration number INPLASY202390090): https://inplasy.com/inplasy-2023-9-0090/).
As a review of published literature, the study did not require ethical approval.
Eligibility criteria
We included any paper, study or document giving syllabus contents for a neuropsychiatry and/or behavioural neurology training course. No eligibility limits were imposed for date of the document or language.
Information sources
Three research and clinical literature databases (PubMed, Embase and CINAHL) were searched on 1 September 2023. The electronic database search was supplemented by reviewing reference lists. Given that many syllabus outlines may not exist in the peer-reviewed literature, we also supplemented the literature database search by searching the web, and we published a request via the Global Neuropsychiatry Group to identify grey literature with syllabus contents. We requested anyone with knowledge of neuropsychiatry or behavioural neurology training courses to inform us. Course leads were then contacted to request syllabus descriptions and courses were identified online to download syllabus descriptions.
Search
For literature databases, we used the search terms ‘(neuropsychiatr* OR neuro-psychiatry OR neuro-psychiatric OR behavioural neurology OR behavioral neurology) AND (syllabus OR curriculum OR training)’, suitably adapted for each database. We additionally searched the web using similar search terms. The request for syllabuses from the Global Neuropsychiatry Group discussion group was sent to all group members.
Selection of sources of evidence
References from the search of literature databases were uploaded to Rayyan – an online platform that allows reviewers to collaborate and organise papers to conduct systematic-style reviews. Duplicate records were identified and removed using Rayyan’s inbuilt function. Titles and abstracts were independently screened by authors K.K. and V.B. and disagreements resolved through consensus. Syllabus documents identified through the grey literature identification process were entered directly into the full-text screening stage. The full text of papers and documents was independently assessed by K.K. and V.B. and the final list of documents was identified.
Data charting and synthesis
Syllabus components were extracted in an iterative process where individual syllabus items were extracted document by document on a coding spreadsheet. If a syllabus item was encountered that was common to a previous code, it was counted under that code. If it was a new item, it was added as a new code and previous documents were checked to ensure that it had not been missed previously. Initial coding was completed by author K.K. and checked by V.B. Higher-level syllabus component categories were coded using the upward coding approach, which involves grouping individual components into semantic categories and transforming the data from a lower to a higher level of abstraction. Reference Jansen28 Syllabus components were included in higher-level categories non-exclusively, so for example the syllabus component ‘Stroke (and the neuropsychiatric sequelae of)’ contributed to both the ‘Stroke’ and ‘Secondary psychiatric syndromes’ categories. We subsequently calculated frequency tables to identify how frequently syllabus component categories appeared across syllabus documents.
Results
We identified 23 neuropsychiatry and behavioural neurology syllabus documents. The PRISMA diagram for document identification process in the study is illustrated in Fig. 1. Details of all syllabus documents included in the final analysis are listed in in Table 1. We identified syllabus documents from the USA (k = 8), UK (k = 7), Australia (k = 2), Australia and New Zealand (k = 1), Argentina (k = 1), Chile (k = 1), Mexico (k = 1), South Africa (k = 1) and an international organisation (k = 1).
Fig. 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram for the scoping review process.
Table 1 Syllabus documents included in the scoping review
ARG, Argentina; AUS, Australia; CHL, Chile; INT, International; MEX, Mexico; NZL, New Zealand; ZAF, South Africa; PRL, peer-reviewed literature; PC, personal communication.
Syllabus components
Frequency tables for syllabus components are shown in Tables 2, 3, 4 and 5, highlighting topic groupings for neuropsychiatric disorders, fundamental issues, assessment and intervention. Full details of syllabus categories and their constituent syllabus components are shown in Tables S1 to S4 of the supplementary material, available at https://doi.org/10.1192/bjb.2025.10184.
Table 2 Frequency of neuropsychiatric disorders in included syllabuses
Table 3 Frequency of fundamental issue topics in syllabuses
Table 4 Frequency of assessment topics in syllabuses
Table 5 Frequency of intervention topics in syllabuses
Syllabus formats
Documents included position papers from the peer-reviewed literature (k = 8), syllabuses downloaded from websites (k = 7), syllabuses received through personal communication (k = 6) and position papers published as academic books chapters (k = 2). Documents described active training courses (k = 11), a formal syllabus for an active training course that had been superseded by a subsequent syllabus (k = 1) and a formal syllabus for proposed training courses that had not yet been implemented (k = 1). Of these formal training courses, k = 7 were open only to physicians, k = 1 only to clinical psychologists, k = 2 only to neurologists, k = 3 only to psychiatrists, and k = 4 were academic courses that were open to graduates, including those without clinical training. Within all courses, k = 8 involved supervised clinical practice: clinical components of these clinical training courses are outlined in Table 6.
Table 6 Clinical training components of neuropsychiatry and behavioural neurology training courses
Discussion
In this scoping review of both peer-reviewed and grey literature, we identified 23 unique syllabuses for neuropsychiatry and behavioural neurology courses to identify common course components. The identified course components indicate a thorough coverage of major neuropsychiatric conditions, with the most prevalent disorders covered by most courses and lower prevalence disorders covered less commonly. The covered disorders do not solely focus on the co-presentation of traditionally psychiatric and neurological disorders, but also include functional, behavioural and cognitively defined disorders. Neuropsychiatry and behavioural neurology training was conceptualised as teaching across a range of fundamental issues in mind and brain medicine, neuropsychology, differing degrees of philosophy, ethics and social science. Assessment and intervention components focused on a range of clinical skills and knowledge necessary to work across both mental health and neurological services, with a focus on management of cases in the social and institutional context of the trainee.
We note a clear evolution from proposals in the earlier peer-reviewed literature concerning the necessary components of training to the later development of formal training courses – likely indicating a healthy progression from debate to implementation. Of the syllabuses from formal training programmes, we also note that neuropsychiatry and behavioural neurology training is quite diverse in terms of how it is positioned with regard to clinical training pathways and academic learning. Some training is profession specific – exclusively aimed at physicians, specific medical specialties or clinical psychologists – some is embedded as a component within wider core clinical training, some implements training for a clinical specialisation, and some is designed as academic study, aimed at developing a domain knowledge and is inclusive of wider health professionals and even those with a purely academic interest.
We also note what may at first seem like an anomaly in the frequency of syllabus components. In the ‘fundamental issues’ section the specifically labelled ‘psychiatry’ component appears more frequently than the ‘neurology’ component. However, this appears to be down to naming conventions rather than content per se. There were more syllabuses that classified themselves as ‘neuropsychiatry’ rather than ‘neuropsychiatry and behavioural neurology’ or solely ‘behavioural neurology’, and so some topics were preferentially labelled as ‘psychiatry of’ or ‘neuropsychiatry of’, whereas core neurology components tended not to be named ‘neurology of’. In fact, the analysis of syllabus components as a whole shows that content from psychiatry, neurology, neuropsychology and social science is widely represented. It is also worth noting a broader reality, that in the majority of countries, formal training routes in neuropsychiatry and behavioural neurology are not available, although trainees report varying levels of integration into core training, but express a clear demand for further exposure. Reference Molina-Ruiz, Nakagami, Mörkl, Vargas, Shalbafan and Chang19,Reference Costello, Baum, Watson, Badenoch, Burchill and Rogers34
Combining internationally sourced syllabus components risks implying that neuropsychiatry and behavioural neurology should be defined in terms of a ‘global average’. Although some common components are likely to be universal, the reported profile should not be seen as prescriptive. The extent to which neuropsychiatry and behavioural neurology need to be adapted to local or regional contexts has been debated with regard to the needs of Latin America Reference Ramírez-Bermúdez, Juarez and Aliseda10 and India and South Asia. Reference Krishnamoorthy, Misra, Agrawal, Faruqui and Bodani35 For example, the neuropsychiatry of neglected tropical diseases Reference Berkowitz, Raibagkar, Pritt and Mateen36 is a common focus of clinical and research concern and high priority in some regions, Reference Rosa da, Junior and Gondim37 but less so in others. Therefore, any standardised framework should remain flexible, allowing for core components that transfer across countries while including cultural, clinical and educational adaptations that reflect the priorities of different regions and the needs of different professions within those regions.
It is also useful to compare the state of neuropsychiatry training in light of existing consensus syllabuses for medical specialties. Researchers and professional bodies have published a number of recommendations and consensus guidelines for syllabus contents. These variously range from broad clinical areas, such as clinical experience in neurology, Reference Safdieh, Govindarajan, Gelb, Odia and Soni38 to specific context-bound interventions, such as pain management in emergency medicine Reference Poon, Nelson, Hoppe, Perrone, Sande and Yealy39 and ultrasound assessment in critical care. Reference Neri, Storti and Lichtenstein40 In parallel, many clinical specialties do not have consensus recommendations and attempts to create them have faltered owing to concerns about adequate applicability across countries and contexts. Reference Weisz and Nannestad41 Neuropsychiatry may face unique training challenges as it is an interdisciplinary specialty, primarily drawing on approaches from established specialties of psychiatry, neurology and neuropsychology, Reference Trapp, Martyna, Siddiqi and Bajestan15 and there is a lack of cross-training between neurology and psychiatry since the two fields diverged in the 20th century. Reference Casper42 Furthermore, the rapid evolution of neuroscientific understanding and diagnostic technologies requires training programmes to balance foundational knowledge with emerging methodologies, creating additional complexity in curriculum design that may not be present in more established, single-discipline specialties. We suggest that attempts to create a single ‘super curriculum’ may not be successful in neuropsychiatry owing to variation in needs across countries and regions, but awareness of international developments and communication between training curriculum developers is likely to be key in disseminating best practices relevant to local contexts.
Limitations
We highlight some potential limitations of this scoping review. Although we did not limit syllabuses by language, database searches were completed in English. The databases we selected have a range of non-English language journals abstracted in English, although it is likely that non-English language journals are less likely to be indexed in these databases at all. Although we complemented our database searches by including a request to the Global Neuropsychiatry Group discussion network which, at the time of the query, included about 300 people from across the world with self-described interest in neuropsychiatry, this is primarily an English language group and relies on motivated individuals to respond, and therefore selection bias may have occurred. We identified only three non-English language syllabuses, all from Latin America, but it is unclear whether this reflects a greater presence of neuropsychiatry and behavioural neurology training in the region or simply greater visibility to our search. We also note that there is no standard format for the communication of syllabuses and the documents retrieved varied in their format – from formal descriptions designed to satisfy the accreditation criteria of academic or regulatory bodies to online descriptions aimed at prospective trainees. This may have under-recognised smaller topics, as these were less likely to be included in documents aimed at the public, which appeared more focused on ‘headline’ topics.
We also note that training and syllabus development is an ongoing process and we invite authors of neuropsychiatry and behavioural neurology syllabuses not included in this review, or of those released subsequent to this review, to contact us to help understand how training develops into the future.
About the authors
Keishema Kerr is a clinical psychologist at University College London, London, UK. Lauren Burns is a clinical psychologist at University College London, London, UK. Sheldon Benjamin is a Professor of Psychiatry and Neurology at the Department of Neurology and Department of Psychiatry and Behavioral Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA. Eileen M. Joyce is a Professor of Neuropsychiatry at UCL Queen Square Institute of Neurology, University College London, London, UK. Jasvinder Singh is a neuropsychiatrist at the University of Queensland, Brisbane, and Omega Mind Clinics, Brisbane, Australia. Jesús Ramírez-Bermúdez is a clinician, researcher, and professor at the Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico. Biba Stanton is a consultant neurologist and visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and King’s College Hospital NHS Foundation Trust, London, UK. Vaughan Bell is a professor of clinical psychology and cognitive neuropsychiatry at University College London, London, UK.
Supplementary material
The supplementary material is available online at https://doi.org/10.1192/bjb.2025.10184.
Data availability
Data availability is not applicable to this article as no new data were created or analysed in this study.
Author contributions
K.K., L.B. and V.B. were involved in developing the research question, designing the study and carrying it out. All authors were involved in interpreting the data and writing the article.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
V.B. is an unpaid member of the board of directors of the British Neuropsychiatry Association, a registered charity that runs continuous professional training and academic conferences. E.M.J. is an unpaid coopted member of the Royal College of Psychiatrists’ Faculty of Neuropsychiatry Executive Committee and Chair of the Sub-Specialty Advisory Committee for education and training. S.B. is a board director of the American Board of Psychiatry and Neurology.
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