About Neuropsychiatry

What is a Neuropsychiatrist?

A Neuropsychiatrist is a subspecialist psychiatrist that has expertise in treating psychiatric aspects of neurological, cognitive and neurodegenerative disorders.

  • Likely to have significant, experienced-based training in specialist (tertiary/quaternary) hospital neuropsychiatric settings

  • In Australia – no formal training for neuropsychiatry

  • RANZCP (College of Psychiatrists) has a Section of Neuropsychiatry

  • A Neuropsychiatrist is someone who calls themselves a Neuropsychiatrist

What are Neuropsychiatric Disorders?

Example neuropsychiatric disorders:

  • Psychiatric symptoms due to acquired brain injury

  • Psychiatric symptoms due dementia (typical dementia but also atypical, young-onset)

  • Psychiatric symptoms due epilepsy

  • Functional neurological disorders

  • Psychiatric symptoms of movement disorders (Parkinsons disease, Tourettes)

  • Psychiatric symptoms due to stroke or cerebrovascular disease

  • Psychiatric symptoms due to inflammatory, infectious or immunological disease (multiple sclerosis, encephalitis, autoimmune disorders)

  • Psychiatric symptoms in intellectual disability and neurogenetic disorders

What Do Neuropsychiatrists Do?

  • Take a standard psychiatric history

  • Undertake cognitive examinations

  • Undertake limited neurological examination

  • Review neuroimaging

  • Review general medical comorbidities

  • Understand and perform physical treatments (ECT, TMS, DBS…)

  • Understand the interface between general medical conditions and psychiatry

Neuropsychiatry vs Psychiatry

  • Neuropsychiatry is a subspecialty of psychiatry

  • Akin to old-age psychiatry, forensic psychiatry, addiction psychiatry

  • Starts with standard psychiatric training and further subspecialty training and experience

  • Will have an experience weighted towards organic disorders (brain injury, neurological disorders, stroke, intellectual disability, etc)

  • An example: I have cognitively assessed well 5-10000 patients, routinely do neurological examinations, and regularly review neuroimaging (having a PhD in MRI scanning)

  • Comfort in complex clinical conditions (e.g. cases – autoimmune chorea, transverse myelitis)

What Is a Neuropsychiatric Case?

  • Functional neurological disorder

  • Complex cognitive disorder

  • Traumatic brain injury, with behavioural issues or psychiatric illness

  • Other acquired brain injuries (stroke, hypoxic injury)

  • Comorbid psychiatric disorder with general medical or neurological illness

  • Interplay between cognitive impairment and psychiatric illness

  • Uncertainty regarding competency in complex medical illness

  • Behavioural or psychiatric presentations of intellectual disability or neurogenetic disorders

  • Issues regarding physical treatments in psychiatry

  • Typical medicolegal issues (injury, negligence, abuse, impairment) in context of neuropsychiatric illness

How Do I Brief a Neuropsychiatrist?

  • Probably how you would brief a psychiatrist generally, but….

  • Pre-existing neuropsychology is incredibly helpful

  • Neuroimaging results (reports, but also original images if possible)

  • Medical correspondence and discharge summaries – also incredibly helpful

  • As always, past psychiatric correspondence and IMEs helpful

  • Don’t expect a cognitive examination that will suffice for court – neuropsychological testing remains the gold standard

  • Otherwise – how you would brief a regular psychiatrist