Neuropsychiatry

Overview

Neuropsychiatry is the interface of Psychiatry and Neurology that deals with mental disorders, which in most cases can be shown to have their origin from an identifiable brain malfunction. The Neuropsychiatry team are based at the Rosa Burden centre, Southmead Hospital.

Please see the NBT website - Neuropsychiatry - For Clinicians for further information on eligibility criteria including exclusions. Referrals are triaged and those that do not meet the eligibility criteria may be returned.

Children and Young People

Please note that only patients aged 17 years and 9 months or older can be referred to this service. CYP who are under this age should be referred to appropriate paediatric services:

• CAMHS Referral information
• Children's Community Services

Sleep Disorders Clinic

Please see the Sleep Medicine section for details on Neuropsychiatry Sleep Disorders clinic.

Complications of Acquired Brain Injury

There is a neuropsychiatry service for patients with neuropsychiatric problems caused by acquired brain injury. This is available via a RAS as detailed in referral section below.

Inclusion criteria:

• Acquired Brain Injury in the form of trauma, stroke, infective encephalitis, anoxic/hypoxic, metabolic (hypoglycaemic)
  • routine review all infective encephalitis patients following discharge from Infectious Diseases
• ABI with psychiatric complications
• ABI with cognitive impairment/suspected neurodegenerative dementia
• Suspected CTE (chronic traumatic encephalopathy)

Exclusion criteria:

• primary mental health disorder predates the brain injury
• primary diagnosis or presentation ischronic pain, fibromyalgia, personality disorder or chronic fatigue syndrome

Secretary: Yvonne.Munn@nbt.nhs.uk

Concussion

Please see the Concussion / mild traumatic brain injury page.

Functional Neurology

Functional Neurology deals with neurological symptoms without evidence of underlying organic pathology.

Please see the Functional Neurological Symptoms Referral page on the NBT website for details of this service and referral criteria:

The current pathway for referral is as follows:

• Step 1: Diagnosis and explanation made by a local neurologist, patient education material provided
• Step 2: Brief intervention by local services as able e.g. liaison psychiatry team, NHS Talking Therapies, physiotherapy
• Step 3: Chronic symptoms following steps 1 and 2: Referral to outpatient neuropsychiatry for assessment and guidance +/- CBT
• Step 4: MDT inpatient programme

Please note that there is no specific clinic for non neurological somatoform disorders or other 'medically unexplained symptoms'.

Patients with non-neurological somatoform disorders should be managed in primary care with support from NHS Talking Therapies or mental health services, or referrers can request advice and guidance from relevant specialities.

General Neuropsychiatry

The general neuropsychiatry service provides psychiatric assessment for mental health problems associated with neurological disease.

The service can offer assessment and support for psychiatric aspects of problems including:

• Parkinson’s Disease
• Epilepsy
• Multiple sclerosis
• Young onset dementia
• Tourette’s Syndrome
• Neurodevelopmental disorders

See the NBT General Neuropsychiatry referral page for details.

Referral

Referrals can now be directed via eReferral via a Triage Service. These services can be found on eRS under ' Mental Health - Adults of all Ages' and are not listed under neurology. Please note that there is more than one Neuropsychiatry Triage Service available on e-Referral. If not sent to the correct one the referral may be rejected as they cannot be forwarded to the correct service. Referrals are triaged by secondary care clinicians and if referral criteria are met then the patient will be contacted to arrange an outpatient assessment. If referral criteria are not met then the referrer will be given advice on eReferral.

Please note that there is more than one Neuropsychiatry Triage Service available on e-Referral. We need to be aware that when submitting a referral via one of these services, that it is the most appropriate one for that particular referral:

Neuropsychiatry Triage Service (Mental Health – Adults of all Ages’ and then clinic type ‘NOS’)   - this is where referrals for the following should be submitted: 

• Epilepsy - complex neuropsychiatric problems related to epilepsy, management of intractable epilepsy, NEAD and evaluation of patients undergoing neurosurgical procedures for the treatment of epilepsy.
• Functional Neurology – deals with any Neurological symptom without evidence of underlying organic pathology.
• Sleep disorder - Central Disorders of Hypersomnolence (e.g. Narcolepsy, Idiopathic Hypersomnia); Sleep related Movement Disorders (e.g. Periodic Limb Movement Disorder);  Parasomnias; Circadian Rhythm Sleep-Wake Disorders
• General Neuropsychiatry - assessment and recommendations for patients with mental disorder in the context of neurological disease or with psychiatric symptoms presumed to be secondary to an organic condition

The Neuropharmacology Clinic at NBT is closed.

Neuropsychiatry (complications of acquired brain injury) Triage Service (Mental Health - Adults of all ages and then clinic type Memory problems) this is where the following referrals should be sent:

• Acquired Brain Injury with Neuropsychiatric complications that are a result of the ABI.

Exclusions - The Neuropsychiatrists have advised that they do no routinely see patients whose primary diagnosis or presentation is:

• Chronic Fatigue Syndrome
• ADHD
• Personality Disorder
• Chronic Insomnia
• Chronic pain/ Fibromyalgia
• Complex behavioural problems
• Non neurological somatoform conditions

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.