The Neuropsychiatry service is based at the Barberry, in Edgbaston, Birmingham where we have an outpatient clinic and a Video Telemetry Unit (Vetiver Suite). We accept referrals from across the UK where funding is agreed but predominantly work with people from the West Midlands region.
To access the service people need to be aged 16 years or over and meet the referral criteria for the service. We also offer a transition service between Paediatrics and the Neuropsychiatry Service.
For more information about how to refer into Neuropsychiatry and how each team works please see below.
The service is comprised of seven sub-specialities.
Epilepsy and Mental Health
What is epilepsy?
Epilepsy is the most common serious neurological condition. It affects nearly 50 million people of all ages worldwide.
Over 60-70% of people become seizure free after treatment with antiseizure medication (ASMs) however 30-40% of people continue to have seizures with varying degrees of frequency and severity.
People with epilepsy are more likely to experience anxiety and depression than the general population and have higher rates of suicide. The prevalence of dementia is also higher in people with epilepsy and many of the medications we use can cause cognitive difficulties. Living with epilepsy can be challenging and it can have a huge impact on all areas of life.
As a national centre of excellence for epilepsy services, we offer comprehensive assessment, and opinion of individuals with epilepsy and mental health issues. As a research led and innovative centre we are at the forefront of developing novel pathways reflecting expertise in specialist aspects of care including research trials.
Our team
The epilepsy team is comprised of a Consultant Epileptologist & Neuropsychiatrist, Consultant Neuropsychiatrist and a Clinical Nurse Specialist in Epilepsy (CNS). We have support from a Specialist Dietitian and the Neuropsychiatry Occupational Therapists.
Our clinics take place at the Barberry Outpatients Department. We can arrange ward or home visits in exceptional circumstances.
The referral pathway
The service has expertise in the following areas:
- Diagnosis of seizure disorder where there has been diagnostic doubt
- The treatment of drug resistant epilepsy
- Treatment of mental health disorders in the setting of uncontrolled seizures where the treatment is likely to cause deterioration in seizure control
- Drug trials for people with chronic epilepsy who continue to have uncontrolled seizures
- Treatment of uncontrolled seizures
- Identification of potential surgical candidates for epilepsy surgery through access to prolonged video telemetry monitoring which can be either admission to Vetiver telemetry unit or through home video telemetry.
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Managing vagus nerve stimulation (VNS) treatment
The service does not accept service users without a suspected or confirmed mental health comorbidity except for service users suitable for drug trials where The Barberry is listed by the Sponsor as a trial site.
What happens at the first appointment?
At the initial assessment we will work through the relevant history, seizure semiology and previous treatment strategies tried (including ASM’s, other relevant medical, surgical and psychiatric history), in addition to information relating to social circumstances, safeguarding issues and risk.
Other investigations might include where relevant, screen of bloods, a general health screen, (height, weight, blood pressure recording and heart rate) and EEG (basic or more in depth). We may refer on for MRI/PET scans if required.
Appropriate tools will be used to measure mood, e.g. The HADS (Hospital, Anxiety and Depression Scale) and referral on within the team will be arranged where there is a need for more complex mental health assessment.
Further investigative options may be arranged at the follow up appointment with the Consultant Neuropsychiatrist or CNS. These may include video telemetry admission and further specialist scanning. Care management plan will be set by the consultant or CNS and circulated to team, referrer, G.P and service user.
What happens at the follow up appointment?
Frequency of contact is dependent upon clinical presentation such as frequency and severity of seizures. Where seizures are considered to be frequent, enduring and a threat to life, review will be more frequent (at least 3 monthly) where seizures are improving this will reduce to 6 monthly. Follow up care may be with the consultant or CNS depending upon presenting features of condition.
Typically assessment will consist of 1-2 medic appointments and follow up care with CNS twice a year. Telephone reviews by the CNS will also be built into the care package if appropriate.
The service is not an emergency one and service users are given a plan for contacting their GP, secondary services or A&E in these circumstances. Every effort will be made to telephone triage these cases in a timely manner.
Service users can move appropriately between pathways within the epilepsy service, for instance from medication management to VNS where appropriate and after discussion in MDT meeting.
Further investigations may be useful to help monitor clinical presentation such as further EEG investigations or imaging as appropriate. These will be discussed at the weekly MDT forum.
What treatment is available?
We offer treatment with antiseizure medications primarily however the majority of our service users have drug resistant epilepsy. We work closely with the QE Neurosurgical team and will refer service users for vagus nerve stimulation (VNS) or neurosurgery where appropriate.
When do we discharge?
The decision to discharge a service user will be taken by the reviewing clinician within the team and discussed in the weekly epilepsy MDT if appropriate. Service users will be discharged if:
- There is no ongoing significant mental health co-morbidity.
- Treatment can be implemented by local services either in primary or secondary care with advice from the epilepsy clinic
- Seizures have been in remission for 12 months
- There have been no active treatment changes over two clinic visits.
- Service users may also be discharged if they do not attend (DNA) their initial triage assessment, or fail to attend 2 successive follow up appointments.
It is recognised that epilepsy can be a lifelong, life-threatening condition for some service users, which is often poorly managed in primary care. Service users re-referred to the service will be offered a priority appointment with the CNS under whom their care previously resided to avoid the risk of mortality due to status epilepticus and sudden death in epilepsy (SUDEP).
Unplanned discharge
If a service user does not wish to continue treatment with the service, the service user will be discharged and this will be reported back to the referring clinician and GP who will make a decision about future requirements for the service user’s care.
The outcome of the service user contact with the epilepsy service will be reported to the referring clinician and/or the service user’s GP through a discharge letter which will include management advice as appropriate.
Further information
Non-epileptic attack disorder (NEAD)
What is non-epileptic attack disorder (NEAD)?
Non-epileptic attack disorder (NEAD) describes a condition in which people can have episodes which look similar to an epileptic seizure or fainting spell, but it is not caused by abnormal electrical discharges or blood pressure.
The term ‘non-epileptic seizure’ can lead to a lot of confusion amongst people. It is actually a well-recognised and common disorder that affects one in four patients coming to epilepsy clinics. Non-epileptic attacks can also be called ‘dissociative seizures’. This is because the main mechanism for seizures is a normal brain reflex called dissociation that seems to go into overdrive in some people, causing symptoms that can look like seizures.
Non-epileptic attacks happen when the brain can’t handle particular thoughts, memories, emotions or sensations. They can also sometimes relate to stress or a previous experience of trauma, i.e. something outside your control which feels too hard to bear.
Our team
The NEAD team is comprised of a Consultant Neuropsychiatrist & Epileptologist, a Consultant Neuropsychiatrist, and two Neuropsychiatry Liaison Nurses.
Referral pathway
Inclusion criteria: Service users aged 16 years and above who present with non-epileptic attack disorder.
Some cases may be referred for investigation and for a definitive opinion, where there is diagnostic doubt. Some will be for access to the NEAD care pathway when a confident diagnosis has been made by a clinician with irrefutable evidence of seizure without epileptiform discharge.
The service has expertise in the following treatment strategies:
- Diagnosis of seizure disorder where there has been diagnostic doubt
- Identification of causative factors and support with diagnosis that can feel stigmatising to the service user.
- Time limited treatment pathways with monitored outcomes
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What happens at the first appointment?
Following discussion in the MDT meeting the referral will be allocated to either a Consultant or for an initial triage with either specialist nurse or junior doctor where appropriate. Investigations will be arranged and history taken, prior to a follow up review with consultant.
Initial assessment will include documentation of relevant history, seizure semiology, previous treatment strategies tried, other relevant medical, surgical and psychiatric history.
Other investigations might include where relevant, screen of bloods, general health screen, (height, weight, blood pressure recording and heart rate) EEG (basic or more in depth). Appropriate tools will be used to measure mood, e.g., The HADS (hospital, anxiety and depression scale) and referral on within the team will be arranged where there is need for more complex mental health assessment.
Further investigative options may be arranged at the follow up appointment with the consultant to aid diagnosis including video telemetry admission to clarify diagnosis. Care management plan will be set by the consultant and circulated to team, referrer and service user.
What happens at follow up appointments?
Frequency of contact
Once diagnosis is established a clinical management plan will be formulated. The service user will be given an explanation of the diagnosis and supported through this. A time limited care package will be offered to explain diagnosis and to help reduce provocative trigger factors.
Follow up care will be coordinated by the Neuropsychiatry liaison nurse and will consist of a package of care which is time limited through the NEAD pathway. Typically six sessions of group work will be offered prior to discharge.
Care plan
All service users will receive a copy of their individual management plan.
Engagement
All assessments are undertaken at the Barberry in the Outpatient Department. Exceptions may be made to accommodate complex cases.
Loss of Engagement:
If someone does not attend for their session, they are sent a reminder letter asking them to rebook within 14 days. If there is no communication they are discharged back to the referrer..
What treatment is available?
The NEAD pathway has two branches:
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NEAD group – a psychoeducational group that runs for four weeks, each session lasting 1.5 hours. Groups are held at the Barberry and facilitated by the Neuropsychiatry Liaison Nurses.
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1:1 sessions with Neuropsychiatry Liaison Nurses
At the end of each branch there is a review focused on progress, skills and signposting on to further support, e.g. counselling, psychotherapy or third sector agencies.
The pathway is designed to equip service users with the tools they require to manage their NEAD.
What happens after treatment is completed?
The decision to discharge a service user will be taken by the reviewing clinician within the team and discussed in the weekly MDT meeting if appropriate. Service users will be discharged if:
- Treatment can be implemented by local services either in primary or secondary care with advice from the clinic
- The service user has completed the care package offered.
- Service users will also be discharged if they DNA their initial triage assessment, fail to attend 2 successive follow up appointments or do not engage when offered the time limited care package.
Unplanned discharge
If a service user does not wish to continue treatment with the service, they will be discharged and this will be reported back to the referring clinician and GP who will make a decision about future requirements for the service user’s care.
The outcome of the service user contact with the service will be reported to the referring clinician and/or the service user’s GP through a discharge letter which will include management advice as appropriate
Further information
Sleep Disorders
The Regional non-respiratory sleep service sees service users aged 16 years and above who present with symptoms of daytime hypersomnolence, disrupted sleep or an irregular sleep-wake cycle which has a significant impact on quality of life and daytime functioning. The service also offers second opinions on complex presentations and review of management of those with established sleep disorders which are poorly controlled.
The service has expertise in the following sleep disorders:
- Parasomnias – REM and non-REM behavioural sleep disorders
- Hypersomnia – narcolepsy spectrum disorders and idiopathic hypersomnia
- Insomnias
- Circadian rhythm disorders
- Slow wave sleep disorder
- Sleep related movement disorders – Restless legs syndrome, periodic limb movement disorder
- Other rare disorders such as cataplexy and Kleine-Levin Syndrome
For respiratory sleep comorbidity, the service has the expertise to offer diagnosis however, treatment is referred onto local respiratory sleep services.
Our team
Our team consists of three part time consultant neuropsychiatrists and somnologists, junior doctors, two part-time specialist nurses who both assess new patients and treat for insomnia and occupational therapists trained in provision of Cognitive behavioural Therapy for Insomnia (CBT-I). Junior doctors also provide treatment for insomnia.
The referral pathway
Referrals are accepted from local, regional and national organisations at primary, secondary and tertiary levels. Please complete our single point of access referral form, preferably attaching an informative letter stating reason for referral, summarising presenting and previous treatment strategies and relevant investigations.
For support and advice concerning a referral please contact our service on:
Jackie Robinson Central Administrator/Funding Coordinator 0121 301 2321
Kim Piercy Service Manager 0121 301 2285
What happens at the first appointment?
Before to attending the first appointment, service users will be sent a questionnaire pack to complete and bring to the appointment. This consists of a range of screening assessments to help determine sleep quantity, quality, daytime consequences, comorbidities such as depression and anxiety and overall quality of life.
At the appointment service users will be assessed by one of our junior doctors or specialist nurses which may involve relevant physical examination such as blood pressure, blood and urine tests. People may be fitted with an Actiwatch to wear for a week or fortnight. An Actiwatch is a device worn on the wrist that monitors sleep and waking periods to help us determine the sleep pattern. People may also need to keep a sleep diary, for us to compare the watch data with.
Any further investigations necessary for diagnosis will be identified at this appointment.
The sleep service is not able to offer community assessments in view of the complex investigations required. The sleep service will try to accommodate community follow up should this be needed.
What happens at follow up appointments?
When the Actiwatch is returned we upload the data from it for analysis. We will discuss the service user’s case in our multidisciplinary meeting and, considering specific circumstances, may offer a consultant follow up appointment or refer on to our specialist inpatient video telemetry unit for further investigations (Vetiver Suite). We may also refer service users for treatment of insomnia or circadian rhythm disorders if we feel this is the best service to meet their needs.
What treatment is available?
Once a diagnosis is established an individualised management plan is discussed with the service user. This may involve discharge with a management plan to be implemented locally; a management plan within the regional sleep service; referral to a respiratory sleep service or referral for an ENT opinion. Treatment pathways are condition specific and dependent on clinical need and symptom severity. The consultant neuropsychiatrist can advise on any suitable medication if this the most appropriate treatment for the diagnosis. CBT and other psychological interventions are offered as part of the recommended evidence based treatments to support some non-respiratory sleep disorders. If suitable, individuals with chronic insomnia disorder are directed towards the Cognitive Behavioural Therapy for Insomnia (CBT-I) pathway. This is the first line treatment recommendation as per NICE guidelines. For more information see:
Scenario: Managing insomnia | Management | Insomnia | CKS | NICE
What happens after treatment is complete?
The goal of our service is to equip service users and other health care professionals working with them with the tools they need to understand and manage their condition and to discharge people back to the care of their GP.
After completion of treatment, we will discuss the service user case in the twice monthly sleep MDT and a decision is made to either discharge, offer a top-up CBT-I session in 3-6 months or offer consultant review.
Service users will be discharged if:
- Treatment can be implemented by local services either in primary or secondary care with advice from the sleep clinic
- The sleep disorder is in remission
- There is no active treatment being offered by the sleep service
- Individuals users will also be discharged if they do not attend their initial triage assessment or fail to attend 2 successive follow up appointments.
Individuals that remain within the sleep service for follow up in view of clinical need and review of medications prescribed may have 1-2 reviews per year.
We are happy to accept re-referrals if there are any new or deteriorating aspects of their condition.
Tourette Syndrome
What is Tourette Syndrome?
Tourette syndrome is a developmental disorder characterised by uncontrolled movements (motor tics) and vocalisations (vocal tics).
Our team
Prof AE Cavanna leads the specialist Tourette Syndrome Clinic and liaises with primary care and other specialist care providers to coordinate the care pathways
Referral pathway
Referrals to the specialist Tourette syndrome clinic are accepted from local, regional and national organisations at primary, secondary and tertiary levels. For service users under the age of 16, ongoing involvement of a paediatrician / child and adolescent psychiatrist need to be documented within the referral.
What happens at the first appointment?
The first assessment is conducted according to international guidelines (European Society for the Study of Tourette Syndrome, ESSTS) and is divided into three parts. In part 1, an in-depth clinical interview is conducted according to the National Hospital Interview Schedule for Tourette Syndrome (NHIS-TS). In part 2, a standardised battery of validated self-report measures are completed by the service user. In part 3, a care plan tailored to the individual needs of the service user is agreed.
What happens at follow up appointments?
Service users receive a copy of their care plan, which includes detailed information about the recommended treatment interventions. Follow-up appointments are offered according to the PIFU (Patient-Initiated Follow-Up) model.
What treatment is available?
Treatment is individualised and includes psychoeducation, pharmacotherapy, and behavioural therapy. A referral to the National Hospital for Neurology and Neurosurgery for brain surgery (deep brain stimulation, DBS) can be considered for highly selected service users, according to the British and European guidelines on DBS for Tourette syndrome.
When are people discharged?
Treatment is often lifelong, with reviews being required according to changes in clinical presentation.
Huntington's Disease
What is Huntington’s Disease?
Huntington’s Disease is a rare inherited neurodegenerative illness caused by a defective gene.
- It affects the way we think, the way we behave and the way we move.
- It affects both males and females.
- Symptoms usually start to present between the ages of 30-50 but Juvenile Huntington’s Disease can present at a much younger age.
- Not everyone with Huntington’s Disease will have mental health difficulties
- Some patients will develop Organic Personality Disorder and may require treatment from appropriate mental health services.
- Not everyone with the disease will display obvious involuntary movements.
- Often cognitive decline is already significant before any physical symptoms are present
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Our team
Our team consists of:
- Consultant Neuropsychiatrists
- Neuropsychiatry Specialist Nurse
- Senior Occupational Therapist and education lead
- Specialist Speech and Language Therapist
- Specialist Dietician
- Team Secretary
We also have strong links with the Huntington’s Disease Association and their team of specialist advisors working across the West Midlands area.
The referral pathway
Referrals are accepted from other consultants, GPs and other health workers.
What happens at the first appointment?
Our specialist team includes the following
Specialist Assessment, advice and Diagnosis.
Clinics and community visits run by our consultant and specialist nurse.
Occupational therapy
Speech and Language therapy
Dietetics
Management of sleep
Clinical research and education
What we cannot do:
- We cannot provide urgent or crisis care
- We do not have access to funding for placements or care packages
- We are unable to provide inpatient care
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What happens at follow up appointments?
We discuss our service users in a multidisciplinary meeting and, considering their specific circumstances, will offer a treatment plan if we feel we are the best service to meet their needs.
What treatment is available?
Treatment focuses on monitoring disease progression, management of symptoms and associated risk. This can include:
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Medication where and when required
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Assessment and support with physical and cognitive function
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Specialist dietary and nutritional support
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Advice and management of safe eating and drinking
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Help with management of mood and behaviour
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Advanced care planning to ensure your wishes and preferences are known and recorded for when you may no longer be able to communicate or make decisions
We offer diagnosis, assessment and management of all aspects of Huntington’s disease and do not distinguish between physical and mental care. We also provide advice and support for family members and others affected by HD. We offer the opportunity for all parties to be involved in research.
Research
Research is ongoing and many of our patients and families can choose to take part in research if they wish to do so.
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Chronic Fatigue Syndrome
What is Chronic Fatigue Syndrome?
The term fatigue can be used to describe difficulty or inability to initiate activity reduced capacity to maintain activity, or difficulty with concentration, memory, and emotional stability (mental fatigue). People may report one or a combination of these symptoms, and they may occur alone or in conjunction with other complaints.
Fatigue is a very common problem. Acute fatigue (lasting one month or less) is most often related to an acute medical condition, which can be diagnosed on the basis of its other clinical manifestations. For example, a patient with the flu will describe fatigue in association with fever and respiratory symptoms. Acute fatigue may also be the result of a recent life stressor.
Chronic fatigue refers to persistent or recurrent fatigue lasting for over six weeks. A specific cause of chronic fatigue can be identified in approximately two-thirds of patients, ranging from heart and lung disease, hormonal imbalances, autoimmune illness, or mental health problems. These are usually diagnosed in Primary Care after a careful review of the clinical history, physical observations, and relevant investigations.
In a small minority of cases, chronic fatigue is explained by Chronic Fatigue Syndrome (CFS). CFS, also known as myalgic encephalomyelitis (ME), is an illness of uncertain cause. The condition has long been recognized, and many different names have been used to describe it. While underlying objective findings involving the central and autonomic nervous systems, the immune system, and energy metabolism have been described, these have not yet led to a clear understanding of the mechanisms underlying the disease, or to a reliable diagnostic test.
For a diagnosis of CFS to be made, symptoms should be present for at least 3 months, have substantial intensity, and significantly disturb normal function and quality of life.
In addition to fatigue, other criteria include post-exertional malaise, unrefreshing sleep, and cognitive impairment.
People with CFS commonly wake up exhausted and feeling as if they have not slept at all—no matter how long they have been asleep.
Other common symptoms of CFS include chronic pain, Digestive problems, orthostatic intolerance including cardio and respiratory symptoms.
Our team
The team consists of a Consultant Neuropsychiatrist, Clinical Nurse Specialist and Senior Occupational Therapist and therapeutic staff who specialise in CFS.
The referral pathway
We are a national service from age 16 and over. People can be referred to the service if they have received a diagnosis by a GP, Rheumatologist or Neurologist. Where a diagnosis is uncertain people can be referred for assessment and diagnosis by our team.
What happens at the first appointment?
The first appointment will be with a Specialist Nurse or with the service Consultant. We offer face-to-face or remote consultations depending on the service users’ circumstances.
NICE Guidance: As a service we work within NICE guidelines and focus on education and promotion of self-management:
The consultation will include, but is not limited to:
- a clinical assessment (including relevant symptoms and history, comorbidities, overall physical and mental health, anything that is known to exacerbate or alleviate symptoms, and sleep quality)
- an assessment of physical functioning
- the impact of symptoms on psychological, emotional, and social wellbeing
- Current and past experiences of medicines (including tolerance and sensitivities), vitamins and other supplements.
- A brief dietary assessment (including weight history before and after their diagnosis of ME/CFS, use of restrictive and alternative diets, and access to shopping and cooking)
We will also review previous investigations and suggest further tests if needed.
What happens at follow up appointments?
We will discuss our service users in a multidisciplinary meeting and, considering their specific circumstances, will offer a treatment plan if we feel we are the best service to meet their needs.
What treatment is available?
We appreciate that people experience CFS differently and to different extremes. Some will have a similar catalogue of symptoms and others may have more physical than cognitive and vice versa. Understanding the condition is essential to understanding how to manage it.
A Symptom and Fatigue Management Course is run by Occupational Therapy.
The course includes education and guidance around activity analysis, fatigue management, pain management education, sleep hygiene, cognitive difficulties, and orthostatic symptoms. It is also an opportunity to meet other people with the condition.
Many therapies have been tried in people with CFS, but none have been proven to be curative. Overexertion in the early stages of the illness is likely to lead to poorer outcomes, so treatment should focus on managing fatigue and avoiding overexertion. Common symptoms such as sleep disturbance, pain, depression and anxiety, irritable bowel, and dizziness and light-headedness can also be addressed.
Remaining active is often important for people with CFS. However, the approach to activity management must be individualized, since doing too much can exacerbate post-exertional malaise.
To minimise post-exertional malaise, therapists and service users must determine individual limits regarding the degree of activity that can be tolerated. We may service users to gently push themselves, but they should not try to do too much, even if they happen to have much more energy on one particular day. The objective is not an immediate return to previous levels of functioning, but rather maintenance of a slowly progressive level of activity.
We refer to this process of understanding your limits, adapting your activities to those limits, and gently try to expand those limits, when possible, a pacing or energy management. This is the recommended treatment for CFS according to current guidance from NICE.
We also run a separate Young People’s Symptom Management and Wellbeing Course. Their symptoms may have interrupted their education or limited their employment opportunities. It may have contributed to feelings of social isolation and low self-esteem. This course addresses sleep hygiene, activity analysis, self-esteem and emotional wellbeing, nutrition and lifestyle education and understanding medications and pain.
We also offer a One-to-one therapeutic intervention’s for those with coexisting mental health difficulties such as significant mood and anxiety disorders where we feel a group environment would not be appropriate. One to one can only be offered in these circumstances and will be determined by the clinical team.
What happens after people complete treatment?
The goal of our service is to equip service users with the tools they need to understand and self-manage their condition. Therefore, we will discharge service users back to the care of their GP once treatment is complete.
NICE guidance states that people with CFS should be reviewed in Primary Care at least once a year.
We are happy to accept re-referrals if there are any new or deteriorating aspects of your condition.
Functional Neurological Disorder (FND) and General Neuropsychiatry
What conditions do the general neuropsychiatry service work with?
The general neuropsychiatry service offers assessment, opinion and advice on risk management for any general neuropsychiatry condition for adults over 16 years of age.
This includes identified or suspected psychiatric symptoms resulting from a neurological and/or neurosurgical disorder that are not part of an adjustment disorder or other pre-existing mental health problem, and require specialist assessment and management., including nervous system complications of systemic disorders (HIV, systemic lupus erythematosus (SLE), Sarcoidosis, metabolic disorders and others) where patients are under primary and secondary care who will continue with their ongoing care.
We also offer assessment and treatment for adults over 16 years of age who have Functional Neurological Disorder (FND) that has failed to improve with primary or secondary care management and where there is unacceptable symptom control. Likewise, for people with FND with high severity of symptoms.
Finally, we offer assessment and diagnosis for people with likely functional neurological disorders where there is uncertainty regarding diagnosis and all relevant tests and scans have been completed by primary and secondary care.
Our team
Our team consists of one full time and two part time consultant neuropsychiatrists, along with a team of occupational therapists that run the group and individual self management programmes and a part time physiotherapist.
The referral pathway
Referrals are accepted from local, regional and national organisations at primary, secondary and tertiary levels. Please complete our single point of access referral form, preferably attaching an informative letter stating reason for referral, summarising presenting and previous treatment strategies and relevant investigations.
You can also use the FND service referral form: Functional neurological disorders referral form
We have a service user information leaflet about FND.
Inclusion criteria:
- Adults over 16 years of age.
- For assessment and opinion only and advice on risk management: Identified or suspected psychiatric symptoms resulting from a neurological and/or neurosurgical disorder that are not part of an adjustment disorder or other pre-existing mental health problem, and require specialist assessment and management., including nervous system complications of systemic disorders (HIV, systemic lupus erythematosus (SLE), Sarcoidosis, metabolic disorders and others) where patients are under primary and secondary care who will continue with their ongoing care.
- For assessment and treatment:
- Functional neurological disorders that have failed to improve with primary or secondary care management and there is unacceptable symptom control.
- Functional neurological disorders with high severity of symptoms.
- Likely functional neurological disorders where there is uncertainty regarding diagnosis and all relevant tests and scans have been completed by primary and secondary care.
Exclusion criteria
- Primary issue is functional/dissociative seizures. Please refer to non-epileptic attack disorder pathway.
- Primary concern is pain. Please refer to local pain management services.
- Primary concern is health anxiety. Please refer to local psychology services.
- Primary concern is a neurodevelopmental condition. Please refer to specialist neurodevelopmental services.
- Primary issue is acquired brain injury. Please refer to local specialist brain injury services.
- Where patient has significant learning difficulties and will not be able to use self-management strategies.
- Where patient has unstable acute mental health difficulties and is not being supported by secondary mental health services. As we are a tertiary service, we are unable to respond in an emergency and do not offer a crisis intervention or home treatment service.If the individual requires the involvement of local mental health services, responsibility needs to rest locally to ensure access to all mental health services in the local area and this needs to be the responsibility of the referrer.
- Referral is for neuropsychology testing only. Please refer to physical health psychology services.
- Symptoms are primarily sensory, and this has not been assessed by relevant services.
- Symptoms are primarily cognitive, and this has not been assessed by relevant services.
- Has not been assessed by neurologist.
- Has not had relevant diagnostic tests or imaging completed to enable diagnostic certainty.
- Person is not accepting of diagnosis of FND and/or not willing to engage in self management programme.
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What happens at the first appointment?
You will usually be assessed by one of our consultant neuropsychiatrists, particularly if there is some diagnostic uncertainty, or our lead occupational therapist if you already have an established diagnosis of FND and have been primarily referred for treatment.
What happens at follow up appointments?
We will discuss your case in a multidisciplinary meeting and, considering your specific circumstances, will offer you a treatment plan if we feel we are the best service to meet any needs.
What treatment is available?
Our consultant neuropsychiatrists can advise on the most suitable medication and offer guidance on this to other services.
Our FND treatment programmes are provided by our occupational therapists and physiotherapist and follow the consensus guidelines for Functional Neurological Disorder available below.
We currently provide an online 5-week group programme of education and self management strategies to help people to improve their functioning from their symptoms. The group compiles of 5 sessions based around, improving knowledge of FND, fatigue and symptom management, sleep advice, regulation and relaxation, challenging unhelpful thoughts and feelings using a CBT model and managing setbacks and difficulties. On completing this programme, service users will be reviewed and further treatment options both within the service and with local services will be explored.
We provide the same content of self management in individual sessions, both online or face to face for those who do not feel that a group would suit them.
We also provide bespoke specialist physiotherapy for those who have already had physiotherapy treatment from their local teams and have had limited benefit from this.
What happens when treatment is completed?
The goal of our service is to people you with the tools they need to understand and self-manage their condition. Therefore, we will discharge service users back to the care of their GP once treatment is complete.
We are happy to accept re-referrals if there are any new or deteriorating aspects of service user’s conditions.
Useful links
How to access our Service
Referrals are accepted from local, regional and national organisations at primary, secondary and tertiary levels. Please either complete our single point of access referral form, preferably attaching an informative letter stating reason for referral, summarising presenting and previous treatment strategies and relevant investigations.
For support and advice concerning a referral please contact:
Jackie Robinson Lead Administrator for Neuropsychiatry
Kim Piercy Neuropsychiatry Service Manager on 0121 301 2321.
How we can help
Neuropsychiatry in BSMHFT is a specialist service which has evolved over many years. We are at the forefront of international research and the teaching in Neuropsychiatry.
We aim to provide specialist assessment and treatment for our service users, who are at the heart of the care we provide. To achieve this we work alongside mainstream mental health services, social care agencies and voluntary organisations.
As a tertiary service we do not offer a care programme approach (CPA) for service users. Where this is indicated we will work alongside local community mental health teams (CMHTs).
We offer a comprehensive multidisciplinary approach and our teams are comprised of
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Neuropsychiatrists
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Neuropsychiatry Liaison Nurses
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Clinical Nurse Specialists
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Occupational Therapists
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Dietitians (HD and Epilepsy)
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Speech and Language Therapists (HD only)
Vetivier Suite
What is the Vetivier Suite?
Vetiver Suite / EEG is a diagnostic neurophysiology service. This includes an outpatient EEG (electroencephalogram) service as well as an inpatient ward where we monitor EEG, video, polysomnography (sleep parameters) during 2 – 4 night investigations. These investigations are carried out for the investigation and assessment of epilepsy, differential diagnosis of episodes of altered awareness and sleep disorders.
Our team
Our Team consists of specially trained nursing staff and HCA’s, Healthcare Scientists, Consultant Scientist and Consultant Neurophysiologist as well as a Consultant Neuropsychiatrist and Junior medical staff.
The referral pathway
Referrals for our Inpatient investigations for Video Telemetry, are from Consultant Neuropsychiatrists and our Epilepsy specialist nurse. Referrals for other EEG services, e.g outpatient EEG come from our Neuropsychiatrists and other BSMHFT care providers via a referral form. We also provide an EEG service for St Andrews Healthcare.
What happens at the first appointment?
Service users can be referred for one of the following investigations :
- Routine EEG – A 1 hour appointment with a 20 minute EEG (trace of brain activity), at the Vetivier Suite.
- Ambulatory EEG – EEG wires are attached to the head and connected to a bag which is carried. Service users will be required to return to The Barberry each day for battery change and electrode check.
- Inpatient Video Telemetry / Polysomnography – service users stay in our specialised en suite room for 2 – 4 nights where their EEG and video will be monitored.
- Home Video Telemetry – The team will visit service users at home and set up EEG and video. They return each day to upload data.
Information regarding the various investigation r will be sent out with the appointment letter. Prior to an Inpatient VT study service users will have a triage with one of our doctors.
If service users do not attend, or cancel 2 appointments they will be discharged from the waiting list. Our investigations are allocated individually and require a large amount of organisation. It is imperative that people inform us if they will not be attending a scheduled appointment.
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