A review of training in neuropsychiatry

A Nicol,J Bird

doi:10.1192/pb.16.10.631

Abstract

The boundary between neurology and psychiatry has never been sharply defined. It remains the case that a number of conditions (e.g. epilepsy, head-injury sequelae, dementia, and conversion hysteria) are seen by both neurologists and psychiatrists (Reynolds & Trimble, 1989). Few neurologists would dispute that there may be a marked psychiatric element to the presentation of multiple sclerosis, and it has long been noticed that even unmedicated chronic schizophrenic patients sometimes exhibit abnormalities of movement and so-called “soft” neurological signs such as dysgraphia and clumsiness (Lishman, 1988). These and other conditions may all on occasion present to the neuropsychiatrist.

Highlights

The scheme provides the psychiatric higher trainee with opportunities to develop negotiation skills with colleagues in a variety of disciplines
It emerged that there are a total of five senior registrar neuropsychiatry posts in the UK, two of which are at the Maudsley, one each in Belfast and Keele, and a shared post in Birmingham
In addition to the above posts, regular sessional training was offered on nine rotations, in the form of out-patients attendance, and occasional experience in neuropsychiatry was available on 12 schemes

Summary

Training aspects of the Birmingham court diversionscheme

The scheme provides the psychiatric higher trainee with opportunities to develop negotiation skills with colleagues in a variety of disciplines. Over-burdened local services are often initially sceptical about admitting patients to their few beds (especially since this group will often require intensive nursing input) when the staff have not had an opportunity to make a complete community assessment and information concerning prior history is sketchy. Without psychiatric diversion the court has no options other than to return the person into the community or to remand him or her into custody. As a training opportunity we believe the scheme is unusual, in that it teaches one to make rapid assess ments which are sufficiently coherent so as to stand up to scrutiny by lawyers. The oppor tunity of diverting the mentally ill from custody towards appropriate psychiatric treatment is one we have found to be satisfying, in spite of any angst involved in the proceedings

The study

Findings

Nicol and Bird