Neuropsychiatric Services Research Articles

Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target.

The presence of a positive family relationship has been suggested as a protective factor from parental stress and from the development of full-blown psychosis. However, to date, there is limited research on family functioning in adolescents with psychosis and at clinical high risk for psychosis (CHR-P). This study is aimed at comparing family functioning and perceived stress in parents of adolescents with either CHR-P, early onset psychosis (EOP), or other psychiatric disorders (no CHR-P). As a secondary aim, it will correlate family functioning with parental perceived stress in order to find critical targets of intervention. We conducted a Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD)—compliant, real-world, cross-sectional study. One-hundred and eleven adolescents aged 12–17 who access the institute of hospitalization and care with scientific character (IRCCS) Mondino Foundation Neuropsychiatric services (Pavia, Italy) between 2017 and 2020 and their parents (n = 222) were included. Sociodemographic characteristics of adolescents and their parents were collected. Family functioning was evaluated through the Family Adaptability and Cohesion Evaluation Scale-IV (FACES-IV) and the level of stress through the Perceived Stress Scale (PSS). Twenty adolescents had EOP, 38 had CHR-P, and 59 had no CHR-P. In total, 2.6% of CHR-P adolescents were adopted, 76.3% had separated-divorced parents, and 34.2% of parents had a depressive disorder. Among the FACES-IV sub-scale, maternal rigidity was progressively increased from no-CHR-P to CHR-P to EOP group, with statistical differences between EOP and the other two groups (p = 0.01). CHR-P mothers and fathers showed a high level of PSS values, without group difference. Lastly, PSS values correlated positively with the Rigidity, Disengagement, and Chaos scale of FACES-IV and negatively with the Communication scale (p < 0.05). Our results suggest that family functioning has a central role and could represent a worthwhile target of intervention for adolescents at CHR-P, leading the way to new preventive approaches.

Prognostic Accuracy of DSM-5 Attenuated Psychosis Syndrome in Adolescents: Prospective Real-World 5-Year Cohort Study.

There is limited research in adolescents at risk for psychosis. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attenuated psychosis syndrome (DSM-5 APS) criteria have not been validated in this group. We conducted a RECORD-compliant, real-world, prospective, 5-year cohort study addressing clinical profile, transition to psychosis, and prognostic accuracy of DSM-5 APS in help-seeking inpatient/outpatient adolescents accessing Children and Adolescent Neuropsychiatric services at IRCCS Mondino Foundation (Pavia, Lombardy, Italy) between 2012 and 2019. About 243 adolescents (31 early-onset psychosis [EOP]; 110 meeting DSM-5 APS criteria, DSM-5 APS; 102 not meeting psychotic or DSM-5 APS criteria, non-APS) were included. At baseline, DSM-5 APS adolescents (aged 15.4 ± 1.6) had on average 2.3 comorbid disorders (higher than EOP/non-APS, P < .001). DSM-5 APS adolescents had an intermediate psychopathological profile between non-APS/EOP (P < .001) and worsen Clinical Global Impression-Severity than non-APS (P < .001). DSM-5 APS functioning was intermediate between non-APS and EOP. 39.1% of DSM-5 APS were treated with psychotropic drugs (average = 64 days); 53.6% received psychotherapy. Follow-up of DSM-5 APS and non-APS groups lasted 33 and 26 months, respectively (median). The cumulative risk of transition at 1-5 years was 13%, 17%, 24.2%, 26.8%, and 26.8% in the DSM-5 APS group, 0%, 0%, 3.2%, 3.2%, and 3.2% in the non-APS group. The 5-year prognostic accuracy of the DSM-5 APS in adolescent was adequate (area under the curve = 0.77; Harrell's C = 0.736, 95%CI 0.697-0.775), with high sensitivity (91.3%) and suboptimal specificity (63.2%). The DSM-5 APS diagnosis can be used to detect help-seeking adolescents at risk of psychosis and predict their long-term outcomes. Future research should consolidate these findings.

Impact of mobile health application on data collection and self-management of epilepsy

Recent advances in mobile health have enabled health data collection, which includes seizure and medication tracking and epilepsy self-management. We developed a mobile epilepsy management application, integrated with a hospital electronic health record (EHR). In this prospective clinical trial, we assessed whether the mobile application provides quality healthcare data compared to conventional clinic visits, and enhances epilepsy self-management for patients with epilepsy. The study population includes patients with epilepsy (ages 15 years and older) and caregivers for children with epilepsy. Participants were provided access to the application for 90 days. We compared healthcare data collected from the mobile application with data obtained from clinic visits. The healthcare data included seizure records, seizure triggering factors, medication adherence rate, profiles of adverse events resulting from anti-seizure medication (ASM), and comorbidity screenings. In addition, we conducted baseline and follow-up questionnaires after the 90-day period to evaluate how this mobile application improved epilepsy knowledge and self-efficacy in seizure management. Data of 99 participants (18 patients with epilepsy and 81 caregivers) were analyzed. Among 24 individuals who had seizures, we obtained detailed seizure records from 13 individuals through clinic visits and for 18 from the application. Aside from the 6 individuals who reported their medication adherence during clinic visitation, half of the study participants had adherence rates of over 70%, as monitored through the application. However, the adherence rates were not reliable due to high variability. Twenty-three individuals reported 59 adverse reactions on the application, whereas 21 individuals reported 24 adverse reactions during clinic visits. We collected comorbidity data from 4 individuals during clinic visits. In comparison, 64 participants underwent comorbidity self-screening on the application, and 2 of them were referred to neuropsychiatric services. Compared to rare/non-users, app users demonstrated significant improvement in epilepsy knowledge score (p < 0.001) and self-efficacy score (p = 0.038). In conclusion, mobile health technology would help patients and caregivers to record their healthcare data and aid in self-management. Mobile health technology would provide an influential clinical validity in epilepsy care when users engage and actively maintain records on the application.

Trends in admissions to a child and adolescent neuropsychiatric inpatient unit in the 2007–2017 decade: how contemporary neuropsychiatry is changing in Northwestern Italy

PurposeRising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services.MethodsThe present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007–2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis.ResultsThe overall number of inpatient admissions decreased significantly (APC = − 5.91), in particular for children under 12 years of age (APC = − 7.23). The rate of neurologic diagnoses significantly decreased (APC = − 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admission (APC = 6.69) increased. Among the psychiatric diagnoses, depression significantly rose (APC = 41.89), in particular among female adolescents (APC = 40.30).ConclusionsThese data document a substantial change in the utilization of inpatient neuropsychiatric services for children and adolescents, with a major increase in psychiatric hospitalizations and a parallel decrease in neurological ones. These trends call for greater attention to early preventive intervention in mental healthcare system.

Hearing Loss in Children: Clinical-Epidemiological Data from Two Different Provinces of the Same Region.

Background: In many countries, neonatal hearing screening programs (NHS) have been available for many years; however, because of the presence of hearing loss at late onset, early hearing detection programs (EHDP) have been implemented. The aim of this study was to evaluate all cases of infantile hearing loss under the care of two different provinces of a regional health service since the introduction of NHS. Methods: Clinical data (the presence of audiological risk factors, age at which children are placed under the care of health service, entity of hearing loss, treatment, and exposure to bilingualism) were retrospectively collected during the period from 1 January 2012 to 31 December 2018, starting from the IT management system used in all of the regional neuropsychiatric services. Results: In total, 124 children were included—116 cases failed the screening, 1 case had an untraceable result, and 7 cases (5.6%) had hearing screening that passed. Most of the children were placed under the care of a neuropsychiatric infantile and adolescence (NPIA) service within the first year of life. The main differences across the two provinces concerned the percentages of audiological risk factors and the number of unilateral hearing loss cases. Conclusion: In order to plan and manage hearing rehabilitation programs for children in the best way, it is very important to know the local clinical-epidemiological features of the population.

Facing biological risk in child and adolescence neuropsychiatric services during COVID-19 outbreak: Management of protection levels for the direct access

Maternal mortality accounts for most deaths in agrarian communities of Nigeria due to poor access to midwives services and inadequate Skilled Birth Attendants (SBAs). The Midwives Service Scheme (MSS) was established to engage more SBAs and advocate better utilization of pre and post-natal care services.

Psychedelic treatment of functional neurological disorder: a systematic review.

Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatric services, yet the therapeutic evidence base is somewhat limited. There has been recent interest in the therapeutic potential of psychedelics such as psilocybin and lysergic acid diethylamide (LSD), and in recent studies psychedelics have shown promise in treating a range of neuropsychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 and 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified. In most cases, patients received a course of psychotherapy with variable adjunctive administration of psychedelics (in a combination known as ‘psycholytic therapy’), with protocols varying between studies. Of those treated, 69% (n = 18) were found to have made at least some recovery on heterogeneous and subjective clinician-rated criteria. Adverse events were mostly mild and transient; however, at least one patient terminated the study due to distressing effects. All included studies were of low quality, often lacking control groups and valid outcome measures. Although no conclusions on efficacy may be drawn from these data, further research may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.

Triadic Interactions in Families of Adolescents with Anorexia Nervosa and Families of Adolescents with Internalizing Disorders.

The latest studies and practice guidelines for the treatment of adolescent patients with anorexia nervosa agree in pointing out the key role played by parents in determining the young patients’ therapeutic possibilities and outcomes. Still family functioning has usually been studied using only self-reported instruments. The aim of the present study is therefore to investigate the triadic interactions within the families of adolescents with anorexia nervosa using a semi-standardized observational tool based on a recorded play session, the Lausanne Trilogue Play (LTP). Parents and adolescent daughters, consecutively referred to adolescent neuropsychiatric services, participated in the study and underwent the observational procedure (LTP). The 20 families of adolescent girls with anorexia nervosa (restricting type) were compared with 20 families of patients with internalizing disorders (anxiety and depression). The results showed different interactive patterns in the families of adolescents with anorexia nervosa: they had greater difficulties in respecting roles during the play, maintaining the joint attention and in sharing positive affect, especially in the three-together phase (third phase). The majority of these families (12) exhibited collusive alliances. The parental subsystem appeared frequently unable to maintain a structuring role, i.e., providing help, support and guidance to the daughters, while the girls in turn often found it hard to show independent ideas and develop personal projects. Parents experienced difficulty in carving out a couple-specific relational space, from which the ill daughter was at least temporarily excluded also when they were asked to continue to interact with each other, letting the daughter be simply present in a third-part position (fourth phase). The study of the triadic interactions in the families of adolescents with anorexia nervosa may help to shift the attention from the exclusive mother–daughter relation to the involvement of the father, and of the parental couple as a whole. The family functioning is in fact well established as a maintaining factor of anorexia nervosa or vice versa as a facilitating factor in the therapeutic process.

La fuga dal "recinto": la trincea e la follia

The essay focuses on the way in which Italian Military High Command and Italian War Neuro-psychiatric services progressively dealt with what the British called, after the debacle of the Somme, the shell schock, i.e. posttraumatic desease. It analyses the wide debate on the weird that involved the most eminent psychiatrists and the main scientific Journals. The belief of a hereditary pathology was gradually set aside, so was the temptation to consider the berserk a coward. The source of the psychiatric diseases was progressively acknowledged in the atrocities suffered in the war even if post-traumatic disease was still considered, in many writings, only a temporary phenomenon, if not mere dissimulation at the end of the war.

Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE.

Background and objectivesNeuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi.MethodsThe study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were collected from the ACPN to describe patterns of insurance coverage and patient cost-sharing. The data included information on patient visits to the ACPN from January 1, 2010 till May 16, 2013. The data also included insurance coverage, total cost of treatment for each patient and the amount of coinsurances and deductibles paid by each patient. Additionally, the study utilized data published by HAAD on health services utilization, and health insurance plans in 2014. The percentage of total costs paid by patients and insurance were calculated by insurance groups and health service. Insurance plans with different patient cost-sharing arrangements for mental health treatment benefits were divided into three groups. ANOVA and MANOVA analyses were performed to test for differences among three categories of neuropsychiatric services (neurology, psychiatry and psychotherapy) in terms of the total costs and patient cost-sharing. The data were analysed using STATA version 12.ResultsAbout 36 % of the total costs on ambulatory neuropsychiatric services was paid directly by patients; 1 % of total costs was covered by patients as co-insurances and deductibles, and 63 % of total costs was covered by insurance providers. The average cost per visit was about 485 AED ($132), including 304 AED ($83) paid by insurance and 181 AED ($49) paid by patient. About 44 % of total costs was related to psychiatry services, 28 % of total costs was related to neurology services, and 28 % of total costs was related to psychotherapy services. Using ANOVA analyses, statistical differences were found among three categories of neuropsychiatric services in terms of the total costs and patient cost-sharing. These findings provide hint on some degree of association between patient cost-sharing and neuropsychiatry services utilization.ConclusionsThe determination of parities in the coverage and finance between neuropsychiatric and physical health services will help policymakers make informed decisions on regulations of health insurance plans. Given the level of unmet need for neuropsychiatric services in Abu Dhabi, there is a need to fully include neuropsychiatric services in all basic and enhanced insurance plans. The study provided a description of patient cost-sharing and coverage of neuropsychiatric services in order for policymakers to recognize the disparities of the coverage and the degree of economic burden on households.

A comparison of clinician and caregiver assessment of functioning in patients attending a child and adolescent mental health clinic in Nigeria

Objective. To compare clinician and caregiver assessments of functioning and impairment among children attending a specialist mental health facility. Methods. Caregivers of patients attending the Harvey Road Child and Adolescent Centre ( N =155) were consecutively recruited over a 1-month period. The caregivers were requested to fill in a sociodemographic questionnaire, the Columbia Impairment Scale (CIS), the 12- item version of the General Health Questionnaire (GHQ-12) and the Zarit Burden Interview. Scoring on the Children’s Global Assessment Scale (CGAS) was done by clinicians. Results. The mean (standard deviation (SD)) age of patients and caregivers was 12.3 (4.9) years and 41.5 (8.9), respectively. Mean (SD) scores on the CGAS and CIS were 55.3 (22.8) and 16.4 (14.3), respectively, while mean scores on the Zarit Burden Interview and the GHQ were 27.9 (17.2) and 2.5 (2.6), respectively. Poorer clinician-rated functioning was associated with lower educational level of the child, a main diagnosis other than seizure disorder, longer duration of illness, and presence of comorbidity. Worse caregiver rating of impairment was equally associated with lower child education, and main diagnosis other than seizure disorder. Both CGAS and CIS scores showed significant correlation with Zarit and GHQ scores. Finally, a significant correlation was found between CGAS and CIS scores ( r =−0.388, p <0.001). Conclusion. Children attending specialist neuropsychiatric services have functional impairment which may be associated with lower child education, and which is linked with increased caregiver burden and psychiatric morbidity.

Commissioning neuropsychiatry services: barriers and lessons

Aims and methodPrevious studies have shown variations in commissioning of neuropsychiatry services and this makes access to neuropsychiatric services a post-code lottery. In this survey, we approached all mental health and neuropsychiatric service commissioners within London to map current funding and commissioning arrangements, and explored perceived barriers to neuropsychiatric service commissioning.Results83% of commissioners within London responded. There was significant variability between neuropsychiatric services commissioned through the mental health stream. Contracting arrangements were variable. Lack of earmarked fund for neuropsychiatry and disjointed funding stream for such services were identified by commissioners as a barrier, as was the critical mass of neuropsychiatric cases.Clinical implicationsNeuropsychiatric service development continues to be hindered by lack of clear commissioning process. Strategic drive is needed to promote more equitable neuropsychiatric services. National or regional commissioning covering a large population will provide a better model for neuropsychiatric services to be commissioned.

Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis.

Introduction There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders.Methods A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews.Results Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457–1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168–3739 per DALY adverted).Conclusion This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions.

Transition to adult mental health services for young people with attention deficit hyperactivity disorder in Italy: Parents’ and clinicians’ experiences

Objective. The aim of this study was to describe the experiences of parents and clinicians in relation to the transition from child and adolescent neuropsychiatric services (CANPS) to adult services for people with attention deficit hyperactivity disorder (ADHD) in Italy. Methods. Parents of people with ADHD who reached the transition boundary for CANPS were sampled from the A.I.F.A. association (Italian Association of ADHD Families). We thematically analyzed informative and qualitative questionnaires completed by parents and clinicians. Results. Parents’ (n = 24) and clinicians’ (n = 27) experiences differed slightly on challenges and unmet needs, whereas clinicians agreed on the variables required for an optimal transition process. Poor transition and multiple barriers to such care were identified. Specifically, far fewer people received services, especially public health services, after reaching the age of 18, and perceived barriers included problems with user access, limited transition protocols, poor service coordination, and possible lack of ADHD-related knowledge on the part of adult practitioners. Conclusions. Care continuity in mental healthcare remains a need to be prioritized and better defined also for ADHD patients (and their parents). Parents’ and clinicians’ experiences are more likely to be positive if transition management is characterized by a gradual preparation, a period of parallel care, and commonly acknowledged, clear information on available services and how to access them. Identifying the needs and barriers of the people representing the different roles (clinicians, parents, and users) involved in the transition to adult mental health services is of particular importance in designing effective, shared transfer planning procedures.

Pathways to a Career in Military Psychiatry.

Psychiatric healthcare has been an essential aspect of the military medical mission over the past century. From very limited psychiatric services available during World War I to the development of multiple psychiatric graduate medical education training programs within the military healthcare system after World War II, psychiatry within the military has markedly evolved. With the onset of Operation Enduring Freedom in 2001 and Operation Iraqi Freedom in 2003, the USA embarked on the longest continuous conflict in its history, producing thousands of personnel suffering from combat-related psychiatric disorders and placing additional psychological stress on their spouses and children requiring the services of skilled psychiatric physicians both wearing the military uniform and serving as civilian healthcare providers in a military treatment facility. This paper will present an overview of the history of military psychiatric graduate medical education, current avenues of access to serve as a military psychiatrist either in uniform or as a civilian, and the opportunities and experiences one may expect working in the military healthcare system. Psychiatry GraduateMedical Education training has significantly evolved from the first known four Department of Defense psychiatric residents (two Army and two Navy) in 1909 who trained for 2 years at Saint Elizabeth Hospital in Washington, DC. However, very few psychiatrists were sponsored for training over the next several decades despite the evident need for psychiatric services in World War I when the total number of psychiatrists in the Army increased from 50 at the beginning of the war to nearly 700 when the Armistice was signed in 1918 [1]. Attrition from themilitary psychiatry ranks post-World War I significantly reduced the inventory to less than 100 in 1940, necessitating another quick infusion of psychiatric physicians into the Armed Forces to include the establishment of a standardized 12-week neuropsychiatry course for non-psychiatric clinicians which produced 1300 graduates to augment the pool of neuropsychiatric services available for service members [2, 3]. In 1946, Congress passed the National Mental Health Act which provided funds for a number of mental health initiatives including the training of mental health professionals, and over the course of the next decade, eight military psychiatry residency programs opened and received certification from the Accreditation Council for Graduate Medical Education [4]. Since the 1950s, there has been significant change in the total number and location of military psychiatry training programs to include a significant restructuring during the 1990s in unison with the large drawdown of troops after Operation Desert Storm. Six Military Psychiatry Graduate Medical Education training programs are currently in operation. The demand for behavioral health services post-9/11 for both service members and their families greatly increased in the setting of continuous combat operations and quickly exceeded existing resources. This increase in clinical demand necessitated increasing the numbers of psychiatrists within military treatment facilities and thus expanded opportunities for entry intomilitary psychiatry besides the traditional path of completing a military graduate medical education training program. A career in military psychiatry can now be achieved through several different pathways as discussed below.

Clinical Manual of Neuropsychiatryedited by YudofskyStuart C., M.D., and HalesRobert E., M.D., M.B.A. Washington, DC, American Psychiatric Publishing, 2012, 447 pp., $79.00.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessClinical Manual of NeuropsychiatryHal S. Wortzel, M.D.Hal S. WortzelSearch for more papers by this author, M.D.Published Online:1 Sep 2013https://doi.org/10.1176/appi.ajp.2013.13020193AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by YudofskyStuart C., M.D., and HalesRobert E., M.D., M.B.A. Washington, DC, American Psychiatric Publishing, 2012, 447 pp., $79.00.I had the opportunity to review the fifth edition of the American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences for the Journal a few years back. The task, commensurate with the size and scope of the textbook, was a bit intimidating and very labor intensive, albeit extremely rewarding. There remain few other sources representing well-written, comprehensive, and up-to-date textbooks of neuropsychiatry. In a perfect world, we could all read such a text from cover to cover. In reality, many psychiatrists will not be able to dedicate the time and resources required to undertake such a comprehensive study of neuropsychiatry, and for the neuropsychiatry uninitiate, the volume and density of information presented may prove a bit overwhelming. A companion volume, one that is shorter, more clinically focused, and more accessible to novices and that requires less of an investment in terms of time and money, would be a welcome follow-up. Thankfully, Yudofsky and Hales identified this need and provided us with the Clinical Manual of Neuropsychiatry.At first glance, some might be inclined to describe the manual as an abridged version of the textbook preceding it. In actuality, this clinical manual is a very careful distillation of that textbook, with a watchful eye toward imparting information that is immediately deployable in clinical settings. This is not a resource for the basic neuroscientist, nor is it an up-to-date treatise on emerging research and its potential implications for neuropsychiatric practice. To the extent that research is discussed, its presentation is appropriately tailored to the manual’s clinical focus, emphasizing the evidence base for assessments and/or therapies for neuropsychiatric conditions. This is the nuts and bolts, cut-to-the-chase clinical version of the reference textbook that is accessible to clinicians and expedient in its delivery of clinically useful content.The manual consists of 12 chapters, starting with two excellent primers on the subjects of neuropsychological evaluation and neuroimaging in neuropsychiatry. Next come eight chapters dedicated to specific neuropsychiatric syndromes/disorders, including delirium, traumatic brain injury, seizure disorders, cerebrovascular disorders, brain tumors, HIV infection of the CNS, dementias associated with motor dysfunction, and Alzheimer’s disease and other dementing illnesses. The manual concludes with two treatment-oriented chapters: one on psychopharmacology for neuropsychiatric disorders and the other on cognitive rehabilitation and behavioral therapies. Like the clinical manual itself, each of the chapters is considerably shorter and more rapidly accessible than the analogous chapter in the textbook. The book itself, with its relatively small size, light weight, and soft cover, is far more convenient as a traveling companion across practice sites for clinicians on the go.The audience for this clinical manual is quite broad. All of its readers will find it a practical reference on the evaluation and management of neuropsychiatric problems encountered in many clinical settings. Students, residents, and/or neuropsychiatry novices at various stages of general psychiatric careers will find the clinical manual to be an enjoyable introductory neuropsychiatry text. They are likely to appreciate the clinical orientation of this volume and the manner in which it transmits knowledge that is useable in everyday practice. The manual will undoubtedly compel many of its readers to pursue additional readings and to delve deeper into the field. More experienced neuropsychiatrists will appreciate the concise and up-to-date clinical refresher offered by the manual and may wish to use it as a complement to other in-depth neuropsychiatric resources and as a vehicle for teaching neuropsychiatry to trainees and other professionals.Sometimes less is more. This is particularly true when it comes to continuing educational needs of busy clinicians faced with ever-expanding requisite knowledge bases. The Clinical Manual of Neuropsychiatry is an excellent educational tool for such instances, true to its name and intended purpose.Denver, Colo.Dr. Wortzel is Director of Neuropsychiatric Services and Psychiatric Fellowship at the VISN 19 Mental Illness Research, Education and Clinical Center, Denver VA Medical Center, as well as Michael K. Cooper Professor of Neurocognitive Disease, Director of Neuropsychiatry Service, and Assistant Professor of Psychiatry and Neurology at the University of Colorado School of Medicine, Denver.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 170Issue 9 September 2013Pages 1063-1064 Metrics PDF download History Accepted 1 March 2013 Published online 1 September 2013 Published in print 1 September 2013

The evolving discipline and services of neuropsychiatry in the United Kingdom.

The last few decades have seen a renaissance in the development of neuropsychiatric services on a global scale. This paper reviews the existing literature on the changing role of the clinical neuropsychiatrist and discusses the evolving theory and practice of neuropsychiatry in the United Kingdom. The rapidly evolving specialty of neuropsychiatry is currently facing a number of challenges. These include, but are not limited to, uncertainties about the curricular requirements for clinical neuropsychiatrists and the changing roles within the wider scenario of health-care service provision. An informed historical perspective on this multifaceted discipline allows key insights into its future development.

The ICF-based functioning profiles of school children in care with the neuropsychiatric community services in the Piedmont region: Evidences for better caring and programming

Purpose. In the Piedmont region, as in the rest of Italy, school integration of ‘handicapped students’ in regular classes, independently of the pathologies they are suffering from, involves almost the totality of students between the age of 3 and 14 and the majority of students between the age of 14 and 18. The responsibility to ‘recognise the student as a handicapped person’ is attributed to the regional public health system (Child Neuro-Psychiatry Services – CNPS). The information about the students is registered in the regional NPI.net, a Web-based application. The question was if ICF could help to develop a monitoring system about school inclusion processes better than the existing one. In fact, because all information is based on medical diagnosis embedded in narrative descriptions, it is often difficult to obtain reliable and comparable data on the disability profiles and the quality of children and adolescents school experience.Methods. Six CNPS, covering 50% of the Piedmont region, started a pilot study on disabled children at school. Diagnostic data of the children and a brief description of their functioning profiles using ICF were considered. Approximately 1000 school children and adolescents with disability were selected for this study.Results. We studied the extension and the severity of impairment of body functions (BF) and/or of activity (A&P) restriction, and the extension and the intensity of facilitators and barriers (EF) together with other factors such as provenience (Local Health Authorities – LHA), main health condition and age of the subjects. The analysis of variance, taking into account LHA, main health condition and age, confirmed the statistical significance of these three factors in differentiating the personal profiles in terms of BF, A&P and EF.Conclusions. The study shows the feasibility and reliability of the use of ICF-based functioning descriptions to monitor school inclusion processes and to better investigate the differences between LHAs in diagnostic procedures, disease prevalence and characteristics of facilitators and barriers. As a direct consequence of the study, the Regional Councils for Instruction, Health and Social Politics have started a 3-year training programme for approximately 2500 school operators, 350 health operators in NPI services and 350 social operators.

The Size of Demand for Specialized Neuropsychiatry Services: Rates of Referrals to Neuropsychiatric Services in the South Thames Region of the United Kingdom

The Size of Demand for Specialized Neuropsychiatry Services: Rates of Referrals to Neuropsychiatric Services in the South Thames Region of the United Kingdom

The Size of Demand for Specialized Neuropsychiatry Services: Rates of Referrals to Neuropsychiatric Services in the South Thames Region of the United Kingdom

The authors assessed the number of referrals to neuropsychiatry services covering South London, Kent, Surrey, and Sussex (population 6,887,000) over a 2-year period. The average referral rate was 11.2 per 100,000 per population for each year. Geographical distance from the specialist provider strongly affected referral rates, with clinicians in South London making more referrals than those from outside London. Assessment of appropriateness of referrals indicated that more than 86% of referrals were highly appropriate, and thus the higher level of referrals from close proximity cannot be attributed to inappropriate referrals. A survey of clinicians reported lower awareness of services and how to access these services among those clinicians working at a greater distance from the service provider, which likely results in unmet needs. Greater attempts should be made to improve access to neuropsychiatric services for clinicians who do not practice within close proximity of a specialist neuropsychiatry service.