Neuropsychiatrists specialise in the assessment and treatment of people with:
- Psychiatric symptoms arising in the context of recognised neurological disorders such as epilepsy, acquired brain injury, multiple sclerosis and neurodegenerative diseases such as Parkinson’s disease and Huntington’s disease.
- Functional neurological disorders sometimes referred to as conversion disorders and dissociative disorders
- Psychiatric symptoms when there is concern that these are due to an underlying neurological process such as NMDA receptor encephalitis or systemic lupus erythematosus.
Trainees often ask about what training constitutes ‘neuropsychiatry’. The Faculty of Neuropsychiatry, The Association of British Neurologists and The British Neuropsychiatry Association have agreed this syllabus to guide trainees.
A) Neuropsychiatry is not endorsed as a sub-specialty by the GMC and therefore there is no formal training pathway leading to a Neuropsychiatry CCT at present.
B) The syllabus is for guidance only and has no force for the provision of training by trusts or deaneries.
Most consultants in neuropsychiatry posts have had to devise a plan to meet their own training requirements according to the resources available to them.
A typical path taken by most established neuropsychiatrists involves training posts in both neurology and psychiatry at CT level, followed by ST posts in neuropsychiatry (of which there are few) or liaison psychiatry in which there is a significant neuropsychiatry component, e.g. in regional neuroscience centres.
This may be supplemented by a series of structured special interest sessions organised through honorary clinical attachment placements within established neuropsychiatry services and/or by completing an MSc in Clinical Neuropsychiatry such as those available through Birmingham and Kings.
I first became interested in neuropsychiatry as a core trainee when I interrupted my psychiatry training to take a six month training post in general neurology and neurological rehabilitation. My higher training in psychiatry was at the Maudsley Hospital where I started off with a post in liaison psychiatry and finished off with a one year post in neuropsychiatry at Queen Square. I used my special interest days to gain further experience by means of honorary clinical observer/attachment posts in epilepsy, general neuropsychiatry and the Huntington’s disease.
I gained my CCT in general adult and liaison psychiatry in 2009 and initially took a consultant post with a Home Treatment Team before being appointed as a consultant liaison psychiatrist and associate clinical director to the Department of Psychological Medicine at St Bartholomew’s & The Royal London Hospitals in 2013. During this period I was able to continue my interest in neuropsychiatry by working one day per week as a neuropsychiatrist at the Chalfont Centre for Epilepsy and also carrying out one session per week in cognitive neuropsychiatry within our local memory clinic.
Over the last five years I have been able to move into more specific liaison neuropsychiatry with a particular focus on general neurology patients from our regional neuroscience centre and patients in our major trauma centre and cardiac pathways who have suffered traumatic and/or hypoxic brain injury. I also do a once monthly MDT clinic for TBI patients at Queen Square.
Having completed my Neurology and Psychiatry joint training in Egypt (including MSc studies), I moved to the UK. I completed my core training that included a 6 month post of Neuropsychiatry in the West Midlands. As a higher trainee, I had my Old Age Psychiatry rotation in the North West. With my passion for Neuropsychiatry, I managed to negotiate an out of deanery full year Neuropsychiatry post at the same department where I worked as a junior doctor. During my SpR training, I utilised my special interest sessions in Neuroscience related specialties. For a considerable period of time, I attended the Cerebral Function Unit in Hope Hospital in Salford, Manchester with Prof David Neary once a week. The end of my Neuropsychiatry post had coincided with the retirement of my Neuropsychiatrist trainer, Dr Ken Barrett who had been a role model for me since my SHO days! It was quite a nice and natural transition for me to take over from Ken; the job that I am still doing to the present date! The job covers specialist Neuropsychiatry in inpatient and community settings as well as Neuroscience liaison work. The service continues to provide core and specialist full time training and specialist interest sessions.
I came the scenic route to neuropsychiatry. I started off as a basic scientist with a degree in experimental psychology and a PhD in behavioural neuroscience. I then trained in medicine, thought I would specialise in neurology and therefore did MRCP. However I was put off neurology when doing an SHO job and essentially drifted into psychiatry. I was lucky to train and do my research as an SpR with Alwyn Lishman. I then did the rare thing and left The Maudsley! I spent 18 months at NIH in Washington DC and came back to a senior lectureship in London (50% clinical). As is still the case, there were very few consultant jobs in neuropsychiatry so I worked as a CMHT and inpatient general psychiatrist for 13 years. I maintained my ‘neuro’ interest by undertaking research into cognition and neuroimaging in schizophrenia. I eventually became a neuropsychiatrist when a job came up at the National Hospital for Neurology and Neurosurgery 14 years ago. So I have been a general psychiatrist for roughly as long as a neuropsychiatrist.
Although this is an unusual career path, I think it illustrates two things about neuropsychiatry as a career. One is that there are many routes to becoming a neuropsychiatrist. It is important to take opportunities as they come along to gather expertise through research, special interest attachments and liaison SpR posts where you can see neurology patients. There are very few rotations with dedicated SpR neuropsychiatry posts and we have put a list of these on this website. The other point is that, to be an effective neuropsychiatrist, you need to apply the principles and procedures you learned as a general psychiatrist. Remember, in a neurology setting, you will be the one on the spot for advising on mental health and the law, when to apply the Mental Health Act versus the Mental Capacity Act, deprivation of liberty and safeguarding.