Clinical Neuropsychiatry

The Clinical Neuropsychiatry Stream of the MNC is based at the Neuropsychiatry Unit (NPU), John Cade Building, Royal Melbourne Hospital. The NPU is a statewide specialist mental health service that offers neuropsychiatric assessment and advice to psychiatric, neurological and other medical and mental health services.

We are a multidisciplinary team including consultant neuropsychiatrists, neuropsychologists, occupational therapists, social workers, behavioural neurologists, training psychiatrists, resident medical officers and mental health and general medical nursing.

The unit offers inpatient, outpatient, off-site and telemedicine assessments to other services across the state and the region. With expertise in organic mental disorders, early onset and atypical dementia, Huntington's disease, epilepsy, neurodegenerative conditions, neuroimaging in mental illness, chronic psychotic disorders, movement disorders, ECT and psychosurgery, the unit has strong links to research in cognitive and clinical neuropsychiatry and training within the North-Western Mental Health Region and beyond.

The unit is involved in a range of world-leading research endeavours, innovative educational programmes, and training of mental health clinicians to meet the future specialised mental health needs of the community. The NPU has undertaken research work across a number of neuropsychiatric conditions, including the following ongoing studies.

Clinical Neuropsychiatry at RMH

Dr Dennis Velakoulis is the Clinical Director of the Centre and is also the Director of the Neuropsychiatry Unit, which is a Victoria-wide service that is located at the Royal Melbourne Hospital (RMH). It is an 8-bed inpatient unit with an average length of stay of 10 days. Dr Velakoulis' main interest is clinical research, education in neuropsychiatry and excellence in clinical practice of neuropsychiatry.

Clinical Goals

The Neuropsychiatry Unit at RMH specialises in a range of clinical disorders and treatments including:

• Younger onset dementia
• Huntington's disease
• Epilepsy and psychiatric disorders
• Creutzfeld Jacob disease
• Movement disorders
• Neurological disorders that present as psychiatric phenocopies
• Intellectual disability
• Treatment resistant psychiatric disorders (particularly schizophrenia)
• Cognitive impairment in psychiatric disorders
• Electroconvulsive Therapy (ECT)
• Psychosurgery (RMH is the only site undertaking these medical procedures)

Research Areas & Approach

The Neuropsychiatry Unit has a long history of clinical collaboration with Clinical
Neurosciences at the Royal Melbourne Hospital.

In close collaboration with A/Prof Terence O'Brien and Dr Raju Yerra of the Comprehensive Epilepsy Program a number of research projects in the neuropsychiatry of epilepsy have commenced.

The studies include:

• A retrospective study examining co-morbid neuropsychiatric disorders in patients with focal epilepsy. This includes comprehensive neuropsychiatric, neuroimaging and neurological evaluations undertaken over the last ten years
• Dr Sophia Adams is undertaking her doctoral thesis in a prospective follow-up study of these patients that will provide important information about the course of epilepsy and the relationship between epilepsy and neuropsychiatric disorders
• The outcome of patients with first seizures compared with concurrently treated patients with non-epileptic seizures is also being investigated

Phylis Chua is undertaking her PhD examining pre-onset Huntington's disease individuals identified by genetic screening. She has assessed them comprehensively using neuropsychological, clinical and brain imaging techniques.

Case Studies: The clinical populations at the Neuropsychiatry Unit include patients with rare or atypical conditions, which provide insights into the relationship between brain pathology and mental or cognitive symptoms.

Clinical tools designed by the RMH team

The clinical team at RMH has developed three useful screening tools, the Neuropsychiatry Unit Cognitive Screen (NUCOG) the Behavioural Assessment Tool for Cognition and Higher function (BATCH) and the CogRisk.

• The NUCOG is a bedside battery that has been used in neuropsychiatric populations to assess cognition in medical or psychiatric patients. It assists clinicians in their assessment of cognitive deficits
• The BATCH uses systematic observation and recording of ward-based behaviours to assess cognitive function in patients who cannot be formally tested
• The CogRisk is a carer questionnaire that provides information on the patient's demographics, cognitive risk factors and cognitive symptoms

Education Programs

The neuropsychiatrists and neuropsychologists at RMH run a regular seminar series for mental health clinicians interested in diagnosing and managing complex neuropsychiatric disorders. Workshops and seminars previously conducted include:

• Problem-solving rare, unusual and complex clinical neuropsychiatric dilemmas
• The assessment and management of brain impairment
• Neuropsychiatry in the aged
• Managing behaviour change
• Diagnosis and management of Younger Onset Dementia (YOD)

Younger Onset Dementia has been an area of clinical and research interest at the Neuropsychiatric Unit, and several workshops and symposia have been presented at national conferences on this topic. In conjunction with Alzheimer's Australia, the Neuropsychiatry Unit has developed an information book for carers and clinicians working with patients suffering YOD. More recently the Neuropsychiatry Unit has received a grant from the Mental Health Branch to archive and collate clinical video material into a Multimedia Clinical Archive. The archive includes past videos collected by Dr John Lloyd (Director Neuropsychiatry Unit 1973 -2001) and ongoing video collection. This archive will ensure that educative and informative clinical material can be made widely available to clinicians and students.

Neuropsychology

The neuropsychologists at RMH provide onsite supervision for rural psychologists, involving supervision and training over a two week period. Through telepsychiatry (a psychology rural outreach program) the team provides monthly supervision sessions for psychologists working in aged psychiatry and a monthly case discussion and professional development for other Southwest Healthcare Network psychologists.

Clinical students

The RMH environment is active in training students from Masters and Doctorate Clinical Neuropsychology programs, as well as students completing Advanced Medical Science, Occupational Therapy, and Social Work degrees.

Neuroimaging tools used in our clinical neuropsychiatric practice

Consultant Neuropsychiatrists in the Unit have expertise in integrating the findings from neuroimaging with clinical presentations of patients. This expertise derives from years of clinical and research experience with neuroimaging of neuropsychiatric disorders. Patients benefit from the latest MRI scanning techniques, which: Have greater sensitivity to detect and monitor early brain changes in neurodegenerative disorders The on-site single-photon emission computed tomography (SPECT) scanner allows us to monitor changes in brain metabolism Electroencephalography (EEG) is also used in neuropsychiatric conditions, including delirium, epilepsy, and drug withdrawal states