The fields of neurology and psychiatry are being brought closer together by advances in basic neuroscience, genetics, pharmacology, and neuroimaging. Each field offers unique perspectives for understanding diseases of the brain and central nervous system, and the reunification of the two fields are providing increasing insights into the mind-brain.
In 2003 the Division of Neuropsychiatry at Rhode Island Hospital was established to evaluate and treat individuals with brain-behavior disorders. Working in conjunction with several of RIH's programs, the division collaborates with the Comprehensive Epilepsy Program, the Division of Neuropsychology, the Mood Disorders Program, and the Aging and Dementia Program. The division of neuropsychiatry is affiliated with Brown University's departments of psychiatry and neurology, and conducts studies sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), the American Epilepsy Society, the Epilepsy Foundation, other private foundations and the departments of psychiatry and neurology at Rhode Island Hospital.
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Consultative Neuropsychiatric Evaluation
Referrals for a consultative neuropsychiatric evaluation (CNE) are made from across New England. The primary sources for the referrals include neurologists, psychiatrists, psychologists, neuropsychologists, internists, pediatricians and school special services departments. The individuals typically have seen a number of physicians, over a number of years, for their workup and treatment.
The CNE is a specialized, integrated assessment of the complex interactions of brain and behavior. The evaluation entails a complete neurological and complete psychiatric evaluation, including history of present illness, review of systems, past medical history, medications, treatments and hospitalizations, family history, birth and developmental history, social history, substance history, and neuropsychiatric examination. Corroborative historical information is obtained from the family member, who usually attends the evaluation. The neuropsychiatric examination involves a complete mental status examination with bedside neuropsychiatric cognitive testing, general neurological examination, and with school aged children, an examination of minor neurological dysfunction.
Along with the CNE, records from the individual’s neurologist(s), psychiatrist(s), and therapist(s), are reviewed. Neurological workup including neuroimaging [CT, MRI, SPECT, PET scan(s)], serology, CSF, EEG (routine, ambulatory, video/long term monitoring), and EMG are reviewed. Psychiatric treatments and treatment responses are reviewed. Neuropsychological testing is also reviewed along with prior medical work up.
The formulation and the assessment are thoroughly discussed with the patient and family member, with a problems list orientation that addresses individual symptoms, signs, and interpersonal dynamics. Further work up is delineated if indicated. Treatment recommendations are made accordingly to address the interaction of their signs, symptoms and social environment. Educational literature and support services are offered for the patient and the family.
A report of the evaluation is generated and mailed to the referring physician/clinician along with copies to other treatment providers to provide continuity of care for the patient. Neuropsychiatric Independent Medical Evaluations are also provided upon arrangement.
Neuropsychiatry Research Assistants: Anna Eng, Michelle Sosa, Jackie Albro, Anita Curran
Data Manager: Joan Kelley
Students: Stephanie Syc; not pictured: Kathleen Leaver, Dan Bi Lee, Danny Lee, Roopa Modha
Rhode Island Hospital staff neuropsychologists, Dr. Geoffrey Tremont, Dr. Holly Westervelt, and Dr. Jennifer Davis, are integral parts of the neuropsychiatry diagnostic team.