Evaluations at NC Neuropsychiatry (NCN) are unusually comprehensive. We address uncommon problems or difficult problems, which is why a substantial number of our referrals come from neurologists, psychiatrists and neuropsychologists. Our examination includes elements of the neurological examination, a psychiatric mental status examination, a number of different psychological tests and rating scales, and cognitive tests, both computerized cognitive tests and conventional paper and pencil tests.
Depending on the nature of the patient's complaints, we might do a psychiatric evaluation, a neuropsychiatric evaluation, a psychoeducational evaluation or a formal neuropsychological evaluation.
The evaluation process begins before the patient is even seen at NCN. After a referral is successfully made, the patient is requested to respond to the health questionnaire, their previous medical history, and to a number of different rating scales and symptom checklists. Family members, or others who may be familiar with the patient's difficulties, are invited to participate in the online assessment process. Tests like the Neuropsych Questionnaire can be taken by multiple people and can address different spans of time during which the patient's difficulties evolved.
After the patient arrives in the clinic, there may be a bit more paperwork, but most of the work is done by technicians who measure the patient's height and weight and vital signs, and gather a bit more information about the patient's history and the present complaints. Then, the patient is seen either by a physician, a physician’s assistant or nurse practitioner; the medical history is completed and an examination is done. There is a routine, screening physical examination, and in most cases, a comprehensive neurological examination. There is also a psychiatric interview and mental status examination. If the patient is initially seen by a physician's assistant, then one of the psychiatrists or neuropsychiatrists also sees the patient, especially in more complex cases. Nurse practitioners, however, are licensed to evaluate patients independently.
After the initial history and physical, the patient is administered a battery of psychological tests, which may address specific symptoms, feelings, ways of thinking, or aspects of the patient's personality, as well as a battery of neurocognitive tests to measure the patient's general mental ability, his or her attention, memory, executive function, reaction time, etc.
One’s spouse, or one’s most important family members and closest friends, are strongly encouraged to accompany the patient to the initial evaluation. In most cases, they participate in the initial interview, and they can often accompany the patient while he or she is being tested. They usually participate in the conversation that occurs between the doctor and the patient at the end of the evaluation, when we are able to give you at least some idea of what we think is the matter, whether further diagnostic studies are going to be necessary, or what particular treatment we recommend. There are certainly times when the results of our initial evaluation are inconclusive, and more information needs to be gathered. However, we have been about this business for a long time, and we are usually able to give people at least a measure of guidance after the initial visit.
During a particularly long evaluation, patients are certainly encouraged to take a break or to go out for lunch. Sometimes, patients will choose to do a complete evaluation over the course of two days. Sometimes, the patient will see a neuropsychiatrist on one day and the neuropsychologist on another.