Evaluation & Treatment
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.
Neuropsychiatrists and Neuropsychologists
Sometimes people ask us about the difference between a neuropsychiatrist and a neuropsychologist. There is a great deal of overlap between our evaluations, but the differences are really quite straightforward. Neuropsychiatrists are MDs, and are trained in neurological, psychiatric and medical assessment and differential diagnosis. Because they're MDs, they can prescribe medications.
Neuropsychologists, on the other hand, have a PhD degree, and aren’t licensed to practice medicine. They are trained to perform a much more comprehensive battery of psychological tests, including tests of personality and cognition. Their evaluation usually requires six or eight hours. A neuropsychologist is able to address questions about the patient that no other specialty can do.
Ordinarily, we refer our patients back to the referring physician with advice for proper care management over time. Sometimes, however, it is necessary, or more convenient, for us to treat the patient ourselves. We love to treat patients, but we can't treat everybody. First, it's not necessary for everybody to be followed up by a highly specialized physician. Second, it's important for us to keep our schedules open, so we can meet the increasing demand for neuropsychiatric evaluation.
Neuropsychiatric treatments include counseling, advice advocacy and medication treatment. Most of the treatments at NCN are administered by physicians assistants or nurse practitioners under the supervision of an attending psychiatrist or neuropsychiatrist. The physicians at NCN also see certain patients on a regular basis, but they are usually our most challenging patients. The psychiatrists tend to spend more time with new referrals and difficult diagnostic questions. They also have to work closely with the PAs and nurse practitioners when their patients are in difficulty or the course of their treatment takes an untoward turn.
Formal psychotherapy like cognitive behavioral therapy, is performed at NCN by clinical psychologists.
Medication treatment is an area of particular expertise. Most of our research over the years, and all of our clinical trials, has been concerned with medication treatment. Much of what our doctors have written is about medication treatment. We are particularly careful about medication side effects. Patients, for example, who are treated with psychostimulants must all have a screening cardiogram to make sure they don't have an unusual cardiac arrhythmia that might complicate the effects of medication. We are particularly concerned about the weight gain that accompanies many of the drugs prescribed by psychiatrists and neurologists - at our clinic, every patient is weighed, and at every visit.