Establishing a neuropsychiatry clinic at Tygerberg hospital
CITATION: La Cock, C. et al. 1999. Establishing a neuropsychiatry clinic at Tygerberg hospital. South African Medical Journal, 89(6):653-660.
The original publication is available at http://www.samj.org.za
Objective. Neuropsychiatry is a neglected subspecialty in South Africa. The aim of this study was to assess the need for neuropsychiatry clinics by evaluating a recently established unit in South Africa and testing opinions of heads of academic psychiatry departments. Design. Three separate aspects were investigated. First, a retrospective analysis of patient records from the University of Stellenbosch neuropsychiatry and neuropsychology clinic (USNNC) was undertaken. Second, interviews were conducted with the clinical staff of the clinic, and third, questionnaires were sent to all heads of psychiatry departments in South Africa. Setting. USNNC, situated at Tygerberg Hospital. Subjects. Patients attending the USNNC, clinicians of the USNNC and heads of academic psychiatry departments in South Africa. Main outcome measures. Patients were assessed by means of a standard clinical assessment procedure and a multi-axial diagnosis was made according to the criteria of the Diagnostic nod Statistical Manual of Mental Disorders (DSM-IV), 4th ed. A semi-structured interview was conducted with the USNNC clinical staff to assess their opinions regarding the clinical importance of such a specialised clinic, possibilities for training, opportunities for research and possible improvements that could be made. The staff included a psychiatrist, a psychologist, an occupational therapist, a neurologist and a nuclear physician. An adapted questionnaire was used to assess the attitudes of heads of psychiatry departments in South Africa toward neuropsychiatry. Results. Mild neurocognitive disorder was the most common DSM-IV diagnosis. Head injuries were the most common Axis III disorder. According to USNNC clinicians, a multidisciplinary neuropsychiatric clinic provides for improved diagnosis and management of these disorders, as well as providing excellent training opportunities for psychiatry registrars and students of related disciplines. Heads of departments of psychiatry in South Africa had a clear understanding of the entity of neuropsychiatry but were divided on the question of fostering neuropsychiatry as a subspecialty. Most were confident that their graduates acquire the necessary clinical skills to evaluate and treat common neuropsychiatric disorders. Conclusions. Mild cognitive impairment, often due to head trauma, is most appropriately managed within a multidisciplinary setting. Such a facility provides good training opportunities for students in various disciplines. Much-needed research on treatment outcomes and cognitive rehabilitation can be undertaken in this setting. Improved communication between psychiatry departments in South Africa should lead to a pooling of resources and the provision of a better service to neuropsychiatric patients.