Establishing a neuropsychiatry clinic at Tygerberg hospital

Objective. Neuropsychiatry is a neglected subspecialty in South Africa. The aim of this study was to assess the need for neuropsychiatry clinics by ev aluating a recently established unit in South Africa and testing opinions o f heads of academic psychiatry departments. Design. Three separate aspects were investigated. First, a retrospective an alysis of patient records from the University of Stellenbosch neuropsychiat ry and neuropsychology clinic (USNNC) was undertaken. Second, interviews we re conducted with the clinical staff of the clinic and third, questionnaire s 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 o f academic psychiatry departments in South Africa. Main outcome measures. Patients were assessed by means of a standard clinic al assessment procedure and a multi-axial diagnosis was made according to t he criteria of the Diagnostic and Statistical Manual of Mental Disorders (D SM-IV), 4th ed. A semi-structured interview was conducted with the USNNC cl inical staff to assess their opinions regarding the clinical importance of such a specialised clinic, possibilities for training, opportunities for re search and possible improvements that could be made. The staff included a p sychiatrist, a psychologist, an occupational therapist, a neurologist and a nuclear physician. An adapted questionnaire was used to assess the attitud es of heads of psychiatry departments in South Africa toward neuropsychiatr y. Results. Mild neurocognitive disorder was the most common DSM-IV diagnosis. Head injuries were the most common Axis III disorder. According to USNNC c linicians, a multidisciplinary neuropsychiatric clinic provides for improve d diagnosis and management of these disorders, as well as providing excelle nt training opportunities for Psychiatry registrars and students of related disciplines. Heads of departments of psychiatry in South Africa had a clea r understanding of the entity of neuropsychiatry but were divided on the qu estion 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 a ppropriately managed within a multidisciplinary setting. Such a facility pr ovides good training opportunities for students in various disciplines. Muc h-needed research on treatment outcomes and cognitive rehabilitation can be undertaken in this setting. Improved communication between psychiatry depa rtments in South Africa should lead to a pooling of resources and the provi sion of a better service to neuropsychiatric patients.