#7181 Can experience in clinical neurology add value to psychiatric care?

<h3></h3> In psychiatry, the phenomenology of the patient’s experience and collateral history from their family and caregivers is essential in formulating a diagnosis and management plan. The same is true in neurology. One might be forgiven for thinking that neurology (and perhaps neuropsychiatry) is only concerned with obscure and uncommon conditions. However, the reality couldn’t be further from the truth. Perhaps the only difference is that neurologists may do a focused neurological examination. This is often a very brief examination that looks to answer a specific clinical question. Perhaps this is somewhere that skills learned in the neurology outpatient’s clinic can add value to psychiatry? The UK has many fewer neurologists per person as compared with the average in Europe (1,2). Many patients with neurological diseases may never see a neurologist, especially if their symptoms are primarily psychiatric. On a working age adult psychiatric ward, one must only examine a few patients on antipsychotics to discover symptoms of untreated parkinsonism or restless leg syndrome RLS, which the patient may not have been able to articulate (3). Recognition of RLS is particularly important given it’s interaction with psychiatric medications (4). On an older adult psychiatric ward, neurological history taking and examination can unmask neurodegenerative illness such as Parkinson’s disease (PD) (5) and dementia with Lewy bodies (DLB) (6). Up to a third of patients with PD have no tremor at presentation and can easily be missed (7,8). Then there are rarer neuropsychiatric illnesses such as autoimmune antibody mediated encephalitis (AIAME), which can present with a subacute course with primarily psychiatric symptoms with only subtle neurological signs (9,10). Signs which might only be detected by a discerning psychiatry trainee on a busy inpatient ward. If we are to detect rarer conditions with primarily psychiatric symptoms, AIAME being one of many, then in the UK it seems psychiatrists are best placed to screen for them. Then there are the myriad of functional neurological disorders (FND), which are increasingly seen in psychiatric inpatient services. Accurate and early diagnosis of FND is thought to be important in determining recovery (11). If psychiatrists can make the diagnosis independently, then outcomes might be improved. Detecting common neuropsychiatric syndromes relies on both history <i>and</i> examination skills. In the absence of a local neuropsychiatrist, a neurology clinic may be the next best opportunity to learn these skills. Is summary, experience in clinical neurology can certainly add value to psychiatric care. <h3>References</h3> Association of British Neurologists: UK neurology workforce survey. <i>ACNR Adv Clin Neurosci Rehabil</i> [Internet]. 2020 Sep 17 [cited 2023 Jul 3]; Available from: https://acnr.co.uk/articles/neurology-workforce/ Brader C. Health care services for neurological conditions. 2022 May 27 [cited 2023 Nov 16]; Available from: https://lordslibrary.parliament.uk/health-care-services-for-neurological-conditions/ Ali T, Sisay M, Tariku M, Mekuria AN, Desalew A. Antipsychotic-induced extrapyramidal side effects: a systematic review and meta-analysis of observational studies. <i>PloS One</i>. 2021;<b>16</b>(9):e0257129. Mansur A, Castillo PR, Rocha Cabrero F, Bokhari SRA. Restless legs syndrome. In: <i>StatPearls</i> [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430878/ Roos DS, Klein M, Deeg DJH, Doty RL, Berendse HW. Prevalence of prodromal symptoms of parkinson’s disease in the late middle-aged population. <i>J Park Dis</i>. <b>12</b>(3):967–74. Yamada M, Komatsu J, Nakamura K, Sakai K, Samuraki-Yokohama M, Nakajima K, <i>et al</i>. Diagnostic criteria for dementia with lewy bodies: updates and future directions. <i>J Mov Disord</i>. 2020, Jan;<b>13</b>(1):1–10. Pasquini J, Ceravolo R, Qamhawi Z, Lee JY, Deuschl G, Brooks DJ, <i>et al</i>. Progression of tremor in early stages of parkinson’s disease: a clinical and neuroimaging study. <i>Brain</i> 2018 Mar 1;<b>141</b>(3):811–21. Rajput AH, Rozdilsky B, Ang L. Occurrence of resting tremor in parkinson’s disease. <i>Neurology</i> 1991 Aug;<b>41</b>(8):1298–9. Rössling R, Prüss H. SOP: antibody-associated autoimmune encephalitis. <i>Neurol Res Pract</i>. 2020 Jan 15;<b>2</b>(1):1. Hara M, Ariño H, Petit-Pedrol M, Sabater L, Titulaer MJ, Martinez-Hernandez E, <i>et al</i>. DPPX antibody-associated encephalitis. <i>Neurology</i> 2017 Apr 4;<b>88</b>(14):1340–8. Espay AJ, Aybek S, Carson A, Edwards MJ, Goldstein LH, Hallett M, <i>et al</i>. Current concepts in diagnosis and treatment of functional neurological disorders. <i>JAMA Neurol</i>. 2018 Sep 1;<b>75</b>(9):1132–41.