Overview

Many general psychiatric disorders can be perfectly stable and well managed by colleagues in general adult psychiatry, until something unusual happens. For example, a patient well managed for years with depot anti-psychotic medication for schizophrenia, develops a movement disorder, seizures, a memory problem, or new psychotic symptoms.

Many drugs used to treat psychotic disorders have long-term side effects, for example, tremor, stiffness and other ‘extra-pyramidal’ symptoms. A patient with a psychiatric condition is as likely as any other member of the general population to develop a dementia or new presentation of a physical illness with neuropsychiatric symptoms.

There are many other examples of this happening, such as schizophrenia complicating autism; schizophrenia occurring after narcolepsy; Huntington’s being a movement disorder and presenting as a form of psychosis. These cases have actually happened and have been managed by me.

Neurologists and general adult psychiatrists are also often the first to see patients with unusual symptoms such as blackouts, amnesias, paralyses, freezing episodes.

When the symptoms make no sense after exhaustive searches for explanations from neurological investigations and excluding general psychiatric conditions, a neuropsychiatrist needs to be involved to look for conditions often seen in neuropsychiatry such as:

• Fugue (a type of dissociative state)
• Psychogenic amnesia
• Somatoform disorder
• Catatonia
• Functional paralyses and sensory loss (which used to be called ‘conversion’ disorders)