Neuropsychiatry filling a gap at Mediclinic Morningside
Posted on 12 June 2023
Dr Karishma Lowton is among the fewer than 10 trained neuropsychiatrists in South Africa. She brings her sub-specialist skills to Mediclinic Morningside.
Neuropsychiatry is a field of neurology that bridges the gap between psychiatry and neurology. It focuses on management of the behavioural and cognitive complications that arise from brain injuries and neurological conditions – the aim being to improve patient functionality. But a real need exists for training more doctors in this sub-specialty, says Dr Karishma Lowton, a neuropsychiatrist at Mediclinic Morningside.
“Neuropsychiatry patients are either managed by psychiatrists or independently by neurologists. With neuropsychiatry, we are learning and using a language to communicate effectively with our colleagues about an area in medicine with a significant gap; to optimise patient benefits while bringing together two specialties,” she explains.
To train in this field, a doctor needs to first qualify as a psychiatrist and then complete a further two years of intensive academic and clinical training before attempting examination. “Essentially, as neuropsychiatrists, we are trained in managing the neurobehavioural and neurocognitive symptoms of neurological disease,” Dr Lowton says. Neuropsychiatrists work with both non-traumatic and traumatic brain injuries (TBIs).
TBIs, whether intracranial or extracranial – inside or outside of the skull – can cause changes in people’s personalities. It can affect their moods, and cause anxiety, psychosis, or neurocognitive impairment – a term used synonymously with dementia. “That’s where we come in. We’re able to establish deficits and improve functionality in conjunction with a team of allied professionals in combination with medications.”
Examples of non-traumatic TBIs include strokes, infections, autoimmune conditions, and epilepsy, explains Dr Lowton. “While we don’t manage the neurological condition – this is the job of the neurologist – we focus on the complications that arise from these complex conditions that affect people’s behaviour and cognition.”
Such complications often lead to mental health disorders, most commonly depression, which has been reported in some studies to be up to 24% more likely in patients with any traumatic or non-traumatic brain injury. “This is often followed by anxiety and apathy, and less frequently, we see bipolar or psychosis arising as complications,” she says. “Personality changes are also common.”
The neuropsychiatrist’s role is about more than just extrapolating a diagnosis and a treatment plan. “It’s about administering the diagnosis, which requires a lot of psychoeducation [empathetically teaching patients and their families about the nature of the mental illnesses], intensive assessments and appropriate therapies depending on the diagnosis,” says Dr Lowton. The patient also undergoes multiple neurocognitive assessments to consolidate information. “Determining the correct medications for the patient while considering their comorbidities and the treatment goals is an important part of our role.”
Attaining these goals requires a multidisciplinary team approach and neuropsychiatrists work with experts in various fields, including neuropsychologists, occupational therapists, speech therapists, physiotherapists, as well as social workers and dietitians.
Dementia on the rise
Neuropsychiatry is a novel discipline that uses a unique approach, Dr Lowton says, but one that’s particularly necessary, especially since people are living much longer. “Rates of dementia are increasing, and the World Health Organization (WHO) predicts that it will soon be one of the top leading causes of mortality and morbidity. It’s important to have trained professionals in place who can not only identify and diagnose, but also manage such conditions and restore as much functionality as possible.”
Although Mediclinic Morningside does not have a licence to admit psychiatric patients, Dr Lowton provides consultation liaison psychiatry services. “Here, patients are usuallyadmitted for medical conditions, but when they have a psychiatric comorbidity, they also need to be assessed. I’ve found that creating a relationship with the physicians, surgeons and ICU specialists, and delivering this service has provided Mediclinic Morningside’s patients with a more holistic approach to managing their various conditions while admitted. This has been greatly beneficial and well received.”