Neuropsychiatry

These presentations may include anxiety, depression and psychosis occurring in the context of epilepsy, parkinson’s, multiple sclerosis, encephalitis and other neurological diseases.

We provide:

• Outpatient clinics for general and specialised Neuropsychiatric presentations
• Inpatient admissions to Hughlings Jackson ward, a tertiary referral unit.
• Consultation-liaison neuropsychiatric service for inpatients admitted to neurological, neurosurgical and neuro critical care beds at NHNN. 
• Our approaches include: neuropsychiatric, pharmacological, psychological (primarily cognitive behavioural therapy), occupational therapy, specialised physiotherapy and care from a core experienced team of dually trained nurses in both mental and physical health.

Functional neurological symptom disorder encompasses symptoms seemingly manifested through the neurological system but which are not caused by a physical neurological disease.

See Functional Neurological Disorder (FND) rehabilitation service for more information and patient self-help videos.

The National Hospital Tourette Syndrome service is a specialist service provided by the Neuropsychiatry Department. We are primarily a consultation service which provides assessment, advice and treatment to patients with a suspected or confirmed diagnosis of Tourette syndrome. We also work closely with neurologists in the movement disorders service.

The clinical service includes consultant neuropsychiatrists who assess patients in their outpatient clinics. In addition, the service is supported by a CBT therapist who can provide Cognitive Behavioural Interventions for Tics (CBIT), including habit reversal therapy, to patients who meet the feasibility criteria and are unable to access such therapy in their local area. Our service can manage neurologically complex presentations within NHNN in close collaboration with other neurologists and neurosurgeons. There is also a provision, by referral to movement disorder colleagues, to consider and provide Botulinum toxin treatment for tics where appropriate.

We have capacity to accept referrals from neurologists or psychiatrists. We are unable to accept GP referrals of new patients unless the GP has been advised by a neurologist to refer. Referrals must include reason for the referral (diagnostic, second opinion or treatment), details of previous treatments and results of relevant investigations. The referral must highlight if the patient has significant symptoms of comorbid obsessive compulsive disorder as this condition requires further consideration of treatment. If a diagnosis of Tourette syndrome is confirmed on assessment, patients are offered a choice between appropriate medications for their condition which must be supplied locally. We are unable to provide long term follow up or urgent treatment. Patients who are stabilised on certain medications or have significant other psychiatric conditions will need to remain under the continuing care of their local mental health services. Any acute risk will need to be managed by local services.

Our service has close links with academics working at the UCL Queen Square Institute of Neurology and patients may be invited to participate in research studies of Tourette’s syndrome. 

About Tourette syndrome in adults

Tourette syndrome (abbreviated as TS or Tourette's; also known as Gilles de la Tourette syndrome) is a neuropsychiatric disorder with onset usually occurring before the age of 18. It is characterised by repeated involuntary movements (motor tics) and uncontrollable noises (phonic tics). Common tics are throat-clearing and blinking but more complex movements or repetition of words, rarely with swear words, can be seen. About one of every 100 people has Tourette syndrome. It is more common in boys than girls. The tics usually start in childhood and may be worst in the early teens. It often occurs with other problems, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety and depression. Not all tics indicate Tourette syndrome.

The cause of Tourette syndrome is unknown, but it is considered to be related to alterations in dopamine neurotransmission in the movement areas of the brain. For a diagnosis of Tourette syndrome, both multiple motor and one or more phonic tics need to be present with tics occurring many times a day, nearly daily, over a period of more than one year. If motor or phonic tics occur alone this is referred to as a chronic motor or phonic tic disorder but is manged in the same way. No treatment is needed unless the tics interfere with everyday life. In clinically significant cases it is frequently a cause of marked distress or significant impairment in social, occupational, or other important areas of functioning. Although there's no cure for Tourette syndrome, effective treatments are available and require comprehensive management which may include medication, cognitive-behavioural therapy and other approaches.

More information:

• NHS tics treatment
• Tourettes Action