Impact of neuropsychiatry screening in neurological in-patients: comparison with routine clinical practice

Abstract

Earl J, Pop O, Jefferies K, Agrawal N. Impact of neuropsychiatry screening in neurological in-patients: comparison with routine clinical practiceBackground: It is now well recognised that the rate of psychiatric comorbidity is high in patients with neurological disorders. Psychiatric comorbidity has a significant impact on quality of life and often goes undetected in routine clinical practice.Objectives: To compare the rate of detection of psychiatric illness in routine clinical practice with the prevalence of mental illness established using a dedicated screening programme at a regional neuroscience centre and to assess if the screening programme had any enduring impact on routine clinical practice after its completion.Methods: Consecutive admissions to a neurology ward in the 3-month period before (n = 160) and after (n = 158) a dedicated neuropsychiatric screening programme was carried out were identified. Case notes were then reviewed to establish if symptoms of mental illness were identified by the treating neurologists and if patients were referred for neuropsychiatric assessment. Rates of detection of neuropsychiatric problems and rates of referral for treatment were compared with those identified during the screening programme.Results: In routine clinical practice, over two 3-month study periods, psychiatric symptoms were identified in 23.7% of patients and only 10.6% received neuropsychiatric interventions. This is much lower as compared with rates identified (51.3%) and treated (51.3%) during dedicated screening. Detection of mood symptoms decreased from 14.7% pre-screening to 3.8% in the post-screening period.Conclusion: Rate of detection and treatment of neuropsychiatric problems remain low in neurology in-patients in routine clinical practice. Neuropsychiatric screening is effective but does not have sustained effect once it stops. Hence we suggest that active ongoing screening should be incorporated into routine practice.