Subspecialty Programs
Neuropsychiatry Program Overview
The fields of neurology and psychiatry are being brought closer together by advances in basic neuroscience, genetics, pharmacology, and neuroimaging. Each field offers unique perspectives for understanding diseases of the brain and central nervous system, and the reunification of the two fields are providing increasing insights into the mind-brain.
In 2003, The Division of Neuropsychiatry at Rhode Island Hospital (RIH) was established to evaluate and treat individuals with brain-behavior disorders. Working in conjunction with several of RIH's programs, the division collaborates with the Comprehensive Epilepsy Program, the Division of Neuropsychology, and the Mood Disorders Program. The division of neuropsychiatry is affiliated with Brown University's departments of psychiatry and neurology, and conducts studies sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), the American Epilepsy Society, the Epilepsy Foundation, other private foundations and the departments of psychiatry and neurology at Rhode Island Hospital.
The Consultative Neuropsychiatric Evaluation
Referrals for a consultative neuropsychiatric evaluation (CNE) are made from across New England. The primary sources for the referrals include neurologists, psychiatrists, psychologists, neuropsychologists, internists, pediatricians and school special services departments. The individuals typically have seen a number of physicians, over a number of years, for their workup and treatment.
The CNE is a specialized, integrated assessment of the complex interactions of brain and behavior. The evaluation entails a complete neurological and complete psychiatric evaluation, including history of present illness, review of systems, past medical history, medications, treatments and hospitalizations, family history, birth and developmental history, social history, substance history, and neuropsychiatric examination. Corroborative historical information is obtained from the family member, who usually attends the evaluation. The neuropsychiatric examination involves a complete mental status examination with bedside neuropsychiatric cognitive testing, general neurological examination, and with school aged children, an examination of minor neurological dysfunction.
Along with the CNE, records from the individual’s neurologist(s), psychiatrist(s), and therapist(s), are reviewed. Neurological workup including neuroimaging [CT, MRI, SPECT, PET scan(s)], serology, CSF, EEG (routine, ambulatory, video/long term monitoring), and EMG are reviewed. Psychiatric treatments and treatment responses are reviewed. Neuropsychological testing is also reviewed along with prior medical work up.
The formulation and the assessment are thoroughly discussed with the patient and family member, with a problems list orientation that addresses individual symptoms, signs, and interpersonal dynamics. Further work up is delineated if indicated. Treatment recommendations are made accordingly to address the interaction of their signs, symptoms and social environment. Educational literature and support services are offered for the patient and the family.
A report of the evaluation is generated and mailed to the referring physician/clinician along with copies to other treatment providers to provide continuity of care for the patient. Neuropsychiatric Independent Medical Evaluations are also provided upon arrangement.
Brown Neuropsychiatry Combined Residency
In addition to Clinical Services and Research activities, the Neuropsychiatry Program at RIH is a major component of the Brown University combined residency training in neurology and psychiatry. This residency is designed for physicians who plan on a clinical or research career in the clinical neurosciences. The mission of the Brown University Combined Residency Program in Neurology and Psychiatry is to provide solid clinical and research training in both neurology and psychiatry and in the combined perspective for future leaders in clinical neuroscience. A critical mass of neuropsychiatry exists at Brown University with exposure to various subspecialty areas and practices. Neuropsychiatry residents can have a longitudinal neuropsychiatry clinic at RIH where they develop the integrative approach to mind-brain disorders. At the completion of training, combined residents are eligible for board certification in both neurology and psychiatry.
Research
Clinical research is an important part of the Division of Neuropsychiatry. A weekly neuropsychiatry research meeting is held, providing a forum for researchers in neuropsychiatry to discuss and plan current research projects. In keeping with our comprehensive approach for helping patients, we are working with other institutions across the nation to understand the various neuropsychiatric problems of persons with epilepsy and nonepileptic seizures (NES).
The Division is conducting the first pilot placebo controlled randomized pharmacologic trial for patients with NES, sponsored by the National Institute of Neurological Disorders and Stroke (NINDS). Studies of genetic variations in patients with conversion disorders are conducted in collaboration with Dr. Valerie Voon from the NINDS Intramural Program.
For more information on the Center's research programs and whether you could participate, e-mail or call Anna Eng at (401)444-9979.
Ongoing Clinical Trials And Research Studies
|
This ongoing study is a placebo-controlled trial of a serotonin specific medication for patients who experience nonepileptic seizures (NES); this study is one part of a program to develop combined treatments of psychosocial treatments and medication for these patients with NES.
Another ongoing study is an open clinical trial for patients diagnosed with NES by video EEG. It is designed to evaluate the effectiveness of family therapy or cognitive behavioral therapy in the treatment of patients with NES. |
|
|
This is a study examining the genetic variations in patients with NES. |
|
|
Cognitive function and depression in Epilepsy |
Many patients with epilepsy experience depression. The relationship between epilepsy and depression is unclear. The goal of the study is to better understand if certain aspects of cognitive functioning (i.e., executive dysfunction) may place an individual at greater risk for depression. Results may lead to better identification of individuals at risk for depression and inform future treatments for depression in patients with epilepsy. |
|
Family Functioning and Quality of Life in Patients with Epilepsy |
Patients and their families are currently participating in this year-long study that looks at the relationships between family functioning, quality of life, and symptoms of epilepsy. The information that we collect from this study will help us better understand how symptoms of epilepsy affect family life. This information will help us to provide better treatment for patients and their families. |
Click for Publications from the Division of Neuropsychiatry
Research and training opportunities are provided for neurology and psychiatry residents, geriatric neurology fellows, geriatric psychiatry fellows, geriatric medicine fellows and post-doctoral neuropsychology fellows. Undergraduate and graduate students from Brown University are engaged in research studies of neuropsychiatric aspects of epilepsy in summer projects and semester courses.
The Division of Neuropsychiatry's Staff
W. Curt LaFrance, Jr., MD, MPH, is the director of the division of neuropsychiatry at Rhode Island Hospital and assistant professor (research) of psychiatry and human behavior and clinical neurosciences (neurology) at the Warren Alpert Medical School of Brown University. Board-certified in both in neurology and psychiatry, LaFrance examines the overlap between brain and behavior in his neuropsychiatry clinic, in teaching, and in his research. LaFrance's area of expertise is in the neuropsychiatric aspects of epilepsy, with a particular research focus on treatment and diagnosis of patients with nonepileptic seizures (NES). LaFrance is currently the principal investigator (PI) on two studies of nonepileptic seizures: one to determine the effectiveness of psychotherapy for patients diagnosed with non-epileptic seizures, and another studying medication treatment for patients experiencing nonepileptic seizures. He is PI on a study with the NINDS intramural program examining the genetics of conversion disorders, and he is co-PI on an Epilepsy Foundation study assessing the cognitive aspects of depression and epilepsy.
Neuropsychiatry Research Assistants: Anna Eng Michelle Sosa Jackie Albro Anita Curran
Data Manager: Joan Kelley
Students: Stephanie Syc; not pictured: Kathleen Leaver, Dan Bi Lee, Danny Lee, Roopa Modha
Colleagues in Neuropsychiatry at Rhode Island Hospital
Dr. Colin Harrington is the Director of the Consult-Liaison Service at Rhode Island Hospital. After completing the Brown University Neuropsychiatry Fellowship, he has since provided inpatient and outpatient neuropsychiatric assessments for patients with medical-psychiatric issues. Dr. Harrington has received the Brown University Teaching Award of Excellence.
Dr. Michael Friedman provides longitudinal follow-up for many of the patients seen in the neuropsychiatry clinic at RIH. He also performs initial consultations, including neurology and psychiatry assessments in the Alzheimer’s Disease & Memory Disorders Center. Along with clinical care, he attends the weekly dementia research meetings.
Rhode Island Hospital staff neuropsychologists, Dr. Geoffrey Tremont, Dr. Holly Westervelt, and Dr. Jennifer Davis, are integral parts of the neuropsychiatry diagnostic team.
To Make An Appointment
The Division of Neuropsychiatry is located at Rhode Island Hospital, Potter Building – 3rd Floor, 593 Eddy Street, Providence, Rhode Island, 02903.
Appointments can be made by calling (401) 444-3534. For more information, go to our neuropsychiatry office website.
Getting To The Center
Public parking is available at Public Lot B across from the Ambulatory Patient Care (APC) building.