Outpatient clinics

Our Neuropsychiatrist team assess patients referred for a general neuropsychiatric assessment when patients are not diverted into one of our illness-specific clinics. Outpatient clinics run on Tuesdays, Wednesdays, and Thursday afternoons at our newest site, the RMH Elizabeth St at 635 Elizabeth St, Melbourne, Victoria.

New assessments usually take 90 minutes and will involve taking a history from the patient and informants (carers, family, or other health professionals), and may involve a neurological examination and cognitive examination.

Review of neuroimaging studies (MRI, CT, SPECT, PET) also occurs if images are available; we recommend that patients or their referrers ensure that images (either on film or on CD) are available, as these are preferred to imaging reports alone. All available information on patients is requested, including past reports, summaries and correspondence; ideally, this is sent in with the original referral. In some situations, patients will be reviewed after an original assessment.

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Our neuropsychologists conduct outpatient neuropsychology assessments after patients have been medically reviewed by our Consultant Neuropsychiatrists, and where initial cognitive assessment highlights areas that warrant further examination.

First assessments usually take up to 3 hours and are conducted on Tuesdays, Wednesdays, and Thursdays.
These assessments generally involve an interview and pencil-and-paper assessments. After assessment, a specific subsequent feedback session with the patient may be arranged, often with one of the Consultant Neuropsychiatrists, to provide feedback and future planning.

Since 2005, Neuropsychiatry has run a dedicated young-onset dementia (YOD) service, for those living with dementia and their families, where onset of symptoms has begun before the age of 65 years. Due to the heterogeneity of presenting issues, there can often be a significant delay in diagnosis of several years, hence the need for centralised specialist services such as the MYOD clinic. Early diagnosis has a wide range of benefits, including access to medical treatments and research studies, services, education and the ability to plan for the future while people still have capacity.

Our team of neuropsychiatrists, neuropsychologists and social workers in the MYOD clinic can support people living with dementia and their families to navigate these challenges, including but not limited to:

• Support to remain in the workplace for as long as is practical
• Assessment and support to remain driving as long as is safe and possible
• Provision of information to the NDIS to enable adequate, age appropriate support and care
• Referral to and collaboration with other relevant clinical services, including genetic counselling and neurology clinics.
• Support to manage transitions to respite and residential care
• Provision of telehealth appointments where mobility, cognition and/or geography provide a barrier to care

Neuropsychiatry has partnerships with several key non-government organisations such as Dementia Australia and Huntington’s Victoria, as well as Cognition, Dementia and Memory Services (CDAMS) across Victoria. Neuropsychiatry also has access to a broad range of research studies that may be of interest to people living with dementia. Refer to us here.

Young Onset Dementia Service List

‍This list of Young Onset Dementia services and community supports has been compiled to support individuals, family members and health professionals assisting people living with Young Onset Dementia.

If any changes are require or if you have a service you feel could be included, please email info@ypinh.org.au

The Cognitive Assessment and Advisory Service (CAAS) is an initiative providing access to neuropsychology services across NorthWestern Mental Health, through a centralised outpatient clinic co-located in Neuropsychiatry at The Royal Melbourne Hospital.

The Service provides formal cognitive assessment and cognitive behavioural strategies for consumers aged between 15 to 65 years with a mental health diagnosis.

Referrals are open to consumers from:
- Orygen Youth Services
- Inner West Area Mental Health Service
- MidWest Area Mental Health Service
- Northern Area Mental Health Service
- NorthWest Area Mental Health Service

To make a referral, or for more information, please contact us via our inbox: Neuropsychiatry@mh.org.au attention it to Dr Joanna Neath, Senior Clinical Neuropsychologist or telephone (03 9138 2050)

Huntington's disease (HD) is a genetic neurological disorder that affects movement, thinking and behaviour that commonly affects multiple members of one family. It affects neurons in a particular part of the brain called the striatum, which plays a roll in the regulation of movement as well as emotion and thinking. A progressive disorder, it frequently presents with behavioural disturbance or mental illness, and the illness may first present psychiatrically.

The Royal Melbourne Hospital has been providing assessment services since the early 1970s, and with the advent of genetic testing for the disease in the 1990s, Neuropsychiatry has been active in the assessment, diagnosis and treatment of patients with HD.  In fact, we are the older HD clinic in the world.

We see people who have a history of HD in their family at all stages from the genetic testing phase to the symptomatic phase through to entry into residential care.  Calvary Care Bethlehem has services which are well-equipped for dealing with the preparation of end-of-life (palliative care) phase of HD and we would usually refer to this service at this phase.

Predictive clinic

Our predictive clinic has been running for over 25 years, and sees and assesses individuals who have discovered that they are genetic risk of HD, and are interested in considering genetic testing options. This service is run in conjunction with and parallel to services from Victorian Clinical Genetic Services Victoria (VCGS) and also the Neurogenetics Service at RMH

When individuals at risk for HD undergo genetic counselling regarding their risk for HD, they may be referred to the Predictive Clinic at the Neuropsychiatry Unit. This may occur particularly when there is a concern regarding the presence of neurological or psychiatric symptoms, or when individuals have expressed an interest in ongoing clinical follow-up. Assessments are undertaken by our consultant neuropsychiatrists and may involve a clinical and neurological examination.

Referrals to our Predictive Clinic are generally managed by VCGS genetic counsellors and the RMH Neurogenetic service as part of their ongoing counselling, in consultation with clinicians from the Neuropsychiatry Unit. If in doubt, please contact us to discuss a referral.

Symptomatic clinic

All of our consultant neuropsychiatrists that see all patients in our Symptomatic HD Clinic. Assessment generally involves a review of motor, psychiatric and cognitive symptoms, and neuroradiological review where appropriate. Ongoing management may involve medication treatment for movement disturbance and psychiatric illness, in addition to behavioural management strategies and support for cognitive impairment. Allied health involvement such as neuropsychology, speech therapy and social work assessments for patients with HD are also offered, for initial assessment as well as for review.

We work closely with Huntington's Victoria (HV), a not-for-profit organisation funded by the Victorian State Government which operates as a specialist service to assist patients and their families affected by HD. Workers from HV will often attend our clinics (with the patient's consent), to assist in the assessment of healthcare, social, occupational and community needs and to assist in the brokering of effective community care. This is often an essential service for our HD patients, who often have complex needs that are not clearly met by acute health or disability services. HV workers can also assist their clients with the process of registering for the NDIS

For referral to the clinic, please click on the Referrers tab in the menu at the top of this page.

Obsessive-compulsive disorder (OCD) is an anxiety disorder with a worldwide prevalence of between 1-3 It is characterised by recurrent obsessions and/or compulsions, including but not limited to concerns about contamination and disease, checking and seeking reassurance, safety and hoarding.

Obsessions are persistent and anxiety provoking thoughts, images or impulses which dominate the thinking of an individual. Compulsions are recurrent mental acts or behaviours that often occur in relation to obsessional cues and can act to reduce the experience of anxiety or distress. While, historically, OCD was viewed as a chronic disorder which was intractable and non-responsive to treatment the prognosis has improved with the advent of psychological and pharmacological interventions.

Despite the availability of these treatments 20% to 30% of patients with OCD fail to improve and up to 10% develop a severe intractable form of the illness. For a small proportion of patients with treatment resistant OCD, deep brain stimulation (DBS) may be considered as a possible treatment.

DBS involves the implantation of stimulation electrodes in highly localized brain regions with the aim of modifying brain activity. DBS has been extensively and successfully used in Parkinson's disease, chronic pain, intractable tremor and dystonia. DBS has a number of significant advantages over traditional lesional procedures as it is adjustable, controlled and reversible. Evidence worldwide suggests that DBS for OCD has a response rate of up to 75% and can reduce symptoms by typically up to 60%.

Neuropsychiatry at RMH was the first and remains the only clinical service to offer DBS for OCD within Australia. All patients who proceed to surgery have met the requirements of the Mental Health Review Tribunal who govern the use of Neurosurgery for Mental Illness (for more information, see here).

Comprehensive clinical data is collected during the admission and in regular follow-up appointments, which includes psychiatric measures (self-report, carer scales, clinician rated scales), functional assessments and cognitive assessments.

Preliminary data from the unit has been presented at a variety of national and international conferences and meetings, with results from the first seven patients published in the Australian and New Zealand Journal of Psychiatry (here).

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The general eligibility criteria for DBS for OCD include

1. Confirmation of diagnosis of severe, treatment refractory OCD

2. Assessment of medical, surgical and psychiatric history regarding suitability for surgery

3. Capacity to make informed decisions regarding proceeding to surgery.

4. Patients must have a treating psychiatrist outside of their care at RMH Neuropsychiatry.

Following initial referral, patients will be screen via outpatient neuropsychiatrist assessment, and if felt to be suitable, progression to inpatient multidisciplinary assessment, including neurology, neuropsychiatry, neuropsychology, occupational therapy and social work input. If DBS is recommended following this assessment, then a submission is put forward to the Mental Health Review Tribunal for consideration.

Referrals are open to patients across Australia, and can be sentvia email to Neuropsychiatry@mh.org.au

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 Dr Sarah Farrand presented on 'DBS for OCD' at the University of Melbourne's Department of Psychiatry Seminar Series in November 2021. https://youtu.be/RTtc_EGv-q8

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The Video Telemetry service is a joint service between Royal Melbourne Neuropsychiatry department and Royal Melbourne Internationally recognised epilepsy centre. The multidisciplinary Diagnostic and Assessment service specialises in the characterisation of an array of neuropsychiatric and neurological conditions that present with seizures.

Young-onset dementia (YOD) is characterised by symptom onset prior to age 65. YOD is associated with unique challenges and significant psychosocial impacts for both the individual and their family. As many post-diagnostic services are targeted towards older adults with dementia, those with YOD and their caregivers often feel isolated, less supported and are at higher risk of poor mental health. Therefore, there is a great need for targeted interventions to support people with YOD and their caregivers.

The MAPS program has been designed by our team, led by Associate Professor Samantha Loi, in collaboration with Professor Felicity Baker and a team of music therapists from the Faculty of Fine Arts and Music at the University of Melbourne. It is an 8-week online group therapy intervention for people with a diagnosis of YOD and their caregivers. The program is co-facilitated by a psychologist and a music therapist, and combines cognitive behavioural therapy-informed discussions and music therapy in the form of therapeutic song writing. The main aims of the program are to improve mental health and coping skills, and increase feelings of social connection for couples affected by YOD.

If you are interested in participating in the MAPS program and would like to learn more, or if you would like to refer a couple affected by YOD, please contact us at maps-program@unimelb.edu.au The program also featured on a recent episode of the Psych Matters podcast, hosted by the Royal Australian and NewZealand College of Psychiatrists. Click the following link to listen ,https://psychmatters.ranzcp.org/1072258/11157160

‍"The program helped us learn how to deal with it and not let it suffocate us"

"Hearing other people's stories and experiences made me feel like we are not alone"

"It was amazing what we were able to put together [the song]. It holds a lot of truth and value"