NEUROCARE
Specialist Neuropsychiatric Liaison Service

brain . mind . body integrative health

NEUROCARE

Both brain-specific and general physical illnesses are capable of causing complications of brain or mind.

Complications can include confusional states (delirium), memory problems (dementia), attention deficits (ADD), emotional symptoms (depression, anxiety), abnormal behaviour, or specific brain region (focal) deficits.

NEUROCARE is a unique service offering comprehensive coordinated care lead by the discipline of Neuropsychiatry.

Neuropsychiatrists are fully qualified general Medical Doctors and specialist Psychiatrists who have gained extensive experience in the different medical sub-specialities able to affect the brain.

We offer multi-disciplinary outpatient consultation, coordinated memory clinics, hospital liaison services, various options for hospitalization (medical and therapeutic), and also community monitoring programs.

The ability to perform specialist tests (blood tests, brain scans, EEG, memory tests and general internet based screening and monitoring software) often proof crucially important.

This service is coordinated by Dr Jan Swanepoel, specialist Liaison Neuropsychiatrist, and is supported by inhouse medical specialists offering Neurological-, Neurosurgical-, Neuropsychological- and specialist Physician intervention.


More on Dr Jan Swanepoel click here...
NEUROCARE Stellenbosch

Suite 109, Medi-Clinic Stellenbosch: 021-8612000



Neuropsychiatry

Gail Scott: 066-4701447


Neurology

Marietjie Heath: 021-8879015


Memory Clinic

Gail Scott: 066-4701447


Dr Jan Swanepoel: 082-5080744

Liaison Neuropsychiatry

Liaison Neuropsychiatry is the sub-specialty which provides psychiatric treatment to patients attending general hospitals, whether they attend out-patient clinics, AE emergency departments or are admitted to in-patient wards. Therefore it deals with the interface between physical and psychological health.

There is now abundant evidence that medical and surgical patients have a high prevalence of psychiatric disorder which can be effectively treated with psychological or pharmacological methods. One quarter of all patients admitted to hospital with a physical illness also have a mental health condition which, in most cases, does not receive necessary treatment while the patient is in hospital.

Critical situations

Liaison Neuropsychiatric input must be considered in the following patient groups:

Neurology situations - Patients suffering epilepsy often experience psychotic symptoms, memory problems and has a 6x increased suicide rate. Parkinson's patients often hallucinate, patients diagnosed with brain tumours need input from start to completed post-operative rehabilitation, not to mention the many needs of those who suffered brain injury or trauma, bleeds, dementia or MS.

Hematology situations - Systemic illness such as leukemia or lymphoma notoriously affect brain and mind. Memory problems, chemo-related side-effects, fatigue, depression, anxiety or suicide are common complications, whilst rehabilitation after bone-marrow transplant is vital.

 

Additional situations

Oncology situations - Cancer sufferers often need Neuropsychiatric input when battling chronic illness conditions, chemo-related complications such as memory problems, fatigue, eating problems or nausea, whilst terminal situations necessitate the care of families and loved-ones.

Rheumatology situations - Conditions such as Rheumatoid Arthritis, and many other immunological systemic illness by definition affect brains detrimentally. SLE patients often hallucinate, whilst immune suppression therapy such as steroids often cause mind symptoms such as depression, panic and memory problems.

Cardiology situations - Cardiovascular sufferers such as myocardial infarction (heart attacks) patients, those with valve lesions or irregular beats (heart flutter) often suffer serious depressive and anxiety complications, and may even end up with vascular dementia. Much can be done to improve function, prevent complications to brain or mind or assist with rehabilitation after cardiac surgery.

Gynecology situations - Hormonal conditions, female cancers or infectious STD states often require intervention Neuropsychiatrically. Post-natal depression can be treated successfully, whilst brain medication often prove successful for menopausal emotional fluctuations.

Surgery situations - Post-operative complications such as delirium (confusion), abnormal pain conditions, depression or medication addiction often necessitate brain or mind input. Multi-trauma victims (Post Traumatic Stress Disorder), those after joint replacement or with resulting weakness benefit from specialized and comprehensive rehabilitation programs.

 

Adult Attention Deficit

Attention Deficit Disorder impacts many adults and its frustrating symptoms can hinder everything from your relationships to your career development.

Once you identify your own symptoms and understand the challenges that come with ADD, you can learn to compensate for areas of weakness and take advantage of your many strengths and talents.

Understanding ADD in Adults

Attention deficit disorder is not just a problem in children. If you were diagnosed with childhood ADHD, chances are, you’ve carried at least some of the symptoms into adulthood. But even if you were never diagnosed with ADHD as a child, that doesn’t mean you can’t be affected by it as an adult.

Attention deficit disorder often goes unrecognized throughout childhood. This was especially common in the past, when very few people were aware of ADHD. Instead of recognizing your symptoms and identifying the real issue, your family, teachers, or other parents may have labeled you a dreamer, a goof-off, a slacker, a troublemaker, or just a bad student.

Alternately, you may have been able to compensate for the symptoms of ADHD when you were young, only to run into problems as your responsibilities increase. The more balls you’re trying to keep in the air—pursuing a career, raising a family, running a household—the greater the demand on your abilities to organize, focus, and remain calm.

This can be challenging for anyone, but if you have ADD, it can feel downright impossible.

That’s why a clear diagnosis of Adult ADD can be an enormous source of relief and hope. It helps you understand what you’re up against for the first time and realize that you’re not to blame.

The difficulties you’ve had are symptoms of attention deficit disorder—not the result of personal weakness or a character flaw.

Screening test...

Inattention is considered an important core aspect of suffering Adult Attention Deficit disorder.

If you have experienced more than 3 of the symptoms listed below, chances are that your performance is impaired by your current ability to attend or concentrate on what is important.

In such cases we strongly recommend a more detailed assessment by a professional, or at least a more detailed measurement such as offered by our measuring module.

Do you often...

1. Fail to give close attention to detail at work...

2. Have trouble keeping attention on tasks...

3. Seem not to listen when spoken to directly...

4. Fail to follow instructions with work...

5. Have trouble organizing activities...

6. Avoid things that take a lot of mental effort...

7. Loose things needed for tasks and activities...

8. Are you easily distracted (by people, sounds etc.)...

9. Are you often forgetful in daily activities...



Memory Disorders

It's normal to forget. We all forget. But as we grow older, the time comes when we start to forget more than we used to. However, if this starts to happen regularly, we may start to worry about whether we suffer dementia.

Dementia mainly affects older people. After the age of 65, the risk of developing it doubles every 5 years. Over the age of 80, about one in five people suffer from some degree of dementia.

Having said this, it's important to remember that four out of five people over the age of 80 are not suffering from dementia.

Take action

There are several different causes for memory disorders, so further medical tests to establish the reason for forgetting is critically important.

Many causes are reversable, so all people (of all ages) concerned about their memory function must be examined in a specialist memory clinic.

The following symptoms are especially important to pay attention to:

  1. difficulty in finding the right words.
  2. difficulty with skills learnt early in life, like dressing.
  3. failure of intelligence, judgment and logic.
  4. personality change: becoming irritable, withdrawn.
  5. suspiciousness: believing others are out to harm him/her.
  6. anxiety and depression arising "for no reason".
  7. uncharacteristic behaviour, including reluctance to wash, wandering and turning aggressive.

There is always hope and potential improvement - but only when the exact diagnosis is made, and specialist medication prescribed.

Screening test...

Being forgetful may be caused by attention problems, stress, reversable medical conditions or primary memory illnesses.

If you have experienced more than 2 of the symptoms listed below, chances are that you are suffering a medical memory disorder or illness.

In such cases we strongly recommend a more detailed assessment by a professional, or at least a more detailed measurement such as offered by our measuring module.

Have you suffered...

1. Have you been experiencing memory problems?

2. Have you developed language problems?

3. Have you lately been struggling to do things?

4. Have you been failing to identify things?

5. Have you lately been struggling to organize or plan your life?

6. Has your memory problems started gradually?

7. Does your memory continue to decline?



Epilepsy

Epilepsy can cause difficulties by way of typical epileptic fits ("seizures"), episodes of being absent ("absences"), as well as various other chemical-electrical complications.

Epilepsy patients are therefore medically vulnerable to developing dissociation ("disconnecting from themselves or the world"), attention deficit disorder (ADD), various types of forgetfullness (memory problems), clinical depression or uncontrolable anxiety.

These symptoms must be identified as they can effectively be managed in specialist treatment centres.

Unfortunitely most patients suffering Epilepsy is unaware of the medical nature of these complications, and often "blame themselves" for "not coping".

Nothing can be further away from the truth as research has shown that most Patients suffering a chronic physical illness is generally better at coping with life's challenges despite their illness.

Mistaking chemical-electrical complications which produce brain and mind symptoms is like blaming yourself for getting a chest infection...

Most first-world treatment centers for Epilepsy involve a team of experts such as a Neurologist, Neurolab Technicians (for EEG monitoring), a Neuropsychiatrist (treating complications) and a Neuropsychologist (for memory tests etc.).

Under-estimating Epilepsy and its complications will have serious consequences, not only medically, but also in terms of professional- and interperonal function.

Focussing onEpilepsy complications, will in most instances make a big difference to quality of life in general terms.

Screening test...

If you have suffered any one of the following symptoms chances are that you can benefit from specialist input:

Have you ever...

1. Felt detached from your surroundings?

2. Felt that other people, or the world were not real?

3. Experienced an abnormal depressed mood for you?

4. Had thoughts of death or even suicide?

5. Found it difficult to control thoughts of worry?

6. Suffered from regular muscle tension?

7. Had trouble keeping attention on tasks?

8. Had trouble with your thought processes?

9. Been forgetful in daily activities?

10. Been agitated or irritable?



Traumatic Brain Injury

Traumatic brain injury (or even "concussion") is often referred to as "TBI".

Since our brain defines who we are, the consequences of a brain injury can affect all aspects of our lives, including our personality.

No two brain injuries are alike and the consequence of two similar injuries may be very different. Symptoms may appear right away or may not be present for days or months after the injury.

Most people are unaware of the scope of TBI or its overwhelming nature.

TBI complications are common and may be missed initially when the medical team is focused on saving the individual's life.

A brain injury can be classified as "mild" if loss of consciousness or confusion and disorientation is shorter than 30 minutes. Even though this type of TBI is called "mild", the effect on the family and the injured person can be devastating.

"Severe" brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours.

TBI complications

While MRI and CAT scans are often normal, the individual may struggle with significant TBI complications:

These symptoms are commonly overlooked, and can be improved or managed by specialist Neuropsychiatrists and the application of modern neurotropic medication and rehabilitation exercises.

 
Screening test...

Brain injury related complications may appear right away or may not be present for days or even months after the injury.

If you have experienced more than 2 of the symptoms listed below, chances are that you have developed complications.

In such cases we strongly recommend a more detailed assessment by a professional, or at least a more detailed measurement such as offered by our measuring module.

Have you suffered...

1. Noise sensitivity; easily upset by loud noise...

2. Being irritable, easily angered...

3. Forgetfulness, poor memory ...

4. Poor concentration ...

5. Taking longer to think...

6. Light-sensitivity, easily upset by bright light...

7. Feelings of depressed or tearful...

8. Feelings of frustration or being impatient...

9. Excessive tiredness either mentally or physically...



Stroke

Suffering a stroke may not be the end of a fullfilling life. Many Patients suffering a stroke may recover in full, whilst others may adapt to even permanent deficits to the extend that they continue to enjoy a productive, enjoyable life.

Research show that recovery from stroke is heavily dependent on managing "stroke complications", and is not simply a fucntion of regaining muscle strength.

The most common medical complications developing after stroke are depression and "unlogical sadness", anxiety and panic attack, even paranoia (suspiciousness), attention-, concentration and memory problems.

Sadly most Patients,their families and even some Doctors caring for stroke patients, ignore these complications, thereby compromising optimal recovery significantly. Not identifying them is a large part of the problem.

Immediately after suffering a stroke, Patients must be rusked of to the nearest specialist medical center where an interventional Radiologist, Cardiologist or stroke Physician may reverse the clot or treat the cause acutely.

Equally important is to manage the first 2 years after stroke well too. Stroke rehabilitation is offered at specialist clinics where Patients can access a rehabilitative Neuropsychiatrist, a clinical Neurologist and stroke Occupational Therapists.

Such specialists will focus on regaining function that was lost, preventing and treating complications and help Patients to adjust to a life changed.

Above all, never give up hope, as many people continue to improve for years to come after stroke.

 

Screening test...

If you have suffered any one of the following symptoms chances are that you can benefit from specialist input:

Have you ever...

1. Experienced an inability to think or make decisions?

2. Felt completely hopeless?

3. Experienced an abnormal depressed mood for you?

4. Had thoughts of death or even suicide?

5. Found it difficult to control thoughts of worry?

6. Suffered from regular muscle tension?

7. Been agitated or irritable?

8. Had trouble keeping attention on tasks?

9. Been forgetful in daily activities?

10. Felt that your memory continues to decline ?



Parkinson's disease

Parkinson's disease may affect people as young as 45 years old, and is also often overlooked in older individuals as "being tremulous" is considered "normal" in error.

Much can be done for patients with this condition, but sadly many individuals strangely feel ashamed for suffering involentary movements and often hide their symptoms i.s.o. consulting with a specialist Neurologist. Many effective medications exist that generally make the world of difference.

Parkinson's disease is perhaps the best example of all illnesses of the chemical-medical nature of Neuropsychiatric complications.

Where Parkinson's motor (muscle) symptoms is casued by a relative shortage of the brain chemical dopamine, Neuropsychiatric complications are caused by episodic excess of the same chemical (caused by over-treatment, or sometimes due to variable release by the brain).

The Neuropsychiatric complications include anxiety, unlogical paranoia, emotionality such as depression, occasionally forgetfullness (memory problems), and rarely hallucinations (such as shadows at night etc.).

Ideally Parkinson's patients should receive specialist input from a Neurologist (addressing muscle and movement symptoms), and a Neuropsychiatrist (monitoring for and treating chemical-medical complications).

Neuropsychiatrists are medical Doctors that specialised further in the treatment of brain and mind complications of various physical illnesses such as Parkinson's, and needs to be distinguised from Psychologists.

Comprehensive management strategies involving a team of specialists will make the difference between leading a functional and enjoyable life when diagnosed with Parkinson's disease.

 

Screening test...

Parkinson's disease cause Neurological and Neuropsychiatric complications. Identifying treatable complications early is vital to effective intervention and quality of life.

If you have suffered any one of the following symptoms chancesare that you can benefit from specialist input:

Have you ever...

1. Experienced an inability to think or make decisions?

2. Felt completely hopeless?

3. Experienced an abnormal depressed mood for you?

4. Had thoughts of death or even suicide?

5. Found it difficult to control thoughts of worry?

6. Suffered from regular muscle tension?

7. Been agitated or irritable?

8. Had trouble keeping attention on tasks?

9. Been forgetful in daily activities?

10. Felt that your memory continues to decline ?