Attention and Concentration: this refers to an individual's ability to focus, sustain and switch their attentional resources appropriately.

Verbal Intelligence: this refers to an individual's level of acquired intelligence. This acquired knowledge is typically developed through schooling and other forms of education. It is often considered a marker for an individual's 'premorbid' level of functioning as it represents, on average, what someone was able to accumulate when they were able to apply their cognitive resources prior to any brain damage.

Visuospatial/Non-verbal reasoning and problem solving: this refers to the more visual and fluid aspects of intellectual ability. Performance here is far less dependent upon an individuals formal level of education or knowledge of the English language. Performance on these tests represents what is often considered to be a 'culture-fair' indicator of intellectual ability. Typically , as these tests attempt to avoid reliance on English language abilities, they are presented within a visual and spatial format.

Working Memory and mental flexibility: this refers to those abilities that relate to the temporary storage, organisation and utilisation of information in one's mind. This information is used to guide and evaluate ongoing behaviour and decision making.

Anterograde Memory: this refers to those abilities that are necessary for the acquisition, storage and retrieval of newly learned information. This ability can be divided in terms of the nature of the to-be-remembered material, i.e. material presented within the auditory versus visual modality.

Language function: this refers, in the neuropsychological setting, mainly to verbal fluency, both phonemic and semantic and visual confrontation naming. In addition to these formal measures of language functioning qualitative assessment of language function is also undertaken. A complete and detailed assessment of language abilities is usually undertaken by a Speech and Language Therapist.

Processing Speed: this refers to the speed with which cognitive abilities can be utilised in relation to specific task demands.

Executive function: this is a broad concept that incorporates many facets. Some of these can be tapped, to some extent, through formal cognitive assessment, but many aspects of this domain are only really apparent through the skilful evaluation of an individual using multiple sources of evidence. This domain refers to the highest level of cognitive function and is typically thought to be important in such things as planning, organisation, time management, adaptability to changing task demands, social appropriateness of behaviour, etc. In essence executive function refers to the ability of an individual to appropriately make use of their abilities in applying themselves to achieve a goal in a culturally appropriate way.

Should I bring my glasses or hearing aid to the appointment?

Is there anything else I should bring?

I’m worried about my memory, should I be worried?

Will a neuropsychological assessment hurt, involve injections or other procedures?

How long will it take?

What happens after I have completed the assessment?

What happens if my assessment suggests that there is something seriously wrong?

Will my interactions with neuropsychology be confidential?

Neuropsychological Assessment

A neuropsychological assessment provides an objective way of characterising cognitive, emotional and behavioural symptoms. This process typically involves completing a number of different cognitive tasks and questionnaires. The process is not painful but it may take a number of hours.

A neuropsychological assessment might involve assessment of:

• Attention and concentration
• Verbal intellectual skills
• Visuospatial/Non-verbal reasoning and problem solving
• Working memory and mental flexibility
• Auditory memory
• Visual memory
• Language
• Processing speed
• Executive function
• Mood and anxiety/stress
• Test score validity

Results of the  assessment are typically presented in report format and may also be discussed directly with the patient.

The significance of the findings of the assessment in relation to the referral question, along with a short summary, are briefly summarised at the end of the report.

Neuropsychological Treatment

Where appropriate, treatment is offered to help improve or mitigate the impact of presented cognitive, emotional and behavioural difficulties. Within the Clinical Neuropsychology service this is provided within the framework of a brief goal-focused intervention model. This work involves aspects of cognitive rehabilitation, the implementation of strategies to compensate for cognitive problems and, where appropriate, brief psychological therapy interventions for associated psychological difficulties, typically within a cognitive-behavioural therapy framework.

Comprehensive post-acute multi-disciplinary neuro-rehabilitation, including neuropsychological input and behavioural management approaches, is offered by the Frenchay Brain Injury Rehabilitation Unit and the Head Injury Therapy Unit at Frenchay .

The Department of Neuropsychology offers a Clinical Neuropsychology service to local GPs and referrers from within the Neuro-MSK Division of North Bristol NHS Trust.

Clinical Neuropsychology is concerned with the assessment and rehabilitation/treatment of cognitive, emotional and behavioural difficulties following identified or suspected brain damage or neurological disease. The service provided is a neuropsychological one, i.e. medical responsibility for the care of the patient remains with their medical care provider.

Our Clinical Neuropsychologists are engaged along the entire pathway of care from acute neurosciences through to the community. We work with a number of specialist Multidisciplinary TEams (MDTs) and services seeing adult patients, from 18 years of age, with a range of neurological conditions for their difficulties including:

• brain injury
• stroke
• encephalitis
• brain tumours
• epilepsy
• neurodegenerative diseases
• genetic and metabolic conditions affecting the central nervous system.

Additional Clinical Neuropsychology services are available as part of the comprehensive brain injury rehabilitation services provided by the Frenchay Brain Injury Rehabilitation Unit (inpatient rehabilitation) and the Head Injury Therapy Unit (community rehabilitation).

Other Clinical Neuropsychology services are offered within specialist teams including:

• stroke
• epilepsy surgery
• multiple sclerosis
• cognitive disorders (dementia) clinic.

Services for children with neuropsychological difficulties are provided by the Department of Paediatric Neuropsychology, Bristol Royal Hospital for Children. 

In partnership with the University of Bristol we provide British Psychological Society Accredited postgraduate training in Clinical Neuropsychology. For more information visit  www.bristol.ac.uk/expsych/courses/postgraduate/clinical-neuropsychology

Below are links to some external webpages and organisations that you may find helpful.

 

Organisations for Visible Difference

Changing Faces - https://www.changingfaces.org.uk

Centre for Appearance Research - https://www.uwe.ac.uk/research/centres-and-groups/appearance

 

Condition Specific Organisations

Acne - https://www.acnesupport.org.uk

Albinism - https://www.albinism.org.uk

Alopecia - https://www.alopecia.org.uk

Amputation - https://limbless-association.org

Artificial Eye - https://www.naes.nhs.uk/

Autoinflammatory Conditions - https://www.autoinflammatory.uk

Bells Palsy - https://bellspalsy.org.uk/

Birthmark - https://www.birthmarksupportgroup.org.uk, https://birthmark.org, www.vbfeurope.org, www.birthmarksupportgroup.org.uk

Breast Reconstruction - www.keepingabreast.org.uk

Burns and Scars - https://katiepiperfoundation.org.uk

Cancer - www.macmillan.org.uk/information-and-support/coping/changes-to-appearance-and-body-image, www.lookgoodfeelbetter.co.uk

Charcot Marie Tooth Disease - https://www.cmt.org.uk

Cleft Lip and Palate - https://www.clapa.com

Congenital Melanocytic Naevus - https://www.caringmattersnow.co.uk

Craniofacial - https://www.headlines.org.uk

Down Syndrome - https://www.downs-syndrome.org.uk

Dwarfism - https://littlepeopleuk.org

Epidermolysis Bullosa - https://www.debra.org.uk/

Eczema - https://www.eos.org.uk/, https://eczema.org

Ehlers-Danlos Syndromes - https://www.ehlers-danlos.org

Eye Conditions - https://glaucoma.uk

Facial Palsy - https://www.facialpalsy.org.uk/

Goldenhar - https://www.goldenhar.org.uk

Ichthyosis - https://www.ichthyosis.org.uk/

Lupus - https://www.lupusuk.org.uk

Lymphoedema - https://www.lymphoedema.org

Mastectomy - https://www.flatfriends.org.uk

Microphthalmia, Anophthalmia and Coloboma - https://macs.org.uk/

Microtia - http://www.microtiauk.org

Muscular Dystrophy - https://www.musculardystrophyuk.org

Necrotising Fasciitis - https://nfsuk.org.uk

Noonan Syndrome - https://www.noonansyndrome.org.uk

Psoriasis - https://www.psoriasis-association.org.uk

Rosacea - http://www.rosacea.org

Scars - https://www.scarfree.org.uk/, https://www.battle-scars-self-harm.org.uk, www.scarinfo.org

Scleroderma and Raynaud’s - https://www.sruk.co.uk/

Skin Conditions - https://skinsupport.org.uk, https://www.britishskinfoundation.org.uk

Sweat Concerns - https://www.sweathelp.org

Vitiligo - https://vitiligosociety.org/

How long will I have to wait to be given an appointment?

I think I’m being silly about a small blemish but I really hate the way it looks. Can I gain some support from Outlook?

How do I get referred?

We are a service offering specialist psychological support to people with a different, unusual or changed appearance.

We accept referrals from healthcare professionals from a primary care, hospital and specialist care services. We work with individuals whose physical condition, illness or treatment has resulted in a different, unusual, or altered appearance.

Our appearance can be affected by a range of congenital or acquired conditions, and although the majority of individuals will adjust well to their different or altered appearance, for some it can be more challenging. A change in appearance following trauma, illness and/or treatment, for example burn injuries or scars as the result of an accident or surgical procedure, are common referrals to Outlook.

However, many physical conditions may lead to a different, unusual, or altered appearance and the information below might help determine whether a referral to Outlook is appropriate.

Dermatological conditions can sometimes result in noticeable differences to the skin’s appearance, texture, colour, and health. These conditions can be uncomfortable and frustrating and can result in individuals wanting to hide their skin in fear of being judged. 

Endocrinological conditions can sometimes result in differences to our growth and development. For example, areas of the body may develop more rapidly or more slowly compared to other people meaning that they might be more visibly distinguishable from their peers or broader group.

Whilst gastrointestinal and/or urological conditions themselves may not be visible, treatment or management can often involve an altered appearance. For example, where surgery is advocated for diverticulitis, a colostomy might result in a temporary stoma. However, where it is permanent some individuals may experience appearance-related concerns  around management for the condition.

Maxillofacial conditions and injury can often result in differences to the way our mouth, jaw, face or neck look. The face is central to communication, whether verbal and non-verbal, and a visible difference in this area can affect the way in which we are understood, how others interact with us and we interact socially or professionally.

Musculoskeletal, orthopaedic and/or rheumatological conditions affect the bones, joint, muscles, ligaments, and tendons and can therefore cause differences in the way the body looks and moves.

Neurological conditions affect the nervous system (the brain and spinal cord) and can sometimes result in paralysis or mobility difficulties, for example facial palsy or hemiplegia.  Our or others perception of this difference may impact our confidence and emotional wellbeing, particularly it impacts on how people interact with us or treat us differently than  that which is appropriate.

Evidence suggests that “beauty means good” is a universal belief, irrespective of cultural heritage. However, diverse cultures might define ‘beauty’ differently and, therefore, will vary considerably in practice. Having a different, unusual, or altered appearance from ethnical or cultural expectations can lead to individuals experiencing challenges unrelated to the effect of the condition, illness or injury but might require additional support to address challenges to achieving their full potential.   

As appearance has a cultural context, having a different, unusual, or changed appearance may lead individuals to experience a heightened sense of awareness and monitoring of their appearance as well as low confidence and mood. Some individuals may experience time when they are asked questions about their appearance and/or experience others responding negatively towards them (for example, others staring or pointing). This can be challenging and may lead to feelings of embarrassment and shame.

At Outlook we support individuals with a different, unusual, or changed appearance as a consequence of a congenital condition or acquired through illness, injury or treatment. We accept referrals for those struggling to adjust to their appearance, cope with emotional issues around their appearance, or find intimate relationships, family, social or working situations challenging. For more information, please visit our ‘How Outlook can Help’ page or changingfaces.org.uk.

If you are a previous client and want to give us feedback

We really value feedback from all clients who access the service and we will ask people at the end of their time with us to complete an anonymous feedback form. 

Consultant Neuropsychiatrist
Dr Monica Mohan, Consultant Neuropsychiatrist
Dr Elizabeth Mallam, Consultant Neurologist 
Dr Dane Rayment, Consultant Neuropsychiatrist

Specialty Doctor
Dr Kumaravilli Taralipoyina

Dr Omur Miles

Neuropsychiatry Management Team
Ellicia Sulway, General Manager NMSK division
Dr Anish Patel, Clinical Lead

Senior Nursing Staff
Lisa Nikitin, Ward Manager and Sister

Therapists
Patrick Cookson, Physiotherapist
Alex Reuben, Occupational Therapist

 

 

We accept referrals from GPs, neurologists and psychiatrists.

We are a specialized, tertiary service and will accept referrals from any region if the patient is able to travel to our outpatient clinic.

If the patient is not from England then funding arrangements will need to be agreed prior to our being able to accept the referral.

We do not operate an emergency service, if a referral is considered more urgent we can place the patient on a cancellation list to potentially be offered appointments at short notice. Otherwise there is a usual wait of several months for an outpatient assessment.

Initial assessments are for up to an hour. Follow ups are up to 30 minutes.

Eligibility Criteria

• Age 17 years, 9 months +
• Identified or suspected neuropsychiatric disorder requiring a tertiary service
• Epilepsy with psychiatric symptoms, and/or non-epileptic attacks
• Psychiatric symptoms presumed secondary to neurological disorders such as:
  • Brain lesions
  • Parkinson’s and other movement disorders
  • Young onset dementia
  • Multiple Sclerosis
  • Encephalitis
  • Neurodevelopmental disorders
• Patients requiring pre-surgical psychiatric assessment in epilepsy or deep brain stimulation
• Diagnosis of functional neurological disorder, or neurological or memory complaints thought to have psychological or psychiatric causation following local secondary assessment
• Neurological sleep disorders (except chronic insomnia)

We do not routinely see patients whose primary problem is:

• Chronic Fatigue Syndrome
• Chronic Pain/Fibromyalgia
• Personality Disorder
• Complex behavioural problems
• Non-neurological somatoform conditions
• Attention deficit hyperactivity disorder
• Chronic Insomnia
• Long term consequences of traumatic brain injury

How to refer

GP’s in England please refer using use the electronic referrals system.

If referring from elsewhere, or from secondary care please write a referral letter.

The Dual Energy X-ray Absorptiometry (DXA) method of assessing bone mineral density is the gold-standard.  It is the most accurate and reliable method currently used. In order to determine if you have osteoporosis we will scan both of your hips, along with your lumbar spine, as these areas are a good indication of the density of the bones in the rest of your body. On occasions, such as in cases of primary hyperparathyroidism or if the patient has left and right total hip replacements, it may be necessary to scan the distal forearm in order to support the lumbar spine BMD data.

Vertebral fracture assessment (VFA)
Additionally, we may offer a VFA to women aged 65 and over and men aged 70 and over. This will include two extra scans of the spine which take additional 5 minutes. This quick technique helps to identify potential broken bones in the back due to osteoporosis (vertebral fractures).
Features of vertebral fracture might include back pain or height loss, however many vertebral fractures are not picked up. It is very important to identify vertebral fractures, because they increase the chance of breaking more bones in the future.

How does DXA work?
The DXA scanner has two separate X-ray beams; one will be absorbed mostly by the soft tissue surrounding your bones, whilst the other X-ray will be absorbed by the bone. In order to differentiate between the two types of bone, the scanner will subtract the x-rays absorbed by the soft tissue away from the total X-rays absorbed. This will produce a good estimate of your bone mineral density.

You will be asked to lie down on the scanning couch, whilst the scanning arm passes over you. The scan does not involve going into an enclosed tunnel, you can remain dressed for the scan as long as there are no metal fastenings on your clothing, and typically only takes 10-15 minutes. The DXA scan uses a minimal level of radiation in order to produce accurate results and is approximately one tenth of a normal chest X-ray, or the equivalent of one day’s natural background radiation.

In order to have a DXA scan here at Southmead Hospital Bristol you must be able to transfer to the scanning table independently and not weigh more than 160kg in weight.  Pregnant women will not be given a DXA scan as the radiation may harm the unborn child. They should ask for a referral from their GP when a scan is desired after pregnancy.