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.

Some patients require intravenous or subcutaneous treatment for osteoporosis with Zoledronate or Denosumab. Zoledronate is given once a year and Denosumab every six months.

We have a day case facility for administering this drug at Southmead Hospital Bristol.

If you are to be given this treatment, you will need a couple of blood tests to check you are suitable, which will be arranged by the doctor who sees you in clinic.

Dr Emma Clark runs an osteoporosis clinic every fortnight, for patients with more complicated or severe forms of osteoporosis who require investigations or treatment beyond the scope of the GP.

For patients who are being seen in this clinic and have not yet had a DXA scan, we run a one-stop service in which patients have the DXA scan on the same day as being seen in the clinic. Patients with other bone disorders, such as Paget’s disease, are also seen in this clinic.

Osteoporosis & Metabolic Bone Disease

This service assesses patients with severe/complex osteoporosis and offers advice on alternative treatment for patients intolerant to oral bisphosphonates. 

We accept referrals for patients with other metabolic bone problems such as Paget's disease, primary hyperparathyroidism and osteomalacia.

North Bristol NHS Trust’s neuropsychiatry service is based at The Rosa Burden Centre, Southmead Hospital.

The neuropsychiatry team is a mix of professionals from different disciplines including:

• Doctors in psychiatry and neurology.
• Nurse therapists trained in physical and mental health.
• Psychological therapy.
• Physiotherapy.
• Occupational therapy.

We work with patients who have a mixture of different problems including:

• Mental illness associated with neurological diseases.
• Epilepsy and non-epileptic attacks.
• Functional neurological symptoms.
• Neurological sleep disorders.

We aim to provide high quality specialist assessment and treatment plans that incorporate expertise in both physical and mental health.

Being a part of the neuroscience department, we work closely with our colleagues in neurology and neurosurgery. We also provide neuropsychiatry support for the mental health liaison team for inpatients in other wards at Southmead Hospital.

Our outpatient clinics take referrals from across the south west from general practitioners, neurologists, neurosurgeons and psychiatrists.

Our inpatient service is situated within the Rosa Burden Centre. We have two inpatient beds for patients with neuropsychiatric conditions, and two inpatient beds for assessment of sleep disorders.

Osteoporosis is the term used to describe bones when they become ‘porous’, when the struts which make up the mesh-like structure within bone start to disappear. This leads to a reduction in bone strength and an increased risk of fracture after injuries such as a low impact fall.

These broken bones or ‘fragility fractures’ can occur in different parts of the body, although the wrist, hip and spine are most commonly affected. Osteoporotic bones don’t cause any other symptoms such as pain.

Osteoporosis is thought to affect 1 in 3 women and 1 in 7 men during their lifetime. It is critical that the bone mineral density (BMD) of those at risk is measured in order to find out if you have osteoporosis or at risk of developing it.

The North Bristol NHS Trust Osteoporosis Service at Southmead Hospital Bristol provides a bone densitometry DXA scanning service for patients who have had a fragility fracture or are at risk of osteoporosis for other reasons.

We perform DXA scans using a Hologic Horizon bone densitometer, which uses a very low dose of X-ray in order to quickly and accurately work out your bone density. A DXA report, including recommendations for treatment, will then be sent to doctor.

According to the result, this may also include an assessment of your risk of breaking a bone over the next ten years, using the FRAX tool, which can be helpful in deciding about whether you need treatment. For more information about the FRAX tool, visit  www.fraxplus.org.

Your GP can refer you for a DXA:

• If you are a postmenopausal woman over 50 with a low trauma fracture (defined as a limb fracture after a fall from standing height or less while stationary or walking, or a vertebral fracture of the spine)
• Or, if you are a woman or man over 50 with a FRAX score in the intermediate or high risk zone

To make a referral, your GP needs to complete a NBT DXA request form on the ‘ICE’ system.

In other circumstances, your GP may want to contact us first to establish eligibility. If you are ineligible for a scan under the NHS, we also offer this service self-funded at a cost of £200. Please note, we still require a referral for private scans.

Alternatively, it may be that you are referred for a DXA scan by a hospital consultant looking after you for a condition such as breast cancer or celiac disease.

Dr Shalini Janagan is the DXA service lead. Prof Emma Clark leads on the vertebral fracture assessment.

Neurophysiology Head of Specialty
Peter Walsh
Peter.walsh@nbt.nhs.uk

Neurophysiology Medical Consultants
Dr Nick Kane
Dr Agepong Oware
Dr Sabine Klepsch

Neurophysiology Medical Registrar
Dr Luke Canham

Healthcare Scientists
Peter Walsh (Service Manager)
Hayley Marriott
Nadine Harris
Portia Chorlton
Kelly Macey
Adam Pearson
Hollie Morris
Lealah Nouri
Georgina Hazelwood
Steve Chaffey (Trainee)
Claire Johnson (Adult Epilepsy Surgery Program)
Abigail Parks Galton (Adult Epilepsy Surgery Program)
Abby Warren (Adult Epilepsy Surgery Program)
Eibhin Goulding (Adult Epilepsy Surgery Program)

Neurophysiology, located at Gate 36, Level 1, Brunel building, Southmead Hospital, provides diagnostic and ‘functional monitoring’ services covering a wide range of conditions affecting both the central and peripheral nervous system.

Tests include:

• EEG
• NCS/EMG
• Ambulatory EEG monitoring Video
• Video/EEG monitoring for Epilepsy Surgery
• Evoked responses (Brainstem Auditory, Visual, Somatosensory and Motor pathways)

We support the Adult Epilepsy Surgery Programs, the Sleep Service, and the Neurosurgical and Spinal Surgeons with Intra-Operative Monitoring.