Developing a Neuropsychiatry Curriculum for Clinical Psychologists and Neuropsychologists: An e-Delphi Study

This study utilized a three-round e-Delphi process with a multidisciplinary panel of experts to develop and validate a comprehensive neuropsychiatry curriculum for clinical psychologists and neuropsychologists, resulting in a framework of 40 core and 38 supplementary syllabus items designed to address current training gaps in neuropsychiatric care.

The Gist

Imagine you are building a massive, complex house. You have a team of expert carpenters (clinical psychologists) who are amazing at building standard rooms like bedrooms and kitchens. However, this house has a very tricky, unusual foundation where the plumbing (the brain) and the electrical wiring (the mind/emotions) are constantly tangled up. This is neuropsychiatry.

The authors of this paper noticed that while their carpenters are skilled, they haven't been given a specific blueprint for fixing these tangled "brain-mind" problems. So, they decided to hold a series of meetings to create that missing blueprint.

Here is how they did it, using a simple analogy:

The "Expert Panel" Dinner Party

Instead of a standard meeting, the researchers invited 19 experts to a virtual "dinner party." This group wasn't just one type of person; it was a mix of:

• The Builders: Clinical psychologists and neuropsychologists.
• The Doctors: Psychiatrists and neurologists.
• The Residents: People who have actually lived through these brain-mind conditions (lived experience).

The Three-Round Game

They played a game called the e-Delphi method to agree on what the blueprint should look like. Think of it like a game of "Telephone" but with a twist: everyone writes down their ideas secretly, then they all see the group's average answer, and then they get to change their minds based on what the group thinks.

1. Round 1 (The Brainstorm): They started with a huge list of 80 possible topics (like "how to read brain scans" or "how to treat memory loss"). The experts voted on which ones were absolutely essential ("Core") and which were just "nice to know" ("Supplementary"). Some topics, like "art therapy techniques," were voted off the list because they didn't fit the specific goal.
2. Round 2 (The Refinement): The experts looked at the topics that were still controversial. They added new ideas suggested by the group, like "how to handle the unique symptoms of the pandemic" or "how culture changes how symptoms look."
3. Round 3 (The Final Vote): The group met one last time (via video call) to settle the arguments. They voted on the final list. To pass, a topic needed at least 75% of the group to agree.

The Final Blueprint

After all the voting and talking, they produced a final list of topics for the "carpenters" to learn. They split these into two buckets:

The "Must-Have" Core Tools (40 items):
These are the things every psychologist needs to know deeply to do their job.

• The Big Conditions: Things like dementia, stroke, epilepsy, and traumatic brain injuries.
• The Tricky Behaviors: How to handle aggression, confusion (delirium), or when a patient doesn't realize they are sick (anosognosia).
• The Human Side: How to work with families, how to handle legal issues (like mental capacity), and how to treat the patient with cultural sensitivity.
• The "Brain-Mind" Overlap: How to treat depression or anxiety when it's actually caused by a physical brain problem.

The "Good-to-Know" Supplementary Tools (38 items):
These are important topics, but they might not need to be studied as deeply, or they are less common.

• Rare Conditions: Things like specific genetic disorders or rare brain tumors.
• New Frontiers: Emerging ideas like "psychedelic therapy" or "hypnosis" (which are being looked at more closely but aren't standard yet).
• Technical Skills: How to interpret brain scans or understand the history of the field.

What They Learned (and What They Didn't Say)

The paper concludes that this list is a solid starting point for training psychologists. It confirms that while psychologists already have great tools, they need specific training to understand how physical brain issues create mental health problems.

Important Note on the Paper's Limits:
The authors are very careful to say that this blueprint was built mostly by experts in the United Kingdom working within their specific health system. They admit that if you tried to use this exact same blueprint in a different country or a different type of hospital, you might need to tweak it. They didn't claim this is the only way to do it, just a strong, agreed-upon starting point for now.

In short: A group of diverse experts played a voting game to create a "survival guide" for psychologists, ensuring they know exactly how to handle the messy, complex intersection where brain injuries meet mental health struggles.

Technical Summary

Technical Summary: Developing a Neuropsychiatry Curriculum for Clinical Psychologists and Neuropsychologists

Problem Statement
Neuropsychiatric presentations, which exist at the intersection of neurology and psychiatry, are prevalent across general neurological and mental health services. Despite the high demand for psychological support in conditions such as epilepsy, dementia, stroke, and traumatic brain injury (TBI), core training programs for clinical psychologists and clinical neuropsychologists often inadequately cover neuropsychiatric competencies. Existing curricula vary widely, ranging from the complete absence of neuropsychiatry to narrow definitions limited to neurodevelopmental disorders or vague inclusions without elaboration. Consequently, there is a lack of a standardized, consensus-based framework to guide postgraduate training in this multidisciplinary field.

Methodology
The authors employed a modified three-round e-Delphi study to achieve expert consensus on a neuropsychiatry syllabus.

• Panel Composition: The study recruited 19 experts, including clinical psychologists, clinical neuropsychologists, psychiatrists, neurologists, and individuals with lived experience of neuropsychiatric disorders. The panel was predominantly based in the United Kingdom's National Health Service (NHS).
• Process:
  • Round 1: Panelists rated 80 initial syllabus items (derived from textbook reviews, conference topics, and a scoping review) on a three-point Likert scale (1: Not necessary, 2: Supplementary, 3: Core). Consensus for inclusion was defined as a mean score ≥ 2.0 and a Mean Distance from the Mean (MDM) ≤ 0.2. Items with >50% rejection were excluded. Free-text suggestions for new topics were collected.
  • Round 2: Panelists rated 57 items (40 non-consensus items from Round 1 plus 17 new suggestions). The same consensus thresholds applied.
  • Round 3 (Consensus Meeting): A live video conference was held with 14 attendees to resolve outstanding items. Items were discussed, rephrased for clarity, and voted upon. Final classification as "Core" or "Supplementary" required ≥75% panel agreement.
• Constraints: Participants were instructed to assume the syllabus was for a year of part-time post-qualification teaching, targeting competencies not already covered by core training in common mental health or standard cognitive assessment.

Key Results
The iterative process resulted in a finalized curriculum comprising 78 distinct syllabus items, categorized as follows:

• Core Syllabus (40 Items): These topics represent in-depth competencies required for practice. Key areas include:

  • Specific Disorders: Autoimmune and neuroinflammatory disorders, delirium, functional neurological disorders (FND), neuropsychiatric sequelae of epilepsy, stroke, TBI, dementia, multiple sclerosis, and motor neuron disease (MND).
  • Neurodevelopmental Conditions: Adult ADHD and Autism.
  • Clinical Competencies: Formulating neuropsychological assessments for neuropsychiatric syndromes, qualitative aspects of test performance in these syndromes, family interventions, positive behavior support for challenging behavior, and cultural issues in assessment.
  • Legal and Ethical: Mental capacity, safeguarding, and mental health law.
  • Other: Confabulation, anosognosia, apathy, and the neuropsychiatric consequences of common psychiatric conditions.

• Supplementary Syllabus (38 Items): These topics cover background knowledge for less frequent but prevalent disorders, or competencies in interpreting data and conceptual issues. Key areas include:

  • Disorders: Catatonia, disorders of consciousness, genetic neuropsychiatric syndromes, brain tumors, metabolic disorders, and vestibular disorders.
  • Emerging/Conceptual: Psychedelic-assisted psychotherapy, hypnosis, the role of the gut-brain axis, evolutionary models, and the philosophy of neuropsychiatry.
  • Skills: Interpreting structural brain scans, the function of the neurological examination, and medicolegal issues.

Several items were removed or consolidated during the process. For instance, "physiotherapy" was excluded as outside the scope, while "post-concussion syndrome" was subsumed under TBI. Medication effects and mental capacity laws were consolidated into single items to streamline the curriculum.

Significance and Claims
The paper claims to provide the first e-Delphi-derived framework specifically designed to define neuropsychiatric competencies for postgraduate psychology training. The authors assert that the resulting syllabus:

1. Validates Domain Coverage: The core items show strong overlap with international neuropsychiatry syllabuses, suggesting domain validity.
2. Bridges Training Gaps: It addresses specific areas where core training is insufficient, particularly regarding the adaptation of psychological interventions (e.g., family interventions, positive behavior support) to neuropsychiatric populations and the specific cultural presentations of these syndromes.
3. Reflects Multidisciplinary Reality: The inclusion of items like "interpreting structural brain scans" and "the neurological examination" acknowledges the necessity for psychologists to understand the language and tools of their medical colleagues in multidisciplinary teams.
4. Offers a Flexible Framework: The authors explicitly state that the curriculum is "informative rather than definitive." They acknowledge limitations regarding the UK-centric nature of the panel and the potential for regional variations in practice. Therefore, the paper positions the syllabus as a framework requiring modification for application in diverse healthcare settings and countries outside the UK.

The study concludes that as the role of psychologists expands across health services and the population ages, this consensus-based curriculum offers a necessary foundation for training clinicians to work effectively across traditional service boundaries in neuropsychiatry.