Conditions we specialize in
Conditions we commonly consult on
While our services can be helpful with nearly any medical complaint, here are some of the common conditions we encounter where the standard medical model has failed, leaving patients feeling confused and alone.
We specialize in conditions that fall between the cracks of medical care. These syndromes may be diagnosed by a neurologist or a psychiatrist, but there are barriers to proper treatment because they land between the two. Maybe they are best diagnosed and followed for evolution by neurologists, but all of the most effective tools for treatment are found in Psychiatry. If these conditions blossom into another neurologic syndrome, or the original neurologic event remains active, a neurologist always has a role in treatment. However, the key message is that the syndromes require constant coordination between a neurologist familiar with the condition and a psychiatrist who is as well. If a patient has this coordinated approach to care, then a Neuropsychiatrist isn’t particularly necessary. Most of my patients will have seen a neurologist who says they need a psychiatrist or they will have seen a psychiatrist insisting their problem is neurologic. They might have seen half a dozen of each, going to specialist after specialist never seeming to understand the results of testing, often being told that the tests came back normal and to return to their PCP or psychiatrist.
Common Conditions we see may include:
Autoimmune Encephalitis
Better called “immune mediated encephalopathy,” this condition often includes an atypical cluster of symptoms. It is a rapidly evolving concept that many neurologists and psychiatrists misunderstand. The neurologist may misunderstand it and think they have “ruled it out” due to basic labs and imaging, which are often normal, especially at first. It isn’t simple delirium though, and it can look like mania, psychosis, bizarre delusions and behaviors. A famous, however scientifically out of date, book called “Brain on Fire” brought this condition to popular awareness, but since then dozens of new antibodies have been identified. Like most other neuropsychiatric conditions, the treatment of the syndrome involves clear coordination between neurology and psychiatry and without this outcomes are poor. Families of people affected by this disorder will likely benefit from a Health Coaching relationship. This will help families understand the complexity of this disorder and know the different pathways to care for their loved ones are.
Atypical psychosis
The typical schizophrenia patient develops their first symptoms either in adolescence or young adulthood, has auditory hallucinations (not visual or mixed), has at least 6 months to a year of isolation, paranoia, or depressive symptoms, and responds well to antipsychotic treatment. Having one or two atypical features (later onset, visual hallucinations, or a very long or practically no prodrome) may still indicate schizophrenia, but 2 or more “red flags” indicates that something else may be going on. While treatment still requires a psychiatrist, many medical causes need to be considered and at times treated by neurologists and other medical practitioners. A neuropsichiatrist Health Coach can help consult on care with families or individuals to make sure other medical conditions have been addressed and to help them understand the complex nature of the illness.
Long COVID, Chronic Lyme, Myalgic Encephalomyelitis, Chronic Fatigue
From faux pas to hot topic, these post-viral syndromes have a sordid history in the scientific literature and medical training. Most physicians haven’t even heard of Myalgic Encephalomyelitis (post Epstein-Barr-Virus syndrome) even though there is CDC guidance suggesting that it has a huge impact on society and is significantly underdiagnosed. Most physicians are taught that Chronic Lyme doesn’t exist, mainly because of the wave of chronic lyme clinics using scientifically disproven treatments like long term antibiotics. Finally, with the Covid Pandemic, the post-viral syndrome with chronic fatigue, brain fog, muscle pain, insomnia, migraine, and depression is being taken seriously, but the coordinated approach is still very rarely found. Patients with these syndromes may be diagnosed by a neurologist, but are best managed with psychiatric medications and behavioral modification. As a Neuropsychiatrist, Dr. Claunch has taken a special interest in these patients (see his book!). He can diagnose and treat with virtual telehealth appointments, but these patients particularly benefit from Shared Medical Appointments. These allow for more education of the patient as well as an opportunity for patients to share their journeys and offer advice to each other.
Catatonia and melancholia
These are some of the oldest and most well understood and treatable syndromes in psychiatry and neuropsychiatry, but the most likely to lead to misdiagnosis and inappropriate care. Modern psychiatry has distilled a rich history of the Depression syndrome into a 9 item checklist that has never properly delineated different forms of depression, which are incidentally treated very differently. Both Catatonia and Melancholia can look like a progressive dementia or episodic delirium. Catatonia, in its essence, is a disorder defined by freezing of movement and thought, as if the battery has been removed. Melancholia is a deep depression, progressive, with a feeling of emptiness or extreme dissociation, often with mild or moderate hallucinations. Medical causes need to be ruled out, often with the help of a neurologist, but the treatment is primarily psychiatric. Health Coaching with Dr. Claunch can be life changing or even life saving for these patients and their loved ones.
Perceptual disorders
While not considered dangerous, disorders of perception can be some of the most frightening syndromes in all of medicine. Without other psychotic features, patients may hallucinate or have visual or auditory distortions. These include but are not limited to Visual Snow, Prolonged Deja vu or its counterpart Jamais vu, feeling as if there are parasites in the skin, hyperacusis (where all sounds are very loud or distorted), phantom sensations or smells, and others. At times patients are afraid to tell doctors about these symptoms, and at other times patients obsess over them and feel dismissed by doctors. Health Coaching with Dr. Claunch can help confirm this is the problem and possibly identify treatable components as well as helping individuals learn about their diagnosis and management.
Atypical pain disorders
Of all of the common medical complaints, pain is the one most mis-managed by modern medicine. When pain becomes atypical or Chronic, it truly requires an integrated approach that can be either inappropriately neglected or harmfully chased with addictive medications. These diagnoses include Chronic Pelvic Pain, Fibromyalgia, Ehlers-Danlos and other Joint Hypermobility syndromes, Mixed Connective Tissue Disorders, Complex Regional Pain Syndrome (or Reflex Sympathetic Dystrophy), or “just” Chronic Pain Syndrome. The necessity for coordination goes beyond neurology and psychiatry and will often include Rheumatology, Gastrointestinal doctors, Orthopedists, and especially Psychotherapists. In most cases, there are very good treatments for at least components of the disorder, and monitoring for immunologic and neurologic syndromes is ongoing. Practical Neuropsychiatry offers Shared Medical Appointments that go beyond a typical doctor-patient interaction. Through SMAs patients learn far more about what causes their pain, different paths to treatment, and most importantly patients learn from each other about how unique each case is, and how components of the syndrome are similar in a supportive environment.
Atypical spells
Nearly every experience read about in fantasy novels can be experienced by patients with atypical spells. Maybe you’ve spent time floating out of your body. Perhaps there are episodes of loss of consciousness with dreams of a spiritual nature. Maybe you spend three hours in a strange panic attack or feel as if your body is melting. The brain can do some phenomenal things, and they can occur in very healthy people or very sick people. These symptoms don’t tend to occur on your physicians’ checklists, and there is no good time to bring them up in a clinical visit that lasts 15 minutes. And you’re not crazy, and you feel fine now, so why open that bottle. Health Coaching offers these patients a supportive environment to understand and explore their atypical spells with a Neuropsychiatrist. For patients in Massachusetts, Shared Medical Appointments offer a unique opportunity to learn more about these atypical spells and share with other patients experiencing similar things.
Non-epileptic seizures/events
A rising hot topic in neurology training, but one of the earliest neuropsychiatric diagnoses, seizure spells, are at once simple to diagnose as being epileptic or not, and very poorly managed in the field of neurology. While they can be suspected at the first neurology encounter, I’ve watched patients languish in treatment for years in a neurology clinic rather than get specialized help which requires psychiatric and psychotherapeutic techniques. Neurologists may also misdiagnose many classic psychiatric syndromes as Non-epileptic seizures, including relatively classic panic attacks and PTSD associated dissociative spells. If those PTSD associated dissociative spells include shaking, general psychiatrists may feel very uncomfortable without close monitoring by a neurologist, or even insist that a 10th neurology evaluation is necessary because they believe epilepsy is playing a role.Through Health Coaching Dr. Claunch will not only help individuals understand their diagnosis, but will also communicate with their other providers to optimize treatments for this symptom target.
Cognitive Decline
The vast majority of patients bothered by cognitive decline do not have degenerative dementia like Alzheimer’s. In fact, the more a patient is worried about their forgetfulness, the more likely it is to have a myriad of treatable medical contributors. These are best managed by primary care physicians by treating those medical contributors and counseling patients on diet, exercise, sleep hygiene, and increased social and physical activity, but primary care doctors have little time to do this work and may believe the medical problem is a degenerative dementia. Likewise, many of the primary dementias are dismissed as being depression or other primary psychiatric diagnoses. To properly diagnose this, a physical exam is often required, and treatment of genuine degenerative dementias often requires extensive counseling and includes family discussions. Health Coaching with a Neuropsychiatrist can best help families understand what is happening to their loved ones and how to best manage their care. Individuals may find it helpful to learn about various signs of cognitive decline and what to watch for as symptoms worsen.
Misunderstood beliefs
The field of psychiatry and medicine consequently has a sordid history of overpathologizing normal human experiences. I’ve met patients on long term psychiatric wards in Massachusetts who would be considered a good preacher in my homeland of Florida. Other people have had their socially appropriate religious experiences sedated with antipsychotics. I’ve met people who were no danger to themselves or others, able to function for many years by hiding their beliefs, suddenly institutionalized because they couldn’t stay safe in their own beautiful world during the pandemic. Medications do not help these atypical belief systems because they aren’t due to a medical illness. However, differentiating them from genuine psychotic experiences and medical conditions like migraine or seizure can be very difficult for some physicians. Health Coaching with Practical Neuropsychiatry can help tease out these experiences in a safe way, identify if any testing is appropriate, and help patients navigate what can be a very frightening medical industrial complex.