PNI.org | Pacific Neuropsychiatric Institute

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Reality Begins with Consciousness

A Paradigm Shift that Works

Vernon M Neppe and Edward R. Close. Second Edition

Once in many decades, a book comes out that is so important that it literally impacts on the whole basis of thinking about Reality, Life and existence, and all of Science. We believe that Reality Begins with Consciousness: A Paradigm Shift that Works is such a book. Its importance cannot be overemphasized.

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PNI.org | Pacific Neuropsychiatric Institute

www.brainvoyage.com | www.vernonneppe.org | www.tddvp.com | www.ecao.us | www.healthyharmony.com�

TDVP Competition

Gateway to Dr. Vernon Neppe's Websites

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Reality Begins with Consciousness

A Paradigm Shift that Works

Vernon M Neppe and Edward R. Close. Second Edition

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Forensics | Pacific Neuropsychiatric Institute

Dr. Neppe on Attorney medical expert selection

Closed Head Injury

Ethics

Interesting Perspectives

Neuropsychiatry

Psychopharmacology

Forensic Links

Buspirone and Attention Deficit Disorder

Buspirone and Agggression

Cry the Beloved Mind: Dr. Neppe's latest book

What is Forensics?

Forensics implies the practice of law in relation to medicine. The specific forensic discipline in this site focuses on forensic neuropsychiatry and psychopharmacology which is law in relation to neuropsychiatry and psychopharmacology. This area involves both civil and criminal issues and may relate to such areas as standard of care, traumatic brain injury, post-traumatic stress disorder, complications of medication prescriptions such as movement disorders, committals and malingering. Forensic neuropsychiatry and psychopharmacology is in contradistinction to a coroner who may be involved with the analysis of pathologic specimens - examination of tissues or organs in autopsy who is practicing forensic pathology. There is a subcertification in forensic psychiatry both through the American Board of Psychiatry and Neurology as well as the American Association for Psychiatry and the Law. Additionally, the American Board of Forensic Examiners have a certification in Forensic Medicine which is broader.

Forensic Neuropsychiatry

What is neuropsychiatry and how does it link with forensic practice? There are several conditions that psychiatrists, neurologists and internists refer: The first relates to pharmacologic prescription relating to brain function such as difficult or refractory cases or dilemmas about treatment options. The second involves a broad spectrum of cases with possible brain disease and frequently behavioral abnormalities: these cases, like the first group, frequently have forensic facets in their neuropsychiatric evaluation. Medicolegal aspects are very diverse including reviewing records, research opinions, competency evaluations, malpractice, torts relating to head trauma or cerebral anoxia, possible psychiatric disability, tardive dyskinesia, pain syndromes, aggression, attention deficit disorder and post-traumatic stress disorder. Neuropsychiatry also encompasses assessments of strange or atypical symptoms, the behavioral aspects of neurology, seizure phenomena, refractory psychiatric illness, dementia, and atypical spells.

What is the difference between Neuropsychiatrists and Neuropsychologists?

• are MDs: They are physicians, who are medically trained at medical schools and have thereafter specialized in an extremely complex area.
• are an unusual, highly educated medical subspecialty.
• their background is in psychiatry and neurology
• they specialize in pathology of the higher brain at the clinical neurological and psychiatric levels
• they are clinicians who focus on managing difficulties, assessing prognosis and prescribing medications
• usually perform specialized neuropsychiatric evaluations
• use tests that are standardized for a particular population and will commonly find areas of abnormality which may or may not be clinically relevant.
• neuropsychiatric evaluations involve assessments of higher cerebral cortical functions, integration of brain symptomatology such as temporal lobe phenomena, correlations with neurological and psychiatric diagnoses and appropriate prescriptions, and several clinically relevant neuropsychiatric tests.
• also rely on neuropsychological tests and such measures as ambulatory electroencephalography.
• neuropsychiatrists are often the "captains" of the treating team for neurological conditions with associated psychiatric disorders or psychiatric conditions with neurological disorders.
• typical patients with neuropsychiatric conditions include patients who suffer from

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• seizures with behavioral, emotional or thinking difficulties
• traumatic head injuries with personality or other changes including post-traumatic stress disorders
• headaches or migraines with mood changes, depression or anxiety
• movement disorders such as tardive dyskinesia with associated medication or psychiatric elements
• brain injuries or disturbances
• temporal lobe disease

• are not physicians.
• generally have PhDs in psychology.
• have subspecialized in the psychological assessment and management of higher brain function.
• cannot prescribe
• usually perform specialized neuropsychological evaluations such as personality, intelligence and specific brain disorder evaluations.
• these tests are standardized and will commonly find areas of abnormality which may or may not be clinically relevant.

And what is a psychopharmacologist?

• may or may not be physicians
• are experts in the pharmacology of the brain
• if physicians, prescribe for patients
• often are trained in techniques of biological psychiatry
• have special expertise in brain medications over and above that in psychiatric and neurological training
• practice a very difficult and important subspecialty.

Where do these specialties fit forensically?

• the domains of neuropsychiatry and neuropsychology overlap.
• because they are physicians, neuropsychiatric opinions may be perceived by a jury with more weight than a neuropsychological opinion, just as the opinions of psychiatrists may be perceived more heavily than psychologists.
• neuropsychologists are not specifically trained to express a pharmacological opinion, nor opinions on medical or neurological or psychiatric examinations, nor on recommended medical treatments, diagnoses or investigations.
• neuropsychiatrists may be specifically trained to express pharmacological, medical, brain related neurological or psychiatric opinions, and express opinions on recommended medical treatments, diagnoses or investigations.
• neuropsychiatrists performing expert witness work should be specifically trained to express opinions on pharmacological, medical and brain related neurological and psychiatric findings, recommended medical treatments, diagnoses and investigations.

Where does Dr Vernon Neppe and the Pacific Neuropsychiatric Institute fit this description?

• Dr Vernon Neppe MD, PhD is a highly trained, experienced and internationally recognized neuropsychiatrist/behavioral neurologist, and psychopharmacologist as well as forensic psychiatrist/forensic neuropsychiatrist.
• He was recruited after an international search to establish what was then apparently the first Division of Neuropsychiatry in a Department of Psychiatry in the USA ( in 1986, at the University of Washington, Seattle)
• He has established a model neuropsychiatric institute for complex clinical evaluations and also does forensic evaluations. This is the Pacific Neuropsychiatric Institute.
• He also has a PhD and so is an MD, PhD.
• He has a string of specialist qualifications making him academically one of the most highly trained physicians in the United States. (VERNON M. NEPPE MD, PhD(Med), FRSSAf, FAPA, FFPsych(SA), FRCPC, MMed (Psych), DipABPN [Psychiatry; Geriatric Psychiatry (91-01-11); Forensic Psychiatry (94-04)], DABFM, DABFE, DABPS (Psychopharmacology), FACFE, LMACFE, MB, BCh, DPsM , BA). On paper, this makes Dr Neppe one of the most highly qualified physicians in his area in the world. He has USA board certifications as well as numerous non-USA specialist qualifications.
• He has been working in this field for more than a quarter of century
• He has been regarded by his peers as a leading expert in his area (for example, he appears in every edition to date of Americas Top Doctors, and at times is the only Neuropsychiatrist [2002 edition] under Psychiatry listed in the Western United States in the book, and certainly the only one listed under Neuropsychiatry / Behavioral Neurology. He also is listed under Forensic Neuropsychiatry (only one) and Psychopharmacology. Americas Top Doctors is a peer voted primary source for such information with 2005 being the fifth edition. Moreover, Dr Neppe was also listed in the peer voted on book, Best Doctors in America, when it was the authority in the mid/late 1990s).
• He is an academic as well (an Adjunct Full Professor in St Louis, 1700 miles from his home base, a singular honor, attesting to his degree of respect (an extremely unusual honor). He endeavors to keep up-to-date on the standard texts, controversies and trends in his field as well as with clinical changes.
• He is author of two books on psychopharmacology and has made ground-breaking contributions to the area.
• He has developed several measuring and other neuropsychiatric tests and pioneered the area of neuropsychiatry.
• He was instrumental in the American Medical Association listing a subspeciality of neuropsychiatry under psychiatry.
• He also has been recognized as the pioneer of several major areas of research in psychopharmacology, such as the use of anticonvulsants in psychiatry and developing a treatment for tardive dyskinesia.

Specifically, in Forensic Neuropsychiatry and Behavioral Neurology, where does Dr Neppe fit in the realm of being retained for expert testimony?

• Dr Vernon Neppe MD, PhD is a highly trained, experienced and recognized forensic expert
• His forensic certifications include Forensic Psychiatry by the American Board of Psychiatry and Neurology (1994-2004); also DABFM, DABFE, DABPS (Psychopharmacology), FACFE.
• He is experienced in virtually every facet of medicolegal work
• As with Neuropsychiatry, he has been regarded by his peers as a leading expert in his area. For example, he appears to be the only Forensic Psychiatrist under Psychiatry listed in the Western United States in the book, Americas Top Doctors, a peer voted primary source for such information, 2002 edition and thereafter is so listed, for example, currently is the only person listed under Forensic Neuropsychiatry.
• His range of case expertise is broad: He prefers civil, competence and disability work compared with criminal work.
• He has been retained repetitively by plaintiff and defense.�
• He will express the real opinion he thinks, and what may need to be done. This is extremely useful in preliminary chart reviews or research in a particular area, where legal questions of how and whether to proceed or plan defense of cases or settle are important.
• He can assist attorneys who are not experts in areas of neuropsychiatry in advising them about such factors as deposing or cross-examining.
• He has acted as consultant, reviewer of medical records, expert witness in depositions, rebuttal / surebuttal witness.
• He works quickly, a major advantage in terms of time for attorneys. Yet he endeavors to be thorough and may point out areas in which he needs more information.
• Patients requiring "independent," "plaintiff" and "defense" medicolegal examinations can be evaluated at the Pacific Neuropsychiatric Institute. Sometimes patients with medical insurance are referred by other physicians for a complex, comprehensive, clinical evaluation of their medical status at the Pacific Neuropsychiatric Institute: this kind of clinical evaluation is linked with their medical insurance as Dr Neppe becomes a provider of treatment.
• He is an excellent communicator, being an internationally in demand speaker, and a writer who writes medical scientific information for the layperson in a dialogic framework (e.g. the book Cry the Beloved Mind). This has been and should continue to be of value in a context of delivering expert testimony. He has also been consulted by the lay media: radio, television, newspapers and other publications.
• As a writer, playwright and highly published scientist he is experienced in writing a well-organized and concise report.
• Also, as a writer for laypersons, he has learnt to explain complex matters in a manner understandable to triers of fact.
• Possibly because of these attributes, Dr Vernon Neppe

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• makes an accomplished, excellent and formidable expert witness;
• is extremely good at justifying his position to opposing counsel attacks;
• conveys his expertise and knowledge of the subject matter in a confident but not arrogant style and with care about grooming and professional dress;
• comes across as coherent, logical and believable with a comfortable presentation style.

• makes an accomplished, excellent and formidable expert witness.
• In general, because of his professional backgrounds in Neuropsychiatry / Behavioral Neurology and Psychopharmacology, and his unique attributes (his background), Dr Neppe may be more able to use his expertise appropriately to teach a jury what in his opinion is the correct answer or direction for a particular case than some of his opposite witnesses such as Neuropsychologists, Neurologists or Psychiatrists.
• Dr Neppe can address a far broader area of expertise than many experts in the areas of neuropsychologists, neurologists or psychiatry are expert in doing.
• On the other hand, as a psychiatrist as well he can also express opinions on psychiatric issues.

In what special contexts is Dr Neppe a logical expert witness?

Most certainly, Dr Neppe is an eminently logical expert witness provided the case is within his expertise realm.

Dr Neppe has special expertise in the following medicolegal areas:

special expertise in brain injury including traumatic brain injury and this includes also "minor" head injury with alleged changes in thinking, emotion, motivation or personality. (He has written chapters in key books; and also has developed his own classification?learn more)

special expertise in psychopharmacology (numerous chapters; two books; many articles; lectures round the world; major contributions)

special expertise in malpractice issues

special expertise in neuroleptics , anticonvulsants, azapirones, antidepressants, anti-anxiety agents

special expertise in seizure disorders, atypical spells, brain function and psychiatric elements (includes a classification of psychiatric disorders in patients with seizure disorders).

special expertise in tardive dyskinesia and other drug-related extrapyramidal disorders (publications and expert testimony)

special expertise in neuroleptic malignant syndrome (publications and expert testimony)

special expertise in medication side-effects

special expertise in differentiating the pre-existing condition from the new neuropsychiatric condition

special expertise in neuropsychiatric issues of any kind (e.g. competence, responsibility, medication)

special expertise in differentiating the organic from the psychological

special expertise in brain function assessments and competency issues

special expertise in so-called "diet" medicines such as Ephedra

special expertise in disorders of consciousness and higher brain function

In what kinds of forensic neuropsychiatric and psychopharmacological contexts can Dr Neppe be used?

Areas such as competence in the area, expertise and appropriate credentials are vital for expert witnesses. Communication skills and credibility are critically important too. The information above gives a perspective of where Dr Neppe fits in that regard.

The following guidelines may assist when he can best be retained.

Professor Neppe can express opinions in a wide variety of different contexts.

Chart review can be valuable to establish forensic neuropsychiatric and psychopharmacological perspectives and strategies.

Evaluations of patients whom Dr Neppe has seen clinically, are very useful.

Dr Neppe makes an excellent expert witness during depositions, trial and advising in preparation for trial.

Whereas Dr Neppe does not generally accept criminal cases, he is prepared to act as an advisory consultant.

Dr Neppe is an eminently suitable rebuttal or surebuttal witness in neuropsychiatry, psychopharmacology and the biological aspects of psychiatry.

Dr Neppe can give expert appraisals of some of the medical strengths and weaknesses of cases within his domain of expertise. Attorneys have found this very useful in their evaluations as to whether to settle a case or even take the case on.

Dr Neppe may be useful as a so-called "big gun." Whereas the attitudes of jurors may differ, because of his background, qualifications, expertise and experience in communication skills, theoretically, this could be a major advantage, though, of course, no warrantees can be made!

Dr Neppe's rates are highly competitive for this level of expertise.

Dr Neppe has been retained nationally in the USA as well as outside the USA in Forensic Psychiatry / Neuropsychiatry.

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He is retained by both plaintiff and defense in civil cases and endeavors to deliver unbiased expert opinions in that regard.

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Of course, Dr Neppe does not work with individuals who may be representing themselves, only with attorneys.

How far geographically does Dr Neppe consult?

Geographically, Dr Vernon Neppe does cases from all round the United States. This includes the Pacific Northwest, the West, the Midwest both in the north and south, the Northeast and the Southeast.

He has also been consulted in Canada (in which country, he has an FRCPC specialist qualification).

Additionally he has been consulted on cases from as far afield as Singapore.

Doctor Neppe's Background

Vernon M. Neppe: MD, PhD(Med), FRSSAf, FAPA, FFPsych(SA), FCPsych, FRCPC, MMed (Psych), ABPN, DACFM, DABFE, DABPS, FACFE, MB, BCh, DPsM, BA, Director and President of the Pacific Neuropsychiatric Institute, in Seattle, practices medicine in Washington state. He is Board Certified by the ABPN in psychiatry with further sub-certifications in geriatric psychiatry and (till 2004) forensic psychiatry. He is also boarded by the ABFE as a Forensic Examiner, in Forensic Medicine and in Psychological Specialties (Psychopharmacology). He also has overseas specialist qualification with majors in Psychiatry and Neurology. He practices as a Neuropsychiatrist and Behavioral Neurologist, Psychopharmacologist and also as a Forensic specialist. He is listed under Neuropsychiatry in editions of Woodward White's book The Best Doctors in America and also in editions of Americas Top Doctors. As a Psychopharmacologist he was author of the acclaimed book Innovative Psychopharmacotherapy and the pioneered sciction in and Cry the Beloved Mind: A Voyage of Hope. Dr Neppe has been licensed to practice medicine in Britain, in states of the United States and Australia and is additionally on the Canadian and South African specialist registers and listed in the American Board of Medical Specialties.

Dr Vernon Neppe founded the Pacific Neuropsychiatric Institute (PNI) in Seattle, WA in late 1992. The PNI aims at serving as an international model in the discipline of Neuropsychiatry with clinical, academic, research, forensic and educational emphases. His major current academic university affiliation reflects the unusual special honor of being an (adjunct full ) Professor of Psychiatry and Human Behavior at St Louis University, St Louis, MO (1700 miles away). In 1986, Professor Neppe was recruited internationally to establish (and became Director of) the first Division of Neuropsychiatry in a Department of Psychiatry in the United States (at the University of Washington, Seattle). Prior to that, he had trained and worked at the University of Witwatersrand, Johannesburg, South Africa (medical degree, internship, specialist post-graduate training and as a consultant attending then senior consultant). He was also honored as the Witwatersrand University Overseas Traveling Fellow for 1982-3 and worked at Cornell University Medical College, New York where he consolidated his psychopharmacology, chronobiology and sleep-wake disorders, epileptology, geriatric and neuropsychological experience.
He is also an attending physician at Northwest Hospital, Seattle, WA and on courtesy staff of Overlake Hospital, Bellevue, WA.

Dr Neppe is a clinician and forensic specialist who may be retained in the USA by plaintiff or defense in civil litigation, and has also expressed expert opinions in criminal cases although this is an area he no longer prefers to do. He has also served in arbitration, and rebuttal capacities. Dr Neppe consults nationally, particularly on challenging and complex cases, giving opinions on all sides, Professor Neppe also consults on difficult medicolegal problems in his disciplines providing an objective opinion on the medical strengths and weaknesses of individual cases, and possibly finds aspects that had not previously been considered relevant. This may involve a review of records to obtain preliminary ideas as to how to proceed further or be based on the extensive clinical evaluations performed at the Pacific Neuropsychiatric Institute.
He is listed in online expert databases under neuropsychiatry, head injury, pharmacology (specifically psychopharmacology), personal injury and psychiatric medicine. Despite this the vast majority of his work is not specifically forensic, but clinical.

Dr Vernon Neppe trained (and later worked) at the University of Witwatersrand, Johannesburg, South Africa (medical degree in 1973, internship, specialist post-graduate training and as a consultant attending then senior consultant) and was also honored as the Witwatersrand University Overseas Traveling Fellow for 1982-3 and worked at Cornell University Medical College, New York where he consolidated his psychopharmacology, chronobiology and sleep-wake disorders, epileptology, geriatric and neuropsychological experience.

He is a fellow of six and member of twelve professional associations (including the American or International Psychiatric, Medical, Neuropsychiatric, Epilepsy, Psychogeriatric, Clinical Psychopharmacology and Bariatric Associations and Societies) and his Consultancies have included the Epilepsy Institute and the American Psychiatric Assn Diagnostic and Statistical Manual III revision (transcultural issues) and IV (Organic Mental Disorders) and IV R (Adviser on Delirium, Dementia, and Amnestic and Other Cognitive Disorders).

Amongst his special honors has been book listings in Marquis Who's Who in the World, Americas Top Doctors, Americas Top Psychiatrists, The Best Doctors in America, Men of Achievement, Five Thousand Personalities of the World, Two Thousand Notable American Men, and Five Hundred Leaders of Influence. Dr Neppe was an International Man of the Year 1992-3 from the International Biographical Center in Cambridge, England "in recognition of his services to Neuropsychiatry, Psychopharmacology and Anomalistic Psychology." He was one of 3 winners worldwide of the Rupert Sheldrake New Scientist Research Hypothesis Competition (1983, London) and received the Marius Valkhoff Medal in 1982. His latest award is his international recognition as apparently the first physician living in the United States elected to Fellowship of the Royal Society of South Africa (Foreign Fellow).

Professor Neppe has extensive scientific publications (more than two hundred including abstracts) and is an internationally sought lecturer and has made hundreds of scientific presentations in eleven countries including chairing international conferences on four continents and radio and television appearances around the world. He is author of three books, served as founding editor of a journal, guest editor of the Journal of Clinical Psychiatry, and has served on the editorial boards of numerous others. and has acted as a referee for numerous scientific journals. He has, inter alia, contributed to key textbooks in psychiatry, neuropsychiatry, forensic neuropsychology, traumatic brain injury and anomalistic psychology.

His latest book, Cry the Beloved Mind: A Voyage of Hope, written for the general public, patients and family members, as well as colleagues in the medical, pharmaceutical, psychological and legal professions, has been perceived as a major contribution and a classic, defining as it does, the new literary genre of "sciction."

He is also the author of the text books Innovative Psychopharmacotherapy and of The Psychology of D�j� Vu and has served as guest editor and founding editor of a South African scientific Journal. He has served on other editorial boards.

Professor Neppe's major research areas include pharmacologic, neuropsychiatric and phenomenologic elements. He developed several measuring neuropsychiatric instruments and inventories including the BROCAS SCAN (Screening Cerebral Assessment of Neppe), The INSET (Inventory of Neppe of Symptoms of Epilepsy and the Temporal Lobe), the STRAW (the first time / severity measure for tardive dyskinesia), a geriatric inpatient instrument namely The PBRS (with JP Loebel) (The Problem Behaviors Rating Scale) as well as research Subjective Paranormal Questionnaires and Narcolepsy Questionnaires. Additionally, he first demonstrated the links of anomalistic psychological experiences (subjective paranormal experience) with the temporal lobe of the brain. His pharmacologic areas include the only double blind study demonstrating the value of carbamazepine in dyscontrol and psychosis thereby being a major pioneer of the whole area of anticonvulsant drugs in psychiatry —this has possibly impacted on millions, the use of high dose buspirone as a successful treatment for tardive dyskinesia, and the extended use of azapirones in aggression and attention deficit disorder. He has also developed concepts in medical areas such as deinduction, non-vertiginous dizziness, �dysproccia, chindling and possible temporal lobe symptoms.

He is also a media resource. (More info.)

PNI Neuropsychiatric Evaluations

What kinds of review do neuropsychiatric patients have? Because it is a new specialty, guidelines are lacking. At the Pacific Neuropsychiatric Institute, these evaluations are generally extensive, involving several units of neuropsychiatric testing and numerous comprehensive complex clinical consultations as well as appropriate electroencephalographic (e.g. outpatient home ambulatory monitoring) and neuroradiologic (e.g. MRI, SPECT) examinations. Following on these clinical comprehensive assessments with follow-ups occur as necessary. These evaluations are frequently highly relevant to prognosis and etiology and two of the clinical tests we developed have been very useful and simple instruments in evaluation of the progress over long and short periods of time, in one instance examining defects of higher brain function and in the second, concentrating on symptomatology. Our hope is to delineate what is clinically relevant as opposed to findings of dubious significance which are sometimes generated with full scale neuropsychological batteries - such batteries can, of course, be very helpful in the holistic medical context. Many patients are initially clinically, not forensically, referred for appropriate medical management, and the medical insurances in those instances become the appropriate source for billing.

The Address of the Pacific Neuropsychiatric Institute

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