Childhood trauma and schizotypy in non-clinical samples: A systematic review and meta-analysis.

The association of early life adversities and psychosis symptoms is well documented in clinical populations; however, whether this relationship also extends into subclinical psychosis remains unclear. In particular, are early life adversities associated with increased levels of schizotypal personality traits in non-clinical samples? We conducted a systematic review and meta-analysis of associations between early life adversities and psychometrically defined schizotypal traits in non-clinical samples. The review followed PRISMA guidelines. The search using PubMed, Web of Science and EBSCO databases identified 1,609 articles in total. Twenty-five studies (N = 15,253 participants) met eligibility criteria for the review. An assessment of study quality showed that fewer than half of all studies were rated as methodologically robust. Meta-analyses showed that all forms of childhood abuse (emotional, physical and sexual) and neglect (emotional and physical) were significantly associated with psychometric schizotypy. The association of schizotypy traits with childhood emotional abuse (r = .33: 95%CI .30 to .37) was significantly larger than for all other form of abuse or neglect. Meta-regression analyses showed that the physical abuse-schizotypy relationship was stronger in samples with more women participants; and the sexual abuse-schizotypy relationship was stronger in younger samples. The current review identifies a dose-response relationship between all forms of abuse/neglect and schizotypy scores in non-clinical samples; however, a stronger association emerged for emotional abuse. More research is required to address the relationship of trauma types and specific symptom types. Future research should also address the under-representation of men.

Paranormal beliefs and cognitive function: A systematic review and assessment of study quality across four decades of research.

BACKGROUND: Research into paranormal beliefs and cognitive functioning has expanded considerably since the last review almost 30 years ago, prompting the need for a comprehensive review. The current systematic review aims to identify the reported associations between paranormal beliefs and cognitive functioning, and to assess study quality. METHOD: We searched four databases (Scopus, ScienceDirect, SpringerLink, and OpenGrey) from inception until May 2021. Inclusion criteria comprised papers published in English that contained original data assessing paranormal beliefs and cognitive function in healthy adult samples. Study quality and risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) and results were synthesised through narrative review. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was preregistered as part of a larger registration on the Open Science Framework (https://osf.io/uzm5v). RESULTS: From 475 identified studies, 71 (n = 20,993) met our inclusion criteria. Studies were subsequently divided into the following six categories: perceptual and cognitive biases (k = 19, n = 3,397), reasoning (k = 17, n = 9,661), intelligence, critical thinking, and academic ability (k = 12, n = 2,657), thinking style (k = 13, n = 4,100), executive function and memory (k = 6, n = 810), and other cognitive functions (k = 4, n = 368). Study quality was rated as good-to-strong for 75% of studies and appears to be improving across time. Nonetheless, we identified areas of methodological weakness including: the lack of preregistration, discussion of limitations, a-priori justification of sample size, assessment of nonrespondents, and the failure to adjust for multiple testing. Over 60% of studies have recruited undergraduates and 30% exclusively psychology undergraduates, which raises doubt about external validity. Our narrative synthesis indicates high heterogeneity of study findings. The most consistent associations emerge for paranormal beliefs with increased intuitive thinking and confirmatory bias, and reduced conditional reasoning ability and perception of randomness. CONCLUSIONS: Although study quality is good, areas of methodological weakness exist. In addressing these methodological issues, we propose that authors engage with preregistration of data collection and analysis procedures. At a conceptual level, we argue poorer cognitive performance across seemingly disparate cognitive domains might reflect the influence of an over-arching executive dysfunction.

Whole Life: a feasibility study of a recovery-focussed intervention in patients with stabilised schizophrenia [version 2; peer review: 2 approved, 1 approved with reservations].

Background: The Recovery Approach is about supporting people to live the best life they possibly can. This paper reports on a 2008-11 study of a recovery-focussed, one-to-one coaching programme called Whole Life (WL) in a group of people with stabilised schizophrenia. WL comprises 15 modules, each addressing an aspect of life that may pose challenges for someone with mental illness. It involves regular meetings with a coach, additional homework activities and lasts approximately one-year. This level of commitment requires participants to be motivated and enthusiastic. Methods: This was a non-randomised feasibility study, designed to assess acceptability and potential benefits of WL. The WL group was compared to another group of people with the same diagnosis, who received their usual treatment. This was not a strict control group. The primary outcome measure was the Social Adaptation Self-Assessment Scale. Results: Of those recruited to the WL group, 33/44 (75%) completed the full programme. WL participants showed an 11-point increase in mean SASS between baseline and Week 60. Subjective ratings showed benefits of WL at 3 and 6 months after the intervention had ceased, with most saying they felt better and none saying that they felt worse. The comparison group was more ill than the WL group at baseline and showed some improvement over the course of the study, albeit at a lower level than the WL group. However, controlling for baseline group differences meant that none of the outcome measures could reliably distinguish between WL and comparison groups. Conclusions: The study showed that WL is an acceptable and helpful intervention for motivated and enthusiastic individuals. It may have wider applicability for people with a less serious and chronic mental illness, although we do not know how it compares to other interventions. We discuss some methodological limitations of the study.

Feasibility and acceptability of transcranial stimulation in obsessive-compulsive symptoms (FEATSOCS): study protocol for a randomised controlled trial of transcranial direct current stimulation (tDCS) in obsessive-compulsive disorder (OCD).

BACKGROUND: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). METHODS: The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks' washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. DISCUSSION: We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. TRIAL REGISTRATION: ISRCTN17937049 . (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.

COVID-19 deaths in a secondary mental health service.

We present data on outcomes associated with COVID-19 in a time-limited sample of 1181 patients who were receiving treatment within secondary care services from a mental health and learning disabilities service provider. Unfortunately, 101 (9%) died after contracting COVID-19, though the real death rate is probably lower due to mild, unreported cases. Those who died were more likely to be male, of older age (75.7 vs. 42.7 yrs) and have a diagnosis of dementia (57% vs. 3.4%). We examined Health of the Nation Outcome Scale (HoNOS) scores as possible predictors for COVID-19 outcomes. Although the deceased group had higher HoNOS scores (17.7 vs. 13.2), the differences disappeared when examining only cases of dementia in 65+ age-group, suggesting that diagnosis is key. There has been little information published about people with severe mental health problems within secondary care. Although our sample is small, it does highlight some important inequalities that would benefit from further research.

Development of the Paranormal and Supernatural Beliefs Scale using classical and modern test theory.

BACKGROUND: This study describes the construction and validation of a new scale for measuring belief in paranormal phenomena. The work aims to address psychometric and conceptual shortcomings associated with existing measures of paranormal belief. The study also compares the use of classic test theory and modern test theory as methods for scale development. METHOD: We combined novel items and amended items taken from existing scales, to produce an initial corpus of 29 items. Two hundred and thirty-one adult participants rated their level of agreement with each item using a seven-point Likert scale. RESULTS: Classical test theory methods (including exploratory factor analysis and principal components analysis) reduced the scale to 14 items and one overarching factor: Supernatural Beliefs. The factor demonstrated high internal reliability, with an excellent test-retest reliability for the total scale. Modern test theory methods (Rasch analysis using a rating scale model) reduced the scale to 13 items with a four-point response format. The Rasch scale was found to be most effective at differentiating between individuals with moderate-high levels of paranormal beliefs, and differential item functioning analysis indicated that the Rasch scale represents a valid measure of belief in paranormal phenomena. CONCLUSIONS: The scale developed using modern test theory is identified as the final scale as this model allowed for in-depth analyses and refinement of the scale that was not possible using classical test theory. Results support the psychometric reliability of this new scale for assessing belief in paranormal phenomena, particularly when differentiating between individuals with higher levels of belief.

Mental and behavioural disorders and COVID-19-associated death in older people.

Health factors such as diabetes, severe obesity and chronic kidney disease are all associated with a more severe outcome following coronavirus disease 2019 (COVID-19) infection. However, there has been little exploration into the impact of mental and behavioural disorders on outcomes associated with COVID-19. We investigated outcomes for older people who used mental health services. Those who had a COVID-19-associated death had previously rated worse across a range of health and social problems, including mental health related problems. Our findings evidence the need to urgently explore whether mental and behavioural disorders should also be considered a health risk factor for a more severe outcome from COVID-19 infection in older people.

A model for predicting missing items on the Health of the Nation Outcome Scale (HoNOS).

HoNOS is one of the most widely used clinician rated outcome measures in mental health services. A commonly encountered problem is that one or more of the 12 individual HoNOS items is left uncompleted (missing data rates of up to 25% have been reported), which affects the degree to which organisations can rely on the accuracy of historical HoNOS data. In this brief paper we outline a simple statistical method of predicting missing item scores for HoNOS, both in general adult and 65+ populations. The method accounts for the average pattern of responding being non-uniform across items: i.e., some HoNOS items consistently elicit higher scores than others. By calculating individual item weights based on a very large sample of fully completed HoNOS assessments, we were able to accurately predict the value of missing items in a new sample. We contrast the accuracy of this approach with two other simple statistical procedures, and show that the weighted means model returns a much lower error rate. Although this is not the only method of predicting missing items, it carries the advantages of being: (i) free of charge, (ii) easily applicable to large datasets using a spreadsheet and (iii) unreliant on the availability of previous assessment data for the same patients. We hope this method will be of use to other organisations that are processing large volumes of HoNOS data.

The effect of integrated care on self-management and emergency department attendance.

Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017-2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire. RESULTS: Analysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.Clinical implicationsAn integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.Declaration of interestNone.

Sex differences in the association between childhood adversities and schizotypal personality traits.

Patients with psychosis report higher levels of adverse events in childhood. This relationship has not been extensively examined in healthy individuals who score highly on schizotypal personality traits. This study examined the association between different childhood traumas and psychosis-like traits in a general population sample, as well as differences in those links between men and women. Participants completed an online survey including measures of physical, emotional, and sexual abuse, and schizotypal personality traits. Results showed that the experience of emotional abuse was associated with a range of both positive and negative psychosis-like traits in both sexes. Sex differences emerged in the association between physical abuse and schizotypal personality traits. Although men reported more physical abuse in early life than women, this type of trauma was only associated with schizotypal traits in women and not in men. Additionally, women scored higher than men in sexual abuse; however, sexual abuse did not explicitly predict any schizotypal traits in the presence of the other two types of abuse. A simple linear or dose-response relationship between different types of trauma and psychosis-like traits was not supported. The importance of emotional abuse on schizotypy was highlighted in both sexes.

Sex differences in Alzheimer's disease.

PURPOSE OF REVIEW: Women are more impacted by Alzheimer's disease than men - they are at significantly greater risk of developing Alzheimer's disease, and recent research shows that they also appear to suffer a greater cognitive deterioration than men at the same disease stage. The purpose of this article is to review recent studies on examining sex differences in cognitive function in Alzheimer's disease. RECENT FINDINGS: We searched electronically for articles, reviews and meta-analyses published between 1/2016 and 12/2017 and identified 298 articles on sex differences in cognition in Alzheimer's disease. The key themes to emerge were sex differences in cognitive function, risk factors, resilience, and cognitive reserve. SUMMARY: Evidence is steadily and increasingly accumulating to confirm the poorer cognitive outcome for women than men with Alzheimer's disease. Although small in size, the effects occur across a broad range of cognitive domains including visuospatial, verbal, episodic memory, and semantic memory - some of which typically reveal a sex-related processing advantage for healthy women. Explanations have been linked to a variety of factors including differences in cognitive reserve, resilience, as well as genetics (apolipoprotein ε4) and functional and structural brain changes. Sex-related differences in risk factors, resilience, cognitive reserve, and rates of deterioration have implications for clinical practice.

The Herts and minds study: evaluating the effectiveness of mentalization-based treatment (MBT) as an intervention for children in foster care with emotional and/or behavioural problems: a phase II, feasibility, randomised controlled trial.

BACKGROUND: A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important. METHODS/DESIGN: This protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of mentalization-based treatment (MBT) as a treatment for reducing emotional and behavioural difficulties in looked after children and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. MBT is a relatively new intervention which, in the adaptation of the model tested here, includes many of the features of therapy identified in NICE guidelines as necessary to support children in care. The two arms are MBT and usual clinical care (UCC). The study will take place in Hertfordshire Partnership University NHS Foundation Trust with follow-up at 12 and 24 weeks. DISCUSSION: This study will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full-scale definitive randomised controlled trial (RCT). This study therefore has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care. TRIAL REGISTRATION: ISRCTN90349442.

Sex differences in cognitive impairment in Alzheimer's disease.

Sex differences in neurocognitive abilities have been extensively explored both in the healthy population and in many disorders. Until recently, however, little work has examined such differences in people with Alzheimer's disease (AD). This is despite clear evidence that AD is more prevalent in women, and converging lines of evidence from brain imaging, post-mortem analyses, hormone therapy and genetics suggesting that AD affects men and women differently. We provide an overview of evidence attesting to the poorer cognitive profiles in women than in men at the same stage of AD. Indeed, men significantly outperform women in several cognitive domains, including: Language and semantic abilities, visuospatial abilities and episodic memory. These differences do not appear to be attributable to any differences in age, education, or dementia severity. Reasons posited for this female disadvantage include a reduction of estrogen in postmenopausal women, greater cognitive reserve in men, and the influence of the apolipoprotein E ε4 allele. Assessment of cognitive abilities contributes to the diagnosis of the condition and thus, it is crucial to identify the role of sex differences if potentially more accurate diagnoses and treatments are to emerge.

Perception of Suicide Risk in Mental Health Professionals.

This study employed an independent-groups design (4 conditions) to investigate possible biases in the suicide risk perception of mental health professionals. Four hundred participants comprising doctors, nurses and social workers viewed a vignette describing a fictitious patient with a long-term mental illness. The case was presented as being drawn from a sample of twenty similar clinical case reports, of which 10 were associated with an outcome of suicide. The participant tasks were (i) to decide whether the presented vignette was one of those cases or not, and (ii) to provide an assessment of confidence in that decision. The 4 conditions were used to investigate whether the presence of an associated face, and the nature of the emotional state expressed by that face, affected the response profile. In fact, there were no significant differences between conditions, but there was a significant bias across all conditions towards associating the vignette with suicide, despite the base rate being pre-determined at 50%. The bias was more pronounced in doctors and in male respondents. Moreover, many participants indicated substantial confidence in their decisions. The results are discussed in terms of availability bias and over-confidence bias.

To admit or not to admit? The effect of framing on risk assessment decision making in psychiatrists.

BACKGROUND: The way that information is presented is well known to induce a range of biases in human decision tasks. Little research exists on framing effects in psychiatric decision making, but it is reasonable to assume that psychiatrists are not immune and, if so, there may be implications for the welfare of patients, staff and the general public. AIMS: To investigate whether presentation of risk information in different formats (frequency, percentage and semantic) influences inpatient admission decisions by psychiatrists. METHODS: Six-hundred seventy-eight general adult psychiatrists read a short clinical vignette presenting a case scenario of a patient presenting for inpatient admission. One of four condition questions followed the vignette, incorporating either numerical or percentage probabilities and the semantic labels "high" and "low" risk. In each condition, the actual risk was identical, but the way it was presented varied. The decision to admit the patient or not was recorded and compared across conditions. RESULTS: More individuals chose to admit the patient when risk information was presented in numerical form (X2 = 7.43, p = 0.006) and with the semantic label "high" (X2 = 7.27, p = 0.007). CONCLUSIONS: Presentation of risk information may influence decision making in psychiatrists. This has important implications for mental health clinical practice where clinicians are required to interpret probabilistic information within their daily work.

Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial.

AIM: Supervised consumption of opioid maintenance treatment (OMT) is standard in many drug centres reducing drug diversion, but is costly. We aimed to determine whether supervised consumption of OMT improved retention and other measures of drug use. DESIGN: Pragmatic randomized controlled trial comparing 3 months of daily supervised consumption of OMT with 1 month or less of daily supervised OMT, then daily unsupervised consumption. SETTING: Four community drug services in the United Kingdom. PARTICIPANTS: A total of 293 opioid-dependent patients entering OMT. PRIMARY OUTCOME: retention in treatment at 12 weeks. Secondary: retention at 6 months; illicit drug use [Maudsley Addiction Profile (MAP)]; quality of life (SF-12 and MAP); criminality (MAP); and social functioning. FINDINGS: No significant between-group difference was observed for the primary outcome: 69% (100 of 145) supervised and 74% (109 of 148) unsupervised were retained [odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.43-1.27]. Per protocol survival analysis suggested that supervised patients were less well retained (hazard ratio for retention = 0.71, 95% CI = 0.51-1.00). Illicit opioid use reduced in both groups and, while not statistically significant by intention-to-treat analysis, favoured unsupervised patients in per protocol analysis (odds of positive opioid screen for supervised versus unsupervised = 2.07, 95% CI = 1.05-4.06). Data on criminal activity also favoured unsupervised patients with 21% supervised patients committing crime versus 9% unsupervised (OR = 3.37, 95% CI = 1.28-8.86). CONCLUSIONS: There was no evidence of a difference in treatment retention or opioid use rates between patients whose consumption of opioid maintenance treatment was supervised for 3 months daily (except Saturdays) compared with supervision for 1 month. There was some evidence that longer periods of supervised consumption were associated with higher levels of criminality.

Remission of obsessive-compulsive disorders and syndromes; evidence from a prospective community cohort study over 30 years.

OBJECTIVE: Studies suggest that obsessive-compulsive disorder (OCD) is an unremitting disorder. We report a prospective, longitudinal investigation into OCD and sub-diagnostic OC syndrome (OCS) over a 30-year period to determine the extent to which individuals with clinically relevant OC symptomatology cumulatively remit, as well as the remission latency. METHODS: Five hundred and ninety-one participants drawn from the general population of Zurich, Switzerland, participated in a series of seven interviews over a period of 30 years. RESULTS: Median duration for OCD, OCS and unimpairing OC symptoms was 16, 14 and 6 years, respectively, suggesting a better prognosis for remission for less severe illness. Individuals with a longer duration of illness, greater number of OC-burdened years and those seeking professional help experienced significantly delayed remission. In addition, these factors together with the presence of comorbid anxiety disorders were associated with significantly reduced remission rates. We found a trend towards statistical significance for comorbid affective disorders and reduced remission rates. CONCLUSIONS: Our findings suggest a lack of diagnostic stability over the long-term and a high chance of eventual remission, albeit often after several years of illness, for obsessive-compulsive syndromes including OCD. However, roughly one-third of OCD cases do not remit by 50 years of age.

Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics.

OBJECTIVE: This study aims to expand the available knowledge on Obsessive Compulsive Disorder (OCD)-comorbidity by investigating the prevalence and clinical impact on a group of individuals with OCD or subthreshold OC syndrome (OCS), prospectively followed-up over an extended period. METHODS: A stratified sample of the general population of the canton of Zurich, Switzerland (n = 591), participated in a series of seven interviews over a 30-year period. Clinically significant comorbid subgroups of OCD/OCS were compared to cases of OCD/OCS without respective comorbidity, in order to determine differences in socio-demographic and other clinical characteristics. RESULTS: Lifetime rates of psychiatric comorbidity were high and increased in prevalence across the OC severity spectrum. Bipolar affective disorder was significantly associated with OCD whereas unipolar major depression and both alcohol and drug misuse disorders were not. Most forms of comorbidity increased distress and impacted negatively on family and work relationships, though disorder-specific effects were observed. Thus, agoraphobia and GAD were associated with increased OCD-severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour. CONCLUSIONS: Despite the statistical limitations imposed by the small sample-size, our findings highlight the negative impact of psychiatric comorbidity on health and psychosocial function.

Effectiveness of a recovery-orientated psychiatric intervention package on the wellbeing of people with early dementia: a preliminary randomised controlled trial.

OBJECTIVE: To investigate whether recovery-orientated psychiatric assessment and therapeutic intervention enhances the wellbeing of people with dementia and their family carers. METHODS: In a preliminary randomised controlled trial, 48 people with early dementia were recruited. Of 34 who completed the trial, 17 were in the recovery and 17 in the treatment as usual group. Recovery participants received a recovery-focused pre-diagnostic wellbeing assessment and counselling, diagnostic consultation with written feedback and post-diagnostic support over a period of 6 months using the WHO Wellbeing Index as the primary measure, and Mini Mental State Examination, Cornell Scale for Depression in Dementia, EUROQOL and Zarit Burden Interview as secondary outcome measures. RESULTS: People in the recovery group showed a significant improvement in the WHO Wellbeing Index (18.3 for recovery vs 9.46 for treatment as usual; t = -2.28, p = 0.03), with trends of improvement in other outcome measures. CONCLUSIONS: This trial shows that a recovery-focused diagnostic consultation and post-diagnostic support enhance the wellbeing of people with mild cognitive impairment and early dementia.