Psychosocial impact of being diagnosed with mild cognitive impairment: patient and carer perspective.

BACKGROUND: Mild cognitive impairment (MCI) may represent an intermediate, prodromal phase of dementia. Although persons with MCI (PwMCI) are able to function independently, they often experience reduced ability to carry out their usual activities. This can result in social, emotional and functional challenges. AIMS: To explore the understanding and psychosocial impact of receiving a diagnosis of MCI on patients and carers. METHOD: A cross-sectional cohort study was conducted at St James's Hospital Memory Clinic involving patients who attended the clinic for assessment from 1 January 2020 to 30 April 2021 and received a diagnosis of MCI. We completed questionnaires with patients and a nominated family member or friend of each patient (FwMCI). RESULTS: Forty-seven PwMCI participated in the study, and 36 nominated family members and/or friends completed the FwMCI questionnaire. In our cohort of PwMCI, most of the participants were not aware of their diagnosis; only 21% used the term MCI, and only 25% attributed their problems to a pathological cause. The majority of participants had no recollection of any discussion around the likelihood of progression. One-third of participants expressed relief that they did not have dementia. Most PwMCI reported positive psychological well-being and did not endorse symptoms of depression or anxiety. There was slight discordance of illness perception among the PwMCI-FwMCI dyads. Forty-seven per cent of FwMCI reported at least a mild degree of carer burden on the Zarit Burden Scale. CONCLUSIONS: Patients' awareness of being diagnosed with MCI is relatively limited. Public education campaigns raising awareness about MCI can help influence the 'illness representation' for MCI and enable people to seek timely advice and support.

Perspectives of psychiatric trainees and examiners on the assessment of communication skills during an online clinical examination: a qualitative study.

BACKGROUND: Effective doctor-patient communication is a core competency for healthcare professionals. With the pivot to online clinical education and assessment due to the COVID-19 pandemic, there was a need to explore the views of psychiatric trainees and examiners on assessment of communication skills during online high stakes postgraduate examinations. METHODS: The study was designed as descriptive qualitative research. All candidates and examiners of the September and November 2020 sitting of online Basic Specialist Training exam (a clinical Objective Structured Clinical Examination exam completed in the first 4 years of psychiatry training) were invited to participate. The respondents were interviewed by Zoom which was transcribed verbatim. Data were analyzed by NVivo20 pro and various themes and subthemes were drawn using Braun and Clarke thematic analysis. RESULTS: A total of seven candidates and seven examiners were interviewed with an average duration of 30 minutes and 25 minutes, respectively. Four main themes emerged: Communication, Screen optimization, Continuation postpandemic and Overall experience. All candidates preferred to continue an online format post pandemic for practical reasons e.g., avoiding travel and overnight stay, while all examiners preferred to go back to in-person Objective Structured Clinical Examination. However, continuation of online Clinical Formulation and Management Examination was agreed by both groups. CONCLUSION: The participants were largely satisfied with the online examination but did not consider it equal to face-to-face for picking up nonverbal cues. Overall minimal technical issues were reported. These findings may be helpful to modify current psychiatry membership examinations or similar assessments in other countries and specialties.

Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD).

OBJECTIVE: To estimate the prevalence of PDs according to Millon's evolution-based model among adult ADHD outpatients. METHOD: Cross-sectional study of consecutive patients referred to an adult ADHD clinic. PDs were evaluated with Millon Clinical Multiaxial Inventory-III (MCMI-III). RESULTS: One-hundred-eighty-one participants had valid MCMI-III, of whom147 were diagnosed with ADHD. Mean age: 32.97, SD:11.56, females: 74 (50.3%). Among the 147 participants with ADHD, 29 (19.7%) did not meet criteria for any PD, 43 (29.3%) met the criteria for one PD, 34 (23.1%) for two PDs and the rest three or more. Most common PD was Dependent (n = 58) followed by Depressive (n = 45). Inattentive sub-type was associated with dependent PD, while combined type with antisocial, negativistic (passive/aggressive) and sadistic PD. CONCLUSION: Particular personality profiles were more common with different ADHD subtypes. Given the developmental origins of PD, further research may help identify possible links with childhood difficulties.

Holistic assessment of patients with chronic mental disorders who attend a metabolic clinic in Sligo Town catchment area.

BACKGROUND: People with serious mental illness exhibit higher morbidity and mortality rates of chronic diseases than the general population. AIMS: The aim of this study was to establish a dedicated clinic for patients with chronic mental illness to monitor physical health and quality of life in accordance with best practice guidelines. METHODS: Patients were invited to attend the clinic. The following areas were examined: personal and family history of cardiovascular disease, diet, exercise, and smoking. Mental state examination, waist circumference, BP, pulse, ECG and BMI. Laboratory tests including U + E, LFTs, HbA1c, Lipid profile and other tests as appropriate such as serum lithium. AIMS scale, HoNOS and WHOQOL-BREF scales as additional indicators of global health. RESULTS: A total of 80 patients attended during 3.5 years of clinic. Mean age was 54.9 years (SD: 13.81) at first contact and 45% were females. Mean years in the service was 19.66 (SD: 11.54) and mean number of previous hospital admissions was 4.4 (SD: 5.63). Metabolic syndrome was present in 42% at first assessment. A statistically significant improvement was found for the psychological domain of the WHOQOL-BREF and the HoNOs, particularly at third assessment. (ß = 4.64, Wald x2 = 7.38, df:1, p = 0.007, CI:1.3-8.1, ß = - .889, Wald x2 = 4.08, df:1, p = 0.043, CI: - 1.752 to - .026) respectively. CONCLUSION: The results show a high prevalence of physical health conditions in this cohort, some of which represent a new diagnosis. This implicates better allocation of existing resources for screening and early detection, and potential to run joint clinics with primary care.

A decade of service development: audit of service users' experience of a rural Psychiatry of Later Life (POLL) service.

INTRODUCTION: The HSE "Vision for change", national service plan and other policies emphasise the importance of incorporating the views of service users and carers in the design and delivery of mental health services. AIMS: To obtain the views of service users in relation to a rural POLL service. Compare our service to best practice and address issues identified. Repeat the audit cycle based on recommendations. METHODOLOGY: New referrals to the POLL service were identified, and a pseudo-anonymised audit tool questionnaire was posted to these patients after initially making a telephone contact and obtaining informed consent. Results were compared to standards set by our team based on local and national policies. We used Microsoft Excel and performed a thematic analysis of qualitative data in the fourth cycle. This audit has been repeated on four occasions: 2012, 2013, 2016 and 2019. RESULTS: More than 90% of patients marked as being benefited by the POLL team. Overall, most positive responses pertained to supportive and professional staff, resolution of disease symptoms, psycho-education and attentive follow-up whereas negative responses were in relation to limited access to disabled parking spaces, perceived inadequate discharge planning and non-resolution of disease symptoms in few patients. CONCLUSION: Involving POLL patients in audit provided useful insights to improve the quality of service. We resolved the issue of disabled parking access and have developed a service information leaflet and a discharge leaflet. We intend to focus more on psychoeducation and discharge planning based on the results of the current cycle.