Objectives To examine the delivery and assessment of psychiatry at undergraduate level in the six medical schools in the Republic of Ireland offering a medical degree programme. Methods A narrative description of the delivery and assessment of psychiatry at undergraduate level by collaborative senior faculty members from all six universities in Ireland. Results Psychiatry is integrated to varying degrees across all medical schools. Clinical experience in general adult psychiatry and sub-specialities is provided by each medical school; however, the duration of clinical attachment varies, and the provision of some sub-specialities (i.e. forensic psychiatry) is dependent on locally available resources. Five medical schools provide ‘live’ large group teaching sessions (lectures), and all medical schools provide an array of small group teaching sessions. Continuous assessment encompasses 10–35% of the total assessment marks, depending on the medical school. Only one medical school does not provide a clinical examination in the form of an Objective Structured Clinical Examination with viva examinations occurring at three medical schools. Conclusions Many similarities exist in relation to the delivery of psychiatry at undergraduate level in Ireland. Significant variability exists in relation to assessment with differences in continuous assessment, written and clinical exams and the use of vivas noted. The use of e-learning platforms has increased significantly in recent years, with their role envisaged to include cross-disciplinary teaching sessions and analysis of examinations and individual components within examinations which will help refine future examinations and enable greater sharing of resources between medical schools.
Involuntary admission is one of the most ethically challenging practices in medicine, yet we are only beginning to learn more about the patient's perspective.To investigate (i) peoples' perception of the necessity of their involuntary admission at one year after discharge (ii) readmission rates to hospital and the influence of insight and recovery style.We interviewed individuals admitted involuntarily at one year following discharge using the Mac Arthur Admission Experience Interview, Birchwood Insight Scale, the Drug Attitude Inventory, Global Assessment of Functioning and the Recovery Style Questionnaire.Sixty-eight people (84%) were re-interviewed at one year and fewer (60%) reported that their involuntary admission had been necessary when compared to inception (72%). Of the 33% that changed their views, most reflected negatively on their involuntary admission. We found that insight was moderately associated with the acknowledgement that the involuntary admission was necessary. Within a year, 43% were readmitted to hospital and half of these admissions were involuntary. Individuals with a sealing over recovery style were at four times the risk of involuntary readmission.Peoples' perception of the necessity of their involuntary admissions is not stable over time and risk of involuntary readmission is associated with recovery style.
Autism spectrum disorder (ASD) is a highly impairing neurodevelopmental condition, manifesting in childhood and continuing into adult life. Comorbid psychiatric and physical illness lends considerable increased mortality to the condition. An increased awareness of comorbid conditions in adults with normal IQ ASD could improve diagnostic formulation, facilitate targeted treatments and improve psychosocial outcomes.
This study examines the prevalence of comorbid psychiatric and physical illness in 413 adults with normal IQ ASD, attending a tertiary referral neurodevelopmental clinic in South London, to determine if rates of comorbid illness would be greater than rates reported in the general population.
This study noted autism spectrum disorder in 70% of participants, with a male-to-female ratio of 2.8:1. Milder forms of ASD were recorded for 88%. Participants with autism spectrum disorder were more likely to be single, unemployed and living in the company of others. Seventy-six percent suffered from a comorbid Axis I illness and 2% suffered from a comorbid Axis II condition. Anxiety spectrum disorders were the most common comorbid psychiatric illness, followed by attention deficit hyperactivity disorder, mood disorders and deliberate self-harm. Psychosis, substance-use disorder, eating disorder and tic disorder were rarely diagnosed. Participants with Asperger’s syndrome were statistically more likely to be diagnosed with a comorbid psychiatric illness, most commonly obsessive compulsive disorder. Eighty-four percent of participants had a history of physical illness, most frequently asthma followed by head injury. Sleep difficulties and eating disturbance were notably high at 42% and 25% respectively.
Adults with normal IQ autism spectrum disorder suffer higher rates of physical and psychiatric morbidity, display a poorer ability to engage with treatment and have a lower chance of recovery compared to the general population. Increased awareness and a high degree of diagnostic skill to identify those with the disorder should be promoted among physicians and psychiatrists.
Background There is limited knowledge of how individuals reflect on their involuntary admission. Objectives To investigate, at one year after an involuntary admission, (i) peoples perception of the necessity of their involuntary admission (ii) the enduring impact on the relationship with their family, consultant psychiatrist and employment prospects (iii) readmission rates to hospital and risk factors for readmission. Methods People that were admitted involuntarily over a 15 month period were re-interviewed at one year following discharge. Results Sixty eight people were re-interviewed at one year and this resulted in a follow-up rate of 84%. Prior to discharge, 72% of people reported that their involuntary admission had been necessary however this reduced to 60% after one year. Over one third of people changed their views and the majority of these patients reflected negatively towards their involuntary admission. One quarter of people continued to experience a negative impact on the relationship with a family member and their consultant psychiatrist one year after an involuntary admission, while 13% reported a positive impact. A similar proportion perceived that it had negative consequences in their employment. Within one year, 43% of all patients involuntarily admitted in the study period were readmitted to hospital and half of these admissions were involuntary. Involuntary readmission was associated with a sealing over recovery style. Conclusions Peoples’ perception of the necessity of their involuntary admissions changes significantly over time. Involuntary admissions can have a lasting negative impact on the relationship with family members and treating consultant psychiatrist.
The enactment of the Medicare legislation and the establishment of a National Institute for Aging in the 1960s and 1970s has spurred a number of developments which have proven to represent watershed advances in the surgical care of the elderly. The development of a multidisciplinary approach to both geriatric surgical care and research ultimately may prove to be the greatest advance yet seen.
Background Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties. Method A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2). Results A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale. Conclusions The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.
Purpose of review Individuals with 22q11.2 deletion syndrome have high rates of comorbid mental illness, particularly psychosis and schizophrenia. The purpose of this review is to summarize recent research in the area of 22q11.2 deletion syndrome and psychosis. Recent findings Research over the past year has identified negative symptoms, functional impairment, dysphoric mood and a childhood diagnosis of attention deficit hyperactivity disorder as important clinical predictors of psychosis risk in 22q11.2 deletion syndrome. As previously reported in nondeleted schizophrenia, recent studies have implicated neuroinflammation as a possible neurobiological mechanism for psychosis in 22q11.2 deletion syndrome. Recent neuroimaging findings suggest that the cortex is significantly thinner in those with 22q11.2 deletion syndrome and psychosis compared to those without psychosis, replicating similar findings in nondeleted schizophrenia. Further data from the International 22q11.2 Deletion Syndrome Brain and Behavior Consortium have suggested that chromosomal microdeletions are significantly more likely to involve protein-coding genes and several rare copy number variants are associated with the presence of psychosis in deleted individuals. Summary There have been several significant recent advances to further characterize the high rates of psychosis in 22q11.2 deletion syndrome, to identify additional clinical predictors of psychosis and to increase our understanding of the neural substrate and genetic aetiology of psychosis in 22q11.2 deletion syndrome.
Summary Autism spectrum disorders (ASDs) are lifelong conditions. Although not all adults with ASD require psychiatric input, general adult psychiatrists increasingly find themselves responsible for the care of adults with the disorder. This may present a new and unique challenge to them. Here, we summarise the core clinical features of ASD; discuss appropriate diagnostic practice; review the principles of management; and identify key educational, social care and voluntary services for adults with ASD in the UK.
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