Aims: Despite sleep being an important factor in maintaining mental health, some students frequently experience poor sleep quality and insufficient duration. Reasons such as prioritising academic duties over sleep and well-being may be implicated in the understanding of this relationship. Our study aims to assess the relationship between sleep duration and quality and mental health parameters among university students in the UAE.

Methods: A cross-sectional study was conducted with 550 university students, of whom 420 met inclusion criteria. Most notably, 81 were excluded due to pre-existing medical conditions. Data was collected using an online self-administered questionnaire incorporating the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI) to evaluate anxiety, depression, and sleep quality. Data was analysed using SPSS with significance at p < 0.05. Ethical approval from the University of Sharjah Ethics Committee was obtained, and informed consent was taken from all participants.

Results: The sample comprised 61% males (n=256) and 39% females (n=164), predominantly undergraduates (93.1%, n=391) aged 18–23 (92.9%, n=390). Poor sleep quality (PSQI≥5) was identified in 87.2% (n=366), with a mean PSQI score of 7.84 (SD=3.26). Mean anxiety (GAD-7) and depression (PHQ-9) scores were 8.49 ± 5.655 and 9.75 ± 6.376, respectively, with pronounced gender disparities: 24.6% of females reported severe anxiety symptoms versus 6.7% of males (p<0.001). Similarly, females scored higher on PHQ-9, with 25.8% having severe depressive symptoms compared with 12.8% of males (p=0.004). Mid-range GPA students (3.0–3.5) had significantly worse sleep quality (PSQI = 8.75±3.73) compared with higher (3.5–4.0; 7.22±2.88) and lower (<3.0; 7.84±3.10) GPA groups (p = 0.003). Participants with severe anxiety had significantly higher PSQI scores (10.28±3.362) than those with none/mild symptoms (6.98±2.863; p<0.001). Similarly, 81.1% with severe anxiety and 80.5% of students with severe depressive symptoms scored above the median PSQI score (median=7.00, p<0.001).

Conclusion: The study findings elucidate an important correlation between sleep quality, mental health parameters, and academic performance among university students, with notable gender disparities. Mid-range GPA students (3.0–3.5) reported the worst sleep quality, suggesting this group being more likely to experience stress-related sleep difficulties, while possibly striving for higher GPAs. The high prevalence of poor sleep, moderate-to-severe anxiety, and depression symptoms particularly among female students highlights a pressing need for gender-sensitive interventions. Further studies are required to ascertain culturally appropriate approaches to improve quality of sleep and mental health among university students.

*et al: Fatima Alameeri and Yousif Hameed

Aims: Sleep is altered during pregnancy, particularly during the third trimester. Low Vitamin D levels have been linked to shorter sleep duration, depression and anxiety. In the NiPPeR double-blind randomised controlled trial of nutritional supplementation, women received either a formulation with additional ingredients including Vitamin D (‘intervention group’) or standard prenatal vitamins (‘control group’). The association between Vitamin D deficiency, sleep, depression and anxiety was examined from pre-conception to six months post-partum. We aimed primarily to determine if women deficient in Vitamin D (<50nmol/L) were more likely to have disordered sleep compared with those Vitamin D sufficient. A secondary aim was to examine if women deficient in Vitamin D were more likely to be depressed or anxious compared with those with adequate Vitamin D levels.

Methods: We examined sleep data from women with at least one measurement of Vitamin D in the pregnancy and post-delivery periods (n=515). Pittsburgh Sleep Quality Index (PSQI) scores were compared between those with sufficient or deficient Vitamin D levels: by convention a PSQI score of >5 is considered to indicate disordered sleep. Depression was assessed using the Edinburgh Postnatal Depression Score (EPDS), with a score >13 indicating depression. The State-Trait Anxiety short form scale was used to measure anxiety, with a cut off >45 indicating state anxiety. One-way ANOVA in Stata version 18.0 was used throughout.

Results: As reported previously, the intervention substantially reduced the proportion of women who were Vitamin D deficient during pregnancy but did not change EPDS scores; PSQI scores were also not changed by the intervention. In the combined control and intervention group total PSQI scores increased from pre-conception until six weeks post-delivery. Total hours of sleep declined from pregnancy weeks 19–20 to six weeks post-delivery. At recruitment preconception, PSQI scores were higher in those deficient in Vitamin D, compared with those with sufficient levels (p=0.015); at later time-points PSQI scores were higher in Vitamin D deficient women but not significantly so. Depression as assessed by EPDS >13 was associated with Vitamin D deficiency only at preconception recruitment (p=0.019) and at 7 weeks’ gestation (p=0.004), but not later in pregnancy or post-delivery. There was no association found between anxiety and Vitamin D status.

Conclusion: At pre-conception, sleep was worse in women with low Vitamin D levels. At preconception and early in pregnancy, low Vitamin D levels were associated with depression. Intervention with a Vitamin D containing supplement did not improve sleep in pregnant women.

Aims: Much like a doctor’s diagnostic or procedural skills, communication skills are crucial in shaping patient outcomes. Poor communication in psychiatry through use of medical jargon, failure to validate concerns or a lack of empathy, can have far-reaching consequences including breakdown of the doctor-patient relationship, disengagement from treatment potentially resulting in a mental health crisis and future distrust of medical professionals. Concerningly, research suggests that without targeted training, medical students’ communication skills and empathy declines during their degree. However, despite its importance, training in communication skills in psychiatry is often underrepresented in the medical curriculum. This workshop aimed to bridge this gap, equipping students with communication skills for mental health settings, improving student confidence and ultimately enhancing patient-centred care.

Methods: This workshop was co-developed by doctors in psychiatry at different stages of training, education fellows and patient actors. The aim was to integrate both clinical and communication expertise. Workshops were primarily delivered face to face, with one session trialled online. There were between 24–28 students in attendance for each workshop. The students were fourth year medical students from Queen Mary University, London, on placement in psychiatry at North East London NHS Foundation Trust. Forum theatre simulation techniques were used by facilitators to role play a doctor-patient consultation and encourage students to interact and actively reflect. Students then worked in groups and practiced explaining common psychiatric diagnoses and management plans to a simulated patient or relative.

Results: Pre- and post-session questionnaires were completed by students. Prior to the workshop, 80–92% of students reported lacking confidence in explaining a psychiatric diagnosis to a patient and 73–94% felt unprepared to discuss a psychiatric management plan. Whereas following the workshop, 72–80% felt quite or very confident explaining a psychiatric diagnosis and 82–95% reported reduced anxiety around communicating with patients in mental health settings; 91–100% rated the session as useful, engaging, and thought-provoking.

Conclusion: This workshop notably improved medical students’ subjective confidence in communication in mental health settings. By integrating experiential learning, real-time feedback, and role-plays, students developed essential skills for communication in psychiatry. The overwhelmingly positive feedback from students supports the need for structured communication training in medical curricula. Future sessions should include follow-up assessments to evaluate long-term skill retention and could expand to include other important areas of communication such as multidisciplinary team communication and conflict management.

Aims: Enduring inequalities in mental healthcare exist between UK minority ethnic and White British groups, which were further aggravated during the pandemic. Through 2022–23 the nationally funded ARIADNE research project carried out qualitative research and co-production workshops to suggest local (in four participating sites of England) and also identified over-arching solutions to improve access and experience of care. After the ARIADNE research project ended, a further co-designed impact analysis initiative was carried out in 2024 in two original participating sites (Coventry/Warwickshire and East London).

Methods: Workshops were held in the two sites, attended by staff and experts by experience (carers and service users) to explore the impact and progress of the action plans from the ARIADNE study. Subsequently a national workshop was then held bringing together national opinion leaders and local stakeholders to identify key themes.

Results: A content analysis of the workshops and the national event minutes were carried out to identify progress, ongoing barriers and solutions to improving access:

There is a need to refine the concept of minoritised communities. Sharing experiences of racism towards individuals from minority ethnic groups who grew up in England and towards immigrants would be valuable. Care providers should arrange safe spaces for these conversations.

Pandemic and lockdown deteriorated the quality of mental health care provision and increased demand for mental health support. This disproportionately affected ethnic minorities and exacerbated their struggle in accessing mental healthcare complicated by stigma (both internal, in-group, external and cultural).

Professionals were in some cases experienced as being ‘blind’ to the issues of ethnic minorities and also impacted by institutional racism.

Education, cultural mediation and digital interventions that can offer solutions and overcome barriers to access the solutions need to be local and personalised.

Crucially, a human rights approach is required to promote integration and social cohesion. Offer of care should be diversified by including participatory culture, voluntary sector involvement and lived-experience involvement (e.g. peer work). Some potentially helpful developments and service reconfigurations were noted with population-based approach and neighbourhood models of community mental health care.

Conclusion: Locally led co-production research offer valuable intelligence and can be a resource to local health systems. It can utilised in planning of service re-design and resource allocation. Such continuous co-production increases research impact and minimises delay in putting research findings into practice. The themes raised and initiatives undertaken may be inspirational to other areas and national initiatives.

Aims: This quality improvement project (QIP) aims to evaluate the assessment of anticholinergic burden (ACB) of medications, using a validated tool, in patients admitted to Bristol Royal Infirmary and referred to Later Life Liaison Psychiatry, aiming to increase awareness and reduce ACB where appropriate.

Methods: The Anticholinergic burden Effect on Cognition (AEC) validated tool was selected to assess ACB. Baseline data was collected and anonymised from 20 patients via team assessments in patient records. Data included the AEC score, medications involved, prescription indication, whether ACB was considered, and if AEC score was documented.

An educational intervention involved teaching liaison psychiatry staff on ACB, AEC and strategies for deprescribing or switching medication. The team’s knowledge was evaluated before and after teaching using questionnaires. An educational poster was displayed around the office.

Post-intervention data was collected from five additional patients, and the results were analysed.

Results: Baseline data showed 25% of patients (n=20) scored AEC ≥3. 30% were on multiple medications with an AEC score, 50% were prescribed antidepressants, predominantly mirtazapine and sertraline (both AEC=1). Only 15% of the assessments had a documented AEC.

Prior to the educational intervention, 71% of the team reported their ACB knowledge level as “very poor”, “poor”, or “average”. After the teaching, 71% of the team rated their knowledge as “very good”, indicating significant improvement.

Following the intervention, no patients (n=5) scored AEC ≥3, and 60% of assessments documented the AEC score.

Conclusion: The most prescribed medications contributing to ACB were, in order, cyclizine, mirtazapine and sertraline, aligning with current national literature. Most patients with AEC ≥3 were taking multiple drugs, leading to a cumulative effect. Of the assessments that did not document the AEC score after teaching, all had scores of 0, suggesting staff may not view this score as significant.

All psychiatry liaison colleagues acknowledged the importance of ACB, but had a knowledge gap prior to the educational intervention, which showed improvement following a well-received teaching session.

This QIP demonstrates patients interfacing with old age psychiatry liaison can have a high ACB. The liaison team are well-placed to acknowledge and review these medications collaboratively with medical colleagues. An education intervention shows improvements in assessing ACB in our service.

For sustainability, further service level interventions have been implemented, including bookmarking the AEC calculator on staff computers (medichec.com) and adding a prompt to the team’s initial assessment template to check AEC. These measures aim to continue improving patient outcomes.

Aims: This service evaluation sought to assess the consistency of documentation in 5 key areas of analgesic prescribing in a medium secure forensic unit in South Wales.

Methods: Five key areas which are important to document when prescribing analgesia were defined as follows: 1) Indication, 2) Prescription Review, 3) Risk, 4) Discontinuation Guidance and 5) Patient Counselling on Analgesic Choice. Data was collated on these 5 key areas for opioid and pregabalin prescriptions between 1 November 2023 and 1 April 2024. Using Hospital Electronic Prescribing and Medicines Administration (HEPMA), it was possible to establish prescription data. Information on each prescription was then collated from: clinical team meeting (CTM) notes, nursing notes, GP contact records and tribunal reports for each patient.

Results: There were 18 analgesic prescriptions which fitted project criteria. 11% prescriptions were for morphine, 17% for co-codamol, 39% for codeine and 33% for pregabalin. Documentation across the 5 key areas was deficient, with 0% patients with documentation in all 5 key areas, 14% patients with documentation in 4 areas, 36% patients with documentation in 3 areas and 50% patients with documentation in <2 areas. Indications were better recorded in CTM notes than on HEPMA. On HEPMA, only 50% prescriptions had an indication, and of those only 6% had a specific indication with the remainder noted as “pain” (33%) or “pain team advice” (11%). In comparison, 90% prescriptions from CTM notes had an indication; the most common indication being leg pain (40%). In terms of prescription reviews, only 56% prescriptions were reviewed. No patients had any documented consideration of the risk of prescribing analgesia based on their substance misuse history despite 93% patients included having a recorded substance misuse history. 57% patients were prescribed the drug they have a recorded history of addiction to. Only 36% prescriptions documented the physical health risks of prescribing analgesia. Similarly, there was no documented guidance for any patient on circumstances to discontinue analgesia. In regard to patient counselling, only 50% patients were counselled on the choice of analgesia.

Conclusion: Multiple sources of information made it time consuming to get a holistic view of each prescription. Some of the key areas such as discontinuation guidance and substance misuse risk were not documented at all, with other areas having sporadic documentation depending on the prescriber. To improve future practice, changing HEPMA to have mandatory fields to record 5 key areas when prescribing analgesia would ensure consistency of documentation.

Aims: People under mental health (MH) services’ care are at increased risk of suicide. We aimed to identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.

Methods: A population-based study of all who died by suicide in the year following an MH services contact in Wales, 2001–2015 (cases), paired with similar patients, with the same mental health diagnoses, who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database – Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.

Results: We matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm.

A high proportion (98.3%) of cases were in contact with primary and secondary healthcare services in the year before their death. Compared with controls, cases were more likely to attend emergency departments (OR 2.4 [2.1–2.7]) and have emergency hospital admissions (OR 1.5 [1.4–1.7]); but less likely to have primary care contacts (OR 0.7 [0.6–0.9]), out-patient attendances (OR 0.2 [0.2–0.3]) and missed/cancelled out-patient appointments (OR 0.9 [0.8–1.0]).

A high proportion of cases presented to primary and secondary healthcare services with accidents, injury and poisoning, and especially self-harm – more so than controls (for self-harm, 28.5% of cases compared with 8.5% of controls; OR 3.6 [2.8–4.5]). This was particularly true for female patients admitted to hospital with injury and poisoning (OR 3.3 [2.5–4.5] in females compared with 2.6 [2.1–3.1] in males).

Conclusion: We may be missing existing opportunities to intervene across all settings, particularly when people present to emergency departments and hospitals, especially with self-harm. Intent underlying injury and poisoning events may be undisclosed, or recorded as undetermined or without specifying intent when they may in fact be self-harm, particularly in females. Efforts should be made to appropriately identify those who are self-harming, including by direct and non-judgmental questioning on presentation underpinned by staff training and awareness. Prevention efforts should focus on strengthening non-urgent and routine contacts (primary care and outpatients), responding to emergency contacts, and better self-harm care. This study also highlights the benefits of enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth.

Aims: Primary insomnia, a separate diagnosis that is now included within the newly broader categorization of insomnia, greatly affects the quality of life. This meta-analysis evaluates the efficacy and safety of orexin receptor antagonists (ORAs) and Z-drugs for insomnia in adults.

Pharmacological approaches to the management of insomnia include the use of our own rendition of those generic drugs commonly referred to as ORAs and Z-drugs. Z-drugs are mainly used; nevertheless, doubts as to their long-term security remain. Targeted at orexin receptors, ORAs are novel. This system consolidates knowledge for use in clinical evaluation and management.

Methods: Accordingly, a Cochrane-Central Register of Controlled Trials Database, a Systematic review using the keywords, ORAs, and Z-drugs was conducted. The criteria for patient inclusion involved all adults diagnosed with insomnia. Measurements of the extent of benefits from the interventions were: Total sleep time, sleep onset latency, and adverse effects.

Bias was determined using SRR and overall risk of bias was determined using the ROB 2 tool. This meta-analysis was conducted by applying random effects models.

Results: Six trials showed that ORAs shortened sleep onset latency compared with zolpidem and other Z-drugs (mean difference −15.3 min, 95% CI −22.1 to −8.5). Total sleep time was similar to total time between sleep onset and wake-up in both groups. ORAs demonstrated a superior safety profile, with lower incidence of next-day somnolence (risk ratio: 0).

This was associated with a decreased risk for cognitive impairment at follow up (risk ratio: 0.65, 95% CI: 0.52–0.81) and for dependency (risk ratio: 0.38, 95% CI: 0.25–0.58).

According to the funnel plot analysis there was no significant publication bias that exists within the studies.

Conclusion: They [ORAs] are at least as effective as the Z-drugs in the management of insomnia and are safer in terms of next-day implications and withdrawal especially in elderly patients. These experiments affirm using ORAs as a first-line pharmacological remedy in chronic insomnia in adults.

Aims: Mental health disorders represent a significant burden globally, yet access to psychiatric care remains limited, especially in low- and middle-income countries. In Sudan, the utilization of mental health services is restricted by financial constraints, social stigma, and lack of service availability. This study aims to identify key barriers affecting mental health service utilization in Khartoum, assess the availability and affordability of essential psychotropic medications, and explore their influence on patient access to care.

Methods: A cross-sectional hospital-based study was conducted from October to December 2022 at Tigani El-mahi Psychiatric Teaching Hospital and Taha Bashar Psychiatric Hospitals in Khartoum. A stratified random sample of 384 psychiatric outpatients and their caregivers was interviewed using a structured questionnaire covering demographics, accessibility, affordability, stigma, and attitudes toward psychiatric care. Additionally, the availability of 24 essential psychotropic medications was assessed in public and private pharmacies. Ethical approval was obtained, and informed consent was secured from all participants.

Results: The most commonly reported barriers to mental health service utilization were financial constraints (34.4%), limited-service availability (21.4%), and stigma (10.9%). Over 84% of participants reported no psychiatric services within their locality, 49.5% travelled 1–3 hours, while 24.2% travelled more than 3 hours to access care. Medication shortages were significant, with the availability of essential psychiatric drugs ranging from 16.1–28.6% in public hospital pharmacies and hardly exceeding 37.5% in private pharmacies. Affordability was a major concern, with 70.3% of participants stating that prescribed medications were unaffordable and difficult to purchase. Education level was significantly associated with healthcare-seeking behaviour (p=0.018), with university-educated individuals more likely to seek treatment. These findings align with studies from other LMICs, where financial and accessibility challenges are similarly identified as major barriers to psychiatric service utilization.

Conclusion: Mental health service utilization in Sudan is severely impacted by financial constraints, limited-service availability, and stigma. Addressing these barriers requires integrating psychiatric care into primary healthcare, expanding community-based services, and ensuring the affordability and availability of essential psychotropic medications. Subsidized medication programmes, targeted community outreach, and mental health literacy initiatives could play a key role in improving accessibility. These findings contribute to the global discourse on mental health equity in resource-limited settings and underscore the urgent need for policy reforms and investment in mental health infrastructure.

Funding Statement: No external funding was received for this study.

Aims: People with severe mental illnesses experience poorer physical health outcomes compared with the general population, partially related to fragmented care. The Integrating our Mental and Physical Healthcare Systems project implemented an Advice and Guidance Line, supported by colleagues in King’s Health Partners, using the Consultant Connect (CC) app in the South London and Maudsley NHS Foundation Trust to enhance collaborative physical healthcare. This study evaluates the app’s impact on inpatient transfers from mental health wards to acute hospitals, focusing on clinical outcomes and cost savings.

Methods: This cost-minimisation analysis used retrospective observational data to analyse electronic health records across a 42-month period (21 months pre- and post-intervention) centred on the CC introduction date in June 2020. The study population was Trust adult inpatients during the study period. Outcome measures were the number of Trust inpatients who attended ED in, or were admitted to, one of the four acute NHS Trusts serving the catchment area. Transfers with a primary COVID-19 diagnosis were excluded. Outcomes are presented as the number of transfers per Trust inpatient bed-year. This divisor accounts for the decrease in bed-days during the pandemic.

Results: In the pre-CC period there were 5,472 Trust inpatients across 7,308 inpatient episodes (1,328.78 bed-years) with 1,834 ED transfers. Post-CC the Trust had 5,362 inpatients across 7,396 episodes (1,183.06 bed-years) with 530 ED transfers. The number of ED transfers per bed-year was 1.38 in the pre-CC period, and 0.45 in the post-CC period, a 68% reduction (p<0.001, Chi-square). Interrupted time-series analysis confirmed this decrease (−0.752, 95%CI [−1.117, −0.386], p<0.001). There was no significant difference in admission rates pre- and post-intervention. Based on recent annual bed occupancy (720.97 bed-years) and costs (£457 per ED transfer), CC prevents approximately 670 transfers annually, generating total Trust savings of £241,720 after deducting annual service costs (£61,698) and annualised implementation costs (£3,000).

Conclusion: While the pandemic contributed to an initial decrease in ED transfers, the reduction was sustained even as overall ED presentations at the four hospitals returned to pre-pandemic levels. There was no change in admissions to acute Trusts, suggesting that the level of care provided was appropriate to need. The Advice and Guidance model appears cost-effective in managing physical health within mental health settings. These findings support wider implementation of similar services across mental health trusts, though further evaluation in a post-pandemic context is warranted.

Aims: Artificial Intelligence Ambient Voice Technology (AI AVT) which uses a large language model to summarise clinical dialogue into electronic notes and GP letters has emerged. Although effective in general practice and medical settings, its potential in psychiatry is unknown. In this proof of concept study, we sought to apply AI AVT into clinical practice for a limited duration.

The specific aims were to:

Assess the functionality and suitability of AI AVT in a child and adolescent mental health service (CAMHS) outpatient clinic for the selected use cases.

Identify whether AI AVT reduces documentation burden during and after clinical consultations, and improves clinician work satisfaction.

Identify whether AI AVT is acceptable to patients.

Identify potential challenges and issues from a clinician, organisational and patient perspective and to make recommendations for refinements.

Methods: We conducted a mixed-methods pre-post (manual versus AVT-assisted documentation) service development pilot with 10 clinician participants in a CAMHS outpatient clinic. Use cases were attention deficit hyperactivity disorder medication reviews, general medical reviews and developmental history assessments. The primary outcome was time taken to complete administrative tasks per patient. Secondary outcomes included qualitative clinician experience and patient/carer perception and acceptability of AVT. Measures including questionnaires, time sheets and focus groups were conducted at baseline and intervention. Data analysis included descriptive statistics and mixed linear regression. Focus groups were audio-recorded before being transcribed and thematically analysed.

Results: AVT was used in 351 clinical encounters. Administration time for 251 encounters was recorded (AVT n=171). The median time per encounter reduced from 27 minutes (manual) to 10 minutes (AVT) (p<0.001). On average, AVT-assisted documentation took 45% of the time of manual documentation (p<0.001). Clinician-rated accuracy, quality and efficiency of AVT-assisted documentation was statistically significant in its favour. Patient acceptance was high: only 3 preferred for AVT not to be used (0.85%). 97% felt clinicians were not distracted by taking notes. Thematic analysis from focus groups identified positive effects from AVT (improved productivity and mental wellbeing) balanced by barriers (technological limitations).

Conclusion: Although subject to the limitations of a small pilot study, we demonstrated that AVT can be implemented successfully, resulting in significantly reduced documentation burden. To evaluate its scalability and potential to further streamline processes, we are currently in phase 2 which involves expanding the clinical roles of our participants and the use cases across Central & North West London NHS Foundation Trust (5 boroughs).

Aims: Dementia is a leading cause of disability and loss of independence among older people. There is growing concern about ethnic disparities and inequalities in dementia care. In the UK, Black and South Asian people have a higher risk of developing dementia compared with their White counterparts. Despite this, there is underrepresentation of minority ethnic groups in dementia services and they are more likely to have a delayed diagnosis or no diagnosis.

This literature review aims to identify the ethnic disparities in dementia care. It also aims to explore the causes of delayed diagnosis and underdiagnosis of dementia amongst Black, Asian and Minority Ethnic (BAME) groups, particularly Black and South Asian ethnic groups in the UK.

Methods: An electronic literature search was performed using PubMed and Google Scholar.

Results: Across the literature, it is evident that health inequalities currently exist and exacerbate the disparities in the care of BAME dementia patients. These inequalities can affect quality of care and lead to overall poorer outcomes for people from BAME backgrounds.

Multiple risk factors for dementia such as hypertension and diabetes disproportionately affect Black and South Asian people.

Delayed diagnosis and underdiagnosis of dementia in BAME groups can be attributed to multiple barriers to accessing dementia diagnostic services such as stigma, lack of knowledge, misperceptions, language barriers and cultural beliefs.

In secondary care, patients from BAME groups are younger and have greater severity of dementia at the time of diagnosis.

Survival time following a dementia diagnosis can vary across different ethnic groups. However, there are contrasting findings between studies. Further research is required to investigate these contradictory findings to clarify how survival time post-diagnosis is affected by ethnic background.

Across multiple studies, data from large ethnic groups such as South Asian or Black are combined without taking into account the diverse subgroups within these larger groups. Further research is required within ethnic subgroups to provide a more person-centred approach.

Conclusion: There is a need to tackle the ethnic disparities in dementia care faced by South Asian and Black people in the UK. This requires action and collaboration between people from BAME communities, healthcare professionals and policymakers, in order to improve timely access to services. Further research should address the disparities to ensure equitable and inclusive dementia healthcare.

Aims: As the climate crisis escalates, pregnant women are increasingly exposed to extreme weather events, such as heatwaves and floods, which may lead to psychological distress and adverse mental health outcomes for both mothers and infants. This scoping review synthesizes research on the direct and indirect effects of climate change-related stressors on maternal mental health, identifying key trends, interventions, and mitigative strategies. Emphasis is placed on socioeconomic disparities in both high- and low-income countries, as these groups are disproportionately affected.

Methods: A systematic search was conducted to identify studies focusing on mental health, pregnancy (pre-, during, post-), and climate change, as defined in the AR6 Climate Change 2023 Synthesis Report, published up to October 2024. Data extraction included study design, population, interventions/exposures, outcomes, and socioeconomic implications. Only original articles and preprints in languages translatable to English were considered.

Results: The initial search retrieved 675 articles, of which 14 met the inclusion criteria. Two studies were from middle-income countries (Egypt and Turkey), while the remainder came from high-income countries (Australia, Canada, and the USA). The studies examined climate-related exposures, such as hurricanes, flooding, and extreme heat. Key findings indicate that acute exposure to high temperatures was associated with an increase in psychiatric emergency visits among pregnant women. Similarly, prenatal stress from natural disasters (e.g., hurricanes) was linked to higher levels of maternal mental health symptoms (e.g., depression, PTSD) and changes in infant temperament. Socioeconomic vulnerability played a critical role, with middle-income regions facing greater healthcare barriers, fewer mental health resources, and economic instability. Even in high-income regions, marginalized populations (e.g., Puerto Rico and the US Virgin Islands) experienced healthcare disruptions and prolonged recovery following climate disasters.

Conclusion: While the findings highlight the intersection of climate change and maternal mental health, several studies were limited by small sample sizes and reliance on self-reported data. A significant gap exists, as no studies specifically focused on maternal mental health in low-income countries affected by climate change were found during the literature search. Socioeconomic disparities strongly influenced mental health outcomes, underscoring the urgent need for equitable healthcare policies, financial support systems, and culturally adapted interventions. The review calls for the integration of climate resilience strategies into maternal healthcare and the strengthening of mental health infrastructure in low- and middle-income settings. Future research must prioritize longitudinal studies, policy-driven interventions, and targeted support for vulnerable populations.

Aims: About 9% of India’s population is made up of tribal communities consisting 120 million people nationwide. The mental health literacy of these communities is an unexplored topic. This literature review is aimed to identify and summarise existing factors that influence mental health literacy of the tribal communities in India and use this information to develop a survey questionnaire to support the development of a community radio programme.

Methods: SCOPUS, PubMed, Cochrane Library, Web of Science Journal, and Google Scholar were searched for peer-reviewed articles published in English from 1991–2024. Qualitative, quantitative, and mixed methods studies focusing on mental health knowledge and awareness reported from India were selected following PRISMA. Papers were appraised using the Calgary Health Region critical appraisal tool and extracted data were analysed using a narrative synthesis. The key findings were used to develop a survey questionnaire to support the development of a community radio programme to promote mental health literacy among the Indian tribal population.

Results: Out of 103 papers initially identified, 11 papers were chosen for full text review, data extraction, and analysis upon critical appraisal. Cultural differences, access to healthcare, economic status and lack of education were found to be key factors influencing mental health in tribal communities, through the investigation.

Conclusion: The corresponding survey questionnaire was thus divided into multiple sections spanning demographic group, socio-economic status, attitude towards mental health, and care-seeking behaviour/prevention, to survey and promote mental health literacy. Through the study, it was established that mental health literacy of tribal communities is mainly impacted by access to education, cultural differences, healthcare access, and economic deprivation. Further research must be conducted to evaluate how mental health literacy can be promoted through survey questionnaire and community media/radio within tribal Indian communities.

Aims: Managing insomnia is a common challenge for psychiatrists and their patients. A real-world cohort study on first-line treatment patterns in 265,382 patients with insomnia found that 42.4% of that group were prescribed hypnotic medications. Among those, first prescriptions were most frequently a Z-drug with 35.8% of all patients on these medications. Z-drugs include zolpidem, zopiclone, eszopiclone and zaleplon. We aimed to assess the prevalence and associated factors of Z-drug prescribing in a Community Mental Health Team (CMHT) setting in Helensburgh, Scotland.

Methods: A cross-sectional survey was conducted to examine the prescribing of Z-drugs in a cohort of 412 patients attending the Helensburgh CMHT outpatient clinics between May and August 2021. Data on who was on Z-drugs was extracted from General Practitioner records on Clinical Portal. Once the list of who was on Z-drugs was compiled, associated factors were extracted from their Electronic Medical Information System (EMIS) records. Analyses were done to compare the characteristics of those on Z-drugs versus those not on Z-drugs. Continuous factors were found to be approximately normally distributed and were compared between groups using the unpaired t-test. The Chi-square test was used to compare categorical variables between groups.

Results: Of the 412 patients in the dataset, 30 (7%) were on Z-drugs. Zopiclone and zolpidem were the only Z-drugs prescribed with rates of 86.7% and 13.3% respectively. The analysis results suggested that age, sex and the number of psychiatric medications varied significantly between those on Z-drugs compared with those not on Z-drugs. However, the primary diagnosis of the groups was not significantly different (p=0.63). The group on Z-drugs had a higher proportion of females (77%) than the group not on Z-drugs (57%) (p=0.04). Z-drug users were older, with mean age of 51.5±14.0 years, compared with a mean age of 42.0±14.7 years in the group not on Z-drugs (p=<0.001). The number of psychiatric medications was higher in Z-drug users i.e. 3.4±1.0 compared with 1.9±1.2 for those not on Z-drugs (p=<0.001).

Conclusion: The prevalence of Z-drug prescriptions can vary significantly across different countries and regions, which makes it challenging to generalize. Rebound insomnia and withdrawal symptoms occur infrequently upon discontinuation, however it may be less common and milder than those seen upon discontinuation of benzodiazepines. Z-drugs have known side effects including headaches, dizziness, anterograde amnesia, confusion, and hallucinations, and it is important to monitor their prescribing and associated factors in different settings including secondary care.

Aims: This realist evaluation explored the implementation and effectiveness of a novel physical activity (PA) service within a male Psychiatric Intensive Care Unit (PICU) at St Charles Hospital, London. The study aimed to understand “what works, for whom, how, and under what circumstances” regarding the PA service’s impact on patient well-being and staff experiences. The evaluation aimed to develop and refine programme theories explaining the relationships between the PICU’s resources, context, and the mechanisms generating observed outcomes, ultimately informing recommendations for future PICU PA programme design.

Methods: A realist inquiry framework, utilizing the Context-Intervention-Actor-Response Mechanism-Outcome Configuration (CIAMOc), guided the evaluation. Data collection, aligned with RAMESIS II reporting standards, spanned six months (March–October 2023) and employed a mixed-methods approach. This included 85 hours of ethnographic observation on the ward, semi-structured interviews with 18 staff and 9 patients, and two staff focus groups. Data analysis involved iterative coding and theory refinement using a CIAMO heuristic tool. Candidate programme theories, derived from a prior realist synthesis, were deductively explored and inductively refined through the three phases of realist interviewing (theory gleaning, refinement, and consolidation).

Results: Eighteen interlinked programme theories were developed, highlighting the critical role of leadership, the physical environment, and the social environment in PA service success. Findings emphasised that stable leadership, staff retention, and a cohesive team were foundational for creating a therapeutic culture conducive to PA implementation. Leadership “buy-in”, demonstrated through valuing and supporting PA, empowered staff and facilitated efficient processes. Redeveloping the ward gym with safe, tailored equipment and maximizing access to diverse PA opportunities (gardening, sports) promoted patient agency and engagement. The dedicated Physical Activity Nurse (PAN) played a crucial role in motivating patients, fostering positive social interactions, and normalizing PA experiences. Preliminary findings suggest that the PA service contributed to reduced violent incidents, weight gain, and improved staff job satisfaction, though further analysis is exploring the specific mechanisms driving these outcomes.

Conclusion: This realist evaluation provides valuable insights into the complex factors influencing the success of PA programmes in PICU settings. The study demonstrates that a multi-component approach, addressing leadership, physical environment, and social dynamics, is essential for effective implementation. By understanding the underlying mechanisms and contextual influences, this research can inform the development of more effective and sustainable PA interventions that promote patient well-being, reduce restrictive practices, and enhance staff experiences within PICUs. Further analysis will explore the specific mechanisms linking PA to positive outcomes, providing a stronger evidence base for future programme design and implementation.

Aims: Individuals with severe mental illness (SMI) experience significant physical comorbidities, contributing to a 20-year gap in life expectancy compared with the general Australian population. However, disparities persist in how their physical healthcare needs are addressed in healthcare settings. Recent full report from Unequally Unwell (2024) identifies age, gender and rurality as contributing factors to mortality in SMI patients, yet little research has examined how these factors influence access to physical healthcare. This study investigates whether age, gender and rurality predict healthcare engagement, specifically whether patients access their care and whether their physical health is addressed in general practitioner (GP) and psychiatric consultations.

Methods: This study analysed a de-identified dataset from 235 mental health patients and 96 carers who participated in a survey conducted by Lived Experience Australia. Participants provided demographic information and reported on their healthcare experiences, including whether they had visited a GP or a psychiatrist in the past 12 months, and whether their physical health was discussed. Chi-square tests and ordinal logistic regression were used to assess relationships between these variables.

Results: Results showed that age significantly influenced whether a psychiatrist inquired about physical health, with older individuals being more likely to be asked (B=0.879, SE=0.431, z=2.039, OR=2.41, p=0.041). No significant associations were found between rurality and healthcare engagement, though a non-significant trend suggested potential disparities. Similarly, gender identity did not significantly predict physical health discussions, though a weak-to-moderate association was observed for psychiatrist visits (χ²(2)=8.03, p=0.018); an effect which disappeared when non-binary individuals with SMI were removed from the analysis. Notably, engagement with GPs showed no significant differences across demographic groups.

Conclusion: These findings suggest that younger individuals with SMI may be at a greater risk of diagnostic overshadowing for psychiatric care, where their physical health concerns are overlooked. Additionally, non-binary individuals with SMI appear to have lower rates of psychiatric utilisation within 12 months. This disparity may be influenced by systemic barriers such as stigma and discrimination in healthcare settings, which can lead to decreased help-seeking behaviours or suboptimal care experiences for non-binary individuals. This highlights the need for targeted interventions to ensure routine physical health discussion/screening within mental health services, which could facilitate early detection of physical health issues, and help mitigate the mortality gap in this vulnerable population.

Aims: This study aimed to assess clinician-reported prevalence of climate-related anxiety among children and adolescents in CAMHS, evaluate awareness of its impact, and explore the perceived relevance of Aberdeen’s oil and gas industry context to patient mental health.

Methods: A cross-sectional online survey was distributed to the CAMHS team at City Hospital Aberdeen, comprising four questions on climate-related anxiety and one open-text query. Sixteen clinicians participated. Data were collected anonymously via Microsoft Forms, with quantitative analysis of closed responses and thematic review of qualitative feedback.

Results: Prevalence and Impact: 37.5% (6/16) of clinicians reported encountering climate-related anxiety in patients over the past year, with 43.8% (7/16) ranking it as affecting young people “very much” or “quite so”. Conversely, 50% (8/16) deemed it “not a significant issue”.

Clinical Consideration: 93.8% (15/16) admitted they do not routinely assess climate-related concerns during patient evaluations.

Local Industry Context: Qualitative responses highlighted that Aberdeen’s status as an oil and gas hub may indirectly affect patients through familial job instability, frequent relocations, and eco-guilt (e.g., “Yes, the nature of the work means children face big changes and school moves”).

Awareness Gaps: Clinicians acknowledged systemic oversight in addressing climate-related anxiety during assessments.

Conclusion: Climate-related anxiety is inconsistently recognised and addressed in CAMHS practice, despite emerging cases and contextual ties to local industry stressors. Clinician responses reflect uncertainty about its significance, compounded by a lack of structured assessment protocols. These findings underscore the need for training to integrate climate-related concerns into routine evaluations, particularly in regions with economic dependencies on environmentally impactful industries. Recommendations include developing evidence-based screening tools, fostering interdisciplinary collaboration with environmental health sectors, and addressing systemic gaps to ensure holistic, context-sensitive care for young people.

Aims: Changes to sleep, weight, and endocrine function are common in Alzheimer’s disease (AD) and Lewy-body dementia (LBD). The cause of these is not known, but they may be related to hypothalamic neurodegeneration. Our aim was to assess whether hypothalamic volume is reduced in people with AD and LBD, and whether hypothalamic volume is associated with these common symptoms.

Methods: We performed a systematic search of MEDLINE and EMBASE for studies using structural magnetic resonance imaging to examine hypothalamic volume in AD or LBD. The Newcastle–Ottawa scale was used to assess the risk of bias. A random-effects meta-analysis was conducted using the standardised mean difference (SMD) in hypothalamic volume, and a narrative synthesis was used to examine the relationship between hypothalamic volume and sleep, weight, and endocrine function.

Results: We screened 6542 articles which identified 12 studies for inclusion, of which 10 had a low to moderate risk of bias. People with mild-moderate AD had a significantly smaller hypothalamus (−10.1%) compared with controls (pooled SMD= −0.49 (−0.86 to −0.13), p=0.018; I2=67% (21.5–86.1%); n= 454 (AD), 715 (controls)). The only study in people with LBD found grey matter loss in the hypothalamus compared with controls using voxel-based morphometry. Hypothalamic volume loss in AD was more marked in men and was associated with plasma levels of sex hormones and reduced bone mineral density. Body mass index, appetite and sleep were not associated with hypothalamic volume in AD.

Conclusion: Reduced hypothalamic volume is seen early in AD and this may influence endocrine function. A better understanding of hypothalamic degeneration in dementia may help elucidate how pathology relates to symptoms in AD and LBD and reveal new targets for intervention.

Aims: Antinuclear antibody (ANA) is a sensitive but non-specific blood test frequently undertaken as part of the clinical assessment for a number of autoimmune diseases. While ANA positivity is associated with a number of autoimmune diseases, such as systemic lupus erythematosus (SLE), approximately one fifth of the population will test positive without having or subsequently developing an autoimmune disease. While there is a growing body of evidence demonstrating that patients with an autoimmune disease are more likely to develop psychiatric disorders, such as schizophrenia, the risk in patients who test positive for ANA but who never develop an autoimmune disease has not been established.

Methods: We undertook a retrospective cohort analysis using TriNetX, a large real-world population database, consisting of anonymised health records of over 250 million patients across 19 countries. Patients aged 16–90 years, without a recorded ICD diagnosis of an autoimmune disease were identified and divided into two cohorts – those with at least one positive ANA blood test, matched against those with at least one negative ANA blood test in the absence of any positive ANA antibody results. Confounding risk factors were controlled through propensity score matching for age, sex, sociodemographics, clinical characteristics and psychotropic medication use. Primary outcome was the incidence of and hazard ratios for psychiatric diagnoses from 3 months–10 years after the ANA test result.

Results: 454,740 patients were included in the primary analysis, 227,370 in the ANA positive group, 227,370 in the ANA negative group. There was no statistically significant difference in the risk of diagnosis of overall F20–29 diagnosis (HR 0.939, p=0.0674) and specifically F20 Schizophrenia (HR 0.964, p=0.5870).

Conclusion: A positive ANA blood test in the absence of an autoimmune disease was not associated with an increased long-term risk of psychiatric disorders. This result suggests that clinical testing of ANA in patients presenting with psychiatric disorders without features suggestive of a systemic autoimmune disease may be unwarranted.