The growing number of elderly individuals living alone presents a major social issue, encompassing loneliness, isolation, economic and health challenges, and increased risk ofsuicide. This study aimed to identify factors associated with suicide risk among elderly individuals living alone in Jeju.

A total of 4,742 participants completed questionnaires to assess their sociodemographic characteristics. Depressive symptoms were evaluated using the Short Form Geriatric Depression Scale-Korean version (sGDS-K), with a cutoff score of eight indicating the presence of depressive symptoms. Suicide risk was assessed using the Mini-International Neuropsychiatric Interview-Plus. Multivariate logistic regression analysis was performed to identify significant correlates of suicide risk.

Multivariate logistic regression analysis identified the following factors as significantly associated with suicide risk: poor subjective health status (odds ratio [OR]=1.590, 95% confidence interval [CI]: 1.137–2.224), current drinking (OR=1.511, 95% CI: 1.119–2.042), hypertension (OR=1.419, 95% CI: 1.133–1.778), and sGDS scores ≥8 (OR=4.318, 95% CI: 3.408–5.469).

This study highlights the importance of intensive mental health services and socioeconomic support in preventing suicide among elderly individuals living alone. Targeted interventions should focus on those who have poor subjective health status, are current drinkers, have hypertension, or exhibit depressive symptoms.

To evaluate the impact of sleep interventions on sleep quality, duration, and efficiency in adults with psychotic disorders, and to assess secondary effects on psychotic symptoms, daytime functioning, and mental health stability.

A systematic review of studies published in the past 10 years was conducted, including meta-analysis, randomized and non-randomized trials, and observational studies. Eligible studies involved adults (≥18 years) with psychotic disorders and documented sleep disturbances. Interventions included pharmacological agents (melatonin, Z-drugs, antipsychotics), psychological therapies (CBT-I), and other complementary therapies (light, relaxation).

Twenty-three studies met inclusion criteria. Cognitive Behavioural Therapy for Insomnia (CBT-I), was the most frequently studied and consistently effective intervention across delivery formats. Pharmacological agents offered variable short-term benefits but raised concerns about side-effects, tolerance, and dependency. Adjunctive therapies such as music therapy, relaxation and exercise, light-dark rhythm modulation etc. demonstrated promise in specific subpopulations. Common limitations included methodological heterogeneity, small samples, and limited long-term follow-up.

CBT-I, adapted for psychotic disorders, appears the most robustly supported intervention. Integrated approaches combining psychological, pharmacological, and adjunct therapies may optimise outcomes. Large-scale, long-term studies and pathways for routine care integration are warranted, with inclusion in national guidelines.

Guided by the Model for Improvement, this project aims to increase the completion of core assessments and capacity-to-consent documentation in MHA referrals made by the MHLT to at least95% within six months. The ultimate objective is to enhance resource efficiency, ensure compliance with the MHA Code of Practice, and guarantee that formal detention is initiated only when legally and clinically justified.

A baseline diagnostic analysis of referrals from the Mental Health Liaison Team (MHLT) at Chesterfield Royal Hospital revealed that 33% (10/30) of MHA referrals did not result in detention. Critically, 90% of patients without a recorded core assessment and 70% without documented capacity were ultimately admitted informally or discharged. This diagnostic phase indicated a direct correlation between missing documentation and a lack of clinical necessity for formal detention, suggesting that a lack of structured assessment acted as a barrier to identifying less restrictive alternatives.

The project involved mapping the current MHLT referral process, identifying a lack of a structured, mandatory protocol as a key driver for poor-quality referrals. A driver diagram was developed to focus on staff competency and referral mechanics. Two PDSA cycles are currently being implemented:

• • System Mechanics: Introduction of mandatory digital fields in the referral pathway requiring confirmation of a core assessment, capacity assessment, and documented consideration of informal admission.

• • Staff Competency: Delivery of structured teaching sessions to MHLT staff regarding MHA principles and the introduction of visual aids prompting documentation prior to referral submission.

Based on the diagnostic phase, which showed that formal assessment was more frequently omitted in referrals that ultimately did not require detention, we expect a substantial improvement in referral quality by ensuring these steps are taken pre-referral. We are currently implementing these changes and monitoring process measures. A follow-up audit will be conducted to formally measure the increase in documentation compliance and the subsequent reduction in referrals not resulting in detention, aiming to demonstrate improved resource efficiency and adherence to the MHA Code of Practice.

This ongoing QI initiative indicates that structural changes to referral mechanisms, paired with targeted staff education, can be effective in improving documentation fidelity. By enhancing the decision filter for referrers, this project aims to ensure that MHA assessments are initiated only when legally and clinically justified

This project examines how mental health professionals perceive and engage with digital phone applications (apps) in clinical practice. ‘MindMeds’, a patient-developed mental health app at Southwest London and St George’s Mental Health (SWLSTG) Trust, was used as a case example. Findings will inform strategies to improve adoption of the MindMeds app, as well as embedding digital tools into clinical practice, workflow embedding and aligning with Trust digital health priorities.

A qualitative staff survey was distributed via Microsoft Office Forms to all SWLSTG Trust staff. Recruitment was conducted through mass email and Trust communications. The survey collected key demographic information and included Likert-scale items assessing digital confidence and familiarity with mental health apps. Semi-structured free-text questions explored staff awareness, attitudes towards digital apps, key enablers and barriers, clinical considerations of how apps fit into workflows, as well as wider systemic factors such as the Trust’s position on digital innovation.

Qualitative data were analysed using reflexive thematic analysis following Braun and Clarke’s six-step framework, with quantitative findings used to contextualise findings and gauge the prevalence of emerging themes.

31 responses were received and thematic saturation was achieved. Although reported digital confidence was high (median 8/10), awareness and regular use of digital apps (particularly MindMeds) was low. 45% of respondents had never heard of the app despite multiple publicity efforts.

Five key themes emerged: 1) Time and workload pressures; 2) Concerns regarding safe integration with electronic patient records; 3) Uncertainty regarding evidence base and regulation; 4) Limited awareness and visibility of Trust-endorsed apps; 5) Variable patient digital literacy and access.

Challenges were particularly pronounced in inpatient, crisis, and CAMHS settings. Clinicians consistently reflected that apps were more likely to be adopted when aligned with existingworkflows, had a clear clinical purpose, and allowed patient-generated data to be accessed within the electronic patient record.

Digital mental health apps remain poorly embedded in routine practice in SWLSTG Trust, with MindMeds gaining little traction despite extensive development. Uptake appears to be limited less by staff attitudes, and more by structural, governance, and workflow barriers. Improving adoption may require simplification of digital tools, integration with core clinical systems, and clear Trust-level governance, training, and operational support. Focusing on high-value use cases alongside co-design and targeted awareness efforts may enable more effective and equitable integration of digital apps into mental health care.

Multidisciplinary care is essential for safe and effective inpatient psychiatric treatment. Involvement of social work and psychology services supports psychosocial assessment, risk management, discharge planning, and continuity of care. This audit assessed compliance with local guidelines for multidisciplinary inpatient care, informed by the Royal College of Psychiatrists’ Core Standards for Inpatient Mental Health Services (Centre for Quality Improvement), which emphasise timely multidisciplinary involvement, including psychology and social work input, and clear documentation in multidisciplinary team reviews. We aimed to identify good practices and any gaps in early referral and documentation.

A retrospective audit at the Behavioural Sciences Institute (BSI), Al Ain Hospital, United Arab Emirates, reviewed electronic records of 193 psychiatric admissions. Four standards from the Royal College of Psychiatrists’ Core Standards were assessed: (1) social work referral within a week; (2) psychology referral within a week of admission; (3)documentation of social work input in multidisciplinary team (MDT notes; and (4) psychology input documented in MDT notes. Compliance was measured by percentage, stratified by unit type (male, female, forensic) to explore practice variation. Descriptive data analysis was used.

Social work referrals within one week were completed in 29.0% of admissions, and psychology referrals in 32.6%. Documentation rates were higher but still suboptimal: social work input was recorded in 38.3% of cases, and psychology in 44.0%. There was variation between units. The male unit had the lowest early referral compliance, with social work and psychology orders in 16.0% and 22.0% of cases, respectively. MDT documentation was higher but incomplete. The female unit performed better, with social work orders in 47.5% and psychology orders in 50.8%, though psychology documentation was low at 32.8%. In the forensic unit, early referrals were moderate for social work (34.4%) and low for psychology (25.0%), but MDT documentation was the highest, with social work noted in 75.0% and psychology in 56.3%. Overall, MDT documentation rates exceeded early referral rates, indicating delayed multidisciplinary involvement.

This audit found gaps in referral practices for social work and psychology in psychiatric inpatient care, especially early referral within a week of admission. Documentation in MDT notes was more frequent but still below standards, indicating delayed engagement. To improve care, structured admission pathways, automated referrals, standardised documentation, and staff education are needed.

No financial sponsorship was received for this project.

Adolescent suicide is a leading cause of mortality worldwide, yet prediction remains limited by symptom-based clinical assessment. This study aimed to synthesise genetic, biological, neuroimaging and sociocultural evidence to develop a mechanistically informed framework for adolescent suicide risk, moving beyond single-domain or correlational models.

We conducted a PRISMA-compliant systematic review and meta-analysis registered with PROSPERO (CRD420251020839). Searches of PubMed, EMBASE, PsycINFO, CENTRAL, Scopus and Web of Science identified studies published between 2005 and 2025 involving adolescents aged 10–19 years reporting suicidal ideation, suicide attempts or death by suicide. Eligible studies contributed data from at least one domain: genome-wide association studies or polygenic risk scores, neuroimaging, inflammatory or neurotrophic biomarkers, sociocultural risk factors, or treatment outcomes related to lithium, sodium valproate or electroconvulsive therapy (ECT). Random-effects meta-analysis generated pooled effect sizes, with heterogeneity quantified using I². Machine-learning analyses used harmonised study-level estimates only, employing XGBoost with nested cross-validation and SHAP interpretation. Mendelian randomisation was applied to explore genetically informed pathways.

A total of 140 studies comprising 1,526,000 adolescents from 80 countries were included. The pooled effect size for suicide risk across domains was d=0.71 (95% CI 0.58–0.83; I²=78%). Significant predictors included polygenic risk for major depressive disorder (r=0.21), elevated interleukin-6 (r=0.38) and C-reactive protein (r=0.32), ventromedial prefrontal cortex hypoactivity (r=−0.31), childhood trauma (r=0.42) and sexual and gender minority stress (r=0.44) (all p<0.001). An integrative Bio-Psycho-Social Suicide Risk Index achieved an internally validated area under the curve of 0.93, interpreted as hypothesis-generating. Mendelian randomisation supported genetically informed pathways linking liability to inflammation and neural dysfunction. Secondary exploratory analyses suggested associations between lithium and reduced inflammatory markers, sodium valproate and improved inhibitory neurotransmission, and ECT and increased hippocampal volume.

Adolescent suicide reflects interacting genetic, neurobiological and sociocultural processes. This global meta-analysis provides the most comprehensive mechanistic synthesis to date and proposes a biologically informed framework to complement clinical judgement. Prospective external validation is required before clinical implementation.

The aim was to create a visual representation of a patient's journey through an acute male unit within a medium secure setting at a specialist forensic mental health service. This poster would also be accompanied by leaflets about specific topics that patients can request if they would like further information. I noticed that many patients admitted onto the ward were asking the same questions to me and other staff during their ward rounds which identified an unmet need. Patients did not have a resource to find out answers or know who best to approach, so I wanted to resolve this. I aimed to improve patient experience on the ward which would improve outcomes and reduce frustration, the risk of getting incorrect information, aggression and complaints.

I organised focus groups with both patients and staff from each discipline of the Multidisciplinary Team to gather qualitative data about this topic, including thoughts on the idea of the poster itself, and what kind of information they would want included. I frequently joined patient Community Meetings and provided versions of the poster before it was printed so that they could continue to provide their opinions and contributions so it would be co-produced and to ensure the information was relevant.

Once the poster was on display on the ward, I organised further focus groups to collect qualitative data again from both patients and staff. The results were overwhelmingly positive. Some feedback from patients included comments such as “It is easy to understand”, “It is helpful to have a visual poster that I can refer to without having to ask staff”. Feedback from staff included comments such as “Great visuals and really clear to follow”.

This poster has so far had a positive outcome for both patients and staff. For patients it has helped to reduce confusion when admitted onto the ward and frustration regarding the ward processes and their next steps. They have felt more empowered in the knowledge that they can seek answers to commonly asked questions of their own accord. For staff it has allowed ward rounds to be more directed and they feel their role is more understood. The project has scope and is potentially in the process of being replicated in other wards within the service, and could also be replicated in other units nationally so that patients would be able to have a similar experience.

This Quality Improvement project aimed to ensure safer prescribing of antipsychotics in dementia by standardising information provision, enhancing clinician confidence, and promoting psychosocial interventions as first-line treatments.

We conducted an audit to assess the frequency of discussions regarding antipsychotic use and information provision to patients, families and carers. A structured intervention was introduced, including:

–Development and distribution of an evidence-based information leaflet.

–Staff training sessions on antipsychotic prescribing in dementia.

–Behaviour that Challenges (BtC) consultations to help caregivers understand distress triggers and alternative management strategies.

A sustained improvement was achieved, with 100% of patients and caregivers receiving information leaflets for seven consecutive months. We introduced BtC consultations which led to improved understanding of behavioural triggers and better management. After these interventions we reassessed reliance on antipsychotic prescriptions and found an overall reduction in the number of prescriptions.

This QI project successfully enhanced the safety of antipsychotic prescribing in dementia by improving information-sharing and prioritising non-pharmacological interventions. Future steps include expanding leaflet distribution across older adult services and continued collaboration with pharmacies and primary care teams.

The aim of this quality improvement project was for initial seclusion reviews completed by resident doctors to achieve 80% compliance when standardised against all domains featured in the Mental Health Units (Use of Force) Act 2018 between the dates of September 2025 and January 2026.

A quality improvement project was undertaken between September 2025 and January 2026. A driver diagram was developed at project initiation to identify primary drivers, which included improving clinicians’ understanding of documentation requirements, increasing access to relevant criteria and resources and enhancing multidisciplinary knowledge regarding patient seclusions. Secondary drivers included targeted education for new and current doctors, improving accessibility and usability of the seclusion review template and policy and strengthening multidisciplinary team communication. A fishbone diagram was created, highlighting contributing factors related to people (time pressures, burnout, unfamiliarity with the process), process (time-consuming steps, inadequate handovers, limited out-of-hours support) and environment (reviews occurring overnight, limited software support). Based on these diagrams, a total of 4 PDSA cycles were performed, implementing 4 change ideas: (1) increasing accessibility to the seclusion proforma in handover, (2) circulating the proforma via email, (3) incorporating teaching into the academic programme, and (4) providing core trainee teaching in small groups. Regular audits were undertaken at two weekly intervals, and data was analysed using a Statistical Process Control chart.

Despite the interventions, there was minimal change in the overall compliance rate. Of the reviews that met all required criteria, compliance increased from 75% to 83%. This is likely attributable to the small number of seclusion reviews occurring within each two-week period, as well as the random variation introduced by different on-call doctors. These factors produced substantial fluctuations in the results, depending on the doctors' level of training and the workload of their shifts. At the level of individual domains, documentation of risk assessment to self and others alongside subjective and objective assessments of physical health increased, indicating a positive change.

This quality improvement project demonstrates that achieving the target of 80% compliance with the seclusion review requirements set out in the Mental Health Units (Use of Force) Act 2018 is unlikely to be sustained through educational or individual-level interventions alone. More directive system-level approaches may be required for sustained compliance, such as mandatory completion of all domains prior to submission of a seclusion review and efforts to reduce the overall use of seclusion to allow adequate time for high-quality, reflective documentation. Improving compliance with seclusion reviews is central to patient safety and safeguarding the rights of service users.

People with eating disorders can find the experience of social eating difficult, and being able to eat socially can be an important part of recovery. In the context of mental health treatment, experiences of mastery within virtual reality (VR) can be transferred to real life, and previous qualitative research has identified that a VR café environment could be a useful treatment adjunct for people with eating disorders. The aim of this project was to develop a VR café intervention for people with eating disorders who find social eating challenging.

We used the Person-Based Approach to develop the VR café. In Study 1 we conducted qualitative interviews and focus groups with young people with personal experience of a range of different eating disorders (n=15), parents and carers (n=4), and clinicians from a variety of professional backgrounds (n=6), to inform the design of the intervention. In Study 2, the café was further developed through a series of development activities and think aloud interviews with people with experience of eating disorders (n=12).

Study 1 participants described a range of challenges associated with cafés, which were incorporated into the initial build of the VR café by our industry partners,Virtual Bodyworks (Kiin). These included challenges related to social interactions with café staff, the busyness of café settings, and around choosing and ordering food and drink from café menus. Study 2 participants further shaped the intervention, contributing to the scripts for VR café staff; helping to develop food and drink menus; providing feedback on measures for assessing the effectiveness of the intervention; and advising on the ways clinicians could helpfully support people using the VR café, including through the provision of feedback on a written guidance document. During think-aloud interviews, Study 2 participants also identified areas for improvement to the content and experience of the VR café.

By placing the perspectives and ideas of people with eating disorders at the heart of the design of the VR café, we have developed a safe space for people with diverse eating disorders to practice relevant challenges related to social eating whilst being supported by a clinician. The intervention aims to reduce anxiety, increase confidence, and improve tolerance of uncertainty around social eating settings, and will be offered to young people accessing eating disorder treatment in two participating NHS trusts, as part of a mixed methods feasibility trial.

The Mental Health Intensive Support Team at Cheshire and Wirral Partnership NHS Foundation Trust commissioned a bespoke, 8-day training programme centred on the principles and delivery of dialogical practice, informed by an Open Dialogue approach. The training was commissioned to support the embedding of these principles into the rehabilitative model of care, with consideration being given to how to adapt the approach to the clinical model.

The aim was to evaluate the experiences of the clinical staff participating in the training that was delivered between April 2025 and November 2025, across two training cohorts.

The training package was offered to clinical staff of all bandings who had not previously completed any formal training in Open Dialogue or dialogical practice.

Data was collected via questionnaires that were completed at key points throughout the training. A pre-training questionnaire was completed prior to starting the 8-day training programme, and a post-training questionnaire after each of the four 2-day training blocks. All questionnaires were optional and anonymous.

Data collected was collated and a reflexive thematic analysis was completed to identify core themes highlighting staff experiences.

Across both cohorts the self-rated knowledge scores consistently improved across each training block. Average scores went from 4/4.5 out of 10 prior to attending the training (cohort 1/cohort 2 respectively) to 8.6/8.4 out of 10 at the completion of training (cohort 1/cohort 2 respectively) across both cohorts. 100% of respondents felt that the training met their expectations, alongside 98% of respondents feeling that the training will improve their work.

A reflexive thematic analysis identified six core themes from the qualitative data: (1) feeling more comfortable – beginner to more competent, (2) the value of experiential learning, (3) growing through it, (4) learning together, (5) learning how to really listen and (6) empathetic hope for the future.

The data identified that participants, overall, had a resoundingly positive experience of the training. Participants’ knowledge and understanding of dialogical principles improved, alongside participants also reporting positive changes both personally and relationally. The latter wasn’t an intended outcome but aligns with experiences of Open Dialogue training reported in the literature. The evaluation demonstrated that many participants left the training feeling hopeful for a future where dialogical principles areembedded into care delivery, and where individuals and their networks have more opportunities to have their voices heard.

This study aimed to estimate the prevalence of Childhood trauma (CT) subtypes and problematic internet use (PIU) among Sudanese medical students and the association between them. It examined which subtypes of the CT are most significantly associated with PIU, it also assessed the demographic predictors for PIU.

A descriptive cross-sectional study was conducted using an online questionnaire, it was distributed among 430 medical students from six universities located in Khartoum and Al Jazeera states, Sudan. Childhood maltreatment was measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and problematic internet use levels were assessed using the Chinese Internet Addiction Scale-Revised (CIAS-R). Both instruments are internationally validated. Descriptive statistics were reported as frequencies and percentages for categorical variables, and as medians with interquartile ranges for non-normally distributed continuous variables; Spearman correlation and multiple linear regression were used to assess associations and identify predictors of PIU while controlling for trauma-related anddemographic variables. A significance level of p <0.05 was applied.

Emotional abuse appeared as the most common form of childhood trauma, 48.8% (n=210), followed by physical neglect, 40.5% (n=174), and sexual abuse, 34.0% (n=146).The prevalence of problematic internet use among the participants was 46.0% (n=198). Also, a significant positive association was observed between PIU and overall CT scores (ρ=0.189, p<0.001). Among childhood trauma subtypes, emotional abuse had the strongest association with problematic internet use (ρ=0.219, p<0.001), while physical neglect, emotional neglect, and physical abuse also contributed. Furthermore, fifth-year students had remarkably lower CIAS-R scores compared to first-year students.

Emotional abuse emerged as the strongest indicator of problematic internet use severity among medical students. These findings emphasize the necessity for trauma-informed interventions, including counselling services and awareness programmes, to indicate the influences of childhood trauma and minimize problematic internet use among Sudanese medical student populations. Future studies should assess the internal psychological factors through which emotional abuse influences problematic internet use; understanding these details will contribute to building more targeted interventions.

Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia accounting for approximately 10–20% of all dementia cases. The behavioural variant (bvFTD) is the most common presentation, comprising 50–57% of autopsy-confirmed FTD cases. bvFTD is highly heritable, and most implicated genes are MAPT, GRN (progranulin), and C9orf72.

We report a case of two brothers, the first brother, aged 62, was assessed in the memory service in 2022 following a five-year history of behavioural change including inappropriate behaviour, overeating, apathy, and memory impairment. His Addenbrooke’s Cognitive Examination (ACEIII) score was 56/100. CT brain imaging showed generalised atrophy, more pronounced on the right. PET CT demonstrated hypometabolism particularly in the right frontotemporal region. Amyloid PET imaging showed no abnormal amyloid binding.

The second brother, aged 64, was assessed in 2024 with a two-year history of progressive cognitive decline and pronounced frontal lobesymptoms including apathy, irritability, lack of insight, impaired executive function, and poor financial management leading to debt. He required family support for most activities of daily living and scored 24/100 on the ACE. CT brain imaging showed pronounced frontal and medial temporal lobe atrophy. FDG-PET demonstrated reduced uptake in the frontal, temporal, and parietal lobes.

Both brothers underwent whole genome sequencing and were found to be heterozygous for a GRN mutation. Predictive genetic testing was recommended to their children, and two of four tested positive for the mutation.

GRN mutations account for 35% of genetic FTD and around 10% of all FTD cases. GRN-FTD follows an autosomal dominant inheritance pattern. In our patients, there was no family history of FTD, although their father had possible undiagnosed dementia while their mother had Parkinson’s disease and Alzheimer’s disease. Notably, up to 13% of bvFTD cases carry a genetic variant despite no family history.

Genetic testing is a crucial diagnostic tool for defining the molecular pathology of the disease particularly in psychiatric settings where early bvFTD is often misdiagnosed as a primary psychiatric disorder. Furthermore, Identification of a GRN mutation is also essential for determining eligibility for clinical trials.

Predictive genetic testing for at-risk relatives enables them to make informed decisions regarding life and future care.

This case highlights the importance of whole genome sequencing and predictive genetic testing even in the absence of a convincing family history. This could improve both patient care and our overall understanding of the disease.

Cerebral Amyloid Angiopathy (CAA) is a type of vascular disease present in more than 80% of confirmed Alzheimer’s disease patients. It is characterized by the presence of Amyloid-β protein deposited within the walls of vessels which results in various clinical presentations including vascular rupture of fragile amyloid-β laden vessels. Over the past 5 years, there has been a reported significant increase in publication, diagnoses, and referrals of CAA.

In our memory service, features of CAA including peripheral microhaemorrhages and superficial siderosis were reported in 28% of MRI’s requested in the past year, with CAA specifically mentioned in 50% of those. This therefore poses several challenges on a memory service regarding how these should be interpreted and how they may affect the patient’s management plan, including how the patients stroke primary prevention should be reviewed in this setting, which will be outlined in this poster.

CAA and Alzheimer’s disease (AD) frequently co-occur due to their shared proteinopathy and both diseases share impaired clearance through perivascular drainage pathways as a primary pathogenic mechanism. However, they differ in location of protein deposition and peptide composition. Their clinical overlap is critical for memory services, as CAA accelerates cognitive decline through mechanisms such as white matter structural disconnection and microinfarction, even in the absence of acute haemorrhage.

The emergence of anti-Amyloid monoclonal antibodies also makes CAA awareness mandatory. These treatments can trigger Amyloid-Related Imaging Abnormalities (ARIA), which represent an iatrogenic form of CAA-related inflammation. Pre-treatment screening with MRI is essential and current guidelines suggest that patients with features of CAA including microbleeds and cortical superficial siderosis should generally be excluded from these AD therapies due to high ARIA risk.

For patients diagnosed with CAA, aggressive vascular risk factor control is paramount to reduce recurrent haemorrhage risk. In patients with probable CAA, clinicians should exercise caution with anticoagulants, statins, and regular NSAID use, as these may exacerbate haemorrhagic risk in high-burden, and antiplatelet treatment for primary prevention is not recommended. This suggests improved collaboration between stroke and cognitive specialists is necessary to manage the complex balance between ischaemic prevention and haemorrhagic risk.

Increasing awareness of CAA among doctors, including within memory services, is vital for accurate diagnosis, risk stratification, and the safe implementation of emerging AD therapeutics. This poster outlines the current evidence on the pathophysiology of CAA, including its overlap and differences with AD, and its current and future implications focussing on a memory service.

This quality improvement project aimed to assess current foot care practices on a psychiatric rehabilitation ward and to inform the implementation of a structured approach to routine foot checks delivered by ward staff.

A cross-sectional study with semi-structured questionnaire administered by physicianto in-patients on a psychiatric rehabilitation ward to assess foot care practices in December 2025. Data were collected on demographics (age, sex), length of admission, history of foot inspection during admission, presence of foot problems, treatment received, patient attitudes towards routine foot checks, and risk factors for foot-related complications. Eight patients completed the questionnaire; two patients were unable to participate due to their current mental state. There were no exclusion criteria.

Only 25% of patients reported having had their feet inspected since admission. Of those who received a foot check, one patient was referred to podiatry for further assessment.

50% of these patients fall within the age of 45–64years.

75% of these patients have been on the current ward for more than a month and none expressed a preference for regular foot checks by staff. Three patients were identified ashaving risk factors for developing foot-related problems, including medical comorbidities and lifestyle factors, without evidence of consistent monitoring.

88% of these patients haven’t experienced any foot conditions since their stay.

Routine foot care assessment was infrequent despite identifiable patient risk factors. Introducing a structured foot-check protocol with clearly defined staff responsibility may improve early identification of foot problems and support preventative physical health care in psychiatric rehabilitation settings. No external financial sponsorship was received for this project.

To assess compliance with Trust Smoke-Free standards on older adult psychiatric wards, specifically: documentation of smoking status on admission; timely initiation of nicotine replacement therapy (NRT); regular multidisciplinary team (MDT) review of tobacco dependence treatment; and referral to the Trust Tobacco Dependency Team. The audit also aimed to identify potential age - or diagnosis-related inequities in assessment and treatment.

A cross-sectional baseline clinical audit was conducted across four older adult psychiatric inpatient wards. All inpatients present on 21/11/2025 were included (n=53). Data were extracted from electronic patient records (RiO), the electronic prescribing system (EPMA), and MDT documentation. Compliance was measured against four Trust Smoke-Free standards. Smoking status documentation was assessed across all admissions, while treatment, review, and referral standards were assessed in patients with documented tobacco dependence (n=6).

Smoking status was documented during admission clerking in 31% of patients (16/53). Among identified smokers, compliance with prescribing tobacco dependence treatment within 30 minutes of admission was 0%. Although 83% of smokers were eventually prescribed NRT, all prescriptions occurred more than five hours after admission, and 17% of smokers were never prescribed NRT. There was 0% compliance with regular MDT review of tobacco dependence treatment. Referral to the Tobacco Dependency Team within 24 hours occurred in only 17% of smokers.

This audit demonstrates poor baseline compliance with Smoke-Free standards on older adult psychiatric wards, particularly in the identification and timely management of tobacco dependence. The findings highlight risks of diagnostic overshadowing and avoidable behavioural disturbance in older adult psychiatry. Targeted quality improvement interventions focusing on admission clerking, MDT review, and referral pathways are required to promote equitable, person-centred care and an equal standard of care. A re-audit is planned following implementation of these interventions.

Tardive Dyskinesia (TD) is a movement disorder that typically occurs in individuals with longstanding use of dopamine receptor blocking agents; this typically includes second generation anti-psychotics, but can also include anti-emetic/anti-vertigo drugs and even other drugs. The onset of TD is often insidious with the first symptoms presenting over days to weeks and usually even months, prior to development into a full syndrome. It can only occur 3 months after the exposure to such agents for those under the age of 60 and 1 month of exposure for those aged above 60.

We present the case of a 66-year-old gentleman with a severe intellectual disability and a history of challenging behaviour. He has been previously under the care of his community learning disability service for a previous history of challenging behaviour but was re-referred on this occasion with the concerns about strange behaviour.

Staff noted and reported a intermittent abnormalities in movement and this gentleman’s case was referred to Psychiatry for follow up. These abnormalities also included difficulties in swallowing food. As part of the psychiatric evaluation the physical health of the gentleman was reviewed and the nature of the intermittent abnormalities in movement prompted a referral to the local Neurology department in order to evaluate whether there may be a form of epilepsy that this gentleman was suffering from. This gentleman was diagnosed with Tardive Dyskinesia after extensive ruling out of potential physical and mental health concerns. His treatment of Tetrabenazine was initiated and has since been tapered up to a total daily dose of 125mg per day. His symptoms have improved and with the aid of his local speech and language therapy team and dietetics team, he is able to safely eat food.

This case highlights the complexities of Tardive Dyskinesia and how these symptoms can be easily overlooked in someone with an intellectual disability. It also underscores the importance of proactive monitoring as well as regular medication review. This case further highlights the importance of a multidisciplinary approach towards the care of individuals with intellectual disabilities.

This case further highlights the need for structures screening for Tardive Dyskinesia in the ID population; particularly those receiving long-term antipsychotics. This case further lends weight to the regular use of movement assessments and reinforces the need for continued deprescribing where clinically appropriate.

Inattention and hyperactivity/impulsivity are frequently associated with intellectual disability (ID), contributing to significant behavioural dysregulation and functional impairment. Protein kinase C (PKC) has emerged as a key molecular target in the neurobiology of impulsivity, with PKC overactivity disrupting dopaminergic regulation and prefrontal cortical functioning, leading to impaired inhibition and executive dysfunction. Endoxifen, an active metabolite of Tamoxifen, is a selective PKC inhibitor that has demonstrated antimanic, anti-impulsive, and emotion-stabilising effects in adults. Emerging clinical evidence suggests benefit in behavioural dysregulation across several psychiatric conditions; however, paediatric use remains limited and largely off-label. This case report aims to evaluate the efficacy and tolerability of endoxifen for behavioural symptoms in an adolescent with ID who showed inadequate response to standard treatments.

A 14-year-old male with global developmental delay and significant speech–language impairment presented with repetitive verbal behaviours, hyperactivity, poor sitting tolerance, and frequent anger outbursts for two years. He was provisionally diagnosed with ID with behavioural impairment. Baseline BMI was 21 kg/m², and comorbid hypothyroidism was managed with replacement therapy.

Previous trials of risperidone (4 mg/day) with divalproex sodium (1500 mg/day) resulted in minimal improvement and adverse effects, including nausea, increased appetite, and weight gain. Subsequent treatment with oxcarbazepine (titrated to 1350 mg/day) and aripiprazole (10 mg/day) was complicated by hyponatremia, necessitating discontinuation of oxcarbazepine.

Following informed consent and assent, endoxifen was initiated at 8 mg/day and gradually titrated to 24 mg/day, while aripiprazole was continued at 5 mg/day. Clinical response and tolerability were monitored over 12 months.

Over one year of treatment, the patient demonstrated sustained reductions in impulsivity, hyperactivity, repetitive behaviours, and anger outbursts, with notable improvements in behavioural regulation and overall family functioning. The medication was well tolerated, with no significant metabolic, neurological, or systemic adverse effects, and adherence remained satisfactory throughout follow-up.

Endoxifen showed favourable efficacy and tolerability in managing behavioural dysregulation in an adolescent with ID who was refractory or intolerant to conventional psychotropics. Targeting PKC-mediated pathways may represent a promising therapeutic strategy for impulsivity and aggression in neurodevelopmental disorders. Larger controlled studies are needed to establish safety and long-term efficacy.

REM sleep behaviour disorder (RBD) is characterised by loss of physiological REM atonia, resulting in dream-enactment behaviours that may be violent and pose significant risk to patients and bed partners. RBD may be idiopathic, secondary to neurological disease, or medication-induced. Medications, including antidepressants and sedative-hypnotics, have been implicated in precipitating or unmasking RBD, particularly in individuals with underlying neuropsychiatric vulnerability and structural brain injury.

A 60-year-old man who was diagnosed with PTSD following a severe physical assault 30 years ago. He also sustained a scalp laceration, severe bruising to his body, hearing impairment, memory problems, and anxiety problems. Documentation of prior neurological and neuroimaging follow-up was unavailable.

He presented with a six-year history of progressively worsening sleep-related behaviours. These included snoring, talking, shouting, odd sounds, nightmares, increased restlessness, abnormal nocturnal movements, falls from bed when startled, and a recent episode of violent behaviour during sleep resulting in injury to his partner. He had a longstanding psychotropic polypharmacy, including paroxetine, carbamazepine, risperidone, and zopiclone. Collateral history highlighted worsening impairment of his memory and concentration levels, and recent changes in his personality.

Physical examination revealed an abnormal gait, positive Romberg’s test and tremors of his upper limb, with involuntary tic-like movements and repetitive blinking. Cognitive assessment revealed significant deficits in memory, recall, attention and language. Due to a childhood history of petite mal epilepsy, an electroencephalogram was done and it showed no epileptiform discharges. Neuroimaging identified chronic gliotic change and encephalomalacia in the left frontal lobe, consistent with previous injury. Previous oximetry and multi-channel sleep studies excluded sleep apnoea.

Zopiclone and paroxetine were gradually discontinued, and sertraline and melatonin were initiated. Risk management involved separate sleeping arrangements. Subsequently, violent sleep-related behaviours resolved. The patient was referred to Memory Services for further neurocognitive assessment.

The combination of violent dream-enactment behaviours, associated injury to a bed partner, absence of epileptiform activity, structural frontal lobe injury and improvement following gradual withdrawal of long-term paroxetine and zopiclone supported a diagnosis of likely medication-induced RBD in the context of TBI.

This case illustrates the risks of diagnostic overshadowing in patients with established psychiatric diagnoses and highlights the importance of considering organic and iatrogenic causes when new behavioural disturbance emerges, such as violent sleep-related behaviours. This case highlights the importance of awareness of the long-term neuropsychiatric sequelae of TBI and regular medication review and rationalisation to minimise iatrogenic harm