Background

Armed conflict and political instability are major determinants of population mental health, disrupting service delivery, workforce sustainability, and prevention systems. Following the 2021 military coup in Myanmar, formal psychiatric training pathways and national mental health services were severely fragmented or collapsed. In response, the Myanmar Board of Psychiatry (M.B.Psych) was reconstituted in 2025 to support a population-oriented, task-shared mental health system operating under complex humanitarian conditions.

Aims

To describe a national public mental health model integrating workforce development, service delivery, prevention, and community-based interventions in a protracted conflict setting.

A descriptive programme analysis was conducted using routine training, service delivery, and supervision data from M.B.Psych activities between January and December 2025. Interventions were mapped across core public mental health domains, including promotion, prevention, treatment, capacity building, and system governance.

M.B.Psych implemented a multi-layered mental health system spanning community, primary, and specialist care. Workforce capacity was strengthened through postgraduate psychiatric training, undergraduate teaching, medical education programmes, and international global mental health certification, with seven psychiatrists qualifying during the study period, supporting continuity of specialist care despite widespread displacement.

Population-level preventive and promotive interventions included nationwide Psychological First Aid, Mental Health and Psychosocial Support (MHPSS), mhGAP training, suicide prevention services, and school-based mental health programmes. Task-sharing enabled trained volunteers, lay counsellors, and primary care clinicians to deliver frontline care with structured psychiatric supervision.

Clinical services were delivered through an integrated hybrid model combining tele-mental health, primary mental health clinics, suicide prevention hotlines, and targeted on-ground psychiatric deployment in conflict-affected regions. Diaspora psychiatrists provided sustained supervision, psychotherapy training, and clinical governance support. Contextually adapted resources, including a Myanmar-language WHO Group PM+ manual and military-focused MHPSS materials, supported scalable and culturally appropriate interventions.

This public mental health model demonstrates that equitable, population-based mental health systems can be sustained during armed conflict through task-sharing, digital delivery, diaspora engagement, and integrated education–service frameworks. The Myanmar experience offers transferable lessons for global mental health system strengthening in fragile and conflict-affected settings.

Acknowledgements

The authors acknowledge the commitment and resilience of all Civil Disobedience Movement (CDM) mental health professionals, psychiatrists, psychologists, trainees, volunteers, and the Myanmar psychiatrist diaspora who contributed to service delivery, training, supervision, and community mental health support under extremely challenging conditions.

Congenital insensitivity to pain (CIP) is a rare neurogenetic condition characterised by lifelong absence of nociception, removing a fundamental biological deterrent to injury. Psychiatric risk-assessment frameworks implicitly rely on pain perception, distress cues, and behavioural feedback to signal escalation. We describe a case of severe self-harm escalation in a young adult with genetically confirmed CIP, emotionally unstable personality disorder (EUPD) highlighting critical limitations of standard inpatient risk-management approaches and the need for pain-independent safeguarding strategies.

We describe a female in her early twenties admitted to an acute psychiatric ward under the Mental Health Act following overdose and repeated self-harm. She has a childhood diagnosis of genetically confirmed congenital insensitivity to pain due to a homozygous SCN9A mutation, with lifelong absence of pain perception and a history of significant injuries without reported pain. She also has longstanding neurodevelopmental and personality vulnerabilities, including autism spectrum traits and emotionally unstable personality disorder, with self-harm beginning in early life. During admission, she described persistent internal voices and intrusive phenomena consistent with pseudo-hallucinations associated with EUPD and autism, rather than primary psychotic illness. Despite prior minor self-harm episodes, environmental access to hazards such as sharps and boiling water continued. This culminated in a severe self-inflicted scald injury requiring admission to a specialist burns unit and intravenous antibiotics, with minimal behavioural or verbal pain response observed during injury assessment and wound care.

This case demonstrates how self-harm can escalate rapidly and silently when nociceptive feedback is absent. The absence of pain and distress cues rendered conventional observation levels and harm-minimisation strategies ineffective, delaying recognition of injury severity. Risk could not be reliably inferred from reported experience, expressed intent, or diagnostic category. Even in the absence of primary psychosis, self-harm associated with EUPD and autism progressed to life-threatening physical injury without typical warning signals, exposing a critical blind spot in inpatient psychiatric risk frameworks that rely on pain-dependent deterrence and behavioural escalation markers.

In patients with congenital insensitivity to pain, self-harm risk must be assessed independently of pain perception and expressed distress. Psychiatry services should implement pain-independent safeguards, including early and sustained environmental restriction, routine body mapping, scheduled wound and physical observations, and prioritisation of psychotic symptom control. This case highlights the need for integrated neuropsychiatric approaches and revised inpatient risk frameworks when biological pain deterrents are absent.

The use of seclusion in intellectual disability services presents significant ethical and emotional challenges for staff. While the impact of restrictive practices on patients has been widely explored, there is limited literature examining the potential for moral injury among staff involved in delivering seclusion. This service evaluation aimed to explore the nature of moral injury experienced by staff involved in seclusion within an intellectual disability assessment and treatment unit (ATU), alongside perceived contributing factors, available support, and coping strategies.

An exploratory mixed-methods service evaluation was conducted in an intellectual disability assessment and treatment unit. Anonymous staff surveys were used to collect both quantitative and qualitative data. Quantitative data were gathered using a modified moral injury rating scale to explore levels of moral distress and wellbeing. Qualitative data were obtained through free text responses exploring staff experiences of seclusion, including ethical dilemmas and emotional responses. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic analysis.

Findings suggest that staff involved in the use of seclusion may experience features consistent with moral injury. Key themes included the emotional impact of enforcing restrictive practices, perceived lack of autonomy within organisational systems, repeated or prolonged use of seclusion, and limited opportunities for structured debriefing and reflective practice. Staff described tensions between professional values and organisational demands, alongside variable access to psychological and supervisory support.

This service evaluation highlights moral injury as a potential occupational risk for staff involved in seclusion within intellectual disability services. Addressing moral injury through reflective spaces, supervision and organisational support may be important in promoting staff wellbeing, reducing burnout, and maintaining standards of patient care. Further work is warranted to better understand moral injury in restrictive practices and to evaluate interventions aimed at mitigating its impact.

Outcome measurement in addiction psychiatry commonly prioritises abstinence, attendance, and treatment completion. These endpoints may fail to capture meaningful clinical progress, particularly in outpatient settings where recovery is often non-linear. This evaluation aimed to compare routinely recorded service outcomes with patient-reported indicators of progress, and to assess their relationship to engagement and re-presentation.

A retrospective service evaluation was conducted within an outpatient addiction service. Consecutive patients completing at least one follow-up appointment over a 6-month period were included (n=162). Routine outcome measures (attendance, substance use status, treatment completion) were extracted from clinical records. Patient-reported outcomes were obtained through brief structured questions recorded during routine reviews, focusing on stability, harm reduction, and help-seeking behaviour.

The cohort had a mean age of 42 years; 60% were male. Abstinence at last contact was documented in 28% of patients, while 71% demonstrated at least one patient-reported functional improvement. Improvements included reduced substance-related harm (46%), increased stability in housing or relationships (39%), and earlier help-seeking during relapse (33%). Attendance and abstinence showed weak correlation with patient-reported progress. Notably, 58% of patients who did not meet traditional “successful outcome” criteria reported clinically meaningful gains. Re-presentation rates within 6 months were lower among patients reporting functional improvements, regardless of abstinence status.

Routinely used endpoints in addiction psychiatry may underestimate meaningful recovery and distort service effectiveness. Incorporating patient-centred and functional outcome measures alongside traditional metrics may better reflect real-world progress and inform service development in outpatient addiction care.

There is growing evidence that certain subtypes of major depressive disorder, especially treatment-resistant depression and anhedonia-predominant phenotypes, are marked by both chronic neuroimmune activation and disruptions in reward processing circuitry. These results cast doubt on purely monoaminergic models of depression and highlight the need to comprehend how psychotherapeutic interventions may work through biological systems controlling immune function, stress regulation, and plasticity rather than just suppressing symptoms. Some therapies like Cognitive behavioural therapy, Mindfulness based and Trauma focused therapies have been shown to bring positive neuro immune, autonomic and epigenetic changes in brain.With an emphasis on finding common neurobiological pathways and potential biomarkers of treatment response across psychotherapy modalities, this review attempts to outline the biological correlates and mechanisms of action of psychotherapy.

To find systematic reviews, meta-analyses, and important longitudinal studies looking at biological changes linked to psychotherapy, a targeted systematic search ofMEDLINE/PubMed and major online publishing platforms was carried out. Studies that used biological measurements at two time points (pre- and post-intervention) were eligible. Four predetermined domains were used to classify the extracted biological outcomes:

1. Neuroimaging techniques, such as task-based and resting-state functional neuroimaging;

2. Physiological and autonomic measures of stress management, especially heart rate variability;

3. Indicators of inflammatory and immune function;

4. DNA methylation alterations linked to treatment response are the main focus of epigenetic markers.

People receiving Cognitive behavioural therapy (CBT) for depression consistently show changes in the fronto-cingulate–limbic circuitry, specifically in the medial prefrontal cortex and ventral anterior cingulate cortex (vACC), according to longitudinal functional magnetic resonance imaging (fMRI) studies. Standardized measures like the Beck Depression Inventory (BDI) show a strong correlation between these brain alterations and clinical improvement. Additionally, convergent reductions in limbic reactivity–most notably decreased right amygdala activation–across a variety of successful depression treatments are suggested by coordinate-based meta-analytic evidence, supporting the existence of shared neural pathways of symptom improvement.

Autonomic biomarkers have also emerged as promising predictors of the effectiveness of psychotherapy, particularly in the treatment of post-traumatic stress disorder (PTSD). Higher levels of high-frequency heart rate variability (HF-HRV) under basal conditions, associated with parasympathetic tone, have been related to the magnitudes of improvements following psychological therapy including CBT.

Available evidence for immune-related consequences is inconsistent. On the one hand, trials of mindfulness-based interventions show consistently that mindfulness may have limited and variable effects on inflammation with extensive methodology variations between studies that use similar populations, biological markers used for immune evaluation, and interventions. There is some promising evidence that trauma-focused psychotherapy may show differences in longitudinal changes in peripheral DNA methylation between responders and non-responders to trauma-focused psychotherapy while targeting immune function, stress pathways, and neuroplasticity pathways.

Within psychotherapeutic approaches, the strongest consistently accumulated biological evidence points to two related psychological constructs:

(i) the fronto-cingulate–limbic neural networks that are involved in emotion regulation and self-reference;

(ii) regulation of stress and immune system functions.

However, the existing evidence base is limited by small sample size, heterogeneous experimental designs and biomarker measurements, and the timing of the biological measurements. Next generation randomized controlled trials of psychotherapy should employ harmonized multimodal protocols of biomarkers to examine the longitudinal patterns of the causal mechanisms and to elucidate the clinically relevant biomarkers of the response to the treatment

This project aimed to improve trainees’ understanding and effectiveness at Mental Health Act tribunals (MHTs) through education. It explored how training influences trainees’ understanding of the legal process, confidence in preparation and ability to present evidence.

MHTs are vital in the protection of detained patients’ rights. Despite this, many trainees in Wales lack the opportunity to observe them. This can lead to impaired effectiveness at tribunal and anxiety for many trainees.

A session was designed comprising of a lecture introducing format and criteria of the tribunal, followed by a mock session. The mock was observed and was followed by a facilitated discussion.

Pre- and post-training questionnaires assessed knowledge of detention criteria, tribunal proceedings, confidence levels and interest in future educational sessions. Quantitative and qualitative data were obtained with Likert scales assessing interest in future educational sessions.

The key points from the pre-training survey (N=12) were a good awareness of why tribunals happen (12/12), some awareness of the legal criteria (5/12) and limited experience of taking part in tribunals (3 observed, 2 wrote reports, 1 oral evidence). All agreed that training would be helpful, and most were willing to take part.

Post-training survey (N=7) showed improvement in knowledge of detention criteria (6/7).Most respondents agreed that the session felt realistic and thought that the session would be helpful in the future.

The improvement of trainee’s knowledge of detention criteria shows high educational impact and the positive feedback on the realism of the mock suggests that it should have high validity to real life. We plan to expand the session to offer it to more trainees and ultimately aim to open it for all professionals involved in MHTs.

To assess the completeness and quality of ECT documentation across seven patient records and to implement improvements where compliance fell below 100%.

A retrospective review of seven ECT cases conducted between October and December 2024 was performed. Each case was evaluated against a 20-item ECT documentation checklist. Compliance rates were calculated, and deficiencies were examined using a QI framework to determine underlying causes.

Full Compliance (100%) was achieved in 15 of 20 criteria. Deficiencies were noted in the documentation of Montgomery–Åsberg depression rating scale (MADRS) score (71.4%), Mini-Addenbrooke's Cognitive Examination (MINI-ACE) assessments (85.7%), and record of previous treatment failure (85.7%). Root causes included limited staff awareness, non-mandatory templates, unclear policies and reliance on paper-based systems.

Two of the five non-compliant criteria related to capacity and consent, in both cases, documentation accurately reflected the clinical situation and were therefore considered fully compliant.

While overall documentation standards were high,notable gaps persisted in clinical assessment domains. A structured QI approach, combining system redesign with enhanced staff support has the potential to address these deficiencies and strengthen the safety, consistency and governance of ECT delivery.

To evaluate patient activity, clinical outcomes, and occupancy trends in a specialist inpatient psychiatric rehabilitation service over six years, with the goal of informing service delivery and quality improvement. The service (Maple House, Warrington) is a 23 bed high dependency rehabilitation unit for men with complex mental health needs due to mental illness and/or acquired brain injury.

A retrospective evaluation of routinely collected clinical data from April 2018 to April 2024 was undertaken. Key indicators included referrals, admissions, discharges, length of stay (completed and ongoing cases), patient demographics, diagnostic profiles, Mental Health Act status, discharge destinations, and clinical outcomes. Descriptive statistics were calculated, including median and mean length of stay, admission and discharge rates, and outcome distributions. Ongoing occupancy and patient length of stay were analyzed to identify trends in service utilization.

- Referrals and Admissions: 76 referrals were received, of which 38 were admitted (50%).

- Discharges: 23 patients were discharged during the period (42.4% of admissions). Completed cases had a median length of stay of 746 days (approximately 25 months), in line with the planned treatment and rehabilitation pathway of 18–24 months.

- Demographics and Diagnoses: Patients were men, mainly in the age group of 20-40 years, with complex psychiatric conditions, including schizophrenia (51%), Schizoaffective disorder(11%), intellectual disability/Autism(11%), bipolar affective disorder(7%), organic personality disorder due to acquired brain injury(7%), and comorbid substance misuse in 26% of cases.

- Clinical Outcomes: Most patients showed measurable improvements in functional abilities, risk reduction, and engagement, with 70% discharged to supported or independent living.

- Occupancy Trends: The unit frequently reached full capacity, with several ongoing cases exceeding three years of admission as of April 2024, highlighting challenges in managing long-stay patients.

The service delivers structured psychiatric rehabilitation for patients with complex needs, achieving clinical, functional and risk reduction outcomes largely within the intended treatment timeframe. Findings highlight areas for ongoing monitoring, including long-stay cases and occupancy pressures. This study is relevant considering the ongoing ACER study (Killaspy et al., 2021–2026) investigating the clinical and cost-effectiveness of in patient rehabilitation across the UK, reinforcing the need for further systematic evaluations in this area.

To systematically review the literature on psychedelic-related mechanisms relevant to forensic psychiatry, examining potential therapeutic benefits linked to reduction in crime-related behaviour, associated clinical and legal risks, and the practical considerations required were such approaches ever to be explored within UK forensic mental health services.

A systematic literature search was conducted in PubMed and PsycINFO in accordance with PRISMA principles. Peer-reviewed publications were screened, including randomised controlled trials, observational and qualitative studies, mechanistic and neurobiological research, reviews, and translational papers relating to psychedelic-assisted therapies. Additional literature addressing trauma, substance misuse, offending behaviour, psychosis risk, forensic rehabilitation, capacity, consent, and criminal responsibility was included. Given heterogeneity in populations, interventions, and outcomes, findings were synthesised using a structured narrative and thematic approach, interpreted within the context of UK forensic psychiatric practice and legal frameworks.

The literature identified several mechanisms with potential indirect relevance to forensic psychiatry. These included enhanced trauma and emotional processing, increased psychological flexibility, disruption of rigid self-concepts and offence-supportive beliefs, improved empathy and perspective-taking, and reductions in substance misuse–factors associated with offending behaviour and recidivism. Such mechanisms are theoretically relevant to offence-related psychotherapy, substance misuse treatment, and rehabilitative interventions within secure services.

However, substantial and consistent risks were also identified, particularly precipitation or exacerbation of psychosis, affective instability, behavioural disinhibition, impaired judgement, and significant challenges in assessing capacity and criminal responsibility during altered states of consciousness. Practical analysis indicated that any hypothetical consideration would require extremely stringent patient selection excluding psychotic disorders, delivery within highly specialised and non-coercive settings, close integration with established psychotherapeutic models, and robust safeguards aligned with the Mental Health Act, Mental Capacity Act, and the forensic mandate of public protection. No evidence supports routine or near-term clinical use in forensic populations.

This systematic review highlights a complex balance between theoretical therapeutic promise and significant clinical, ethical, and legal risks associated with psychedelic-informed approaches in forensic psychiatry. While direct implementation is currently inappropriate within UK forensic services, critical engagement with this literature offers valuable insights into mechanisms of psychological change, rehabilitation, and risk formulation. Any future consideration would require exceptional safeguards, specialist expertise, and a clear ethical mandate centred on patient welfare, legal responsibility, and public safety.

The early years of a child's life, particularly from birth to two years, are critical forcognitive, emotional, and social development. In the UK, Health Visitors and Family Nurse Practitioners (FNPs) play a pivotal role in supporting families during this period by delivering the Healthy Child Programme, offering guidance, and implementing early interventions to reduce health inequalities. These practitioners face significant challenges, including high caseloads, workforce shortages, and limited resources, which impact both the quality and quantity of care. This study explores the experiences of Health Visitors and FNPs, examining systemic barriers and identifying opportunities for innovation. It also evaluates the potential of digital tools, like the Pause App, to address gaps, foster empathetic and effective support, and improve outcomes for families and practitioners. By amplifying practitioners' voices through interviews, this study aims to inform policies and practices that better equip professionals to meet the diverse needs of parents and young children.

Semi-structured interviews were conducted with 25 professionals, including Health Visitors and FNPs. Discussions explored their roles, programme advantages and disadvantages, challenges in practice, parent feedback, and available tools. Interviews were audio-recorded and analysed using Braun and Clarke’s thematic analysis approach. Coding was performed collaboratively using Taguette software. Themes were identified, refined, and validated through group discussions, with representative quotes selected to illustrate findings.

The analysis revealed key themes. Several challenges emerged as dominant themes: individual struggles, service constraints, and balancing competing responsibilities. Current tools were discussed extensively, with participants highlighting gaps, and areas for improvement. Engagement with families was identified as a critical factor in achieving positive outcomes, particularly in vulnerable populations. Trust was identified as a multifaceted theme, addressing relationships with parents, social services, and the extendedfamily context. Parent characteristics such as vulnerability, language and cultural differences, and balancing work, school and parenting were all factors that influenced service delivery. Feedback from practitioners underscored the importance of addressing needs such as mental health and safeguarding. These findings highlight the complexity of supporting families and the necessity of addressing systemic, cultural, and individual factors to enhance service effectiveness.

This study highlights the challenges faced by practitioners in supporting families during early childhood. Despite systemic barriers like workforce shortages and limited resources, innovative tools such as the Pause App offer opportunities to improve services. Addressing gaps, fostering trust, and prioritising tailored support can enhance the effectiveness and sustainability of early years interventions.

This audit aimed to evaluate the quality, completeness, and legal compliance of capacity assessment documentation for older adult psychiatry inpatients at an older adult inpatient ward in the Black Country. The standards were based on the Mental Capacity Act (MCA) 2005 and its Code of Practice, which require that capacity assessments are properly recorded, with clear rationale and evidence for each element of the functional test. The MCA emphasises supporting individuals in decision-making and ensuring that decisions made for those lacking capacity are in their best interests and represent the least restrictive option. Recent literature, such as Ngwenya (2023), highlights that high-quality documentation is essential for safeguarding patient autonomy and ensuring legal defensibility, yet audits often reveal significant variability in practice.

The audit reviewed all MCA and Best Interests forms completed for inpatients admitted to the older adult inpatient ward between 1st March and 1st September 2025. Data were collected from the RiO electronic patient record system. Seven key standards were assessed: decision-specific documentation, support to decide, completion of the functional test (understand, retain, use & weigh, communicate), diagnostic link to mental impairment, documentation of best interests decisions, consultation with relevant others, and proper completion by the assessor. A total of 61 forms from 39 admissions were analysed using a pro forma with “Yes/No” ratings for each standard.

Compliance rates varied: decision-specific documentation (90%), support to decide (70%), functional test (60.6%), diagnostic link (84.6%), best interests (32.4%), consultation (29.7%), and completed by (100%). Only 14.7% of forms met all standards. Three patients lacked a capacity assessment on admission, and one form had no result recorded. Good documentation included detailed evidence of patient understanding and reasoning; poor examples were vague or lacked rationale. The most significant gaps were in documenting best interests decisions and consultation with family or advocates. These findings echo national trends, where audits frequently identify insufficient detail in functional assessments and limited evidence of patient-centred approaches (Ngwenya, 2023).

The audit revealed substantial variability and gaps in capacity documentation. Recommendations include regular training on MCA documentation, peer review and supervision of assessments, appointing capacity champions on the ward, and establishing feedback loops through audit presentations at governance meetings. These measures, aligned with national best practice, will help ensure legal compliance, protect patient rights, and improve the quality of care for vulnerable older adults.

Evaluate whether neuroimaging can predict response to cognitive behavioural therapy in those between ages 6–60 years with a diagnosis of major depressive disorder (MDD) and its use in a more personalised treatment plan.

A literature review was conducted using Ovid database (Medline, Embase, Emcare) and Google Scholar. Relevant studies were identified using a broad search which were then systematically screened. Inclusion criteria were participants aged 6–60 years with MDD, the use of neuroimaging and electrophysiological techniques as biomarkers pretreatment, and assessment of those biomarkers. Eligible literature included randomised controlled trials, cohort, case-control studies, systematic reviews, and meta-analyses published in English. Exclusions were studies with other comorbidities, non-CBT interventions, or combined CBT and pharmacotherapy without separate analyses. Out of 649 identified studies, only nine met the inclusion criteria. The findings were grouped by neuroimaging modality.

Evidence identified fronto-limbic and thalamo-cortical networks as key predictors of CBT response across the nine studies. Task-based fMRI studies showed lower pretreatment activity in subgenual anterior cingulate cortex which predicted superior outcomes. Siegle et al. demonstrated over 75% accuracy in classifying responders and 70% accuracy in remitters (R²=0.29) amongst 49 unmedicated adults. In 22 adults, Richy et al. found greater pretreatment ventromedial prefrontal and anterior temporal activation predicted symptom reduction with post treatment normalisation of fronto-limbic function. Feurer et al. found that greater rostral and subgenual anterior cingulate engagement predicted larger symptom improvement across psychotherapy modalities in 72 adults (B=−0.39, p=0.002).

Dunlop et al. showed subcallosal cingulate connectivity differentiated CBT vs antidepressant responders with 72–78% accuracy for remission and up to 89% accuracy for non-responders in 122 treatment-naive adults. In 30 adolescent participants, Tymofiyeva et al. demonstrated using structural diffusion imaging that greater thalamo-cortical connectivity predicted CBT response with 83% accuracy. Using Neurochemical imaging Dunlop and Mayberg showed that lower anterior insula metabolism predicted CBT response compared to subgenual anterior cingulate hypermetabolism which predicted non-response in 63 adults with MDD. Feurer et al. in 2 separate studies showed that in 112 adolescents with MDD, electrophysiological studies demonstrated that reduced reward positivity, increased late positive potential during reappraisal, and enhanced neural differentiation during self-referential processing predicted CBT outcomes more reliably than self-report measures. A systematic review by Fonseka et al. confirmed consistent involvement of anterior cingulate, prefrontal, insular and limbic regions.

Neuroimaging and electrophysiological biomarkers show promise for predicting CBT response in depression, particularly within anterior cingulate, prefrontal, insular, and thalamo-cortical neural circuits. Despite this, heterogeneity and limitation in replication restrict clinical translation. Larger, prospective, multimodal studies are needed to validate the use of biomarkers in psychotherapy for MDD.

In the Mouth of Madness (1995) directed by John Carpenter, is a horror film in which through a nonlinear narrative and perspective of the protagonist, the writings of a horror author are discovered to cause madness and potentially physically change reality. This film is open to a variety of rich interpretations of the possible experience of mental illness and has been used by the researcher to teach medical students about mental illness and its psychopathology. The researcher aims to inspire other educators to utilise film and film analysis in their teaching as a useful and engaging tool that can aid with psychiatric teaching.

Through interpretation of the five key elements of film, cinematography, Editing, mise-en-scène, performance and sound the film will be analysed. This analysis will be informed by the researcher's experience as a psychiatric trainee and of film analysis from completing a medical humanities degree.

This film shows the potential journey of a patient experiencing a first psychotic episode, providing informative examples of delusions of reference, passivity, nihilism and grandiosity, as well as a variety of perceptual disturbances. The film also provides an illustrative example of the societal stigma of mental illness and thoughtfully questions the viewer's assumptions, as exemplified in the following film quote:

A reality is just what we tell each other it is. Sane and insane could easily switch places. If the insane were to become the majority you would find yourself locked up in a padded cell wondering what happened to the world.

This film analysis provides a rich source of material that can be used to educate and inform medical students about key aspects of psychopathology and lead them to question and examine their own and societal assumptions regarding mental illness. This analysis will hopefully inspire other educators to utilise film and film analysis in their teaching as a useful and engaging tool to aid with their psychiatric teaching.

Antipsychotic medications acting on dopamine D2 receptors are commonly associated with hyperprolactinaemia, which can lead to distressing symptoms such as galactorrhoea, menstrual irregularities and sexual dysfunction, as well as longer-term complications including osteoporosis.

This re-audit aimed to assess adherence to Trust guidance on baseline prolactin monitoring and management of elevated prolactin level.

Trust guideline on antipsychotic induced hyperprolactinemia states the following: “Pre-treatment screening is vital in helping to determine whether or not a subsequent elevated prolactin level is due to medication”.

A retrospective audit was conducted for all patients admitted to Rose Ward, Prospect Park Hospital, between 1 June and 31 August 2025.

Audit standards were: (1) all admitted patients should have serum prolactin measured on admission; and (2) prolactin levels >1000 mIU/L should prompt clinical intervention. Data were obtained from ICE blood test records, with RiO used to identify documentation of blood tests, refusals, and management of raised prolactin levels.

Of 42 patients admitted during the audit period, 76% (n=32) had serum prolactin measured on admission, demonstrating improvement compared to 69% in the 2024 audit. Of the remaining patients, six refused blood tests and four had no documentation of prolactin measurement.

As per Standard 2, four patients had prolactin levels >1000 mIU/L,100% had clinical intervention, action was taken as follows:

Patient A was a known case of prolactinoma and already under endocrinology

Patient B & C were already on antipsychotics on admission (Paliperidone and Risperidone). They were monitored and reported no symptoms. Macroprolactin was pending but not followed up for Patient B.

Patient D was already known to have hyperprolactinaemia as she was on zuclopenthixol and aripiprazole 5mg. The plan was to continue with 5mg and monitor her prolactin levels.

This re-audit demonstrates improved compliance with baseline prolactin monitoring and appropriate identification and management of hyperprolactinaemia. Nevertheless, poor documentation of clinical symptoms highlights the need for improved clinician awareness and structured assessment.

Action plan: Enhance junior doctor education with Prolactin Monitoring guidance added to FY1 Doctor Induction Handover Booklet + Presentation for incoming rotation (Dec 2025). Posters on prolactin monitoring and management distributed to the On-Call room, Doctor’s mess and Rose Ward clinic room, and the introduction of a symptom screening tool adapted from the Glasgow Antipsychotic Side-Effect Scale to support holistic assessment and management.

No pharmacological stabilising treatments are currently approved for stimulant use disorder, despite its rapidly increasing global prevalence. Stimulants–including methamphetamine, amphetamine, and cocaine–continue to rise in production and availability worldwide. Methamphetamine remains one of the most misused Class A drugs. In Singapore, Methamphetamine–commonly known as “ICE”–is the leading drug implicated in arrests. In the absence of effective treatments, patients’ lived experiences may provide insights into potential therapeutic strategies.

We describe two cases illustrating non-prescription use of Armodafinil among individuals with methamphetamine use disorder.

Mr M, a 40-year-old Indian man with methamphetamine use disorder with three prior incarcerations for methamphetamine-related offences, presented to the emergency department with methamphetamine withdrawal symptoms and poor sleep. He reported intermittent use of ICE over the preceding three months. He disclosed substituting with armodafinil when unable to obtain ICE from his usual supplier. He described armodafinil as improving focus and mood, enabling him to function in daily activities, including his work as a cleaner, without producing the euphoric “high” associated with methamphetamine.

Mr N, a 54-year-old Malay man with methamphetamine use disorder, sedative–hypnotic use disorder, and prior drug-induced psychotic episodes, was brought to clinic by his cousin. He presented with acute psychotic symptoms, including auditory and visual hallucinations and grandiose delusions, along with insomnia of two days. After stabilisation with antipsychotic treatment, he denied recent ICE use but disclosed regular armodafinil use over several months. He reported ingesting approximately 500 mg of daily dose, purchased illicitly, to maintain alertness and daily functioning. He described armodafinil as more effective and longer-lasting than caffeinated beverages and denied cravings comparable to ICE.

Chronic stimulant exposure dysregulates dopaminergic and noradrenergic neurotransmission, resulting in blunted reward processing, and compulsive drug-seeking. Modafinil and armodafinil, approved for sleep–wake disorders, act via atypical dopamine transporter inhibition. Modafinil has been explored as a substitution agent in stimulant use disorder, though randomised controlled trials have not demonstrated clear relapse-prevention efficacy. There has been no trials of armodafinil yet. Mechanistically, armodafinil is more potent and longer-acting than modafinil. This case study shows its risks, including psychosis and insomnia, particularly at high or unsupervised doses.

These cases highlight an emergent, patient-driven harm-reduction pattern in which Armodafinil is used as a functional substitute for methamphetamine to preserve wakefulness and daily functioning. This behaviour underscores the unmet need for stabilising pharmacological options in stimulant use disorder and warrants further systematic investigations.

Close Observations (1:1) are used as a measure of safety to closely monitor patients who are acutely unwell and with significant risks to their health, their safety, and the safety of others. However, the lack of substantial patient-staff engagement and continuous Multidisciplinary Team assessment can lead to an unnecessarily prolonged state of close observation. We aim to reduce the number of Close Observations on Pine Ward by 10% by the end of October 2025.

This was a trust-wide project that lasted for one year, starting in November 2024. Our Multidisciplinary Team tried numerous change ideas using the Plan–Do–Study–Act framework. The change ideas that proved effective were the following: i) Increasing the number of structured therapeutic activities to subsequently improve patient experience, and reduce the number of 1:1 continuous observations. ii) Introduction of the Boredom Breaker Box to alleviate boredom in the patient experience. The box contains several activities ofinterest, i.e., comics, card games, and painting equipment.

Results regarding the data of enhanced observations were gathered through the Trust's tabbed journal. Questionnaires regarding patients' and staff experience were circulated quarterly throughout the year. The following results were produced: i) Number of unique patients onClose Observationsreduced from 10 to 6 (40%) per month by October 2025. ii) Overall, 49% improvement in patients' experience on the ward (increase from an average satisfaction of 3.14 to 4.68). iii) Overall, 20% increase in staff confidence to engage patients in 'boredom breaker' activities.

The involvement of staff in introducing games and new activities on the ward, along with increased participation from both staff and patients, has helped alleviate boredom, improved patient productivity and engagement, and significantly reduced the number of 1:1 enhanced observations. Limitations in our project include: patients’ dynamics, increased patient flow, over-stimulation from high acuity on the ward, and the use of temporary staffing. Sustainability plans include: a poster with planned structured activities placed in different strategic areas on the ward, an allocated activity champion, a weekly patient care plan review to inform activity of interest, and daily check and handover of the boredom breaker box.

Muslims in the United Kingdom face significant barriers to accessing mental health care. Cultural and religious practices influence how Muslims access mental health care and interpret causes of mental illnesses. However, current literature does not clearly separate cultural and religious influences on help-seeking, making it difficult to determine how each factor independently influences help-seeking behaviours.

The overarching aim of this study was to explore how Islamic beliefs influence mental health help-seeking for Muslim university students.

Participants were recruited through convenience, purposive and snowball sampling. Semi-structured interviews discussing mental health and Islam were conducted with participants who identified as Muslims living in the UK. Reflexive inductive thematic analysis was used to analyse interview transcripts.

Nine Muslim university students, eight of whom studied medicine, were recruited. Five major themes were identified:

• • Generational differences in understanding mental illness.

• • Relationship between culture and religion.

• • Mental health and the supernatural.

• • Choosing a mental health service.

• • Gender differences.

A key finding was the existence of a ‘dual lens’; participants demonstrated high mental health literacy whilst simultaneously holding beliefs in supernatural causes of mental illness. Thisresulted in a circumstantial preference for mental health care. Whilst National Health Service (NHS) services were the first resort for mental illnesses deemed purely biomedical, they were avoided if participants believed supernatural factors were causing the illness. This was due to a fear of scepticism from clinicians and perceptions of a lack of NHS cultural competency. Instead, participants preferred to seek help from Muslim mental health organisations (MMHOs). But access to MMHOs was hindered by a lack of awareness of these services.

Islamic beliefs can act as a strong motivator for help-seeking for the participants, though this is often overshadowed by cultural stigma. To address patients’ ‘dual lens’ framework, clinicians must adopt a ‘biopsychosocial-spiritual’ model that validates religious beliefs as part of holistic care. Increased collaboration between the NHS and MMHOs is crucial to bridge the current service gap and increase awareness in the Muslim community of the mental health support available.

Obstructive sleep apnoea (OSA) is a common sleep disorder linked to significant psychological issues, particularly depression and anxiety. The relationship between OSA and these mental health conditions is complex and has not been thoroughly studied in the Omani population.

This study aimed to assess the prevalence of depression and anxiety in patients diagnosed with OSA at Almasarra Hospital (AMH) in Oman and to identify related socio-demographic and clinical factors.

This cross-sectional study involved 108 patients diagnosed with OSA, with data collected during routine follow-ups at AMH. Structured questionnaires were used to gather demographic information and responses to the Hospital Anxiety and Depression Scale (HADS). Statistical analyses included descriptive statistics, Pearson correlation, and regression models to identify predictors of depression and anxiety.

The study found that 22.2% of participants exhibited depressive symptoms, while 17.6% showed anxiety symptoms. A significant positive correlation was found between anxiety and depression scores (r=0.680, p<0.01). Regression analysis revealed that higher BMI and employment status were significant predictors of both depression and anxiety (p<0.05). The mean age of participants was 38.35 years, with a notable prevalence of overweight/obesity (mean BMI=32.31). While sleep severity indices showed only marginal associations, psychosocial factors appeared to have a greater impact.

A significant proportion of Omani patients with OSA experience symptoms of depression and anxiety, which are interconnected and influenced by lifestyle factors. Incorporating mental health assessments into routine OSA management may enhance patient outcomes and overall quality of life.

Antipsychotics are frequently prescribed for behavioural and psychological symptoms of dementia (BPSD), despite well-established associations with increased cardiovascular morbidity and mortality. National and international guidelines recommend careful baseline cardiovascular assessment, ECG monitoring, metabolic screening, and documentation of risk–benefit discussions when initiating antipsychotics in older adults. Patients with dementiarepresent a particularly vulnerable group, often with multiple cardiovascular risk factors, yet adherence to monitoring standards remains variable.

The aim of this audit is to evaluate compliance with recommended cardiovascular risk assessment, monitoring, and documentation standards in dementia patients prescribed antipsychotics across inpatient mental health services.

A retrospective audit was conducted across three wards in two hospitals. Twenty inpatients with a diagnosis of dementia who were prescribed antipsychotics for BPSD were included. Data was extracted from electronic medical records, focusing on baseline cardiovascular history, physical observations, ECG monitoring, metabolic investigations, documentation of QTc intervals, ongoing monitoring, medication review, and evidence of documented cardiovascular risk discussions. Standards were derived from NICE guidance and local trust policies.

The mean age at admission was 77.3 years, with an average length of stay of 192.6 days. All patients were detained under the Mental Health Order (Northern Ireland). Antipsychotics prescribed included risperidone (n=9), olanzapine (n=5), quetiapine (n=4), and haloperidol (n=2). Six patients had a documented cardiac history, though one was not recorded on admission. Hypertension was present in eight patients, diabetes in three, and atrial fibrillation in three.

Baseline physical observations were largely completed, with blood pressure, heart rate, and weight recorded in 19 of 20 patients. However, ECG monitoring was inconsistent: only eight patients had an ECG on admission, and just three had an ECG performed before or within 72 hours of antipsychotic initiation. QTc was documented in six patients, with appropriate action taken in the single case of prolongation. Metabolic monitoring was incomplete, with HbA1c checked in only 11 patients and ongoing metabolic monitoring documented in seven. While medication was reviewed regularly in MDT meetings for all patients, there was no documentation in any case of cardiovascular risks or risk–benefit discussions relating to antipsychotic use.

This audit demonstrates significant gaps in cardiovascular risk assessment and documentation of risk–benefit discussions in dementia patients prescribed antipsychotics. Although routine observations and medication reviews were consistently performed, adherence to guideline-recommended cardiovascular monitoring was poor. Future targeted interventions could include increasing awareness amongst staff, standardized prescribing checklists, and electronic prompts, are required to improve patient safety and ensure compliance with best practice.