We wanted to develop a dedicated pathway to support people through their rehab journey from the start of their inpatient admission until 18 months post discharge. The overarching aim of this pathway is to improve the service user journey whilst saving the trust money at the same time.

A thorough service evaluation across the five boroughs within North London Foundation Trust (NLFT) in order to map out the current processes in place and discrepancies between services.

Literature review of current practices in rehabilitation psychiatry across the country, cross referenced with NICE guidelines to establish the best evidence-based pathway.

Most importantly qualitative research from interviews with service users, carers and staff in order to develop a co-produced pathway that is driven by the needs of those we are trying to support.

The above methods were used to co-produce a pilot rehabilitation pathway in Haringey which began in May 2024.

Our pilot project has reduced the number of rehab bed days by 2695 (projected for end of May 2026), which is a reduced Integrated Care Board (ICB) spend of £1540,000 (based on average cost of rehab bed of £4000/week).

Our re-admission shows 302 days saved at a cost saving of £172,571.

Our qualitative data shows service users under the pathway are able to live more independently, are engaging with our Occupational Therapy (OT) and psychology groups, have reductions in their package of care needs and as a result of the reduction in out of area beds we are able to deliver our care, closer to home.

The Haringey Rehabilitation Pathway is an excellent example of a co-produced pathway that addresses the needs identified from a robust service evaluation.

The outcomes of the pilot pathway show considerable financial savings to the trust and ICB. There has been a dramatic reduction in the number of rehabilitation bed days, out of area placements and readmission rates and our service users feedback is proof that this pathway is supportive and enables independence by focussing on relationship building and development of life skills.

Future developments include rolling out our pathway across the whole trust.

Data on survival rates of patients with dementia is sparse in Asian populations. Thus the aim of this study is to determine rates of survival of patients with dementia in Sri Lanka.

A descriptive cross-sectional analysis of data was done using the data of patients who have registered at the National Institute of Mental Health Sri Lanka, Older Persons Mental Health Clinic (largest governmental psychogeriatric service provider in Sri Lanka) from 2021 to 2023.

Total registries were 366. Prevalence of Alzheimer’s, vascular and mixed aetiology were 149 (40.41%), 83 (22.67%), 112 (30.6%) respectively. 203 (55.46%) had defaulted up to 2025. Out of 163 under regular follow up 17 (10.43%) had passed away. Mean years of survival with the disease was 3.7 years. Cause of death was dementia and related complications in 13 (76.47%) and vascular events in the rest. Mean age of death had been 77 years and male to female ratio was 0.7. Out of the defaulted 74 (36.45%) had beencontactable. Out of them 57 (77.03%) had passed away. Mean years of survival had been 2.01 years. Cause of death was dementia and related complications in 39 (68.42%) and vascular events in the rest. In the 146 surviving patients under regular follow up mean age was 73. Male to female ratio was 0.55. Mean years of life they had been living with dementia was 4.03 up to 2025. Among 17 surviving contactable patients who had defaulted it was 3.18 years. Odds of death in patients under regular clinic follow up compared with defaulted was 0.035 (Fisher’s exact p-value 2.5´ 10−24)

Regular clinic follow up is associated with a statistically significant lower rate of death compared to defaulters among patients with dementia.

Tobacco use remains highly prevalent among individuals with severe mental illness and is a major contributor to excess physical morbidity and premature mortality. Institutional smoking cessation policies aim to standardise nicotine dependence assessment, nicotine replacement therapy (NRT) prescribing and monitoring, patient education, and dischargeplanning in psychiatric inpatient settings. However, local data evaluating adherence to these standards in routine clinical practice are limited. This audit aimed to assess adherence to the institutional Smoking Cessation Policy across inpatient psychiatric services at Hamad Hospital, with a focus on documentation of nicotine dependence, NRT prescribing and monitoring, patient education, referral practices, and discharge continuity. It was hypothesised that documentation quality and continuity-of-care components would demonstrate lower compliance than initial screening processes.

A retrospective clinical audit was conducted between January and August 2024 across inpatient psychiatric units at Hamad Hospital. A total of 144 inpatient medical records were reviewed using the Cerner electronic health record system. Audit standards were derived from the institutional Smoking Cessation Policy and included documentation of smoking status, nicotine dependence screening and severity assessment, initiation and monitoring of NRT, documentation of side effects, delivery of patient and family education, provision of motivational interventions, referral to the Tobacco Control Center, and smoking cessation planning within discharge summaries. Data were extracted using a standardised audit tool and analysed descriptively.

Approximately 40% of admitted patients were identified as current smokers. Nursing compliance with initial nicotine dependence screening was high, exceeding 97%. In contrast, documentation of nicotine dependence severity was recorded in only 30.2% of cases. Appropriate NRT strength was documented in 12.3% of smokers, while monitoring for NRT-related side effects was not documented in any record. Only 20% of identified smokers received NRT, while 29% declined treatment. Referral to the Tobacco Control Center was documented in 18% of cases, with a further 13% documenting patient refusal. Motivationalinterventions were documented in 1.8% of cases. No records contained documentation of patient or family education or provision of educational materials. Discharge summaries showed limited continuity planning, with NRT prescriptions documented in only 3.3% of cases.

This audit demonstrates significant gaps between institutional smoking cessation policy standards and routine clinical practice within psychiatric inpatient services, particularly in documentation quality, patient education, and discharge continuity. While initial screening processes were consistently completed, downstream interventions and continuity-of-care measures were poorly documented. Targeted staff training, improved access to educational resources, and structured monitoring and documentation systems are required to strengthen implementation of smoking cessation policy and improve tobacco-related health outcomes for psychiatric inpatients.

To assess the time difference in creating CDDs and EDDs manually versus using Copilot in general adult psychiatry.

To assess the quality of AI generated CDDs and EDDs.

Resident doctors will be asked to time themselves while writing a CDD and EDDmanually for a selected patient. They will then use the Copilot agent to generate a CDD and EDD for the same patient and record the time taken. The time difference will be analysed to determine the efficiency gains. Qualitative feedback will also be collected regarding the usability and accuracy of the Copilot-generated documents.

Rationale: The audit was prompted by the auditor’s personal experience with dyslexia and the challenges of managing discharge documentation in a high-pressure clinical environment. The Copilot agent offers a potential solution to reduce documentation time and improve patient flow.

Service areas/teams included: The audit was carried out in Royal Cornhill hospital and included data from general adult psychiatry.

Sample Size: 5 patient cases.

Metrics Recorded:

• • Time taken with Copilot vs. without Copilot,

• • Number of TrakCare pages referenced,

• • Number and nature of mistakes,

• • Qualitative comments on errors,

• • Minutes saved and percentage time saved,

For CDDs:

• • Average time saved: 13 minutes 13 seconds per case.

• • Average percentage time saved: 75.3%

• • Largest amount of time saved: 17 minutes 34 seconds (≈74.5% reduction).

• • Largest percentage of time saved: 76.6%.

For EDDs:

• • Average time saved: 26 minutes 22 seconds per case.

• • Average percentage time saved: 76.7%.

• • Largest amount of time saved: 33 minutes 34 seconds (≈79.9% reduction).

• • Largest percentage of time saved: 81.5%.

Error Analysis: Common issues included missing clinical data (e.g., blood results, imaging) due to incomplete inpatient records, medication discrepancies caused by changes not reflected in TrackCare, and errors linked to prior documentation (e.g., suspected perforation). Not all CDDs and EDDs contained all the information about medications due to inaccurate or incomplete record keeping on TrakCare. No errors were due to hallucination by the AI.

Observations: Significant time savings were achieved in most cases. Accuracy depends on completeness of source documentation and integration with TrackCare.

The Copilot agent demonstrates substantial potential to reduce documentation time while maintaining acceptable accuracy. However, integration with real-time clinical data and improved handling of medication updates are essential for reliability.

The Collaborative Learning and Improvement Programme (CLIP) is a hospital-wide educational initiative on medication safety, co-visioned and co-produced by interdisciplinary members of the Changi General Hospital (CGH) Medication Safety Committee (MSC). CGH is a public hospital in Singapore, where CLIP has been operational since October 2023 and various educational materials have been implemented into hospital-wide junior, senior doctor and interprofessional education and training. In September 2024, inspired by a departmental case conference which triggered discussions on Neuroleptic Malignant Syndrome (NMS), the MSC Chairperson from the department of Psychological Medicine worked with departmental trainees on developing CLIP educational material on NMS. We aimed to design a CLIP educational infographic on NMS and implement this in hospital-wide mental health training.

Digital technology-enhanced learning using the infographic, with microlearning as the pedagogy, formed the framework to design the CLIP interprofessional educational infographic.

The design phase involved engaging stakeholders and end-users from the department, including Psychiatry trainees, from September–October 2025. Pharmacist, nursing and medical members of the MSC were engaged at the committee meeting in November 2025 to ensure interdisciplinary stakeholder contribution to designing the infographic. The final version of the infographic was implemented and shared in a mental health training session for the hospital’s Internal Medicine department conducted by a Psychiatry consultant in December 2025.

Qualitative feedback was captured at the planning, design and iteration phases.Qualitative and quantitative methodology was employed to capture end-user feedback from medical doctors in the implementation phase.

Qualitative feedback in the design phase led to various iterations of the infographic content, design and aesthetics, with the finalised infographic incorporating the themes captured from this feedback.In the implementation phase, quantitative feedback captured from end-users showed improvements in self-rated awareness of risk factors (69.6% to 100%) and signs and symptoms (60.9% to 100%) of NMS, and confidence in recognizing and managing NMS (4.3% to 70.6%). All participants rated the infographic as useful in aiding recognition and management of NMS. Qualitative feedback centred on the usefulness of the infographic’s design, organization and informativeness.

We designed a trainee-led infographic on NMS underpinned by interdisciplinary feedback, the implementation of which in the mental health training of general medical doctors has shown promising results, reinforcing the value of the CLIP. The CLIP NMS infographic will be made accessible to all hospital staff via the hospital intranet as a systems intervention and will be incorporated into interdisciplinary CLIP educational programmes.

Different teaching modalities are used within medical curricula to educate students about the principles and intricacies of psychiatry. Given the advancement in digital technology, medical education is evolving to include new digital based interventions and learning approaches, including the use of artificial intelligence (AI) based interventions. This review aims to systematically identify how artificial intelligence is used within medical curricula when teaching students about psychiatry, and is unique as reviewers are at different stages of training.

An advanced literature search was undertaken using OVID (MEDLINE), and Web of Science. Four key search terms were used within these databases – ‘psychiatry*’ AND ‘medical education’ AND ‘artificial intelligence’ AND ‘students’. Studies commenting or focusing on artificial intelligence-based interventions within healthcare education were included, and no restriction on the country, language or methodology. PRISMA checklist utilised. Results were thematically analysed.

332 studies were retrieved (19 were excluded due to duplication). 313 studies were screened, and 16 full texts were screened and 4 studies were deemed suitable for inclusion.

Key areas highlighted within these studies suggest AI can be in a versatile manner to help shape educational interventions. One study highlighted numerous roles that ChatGPT can undertake within an educational setting, including providing prompts for debates within students, facilitating self-directed learning, providing information to students, and can be used to create further learning materials, including vignettes for hypothetical cases – after a relevant prompt. However, the study highlighted key limitations to consider when using this novel approach as follows: the likelihood of inaccuracies leading to misinformation, differences between languages/translation, and lackof replicability and reproducibility of responses and results.

Another study showcased the creation of a web-based AI supported educational tool developed for psychiatric education, and students reported significant user satisfaction and mentioned that the platform was effective and supported them through their placements.

This review highlights the limited availability of literature surrounding the use of artificial intelligence to teach medical students about psychiatry. Additionally, the limited available literature highlighted that AI can be used in a versatile manner to create learning prompts, aides, and to create realistic case studies and vignettes that can help improve learning. However several limitations have been highlighted about the use ofAI-related materials within medical education, and further research and innovation is required within this area.

Multiple sclerosis (MS) is the most common demyelinating neurological diseases worldwide. Around 2.3 million people globally and 100,000 people in the UK were living with MS. Psychotic presentation is rare, but it may affect 2-4% of the individuals with MS, which is more than in the general population (1%). The psychotic symptoms reported in multiple sclerosis included both affective and schizophrenia-like symptoms with a predominance of positive psychotic symptoms, most frequently persecutory delusions.

Case reports

Patient X is a 35-year-old female of Asian origin, with an established diagnosis of Multiple sclerosis, presented to the crisis team with thoughts to end her life as she firmly believed with impregnable conviction that her husband was unfaithful and was having an affair with the patient’s mother for the last 3 months. It impacted her sleep and overall quality of life as she used to keep up throughout the night to gather evidence of her husband’s infidelity. She was diagnosed with ‘Secondary psychotic syndrome, with delusions’ according to ICD 11. (6E61.1) The diagnosis of Multiple sclerosis was established around two years prior to her psychotic presentation which was treated with Natalizumab infusion. During the time of her presentation to our service, the symptoms related to MS was stable with no significant findings on neurological examination. X was commenced on a low dose of antipsychotic, initially Quetiapine (which she declined to take due to metabolic side effect) and then on Aripiprazole, 10 mg once daily. X showed considerable improvement within four weeks of initiation of the antipsychotic along with psychosocial support. She has been followed up by local neurology specialist teams actively and remained stable with respect to the demyelinating process secondary to MS on repeat MRI.

Discussion:

Psychotic symptoms may develop during the onset of MS or more frequently during illness as seen in this case. Regarding management, presence of Multiple sclerosis also makes the individual vulnerable to the side effects of antipsychotic drug like extrapyramidal side effects. Psychotic symptoms can be secondary to the demyelination process or results as a side effect of medication to treat MS like corticosteroids and beta- interferon.

Although, cognitive and affective symptoms like depression are very common in pertinent among patients with MS, psychotic symptoms among them are more than the general population. Considering these, it is important to explore the organic underpinning of patients presenting with psychosis.

The National Psychiatry Student Conference (NPSC) is an annual student-led conference supported by the RCPsych Choose Psychiatry programme. The 2026 NSPC was hosted by Kent and Medway Medical School. Understanding student perspectives of such enrichment activities is important to inform future conference design and maximise educational impact. This mixed-methods study aimed to examine students’ perceptions of thequality, relevance and impact of the conference, including attitudes towards psychiatry and future career intentions.

All student delegates attending the 2026 NSPC were invited to complete an anonymous post-conference questionnaire including Likert-scale items and free-text responses exploring overall experience, session quality and perceived impact. A purposive sample of respondents was invited to take part in semi-structured interviews to explore experiences in greater depth. Questionnaire data were analysed descriptively, and interview data were analysed using thematic analysis.

Of 103 delegates, 68 students completed the questionnaire and 11 were interviewed.

Questionnaire data indicated positive experiences of the conference overall (98% were satisfied or very satisfied), and of the individual programmed activities, with an average session score of 4.5/5. The most popular sessions included a consultant’s journey through their career and lived experience of mental illness, functional neurological disorder, interactive workshops, and a subspeciality panel Q&A. Ninety percent of respondents reported that the conference had increased their interest in psychiatry as a career.

Interview data aligned closely with these findings. Students described the conference as well organised, welcoming and engaging, and valued opportunities to hear directly from clinicians about career pathways and the breadth of psychiatric practice. Many reported that the conference challenged preconceptions about psychiatry and increased awareness of the range of subspecialties and research opportunities.

For many delegates, this was their first academic conference. Barriers to attendance included travel distance and cost, with subsidised accommodation and low-cost tickets described as important enablers of participation.

This mixed-methods evaluation demonstrates that a student-led national psychiatry conference was experienced as engaging and educationally valuable by attending, self-selecting students, with delegates reporting more positive attitudes towards psychiatry as a career and a deeper understanding of the specialty. Findings also highlighted practical barriers to participation, particularly cost and travel. Overall, the results support the value of student-led conferences within undergraduate psychiatry, and emphasise the importance of accessibility in maximising their impact and reach.

Recent large registry studies report associations between GLP-1 RA use and reduced substance-related harms. We synthesize this evidence, identify critical knowledge gaps, and define research priorities needed before clinical translation.

A targeted evidence synthesis was conducted across three domains:

1. Large registry studies examining outcomes in people with AUD or opioid use disorder (OUD) prescribed GLP-1 RAs.

2. Real-world cohort studies comparing overdose and hospitalisation rates between GLP-1 RA users and non-users.

3. Neuroscience literature describing GLP-1 receptor activity in reward-related brain regions.

Multiple observational studies show associations between GLP-1 RA use and reduced substance-related harms.

In a Swedish cohort of 227,866 individuals with AUD, semaglutide was associated with reduced alcohol-related hospitalisations (Lähteenvuo 2024). US data (>500,000 OUD, >800,000 AUD patients) showed lower opioid overdose and alcohol intoxication rates among GLP-1 RA users (Qeadan 2024; Wang 2024).

All current human findings are observational, but several human randomised controlled trials are now underway, including trials of semaglutide and exenatide for AUD, semaglutide for cocaine use disorder, and liraglutide for nicotine dependence.

The overlap between metabolic and addiction pathways may explain these associations, as GLP-1 signaling modulates reward processing relevant to both food intake and substance use. Preclinical studies demonstrate GLP-1R-mediated reduction in substance self-administration via reward pathway modulation in VTA, NAcc, and PFC. While this provides biological plausibility, observational human data cannot establish causality, and RCT evidence is needed.

Observational data suggest potential associations between GLP-1 RA use and reduced substance-related harms, but cannot establish causality due to confounding. Before clinical application, essential research includes: (1) completion of ongoing RCTs with addiction-specific outcomes, (2) safety and tolerability evaluation in actively substance-using populations, including assessment of nausea/vomiting risks and drug interactions with methadone, buprenorphine, and benzodiazepines, (3) adherence and implementation feasibility studies in populations with chaotic substance use, and (4) health economics modeling. Psychiatrists should monitor emerging trial results critically as this evidence base develops in the coming years.

To evaluate whether the pre-lithium workup in patients with Bipolar Affective Disorder (BPAD) initiated on lithium in Psychiatry in patient unit of Allied Hospital, Faisalabad adheres to the Maudsley prescribing guidelines in psychiatry.

This study was conducted in 2025 at a tertiary care hospital in Faisalabad, data was collected from files of 72 inpatients in psychiatry ward prescribed lithium, to check if adequate pre lithium workup was done for each patient as recommended by Maudsley prescribing guidelines. A baseline audit was followed by a faculty led presentation on guidelines, and a re audit 3 months later, in which data was observed from 86 patients files. Initial findings revealed unsatisfactory workup . Results were discussed in a departmental meeting, leading to targeted teaching session for all the residents. The reaudit showed significant improvement in workup practices prior to prescribing lithium as recommended

The initial audit revealed that only 50(69.4%) out of 72 patients had their LFTs done, 3 (4.2%) had TFTs, 14(19.4%) had ECG and None of the patients got their weight measured before prescribing lithium.

A reaudit done 3 months later showed results from 86 patients according to which there was much improvement in compliance with the guidelines as 74(86%) had their LFTs, 53 (61.6%) had TFTs, 58 (67.4%) had ECG and 33 (38.4%) had weight measured before prescribing lithium.

These findings indicate a positive staff response and significant progress in adhering to pre lithium workup guidelines

Lithium is the most effective mood stabiliser for the treatment and long-term prophylaxis of BPAD and helps in reducing relapse and suicide risk. Although it is very effective, lithium has a narrow therapeutic index and can cause range of adverse effects involving renal, thyroid, cardiovascular and metabolic systems. Therefore, it is essential to do baseline physical health assessment before initiating lithium therapy. It helps to identify pre-existing risk factors and ensures safe prescribing. Lithium can commonly cause hypothyroidism, renal impairment, weight gain and cardiac conduction abnormalities. The risk increases with longer treatment duration and cumulative exposure.

This audit demonstrated initially poor compliance with pre lithium workup as recommended by Maudsley prescribing guidelines. Rates of RFTs, TFTs, ECG and Weight measurement were very low which could have resulted in avoidable complications. Later intervention and reaudit showed much improved compliance with recommended standards. This highlights the importance of audit driven interventions leading to improvement in quality of care for patients in their best interest. Ongoing education, standardised pre-lithium checklists and regular re-auditing are recommended to ensure sustained compliance and further improvement in patient safety

Current dementia referral pathways within Mental Health of Learning Disability (MHLD) Team in Kent and Medway were analysed in order to understand existing practices while identifying opportunities for improvement. Objectives were: (1) to capture staff opinions on what MHLD should provide for people with intellectual disability (ID) and dementia, and (2) to analyse dementia-related referrals to East and West Kent MHLD over 12 months. Audit standards were drawn from NICE NG54, which advises referral of people with learning disabilities and suspected dementia to a specialist psychiatrist. We hypothesised that pathways would lack clarity.

We employed a mixed-methods research design. An anonymous survey was used to collect opinions from MHLD clinicians across Kent about referral practices, assessment responsibilities, prescribing, and post-diagnostic support. We conducted a retrospective evaluation of dementia-related referrals from January-December 2024 by reviewing referral meeting documents and electronic health records. We collected information on demographics, referral sources, outcomes, and follow-up details. Descriptive statistics and thematic analysis were used.

Eighteen staff responded. Most (83%) supported a formalised pathway, mentioning inconsistency in the current system. Views on assessment, diagnosis, prescribing, and follow-up were divided; joint working was favoured but resource limitations were noted. Confidence gaps in diagnosis and prescribing for ID were highlighted. Twenty-seven dementia-related referrals were identified (41% East, 59% West; mean age 55.7; 63% male; 59% with Down’s Syndrome). Overall, 48% were accepted, with marked variation (82% East vs. 25% West). Psychiatric input occurred in 84% of cases, and 77% were redirected to MAS or CLDT. No confirmed diagnoses were made at initial or three-month follow-up.

Our findings indicate differences in how dementia referrals for people with ID are managed across Kent and Medway. The staff supports the creation of a formalised pathway which would address inconsistencies and define roles among MHLD, MAS and CLDT and maintain compliance with NICE guidance. A standardised approach together with enhanced training resources could improve dementia care delivery to patients with ID.

A number of subtypes of obsessive-compulsive disorder (OCD) have been described, one of which is religious OCD (ROCD), also referred to as Scrupulosity Disorder. Whilst there is an expanding literature which investigates the link between OCD and religion, there is very little research which examines the impact of clergy attitudes and intervention upon a sufferer of ROCD. The study aims to begin the task of developing an understanding of how those in Christian pastoral ministry in the UK typically view ROCD, how they are likely to deal with it in someone for whom they have pastoral care, and whether such interventionsare compatible with current models of clinical care.

The study involved conducting in-depth interviews with six respondents working professionally in pastoral ministry. The respondents were interviewed using a questionnaire comprising a series of open questions. The initial phase of the interview was designed toencourage discussion as to how a respondent might react to someone with typical ROCD symptoms, having had such explained to them. The nature of ROCD as a psychiatric diagnosis was then explained, including some cognitive theory and a description of typical treatment. The remainder of the interview concerned itself with exploring respondents’ views on these matters.

There was general consistency of thought between correspondents; all were willing to give credence to a psychopathological attribution of ROCD and the implication that a psychological approach is useful in its management. All were clear that an empathetic and sensitive approach is necessary and that a response which conveys a sense of judgement is to be avoided. Recommendations were generated which would broadly be viewed as psycho education from a clinical standpoint: reflection on the nature of God; an explanation that obsessions do not confer culpability nor are they indicative of an underlying spiritual or moral deficit; an exploration of the dissonance created by the sufferer’s unsuccessful attempts to resist compulsive behaviour.

The principal source of conflict between pastoral care and treatment occurs when a minister seeks to offer reassurance to combat the doubts and anxieties of a sufferer. Conversely, respondents’ recommendations are clearly well suited to pastoral intervention, being of a theological nature. It is here, with the ‘theological examination’ of a sufferer’s negative appraisal of obsessions, that the minister might best use the authority invested in him/her, rather than by the giving of permission to follow the edicts of the therapist.

In long-stay dementia psychiatry settings, multidisciplinary team (MDT) documentation frequently accumulates extensive historical detail, which can obscure current clinical priorities, hinder longitudinal tracking of progress, and reduce clarity around accountability for care planning. Improving the structure and accessibility of MDT records is therefore essential for maintaining continuity of care in complex, chronic inpatient populations. This Quality Improvement Project (QIP) aimed to enhance the clarity, structure, and continuity of weekly MDT documentation in a long-stay old age psychiatry unit. Specific objectives were to ensure clear differentiation of current and resolved issues with explicit progress tracking, consistent use of closed-loop communication with named responsibility and timeframes, and improved accessibility of MDT plans to support ward handover.

Baseline analysis assessed the presence of core clinical information, identification of current issues, progress tracking, and action accountability within MDT documentation. Astructured MDT template was co-designed with the multidisciplinary team to prioritise current issues, document progress using a standardised framework (better/same/worse), and assign actions to named individuals or teams with review dates. Weekly MDT summary sheets were produced and made available in the nurses’ office to support continuity during daily handovers. Interventions were implemented iteratively using Plan–Do–Study–Act cycles, with re-audit following each cycle.

At baseline, MDT documentation was highly inconsistent, with key clinical elements recorded in only 0–15% of cases. Following introduction of the structured template, completion of core documentation fields increased to 84–100% after the first cycle and reached 100% across all measured domains by the second cycle. Accountability measures improved markedly, with documentation of responsible teams increasing from 1.67% at baseline to 100%, and inclusion of review dates rising from 0% to 100%. The introduction of closed-loop communication and weekly MDT summaries improved the clarity of MDT plans and facilitated information transfer to ward staff, evidenced by unprompted use of summaries by nursing staff during handovers.

This QIP demonstrates that a simple, structured approach to MDT documentation can produce substantial and sustained improvements in clarity, accountability, and continuity of care within a long-stay dementia psychiatry unit. The interventions were low-cost, acceptable to staff, and readily integrated into routine practice. These findings support the wider applicability of structured MDT documentation to improve care coordination in long-term psychiatric inpatient settings, although further work is required to assess sustainability and patient-centred outcomes.

Individuals with first-episode psychosis (FEP) have a high prevalence of obesity and cardiometabolic abnormalities, compounded by antipsychotic-related metabolic side effects and unhealthy lifestyle behaviours, including tobacco smoking, physical inactivity, poor dietary habits, and substance use, resulting in an elevated risk of premature mortality. Black and minority ethnic populations exhibit elevated cardiometabolic risk, with ethnicity influencing the onset, progression, and outcomes of cardiometabolic disease. To mitigate these risks, the National Clinical Audit of Psychosis (NCAP) – Early Intervention in Psychosis standards require routine monitoring of body mass index (BMI) and intervention when thresholds are exceeded: BMI ≥25 kg/m² for the general population, compared with the lower threshold of BMI ≥23 kg/m² for South Asian and Chinese populations.

This audit aimed to establish a baseline understanding of BMI distribution within the Northamptonshire Early Psychosis Service (NSTEP), with a focus on ethnic groups at increased cardiometabolic risk, to inform future quality improvement initiatives.

A retrospective audit was conducted on cross-sectional caseload data from NSTEP North and South as of 11th March 2025. BMI and ethnicity were recorded, with BMI categorized as <20 kg/m², 20–24.9 kg/m², 25–29.9 kg/m² (overweight), and ≥30 kg/m² (obese); for South Asian and Chinese patients, BMI ≥23 kg/m² was also noted. Antipsychotic prescribing patterns from a previous quality improvement project (September 2024) were included to contextualize metabolic risk.

Of 187 patients, 182 (97%) had BMI recorded; BMI was <20 kg/m² in 6%, 20–24.9 kg/m² in 28%, 25–29.9 kg/m² in 34%, and ≥30 kg/m² in 29%, with approximately two-thirds of the total caseload (64%) falling in the overweight or obese range, and a higher prevalence in NSTEP North than South (68% vs. 63%). Among South Asian/Asian patients, 68% (13/19) had BMI ≥23 kg/m² while Black Caribbean/African patients showed 68% (23/34) prevalence of overweight or obesity. Approximately half of patients across both services were either not prescribed antipsychotic medication or were treated with Aripiprazole, a relatively weight-neutral antipsychotic.

This audit demonstrates that two-thirds of NSTEP patients are overweight or obese, with particularly high prevalence among South Asian/Asian and Black Caribbean/African populations, despite weight-neutral antipsychotic prescribing. These findings highlight the need for targeted, culturally informed lifestyle and weight management interventions. The plan is to introduce resource packs containing diet and exercise guidance, promote local NHS exercise and weight management programmes, encourage NSTEPactivity groups to incorporate exercise, and collaborate with the NHS Diabetes Prevention Programme to improve patient access.

To understand the frequency, nature and location of medical emergencies at the Royal Edinburgh Hospital, (REH) a stand-alone psychiatric institute, between May 2018 and January 2025.

Resident doctors at the Royal Edinburgh Hospital are part of a small crash team responding to medical emergencies across the Royal Edinburgh Hospital, a stand-alone psychiatric facility in Edinburgh with 29 wards and approximately 570 beds. Inpatient units included acute adult wards, an intensive psychiatric care unit, rehabilitation and psychiatry of old agewards. Additionally, there are specialist day services for young patients, a medium secure forensic unit, residential unit for learning disability patients and an acquired brain injury unit.

As a non-acute site, access to emergency medications and resources is limited. Additionally the site is large, complex and difficult to navigate. Knowing what medical emergencies occur and where could help resident doctors prepare for their on-calls and improve the patient outcomes.

2222 medical emergency calls made between May 2018 and January 2025 were reviewed by checking yellow forms completed after a medical emergency and collecting information from switchboard.

The frequency of medical emergencies increased between May 2018 and January 2025 with an average of 5–6 calls per month by January 2025.

The most common 2222 call sites were the acute adult wards, followed by psychiatry of old age wards and the rehabilitation wards.

The most common cause of an emergency was seizure (20.9%), followed by choking (11.8%), ligature (10.6%), overdose (6.9%) and unresponsive episodes (6.5%).

Little published research appears to exist on medical emergencies at stand-alone psychiatric hospitals.

These findings have been shared locally and resulted in multiple interventions, for example the creation of a new seizure protocol which better reflects the skills and background of the responding team, a new trainee site map, amended simulation training which is tailored to staff working in different areas, new trainee induction talk and 2222 focused site tour for rotating doctors.

New resident doctors have reported increased confidence in approaching their on-calls and attending medical emergencies as a result of these interventions.

Child and Adolescent Mental Health Services (CAMHS) face unprecedented demand, with many referrals rejected due to incomplete clinical information. Standardized digital tools like the Development and Well-Being Assessment (DAWBA), that generate algorithm-based probable diagnoses from multi-informant symptom reports, could improve referral outcomes. However, thereal-world impact of these tools on referral outcomes remains underexplored. In this context, the current study aimed to examine whether diagnostic probabilities generated by the DAWBA predict referral acceptance in CAMHS. It also explored how the information available to triage team, including referral source, influences referral outcomes.

We conducted a secondary analysis of anonymised data extracted from a randomized controlled trial conducted across eight NHS Trusts in England. The sample included 483 participants aged 5–17 years with documented DAWBA diagnostic probabilities and referral outcomes. Sociodemographic characteristics and clinical variables were also examined.

Overall, 54.5% (n=263) of referrals were rejected. There were no significant differences in referral acceptance by sex, ethnicity, deprivation, or referral source. Referral acceptance was associated with older age, higher Strength and Deficit Questionnaire (SDQ)parent-rated impact scores, history of previous CAMHS referral, and study recruitment site. Binomial logistic regression showed higher parent impact scores (OR=1.1, 95% CI: 1.01, 1.21) and previous CAMHS referral (OR=2.3, 95% CI: 1.38, 3.69) increased odds of referral acceptance. Referral acceptance also varied with recruitment site. However, a high to very high probability of DAWBA generated diagnoses did not increase chances of referral acceptance with 54% emotional disorders, 78.6% behavioural disorders, or 52.9% comorbid emotional and behavioural disorders being rejected.

This study highlights key gaps in the current CAMHS referral process. While previous CAMHS referral and parent-rated SDQ impact scores were associated with referral acceptance, DAWBA diagnostic probabilities were not. This suggests that children with clinically significant difficulties, identified via standardised assessment, may still face barriers in accessing care. Significant site-level variation in referral acceptance underscores the need for more equitable referral processes.

Early Intervention in Psychosis (EIP) services play an important role in improving outcomes after a first-episode psychosis. Some UK EIP services include adults aged ≥36. Given the cardiometabolic risks associated with antipsychotic treatment and a higher prevalence of hypertension in this cohort, physical health monitoring including blood pressure (BP) is essential. This audit aimed to assess adherence to national NICE guidelines (NICE NG136, CG185, CG178) and establish a baseline understanding of the detection and management of elevated BP in patients ≥36 in the Northamptonshire EIP service.

Retrospective case note review of all EIP caseload patients aged ≥36 on 27th of February 2025. Records from 28th February 2024-27th of February 2025 were evaluated. Data collected included ethnicity, completion of an annual physical health check (PHC), including BP; presence of elevated BP (≥140/90 mmHg), documented actions by EIP following elevated readings, known hypertension diagnosis, antihypertensive treatment, and antipsychotic prescribing.

The total EIP caseload: 185; 58 patients aged ≥36 (31.3%; 34 female and 24 male).PHC completed within the past year 45/58 (77.5%); 13/58 did not have a recorded PHC due to missed appointments, recent referrals, close timing exclusion, having an inpatient PHC, or missing BP documentation. Among the 45 who underwent PHC, 17 (37.7%) showed elevated BP (≥140/90 mmHg). Actions taken by EIP were documented for 3 of these 17 cases (17.6%). These included GP referral, repeat BP arrangement, or advised home monitoring. Of the 17 identified, five had a pre-existing diagnosis of hypertension, and four were prescribed antihypertensive medication. Fifteen of the 17 identified with elevated BP were prescribed antipsychotics: aripiprazole (n=8), quetiapine (n=4), and olanzapine (n=3).

Annual PHC completion for adults aged ≥36 in EIP was moderately high (77.5%), but a relevant cohort (37.7%) had elevated BP reading and clinical follow-up was limited (17.6%) and varying actions. The audit results indicate a gap between detection and management of hypertension within EIP care. Recommendations included dissemination of results and stakeholder engagement. In collaboration with primary care colleagues, we have developed - and are now implementing - a concise hypertension pathway/visual guide for identifying and managing elevated BP. The guide specifies clear BP thresholds, referral routes, and documentation standards to ensure reduction in delay to reduce delays in diagnosis and treatment of hypertension.