Xanomeline/trospium chloride (KarXT) is approved in the US for schizophrenia in adults. KarXT combines the dual M1/M4-preferring muscarinic receptor agonist xanomeline with the peripherally restricted pan muscarinic receptor antagonist trospium chloride to reduce side effects related to xanomeline activation of peripheral muscarinic receptors. KarXT efficacy and safety were demonstrated in the EMERGENT trials and a phase 4 trial evaluating tolerability of administration with/without food. This post-hoc analysis compared onset, duration, and incidence of treatment-emergent adverse events (TEAEs) by KarXT dose (100mg/20mg and 125mg/30mg twice daily [BID]) and titration schedule with data from these completed trials.

The phase 4 “food effect” inpatient, open-label trial (NCT06572449) enrolled adults with schizophrenia, Positive and Negative Symptom Scale (PANSS) total score ≤80, and Clinical Global Impression-Severity (CGI-S) score ≤4. In weeks 1-4, participants began KarXT at 50mg/20mg BID (days 1-7), followed by 100mg/20mg (days 8-14), and increased to a maximum of 125mg/30mg (cohort 1) or continued with 100mg/20mg (cohort 2) (days 15-28). The inpatient, 5-week, randomized, double-blind, placebo-controlled, phase 2EMERGENT-1 (NCT03697252) and phase 3 EMERGENT-2 (NCT04659161) and EMERGENT-3 (NCT04738123) trials enrolled adults with confirmed schizophrenia and recent worsening of psychosis warranting hospitalization, PANSS total score ≥80, and CGI-S score ≥4. KarXT BID dosing began at 50mg/20mg (days 1-2), followed by 100mg/20mg (days 3-7), and increased to a maximum of 125mg/30mg (days 8-35). Food effect trial TEAE analyses by maximum KarXT dose and titration schedule were restricted to weeks 1-4; results from EMERGENT were pooled.

In the food effect trial, KarXT TEAEs occurred in 69.9% (100mg/20mg) and 59.0% (125mg/30mg) of participants; in pooled EMERGENT, rates were 77.8% and 67.1%, respectively. Peak incidence of procholinergic and anticholinergic TEAEs coincided with transition to the KarXT 100mg/20mg dose (food effect: week 2; pooled EMERGENT: days 3-7); incidence of TEAEs plateaued or decreased with transition to KarXT 125mg/30mg. Nausea duration was longer for those maintained on KarXT 100mg/20mg in both datasets. Efficacy was measured by decrease in PANSS total score and observed with 100mg/20mg and 125mg/30mg in both study populations.

Overall, TEAE incidence and duration appeared to be similar regardless of titration speed to KarXT 125mg/30mg BID. Data suggest the duration of certain TEAEs is longer with 100mg/20mg BID, potentially due to the higher ratio of X to T of 5:1 versus 4.1:1. In some circumstances, potential improvements in tolerability may be seen with more rapid titration and/or uptitration to KarXT 125mg/30mg BID.

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioural therapeutic modality that promotes psychological flexibility through six core principles: acceptance, cognitive defusion, contact with the present moment, self-as-context, values, and committed action. This pilot study aimed to evaluate the effectiveness of an immersive ACT intervention delivered in a fully interactive environment for reducing symptoms of depression, anxiety, and obsessive-compulsive disorder (OCD) among medical students. The immersive ACT experience was created by uploading and adapting ACT therapeutic content into the Immersive Studio software, which projected the material onto the walls of the suite. Participants could interact with the content presented visually and auditorily by touching the walls. The use of immersive technology was intended to enhance engagement and experiential learning of ACT principles, thereby reducing symptoms of depression, anxiety, and/or OCD.

A pre-post intervention design was implemented at Cardiff University’s School of Medicine HIVE immersive learning suite: a 5×5 metre room equipped with fully immersiveand interactive capabilities. This environment enabled participants to engage with ACT content across three immersive modules, each designed to teach and apply ACT’s six core principles in a dynamic and experiential manner. Pre-and post-intervention scores were collated using the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalised Anxiety Disorder-7 (GAD-7) for anxiety, and Obsessive-Compulsive Inventory-Revised (OCI-R) for OCD as standardised, validated measures.

Ten medical students completed all elements of the three immersive ACT modules, as well as the pre and post measures. Scores from the three validated measures were analysed using the Wilcoxon Signed Rank test to assess changes in symptom severity. Depressive symptoms significantly decreased following the intervention, with mean PHQ-9 scores reducing from 7.13 to 4.00 (z=−2.207, p <0.05). No statistically significant changes were observed in anxiety (GAD-7) or OCD (OCI-R) scores.

Delivering ACT as an immersive and interactive therapeutic modality appears to be an effective approach for reducing depressive symptoms among medical students. This pilot study highlights the potential of immersive environments to enhance psychological interventions and enhance psychological flexibility. Further research with larger samples (currently underway) is required to examine its impact on anxiety, depression and OCD symptoms and to optimise immersive delivery for broader mental health benefits.

Skin disease carries a high burden of psychological morbidity and dermatology often functions as the first clinical contact for primary psychiatric presentations.

We aim to:

* Quantify psychiatric morbidity presenting to dermatology.

* Assess progress since the All-Party Parliamentary Group on Skin (APPG) report on Mental Health and Skin Disease (2020).

* Map psychiatry’s engagement in psycho-dermatology across curricula, training, and research.

* Evaluate practical Royal College of Psychiatrists (RCPsych) and British Association of Dermatologists (BAD) solutions for service development.

Exploratory mapping of authoritative UK sources to characterise clinical need, service models, training, and research activity. Reviewed materials included the APPG (2020) report, BAD and Psychodermatology UK resources, UK service evaluations, RCPsych curricula and liaison guidance, and recent publication-trend analyses. Emphasis was placed on high-impact findings and actionable service metrics.

Evidence indicates a substantial psychiatric caseload presents to dermatology and is under-recognised by mainstream psychiatric services:

1. Burden: The APPG survey reports 98% of patients experience negative psychological impact, with 5% offering spontaneous disclosures of suicidal ideation, evidencing substantial unmet psychiatric morbidity.

2. First Contact: Dermatologists frequently receive first presentations of DI, BDD, and complex psychological distress. They explicitly highlight the need for psychiatric presence given limited psychiatric training.

3. Service and Commissioning gaps: Integrated pilots show benefit from liaison psychiatry, yet provision remains patchy. Dermatology stakeholders note that complex psycho-dermatology consultations align more closely with psychiatry tariffs, underscoring commissioning gaps.

4. Curriculum gap and Competency mapping: The Royal College encourages special Interest Development with provision of 2 session weekly. However, recent RCPsych Liaison Curriculum contains minimal psychodermatology-specific content or competencies, and pathways to competency are not clearly defined.

5. Research gap: The UK research base on this topic remains predominantly dermatology-led, with psychiatry perspectives under-represented. The APPG report calls for multidisciplinary research networks and collaboration.

6. Training outside psychiatry: Structured psychodermatology education is developing via BAD/Psychodermatology UK but sits outside RCPsych governance. There is no clear endorsement of these pathways from the RCPsych.

Dermatology clinics host a psychiatric caseload that psychiatry seldom encounters, contributing to missed diagnoses and unmet risk needs. The explicit calls from dermatologists for psychological/psychiatric involvement and tariff alignment, highlights clear structural gaps. The evidence supports RCPsych-endorsed optional psycho-dermatology pathways, BAD-linked clinical rotations, development of College guidance, and Psycho-dermatology special interest groups. These targeted steps would bring this invisible caseload into psychiatry's view and strengthen diagnostic accuracy, patient safety, and multidisciplinary mind–skin care.

Depression represents a leading cause of disability in England, with NHS Talking Therapies providing evidence-based psychological treatments to over 1.8 million people annually. Despite overall effectiveness, persistent disparities in recovery and engagement exist across demographic groups, particularly by age and ethnicity. Predictive modelling offers an opportunity to identify patients at risk of dropout or non-recovery, but few studies have evaluated such models for fairness.

This study aimed to develop and evaluate fairness-aware machine learning models to predict recovery and dropout in NHS Talking Therapies using early-treatment clinical data. In addition to assessing predictive performance, the study quantified algorithmic fairness across demographic groups, focusing on disparities in true positive rates by age and ethnicity. We hypothesised that integrating fairness constraints into model training would reduce demographic disparities while preserving predictive performance, thereby supporting more equitable and targeted service delivery.

This study analysed routinely collected clinical data from 33,341 patients discharged from an NHS Foundation Trust in North-West England between January 2024 andJuly 2025. Outcomes included dropout after assessment, dropout before session four, and recovery following at least one therapy session. Predictor variables comprised demographic characteristics, referral pathway, and item-level Patient Health Questionnaire-9 (PHQ-9) responses, including early symptom change. Baseline models included L2-regularised logistic regression and Extreme Gradient Boosting (XGBoost). Performance was evaluated using the Area Under the Receiver Operating Characteristic Curve (AUROC), accuracy, and Equal Opportunity (parity in true positive rate (TPR)) across age, gender, and ethnicity. A custom fairness-aware XGBoost model was developed using a dynamic dual-ascent regularisation controller to reduce subgroup disparities during training.

Baseline models showed moderate discrimination (AUROC 0.65 for dropout after assessment; 0.75 for recovery), with logistic regression performing similarly to XGBoost. However, substantial disparities were observed, with TPR gaps exceeding 0.40 across age groups and 0.30 across ethnic groups. The fairness-aware XGBoost model maintained discrimination (AUROC 0.64–0.74) while markedly reducing subgroup disparities, achieving up to an 84% reduction in age-related gaps, approximately 50% in gender, and 40% in ethnicity, with only a minimal reduction in overall accuracy.

These findings demonstrate that fairness-aware optimisation can mitigate demographic disparities in predictive modelling for mental health services while preserving predictive performance. To our knowledge, this represents the first application of fairness-constrained machine learning in NHS Talking Therapies. Such approaches could support more equitable, data-driven care pathways when implemented as clinician decision-support tools with ongoing fairness monitoring.

Older People’s Mental Health (OPMH) patients admitted to acute hospitals often experience fragmented care, particularly those with dementia or delirium. Delirium is associated with increased mortality and morbidity and prolonged hospital stays; yet it remains under-recognised and sub-optimally managed. National guidance emphasises earlyidentification, prompt access to mental health expertise, and collaborative multidisciplinary management. Locally, staff reported delays in psychiatric review, uncertainty in delirium management, and inconsistent use of cognitive screening tools.

This Quality Improvement (QI) Project aimed to:

1. Improve timely psychiatric input for OPMH patients admitted to the acute hospital.

2. Increase recognition and documentation of delirium, and behavioural/psychological symptoms of dementia (BPSD).

3. Enhance staff confidence in managing delirium/BPSD through education and standardised pathways.

Using QI methodology, we conducted three Plan–Do–Study–Act(PDSA) cycles over a twelve-month period.

Interventions included streamlining patient allocation processes through enhanced morning triage meetings; contributing to dementia strategy group initiatives; establishing weekly liaison meetings between psychiatry and dementia/delirium nursing teams; developing liaison ‘champion’ roles; and delivering a programme of internal and external teaching.

Quantitative data was collected monthly from mental health and acute trust electronic patient records and qualitative data by anonymous questionnaires.

Following implementation:

Response time within 24 hours showed special-cause improvement (78.5% at baseline to 82.7% post-intervention); however, the process is still not stable enough to reliably meet the 90% target.

There was no sustained improvement in use of cognitive screening tools although there was sustained improvement in documentation of delirium diagnostic features (attention, fluctuation, cognitive change; 21% to 74%).

There was a trend to improvement in deprescribing and reduction in security team intervention. There was a sustained reduction in need for Mental Health Act referral (16.4% at baseline to 6.9% post-intervention) and reduction in average length of stay (33 days at baseline to 25 days post-intervention). There was a trend of increasing use of acute sedatives, but this change did not reach significance.

Qualitative feedback highlighted improved communication, increased confidence, clearer escalation processes, and reduced distress among patients with BPSD.

Simple, low-cost interventions–education, standardised pathways, and collaborative daily reviews–enhanced both the timeliness and quality of psychiatric input. Future work includes sustaining improvements across wards, improving completion of standardised screening tools and evaluating patient-centred outcomes such as length of stay and readmission. Planned next interventions include development of non-medical prescribing protocols and deeper service change in the trust in collaboration with the older people’s mental health teams.

Early intervention services (EIS) for first-episode psychosis (FEP) aim to improve clinical and functional outcomes, yet uncertainty remains regarding their effectiveness compared with treatment as usual (TAU) across heterogeneous service models. This systematic review and meta-analysis evaluated the effectiveness of EIS versus TAU on symptom severity, relapse, hospitalisation and functional recovery in individuals with FEP.

We conducted a PRISMA-compliant systematic review and meta-analysis prospectively registered with PROSPERO (CRD420251012486). PubMed, Embase, PsycINFO and the Cochrane Library were searched from inception to March 2025 for randomised controlled trials comparing EIS with TAU in individuals experiencing FEP. Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool, with discrepancies resolved by consensus. Random-effects meta-analyses estimated pooled standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals. Heterogeneity was assessed using I² statistics. Meta-regression explored moderators including timing of intervention, participant age and inclusion of cognitive-behavioural therapy (CBT).

Twenty randomised controlled trials involving 4,562 participants were included, with follow-up durations ranging from 12 to 24 months. Compared with TAU, EIS was associated with lower symptom severity (PANSS SMD=−0.38, 95% CI −0.50 to −0.26), reduced relapse rates (OR=0.55, 95% CI 0.40–0.75; number needed to treat=8), fewer hospitalisation days (SMD=−0.44) and improved functional outcomes (GAF SMD=0.47) (all p <0.001). Substantial heterogeneity was observed (I²=98.1%). Meta-regression demonstrated stronger effects when EIS was initiated within three months of psychosis onset, among participants younger than 25 years, and in programmes incorporating CBT. No evidence of publication bias was detected.

EIS is associated with superior clinical and functional outcomes compared with TAU in individuals with FEP, despite substantial between-study heterogeneity. Earlier initiation and inclusion of CBT appear to enhance effectiveness. These findings support prioritisation of scalable EIS models within routine psychiatric services, particularly for young people experiencing early psychosis.

Kent and Medway Mental Health Trust facilitates regular Resident–Senior Forums for doctors of all grades, a structured space to raise work-related concerns and share feedback. Forums are attended by representatives from medical education, staffing and the Guardian of Safe Working Hours. They were initially piloted across two localities in 2023 as part of a QIP to improve on-call communication, receiving positive feedback and average attendance of 14 people. The forums have since been expanded trust-wide since 2024. After the initial phase chaired by locality tutors, I have chaired the forums as a resident doctor since August 2024 to provide continuity and peer-led perspective.

The forums have supported discussion on a range of clinical and operational issues, including updates on standard operating procedures, consultant ward cover, rota andpay concerns, resident safety, ward access and educational needs. Issues have been escalated to senior colleagues across medical and non-medical departments, with actions fed back at later meetings. Topics such as physical health pathways and clinical handovers have led to QIP projects, with results shared with attendees. Non-medical teams have also joined forums to gather interactive feedback from doctors on issues such as clinical systems.

Since August 2024, attendance has risen to an average of 31 participants (range 18–43). In June 2025, feedback was re-collected from 14 medical staff from foundation to consultant grades: 71% had attended and 93% were aware of forums. Among attendees, 80% still found forums useful (sustained from 75–80% in the initial trial), 70% felt listened to (from 80%) and 90% felt able to raise concerns. Reported benefits included access to decision makers, a safe environment to voice concerns and improved understanding of organisational processes. Qualitative comments described the forums as an “opportunity to raise concerns and learn about colleagues’ issues”, “a voice for residents and consultants”, and “a shared space for juniors to be heard by seniors”. The main barrier to attendance was difficulty being released from clinical duties. Suggested improvements included increasing resident engagement, widening the agenda, clearer action tracking and adjusting timing. In response, the forums have been added to induction materials, an explanatory communication circulated trust-wide and the timing moved to lunchtime for 2026.

The forums provide an effective route for raising concerns with seniors and have supported meaningful service improvements. Chairing as a resident doctor has also offered leadership development, insight into policy implementation and greater understanding of multidisciplinary roles.

This audit aims to review the prescribing of melatonin in adults with intellectual disability (ID) to understand current patterns of melatonin use within this population and to assess whether prescribing practice follows existing clinical guidelines. In addition, the audit seeks to compare the current findings with those from previous audits conducted in 2018 and 2021 to provide a longitudinal overview of changes in melatonin prescribing over time.

A retrospective audit was conducted to assess the use of melatonin in adults with intellectual disability and insomnia. From a total population of 322 patients, a sample of 50 patients was selected using systematic random sampling. The inclusion criteria focused on adult patients with intellectual disability prescribed melatonin by the Intellectual Disability Psychiatry Team at Leicestershire Partnership Trust. Patients in transition from the Child and Adolescent Mental Health Services (CAMHS) and those under adult Community Mental Health Teams (CMHT) were excluded. The audit covered the period from January 2022 to December 2024, with data collected from patient records and GP correspondence. Data collection focused on melatonin initiation, dosing, and prior sleep hygiene, with reviews of effectiveness and side effects during the first and most recent 12 months. The later review also assessed withdrawal or dose reduction where appropriate.

Insomnia was the indication for prescription in all 50 patients, with 42% (21/50) having severe, 26% (13/50) moderate, and 32% (16/50) mild Intellectual Disability. The initiation dose was 2mg in 62% (31/50). The current dose is over 10mg (12mg) in 2% (1/50). While all were reviewed post-initiation (within 2 weeks to 1 year), only 40% (20/50) had a review within 2 months. Sleep hygiene advice was undocumented in 80% in the first year and in 88% (44/50) in the past year. There was no review of side effects in 70% in the first 12 months and 51% in the last year. Insomnia had resolved for ≥6 months in 21% (10/50), but 50% (5/10) of these had no trial of dose reduction.

This audit demonstrates some improvement in adherence to prescribing guidelines for melatonin in individuals with intellectual disability, particularly regarding indication, starting dose, and regular reviews of effectiveness. However, it also highlights ongoing gaps in best practice, including timely initial reviews, consistent monitoring of side effects, provision of sleep hygiene advice, and opportunities for deprescribing. These findings underscore the need for more structured and comprehensive approaches to monitoring and documentation.

The global mental health burden continues to increase, alongside rising community demand for accessible mental health education. While resident-led outreach initiatives are encouraged within graduate medical education, there is limited longitudinal evaluation of their scalability, sustainability, and community impact, particularly within psychiatry and the Middle East. This study aimed to evaluate the design, expansion, reach, and perceived impact of a resident-led Mental Health Awareness programme embedded within leadership training at Hamad Medical Corporation (HMC), Qatar. We hypothesised that a structured resident-led model would demonstrate scalable growth, sustained community engagement, and meaningful perceived benefit.

A three-year descriptive programme evaluation was conducted for the Leadership Sub-Committee of the Psychiatry Residency Training Program (Mental Health Awareness). The initiative delivered interactive educational sessions, stigma-reduction workshops, and skills-based mental health literacy training tailored to secondary school students and teachers, university students, youth summer programmes, and government-sector staff. Prospective process indicators included number of sessions delivered, annual delivery hours, and diversity of audience sectors. Qualitative narrative feedback from host organisations and participants was systematically collated following each activity. Iterative quality-improvement cycles were implemented to refine content, delivery approaches, and community partnerships.

Programme delivery expanded approximately six-fold over the evaluation period, with annual activity increasing from approximately 25 hours to 150 hours. Engagement evolved from opportunistic school-based sessions to a structured annual outreach calendarencompassing educational institutions, youth programmes, and governmental organisations. Inbound requests and repeat invitations increased consistently year-on-year, demonstrating sustained demand and stakeholder satisfaction. Qualitative feedback highlighted improved mental health literacy, increased willingness to seek professional help, stigma reduction, and practical benefit for educators and organisational staff. Host institutions emphasised cultural relevance, continuity of engagement, and the credibility of resident leadership as key strengths.

Embedding community mental health outreach within structured psychiatry residency leadership training can produce scalable, sustainable, and high-demand public mental health engagement. Progressive expansion in activity volume, diversification of target audiences, and consistently positive stakeholder feedback support institutionalisation and strategic resourcing of resident-led mental health awareness initiatives as a core public mental health function.

Pro re nata (PRN) medication is often used on mental health wards to manage agitation, restlessness and risky behaviours. It is important that these medicines are prescribed according to the guidelines and reviewed regularly to ensure patient safety. This audit aims to assess patterns of PRN medication use on mental health wards in Luton and Bedfordshire and to determine whether PRN medications are actively reviewed and discontinued when no longer required.

We retrospectively reviewed the case records of 25 randomly selected in-patients across General Adult, Old Age and CAMHS wards. Data were collected on patient demographics, diagnosis, legal status, PRN prescriptions, utilisation and administration practices.

The audit showed a high prevalence of PRN medication use, with 84% of patients reviewed prescribed PRN medication. Promethazine and lorazepam were the most frequently prescribed PRN medications, either alone or in combination.10 out of 21 patients were prescribed both promethazine and lorazepam.

There was noticeable variation in PRN utilisation with 6 out of 21 patients requiring frequent PRN administration (more than 20 doses since admission). PRN prescribing appeared appropriate to clinical presentation as approximately 84% of patients requiring higher-frequency PRN use had psychotic symptoms or emotionally unstable personality disorder.

PRN administration adhered to best practice guidance with oral medication regularly offered prior to IM administration.

Areas for improvement were identified: 5 out of 21 patients had PRN prescriptions that were no longer clinically indicated but remained active. PRN protocols were not consistently updated following changes in legal status for 2 patients.

• • Introduce regular PRN medication reviews during ward rounds and at defined intervals.

• • PRN medications that have not been used for a specified period should be reviewed and discontinued where clinically appropriate.

• • PRN protocols should be promptly reviewed and updated following any change in a patient’s legal status.

• • Patients requiring frequent PRN medication should receive a multidisciplinary review to explore underlying causes and consider alternative management strategies.

• • Improve documentation of PRN indications, review dates and clinical rationale to support safe prescribing.

Non-engagement in outpatient addiction services is frequently attributed to poor motivation or readiness to change. This evaluation aimed to examine demographic and service-level factors associated with non-attendance, and to test whether documented motivation predicted engagement.

A retrospective review of all new referrals to a UK outpatient addiction service over 12 months was undertaken (n=214). Demographic, clinical, and appointment data were analysed, including housing status, referral source, clinician continuity, and attendance. Patient feedback recorded during routine contacts was thematically reviewed.

Mean age was 41 years; 62% were male. Primary substances were alcohol (48%), opiates (27%), stimulants (15%), and polysubstance use (10%). Overall DNA rate was 29%, rising to 38% following initial assessment. Housing instability was associated with higher DNA rates (43% vs 23%). Clinician changes were associated with increased non-attendance (DNA 41% vs 24%). No association was found between documented motivation and attendance. Over half of those who initially disengaged (54%) re-presented within 6 months.

Non-engagement in outpatient addiction services is better understood as a dynamic interaction between patient circumstances and service design rather than a simple reflection of motivation. Interventions focused on continuity, flexible scheduling, and proactive follow-up may reduce disengagement more effectively than motivational approaches alone. Reframing non-engagement as a service-level challenge has importantimplications for engagement strategies, clinician attitudes, and outcome evaluation in addiction psychiatry.

Our aim is to evaluate the trust-wide adherence to NICE and Maudsley guidelines for baseline and follow-up prolactin monitoring in patients prescribed medium to high risk antipsychotic medications across inpatient and outpatient services of Surrey and Borders Partnership (SABP) NHS Foundation Trust. This re-audit was performed to complete the cycle by assessing the impact of trust-wide recommendations implemented following the initial 2021 SABP audit on prolactin monitoring.

Data were collected for inpatients admitted to working- and old-age wards across the trust during September 2025 (n=160), including those prescribed antipsychotics with medium to high risk of hyperprolactinaemia. Patients were categorised according to whetherthey were established on an antipsychotic prior to admission or initiated on a new antipsychotic during admission.

For patients already prescribed antipsychotics, electronic records were reviewed to determine whether serum prolactin levels had been measured within the preceding 12 months, including tests performed in community settings or during previous admissions. For patients commenced on a new antipsychotic during admission, compliance with baseline prolactin measurement prior to treatment initiation was assessed. Where elevated prolactin levels were identified, further data were collected to determine whether symptoms of hyperprolactinaemia had been assessed, whether appropriate management had been initiated, and whether repeat prolactin testing had been performed in line with guidance. Data were obtained retrospectively from electronic care records, SystmOne, and the ICE pathology system.

During September 2025, compliance with serum prolactin monitoring for patients prescribed medium- to high-risk antipsychotics was 100% both prior to admission and during inpatient initiation. This represents a substantial improvement from compliance rates of 47% and 43%, respectively, identified in the 2021 audit.

Of the 25 inpatients commenced on medium- to high-risk antipsychotics who had prolactin levels measured, 9 were found to have hyperprolactinaemia. Appropriate management was initiated in 4 of these cases, and repeat prolactin testing was performed in 3. Compared with the 2021 audit, this reflects an 11% improvement in appropriate management, alongside a 33% reduction in repeat prolactin testing.

This re-audit demonstrates a marked improvement in compliance with recommended prolactin monitoring, achieving full adherence to guidelines across inpatient services. However, despite improved detection, there remains a significant gap in the subsequent management of hyperprolactinaemia. These findings highlight the need for further quality improvement initiatives, including the introduction of a standardised management pathway, supported by electronic prompts and targeted clinician education, to ensure timely and consistent management of abnormal prolactin results.

Increasing evidence suggests that autobiographical memory exists on a continuum rather than a dichotomy of normal and abnormal. We present a case of lifelong deficiency of episodic autobiographical memory.

A 60-year-old military veteran was referred to a memory clinic with a lifelong difficulty in recalling personal life events across his lifespan, including childhood, military service, and later life. The lack of recall was more marked for remote memories. This concern came to attention following recent interpersonal conflicts, which triggered anxiety about possible dementia. Knowledge of his past was largely derived from factual information obtained from family and friends.

Cognitive assessment using the Addenbrooke’s Cognitive Examination yielded a score of 95/100. CT brain imaging revealed a foreign body, likely an air-gun pellet, beneath the right orbital socket, with no recollection of the associated incident. There were no functional impairments, behavioural changes, or affective symptoms. An autobiographical interview spanning multiple life stages demonstrated reliance on external semantic details to compensate for episodic recall. Qualitative indices of episodic richness, vividness, emotional salience, and temporal integration were markedly reduced, particularly for remote autobiographical memories.

Following discussion of possible supportive options, including psychological interventions, further support was declined. He expressed a preference for understanding his condition rather than altering his way of life.

This case illustrates a lifelong deficit in episodic autobiographical memory with preserved semantic memory and intact general cognition. Dementia was ruled out due to the lack of marked impairment in cognitive domains. The amnesia was selective for autobiographical episodic memory and extended across all life stages, making dissociative amnesia unlikely. There was no evidence of intrusive memories, avoidance, hyperarousal, or trauma-related symptomatology to suggest PTSD. A diagnosis of severely deficient autobiographical memory (SDAM) was therefore made.

SDAM refers to an inability to mentally re-experience personal events despite intact semantic learning and recall. First described in 2015, only a small number of cases have been reported to date, although it is presumed to be under-recognised in clinical practice. This case is notable for the diagnostic uncertainty it posed and for highlighting patient perspectives on engagement with treatment.

Severely deficient autobiographical memory illustrates the functional spectrum of autobiographical memory and challenges traditional categorical models. This case underscores interindividual differences in remembering the past, highlights the risk of misdiagnosis, and emphasises the need for greater clinical awareness and research into spectrum-based conceptualisations of autobiographical memory.

Olanzapine long-acting injection (OLAI) is prescribed as maintenance antipsychotic treatment within small established clinics in Southwark and Lambeth. Despite the association between long-acting antipsychotics use and reductions in the number of relapses and hospital admissions, and oral olanzapine being the most commonly prescribed antipsychotic, OLAI is the least commonly prescribed LAI. This is due to staff, space and funding resources needed for post-injection monitoring, a requirement unique to OLAI. In order to provide equitable access to evidence-based treatments like OLAI within the Trust, provision of OLAI must be expanded. This observational, non-interventional, retrospective study aims to measure a range of relevant outcomes in order to demonstrate the achievement of good treatment value.

25 patients were initiated on OLAI between January 2020 and January 2022 and were followed up for 2 years. Our main outcome measures are: continuation rates of OLAI over the 2 year follow-up period, and reasons for stopping, relapse rates (number of bed days and hospital admissions) 2 years before and after starting OLAI, adherence to physical health and side-effect monitoring, and physical health outcomes. A retrospective review of general clinical patient notes and OLAI clinic notes was conducted.

Out of the 21 patients included in analysis, the 2 year continuation rate was 42.9% (n=9). Within these 9 patients, there was a notable reduction in the mean number of bed days, and zero admissions during the 2 year follow-up period. The most common reasons for discontinuation were adverse effects, main one being weight gain, followed by post-injection monitoring. Physical health monitoring during the 2 year follow-up period was inconsistent, this may partly be due to the Covid-19 pandemic. Weight was most consistently measured, however blood test measures were done less frequently, and declined over time. For the 9 patients who were followed up for 2 years, weight increased by a mean of 7.42kg.

Whilst OLAI appears to have a very positive effect on the rate of relapse, especially with the reduction of admissions to zero, adverse effects and post-injection monitoring requirements may discourage patients from continuing. Next steps include embedding processes to ensure all physical health parameters are monitored, consider preventative measures against common adverse effects, and activities to improve acceptability of post-injection monitoring. By doing so, we can continue to promote patient safety as OLAI provision expands within the Trust. Co-authored with Dr Juliet Hurn, Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust.

Patients presenting to the Emergency Department (ED) with acute mental health concerns are referred to liaison/on-call psychiatry for assessment. A proportion of these patients leave ED before psychiatric review takes place. The HSE and National Clinical Programme for Self-Harm and Suicide-related Ideation (NCP-SHSI) emphasise that clear documentation and timely communication with primary care are essential to ensure continuity of care, even when psychiatric assessment is not completed. Given the clinical risks associated with acute mental health presentations, ensuring that GPs are informed when a patient leaves prior to psychiatric assessment is crucial for patient safety, follow-up planning and clinical governance.

Aimswere:

To evaluate compliance with the HSE and NCP-SHSI regarding GP communication for patients who leave ED prior to psychiatric assessment.

To analyse risks associated with lack of GP communication in this patient cohort.

To implement a risk treatment plan.

To re-evaluate compliance following implementation of the risk treatment plan.

All referrals to liaison/on-call psychiatry are recorded on the Siilo app. All referrals over a one month period were reviewed. Patients who left ED before psychiatric assessment were identified. Electronic patient records were reviewed to determine whether GP correspondence had been sent.

Risk identification, description and analysis were undertaken as per the HSE Enterprise Risk Management Policy and Procedures 2023.

Following implementation of a risk treatment plan, all referrals from ED over a two week period were reviewed.

A total of 167 psychiatry referrals from the ED were initially reviewed. Twenty patients left ED prior to psychiatric assessment. GP letters were sent for only 20% of these patients, compared with 57.8% of patients who completed assessment. Overall, GP correspondence was sent for 53.3% of ED presentations. When analysis was limited to patients with a registered GP, correspondence was sent in 60.1% of cases, leaving 39.9% without documented GP communication despite eligibility.

Using the HSE impact, likelihood, risk scoring and rating matrices, this lack of communication was identified as a medium risk.

Initial findings demonstrated a significant shortfall in GP correspondence, highlighting an area for quality improvement in continuity of care and communication with primary care services.

A risk treatment plan was created, involving education sessions for the liaison psychiatry NCHDs, CNSs and all psychiatry NCHDs on the local on-call rota.

Re-evaluation after implementation of risk treatment plan demonstrated significantly improved compliance. Ongoing monitoring is recommended to ensure the sustainability of quality improvement, particularly following periods of high staff turnover.

Antipsychotic medicines can cause QT prolongation, are pro-arrhythmogenic (specifically, they can increase the risk of torsade de pointes) and are linked to sudden cardiac death. The Maudsley prescribing guidelines advise patients being treated with antipsychotic medications should have an ECG both on admission and before discharge if their medication regime has changed. The aim of this audit was to establish current adherence to national guidance in the Acute Mental Health Inpatient Centre (AMHIC) in the Belfast Health and Social Care Trust (BHSCT).

The decision was made to collect data based on all the discharges from AMHIC. Data was retrospectively collected using the H&C numbers of the patients discharged in the entire month of December. The unit consists of 5 acute inpatient wards and in December there was a total of 42 discharges. Of these 42 patients, 8 were not on any antipsychotic medicines so they were discounted from the data set. A further 2 patients had no changes made to their antipsychotic during inpatient admission, so they were also not included. This left 34 patients on which to base the review. We collected information for 34 patients, including whether patients had an admission ECG, how long it took to get their admission ECG during admission and if this was being done in a ‘timely fashion’ (defined as within one week of admission for the purposes of this audit) and if patients got a discharge ECG.

100% of patients did not have a discharge ECG prior to them leaving hospital.

1. 20.59% (7/34) of the patients had no ECG completed during admission.

2. 50% (17/34) of patients did not have ECG completed within 7 days of admission to AMHIC.

Results suggest that recommended ECG monitoring for patients on antipsychotic medicines is not being completed consistently at ward level. This has helped to assess areas for improvement and to put together plans for future interventions for ensuring patient safety while on antipsychotic medications. Interventions are required to improve timely ECGs both at admission and discharge within the inpatient setting. We have arranged a teaching session during the monthly patient safety meeting to communicate our findings to our medical and nursing colleagues. We have made reminder posters for each ward nurses’ station and clinical room. We plan to address this issue by using the PDSA model for effective change management.

Objective structured clinical examination (OSCE) is a key method used widely in undergraduate medical education since 1975 to assess clinical competencies. While OSCEs have relatively high relatability, validity and objectivity, evidence shows that OSCEs are amongst the most anxiety provoking assessments. In psychiatry OSCEs, medical students often report limited understanding of examiner expectation of a competent performance, as an anxiety trigger.

Providing opportunities to medical students to assess OSCEs from an examiner perspective could help clarify expected performance standard, improve confidence and reduce OSCE-related stress.

The aim of this project was to develop video-based psychiatry OSCEs with accompanying marking rubric as a revision resource, that can be used by medical students to learn by observing and assessing performances from an examiner’s perspective.

Commonly examined psychiatry scenarios at undergraduate level were selected. Candidate instructions and actor briefs were written for each selected scenario.

OSCE stations were filmed using trained actors as patients and resident doctors at various grades of training who volunteered as candidates. Candidates performed unscripted consultations after reading the candidate instructions, replicating real OSCE conditions.

For each scenario, a structured marking rubric was developed. It was specifically designed for medical students who will use it to assess the OSCE candidates while observing the recorded performances. Whilst not identical to the official examination marking scheme, the marking rubric highlights specific skills and competencies students are assessed on for each scenario and the common pitfalls.

All scenarios, candidate instructions, actors' briefs, marking rubrics and videos that were created, underwent multiple rounds of peer review to ensure accuracy, user friendliness, educational value and alignment with Kent and Medway Medical School(KMMS) examination standards.

Ten psychiatry OSCE station videos with corresponding marking rubrics have been created. The marking rubrics are designed to facilitate self-directed learning with ease ofstudent use in mind. This resource offers a flexible, repeatable approach to OSCE preparation.

This collection of psychiatry OSCE videos and accompanying marking rubrics, have the potential to reduce assessment-related anxiety and improve OSCE performance. Furthermore, the added advantage of this resource is that it will be accessible to medical students who can utilise it at their own pace from any location.

Next steps include piloting the resource with third year KMMS medical students to evaluate educational impact.

This audit aimed to evaluate adherence to the Community Child and Adolescent Mental Health Services (CAMHS) Physical Health Standard Operating Procedure for monitoring patients prescribed antipsychotic medication within Centenary House CAMHS. The hypothesis was that recommended physical health monitoring would be incomplete for a substantial proportion of patients.

A retrospective service evaluation was conducted of all patients under medical care at Centenary House CAMHS who were prescribed antipsychotic medication during the audit period (n=13).

Electronic clinical records were reviewed using structured searches within the SystmOne electronic health record and ICE blood results system. Evidence of baseline physical health monitoring was sought; where baseline data were unavailable (for example, due to out-of-area initiation), monitoring within the preceding six months was assessed.

The parameters audited were appropriate blood tests for antipsychotic monitoring, electrocardiogram (ECG), height and weight, blood pressure and pulse, documented neurological examination for EPSEs, and allergy status. No patients meeting inclusion criteria were excluded.

This work was undertaken as a service evaluation audit with appropriate local approval and anonymisation of patient data.

Thirteen patients were identified; ten prescribed aripiprazole, two quetiapine and one risperidone. Documented compliance rates were 77% (10/13) for blood tests, 85% (11/13) for electrocardiogram, 62% (8/13) for height and weight, 62% (8/13) for blood pressure and heart rate, and 62% (8/13) for allergy status. No patient had a documented neurological examination for EPSEs. Only six patients had all required physical health parameters documented either at baseline or within the previous six months. Prolactin monitoring was absent in the single patient prescribed risperidone.

Physical health monitoring for children and young people prescribed antipsychotics within this community CAMHS was variable and frequently incomplete, particularly for neurological assessment and consistent documentation. Service improvements are required to standardise monitoring and improve patient safety.

Proposed next steps include

1. Implementation of electronic reminders

2. Introduction of a structured antipsychotic monitoring template

3. Targeted teaching for medical staff and

4. Planned re-audit within six to twelve months to assess improvement.

As per NHS Forth Valley Psychiatry Emergency plan 2023, any patient admitted to the mental health unit should have a senior review within 48 hours of admission, regardless of the day of the week. A senior review is defined as either a higher trainee, i.e. ST4-6, or a consultant psychiatrist. Previous audits have reviewed compliance of this in the years 2021 and 2022. The aim of this re-audit was to review the compliance of the 48-hour senior review policy between 2023 to 2025.

Electronic patient records of patients admitted to five mental health wards in Forth Valley Royal Hospital were reviewed to determine whether there was a clear documentation of senior review within 48 hours of admission, in line with the existing policy. This was done biannually for the duration between August 2022-- August 2025 in a retrospective manner.

In 2025, all wards achieved 100 percent compliance with 48 hour senior review policy. Overall average of compliance in duration from Aug 2022 - February 2023 was 97 percentage which increased to 100 percentage between August 2024 - August 2025. One ward which showed low compliance (78%) in the time period August 2022 - February 2023, demonstrated progressive improvement in the re-audit cycles in February 2024 (89%), August 2024 (90%) and further 100 % compliance in both audit cycles in 2025. Interestingly, the Intensive Psychiatric Care Unit, which has the most acutely unwell patients, had showed full compliance with the 48-hour policy in all audit cycles since 2021.

Sustained improvement in compliance to 48 hours senior review policy was demonstrated by this audit, with all wards achieving full compliance in2025. To improve quality of care, a new audit process is being planned for the introduction of a standardised senior review template. Additionally, discussions are ongoing within the trust to adopt a 24-hour senior review policy which is the standard practice in medical wards.

Autistic females are less likely to receive an autism diagnosis in childhood than autistic males. In recent years, increasing numbers of adults have come to identify as autistic prior to, or in the absence of, a formal diagnosis. While existing research has examined experiences of receiving an autism diagnosis in adulthood, comparatively little is known about how adults come to self-diagnose, the meanings they attach to this process, and how self-diagnosis shapes decisions about seeking formal assessment.

This qualitative study involved 30 female participants aged 18–43 who had, at some point, identified as autistic without holding a formal diagnosis. Participants took part in one-to-one, online, semi-structured interviews exploring their understandings of autism, pathways to self-diagnosis, perceived barriers and facilitators, attitudes towards both self- and professional diagnosis, and intentions regarding formal assessment. Interview transcripts were analysed using Framework Analysis.

Framework Analysis identified six interrelated themes.

First, participants described self-diagnosis as a prolonged sense-making process involving extensive reflection and information-seeking, challenging portrayals of self-diagnosis as impulsive or trend-driven.

Second, accounts reflected heterogeneous social representations of autism: older, male-centred stereotypes were frequently rejected, while gender differences were instead mapped onto alternative frameworks such as high–low functioning distinctions.

Third, self-diagnosis was commonly experienced as an “aha” moment of epistemic and affective clarity following extended uncertainty, countering social contagion narratives.

Fourth, an economy of legitimacy shaped participants’ experiences. Structural barriers to professional diagnosis, including gendered underdiagnosis and lengthy waiting lists, positioned self-diagnosis as a necessary substitute for institutional validation, while media discourses framing self-diagnosis as “trendy” or as social contagion undermined its credibility and generated self-doubt.

Fifth, participants adopted a reflexive stance towards self-diagnosis, emphasising its provisional status, distancing themselves from “frivolous” self-identification, and expressing ambivalence about the label; social media was viewed as both informative and epistemically suspect.

Finally, attitudes towards professional diagnosis were ambivalent: a strong desire for validation coexisted with fears of dismissal, misrecognition, or gendered misdiagnosis, shaped by material and emotional barriers and mediated by social relationships influencing disclosure and decisions about seeking assessment.

Self-diagnosis functions as a meaningful response to diagnostic exclusion rather than a trivial or trend-driven practice. Recognising its role has important implications for clinical practice, service access, and how autism is understood beyond traditional diagnostic pathways.