High-Dose Antipsychotic Therapy (HDAT) is associated with increased risk of adverse physical health outcomes and requires robust monitoring in line with Royal College of Psychiatrists (RCPsych) guidance and local Trust policy. This audit aimed to:

1. Assess compliance with Sussex Partnership NHS Foundation Trust (SPFT) HDAT physical health monitoring policy.

2. Assess compliance with theRCPsychconsensus statement on HDAT monitoring.

3. Identify patterns of antipsychotic polypharmacy within a community rehabilitation cohort.

A cross-sectional audit was conducted in December 2025 within the East Sussex Rehabilitation Pathway (ESRP), part of SPFT. The cohort included adults aged 18–65 receiving care from a community rehabilitation team in Eastbourne. Medication records were reviewed, and the antipsychotic high-dose calculator was used to identify patients prescribed HDAT in accordance with BNF criteria. Data were collected from electronic patient records (Carenotes) and HDAT monitoring forms. Variables included diagnosis, ethnicity, number of antipsychotics prescribed, and completion of recommended HDAT monitoring (blood tests, ECG, weight/physical observations, GASS side-effect scale, and HDAT documentation).

Eleven patients met criteria for HDAT, representing approximately 18% of the rehabilitation caseload. The majority were White British (64%).

Paranoid schizophrenia was the most common diagnosis (64%), followed by schizo affective disorder (27%) and persistent delusional disorder (9%). Most patients (73%) were prescribed two antipsychotics, while 27% were prescribed three, indicating a high prevalence of antipsychotic polypharmacy.

Compliance with HDAT monitoring was variable: blood tests and weight/physical observations were completed in 45% of patients, ECGs in 27%, GASS was offered in 27%, and HDAT documentation was fully up to date in 36% of cases.

HDAT use within this community rehabilitation cohort was relatively common and largely driven by antipsychotic polypharmacy in patients with severe and enduring psychotic illness. Monitoring compliance was inconsistent and fell short of RCPsych and local policy standards. These findings highlight the need for improved identification of HDAT, better utilisation of monitoring tools, and strengthened multidisciplinary oversight to ensure safe, high-quality care. Findings were presented to the multidisciplinary team, and an action plan for improvement was formulated, with re-audit planned in six months.

The aim of this clinical audit was to evaluate adherence to national guidelines and standards for antipsychotic prescription monitoring in children and young person attending CAMHS Devon, identifying areas for improvement and ensure that they receive safe and effective treatment. It was a re-audit of clinical audits that was done between June 2019 and February 2020 [3]. We aim to provide the various clinical indications and diagnoses for prescribing the antipsychotics, as well as to evaluate the quality of care and the standard of monitoring of antipsychotic prescribing. Our objective was to improve the quality of care and physical health monitoring of children and young person who are prescribed antipsychotic medications. This will contribute to ensure that children and young person receiving antipsychotic medications receive safe, high quality and effective care

This audit was registered with DPT NHS trust clinical improvement team in September 2024 after attending a drop-in session with them for guidance and necessary support. Our evidence-based standards were POMH-UK audit of 2010 and 2012, CAMHS audit, 2019 and NICE guidelines. This was a retrospective re-audit looking at the records of all children and adolescents under the care of the entire Devon CAMHS teams currently prescribed antipsychotic medications.

We screened the records of all the caseloads [N=743 cases] that were opened to the 24 clinicians/prescribers working across the 3 CAMHS teams in CFHD, looking through their clinical notes on the electronic records [SystmOne and archives of carenotes]. We subsequently selected cases [n=74] of children and adolescents who met our inclusion criteria of been prescribed antipsychotic medications within the period of interest, July 2023 to August 2024. The data collected were similar [with slight modification] to the previous audits and this was compiled and analysed using Microsoft excel. The data was collected in this way in order to make it easy for comparisons.

• • Demographic details.

• • Psychiatric diagnoses.

• • Information about other clinical indications.

• • Information about antipsychotics and other medications currently prescribed.

• • Information about physical health screening and side effect monitoring.

• • Information about medication review.

Comparisons were also made between the data from this audit and the previous ones POMH 2010, 2012 and Devon Audit, 2019.

We found a good standard of practice in terms of adequate documentation of the clinical indications and reasons for prescribing antipsychotic medications for about 10% [n-74] of children and young person attending our service. Regarding mental health diagnoses, off licence prescriptions and targeting specific symptoms, 65% [n-48] of cases prescribed antipsychotics had confirmed diagnosis of ASD and about 10% had ICD 10 diagnosis F20-29. About 59% of the prescriptions and oversight were done and under the supervision of consultant Child and Adolescent Psychiatrists. Aripiprazole was the most prescribed antipsychotic in 35% of cases and Melatonin in 46% of other medications prescribed. Evidence of physical health screenings were documented in almost 91% of those on antipsychotic medications. The most common side effects reported were weight gain [12%], tiredness [7%] and elevated Prolactin level in [3%]. There was no documented evidence of formal assessment of extrapyramidal side effect in all the cases and in 9% of cases there was no evidence of at least one physical health checks within the period of audit. All the identified 74 cases had medication review and there was no use of typical antipsychotic or polypharmacy prescription, which would be considered as a safe prescribing practice.

The selection of antipsychotics for children and adolescents should include an evaluation of their individual therapeutic benefits, safety profiles and an approval status as per national formulary for use in this population.

An Emergency Detention Certificate (EDC) can be issued by any registered medical practitioner in Scotland. An EDC authorises detention of a person with a likely mental disorder in hospital for up to 72 hours. The granting of an EDC poses significant restrictions on a patient’s liberty and rights. It is therefore crucial that the completion of EDCs meet both sufficient clinical and legal requirements.

The aim of this quality improvement project is to systematically evaluate EDCs issued across 2 sites in NHS Lanarkshire over a defined time period to identify any areas for improvement. Ultimately, we aim to improve compliance with completion of EDCs in line with the principles of the Mental Health Act.

EDCs across NHS Lanarkshire in a 6-month period were obtained. A standardised scoring system was devised to evaluate each EDC against a minimum criteria. The standardised scoring system utilised by the three reviewers generated a total score of 28, with a higher score reflecting a higher quality of EDC completion.

Data regarding the practitioner who completed the EDC and if Mental Health Officer consent was sought was also obtained.

A total of 125 EDCs were identified. 8 EDCs utilised the incorrect form and so were excluded. 117 EDCs were reviewed. We found a range of scores from 16 to 28. The average score was 23.

EDCs were completed by doctors from a range of settings. 51.3% of EDCs were completed by psychiatry resident doctors or psychiatry consultants, 11.1% by GPs and 37.6% by resident doctors in medical wards. The average score for EDCs completed by doctors working in psychiatry was higher at 24.2. EDCs completed by doctors working in medical wards and by GPs scored 22.1 and 20.2 respectively. 35% of EDCs completed had MHO consent. Of the EDCs that had MHO consent, 53.6% EDCs were placed by doctors working in psychiatry.

Completion of EDCs remains suboptimal and there is still work to be done in improving the quality of EDC completion. EDCs are generally completed to a higher standard by doctors working in psychiatry which may be due to a range of factors includingteaching on EDC completion and regular informal feedback. MHO consenting to the granting of an EDC continues to remain low at 35%.

This quality improvement project highlights the need for teaching and education tools as anintervention to improve the standard of completion of EDCs.

Over 90% of patients with depression report troublesome sleep-wake disturbances, and patients with depression are more likely to have comorbid sleep disorders such as insomnia. They also display small but significant deficits in a variety of cognitive domains, and both sleep and cognitive problems can persist into remission. Sleep disturbances also adversely affect cognition, however due to heterogeneity of methods and results in the extant literature, further research is required to assess how sleep disturbances affect cognition in depression.

Forty participants aged 18–65 with unipolar depression and 40 gender- and age-matched controls were recruited to this naturalistic observational study. Baseline measures of mood and sleep were completed, and participants then wore a triaxial accelerometer (actigraph) and completed a sleep diary. At the second study visit 14 days later participants completed a battery of neuropsychological tasks, including the Psychomotor Vigilance (PVT), Continuous Performance (CPT), Digit Symbol Substitution (DSST), and Trail-Making-Test (TMT).

Following exclusions, 34 participants in each group were included in the final analysis. In the depression group the average age was 49.5, 53% were female, and 94% White British Ethnicity. 44.1% were diagnosed with comorbid disorders (e.g. anxiety) and were prescribed a median 2 psychotropic medications. Eight patients were not currently depressed as assessed by the Hamilton Depression Rating Scale. The depression group were significantly more likely to report insomnia symptoms than controls, and although there was no difference in the average hours of night-time sleep (depression=6.39, control=6.69), the depression group had a significantly lower Sleep Regularity Index and more nights of short sleep (depression=6, control=4). There were no significant group differences between the primary outcomes PVT and CPT, however the depression group demonstrated significantly slower DSST and TMT-A performance. There were few significant correlations between sleep and cognitive variables, with the strongest observed between insomnia symptoms and slower DSST performance. Multiple regression analyses showed that insomnia symptoms, but not actigraph-measured hours of sleep, moderated the relationship between depression symptoms and PVT performance.

In this study, participants with depression reported significantly more insomnia, and had a less regular sleep schedule than controls. There were no group differences on the primary outcome sustained attention tasks, but the depression group demonstrated significantly slower psychomotor processing. The relationship between depression symptoms and sustained attention was moderated by insomnia symptoms but not average hours of sleep.

Recreational ketamine use and treatment-seeking for associated complications is increasing in England. Complications of ketamine dependence can be debilitating, leading to continued dependence and surgical intervention. However, treatment remains under-researched, with lacking understanding of those seeking treatment or requiring specialist inpatient detoxification. This study aims to analyse demographic and clinical characteristics of an inpatient ketamine detoxification population in the north of England between January 2016 and September 2025, with the aim to inform public health strategies and aid prevention efforts.

This retrospective cross-sectional study was conducted using routinely collected clinical data for patients that attended for ketamine detoxification at the Chapman Barker Unit (CBU), a regional specialist inpatient detoxification treatment service in Greater Manchester, UK. Patients were identified using clinical logbooks and the Patient Registration and Information System (PaRIS). The primary analysis included 59 patients admitted for ketamine detoxification. Comparative analyses were conducted between the ketamine-only detoxification patients (n=23) and the ketamine plus polysubstance detoxification patients (n=36) to explore the relationship between ketamine dose and physical harms.

Ketamine detoxification admissions increased between 2016 and 2025. One third occurred between January and August 2025. Most patients were male, younger, WhiteBritish, heterosexual, single and unemployed with traumatic experiences and criminal justice involvement. Mean age of ketamine use was 18 years with 5.2 years of usage. Most inhaled ketamine, and mean daily usage was 5.4g, with higher dose in those experiencing lower urinary tract symptoms. Anxiety, depression, suicidal ideation and past suicide attempts were common, along with concerning urological pathologies in particular ketamine bladder syndrome, cystitis, nasal damage and hydronephrosis. Cravings and anxiety were common withdrawal symptoms. Alanine transaminase (ALT) levels increased from admission to discharge. Ketamine-only detoxification patients were more likely to be single, use higher ketamine doses, inhale ketamine, experience depression, have ketamine bladder syndrome and hydronephrosis. PTSD was more prevalent in polysubstance patients. Diazepam reducing regimes were the standard detoxification approach. Most patients completed detoxification.

Ketamine detoxification admissions are increasing, with a predominantly young population with prolonged high-dose ketamine usage, associated urological pathology and hepatic injury. Specialist inpatient detoxification is successful, and further evidence-based treatment and relapse prevention protocols are required. Targeted public health campaigns should raise awareness of the physical, psychological and social harms associated with ketamine dependence.

Outcomes in schizophrenia vary widely, with a possibility of recovery. Besides symptomatic improvement, functional improvement is a key component of recovery and is a robust outcome indicator in patients with schizophrenia. Improvement in function leads to better self-esteem and quality of life. National Institute for Health and Care Excellence (NICE) guideline CG178 directs providers to document the daytime activities and occupational outcomes for patients with schizophrenia, thus assessing how they are functioning. This work was intended to assess and analyse the documentation of functionality in this patient population during routine clinical appointments.

This was a clinical audit. Data was collected from digital patient care records including clinic letters. A predesigned questionnaire was utilised for the assessment and documentation of the psychosocial and occupational functioning of 30 consecutive patients with schizophrenia. Each patient had been attending community mental health team clinics for at least one year.

The average age of the sample was 46.0 ± 11.5 years (range 21-67). The mean duration of illness was 15.3 ± 9.8 years (range: 1-42), suggesting that most patients had chronic illness. The cohort included 20 (66.7%) male and 10 (33.3%) female patients, from a range of ethnic backgrounds: 36.7% Caucasians, 26.7% Asians, 20.0% Afro-Caribbean, and others. In routine clinical practice, the assessment and documentation of variables indicating the functional status of patients with schizophrenia were extremely varied and, overall, appeared inadequate. There were no specific scales used to assess patient functioning. Most of the patients had functional impairments in various domains including work, leisure activities, relationships, activities of daily living, and social interaction. However, there were examples of productive engagement with paid and unpaid work in a few patients. Various factors that might contribute to functional impairment were observed, such as physical and mental comorbidities, disabilities, substance misuse, educational underachievement, adverse living conditions and social isolation. In addition, lack of interest in work and refusal to seek employment support were also noted.

Despite available interventions and support, functional impairments in multiple domains continue to impact patients with schizophrenia. There is a need to assess and record the functioning of these patients routinely during clinical interactions. Use of structured and validated metrics may be helpful. In addition to symptomatic improvement, the functionality of the patients is an appropriate indicator of the effectiveness of treatment and degree of therapeutic benefit. Functionality can therefore be used as an outcome measure.

To improve induction to medical seclusion reviews (MSRs) for Resident Doctors (RDs) rotating into psychiatry in Derbyshire Healthcare NHS Foundation Trust (DHCFT).

Concerns were previously raised by rotating RDs in DHCFT regarding induction to seclusion and feeling unprepared for leading MSRs. Seclusion, as restrictive practice with potential large impacts on our patients, is closely audited both nationally and locally as per the Mental Health Act Code of Practice. Many RDs are not psychiatry trainees and are therefore unfamiliar with the process. Nursing staff within the trust had also reported concerns regarding safety awareness of RDs during MSRs particularly soon after newly rotating into the trust.

We developed a video of a mock scenario encompassing all aspects of a MSR including timing and structure of reviews based on both local guidelines and the Mental Health Act Code of Practice. This video was recorded within a seclusion suite to demonstrate the layout. This was shown to current RDs 3 months into their rotation. A survey wascompleted on previous experience of seclusion, confidence of completing seclusion reviews, whether had been previously inducted on seclusion and preparedness to complete MSRs prior to viewing the video. Results were compared with a follow-up survey after viewing the video assessing its impact.

Of the 29 respondents to the initial survey; 79% (n=23) reported having no previous induction to seclusion. Respondents were a mixture of Foundation Doctors, GP trainees, Psychiatric Core trainees and Psychiatric Higher Specialty trainees. Mean confidence completing seclusion reviews was 2.66/5. 93% (n=27) of respondents stated they were not prepared enough to complete a MSR after induction. 22 reponses were received to the follow-up survey. Mean confidence completing seclusion reviews increased to 4.23/5. 100% of respondents stated a video on seclusion in induction would be helpful.

This video has demonstrated a novel, relevant and sustainable approach to delivering induction for RDs surrounding a unique aspect of psychiatry which had previously been insufficient in preparing newly rotating RDs for completing seclusion reviews. This video is being further shared with East Midlands School of Psychiatry so that it can contribute to shared learning across other trusts within the region.

Clinic letters are a key method of communication between secondary mental health services, primary care, and patients. However, traditional psychiatry clinic letters are often lengthy, clinician-centred, and difficult for readers to quickly identify key information and actions. This sits at odds with national priorities emphasising patient-centred care, shared decision-making, and improved collaboration across healthcare interfaces.

Informal feedback within our service suggested that existing clinic letters lacked clarity and accessibility for both general practitioners (GPs) and patients.

This quality improvement project aimed to design and implement a structured, patient-addressed clinic letter template and to evaluate its impact on satisfaction with letter length, layout, ease of understanding, and content among GPs and patients.

A structured clinic letter template was developed through multidisciplinary discussion, informed by best-practice guidance and principles of patient-centred communication. Key features included clear headings, concise language, explicit action points, and written directly to the patient, with GPs copied into correspondence.

GP satisfaction with clinic letters was assessed before and after implementation using a brief feedback survey. Respondents rated satisfaction with letter length, layout, ease of understanding, and content as satisfied, neutral, or dissatisfied. Following implementation, patient feedback was also collected, as patients did not routinely receive clinic letters prior to this project.

GP satisfaction was assessed pre- and post-intervention (n=6 pre; n=8 post); patient feedback was collected post-intervention (n=12).

Following implementation of the structured clinic letter template:

• • GP satisfaction withletter lengthincreased from17% to 100%.

• • GP satisfaction withletter clarityincreased from50% to 100%.

• • GP satisfaction withletter contentincreased from33% to 87%(neutral responses reduced from 50% to 0%).

• • GP satisfaction withlayoutincreased from17% to 88%(neutral responses reduced from 50% to 0%).

Patient feedback demonstrated 100% satisfactionwith letter length, clarity, content, and layout.

Routine sharing of clinic letters with patients represented an additional improvement post-intervention, improving transparency and patient involvement.

Implementation of a structured, patient-addressed clinic letter template led to substantial improvements in GP and patient satisfaction with letter length, clarity, content and layout. This project demonstrates how simple, low-resource changes to written communication can support patient-centred care and improve collaboration across the primary–secondary care interface, aligning with national strategic priorities for mental health services.

To investigate the personality profiles of heroin addicts in Pakistan using the Eysenck Personality Questionnaire (EPQ) and to explore how personality traits such as extraversion, neuroticism, and psychoticism relate to substance abuse within the sociocultural and economic context of the region.

A cross-sectional study in Islamabad (May 2023–May 2024) assessed 300 heroin-dependent individuals (sample size calculated using the WHO calculator), aged 18–60, in rehabilitation centres. Participants were selected using purposive sampling to meet study criteria. The Eysenck Personality Questionnaire measured extraversion, neuroticism, and psychoticism. Data were collected via self-administered questionnaires andanalysed in SPSS v29; Chi-squared tests determined significance (p < 0.05). Ethical approval was obtained from the institutional review board of Islamabad Medical and Dental College, and all participants provided informed consent.

Data was collected from 300 participants aged 18–60. Overall, heroin addicts had a mean extraversion score of 12.4 (SD = 4.8; range 5–20), neuroticism 17.6 (SD = 5.2; range 7–25), and psychoticism 8.3 (SD = 3.9; range 2–15), indicating average sociability, high emotional instability, and moderate aggression.

Age group differences were significant: the 18–30 group had the highest scores for extraversion (13.2), neuroticism (18.4), and psychoticism (9.1), followed by 31–45 (11.5, 17.0, 8.0) and ≥46 (11.0, 16.8, 7.5) (p = 0.02–0.04). Addiction duration was inversely related to scores: participants with <1 year of addiction scored highest (extraversion 13.5,neuroticism 19.0, psychoticism 9.5), 1–5 years scored moderately (12.0, 17.8, 8.3), and >5 years scored lowest (11.2, 16.5, 7.8) (p = 0.01–0.03).

Gender differences were not statistically significant: males had mean scores of 12.5, 17.5, and 8.4; females had 12.0, 18.0, and 8.0 for extraversion, neuroticism, and psychoticism, respectively (p > 0.05).

Heroin addicts in Pakistan exhibit high neuroticism and moderate extraversion and psychoticism, with younger individuals and those with shorter addiction duration showing higher trait levels. These findings underscore the need for personalized interventions, such as CBT, DBT, peer support, and medication-assisted treatment, to address emotional instability and improve recovery outcomes. Policymakers should prioritize individualized treatment strategies and support further research to enhance rehabilitation effectiveness.

The DVLA (Driver and Vehicle Licensing Agency) rules require patients with psychiatric diagnoses such as psychosis, mania, or depression to stop driving and/or notify the DVLA. Despite this, patients are often discharged without being informed of these legal responsibilities. There was no standardised approach within our trust to ensure this guidance was communicated clearly and consistently.

This project aimed to improve the communication of DVLA driving restrictions to psychiatric inpatients being discharged on medications or with a diagnosis that may impair fitness to drive.

We created clear, patient-friendly DVLA information leaflets, covering psychosis, mania/hypomania, and depression, based directly on the latest DVLA guidance. These were uploaded to the Trust resource page. A prompt was also added to the electronic discharge summary to remind clinicians to check that the relevant guidance has been provided.

The leaflets provided a simple, visible solution that improved staff confidence in advising patients. Feedback from members of the team highlighted that easy access to up-to-date, printable resources removed uncertainty around DVLA requirements. Discharge summaries more frequently included DVLA advice, and patients were consistently provided with relevant written information.

Introducing guidance leaflets within the trust enabled a sustainable, straightforward solution to a long-standing gap in discharge communication. This project improved DVLA compliance, patient safety, clinician confidence, and could be easily replicated across other wards and trusts. We plan to expand this project to other mental health services, such as the Crisis Resolution and Home Treatment Team (CRHTT). This will include adapting the existing leaflets to suit community and crisis settings, ensuring patients consistently receive appropriate DVLA advice across all points of care.

Adult patients are expected to understand, retain, weigh and use information to make a decision about their illness. When patients refuse recommended medical investigations, clinicians have a clinical, ethical, and legal responsibility to assess and record decision-making capacity. Failure to do so may compromise patient safety and expose clinicians and organisations to medico-legal risk. This quality improvement project aimed to assess whether decision-making capacity assessments were documented when psychiatric patients declined standard admission investigations, which included physical examinations, electrocardiograms (ECGs), and blood tests.

A cross-sectional audit was conducted involving 18 adult patients admitted over the audit period. Data was collected retrospectively from clinical records and reviewed to determine patient acceptance or refusal of admission investigations and whether decision-making capacity assessment was documented at the time of refusal. Patients who accepted all investigations were included to provide context for overall practice, with focused analysis on those who refused one or more components of physical examination, ECG, or blood tests.

13 of the 18 patients agreed to all admission investigations. Five patients refused at least one component of the recommended investigations. Among these five patients, there was no documented evidence of a decision-making capacity assessment at the time of refusal, resulting in a 0% documentation rate. This result revealed a significant gap between expected standards of care and current clinical practices. The absence of recorded capacity assessments raises concerns regarding informed refusal, patient autonomy, and medico-legal accountability. Possible contributory factors include time pressures in acute settings, limited clinician awareness of documentation requirements, and the absence of structured prompts within clinical documentation systems.

This audit demonstrated inadequate documentation of capacity assessments when patients refused admission investigations. Targeted quality improvement interventions are required such as, improving clinician education on capacity assessments, documentation practices, incorporation of capacity prompts into admission proformas, and re-audit to assessimprovement. Strengthening documentation of capacity assessments will support ethical clinical decision-making, safeguard patient autonomy and reduce medico-legal risk.

Sodium Valproate is widely used in the treatment of epilepsy and is also commonly prescribed for psychiatric disorders, particularly Bipolar Disorder. Enuresis associated with sodium valproate has been reported in paediatric populations with epilepsy, and in a case report involving a paediatric patient with Bipolar Disorder. However, data in the adult psychiatric population remains limited.

This is a case report of a 20 year old gentleman diagnosed with Unspecified nonorganic psychosis. He had a four month psychiatric admission with first episode psychosis, which included 2 months in Psychiatric Intensive Care Unit (PICU). He was initially started on Olanzapine, which was titrated up to 20mg per day, however there was no response. Due to significant aggression, Sodium Valproate was introduced and increased up to 2500mg nocte. Due to lack of response with Olanzapine, antipsychotic medication was initially changed to Haloperidol during which he developed oculogyric crises which necessitated dose reduction. Due to persisting psychotic symptoms, it was changed to Zuclopenthixol. At discharge, he was on Zuclopenthixol depot 350mg every two weeks, Sodium Valproate 2500mg nocte and Procyclidine 5mg three times a day.

During follow up in the community by the Early Intervention Service, he was noted to have extrapyramidal side effects due to which the dose of Zuclopenthixol was reduced and Procyclidine was increased. He also reported nocturnal enuresis every night. There were no other urinary symptoms, and he had not had urinary incontinence or enuresis in the past. Initially, the dose of Sodium Valproate was split to 1000mg in the morning and 1500mg at night with a view to reduce nocturnal sedation, however the symptom persisted. The dose of Sodium Valproate was then reduced to 1000mg twice a day after which nocturnal enuresis resolved completely. During subsequent follow-ups, the dose of Sodium Valproate was reduced further, with a plan to gradually reduce and stop it in the long term. He remained free of psychotic symptoms during the period of follow up, without recurrence of enuresis.

The onset on nocturnal enuresis following initiation of Sodium Valproate, and resolution following dose reduction suggests a possible association between the two. This is in accordance with previous reports indicating enuresis as a dose related side effect of Sodium Valproate.

Nocturnal enuresis is a potentially under recognised side effect of Sodium Valproate. Clinicians should screen for this adverse effect as it may significantly impact quality of life and treatment adherence.

Resident doctor handbooks are a key system-level resource supporting safe, effective working and trainee induction. Within Lancashire and South Cumbria NHS Foundation Trust (LSCFT), variation was identified between the East and Central psychiatry locality handbooks, reflecting differences in site coverage and resulting in gaps in essential information. This inconsistency risked inefficiency, uncertainty, and increased anxiety for new starters. The aim of this quality improvement project was to improve the consistency, accessibility, and reliability of resident doctor information by identifying and addressing variation in handbook content and standardising guidance across the East and Central localities.

A baseline comparison of the East and Central resident doctor handbooks was undertaken to identify missing content, inconsistencies, and areas lacking sufficient detail. Content was reviewed against key trainee domains, including emergency management, risk and legal processes, physical health responsibilities, and routine ward duties. Identified gaps informed a structured programme of handbook revision. Iterative updates were discussed with the Central locality educational lead and reviewed with the consultant body at consultant meetings and within monthly college tutor meetings. Finalised content was reviewed with the East locality educational lead to validate accuracy and ensure parity across both handbooks.

The intervention resulted in a standardised handbook structure and improved content parity across the East and Central localities. Previously missing sections were added to the Central handbook, new clinically relevant sections were introduced to both handbooks, and existing sections were expanded to improve clarity and usability. Updates focused on psychiatric and medical emergencies, management of acute disturbance, risk and legalprocesses, physical health assessment, and practical ward guidance. Positive feedback was received from educational leads in both localities and from the consultant body, alongside informal positive trainee feedback regarding clarity and usability. The revised handbooks were distributed to new starters in August 2025, with planned redistribution to subsequent cohorts in February 2026.

This quality improvement project successfully addressed unwarranted variation in resident doctor handbook content across two psychiatry localities through standardisation and educational lead(s) co-production. Improving the consistency and accessibility of trainee information supports safer working, enhances trainee experience, and reduces uncertainty for new starters. Future work will include extending the intervention to the North locality, incorporating additional clinically relevant content such as venous thromboembolism assessment guidance, and ensuring parity across specialty-specific handbooks, including learning disability and forensic services.

Background

Women admitted to Psychiatric Intensive Care Units (PICU) frequently present with complex trauma histories, emotional dysregulation and heightened sensitivity to coercion, confinement and interpersonal authority. While restrictive boundaries may be required to maintain safety, poorly implemented or inflexible restrictions risk re-traumatisation, escalation of distress and disruption of therapeutic engagement. There is limited literature exploring how boundary implementation itself influences safety and engagement for women in PICU.

Aim

To explore how boundary-related clinical decisions influenced safety, emotional regulation and engagement in women admitted to PICU, and to identify gender-sensitive, trauma-informed approaches perceived by clinicians as helpful in practice.

Methods

A qualitative service evaluation using reflective thematic analysis was undertaken involving three anonymised female PICU admissions detained under the Mental Health Act. Cases were purposively selected to illustrate differing trajectories following boundary implementation: escalation, de-escalation and neutral outcomes. Data were derived from contemporaneous clinical documentation and multidisciplinary team reflections. The evaluation aimed to generate practice-based learning rather than generalisable outcomes.

Direct service-user interviews were not conducted to avoid placing additional demands on patients during acute admission. Findings reflect clinician interpretations of observed patterns of response to boundary setting.

Results

Three key patterns emerged:

Collaborative and relational boundary setting was associated with reduced agitation and improved engagement.

Blanket or rigid restrictions were more frequently linked with trauma re-experiencing, protest behaviours and escalation.

Necessary restrictive interventions, when poorly communicated, negatively affected dignity and delayed therapeutic re-engagement, even when clinically justified.

Gender-sensitive negotiation, preservation of autonomy where safe, and compassionate communication appeared clinically impactful.

Discussion

The findings suggest that in female PICU populations, how boundaries are enacted may be as influential as what restrictions are applied. Trauma-informed, collaborative approaches may mitigate escalation while maintaining safety. A reflective boundary-decision framework is proposed to support proportionality, transparency and restoration of autonomy.

Conclusion

Boundary implementation in female PICU settings has important implications for safety, emotional regulation and therapeutic alliance. Gender-sensitive, trauma-informed boundary practices may support safer care and improved engagement. Future work should incorporate co-produced evaluation and service-user perspectives to strengthen the evidence base.

The aim of the QIP is to reduce the average time between patient discharge and discharge summary completion from the current baseline (10–15 days) to within 7 days post discharge for more than 70% of discharges on Norman and Betts Ward.

We tried to achieve this by ensuring resident doctors have protected time to complete discharge summaries, providing a structured and standardized discharge summary template to improve consistency, and raising awareness among staff regarding the importance of timely discharge documentation to enhance communication with GPs and Community Mental Health Teams.

Baseline data were collected retrospectively between March and June 2025 on the Norman and April and July on Betts acute inpatient psychiatric wards, measuring the timebetween patient discharge and discharge summary completion. Post intervention data were collected prospectively over five months following the introduction of protected time for resident doctors.

An intervention was implemented to improve discharge planning, including protected time for resident doctors dedicated to discharge summaries, and a standardised discharge summary template.

The intervention began in July 2025 on Norman Ward and in August 2025 on Betts Ward, with data collected prospectively as the changes were implemented. The primary outcome measured was the proportion of discharge summaries completed within 7 days of patient discharge. Secondary outcomes included mean completion time of discharge summaries.

Data were analysed using SPSS with appropriate comparative tests. Informal staff feedback was collected to assess acceptability. The project was registered with Oxleas NHS Foundation Trust.

During the post-intervention period, a total of 95 patients were discharged from both wards. Both wards demonstrated a significant reduction in discharge summary completion times. Mean completion time decreased from 11.3 to 3.7 days on Norman Ward and from 15.4 to 6.2 days on Betts Ward. Mann–Whitney U test showed a statistically significant reduction in completion time for both wards (p <0.001).

Post intervention, 80% of discharge summaries on Norman Ward and 66% on Betts Ward were completed within 7 days, compared with 31% across both wards at baseline, demonstrating a marked overall improvement.

After the intervention discharge summary completion times significantlyreduced and increased the proportion completed within 7 days. The intervention is feasible, effective, and sustainable, with plans to initiate protected discharge summary time as routine practice and handover processes to future doctors to maintain continuity and patient safety.

To improve access to menopause healthcare for women with intellectual disabilities (ID) by August 2026 in Oxleas NHS Foundation Trust, by providing education and person-centred services. Objectives were for 90% of clinicians to feel confident in identifying menopause symptoms; perimenopause screening tool implementation; and development of menopause groups for patients and carers with attendees improving by at least one point using Likert scales.

Gynaecologist-led teaching on perimenopause and menopause in women with ID was delivered to Greenwich Learning Disability Team.

A baseline audit established perimenopause screening of women aged over 40 at psychiatric assessments in Greenwich Learning Disability Team. The Greene Climacteric Scale was developed into an easy-read perimenopause screening tool following Plan–Do–Study–Act (PDSA) methodology with patient and clinician collaboration. This tool and a prompt on the Psychiatry assessment template were implemented.

Menopause Groups were developed for women with ID, carers and relatives, using PDSA cycles with patient feedback. Groups addressed physical and emotional symptoms of perimenopause and menopause, treatment options and coping strategies, over three 1.5-hour weekly workshops. Practical activities included menstrual pads, flash cards and mindfulness alongside sharing of experiences.

31 clinicians attended menopause teaching and 100% deemed menopause as relevant to clinical practice with knowledge of perimenopause/menopause in PwID increasing from 9% to 70%. Confidence in discussing symptoms with patients increased from 57% to 80% and awareness of services increased from 17% to 90%. Thematic analysis revealed barriers included embarrassment, lack of knowledge, diagnostic overshadowing and poor patient understanding.

Of the 7 eligible patients from the baseline audit, none were screened for perimenopause, menopause or menstruation status between August 2024–August 2025.

6 patients and 6 carers attended the Greenwich Menopause Group. On a 3-point Likert Scale, all patients improved by >1 point. Knowledge of symptoms increased from 50% to 100% and confidence in getting help increased from 67% to 100%. On a 5-point Likert Scale, carers’knowledge increased from 4.3 to 4.8. Confidence in talking to their patients increased from 4.5 to 4.8. Patients enjoyed visual demonstrations and wellbeing activities, and carers appreciated open discussions and easy-read materials. Multi-disciplinary facilitators felt it was a rewarding and valuable initiative.

Menopause groups, screening and upskilling staff to support women with ID to navigate the menopause has improved the quality of patient care. Collaboration and dissemination of interventions across South East London and North London ID services, Primary Care and Mencap is ongoing to widen access.

To improve awareness, confidence, and engagement in research among psychiatry trainees. Our SMART aim was that by August 2026, at least 75% of trainees would report moderate or higher confidence in research on post-intervention Likert scale questionnaires.

Baseline data were collected using questionnaires distributed to Core (CT1–CT3) and Higher (ST4–ST6) trainees. Measures included awareness of research contacts, understanding of ARCP requirements, current involvement in research, and self-rated confidence. A fishbone analysis identified key barriers across people, process, workload, communication, training, and organisational domains. Stakeholders included Training Programme Directors, research-active consultants, Trust R&D teams, and academic partners. Interventions were designed using QI methodology and driver diagrams.

Interest in research was high across all trainees. However, core trainees demonstrated low awareness of research contacts, processes, and ARCP requirements, with limited active involvement. Higher trainees reported greater awareness and participation but continued to identify barriers including lack of time, mentorship, and clear guidance. Confidence scores were low–moderate in core trainees and moderate in higher trainees.

There is a clear gap between trainee interest in research and actual engagement. System-level interventions focusing on awareness, mentorship, and access to opportunities are expected to improve research confidence and participation. This project aims to foster a sustainable research culture within psychiatry training and support trainees in meeting curriculum and ARCP requirements.

The Medical Education Tariffs paid to healthcare providers to cover the costs of hosting and training medical students on clinical placements are not a direct payment for teaching quality, but a contribution to provider costs. In England, the 2024/25 allocations were set at £34,355 per medical student. Trusts are required to submit annual accountabilityreports to regulatory bodies on the use of this funding. However, accessing these reports or obtaining clarity on their content is very challenging and the quality assurance provided remains poor.

We sent a Freedom of Information request to all the mental health trusts and health boards in the UK and Northern Ireland in December 2025 to explore their management of the undergraduate medical education funding and their adherence to reporting tools in place.

The overall response rate was 89% from 70 trusts and health boards across the four nations that offer psychiatric placements to medical students.

England 87% response.

Wales 100% response.

Scotland 85% response.

Northern Ireland 80% response.

Ringfencing of funding specifically for psychiatric undergraduate education happens in 27% of responders across Scotland, Wales and Northern Ireland and 82% of responders in England.

Specific records on the use of funding are kept in 59% of responders across Scotland, Wales and Northern Ireland and 77% responders in England, but less than 5% were able to provide a full breakdown of costs.

Employment of Clinical teaching fellows was the most consistent use of the funds across the four nations.

Reporting tools are used by 90% of responders in Scotland, Wales and Northern Ireland and 69% of responders in England.

Reports are available for public viewing in just 23% responders in Scotland, Wales and Northern Ireland and 10% of responders in England.

There was significant variation in the use and monitoring of funds between the four nations. All providers need to fulfil their statutory obligation to provide detailed reports to the designated regulatory bodies on their management of the undergraduate education tariff. Effective, transparent management of the education budget is crucial to support the development of the future health workforce as discussed in the NHS 10-year plan. The College Undergraduate Education Forum is setting up a working group to develop guidance on the use of tariffs and will continue to encourage transparency and clarity on the process.

Strangulation is the commonest method of suicide for both males and females, accounting for 56.6% of completed suicide in England and Wales in 2024. The inpatient mental health setting is a high-risk period for suicide attempts and completed suicide. A mental health admission should offer service users a contained environment where potential risks are well managed. However, there is no formal teaching to core psychiatry trainee doctors at East London NHS Foundation Trust regarding managing ligature emergencies on the mental health wards. Therefore the aim of this project was to improve confidence of resident doctors in managing ligature emergencies on inpatient mental health wards.

A 1-hour teaching session on managing ligature emergencies was given to core trainee psychiatry doctors during their weekly teaching afternoon, which included theoretical teaching and a clinical simulation. This was run on three occasions across two sites at East London Foundation Trust. A pre- and post-session questionnaire usinga 5-point Likert scale: 1 (Not confident) to 5 (Completely confident) was formulated and provided to core traineepsychiatry doctors (n=20) to assess confidence across three domains of strangulation management: (1) removing a ligature, (2) an A to E assessment of a person who has tied a ligature and (3) recognising the red flags after a ligature. The self-perceived competence score was calculated as a percentage for each domain.

On average, scores improved by 2.33 (domain 1), 1.3 (domain 2) and 1.58 (domain 3). When we categorised into binary ‘Not confident’ (scores 1–3) and ‘Confident’ (scores 4–5) there was an improvement in confidence by 66.25% in domain 1, 49.6% in domain 2 and 83.75% in domain 3. The improvement between these categories was statistically significant with a p value of <0.05. Only one person had received any prior training regarding ligatures.

This simulation resulted in doctors’ confidence improving significantly in all three domains. This pilot project demonstrates there is a gap in training for doctors and that peer-lead simulation is an effective way to address this. This project is live and we are continuing to complete more cycles of data. With each cycle, we are refining the teaching and the simulation based on the feedback. We aim to integrate the strangulation teaching session into the resident doctor’s induction across all sites, with the plan for regional rollout in the future.