Effective handovers are crucial for patient safety and continuity of care in psychiatry. The Excel-based handover format used across three South Glasgow-linked hospitals (Dykebar, Leverndale and Inverclyde) frequently contained unresolved or outdated tasks, and did not clearly indicate urgency or ownership. Previous audits highlighted inefficiencies in this system, revealing an opportunity for innovation. We aimed to introduce a new Microsoft Teams handover, to improve clarity and efficiency and support safe on-call working across all three sites.

Between December 2024 and March 2025, feedback was collected from resident doctors across three South Glasgow psychiatric hospitals via anonymised Likert scale and free-text surveys, to explore their experiences with the Excel handover and openness towards trialling a new Teams format. The handover was created using Planner software, utilising tabsand columns to organise wards. Advice was sought from Information Governance regarding use of patient data, and subsequently implemented: the system was made private with closely managed access, and a retention period was applied via automated workflows to transfer completed tasks onto a private Excel sheet every three months, to be stored locally for audit trail. Clinical directors and residents received demonstrations and tutorials, and approved of the launch. The Teams system was implemented across all three sites in April 2025. Post-intervention feedback was collected in May 2025 to gauge opinions on the new handover; following this, the system remained in use and was later replicated at other Glasgow hospitals with our guidance on setup and workflow.

All eight participants in the preliminary survey indicated they found the Excel handover had become inefficient and unclear, and were interested in trialling the new system. Following launch of the Teams handover, all 15 respondents agreed it brought improved usability, clarity, and clinical efficiency. Comments acknowledged the clean interface and the ability to check tasks off, assign due-dates, and schedule repeating tasks ahead of time. Later in 2025, resident doctors in North Glasgow reached out and successfully adapted this project at Gartnavel and Stobhill hospitals, demonstrating positive change across multiple areas of the health board.

The findings provide evidence of improved satisfaction with the on-call handover since our introduction of the Teams interface. It is suggested that resident doctors value clarity and efficiency for smooth, safe team-working. The small sample size and single-region implementation limit generalisability, but feedback shows the project has brought a positive change to clinical work and has now been implemented at multiple hospitals.

To evaluate the impact of AI use on psychotherapy training for “core trainee” psychiatry residents. Psychotherapy training for residents includes theory-based teaching, courses, Balint groups, and completion of two psychotherapy cases across different modalities, all supervised by experienced psychotherapists. This includes anonymised case summaries, including a formulation.

A short questionnaire about AI use was sent to core training psychiatry residents working in CWPT via email, asking about their use of AI in psychotherapy training. The data is both quantitative and qualitative, summarising emerging themes. A similar survey was done for England-based psychotherapy tutors and is reported in a separate poster.

14 out of 32 residents completed the questionnaire. 85.7% of responders reported they don’t have experience of using AI in psychotherapy training or teaching. Those who used it reported using it for questions about psychotherapy, advice on how to discuss certain topics, and to “consolidate summaries and formulations” or “to write up sessions”.

When combining the “yes” and “maybe” responses, most residents supported using AI for teaching psychotherapy concepts, assisting with scribing, and producing formulations (57.14%, 71.42%, and 71.42%, respectively). 28.57% did not support the use of AI-assisted formulation.

28.57% of residents expressed concerns about confidentiality, 35.71% mentioned concerns about a “lack of contextual or emotional understanding” by AI. 14.28% had concerns about AI replacing therapists in the future or about inputting data into AI models, which could facilitate this. 14.28% mentioned that the responses generated can be inaccurate.

When asked about the “best use” of AI 42.85% listed explaining or breaking down concepts (teaching). 14.28% suggested its use for scribing.

Most respondents didn’t use AI in psychotherapy training or teaching. There is however significant support for its use for teaching, scribing and formulations. The residents expressed relevant concerns about the data protection and about AI lacking an in-depth understanding about emotions and context if being used in patient care.

A significant part of psychotherapy learning involves reflections about the sessions, facilitated by writing session summaries and supervision. The case formulation is a key part of the shared understanding, between resident, patient and the supervisor. AI being used to replace the process can negatively impact learning. Agreed guidance on best practice for the use of AI in psychotherapy training could assist residents in learning psychotherapy concepts and understanding potential pitfalls with AI use.

GAP is the largest psychiatric specialty, but most treatment evidence is generated in other populations, or excludes participants with severe conditions, comorbidities and treatment-resistance–essentially omitting most GAP inpatients. Consequently, the published evidence may have limited relevance.

Aimswere to characteriseGAP inpatients–diagnoses, severity, treatment-resistance, comorbidities, and legal status–to benchmark and inform the development of a framework to meta-analyse publications to test how accurately they reflect real-world practice.

We characterised consecutive admissions to a GAP ward using the measures usually employed in psychiatric publications. Data included demographics, Brief Psychiatric Rating Scale (BPRS), Inventory of Depressive Symptomatology (IDS-SR), Personality Disorder Severity (PDS-ICD-11), Generalised Anxiety Disorder scale (GAD-7), Substance Use scale (TAPS), and medical abnormalities and comorbidities.

N=65 (‘GAP-65’, 11 declined/could not be consented). Psychosis Group N=32: 60% treatment-resistant (clozapine protocol), severe psychosis (BPRS mean 58.2), very severe depression (IDS-SR mean 39.4), smoking, alcohol, and cardiometabolic disease frequent. Bipolar Mania Group N=5: Severe mania (YMRS mean 39.6), 60% obese, 50% hypertensive, and frequent metabolic abnormalities (DM II, prolactin elevation). Bipolar Depression Group N=2: All treatment-resistant (Massachusetts General Hospital Staging), 50% DM II and hypertensive. Unipolar Depression Group N=9: Very severe depression (IDS-SR mean 50.6), 57.1% treatment-resistant, 38% obese, 71% hypertensive, and high rates of cardiometabolic and respiratory illness. Axis II Group N=15: 80% PD, 93.3% suicidal ideation, physical comorbidities less common but mean BMI 30.2.

When these features are operationalised, an extremely low proportion of GAP inpatients would meet criteria for recruitment into even exemplars of contemporary academic psychiatry e.g. 1) translational neuroscience; Rupprechter et al., Brain (2020) (£4.7M, N=475)–92% participants were in the healthy or mild depression range and treatment-resistant patients were excluded c.f. GAP-65 who were all severely ill and mostly treatment-resistant. 2) treatment trials; Jog et al., JAMA Netw Open (2025) (highlighted by evidencealerts.com, including for clinical relevance)–participants were in the moderate depression range, treatment-resistant patients were excluded, and the reduction in depression scores following transcranial direct current stimulation would not move pertinent GAP-65 patients out of the severe range of illness.

Our results highlight a critical gap in psychiatric research: Studies that are highly cited and influential do not adequately represent the severity and complexity of typical GAP inpatients. Correspondingly, we propose a systematic review and meta-analysis of clinically important features of GAP inpatients to evaluate the extent to which psychiatric research represents real-world practice.

The aim of this auditis to assess the adequacy of on-call room facilities and their impact on resident doctors’ rest and recovery during shifts. It also sought to evaluate the challenges and safety risks associated with driving long distances during and after on-call duties.

Data were collected through direct observation and surveys completed by participating resident doctors. The audit assessed cleanliness, availability of rest facilities, access to kitchen and bathroom amenities, and perceived impact on fatigue and driving safety. Driving distances between the hospital and doctors’ homes were recorded and analysed. Surveys also explored how often doctors felt tired when driving after on-call shifts and their perceived ability to drive home safely. Data were collected from seven resident doctors covering shifts between 17 August 2024 and 20 September 2024.

The audit identified significant deficiencies in on-call room conditions. Rooms were frequently unclean, infested with insects, and lacked basic hygiene measures such as bed linen. Many rooms were used as day offices, limiting opportunities for rest. Additional issues included lack of water access in kitchen areas and poor lighting. These conditions were associated with increased fatigue and stress among resident doctors.

Driving analysis showed a total of 626.3 miles driven during recorded journeys, with 247.4 miles driven when returning home after on-call shifts. Survey responses indicated high levels of fatigue related to driving: doctors reported feeling occasionally tired on 6 shifts, frequently tired on 17 shifts, and very frequently tired on 15 shifts. Regarding the ability to drive home, responses were “Yes” for 18 shifts, “No” for 4 shifts, and “Maybe” for 16 shifts.

The findings underscore the need to enhance on-call room facilities to ensure adequate rest and mitigate fatigue-related risks. Improvements should align with BMA guidance, including provision of dedicated, hygienic rest areas that are not used for clinical work. Addressing long driving distances and post-shift commuting risks is also crucial to enhancing resident doctors’ safety and well-being.

Cultural psychiatry explores the impact of social and cultural context on mental health and illness. Given new urgency by global anti-racism campaigns, cultural psychiatry teaching has been increasingly prioritised in recent years. However, there is currently little evidence on how cultural psychiatry training is being implemented in practice. By comparing different approaches, this research provides guidance on the benefits and limitations of different formats for teaching cultural psychiatry.

Four case studies of UK teaching programmes are compared, selected to reflect national variation and diversity of approach. The case studies differ in audience, form andstructure; on whether they were online or in-person; on whether they were mandatory or informal; and in their use of resources.

All groups emphasised the importance of psychological safety when facilitating challenging conversations. Informal sessions were associated with more open conversations; limitations included variable attendance, inadequate organisational time, problems inviting external speakers, and difficulties creating a safe frame. Online spaces were more accessible; but with concerns around engagement, safety and the ability to challenge insensitive comments. Sessions with external speakers brought alternate perspectives, but needed careful management to avoid insensitivity. Consideration was given to whether race and ethnicity were prioritised over other elements of culture such as sexuality, gender, religion and class.

Bringing cultural psychiatry into the curriculum offers the potential to improve both patient care and clinician wellbeing. Lessons learned from these case studies can guide mental health and teaching organisations seeking to implement similar courses.

A community engagement programme can improve individuals’ mental health literacy and create awareness about mental health in communities. The conference aimed to reduce mental health stigma and improve mental health outcomes in the community.

The impact of the conference was mapped out by applying Theory of Change. They are input, which are resources including financial sponsorship and institutional support; expertise from leading psychiatrists in the UK, psychologists, researchers, practitioners, and individuals with lived experiences from a South Asian background. Keynotes were given by Professors Dinesh Bhugra, Nusrat Husain, and Subodh Dave. Engagement tools include a survey (N=42), sticky note messages (N=41), a data map, and a website (https://samhstigma.my.canva.site). Activities included 15 presentations, both in person and online. Outputs included hybrid delivery and participation (62 in-person, 13 online), recording of the conference, and a booklet with presenters’ profiles and a summary of their presentation.

Short-term outcomes include increased mental health literacy, awareness of the cultural dimension of stigma, attitudinal shift, and strengthened professional networking. Some medium-term outcomes included greater collaboration between institutions and the community, integration of lived experience voices into future research and practice, through ripple effects of awareness, increased help-seeking behaviour, and encouraging culturally sensitive approaches being adopted in clinical settings. Long-term outcomes included, at a personal, community, and institutional level, reducing stigma, access to mental health services improved for South Asians.

“Nothing About Us Without Us” can further strengthen the Theory of Change framework applied to the community engagement program. It aligns with the critical long-term impact, which is empowerment and inclusion. It makes community engagement more effective and relatable as it enhances credibility and authenticity. The principle suggests that people who are directly affected by an issue must be actively involved in making decisions, policies, and programmes about that particular issue. Bilateral learning is another principle that is integrated into the programme. It involves creating a two-way exchange of knowledge between the community and professionals, including psychiatrists, counselling therapists, advocates, and researchers. The community gains information about evidence-based strategies for mental health care.

In the future, community members can be included in co-designing the agenda for community engagement programmes. The conference format can further be made interactive by including a panel discussion where queries from the community are clarified by mentalhealth professionals, conducting a workshop on shared problem-solving, storytelling, and allocating time for questions and answers with people with lived experience, alongside reflections from the professionals.

To compare UK Assertive Outreach Teams (AOT) and Vancouver Assertive Community Treatment (ACT) with respect to core model components, multidisciplinary team (MDT) delivery, crisis response, safety management, and interagency working. The evaluation also aimed to identify shared principles and locally specific adaptations, including police integration within the Vancouver model.

A descriptive, comparative service evaluation was conducted using a structured side-by-side framework across predefined domains: service context, implementation/operation, staffing/roles, and distinctive operational features. A scoping review and targeted grey-literature review identified established ACT components and local descriptions of intensive/assertive community care, including NHS England guidance and published descriptions of the Vancouver ACT model. Data were extracted into a comparison matrix (population focus, MDT composition, contact intensity, crisis/safety processes, and interagency interfaces) and synthesised narratively to describe similarities and differences.

Both services reflect core ACT principles reported in the literature, including MDT-based delivery and intensive, community-based support for people with severe mental illness and complex needs. NHS England guidance describes intensive and assertive community mental health care as a distinct, high-support form of community provision, consistent with the aims of assertive/outreach-style models. A key difference is Vancouver ACT’s formal integration of law enforcement, with designated Vancouver Police Department officers embedded within the team to enable coordinated responses. This embedded-police element represents a distinct approach to crisis intervention and safety management compared with standard UK community configurations described in national guidance.

UK AOT-style services and Vancouver ACT share a common basis of MDT, high-intensity community care, but differ in how safety functions and interagency crisis working are structurally embedded. Further evaluation should compare outcomes (engagement, admissions, safety events, patient experience) and process measures (response times, multi-agency coordination) to determine benefits, risks, and acceptability across settings.

High Dose Antipsychotic Therapy (HDAT) is defined as prescribing a single antipsychotic above the British National Formulary (BNF) maximum or a combinedpercentage dose of two or more antipsychotics exceeding this limit.HDAT is off-label and associated with increased morbidity and mortality, requiring documented clinical justification and risk–benefit discussion.This audit evaluated HDAT prevalence, adherence to Trust monitoring standards and reported side effects among adults prescribed antipsychotics in inpatient and community settings.

A cross-sectional audit was conducted between May and August 2025 of adults aged 18–65 years receiving antipsychotic therapy.All patients in nine inpatient psychiatric wards and a random sample of patients from two Community Mental Health Teams and one Early Intervention in Psychosis service were audited.Prescription charts, clinic letters and medical records were reviewed to assess prescribing patterns, HDAT prevalence, compliance with Trust monitoring standards, patient demographics, psychiatric diagnosis, treatment duration, and medication side effects.

A total of 337 patients were audited (n=142 female, 42.1%; n=195 male, 57.9%), mean age 41 years. Most identified as White (76.9%), with 19.0% Black or Asian and 4.2% unknown ethnicity. The majority (72.7%) were prescribed at least one additional psychotropic medication and 18.1% reported side effects, predominantly extrapyramidal symptoms (52.5%), weight gain (24.6%), and sedation (23%).Thirteen patients (3.9%) met HDAT criteria, primarily in inpatient settings (n=11); mean age 43 years.Most were male (84.6%), White (92.3%) and diagnosed with schizophrenia (84.6%).Over half (69.2%) received two antipsychotics, whilst 30.7% were prescribed a single antipsychotic above BNF limits.HDAT monitoring was fully compliant in 38.5% of cases, partially in 23.0%, and incomplete in 30.8%.Fewer HDAT patients reported medication side effects (15.4%).In the overall, sample, 32.6% had received antipsychotic treatment for over 12 months, rising to 46.2%among those on HDAT.

HDAT was infrequent, largely confined to inpatient settings and typically associated with antipsychotic polypharmacy and co-administered psychotropics.White men were more likely to receive HDAT, despite a broadly balanced gender distribution overall. Frequent side effects, relatively young cohort and known risks of HDAT highlights the importance of adherence to Trust monitoring standards, which was achieved in fewer than half of cases. The low rate of side effects among patients receiving HDAT likely reflects under-recognition or under-reporting rather than true tolerability, particularly in the context of polypharmacy and long-term treatment.These findings support the need for targeted clinician education and improved systems to promote safer HDAT practice.

Anorexia nervosa (AN) is associated with high morbidity and mortality and significant barriers to recovery, including food-related anxiety and avoidance behaviours. Virtual reality (VR) interventions offer immersive, safe exposure to feared stimuli and may enhance engagement with treatment. The OASIS feasibility study aimed to evaluate the acceptability, feasibility, and preliminary effectiveness of a VR-based, AI-personalized adjunct to treatment as usual (TAU) in adults with AN.

This is a single-site feasibility study conducted at South London and Maudsley NHS Foundation Trust (SLaM). Up to 45 adults with AN from inpatient, day-care, and outpatient services will participate in a one-week VR intervention alongside TAU. The OASIS app, delivered via Pico 4 headset, will provide personalized sessions including psychoeducation, graded food exposure, motivational support from a virtual companion, and relaxation exercises. Primary outcomes will include recruitment, adherence, retention, and acceptability. Secondary outcomes will include anxiety, relaxation, BMI, and qualitative feedback from focus groups with patients, carers, and clinicians. Data will be analysed descriptively, and thematic analysis will be applied to qualitative data.

The OASIS study will provide evidence on the feasibility and acceptability of a VR-based intervention for adults with AN and will inform the design of a future randomized controlled trial. Insights from patient, carer, and clinician feedback will guide refinement of the intervention and identify barriers and facilitators to implementation in routine clinical care.

To assess the effectiveness of the STOMP pathway in supporting the reduction of psychotropic medication prescribing among people with learning disabilities.

Adults with learning disabilities under the care of the Community Learning Disability Team who were prescribed one or more psychotropic medications were considered. Reviewed data from January 2024 to April 2025 and sources included Electronic health records, STOMP review templates, MDT notes. There were 30 participants in the sample.

The audit demonstrated a high level of compliance across most criteria relating to psychotropic medication use. Documentation of the clinical rationale for psychotropic useachieved full compliance (100%). Medication reviews within the previous 12 months were completed for the majority of individuals (93%). Non-pharmacological interventions were documented in 87% of cases, indicating good but not universal adherence. Evidence of involvement of the person and/or their carer in decision-making was present in 90% of records. However, documentation of attempted or completed reduction in psychotropic medication was comparatively lower (70%), highlighting an area for potential improvement.

The audit shows that the STOMP pathway has had a positive impact on reducing unnecessary psychotropic prescribing in people with learning disabilities. Continued focus on structured reviews, non-drug alternatives, and stakeholder involvement will help sustain this progress.

To assess how many patients were seen within the 15 working days from referral to first appointment within North Leeds OPS CMHT in line with LYPFT guidance and whether electronic documentation and letter to GP were completed in a timely manner. A re-audit was completed after interventions were implemented to assess the effectiveness of these. The interventions implemented were: including resident doctors in the gatekeeping assessment rota; reminder of need to document reasons for delay in assessment in referrals meeting or subsequent contacts and implementing a record of patients not accepted for follow up after assessment with reminders to be sent to assessing staff of need to complete letter within 2 weeks by administration team.

A review of all referrals to North Leeds OPS CMHT was completed from August to October 2024 and subsequently from August to October 2025. Each patient’s notes were reviewed to extract the outcome of referral. If accepted for assessment; referral date, first appointment date, date of electronic documentation and date of letter to GP sent were extracted. The time intervals between referral and each outcome were subsequently calculated utilising microsoft excel.

For the 2024 cycle the following results were found: 80 referrals were received with 30 referrals accepted for assessment; 70% were seen within 15 working days; 33% had reason for delay documented; all had electronic documentation; 73% had electronic documentation within 24 hours; 87% had letters to GP sent and 33% had GP letter sent within 2 weeks.

For the 2025 cycle the following results were found: 100 referrals were received with 39 referrals accepted for assessment; 87% were seen within 15 working days; 40% had reason for delay documented; 97% had electronic documentation; 61% had electronic documentation within 24 hours; 79% had letters to GP sent and 41% had a GP letter sent within 2 weeks.

Despite an increase in service demands there was an improvement in the number of patients seen within 15 working days with this now sitting above the trust set standard of 80% demonstrating the impact of inclusion of more MDT members for gatekeeping assessments. There were mixed results with regards to timeliness of documentation, this was likely a result of interventions being implemented at a time of greater service pressure resulting in prioritisation of direct patient care above documentation.

To reduce the time resident doctors spend requesting blood tests on an acute psychiatric inpatient ward by introducing pre-printed patient identification (ID) stickers.

Baseline timings for routine hand-written blood requests were recorded on an acute male inpatient psychiatric unit in Leeds. Using a fish bone analysis, root causes of inefficiency were identified. A PDSA cycle tested the intervention: ward administrators printed 2 pages of patient ID stickers for all new admissions which were then stored in the MDT room for use on blood request forms and bottles. A one-point lesson and step-by-step guide were distributed to all resident doctors and displayed in the doctor's office to support sustainability during staff rotation.

Mean time to request routine blood tests decreased from 7 minutes on average to 2.3 minutes after introducing patient stickers–an approximate 67% reduction–saving 3 hours 15 minutes per month across 28 routine requests on just 1 acute inpatient ward. Informal feedback indicated improved efficiency and a reduction in errors on request forms after introducing the ID labels. The process has been adopted locally and presented at the Adult Acute Inpatient Clinical Improvement Forum, where colleagues supported trust-wide roll-out.

Pre-printed patient ID stickers reduced time and errors in blood requesting on an acute psychiatric ward. The intervention is low cost, sustainable and suitable for scaling across inpatient services.

In England, access to acute psychiatric care is increasingly affected by limited inpatient capacity, which can lead to lengthy waits in emergency departments. Emergency departments often become the default place of care for patients in acute mental health crisis while awaiting psychiatric assessment or admission. This creates strain for clinicians delivering emergency mental health care, particularly out of hours, and can lead to uncertainty and moral distress. For patients, these friction points occur when they are most unwell, shaping their experiences of care at times of acute distress and vulnerability.

We aim to explore and compare potential routes of access into acute psychiatric care across England and Germany. We are using a narrative service-mapping approach, focusing on the patient journey and the experience of psychiatry trainees, who are often responsible for out-of-hours assessment and decision making. We are hoping to stimulate reflection, discussion and generate learning across different but comparable systems.

We undertook a comparative narrative service-mapping exercise based on a hypothetical patient presenting in acute mental health crisis. Using the same clinical scenario, we mapped likely pathways through community, emergency and inpatient psychiatric settings in England and Germany. Mapping was informed by clinicians’ experience of working within these systems. We worked with middle-grade and higher trainee psychiatrists involved in delivering acute and out-of-hours care in these three countries. The exercise focuses on access routes, transitions between services and areas of system pressure. Narrative elements are used to reflect how these pathways may be experienced by both the patient and the clinician providing care.

Across both systems, difficulties accessing care and fragmented transitions between services, were identified as sources of distress for patients and pressure for clinicians. Emergency departments emerged as settings of prolonged waiting. Differences were noted in routes to admission, gatekeeping processes and alternatives to inpatient care. These structural features shape doctors experience, including responsibility for decision-making under pressure, risk management and exposure to moral distress.

This comparative narrative mapping highlights how the organisation of acute psychiatric services influences patient journeys and clinician experience. By foregrounding experience and reflective clinical narratives, this work aims to support discussion about shared challenges, system pressures, and potential learning across European systems. This work reflects the perspective of clinicians, using a hypothetical scenario. It is not intended to represent all patient experiences or to provide quantitative comparison between systems.

To improve compliance with Trust and NICE guidance requiring completion of venous thromboembolism (VTE) risk assessments within 24 hours of admission for adult psychiatric inpatients.

Baseline data were collected in May, 2025 from 20 inpatients to assess timeliness and documentation of VTE risk assessments following admission. Electronic records (RiO and NerveCentre) were reviewed to determine whether assessments were completed within 24 hours and whether reasons for delay were documented.

Following baseline measurement, a series of targeted quality improvement interventions were introduced. These included ward poster reminders, education during handovers and MDT meetings, VTE training incorporated into resident doctor inductions, routine MDT review of VTE status, addition of a VTE column to doctors’ handover sheets, ward-specific completion protocols, and reinforcement of documentation standards.

Post-intervention data were then collected retrospectively in November 2025 for 13 inpatients admitted after implementation of these measures. The same outcome measures were analysed to assess improvement.

Overall VTE assessment completion was 100% at both baseline and post-intervention. Timely completion within 24 hours improved from 50% (10/20) at baseline to 84.6% (11/13) post-intervention. Delayed assessments decreased from 50% to 15.4%. Documentation of reasons for delay improved from 20% to 100%. Mean time to assessment reduced substantially from 36 hours to 11.6 hours. Documented reasons for delay included patient refusal and the patient being asleep at the time of assessment.

Targeted, low-cost quality improvement interventions led to marked improvement in the timeliness and documentation of VTE risk assessments in an adult psychiatric inpatient ward. Although the NICE target of >95% completion within 24 hours has not yet been achieved, substantial progress was demonstrated. Sustained education, system prompts, and MDT oversight are expected to support further improvement and enhance patient safety.

Graves disease (GD) is an autoimmune thyroid disease and is the most common cause of hyperthyroidism in developed countries. Research suggests that patients with GD experience high levels of anxiety and depression. Until recently, this increased prevalence hasbeen attributed largely to Graves-induced hyperthyroidism, however even after achieving euthyroidism, many patients continue to suffer from neuropsychiatric symptoms. This suggests that the mood symptoms present in these individuals may be associated with the autoimmune inflammatory processes underlying GD. This relationship has yet to be fully understood, highlighting the need for an evaluation of the current literature. This systematic review aimed to assess the prevalence of anxiety and depression in GD patients and to identify associated risk factors.

The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024611942). EMBASE, MEDLINE, PsycINFO and the Cochrane Library were searched up to 31 October 2024. Papers were included providing the participants were diagnosed with GD and satisfied the diagnostic criteria for anxiety, depression or both; or provided symptomatology measures. Studies were quality assessed using Hawker’s tool. 29 studies were included and underwent data extraction. Studies using a case-control design were summarised separately.

Symptoms of anxiety and depression were consistently higher in the GD group versus healthy controls. GD patients displayed a higher baseline degree of anxiety and depression, compared with patients with other causes of hyperthyroidism. Depression and anxiety were more prevalent in relapsed hyperthyroid GD patients, compared with remitted euthyroid GD patients. Risk factors included body mass index (BMI), physical activity, gender, stress and smoking. A limitation of the review was the high study heterogeneity resulting from the variety of study designs included.

These findings highlight a population that may benefit from early psychiatric assessment. The higher prevalence of anxiety and depression observed in GD patients, including those who are euthyroid, reflects the complex interplay between autoimmune, endocrine and psychological processes underpinning the relationship between GD and mental health conditions. This pattern emphasises the need for a multidisciplinary, integrated and holistic approach when managing and treating GD patients. Future research establishing the mechanisms responsible for this increased prevalence could facilitate the development of targeted interventions and preventative treatments.

Funding: None.

Psychiatric conditions can impair fitness to drive, and clinicians have a professional duty to provide and document appropriate advice in accordance with DVLA guidance. This quality improvement project (QIP) aimed to evaluate adherence to DVLA guidelines regarding the provision of documented driving advice to patients with psychiatric conditions under the Home Treatment Team (HTT), firstly as a baseline measurement, and after meaningful intervention. Identifying disparities in compliance across different diagnosis, sex and age, to enhance patient’s safety and clinical practice.

An initial retrospective review of HTT electronic patient records was conducted over three months (June–August 2024) for a total of 86 patients. Variables collected included primary psychiatric diagnosis, age, sex and whether DVLA driving advice was documented as given. Standards were based on DVLA guidance “Assessing fitness to drive: a guide for medical professionals”. Following baseline measurement, a multi-strategy intervention package was implemented: (1) Multi-Disciplinary Team (MDT) checklist prompt to ensure driving status and advice were considered and recorded during the MDT, (2) Patient information leaflet summarising DVLA advice, (3) Presentation of initial findings at Learning-From-Excellent meeting, and (4) Staff education leaflet and teaching highlighting the clinical and medico-legal importance of driving advice. A second retrospective audit cycle was completed using identical methodology over four months (January–April 2025) for a total of 93 patients, again evaluating documentation of DVLA guidance being given.

Baseline documentation of driving advice was present in 25/86 records (29.1%), with 61/86 (70.9%) illustrating no documented driving advice. Following our intervention, documentation improved to 76/93 records (81.7%), with 17/93 (18.3%) lacking documentation, showing an absolute improvement of +52.6%.

In the second cycle (n=93), 59 records related to female patients and 34 to male patients. Driving advice was applicable in 54/93 cases (36 female; 18 male). Where applicable, documented advice was provided in 29/36 female cases (80.6%) and 14/18 male cases (77.8%), demonstrating comparable adherence across sexes. Among those given advice, the most common age group was 40–60 years for both females (12/29; 41.4%) and males (7/14; 50.0%).

This two-cycle QIP demonstrated substantial improvement in adherence to DVLA guidance documentation within HTT, increasing from 29% to 82% following low-cost meaningful interventions embedded into MDT workflow and staff education. Post-intervention data revealed similar compliance across sexes, with most documented advice delivered to patients aged 40–60 years. Future work should assess the quality of driving advice given and strategies to support consistent practice.

Opioid substitution therapy (OST) with methadone or buprenorphine is a cornerstone of treatment for opioid use disorder, with urine toxicology screening routinely used to monitor adherence and detect illicit opioid use. Unexpected positive opioid results can lead to clinical confusion, unnecessary dose adjustments, and potential strain on the therapeutic alliance. Dietary sources, particularly poppy seed–containing foods such as muffins, bagels, or pastries, have been reported to cause transient, false-positive opioid urine screens due to the morphine and codeine content of the seeds.

Despite being well-documented in pharmacology literature, awareness of this phenomenon in clinical addiction psychiatry remains limited, and it may lead to unnecessary interventions or patient distress. This case series aims to describe instances of poppy seed–induced false-positive opioid screens in patients receiving OST, highlight the clinical impact, and provide practical guidance for recognizing and managing this rare but important interaction.

Three adult OST patients (aged 28–45)–two on methadone, one on buprenorphine–were identified after routine urine toxicology unexpectedly tested positive for opiates (negative for 6-MAM). All had stable adherence, no illicit opioid use, and no recent dose changes.

History revealed recent consumption of poppy seed–containing baked goods: two muffins and one bagel. No other medications, supplements, or substances were reported. Patients were counseled, and repeat testing 48–72 hours later was negative for opioids, confirming dietary exposure. No withdrawal, overdose, or adverse events occurred, and OST adherence remained unchanged.

These cases illustrate a clinically important but under-recognized phenomenon: dietary intake of poppy seed–containing foods can produce transient false-positive opioid results in patients receiving OST. All three patients demonstrated positive urine screens despite stable adherence, no illicit opioid use, and absence of clinical signs of relapse. The temporal association with poppy seed consumption, together with resolution on repeat testing, supports the conclusion that dietary exposure was responsible.

False-positive opioid screens can have significant clinical implications, including unnecessary treatment adjustments, increased monitoring, or erosion of trust between patients and clinicians. Detailed dietary histories, patient counseling, and repeat testing when unexpected results occur can help distinguish between true non-adherence and food-related effects.

Poppy seed consumption can cause transient false-positive opioid urine screens in patients receiving opioid substitution therapy, potentially leading to clinical confusion and unnecessary interventions. Clinicians should consider dietary sources when interpreting unexpected opioid results, take detailed dietary histories, and provide patient education.

Schizophrenia affects 0.43% of global adults, with an estimated annual excess economic burden of $343.2 billion in the United States alone. The schizophrenia drug ecosystem is characterized by significant heterogeneity in patient responses, warranting continual drug discovery efforts to improve outcomes for patients responding suboptimally to existing treatments. Given the centrality of dopamine D2 receptor (DRD2) antagonism in current treatments, this study focused on (i) identifying strong DRD2 binders among Food and Drug Administration (FDA)-approved drugs as repurposing candidates and (ii) generating optimized variants of known antipsychotics as novel drug candidates.

We developed a computational drug discovery pipeline to score potential drug candidates based on DRD2 receptor binding affinity. Molecular docking scores were calculated by dockstring, a Python wrapper for AutoDock Vina, that automatically finds the best binding pose and returns its binding affinity to the receptor. Virtual screening was performed on:

1. ∼1,600 FDA-approved drugs, with emphasis placed on central nervous system-active drugs known to permeate the blood-brain barrier.

2. 450 variant ligands of six reference antipsychotics (haloperidol, trifluoperazine, fluphenazine, chlorpromazine, thioridazine, and risperidone), generated using SwissSimilarity.

A molecular weight threshold of 500 Da was applied to exclude large ligands, consistent with Lipinski’s Rule of 5 for oral bioavailability. Candidates achieving high binding affinity (≤-9.5 kcal/mol) were further evaluated against existing literature.

Among FDA-approved drugs, risperidone achieved the lowest docking score and therefore the best binding affinity (-11.9 kcal/mol), validating our pipeline by recapitulating a known antipsychotic. Several candidates with high predicted binding affinities (≤-9.5 kcal/mol) were identified, with two of particular interest:

• • Dolasetron. Other serotonin 5-HT3 receptor antagonists, especially ondansetron, have improved schizophrenic symptoms in previous studies, making this a promising line of investigation.

• • Trazodone. A population-based cohort study published last year offered evidence that trazodone reduced risk of re-hospitalisation for delirium in older patients as compared to other antipsychotics.

Ligand optimization yielded 4 distinct molecules with superior binding affinities relative to their parent compounds. The best-performing variant achieved -13.6 kcal/mol (risperidone-derived), while the largest improvement was observed for thioridazine (-12.7 kcal/mol versus -8.5 kcal/mol original).

An automated DRD2-focused docking workflow can recover known antipsychotics, surface plausible repurposing candidates, and propose optimized variants with improved predicted binding. While these computational hits require further ADMET analysis and experimental validation before strong conclusions are drawn about clinical potential, our results demonstrate the potential utility of computational drug discovery methods in expanding therapeutic options for schizophrenia.

Maladaptive daydreaming (MD) is a pattern of immersive and emotionally charged daydreaming that can significantly interfere with an individual’s social functioning and daily activities. MD is not formally recognised as a mental disorder in the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM–5–TR). This study aimed to determine the prevalence of MD and attention-deficit/hyperactivity disorder (ADHD) among medical students, identify the association of the two conditions, and assess the impact of socio-demographic factors.

A cross-sectional analytical study was conducted among medical students enrolled at the University of Rwanda and the University of Medical Sciences and Technology, with participants primarily residing in Rwanda, Tanzania, and other countries. Respondents were classified into two groups–maladaptive daydreamers (MDers) and non-maladaptive daydreamers (non-MDers)–based on the 16-item Maladaptive Daydreaming Scale (MDS-16). Data were collected using validated paper-based and online Google Forms self-administered questionnaires (MDS-16 and Adult ADHD Self-Report Scale [ASRS-v1.1]). Ethical approval was obtained, and data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.

Our study included 584 respondents (52.9% male, 47.1% female) with a mean age of 21.6 ± 1.7 years. The prevalence of probable MD was 22.9%, while ADHD was reported in 21.4% of participants. Among students with MD, 48% screened positive for ADHD,compared with 16.2% who did not meet criteria for ADHD. Both MD and ADHD were significantly associated with poor academic performance (p <0.003 and p <0.001, respectively). Using logistic regression, there was a strong positive correlation between MD and ADHD (p <0.001; R²=0.168).

MD and ADHD show a significant positive relationship, and their co-occurrence is associated with a measurable decline in academic performance as perceived by the participants. These findings underscore the need for early screening strategies, the provision of counselling and psycho-educational support for affected students. Future longitudinal and randomised studies are warranted to establish standardised diagnostic criteria and therapeutic guidelines for MD and to differentiate it from related attentional and behavioural disorders across diverse populations.