1. To synthesize fragmented evidence: The study seeks to bring together diverse research from community, hospital, and caregiver-focused studies to create a unified understanding of schizophrenia in Africa.

2. To guide clinical practice and service delivery: The study aims to provide evidence-based insights that help develop culturally appropriate healthcare and support services.

3. To evaluate research methodology and design: The review aims to examine how studies are conducted, focusing on study designs, diagnostic criteria (such as ICD–10 or DSM), and analytical approaches used across the continent.

4. To identify gaps in current literature: The study aims to highlight areas where evidence is lacking–specifically regarding interventional studies, caregiver burden, and long-term psychosocial outcomes.

5. To inform international policy and practice: The study aims to draw lessons for global mental health strategies, including care for African diaspora communities in high-income settings such as the UK.

We conducted a systematic review of observational and interventional studies on schizophrenia in Africa. Searches covered PubMed, Embase, PsycINFO, African Journals Online, and Web of Science (terms: “schizophrenia” AND “Africa” with no language restrictions). All studies provided were included, and overlapping cohorts were explicitly flagged but retained. Data were extracted using standardized tables aligned with PRISMA and MMAT-compatible reporting. Extracted variables included study design, setting, population characteristics, diagnostic criteria, data collection, and analytical approach.

A total of 24 studies (1987–2025) from East, West, Southern, and North Africa were included. Study designs comprised longitudinal cohorts (n=5), cross-sectional surveys (n=14), mixed-methods studies (n=1), and randomized or dyadic trials (n=4). Diagnosticapproaches varied, most commonly CIDI/SCAN, ICD–10, or DSM criteria. Community-based cohorts were concentrated in Ethiopia, while hospital-based studies dominated West and Southern Africa. Evidence on caregiver burden and psychosocial interventions is emerging but remains limited in scale and duration. Interventional studies are few, with small sample sizes and heterogeneity in outcome measures.

The African schizophrenia literature demonstrates robust observational foundations but limited interventional and caregiver-inclusive evidence. Heterogeneity in diagnostic and outcome measures constrains comparability. To improve clinical care, research should prioritize standardized assessments, scalable psychosocial interventions, and caregiver-inclusive approaches embedded in routine services. Future efforts should collaborate with African-led initiatives and integrate findings into WHO guidelines to enhance equitable schizophrenia care worldwide.

The period immediately following discharge from psychiatric inpatient mental health care is associated with heightened clinical vulnerability, including increased risk of relapse, crisis presentation and suicide. National standards from the National Confidential Inquiry into Suicide and Safety in Mental Health, NHS CQUIN targets and the Welsh Government Crisis Care Concordat recommend that all adult patients receive follow-up by a mental health professional within 72 hours of discharge and that discharge documentation comprehensively records risk, mental state, medication and care planning. A previous regional audit identified variable compliance and incomplete documentation across sites. This re-audit aimed to assess current adherence to these standards, evaluate whether implemented quality improvement measures had improved practice, and identify ongoing gaps to inform further service development.

A retrospective clinical re-audit was undertaken across three adult inpatient units (East, Central and West) within Betsi Cadwaladr University Health Board. All eligible discharges occurring during June–July 2025 were included. Electronic discharge summaries and 72-hour follow-up records were reviewed using predefined criteria. Standards assessed included completion of follow-up within 72 hours and documentation of risk assessment, mental state examination (MSE), medication information, and a comprehensive discharge plan, alongside the quality of follow-up notes. Cases recorded as not applicable or refused were excluded. Missing or undocumented items were classified as non-compliant. Compliance rates were calculated overall and by site and compared with baseline findings from the initial audit.

Thirty-eight discharges were reviewed. Overall compliance with 72-hour follow-up was 78.4% (29/37). Documentation of comprehensive discharge plans was highest (86.5%), followed by MSE (78.8%) and risk assessment (72.7%). Medication documentation remained comparatively low at 63.6%. Considerable inter-site variation was observed. The Central site achieved 100% follow-up compliance and consistently strong documentation across domains. In contrast, the East site demonstrated lower follow-up completion (57%) and particularly poor medication documentation (20%), while the West site showed moderate follow-up rates (66.7%) with weaker recording of risk (46.2%) and medication (53.8%). Compared with baseline data, overall follow-up and discharge planning showed modest improvement, but reliability of documentation remained inconsistent.

Although small gains were demonstrated following initial interventions, substantial variation persists between sites, indicating inconsistent processes and handover practices. Standardised electronic templates, discharge checklists, automated alerts and routine audit feedback have been introduced to improve reliability. Ongoing quality improvement and targeted site support are required to achieve consistent adherence to national standards and to enhance safety during the high-risk transition from inpatient to community care.

Other authors-Dr. Aanika Nawer Hoque,Dr Nur Efina Mokhtar,Dr Charlotte Hague-Roberts

Additional Author Dr Bethany Ranjit Consultant Psychiatrist.

To evaluate compliance with NICE national standards for physical health monitoring in adults receiving ADHD medication in the community setting along with reviewing the side effects profiles and follow up intervals.

NHS England commissioned a project to consider ADHD service provision.This highlighted a significant number of challenges our ADHD services face with increases in demand for ADHD services. In tandem with this NICE recommends that physical health monitoring (blood pressure, heart rate and weight) should take place prior to initiating medication and at a minimum of six-monthly intervals, alongside structured side-effect reviews. Given the significant increases in the outpatient ADHD patient caseloads, we were concerned about the documentation and monitoring requirements of this demographic of patients.

A retrospective cohort audit of 207 adults prescribed ADHD medication by YCC CMHT was undertaken. Data extracted included demographic details, medication type and dose, dates and completeness of physical observation checks, and physical comorbidities. Additional variables collected included duration on stable dose, carecoordination status and psychiatric comorbidities. These were included to assess suitability for sharedcare transition.

The sample included 105 males and 102 females, with a mean age of 36.1 years. Medications prescribed were Lisdexamfetamine 63.3%, methylphenidate XL 20.3%, methylphenidate IR 4.3%, guanfacine 3.9%, Atomoxetine 2.9% and Dexamphetamine 0.5%. 60% of patients had been on a stable dose for more than six months. Physical health observations were recorded for 174 patients 84.1%, although documentation was frequently incomplete, with missing pulse or weight entries. No standardised monitoring tool was used. Monitoring intervals were within NICE recommendations for 30.9%, whereas 28.5% were reviewed between 6–12 months, 24.6% beyond 12 months and 15.9% had no monitoring recorded. Psychiatric comorbidities were present in 37% of patients. Physical comorbidities included Asthma 7.2%, Hypertension 2.8%, Fibromyalgia 2.4%, Polycystic ovarian syndrome 1.9% and Hypothyroidism 1.9%.

A substantial proportion of patients did not receive physical health monitoring within recommended intervals, and documentation quality was inconsistent and varied in detail. The absence of standardised tools likely contributed to underreporting of relevant adverse effects. Operational challenges, including limited access to monitoring equipment and continued prescribing despite nonattendance, were notable barriers. Implementing electronic prompts and adopting standardised monitoring templates may improve adherence to guidelines and enhance patient safety. Whilst also enhancing patient suitability for shared-care transitions.

Catatonia is a treatable syndrome that can occur due to psychiatric and neurological pathology, such as hypoxic-ischaemic brain injury. Many neuroanatomical pathways may contribute to catatonia but no single pathway has been found to be the sole cause.

A systematic review assessing evidence of adult-only cases of catatonia after hypoxic-ischaemic brain injury and summarisation of the presentation, lesion location, treatment and outcome.

A PRISMA-2020 compliant PubMed/MEDLINE search of terms related to catatonia and hypoxia/ischaemia was carried out. Catatonia had to be explicitly diagnosed and must have been secondary to a hypoxic-ischaemic insult. Data were extracted based on lesion characteristics, timeline, treatment, and outcome.

Seven studies met the criteria and they were all case reports. Lesions were heterogeneous and included bilateral parietal watershed infarcts, basal ganglia, thalamus,corona radiata, extensive white matter disease, pontine and cerebellar infarcts, and fronto-insular atrophy with inferred hypoxia. Presentations ranged from stuporous catatonia to delirium and affective disorders with catatonic features. Outcomes were generally good and catatonia resolved; however, post-neurological consequences of hypoxic-ischaemic insult remained in a few.

The evidence was limited to case reports and no single lesion causing catatonia was found.The findings supported the disrupted cortico-striato-thalamo-cortical motor pathway and the disconnection pathway as a possible cause for catatonia. There was also evidence for the involvement of neurochemical pathways such as GABA, dopamine and NMDA as a potential cause or treatment focus. Further studies with standardised catatonia measures and imaging are required.

To improve the quality of psychiatric history taking and mental state examination by psychiatric trainee doctors in North Wales.

A retrospective psychiatric case note audit was conducted across three acute psychiatric inpatient units in North Wales (Wrexham, Rhyl and Bangor sites). A total of 35 inpatient records were reviewed (Wrexham n=15, Rhyl n=10, Bangor n=10) against standards derived from the Oxford Textbook of Psychiatry chapter on history taking and mental state examination. Quality was scored (0–2) against 60 essential criteria.

The aggregate compliance to the standards was 50.6%, demonstrating significantly less than the 100% target for full documentation. While administrative tasks (84.3%) and objective MSE findings (68.5%) were relatively well-documented, complex narrative elements such as HOPC especially core symptoms of anxiety (10.0%), depression (26.8%),and past psychiatric history (22.9%) showed critical gaps. The History of Presenting Complaint achieved only 26.4% compliance. Most significantly, while risk assessment was documented in 58.1% of cases, the translation into an actionable risk management plan was documented in only 8.6% patients.

There was variation in quality standards achieved at all the three acute psychiatric sites in North Wales. The resident trainee doctors used different admission clerking proformas at the three sites. The details captured in the admission clerking for new psychiatric admissions did not fully align with the details expected in a psychiatric history taking scenario as per the standards in the Oxford Textbook of Psychiatry. The missing information in history taking can contribute to suboptimal patient care including suboptimal risk management and such missing information and detail in history taking is seldom fully rectified later in the admission. We argue that the solution is not merely the introduction of another “tick-box” proforma, but the implementation of a standard with clear expectations to follow traditional detailed psychiatric history taking and mental state examination with clinical reasoning and synthesis, regardless of tool used for completing the clerking. Training sessions are being planned to be delivered to the trainee doctors with the aim of achieving 100% compliance in the re-audit ensuring that the “full story” is captured for every patient, every time.

The purpose of this audit was to ensure that patients who are receiving long acting injectables of antipsychotic medication are having their prolactin monitored as per national and Trust guidelines.

Prolactin is a hormone responsible for lactation, breast development, and other actions needed to maintain homeostasis. Hyperprolactinemia is defined as an increase in prolactin level above the normal range that is sustained. The Trust guidelines outline that a baseline prolactin must be established before starting or changing an antipsychotic. The patient must then be evaluated for symptoms of hyperprolactinemia and prolactin serum level re-checked 3 months later.

This was a retrospective review using the serum prolactin levels available on ICE test results system and information available from clinics letters and documentation. All patients were above the age of 18 and receiving regular depots at the community depot clinic. All patients presented to the depot clinic between the 1st May 2024 and 31st May 2024.

A study sample was obtained using a list of patients from the depot clinic. Out of that list, 108 patients present to the depot clinic within the set timeframe. 31 patients were excluded as they were on an Aripiprazole depot, which does not requiring monitoring of prolactin levels as per NICE and Trust guidelines. A further 18 patients were excluded as the depot was started before 2014, and a start date was unobtainable. 2 patients started the depot in a different Trust and 2 patients started the depot in South Essex, therefore a baseline prolactin was unobtainable. A total of 55 patients were finally included in the study sample.

The target for compliance was 100%.

Of the 55 patients commenced on long-acting injectable treatment, 33 (60%) did not have a baseline prolactin level measured prior to initiation, and 22 (40%) did not have prolactin levels checked within the preceding year. Sixteen patients (29%) had neither a baseline nor a follow-up prolactin measurement. Physical health checks within the last year were completed and documented in 37 patients (67%). Overall compliance was 40% for baseline prolactin monitoring, 60% for annual prolactin monitoring, and 67% for annual physical health checks.

There was inadequate monitoring of prolactin levels in community patients receiving long acting injectables, as the target for compliance was not met. As need for monitoring needs to be highlighted, the results of this audit were presented to the community team and at the local teaching.

To review CT and MRI head scan reports of patients aged 65 years and over referred to the Mental Health Liaison Team, focusing on whether dementia-relevant features were consistently reported.

To examine the presence and reporting of cerebral atrophy, vascular changes and infarcts, and to compare acute hospital discharge diagnoses with final community psychiatric diagnoses in order to identify gaps in early recognition of dementia.

This quality improvement project reviewed a randomly selected sample of 14 patients aged 65 years and over referred to the North Mental Health Liaison Team at Chesterfield Royal Hospital between 1 November 2025 and 31 January 2026. CT and MRI head scan reports requested during the acute admission were reviewed.

All data were anonymised in line with information governance requirements. Imaging reports were assessed for documentation of acute pathology, cerebral atrophy, vascular change and established infarcts. Acute hospital discharge diagnoses were compared with subsequent diagnoses made by community mental health services. Data were collected using a structured Microsoft Forms tool and analysed descriptively using Microsoft Excel.

Confusion was the primary indication for neuroimaging in approximately 90% of cases. Over 90% of scans reported no acute intracranial pathology. Cerebral atrophy, either global or focal, was documented in over 80% of scans, whilst vascular changes were reported in approximately 90%. Established infarcts were less consistently described, with variable emphasis on their relevance to cognition. At the point of acute hospital discharge, around 40% of patients were given a functional psychiatric diagnosis. Following community follow-up, approximately 40% of patients were ultimately diagnosed with dementia, indicating a significant shift in diagnostic formulation over time.

Older adults presenting acutely with confusion frequently demonstrate chronic neuroimaging changes relevant to dementia, even when acute pathology is excluded. The proportion of patients later diagnosed with dementia suggests that opportunities for earlier recognition exist during the acute admission. More consistent and structured reporting of dementia-relevant imaging features, alongside closer collaboration between radiology and liaison psychiatry, may support earlier referral to memory services, improve continuity of care and reduce unnecessary repeat investigations.

1. To improve General Adult/Older Adult Higher training experience across North London Foundation Trust at 80% at 1 year.

2. To increase Higher trainee engagement with rotation evaluation survey to 80% at 1 year.

We ran an initial survey amongst NLFT higher trainees, exploring their level of wellbeing in their current posts in 2024. Areas of improvement were identified and mappedusing a fish-bone diagram. During 2025, we held a series of iterative meetings, including with directors of medical education, training programmedirectors, higher trainees and reps to agree on concrete actions for improvement. We ran a second survey in 2025 to re-audit.

We achieved over a 80% satisfaction with the current SpR posts, however, re-audit survey was answered by fewer respondents than expected.

An iterative process involving meetings with different stakeholders (trainees, clinical supervisors, training programme directors, etc.), openly discussing areas for improvement, and implementing small changes can improve trainee wellbeing. However, increasing participation in surveys remains a challenge.

CQC (2018, 2019) is concerned about the high numbers of patients situated a long way from home which could result in social detachment and cut off from the local services that will provide care following discharge. Cheshire and Wirral Partnership NHS Foundation Trust was identified by CQC (2018) as being in the top twenty NHS mental health trusts with the highest number of patients placed in a mental health rehabilitation ward funded by a different provider. Rehab case management provides key worker responsibility, utilising expertise and specialist skills for patients in hospitals in line with NHS England commissioner guidance (2024) to improve quality and ensure services are effective, evidence based and safe. Thus, weekly multi-disciplinary team (MDT) meetings with rehab case management and Cheshire and Wirral Integrated Care Boards (ICBs) were set up in August 2024 to monitor the key components of the admission and discharge planning.

Community mental health transformation is at the heart of the approach where a guiding principle of the rehab case management team is community based by default, inpatient by exception. A data analysis review was undertaken through comparing the results of pre-and post-setting up the MDT with a focus on purpose of admission, defined therapeutic interventions and estimated date of discharge. An admission should only be as long as necessary with emphasis on improved reporting of patients who are clinically readyfor discharge (CRFD). Rehab case management fosters shared-decision making through patient-reported outcome measures including DIALOG and Goal-Based Outcomes to monitor progress, guide treatment and facilitate discharge planning. The Friends and Family Test offers a mechanism for evaluating patient experience and improving quality.

The review demonstratedeffectiveness of collaborative working between rehab case management and Cheshire and Wirral ICBs to reduce the number of patients in out of area hospitals. Improvement in mental health rehabilitation pathways is gleaned through the lens of ‘in sight and in mind’. There have been 14 patients from Cheshire discharged and 14 patients discharged since the inception of the MDT.

The findings suggest that the collaborative working with ICBs has significantly helped improve patient flow, reduce discharge delays and provided a structured, data-driven approach to managing inpatient stays. It is this focus that has achieved the objectives of the NHS England commissioner guidance and the NHS 10 Year Health Plan for England to reduce the reliance on inpatient care and deliver interventions in the least restrictive setting.

Sleep difficulties affect up to 58% of individuals with Functional Neurological Disorder and other neuropsychiatric presentations. The Triangle of Sleep is a clinician-led pilot psychoeducational intervention combining learning points from Cognitive Behaviouralmodel for Insomnia (CBT-I), with behavioural principles for restructuring of day-routine and mindfulness-based exercises, designed to improve sleep. This quality improvement project worked alongside the intervention team to independently collect staff team and patient feedback using two co-production cycles to implement improvements in design and delivery of the intervention.

Participants with sleep difficulties were recruited from the East Kent Neuropsychiatry Clinic to attend three one-hour group sessions covering sleep hygiene, day structuring, and mindfulness. The Plan–Do–Study–Act method was used to guide the approach. An initial scoping review identified how existing guided self-help interventions were quality assured. A questionnaire was developed using andragogy, and self-directed learning (SDL) principles to evaluate participant experiences. Verbal feedback was gathered from semi-structured interviews based on the questionnaire. The data was analysed by five reviewers and discussed with clinicians to produce a consensus document identifying feasible improvements, which were implemented over two PDSA cycles.

The first cycle received responses from 2 patients and 3 student observers. Key themes included clarity of learning objectives (LOs), limited discussion opportunities, repetition, optimal SDL material utilisation, and desire for an additional session. Themes were discussed with clinician facilitators resulting in a consensus document of proposed changes. Revisions included promotion of SDL materials and session restructuring to include clear LOs and discussion opportunities. An additional session was not implemented due to resource constraints.

Before the second cycle, the questionnaire was refined for sustainability of continuous improvement. The second pilot retained 8 participants, with 5 patient feedback responses. There was limited consensus between participants unlike the previous cycle. A key improvement was a 20% increase in use of SDL materials compared to the previous cycle.

A co-production model proved effective for quality assuring a psychoeducational intervention. Iterative patient feedback enabled feasible, patient-centred improvements to acceptability and clarity. While immediate reflections on motivation in applying theories taught were mixed, the use of SDL materials suggests improved self-efficacy for long-term implementation of principles and potential for sleep improvement. The ‘Triangle of Sleep’ pilot provides a foundation for upscaling and the development of digital or AI-supported delivery models to increase reach and sustainability. In areas with less access to formal CBT-i this intervention could provide specialist insomnia treatment with lower clinician burden.

Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist used for anaesthesia and analgesia, with increasing interest in its rapid antidepressant effects. This case evaluates the feasibility, tolerability and clinical response to subcutaneous ketamine in a medically frail older adult with psychotic depression, hypothesising that ketamine would rapidly improve engagement and depressive burden to support nutritional intake and medical recovery.

A 77-year-old man with a prior severe episode of psychotic depression had previously achieved full recovery after eight sessions of electroconvulsive therapy (ECT). In the current episode, he presented similarly with disorientation, nihilistic beliefs, poor engagement, self-neglect and severe weight loss from reduced oral intake, consistent with a depressive relapse with psychotic features.

His case was complicated by medical instability with suspected delirium, as well as limited adherence to and response from conventional antidepressant treatment. Anaesthetic risk in the context of acute physical illness, led to ECT being deferred and subcutaneous ketamine being used as a practical ward-based intervention when urgent treatment was required.

Following multidisciplinary and family discussion, subcutaneous ketamine was initiated as a rapid antidepressant intervention. Three doses were administered over approximately ten days (two at 0.25 mg/kg, followed by escalation to 0.5 mg/kg due to limited initial response). Depressive symptoms were rated using the Cornell Scale for Depression in Dementia (CSDD), alongside serial clinical assessments of mental state, engagement and oral intake.

Treatment was well tolerated, with no dissociative or behavioural adverse effects observed. CSDD scores showed modest change, decreasing from 15 at baseline to 12 after the first dose and to 10 after the third and final dose, with transient improvements in engagement and acceptance of care that were not sustained and did not translate into lasting improvement in overall mental state or nutritional intake.

Subcutaneous ketamine was a feasible and well-tolerated option in this medically frail older adult but did not achieve a clear or sustained antidepressant response in this case. Given the patient’s prior robust response to ECT and the limited benefits observed with ketamine, referral for ECT was re-initiated once anaesthetic risk was acceptable, highlighting the potential role of subcutaneous ketamine as a short-term bridging intervention when ECT is temporarily high-risk and the need for further evidence in older adults with psychotic depression and comorbid physical illness.

To estimate lifetime, 12-month, and 30-day prevalence of OCD in Qatar; characterise symptom profiles and comorbidity patterns; identify sociodemographic correlates; and examine sex differences in functional impairment.

To estimate lifetime, 12-month, and 30-day prevalence of OCD in Qatar; characterise symptom profiles and comorbidity patterns; identify sociodemographic correlates; and examine sex differences in functional impairment.

Weighted lifetime prevalence of OCD was 2.9% (95% confidence interval 2.4–3.5) and was higher among females (3.8%) than males (2.3%; p=0.007). The most commonly reported symptom types were checking (68.2%), religious scrupulosity (65.7%), and cleaning (60.0%). Nearly all individuals with lifetime OCD had at least one psychiatric comorbidity (91.0%), most frequently mood disorders (68.5%), post-traumatic stress disorder (71.3%), and other anxiety disorders (45.9%). Female sex was associated with OCD in an unadjusted model (odds ratio 2.05; p=0.002) but not after controlling for comorbidities (odds ratio 1.24; p=0.397). Compared with ages 18–29 years, ages 30–39 years had the highest odds of OCD (odds ratio 3.1; p=0.006). Qatari nationality was also associated with OCD (odds ratio 1.71; p=0.049). High functional impairment was observed in 76.9% of affected individuals, with significantly greater impairment in home and social domains among females than males.

As the first national epidemiological study of OCD in Qatar, these findings provide a critical baseline for service planning, early detection strategies, and resource allocation. OCD is prevalent, highly impairing, and characterised by extensive psychiatric comorbidity, supporting the need for integrated and culturally responsive care pathways.

South West London and St George’s Mental Health (SWLStG) hospitals operate a 12-hour pathway for mental health patients (MHPs) requiring admission from the A&E. However, prolonged waits beyond this timeframe have been frequently observed, with some patients remaining in A&E for more than 72 hours following the decision to admit (DTA). This audit aimed to determine the proportion of MHPs waiting longer than 72 hours for a psychiatric inpatient bed from a district general hospital A&E over a 13-month period. Secondary aims were to establish the average waiting time for this cohort and to explore whether bed wait duration differed between detained and informal admissions.

Hospital administrative records were retrospectively reviewed for all MHPs awaiting inpatient psychiatric admission from a district general hospital A&E between October 2024 and November 2025. Data collected included time of DTA and time of transfer to an inpatient psychiatric bed. Length of stay (LoS) was calculated from DTA to admission.

During the audit period, 642 patients were assessed as requiring psychiatric admission. Of these, 105 patients (16%) waited longer than 72 hours for an inpatient bed. The mean LoS for this cohort was 5 days, 23 hours, and 12 minutes, with a maximum LoS of 24days, 20 hours, and 39 minutes. Patients detained under the MHA (n=47) experienced longer waiting times compared with informal admissions (n=62), with an average additional delay of 4 hours and 38 minutes (mean LOS 6 days, 1 hour, 8 minutes vs 5 days, 20 hours, 30 minutes respectively).

This audit demonstrates persistent difficulty in achieving timely psychiatric admission from A&E, with 16% of MHPs waiting over 72 hours following DTA. Patients with higher clinical acuity, reflected by detention under the MHA, experienced longer bed waits. Contributing factors are likely multifactorial, including reduced inpatient bed capacity, increasing mental health demand, limited community alternatives, and A&E environments that are poorly resourced for prolonged psychiatric care. Nationally, psychiatric inpatient bed numbers have reduced by approximately 73% over the past three decades, alongside a substantial rise in mental health presentations post Covid pandemic. Future work should replicate this audit across multiple A&E sites to better characterise systemic delays and inform service-level planning.

Prescribing stimulant medication for Attention-Deficit/Hyperactivity Disorder in patients with Postural Orthostatic Tachycardia Syndrome presents a recognised clinical dilemma due to the potential for stimulants to exacerbate tachycardia and autonomic instability. There is limited practical guidance on how such prescribing can be undertaken safely within psychiatric inpatient settings. This case aims to demonstrate how structured multidisciplinary collaboration, robust monitoring protocols, and clear system ownership can enable safe initiation of stimulant treatment in a patient with POTS, while highlighting vulnerabilities in protocol implementation within complex care systems.

A woman in her early twenties was admitted to an acute psychiatric ward with complex psychiatric and medical comorbidities, including POTS (stable on Ivabradine), Epilepsy, and Schizoaffective disorder. Following comprehensive assessment, she was diagnosed with ADHD using the DIVA-5 diagnostic interview.

Given the cardiovascular risks associated with stimulant medication, extensive liaison was undertaken with multiple consultant cardiologists at a tertiary NHS trust. Cardiology confirmed stable POTS, a normal recent ECG, and no evidence of structural heart disease, advising that Lisdexamfetamine 20 mg once daily could be initiated with appropriate precautions.

A detailed monitoring protocol was developed and disseminated, including baseline and thrice-daily lying, sitting, and standing heart rate and blood pressure measurements, NEWS2 scoring, predefined red-flag thresholds, and a clear escalation plan. The patient received structured education regarding symptom reporting, and informed written consent was obtained. The plan was shared with nursing staff and on-call medical teams to support safe implementation.

Lisdexamfetamine was initiated without cardiovascular complications. During the initial two-week intensive monitoring period, no tachycardia, blood pressure instability, or worsening of POTS symptoms were observed. The patient reported significant subjective improvement in ADHD symptoms, corroborated by staff observations. Ongoing weekly monitoring continued following dose changes.

A systems-based challenge was identified when elements of the monitoring protocol were not implemented consistently during a period of medical handover, despite prior written communication. This highlighted a critical gap between protocol dissemination and execution, underscoring the importance of clear ownership and active follow-up when implementing high-risk prescribing plans.

This case demonstrates that stimulant medication can be safely initiated in selected patients with POTS when supported by specialist cardiology input, structured monitoring, and robust multidisciplinary collaboration. However, safe prescribing extends beyond clinical decision-making alone; system-level safeguards, clear accountability, and effective handover processes are essential to mitigate risk. Patient education and proactive MDT engagement are pivotal in ensuring both safety and therapeutic benefit in complex psychiatric prescribing.

The weekly Local Academic Programme (LAP) at Mersey Care NHS Foundation Trust is part of the MRCPsych programme. It aims to prepare psychiatry trainees for theirMRCPsych exams, and within Mersey Care receives positive feedback from attending resident doctors. To support exam practice, multiple-choice questions (MCQs) were introduced in 2024. We decided to extend further support as trainee leads and introduced didactic (maximum 5 minutes) explanations of complex exam topics every session, using different audio/visual technologies. The aim was to cater to different learning methods; Visual, Audio, Reading/Writing, Kinaesthetics.

The quality improvement project used mixed methodology. We used convenience sampling to collect quantitative and qualitative data. Before the start of the semester, a pre-intervention survey was sent to trainee doctors using Google Forms, in February 2025. After 5 MCQs for the audience to practice in the LAP, one of the authors (LAP trainee leads) explained a chosen topic for 5 minutes. We used power point presentations or videos using graphics or white board function on Zoom to explain examinable topics. Paper A and Paper B curriculums were used to select the topic for discussion. Throughout the semester and at the end, we sent out surveys to gather feedback using Smart Surveys until July 2025.

Initial survey data indicated that most trainees struggled to digest concepts in standard MCQ banks and believed they would benefit from short (5-minute) discussions on complex examinable topics, such as biostatistics (e.g. ANOVA vs. ANCOVA) during our sessions.

Following the implementation of the new LAP format, 60.7% found MCQ based explanations helpful. Regarding delivery style, 35% of respondents preferred a mixture of MCQs and whiteboard/video explanations, while 33.33% favoured MCQs with standard explanations. None of the respondents wanted whiteboard/video-based teaching alone.

Qualitative feedback was highly positive, with trainees noting that the explanation of statistical methods was “particularly good” and “very helpful for revision” for Paper B. Participants specifically praised the “simplified” explanations to consolidate learning.

The trainees found the new sessions useful for their organisation, interactivity, and clarity on difficult to understand examinable topics. To support the greatest benefit in MRCPsych examination preparation, trainees preferred a combined approach of MCQ style questions alongside whiteboard/video explanations for more complex topics. Catering to different learning methods and differential attainment in local medical education programmes could potentially improve MRCPsych success rates for resident doctors in psychiatry training.

Psychoeducation is a key evidence-based component of treatment for psychosis, improving insight, adherence, and relapse prevention. The Orygen Psychosis Psychoeducation framework “A Shared Understanding: Psychoeducation in Early Psychosis” emphasises accessible, developmentally appropriate resources for young people and carers. Beechcroft, the regional Tier 4 adolescent inpatient unit for Northern Ireland, regularly admits young people experiencing psychosis. In 2022, a Serious Adverse Incident (SAI) at Beechcroft identified that a young person and their family felt insufficiently informed about a diagnosis of first-episode psychosis. This highlighted a gap in psychoeducational provision within the service and prompted the development of structured, age-appropriate psychoeducation workbooks.

In response to the SAI, two psychoeducation workbooks were developed collaboratively by the Beechcroft team: one for young people, and one for parents and carers. The young person’s workbook is designed for use during the early recovery phase of inpatient admission and includes psychoeducation on the nature of psychosis, risk factors, symptom recognition, relapse indicators, treatment options, and relapse prevention planning. Delivery typically occurs over 4–6 sessions by a doctor, or alternatively could be delivered by another member of the multidisciplinary team (MDT) with appropriate training. The carer version provides parallel content adapted for families, with additional emphasis on understanding psychosis, managing relapse, and addressing feelings of guilt or self-blame. The psychoeducation workbooks have been piloted in Beechcroft with 3 young people and their carers. Qualitative feedback was collated in order to evaluate the effectiveness of our project to date.

Feedback from young people indicated that the workbook improved their understanding of psychosis, enhanced motivation for recovery, and encouraged engagement with treatment planning. Carers described the psychoeducation sessions as empowering, reporting greater confidence in recognising early warning signs and knowing when to seek professional help. Parents expressed relief in understanding that they were not responsible for their child’s illness, which facilitated a more supportive family environment.

The introduction of structured psychoeducation workbooks in Beechcroft has strengthened communication between professionals, young people, and families while embedding NICE and Orygen aligned best practice into routine care. Early feedback suggests that the intervention enhances illness understanding, relapse management, and familyconfidence. Future plans include formal evaluation using outcome measures and exploring adaptations for community use and general adult psychiatric settings. The project demonstrates how learning from an SAI can drive meaningful service improvement and promote recovery-oriented practice in adolescent mental health inpatient units.

A 77-year-old male with no prior contact with psychiatric services, and a medical history of a myocardial infarction and osteoarthritis, presented in 2022 with a 10-week history of psychotic symptoms. These included auditory hallucinations as well as persecutory and somatic delusions. He was diagnosed with Very Late Onset Schizophrenia-Like Psychosis (VLOSLP) and detained under the Mental Health Act due to non-adherence and risk.

Since 2022, several antipsychotics (olanzapine, aripiprazole oral and depot, risperidone) have been trailed, however symptoms persisted with repeated relapses linked to non-adherence. Zuclopenthixol decanoate led to partial stabilisation but with residual psychosis. In June 2023, he attempted suicide by hanging, requiring admission to Intensive Care Unit. Antidepressants (sertraline and then later mirtazapine/vortioxetine) were added for comorbid depressive symptoms.

From September 2023, clozapine was initiated due to treatment-resistance. Titration was limited by hypotension, sedation, constipation, and poor engagement, compounded by persistent psychotic symptoms and delusional beliefs about blood loss and poisoning. Magnetic Resonance Imaging of the brain and autoimmune encephalitis screening were normal.

Between 2024 and 2025, recurrent crises occurred due to non-adherence and entrenched delusions. Clozapine was intermittently stopped and restarted with cardiology input following concerns about heart failure. The multidisciplinary team decided on slow clozapine titration, with use of intramuscular clozapine when non-adherent, and to continue this long-term.

VLOSLP is defined by a patient’s first episode of psychosis after 60 years of age. VLOSLP poses significant diagnostic challenges as up to 60% of cases are secondary to organic causes, and there are significant overlapping features between VLOSLP and neurodegenerative disorders, although the pathophysiology still remains unclear. After 60, the incidence of schizophrenia increases around 11% every 5 years. Clinically, VLOSLP has a lower prominence of negative symptoms and formal thought disorders, and a higher prominence of partition and persecutory delusions, multimodal hallucinations and cognitive impairment. Management requires cautious use of antipsychotics at lower doses due to increased morbidity and mortality risks associated with elderly patients. The literature shows treatment-resistant VLOSLP may benefit from options such as clozapine, electroconvulsive therapy, or neuromodulation strategies.

Currently, the patient remains under inpatient management on clozapine, targeting a serum clozapine level of 0.35-0.45mg/L, with ongoing monitoring for side effects. He still experiences fixed delusions and auditory hallucinations, requiring ongoing encouragement for adherence, with occasional use of intramuscular clozapine. Overall, there is limited evidence on VLOSLP and treatment-resistant VLOSLP, and further research is required for optimal diagnostic and treatment pathways.

Following the military coup in February 2021, Myanmar has experienced widespread human rights violations, insecurity, economic hardship, and disruption of essential services, resulting in a substantial deterioration in population mental health. Media-reported suicides have increased, alongside rising mental health presentations within TeleKyanmar, a nationwide telemedicine service operating under the Ministry of Health, National Unity Government (MOH-NUG). In response, TeleKyanmar launched the Zero Suicide Campaign (ZSC), Myanmar’s first national suicide prevention hotline, in September 2023.

The primary objective of ZSC is to reduce suicide risk through timely crisis intervention. Secondary objectives include narrowing the mental health treatment gap and facilitating rapid referral to appropriate mental health services for individuals at risk.

The preparation phase (December 2022–August 2023) involved multi-stakeholder consultation with mental health and MHPSS experts, followed by three rounds of virtual suicide prevention training (April–June 2023). A total of 168 Civil Disobedience Movement (CDM) professionals completed foundational training, from whom 50 were selected for advanced applied training. The applied programme comprised 24 hours of structured teaching and supervised skills practice, focusing on suicide risk assessment, safety planning, empathic listening, crisis hotline ethics, and operational challenges.

The hotline was launched on World Suicide Prevention Day (10 September 2023) using the Telegram platform. It operates seven days a week across two daily shifts, with three parallel lines. Trained volunteers provide crisis support, supported by live and bi-weekly psychiatric supervision. Standard Operating Procedures guide case management and referrals. Suicide risk is assessed using the Columbia Suicide Severity Rating Scale (C-SSRS) and safety planning is conducted using the Stanley–Brown Safety Plan.

Currently, 41 trained volunteers provide the service. Individuals assessed as medium or high suicide risk are referred to TeleKyanmar mental health clinics within 24–72 hours, while those at lower risk are signposted to community-based online counselling services. The hotline enables anonymous, stigma-reduced access and functions as an effective gateway into structured mental healthcare.

The Zero Suicide Campaign represents a scalable, low-cost public health intervention in a conflict setting. It provides immediate crisis support, reduces barriers to care, and strengthens suicide prevention pathways within a disrupted health system. The model demonstrates how telemedicine-linked crisis services can mitigate suicide risk in humanitarian emergencies.

Acknowledgement: We acknowledge all Civil Disobedience Movement mental health professionals and members of the Myanmar Psychiatrist Diaspora whose voluntary commitment made the Zero Suicide Campaign possible.

Promethazine is a phenothiazine compound first synthesised in the 1940s, with prominent sedative qualities. As a first-generation antihistamine, promethazine has strong affinity as an antagonist of H1histaminergic receptors of the tuberomammillary nucleus, as well as moderate antagonism of muscarinic cholinergic receptors, and weak-moderate affinity to receptors in the serotonergic, dopaminergic, adrenergic and glutaminergic systems. While in the UK promethazine is publicly available ‘over the counter’, it is not recommended by NICE guidelines for insomnia.

We narratively summarise the available evidence for promethazine’s benefit on human sleep outcomes with structured searches, as well as publicly available prescribing trends data from OpenPrescribing and published academic reports.

Promethazine is increasingly prescribed by primary care physicians and psychiatrists in United Kingdom as a treatment for all kinds of sleep concerns, with a near doubling of English GP prescriptions in the past 5 years. There is no good evidence for the clinical benefit of promethazine on sleep outcomes, with an absence of clinical trials or adequate measures of sleep. Use of promethazine as a sleep-aid is actively advised against in international expert consensuses, with evidence based alternatives available including the NICE guidelines’ first-line option, Cognitive-Behavioural Therapy for Insomnia (CBT-I).

For several reasons, it appears that promethazine is not an appropriate treatment for any flavour of sleep problem. First, because there is no clinical trial evidence. Secondly, it is important to remember that sedation is not sleep. These two states of reduced consciousness are different phenomenologically, physiologically, and appear different on EEG recordings. The multiple benefits of natural human sleep cannot be assumed to be achieved by this kind of artificial sedation. Histaminergic antagonism has a very complex pharmacodynamic profile, and psychiatrists cannot expect that there will be linear dose-effects. Third, the addictive nature of promethazine must be acknowledged: there are significant levels of recreational use of promethazine worldwide, in part because of its effects in potentiating opioid agents. Moreover tolerance develops quickly, with diminished sedative effects seen in as few as 3 days. Withdrawal symptoms are common, with rebound insomnia widely reported after long-term use. Finally, the side effect profile of promethazine is of concern including, QTc prolongation, weight gain, and the potent cholinergic effects have a causal effect on dementia. This poster concludes with a summary of alternative approaches for psychiatrists using promethazine in their practice, including CBT-I and alternative, more sleep problem-specific medication options.