There have been long-standing challenges associated with recruitment into psychiatry internationally. In the UK, this issue has inevitably led to a shortage of practising mental health consultants which impacts upon training opportunities, patient care and staff morale. This study aims to explore existing psychiatric trainees’ perspectives on their career choice and the educational experiences that impacted upon their decision.

This is a qualitative research study using semi-structured interviews to explore the perceptions of trainees within psychiatry on their educational journey and the interactions with role models that ultimately influenced their career aspirations. Thematic analysis was used to organise the findings into three overarching themes and various subthemes that aimed to interpret and explain meaning across the dataset.

Thirteen participants were interviewed demonstrating a range of ideas that were broadly grouped into three main themes. Theme one, entitled attitudes and behaviours towards and within psychiatry encompassed the importance of role models within psychiatry, a humanistic approach to patient care and to trainees themselves, and the trainees' experiences of professional stigma. Theme two, influential educational experiences within psychiatry explored the impact of specific teaching and learning experiences, potential barriers and unique and influential opportunities available. Theme three, perspectives and perceptions of psychiatry as a specialty concerned the trainees’ perceptions of how others viewed them as psychiatrists and involved discussion of common misconceptions, access to the specialty prior to application and visibility of the specialty in other contexts.

Exploring trainees’ experiences in the lead up to choosing psychiatry as a career provided valuable insight into existing positive experiences and highlighted aspects of learning and training that could be further developed. The results can be used to provide a platform from which to enhance the educational experiences of future potential psychiatrists.

This study explores the relationship between depressive symptoms and emotional regulation–specifically emotional attention, clarity, and repair–among Pakistani medical students, with an emphasis on gender-based differences.

A cross-sectional study was conducted among 216 medical students at a single medical college in Pakistan. Participants completed the Beck Depression Inventory (BDI) and the Trait Meta-Mood Scale (TMMS). Data on demographics, physical activity, and hobbies were also collected. Gender-stratified chi-square analyses were used to assess associations between depression severity and emotional regulation.

Moderate to severe depressive symptoms were reported by 41.6% of students, while 58.4% exhibited minimal to mild symptoms. Females were significantly more likely to report insufficient emotional attention (12.6% vs. 2.5%,p=0.038), while males more frequently reported sports as a primary hobby and higher levels of vigorous physical activity. No significant gender differences were found in depression severity, emotional clarity, or emotional repair. Overall, 91.7% of students demonstrated adequate or excessive emotional attention, 82.4% had excessive clarity, but a striking 79.6% reported insufficient emotional repair. Lifestyle patterns were also concerning, with 58.3% of students engaging in less than two hours of moderate physical activity per week. Emotional repair was consistently poor across all depression categories and both genders, suggesting a universal deficit in emotion regulation rather than a gender-specific trend.

High levels of depression and emotional dysregulation were observed across the student body, regardless of gender. Within Pakistan’s context of limited mental health services, academic pressure, and cultural stigma, these findings highlight a critical need for institutional support structures. Emotion regulation training, particularly targeting emotional repair, and broader access to psychological services should be prioritized. Given the sample was drawn from a single institution, the generalizability of findings is limited.

Prolonged waiting times for ADHD assessment in child and adolescent mental health services (CAMHS) present a significant challenge. While outsourcing can address immediate waiting list pressures, it may simply shift the bottleneck back to the core CAMHS service. This service evaluation aimed to examine the effectiveness and cost implications of the in-house waiting list model in West Galway CAMHS, with a view to informing management decisions on developing and appropriately resourcing the team for sustainable long-term service delivery.

This service evaluation reviewed CAMHS patients from West Galway who were awaiting ADHD assessment between January 2025 and January 2026. A random sample of 30 patients managed via the in-house waiting list initiative was compared with 28 patients managed through an outsourced model. Outcomes assessed included time to assessment, discharge to GP (without transfer to core CAMHS), diagnosis rate, and subsequent need for CAMHS follow-up. Data were analysed using simple descriptive comparisons to explore differences in service outcomes between the two models.

Direct comparison of time to assessment was limited by differences in team structure and staffing: the in-house waiting list team was newly established and consultant-led, while the outsourced model comprised a well-established external agency with longstanding experience in the UK. Notably, 70% of patients in the in-house team were discharged back to their GP without transfer to core CAMHS, compared with 0% in the outsourced group. Consequently, only 30% of in-house patients required ongoing CAMHS follow-up, versus 100% in the outsourced model. Diagnosis rates are currently being further analysed to examine the detection of comorbidities. These preliminary findings suggest that while outsourcing addresses immediate assessment capacity, the in-house model may offer opportunities for developing a sustainable, consultant-led service with longer-term oversight, provided adequate resourcing.

This service evaluation highlights that a well-structured in-house waiting list team has the potential to improve downstream flow to the core CAMHS service, reducing the secondary bottleneck and minimising repetition of work through clear, consultant-led care plans. Effectiveness is dependent on having the right staffing skill set and staff-to-patient ratio, as limitations in these areas impact throughput, consistency, and the ability to meet service expectations across teams. These findings suggest that appropriately resourced, consultant-led in-house services could provide sustainable improvements in assessment and care delivery, supporting the case for expanding the service.

Specialist dementia inpatient units provide care for individuals with complex neuropsychiatric and behavioural needs. Understanding admission outcomes within these settings is essential for service planning and optimising patient flow. The aim of this service evaluation was to evaluate admission outcomes over a one-year period for all inpatients admitted to a 30-bed specialist dementia intensive care unit including diagnoses, length of stay, discharge destinations and mortality.

A retrospective service evaluation was conducted of all inpatients admitted to Sage, Rosemary and Thyme ward in the Forget Me Not Unit in Worthing between March 2024 and March 2025. Data were extracted from electronic patient records and anonymised prior to analysis, which included demographic data, diagnoses and dementia subtype, legal status upon admission and discharge, proportion of prescribed psychotropic medications, length of stay, time taken to be declared medically optimised for discharge (MOFD), discharge destination and mortality. Descriptive statistical analysis was performed for each ward and for the unit overall.

There were 88 inpatient admissions across all three wards within one year (34% female). This inpatient cohort had a mean age of 80 years (median 81 years) with most admissions being facilitated under section 2 of the mental health act (76%) and a minority under section 3 (15%). Alzheimer’s disease was the most common diagnosis at discharge (42%) followed by mixed dementia (28%) and a smaller proportion of vascular dementia (7%), Lewy body dementia (6%) and frontotemporal dementia (2%). On average, patients were declared MOFD after 63 days (median 49 days) and were subsequently discharged after a mean of 61 days (median 59 days) leading to an average length of stay of 124 days (median 113 days). Approximately 55% of all patients were discharged to a care home, 15% were discharged home and 5% died during their admission. Mortality within twelve months post-discharge was high at 22% with half of these deaths occurring within three months of discharge.

This service evaluation highlights the complexity of care, prolonged admissions and high post-discharge mortality associated with specialist dementia inpatient services. Delays between patients being declared medically optimised and subsequently being discharged from the unit highlight an important area for service improvement, particularly within adult social care. These findings offer a useful baseline for future comparisons which may guide local quality improvement, workforce planning and multidisciplinary team working.

High dose antipsychotic therapy (HDAT) refers to prescribing a single antipsychotic at a dose above the maximum British National Formulary (BNF) limit, or prescribing more than one antipsychotic in combination where the combined percentage of each drug’s maximum BNF dose adds up to more than 100%. The potential additional benefit of surpassing recommended doses of antipsychotic therapy is limited and may be associated with higher rate of adverse effects. HDAT should only be used as a last resort after all other treatments have been exhausted, and the benefits must outweigh the risks. The decision to initiate and continue HDAT prescribing must be clinically justified and robustly documented on a regular basis. The audit aimed to assess compliance of a local community mental health team (CMHT) against trust procedure which requires regular clinical review and physical health assessments to be completed every 6 months.

A retrospective audit was completed of 40 patients who were prescribed HDAT on a single date in February 2025 when the caseload was accessed. Data was collected on clinical reviews, physical investigations and risk assessment forms, using the trusts electronic patient record and shared electronic GP records. Data was collected using a standardised audit tool and analysed in Microsoft Excel.

Of 40 patients prescribed HDAT, 26 (65%) had a review of HDAT completed within the past 6 months. 8 out of 26 reviews (31%) included justification for the continued use of HDAT. Risk assessment forms were completed for 1 out of 26 (4%) patients who had been reviewed. 339 out of 519 (65%) of all physical health assessments were completed in the last 6 months. Overall compliance with trust procedure was 60%.

Adherence to trust standards for prescribing of HDAT was below target. Possible factors identified included difficulty identifying and tracking patients on HDAT, and a lack of system in place for carrying out routine physical health assessments. Recommendations include the creation and maintenance of a live HDAT register, collaboration with physical health team and increasing the awareness of standardised risk assessment forms amongst clinicians.

Previous project conducted within the trust hypothesised and found that a tailored General Practitioner (GP) teaching programme was preferred by trainees and met GP training needs when given in addition to the general teaching programmethat is available to all psychiatric and GP trainees. The recommendation at the time was to develop a wide range of topics within this programme that were aligned with the GP curriculum for psychiatry.

The aims of this project were to evaluate if the current programme is useful and relevant to GP trainees as well as aligned with GP curriculum. To make amendments to the programme to ensure this and therefore, improve the overall quality.

I conducted two cycles with two GP trainee cohorts. In cycle 1: edited PowerPoints from previously designed GP programme with pre-chosen topics, delivered 6 teaching sessions and collected post session feedback on relevance, usefulness as well as qualitative data on what went well and what could be improved.

In cycle 2: Made changes to topics from previous cycle feedback and mapped topics against GP curriculum, formalised a timetable and information letter which was disseminated for smoother process, delivered 6 teaching sessions, modified feedback forms to collect both pre session feedback on confidence in topic and expectations and post session feedback on confidence in topic, expectations, relevance, usefulness and qualitative data on what went well and what could be improved.

The results in cycle 1 showed 88% found the teaching on risk assessment useful and100% found it relevant. However, it reached 100% positive response for usefulness and relevance by the end of cycle 2. Furthermore, the teaching on Balint groups was rated relevant by 50% of trainees and 0% found it useful. Therefore, it was replaced with teaching on personality disorders, which reached 100% positive response for usefulness and relevance in cycle 2.

Overall, in cycle 2, confidence rating increased after the teaching session for all trainees. In the qualitative feedback, overall satisfaction was high and some minor adjustments were asked for, mostly to include more sessions with more sub-speciality specific teaching.

Possible direction for the future would be to take the recommendations from qualitative feedback forward into the next cycle. All topics to continue into the next cycle with additional topics, if possible on subspecialities. Another would be to continue mapping learning objectives to GP curriculum to maintain relevance.

Population ageing in the Gulf Cooperation Council region is accelerating, yet epidemiological data on older adults accessing specialist mental health services remain scarce. This study aimed to describe the demographic profile, diagnostic distribution, psychotropic prescribing patterns, and service utilisation among older adults receiving specialist psychiatric care in the United Arab Emirates (UAE), and to identify predictors of polypharmacy and acute service use.

A retrospective cohort study was conducted including all patients aged ≥60 years who had contact with a tertiary psychiatric hospital in the UAE between January 2018 and December 2025. Service modalities included outpatient, telehealth, emergency, and inpatient care. Demographic, diagnostic, and prescribing data were extracted from electronic records. Descriptive statistics summarised clinical and service characteristics. Multivariable logistic regression was used to identify predictors of polypharmacy (≥3 concurrent psychotropic medications), inpatient admission and 30-day readmission, while negative binomial regression examined predictors of emergency presentations and overall service utilisation.

The cohort comprised 1,363 patients (mean age 68.7 ± 8.2 years; 57.4% female) representing 55 nationalities. Neurocognitive disorders were the most prevalent diagnosis (31.0%), followed by depressive disorders (23.0%) and schizophrenia spectrum disorders (20.0%). Psychotropic medication was prescribed to 89.8% of patients, with polypharmacy in 58.6%. Second-generation antipsychotics (61.7%) and benzodiazepines (59.6%) were the most frequently prescribed classes. Across the study period, 77.2% of patients received outpatient care, 65.8% used telehealth, 42.3% presented to emergency services and 23.2% had at least one inpatient admission; telehealth accounted for 45.2% of all recorded encounters. Bipolar disorder was the strongest predictor of inpatient admission (adjusted odds ratio [aOR] 6.91, p<0.001) and polypharmacy (aOR 4.88, p<0.001). Substance-related and schizophrenia spectrum disorders were also consistently associated with higher odds of hospitalisation and complex prescribing. Psychiatric comorbidity predicted both emergency presentations (incidence rate ratio 2.64, p<0.001) and 30-day readmission (aOR 2.21, p<0.05). Median inpatient length of stay was 22.6 days.

This large older adult psychiatry cohort from the UAE demonstrates high psychotropic exposure, substantial polypharmacy and significant use of acute services. Bipolar, substance-related and schizophrenia spectrum disorders emerged as key drivers of hospitalisation and complex prescribing. Telehealth constituted nearly half of all clinical encounters, challenging assumptions about low digital engagement among older Arab populations. Priorities for service development include medication optimisation and governance, crisis prevention pathways for high-risk diagnostic groups, and culturally responsive expansion of geriatric telepsychiatry.

No financial sponsorship was received for this project.

• • To understand the perspectives of mental health professionals on the management of neuropsychiatric patients and their access to mental health services

• • To identify key themes that could help improve collaboration between neurology, neuropsychiatry and broader mental health services

• • To enhance mental health care for patients with neurological conditions

An online survey was designed and sent to multidisciplinary team members in working age and older adult services in South West London and St George’s (SWLSTG) and Surrey and Borders NHS Trusts (SABP) which collected both qualitative and quantitative data.

There were 29 respondents to the survey with 21 from SWLSTG and 8 from SABP. The majority of respondents were doctors with the largest group being consultants (10) and resident doctors (8) followed by psychologists (5), nurses (3) and other (3). 79.3% of respondents have had 5 or more years of experience working in mental health services and most work in community teams (38.0%) and Liaison (28.0%).

93.1% of clinicians have cared for someone with co-occurring mental health conditions and neurological disorders in the last 12 months. 96.6% of respondents felt confident in assessing the mental health of patients in their day to day practice. However, confidence reduced to 55.2% when assessing the mental health of someone with a neurological disorder.

Crucially, 79.3% of respondents do not feel the service they work in is well designed to look after patients with neurological conditions and co-existing mental health problems. While only 20.7% agree they have access to specialised resources or support for managing such patients, 69.0% do feel supported by their colleagues and seniors in these circumstances.

The majority of respondents think it is harder for someone with a co-occurring mental health issue and neurological condition to access their service compared to those with common or severe mental health conditions. Over 75% of respondents do not think that routine general adult mental health services are well equipped to manage patients with neurological disorders and do not feel there is enough input from neurology services.

There is a gap in service delivery and clinician confidence for patients with neurological conditions who require mental health care. Better access to neuropsychiatric services for advice and co-working opportunities were identified as key areas for improvement. The next steps will involve liaising with local services to create a network of secondary care and third sector organisations and consider the development of guidelines.

Methamphetamine-induced psychosis (MIP) is a severe psychiatric condition increasingly reported in low- and middle-income countries like Pakistan. It manifests with positive, negative, and general psychopathological symptoms, often mimicking primary psychotic disorders. Understanding predictors of severity is crucial for early intervention and prevention of chronicity. The aim is to quantify symptom severity in MIP using the Positive and Negative Syndrome Scale (PANSS) and identify demographic and substance-use-related predictors of higher PANSS scores.

A cross-sectional analytical study was conducted over six months at DHQ/Allied II Hospital, Faisalabad. Ninety-three adults diagnosed with MIP as per DSM–5 criteria were assessed using PANSS. Data on demographics, age of onset, duration, frequency, and route of methamphetamine use were collected. Statistical analyses included correlation, ANOVA, and multivariate linear regression (p < 0.05).

The mean total PANSS score was 88.4 ± 14.2, indicating moderate-to-severe psychosis. Negative symptoms predominated (mean=24.5). Intravenous (IV) use, onset before age 25, and use duration > 2 years were independent predictors of higher total PANSS scores (β=12.8, 7.2, and 9.4, respectively; all p < 0.01). IV users had significantly higher scores than oral or smoking users (p < 0.001).

MIP in this cohort is moderately severe, with negative symptoms notably elevated. Early initiation, prolonged use, and IV administration significantly worsen psychosis severity. These modifiable risk factors highlight targets for public health interventions and early clinical screening in substance use settings.

To evaluate adherence to the Sheffield Health Partnership University NHS Trust (SHPU) clozapine monitoring Standard Operating Procedure (SOP) which requires that patients on clozapine have their plasma levels checked yearly at their annual clozapine review.

To investigate the clinical utility of annual plasma assays in informing dose adjustments.

A retrospective audit was conducted on a random sample of 30 patients drawn from a total population of 108 clozapine-treated patients at the South Recovery Community Mental Health Team (CMHT). To be included, patients had to be under the South Recovery CMHT and on clozapine for at least one year at point of data collection. Data were extracted from an electronic record system, focusing on the completion of annual patient reviews, the requesting of clozapine assays as per protocol, and subsequent clinical actions taken based on results of these assays.

80% of patients were reviewed by a psychiatrist within a 12-month period. Full compliance with the SOP was achieved in 40% of the sample.

Major barriers to compliance included:

• • Psychiatric Reviews: 20% were overdue by at least four months

• • Assay Requests: 23% were not marked as required, often without documented reasoning.

• • Completion: 17% of requested assays were never performed, frequently due to coordination issues between the CMHT and General Practice (GP) services.

Regarding the clinical utility of clozapine assays: Of the nine results outside the therapeutic threshold levels (six low, three high), only three led to a change in dose. This illustrated that the decision to change a patient’s clozapine dose does not entirely depend on the assay result. There can be other factors that determine whether a dose is changed or not such as patient response and preference.

While annual plasma assays led to dose changes in only a small minority of patients, they remain a critical safety tool for identifying extreme outliers and monitoring adherence. Current compliance is hindered by administrative issues. Adherence could be improved by automating review reminders and synchronizing plasma assays with annual physical health blood draws to reduce the risk of them being missed. Clearer protocols are required to define responsibility for requesting and chasing blood results as currently this remains ambiguous. Further investigation with a larger sample size is needed to fully quantify the impact of assays on psychiatrist decision-making.

Post-traumatic stress disorder (PTSD) is associated with autonomic nervous system and hypothalamic–pituitary–adrenal axis dysregulation, both of which are implicated in cardiovascular pathology. Individuals exposed to conflict-related trauma frequently experience long-term mental and physical health comorbidity. This service evaluation aimed to examine the prevalence and timing of atrial fibrillation (AF) among service users with PTSD who were exposed to conflict-related trauma during the Northern Ireland conflict (“The Troubles”), and to assess whether observed patterns align with established biological mechanisms linking chronic psychological stress to cardiac arrhythmia.

A service evaluation was conducted using secondary analysis of fully anonymised, routinely collected health questionnaire data from service users accessing WAVE Trauma Centre, a specialist organisation supporting individuals affected by conflict-related trauma arising from the Northern Ireland conflict. Use of the data was undertaken with organisational permission from WAVE Trauma Centre. Data included demographic variables, reported PTSD diagnoses or symptoms, physical health conditions, and the temporal relationship between trauma exposure and medical diagnoses. The prevalence of atrial fibrillation among service users with PTSD was compared with published population-level prevalence estimates for Northern Ireland. Relevant neurobiological and cardiological literature was reviewed to contextualise findings.

Ninety-eight service users with PTSD were identified within the dataset, of whom nine had a diagnosis of atrial fibrillation (9.2%). This represents an approximately four-fold higher prevalence compared with the estimated 2.3% prevalence of atrial fibrillation in the general Northern Ireland population. In the majority of cases, atrial fibrillation was diagnosed following exposure to conflict-related trauma. A greater proportion of service users with PTSD developed atrial fibrillation before the age of 65 compared with population-based data, suggesting earlier onset. These findings are consistent with reports from large trauma-exposed cohorts demonstrating increased incidence and earlier onset of atrial fibrillation among individuals with PTSD.

This service evaluation identifies an increased prevalence and earlier onset of atrial fibrillation among service users with PTSD following exposure to conflict-related trauma during the Northern Ireland conflict. The findings support existing evidence linking chronic stress-related neurobiological dysregulation to cardiac arrhythmogenesis. Increased awareness of cardiovascular risk within trauma-informed services may facilitate earlier detection and more integrated physical and mental healthcare for individuals with PTSD.

Kent and Medway Medical School (KMMS), a new UK medical school, hosted the 2026 National Student Psychiatry Conference. The conference was organised and delivered by a student committee supported by faculty and the RCPsych Choose Psychiatry team. We describe the learning around the planning and delivery of the conference, and consider its wider educational and institutional impact.

A student organising committee was established with defined roles and responsibilities, supported by frequent planning meetings and oversight by faculty and the Choose Psychiatry team. A conference theme and associated social activities were agreed.

Twelve KMMS students from different year groups led the planning and delivery of the conference; roles included programme development, speaker liaison, sponsorship/budgeting, communications, accommodation, and logistics. Clear role allocation and regular meetings supported coordination of a complex project alongside academic commitments. The weekend conference received overwhelmingly positive feedback regarding organisation, atmosphere and session quality from the 103 delegates and 21 speakers (98% overall satisfaction).

Committee members described developing advanced professional communication, project management and leadership skills under time and resource constraints. Learning extended beyond individual task completion to coordinating interdependent workstreams, negotiating priorities, and responding collectively to challenges. They also described gaining practical experience of leadership within a complex system, including budget management, sponsorship planning, using organisational tools (e.g. spreadsheets, booking systems), and real-time problem solving to manage technical and timetabling issues.

Reflecting on this, students identified improvements for future events, including starting external communications earlier, longer breaks between sessions, ordering merchandise further in advance, and greater delegation on the day.

Despite the workload, students found the experience rewarding. Working as a team towards a shared goal, seeing plans come together, and positive feedback generated a strong sense of enjoyment and achievement, alongside practical learning opportunities rarely available within undergraduate medical education.

Medical students can develop meaningful leadership capability when trusted to lead complex, collective projects with appropriate support. Beyond promoting psychiatry, the conference provided experiential learning in systems-based working and medical leadership. For the medical school and RCPsych, the conference raised the profile of psychiatry within undergraduate training and strengthened national connections. Investing in student-led conferences provides a practical way to support engagement with psychiatry and contribute to long-term recruitment and workforce development.

Executive dysfunction is central to the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and reflects complex, goal-directed behaviours linked to psychosocial and cognitive outcomes. There is a gap in understanding the impact of practical, skills-based interventions on executive functioning in adults with ADHD. This review aimed to evaluate the effectiveness of skills-based interventions on executive functioning, with a secondary focus on psychosocial outcomes.

The review was conducted according to PRISMA guidelines. Searches were conducted on 4 July 2025 across PsychINFO, Medline, Web of Science, Embase and Scopus for studies published from 2013. Peer-reviewed studies examining the effects of skills-based training interventions on executive and psychosocial outcomes in adults with ADHD were eligible. The methodological quality of included studies was assessed for risk of bias and certainty of evidence (GRADE).

The search yielded 12 studies testing the efficacy of interventions,grouped into four categories: goal-orientated interventions (k=4), occupation-focused skills training (k=2), cognitive training with executive coaching (k=2), and Emotion regulation interventions (k=4). Goal-orientated interventions showed mixed results. Only one controlled study found limited between-group improvements, while the others showed none. Non-controlled studies reported several within-group gains, at follow-up but without control groups, improvements cannot be attributed to the intervention alone. Psychosocial outcomes varied, with two controlled studies showing improvements compared to controls, while the remaining studies showed only within-group change. Non-controlled studies showed within-group improvements across psychosocial outcomes, with effects in emotion-regulation interventions, but without control groups, these gains cannot be attributed to interventions. Occupation-focused skills training demonstrated the most consistent within-group improvements, with both studies reporting significant pre-post gains across executive fucntioning domains and quality of life. Cognitive training and executive coaching produced improvements invisuo-spatial working memory, but little evidence of change in daily functioning. Emotion-regulation interventions showed stronger effects, with improvements in executive functioning and moderate-to-large effects compared with self-guided controls, but psychosocial outcomes were less consistently improved.

Skills-based interventions show potential for improving executive functioning and, to a lesser extent, psychosocial outcomes in adults with ADHD. Occupational-focused and emotion-regulation based interventions demonstrated the most consistent benefits while cognitive and goal-orientated interventions showed mixed results. Small samples, heterogeneity in intervention type, study design and outcome measures restrict conclusions. Future research should prioritise robust controlled designs, larger and more diverse samples, and direct comparisons of different skills-based approaches to clarify which interventions yield the greatest impact.

The Alcohol Dependence Guidelines provide the standard for assessment and management of alcohol withdrawal for inpatient units in Nottinghamshire Healthcare NHS Foundation Trust. Compliance with this guideline on the Cedar ward has been inconsistent. This could potentially impact patient safety. Using a problem-focused, collaborative approach, this project aimed to initially measure baseline compliance, identify barriers, and implement changes to improve compliance with the guideline by the end of March 2026.

A retrospective analysis of admissions from August 2025 to March 2026 was used to establish baseline compliance across the various guideline domains (documentation, monitoring, prescribing, and clinical interventions). Data has been collected prospectively to evaluate the impact of implemented change ideas. Multidisciplinary team meetings, survey questionnaires and one to one staff conversations were used to identify barriers for guideline compliance. Changeideas collaboratively identified using a driver diagram included structured teaching sessions for nursing staff and resident doctors, incorporation of alcohol-withdrawal guidance into nursing induction, electronic prescribing notifications prompting CIWA-Ar completion, integration of CIWA-Ar and SADQ tools into the Trust electronic record, and liaison with the Nottinghamshire Area Prescribing Committee to review andupdate existing guidance. Agreed changes were introduced using Plan–Do–Study–Act(PDSA) cycles, with ongoing communication with clinical teams.

Baseline audit findings showed low compliance with several core components of the guideline. Weekly alcohol intake (SADQ score) was documented in 44.4% of cases. Regular chlordiazepoxide prescribing in accordance with guidelines was noted in 55.6% cases, with much lower compliance for as required chlordiazepoxide prescriptions. Escalation of appropriate concerns for clinical review was documented in only 25% of cases. CIWA-Ar was completed in 23.97% of cases. A questionnaire survey of resident doctors identified gaps in awareness and challenges related to processes on the inpatient ward. This suggested that both knowledge gaps and systemic barriers contributed to the problem.

The initial audit confirmed poor compliance with alcohol withdrawal guidelines on Cedar ward, with gaps in documentation, clinical knowledge and awareness identified as key root causes. Implemented changes, such as multidisciplinary teaching on the ward, inclusion of teaching in nursing induction, and prompts in electronic records have improved clinician confidence, recognition, and documentation of withdrawal symptoms. Several process changes being implemented including updating the current guidelines. This is expected to address the root causes of poor compliance with a potential for wider Trust-wide adoption.

BMI and waist circumference should be measured on admission and then regularly for inpatients. We aimed to determine whether this was being met, and to explore staff knowledge of such monitoring.

Retrospective data was collected from Rio, the electronic records system at Bushey Fields Hospital. The fifteen most recently discharged patients from each of five wards as of April 2025 were extracted, after which six patients from each set of fifteen were selected at random. Monitoring data was then extracted by two reviewers.

A questionnaire was separately distributed amongst ward staff to assess staff knowledge of BMI and waist circumference monitoring.

30 patients were included, with ages ranging from 20 to 81, comprising 18 male and 12 female patients. 26 patients were taking an antipsychotic. Patients had a range of physical comorbidities and were taking a range of additional medications.

BMI was recorded at admission for 22 patients, at one week for 20 patients, at two weeks for 23 patients, and at three weeks for 20 patients. Waist circumference was recorded at admission for 9 patients, and at one week for 29 patients.

13 patients had an above normal BMI, but action was only taken for 4. This included lifestyle advice, provision of relevant leaflets and a referral to appropriate services.

15 staff members received the questionnaire, of which 12 responded. 100% of responders were aware of the normal BMI range, but only half knew the normal range for waist to height ratio. 92% were aware of the need for weekly monitoring for patients on antipsychotics, but only 33% were confident in recording relevant parameters on Rio.

Only 25% of responders felt confident referring patients to relevant services, and 75% felt that educational resources on the ward were inadequate.

Not all inpatients on psychiatry ward receive necessary BMI and waist circumference monitoring, and appropriate management is only initiated for a small number of patients.

Most survey responders were not confident recording relevant information on RiO or making referrals to appropriate services and felt that available educational resources were inadequate.

We have made several suggestions in light of this data, including updating electronic record, introducing posters to the ward, staff refresher workshops and the introduction of a streamlined referral pathway for dietician reviews.

Growing research indicates that attention-deficit/hyperactivity disorder (ADHD) may occur at higher rates in individuals with functional neurological disorder (FND). However, reported prevalence differs substantially across studies and FND subtypes. This systematic review and meta-analysis sought to estimate the frequency of ADHD comorbidity within FND populations.

A systematic literature search of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar was conducted through October 2025. Seventy-five studies fulfilled inclusion criteria. Information was extracted regarding study design, sample characteristics, diagnostic methods, and reported ADHD prevalence. Pooled prevalence estimates were calculated using random-effects meta-analytic models.

Across 63 studies involving 115,331 participants, the pooled prevalence of ADHD among individuals with FND was 15% (95% CI: 12–19; I²=92%). Subgroup analyses indicated ADHD rates of 14% (95% CI: 10–18) in functional seizures (22 studies, n=11,117), 6% (95% CI: 1–16) in functional movement disorder (4 studies, n=166), and 27% (95% CI: 19–35) in functional tic-like behaviours (21 studies, n=1057). In studies limited to paediatric populations (33 studies, n=2141), the pooled prevalence was 16% (95% CI: 11–22).

Approximately one in six individuals with FND also meet criteria for ADHD, with particularly elevated rates observed in functional tic-like presentations and in children and adolescents. Considerable heterogeneity was present across studies. These findings underscore the importance of evaluating for ADHD during FND assessment, especially when difficulties with attention regulation or impulse control are prominent.

Clozapine-associated neutropenia occurs in approximately 3.8% of patients globally, with agranulocytosis reported in around 0.9%. Benign ethnic neutropenia (BEN), which is prevalent among Arab and African populations, complicates interpretation of haematological monitoring and may lead to unnecessary treatment interruption. Despite the high representation of BEN-susceptible ethnicities in Gulf populations, regional data on clozapine haematological safety are lacking. This study aimed to estimate the incidence of clozapine-associated neutropenia, identify clinical predictors, and evaluate the role of baseline absolute neutrophil count (ANC) in risk stratification.

A retrospective cohort study was conducted including all patients prescribed clozapine at a tertiary psychiatric hospital in the United Arab Emirates between January 2018 and July 2024. A total of 184 patients were followed over 228.1 patient-years, comprising 3,907 ANC measurements. Neutropenia was defined as ANC <2.0 × 109/L and categorised as mild (1.5–2.0), moderate (1.0–1.5), severe (0.5–1.0), or agranulocytosis (<0.5). Cox proportional hazards regression was used to identify predictors of neutropenia. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of baseline ANC.

Twenty patients (10.9%; 95% CI 7.1–16.2%) developed neutropenia, corresponding to an incidence rate of 9.74 per 100 patient-years (95% CI 5.95–15.05). Most events were mild (n=19, 10.3%), and no cases of agranulocytosis were observed. Patients of Arab or African ethnicity had significantly higher neutropenia rates compared with other ethnic groups (16.2% vs 1.6%; odds ratio 11.5, 95% CI 1.5–87.5; p=0.001). Baseline ANC emerged as the only independent predictor of neutropenia (hazard ratio 0.15, 95% CI 0.07–0.31; p<0.001), with each unit increase associated with an 85% reduction in risk. Baseline ANC demonstrated excellent discriminatory ability (AUC 0.92, 95% CI 0.86–0.97), with an optimal threshold of 3.3 × 109/L (sensitivity 85%, specificity 87.4%). Clozapine was continued in 80% of affected patients, with no permanent discontinuations due to haematological events.

This first Middle Eastern study of clozapine haematological safety demonstrates neutropenia rates comparable to international data and no observed agranulocytosis. Baseline ANC provides excellent risk stratification, while higher neutropenia rates in Arab and African patients likely reflect benign ethnic neutropenia rather than true drug toxicity. These findings support continued clozapine treatment with appropriate monitoring and highlight the need for ethnicity-informed interpretation of haematological results in diverse populations.

No financial sponsorship was received for this project.

A clear and well-timed induction is important in helping resident doctors work safely and confidently in mental health services. Psychiatry presents specific challenges, including the use of legal frameworks, managing risk, and working within multidisciplinary teams. Feedback from doctors starting in the Trust suggested that the induction programme was variable and that some felt unprepared when beginning clinical work.

This Quality Improvement project aimed to review the current induction programme, identify gaps that affect clinical readiness and patient safety, and support improvements in how the induction is structured and delivered.

A mixed-methods survey was sent to resident doctors who had completed the Trust induction programme within the previous 12 months. The survey included rating-scale questions on coverage, usefulness, and preparedness, alongside open-ended questions about individual experiences. Quantitative responses were summarised using simple descriptive measures, and free-text responses were reviewed to identify common themes. The project followed a Plan–Do–Study–Act approach. As this work was carried out as a Quality Improvement project, formal ethical approval was not required.

Eight out of ten resident doctors across different training grades responded. Mostfelt that the induction helped them understand their role within psychiatry, but fewer felt prepared for on-call duties and seclusion reviews. Practical sessions, such as IT access, prescribing systems training, Mental Health Act teaching, and breakaway training, were viewed positively, especially when delivered early and in person. Several key areas, including discharge summaries, ward rounds, and educational meetings, were reported as not covered for some doctors. Common concerns included induction sessions being spread over several weeks, limited protected time, and starting clinical duties before completing essential systems training. These factors reduced attendance and confidence. Most respondents felt that online or recorded learning materials would support learning alongside face-to-face teaching.

The induction programme contains important psychiatry-specific content but is less effective due to delays, poor sequencing, and lack of protected time. A shorter, more focused induction period, completion of essential training before clinical duties begin, and a blended approach to teaching may improve preparedness and support safer patient care. These findings will inform a revised induction programme and a further PDSA cycle.

We intended to study the clinical outcomes and risk factors associated with patients on Community Treatment Order (CTO) and those discharged from Section 3 (S3).

The sample included adult patients admitted (n: 123) on Section 3 of the Mental Health Act in 2022; 11 of them are currently on CTO, along with a further 55 patients currently on CTO, suggesting the sample of 66 in CTO and 112 in the S3 group. Historical and previous 12-month status of clinical and risk factors, readmission rates, duration to first readmission, and total inpatient days were collected from medical records.

Sample (n: 178) consisted of 106 (59.6%) male and 72 (40.4%) female patients; with 52.8% having Caucasian ethnicity; males made up 52.1% of the Caucasian group, vs.69.2% in BME patients (P<0.05). The proportion of men was 69.7% on CTO and 53.6% on S3 (P<.05). The mean age of the groups (CTO: 46.1 ± 17.2; S3: 45.5 ± 17.4) was comparable, and there were no differences in ethnicity, employment, and accommodation status between the two groups.

The number of diagnoses and comorbidities was comparable, whereas the presence of severe mental illness was significantly higher in the CTO: 97.0% vs. S3: 81.3% (p<0.005). History of risk to self, others, neglect, arrests, custodial sentence, probation, and being on CTO or s37/41 was comparable; forensic history and convictions were significantly more in CTO.

Duration from index discharge to readmission was considerably longer in CTO (439.2 ± 471.4) vs S3 (265.5 ± 281.2), which approached statistical significance (p: 0.059). The duration of first readmission and the nature of readmission (informal or formal) were comparable between the groups. Significantly more patients in CTO had depot and oral antipsychotics, and fewer had antidepressants compared to S3; whereas prescriptions of high-dose antipsychotics, more than one antipsychotic, mood stabilisers, and hypnotic drugs were comparable.

In the previous 12-month period, risk to self, to others, self-neglect, opiate use, psychotic symptoms, impaired or absent insight, poor engagement, and poor concordance were all significantly higher in CTO patients compared to those discharged from S3.

There were considerable differences in a few areas of the CTO and S3 patient profile, e.g. forensic history, past convictions, and treatment with depot and antipsychotics. There were many clinical and risk-related factors in the previous 12 months, validating continuation of CTO in a proportion of patients. Future studies should consider differences in symptomatic presentations, functioning and patient-reported outcomes.