Aims: Tatchbury Mount is a large hospital site at the edge of the New Forest National Park (NFNP), home to four secure inpatient units, community teams, an 80-bed nursing home and management offices. It has an abundance of wooded areas and nature. The site is part of the NHS Forest scheme which aims to support the NHS in becoming more sustainable and to reach net zero carbon by 2040. Despite the natural attributes of the site the grounds are underused by staff and patients with the only sensory trail on the site overgrown and neglected.

The aims of our project are threefold: to firstly regenerate the sensory trail, encouraging staff to use their one-day allowance of volunteer leave alongside volunteers from the New Forest National Park Authority (hosting our fellowship). Secondly, to communicate to staff through the wellbeing team and champions network as well as engagement with clinical teams on site the benefits of spending time in nature and to increase awareness of the sensory trail. Finally, to better understand the barriers for NHS staff accessing nature at the site.

Methods: We have liaised with key stakeholders in regeneration of the sensory trail including Hampshire County Council Public health wellbeing team, estates department, NFNPA volunteers and the trust wellbeing team. Two days have been agreed to regenerate the site with advertising created as well as communications through the wellbeing champion network. We will continue to gather insights from staff and have prepared a questionnaire to be completed by NHS staff to evaluate the impact of volunteering on wellbeing.

Results: Through this project we have made links with the Wellbeing team for Hampshire and IoW trust and Hampshire County Council PH wellbeing team. We have identified that staff including the trust wellbeing team are currently not aware of the sensory trail and by using the COM-B model of behaviour change we have identified that the barriers to access nature are multifactorial and link with each other. These include time/workload, staff shortages, culture not to take a break, knowledge that the trails exist and physical health/injuries.

Conclusion: There is great opportunity for NHS sites across the country to be used by staff to connect with nature and in turn enhance wellbeing.

The involvement of the trust Wellbeing team, wellbeing champions and management is vital to ensure that the embedded culture surrounding taking breaks and focusing on wellbeing is recommended and supported.

Aims: Medication errors at the interface of care (admission, transfer and discharge) are a leading cause of patient morbidity and mortality. For this reason, the Scottish Patient Safety Programme and National Institute for Health and Care Excellence (NICE) have highlighted the need for accurate medicines reconciliation, and set a 95% standard that all medicines should be reconciled within 24 hours of the patient’s admission. This audit intended to assess quality of completion of Medicines Reconciliation forms and identify any potential barriers to completion. The objectives of this audit were to assess current adherence to local Medicines Reconciliation guidelines across General Adult Psychiatry Wards 19 and 20 in University Hospital Hairmyres (UHH) and identify any potential factors which may be contributing to Medicines Reconciliation forms not being completed appropriately.

Methods: An audit of Medicines Reconciliation form completion for admissions to Wards 19 and 20 in UHH was carried out retrospectively for all (24 no.) patients admitted from 10/11/2023–12/12/2023 using electronic case notes. Other systems, including the software for online prescribing and TrakCare were also used. Each section of the proforma was assessed and information recorded in an Excel spreadsheet as well as information about whether this was completed in the first 24 hours of admission. Following this, a summary document with the latest guidelines and the link to an e-learning module were distributed amongst the Resident Doctors, and raised at the monthly Resident Doctor’s meeting. The form completion was then re-audited for patients admitted from 11/3/24–11/4/24 (34 no.).

Results: In the first cycle of the audit, only 70% of patients had their form completed within 24 hours of admission, which then improved to 100% in the second cycle. Another section with poor compliance in the first cycle was the section confirming that 2 sources of information had been used (66% completed), which also increased to 100% in the re-audit. In terms of the other parameters assessed, there were improvements in all 12 areas.

Conclusion: The audit was straightforward to carry out and yielded valuable insights to improving inpatient psychiatry care. However, the results may have been influenced by individual variability, given the involvement of multiple doctors in the clerking process for new admissions. The findings highlight the importance of regular training and reinforcement of local guidelines to enhance patient care. Nonetheless, there remains an opportunity for further work in this area, including regional audits and updates to local guidelines.

Aims: In obsessive-compulsive disorder (OCD), treatment non-response is common with recommended medications; hence there is a need to investigate the role of alternative agents. It was intended to evaluate the evidence base involving ondansetron as a treatment strategy for OCD in adults, considering its role as a 5-HT3 receptor antagonist primarily in the limbic system.

Methods: Various electronic databases (PubMed, CINAHL, EMBASE, PsycInfo, Cochrane, Clinical Trials Registers, and PROSPERO) were searched for articles with keywords of ‘ondansetron’, ‘obsessive-compulsive disorder’ or ‘OCD’, and ‘clinical trial’, in the English language, published up to October 2024.

Results: Nine studies were included in this systematic review. Studies used Yale–Brown Obsessive Compulsive Scale (YBOCS) scale for assessment and ondansetron mostly as an augmenting drug. More than half of the studies (five out of nine) had patients with treatment-resistant OCD, and serotonin reuptake inhibitors as the active drug. All trials reported improvement in OCD with ondansetron augmentation, except the study which involved chart review for treatment-resistant OCD. The improvement was observed as early as two weeks following ondansetron augmentation. The reported range of decrease in YBOCS score from baseline in various studies has been 23.2–55%. Treatment response was reported between 37–86.4%. Improvement was noticed in both OCD and treatment-resistant OCD groups. Discontinuation of ondansetron led to worsening of symptoms which was reported in two studies. Overall adverse effects of ondansetron were mild to moderate in degree, with no major clinical concerns, and were generally well tolerated. Commonly reported side effects were constipation, headache, diarrhoea, decreased appetite, dizziness, insomnia, anxiety, nervousness, sweating, dry mouth, muscle cramp and sexual dysfunction. Available studies have major limitations which are mostly small sample sizes and short duration of trials.

Conclusion: Current evidence suggests ondansetron may be beneficial in the treatment of OCD and treatment-resistant OCD, mostly as an augmentation agent; however the evidence is scarce to draw any firm conclusion. Further trials with adequate sample size and duration are required.

Aims: Missed seizures (MS) are non-therapeutic, making their frequency a key measure of an ECT clinic’s efficacy. In our initial audit at the NHFT ECT clinic (October 2021–March 2023), an MS rate of 12.6%, a restimulation rate of 67.5%, and poor adherence to the stimulus dosing protocol were identified. To address this, staff training, discussions, and dose chart displays were introduced. A follow-up audit was then conducted to assess the impact of these interventions.

Methods: The audit was conducted retrospectively over 13 months (June 2023–July 2024). Data were collected on total treatments, patient demographics, and stimulus doses. According to the NHFT ECT protocol, MS is defined as stimulation that fails to produce motor convulsions or EEG activity. The protocol recommends that during the seizure-threshold (ST) determination phase, dosing should be titrated as per the stimulus dosing protocol, while in the treatment phase (TP), restimulation should involve a 10% dose increase. The MS rate was calculated as the ratio of MS to total stimulations, and the restimulation rate as the ratio of total restimulations to MS.

Results: The clinic administered 210 bilateral ECT treatments to 22 patients – predominantly middle-aged (40–60 years), 59.1% male, and 77% White/British. The MS rate decreased to 11.6%, and the restimulation rate increased to 81.5%. Of the 27 MS, 19 occurred in the ST determination phase, with 17 restimulated, while 8 were in the TP, with 5 restimulated. Compared with the initial audit, the ST phase saw MS decrease from 81% to 70%, with correct dosing improving from 36% to 88%. After establishing the ST, full compliance with the dosing protocol was achieved – contrasting with the earlier audit, where 84% either received the same or a slightly higher dose. In TP, the current audit achieved full compliance with the recommended 10% dose increase for all restimulations, whereas previously, 2/3 doses were suboptimally increased. Additionally, documentation of the protocol showed marked improvement.

Conclusion: Appropriate management of MS is vital, as they are linked to treatment failure and increased post-ECT side effects. Our interventions have improved protocol adherence, yet further progress is needed. The Bridgend ECT clinic has maintained an MS rate of ≤5% over six years. To achieve similar outcomes, we recommend that the NHFT ECT clinic restimulate rather than proceed with ‘doubtful’ seizures, as they often lead to MS. Additionally, restimulating at the same dose as the previous MS in subsequent sessions should be avoided, as it is ineffective.

Aims: In people with intellectual disability (ID), anticholinergic burden (ACB) is associated with multimorbidity, polypharmacy, and premature mortality. A previously reported baseline audit evaluated ACB over a period of 3 months in two inpatient units. This project reports on the development of practice recommendations and audit standards based on that work.

Methods: The baseline audit results were discussed in two peer group meetings of prescribers and two multidisciplinary continuing professional development (CPD) sessions. Based on a qualitative analysis of themes from these discussions, good practice recommendations and an Anticholinergic Quick Checklist (ACQC) for screening were finalized.

Results: The practice recommendations were

1. The indication(s) and rationale for prescribing all psychotropic medications, including those with anticholinergic properties, should be clearly stated.

2. Consent-to-treatment procedures or best-interest decision-making processes should be followed and documented.

3. ACB of the patient’s medication regime should be calculated using an instrument like the AEC scale (Medichec), ACB calculator, or equivalent.

4. Side effects of psychotropic medication and treatment outcomes should be monitored using standardised scales like the LUNSERS, GASS, CGI Efficacy Index, CGI Global Improvement, or equivalents.

5. There should be regular monitoring of treatment response and side effects of all prescribed psychotropic medications, including those with anticholinergic properties.

6. There should be regular review and evaluation of the need for continuation or discontinuation of all prescribed psychotropic medications, including those with anticholinergic properties.

Conclusion: There is a need to evaluate the psychometric properties of the Anticholinergic Quick Checklist (ACQC). Larger scale studies and service evaluations are needed to further improve clinical practice in addressing anticholinergic burden (ACB) in people with intellectual disabilities (ID).

Aims: Capgras syndrome (CS) is a rare delusional misidentification syndrome characterized by the belief that a close relative has been replaced by an identical impostor. It is commonly associated with schizophrenia and other psychiatric disorders.

A 43-year-old married Asian female presented with a 5-year history of behavioural changes, including social withdrawal, suspiciousness, reduced self-care, and irrelevant speech. Her symptoms began following a familial conflict, leading to social isolation, self-neglect, and delusional misidentification, including Capgras syndrome, where she believed her mother had been replaced by an imposter. She later developed grandiose delusions, claiming to be a significant political figure. Despite initial improvement with antipsychotic treatment, she discontinued medication, resulting in symptom relapse and aggressive behaviour.

Methods: Case report.

Results: Capgras syndrome, first described in 1923, involves the delusional belief that familiar individuals have been replaced by impostors. It is often associated with psychiatric disorders, such as schizophrenia, and neurodegenerative conditions. This case aligns with the dual-route model of face recognition, suggesting impaired implicit-affective processing alongside intact conscious recognition. The patient’s aggressive behaviour underscores the potential for violence in Capgras syndrome, highlighting the need for careful risk assessment and management. Non-adherence to treatment remains a significant challenge in managing such cases.

Conclusion: This case highlights the importance of early recognition and sustained treatment adherence in Capgras syndrome associated with schizophrenia to prevent deterioration and improve outcomes.

Aims: To establish a formalised process for mentoring to be accessed by psychiatrists of all grades within a mental health trust in Gloucestershire, UK. Mentoring can contribute to career success, higher self-esteem and job satisfaction for mentees and improve performance and job satisfaction for mentors.[1] This in turn fosters innovation and development as part of the culture within the host organisation.[2] We anticipate the creation of a mentoring scheme for psychiatrists will promote these improvements for individuals in the short term and the organisation in the longer term.

[1] The General Medical Council (GMC). The mentoring toolkit: Setting up a formal mentoring scheme. August 2024. [2] Coaching and mentoring. The NHS Leadership academy. https://www.leadershipacademy.nhs.uk/programmes/coaching-and-mentoring/. Accessed November 13, 2024.

Methods: The European Mentoring and Coaching Centre defines mentoring as ‘a learning relationship, involving the sharing of skills, knowledge, and expertise between a mentor and mentee through developmental conversations, experience sharing, and role modelling’.

Mentoring is promoted as part of Good medical practice by the GMC. The Royal College of Psychiatrists highlights its importance for all doctors, especially around periods of transition and to aid in retention and resilience of the workforce.

Gloucestershire Health and Care NHS Foundation trust appointed an experienced psychiatrist as a mentoring lead in 2022 with ambitions to develop a scheme in the trust. A steering group was formed to develop this idea and oversee its inception.

An electronic survey to medical colleagues in psychiatry identified significant interest for a formal mentoring scheme.

Exploration of best practice in adjacent trusts and a literature search developed the organisational process and allocation procedure of pairings. Centralising requests and the use of mentor biographies allowed for the mentor-mentee matching, and a database created.

The scheme is modelled on traditional mentorship, with anticipation of senior clinicians acting as mentors to trainees or more junior colleagues in all cases, unless peer to peer mentoring is requested.

Results: Initially, 8 mentor/mentee matches were made, with a further 7 pairings captured with steering group oversight. Feedback was unanimously positive with praise for the ease of the process and benefits gained from the relationship exchange from both mentors and mentees.

Conclusion: The scheme has an email address for centralising enquiries and is signposted via a flyer across trust working areas and as part of induction for all new doctors in Psychiatry. 4 CPD talks have been delivered to the medical academic programme and next steps include an annual newsletter, development of bitesize training for mentors and a video to further raise the profile of the scheme. Limitations of the scheme are acknowledged given moderate size of the trust and small pool of available mentors.

Aims: A diagnosis of depression is three times more likely to occur in people living with HIV/AIDS. Management is imperative,as it not only ensures reduced depressive symptoms but also improves quality of life. Interpersonal psychotherapy (IPT) and cognitive-behavioural therapy (CBT) have been linked to reduced depressive symptoms. This paper will investigate to what degree both treatment options can help reduce depressive symptoms in people living with HIV/AIDS.

Methods: Randomized controlled trial articles from the Cardiff University repository, PsycARTICLES, PsycINFO, Cinahl, and PubMed databases were collected and dated not later than ten years from 2024. The participants were individuals with an HIV/AIDS diagnosis and depression as a comorbidity. They also had been exposed to either IPT or CBT psychotherapy. The articles were screened, and data from19 articles with 4805 participants were extracted.

Results: Findings showed that CBT reduced depressive symptoms, and its effects were visible in the long term, which involves more than six months. Similarly, IPT was found to have long-term effects, but the difference in the symptoms in IPT was minimal compared with CBT. No significant difference in the efficiency of either therapy was observed.

Conclusion: Both the psychotherapy modalities were found to have positive impact by reducing depressive symptoms. There is a need for more research into improving the psychotherapy intervention time and mode of delivery.

Aims: Epilepsy can present with a wide range of neuropsychiatric manifestations. A seizure episode may take the form of motor convulsions, complex abnormal behaviours or unusual subjective experiences.

Seizures originating in different anatomical locations take characteristic forms, however, there is considerable overlap in the presentation.

Frontal lobe seizures are characterised by motor phenomena which may include complex posturing and behavioural automatism which tend to begin and end abruptly.

This condition is of particular importance to psychiatrists, due to the bizarre nature of automatic behaviour. They may be mistaken as dissociative phenomena or psychotic disorders.

Methods: A 55-year-old female who was previously well, presented to the psychiatric service following episodic disorganised behaviour for two weeks duration. For example, she had cooked rice three times per meal without an apparent reason. Also, she had started collecting a large number of vegetables repeatedly in a shopping centre without a clear purpose. At that time her husband had to forcefully stop her. When inquired later she was unable to recall these events. Family members also noticed that the patient is having episodic repetitive facial movements without losing consciousness.

General physical and neurological examination was normal. Her EEG showed right frontal sharp waves which progress into generalised spikes, suggestive of frontal lobe epilepsy with secondary generalisation. The contrast CT brain was normal. Haematological tests including random blood sugar, serum electrolytes, full blood count, serum calcium levels and the ECG were normal. Intravenous phenytoin sodium was given to control repetitive seizures at the onset.

Subsequently, oral sodium valproate was commenced. She responded well, and symptoms disappeared within a couple of days.

Results: Epilepsy presenting as behavioural and psychiatric manifestations is common but can be easily overlooked. Frontal lobe epilepsy with common aetiology like post traumatic, tumours and genetic causes can have complex seizure semiology.

Overall frontal lobe seizures tend to begin and end abruptly, are brief and frequent. They show a tendency to occur at night and in clusters. Motor phenomena which may include complex posturing and behavioural automatism are usually the most conspicuous feature.

This patient had several bizarre behaviours which could be complex behavioural automatism. The bizarre nature of automatism means that they can often be mistaken for non-epileptic dissociative seizures as well as another psychiatric diagnosis like mania or psychosis.

Conclusion: Our patient highlights the unusual way of presentation of frontal lobe seizures. Clinicians need to be aware of this presentation to minimise possible misdiagnosis and mismanagement.

Aims: To investigate how anticholinergic burden of medications changes during hospital stay for Intensive Care Unit (ICU) patients and to review whether anticholinergic burden predicts delirium and mortality.

Delirium is a common cause of morbidity and mortality within ICU. Anticholinergic Burden (ACB) and Anticholinergic Effect on Cognition (AEC) tools are validated to assess anticholinergic effects from medication. Scores of ≥3 are associated with increased delirium and mortality. This study investigates anticholinergic burden from ICU admission through to hospital discharge.

Methods: Retrospective, ethically approved study of adults (N= 6,305) admitted to ICU in University Hospitals Birmingham over 3 years (2021–2023). Subjects were excluded if <48 hours spent in ICU or readmissions (within a year). Both ACB and AEC tools were used to assess anticholinergic burden (AEC is more sensitive to the cognitive effects of medications). Timepoints assessed: ICU admission, ICU discharge, hospital discharge, and maximum score. We explored secondary outcomes including delirium and mortality. Research performed in collaboration with PIONEER (Health Data Research Hub for Acute Care).

Results: Median age 60.0 years, 61.9% male, and 71.6% of white ethnicity. Median time from hospital to ICU admission 17.1 hours, 86.3% emergency admissions. Median length of stay in ICU 5.2 days (19.2 days in hospital).

Difference in mean score from ICU admission to ICU discharge was +0.38 (p<0.001) for ACB, and +0.29 (p<0.001) for AEC; from ICU discharge to hospital discharge was −0.12 for ACB (p<0.001) and +0.36 (p=0.005) for AEC.

There was a significant rise in patients with high-risk scores (ACB or AEC ≥3): admission to ICU 9.9% had ACB ≥3, and at discharge from ICU 19.9% (p<0.001), with no significant fall back at hospital discharge (18.9%, p=0.229). The AEC tool showed similar Results: admission to ICU, 4.9% of patients had AEC ≥3 and at discharge from ICU 10.5% (p<0.001) However, this tool showed a further rise by hospital discharge 12.3% (p<0.003). Delirium was inadequately recorded.

Results showed anticholinergic burden significantly increases following ICU admission. The proportion of patients with high-risk scores doubles during ICU admission and does not significantly reduce prior to discharge. We were unable to link these scores to delirium with insufficient data collected, but investigations on possible links to mortality are ongoing.

Conclusion: This study demonstrated a significant rise in anticholinergic burden linked to ICU admission, persisting to hospital discharge. This places such patients at risk of drug-induced morbidity and mortality.

Educational pathways in colonial and postcolonial spaces often range far beyond the classroom. Reconstructing histories of this wider terrain of education reveals long-running arguments over what types of new knowledge might be most useful for living well amid war and within fast-changing colonial and postcolonial states. These debates over the provision of useful knowledge—including military, mechanical, linguistic, and religious training—are a window into how people have discussed changing ideas of authority, class mobility, and the future. We trace a wider terrain of education in southern (now South) Sudan, where education histories have generally either focused on a handful of mission-founded formal schools or hagiographies of powerful military men with PhDs. Drawing on archival evidence and interviews gathered in South Sudan since 2019, we argue that histories of education in colonial and postcolonial Africa are crucial to understanding intellectual histories in everyday life.

Aims: This audit explores adherence of the Leeds Community Healthcare (LCH) Learning Disability Clinic to the STAMP/STOMP guidelines. This is to ensure that children with moderate to severe learning disability or autism are not overmedicated with psychotropic medications and are aware of their right to an annual health check.

Methods: This audit took place in 2 cycles: JA in November 2023 and EM in July 2024. On both occasions, 30 clinic patients were randomly selected. Data was collected from SystmOne and Leeds Care Record, to ascertain:

The number of children who had their Annual Health checks in the previous year.

Whether the drug names and dosages had been identified in case notes.

Whether indications for psychotropic treatment were documented.

If the drug was within British National Formulary limits.

Whether there was a discussion of side-effects at initiation and follow-up.

In cycle 2, EM set criteria for “enquiry for side-effects at follow-up”. This was interpreted as a relevant medical appointment in the past 6 months or since a change in dose. In addition, the age of the child was accounted for in the second cycle, as only children >14 years were advised to have an annual physical health review.

Results: Children receiving an annual health check: 70% (cycle 1)/80% (cycle 2).

Drug names and dosages have been documented: 100% (cycles 1 and 2).

Indication for psychotropic medications has been documented: 85% (cycle 1)/93% (cycle 2).

Discussion of side-effects at initiation has been documented: 73% (cycle 1)/38% (cycle 2).

Enquiry for side-effects at follow-up: 77% (cycle 1)/54% (cycle 2).

Conclusion: Medications and dosage were consistently documented across both Audits. In cases where only melatonin or ADHD medication is prescribed, it was more common to find that discussion of adverse effects, and specific impacts on sleep duration and latency were not documented. On an ongoing basis, team members must ensure that patients over the age of 14 (and their families) are aware of their right to an annual physical health check.

One limitation of this study is that ‘discussion of side-effects’ does not clarify the extent and frequency to which these should be discussed. This may account for the large difference between audit cycles. In addition, the spread of information between systems may have increased the possibility of information being lost or overlooked.

Aims: To reduce medication errors on West Ward, a busy adult mental health ward, by addressing multiple domains of medication safety identified in a baseline audit. The project aimed to improve prescribing practices, medication administration, and related processes through targeted interventions and continuous monitoring.

Methods: A baseline audit of medication practices on West Ward revealed significant errors across various domains, including temperature recording, medication stock management, MHRA actions and alerts, record keeping, incomplete processes, prescribing technicalities, clinical issues, administration errors, controlled drug management, emergency drug and equipment availability, medicine ordering, and medicine information.

A quality improvement (QI) project was implemented over six months, incorporating three Plan-Do-Study-Act (PDSA) cycles. Interventions included:

Training: Targeted training for doctors and nurses on best practices in medication safety, focusing on identified error hotspots.

Documentation Improvement: Introduction of standardised templates and improved documentation processes to enhance clarity and completeness.

Induction Changes: Revision of the induction process for new staff to emphasise medication safety protocols and ward-specific procedures.

Controlled Drug Review: A comprehensive review and strengthening of controlled drug management procedures, including prescribing, storage, and administration.

MHRA Record Keeping Review: Implementation of a robust system for recording and acting upon MHRA alerts and drug safety information.

Data was collected throughout the project using regular audits of medication practices, mirroring the baseline audit. Error rates were tracked across all targeted domains for each PDSA cycle to assess the impact of the interventions. Sustained improvement was evaluated through follow-up audits after the project’s completion.

Results: The QI project demonstrated a significant reduction in medication errors on West Ward. Overall, a 51% reduction in the total number of medication errors was achieved over the six-month period. Each PDSA cycle contributed to this improvement, with error rates progressively decreasing. Specific areas showing marked improvement included prescribing technicalities, administration errors, and controlled drug management. Follow-up audits conducted after the project’s conclusion indicated that the reduced error rates were sustained over time, demonstrating the effectiveness of the interventions.

Conclusion: This QI project successfully reduced medication errors on West Ward through a multifaceted approach targeting multiple domains of medication safety. The combination of training, documentation improvements, process changes, and focused reviews. This project demonstrates that targeted QI initiatives can lead to significant and lasting improvements in medication safety within a busy mental health setting, ultimately benefiting patient care and safety. Further work will focus on exploring the factors contributing to sustained improvement and disseminating these findings to other wards and healthcare settings across the organisation.

Aims: This case involves a 32-year-old female with a history of Anorexia Nervosa and Post-Traumatic Stress Disorder (PTSD) admitted for restricted eating. During admission, she reported worsening PTSD symptoms, including nightmares, linked to a reduction in her doxazosin dose. Doxazosin, an alpha-1 adrenergic antagonist, is used off-label to treat PTSD-related nightmares by reducing noradrenergic hyperactivity. This case highlights the challenges of managing complex comorbidities and balancing physical and mental health.

Methods: The patient, a 32-year-old female, was admitted for restricted eating. She had a history of Anorexia Nervosa (restrictive subtype) and PTSD. During admission, she reported increased PTSD symptoms, including frequent nightmares and difficulty distinguishing nightmares from reality.

Initially, her doxazosin dose was reduced from 16 mg to 8 mg due to hypotension concerns. However, this reduction coincided with worsening nightmares and distress. After confirming physical stability (stable blood pressure and no refeeding complications), the dose was increased to 12 mg. This adjustment led to significant improvement: reduced nightmare frequency, decreased distress, and better ability to differentiate nightmares from reality.

Her treatment involved a multidisciplinary approach, including medical monitoring of refeeding syndrome, psychiatric support for PTSD, and nutritional rehabilitation for anorexia nervosa. Regular monitoring of her physical and psychiatric health was maintained throughout her hospital stay.

Results: This case illustrates the complex interplay between physical and psychiatric conditions, particularly in patients with comorbid anorexia nervosa and PTSD. The reduction in doxazosin dose likely disrupted its therapeutic effect on PTSD-related nightmares, leading to symptom exacerbation. Doxazosin alleviates nightmares by blocking noradrenergic hyperactivity, which is implicated in PTSD pathophysiology. Restoring the dose to 12 mg balanced psychiatric symptom management with physical stability.

The case underscores the importance of a multidisciplinary approach in managing complex comorbidities. Collaboration between medical, psychiatric, and nutritional teams was essential to address both her physical health (refeeding syndrome, hypotension risk) and psychiatric needs (PTSD-related nightmares, anorexia nervosa). Regular monitoring and individualized treatment adjustments were key to achieving a positive outcome.

This case highlights the need for careful medication adjustments in patients with comorbid conditions. The decision to increase the doxazosin dose was guided by clinical response and physical stability, demonstrating the importance of personalized care.

Conclusion: This case demonstrates the challenges of managing comorbid anorexia nervosa and PTSD, particularly when physical and psychiatric symptoms interact. The careful adjustment of doxazosin dose, combined with a multidisciplinary approach, led to significant symptom improvement. It emphasizes the importance of individualized treatment plans, close monitoring, and collaboration between medical and psychiatric teams in achieving optimal outcomes.

Aims: This study aimed to elucidate the modulating effects of serum ghrelin on the relationships between interleukin-6 (IL-6) and antidepressant treatment outcomes, particularly focusing on 12-week remission and 24-month relapse in patients with depressive disorders.

Methods: We analysed baseline serum levels of ghrelin and IL-6 in 1,086 patients engaged in a naturalistic, stepwise antidepressant treatment protocol. Remission was assessed using the Hamilton Depression Rating Scale (HAMD), with a score of 7 or less defining remission at 12 weeks. Patients achieving a response (HAMD ≤14) at this interval were tracked for relapse (HAMD >14) quarterly up to 24 months. Logistic regression models, adjusting for sociodemographic and clinical variables, explored the interactive effects of these biomarkers on treatment outcomes.

Results: Our analysis indicated that while serum ghrelin levels did not directly impact treatment outcomes, they significantly modulated the relationship between high IL-6 levels and the likelihood of non-remission at 12 weeks as well as relapse at 24 months. Notably, elevated IL-6 was strongly associated with these negative outcomes primarily in the context of lower ghrelin levels. The modulatory effects of ghrelin were statistically significant in the context of relapse after controlling for relevant covariates.

Conclusion: The findings from this study underscore the critical interplay between inflammatory and metabolic markers in determining the trajectory of depression treatment outcomes. By demonstrating the significant roles of IL-6 and ghrelin, particularly their interactive effects, this research highlights the potential to enhance personalized antidepressant strategies through the integration of biomarker profiles. Future investigations should focus on unravelling the dynamic mechanisms behind these interactions, which could pave the way for refining prediction models for treatment responsiveness and developing targeted interventions that more effectively address the complexities of managing depression.

Aims: Medical education is a cornerstone of the NHS, influencing the continuous improvement of patient care. This study aims to explore the experiences of psychiatric trainees and medical students within a mental health trust, identifying opportunities to enhance medical education quality.

Methods: A qualitative focus group methodology was employed to capture detailed perspectives of participants. Four separate focus groups were conducted, categorized by the level of training: medical students (n=4), foundation doctors (n=4), core psychiatric trainees (n=8), and higher specialty trainees (n=4). Participants were recruited via internal mass email. Focus groups were guided by a standardized topic guide. Data were analysed using thematic analysis.

Results: Key findings reveal shared themes of issues in induction processes, access to information, rota issues, and facilities. Additionally, the study highlighted the importance of structured support for achieving psychotherapy competencies and the necessity for both clinical and non-clinical training. There is also a significant need for better supervision, support, and appreciation.

Conclusion: The study provides insights into the experiences of psychiatric trainees and medical students, highlighting key areas for improvement. Implementing the practical recommendations can enhance medical education quality within mental health trusts, benefiting trainees, educators, and patients.

Aims: Women with mental illness face increased sexual and reproductive health risks, including trauma, sexually transmitted infections (STIs), reproductive-associated diseases, and contraceptive challenges. In 2024, Mersey Care NHS Foundation Trust ratified its clinical policy for physical health care. The authors assessed compliance with annual physical health checks (APHCs), sexual health assessments, and their communication in discharge summaries. The aims of this audit were to identify gaps and develop improvement strategies for the Trust’s general adult female inpatient wards.

Methods: A retrospective audit design was used with convenience sampling based on the data collection day. Compliance was benchmarked against NICE guidelines and the Trust’s Clinical Policy SD29 (target 100%). Data were extracted from electronic patient records for APHCs, sexual and reproductive health screenings, and evidence of actionable findings in discharge summaries. If no valid APHC was available, the most recent assessment was searched for. Topics were “covered” if decision-making processes were documented.

Results: Sixty-two female patients from four general adult inpatient wards were identified. Mean age was 42 years (19–70 years). Mean admission length was 50.82 days (1–339 days). Mental health diagnoses included schizoaffective, psychotic, anxiety, depressive, neurodevelopmental, and personality disorders. 60% of inpatients were detained under Section 2 of the Mental Health Act 1983, 19% under Section 3, and 21% were voluntary.

Regarding APHCs:

94% valid (none fully complete).

Four patients without a valid form; two had documented reasons and one offered follow-up.

All national cancer screening programmes were covered in 55% of age-eligible patients (6% declined).

55% covered sexual health history (3% declined).

22% covered menstrual history.

12% covered obstetrics and gynaecology history (3% declined).

Regarding inpatient screening:

90% lacked documented contraceptive discussions beyond oral contraception on admission.

Pregnancy tests: 48% on admission, 15% during admission, 13% documented reason for non-completion; 25% non-completion in over 45s likely due to undocumented menopausal status.

STI screening considered in 13% of cases.

Sexual health counselling offered to 11%. Four out of seven inpatients accepted.

One patient had a positive STI screen in a previous admission.

Conclusion: Despite high APHC completion rates, gaps in sexual health screening and in documentation were identified. Key improvements include better integration of sexual health within assessments, increased review of reproductive health needs, and more consistent STI screening. The authors suggest exploring staff awareness, regional staff teaching, updating policy guidance, and increasing policy distribution. Future audits should evaluate intervention effectiveness, ensuring comprehensive care for this vulnerable patient population.

Aims: Antipsychotic medications are one of the major iatrogenic causes of hyperprolactinaemia with the attendant short- and long-term effects and risks associated with it. The audit sought to answer the question: are we monitoring for and managing hyperprolactinaemia caused by our medications appropriately, and to compare the results with previous audit.

Methods: A literature search for relevant data and standards with regards to monitoring and management of hyperprolactinaemia was conducted.

The audit was based on the standards derived from South West Yorkshire NHS Partnership Foundation Trust’s (SWYPFT) standards, NICE guidelines, and the Maudsley Prescribing Guidelines In Psychiatry (14th edition), focusing on the Trust’s standards.

The total population under consideration included every patient under the care of the North Kirklees, Community Mental Health Team (CMHT), Older people services, in the time period between 16 January 2024 and 15 August 2024, who was using antipsychotic medication.

Results:

The total number of patients in the study was 78.

1. Patients not requiring monitoring (n=35). These patients were on medications such as olanzapine, quetiapine, or aripiprazole and did not require monitoring.

2. Patients requiring monitoring (n=43). Out of the 43 patients:

First-time antipsychotic users (n=15): 10 patients did not have their prolactin monitored; 5 patients had their prolactin monitored.

Long-acting injection patients (n=8):6 patients had their prolactin monitored; 2 patients did not have their prolactin monitored.

Oral antipsychotic medication patients (n=20):11 patients had their prolactin monitored; 9 patients did not have their prolactin monitored.

Monitoring outcomes:

Out of the 43 patients requiring monitoring, 22 patients had their prolactin monitored (51%).

21 patients (49%) did not have their prolactin monitored.

Conclusion: As compared with the first audit, this re-audit showed only a 10% increase (from 41% to 51%) in monitoring of prolactin levels, still far away from achieving the 100% monitoring goal.

Perhaps, big improvement was not seen because of clinical perception of less significance of prolactin level below 2500 in old age patients.

Aims: Post-traumatic stress disorder (PTSD) is a condition that may develop following exposure to a highly threatening or horrific event or series of events. PTSD can affect people across all age groups with extensive impact on functioning and is often associated with psychoactive substance misuse. Cannabis is one of the most abused psychoactive substances worldwide, with users reporting anxiolytic benefits. Cannabis-based medicinal products (CBMPs) have gained more attention and interest over the past few years due to changes in the legislation around cannabis worldwide. Research has shown cannabis-based medicinal products to be effective in treating several medical conditions. Observational studies in adult populations indicate some therapeutic promise for CBMPs in PTSD, but these results are not generalizable to younger populations.

The authors aimed to complete a search of the literature for any evidence of the benefit of cannabis-based medicinal products in treating children and young people diagnosed with PTSD.

Methods: A comprehensive search of databases, including Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Google Scholar, from their inception until September 2024, was conducted using medical subject headings and keywords: “Post-traumatic stress disorder”, “Medical Marijuana”, “Cannab*”, “Canab*”, “THC*”.

The authors limited their search to papers involving children and young people under 18 years of age. Three of the 105 papers screened – two systematic reviews and one case report – were eligible for inclusion in this review.

Results: The current evidence for treating post-traumatic stress disorder with cannabis-based medicinal products in children and young people under the age of 18 years is limited to case reports, making generalisability of the results to the general population difficult.

Conclusion: The evidence for the use of CBMPs in children and adolescents with PTSD is limited. While there are several studies based on adult participants suggesting the beneficial effects of CBMPs in PTSD, the results cannot be generalized. This review highlights the need for high-quality research to establish the efficacy and safety of CBMPs in treating PTSD among children and adolescents.

Aims: Educating patients about metabolic side effects.

Empowering patients with knowledge and skills to make informed lifestyle choices.

Implementing personalised lifestyle interventions to improve metabolic health parameters.

Monitoring progress to facilitate long-term adherence to healthy behaviours.

Methods: Patients between 18–65 years.

Symptoms of metabolic syndrome i.e. high blood pressure, low HDL, truncal obesity, high triglycerides, impaired fasting glucose.

Patients currently/historically on antipsychotic medication.

Patients who have at least a year left in the service were included in the pilot.

Relative stability in mental health i.e. ability to engage with physical health appointments.

Results: The pilot concluded that patients benefited from tailored lifestyle interventions, giving them a sense of purpose and accountability.

There were significant changes in waist/circumference ratio; with noted improvement. Waist mean change = −5 cm (−6%); Waist:height mean change =−0.03 (−6%).

There were significant changes in weight: 5 individuals lost weight and improved their BMI; 2 individuals improved from overweight >normal.

There were no significant changes in biochemical markers.

A larger sample is required for a longer duration to study the impact of lifestyle interventions.

Conclusion: Small sample size – risk of bias, limited generalizability. Measurements for waist circumference might be prone to error as there is variation in the method of measurement i.e. over or under clothing. Blood results were inconclusive, perhaps the focus of the second phase should be waist circumference since there was marked change and measurable.

Clients would benefit from maintaining a food/mood diary and attending a briefing group at the start of the study to understand the basic principles of nutrition and the digestion process.