Functional Neurological Disorder (FND) presents with diverse and often overlappingneurological symptoms, reflecting marked clinical heterogeneity. Research has largely focused on psychological and psychosocial contributors, while biological and developmental health factors earlier in life remain comparatively underexplored. This study examined the prevalence and clinical relevance of early biological factors, neurodevelopmental features, and childhood or adolescent physical health conditions in a cohort of patients with FND.

We conducted a retrospective analysis of medical records from 282 individuals diagnosed with FND within a tertiary neuropsychiatry service. Extracted data included biological complications occurring around birth, documented neurodevelopmental delays or diagnoses, neurodivergent conditions, and significant medical illnesses during childhood or adolescence. Functional neurological symptoms were grouped into seizure-related, motor, sensory, and cognitive presentations to explore potential associations.

Indicators of early biological and developmental vulnerability were frequently observed. Nearly one-third of patients had recorded perinatal problems, while neurodevelopmental delays and neurodivergent conditions were identified in approximately one-fifth of the cohort. Childhood or adolescent physical illness was common, affecting almost half of the sample.

Early biological, developmental, and physical health factors are commonly documented in individuals with FND and may form part of the broader clinical context in which functional symptoms emerge. Rather than suggesting causation, these findings highlight the importance of considering neurodevelopmental and early-life health vulnerability when conceptualising FND and its varied presentations. Incorporating this perspective may aid in understanding clinical complexity and supporting more individualisedassessment approaches.

Sengkang General Hospital is one of the newest General Hospitals in Singapore. Among the other medical specialities, the department of psychiatry is one which is growing to provide the North East region of Singapore. Our close ally in managing psychiatric patients is the Institute of Mental Health which is a Tertiary Psychiatric care provider. The aim of the exercise was to equip the A&E with assessment and disposition of patients according to the needs and risks which the patient poses.

The Psychiatry department working with the A&E and the Emergency Room of the Institute of Mental Health embarked to develop a protocol/workflow which would assist the A&E in assessing and equip them in placing the patients in the right setting based on the risks and needs. After many cycles of modelling and remodelling of the workflow a final version which was acceptable to all concerned was agreed upon.

This was important to develop as Sengkang General Hospital's department of psychiatry is still in the process of having a fully equipped unit. The junior manpower needed to cover the on call system is still a work in progress.This hasleftthe A&E devoid of full residential cover especially out of hours and during weekends.

Other issues which had to be simultaneously looked at were the comfort of the A&E staff who are at various levels of training, the ease of the Tertiary Care hospital (Institute of Mental Health) in accepting patients and also the comfort of patients to move between hospitals.

The assessments were broadly based on the CSSRS (Columbia-Suicide Severity Rating Scale). This scale is widely used in most of the hospitals in Singapore in suicide risk assessments. The workflow was colour coded for simplicity of use and understanding. Subtracts were developed for use in the child and Adolescent population. Another important aspect to to be taken into consideration was the “medical fitness” of the patient which would also be a deciding factor in the disposition.

A year now into the implementation: the results of the intervention have been promising.The erstwhile problem of difficulties in disposition of patients has reduced significantly, so that it has stopped being a “rolling agenda” item on the inter hospital meetings. There is a nice bonhomie between the 3 stakeholders in management of patients who present with suicide risk to the A&E. Patient movement between hospitals and departments is clearer. Patients get a clearer explanation on why they are moved to a particular destination.

In a General Hospital setting, one of the most important aspect of service provision is the inter-departmental cooperation and exchange of expertise in management of patients. In this instance what seemed to be a simple intervention went a long way in managing a very important section of patients who present to the hospital at a time when theyare most needy and vulnerable. A clear assessment and management of these patients at a place where they are best managed was achieved with appropriate but simplistic intervention. A further scope to come up with similar interventions in psychiatric patients who are presenting with suicide risk is being discussed at the moment.

Co-occurring mental health and substance use disorders are associated with poorer outcomes, prolonged inpatient admissions, frequent readmissions, and fragmented care. Despite national policy advocating integrated treatment, services remain largely siloed, resulting in the persistent “wrong door” phenomenon highlighted in Carol Black’s Independent Review of Drugs. Local needs assessment within Essex Partnership University NHS Foundation Trust (EPUT) identified low staff confidence, lack of clear pathways, minimal psychological input, and poor continuity between inpatient and community services for this population. This Quality Improvement (QI) project aimed to design and implement a pilot inpatient Dual Diagnosis Support Service to improve access to integrated care, enhance staff capability, reduce stigma, and strengthen transition from inpatient admission to community-based support.

A pilot Dual Diagnosis Liaison Service was implemented across three adult inpatient wards in Colchester using existing workforce capacity and no additional funding. The intervention was co-designed with ward managers, multidisciplinary staff, and patients, incorporating lived-experience priorities. Key components included: routine dual diagnosis assessment within seven days of admission; specialist consultation on integrated treatment planning; motivational enhancement and psychoeducation; liaison with psychology andsocial services; and early, structured signposting to community substance misuse and social support services prior to discharge. A phased QI methodology was adopted, supported by governance oversight and iterative service refinement. Process and outcome measures included staff-reported confidence, access to specialist advice, clarity of discharge pathways, and patient experience feedback. Workforce development was embedded through targeted training and ongoing specialist consultation.

Early qualitative feedback indicates improved staff confidence in managing dual diagnosis presentations and increased clarity regarding referral, discharge planning, and community follow-up. Ward teams reported improved access to specialist expertise and enhanced collaboration with external services. Patients valued timely, non-stigmatising support addressing both mental health and substance use needs, particularly early engagement and psychological input. The pilot demonstrated feasibility, acceptability, and scalability within existing resources, directly addressing previously identified service gaps and aligning with national priorities for integrated care and reduction of avoidable hospitalisation.

This QI project demonstrates that an inpatient Dual Diagnosis Support Service can be implemented effectively without additional funding, delivering early improvements in staff capability, patient experience, and pathway integration. The structured, co-produced, and data-informed approach supports sustainability and scalability. Findings from the six-month pilot will inform refinement and planned expansion into community mental health teams, contributing to system-wide improvements in care for people with co-occurring mental health and substance use disorders.

Vascular dementia (VD) is a progressive neurocognitive disorder associated with cognitive decline, behavioural and psychological symptoms, and reduced quality of life. No medications are licensed in the UK specifically for VD, yet cholinesterase inhibitors and memantine–licensed for Alzheimer’s disease–are frequently prescribed off-label based on clinical judgement. Off-label prescribing carries additional responsibilities under GMC, NICE, and UK Government guidance, including ensuring patients receive sufficient information about risks, benefits, and the unlicensed nature of treatment. Locally, Trust policy (MMP39) and the Pan Mersey Shared Care Agreement require explicit documentation of informed consent before prescribing responsibility is transferred to primary care. Within LLAMS St Helens, documentation of consent for off-label prescribing has been inconsistent, and capacity assessments have not always been decision-specific. This project aimed to evaluate current practice and improve the recording of informed consent, capacity, and best-interests processes for patients with VD prescribed antidementia medication.

A retrospective review of clinical records was conducted for all patients diagnosed with VD and prescribed antidementia medication up to 15 March 2025. Data were extracted from RiO consultation notes, MDT records, and prescription summaries, focusing on documentation of consent, capacity, and risk/benefit discussions. Findings were presented to the LLAMS team, followed by an educational workshop reinforcing best practice and the need for explicit off-label consent. A prospective reaudit was completed from March to November 2025 to assess the impact of the intervention.

Cycle 1 (Pre-intervention): Forty patients were reviewed; 30 were prescribed antidementia medication. Of these, 6 (20%) had documentation confirming they were informed about off-label use, 18 (57%) had capacity recorded, and 25 (83%) had a documented risk/benefit discussion.

Cycle 2 (Post-intervention): Forty-one patients were reviewed, of whom 10 were started on antidementia medication. Six of these patients commenced treatment after the educational intervention. Among this group, capacity was documented in all cases (100%), with each recorded as lacking capacity. Risk and benefit discussions with next of kin were documented for 5 patients (83%), and 5 patients (83%) were informed about the off-label or unlicensed nature of treatment.

Compared with Cycle 1, documentation of off-label consent improved from 20% to 83%, and decision-specific capacity recording increased from 57% to 100%, indicating a positive shift in practice following the intervention, although documentation remained variable overall.

This project demonstrates that while risk/benefit discussions are generally well recorded, explicit documentation of off-label consent and decision-specific capacity assessments remains inconsistent. Early improvements following education suggest that structured prompts, enhanced MDT communication, and strengthened GP correspondence may support sustained change. Embedding a consent checklist and ongoing reauditing will help ensure transparent, patient-centred, and legally robust prescribing within LLAMS.

In 2025, 6366 applicants sat Membership of the Royal College of Psychiatrists (MRCPsych) examinations. High stakes for applicants include cost, difficulty, and career progression. Written exams cost around £500, and roughly £1000 for UK-based CASC (Clinical Assessment of Skills and Competencies). Pass rates range between 35–71.2% for written exams and 44.6–65.3% for UK-based CASC. MRCPsych completion is essential for accessing higher training. Trainees attend school-run MRCPsych programmes to becomerounded clinicians, but some voice concerns around insufficient examination focus and purchase additional study resources.

Post-Covid norms include decentralised and online teaching, which diminished networking opportunities enabling peer study groups forming. Theories from Vygotsky (Zone of Proximal Development Theory), Bandura (Social Learning Theory), and Jean Pol-Martin (Protégé Effect) favour peer-learning principles.

This project evaluated whether locally implemented peer-led study groups blending online and in-person sessions improved perceived examination confidence, preparedness, and syllabus knowledge.

Plan, Do, Study, Act approach was utilised. A focus group identified group-study themes (preparation, structure, content, feedback) and challenges (format, learning styles, additional needs, resources, geographical spread, availability) and identified aims and outcome measures (Likert scale measuring perceived examination confidence, preparedness, and syllabus knowledge).

Written examination groups started in January 2025. Participants self-arranged weekly online or face-to-face sessions blending peer-led teaching with group discussion answering multiple choice questions from shared question banks. Session frequency increased approaching examinations, and prioritised questions. Face-to-face CASC sessions featuring consultant examiners occurred monthly between March–July 2025. Affordable technology including microphones and video-calling enabled some examiners to assess remotely.

Feedback (39.4% response) on school-led teaching flagged insufficient interactivity,passion, and examination/curriculum focus. School-led CASC session organisation was praised; however, participant anxiety and feedback quality were concerning.

93.3% of participants felt written examination study groups led by higher trainees and consultants were relevant if available, 66.7% felt peer-led groups were relevant, and 66.7% felt happy with both online or in-person sessions. 100% of CASC participants strongly valued consultant examiner feedback.

Post evaluation, 100% favoured continuing CASC groups; and 87% favoured continuing written examination groups. 100% of CASC participants agreed or strongly agreed perceiving improvements in examination confidence, preparedness, and syllabus knowledge; and 75% of written examination participants strongly agreed perceiving improvements in these areas, satisfying project aims.

Continuing peer-led group study initiatives was deemed worthwhile and successfully improved perceived examination confidence, preparedness, and syllabus knowledge. This represents a relatively inexpensive solution which, if scaled nationally, could beneficially supplement deaneries’ existing MRCPsych programmes.

People with severe mental illness experience significant physical health morbidity and are vulnerable to diagnostic overshadowing. This may be particularly relevant where reproductive health factors overlap with psychiatric symptoms. This case study describes an unrecognised pregnancy identified during admission for psychotic relapse in a woman with schizoaffective disorder and explores learning points for inpatient, community and antenatal care. The hypothesis underpinning this work is that routine pregnancy testing and proactive consideration of reproductive health in women of childbearing potential may reduce the risk of delayed pregnancy recognition and associated harm.

A 35-year-old woman with schizoaffective disorder was managed in the community on a Community Treatment Order with depot antipsychotic medication. She developed persecutory beliefs that her food was being poisoned, reported altered taste and smell, alongside nausea and vomiting, and gradually reduced her food intake, leading to weight loss and non-attendance for depot medication. Due to increasing self-neglect and psychotic relapse, she was recalled to hospital under the Mental Health Act. During admission, antipsychotic treatment was recommenced and partial insight returned. As part of routine physical health monitoring, she was noted to weigh under 50 kg. Medical review identified an unexplained abdominal mass, prompting urgent ultrasound, which demonstrated a previously unrecognised 27-week pregnancy.

Retrospective reflection suggested that first-trimester pregnancy symptoms may have interacted with psychotic experiences. Symptoms consistent with hyperosmia and hypergeusia, recognised features of early pregnancy, may have contributed to altered taste perception and heightened sensitivity to food. Nausea and vomiting associated with morning sickness may have further reinforced persecutory beliefs that food was being poisoned. This cluster of physical symptoms appeared to coincide with increasing fearfulness of professionals, medication non-concordance and subsequent psychotic relapse, highlighting the complex, bidirectional relationship between physical health symptoms and psychopathology. The pregnancy was identified incidentally rather than through routine screening, illustrating how pregnancy-related physiological changes may be misattributed to psychiatric illness in both community and inpatient settings.

This case illustrates the risk of diagnostic overshadowing at the interface of physical and mental health in severe mental illness. It highlights the importance of routine pregnancy testing for women of childbearing potential on admission and maintaining clinical curiosity when physical changes accompany psychiatric deterioration. In community settings, emerging physical symptoms, weight change or non-attendance should prompt consideration of pregnancy and clearer screening pathways. While individual circumstances vary, proactive physical health screening may support safer, more holistic psychiatric and antenatal care.

This quality improvement project aimed to improve junior doctors’ confidence and consistency in performing physical health examinations within a mental health hospital. Additional objectives included improving awareness of escalation pathways to acute medical services and supporting safer, more timely identification of physical health concerns.

The project was conducted at Chase Farm Hospital, part of North London NHS Foundation Trust, which includes older adult, general adult, and forensic inpatient wards. A baseline questionnaire was distributed to junior doctors (Foundation Year, GP trainees, and Core Psychiatry trainees) to assess prior training, confidence levels, and awareness of escalation thresholds when managing physical health issues in psychiatric settings. Based on the findings, a Plan–Do–Study–Act (PDSA) cycle was implemented. Two structured flowcharts were developed: one outlining the expected components of physical examinationin a mental health setting, and another detailing criteria and processes for referral to Accident & Emergency. These resources were disseminated electronically, and a follow-up questionnaire was used to evaluate their perceived usefulness and relevance.

Eleven doctors completed the baseline questionnaire. Eight reported low confidence in performing physical examinations in mental health settings, and all respondents felt that additional structured teaching at induction would be beneficial. Six doctors completed the follow-up questionnaire after introduction of the flowcharts. All respondents found the flowcharts helpful and agreed they would have been valuable at the start of their rotation. There was unanimous support for including the resources in junior doctor induction and displaying them in on-call areas.

This quality improvement project demonstrates that brief, targeted educational tools can significantly improve junior doctor confidence and clarity regarding physical health assessment and escalation in psychiatric inpatient settings. Embedding structured guidance into induction programmes has the potential to enhance patient safety, trainee experience, and multidisciplinary collaboration. Future work will focus on Trust-wide implementation and evaluation of longer-term clinical impact.

Adolescent boys experience high rates of suicide, substance-related harm and school exclusion compared to other genders. However, large-scale studies report lower prevalence of common mental health disorders in boys, raising concern that boys’ mental distress is under-recognised in research and clinical settings. We aimed to examine how constructions of masculinity influence the expression, recognition and measurement of mental distress in adolescent boys aged 10–16. We explored whether current research tools adequately capture male-typical presentations of mental distress, with implications for psychiatric research, clinical assessment and service provision.

A critical narrative synthesis approach was used, using research from adolescent psychiatry, men’s health and public health literature. Evidence from large population-based studies of young people was considered alongside qualitative and epidemiological studies looking at gendered patterns of symptoms, help-seeking behaviour and clinical recognition. Masculinity was conceptualised as a socially constructed and context-dependent set of norms that interact with biological and structural factors. Disordered eating and body image concerns were used as a focused case study to illustrate how male-typical expressions of distress may not be captured by common questionnaires used clinically and in research.

The literature suggests that adolescent boys are more likely to express mental distress through externalising behaviours, irritability, risk-taking, and body-focused practices, which are less likely to be identified by commonly used mental health questionnaires. Survey items frequently reflect female-typical symptom profiles and ideals when assessing body dysmorphia and disordered eating, potentially contributing to an under-detection of eating disorders in boys. Masculine norms around emotional restriction, physical strength and self-reliance may influence how boys experience, interpret and report symptoms, while professional biases and service structures can limit recognition and care when boys do seek help. These factors contribute to a cycle of poor identification, research support, and outcomes.

Current gender-blind measurements of adolescent mental health risk systematically under estimate clinically significant mental distress in adolescent boys. Greater attention to how masculinity affects the expression, reporting and identification of psychiatric symptoms is needed to improve the accuracy of research and psychiatric assessment to ensure boys’ needs are adequately recognised. Incorporating male-typical presentations into screening tools and engaging boys in the design of research measures may improve how boys’ mental health is conceptualised and measured. Addressing these gaps has significant implications for child and adolescent mental health services, prevention strategies and psychiatric training – which has the potential to benefit not only boys, but everyone whose distress does not align with typical diagnostic criteria.

The Mental Health Emergency Centre (MHEC) at Northwick Park Mental Health Unit serves people who present in an acute mental health crisis, most commonly via the emergency department (ED). The MHEC receives several patients a day. To inform service planning, we aimed to describe patient characteristics and clinical interventions delivered.

The study was approved as a service evaluation by the clinical governance department. Records of patients admitted to the MHEC from February 15, 2023, to October 26, 2023, were reviewed. Using a predefined template, two psychiatry residents extracted information from the records of 50 patients each, including patient demographics, attendance, diagnoses, comorbidities, and reattendance to the ED within 28 days. Incomplete records were excluded.

Ninety-six records were included; 94% came via the ED pathway and 6% admitted directly by the Home Treatment Team (HTT). The mean age was 38 years and 58% of patients were men. The most common ethnicity was white (42%) followed by Asian (18%). The most common primary diagnoses were psychotic disorders (39%). The median time from ED arrival to a decision to admit to the MHEC was 11.8 hours, and the median time from ED arrival to discharge from the MHEC was 62.4 hours. The median length of stay (LOS) from the decision to admit until discharge from the MHEC was 2 days. Reattendance to the ED within 28 days was seen in 28% of patients. Medication management was the main intervention offered (62.5%), followed by brief psychological intervention by a trained psychologist (23%). Only four patients did not have a follow-up.

The MHEC is a valuable addition to the urgent and emergency mental health care pathway. Although the patients were not rapidly transferred from ED, the multidisciplinary service allowed brief and intense interventions to be delivered, including psychological therapies, diagnostic review, and medication management.

Lithium and Valproate remain established mood stabilisers with strong evidence for efficacy in bipolar disorder and affective instability. Contemporary clinical practice increasingly reflects a shift towards alternatives such as lamotrigine and atypical antipsychotics. This shift appears driven not only by clinical considerations but also by regulatory, safety and service-level factors. Valproate prescribing has declined markedly among women of childbearing age due to teratogenic risks and regulatory restrictions, while lithium use is challenged by monitoring requirements and systemic barriers within services. These influences may contribute to the underutilisation of effective treatments, raising concerns about the impact of administrative burden, risk management, and evolving prescribing culture on real-world pharmacological practice.

Aim: This study aimed to examine prescribing patterns of lithium, valproate, and alternative mood stabilisers within an AOT cohort across two time points six months apart. It sought to quantify changes in the use of lithium, valproate, and lamotrigine and to explore whether observed trends reflect broader clinical, regulatory, and service-related influences on prescribing practice.

A retrospective observational review of clinical records was conducted including all patients under the care of the AOT at two defined points, six months apart. Patients prescribed mood stabilisers were identified. Data collected included current mood stabiliser (lithium, valproate, lamotrigine, or other), demographic characteristics (age and sex), clinical indication, and changes in prescribing between time points. Descriptive statistics were used to calculate the proportion of patients receiving each mood stabiliser at both time points. Changes in prescribing patterns over the six-month period were analysed and compared across medication groups to identify emerging trends.

The AOT caseload increased from 73 patients in July 2025 to 85 patients in January 2026. Lithium prescribing decreased slightly from 6 patients (8.2%) to 5 patients (5.9%), while valproate use remained numerically stable at 5 patients (6.8% vs 5.9%). Lamotrigine prescribing increased from 3 patients (4.1%) to 6 patients (7.1%), representing the most notable change over the study period. Carbamazepine use declined from 1 patient (1.4%) to none. Overall, lithium and valproate use remained stable or declined slightly, while lamotrigine use increased despite changes in caseload and patient turnover, indicating a gradual shift in mood stabiliser prescribing patterns within the AOT population.

Findings mirror wider trends in psychiatric prescribing, characterised by a relative decline in lithium use due to monitoring and systemic barriers, regulatory driven constraints on valproate, and increasing reliance on lamotrigine and alternative agents. These results suggest that effective mood stabilisers may be underutilised not because of reduced efficacy but due to evolving regulatory frameworks, risk management priorities, and service-level pressures. Understanding these influences is important for informing prescribing practice and ensuring that clinical decision-making remains balanced between safety, feasibility, and therapeutic effectiveness in complex mental health populations.

• • To monitor adherence to the General Medical Council professional standards in prescribing unlicensed medications for patients open to the Stanley Treatment and Intervention team.

• • To identify areas of unlicensed prescribing that require improvement in order to communicate this with prescribers to raise awareness of the professional standards and reinforce them.

• • To ensure good practice in decision-making around treatment choice in conjunction with parents and carers

• • To allow use of unlicensed or off-label medicines in line with recognised clinical practice and/or published evidence

• • To minimise risk associated with unlicensed and off-label use of medicines.

A search was conducted on clinic letters by medical staff in the Stanley Treatment and Intervention Team in community mental health between 1 July 2024 and 31 October 2024. We randomly chose 27 clinic letters.

To complete this audit, we reviewed all 27 patient’s electronic record to identify unlicensed medication use practice using the audit tool.

The total number of patients included in this audit was 27.The number of patients who were initiated on unlicensed medications was 2 out of 27 . Out of these, 2 patients records had clear documentation of discussion of the use of unlicensed medication with the patient, 2 patients records had a clear documentation of the rationale for prescribing a medicine off-label or prescribing an unlicensed medicine and 2 patients records had a clear documentation of the benefit vs risk of unlicensed medication use.

Subsequently, 2 patients records had documentation of clear, accurate and legible record of all medicines prescribed, 2 patients records had clear documentation that sufficient information about the medicines were given to patient, or their parents or carers. Lastly, there were no patients considered to be in a vulnerable group such as children and adolescents, women of childbearing age and elderly patients.

The Stanley Treatment and Intervention Team in community mental health was found to be 100% compliant with the General Medical Council standards. Compared to a previous audit in the inpatient ward, we identified this was due to improved documentation, open discussions with patients and clearly documented rationale. We suggest practices to have a set proforma to support doctors identifying a rationale, prescribing and documenting commencement of unlicensed medications.

Body Dysmorphic Disorder (BDD) is overrepresented in aesthetic medicine (prevalence up to 18.6% in aesthetic cohorts versus ~1.7–2.9% in the general population). Professional bodies recommend psychological assessment before cosmetic intervention and referral to mental health services if BDD is suspected.

We aim to examine post-assessment care by:

• Quantifying the gap between recommended assessment/referral standards and real-world practice.

• Assessing how well the literature captures referral conversion (screening to specialist assessment).

• Identifying patient, clinician, and system barriers that prevent completion of specialist mental-health assessment.

A targeted review was conducted using evidence from aesthetic-surgery meta-analyses, dermatology and plastic surgery guidelines, aesthetic-practice safety documents, insurer psychological-risk frameworks, and psychiatric assessment resources. Sources were reviewed for prevalence data, referral expectations and realities, and documented barriers to mental-health engagement.

Although BDD prevalence in aesthetic settings is consistently studied and reported,published literature rarely captures how many screen-positive patients are referred for psychiatric assessment.

Despite the presence of several high-accuracy validated BDD screening tools, recent database evidence highlights ongoing missed detection: in a cohort of 226,374 cosmetic-surgery patients (from August 2002–August 2022), 52.1% of BDD diagnoses occurred only after procedures.

Literature shows that barriers span patient-level (denial, doctor-shopping), clinician-level (concerns about conflict, reputational or financial impact, limited training), and system-level (lack of structured referral pathways, limited multidisciplinary integration, absence of warm-handover mechanisms). However, there are minimal quantitative studies measuring these factors.

UK-based literature documents BDD prevalence and outcome risk in cosmetic seekers and provides validated screening tools and professional standards, but there is minimal evidence reporting UK metrics on referral-conversion or psychiatric follow-through.

Professional guidelines recommend that suspected BDD requires specialist evaluation, yet referral completion rates remain unmeasured and pathway implementation inconsistent across aesthetic practice settings. The absence of referral-conversion data and evidence of missed diagnoses, highlight a critical knowledge and safety gap. Priority actions include: auditing current screening and referral practices in regulated aesthetic settings, establishing clear referral triggers and destinations, implementing warm-handover mechanisms, and developing integrated pathways between aesthetic and mental health services to improve early detection and patient safety.

Cardiac arrest on ward–post incident review and reflections identified recognition and escalation of the physically deteriorating patient as a key improvement target to improve staff morale and confidence moving forward in context of incident.

SMART goals:

Specific – Improve nursing staff and allied health professionals’ ability in recognising, managing, and escalating physically unwell patients.

Measurable – with results measured via standardized questionnaire scores.

Achievable – through a specialized teaching programme developed by ward doctors.

Relevant – in context of recent significant incident on the ward.

Time specific – in a 6-month timeframe.

Teaching sessions targeting initial assessment and escalation of the physically deteriorating patient were delivered on a two-weekly basis over a time of 4 months, each session was 30 minutes in duration. Subdivision of broad topics was introduced to address nuanced scenarios. Domains were chosen based on common clinical queries and situations that were identified on the ward from a survey of both doctors, nursing staff and allied health care professionals. Session content was pitched at a role-specific level. Session topics included–Airways, NEWS2, SBAR, hypoglycaemia, fluid monitoring, pain, seizures, stroke, UTI.

Data was collected via pre-/post-course questionnaires. The questionnaire consisted of 9 questions in SBA format, following a short clinical scenario stem – 1 question for each clinical domain. Confidence scores (Likert scale) were assessed for each of the 9 domains.

Confidence improved across all wards following the teaching sessions. Small but notable decline in clinical performance post-training in some areas. Persistent performance gap between RMNs and HCAs.

Teaching sessions were delivered in modality of one live session per topic – making it difficult to ensure that all surveyed staff had attended all sessions. There were limited opportunities for staff to review the teaching material after a session, or especially if a session was missed due to rota or clinical commitments.

Therefore an opportunity was identified to develop e-learning modules focusing on weakest domains (Airways, NEWS, SBAR, UTI, hypoglycaemia).

Mode of delivery would be changed to e-learning modules on a digital learningplatform. This allows for easy access for staff in their various schedules, the ability to revisit the material, as well as increased ease in collecting data, adjusting the teaching materials and maintaining consistency in quality of teaching across time.

In Qatar, there are currently no published local data and no standardised inpatient policy/care pathway for personality disorder (PD) management. This creates variability in assessment, crisis planning, psychological input, and prescribing practice. We aimed to establish a baseline epidemiological profile of inpatient PD presentations and describe current inpatient management processes to inform service development. We hypothesised that borderline personality disorder (BPD) would be the most frequent PD diagnosis and that care processes would show wide variability in the absence of a local guideline.

We conducted a retrospective audit within Hamad Medical Corporation Mental Health Services using electronic health record review (Cerner) and structured case-note abstraction. All eligible psychiatric admissions between January and December 2025 were included (N=171). Extracted variables included PD diagnosis and type, documentation supporting BPD diagnostic criteria, MDT review, crisis planning, documented individual and group psychotherapy sessions, inpatient self-harm incidents, documented substance use, and psychotropic prescribing.

A personality disorder diagnosis was recorded in 83 of 171 admissions (48.5%); the remaining 88 admissions (51.5%) did not carry a documented personality disorder diagnosis during the admission period. BPD was the most frequent PD diagnosis (54/83, 65.1%), followed by antisocial PD (13/83, 15.7%). Mean age was 26.8 years (SD 10.9); 55/83 (66.3%) were female and 49/83 (59.0%) were readmissions. For BPD admissions, documentation supported ≥5 diagnostic criteria in 40/54 (74.1%) (median 6 criteria). MDT review was documented in 72/83 (86.7%) and a crisis plan in 51/83 (61.4%). Individual psychotherapy session counts were recorded for 48/83 (57.8%); of these, 26/48 (54.2%) had zero documented sessions. Group psychotherapy session counts were recorded for 51/83(61.4%); of these, 34/51 (66.7%) had zero documented sessions. Self-harm incidents occurred in 21/83 (25.3%), and substance use was documented in 33/83 (39.8%). Antipsychotics were prescribed in 58/83 (69.9%) and benzodiazepines in 33/83 (39.8%).

This first inpatient PD audit in Qatar shows a substantial service burden dominated by BPD, high readmission rates, limited documented psychological input, and incomplete crisis planning. In the context of no local policy/guideline, the findings support developing a standardised inpatient PD pathway by adopting international guidance (with cultural adaptation for the region), strengthening crisis planning and psychological interventions, and reviewing prescribing practice–particularly reducing benzodiazepine use and promoting safer alternatives.

To design, deliver, and evaluate a structured six-month teaching programme for resident doctors and multidisciplinary team (MDT) members within an Old Age Psychiatry service. The objective is to improve clinical knowledge and confidence in key areas of psychiatric care in older adults.

Teaching topics were selected following consultation with senior clinicians and MDT colleagues to ensure clinical relevance. A monthly teaching programme was then implemented in theOld Agepsychiatry department at Birch Hill Hospital between August 2025 and January 2026, aimed at resident doctors hospital-wide and departmental MDT colleagues. Sessions covered physical health investigations in psychiatry, psychosis in older adults, antipsychotics and metabolic side effects, depression in older adults, clinical cases of rarer dementias, and management of alcohol misuse and insomnia. Structured feedback was collected after each session including Likertscale ratings assessing relevance, usefulness and tutor knowledge, as well as self-rated confidence before and after sessions. Free-text responses were analysed qualitatively using thematic analysis. Numerical data were analysed quantitatively to calculate mean scores, mean differences, and paired t-test statistics in the case of self-rated confidence.

From the 49 feedback survey responses, the programme was highly rated across all domains. Likert scale mean scores (where 1=lowest e.g. not very relevant, 5=highest e.g. very relevant) showed 4.90 for relevance, 4.83 for usefulness, and 4.86 for tutor understanding. Self-rated confidence increased from a mean of 3.39 pre-teaching session to a mean of 4.55 post-teaching session, where there was a statistically significant difference (p<0.001) with a large effect size (d=1.07). Qualitatively, thematic analysis identified overarching themes including high clinical relevance, improved understanding of clinical presentations, greater knowledge of pharmacology and medications, appreciation of clear and structured teaching, and the value of group engagement for team cohesiveness.

This six-month structured teaching programme improved knowledge and confidence on a variety of clinical topics among resident doctors and MDT colleagues inOldAgepsychiatry. Qualitative themes highlighted that the programme was very well received and also showed the value of group discussion in teaching for team building, demonstrating broader benefits of such educational interventions. This teaching programme model should be replicated across other services and extended within this department to encourage the development of highly knowledgeable and confident clinicians.

Effective outpatient addiction care depends on patients understanding and retaining clinical advice. However, the extent to which patients recall guidance after appointments is poorly studied. This evaluation aimed to assess patient recall of advice immediately after consultation and one week later, and to explore factors associated with retention.

A prospective service evaluation was conducted in a UK outpatient addictions clinic. Consecutive patients attending a routine follow-up over 6 months were invited to participate (n=121). Demographics (age, gender, primary substance, housing status) and appointment characteristics (clinician continuity, consultation length) were recorded. Recall was assessed via brief structured questionnaires immediately post-consultation and at one-week follow-up, covering key treatment advice, harm-reduction strategies, and safetyguidance. Data were analysed descriptively and associations with patient or appointment factors explored.

Mean age was 40 years; 59% were male. Primary substances included alcohol (46%), opiates (29%), and stimulants/polysubstance use (25%). Immediate recall of all key advice was 68%, but this dropped to 42% at one week. Recall was higher among patients with continuity of care (47% vs 35%) and those attending longer consultations (>30 minutes: 52% vs <30 minutes: 38%). Housing instability and polysubstance use were associated with lower recall. Clinician confidence in patient understanding consistently exceeded actual recall.

Patient recall of clinical advice in outpatient addiction services declines sharply within one week. Continuity of care and longer consultations are associated with improved retention. Simplifying messages, repeating key advice, and providing written or digital reinforcement may enhance understanding and engagement, with implications for treatment planning and service effectiveness.

To evaluate compliance of lithium monitoring practices at Kilbarrack East CMHT with NICE guidelines and identify areas for improvement to enhance patient safety.

This quantitative audit comprised a retrospective initial audit, where data was collected from August 2024 to February 2025 from patients on lithium therapy. Following the initial audit results, which highlighted significant gaps, a multidisciplinary team (MDT) meeting was held to discuss the findings with all clinical stakeholders. Interventions were implemented in March 2025, including a green sticker system for patient identification, a lithium monitoring sheet for tracking assessments, patient monitoring lists to define responsibilities, a lithium blood clinic, and a new Clinical Nurse Specialist reporting system. A prospective follow-up audit was conducted from May to October 2025, with the overall audit concluding in November 2025. Compliance with NICE guidelines was assessed through indicators such as the frequency of lithium level testing as well as renal and thyroid function tests. Statistical analysis was performed to compare compliance rates between the initial and follow-up audits.

The first audit (Cycle 1) revealed that only 12% (3 out of 25) of patients were compliant with all relevant lithium monitoring guidelines. Although all compliant patients had urea and electrolyte (U&E) levels and thyroid function tests conducted, none had calcium levels tested or BMI measured. In the follow-up audit (Cycle 2) in October 2025, the overall compliance improved, with 68% (17 out of 25) compliant, but significant gaps remained; 32% (8 out of 25) did not have their lithium levels tested, and 44% did not undergo U&E or thyroid function tests. Only 8% had calcium levels tested, and no patients had their BMI recorded. These findings indicate that while there was some progress, critical areas still need attention.

The audit cycle demonstrated substantial deficiencies in compliance with NICE guidelines for lithium monitoring at Kilbarrack East CMHT. While some changes led to improvements, significant gaps remain, underscoring the necessity for continuous quality improvement initiatives. A patient education leaflet was introduced after the second audit to enhance adherence to lithium monitoring protocols. Implementing the recommended action plan aims to enhance adherence to monitoring protocols and improve patient safety in lithium therapy management. Regular audits will continue to check progress and make sure guidelines are followed.

Obsessive–compulsive symptoms (OCS) are a reported complication of clozapine treatment but remain under-recognised. Real-world data on their prevalence and clinical correlates in the UK remain limited.

This cross-sectional service evaluation was conducted within a centralised clozapine clinic serving adult secondary care services across Suffolk. Patients receiving clozapine were invited to complete the Obsessive–Compulsive Inventory–Revised (OCI-R) as part of routine clinical assessment. Demographic, clinical, and service-use data were extracted from electronic health records. Illness severity and symptom domains were assessed using the Clinical Global Impression–Schizophrenia scale (CGI-SCH), and functioning using the Global Assessment of Functioning (GAF).

A total of 187 clozapine-treated patients (mean age 46.6 years, SD=12.4; 70.1% male) completed the OCI-R, which showed good internal consistency (α=.87); the mean OCI-R OCD score was 13.2 (SD=9.8).

Overall, 52.4% met criteria for OCS (OCI-R OCD ≥ 12), yet only 8.6% had OCS documented by a psychiatrist in the preceding 18 months, with poor agreement between measures (p < .001), indicating substantial under-recognition. Among patients meeting OCI-R criteria, overall OCS severity did not differ between recognised and unrecognised cases (p=.153); however, clinician recognition was uniquely associated with higher checking subscale scores (p=.004), suggesting preferential identification of more overt compulsive behaviours.

Multivariable linear regression predicting OCI-R OCD scores was statistically significant (p < .001), with higher CGI-SCH positive and cognitive symptom subscale scores independently predicting greater OCS severity after adjustment for demographic, clinical, and treatment-related variables, suggesting that OCS may cluster with a more severe psychosis phenotype and/or shared cognitive-control deficits.

To examine whether positive symptoms inflated OCS scores via overlap with obsessing items, a separate regression predicting the OCI-R obsessing subscale was conducted (p < .001). Higher obsessing scores were independently associated with CGI-SCH positive (p < .001) and depressive symptom severity (p=.019), indicating that OCS severity cannot be explained solely by overlap with positive psychotic symptoms.

OCI-R hoarding subscale scores were modestly associated with CGI-SCH cognitive symptoms (r=.21, p=.005), with no other significant associations, consistent with literature linking hoarding behaviours to cognitive and executive dysfunction rather than psychotic or affective pathology.

OCS were common yet substantially under-recognised in clozapine-treated patients. Their severity was independently associated with positive and cognitive psychotic symptom domains, supporting a clinically meaningful schizo-obsessive phenotype and highlighting the need for routine screening and proactive monitoring within clozapine services.

Language deficits present early in Alzheimer’s disease, with symptoms ranging from word-finding difficulties to non-coherent speech. These can be assessed in high-income countries using picture description tasks (PDT). However, they are culturally specific, so have a reduced utility in Sub-Saharan Africa (SSA). The dementia incidence in SSA is increasing but there is a substantial diagnostic gap. Therefore, there is a need for accessible and culturally acceptable cognitive measures. Also allowing for detection of impairments at an earlier stage and for use in prevention studies. This study aims to determine the diagnostic accuracy of a culturally adapted PDT in Tanzania.

This was a cross-sectional validation in socio economically different communities in Kilimanjaro, Tanzania. Eleven PDT scoring methods were adapted from existing literature. Participants were asked: “tell me everything you can see happening in this picture”. Responses were audio-recorded, transcribed and translated. General cognition was assessed using the Identification and Intervention for Dementia in Elderly Africans (IDEA) screen. Participants with a low IDEA score (≤9) underwent a blinded gold-standard clinical dementia assessment alongside 10% of controls (IDEA >9). Visual acuity was also assessed using a Landolt C near vision chart.

A total of 465 individuals ≥60 years were recruited. 378 individuals were included in the analysis due to 37 refusals and 50 methodological/technical exclusions. All PDT scoring methods, apart from implausible details and words per content unit, correlated with the IDEA screen, age, education and frailty. The scoring method of content units (CUs) showed the greatest correlation. Males, those with greater educational attainment, and a previously skilled occupation performed better. The scoring methods with the highest area under the receiver operating characteristic (AUROC) curve for identification of IDEA score ≤9 were CUs 0.740, CUs and additional details 0.742 and total objects 0.764. The prevalence of dementia was 3.79% (n=8/211). The scoring methods with the highest AUROC curve for identification of dementia were global length of text 0.743 and additional details 0.767.

The diagnostic accuracy was acceptable for three scoring methods to identify cognitive impairment as measured by the IDEA and for two methods in identifying clinical dementia diagnosis. A culturally adapted PDT could be used to support assessment of language in those with cognitive impairment, as part of a wider cognitive testing battery. However, dementia prevalence was very low in this community, potentially biasing findings.

Methamphetamine-induced psychosis (MIP) is recognised in both ICD-11 and DSM-5-TR as a substance-induced psychotic disorder which is associated with severe agitation, violence risk, and medical complications. In Pakistan, MIP presentations to inpatient addiction services have increased recently, however, data on service impact and adherence to best-practice standards remain limited. This audit aims to describe monthly trends and proportions of MIP admissions among all inpatient addiction ward admissions, and to evaluate compliance with international best-practice standards for assessment and management of MIP, in order to identify areas for quality improvement.

A mixed-method clinical audit was conducted in the inpatient addiction ward at Allied Hospital II, Faisalabad. A descriptive service-activity review examined all inpatient addiction admissions over a six-month period (01 July–31 December 2025) to quantify monthly MIP admissions. Subsequently, an admission-based case-note audit assessed consecutive MIP admissions against predefined standards derived from NICE guidance, the Maudsley Prescribing Guidelines, and international recommendations. Adults (≥18 years) admitted with a clinical diagnosis of MIP were included. Admissions with primary psychotic disorders, delirium, psychosis attributable to another substance, or incomplete documentation were excluded. Data were extracted from clinical notes using a structured audit tool.

During the audit period, 82 inpatient addiction admissions were recorded, of which 19 (23.2%) were for MIP. Monthly MIP admissions ranged from 2 to 4 cases, representing 18.2% to 33.3% of total admissions, indicating a sustained and clinically significant service burden. In the standards audit (n=19), documentation of stimulant use history (94.7%), temporal relationship between methamphetamine use and psychotic symptoms (89.5%), exclusion of delirium or medical causes (100%), baseline physical observations (94.7%), and mental state examination (94.7%) met audit targets. Prescribing details and adverse-effect documentation were complete in all cases (100%). Areas of lower compliance included objective toxicology confirmation (42.1%), baseline blood glucose measurement (52.6%), structured risk assessment (78.9%), documentation of de-escalation prior to medication (73.7%), medication safety checks for contraindications or interactions (78.9%), post-medication monitoring (84.2%), and timely reassessment following intervention (73.7%).

Methamphetamine-induced psychosis accounted for nearly one-quarter of inpatient addiction admissions over six months, highlighting a substantial and ongoing clinical burden. While core diagnostic assessment and prescribing practices were generally well documented, important gaps were identified in toxicology confirmation, metabolic screening, structured risk assessment, and post-intervention monitoring. These findings informed the development of a standardized MIP admission checklist and targeted staff education, with re-audit planned to assess the impact of these quality improvement interventions.