This team of simulation fellows and a final-year medical student at a London teaching hospital created an innovative simulation course for fourth-year medical students with the aim to supplement existing undergraduate psychiatry teaching by providing additional opportunity to practice clinical skills. The course allowed students to practice and improve advanced communication skills across a range of inpatient and community settings across GP, A&E, medical and psychiatric environments, with themes exploring psychiatry, heightened emotional states and biopsychosocial influences on mental and physical health in a safe, ethical manner, supplementing the teaching provided on clinical placements.

The course was fully mapped to the university curriculum as well as the Health Education England Future Doctor Vision and the Medical Licensing Assessment content map. Scenarios were written by trained simulation faculty in conjunction with specialty experts across all core specialties for fourth year medical students including obstetrics and gynaecology, paediatrics, psychiatry, and healthcare of the elderly. Scenarios were created to reflect local demographics with addition of detailed social history and population health information. This involved creation of simulated patients from multicultural backgrounds, with limited English or other communication needs, and representation of numerous gender expressions, sexual orientations, and a range of mental health and neurodevelopmental needs.

The pilot course took place on May 2nd with 7 student participants following approval from senior education stakeholders. During debriefs, participants differentiated between psychiatric symptoms and non-pathological human experiences, and reflected on how and why the patient in front of them is presenting the way that they are, with regards to social determinants of physical and mental health. They were also guided to reflect upon the technical and non-technical learning objectives of each scenario including use of Crisis Resource Management principles. Quantitative and qualitative feedback was collected through use of Likert-scales and white space questions; feedback showed heightened confidence and competence in core skills including psychiatric history taking, mental state examination and risk assessment, as well as core communication skills such as explaining a new diagnosis and managing heightened emotion.

Feedback shows the pilot successfully met its aims and enhanced undergraduate training, filling an educational need. Next steps would include formally approaching the university to discuss implementation of the course into the core curriculum. Additional refinements would include further consultation with service users and people with lived experience and consideration around use of actors to ensure complex subjects such as immigration and neurodivergence are portrayed ethically and accurately.

Neurodevelopmental disorders (NDDs), such as dyslexia, dyspraxia, and dyscalculia affect cognitive function and therefore share symptomology with neurodegenerative disorders, such as Alzheimer's disease, vascular dementia, and frontotemporal lobe dementia. The primary aim of this narrative systematic review is to ascertain if there is an association between NDDs and neurodegenerative disorders. Secondary aims are what the prevalence of NDDs within a dementia population is and what effect these early life learning disorders have on patients as they get older. It was hypothesised that NDDs would overestimate the severity of cognitive impairment, thereby increasing the severity of dementia staging, and impacting patient care.

Using a Population, Exposure, Comparator, Outcome, Setting, and Study design (PECOS) framework, keywords of “dementia”, “dyslexia”, “Dyspraxia/clumsy child syndrome/developmental apraxia/motor learning difficulty/disorder of attention and motor perception” and “dyscalculia/mathematical learning disability” were searched for on 4 databases (SCOPUS, OVID, Cochrane Central Register of Controlled Trials and Web of Science) from January 1, 1960 – June 10, 2022. Studies were included if they discussed both neurodegenerative and neurodevelopmental disorders or compared an intervention typically used in one disorder on the other (e.g., dementia intervention being used on neurodevelopmental disorder). Studies were excluded from grey literature articles, or if they only discussed a neurodevelopmental or neurodegenerative disorder without reference to the other, or if it included acquired, rather than neurodevelopmental dyslexia, dyscalculia, or dyspraxia.

A total of 8 studies were included for narrative synthesis. The main finding was an association between dyslexia and both Alzheimer's disease and frontotemporal dementia. Many studies suggested this was due to a genetic phenotype that caused a vulnerability in the language regions of patients’ cortices. There was also evidence of structural changes associated with NDDs and increased levels of grey and white matter atrophy in dementia subtypes, particularly in the language areas of the brain.

Due to screening and consequently formal diagnosis of neurodevelopmental disorders only recently coming into education systems, many adults currently attending memory clinics did not have a formal diagnosis. As there was limited research on dyspraxia and dementia, partly due to limited research into dyspraxia itself and without a standardized diagnostic tool for adolescents and adults, further research is needed in this area. The hypothesis of NDDs increasing the severity of dementia staging was also not supported by the literature results, and on the contrary, some studies suggested greater global preservation of cognitive function in patients with NDDs and dementia.

Eating disorders do not only affect the person who is suffering, but also their family. This qualitative study aims to understand the impacts on individuals who have an adult family member with an eating disorder, and what support they seek for their own well-being.

A convenience sample of 11 volunteer participants (10 family members and 1 charity worker) from the United Kingdom (UK) were recruited for interviews. Four UK eating disorder charities assisted with outreach by sharing the Participant Information Sheet to their service users. Semi-structured interviews were conducted between February and March 2023. Interviews lasted on average 54 minutes and were recorded on video call (n = 9) or face-to-face on the University of Edinburgh campus (n = 2). Transcripts were analysed using thematic analysis, following a grounded-theory constructivist approach.

Participants discussed how their lives were changed by engaging with the care of their family member, leading to a shift in family dynamics and a change in understanding of what it means to be a ‘normal’ family. Most interviewees perceived their relative's eating disorder as a negative disruption to their own life, however one participant said that it had no negative impact on his well-being at all. Conflict in the household was a regular outcome, with four interviewees all using the phrase “treading on eggshells”. Siblings of adults with an eating disorder were described by their parents as being excluded from the family due to the ongoing parental focus on the healing of their child. Some participants accessed support groups and social media to connect with other families working through similar challenges.

Having an adult family member with an eating disorder impacts the wider social network of the family. This dissertation argues that the socially constructed meanings of ‘care’ and ‘normality’, alongside the social relations with people placed in similar positions, inform the lived experiences of these individuals. This study's newfound illness narrative of ‘normality’ theorises that some people do not strive to help their relative with an eating disorder because it has already constructed the meaning of their normal life. Future research should aim to recruit a greater variation of participants, including more fathers, children, and siblings. This work endeavours to increase awareness of the support which families need during this time. It therefore opens the opportunity to consider how existing resources and services, both in healthcare and the third-sector, can be improved in the future.

To design, deliver and evaluate teaching for psychiatry trainees on personality disorder (PD) with the following objectives: to promote understanding and empathy for people with a diagnosis of PD; to equip trainees with skills they can immediately use for therapeutically engaging patients with PD; to introduce the evidence-based treatments that underpin these techniques; and to increase confidence in offering therapeutic clinical encounters for patients with PD.

A single teaching session was designed and delivered to core psychiatry trainees in three components. First, an interactive lecture was delivered on the theory of personality disorder as understood by two evidence-based psychotherapies: Mentalization-Based Treatment (MBT) and Transference-Focused Psychotherapy (TFP). Second, techniques from both were introduced as skills they can readily apply to clinical practice. Lastly, role-play scenarios with original scripts were worked through to highlight theory and techniques. Evaluation was conducted through anonymous participant-rated scores matched to learning objectives pre- and post-delivery of teaching.

20 participants (n = 20) completed the evaluation. 90% of respondents agreed/strongly agreed that they frequently encountered patients with PD. There was high pre-existing confidence in recognising PD in clinical practice; this was little changed by the teaching. Before the teaching, 45% of respondents agreed/strongly agreed with the statement saying they are confident offering clinical encounters for patients with PD; this changed to 90% post-delivery. Pre-delivery, 45% agreed/strongly agreed they possessed skills they could use clinically for PD; this increased to 75% post-delivery. Pre-delivery, 60% agreed/strongly agreed that they can generally empathise with people with PD; this increased to 90% post-delivery. Self-rated knowledge of evidence-based treatments for PD increased for both MBT (20% pre-delivery to 85% post-delivery) and TFP (15% to 75%). 95% of respondents agreed/strongly agreed that they will try out new skills learnt from the session. 100% of respondents agreed/strongly agreed that the teaching was overall useful.

This study shows it is possible to make positive effects on trainee confidence, knowledge and skill in relation to PD in a short and one-off timeframe. Future efforts should include attempts to replicate these findings on larger numbers of participants, across different training and non-training medical grades and in non-medical staff. Future evaluation should also observe if positive changes are sustained across time or lead to improvements in clinical outcomes and patient satisfaction.

To ensure that there is a clear rationale for commencing service users on psychotropic medications.

To ensure that the prescription of psychotropic medications is evidence-based and that they are in line with the Trusts and NICE guidelines.

Ensure that psychotropic medications are regularly reviewed by the managing team.

To ensure that information about medications is adequately shared with patients and carers.

To ensure that service users are well-monitored for side effects.

A 2-week retrospective audit on Phoenix ward.

Clinical information from all the current service users on psychotropic medication was reviewed.

The clinical information was collated from all 8 service users’ medication cards, ward round documents, MDT reviews, and electronic notes (PARIS), and these were analyzed by the inpatient specialty registrar.

1. 1. We attained a 100% mark in some areas of our prescribing such as indicating the rationale, the maximum dose for medication, and also prescribing within BNF limits.

2. 2. We however could not evidence proper information sharing with patients (only 40% documented).

3. 3. We could not evidence sufficient information sharing with carers (only 20% documented).

4. 4. PRN medication was mostly prescribed as a range rather than a clear dose, which gave rise to subjective dispensing bias.

5. 5. Side effect monitoring was documented for 85% of patients, meanwhile, the standard for this is 100%.

Clinicians are to ensure that medication information is always shared with service users, and their carers, and this is documented.

Clinicians are to also ensure that PRN medications are prescribed as a single dose rather than as a dose range.

Ward staff are to ensure that they are monitoring side effects and documenting these clearly on electronic notes and ward round documents.

The MDT is to ensure that all regular and PRN medications are reviewed regularly during ward rounds.

Present this audit, share relevant findings with the clinical team, and monitor the implementation of the action plans by doing a reaudit in 6 months.

Several sites across the North London Mental Health Partnership (NLMHP) do not have a liaison-specific rolling teaching programme. Best practice standards set by the RCPsych Psychiatric Liaison Accreditation Network (PLAN) are therefore not being met.

The aims of this quality improvement project (QIP) were to: (1) ascertain the perceived need for liaison-specific teaching across NLMHP sites; (2) develop and deliver a teaching programme; and (3) assess attendance, clinician satisfaction and confidence before and after teaching sessions.

A pre-programme questionnaire on Microsoft Forms was sent to team members across NLMHP sites to assess whether respondents were receiving liaison-specific teaching, the perceived utility of the programme, and suggestions for development.

A cross-site monthly teaching programme was developed. Sessions were presented by liaison clinicians from a list of liaison-specific topics via Microsoft Teams.

A post-session questionnaire was sent to establish session satisfaction, confidence pre- and post-session, and further comments. Mean satisfaction scores were calculated. Percentage change in confidence score was calculated for each session and overall.

Themes were identified from the qualitative data and suggestions implemented.

Of the 11 professionals who responded to the pre-programme questionnaire, 50% were not receiving any liaison-specific teaching. Respondents agreed the programme would be helpful in improving their knowledge and clinical practice (mean score = 4.9/5).

Attendance for the sessions ranged from 15–27 professionals (mean = 22). A range of 2–10 professionals completed each post-programme questionnaire (mean = 6.3; total responses = 25). Mean satisfaction for each session ranged from 4.3–5/5 (overall mean = 4.7/5). Percentage increase in confidence scores ranged from 4.6–48% (mean = 24%).

Feedback-driven changes made to improve the programme included: making session recordings available; sending reminder emails; creating an online platform and making session feedback available to presenters.

Respondents considered the sessions interesting and informative, that topics provoked good discussion, and that the 'bite-sized' training allowed attendance without interfering with clinical work.

This QIP highlighted the need for a liaison-specific teaching programme across NLMHP. Participants agreed that this would improve their knowledge and practice. The programme was reasonably well-attended across sites. Respondents reported improved confidence and felt the sessions were relevant to their clinical practice.

Limitations included the low and variable questionnaire response rate and limited data on the new programme's utility.

The next stages of the project include wider delivery, involvement of patients and carers, and of specialists in related psychiatric and medical fields.

We aim to see whether DNAR discussions are being undertaken at an appropriate time for our patients, as well as seeing whether these are recorded formally and regularly reviewed, as per local protocol. We also aim to see whether the immediate medical/nursing teams are aware of the local guidelines, as well as which of their patients have a DNAR in situ, and how to find this out. As an old-aged psychiatric unit, this is very important.

We used 2 methods of data collection. One was questionnaires that we gave out to medics, nurses, and HCAs on our wards. We collected quantitative data from them on whether they knew where DNAR forms were and which of their patients had DNAR forms. We then also collected quantitative data from our online notes, looking into which patients had DNARs, whether these were recorded online and in a physical copy, whether it was discussed on clerking, and whether it was regularly reviewed and documented in MDTs. We used data from 51 inpatients over 3 wards.

Over 30% of patients have a DNAR in situ across the 3 wards. The dementia-focussed wards have a higher number of DNARs in place. All patients with a DNAR had a purple form completed and kept on the ward. 75% of staff knew where these were. Only 20% of those with DNARs had these documented online as per local guidelines; only 45% of staff knew where to find this information online. Only 8% of patients had their DNAR status discussed on admission, and 10% in their first MDT. Only 60% staff knew which patients had a DNAR in situ.

There is evidence that purple forms are completed appropriately and stored well. The main issue is the online record-keeping; staff either don't know how to or that they can document this online. This is reiterated as many did not know where the information was online. This demonstrates a lack of knowledge and education.

DNAR conversations are not occurring in the first place; the status is not being regularly reviewed, leading to issues where these conversations are rushed during acute events. It is important to think about these things earlier to ensure everyone, patient, family and staff, understands the process and rationale.

Lack of staff knowledge on which patients have DNARs in situ could be a great issue if an acute event were to occur, and compromises patient safety.

This case report focuses on a 68-year-old Caucasian female, with long-standing symptoms of executive and cerebellar dysfunction, which responded well to rTMS targeting the prefrontal cortex and cerebellum.

This patient was seen in the private sector for long-standing symptoms of low mood, mental fog, unsteady gait, along with slurred speech and poor vision. History indicated the possibility of multiple mini strokes several years earlier, which may have contributed to her current presentation, and MRI Brain confirmed diffuse small vessel disease in periventricular areas and deep white matter, with no atrophy of brainstem or cerebellum. Her medications at the time included venlafaxine 75 mg OD, atorvastatin 20 mg OD, amlodipine 5 mg OD, thiamine HCL 100 mg OD and aspirin 75 mg. She then had a course of standard rTMS (F3 and F4), to which she had no real response. The team then performed a Quantitative Electroencephalography which revealed bilateral prefrontal and cerebellar disconnection, with normal connectivity in the rest of the brain and cortex, which enabled a diagnosis of Organic mood (affective) disorder, F06.3.

Based on the above findings, she was then prescribed a course of rTMS as follows:

1. 1. Bifrontal excitatory Theta burst, at 50–60%, daily for 20 treatments.

2. 2. CB1 and CB2 Cerebellar iTBS (10min) at 50–60%, daily for 20 treatments.

Although long known for its function in fine tuning motor function, emerging research indicates the growing importance of the cerebellum and its neural connections in neuropsychiatric disorders.

Recent studies have shown that those with cerebellar damage show impairments in executive function, and emotional regulation, in addition to language deficits and problems with sensory processing. It is bidirectionally connected with areas associated with processing social salience, including the posterior parietal and prefrontal cortex. With its connections to the prefrontal cortex, limbic structures and monoamine producing brainstem areas, it is likely the cerebellum also plays a key role in fine tuning emotional output, which appears to be corroborated by functional neuroimaging.

This case further supports the emerging evidence base that the cerebellum plays a key role in emotional experience, along with the prospect of using targeted rTMS for therapeutic benefit.

Background: Handover aims to achieve the efficient communication of clinical information when responsibility for patients is transferred. The Royal Edinburgh Hospital (REH), a specialist hospital serving the Lothians, has repeatedly received “red flags” (ranked in the bottom 2% of benchmarked areas) on the handover section of the Scottish training survey (STS) and GMC national training survey of doctors in training (DiT).

Aims:

• • Survey DiT to understand their experience of handover.

• • Introduce a new structured handover process.

• • Re-audit parameters after intervention.

Data from REH DiT were extracted from an anonymised handover survey, disseminated to all psychiatry DiT in Scotland in January 2023. Multiple choice and free-text questions covered handover timings, format, structure, and attendance. The survey was repeated after intervention. In addition, data from the STS were analysed. The intervention consisted of altering shift times to include protected time for handover, introducing a dedicated room, training in the use of an electronic system to record tasks, involvement of senior doctors, and dissemination of the new changes to procedure.

A total of 12 survey responses (25% response rate) pre-intervention (25% FY2s, 17% GPSTs, 58% core trainees) and 14 post-intervention (14% FY2s, 14% GPSTs, 71% core trainees) were analysed. The proportion of respondents reporting that handover always happened at times of shift change increased from 7% to 93% post-intervention. The proportion of those reporting that there was protected time for handover rose from 0% to 50%, and the use of a predetermined structure/format increased from 0% to 43%. After intervention, 86% of DiT felt adequately supported during handover (compared with 17% pre-intervention) and 93% of respondents felt handover ‘allowed for the efficient and effective transfer of information to protect patient safety’ (33% pre-intervention). Prior to the process change, 83% of DiT felt there was no clear senior leadership at handover; this fell to 21%. Post-intervention the use of WhatsApp/texts to hand over information fell by 100%. The new system was welcomed by trainees, but teething problems were identified.

The new process led to improvements in the frequency, consistency, format, recording, and senior support of handover. Issues with the use of video call software and electronic medical records systems have been identified, and work is ongoing to address these in an iterative quality improvement process. Good clinical handover benefits patients (fewer mistakes and increased safety, better continuity of care, improved satisfaction) and clinicians (improved communication skills, increased accountability, feel more informed, improved job satisfaction).

1. - To strengthen shared decision making between psychiatrists and general practitioners (GPs) while avoiding needless outpatient activity.

2. - To promote a seamless partnership between GPs and psychiatrists that will improve efficiency and effectiveness for better patient health outcomes.

3. - To improve patient journey whilst responding to operational pressures.

4. - To test GPs engagement and satisfaction.

Following GPs engagement sessions, a 12 weeks pilot was conducted with the Bath and North East Somerset (BaNES) Primary Care Liaison Service (PCLS) and the 6 Primary Care Networks (PCNs) in BaNES. 22 GP surgeries were allowed access to Advice and Guidance (A&G) system using a digital platform. The pilot ran from 3rd April to 25th June 2023, focussing on answering non-urgent queries related to: psychotropic medications, mental health presentations, and the wider mental health system signposting and awareness.

One Consultant Psychiatrist and One Associate Specialist in Psychiatry were involved. The asynchronous system (eOpinion) with an expected response time of 3–5 working days was used.

To allay any governance risks and to act as a backup should the A&G system process fail to record appropriately, a dual recording of the A&G given – both in the A&G digital platform and the patient electronic record was implemented. Further governance structures were built into the project to establish that actions undertaken by the psychiatrists were effective and justifiable.

82 requests received over the 12 weeks period.

20 out of 22 surgeries took part.

The Psychiatrists spent on average of 3.5 hours per week answering A&G requests. The administrative team spent on average one hour and three quarter per week processing A&G responses.

Although no significant impact on total referrals was noted, there was indication that demand was moving from the referral to A&G request.

All requests were responded within 2 working days.

Requests from GPs were largely appropriate with 88% resulting in advice and guidance, indicating an improved patient journey.

Minimal impact on the operational processes.

Positive feedback from GPs with 91% finding the A&G system useful or very useful. They were keen for the offer to continue.

Effective inter-professional collaboration between GPs and psychiatrists is essential in enhancing patients' overall health outcomes and experiences. For mental health services, this transformational approach should continue to enhance the existing offer. However, we should remain mindful of the potential risk of increased workload burden in General Practices, and the implications of this new clinical model on staff based in specialist services.

Several studies have examined the impact of leadership on employee well-being and health. However, this research has focused on a variable-centred approach. By contrast, the present study adopts a person-centred approach.

To (a) identify latent ‘resources’ profiles among two samples combining vigour at work, work engagement and physical activity levels; (b) examine the link between the identified profiles and indicators of psychological/physical health; and (c) test whether different levels of transformational leadership determine the probability of belonging to a particular profile.

Two samples of workers, S1 and S2 (NS1 = 354; NS2 = 158), completed a cross-sectional survey before their annual medical examination.

For S1, the results of latent profile analysis yielded three profiles: spiritless, spirited and high-spirited. Both high-spirited and spirited profiles showed a positive relationship with mental health, whereas spiritless showed a negative relationship. For S2, two profiles (spirited and spiritless) were replicated, with similar effects on mental health, but none of them was related to total cholesterol. In both samples, transformational leadership determined the probability of belonging to a particular profile.

Transformational leadership increased the probability of belonging to a more positive profile and, therefore, to better workers’ health.

This project evaluated the accuracy and evolution of psychiatric diagnoses in patients admitted through the Outpatient Department (OPD) and Emergency Room (ER) at Benazir Bhutto Hospital. It aimed to understand the factors contributing to diagnostic changes, especially the impact of comorbid conditions and interdisciplinary discussions.

Over an eight-month period, this study reviewed 200 patient records from the psychiatric department. It compared initial psychiatric diagnoses from OPD and ER admissions with final diagnoses at discharge. The evaluation examined the influence of ward round discussions, serial mental state examinations, and newly identified comorbid medical conditions, such as thyroid disorders and neurological issues, on diagnostic changes.

Analysis showed that 38.2% of ER admissions had a revised diagnosis by discharge, compared with 22.5% from OPD. Initial diagnoses primarily included major depressive disorder (30.1%) and bipolar disorder (27.2%). By discharge, increases were observed in personality disorders (up by 18.3%) and substance use disorders (up by 14.7%). Comorbid medical conditions were newly diagnosed in 26.8% of patients. Factors influencing diagnostic changes included ward round discussions (57.3%), serial mental state examinations (40.2%), lab findings (33.5%), and medical/interdisciplinary consultations (29.6%).

The service evaluation at Benazir Bhutto Hospital reveals significant diagnostic evolution in psychiatric care, more pronounced in ER admissions. The identification of additional disorders and comorbid medical conditions highlights the necessity for comprehensive, ongoing psychiatric assessment. Lab findings and interdisciplinary consultations played a crucial role in refining diagnoses, suggesting the importance of an integrated care approach. Recommendations include improving initial diagnostic processes in ER settings and strengthening interdisciplinary communication to enhance accuracy in psychiatric diagnosis and patient treatment outcomes.