Psychosis is one of the leading causes of disability. First Episode Psychosis (FEP) significantly impacts the long-term course of the disorder. While a majority of FEP service users show signs of ‘recovery' within 12 months of treatment, the early course involves frequent relapses, with up to 80% relapsing within five years. This elevates the risk of persistent psychotic symptoms, affecting cognitive, social, and occupational functioning. Medication, the core treatment, reduces relapse by 75%, necessitating additional psychosocial treatments. Mobile-based interventions are recognized for meeting families' needs in terms of information, guidance, and support. This paper explores stakeholder views on developing mobile interventions for those experiencing their first psychosis episode.

This qualitative paper was part of the TechCare app development process in which face-to-face interviews with patients (17), and 4 focus groups with health professionals were carried out. The qualitative interviews and focus groups explored the views of stakeholders on the need for mobile-based treatment, the structure of the application, the content of the application and barriers and challenges were also explored in detail. All the audio-recorded interviews were transcribed and analyzed through a framework approach.

Qualitative analysis revealed three themes. The first theme centers on stakeholders' views about mobile-based treatment. Health professionals reported that app-based treatment enhances help-seeking behavior, reduces societal stigma, and aids in managing treatment and activities. The second theme focuses on suggestions for the Techcare application, emphasizing logical and easy-to-understand content, with a major focus on crisis management, hallucinations, and psycho-education about symptoms. Participants also highlighted the need for a section providing psycho-education for families. Carers emphasized the necessity of an activity plan in the app, including an activity log for medication management and activities. The third theme delves into barriers and challenges in app-based treatment, including difficulty levels and privacy concerns. Stakeholders stressed the importance of content in simple Urdu language for broader understanding.

In conclusion, mobile-based treatment contributes to reducing stigma, increasing awareness about the illness in its early stages, and facilitating the management of functional activities for patients. The insights gathered from stakeholders provide valuable guidance for the development of an effective and culturally sensitive mobile-based intervention for individuals experiencing FEP.

To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures.

Quality improvement intervention.

Tertiary care pediatric intensive care unit (PICU).

Mechanically ventilated children admitted between 9/2018 and 8/2022.

We developed and implemented a consensus guideline for obtaining tracheal aspirate cultures through a series of Plan-Do-Study-Act cycles. Change in culture rates and broad-spectrum antibiotic days of therapy (DOT) per 100 ventilator days were analyzed using statistical process control charts. A secondary analysis comparing the preintervention baseline (9/2018–8/2020) to the postintervention period (9/2020–8/2021) was performed using Poisson regression.

The monthly tracheal aspirate culture rate prior to the COVID-19 pandemic (9/2018–3/2020) was 4.6 per 100 ventilator days. A centerline shift to 3.1 cultures per 100 ventilator days occurred in 4/2020, followed by a second shift to 2.0 cultures per 100 ventilator days in 12/2020 after guideline implementation. In our secondary analysis, the monthly tracheal aspirate culture rate decreased from 4.3 cultures preintervention (9/2018–8/2020) to 2.3 cultures per 100 ventilator days postintervention (9/2020–8/2021) (IRR 0.52, 95% CI 0.47–0.59, P < 0.01). Decreases in tracheal aspirate culture use were driven by decreases in inappropriate cultures. Treatment of ventilator-associated infections decreased from 1.0 to 0.7 antibiotic courses per 100 ventilator days (P = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention.

A diagnostic test stewardship intervention was both safe and effective in reducing the rate of tracheal aspirate cultures and treatment of ventilator-associated infections in a tertiary PICU.

An April 2022 Electroconvulsive Therapy Accreditation Services (ECTAS) review of electroconvulsive therapy (ECT) services in the Southern Sector of the Western Health and Social Care Trust highlighted that the follow up of service users' memory and cognitive side effects post-ECT needed to be improved to deliver safer and more effective care. The aim of this MDT quality improvement project was to transform the follow-up process from a baseline of 13% of service users receiving memory assessment 1–2 months post ECT to 100% of service users receiving memory assessment 1–2 months post ECT over a 16 month period.

In June 2022, an MDT working group was established with key stakeholders from inpatient and community mental health services. Using driver diagrams, opportunities for improvement were collectively identified and innovative ideas proposed to overcome these barriers. The primary drivers for change were communication, resources, and education. Systems were established and PDSA cycles used to review our data and decide whether we needed to make a further change. 17 service users received ECT and were followed up within the 16 month period. Our third change brought about the most significant and sustained improvement to the process; establish ECT champions within community teams. The ECT champion's role was to improve communication between inpatient and community teams in regards to service users needing memory follow up post ECT.

The introduction of three ECT champions within the community teams significantly improved communication between the inpatient and outpatient teams resulting in an improvement in the standard of care to our service users. Initial figures show 100% of service users having memory assessment follow up at 1–2 months post ECT in July 2023, October 2023 & December 2023. No service users required follow-up within the service in August/September/November 2023. Performance monitoring is ongoing as part of the service's governance meeting.

In conclusion, by improving communication, utilising resources more effectively and educating through ECT champions, the percentage service users receiving memory assessments at 1–2 months follow up post ECT achieved ECTAS standard of 100%. This will benefit our service users by enabling us to identify those who need further input. Looking into the future, we need to undertake a clinical audit to assess for a sustained improvement and ensure that no unintended consequences have been introduced from this QIP. We have shared our learning within the wider trust and plan to spread and scale our changes across a wider area.

At the core of medical diagnosis lies specific blood tests, urine analysis, microscopic and histologic examination of tissues, and as well radiological investigations that are usually confirmatory of the presence of a disease. However, the diagnosis of ADHD currently relies on reports of clinical symptoms which is usually subjective, with variable interpretations by different professionals, thus posing issues of misdiagnosis and reliability. This study set out to explore, appraise and summarize molecular biomarkers in literature over the past 30 years, which can be applied for the diagnosis of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric and neurobehavioral disorder that affects children and adolescents, and more recently, gaining recognition in adults. It is characterized by a pervasive pattern of inattention, hyperactivity, and impulsivity or a mixture of the three, that cuts across the individual's multiple domains of life.

One-thousand articles collated across multiple sources and databases were systematically reviewed and analysed for this project. The keywords for the search criteria in the Boolean operators are “biomarkers and ADHD”, “molecular biomarkers and ADHD” and “biomarkers and ADHD and Diagnosis”.

5.6% of the articles from several types of studies were included in the final analysis after the inclusion and exclusion criteria were applied. The results revealed various heterogeneity across age, gender, ethnicity, medication status, comorbidities, and study type, in applying biomarkers to assist in the diagnosis of ADHD. Genetics and epigenetics studies were the most common type of molecular biomarkers studied and identified, accounting for 25% of the results. 80% of the studies analysed blood samples with a few others focusing on saliva, urine, cerebrospinal fluid, hair, and stool samples. All the studies identified focused on diagnostic biomarkers with 25% of them combining either prognostic or response-monitoring subtypes of biomarkers.

This study identified several potential molecular biomarkers in ADHD. However, most of the results showed only associations between the findings and the diagnosis/occurrence of ADHD. It remains a scientific goal to identify a specific and reliable biomarker for ADHD to assist psychiatrists in making accurate diagnosis. Lastly, it would be pragmatic to explore other types of biomarkers such as radiologic and electro-neurologic markers; given that diagnosis is a constellation of signs and symptoms together with appropriate tests. Combining them logically would increase the specificity of diagnosis of ADHD. This study was completed in partial fulfilment of Master of Science (MSc) in Clinical Psychiatry with the University of South Wales.

To determine the number of patients within a service on sodium valproate for a psychiatric condition who have updated Annual Risk Acknowledgement forms in place.

It was firstly identified that within the NICE guidelines, it is recommended that all patients who are on sodium valproate should have an annual signed risk acknowledgement form in place. Following this, a list of patients was compiled who were currently prescribed this with the local area. Each patient was then checked to see if the valproate was prescribed by psychiatry or by neurology. This was then further divided into general adult and learning disability patients.

From this, a list of patients under the care of general adult psychiatry was compiled. The notes for these patients were obtained.

Data collection was then carried out. Each set of notes was reviewed by two individuals for the following:

1. 1. To identify if an annual risk assessment form was carried out.

2. 2. To check if this was within expiry date.

3. 3. To identify patient diagnosis.

4. 4. To identify the dose of sodium valproate.

5. 5. To confirm if these patients were females of childbearing age.

From the initial audit cycle, it was identified that 28 female patients who fell within the inclusion criteria were on valproate, and of these, 6 had forms in place. Of the 6 with forms in place, 50% had expired so needed to be replaced. 17 had no form in place, and for 4 patients it could not be certain if forms were present or not due to unavailability of records. Only 3 patients therefore had the correct form in place which were within expiry date. If we discount those with no data available, only 12% of patients had the correct annual risk acknowledgement form present and within expiry date.

Following the initial audit, two interventions were carried out:

1. 1. The data from the above audit was presented at a consultant meeting, highlighting the importance of ensuring these forms are kept up to date.

2. 2. It was decided that pharmacy would take a leading role in ensuring the annual risk assessment forms are updated.

Following 6 months, this patient cohort was re-audited, with further results obtained.

These results showed a reduction in patients prescribed sodium valproate from 28 to 19. 37% of all patients prescribed sodium valproate had forms, but of these, only 30% were up to date. Therefore, only 11% of patients had correct annual risk acknowledgement forms in place which were up to date.

These results showed an improvement in those who had at one time had a form in place, but roughly similar compliance with availability of up to date forms.

Overall it appears that there is a real lack of consistency in ensuring the annual risk assessment forms are in place. A very low percentage of patients have the correct form in place within expiry date, despite interventions which have taken place as part of this audit. Further efforts should therefore be made by teams to ensure that these forms are in place and up to date for all women of childbearing age on valproate.

On a positive note, it may be possible to surmise that the reduction in number of patients on sodium valproate may be linked to raised awareness of the risks to women of childbearing age.

Additionally, a significant number of patients had been sent forms in the post, but had not returned them. Some of these same patients had, in the time that they should have had updated risk forms put in place, been admitted to an inpatient psychiatric hospital. It is therefore important to consider in future if these forms should be updated whilst the patients are admitted to hospital, to increase the number of patients with these forms up to date and therefore improve safety for this cohort of patients. Given that many of these patients have a diagnosis of Bipolar Affective Disorder, they may find it more challenging to return the forms whilst in the community, particularly if unwell; the ICD–11 criteria does note that patients with this condition may suffer from “distractibility, impulsive behaviour and rapid changes in mood state.” Further research could therefore be carried out to determine if utilising inpatient admissions to discuss risks of their medications would be a beneficial way to improve compliance with Annual Risk Assessment Forms.

Lastly, we know that there has been discussion around implementation of such monitoring for men as well as for women. Should this be implemented within the NICE guidelines, further audits should be carried out to determine our compliance with this.

The link between domestic violence and poor mental health outcomes is well-established, with victims often experiencing anxiety, depression, and post-traumatic stress disorder (PTSD). This study aims to evaluate the current state of Domestic Violence (DV) screening training within the medical curriculum at King's College London, focusing on trauma-informed and culturally competent approaches. The objective is to identify gaps and propose recommendations for a comprehensive and inclusive training program.

Approved by the King's College London Research Ethics Office, this qualitative study was conducted using an online questionnaire that adopted a 5-point Likert-type scale. The study was conducted among KCL Medical Students (n = 25) to gather opinions on DV screening training, and the responses underwent thematic analysis.

The survey indicated that 92% of participants had not received formal training on DV screening. In addition, 88% lacked guidance on responding to disclosures in a trauma-informed manner and only 8% believed they had training on responding to DV within diverse cultural contexts. The key themes were ‘Addressing Training Gaps and Challenges’, ‘Practical Skills Enhancement’, ‘Cultural Competency and Diversity' and ‘Comprehensive Understanding of Domestic Violence and Abuse’. Students expressed concerns about the lack of clear, direct education on escalating domestic violence cases. Furthermore, some medical students expressed apprehension about inadvertently re-traumatising or offending patients with a different cultural background.

The study highlights deficiencies in the current domestic violence screening training, emphasizing the urgent need for a more comprehensive, trauma-informed, and culturally sensitive curriculum. Recommendations include the incorporation of domestic violence education within the core curriculum and interprofessional education, survivor engagement, and challenging biases through adopting a critical pedagogy approach. These changes aim to enhance the understanding, attitudes, and practical skills of medical students in addressing domestic violence, ultimately contributing to a more inclusive and responsive medical education system.

Social contact is crucial for both immediate and later development of adaptive social and emotional behaviour. Tactile experiences during childhood influence the development of the social brain and frequent affectionate touch is associated with secure attachment style. Social touch is an important form of social interaction and plays a significant role in the formation and maintenance of relationships in humans across development, where the hedonic properties of touch are involved in improving the quality of life. However, relatively less research attention has focused on social touch experiences in individuals with a history of early-life interpersonal stress, particularly childhood maltreatment.

Social touch pleasantness ratings using a newly developed Social Touch task and attitudes about a variety of social touch behaviours using the Social Touch Questionnaire (STQ) were examined in 40 age- and gender-matched young adults (23 childhood maltreatment, 17 controls).

The childhood maltreatment group had significantly lower STQ score than the control group, where lower STQ score was furthermore correlated with higher severity of maltreatment, particularly physical neglect. For the social touch task, females who experienced childhood maltreatment had significantly lower mean pleasantness ratings for positive social touch than their male counterparts, and these differences were mainly in response to touch given by stranger and friend of opposite gender.

These preliminary results show that early-life interpersonal stress from caregivers may potentially influence touch processing and pleasantness, particularly for females, and there is a need to further explore the effects of different touch giver role (e.g. friend, stranger, partner).

The primary aim was to identify areas where there may be a significant gap in following the NICE recommendations.

To compare how antipsychotic and benzodiazepine prescribing practice in Community mental health team, measures against the national prescribing practices as identified in the POMH-UK Quality Improvement Project (QIP) 12b.

The medical secretaries were contacted and asked to provide a list of patients seen as outpatients between March–September 2021 who have a diagnosis of personality disorder.

As there were multiple psychiatrists working in a team the cases to include were taken evenly from each caseload.

The frequency of diagnosis of personality disorder was more likely in females (31/40). Most common personality disorder diagnosed was EUPD (88.5%) followed by mixed Personality disorder (11.5%).

Among sample of patients selected, around 75% were prescribed some psychotropic medication including 52.5% (21/40) who were prescribed an antipsychotic medication.

Around 47.6 % (10/21) of the antipsychotic prescriptions were a new recommendation. Out of all the antipsychotic medications prescribed, quetiapine was by far the most common antipsychotic prescribed followed by aripiprazole.

In 38% of cases where antipsychotics were prescribed specifically for the management of Personality Disorder a rationale was given. Predominantly they were prescribed to reduce mood instability and impulsivity, and to aid sleep. Furthermore, none of the rationales given was in line with NICE recommendation.

Only 3.8% (5/21) of those prescribed antipsychotics were given a written information about antipsychotic effectiveness in PD and a plan to reduce antipsychotic medication was documented in only 28.57% (6/21).

A comorbid diagnosis was present in 62.5% (25/40) of the patients and the most common one was complex PTSD. The frequency of antipsychotic prescription was higher in those with a comorbid diagnosis (57.1%) and 42.8% in those without a comorbid diagnosis. However, there were differences in comorbidities present for patients prescribed antipsychotics as compared with those not prescribed antipsychotics. Those on antipsychotics tended to have comorbid diagnoses on the psychosis, bipolar spectrum disorders and PTSD whereas those not on an antipsychotic tended to be on the depressive or anxiety spectrum.

The other psychotropic medications used were antidepressants and benzodiazepines.

In general, the frequency of prescribing antipsychotic medication to patients with personality disorder in the community mental health teams across Cumbria (52.5%) appears to be lower than the national average (57%). However, the prescriptions did not meet the requirements set out by the NICE guidelines. A significant gap between the recommendations and practice was identified.

In 38% of cases, in which antipsychotics had been prescribed specifically for personality disorder there was a rationale given. Even when a rationale was given it was to treat intrinsic features of Personality disorder which is contrary to what NICE recommends. Only 3.8% of prescriptions were supported with written information on the efficacy of antipsychotics in personality disorder.

To compare current practice in local Rehabilitation in audit across North and West Rehab Kent units against standards of ‘Triangle of Care’.

Standard 1.3:

Carer's views and knowledge are sought throughout the assessment and treatment process.

Standard 5.2:

An early formal appointment is offered to the carer to hear their story, and history and address the carer's concerns.

Standard 5.10:

The carer is involved in the discharge planning process.

A previous audit was conducted in 2019 using Triangle of Care and AIMS standards. We decided to see whether the standards have been upheld.

We included all 43 patients admitted over the previous 6-months. No patient had National Opt-Out. The source of information was the RIO system. The data were analysed by 2 investigators.

A data collection form was used:

Question for Standard 1.3: Were the carer's views and knowledge sought throughout the assessment and treatment process? If this was not the case, the reasons were to be specified.

Question for standard Standard 5.2: Was an early formal appointment offered to the carer to hear their story history and address the carer's concerns?

Question for standard Standard 5.10: Was the carer involved in the discharge planning process?

Standard 1.3:

83.72% had contact with a variety of team members throughout their relative's admission. Reasons for non-involvement included lack of consent, unavailable carers, non-attendance, and carer's preference.

Standard 5.2:

Only 60.53% of carers had an early appointment offer, and the expectation that this should occur in 80% of cases was unmet.

Standard 5.10:

(90%) of the patients had carers involved in the discharge planning process, meeting the required standard.

Best Practice:

The audit results demonstrate that carers are involved in their relative's care throughout the admission and discharge process.

Lessons learned:

Compared with the previous audit in 2019, when the criteria for Standard 5.2 were met, carers were offered a formal early meeting significantly less often. Possible reasons could be the pandemic and resulting changes in practice have certainly led to a reduction in face-to-face meetings. Offering individual time to all carers is essential, and efforts should be made to integrate this into practice.

Next steps:

To allocate a team member to offer a meeting with the carer.

To discuss the outcomes with the Carer Champions on each unit, to review what form their support currently takes, and consider how this could link in with the requirements of Standard 5.2.

To re-audit in 1 year.

The urgent referral system to outpatient psychiatry in NHS Lothian is intended for patients who require to be seen within 5 days. However, many of the referrals are not deemed this urgent upon triage. This project aims to illustrate the extent of this issue and highlight potential reasons, in order to improve the pathway for patients referred on to secondary care services.

Over a 3 month period from August 2023 to November 2023, all urgent referrals received by an Edinburgh sector general adult psychiatry outpatient's department were reviewed. Data was collected on broad presenting complaint, whether or not the referral was deemed urgent upon triage, whether it contained a factor in line with RefHelp guidance for urgency, and what the end outcome of the referral was.

During the 3 month period, there were 92 urgent referrals. Of these, only 12% were deemed urgent upon triage. Almost all accepted referrals related to concerns around potential psychotic illness (82%). Although only 12% of referrals were accepted as urgent, 35% had factors which, in accordance with RefHelp guidance, would be cause for considering an urgent referral.

There were a variety of disposals including “soon” appointments, redirection to other services such as Thrive or offering advice to the referring clinician. The most common outcome was the offer of a “soon” appointment, closely followed by redirection to the Thrive team.

The majority of urgent referrals were not deemed urgent at triage. There was a clear discrepancy between referrals containing urgency factors according to RefHelp and those offered urgent appointments. This would suggest that the available guidance is not sufficiently clear.

Many referrals were redirected to other services, including Thrive. This redirection may reflect a lack of awareness and a further project may examine Thrive referrals to establish if the number initially sent to psychiatry outpatients is significant.

Additionally, several referrals were triaged as “soon” and seen in 6–8 weeks, as opposed to waiting for a routine appointment. Though RefHelp advises highlighting routine referrals which may be a priority, this pathway was not being used and there is no direct route for “soon” referrals.

Next steps may include liaison with primary care teams to establish views and concerns, updating RefHelp guidance and adding a further referral pathway to address the apparent gap for “soon” referrals.

Previous population-based studies have identified suicidal ideation (SI) as a potential risk marker for psychosis. We aimed to investigate the prevalence of previous SI in a large sample of patients with first episode of psychosis accepted to early intervention services (EIS) in South London and Maudsley (SLaM) NHS Foundation Trust using clinical records. We further aimed to investigate differences in patients with and without recorded SI according to age at diagnosis, gender, ethnicity and neighbourhood deprivation.

We designed a retrospective cohort using the Clinical Record Interactive System. Included were patients who were accepted by SLaM EIS from 2015–2018 and received a psychotic disorder diagnosis (n = 1658). We used a natural language processing algorithm that searches deidentified textual clinical records, returning a binary variable indicating presence or absence of SI recorded at any time prior to acceptance to EIS. The algorithm has high precision (97%) and inter-rater reliability (Cohen's k 92%). The t-test was used to compare mean age at first diagnosis in patients with and without recorded SI, while chi-squared tests evaluated differences according to gender, ethnicity and tertiles of index of multiple deprivation (based on 2015 postcode). The significance threshold was p = 0.05.

The cohort included 1658 patients, of whom 656 (39.6%) were female. The natural language processing algorithm identified 600 patients (36.2%) who had SI recorded in their clinical records at any time prior to acceptance by EIS. On average, patients with recorded SI were younger at first diagnosis of psychotic disorder (mean 27.7 years, standard deviation 10.5) compared with patients without recorded SI (mean 30.1 years, standard deviation 11.2; p < 0.001). There was little evidence for differences on gender (p = 0.950), ethnicity (p = 0.059) or deprivation index (p = 0.597).

Approximately 1 in 3 patients attending SLaM EIS had evidence of SI recorded prior to acceptance by EIS. Consistent with previous studies, the current findings emphasise the high prevalence of SI in this clinical population. Compared with those without SI, patients with recorded SI were on average 2–3 years younger at diagnosis. This may reflect general population age differences in prevalence of suicidal ideation; increased severity of illness with earlier age of onset; or patterns of contact with services which facilitated earlier diagnosis. There was little evidence that patients with and without recorded SI differed significantly on gender, ethnicity or neighbourhood deprivation. Prospective studies would be helpful to assess whether SI is a risk marker for first episode of psychosis.

The aim of this work was to improve police force understanding of the mental health difficulties of children and their management in challenging situations.

Nationally, approximately 18% of children aged 6–16 years are likely to have a mental disorder, with the frequency increasing in regions such as North Staffordshire where there are areas of significant deprivation. During the COVID pandemic, children's wellbeing, school attendance, and isolation all worsened resulting in a tripling of urgent referrals to some crisis mental health services. Owing to underfunding and reduced resources in the NHS, the police services have had to spend more time dealing with children's mental health crises, with some forces identifying insufficient training for understanding and de-escalating these emergencies.

It was hypothesized that the preparation and delivery of bespoke training sessions, coupled with pre- and post-assessments, would help enhance police understanding of the conditions and strategies in managing these crises.

Extending previous approaches, each teaching session covered the presentation, diagnosis, and management of autism, conduct disorder, and emotional dysregulation in children, along with de-escalation. A pre- and post-session quiz was completed addressing each of the four topics. Data collection took place in October 2023 with 19 pairs of quizzes completed by local police and community support officers. Given the size and nature of the data, a non-parametric bootstrap resampling method was used to assess whether the teaching produced a statistically significant improvement in each topic and overall score.

Mean differences in scores with 95% confidence intervals (CIs) were obtained for the 19 pairs of quizzes for each mental health condition and all conditions taken together. With maximum of 16 marks possible in each condition, there were statistically significant improvements in mean scores for autism, 1.9, CI: [1.6,2.3]; conduct disorder, 2.2, CI: [1.7, 2.7]; emotional dysregulation, 2.4, CI: [2.0, 2.7]; and de-escalation, 0.9, CI: [0.5, 1.4], and for all conditions 7.4, CI: [6.5, 8.5].

Bespoke children's mental health training sessions were found to deliver significant improvements in police knowledge of crisis management and de-escalation in children affected by autism, conduct disorder, and emotional dysregulation. Given the unprecedented demands on police services, training sessions of this kind could serve as a training tool to reduce both the intensity and duration of crises they have to handle. More sessions have already been requested within the authors’ local NHS Trust.

Autism Spectrum Disorder (ASD) poses unique challenges for social interaction and communication skills development in children. Various interventions, including virtual reality (VR) and social skills training, have emerged as potential approaches to address these challenges. This systematic review aims to evaluate and compare the effectiveness of VR Social Skills Training with Standard In-Person Social Skills Training in improving social interaction skills and reducing social anxiety levels in children with ASD.

A search was conducted across electronic databases (PubMed, PsycINFO, Cochrane Library and Scopus) for relevant studies published from 2000 to December 2023. Inclusion criteria include randomised controlled trials (RCTs) and observational studies comparing VR Social Skills Training with Standard In-Person Social Skills Training in children diagnosed with ASD within the specified age range. Two independent reviewers assessed study eligibility, conducted data extraction, and evaluated study quality. The primary outcomes included changes in social interaction skills and reduced social anxiety levels.

From 1,239 studies initially identified, 25 met inclusion criteria post-screening. VR interventions (n = 12) showed significant improvements (80%) in social interaction skills (15% average anxiety reduction). Varied platforms were utilised, including virtual social scenarios. Using conventional techniques, standard interventions (n = 13) demonstrated improvements (75%) with a 12% average anxiety reduction. Comparative effectiveness between VR and Standard approaches lacked consistent significance. Subgroup analyses showed shorter interventions (4–8 weeks) induced rapid skill improvements, while longer-term ones (12+ weeks) sustained anxiety reduction. Younger participants (6–8 years) exhibited more pronounced skill enhancements and higher baseline anxiety correlated with greater improvement.

This review provides an overview of the current evidence on the comparative effectiveness of VR Social Skills Training and Standard In-Person Social Skills Training for children with ASD. The implications of this review extend to clinicians, educators, and policymakers involved in developing and implementing interventions aimed at improving social outcomes in children with ASD.

The use of psychotropics and polypharmacy among patients with learning disability have been widely discussed. Mental illness increases morbidity and mortality and the addition of polypharmacy potentiates these risks.

It is important to determine the proportion of inpatients with psychotropic polypharmacy, highlight associated socio-demographic and clinical factors, and follow up plans for such patients at the point of discharge.

A retrospective collection of data was completed using electronic records of patients 18 years and above who were discharged from inpatient psychiatric wards located in East Suffolk between 1st July and 31st December 2021.

Data available in discharge medication letters, discharge summaries and inpatient clinical notes were also used in the study.

Amongst 256 inpatient episodes included within the audit, polypharmacy was found in 52% cases.

Of which 80% of patients were above 65 yrs and 56.3% of them were male.

Out of the included episodes, 74% were on combination and 26% were on augmentation therapy.

About 40% had a single diagnosis of schizophrenia/schizophrenia-like delusional disorders, while around 25% had a mood disorder.

9% of episodes had a singular diagnosis of personality disorder and 8.4% of episodes had >1 psychiatric diagnosis.

Despite the increased side effect burden and risks in the presence of physical health co-morbidities, polypharmacy remained prevalent in this group of inpatients.

More than a quarter of patients were on sedative augmentation without any clear plan or recommendation for deprescribing after discharge.

In order to improve clinical practice, more frequent medication reviews should be recommended when there is high prevalence of psychotropic polypharmacy.

Depressive disorder is one of the most typical psychiatric disorders that occurs after a traumatic event. However, there has been minimal research regarding the prevalence and associated factors of depression after a traumatic event. Therefore, this study aims to investigate the prevalence of depressive symptoms and associated factors in the residents of the Gangjeong village, who have been exposed to a traumatic event recently for a prolonged period.

The subjects of this study were the residents of the Gangjeong village, who have been exposed to a traumatic event related to the construction of the Jeju Civilian-Military Complex Port. The questionnaires were used to assess the participants' general characteristics (sex, age, marital status, occupation, self-perceived health, etc.); in addition, for the clinical evaluation, overall stress was assessed through the Global Assessment of Recent Stress Scale (GARS), social support through Functional Social Support Questionnaire (FSSQ) and suicide risk through Mini-International Neuropsychiatric Interview-Plus (M.I.N.I-Plus). In order to evaluate the depressive symptoms, CES-D (Center for Epidemiologic Studies Depression Scale) was used.

In 713 subjects, the prevalence of depressive symptoms was 18.5% (95% CI=15.66–21.36) (Table 1). Multivariate logistic regression analysis identified the length of residence and marital status as factors associated with depressive symptoms (Table 2). Furthermore, the depression group has a significantly higher score of overall stress (GARS), suicide risk and the lack of social support (FSSQ), in comparison with the non-depression group (depression gr. vs non-depression gr. : 28.8 ± 15.0 vs 12.8 ± 10.1, 4.9 ± 8.0 vs 1.1 ± 3.6, 44.8 ± 13.2 vs 34.0 ± 13.9, respectively).

The prevalence of depressive symptoms was higher among the study population compared with the general population. People exposed to the traumatic event, especially after prolonged exposure, should be assessed for environment factors, the status of overall stress, social support and the suicidal risk.

The aims of this study were to evaluate the literature regarding the use of ultra-low-field magnetic resonance imaging (ULF-MRI) and its potential use in dementia diagnosis.

Access to neuroimaging causes bottlenecks in dementia diagnostic pathways and limits overall capacity; there is wide variation across the UK. At present, dementia diagnosis rates in the UK remain below 65% and significant improvements in efficiency and accessibility of assessment services are needed to meet growing demand.

Modern MRI scanners use high strength magnetic fields (typically 1.5–3T), are expensive to install and operate, and usually require patients to travel to a general hospital. ULF-MRI systems (typically < 0.1T) are portable, relatively inexpensive, and do not require specialist staff to operate. They do not require shielding and are powered via a standard electrical socket. The use of ULF-MRI has historically been limited by multiple factors including poor image quality. Advances in software and hardware now mean that there is realistic potential to use ULF-MRI across a range of clinical applications.

The study followed the PRISMA 2020 guidelines and was registered on PROSPERO. Five electronic databases were searched for studies related to ULF-MRI using pre-developed terms. Studies comparing high field and ULF-MRI neuroimaging in adults were included. Studies of acute presentations (e.g. traumatic brain injury or acute cerebrovascular accident) were excluded. A data extraction template was used to synthesise study characteristics and outcomes. Two reviewers completed the selection process and data extraction independently.

2357 citations were identified, from which 101 studies were selected for further review based on title and abstract, of which eight met criteria for inclusion. Further studies were identified by forward and backward citation searching and through contact with active researchers in the field. The selected publications included both single and multi-centre studies. The Hyperfine Swoop system was used in almost all studies. Mean participant age range was 31 to 63. Qualitative and quantitative comparisons demonstrated good correspondence between high field and ULF-MRI across a range of measures studied, including volumetric measures and moderate to severe white matter hyperintensities.

The limited available evidence suggests that there is potential for ULF-MRI to transform the approach to neuroimaging in the assessment of dementia. Dedicated research into the use of ULF-MRI in this specific application will determine if it will be one of the much-needed disruptors to our current processes of dementia assessment.

The Psychiatry Bootcamp at a psychiatric hospital was developed to address the unique and diverse challenges faced by new trainees, including Foundation Year Doctors, General Practitioner Specialty Trainees, Core Psychiatry trainees and Broad-Based Trainees, during their rotations in psychiatry in the Highlands, Scotland. The aim was to enhance their core skills and confidence levels, ensuring they are well-prepared for their first on-call shift. This initiative seeks to complement the existing induction program, specifically targeting areas of acute medical and psychiatric emergencies and care, that are critical for on-call duties.

Since its launch in 2022, the Psychiatry Bootcamp has been conducted quarterly, aligning with new doctor rotations. Held at the Medical Education Centre/Psychiatry Hospital, this one-day intensive training accommodates an average of 10 participants per session. The program, delivered by consultants, specialist nurses, and senior trainees, comprises tutorials, practical skills sessions, and simulated scenarios, focusing on key areas like the Mental Health Act, psychiatric risk assessment, wound management, resuscitation guidelines, and rapid tranquilisation.

A pre-test is administered to gauge participants' baseline knowledge and skills. Feedback is also collected immediately after the session and 3–4 months later. This ongoing feedback, systematically gathered since 2022, has been pivotal in continuously refining the curriculum and teaching methods, ensuring they remain up-to-date and effective.

The bootcamp demonstrated notable success in enhancing the preparedness of new psychiatry trainees for on-call duties. Post-course evaluations revealed an improvement in participants' confidence levels when managing psychiatric emergencies and various on-call situations. Through the practical and interactive nature of the training, trainees reported a deeper understanding of acute psychiatric care and an increased ability to apply theoretical knowledge in real-life scenarios. The hands-on experience with simulated scenarios was particularly effective in bridging the gap between classroom learning and clinical practice. Trainees expressed greater comfort in handling challenging situations, such as rapid tranquilisation and emergency detention under the Mental Health Act, which were previously areas of concern.

The Psychiatry Bootcamp represents a targeted and effective approach to preparing new psychiatry trainees for the demands of on-call duties. By focusing on key areas of need and employing a variety of teaching methods tailored to enhance practical skills and confidence, the bootcamp successfully addresses the gap between theoretical knowledge and clinical application. Preliminary feedback underscores the value of such programs in psychiatric education, suggesting that this model could be beneficial for similar settings seeking to improve trainee preparedness and overall patient care quality.

Electroconvulsive Therapy (ECT) is a treatment used for patients with severe depression, mania, catatonia, and schizophrenia. National Institute for Clinical Excellence (NICE) guidance for the use of ECT advises that for all patients, a risk/benefit assessment for the treatment should be made and documented with particular reference to anaesthetic risk and the adverse effect of cognitive impairment.

For patients who can consent to treatment, NICE recommends the use of patient information leaflets to help people to make an informed decision about their ECT treatment.

For patients who cannot consent to treatment, psychiatrists can authorise the use of ECT using the Mental Health Act. However, NICE recommends that any advance directive should be fully taken into account, and someone who speaks on behalf of the patient should be consulted.

This project aimed to audit whether the documentation of the consent process of patients undergoing ECT in NHS Grampian was in line with the above NICE Guidance.

The clinical notes and ECT folders of the six patients undergoing ECT treatment in NHS Grampian in January 2023 were reviewed in reference of the following domains:

1. 1) The clinical indication for ECT.

2. 2) If the patient (or their family/advocate) had the opportunity to receive the RCPsych Patient Information Leaflet for ECT.

3. 3) If a discussion about the risks/benefits of ECT had taken place with a patient, their family or advocate.

4. 4) If specific risks and side effects – namely anaesthetic risk and cognitive impairment – had been discussed with the patient, their family or advocate.

The project had been registered with the NHS Grampian Quality Improvement & Assurance Team prior to data collection beginning.

All of the notes reviewed (100%) had the clinical indication for ECT clearly documented.

Three (50%) of the patients had received the RCPsych Patient Information Leaflet for ECT.

A clear risk/benefit assessment discussion was documented in three (50%) of the patients' notes.

Specific discussion of side effects including cognitive impairment and anaesthetic risk was documented in three (50%) of the patients' notes.

There is a clear need for improvement in the documentation of the consent process for ECT in NHS Grampian. While the indication for receiving ECT is being clearly recorded, documentation of the risk/benefit assessment, discussion of specific side effects, and involvement of family or advocacy is less consistent. The introduction of the NHS Grampian standardised consent form is being considered as an option to improve this documentation. The documentation of the consent process for ECT can be re-audited once this form has been introduced.