The contribution of mental illness towards total Disability Adjusted Life Years is increasing according to the Global Burden of Disease study. As the need for mental health services increases, technological advances are being deployed to improve the delivery of care and lower costs.

The emergence of Artificial Intelligence (AI) technology in mental health and companionship is an evolving topic of discussion. There have been increasing debates about the use of AI in managing mental health problems. As the AI technology and its use grows, it is vital to consider potential harms and ramifications.

There are very limited discussions about the use of chatbots and relevant AI by humans to commit crime especially in those suffering from mental illness. AI can potentially serve as an effective tool to misguide a vulnerable person going through a mental health problem e.g. encourage someone to commit a serious offence. There is evidence that some of the most used AI chatbots tend to accentuate any negative feelings their users already had and potentially reinforce their vulnerable thoughts leading to concerning consequences.

The objective of this study is to review existing evidence for harmful effects of AI chatbots on people with serious mental illness (SMI).

We conducted a review of existing evidence in five databases for relevant studies. The search sources were 4 bibliographical databases (PsycINFO, EMBASE, PubMed, and OVID), the search engine “Google Scholar” and relevant grey literature. Studies were eligible if they explored the role of AI and related technology in causing harm in those with SMI.

Initial searches constrained the scope of review to the harmful effects of AI use in mental health and psychiatry and not just the association with crime due to very limited existing data.

Whilst current AI technology has shown potential in mental healthcare, it is important to acknowledge its limitations. At present, the evidence base for benefits of AI chatbot in mental healthcare is only just getting established and not enough is known or documented around the harmful effects of this technology. Nevertheless, we are seeing increasing cases of vulnerable mental health patients negatively influenced by AI technology. The use of AI chatbots raises various ethical concerns often magnified in people experiencing SMI. Further research will be valuable in understanding the ramifications of AI in psychiatry. This will also help guide the developers of this important and emerging technology to meet recognised ethical frameworks hence safeguarding vulnerable users.

This re-audit of rapid tranquillisation (RT) practices in patients over the age of 65 at a district general hospital took place as part of a wider quality improvement project to assess whether practices had improved following previous audits.

Data was accessed using the hospital's electronic patient record system. Drug charts for patients over 65 admitted to six wards (total n = 172) were reviewed. The wards comprised three geriatric wards, two medical wards, and one surgical ward. Drug charts were reviewed using the audit tool developed in previous audits, which has been designed to collect relevant data according to the recognised standard (in this case the local mental health trust's RT guidance). Data was collected on RT type, RT frequency of RT, RT route, indication documentation, post-RT monitoring, nature of prescription (PRN, stat, or regular), underlying diagnosis of delirium or dementia, and involvement of specialist teams.

• • Of the 172 audited patients, 9 (5.2%) received RT, compared with 13 out of 297 (4.3%) in the previous 2022 audit.

• • PRN remained the most common prescription pattern, with two designated as stat and the remaining three mostly stat but occasionally incorporating PRN. Intramuscular administration continued to be the most common route in both cycles.

• • In the current cycle, the maximum frequency was indicated in 55.5% of cases, whereas it was not indicated in the previous cycle.

• • In the current cycle, indications were documented for 88.8% of prescriptions, a significant increase from 50% in the previous cycle. Furthermore, there was almost 100% compliance in nursing/medical documentation of RT administration in patient notes, which was lacking in the previous audit.

• • Psych liaison or dementia team involvement was observed in around 33% of cases in the current cycle, whereas it was not evident in the previous cycle.

• • Post-sedation monitoring in line with policy was not evident in either cycle.

Overall, both audits highlighted consistent challenges in prescription practices and post-administration monitoring, albeit with variations in compliance levels and team involvement. Since the completion of this re-audit, a new RT policy has been approved which has much clearer guidance for the general hospital. This RT policy will be launched with a programme of teaching and training for the hospital. We aim to track progress by conducting a re-audit within 6–12 months.

This pilot program aimed to enhance the psychiatry experience for foundation doctors (FYs) working at Ayr Hospital by identifying perceived areas where psychiatric support would benefit training, development or education. Subsequently strategies were aimed to be implemented by the psychiatry liaison service to enrich FYs' experience during their medical and surgical rotations. Feedback was aimed to be obtained to determine if the program would have value to other district hospitals and grades of junior doctors.

Unstructured interviews with 4 FYs were conducted in October 2023 to explore the current experience of psychiatry in medical or surgical placements at Ayr Hospital. Identified themes included barriers to completing supervised learning events (SLEs) for mental health cases (a requirement of the 2021 Foundation Curriculum), limited exposure to psychiatry teaching opportunities, and obstacles to pursuing development of interest in psychiatry (such as time to shadow psychiatry, or discuss career prospects in psychiatry).

A pilot program was initiated in November 2023 to improve the experience and education of psychiatry for FYs. This involved:

• • Providing dedicated time on wards for FYs to complete SLEs with a member of the liaison service.

• • Providing time for FYs to shadow the role of liaison psychiatry.

• • Providing additional teaching tutorials, focused on topics chosen by FYs.

• • Providing the opportunity to discuss and develop interest in psychiatry.

A survey to obtain both quantitative and qualitative feedback was sent to each FY that engaged in the program.

17 FYs engaged in the pilot program, with 13 providing feedback. All respondents felt the program increased their knowledge and confidence in approaching cases with a psychiatry element. They also all found the experience positive and a productive use of time. All deemed the program would be useful for other foundation trainees in medical hospitals. Free text feedback highlighted the program's value in facilitating case discussions, removing obstacles in completing mental health SLEs, providing useful relevant tutorials and providing opportunity to discuss further interest of psychiatry.

The pilot program successfully achieved its aim to improve FYs' experience of psychiatry. Although not measured in the survey, the program also appeared to foster positive relationships between the liaison service and junior medical staff. It also helped identify new appropriate referrals for the liaison service. An expansion of the program is planned to other district hospitals in Ayrshire and Arran, including consideration of expanding the participation to wider members of the junior doctor cohort.

According to The Medicines and Healthcare products Regulatory Agency (MHRA) Drug safety update in August 2020 regarding clozapine, monitoring blood clozapine levels for toxicity is now advised in certain clinical situations such as when a patient stops smoking or changes to e-cigarette.

Aim of this audit was to determine whether blood clozapine levels are being performed in patients on clozapine when there has been a change in patient’s smoking status from two localities, East and West Hull community mental health team.

Because there is a risk of significant blood clozapine change within 3–5 days post starting or stopping smoking which consequently increases the risk of toxicity, we also looked at whether a medical review was undertaken post change in smoking status in order to review if any adjustment was required in current clozapine dose.

A list of Hull CMHT patients on clozapine was obtained from local clozapine clinic. The data comprised patients who were on clozapine from both localities of CMHT between October 2022 to October 2023.

Data was obtained retrospectively from Trust's patient electronic record system.

Eligibility criteria was set for the patient on clozapine to be a current smoker, or have been a smoker over last 12 months. Non-smokers and the ones on clozapine without a change in smoking status over the duration period were excluded.

58 patients were identified to be smokers and taking clozapine. Change in smoking status was documented in 21 instances, and therefore included in final analysis of results.

42.86% patients had a clozapine blood level check post smoking status change.

19% of patients from our sample had a medical review after change in smoking status within the duration time of audit.

We concluded that compliance with current MHRA guidelines in relation to blood clozapine levels and change in smoking status is quite poor in Hull CMHT and measures are needed for improvement.

We recommend that every patient with a change in smoking status must have blood clozapine level checked within a week of any change in smoking status and a medical review in two weeks. We identified some scope of improving current clozapine monitoring form on electronic system and recommend changes by adding a section where change in smoking status is recorded.

A recent Cochrane review published in December 2023 concluded that “no trials found that interventions to reduce anticholinergic burden led to any other improvements in cognition compared to usual care”. We describe the case of a 62-year-old lady who developed significant cognitive decline following the initiation of a low dose of procyclidine, which was rapidly reversed upon stopping the medication.

We present the case of a 62-year-old lady with a diagnosis of schizo-affective disorder, whose symptoms had been stabilized on a regime of lithium carbonate 500mg nocte, sulpiride 400mg BD and fluoxetine 20mg OD. When the patient presented to the outpatient clinic, she was noted to have bilateral coarse tremors and slight cogwheel rigidity. Procyclidine was started at a dose of 5mg OD to manage these extrapyramidal side-effects.

Following this, family members reported that the patient had difficulty initiating and following conversations. Short-term memory was affected and she was observed to have reduced attention span. These problems were reportedly getting worse with time, with a simultaneous decline in functional abilities. She was no longer able to carry out her daily shop, and family members ensured that she was no longer driving as they had concerns about her road safety. She stopped taking procyclidine after 1 month and notably, these problems ceased within one week of stopping the medication.

Cognitive testing confirmed that the patient was cognitively intact after procyclidine was stopped. The patient scored 96 on the ‘Addenbrooke's Cognitive Examination’ scale, which falls within the normal range. The ‘Instrumental Activities of Daily Living’ scale was administered to assess functioning at the time of the cognitive impairment. This returned a score of 1/8, indicating that there was significant functional impairment secondary to cognitive impairment when prescribed procyclidine. The ‘Informant Questionnaire on Cognitive Decline in the Elderly’ was administered to objectively quantify the extent of cognitive decline as noted by family. This returned a score of 4.3, confirming that the patient's cognition had indeed been worse when compared with her baseline.

Our case report highlights the rapid improvement in cognition with the removal of anticholinergic burden in a 62-year-old female. Our report can, therefore, be a harbinger for more robust trials to determine the efficacy of interventions to reduce anticholinergic burden in preserving or improving cognition.

It is important to monitor for any change in cognition when prescribing anticholinergic medication in at-risk individuals.

Non-attended appointments can lead to adverse outcomes for a service and its users, including reduced service efficiency; increased waiting times; and impaired patient care. The audit objective was to explore whether DNA rates vary between the current modalities of face-to-face; virtual; and telephone. It was hoped that this would enable the service to better understand the reasons for patients not attending initial assessments and determine whether the modality may present a barrier.

A sample was obtained including all first assessment appointments between March 2022 and March 2023 (n = 386). Data included the modality for each initial appointment. Matched to this data, was whether the patient attended each appointment, creating a frequency of DNAs for each appointment modality across the year. Data analysis was conducted using Microsoft® Excel®. Beyond frequency and percentages, a chi-square test was used to assess for a statistical difference in appointment attendance between modalities.

For this one-year sample the overall attendance rate was 77%: with 299 appointments attended, and 87 ‘DNAs’. The DNA rates across the one-year sample were face-to-face (24%); virtual (22%); and telephone (23%).

The chi-square value produced when analysing the DNA rates between modalities was 0.92 (critical value 5.99). Hence, there was no statistically significant difference in DNA rates by modality.

Despite the absence of variation in DNA rates between modalities, the findings can be viewed as reassuring. The move to include multimedia alternatives to assessments does not appear to be impacting attendance when compared with assessments that continue to occur face-to-face. Balanced against this increased geographical inclusion afforded by remote appointments, is the competing equity issue of digital exclusion, highlighting the need for face-to-face appointment provision to remain accessible across the service.

This audit did not collect demographic data that may have provided insight into whether certain factors may have impacted attendance and could have acted as confounders, for example geographical location.

Introduction of a supportive reminder letter for patients, to bridge the wait between patient's referral and their initial assessment, was an outcome recommendation that was implemented by the service.

The aim of this systematic review is to identify and describe the experiences, barriers and provision of post-diagnostic support in UK rural areas; from the perspective of people living with dementia, healthcare professionals and informal family caregivers.

People living with dementia in rural areas experience numerous barriers to accessing post-diagnostic support.

Systematic Review.

Systematic searches will be conducted in the following databases; SCOPUS, PubMed, PsychINFO and CINAHL Plus. Systematic review tool Rayyan.ai will be used to screen titles and abstracts, prior to full-text review. Following data extraction, The Critical Appraisal Skills Programme (CASP) tool will be used to appraise the quality of studies and assess risk of bias. The data will be deductively analysed through the lens of the Candidacy Framework's 6 dimensions, with a secondary inductive analysis capturing any themes that fall outside of the framework.

242 papers have been screened by first and second reviewer. 15 papers included. Papers still being analysed for full review. Will be complete by March 2024.

This systematic review will help improve understanding of the rural barriers and experiences of post-diagnostic support, and allow researchers and stakeholders to develop and optimise specially tailored dementia interventions in line with the needs of people residing in UK rural communities.

First reviewer: Danielle Bilkey, Second Reviewer: Dr Ellena Businge, Supervisor: Dr Nicolas Farina.

To audit the recording of physical health parameters for the clients of Waverley Community Mental Health Recovery Service (CMHRS).

To ensure Trust and NICE guidelines are met for monitoring of:

1. 1) Psychiatric drug prescribing.

2. 2) Psychiatric disease monitoring.

3. 3) Past medical history and biophysical parameters relevant to prescribing decisions.

A random sample of 100 patients from Waverley CMHRS was analysed. The data was collected between November 2022 and January 2023. The process involved establishing the cohort, dividing the caseload for review, and applying an audit questionnaire. The questionnaire was applied to both SystmOne Electronic Patient Records and GP Shared Care Records to assess compliance with physical health monitoring in both secondary and primary care. All data collected were compiled onto an Excel Spreadsheet. The level of compliance for monitoring of each parameter was calculated and audited against Trust and NICE guidance.

For secondary care:

1. 1. Compliance with physical health monitoring requirements is consistently low.

2. 2. Higher levels of compliance (>50%) for height, weight, Audit C (Alcohol), Smoking status.

3. 3. Lowest compliance levels observed for: blood tests, ECG request, substance misuse status, sleep, medication side effects.

4. 4. Evidence of a comprehensive physical health review was found in 1% of patients.

For primary care:

1. 1. 95% of patients from our sample consented to giving access to their Shared Care Record.

2. 2. Compliance with physical health monitoring requirements in primary care was higher.

3. 3. Compliance was particularly high (> 87%) for: height, weight and BMI, BP, evidence of alcohol monitoring, evidence of smoking monitoring.

4. 4. Smoking monitoring is the parameter with the highest level of compliance (95%).

5. 5. Parameters are monitored more regularly.

The audit identified gaps in the documentation and assessment of physical health parameters within Waverley CMHRS. Compliance with monitoring requirements was significantly lower in secondary care, highlighting the need for intervention. Conversely, primary care demonstrated higher adherence to monitoring guidelines. The results show deficiencies in physical health monitoring that need to be addressed to ensure comprehensive psychiatric care.

The project was crucial in optimizing physical health monitoring within Waverley CMHRS. Recommendations include targeted training, improved communication between primary and secondary care, and the designation of physical health coordinators. An action plan was developed with assigned responsibilities and a timeline for implementation. A re-audit will follow to assess the impact of implemented changes.

The first medical textbook in Arabic, ‘Firdaus as-Hikmah’ (The Paradise of Wisdom) by Tabari (808–861) was composed in in year 848. Tabari's classification of insanity is simple and in term of psychosis, he talks about syndromes of ‘Hearing voices in the head’ (hallucinatory psychosis), ‘humm-al-hubbi’ (love fever) and ‘humm-al-sehr’ (fever from enchantment). The first classification of ‘junun’ (psychosis) comes from Râzī (854–925), who in his ‘Al-Hāwī fil Tib’ (The System of Medicine) divides ‘insanity’ (psychosis) into ‘al-junun al-thābet’ or ‘permanent madness’, and ‘a'rāz tābea-tu leamrāz’ or ‘symptomatic psychotic disorders'. The first medical textbook in Persian language, ‘Dāneshnāma’ (Medical Encyclopaedia) by Hakim Maysarī, completed in 978–9 mentions only melancholia and ‘rejā’ (pseudocyesis/pseudopregnancy) and no other psychotic conditions. Prospective generations of Arabic-inscribing physicians, including Majūsī, also known as Haly Abbas (949–990), Avicenna (980–1037), and Persian-inscribing physicians such as Bokhârī̄ (? −983) and Jorjânī̄ (1040–1137) are strongly influenced by Râzī̄ and use similar taxonomy of psychotic disorders. Moreover, the taxonomy introduced by Râzī̄ and other mediaeval physicians has been used in Arabic and Persian speaking medical communities until the past century. Nevertheless, these were substituted by Latin-based language vocabulary reflecting the International Classification of Diseases (ICD).

The aim of this work is to review the input of Arabic and Persian schools in the development of psychiatric knowledge and classification.

Literature search of ‘Firdaus-al-Hikmah’ of Tabari, ‘Kitāb al-Hāwī fī al-ṭibb’ of Râzī̄, ‘Kitābu'l Malikī’ (The Royal Book) by Majūsī, ‘Al-Qānūn fī al-Ṭibb’ (Canon of Medicine) of Avicenna in Arabic; and ‘Hidâyat al-Mutaʽallemin fi al-Ṭibb’ (A Guide for Medical Students) of Al-Akhwayani Bokhârī and 'Zakhīra-i Khwârazmshâhī' (The Treasure of Kwārazmshāh) and Al- ‘Aghrād'ul tibiyah wa'al-mabāhith'ul Ala'iyah’ (The Aims of Medicin) of Jorjânī in Farsi.

1. ‘Transient‘ or symptomatic psychotic disorders, resulting from direct or indirect brain damage:

1. 1.1. ‘Ekhtelāt-ul-takhayyol’ (disorder of perception), ‘when patients imagine perceptible things, such as seeing people, hearing sounds, or sensing smells that have no external reality’.

2. 1.2. 'Ekhtelāt-al-fekr’ (thought disorder), when the perception is intact and patients perceive the outside reality as it is, however, their thinking is impaired.

3. 1.3. ‘Ekhtelāt-al-aqhl’ ('corruption of the mind’), or ‘junun (madness), defined as a condition when patients say things they should not say, like things they should not like, wish unreasonable things, demand what is not demanded, do things they should not do, or hate things that they normally do not hate.

4. 1.4. 'Sobārā', portrayed as a form of agitated madness resulting from ‘sarsām’ (meningitis/encephalitis).

2. 'Permanent’ psychotic disorders also considered as primary ‘brain’ diseases:

1. 2.1. Mania, described as the worst kind of insanity, presenting symptoms of paranoia, constant anxiety, agitation, hyperactivity, vindictiveness, insomnia, hostility, and ferocity.

2. 2.2. ‘Dâ-al-kalb' (‘dog's disease'), portrayed as a mixed psychosis with a fluctuating picture of anger and playfulness, as well as hostility mixed with gentleness.

3. 2.3. 'Qutrub', outlined as a psychosis when affected individuals dislike people's company and run away from society, rarely resting, and aimlessly moving as if they were in fear of running from someone. Patients become forgetful, and their behaviours disorganised.

The Arabo-Persian classification of mental disorder was progressive and generated a common nomenclature in the Arabo-Persian speaking medical communities, serving the mutual understanding of experts. Moreover, the taxonomy developed was relatively precise and stable, corresponding to modern classification systems. Psychoses were categorised into ‘transient’ and ‘permanent’ disorders, which were considered as a primary ‘brain disease’ of multifactorial aetiology, a concept introduced by Griesinger in the 19th century, known as the ‘organic model’ of mental illnesses.

Child and Adolescent Mental Health Services (CAMHS) is a highly specialised service to which children with severe mental health problems are referred. The COVID-19 pandemic brought with it a lot of uncertainty, and healthcare systems across the UK struggled to cope with the added pressure. The aim of this systematic review is to analyse the literature exploring the effects of the COVID-19 pandemic on the severity of mental health conditions and referral rates to CAMHS services in the UK. The findings from this study will help the services understand the impact of the pandemic on referral rates to CAMHS, the severity of various mental health conditions, and how the services are managing.

An extensive search, following PRISMA guidelines, was undertaken across multiple electronic databases using a predetermined search strategy. Studies reporting on mental health conditions in children post-pandemic and on referral rates to CAMHS in the UK were included. Subsequently, data extraction, quality appraisal and qualitative analysis were performed in a descriptive style.

Initially, referrals to CAMHS decreased during the first lockdown, followed by a significant increase in referrals throughout the pandemic period. The referral rate to CAMHS remains steady until adolescence, with a rapid increase in referrals to the services during the teenage years. More adolescent girls were referred to CAMHS compared with boys and are at an increased risk of developing mental health conditions. A higher number of children and young persons presented with urgent referrals and heightened symptoms during the pandemic compared with the pre-pandemic levels. In particular, there was a significant increase in children presenting with eating disorder problems, accompanied by an increased severity of symptoms. Furthermore, there was an observed rise in depression and anxiety among children and young people, along with an increase in the use of antidepressant medication.

Referrals to CAMHS increased during the pandemic, with increased severity of symptoms observed, particularly in children and young people with eating disorders and neurodevelopmental conditions. Future research should explore the enduring impact of the pandemic on referral rates and presentations to CAMHS. This exploration is essential to aid senior managers and policymakers in decision-making, enabling the implementation of appropriate measures to manage the pattern of demands on CAMHS and shape the future service delivery of CAMHS in the UK.

We sought to review the evidence available to answer the question: Which psychological therapies are effective in the treatment of depression in older adults in an inpatient setting?

An advanced literature search and systematic review was conducted using Web of Science and PubMed. A set of keywords were identified around depression, older age and the inpatient setting. These were combined with a wide range of keywords around psychological therapies.

Non-English language articles were translated using Google translate.

Articles were reviewed for the relevance to the study question by reviewing the title and abstract. Full text articles were retrieved for those felt to be relevant to the study question.

Of 709 articles identified from both databases, 20 articles were retrieved for full text review. Five studies were identified that appeared to offer insight into the study question. These papers focused on interpersonal therapy, cognitive behavioural therapy, or behavioural group therapy.

Brand and Clingempeel (1992) investigated the incremental implementation of group behavioural therapy in a randomized control trial. The study did not show statistically significant differences between treatment groups, but clinical significance differences supported this intervention's efficacy.

A case study by Soller (1997) followed the journey of a 69-year-old man through inpatient CBT sessions over three and a half months. This was followed with outpatient follow up. There was improvement but this was primarily subjective reporting.

A randomized controlled trial by Snarski et al. (2011) looked at the efficacy of behavioural therapy. The authors' overall conclusion was that patients benefit from this intervention and that further investigations should be done to strengthen their findings further.

A pilot study by Cabanel et al. (2017) focused on determining the feasibility of a multi-professional adaptation of group behavioural therapy sessions. This paper provides a signal towards the effectiveness of multi-professional approach to treatment.

Bollmann et al. (2020) focused on the implementation of interpersonal skills groups. It showed good feasibility as well as good patient adherence. Self-reported and observer-reported depression ratings saw improvement throughout the study.

Although the studies showed a signal towards improvement for a range of therapies, the evidence from these studies is not convincing.

There is a lack of high quality research in this area. More studies are needed to determine the most appropriate psychological therapy to use and how this might be adapted to the transient nature of the inpatient setting.

An evaluation of the service and care provided to eating disordered patients referred to Tier 3 CAMHS within NHS Lanarkshire. Eating disorders are recognised as a relatively common disease with preventable mortality. The primary aim was to determine if patients with eating disorders adhere to the assessment and management as outlined in MEED and SIGN 164. The secondary aim was to scope the number of eating disordered cases to plan recruitment and training of specialist staff.

The pilot study was carried out in November 2022 and repeated in January 2024. The Electronic Patient Record and paper notes of eating disordered cases assessed in 2023 were used to audit against MEED and SIGN 164. Additional patient demographics including patient's age, sex, median BMI at initial appointment, working diagnosis and suspected co-morbidity were also collected. The service was further evaluated on its processes from source of referral, time taken to be seen, therapies offered and duration within service.

A total of 46 cases were identified in the audit compared to 57 in the pilot study. Most of the cases seen in 2023 were girls in their early teens (89% between the ages 13–16). 10% have a median % BMI <80%. 15 were given a diagnosis of AN (33%), 4 with BN (9%), 4 with ARFID (9%), 2 with OSFED (4%) and 19 with no formal diagnosis (42%). There was a high level of suspected comorbidity (80%).

Referrals were mostly made by GPs (87%), followed by school (11%) and other professionals (2%). The average time taken for the initial assessment was 63 days (40% were seen within 4 weeks). 14 (30%) of cases were offered FBT only whereas 3 (7%) had CBT-E. 7 (15%) did not receive any intervention and 19 (41%) were given other therapies.

With respect to the MEED risk markers, there had been improved recording of weight changes (40% to 80%), hydration status (40% to 70%), temperature (5% to 30%), bloods, over exercising (85% to 90%), purging (75% to 85%) and self-harm behaviours (85% to 90%). However there had been reduction in the recording of BP/HR (80% to 50%), ECG (75% to 40%) and engagement with services (75% to 60%).

Overall, there's some improvement in assessment and management of ED cases but the standard remains inadequate. This project has helped understand the gaps in services and provisions available. Ongoing evaluation is required to help steer service development and optimise patient care.

Induction training is a crucial part of starting work in a new organization as it orientates new staff to their work role and environment, which ensures that they can work safely and competently. Given the wide geographical area of North Wales, there is logistic difficulty to continue with face-to-face induction sessions for new junior doctors. A digital format for regional induction for new doctors from all sites was introduced in 2021. This virtual induction has dealt with the accessibility problem effectively. Nevertheless, there seemed to be some ongoing issues regarding organising the session with speakers due to overlapping clinical duties. Therefore, a quality improvement project has been initiated to improve the delivery of the sessions with minimal disruption to clinical duties. This paper is aimed to share the preliminary experience of the process of digitalisation of the induction programme.

The pilot regional induction with the above changes was carried out on August 4, 2023 via Microsoft Team Meetings and was accessible to new starters from all three sites in North Wales. The sessions consisted of talks from consultants, the lead clinical pharmacist, the ST in psychiatry and clinical services/Rota coordinator. The induction was divided into morning and afternoon sessions. The participants consisted CTs in psychiatry, GPSTs, and FY trainees. The session was recorded and a pre-recorded session on history taking was introduced. Any queries about pre-recorded session were answered by the chair of session.

It was found that an estimated time saved per induction was 285 minutes with an overall saving for 3 inductions per year of 14.25 hours. The estimated cost saved (based on the lowest pay scale in NHS, £) was £151.13 with an overall saving for 3 inductions per year of £453.39. There were two Assessments of Teaching (AoT) and two Direct Observations of Non-Clinical Skills (DONCS) signed.

Digitalising the regional induction helps to save both time and cost for the health board. It also reduces the risk of speakers in availability. Furthermore, the recording can be sent out early to all the JDs before they join MHLD, which can facilitate a quicker orientation into the new role. It is also a good opportunity for core and specialty trainees to achieve competencies for leadership and teaching.

Flow is a transcranial direct current stimulation (tDCS) treatment for depression without major side effects that patients use at home. Over 30 years of research/clinical use show tDCS is safe (Razza et al., 2020). Flow is CE-marked for treating depression in Europe. Recent NICE briefing published (NICE, 2023). The patient self-administers and remains awake (NICE, 2015), treatment sessions last for about 30 minutes, and are repeated 5 times weekly for three weeks (Flow, 2023). After the initial three-week period, patients self-administer 3 sessions per week for 3 weeks, and then as long as required (Flow, 2023). Meta-analyses of randomised sham-controlled trials (RCT) show tDCS is associated with significant improvements in depressive symptoms and high rates of clinical response and remission relative to placebo sham stimulation (Mutz et al., 2018, 2019; Moffa et al., 2020; Razza et al., 2020). Flow RCT study depression remission rates are 45% (Fu et al., In Press). Flow incorporates an evidence backed healthy lifestyle behaviour training software app, and depression symptom tracking that enables users to monitor their progress/symptoms. Training modules on: ‘Behaviour activation’, ‘Mindfulness’, ‘Exercise for your brain’, ‘An anti-depression diet’, and ‘Therapeutic sleep’. Flow also provides an integrated platform for clinicians to monitor use and depression symptoms.

In a first for the NHS, in a post-marketing informed consent study, NHFT's community mental health team (CMHT) offered Flow to their patients with a diagnosis of depression and evaluated the feasibility and impact.

Outcome measure data collection from baseline to 6 week follow-up point. Self-report measures used were depression: Personal Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS); health related quality of life: EQ-5D-5L; and functioning: Work and Social Adjustment Scale (WSAS). In-depth interviews were undertaken with 14 patients.

There has been high level of adherence (70%) to treatment protocol. There has been statistically significant and ‘reliable improvement’ in depression symptoms. There was statistically significant improvements in real world meaningful functioning and quality of life. Most participants described a positive impact on depressive symptoms, sleep, and functioning.

Flow has been successfully integrated into CMHT treatment offer. It is important to offer CMHT patients an evidence-backed alternative to existing depression treatments (antiddepressant medication and talking therapies). Findings provide support for the approach of delivering together both tDCS and evidence-backed wellbeing behaviour therapy training to patients of CMHTs with experience of depression.

In the densely populated Korail slum of Bangladesh, there is a critical gap in mental health care provision and utilization that was revealed in our ethnographic study. We observed the pivotal role of Community Health Workers (CHWs), Medicine Sellers, and Traditional and Faith-Based Healers (TFHs) in the existing health care service delivery. Moreover, we explored the opportunity to collaborate with them to ensure universal access to biomedical care for serious mental disorders in this slum. As a part of this collaborative approach, we aimed to train these 4 key stakeholders through co-designed training programs that were codeveloped through extensive community engagement including 5 co-designing workshops and 2 writing workshops with them. Furthermore, we refined the initial training program by an expert committee and stakeholders. This training program was piloted to find out the acceptability, feasibility, impact, challenges and areas of improvement.

We followed mixed-methods approach to evaluate the 3-day pilot training with 20 participants at Mirpur, Dhaka. In quantitative part of evaluation we used a) pre and post test assessment that has been carefully designed to assess knowledge, skills, communication, attitudes and motivation, b) session specific questionnaire to find out feedback of the content, activities and time sensitivity of the session, anonymous feedback forms.

In the qualitative part, we conducted a) focus group discussions (FGDs) after completion of training with each group, b) observational notes from each session for deeper understanding.

The pilot training engaged a diverse group of 20 participants and their age ranged from 24 to 52 years, representing 11 different organizations. Though most of the participants were working in the health sector for a long time, we found more than 10% of the participants believed there was no effective biomedical care for the serious mental disorder during pretesting. However, their perception changed during the training. The role playing and case scenario was the most engaging and enjoyable part. We found the participants considered their knowledge regarding the mental health increased up to 80% from their baseline. Our research team also found the increased number of referrals to the biomedical care from the community after the pilot training.

The increased motivation and sense of responsibility reported by participants underscore the training program's effectiveness and the experience and learning from this pilot helped us to further refinements of the training program for the traditional and faith based healer, community health workers and medicine to transform the mental health scenario in Bangladesh.

Neuropsychiatry is a new and burgeoning field of medicine that combines neuroscientific principles with neurology and psychiatric medicine. Currently, there is little to none medical school literature and/or teaching in the subject. Re-integration of Neurology and Psychiatry disciplines has been recommended, especially in undergraduate and graduate medical training as well as in research. Neuropsychiatry disorders are considered one of the most important causes of disability by the World Health Organization. As a concept, Neuropsychiatry is still not clear on a global scale, from neurological examination to medical school teaching. There have already been active efforts to design and implement Neuropsychiatry training to post-graduate trainees worldwide, particularly in USA, Australia and UK. However, there seems to be no such endeavours towards teaching medical students the role of the brain in the manifestation of neurological as well as psychiatry symptoms. We set out to complete a targeted literature review looking for Neuropsychiatry teaching, if any, in medical schools worldwide.

A systematic literature search of relevant key phrases was carried out in PubMed and Google Scholar databases. These phrases were searched between 29–31 January 2024 aimed to encompass the full scope of available teaching resources and materials across psychiatry and neurosciences worldwide. These searches included:

1. (((Neuropsychiatry) AND (Medical students)) AND (Medical school)) AND (Medical education)

2. (((Neuropsychiatry education) AND (training)) AND (medical students)) AND (Medical education)

3. (Neuroscience-in-psychiatry) AND (medical school)

4. ((Neuropsychiatry) AND (Medical education)) AND (Medical students)

5. Further reading was completed from the selected articles (six in total).

A total of 324 results were found from systematic literature search after leaving out the duplicates, of which only 6 articles were included as relevant to aim of our study. None of the articles described clear Neuropsychiatry teaching to the medical students.

Our review highlighted a distinct lack of Neuropsychiatry learning outcomes within medical school curriculum. Neuroscientific principles and methodologies are incorporated in treatment of patients, rationalising clear differentiation between neurology or psychiatry, but the overall picture from both disciplines and utilisation towards diagnosing and managing the cluster of symptoms manifesting from aberrant brain processes is still unclear. In line with previous research around education measurement, we propose that fundamentals from both Neurology and Psychiatry need to be introduced as clinical neuroscience early in medical school and this can be further continued.

Neurodivergent women have different experiences during pregnancy, childbirth, and parenthood than neurotypical women. However, little is known about the perinatal mental health outcomes and parenting experiences in women with Neurodevelopmental Disorders (ND). The systematic review aimed to summarise the literature on perinatal mental health outcomes and parenting experiences among women with ND.

MEDLINE, Embase and PsycINFO databases were searched in October 2023 using the keywords related to pregnancy outcomes, perinatal period, mental health, neurodivergent, and neurodevelopmental disorders. Papers were also identified through citation and/or hand searching. Title, abstracts, and full-text articles were independently screened by two authors, and data were extracted using a custom data extraction spreadsheet. The Joanna Briggs Institute and the Mixed Methods appraisal tools were used for the critical appraisal. The heterogeneity across the included studies ruled out the use of meta-analysis. Therefore, results were summarised using a narrative synthesis.

Fourteen studies were included in the final review; four cohort, four case-control, three cross-sectional and three qualitative studies across 940,354 participants. The studies investigated women with Autism, Asperger's syndrome and Attention-Deficit Hyperactivity Disorder (ADHD), who were either clinically diagnosed or scored appropriately on diagnostic questionnaires. Perinatal mental health outcomes covered anxiety and depression. These were measured using questionnaires such as the Edinburgh Postnatal Depression Scale, participant interviews and clinical diagnosis from qualified healthcare professionals. All fourteen studies found a correlation between Neurodevelopmental Disorders and perinatal anxiety and/or depression symptoms. Seven studies found that neurodivergent women had adverse pregnancy and early parenting experiences. Results suggested this correlation may be mediated by factors such as unsatisfactory healthcare, lack of maternal-infant bond, increased sensory overload, issues with emotional attachment, difficulty reading the facial expression of the baby and problems with breastfeeding. Overall, women with ND were more likely to feel anxious and overwhelmed during the perinatal period, a potential risk factor for perinatal mental illness.

Women with ND are at a higher risk of developing perinatal mental illness and adverse early parenting experiences. Abnormal physical and sensory challenges during pregnancy as well as difficulty with emotional connection and infant bonding during postpartum all contribute to the increased risk of perinatal mental illness. Adaptations to appointments and specialised perinatal care are required for women with ND yet are often not provided. To reduce the risk of perinatal mental illness in women with ND, improvements must be made to the delivery of perinatal care and the knowledge of those providing the care.