Suicide and substance use all contribute significantly to the global burden of mortality and morbidity. While existing evidence establishes the association between substance use and suicidal behaviour in Lower- and Middle-Income Countries (LMICs), only a few studies illustrate how substance use affected deceased people's lifestyles and suicide attempts. The study addresses this gap by exploring the role of substance use (particularly, alcohol and drug use) in overall lifestyles and suicides of deceased with substance use in Pakistan – an underexplored and under-researched country regarding suicide and substance use.

We conducted in-depth qualitative interviews (N = 11) with close relatives and friends of those who died by suicide and have a history of substance use. The topic guide was comprised of a narrative part exploring the circumstances that surrounded the suicidal death of the deceased and a problem-focused part collecting comprehensive details about the deceased's personal, family, psychological, and social context and the role of substance use in the lifestyles and the suicide of the deceased.

The content analysis of interviews revealed five key themes: 1) Reasons for suicide, 2) Personality traits, 3) Psychological distress, 4) Initiation of substance use, and 5) Suicidal tendencies. Most of the participants reported the reason for their loved one's suicide was either an overdose of drugs or alcohol, family dynamics, or societal attitudes such as difficulty in building trust and finding acceptance within the family or society. Deceased individuals were perceived as impulsive with low control over their emotional states. Participants highlighted the underlying psychological distress in the deceased, emphasising the complexity of mental health and substance use problems. Participants reported that the deceased initiated drugs at an early age; had suicidal ideations; and overdosed themselves as a means of suicide.

This study provides valuable insights into the role of substance use in suicide. The findings highlight the need for a holistic approach to understanding the multifaceted factors that may influence suicidal behaviours in individuals with substance use. Understanding these factors can help develop targeted suicide prevention and intervention strategies, particularly in low-resource settings such as Pakistan.

We aimed to review various health outcomes for patients admitted to an older adult psychiatry ward specialising in functional illness, over a one year period.

In 2020 the Mental Welfare Commission for Scotland highlighted a concern about the lack of evidence and data surrounding admission to older people’s functional mental health wards. We aimed to review this for North Lanarkshire and provide a comprehensive overview of our in-patient population that will aid in service review and improve care.

We reviewed the electronic notes of all patients (total: 99) admitted to the ward over a one year period. Extracted data included demographics, medications, mental health act status, discharge destination and readmissions.

We found the average age was 73 years old and the median length of stay was 33 days (mean 63). Patients were admitted with a wide range of diagnosis including (most common to least): mood disorders, psychotic disorders, dementia, substance misuse and ARBD, delirium and personality disorders. 30% of patients required detention under the mental health act during their admission, but this fell to only 7% on discharge. 51% of patients were discharged on an antipsychotic. The majority of patients were discharged home; within a year 34% were readmitted to psychiatry and 40% required a medical admission.

We found that our demographic information was broadly consistent with the mental welfare commission's findings. However there is a significant variation in length of stay shown by the difference in the mean and median, due to a small number of significantly longer admissions. Notably there were numerous admissions with a dementia as a primary diagnosis, on a functional ward. In this age group it was significant that a high proportion of patients were prescribed antipsychotics. Further work is required to better understand these findings.

The Acute Mental Health Inpatient Centre is an 80 bed acute psychiatric inpatient unit in Belfast. The inpatient unit is frequently over capacity resulting in the use of contingency beds or delays in accessing acute inpatient care. Readmissions to hospital after discharge remain a challenge for the service. A service evaluation project was designed to quantify the number of patients being readmitted and determine demographic and diagnostic variables associated with risk of readmission.

1084 sequential discharges were examined between Jan 2022 and Feb 2023. Age, gender and length of stay (LOS) were determined.

For each case it was determined whether or not the case was a readmission, defined as having been discharged within the previous three months.

Diagnosis was available on 1017 (94%) cases and was categorized as schizophrenia/non-affective psychosis, bipolar affective disorder, non-psychotic mental illness, personality disorder, adjustment disorder, substance misuse disorder and dementia/cognitive impairment.

Social deprivation status was determined for each case based on the address of admission and using social deprivation data from the Northern Ireland census, 2017.

Outcome of discharge was readmission at one week, one month and three months.

For the entire cohort, readmission rates at one week, one month and three months were 5.1%, 13.6% and 20.7% respectively.

Risk of readmission was significantly increased in cases with a diagnosis of personality disorder, a LOS under two weeks and female gender.

Individuals who had been readmitted to hospital within three months of the index admission were significantly more likely to be readmitted in the subsequent three months.

Data on social deprivation is currently undergoing analysis and will be available in due course.

Logistic regression was performed to determine how the variables impacted on risk of readmission at 3 months. In the final model, diagnosis of personality disorder (OR 3.1; 95% CI 2.0, 4.7; p < 0.001), diagnosis of schizophrenia (OR 1.8; 95% CI 1.1, 2.7; p < 0.01), the admission being a readmission (OR 3.4; 95% CI 2.4, 5.0; p < 0.001), a LOS less than 2 weeks (OR 1.9; 95% CI 1.3, 2.7; p < 0.001) and female gender (OR 1.7; 95% CI 1.2, 2.4; p < 0.01) all predicted readmission within three months.

The service evaluation project has allowed individuals at a higher risk of readmission to be identified. This study has informed local strategies now being implemented to target community care and provide timely interventions to those groups at highest risk of readmission.

Self-harm is the preventable cause of premature death by suicide. In adolescents suicide is the fourth leading cause of death and Pakistan is one of the youngest nations in the world. Culturally relevant solutions for the prevention of self-harm among adolescent are almost non-existent in LMICs. The aim of this trial is to assess the clinical and cost-effectiveness of a culturally adapted manual assisted problem-solving intervention for youth (YCMAP) with history of self-harm (within 3 months) to reduce self-harm repetition over the period of 12 months.

This was a rater-blind, multicenter randomised controlled trial, with a nested qualitative component to explore perceived usefulness of the intervention from the perspective of different stakeholders. Primary care centers, emergency departments, medical units from participating healthcare facilities in Karachi, Hyderabad, Lahore, Rawalpindi and Multan, Pakistan served as recruitment sites in addition to self-referrals. Patients with a recent history of self-harm (n = 684) were assessed and randomised (1:1) into either of the two trial arms; YCMAP with enhanced treatment as usual (E-TAU) or E-TAU. The YCMAP is a manualized, psychological intervention based on problem-solving therapy, principles of cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), psychoeducation, and a comprehensive assessment of the self-harm attempt using stories of four young people, comprising 8–10 one-to-one sessions delivered over three months by trained therapists. Primary outcome was the reduction in the self-harm repetition at 12-month post-randomisation and secondary outcomes were distress, suicidal ideation, hopelessness, health-related quality of life (QoL), and level of satisfaction with service received, assessed at baseline, 3-, 6-, 9-, and 12-month post-randomisation.

We screened 1099 young people for eligibility and 684 eligible, consented patients were randomly assigned to the YCMAP plus E-TAU arm (n = 342) and E-TAU arm (N = 342). Improvement in repetition rates of self-harm, hopelessness, suicidal ideation and psychological distress were clinically significant in YCMAP arm as compared with E-TAU. Thematic analysis of interviews with adolescents who participated in the intervention arm (N = 20) highlighted the intervention as useful in improving their mental health and well-being, and easy to understand.

Adolescents are an important target population for the prevention of suicide and other mental health problems. Implementation strategies are needed such as digitalization of culturally adapted manual assisted psychological interventions or task shifting approach for scalable suicide prevention interventions in low resource settings like Pakistan to meet mental health needs.

To understand the challenges and barriers experienced by health-care professionals (HCPs) in providing acute cardiac care to patients with severe mental illness (SMI) (schizophrenia, bipolar disorder or severe depression) admitted to hospital following a myocardial infarction (MI).

Semi-structured 1:1 videocall interviews with 12 HCPs in two central-Scotland Health Boards involved in delivering pre-/hospital acute care for a MI (paramedics, cardiology/A&E nurses, cardiology/A&E doctors). Interviewee recruitment was via clinical and research networks and newsletters e.g. the Scottish Ambulance Service, the Royal College of Nursing and Royal College of Physicians and through professional connections. Interviews were audio-recorded, transcribed verbatim and analysed thematically drawing on Braun & Clarke and using NVivo software.

HCPs identified a number of challenges/barriers to providing optimal post-MI acute cardiac care to patients with a SMI across 3 key themes: patient-related; practitioner-related and system/environment-related. Core patient-related challenges/barriers included: diminished patient history capacities especially relating to chronology; the time-consuming nature of effective HCP-patient communication and engagement; medication and intervention concordance concerns and challenging patient behaviour including physical and verbal aggression or severe distress.

Practitioner-related challenges/barriers were: fears of appropriately managing patient behaviour; stigma towards patients with a SMI (putatively arising from knowledge deficits or generational/age-related effects); staff burnout due to length of service and pressures from extreme workloads.

Systemic issues included insufficient staffing precluding the additional time required for effective communication and the distressing nature of hospital environments for patients with a SMI. Side rooms were not routinely available even though these were identified as improving the environment for some patients. A core systemic finding, cited by all interviewees, was the lack of adequate training provision on caring for patients with a SMI. Additional system-level findings were degrees of challenges accessing input from the hospital psychiatric team especially outwith standard hours and problems obtaining rarer psychiatric medications potentially impacting patients’ mental health stability.

Positive findings included that HCPs are generally enthusiastic about providing high quality care to this patient group and to seek help with this. Some HCPs indicated that caring for mentally stable patients with a SMI does not differ from the general population.

Although HCPs aspired to providing optimal acute cardiac care for this patient group, patient-level, professional and systemic barriers often make this challenging. A key area for improvement is enhancing staff training in caring for patients with SMI, ideally delivered in-person.

To review the practice of management of clozapine plasma levels in Solihull CMHTs between April and September 2023. Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) clozapine guidelines were issued in January 2023 and further ratified in December 2023. The standard set out in the January 2023 guideline was that service users with elevated clozapine levels >600mcg/L should be assessed for signs of toxicity and consideration given to a dose reduction. Those with levels above 1000mcg/L should be reviewed urgently.

Clozapine blood clinic diaries were reviewed in order to obtain a list of 48 service users who had attended for clozapine blood tests between April and September 2023. Blood results were reviewed for clozapine level results. For those service users whose clozapine level had been over 600mcg/L, clinical notes were reviewed to determine whether they had been screened for clozapine toxicity.

Of the 48 service users prescribed clozapine, 24 had clozapine levels over 600mcg/L and 11 had levels over 1000mcg/L. Of the service users with clozapine levels over 600mcg/L, 16 (67%) were screened for toxicity. Of those with clozapine levels over 1000mcg/L, 9 (82%) were screened for toxicity.

Between April and September 2023, Solihull CMHTs demonstrated an understanding of the need for actioning elevated plasma levels as a priority, however, this could be further improved. The risks of adverse effects and toxicity with clozapine increase with raised plasma levels, particularly with levels over 1000mcg/L. Therefore, it is important that raised plasma levels are actioned accordingly. Locally, we have implemented a flow chart which summarises the updated clozapine guidelines, to assist clinicians in interpreting and acting on high clozapine levels and to prompt clinicians to review service users for signs of toxicity. We hope to incorporate this visual aid into the updated BSMHFT guidelines.

This quality improvement project was conducted in an Early Intervention in Psychosis CMHT (Community Mental Health Team). We aimed to compare prescribing practices to the RCPsych gold standard for treatment of first episode psychosis. Following an initial audit, intervention was completed aiming to improve adherence to these guidelines and thereby the proportion of patients achieving remission.

An initial audit of the whole CMHT caseload (with exclusions for patients currently admitted to hospital, under the care of a home treatment team or awaiting assessment) was conducted in June 2021. This was completed from information contained in the electronic patient care record. This recorded for each patient details of whether an antipsychotic was recommended, if one was being taken, the dose, if remission was achieved and the number of previously trialled medications. Following this initial audit interventions were completed through designing a one-page flowchart to empower members of the wider multi-disciplinary team (in particular care coordinators) around prompting appropriate medication changes, with an accompanying education session. Following these interventions, a re-audit was completed in March 2023 and the two samples compared through descriptive statistics. In the first audit 269 patients were included (27 exclusions), and in the second 255 (49 exclusions).

The initial pre-intervention audit found that of patients taking medications, 33% (N = 172) hadn't achieved remission. In the follow up audit the proportion of patients taking medication without having achieved remission remained similar at 37% (N = 147). However, the proportion in this group receiving treatment on doses below the licenced maximum improved from 85% (N = 68) to 76% (N = 55). Those on treatment but not in remission who had sufficiently trialled 2 or more antipsychotics (and therefore would meet the criteria for treatment resistance) increased from 50% (N = 52) to 56% (N = 55). The proportion of this treatment-resistant group receiving clozapine remained low, but increased from 3.8% (N = 26) to 9.7% (N = 31).

This project demonstrated modest improvements in prescribing practice, with a small increase in symptomatic patients receiving gold-standard treatment both in terms of numbers of medication trialled and reaching maximum doses. However there remains a significant gap, with a large proportion of symptomatic cases still showing room for medication optimisation. In particular clozapine remains underutilised in this cohort, with only a small minority of patients who would meet the criteria for treatment-resistant psychosis being prescribed it. This leaves room for further interventions to improve prescribing practice.

This study aimed to determine the prevalence of irritable bowel syndrome (IBS) among medical students at Khartoum University and to examine its association with generalized anxiety disorder (GAD).

This cross-sectional study was conducted between December 2020 and February 2021, using the Rome IV criteria to diagnose IBS and a 7-item generalized anxiety disorder (GAD-7) scale to assess GAD. A total of 395 self-administered questionnaires were distributed using proportional allocation based on percentages of students in each academic year and their gender. Simple random sampling was used to select participants. The analysis was done using SPSS, and a p-value of <0.05 was considered significant.

We included 325 medical students with a mean age of 21.4 ± 2.2 years, and 69.5% females and 30.5% males. The overall prevalence of IBS was 16.6%, with the most common subtype being IBS-M (35%), followed by IBS-D (31%), IBS-C (28%), and IBS-U (6%). The prevalence of GAD was 22.8%, and anxiety was detected in 54.5% of students. 7.7% of students had both IBS and GAD, and there was a statistically significant relationship between IBS and GAD (Chi-square = 20.385; p < 0.001).

The study findings aligned with previous literature underscoring the prevalence of IBS and GAD among medical students at Khartoum University. Also, sheds light on a substantial association between them. Providing psychological support and stress management programs to medical students is paramount and key to a favorable prognosis.

The burden of mental health difficulties is a global problem and preventing them from childhood is paramount. Children living in challenged and underserved settings can suffer various harmful lifelong consequences including alcohol and substance abuse, low self-esteem, health issues, poor school performance, self-harm and suicide. This study aims to assess the feasibility, acceptability and efficacy of the culturally adapted Strong Families program in improving child behaviour and family functioning in families living in a challenged setting i.e. Gilgit-Baltistan (GB), Pakistan.

This is a two-arm, multisite feasibility randomised controlled trial with 90 families (n = 45 in intervention, and n = 45 in waitlist group) including a female primary caregiver (mostly mother) and at least one of their children between the age of 8–15 years in three districts of GB. There will be three raters’ blind assessments: at baseline, week 2, and 6 weeks after Strong Families Program sessions.

Strong Families Program is a brief evidence-based prevention programme designed to improve parenting skills, child well-being and family mental health. The primary outcome measures include the feasibility of Strong Families, as determined by families' recruitment, attendance rates, and program completeness (mean number of sessions attended, attrition rates). Additionally, purposefully selected participants, including up to 5 caregivers from each study site, researchers, and facilitators delivering the intervention, will be interviewed. Descriptive statistics will be used to analyse primary and secondary outcomes. The process evaluation will be conducted in terms of program context, reach, fidelity, dose delivered and received, implementation, and recruitment.

The findings from this feasibility trial hold the potential to carry out the large multicentre trial of clinical and cost-effectiveness and scale-up across Pakistan and other similar settings to meaningfully impact child behaviour and family dynamics in culturally diverse contexts.

Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided by the CRHT in Wolverhampton.

In a retrospective, observational, explorative study design, data was collected from the electronic medical records of 100 (54 female and 46 male) consecutive patients who were treated under the general adult (age range 18–65 years) CRHT from 1st December 2022. We collected outcome variables such as symptomatic improvement, change in risk status, days of treatment under CRHT, and discharge destination.

In the sample, 76% had one psychiatric diagnosis, and co-morbidities were present in 20%, with 4% of patients having no syndromal diagnoses. The most common primary diagnosis was personality disorder (24%), followed by psychotic disorders (22%), anxiety disorders 21%, and depression (20%). Overall risk status of red changed from 87% at admission to 17%, at discharge; risk to self from 43% to 17% (p < 0.01), risk to others from 11% to 1% (p < 0.01), respectively. The mean length under care of CRHT was highest with anxiety disorder (27.7 ± 18.2 days), followed by personality disorders 23.7 ± 17.9 days. Age and number of days under CRHT were negatively correlated, suggesting younger age was linked to higher number of days (p < 0.05). Most (71%) patients showed an improvement in their mental health, 15% deteriorated and got admitted to the psychiatric hospital, 9% did not engage and 5% were considered not suitable for care under CRHT for various reasons such as having no fixed abode. Most (80%) patients were discharged back to the community following the CRHT period.

Despite the limitation of subjective clinical assessments, the results suggested that the CRHT was effective in considerable proportions of patients with symptomatic improvement and a decrease in risk level, with a small proportion being admitted to a psychiatric ward. There is a need for objective evaluation of risk and symptomatic change using validated instruments and assessing patient experiences about the services.

This service improvement project seeks to empower individuals diagnosed with Functional Neurological Disorders (FND) by delivering comprehensive information, facilitating informed choices about their care, and encouraging an active role in managing their health.

Information was gathered relating the concerns and expectations of FND patients upon receiving a diagnosis or attending the neuropsychiatric clinic at a regional neuroscience centre. The identification of a patient information leaflet as a valuable resource became apparent. Consequently, a meticulously designed leaflet was developed to educate patients about their condition, providing useful tips and resources. The content of the leaflets underwent a thorough series of reviews, incorporating input from various professionals within the multidisciplinary team, with additional consideration given to feedback from service users. To assess the impact of this intervention, feedback is required from both clinicians and end-users.

The patient information leaflet contains information designed to enlighten patients about their condition, incorporating psychoeducational content on self-help strategies and available treatment modalities. It also highlights support resources available to them. The leaflet can be conveniently stored in the neurology and neuropsychiatric clinic areas for easy clinician access and distribution to relevant patients. Additionally, it is available in PDF format, enabling clinicians to print it in satellite clinics, and medical secretaries can email it to patients along with clinic letters as directed by the clinicians. Initial feedback from patients and clinicians has been overwhelmingly positive, with many considering it an essential intervention.

This service improvement, realized through a relatively modest intervention, can lead to a substantial impact on patient care and satisfaction. Providing patients with pertinent information is crucial for fostering informed decision-making and empowering them to take an active role in their care. Especially for conditions historically stigmatized and misunderstood, it is imperative to disseminate up-to-date information, establishing a reliable and endorsed source to dispel stigma for both patients and their families.

To describe neutropenic fever management practices among healthcare institutions.

Survey.

Members of the Society for Healthcare Epidemiology of America Research Network (SRN) representing healthcare institutions within the United States.

An electronic survey was distributed to SRN representatives, with questions pertaining to demographics, antimicrobial prophylaxis, supportive care, and neutropenic fever management. The survey was distributed from fall 2022 through spring 2023.

40 complete responses were recorded (54.8% response rate), with respondent institutions accounting for approximately 15.7% of 2021 US hematologic malignancy hospitalizations and 14.9% of 2020 US bone marrow transplantations. Most entities have institutional guidelines for neutropenic fever management (35, 87.5%) and prophylaxis (31, 77.5%), and first-line treatment included IV antipseudomonal antibiotics (35, 87.5% cephalosporin; 5, 12.5% penicillin; 0, 0% carbapenem).

We observed significant heterogeneity in treatment course decisions, with roughly half (18, 45.0%) of respondents continuing antibiotics until neutrophil recovery, while the remainder having criteria for de-escalation prior to neutrophil recovery. Respondents were more willing to de-escalate prior to neutrophil recovery in patients with identified clinical (27, 67.5% with pneumonia) or microbiological (30, 75.0% with bacteremia) sources after dedicated treatment courses.

We found substantial variation in the practice of de-escalation of empiric antibiotics relative to neutrophil recovery, highlighting a need for more robust evidence for and adoption of this practice. No respondents use carbapenems as first-line therapy, comparing favorably to prior survey studies conducted in other countries.

This audit aims to address the critical link between antipsychotics and impulsive behaviors, particularly pathological gambling, by emphasizing the importance of assessing patients' gambling history before initiating antipsychotic treatment. The focus is on patients under the care of the Bolton Early Intervention in Psychosis (EIT) service, with the aim of meeting the standard set by NICE guidelines, ensuring that 100% of patients started on antipsychotics are asked about their previous gambling history.

Data was collected from prescription and shared care protocol lists for patients prescribed antipsychotics in the last six months. The PARIS progress notes and clinical correspondence were then searched to determine if patients had been asked about gambling.

The audit revealed a significant gap in the practice, with minimal adherence to NICE guidelines regarding assessing gambling history before prescribing antipsychotics. Out of 35 patients, only one was asked about gambling history.

The recommendations for improvement include incorporating a gambling prompt into the medical review proforma, educating the team about the importance of this assessment, and adding the Problem Gambling Severity Index to the initial review by EIT.

This review aims to evaluate the lasting advantages of cognitive behavioral therapy (CBT) in alleviating anxiety and depression and improving overall health outcomes post-CABG.

A comprehensive search across databases including Science Direct, PsycINFO, PubMed, Google Scholar, VHL, Cochrane, and Scopus was conducted up to October 2023. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane guidelines. Inclusion criteria involved randomized controlled trials reporting on CBT or CBT-based interventions tailored for CABG patients and control groups had usual care, with anxiety and depression symptoms, as well as quality of life, as primary outcomes. Outcome variations were analyzed through standard deviation, while efficacy was measured via confidence intervals. Evaluation of the intervention process included examining feasibility, adherence, acceptability, inclusion rates, safety, and tolerability.

Three randomized controlled trials including a pilot study in America and Denmark, encompassing a total of 286 patients, were reported in this review. The participants' pooled mean age was 63.19 years (intervention) and 63.9 years (control), the male-to-female ratio was approximately 2:1 [males n = 174 (intervention n = 101; control = 73) while females n = 91 (intervention n = 60; control n = 31)], and cardiac as well as non-cardiac comorbidities including psychiatric diagnosis have been reported. The array of therapies ranged from education on anxiety and depression management skills to a combination of CBT and supportive stress management (SSM), and psychoeducational interventions paired with physical therapy. Results indicated that both CBT and SSM led to improvements in anxiety and depression symptoms, accompanied by reduced hospital stays, decreased hopelessness, lower scores in dysmorphic mood and irritability, lowered perceived cognitive impairment and stress, and increased satisfaction with therapy. The cognitive behavioral therapy demonstrated commendable feasibility, acceptability, safety, and efficacy, with some concerns raised about potential issues of low adherence.

This systematic review emphasizes the positive impact of CBT on depression, anxiety, and quality of life in individuals post-CABG surgery. Future studies should adopt standardized CBT protocols, comprehensively evaluating CBT's influence on overall patient prognosis, considering cardiovascular outcomes across diverse ethnic groups, exploring cost-effectiveness, and specific patient cohorts that could benefit the most from CBT interventions.

To assess whether patients admitted to the forensic secure rehabilitation ward are transferred with their physical health notes.

Most patients admitted to secure rehabilitation do not have an open GP record due to last registration with primary care having been many years previous as a result of a lengthy prison/hospital stay. Additionally, patients may be referred from an out of area prison or hospital. A comprehensive psychiatric history paperwork is obtained at referral. This audit was to assess how many patients currently on the rehabilitation ward arrived with complete physical health notes. We defined a complete set of physical health notes to mean:

1. 1. Records from medical consultations linked to physical health during time in prison or psychiatric hospital.

2. 2. Any physical health history prior to current incarceration/admission episode from primary and secondary care.

3. 3. Complete prescription of physical health related medications including allergies, doses, regime, and indication.

Retrospective review of patient electronic records sent by discharging institution when the patient was transferred to the rehabilitation ward.

Data collected: List of documentation of patient's physical health records around transfer time. Identification of the contents of the records provided by the transferring ward.

We then compared the information available to our criteria for complete physical health notes.

Participants: All current residents of the male secure rehabilitation ward (n = 12) were included.

7 out of the 12 patients included were transferred to the secure ward with notes that fulfilled the criteria as set by audit team.

Two patients were transferred with only the prescription of current medications. There was however, a brief physical health summary in care coordination notes sent earlier.

One patient was transferred with the prescription and a brief list of their past medical history.

The remaining 2 patients were transferred without any formal physical health documentation prior to transfer, however, they were transferred from an adjacent ward and therefore, all records were already on the electronic records. There was no formal verbal or written physical health handover.

It is important for our ward to ensure we have comprehensive and complete physical health summary for each patient on admission.

A proforma will be used at preadmission meetings from February 2024 to request specific information from discharging wards. We will re-audit in February 2025 to assess improvement in records requested and obtained.

Adults with Down syndrome (DS) face significant health inequalities and are at increased risk of numerous health concerns. Despite the need, there is a lack of high-quality randomised trial evidence and clinical interventions for people with DS are largely based on consensus guidelines or clinician preferences. As life-expectancy of those with DS increases, the research gap continues to widen.

There is a perception that randomised controlled trials (RCTs) involving people with DS may be hard to carry out due to difficulties in recruitment and retention of participants. However, there is no scientific literature exploring this topic. This systematic review aimed to assess planned vs actual recruitment and retention in RCTs involving adults with DS, and to summarise reported facilitators and barriers to participation of adults with DS in relevant trials.

The MEDLINE, PsycINFO, EMBASE databases were searched systematically to retrieve all RCTs involving adults with DS aged 16 years or older published from 01.11.1961 to 15.12.2023. Ongoing RCTs were identified from trial registries and searches were supplemented by review of reference lists. Data extraction is ongoing but seeks to elicit details of trial design; planned and achieved recruitment sample size; planned and achieved retention rate, and any specific recruitment or retention strategies described. Risk of bias analysis was not relevant to the research question and so not performed. The review was prospectively registered on Prospero (CRD42023447126).

The database searches retrieved 1,825 results. Post deduplication, 1,518 articles underwent title and abstract screening, of which 82 full texts were reviewed. 53 papers were included in the final analysis, reflecting 47 RCTs involving 1,772 individuals. Commonly studied interventions included exercise programmes for physical fitness and pharmaceuticals that may augment neuropsychological function. Studies typically reported small sample sizes at the point of randomisation (mean = 38.5, SD = 49.6), with over half reporting a sample size of n < 50. A significant number of studies reported difficulty recruiting and retaining participants (detailed data will be available in the poster). Of the minority of articles that reported power calculations, several reported failure to meet target sample size.

Initial results point to a paucity of high-quality, large-scale RCTs involving adults with DS and challenges related to recruitment of participants. The results may aid development of strategies that allow clinical trial teams to overcome challenges in recruitment and retention in RCTs, and may eventually contribute to the improved health and wellbeing of adults with DS.

Ornithine transcarbamylase (OTC) is an enzyme of the urea cycle catalyzing the condensation of carbamyl phosphate and ornithine to form citrulline. OTC deficiency leads to elevated serum ammonia and presents as different neurological or psychiatric symptoms. OTC deficiency is an X-linked inborn error of metabolism and most cases occur in neonatal period with severe presentation. Lesser known is the late-onset form that remains latent from infancy and only presents with intriguing symptoms mimicking psychiatric disease in adulthood.

Case report.

We describe a case of adult-onset OTC deficiency in a 40-year-old man with borderline intellectual functioning and a psychotic episode following a protein rich meal. The case was first diagnosed as undifferentiated schizophrenia, until the genetic study was carried out.

Awareness of the adult onset ornithine transcarbamylase deficiency being a rare but possible differential diagnosis in a patient with acute psychiatric symptoms with hyperammonemia. Organic causes such as cerebral, metabolic, toxic causes of psychosis should be actively sought especially when encountering cases of acute psychosis.