The Maternity Trauma and Loss Care Service provides specialist care to women and birthing people who are affected by birth trauma, baby loss and severe fear of childbirth. The service has an integrated team of specialist midwives and psychological practitioners. This evaluation is the first, to our knowledge, to describe the challenges and successes of setting up a Maternal Mental Health Service as depicted in the NHS Long Term Plan.

The sample includes all women and birthing people who were referred to the service over the 12-month period from 1st April 2022 to 31st March 2023.

A mixed-methods design was used to explore and interpret the delivery of the service. Descriptive data was used to describe basic service information: client demographics, time from referral to assessment and numbers accessing treatment. Quantitative data from pre and post clinical measures to look at symptom change over the treatment period. Qualitative data to capture the experience of clients.

The service received 254 referrals between April 2022 and March 2023. For primary referral reasons of accepted clients, 92 clients (50%) were referred due to perinatal trauma, 65 clients (35%) were referred for perinatal loss, 26 clients (14%) for Tokophobia and 2 were referred for other reasons (1%). Three quarters of referrals were accepted and 99 (53%) were pregnant at the time of referral. 53 clients (29%) were postnatal, 32 clients (17%) were post-loss and one was pre-conception.

Of the interventions offered, 49% were offered a midwifery intervention, 31% a psychology intervention and 18% were offered midwifery and psychology treatment. A small number attended groups. 36 clients referred during this 12-month period completed treatment.

PTSD Checklist for DSM-5 scores and Clinical Outcomes in Routine Evaluation scores indicate that service users experienced a reduction of symptoms between the start and end of treatment. There was an average reduction in scores on the PTSD-checklist of 17 and on the Clinical Outcomes in Routine Evaluation of 6.4. 17 clients completed the service satisfaction survey, all of which were positive about the service and its impact on wellbeing.

The Maternity Trauma and Loss Care service continues to fill the gap identified in the long-term plan providing a much needed integrated service to women and birthing people who experience trauma and loss on their reproductive journeys. Areas identified for service development include further developing a pathway for peer support and partners.

This case presentation is on a 54 year old female patient. Prior to 2023, she had never had an inpatient admission for her mental health. She was referred to her local community mental health team in May 2023 as they were concerned that she was suffering from panic disorder. The GP referral stated that this lady was suffering from anxiety and panic attacks. At the time of the GP referral, she was on maximum doses of escitalopram, propranolol and zolpidem (and she had been on these maximum doses for three years prior to the referral). This lady has significant caring responsibilities (she has a brother who is severely disabled and she lives with him and she is his main carer). She sustained an injury to the tip of her left index finger in April 2023 and this injury seemed to cause an acute deterioration in her mental health.

This lady had her first inpatient admission in June 2023 and at that time she was treated for the following: mixed anxiety and depressive disorder. She was discharged to the care of her Community Mental Health Team at that time. Post-discharge, her mental state started to deteriorate and she waded into a river and she also made a serious hanging attempt. After this hanging attempt, she sustained multiple rib fractures, a pleural effusion and atelectasis. She also ended up in ICU following this suicide attempt. She was re-admitted to Holywell Hospital in November 2023.

During her second inpatient admission, it became clear that this lady is very medication-seeking. She was treated for the following mental health conditions on her second inpatient admission in 2023: Generalised Anxiety Disorder and Recurrent Depressive Disorder, Unspecified. Help was also sought from an Addictions Specialist on the second inpatient admission. This lady was given five ECT sessions on her second inpatient admission but it was felt that this was making her more agitated so it was stopped.

This patient is currently still an inpatient and she is hoping to attend a specialist addictions unit when she is discharged from hospital. I will follow her progress with interest. I found this case to be an interesting one as it forced me to consider how to best manage a patient who is very medication-seeking.

A third to a half of patients with psychosis fail to recover to premorbid levels of functioning. Within these are a group of patients with treatment-resistant psychotic disorders, whose presentations are complex, with significant comorbidities, prolonged hospital admissions, and poor social and occupational functioning. Reports suggest an underutilization of clozapine, which is the licensed treatment for resistant schizophrenia for reasons ranging from prescribers’ expertise or reluctance to intolerable side effects and comorbid psychiatric or medical conditions. In Kent, Surrey, and Sussex, clozapine prescription is only 4.93%, which is the third lowest among NHS England Regions.

Complex psychosis in Kent and Medway NHS Partnership and Social Care Trust (KMPT) was handled through a referral through the Out-of-Area Treatment panels to the South London and Maudsley (SLAM) Psychosis unit. This had lengthy wait time for admission and required approval for out-of-area costs which can be significant for longer admissions, placed a considerable travel burden on the family/carers, and made it difficult for reintegration into the local community.

The KCPS was set up as a consultation service to ensure that patients receive the right care to facilitate recovery and that our healthcare professionals and teams are supported in meeting the needs of patients with complex psychosis. This multidisciplinary service, comprising psychiatrists, pharmacists, occupational therapists, and administrators, commenced functioning in January 2023 and we examined the first year of operation. KCPS reviewed the detailed psychiatric/medication history, highlighting prior treatment and effectiveness, with a focus on doses, tolerability, duration, and adherence; we explored the social, occupational, and psychological functioning of each patient; liaised with referrers/carers, reviewed the relevant research literature and provided holistic recommendations to the referrers.

From January to December 2023, there were 36 referrals from a mixture of services, 26.3% of these were from acute wards. The patient's mean age was 42.8 years; 75% were male; the most common diagnosis was schizophrenia (50%), and the commonest comorbidities were Autism spectrum disorder and diabetes (13.9% and 27.8% respectively). Feedback from referrers and carers reported a high level of satisfaction with the service.

Reasons for referral included diagnostic uncertainty, comorbidity, intolerable side effects of clozapine leading to its early discontinuation, and poor psychosocial functioning. The KCPS recommendations were deemed useful in changing the trajectory of illness in some individuals, leading to early discharge and avoiding an out-of-area placement for treatment. Professionals appreciated the opportunity to discuss complex cases in a supportive, friendly, and in-house environment.

The aims of the study were to illustrate the number and type of restrictive practices that were used across two inpatient wards within the Acute Mental Health Inpatient Centre in the Belfast trust over a two year period. This initially would highlight the prevalence and use of such practices and allow for comparison against the data collected after the implementation of the therapy cross. We hoped that with the implementation of the therapy cross we would see a decline in the use of physical interventions, use of IM medications and also the number of aggressive or distressing incidents and behaviours would also decrease.

We utilized a statistical process control to collate and illustrate data. Daily data collection was carried out and compiled over a 2–3 year period and is ongoing with regards to ward incidents of aggressive behaviour, use of physical intervention, use of IM medications. In early October of 2023 the therapy cross was introduced and the run charts and data collection continued allowing for comparison of such behaviours and interventions pre and post intervention.

A percentage decrease of 50% of the weekly average was noted in incidents of aggressive and violent behaviours on one ward in AMHIC following implementation of therapy. A percentage decrease in average weekly use of IM injections was noted to be 13%. A 12% decrease was found in the use of physical intervention on a weekly average following the therapy cross.

The implementation of a therapy cross in early October 2023 indicated improvement in the incidence of use of restrictive measures on two inpatient wards in the Belfast Trust, including the number of physical interventions such as holds that were required and also decreased the incidence of use of IM medications for rapid tranquillization. The data indicates a significant decrease in the number of cases of violent and aggressive behaviour on wards following implementation of a therapy cross.

To identify if COVID-19 has changed the experience for patients under the care of Crisis Resolution Home Treatment teams (HTT).

To identify if COVID-19 altered the response for HTT patients in the context of Personality Disorder (PD).

To provide useful demographic and experiential information about patients using HTT with PD during crisis.

Data regarding the demographics of patients with personality disorders under the care of the Croydon crisis home treatment team were collected retrospectively for two, predetermined time windows. The first window was pre-COVID-19 (26/03/2019–25/03/2020) and the second window was during COVID-19 (26/03/2020–25/03/2021). The demographics of patients with personality disorder referred to the team during these two time periods included were compared.

More patients with personality disorder were referred to the Croydon HTT during COVID-19 (n = 82) when compared with the window before (n = 58). The proportion of referred patients with Emotionally Unstable Personality Disorder (EUPD) was constant before and during COVID-19. The average length of stay reduced from 22.6 days before COVID-19 to 18.7 days during COVID-19. The proportion of rejected referrals to the HTT of patients with personality disorder increased during COVID-19. Finally, the proportion of BAME (Black, Asian, Minority Ethnicity) referrals of patients with personality disorder increased during COVID when compared with before, with this finding not being replicated in any other ethnic group.

Increased numbers of referrals may indicate worsening mental health in the community. This may have been compounded by an inability of community mental health teams and inpatient services to meet such an increase in demand for services. An overall reduction in inpatient admissions during COVID-19 supports this idea. There was a relatively larger drop in duration of admission for patient with personality disorder during COVID-19, when compared with all patients. This may be due to staff feeling unable to offer quick management for patients with personality disorder. Subsequently, staff may have selectively discharged such patients earlier. The rate of rejected referrals to the Croydon HTT was consistently higher than the acceptances both pre- and post- COVID-19. Therefore, HTT clinicians may feel unable to adequately treat PD.

In conclusion, the number of referrals to the HTT increased during COVID-19, however, with a reduced average duration of stay with HTT for patients. The rejection rates for personality disorder patients were consistently higher than for other patient groups, both before and during COVID-19. Additionally, the proportion of patients with personality disorder from BAME backgrounds increased during COVID-19.

This project was launched in January 2022 to improve handover between on-call teams and wards, following GMC concerns in 2020 with the out-of-hours handover process. In 2021, a ‘Hospital At Night’ Microsoft Teams evening meeting was successfully introduced. However there remained low satisfaction with other areas of the handover process, including use of paper forms to handover between shifts. The aims of the project were to review the current handover process and improve quality and satisfaction of handover. The target was to improve baseline satisfaction with the handover process by 20% (6 months after change implementation).

A driver diagram was built to identify factors contributing to quality and satisfaction with handover and develop change ideas.

Qualitative surveys using Likert rating scales were sent to all doctors to explore satisfaction with handover format and quality of information received. Opinions of doctors and the wider MDT were used to develop ideas and evaluate support for change. Surveys were repeated following each cycle.

From July 2022, interventions were introduced and monitored over four QIP cycles. This included an electronic handover in the form of a twice-daily email handover list, which was updated following feedback. Microsoft Teams morning weekend meetings were then introduced and modelled on the existing ‘Hospital At Night' protocol.

Following interventions, the percentage satisfaction with handover format improved from a baseline of 14% and was maintained at an average of 81% across 15 months.

The satisfaction with the quality of handover improved from 36% and was maintained at an average of 97%.

The weekend virtual handover has also been well received with 71% satisfaction. This maintains the satisfaction levels achieved with the ‘Hospital At Night' virtual handover. The involvement of the MDT has been high with 71% of doctors satisfied that the necessary team members are attending.

Introducing a standardised electronic twice-daily handover has improved satisfaction with and quality of handover. It has also improved communication between on-call teams and wards.

The introduction of additional virtual handover meetings at the weekend has also been well received. It allows another opportunity to strengthen clinical leadership and the MDT to work more effectively out-of-hours. Future intervention will be targeted at standardising the content of these meetings and attendance in line with the ‘Hospital At Night' protocol.

We aim to monitor local benefit from these changes, and expand this project to other hospital sites which are not yet using an electronic handover system.

This study focuses on the North Central London Child and Adolescent Mental Health Services (NCL CAMHS) Co-production workstream, initiated to establish co-production as a foundational method for service planning and delivery in the NCL region.

To understand what the CAMHS experts by experience members found useful and did not find useful in co-production projects within Barnet Enfield and Haringey Mental Health NHS Trust and NCL wide co-production.

Semi-structured interviews conducted with experts by experience within the Barnet Enfield and Haringey (BEH) NHS Trust aimed to explore their co-production experiences, identifying facilitators and barriers. The study employed an inductive thematic analysis, grounded in a constructionist epistemological position, to analyse qualitative responses from semi-structured interviews. Braun and Clarke's (2006) methodology guided the analysis, consisting of six phases. The researchers emphasized reflexivity, reflection, and maintaining coherence, consistency, and flexibility throughout the recursive process. The voices of the lived experience co-production members played a central role in the research, influencing the entire report.

Two members of the NCL CAMHS lived experience group served as “Lived Experience Researchers” and received training on coding reliability based on Braun and Clarke's (2006) guidance.

Thematic analysis revealed several key findings. Recognition of co-production values within the group highlighted the importance of giving voice to service users, valuing their individual experiences, and promoting power-sharing. Facilitators included good team working, valuing diversity, accessible online sessions, and promoting equality through interactions. Conversely, barriers included inconsistent meeting timings, power imbalances, and a consultation-style dominance. Participants expressed the need for more involved projects and recommended a transformation of BEH's co-production strategy.

Recommendations for BEH include a comprehensive evaluation of their co-production projects on the ladder of participation, emphasizing the importance of higher-level collaborations. Training for staff on co-production principles is crucial for fostering a mindset shift, and the establishment of a dedicated co-production team, including a co-production lead, is advised by service-users who co-produce. These roles can drive co-production projects, provide organizational structure, and facilitate stakeholder engagement.

Traditional antipsychotic treatment improves positive symptoms in schizophrenia but has little impact on negative and cognitive symptoms. TMS is a non-invasive neuromodulation technique which has been suggested to impact negative and cognitive symptoms of schizophrenia. This systematic review critically appraised the research evaluating the effect of TMS on negative and cognitive symptoms of schizophrenia. Furthermore, we carried out a meta-analysis of randomised controlled trials of the effect of TMS on negative symptoms in schizophrenia.

Systematic review was carried out according to PRISMA guidelines. Cochrane Library, Ovid Medline, Science Direct and PubMed databases were searched for relevant studies using the search terms: “transcranial magnetic stimulation” OR “TMS” OR “repetitive transcranial magnetic stimulation” OR “r-TMS” OR “theta burst stimulation” OR “TBS” AND “negative symptoms” OR “cognitive dysfunction” OR “cognitive impairment” AND “schizophrenia” OR “psychosis”. Only randomised controlled trials evaluating the effect of TMS (rTMS or iTBS, intermittent theta burst) on negative and/or cognitive symptoms in schizophrenia were selected. Thirty-three studies were included in the systematic review. The Standardised mean difference (SMD) with 95% confidence interval (CI) was calculated for each study and pooled across studies using an inverse variance random effect model.

Sixteen studies demonstrated significant improvement in negative symptoms with a superior effect of TMS compared with sham intervention. Eight studies showed improvement in certain domains of cognition and one study showed a delayed effect on negative symptoms. Studies which showed positive effects on negative symptoms have used similar TMS parameters such as 10 Hz over L-DLPFC (Left dorsolateral prefrontal cortex) except for a few studies. Ten studies reported negative results for negative and/or cognitive symptoms, TMS parameters and duration of treatment used varied among these studies. Overall, SMD for SANS (Scale for Assessment of Negative Symptoms) was 0.89 (95%CI: 0.46–1.32, P < 0.00001) and for PANSS-N (Positive and Negative Syndrome scale-negative) was 0.67 (95%CI: 0.22–1.12, P < 0.00001), both in favour of TMS. The heterogeneity of the included studies was high, I2- 85% for SANS and 92% for the PANSS-N subscale with a small to moderate risk of publication bias.

High-frequency rTMS is more effective than sham in improving negative and cognitive symptoms in schizophrenia. Our results suggest the need for well-designed randomised controlled trials with larger sample sizes and standard harmonised cognitive assessments to assess the effect of TMS on negative and cognitive symptoms to provide sufficient evidence for inclusion in routine clinical practice.

Following discharge from inpatient to community psychiatric services, the first 7 days is the most vulnerable and associated with an increased risk of suicide. According to the NICE Guideline 53, it is recommended that patients discharged from inpatient psychiatric services should be reviewed within 7 days by the relevant community services. Our aim was to determine how well we are adhering to this recommendation, appropriately documenting the appointment in the patients' discharge documents as well as the number of patients that attended the appointment.

We collected data on an excel spreadsheet of patients discharged from Huntly ward (a General Adult Psychiatry ward) in the Royal Cornhill Hospital from 01/09/2022 and 14/10/2022 (a period of 6 weeks).

The data collected included name, CHI, date of admission and discharge, community mental health team, follow-up appointment offered, appropriate documentation on Core discharge document and whether the patient attended the appointment.

After the first audit cycle, we had a discussion with the junior doctors on the ward highlighting the importance of 7 day follow up and the need for arranging with the Community mental health team prior to the discharge, documenting a date, time and name of the clinician for the 7 day follow up in the Core discharge document. We also encouraged the use of reminders like using the doctors' diary book on the ward to document anticipated discharges and adequate hand over of patients to the community mental health team at the start of each week's Multidisciplinary Teams meeting.

We subsequently did a re-audit on patients discharged from Huntly ward between 04/04/2023 and 12/05/2023 (6 weeks). We compared the results from the first cycle and the second cycle to identify a change.

First Audit cycle.

Over the 6-week period, 27 patients were admitted into the Huntly ward and 23 patients were discharged.

48% (n = 11/23) of discharged patients were offered a follow up appointment.

91% (n = 10/11) had this appointment documented in the Core discharge document.

100% (n = 7/7) attended the 7 day follow up appointment.

Re-Audit.

Over the 6 week period, 16 patients were admitted and discharged from Huntly ward.

81% (n = 13/16) were offered a 7 day follow up appointment and this was documented in the Core discharge document.

100% (n = 13/13) of the patients attended their 7 day follow up appointment.

The result showed good improvement from 48% to 81%.

Using reminders, properly liaising with the community mental health team, appropriately documenting a named clinician, date and time for the 7 day follow-up ensures that the patient attends.

The importance of offering support during the first week after discharge from psychiatric hospital should continue to be emphasized to prevent adverse outcome during this vulnerable period.

Conduct disorder carries significant individual and societal repercussions. Despite heightened risk-taking and challenges in adapting to changing probabilities of choice outcomes being linked to maladaptive behaviours such as conduct disorder, no study to date has examined the association behind childhood decision-making and adolescent conduct disorder. This study seeks to address this gap by exploring the longitudinal association between these two variables. Understanding the mechanisms underlying conduct disorder could help with developing new preventive interventions.

We used data from the Millennium Cohort Study, a nationally representative UK cohort; participants included those with complete data on exposure, outcome and confounding variables (n = 7,237). The exposure, childhood decision-making at 11 years was measured using the Cambridge Gambling Task risk-taking and risk-adjustment measures. The outcome, a binary measure of adolescent conduct disorder was created using items from the risky and antisocial behaviour interview sections at age 17. We used logistic regression to examine the association between childhood decision-making and adolescent conduct disorder and adjusted for relevant confounders.

The univariable model showed that at age 11, each 20-point increase in risk-taking score increased the odds of conduct disorder behaviour at age 17 by 32% (OR = 1.32, 95% CI 1.18–1.44, p < 0.0001). In the multivariable model, there was strong evidence that a 20-point increase in risk-taking at 11 years was associated with 18% higher odds of conduct disorder behaviour at 17 years (OR = 1.18, 95% CI 1.05–1.33, p = 0.005). There was no evidence that this association differed by sex. Risk adjustment at 11 years showed no association with conduct disorder behaviours at age 17 both in the univariable model (OR = 0.96, 95% CI 0.88–1.06, p = 0.440) and the multivariable model (OR = 0.96, 95% CI 0.88–1.06, p = 0.433).

We found that risk-taking at 11 years was associated with conduct disorder behaviour at 17 years. If causal, our findings suggest that risk-taking might be a potential mechanism underlying adolescent conduct disorder behaviours. This may be useful in informing the design of preventive strategies, such as encouraging positive risk-taking in children and discouraging negative risk-taking behaviours.

Individuals with psychosis experience impairments in real-world functional outcomes such as employment and health. Rare copy number variants (CNVs) are established risk factors for psychosis, neurodevelopmental disorders and cognitive impairment. However, little is known about their effect on real-world functional outcomes in individuals with psychosis.

I aimed to establish the effect of rare neurodevelopmental CNVs on real-world functioning in individuals with psychosis.

I identified 1,932 individuals with psychotic disorders (ICD–10 F20–F29) in the UK Biobank using first-occurrence data (from primary care, hospital inpatient and death register records and self-reported conditions). I mapped UK Biobank data to two domains of real-world functional outcomes – health deficits and vocational outcomes. We previously called CNVs using PennCNV, annotating them with 53 CNVs associated with autism spectrum disorder and developmental delay. I conducted regression analyses with neurodevelopmental CNVs as the predictor, real-world functioning as outcomes and with relevant covariates (e.g. age and sex).

Out of 1,932 individuals with psychotic disorders, 2.5% (n = 49) carried a neurodevelopmental CNV.

Health Deficits

I used first-occurrence diagnosis data to establish comorbid psychiatric diagnoses. I summed these diagnoses and dichotomised them into one or more comorbid diagnoses versus no comorbid psychiatric diagnoses. I conducted a logistic regression analysis – neurodevelopmental CNV carrier status was associated with having at least one psychiatric diagnosis in addition to a psychosis diagnosis (OR 2.1, 95% CI 1.1 - 4.1, p 0.034). Post-hoc analyses revealed an increased rate of dissociative and conversion disorders in CNV carriers (OR 4.5, 95% CI 1.26 - 15.99, p 0.021).

I used first-occurrence physical health diagnosis data to establish the burden of the 20 most prevalent chronic non-cancer illnesses. Neurodevelopmental CNV carrier status was associated with chronic physical health multimorbidity in individuals with psychosis (59.2% vs 43.5%, OR 2.30, 95% CI 1.27–4.17, p 0.006), defined as the presence of two or more chronic physical health conditions.

Vocational Outcomes

I conducted an ordinal regression analysis, establishing that among individuals with psychosis, CNV carriers had a lower likelihood of achieving a higher qualification (OR 0.45, 95% CI 0.27–0.77, p 0.003).

Neurodevelopmental CNVs are associated with important real-world functional outcomes in individuals with psychosis. This work provides information that can guide the assessment and management of individuals with both psychosis and neurodevelopmental CNVs.

The project aims to improve carers’ engagement for patients admitted to our male Psychiatric Intensive Care Unit by improving communication between staff and carers; and by involving carers more in patients’ care.

Hypothesis:

Among patients admitted to PICU, there is inconsistency in communication with carers and in involving carers in patients’ care. We expect an improvement in these parameters with the quality improvement project.

Background:

Within PICUs, patients with severe psychiatric illness face social isolation. Challenges arise when carers are not engaged, impeding patient support and personalised care. Involving carers becomes crucial for informed decision-making, ensuring both patients and carers actively participate in the care process. National Association of PICUs and The Royal College of Psychiatrists' Guidance for PICU sets out recommendations regarding timelines and types of interventions to be offered to carers.

Initial baseline data was collected by reviewing patient electronic notes.

We then tested interventions to improve carers’ engagement by using the Plan-Do-Study-Act (PDSA) methodology over 2 cycles. In the first cycle, we engaged the nursing staff by presenting the baseline data and recommendations to improve carers’ engagement. In the second cycle, we introduced an admission protocol to ensure carers were engaged consistently. The parameters assessed were documentation of carers details; contacting carers within 24 hours of admission; documenting carers' views in care plan; inviting carers to Care Plan Approach (CPA) meetings and offer an appointment for carers with staff.

Data was collected after each PDSA cycle to monitor change.

Of the patients admitted to PICU, 29% had their carers’ details documented at baseline, 40% after the first PDSA and 80% after the second PDSA. 42% of carers were contacted within 24 hours of admission at baseline; 66% and 30% after the two PDSA. 50% of carers had their views included in the care plan at baseline; 0% and 30% after the interventions. At baseline, 42% of patients’ carers were invited to the CPA meeting, 66% and 30% after the two PDSA cycles. 50% of patients’ carers were offered an appointment with staff at baseline, 66% and 30% after the two interventions.

As a result of this quality improvement project there has been an improvement in engaging carers of patients admitted to PICU. This was not sustained for the second cycle due to many regular senior staff being on leave during Christmas. The next steps will be to implement this consistently and produce a carers’ information pack.

Despite the rising prevalence of eating disorders among young people and their associated morbidity and mortality, the level of self-perceived competence of professionals in providing health interventions is unknown. It could be expected that those with low self-perceived competence would be reluctant to initiate therapeutic interventions, which may increase the burden of unmet need for this population. Consequently, a service evaluation project was carried out in Cardiff and Vale Health Board Trust to assess the confidence of healthcare providers in working with young people with eating disorders, and to identify interventions acceptable to clinicians in order to meet this service need.

Fifty-two healthcare workers who worked with young people below 18 years responded to a brief survey. The survey was advertised via email through the medical education department between December 7 2023 and January 5 2024 to healthcare workers based at Adult and Paediatric Emergency departments, in-patient units of General Adult Medical and Paediatric departments and the Community-based Child and Adolescent Mental Health Services (CAMHS). The survey elicited participants’ specialty, location of practice, self-assessed confidence in managing eating disorders in young people, aspect of management participants require support in, and preferred interventions which might support greater literacy in this topic.

Fifty-two participants responded to our survey of whom 48% (25) were doctors, 17% (9) were psychologists, and 13% (7) were nurses. The larger proportion of participants worked in CAMHS (42%) and Paediatric wards/emergency department (37%). About 43% reported having a role in managing young people with eating disorders. Half of the participants reported having “average” to “good” confidence in managing young people with eating disorders while none reported “very good” confidence. Discussion with colleagues was reported as the most common means of getting information about managing young people with eating disorders (79%), while the least cited was local teaching (13%). Most participants wanted support with recognising high risk presentations (60%) and providing psychological interventions (58%). The most highly requested interventions were written resources (65%), and teaching events – virtual (63%) and face-to-face (54%).

Considering the rising prevalence of eating disorders, self-rated confidence of participants in working with young people with eating disorders was relatively low. Interventions can include providing summarised policy documents, simple reference resources, and targeted teaching. These interventions will be implemented and the survey repeated to assess impact of the intervention, with a view to repeating this cycle in order to further drive improvement.

Cognitive stimulation therapy (CST) is a psychosocial treatment for people with dementia. It is an evidence-based treatment which shows improvement in cognition, well-being and quality of life of people living with dementia. CST is recognised as one of the interventions which is cost-effective.

The National Institute of Health and Care Excellence (NICE) guideline recommends that people with mild to moderate dementia should be given opportunities to take part in CST. The CST sessions done in North Norfolk are weekly sessions which span 90 minutes. A group of between 8–10 people attend a 14-week CST treatment course.

The aim of this study is to evaluate the effectiveness of the CST on cognition and social independence of patients with dementia in North Norfolk.

Patients diagnosed with mild to moderate dementia at the memory service were referred for CST sessions. A trained professional assessed the patients to determine their eligibility for CST. The assessment included: assessing motivation to join a group therapy, administration of the short-version of the Addenbrooke Cognitive Examination questionnaire (MINI-ACE) to assess cognitive functions and the administration of Engagement and Independence in Dementia Questionnaire (EIDQ) which measures the social independence of the patients. A higher score on both questionnaires indicates better cognitive function and social independence, respectively.

The CST sessions spanned from February 2023 to May 2023. The patients were re-assessed after the 14-week sessions of CST for their MINI-ACE and EIDQ scores. A qualitative questionnaire was administered for feedback about the sessions.

Data were obtained from patients' clinical record following approval from the research and service evaluation team of the Trust.

Nine patients completed the 14-week CST sessions. The mean age of the patients was 82.9 ± 4.8. 66.7% were male and 33.3% were female. 77.8% were on memory medication and 22.2% were not on memory medication. 44.4%, 33.3%, 11.1% and 11.1% were diagnosed with dementia in Alzheimer's Disease; Mixed Alzheimer's-Vascular Dementia, Lewy Body Dementia and Frontotemporal Dementia, respectively.

The same proportion of patients (44.5%) had both increased and decreased MINI-ACE score after CST while 11% had no changes in MINI-ACE score. Majority (66.7%) had increased EIDQ score after CST, 22.2% had decreased EIDQ score and 11.1% had no changes.

The CST sessions done in North Norfolk showed more positive effect on social independence than cognition in people with dementia.

This audit aimed to assess the recognition and management of perimenopausal symptoms in women diagnosed with depression at the Psychiatry Outpatient Department (OPD) of Benazir Bhutto Hospital, Pakistan. It focused on identifying gaps in screening for perimenopausal symptoms among these patients.

Conducted over a year, this retrospective audit included 250 women aged 45–55 years, previously diagnosed with depression. Post-diagnosis screening for perimenopausal symptoms was performed using the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the Greene Climacteric Scale. Data on initial diagnostic criteria, treatment modalities, and patient outcomes were reviewed. Follow-up interviews provided insights into ongoing symptom management and treatment satisfaction.

The retrospective screening revealed that 78% of these women had significant perimenopausal symptoms per the Greene Climacteric Scale, which were initially overlooked. MENQOL results showed 65% experiencing a substantial impact on quality of life due to menopausal symptoms. Treatment primarily consisted of antidepressants (used by 82% of patients), while 8% received psychological counseling, and 10% were advised on lifestyle adjustments and non-hormonal therapies. Only 45% of the patients reported satisfactory symptom management, indicating a potential discrepancy between the treatments for depression and the underlying perimenopausal condition.

The audit at Benazir Bhutto Hospital demonstrates a high incidence of undiagnosed perimenopausal symptoms in women treated for depression, suggesting a critical need for improved screening protocols. The results indicate that integrating perimenopausal symptom assessment into the initial diagnostic process for depression could lead to more effective, individualized treatment strategies. This approach may enhance the overall treatment satisfaction and quality of life for perimenopausal women, underscoring the importance of holistic patient care in psychiatric settings.

The completion of methadone and buprenorphine prescriptions, together: opioid substitution therapy (OST), must conform to legal requirements for the prescription of controlled drugs (CDs) as well as Home Office approved wording when writing instalment prescriptions.

Our service uses a part automated printing system for individual prescriptions and uses a manual record to track prescriptions issued for individual clients over time, a “script record”.

We aimed to audit the terms used on the internal script record as well to audit compliance of OST prescriptions with the legal requirements for CD prescriptions and Home Office Approved wording for instalments.

All prescriptions for methadone or buprenorphine over the course of a week that were prepared for signing were audited.

The prescriptions were audited against the legal requirements for writing CD prescriptions and against Home Office approved wording for instalment prescriptions.

The script record was audited against internal standards for variation of terms used to describe frequency of collection of instalments.

A total of 64 prescriptions were audited.

100% of prescriptions complied with the legal requirements for the prescription of CDs.

7 prescriptions (11%) omitted Home Office approved wording to instruct what should be done on days when the dispensing pharmacist was closed, i.e. that instalments should be dispensed on the prior open day.

46 prescriptions (72%) had additional Home Office approved wording that was not applicable to the script. For example additional wording to allow for pickup of part of an instalment following a missed day, when the prescription was only for daily supervised consumption to begin with.

Audit of the internal script record found a total of 13 different terms used to describe frequency of collection of instalments; there are 6 standardised terms used within the internal script record. On 2 occasions the frequency of collection of instalments was left blank.

It is essential that prescriptions for controlled drugs follow the legal requirements laid out for them; within the scope of our audit these were entirely adhered to.

There was however more variability in the use of the Home Office approved wording for instalments of OST. Scripts here tended to error for including additional wording not relevant to the specific script. Additionally, the service's own internal script record showed variability in the terms used to describe frequency of collection.

It is evidently important that the wording on prescriptions is clear and concise and the terms used internally are standardised.

We aimed to improve the care for people with intellectual disabilities (PWID) presenting to a community learning disability service (CLDT) with health needs relating to sexual wellbeing, sexuality, and/or gender identity (SSGI). A QI framework was used, focussing on staff education and service development.

We hypothesised that there would be a lack of confidence and staff knowledge around SSGI issues in PWID. We suggested that challenges exist because discussing sex in PWID still feels taboo.

PWID have the same sexual needs as those without any disability. Historically, this population have been discouraged from expressing their sexuality due to certain attitudes, fears, and prejudices. Stigmatising views have included PWID being viewed as asexual or conversely posing a risk of sexual violence, despite evidence showing that they are more vulnerable to sexual abuse. Important issues around capacity and understanding consent highlight the importance of psychosexual education for patients and carers.

Carers and health care professionals are key in educating and supporting PWID, however, our disinclination towards discussing SSGI openly can have unintended negative effects on the wellbeing of our patients. These issues are therefore paramount to understand and address.

Patient-facing staff in a London CLDT were surveyed, and staff focus groups held, to understand attitudes towards SSGI in PWID. Staff knowledge of local services was also explored. Using thematic analysis, we identified both staff and service development needs and devised a set of interventions to address these.

Four educational interventions for staff were developed and evaluated using QI methodology. Interventions included bitesize teaching, externally commissioned training, and resource packs.

Thematic analysis identified a number of barriers to delivering SSGI care, particularly staff's low confidence and a lack of training. Following the four educational interventions, average staff confidence to discuss SSGI increased from 55% to 77%.

Staff responses indicated a lack of SSGI services for PWID locally. In response to this, the QI team, service leads and management agreed upon various service development ideas. These include upskilling specific staff to become SSGI leads; auditing the CLDT caseload to understand the SSGI issues in our population; and trialling a clinical sexology service for a small subset of patients.

A QI approach to staff education demonstrated clear benefit, with staff more confident to address the SSGI needs of PWID. Combined with sustainable service improvement ideas, this can improve patient care.

Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an inflammatory brain disorder characterised by a new onset of obsessive-compulsive disorder, triggered by streptococcal infection likely inducing molecular mimicry of antistreptococcal antibody action within brain tissue. PANDAS is perhaps considered controversial in the field of psychiatry due to debates over the validity of the diagnosis, controversy surrounding aggressive antibiotic and immunomodulatory treatment and limited well-controlled case studies.

A 13-year-old boy, X, presented with new onset worsening confusion, on a background of autism, to a child psychiatric clinic in the Lake District. During the summer, he developed a fixation with Harry Potter and began to act on confabulating beliefs that his mother is (and always has been) Lord Voldemort. X's behaviour became increasingly violent and aggressive and he now only spoke in ‘parseltongue’, refusing to communicate with anyone in any other way. A new personality change was identified as his usual routine behaviours and fixations had dissipated, such as a decrease in his ritualistic behaviours, a loss of his usual inquisitive nature, and an increased fascination with wearing sunglasses due to beliefs that the sun was poisoned by his mother, ‘Lord Voldemort’. Additionally, X's eating habits had markedly changed and now refused all forms of food. Clinically, X also developed a new and sustained tic and was tremulous in clinics, despite no evidence of focal neurological signs. Due to the relatively acute onset of symptoms, an organic cause was queried, which eventually led to the presumed diagnosis of PANDAS.

Extensive investigations, such as an MRI of the brain, autoantibody testing for anti-AQP4, MOG-Ab, and other serological testing, showed no specific cause could be identified other than evident inflammatory changes in the brain. A ‘three-pronged’ treatment approach was adopted: increased psychotherapeutic intervention, antibiotic treatment and IV immunoglobulin therapy.

This case illustrates the importance of recognition of PANDAS and, more pertinently, an appreciation of the biological aspect of the biopsychosocial approach to psychiatry. From the minimal evidence available, there is a suggestion of a relatively good prognosis for patients with suspected PANDAS when intervened timely; however, repeated infections or a chronic course of illness is more difficult to treat. PANDAS remains a diagnostic challenge and perhaps a mystery, with complicated impacts on not only the patient and their families but also the psychiatrist and wider teams involved in the management of care.

The Mediterranean diet has shown to improve mental health outcomes in people with depressive disorder. However, little is known of the impact of the Mediterranean diet on severe mental illness. The aim of this systematic review was to evaluate the impact of a Mediterranean diet on mental health and quality of life outcomes in adolescents and adults with severe mental illness (as defined by schizophrenia spectrum disorders, at risk mental states for psychosis, bipolar affective disorder and severe depression with psychosis).

The following databases were systematically searched: MEDLINE and EMBASE via Ovid, CINAHL via EBSCO, PsychInfo via ProQuest, PubMed and Clinicaltrials.gov, using relevant subject headings and free text search terms to encompass severe mental illness and the Mediterranean diet. Screening, data extraction and quality assessment were completed by two independent reviewers. Eligible study designs included randomised controlled trials, other non-controlled or controlled interventional or experimental studies, cohort studies, case-control studies and cross-sectional studies that included adults and adolescents. The search was not limited to a specific time frame or language. The Mediterranean diet and mental health and quality of life outcomes were defined by primary paper author definitions.

Thirteen eligible studies were identified: 4 interventional, 2 cohort, 2 case-control and 4 cross-sectional studies and 1 mixed methods (interventional and observational) study. Diagnoses in most studies were psychotic illness, schizophrenia, schizoaffective disorder, bipolar affective disorder and depression with psychosis. There was a lack of studies found that included adolescents or participants with at-risk mental states for psychosis. A range of Mediterranean diet adherence scoring systems were used across studies, indicating a notable heterogeneity in the way adherence was evaluated. Most studies included other lifestyle exposures or interventions alongside the Mediterranean diet. There was a marked heterogeneity between studies in how mental health and quality of life outcomes were assessed. Although there was an overall trend towards improved mental health or quality of life outcomes in some studies, others reported no change or a negative association with the dietary/lifestyle exposure or intervention.

The association between Mediterranean diet adherence and mental health outcomes and quality of life in adults and adolescents with severe mental illness remains inconsistent. Lifestyle-based interventions for the treatment of mental illness are cost-effective and relatively easy to implement with less concern about side effects. Therefore, this area requires further research.