Core Psychiatry Trainees (CTs) are required to complete two psychotherapy cases, utilising different therapeutic modalities as part of their training. During supervision sessions, CTs in Coventry and Warwickshire reported feeling underprepared to start their psychotherapy cases. Locally, the most frequently used modality for short cases is Cognitive Behavioural Therapy (CBT). Here we evaluate a local CBT teaching program implemented to prepare CTs, delivered by the trust Psychotherapy Tutor in conjunction with a CT, Dr Bloomfield, who has experience delivering CBT in a talking therapies service.

We implemented a teaching programme which consisted of 30-minute teaching sessions occurring immediately after Balint groups, which are usually well attended. Dr Bloomfield designed a teaching plan, with separate CBT teaching topics divided into 12 sessions. Each session focused on a CBT concept with practical examples. The effectiveness of psychotherapy teaching was evaluated with pre- and post-teaching online surveys assessing preparedness, confidence in formulation, and knowledge of specific techniques. The survey consisted of Likert scales ranging from 1–10 with lower numbers indicating a negative response. Trainees were also surveyed about Psychodynamic Psychotherapy in the absence of specific teaching, as a comparator.

13 CTs responded to the pre-teaching survey and 16 CTs to the post teaching survey, with near-equal weighting across the training grades. Responses indicated a median increase across all areas for CBT, with trainees reporting higher confidence in formulation (7 to 8.5), improved knowledge of CBT techniques (5 to 8) and increased preparedness to start seeing patients (5 to 7). By comparison, there was a modest increase in preparedness (5 to 6) and confidence in psychodynamic formulation (3 to 3.5), with knowledge of specific aspects of Psychodynamic Psychotherapy unchanged (6 and 6).

Regional teaching alone may not be sufficient in preparing trainees to start seeing psychotherapy patients. The CBT learning needs of CTs in Coventry and Warwickshire were effectively met by providing a series of short, tailored sessions covering the different aspects of CBT, resulting in improved confidence, preparedness, and knowledge of CBT techniques. The same increases were not seen in trainees’ responses regarding Psychodynamic Psychotherapy, though small increases were seen in preparedness and confidence in formulation. Our next phase of the teaching will focus on Psychodynamic Psychotherapy teaching, with further repetition of the survey.

• • This case study investigates a rare occurrence of symptom transition in a chronic schizophrenia patient following high-frequency repetitive transcranial magnetic stimulation (rTMS), aiming to understand the unexpected shift from predominantly negative to positive symptoms.

• • rTMS, known for inducing changes in neuronal activity based on Faraday's law, is believed to enhance cortical excitability through high-frequency stimulation.

• • Schizophrenia, a severe and chronic mental disorder, presents with both positive (e.g., delusions, hallucinations) and negative symptoms (e.g., apathy). Current treatments, predominantly antipsychotic drugs, often show limited efficacy, especially for negative symptoms. Non-invasive neuromodulation techniques like rTMS are emerging as potential interventions.

This case involves a 27-year-old banking executive with a 30 months illness duration primarily marked by negative symptoms over the past 3 months. Despite various antipsychotics, there was no improvement, leading to the initiation of high-frequency rTMS on the left dorsolateral prefrontal cortex (DLPFC) as an adjunct strategy for persistent negative symptoms. Surprisingly, after the 5th rTMS session, positive symptoms like delusions and hallucinations emerged. Serial assessments demonstrated a decrease in negative symptom domain scores on PANSS but an increase in positive symptom domain scores on PANSS.

• • Results suggest that 5 Hz rTMS over the left DLPFC may have contributed to the transition to positive symptoms. The discussion explores limited literature on rTMS-induced positive symptoms, with case reports dating back to 2004 indicating the possibility of such induction. Studies propose a link between higher pulse frequency, motor threshold intensity, left prefrontal cortex stimulation, and longer trial durations with the exacerbation of positive symptoms, possibly linked to dopamine changes in specific brain tracts.

• • Recent trials indicate potential improvement in positive symptoms, such as excitement, with low frequency rTMS of the temporo parietal area. However, the efficacy of rTMS varies with the stimulation site, with left prefrontal rTMS showing promise for negative symptoms and left temporo-parietal junction stimulation possibly reducing auditory hallucinations.

This case report suggests that a subset of schizophrenia patients may experience a transient exacerbation of positive symptoms following rTMS. This underscores the need for increased awareness of potential side effects, serving as an exploratory study that calls for future research to refine these findings for a clearer understanding of rTMS-induced symptom switches in schizophrenia.

To evaluate the effectiveness and sustainability of multidisciplinary outpatient caseload reviews in the community mental health team (CMHT).

Caseload review for all patients under the outpatient clinics within South Leicestershire CMHT commenced in August 2022. A consultant psychiatrist and senior nurse spent 2–4 hours weekly reviewing each patient's electronic record chronologically from those waiting the longest for an appointment guided by a template including variables such as stability, risk and medication. Based on clinical need, the patient may be offered an outpatient appointment for ongoing treatment or review for discharge, nurse discharge clinic or transfer to another service.

This process is now embedded into routine clinical work, and momentum sustained by clinical and operational leadership roles within the team. The cycle is iterative and ongoing to ensure patients new to the service are included and flow from referral to discharge maintained.

Between August 2022 to January 2024, 1460 out of a total of 1699 caseload reviews were completed. 622 (42%) of these are identified as suitable to be reviewed for discharge.

Of those, 256 (41%) were suitable for nurse discharge clinic, and 366 (59%) by a medic.

110 patients received an outpatient appointment following nurse discharge clinic, clinically indicated in 25.

Average additional wait time for an outpatient appointment has reduced from 34 weeks (September 2022) to 22 weeks (January 2024).

Consultant Psychiatrists in the CMHT frequently hold high outpatient caseloads with associated delays to care and treatment, and limited capacity and flexibility to respond dynamically to patient need contributing to reduced job satisfaction and burnout. Embedding multiprofessional caseload review into routine work creates greater capacity and responsiveness, reducing outpatient wait times and improving quality of care by earlier identification of those needing more expeditious review. Continuing this in an iterative cycle aligns with key principles of community transformation in the NHS Long Term Plan ensuring effective caseload management and fostering a more dynamic and responsive approach to meet patient need. Engaging senior clinicians and administrative staff is critical to successful implementation and close joint working has a positive ripple effect on team cohesion, morale and shared clinical decision making. The benefits are recognised at Trust board level with funding secured from the local Integrated Care Board to implement caseload reviews across all CMHTs within Leicestershire Partnership NHS Trust.

The aim of this study was to assess the clinical value of urinary tract infections (UTIs) guideline algorithms and the role of nonspecific symptoms to support clinical decision-making in nursing home residents.

In a preplanned secondary analysis of a cross-sectional study including nursing home residents with a presumed UTI, 2 prediction models were used in a decision curve analysis (DCA): (1) guideline-based and (2) extended: nonspecific symptom(s) added to the guideline model. The stringent outcome definition for “true UTIs” included symptom improvement during adequate antimicrobial therapy, based on susceptibility test results. The outcome of a DCA is the Net Benefit to quantify the performance of the prediction models, visualized in a decision curve.

Dutch nursing homes (n = 13).

Nursing home residents with a presumed UTI.

Of the 180 residents with a presumed UTI, 43 fulfilled the definition of “true UTI” (23.9%). The Net Benefit of the guideline-based model was low and the corresponding threshold range was small (21%–28%). The extended model improved the prediction of UTIs. However, the clinical usefulness of the extended model was still limited to a small threshold range (10%–28%).

The clinical usefulness of the current guideline-based algorithm to diagnose UTI in nursing home residents seems limited, and adding nonspecific symptoms does not further improve decision-making due to the small threshold probability. Given the poor performance of the guideline-based model, refinement of the guidelines may be required.

Dutch trial registry: NTR6467; date of first registration, 25/05/2017.

16 year old male with previous diagnoses of autism spectrum disorder and severe anxiety disorder was referred to Child and Adolescent Mental Health Services (CAMHS). His presentation included increasing anxiety, difficulty articulating his thoughts and emotions, difficulty completing tasks, school non-attendance, reduced food intake and possible auditory hallucinations. Risperidone was trialled in the community however refused after 5 days due to “brain fog”. He was seen by CAMHS community team twice weekly for 3 months prior to his emergency detained admission to adolescent psychiatric inpatient unit, due to no oral intake for 72 hours.

Family history included schizophrenia, bipolar disorder, depression and anxiety.

Upon admission, symptoms observed included reduced verbal communication, psychomotor retardation, low mood, agitation, sleep difficulties, ambitendency, echolalia and poor oral intake. He had a Bush-Francis rating score of 8 and given a working diagnosis of catatonia. He responded positively to a lorazepam challenge therefore commenced on 1mg of lorazepam twice daily. Despite increasing doses, the catatonia worsened with severe psychomotor retardation, “psychological pillow” and nil food or fluid intake with Bush Francis score of 18. ECT was arranged as an emergency treatment but put on hold while tolerating all food and fluids requirements via nasogastric tube. Lorazepam dose was titrated to 3mg three times daily but signs seen of benzodiazepine toxicity therefore dose was reduced and ECT arranged for treatment resistance. Improvement seen on reduced dose prior to receiving ECT, therefore ECT put on hold again. His lorazepam dose was titrated up at a slower rate to 4mg three times daily which he was able to tolerate. His catatonia fully resolved at 12mg. Once stable, lorazepam dose was very gradually decreased until stopped. No evidence of catatonia returned.

Medical and psychiatric causes of catatonia were explored.

Two positive blood anti-NMDA receptor tests two months apart; both 1/10 titre. This was discussed with the specialist neurology team in Oxford who advised this was an incidental finding with no clinical implication (1% of healthy population are positive).

Throughout admission, possible fleeting psychotic and depressive symptoms were noted, including not trusting food, hallucinations, worries about contamination and apathetic mood. However, these all improved as the catatonia was treated.

There was no clear underlying psychiatric or medical illness identified as a cause of the patient’s catatonia. Catatonia has a higher prevalence in people with autism. At discharge he was well and reintegrated back to community life without requiring further medication.

To examine whether the rate of clinical and non-clinical complaints towards a mental health service (MHS) in the west of Ireland has changed over the preceding seven years. We aim to clarify the pathways for managing clinical and non-clinical complaints locally and compare with other MHS nationally. We aim to capture the nature of complaints, potential factors in any change in rate and quantify associated workloads via survey of senior clinicians involved in managing complaints.

We obtained anonymous data from a local database maintained by administrative staff regarding annual complaint numbers for the previous seven years (2016–2022). Data separating clinical and non-clinical complaints were available for the previous four years only due to previous recording practices. Current complaint pathways were captured via administrative staff. A survey via telephone or email of Executive Clinical Directors (ECDs) typically involved in complaint management was conducted.

Annual rates of complaints have increased in the past four years, with these representing higher totals than any of the three previous years (2019–2022, n = 27,23,23,46 v. 2016–2018, n = 21,12,14). A significant increase in rate is noted in 2022 (n = 46) representing at least double the rate of five of the preceding six years. Clinical complaints are more predominant than non-clinical across a four year period (mean = 59% annual total) but no significant change in rate was noted. Rates of complaints are perceived to have increased in the previous five years by ECDs (n = 4). Repeat complainants are perceived to be common (n = 4). Workload regarding complaints is reported to be variable between services (n = 2, 0–4 hrs/week v. n = 2, 4–8 hrs/week). A clear appeals pathway is unavailable regarding clinical complaints across MHS (n = 4). A disparity between MHS around clinical complaints structures and recording practices between services is noted.

Overall rates of complaints towards MHS have broadly increased in the last four years, with a significant increase in 2022. There appears to be a significant disparity in structures between both clinical and non-clinical complaints pathways and between individual MHS. Further research in this area and a standardised national framework for management of clinical complaints is needed.

Background: The uncertainty and anxieties about psychotherapy long case among trainees was high. This training was designed to alleviate stress and to increase knowledge and confidence among trainees.

The Primary aim of this project was to improve individual skills and awareness for Psychodynamic Psychotherapy. Secondary aim was to get feedback from trainees to improve future psychotherapy training.

The Null hypothesis (H0): There is no difference between the Pre and Post training questionnaire scores.

This is a blinded study where the researcher cannot identify the participants. A mixed study approach is taken, with both quantitative and qualitative analysis used for this study. A pre training and post training questionnaire was provided to participants. This study collected quantitative data in the form of Likert scale questionnaire as a primary approach to test the hypothesis. The qualitative data was collected by open ended questions. The qualitative part is to understand the trainee's problems and what improvements have to be made in the workshop, to generate a structural model for effective practical psychotherapy training.

The sample consists of 13 Psychiatry Core Trainees at different levels of their training and 1 speciality doctor. 14 feedback questionnaires were available, 1 questionnaire was excluded as it did not fit the inclusion criteria.

The paired t-test was used for all the three quantitative questions: Knowledge of psychotherapy, Theoretical and Clinical Application of Psychotherapy. The t-test showed the difference between pre-and post-questionnaires scores to be statistically significant (p value < 0.05). So, we reject the Null Hypothesis. The effect size was large, with Cohen's d score > 0.8 for all three questionnaires.

Thematic analysis of Qualitative data was done. Codes were formed from the supporting quotes. Themes were derived from the similar codes. Four themes were created:

• • Challenges experienced by core trainees.

• • Emotions and confidence.

• • Knowledge acquired.

• • Suggestions for improvements.

1. 1. We can conclude that the Psychotherapy workshop was effective, and the Core Trainees have better insight than before.

2. 2. The qualitative analysis results were in accordance with the quantitative analysis.

3. 3. Challenges experiences by trainees in managing their own emotions were addressed in the training. Quote (IV) “it was very good! calmed nerves.”

4. 4. There was increase in knowledge and confidence among trainees.

5. 5. Suggestions were full day of training and to have more role playing; to demonstrate the psychological concepts like transference, countertransference, defences, resistances in role play.

Individuals with epilepsy are at risk of developing pre-ictal, ictal, postictal or interictal psychoses. Antipsychotic drugs (APDs) are the main class of drugs used to treat psychosis and schizophrenia. The efficacy and safety of APDs as a treatment for epileptic psychosis is not well understood. Hence, we aimed to conduct a systematic review assessing the effectiveness and adverse effects of antipsychotic drugs to treat psychosis in people with epilepsy.

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, Embase, PsycInfo and AMED from database inception to 20/06/2023. We contacted experts in the field and performed citation searches to identify additional records. Title, abstract, full-text review, and data analysis were conducted in duplicate, with conflicts resolved by discussion among authors. Given the heterogeneity of study designs, meta-analysis was not deemed appropriate; instead, the results were tabulated in a narrative synthesis. The Joanna Briggs Institute Risk of Bias tool was used to assess study quality.

We identified 13 studies, with a total of 1,180 participants. In the 9 case series included, the psychotic symptoms of all but 3 out of 28 patients treated with APDs partially improved or fully resolved. 3 of the cohort studies reported an association between antipsychotic use and longer duration of psychotic episodes, 2 found similar results in both APD and non-APD groups, and 2 did not report control psychosis outcomes. When reported, seizure frequency was observed to remain unchanged or decrease following APD treatment.

Available evidence does not suggest that antipsychotics increase seizure risk in individuals with epilepsy. However, further data from randomised controlled trials and well-controlled cohort studies are urgently needed to draw more definitive conclusions.

To implement a robust and reliable medical handover process in the Bluestone Unit, Craigavon Area Hospital, Southern Health and Social Care Trust. Following discussion with Junior Medical Staff, Doctors did not feel confident that they were always aware of outstanding physical investigations or any acutely unwell patients on the inpatient wards. This could lead to patient safety issues which we aimed to address using the PDSA model for effective change management.

A) Twice daily face to face handover was introduced at 09:00 and 16:45 in the Junior Doctor's office, easily accessible to staff. A standardised handover template was already in existence. The outgoing Doctor On-Call overnight would complete this to handover any outstanding tasks. The Doctor carrying the On-Call bleep during the day would then use this template to lead a formal, face to face handover with a team of Junior Doctors covering each of the inpatient wards. This helped to clarify which wards were covered and ensure timely, effective allocation of tasks.

B) A formal, face to face “weekend handover” was introduced at 15:30 in the Conference Room every Friday afternoon.

A survey was sent to twelve Junior Doctors to gather formal feedback both before and after these interventions.

Following these two interventions:

1. 1. 91.67% feel there is now a structured and comprehensive daily handover. 91.67% felt this was not the case before.

2. 2. 63.64% feel there is now always a successfully completed morning handover. 0% felt this was the case before.

3. 3. 83.33% feel there is now always a successfully completed weekend handover. 41.67% felt this was not the case before.

4. 4. 75% feel they are always aware of sick patients when On-Call. 25% felt they were not at all aware before and 66.67% felt they were only occasionally aware before.

5. 5. 91.67% feel they are always aware of outstanding bloods to chase. 8.33% felt always confident before.

6. 6. 83.33% feel they are always aware of outstanding investigations to chase. 16.67% felt always confident before.

7. 7. 90.9% feel they know which wards are covered and uncovered when carrying On-Call bleep. 9.09% felt they knew before.

The implementation of a formal handover process has significantly improved Doctors' awareness of outstanding tasks and ward cover, which is likely to benefit patient safety moving forward. Further action is necessary to improve communication between medical and nursing colleagues regarding physical investigations performed and appropriate, timely follow up.

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This audit aimed to determine whether the option of clozapine is being considered in those patients on the 16 general adult inpatient wards and Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust who are prescribed HDAT.

A list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether there was documentation in the patient's electronic record that the option of treatment with clozapine was considered. The authors also wished to determine whether, in those HDAT patients in whom clozapine was considered, the rationale for it not being pursued as a treatment option was documented.

29 inpatients on the 16 general adult wards and on the PICU were prescribed HDAT. In 9 (39%) of the HDAT patients, the option of treatment with clozapine was considered. It was documented for 6 of the HDAT patients that the option of clozapine was not applicable. Of the 9 HDAT patients that had a trial of clozapine considered, all of them had documented evidence of the decision in their electronic record. Four of the 9 patients accepted the trial of clozapine, 5 did not accept/it was deemed not appropriate. Of the 5 patients who did not accept the trial of clozapine or were deemed not appropriate, the rationale was documented for each patient.

Given the lack of recommendation and evidence base to prescribe HDAT, the option of clozapine, if appropriate, should always be considered in any patients in whom HDAT is being considered or required. There may be barriers to clozapine being chosen – both patient-related and clinician-related. Any such barriers should be explored and addressed to ensure that treatment-resistant patients are commenced on clozapine without unnecessary delay.

The prevalence of anorexia nervosa (AN) in young people is increasing and it is the psychiatric condition with the highest morbidity and mortality. Atypical antipsychotics are unlicensed for use for AN but research has demonstrated they can improve weight restoration and decrease anxiety and rumination around food and body image. However, prescription of antipsychotics comes with risks such as arrythmias, hyperprolactinaemia or EPSEs.

As a result, NICE (National Institute of Clinical Excellence) and TEWV (Tees, Esk and Wear Valleys) Trust have developed standards to ensure the safety and efficacy of antipsychotic prescribing in young people with anorexia nervosa. This audit aims to measure local compliance with these standards by reviewing antipsychotic prescribing and monitoring in the Children and Young People (CAMHS) Eating Disorder Service covering North Yorkshire.

Clinicians identified all patients under the team currently prescribed an antipsychotic for AN; 8 patients in total. Electronic patient records were hand searched for relevant information.

Standards were derived from RCPsych May 2022: Medical Emergencies In Eating Disorders and local TEWV Guidelines.

Initial data collection was June 2023. Recommendations included a spreadsheet to monitor antipsychotic prescription and advice on documentation of unlicensed indications and provision of medication information. Re-audit was December 2023. Patients included in the initial audit were excluded to avoid duplication of results; 3 patients were in the re-audit.

All patients received full eating disorder assessment and non-pharmacological interventions such as dietetic or psychological input. All patients were prescribed olanzapine. The indication of antipsychotic prescription for all patients was distress/rumination. Compliance with physical health monitoring was 100% in both audits. Compliance with blood-test monitoring was initially 17%, rising to 100% in re-audit. 50% of patients were given medication information, increasing to 67% in re-audit. Compliance with local protocol for unlicensed indications was 13% and 0% in re-audit. Psychiatric follow up and medication review was regular and consistent in both initial and re-audits.

Physical health monitoring was very good, likely due to routine AN monitoring regardless of antipsychotic prescription. Psychiatric review was frequent, reflecting the intensity of CAMHS practice. Initial poor compliance with blood-test monitoring was due to antipsychotic-specific blood tests being omitted from standard tests. Overall compliance improved after implementation of recommendations, particularly blood-test monitoring. Ongoing areas for improvement are following the protocol for unlicensed medication indications and provision of additional medication information. Most patients had psychiatric comorbidities and co-prescribed psychotropic medication, reflecting the complexity and severity of this cohort.

1. 1. Identify changes in the services rendered in the Enhanced access/emergency service following the previously suggested modifications.

2. 2. Identify areas of possible improvement within the service to provide seamless emergency and out-of-hours mental health support to patients.

3. 3. Evaluate adherence to current guidelines for the Enhanced access/emergency service.

An audit of a total of 100 patients on the list was selected in chronological order. Patient documentation was reviewed against the current criteria for patients on the list, which included having a documented care plan in place, remaining open to a community mental health team, and having been reviewed at least within the last 6 months.

The data was then analysed and compared with the previous year's results to see if there was any significant change year over year.

Year on Year improvement:

1. 1. Total number of patients on the list had increased by 16.7%.

2. 2. The number of patients without a care plan on the list reduced by 6.

3. 3. The number of discharged patients on the list was also reduced by 1.

4. 4. The number of patients who had not been reviewed in six months reduced by 9.

While there had been some improvement in the service provision and adherence to the guidelines, there was still ample room for improvement, which would be achieved by adherence to the guidelines and protocols, to ensure better service improvement for enhanced access and out-of-hours emergency services to patients.

Eating disorders (ED) have significant physical and psychosocial impacts, and the highest mortality rates of any psychiatric illness. About a third of patients with Anorexia Nervosa or Bulimia Nervosa do not recover and develop persistent ED. Development of novel treatments is a priority to prevent adverse effects on young people's physical, relational and educational development. Virtual reality (VR) has shown promising efficacy as an innovative mental health treatment, and has potential therapeutic value within ED. People with lived experience (PWLE) and clinicians have demonstrated enthusiasm for a VR café intervention to practice social and food-related challenges. A VR café would enable gradual exposure to challenges in a protected environment, aiming to support people with ED to return to real-life cafés and social eating. This study aims to explore the opinions of key stakeholders to help inform the development of a VR café scenario as an adjunctive treatment for ED.

We conducted semi-structured focus groups and 1:1 interviews with PWLE aged 14–25 years (n = 15), parents/carers (n = 4), and clinicians (n = 6). Participants were recruited via social media, advertisement via ED charities, posters in public places, and snowballing. Following completion of an online screening survey, eligible individuals were invited to participate using purposive sampling to ensure diversity of ages, ethnicities, genders, ED diagnoses, and health professional roles. Data were analysed thematically.

Preliminary analysis indicates that PWLE, parents/carers and clinicians expressed mostly positive opinions regarding a VR café adjunctive treatment. Expressed concerns related to themes of intervention efficacy, translation of learnt skills to real life, and use of VR technology. Most participants agreed a VR café intervention should be a repeated experience (many suggested graded exposure), realistic, and maximally individualised. All stakeholder groups identified a similar range of challenges to experience within a VR café, with themes including choosing food, other people, eating socially or alone, and the café environment. Differences in specific aspects of the scenario that might make challenges harder or easier reflected the unique experiences of individual participants.

These findings build upon previous research demonstrating support from PWLE, parents/carers, and clinicians for the development of a VR café adjunctive treatment for ED. Themes identified are largely consistent across stakeholder groups and relate to the design of a VR café scenario and its implementation as a treatment. This analysis enables the perspectives of key stakeholders to be incorporated into the design of a novel VR café intervention to optimise efficacy and acceptability.

To improve the knowledge of the early intervention in psychosis team staff regarding support and referral options available for patients with suspected or confirmed autism spectrum conditions. We further aimed to develop additional knowledge within this team to help identify, assess and support people who may be neurodivergent with a primary focus on autism.

Starting in September 2022 the team completed a survey to understand baseline knowledge. Plan Do Study Act (PDSA) quality improvement cycles were then used to develop resources and disseminate knowledge within the team to help target the identified staff development areas. Following implementation the team completed a further survey to reassess the changes and ongoing areas of focus and to guide ongoing skill development.

3 PDSA cycles were completed with interventions including collecting data on local services to share within the team, collating these resources and sourcing training sessions. This demonstrated an improvement in many areas at the point of the second survey at which stage the team showed a better understanding of how to access autism assessments, the role of various local autism specific teams including admission avoidance urgent support processes and confidence in supporting people after diagnosis. Work continued following the second survey within the team with further training sessions and both medical and psychology colleagues upskilling to be able to complete autism assessments within our service in conjunction with the neurodevelopmental team. The early intervention team staff have been able to utilise the support of many of these services and often discuss these options now within team meetings.

Initially support and knowledge gaps were identified within our team and work was done to collect and share information about local services and processes to best allow us to support those within our psychosis service who also have an autism spectrum condition and this has been successfully implemented.

This work has grown over the past 2–3 years since the initial quality improvement work was developed and team knowledge has since continued to grow. This has included multiple team members now also being able to complete autism assessments formally in conjunction with the neurodevelopmental service with some assessments now finalised and significant ongoing work to improve experiences of those with both autism and psychosis.

The at-risk mental state (ARMS) describes individuals at high risk of developing schizophrenia or psychosis. This study aimed at exploring the demographic characteristics of individuals who transitioned to psychosis from a large multicenter factorial design trial.

This was a secondary analysis of large multicenter randomised controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states. Participants (n = 326) were randomised to minocycline, omega-3, combined minocycline and omega-3 or to double placebo for 6 months. The primary outcome was transition to psychosis at 12 months.

Forty-five (13.8%) participants transitioned to psychosis. The mean age of participants was 23.31 (5.31 SD) and 15.6% no formal education, 8.9% primary, 48.9% matriculation, 8.9% intermediate and 15.6% graduation and above. Majority 66% of participants were male and 71.1% single, 66.7% living in a joint family, 44.4% were employed, 24% students, 17.8% household/housewife and 3% unemployed. Interestingly 36.8% participants had a family history of psychosis, followed by 21.0% any unknown mental illnesses, 15.8% bipolar disorder, 15.8% depression, 5.3% anxiety and 5.3% intellectual disability. The mean total score for the Prodromal Questionnaire was 8.93, with a standard deviation of 1.67. The mean score on the Comprehensive Assessment for At Risk Mental State (CAARMS) unusual thoughts was 3.98 (SD = 0.84), Non-Bizarre Ideas 3.64 (SD = 0.77), Perceptual Abnormalities 3.76 (SD = 0.71) and disorganized speech 2.49 (SD = 1.12). Participants had mean Social and Occupational Functioning (SOFAS) score of 66.67 which suggests moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

Transition to psychosis appears to have different demographic and clinical correlates which may have the causal relationship to transition. The cross-comparative studies are warranted to understand differences and similarities between the groups.

Usher syndrome (USH) is the leading genetic aetiology of congenital hearing loss and progressive vision loss. It is linked with a high prevalence of mental health issues, including depression. Previous literature attribute this to communication barriers, constraints in mobility, and general feelings of dependency and uncertainty. However, there is little literature considering poor mental health in USH patients as a consequence of gaps in service provision on a national level.

The present report is the case of a 54 year old woman, who was born with USH Type IIa, and was previously diagnosed with depression and retinitis pigmentosa. The patient was recruited via the RareBeacons charity through volunteer sampling. A semi-structured interview was conducted, with 3 main categories: the impact of diagnosis, interpersonal relationships, and challenges in day-to-day life. A common theme of self-isolation was found, largely due to inefficient communication between healthcare providers, including but not limited to years of waiting for hearing aid treatment exacerbating symptoms of social withdrawal. The patient also reported inadequacies in physician knowledge regarding USH and their general unwillingness to be educated further. Unprofessional physician attitudes and lack of sensitivity towards the patient's deafblindness over time led the patient to feel distrust towards the system, which further compromises care.

Areas of improvement on a systemic scale were identified, including increasing awareness of deafblindness in both the medical community and the general public through patient advocacy, as well as streamlining dedicated support pathways. The patient found formal support to be unhelpful, conversely emphasising the impact of informal support, namely web-based support group platforms. Support groups can provide a sense of community and belonging, alongside sharing valuable resources – often overlooked yet vital in USH, a rare condition with little official support. Subsequent research may include expansion of this case report to yield quantitative data, alongside investigating further factors increasing depression in USH patients (e.g. psychosocial, genetic and biological factors).

This report concludes that the gaping inadequacies of the current medical system poses a significant psychological, emotional and social burden on USH patients.