RCPsych Dean's Grand Rounds focuses on understanding a problem or an opportunity for change in clinical practice using a patient story, academic evidence, and contextual data in this area to bridge the evidence-practice gap using a quality improvement approach. The Dean's Grand Rounds aims to embed the lived experience in clinical practice and use data to drive change.

We held five virtual Dean's Grand Rounds with this format from June 2022 to January 2024. The sessions included a variety of medical professionals, carers and expert patients presenting on the chosen theme, followed by a panel discussion. The sessions were then made available for on-demand viewing via the RCPsych website for those unable to attend the live session. Qualitative and quantitative feedback helped us improve the sessions iteratively.

The sessions have enabled discussion of broader issues facing staff and patients, facilitating the exchange of ideas between professionals from divisions of the RCPsych from around the world. Participants globally attended these sessions, with over 1,000 registrations for the Grand Rounds on memory clinics and catatonia. The feedback for the sessions was overwhelmingly positive, with many participants praising the involvement of patients and carers and the opportunity to come together at the RCPsych level for learning. Many were attracted to the sessions because of the themes discussed, with 68.5% having excellent overall experience. Over 92% of the feedback participants thought the Grand Rounds had improved their professional practice. The majority of the feedback participants strongly agreed that lived experience is an important element in understanding the evidence-practice gap (4.4 on a Likert scale of 1, strongly disagree; 5, strongly agree) and that the Grand Rounds had enhanced their understanding of academic evidence and contextual data in the area (4.4, 4.39 respectively on a Likert scale of 1, strongly disagree; 5, strongly agree). The themes that stood out in the feedback were that participants liked the Grand Rounds format and were grateful to hear from patients, with suggestions to allocate more time for questions and answers. Learning from the feedback, we set up a resources page for each Grand Rounds to enable further learning.

In their revitalised format, these sessions are proving highly effective in bringing the worldwide RCPsych community together to improve patient care and deliver educational and informative interactive content available on demand.

This audit focuses on assessing the compliance of health professionals with the UK law by informing the drivers with dementia about their legal requirement to report their condition to the DVLA and their insurance companies. The aim of this audit is to ensure public safety by adhering to the General Medical Council (GMC) guidance; “Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA”, as well as the Driving with Dementia or Mild Cognitive Impairment Consensus Guidelines for Clinicians; endorsed by RCPsych and Alzheimer's Society. This will help ensure public safety and prevent potential accidents or incidents caused by impaired driving.

The audit reviewed retrospective data of 40 patients selected randomly (17 males, 23 females and mean age 78 years old), referred to the memory clinic at Watermill Resource Centre in Berrywood Hospital, Northampton. The inclusion criteria was patients referred between 1st January and 31st December 2022 that were diagnosed with dementia. We set a compliance target of 100%.

The results showed that out of the 40 patients diagnosed with dementia, 23 had a recorded risk assessment. 11 patients were driving at the time of assessment. 7 patients were referred to occupational therapy for a driving assessment. The compliance in informing patients about reporting to the DVLA and their insurance companies was low. 8 out of 11 (73%) patients were informed about reporting to the DVLA, and 5 out of 11 (45%) were informed about contacting their insurance company. Additionally, only 4 out of 11 (36%) patients were informed about the consequences of not reporting to the DVLA and their insurer. There was also a lack of systematic documentation regarding driving risk assessment. There was no record of medics contacting the DVLA.

Overall, the audit revealed a need for improvement in compliance and documentation. It is recommended that health professionals strictly adhere to their responsibilities in risk assessment and informing drivers with dementia about their legal requirements regarding informing DVLA and insurance companies. Clear documentation should be made using a standard template available.

Background: Nature and degree of mental illness can impair abilities of patients to drive safely which puts their own safety and safety of others at risk. There is also an ongoing concern of patients not being properly informed on their duty to inform the DVLA and potentially to stop driving for an extended period.

Aims:

1. 1. To assess if risk assessment of patients in term of driving status was completed at time of admission, during their stay on ward, and if any advice regarding fitness to drive was given at time of discharge.

2. 2. To improve patients being asked about driving status on admission to 100% of patients.

3. 3. To improve rates of service users being informed of the DVLA guidance following a mental health illness to 100% of patients.

It is a Quality Improvement (QI) project. Baseline information on current practices were assessed against local fitness to drive policy of Leicestershire Partnership NHS Trust in May 2023. Data was collected from 10 inpatient (6 general adult & 4 old age) wards. All patients who were discharged in the month of January 2023 were included for audit. Information was collected about driving status of patients at time of admission, during their stay on ward, and if any advice regarding fitness to drive was given at time of discharge. Data was recorded anonymously. Results are reported in percentages for descriptive statistics.

Risk assessment was completed in 95% of patients on admission. About 12% (15/128) of the patients were driving at the time of admission, 80% of them were female. Assessment of driving risk during admission only took place in 11.7% (13/128) of cases. Advice on fitness to drive at time of discharge was given only in 12.5% (16/128) of cases. About ¼ of patients who were driving at time of admission, did not receive advice on fitness to drive at time of discharge from hospital.

There is a huge gap in clinical practice regarding compliance with fitness to drive policy. There is an urgent need to improve awareness among mental health teams that they have a role with regard to assessment of their patients’ risks and fitness to drive. An educational training video will be prepared and shared with clinicians in December 2023 to fill gaps in the service. Further information will be collected on practices related to fitness to drive policy in March 2024 for further evaluation of services.

Psychiatric services are under increasing pressure to provide effective patient care with diminishing resources. In NHS Lothian, there is a sector-based model and chronic issues with lack of inpatient beds.

We aim to examine the admission to discharge process at the Royal Edinburgh Hospital (REH) for patients within the North-West sector of Edinburgh (NW) to identify areas for improvement.

We collected data for NW admissions and discharges from the five General Adult Psychiatry wards in REH in 2023, two of which are allocated NW wards.

Admissions to the Intensive Psychiatric Care Unit were excluded as they indicated differing severity, and discharges via the ‘long-stay’ ward were excluded due to other factors delaying discharge.

Data was collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.

Qualitative data was collected anonymously from staff within NHS Lothian in the form of an online questionnaire to identify strengths and weaknesses of the current processes.

In 2023 there were 133 discharges of NW patients in REH. The average age was 39 years old and most common diagnosis was a psychotic illness (36%).

Qualitative data identified that admitting patients to hospital is increasingly challenging due to capacity issues and the lack of a community transfer plan.

53% of NW patients were admitted to NW wards. 27% of patients were moved between wards during their admission.

Length of stay (LOS) and readmission rates were used as proxy measures to examine patient outcomes. Patients who remained on the same ward during their admission had an average LOS of 28 days. 22% were re-admitted within the calendar year. Outcomes were no better when patients remained on their sector ward.

Patients who moved ward during their admission to hospital had an average LOS of 47 days. 45% were re-admitted.

A lack of bed capacity is having a negative impact on patient care in NHS Lothian. Staff expressed concerns about the admission process and patients are moving wards during acute episodes of care to accommodate a sector-based model and chronic lack of capacity. Lack of continuity during admissions may be contributing to longer admissions and more re-admissions, further impacting on capacity.

A review of the strategic planning of NHS Lothian Psychiatric care is required, including capacity planning, admission protocols and policies on boarding patients. We will disseminate these results to support this process and any future work into this topic.

This study aims to evaluate dietary history documentation by junior doctors in a psychiatric hospital setting in Scotland. With emerging evidence in nutrition psychiatry highlighting diet's impact on mental health, especially ultra-processed foods, this aspect often receives insufficient attention in clinical assessments. The audit benchmarks current documentation against UK Public Health nutritional guidelines and UK Parenteral & Enteral Nutrition Guidelines on Malnutrition, assessing adequacy and consistency across psychiatric diagnoses.

This audit conducted a systematic review of medical records in psychiatric wards, focusing on patients newly admitted over six months. The data collection examined admission sheets by junior doctors, covering patient identifiers, admission time, diagnosis, doctor's grade, and comprehensive details on dietary habits, eating behaviours, BMI, and substance use. The review incorporated a dietitian's input to align dietary assessments with UK Public Health Nutritional expectations and the prevention of Malnutrition Guidelines. The goal was to assess the regularity, quantity, variety, and documented changes in patients' dietary behaviours, screening for potential nutrient deficits, impacts of psychotropic medications, and eating disorder psychopathology.

The results showed significant deficiency in the detail and consistency of dietary history documentation across all wards, regardless of the doctors' grade or the patients' psychiatric diagnoses. Most entries were inadequately documented or entirely missing. A particular discrepancy was noted in documenting dietary habits in patients with low BMI or those on metabolic altering antipsychotics, which should necessitate health behavior change dietary interventions. Furthermore, even in severe psychiatric conditions, there was a gap in dietary documentation indicating a widespread oversight in recognising the potential relevance of nutrition in the overall health and treatment planning of psychiatric patients, regardless of the severity or type of their condition.

The audit reveals a gap in psychiatric patient care concerning detailed dietary relevance history documentation. While Scotland's wards routinely use the Malnutrition Universal Screening Tool (MUST) for identifying malnutrition, this tool often overlooks key dietary elements like variety, quantity, and regularity, which are vital for linking diet content to mental health. This oversight is significant given the burgeoning field of nutritional psychiatry. Our findings suggest the necessity for systemic changes to improve dietary history documentation in psychiatric settings. This includes a more structured and systematic approach, integrating insights into the harmful effects of ultra-processed foods on mental health, to provide holistic care.

Controlled physical restraint is a commonly used, but controversial practice in inpatient psychiatric settings, at times bringing psychiatric practice into potential conflict with accepted medical ethical standards for preserving autonomy and bodily-integrity. However, physical restraint can produce high levels of patient distress, re-traumatise those who have experienced physical or sexual abuse, and may lead to inadvertent bodily injury, and even death on rare occasions. There is an international consensus to attempt to reduce restrictive practices, including physical restraint, as demonstrated in the World Health Organization's Quality Rights Initiative. Post-restraint patient debriefing can promote recovery, prevent future restraint, and promote a more ethical and humanising care environment.

We aimed to audit the frequency of restraint events, and post-restraint debriefs offered to patients in a single, London-based, male acute psychiatric ward.

In the pre-intervention sample, data was extracted from the records of patients admitted over a six-month period (n = 75), to identify the number of patients who had undergone restraint and the number who had been debriefed. The search terms “restrain”, “PMVA”, “response team” and “debrief” were used. After each restraint event, the notes for the following two weeks were reviewed to see if a debrief was delivered.

The intervention consisted of a single description and dissemination of the results in a ward business meeting, with instruction that all staff members within the ward multidisciplinary team can help provide debrief if appropriate to do so. Where a patient was known to have been restrained, debriefs were offered during subsequent ward round reviews as appropriate.

In the post-intervention sample, we collected data from patients admitted over a 10-month period (n = 89).

We used Chi-Squared testing to compare categorical variables pre- and post-intervention.

Pre-intervention, 15 patients underwent restraint and of these, 8 patients (53.33%) were debriefed. Post-intervention, 21 patients underwent restraint and of these, 10 patients (47.62%) were debriefed. There was no statistical difference in the proportion of patients offered a psychological debrief (p = 0.735).

Following a single intervention there was not a sustained difference in the proportion of post-restraint debriefs offered. It is likely more sustained interventions would bring about more substantive practice change. Incorporating the need for post-restraint debriefs in daily ward safety-huddles, or in structured “ward round proformas”, may increase the proportion of patients offered post-restraint debriefing. It is possible that the note review strategy did not capture all debriefs delivered.

Discharge letters to general practitioners (GPs) are pertinent in summarising patients' care in secondary healthcare settings and communicating follow-up management plans for continuity of care. 26 GPs from 13 GP surgeries in the West Midlands thought that discharge letters lacked important information and standardisation. We developed a quality improvement (QI) project to standardise GP discharge summaries within the liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust. We aimed to ensure that 100% of GP discharge letters are written in a standardised format and meet the mandatory subheadings within six months.

A comprehensive literature search was performed, and we invited six GPs across Nottinghamshire to comment on the quality of anonymised discharge summaries written by our colleagues. After discussing the findings with our stakeholders, we developed a new discharge summary template with the subheadings of ‘Reason for Liaison Psychiatry Involvement’, ‘Summary’, ‘Diagnosis (if applicable)’, ‘Risk Formulation’, and ‘Treatment or Plan of Action’.

We held a team meeting and distributed a guidance document with scoring criteria for each subheading for our clinical colleagues to practise for two weeks. Subsequently, 75 discharge summaries were randomly selected and independently scored across seven weeks by an internal team member and an external QI data analyst to improve inter-rater reliability. 98 discharge summaries written six weeks before the new letter template was introduced were retrospectively scored for baseline measurement.

At baseline, the discharge summary scores ranged between 6 and 20 (out of a maximum of 20), depending on the individual completing them. The mean score was 12.3.

The implementation of the new discharge summary template improved the mean score to 19.0, irrespective of the author. The mean score was consistent across seven weeks.

Most of our colleagues did not face significant challenges in learning a new style of writing and for some, a standardised template reduced administrative time. The same GPs reviewed the new set of anonymised discharge summaries and were satisfied with the new summary format.

Formulating a standardised discharge summary template which adhered to professional guidelines was pivotal in improving the quality of GP discharge summaries. GP involvement throughout the project convinced stakeholders and colleagues to commit to a new writing template and tremendously helped achieve our project aim.

Aim 1: Identify the proportion of 11–19-year-olds in the Mental Health of Children and Young People 2017 survey screening positive for a possible eating problem, using the Development and Wellbeing Assessment.

Aim 2: Describe patterns of service contact in individuals screening positive for possible eating problems.

We used data from the Mental Health of Children and Young People 2017 survey, a stratified probability sample of children and their parents and teachers across England. The screening questions from the Eating Disorders module of the Development and Wellbeing Assessment (DAWBA) was completed by all children aged 11–19, all parents of children ages 11–16 and parents of children ages 17–19 where consent was given. Individuals were classified as screening positive for possible eating problems if they had one or more self-reported symptoms, or two or more parent-reported symptoms. We describe the proportion of individuals screening positive by age, sex, co-morbidities, and household income.

Individuals also answered questions about help seeking from different sources (in relation to any mental health concern). We classify these sources of support as informal, professional and specialist.

We analysed all data using Stata 17.

A total of 36.4% (95% CI 34.8, 38.1) of children and young people aged 11–17 in England screened positive for a possible eating problem, including 47.6% of females (95% CI 45.3, 50.0) and 25.6% of males (95% CI 23.7, 27.8). 60.7% (95% CI 57.9, 63.4) of individuals who screened positive reported that they received no help over the previous year; 13.1% (95% CI 11.2, 15.4) had received informal help only; 17.0% (95% CI 15.0, 19.3) had professional but not specialist help; and 9.13% (95% CI 7.67, 10.9) had received specialist help. High proportions of individuals who received support from formal services during the year prior to the survey screened positive for possible eating problems: 42.7% (95% CI 38.6, 47.0) for teachers, 46.9% (95% CI 40.9, 53.0) for GPs, 32.2% (95% CI 23.1, 42.9) for Paediatrics and Child Health and 50.0% (95% CI 43.1, 56.8) for Mental Health Services.

Despite high numbers of young people screening positive for a possible eating problem, rates of help seeking in this group were low. Conversely, high proportions of those seeking professional help have a possible eating problem.

Clinicians should be aware of the high proportions of individuals with possible eating problems accessing their services. Future research should aim to increase help seeking in individuals with possible eating problems.

To identify the patterns of psychiatric help seeking behaviour among patients with psychotic illness presenting to mental health institute in Pakistan.

This Descriptive, Cross-Sectional Design comprised of a sample of 103 patients with psychotic diseases, chosen via non-probability – consecutive sampling at Outpatient Department of Sir Cowasjee Jehangir Institute of Psychiatry, Hyderabad. The relatives of psychotic patients who were between 18 and 65 years of age with either gender and living with at least one family member were interviewed after taking informed written consent. An anonymous self-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, psychiatric diagnosis and disease particulars, pattern of help seeking and time and reasons for delay.

The mean age of the sample stood at 32 years (±9.5 SD). 1/3 of the sample comprised of male patients while only 24% were comprised of female population. The mean time elapsed after first episode psychosis till interview was 82 ± 32 months (7 years) while mean delay in help seeking to any helper was reported to be 41 ± 17 months (3.5 years). Majority of the patients approached first to faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) while only 1/5 of the patients approached to psychiatrists for treatment of first psychotic episode. The mean time duration to approach to psychiatrist after first episode psychosis was reported to be 73 ± 38 months (around 6 years).

The study showed that most frequent source of health care for psychiatric patients were faith healers (Aamil Baba, Witch Doctor, Pir, Religious Leader, Molvi, Imam or Religious Cleric) as compared with one-third who went to qualified healthcare providers like psychiatrists or physicians. There is a huge delay in proper help seeking among psychiatric patients. Health education aiming at increasing awareness among general population regarding treatment options for psychiatric illness is recommended to improve the quality of life of people living in our locality.

Catatonia is a rare neuropsychiatric syndrome in children. It is characterised by mutism, stupor, posturing, negativism, and rigidity. Historically, catatonia was associated only with psychosis, however catatonic symptoms are being recognised as more prevalent in people with Autism Spectrum Disorder (ASD). Our case report highlights the importance of investigating the potential underlying psychopathology and/or neurodevelopmental condition as this may guide management.

We present a case of a boy in early adolescence who was admitted to the Emergency Department for abnormal slowing of movement and stuttered speech. He described losing all interest in his hobbies, lying down for long periods of time, sometimes being unresponsive and ‘freezing’ in place. On examination, his symptoms were consistent with catatonia: mutism, grimacing, abnormal gait, and ambitendency were all present. He was investigated extensively to rule out medical and neurological causes, all of which were normal. He was assessed and managed by the Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD). After appropriate treatment, he was discharged from the hospital and was managed jointly by CIPPRD and the local Child and Adolescent Mental Health Service (CAMHS). This assessment revealed that the presentation of catatonia occurred during a depressive episode on a background of ASD and underlying Intellectual Disability. He was prescribed fluoxetine as opposed to benzodiazepines or antipsychotics, which led to the catatonic symptoms receding. The neurodevelopmental review revealed that his pattern of social communication and speech after catatonia improvement was consistent with ASD, which was then formally diagnosed.

Untreated catatonia can be fatal. Early diagnosis and management are crucial to avoiding complications. Our case report highlights the challenge of treating paediatric catatonia and the diagnostic and therapeutic importance of understanding underlying psychopathology to decide treatment. Studies have shown that in this population, assessing and treating the underlying psychopathology as opposed to sole use of the lorazepam is essential.

Catatonia in paediatric and adolescent populations may be a first presentation of emotional and behavioural problems underlying autism spectrum disorder (ASD). When treating catatonia, consideration of the underlying psychopathology may warrant alternative pharmacological treatments to the traditional lorazepam challenge test and antipsychotics. The course of catatonia and associated comorbid affective and/or psychotic disorders may fluctuate with environment and therefore a biopsychosocial therapeutic model is warranted.

Obesity and mental health are significant global health concerns. Evidence has linked increased adiposity with depression and well-being; however, there is limited documented evidence in Ireland. Research also suggests that lifestyle factors and disease conditions are related to mental health. These may modulate relationships between adiposity and depression and well-being. The aim of this study was to examine associations between mental health scores and adiposity defined using body mass index (BMI) and waist-height ratio, and subsequently determine whether significant relationships persist following adjustment for lifestyle factors and common disease conditions.

This was a cross-sectional study of 1,821 men and women aged 46–73 years, randomly selected from a large primary care centre. Depression and well-being were assessed using the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D) and the World Health Organization-Five (WHO-5) Well-Being Index. Linear regression analyses were performed to examine relationships between mental health scores (dependent variable) and adiposity defined using BMI and waist-height ratio (independent variable), while adjusting for demographic characteristics, lifestyle factors and disease conditions. These demographic, lifestyle and disease factors included gender, age, education, smoking status, alcohol intake, physical activity levels, dietary quality, type 2 diabetes, cardiovascular disease and cancer.

BMI and waist-height ratio had a significant positive association with depression scores and a significant inverse association with well-being scores in males and females. These associations were maintained following adjustment for demographic variables and lifestyle factors. In final models where disease conditions were adjusted for, BMI (β = 0.743, p <0.001) and waist-height ratio (β = 0.719, p <0.001) associations with the CES-D score remained significant. In stratified analyses, relationships between measures of adiposity and depression were found to be stronger in females (BMI: β = 0.806, p = 0.007; waist-height ratio: β = 0.768, p = 0.01) than males (BMI: β = 0.573, p = 0.049; waist-height ratio: β = 0.593, p = 0.044) but no effect modification was identified.

This study demonstrates a significant association between increased adiposity and poorer mental health in a middle- to older-aged population, which is in agreement with previous evidence. In addition, these findings suggest that the positive relationship between adiposity and depression is independent of lifestyle factors and disease conditions and is stronger in females. Targeted interventions for reducing depression should include better weight management population-level measures, particularly in the female population.

This poster will:

1. 1. Describe the establishment of an acute crisis management service within a Child and Adolescent Mental Health Service (CAMHS) in the Republic of Ireland.

2. 2. Summarise clinical activity during the first six months of the service and qualitative feedback from service users and clinicians on their experience of the service.

In December 2021 the Republic of Ireland Health Service Executive approved the roll out of acute crisis management services for CAMHS – known as Hubs, with a remit to provide intensive brief interventions to support young people experiencing acute Psychiatric crises. Multiple weekly appointments are provided in clinic, at home or via telehealth.

The Lucena Clinic CAMHS – based in Counties Dublin and Wicklow, was chosen as a pilot site. Staff were recruited in January 2023 consisting of:

1. 1 FTE Consultant Child and Adolescent Psychiatrist

2. 1 Candidate Advance Nurse Practitioner

3. 1 Senior Social Worker

4. 1 Senior Occupation Therapist

5. 1 Administrator

A multi-disciplinary Steering Group was established with a view to planning clinical programs, ensuring safety and governance, procuring resources and embedding service evaluation.

The service went live in May 2023. Clinical data was gained from data entry to the service Electronic Patient Record.

Qualitative feedback was gained from service users using post-discharge questionnaires and from clinicians using semi-structured interview.

1. 1. Between May and December 2023 the Hub received 61 referrals and accepted 35.

2. 2. 27 of those accepted were new referrals to the service.

3. 3. Patients received an average of 27.1 hours of clinical intervention during their admission.

4. 4. Shortest admission was 10 hrs, the longest 66.5 hrs.

5. 5. 6 young people were seen at home, totalling 41 visits.

6. 6. 24 young people were discharged to CAMHS, 2 to GP, 2 to the clinic's Day Program, 3 required in-patient admission.

Service user feedback was positive with families highlighting ease of access to the service, intensity of intervention and a friendly environment as positives.

One parent remarked that they did not feel the Hub was the right setting for their child's care.

Clinician feedback highlighted the Hub as a positive support for community CAMHS with rapid access to intervention and communication from the Hub team mentioned as positives. One drawback identified was the intensity of intervention setting an unrealistic expectation for ongoing care.

The Hub appears a welcome addition to CAMHS with positive feedback from service users and clinicians. Ongoing development phase and evaluation is required.

Emotional Intelligence (EI) is a skill that can help doctors be more effective leaders, work well with others and display the ability of self-control in stressful situations so one is able to act in a calm and rational manner. It is defined as the awareness of one's own emotions and emotions in others and how this affects behaviour. It is a skill that can be developed to allow doctors to manage their emotions to support personal strengths, solve problems and influence the performance of others for positive outcomes.

In the new Core psychiatry curriculum, under 5.1 Team work, trainees are to demonstrate an awareness of how individual personal qualities, emotions and behaviours of both yourself and your team, impact on teamworking and the quality of patient care.

The aim of the workshop was to uncover the definition, science and core components of EI, to reflect on one's own EI and to commit to developing an action plan for building EI skill.

4 small group-based interactive virtual workshops took place on a monthly basis from September 2022 till December 2022. They were facilitated by a Psychiatry Higher Trainee Emotional Intelligence Practitioner. 28 Black Country Healthcare NHS Foundation trust Core trainees (CT1-CT3) were invited. 60% (17) of trainees attended the 1 hour workshop and completed anonymous feedback at the end of the workshop.

94% of attendees completed anonymous post-workshop feedback. The results showed the following: 100% agreed that the workshop clearly stated and met the objectives, 100% agreed that the workshop covered useful material, 100% felt that it was practical to needs and interests of trainees, 100% felt it was applicable to professional and personal life including mental wellbeing, 100% agreed that the workshop enabled them to reflect on EI skills that can be applied to work, 94% felt that the workshop is relevant and useful to doctors and 100% of participants would recommend this workshop to Psychiatry Doctors and Doctors from other specialities.

It can be concluded that all CT doctors who participated in the EI workshops found them helpful and relevant within their Core Psychiatry Training Programme. All participants found the benefits applicable to both professional and personal life as well as enhancing mental wellbeing. This is reflected by the positive and encouraging anonymous feedback results. Developing awareness of emotions and self-awareness is part of the new Psychiatry curriculum and therefore some teaching/training should be made available to trainee doctors.

Clinical guidance indicates that methadone doses of 60–120mg are therapeutic as opioid substitution therapy (OST). Audit was completed to understand why patients open to Newcastle Treatment and Recovery (Addictions) are being prescribed doses below 60mg and to identify areas for improvement.

285 patients were identified via prescription software as currently prescribed <60mg methadone. A random sample of 50 cases was obtained for audit during signing of routine prescriptions. Case sample was adjusted to ensure even distribution between keyworkers. Review then completed of prescribing card and clinical entries in the last 6 months. Standards included reason for subtherapeutic dosing and evidence of instability with use of illicit opioids, or other substances (excluding alcohol or cannabis), alongside secondary outcomes.

54% of cases were found to currently be undergoing a change in their dose – mostly reducing though 2 increasing and 2 preparing to switch to buprenorphine. The remaining 46% were maintained on a consistent dose of methadone below 60mg. Of these 8 were advised to change their dose but this was declined. The remaining 15 had no additional advice recorded and remained on sub-therapeutic dose. Of 50 cases 8 were unstable with regards illicit opioid use, 21 were using other substances (1 gabapentin with the remaining using cocaine). For those using illicit opioids 63% were advised of an increase but declined whilst 25% were not advised of any change in their OST. Of those using other substances 48% had no change in OST considered whilst a further 10% continued with a reduction.

The audit found that a proportion of cases prescribed a sub-therapeutic dose were being maintained on this dose. Most concerning was the proportion of patients who were not advised to increase despite use of illicit opioids but also the proportion who were not following advice from their keyworker. Additional concerns highlighted uncertainty in practice around the role of OST in those who remain using other substances, in particular cocaine. Department of Health guidance recommends that doses in these cases should be optimised which would mean at least targeting therapeutic range. Recommendations made included to develop further training to ensure consistency of practice as well as requiring that all patients on sub-therapeutic doses of methadone should be booked for strategic care plan reviews at a minimum of 6 monthly.

To improve the quality of care received by service users of Electroconvulsive Therapy (ECT) treatment in Lincolnshire Partnership Foundation Trust (LPFT) by measuring the compliance of the local ECT clinic in Lincolnshire in accordance with National Institute of clinical excellence guidance and ECT accreditation services standards.

Pre-audit work up includes consultations with ECT clinic lead and stake holders to ensure ethical and governance standard are met. This audit is conducted with the permission of trust quality and safety team.

Sample population is identified from ECT clinic registry, Lincoln. A total of 10 patients who received ECT treatment between January 2023 and August 2023 are included regardless whether the necessary information is available on the clinical system or not, to minimise selection bias. Retrospective data collection by using Rio electronic case records. Descriptive analysis of data using Microsoft Excel and evaluation of results is based on 3 key domains such as indication, consent process and monitoring.

A total of 10 service users, comprising 30% males and 70% females, underwent treatment in both inpatient (80%) and outpatient (20%) settings, primarily for severe depressive illness. In 70% of cases, a pre-ECT assessment was documented to evaluate potential risks and benefits. The consent procedure was completed by a psychiatrist in 70% of instances. However, ongoing consent was not consistently reviewed at each ECT treatment.

Baseline monitoring using the Clinical Global Impression and Comprehensive Psychopathological Rating Scale was conducted in 20% of cases, with no follow-up assessments performed after each treatment. The Montgomery–Åsberg Depression Rating Scale was employed at baseline for 40% of patients, yet there was no evidence of weekly monitoring. While the Montreal Cognitive Assessment was administered to all patients at baseline, it was not conducted after every four treatments.

Post-ECT follow-up data revealed that less than a quarter of patients underwent clinician reviews. Validated rating scales were utilized in no more than a fifth of patients at both one week and two months after treatment.

The findings suggest the need for improved documentation of the entire consent process and in regularly assessing the ongoing validity of consent. Moreover, there is a need for stronger monitoring at baseline, during, and after ECT treatment. It is recommended to revise the local ECT record pathway by December 2023, with a follow-up re-audit scheduled for March 2024 to evaluate the effectiveness of the implemented changes.

While dopamine antagonists are an effective treatment for positive psychotic symptoms, they are rarely effective when it comes to treating the cognitive (memory, learning, planning, etc.) and negative (avolition and social withdrawal) symptoms of the disorder. Furthermore, for a sizeable proportion, standard dopamine antagonists are not effective for positive symptoms either. As such, refractory symptoms are a major burden for patients, carers, and clinical services.

To address this, The TUNE-UP (Treating Unmet Needs in Psychiatry) clinic in Oxford was established in September 2023 as an innovative solution aiming to: (A) Undertake an in-depth assessment of cognitive, negative, and positive symptoms; (B) Identify potentially modifiable causative factors contributing to refractory symptoms (e.g., cholinergic burden, sleep disturbances, physical comorbidities, affective symptoms); and (C) Implement management plans including community clozapine initiation where appropriate. We have analysed data from the clinic's initial five months of operation to establish a baseline understanding of our patient population and identify trends in symptoms.

In the first five months of operations, 21 referrals were accepted comprising 80.9% males (mean age 43.3 years, SD 13.7). 3 were referred for cognitive symptoms, 1 for negative and cognitive symptoms, 11 for positive symptoms, 3 for medication optimisation, and 3 for clozapine re-titration. Of those fully assessed (N = 17), mean total symptom scores measured using the Positive and Negative Syndrome Scale (PANSS) were of mild/moderate severity (70.5, SD 18.4). Objective cognitive testing via the Screen for Cognitive Impairment in Psychiatry (SCIP) demonstrated a total mean score of 54.1 (SD 12.1), markedly below what would be expected in a matched control population (76.3). Cognitive scores were lower in those of older age (r = −0.62, p = 0.01). Subjective experience of cognitive impairment was measured using the Subjective Scale to Investigate Cognition in Schizophrenia, poor subjective cognition was associated with more severe negative symptoms (r = 0.57, p = 0.03), but not objective SCIP results (r = 0.12, p = 0.85).

Refractory positive symptoms remain a priority for clinicians, but cognitive and negative symptoms are highly prevalent reinforcing the need for a comprehensive approach. Routine structured assessment of all symptom domains is feasible in clinical practice. Future work should examine the longitudinal impact of various interventions on different symptom domains.

Internet gaming disorder (IGD) is a recognised mental health condition characterised by impulsive gaming, where gaming takes precedence over all other activities and negatively impacts the life of a person. IGD has an estimated prevalence of 2–5% of all mental health disorders. Limited research exists on the treatment effects of various therapeutic interventions for gaming disorder, highlighting the need for comprehensive investigations of evidence-based approaches and to improve intervention strategies.

This systematic review aims to identify most of the intervention studies on internet gaming disorder using a control group, to determine the effect of the interventions and to examine moderators for these interventions.

We reviewed available treatment interventions for children and adolescents. A search on Pubmed central, PsycINFO, Embase, MEDLINE, Cochrane, CINAHL and Google Scholar Library was conducted. Various interventions, whether individual or group-based, incorporate Cognitive Behavioural Therapy (CBT), family therapy and pharmacological treatments for gaming disorder and these were selected for this review among all the other interventions examined. Some exclusively use CBT, while others combine it with different treatments. This includes both online and in-person CBT, encompassing behavioural including limited exposure and cognitive elements.

The comprehensive search resulted in 113 studies from 2018–2023 and we ended up with 25 studies by excluding studies according to the exclusion criteria.

This systematic review identified a total of 113 studies, of which 25 studies were finally selected and were included. It examined interventions for internet gaming disorder (IGD). Cognitive Behavioural Therapy (CBT), Family Therapy, and Psychopharmacological treatments were assessed across diverse studies.

Findings indicate significant improvements post-intervention, with CBT and family therapy showing promising results in reducing IGD symptoms. Pharmacotherapy combined with psychotherapy emerged as the most effective treatment option. The study underscores the need for multifaceted approaches in addressing IGD, contributing valuable insights for future treatment strategies.

The review highlights promising outcomes for Internet Gaming Disorder interventions, with Cognitive Behavioural Therapy and Family Therapy demonstrating effectiveness. Combining pharmacotherapy with psychotherapy is most beneficial, emphasising the importance of comprehensive treatments needed for IGDs.

Our previous findings challenged the widely held view among a large proportion of psychiatrists (41% to 82%) that previous non-adherence to antipsychotics is a major barrier to the introduction of clozapine (Brodeur et al. 2022 BJPsych). Indeed, our previous work showed that most patients, even those with the poorest adherence profiles, remained on their treatment after clozapine initiation (>68% for clozapine and >84% for all antipsychotics combined) after one year of follow-up. Because of this, the study extended the follow-up period to three years to assess whether patterns of adherence were sustained over time. Therefore, this study aimed to determine whether poor adherence prior to initiating clozapine predicted poor adherence to clozapine or any other antipsychotic (including clozapine) three years after initiation.

This cohort study included 2,258 patients living in Quebec (Canada) with a diagnosis of SCZ who initiated oral clozapine between 2009 and 2016 (index date). Adherence to AP was measured by the medication possession ratio (MPR) over a 1-year period before and a 3-year period after the index date. Five groups of patients were formed based on their prior MPR level (independent variable), and two dependent variables were defined after clozapine initiation (good adherence (MPR ≥ 0.8) to any APs and to clozapine only). In addition to multiple logistic regression, state sequence analysis was used to visualise the trajectories of AP use over time, before and after clozapine initiation, for each group.

The graphical representation of the SSA immediately showed that AP adherence was significantly improved in all groups, regardless of the level of previous adherence to AP treatment. On the other hand, logistic regression showed that poorer adherence to APs before the index date was significantly associated with an increased risk of poor adherence to any AP treatment 3 years after the index date (adjusted ORs ranging from 2.2 to 3.0). However, the majority of patients (ranging from 80.8% to 92.4%) had good adherence to any APs and to oral clozapine (ranging from 57.7% to 73.8%), regardless of previous adherence level.

These results add to previous findings and demonstrate that initiation of clozapine leads to improved adherence over a 3-year period. Although widely recognised by clinicians as a barrier to clozapine use, previous poor adherence does not appear to justify avoiding clozapine treatment in patients who would otherwise be considered eligible.