The younger generation of today is highly dependent on digital technologies worldwide. Studies on young children's cognitive and socio-emotional development have shown that there can be conflicting effects from using screen-based media or from exposing them to it. The study explored the relation between unsupervised use of digital screen time with student mental health and behavioral problems.

It was a cross sectional descriptive study approached primary and secondary school going children from grades 2–8 (age 6 to 14 years), purposively selected six schools consist of three English and Bangla medium schools from Dhaka city. A total of 420 students along with their parents were enrolled by clustered random sampling. Study explored the effect of the unsupervised screen time on student mental health and social wellbeing through semi structured questionnaires, Strength and Difficulties Questionnaire (SDQ), Pittsburgh Quality of Sleep Scale (PSQI), Spencer Children Anxiety Scale (SCAS) and Development and Wellbeing Assessment Scale (DAWBA).

Students used various forms of digital screens for 4.6 hours every day, and 56% of them used these devices without parental supervision or monitoring. English Medium students spend significantly more time on screens on a daily average (5.5 hours) compared with students at Bangla Medium schools (3.7 hours). 21.2% students had mental health concern, this percentage was higher in the unsupervised group (56.2%) than in the supervised group (43.8%). In the unsupervised group, students experienced higher levels of emotional difficulties (15.7%), behavioral difficulties (28.3%), hyperactivity behavior difficulties (17.4%), peer relations difficulties (28.8%), and pro-social behavior difficulties (6.7%) compared with supervised group. 83.3% of students in the supervised group found higher levels of anxiety compared with the unsupervised group (16.7). In the unsupervised group, 15.4% of the students had experienced sleeping problems, compared with 14% in the supervised group.

These results suggest an impact of unsupervised screen time on the prevalence of mental health problems among students. Appropriate screen usage may be a major intervention target to improve children's mental health and wellbeing.

Rapid Tranquillisation (RT) is the administration of parenteral sedation to de-escalate situations where patients may harm themselves and/or others. RT is a restrictive intervention potentially breaching patients’ human rights and is reserved for situations where other measures have failed. NICE guidelines (NG10) state that once immediate risks are managed, post-RT incident debriefing of patients and staff should be conducted. This study examines concordance with NG10 at an adult inpatient psychiatric unit and explores ways to improve compliance and patient/staff experience.

Adult psychiatric inpatients (aged 18–65) who received single or multiple RT therapy during the admission study period (October 2023) were included. Data collected from Electronic Patient Records and chart review included gender, age, ward type, date of RT and drug(s) administered. Following RT, anonymised data was collected on the presence, nature and details of debriefing.

49 adult psychiatry patients were admitted during the study period and there were 32 episodes of RT use in 9 patients (18.4% of inpatients). 56.7% of these occurred on general wards and 43.8% on psychiatry intensive care, with 6 patients (66.7%) >1 episode. Intramuscular drugs used included one or more of lorazepam (78.1% of patients), haloperidol (25%), promethazine (21.9%) and aripiprazole (9.4%). After 46.9% (15/32) of RT episodes debrief was offered, and occurred in 28.1% (9/32); 40% (6/15) of those offered debrief did not participate. 52.4% (11/21) of female patients were offered debrief with 81.8% (9/11) uptake, compared with 36.3% (4/11) of male patients offered with 25% (1/4) uptake. No accounts were taken from patients’ advocate, carer or witnesses. Details of debriefs conducted were documented in 33.3% (3/9). Reasons for not conducting debriefing were documented in 43.5% (10/23). The most common reason given was “not clinically appropriate”. During debriefs, no patients were offered information leaflets about the RT medication used. Finally, staff debriefing occurred in 31.3% (10/32) of episodes.

Compliance with NG10 guidelines for debriefing inpatients following RT was low and was worse in male than female patients. Staff debriefing was poor and no witness or advocate accounts were utilised. These findings may be due to the stressful ward environment or disrupted patient-professional relationship immediately following RT administration. Understanding the reasons for the gender differences in uptake, patient, staff or environmental factors contributing to lack of debriefing will allow interventions and improve holistic patient care following RT. Information and awareness of RT therapy should be available for patients more readily on ward admission and following RT.

Pharmacological treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) is of limited benefit. The addition of non-pharmacological interventions is often essential for optimal symptom control. Music is a viable way to help patients communicate and improve quality of life. This study aims to find the most effective way to use music on a busy dementia ward.

17 inpatients (aged 63–93 years) took part over a five-week period. Music with projected lyrics was individualised and based on their preferences. Instruments (e.g., maracas) were used in some group sessions. We used the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Music in Dementia Assessment Scales (MiDAS) to evaluate patients’ behaviour before and after musical intervention.

Of NPI-Q scores, a significant difference between mean scores before and after the music intervention was found. Specifically, Delusion, Motor Disturbances, and Agitation scores were significantly reduced after music intervention. Of MiDAS, significant differences were found in Interest, Response, and Enjoyment during specific intervals.

A multisensory inpatient environment was effective in delivering music-based activities and managed behavioural symptoms in the short term to people with advanced dementia. Its use for inpatient wards must be further investigated as an economical and personalised non-pharmacological therapeutic tool for patients with dementia.

Dementia is a debilitating neurodegenerative disorder that can negatively impact the lives of those affected and their families. Providing safe and person-centered care for individuals living with dementia is a global need with particular emphasis on providing individuals and their families with a rapid diagnosis of their condition following the commencement of symptoms. This study aimed to establish the mean duration of cognitive symptoms before a formal diagnosis of dementia is given in the United Arab Emirates (UAE). We also studied demographic and symptom-specific factors affecting the time for dementia to be formally diagnosed. Our study examined a global issue through a more localized lens to identify areas for improvement.

The study involved extracting and analyzing anonymous data from the electronic medical records of dementia patients at Al-Ain Hospital, UAE. Following ethical approval, the data for individuals diagnosed with any form of dementia from 01/01/2010 to 31/12/2019 were extracted using a set of related diagnostic codes. A short questionnaire was completed for every record that matched the search criteria. Demographic information was collected in addition to details of diagnosis, presenting symptoms, comorbidities, and medications.

A two-tailed independent t-test was conducted to assess the effect of demographic characteristics (gender, nationality, and age) on the time to receive a diagnosis of dementia. A one-way ANOVA was conducted to assess the effect of initial symptoms, including forgetfulness, agitation/aggression, and hallucinations, on the time taken to receive a diagnosis.

Out of the total sample of 825, 442 (53.6%) were females, with 518 (63%) being Emirati citizens. The mean age of the studied sample at the time of diagnosis was 78 years (SD = 11.1). Alzheimer's dementia, 335 (40.6%), was the most common subtype diagnosed. The mean duration of symptoms (DUS) before formal diagnosis was 34.6 months (SD = 28.8). A statistically significant relationship was found between age and DUS, with those over 70 years of age at the time of diagnosis more likely to have a longer DUS (p < 0.001). There was a statistically significant mean difference in the DUS and some initial symptoms, namely agitation/aggression(p < 0.001), lability (p < 0.003), disinhibition (p < 0.001), and hallucinations (p < 0.001).

To our knowledge, this is the first study of its kind in the UAE. Future investigation in this area is much needed, and this study will provide the foundations for dementia awareness campaigns encouraging early presentation to the services.

No financial sponsorship has been received for this study.

Lewy Body Dementia (LBD) is the second commonest dementia. It accounts for around 7% of dementia cases in secondary care. Studies have shown that LBD patients have an accelerated trajectory towards death when compared with other forms of dementia. Studies have suggested that LBD cases, as compared with Alzheimer dementia, have accelerated cognitive decline, more comorbid conditions, a higher mortality rate, greater service use and poorer quality of life. Most previous studies of LBD have been based on select research cohorts, so less is known about the naturalistic patterns, characteristics, and outcomes of the disease in routine clinical settings.

The aim of the study is to determine the average duration from the time of diagnosis to death among patients with Lewy body dementia in OPMH to understand the prognostic pattern of LBD in our locality.

Objectives

1. 1. To determine the commonest age of diagnosis and death of patients diagnosed with LBD in OPMH.

2. 2. To explore sociodemographic distribution of patients within the study population.

3. 3. To determine the time from diagnosis to death of patients diagnosed with LBD in OPHM.

4. 4. To determine the common psychotropics combinations used in management of LBD in our psychogeriatric unit.

This is a retrospective cross-sectional study of all the patients with diagnosis of LBD that presented to Humber Older People Mental Health Services in Hull. The sample consisted of electronic records of all 39 patients under the team but only 38 met the inclusion criteria. Patients’ records were reviewed and information such as gender, ethnicity, age at diagnosis, age at death or age at recruitment if alive, and psychotropic medication they are/were on was retrieved from the records. The time from diagnosis to death was obtained by subtracting age at diagnosis from age at death and this is recorded in years.

The result showed that majority of our patients were male and about 68.4% of our patients received their diagnosis between the age of 70 and 84 years and that 59.3% of them died within 5 years of receiving their diagnosis. The result also showed that the commonest psychotropic prescribed for LBD patients were single anticholinesterase inhibitor (donepezil or rivastigmine).

This study showed that majority of patients died within 5 years of receiving their diagnosis of Lewy body dementia. This underscores the fatality and mortality associated with Lewy body dementia. More needs to be done in developing strategies to ensure improved awareness of Lewy body dementia in our community.

In a recent national study in India, 35% of women reported experiencing domestic violence. The association between domestic violence and mental health outcomes especially suicidal risk has been less studied in Asia especially in India. With this context in mind, we aimed to establish a preliminary prevalence of suicidal risk in women reporting domestic violence using self-injurious thoughts and behaviors as proxy measures. We also wanted to probe the feasibility of assessing suicidal risk in a community center for vulnerable women with limited access to referral care and to determine the acceptability of safety plans as well as referral to a hospital setting for women with increased suicidal risk.

A single center cross-sectional pilot study was conducted among 50 females who have officially reported Domestic Violence. The participants had reported this domestic violence to a ‘SHE Teams’ center in Telangana state, India, which is a women safety surveillance initiative launched by the state government. HARK (Humiliation, Afraid, Rape, Kick) questionnaire to assess the type of domestic violence experienced and SITBI (Self Injurious Thoughts and Behaviors Interview) questionnaire to evaluate the type of self-harm in victims were used.

It was found that 100% of the study population experienced emotional abuse, 50% sexual abuse, 74% physical abuse and 80% of them were afraid of their partners. It was also found that 64% had suicidal ideation, 40% had made a suicidal plan, 22% made suicidal gestures, 34% have attempted to commit suicide at least once. 12% had thoughts of Non-Suicidal Self Injury and 10% have committed Non-Suicidal Self Injury. Women who were unemployed and those who were harassed for dowry/endowment by the spouse or spouse's family had a statistically significant association with elevated suicidal risk. 17 participants were referred to a psychiatrist in the nearby hospital and 32 requested for shelter in fear of future violence.

Domestic violence is a risk factor for poor mental health among women and suicide is one of the main causes of premature death in this population. To prevent more suicides in women, identifying risk and referral of domestic violence victims should be an essential part of health care systems apart from adequate legal support. This pilot study provides preliminary data for a future study of risk factors mediating suicidal risk in women who are victims of domestic violence and to develop targeted interventions as well.

In patients with cognitive impairment, it is important to assess the possible impact of medications on cognition. Levetiracetam is an antiepileptic medication used in the management of epilepsy. Its effect on cognition is unclear.

We present a case study of a 57-year-old female who developed cognitive impairment associated with levetiracetam.

She was referred to Memory Services from her GP due to cognitive impairment. Her past medical history included an optic nerve glioma which was surgically removed followed by radiotherapy, and meningiomas which were managed with stereotactic radiosurgery. She had no previous psychiatric history.

Following a first seizure, she was started on levetiracetam 250 mg BD. Over the following months, she developed worsening symptoms of poor memory, fatigue and lethargy, sleeping excessively, headaches, and subsequently, low mood and occasional suicidal thoughts. Levetiracetam dose was halved. When seen in Memory Services 3 months later, it was reported that there had been a gradual but partial improvement in her symptoms since the dose reduction. Addenbrooke's Cognitive Examination (ACE-III) score was 67/100. Short form mood scale was 3/15, below the threshold for depression. Blood tests were normal. MRI Head showed meningiomas and diffuse white matter hyperintensities, both unchanged from previous imaging.

The patient then started lamotrigine and stopped levetiracetam. On follow up (2 months after initial memory assessment), ACE-III score improved to 80/100 and it was reported that her symptoms had completely resolved.

In this case, there is evidence to support a causal link between levetiracetam and the patient's cognitive impairment – there was a temporal relationship, dose response relationship, and reversibility, which are all in the Bradford Hill criteria for causation. Other causes were considered and deemed less likely, including depression; the mood symptoms were not the predominant symptoms and developed after the other symptoms, and the patient scored below the threshold score for depression on short form mood scale.

Regarding the aetiology in this case, one hypothesis is that there may have been risk factors that made this patient more susceptible to cognitive side effects from the biological effects of levetiracetam, such as previous neurosurgery and radiosurgery. Another hypothesis is that the levetiracetam may have triggered an atypical depressive episode which manifested predominantly with memory symptoms and tiredness.

This case study highlights the importance of reviewing medications when assessing cognitive impairment, and of obtaining a clear timeline of symptoms. There is a need for further research looking at the effect of levetiracetam on cognition.

Pro re Nata (PRN) psychotropic medication prescription and administration play a crucial role in addressing patients’ immediate needs and medical care plans in acute mental health services. However, regarding the appropriate indication, use, and documentation of PRN medication prescription, review, and administration practices should be as per NICE guidelines to ensure patient safety and care quality.

This audit will encompass an evaluation of PRN medication prescription in acute inpatient psychiatry as per NICE guidelines and a reaudit after recommendations implementation.

We made 8 sets of questionnaires based on The National Institute for Health and Care Excellence (NICE) guidelines recommendation for PRN prescription as per local trust policy. We collected data from 28 patients in the acute inpatient mental health unit for the first cycle. Data was collected from patients' records which included medicine charts, progress notes, and MDT reviews. We analyzed data from the first cycle and implemented changes in Clinical practice. This includes including these guidelines in junior doctor induction, weekly discussion with team pharmacist, adding prompts in medication chart, and weekly review of PRN medication in ward MDT. After 2 months we collected data of 25 patients for reaudit.

We analyzed first-cycle data, which required improvement as per AUDIT standard compliance. We implemented recommendations before reaudit. We found there were significant improvements in some areas of concern, although this was not 100 percent audit standard. This area includes a review of PRN medication prescriptions in the last 7 days (25 percent in the first cycle, 56 percent in reaudit), grouping them if both oral and intramuscular formulations were prescribed to avoid overdose (7.2 percent, 28 percent), documentation of minimum (10.7 percent, 24 percent) and maximum dose (100 percent, 100 percent) of PRN within 24 hours, documentation of indication (100 percent, 96 percent).

The findings of this audit and recommendations after the first cycle of audit contribute to enhancing quality of PRN medication prescription practice in acute inpatient mental health services for health care professionals. Addressing potential areas of prescription, administration, and review and providing valuable recommendations and insight for improvement of patient safety and best clinical practice.

The aim of this audit was to review the availability of recommended resuscitation equipment in Prospect Park Hospital (PPH), a psychiatric hospital based in Berkshire.

The objective was to improve patient safety standards and address staff concerns by ensuring that recommended resuscitation equipment was accessible and fit for purpose.

Our hypothesis was that the current standard of resuscitation equipment at PPH was unsatisfactory.

Background

This review followed concerns by doctors who struggled to obtain the necessary equipment required for emergency situations, particularly during their out of hours shifts.

This project was significant as within the previous year there had been two incident reports and extensive anecdotal evidence of equipment failure/absence.

Whilst each ward had been tasked with completing a weekly checklist issued by the Resuscitation team, these had not been audited to ensure that standards were being met.

Data was collected from ten locations at Prospect Park Hospital from 9th May to 15th May 2023.

Information was obtained by two doctors visiting the specified wards, reviewing the resuscitation bag equipment based on the standardised checklist.

The standards used were from local trust policy and Resuscitation Council UK policy.

7/10 locations did not meet the standards for resuscitation equipment, including missing or expired equipment such as adrenaline, suction devices and oxygen masks.

4/10 wards had not completed the weekly emergency drug checklist within the stipulated time frame.

70% of staff completed checklists were incorrect.

Our hypothesis was proven to be correct, in that the current standard of resuscitation equipment at PPH was unsatisfactory.

We worked closely with the Resuscitation lead to recommend improvements, including an updated, more detailed checklist, a standardised procedure for ward managers and regular future audits.

Due to the significance of the findings, this has since been re-audited and is in the process of being rolled out Trust-wide, including all inpatient and community settings.

As a result of this audit, the Resuscitation team have been granted additional staffing to action these changes and increased their remit to monitoring equipment in addition to training.

These findings demonstrate that it is vital that the recommended resuscitation equipment is available and suitably maintained, particularly in a community hospital setting with limited resources where it can be life-saving.

Dysregulated behaviours are prevalent amongst young people worldwide. Emotional dysregulation plays a key role in these behaviours. Several psychiatric disorders have significant elements of emotional dysregulation, making it a potentially effective transdiagnostic therapeutic target. Dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and schema therapy (ST) can effectively manage emotional dysregulation, however access may be limited in clinical practice.

We aimed to explore whether young people with emotional dysregulation engaging in dysregulated behaviours receive support for emotion regulation. We hypothesised that those with emotionally unstable personality disorder (EUPD) will have a higher prevalence of self-harm, disordered eating, and/or substance misuse and more referrals for DBT, MBT, or ST than those with bipolar disorder, autism, attention deficit/hyperactivity disorder (ADHD), schizophrenia, or schizoaffective disorder.

De-identified clinical records from the West London NHS Trust on 2,413 16- to 25-year-olds with an ICD–10 diagnosis of EUPD, bipolar disorder, autism, ADHD, schizophrenia, and/or schizoaffective disorder were obtained through Akrivia. Chi-squared tests were performed.

Young people with bipolar disorder had the highest prevalence of self-harm, disordered eating, and substance misuse (88.35%, n = 182), χ2 (4, N = 3138) = 39.14, p < 0.001, but the lowest number of references to DBT, MBT, or ST. Those with EUPD had the highest number of references to DBT, χ2 (4, N = 2585) = 886.75, p < 0.001, MBT, χ2 (4, N = 2585) = 81.63, p < 0.001, or ST, LR (4, N = 2585) = 21.03, p < 0.001.

There could be an unmet need for psychological interventions for young people with bipolar disorder. A more transdiagnostic approach to offering psychotherapies that target emotional dysregulation should be applied in clinical practice.

Incidents involving patient violence and aggression are a common occurrence on the neurosciences wards. Many staff do not know how to de-escalate or manage such incidents, leaving them vulnerable and unsupported. This project was designed to increase mean staff confidence by at least 2 points (on a scale of 1–10) regarding confidence and satisfaction in managing patient violence during a 6-week period.

Using Plan-Do-Study-Act (PDSA) quality improvement methodology, we carried out a preliminary survey on 2 neurosciences wards. Multidisciplinary staff were interviewed about their confidence (on a scale of 1–10) in managing violence. The survey and interview assessed which measures were already in place on the wards, such as Datix reporting and referral pathways. The first intervention focused on preventing patient violence with informative posters on referral pathways and verbal de-escalation techniques; these were distributed throughout the wards and staff were notified via email. Follow-up surveys were collected, enquiring whether staff had seen the posters and how their confidence levels have changed. The second intervention was implemented 2 weeks later and focused on post-incident support. We distributed leaflets on Critical Incident Staff Support and sent an email link to a verbal de-escalation playlist. Follow-up surveys were collected again to track changes in staff confidence and satisfaction. Weekly electronic clinical record searches were recorded to track the number of incidences of patient aggression during the same 6-week period.

Staff confidence (N = 24) in verbally de-escalating violence and aggression increased by 1.1 and 1.75 points for Wards A and B, respectively. Of the 6 staff members who were followed up, only 1 experienced a 2-point increase from baseline in confidence in verbal de-escalation; 1 staff member experienced a 1-point increase, 3 experienced no change, and 1 reported a 1-point decrease. Staff satisfaction in management of violence on their wards increased by 1.04 and 1.75 points for Wards A and B, respectively. Staff confidence in knowing which team to refer patient violence to increased by 1.167 and 1.07 points for Wards A and B. Incidences of patient violence reported on EPIC decreased by 8 episodes for Ward B and increased by 2 episodes for Ward A.

Low-cost, simple intervention techniques are largely ineffective in improving staff confidence in handling violence. During verbal feedback, most staff agreed that training and simulation-based days would be useful. Ward managers should seek to include well-structured training to improve staff confidence.

Aim: To compare and evaluate three improvement collaboratives designs in terms of tangible and non-tangible benefits.

Background: Leading health systems have invested in substantial quality improvement capacity building, but little is known about the aggregate effect of these investments at the health system level.

Collaborative learning is one of the educational approaches of using groups to enhance learning through working together. Research shows that collaborative experiences that are active, social, contextual, engaging and student-owned leads to deeper learning.

CNWL organised three collaborative programmes with varying duration and distinct approaches to team selection, wrap-around support mechanisms, training design and post-collaborative QI support.

These three virtual collaborative programmes were co-designed with service users and carers to support 24 teams each in planning, delivering and sustaining improvements aligned with the Trust's Strategic Priorities.

All programmes provided knowledge on the Model for Improvement and co-production, enabling frontline ownership of safety solutions while building organisational QI capacity and capability.

Each collaborative was divided into Planning and Delivery phases. The evaluation, which covers a 3-year period, compares programme metrics to assess effectiveness, impact and identify areas for improvement.

Incorporating cognitive diversity is crucial in improving the learning process. Collaboratives play a vital role in achieving this, as they bring together different services, staff, and SU&C to drive improvement.

The benefits of collaborative work in quality improvement extend beyond the project data, as it can lead to positive unintended consequences such as a shift in team culture and the adoption of an improvement mindset. These outcomes gained on the journey should be evaluated and celebrated. Moreover, collaboration fosters a culture and platform for sharing and spreading learning beyond the team/service.

However, it is important to take the time to consider and compare different designs of collaboratives during the scoping phase. Factors such as the duration of the collaborative programme, the need for additional wrap-around support and the selection of measures to evaluate the programme should be carefully considered before proceeding.

Effects of changes

1. 1. Comparing different collaborative designs identified the key enablers to a successful project. They were application process brought teams together that were ready and willing to improve; targeted wrap-around support to Sponsors, SU&Cs, Coaches and having decision gateways in design enabled focused and candid conversations about team progression.

2. 2. Collaborative with longer time frame were more resource intensive but had a greater positive impact on safety culture, successful projects and sustained gains than the shorter duration.

3. 3. CNWL Added Value framework evaluated tangible and non-tangible benefits, i.e. staff experience, safety and learning culture, patient experience, streamlined processes and efficiencies gained.

It is important to look at the local context when designing a collaborative with their clinical setting.

A consideration should be based on resources available to support the entire duration of collaborative and what are the desired outcomes of the collaborative.

In outpatient settings, depot administrations are done to a large extent by Community mental health nurses and other trained clinical personnel who are not psychiatrists. As a result of this, there is a possibility that patients who are having depot medications are not reviewed by a psychiatrist for a long duration of time which can be more than a year. The aim of this audit is to find out if patients currently taking depot medication under a General Adult Community Mental Health Service in North Norfolk are being reviewed by a psychiatrist according to the standard guidelines. The Maudsley prescribing guidelines states that all patients receiving long-term treatment with antipsychotics medication should be seen by their responsible psychiatrist at least once a year (ideally more frequently) to review their treatment and progress.

List of patients currently on depot medication were taken from the spreadsheet on the Unit's Shared drive. All 47 patients currently receiving depot medication on this list were reviewed. The review period was from Ist January 2023 to 31st December 2023. Psychiatrist Review included Reviews/Appointments by Consultant Psychiatrists, Specialty registrars, Trainee doctors and GPST doctors in psychiatry posting.

It was recorded that 28 patients on depot medication have been reviewed within the last one year which is approximately 60% of the patients currently on depot medication. 19 patients who are currently on depot medication have not been reviewed by a psychiatrist in the last one year, which is approximately 40% of the patients on depot medication. Out of the 19 patients who have not been reviewed in the last one year by a psychiatrist, only 8 of them were offered an appointment.

We can conclude only 60% of patients currently on depot medication were seen by a psychiatrist for a medication review in the last one year. This fell below the expected target of having 100% of these patients meeting with the standard that states all patients receiving long-term treatment with antipsychotic medication should be seen by their responsible psychiatrist at least once a year. A significant proportion of patients might have been deprived of an adequate assessment of their progress and response to treatment and the review of the side effects of these depot medications. These findings have been discussed with the Community Team Manager who has agreed to facilitate that these patients are reviewed promptly.

A precision medicine approach to clozapine dosing aims to personalise it in two ways: i) during titration, and ii) for succeeding dose adjustments. This requires valid models of dose/concentration relationships, but cross-sectional models suffer from population-level artefacts and individual problems due to poor adherence or stopping smoking. Longitudinal data sets from two mental health trusts allowed poor adherence and smoking cessation to be identified. We then modelled dose/concentration relationships to construct personalised targets for i) and ii).

Demographics and co-prescribed medication were recorded for 137 patients from Greater Manchester Mental Health (GMMH) Trust who had two or more successive plasma levels and doses from 2016–2018. 412 patients from Pennine Care Foundation Trust (PCFT) who had successive plasma levels and doses from 2009–2023 were also recorded. In each sample, adherent patients (88 from GMMH and 371 from PCFT) were identified after excluding: > two-fold variation between blood samples in clozapine/norclozapine ratios, > two-fold variation in dose/concentration ratios, a clozapine/norclozapine ratio > 3, or a dose/concentration ratio > two standard deviations from the sample mean. Those whose smoking status (smoker vs non-smoker) changed between samples were excluded.

To identify i) titration targets, we used raw data in first samples (checked with logistic regression) to identify dose thresholds which produced most levels above 0.35 μg/ml (therapeutic) and no levels greater than 1 μg/ml (toxic). To model ii) effective dose adjustment, we used the equation Dt = Dc(Ct/Cc) to identify the most effective dose for the second samples. Dt was target dose, Dc current dose, Ct target level (0.45 μg/ml), and Cc current level.

First sample dose/concentration ratio in adherent patients correlated r > 0.75 with second samples’ dose/concentration. >84% of plasma levels were within 20% of the mean across both samples.

1. i. The GMMH dataset titration targets were 325 mg, 300 mg, 225 mg, and 175 mg daily for male smokers, female smokers, male non-smokers, and female non-smokers, respectively. In PCFT, data suggested corresponding targets of 375 mg, 325 mg, 225 mg and 175 mg. Targets avoided toxicity and gave therapeutic levels in > 50% of cases.

2. ii. Target dose, ascertained using the equation, and actual second dose were compared: in adherent cases, toxicity only occurred when actual doses were 1.5-fold greater than target dose, and above target all plasma levels exceeded 0.35 μg/ml in GMMH. PCFT data appeared similar.

Relatively safe and effective titration targets for smokers and non-smokers from both sexes were identified. A simple equation would improve precision and effectiveness of dose adjustment thereafter.

Main Objective

To assess the prevalence of depression (major depression) amongst adult hemophilia patients in Zambia.

Specific Objectives

1. 1. To assess the prevalence of depression amongst adult hemophilia patients in Zambia using the Patient Health Questionnaire 9 (PHQ9) tool to screen for/diagnose depression.

2. 2. To determine risk factors, amongst hemophilia patients, to developing depression.

3. 3. To ascertain factors that significantly associate with depression amongst adult patients with hemophilia in Zambia.

This was a quantitative cross-sectional study, conducted by administering the study questionnaire to collect data on demographic characteristics, clinical characteristics and the Patient Health Questionnaire – 9. A total of 59 adult patients with Hemophilia in Zambia, registered under the Hemophilia Foundation of Zambia were interviewed through the questionnaire. The data were analyzed using STATA 14. Descriptive analyses were done on the data, responses on PHQ-9 were totaled to assess for the prevalence of depression. Depression was defined as PHQ-9 ≥ 5; Major Depression as PHQ-9 ≥ 10. Pearson Chi-2 test was done to assess for associations and a logistic regression model was created to show the relationship between significant risk factors (independent variables) and depression.

59 participants were interviewed in this study. They were all male with an average age of 24.77 years from various parts of Zambia. 91.53% of the patients reported to have Hemophilia A, while 8.47% had Hemophilia B, there were no patients with Hemophilia C. The average PHQ-9 score was 8.66. 83.04% of participants had depressive symptoms (PHQ > 5); 44.06% having major depression and only 16.96% of the participants reported no depression. Number of painful bleeding episodes (OR = 2.063; P = 0.048) and difficulty in performing daily activity (OR = 4.311; P = 0.008) were significantly associated with a higher risk for major depression.

There was a high prevalence of major depression (44.06%) amongst adult patients with hemophilia registered under the Hemophilia Foundation of Zambia. Hence there is need for addition of mental health care to the multidisciplinary management of adults with hemophilia for improved health outcomes due to the high prevalence of depression amongst this group. Additionally, patients who suffer many painful bleeding episodes must be prioritized candidates for mental health care.

Legality of driving and serious mental illness is often poorly understood by service users and staff. The risk of rare but serious consequences indicate the value in including driving risk in initial assessments. The Driving and Vehicle Licensing Authority (DVLA) advises not to drive and notify them of changes in condition or concerns around an individual's ability to drive. Crisis periods can represent changes in condition for individuals with chronic mental health conditions including psychotic disorders, manic episodes, severe anxiety and depression, and personality disorders. It therefore is pertinent for home treatment team (HTT) clinicians to consider driving safety, in patients requiring crisis intervention. The aim of our audit was to identify what proportion of patients on the Kingston and Richmond HTT caseloads are asked about driving and implement changes to facilitate discussion thereby improving safety.

Retrospective data was collected from Rio clinical record software from the entire Richmond HTT and Kingston HTT caseloads at baseline, two and four months post-intervention. Clinical records were reviewed to establish if driving was being discussed. Data was inputted anonymously into Excel and simple statistical analyses conducted.

Inclusion criteria were patients on the Richmond Kingston HTT caseloads on the date of data extraction for cycles 1, 2 and 3. Patients were excluded who had not yet had their initial assessment.

Following initial data collection we joined stakeholders at Trust-Wide HTT Governance meeting covering five boroughs and presented findings. We agreed changes to implement including incorporating a driving prompt in the initial assessment proforma and providing a DVLA leaflet in the welcome pack.

From baseline data of combined caseloads, 17.7% of patients had documented evidence of driving discussion. At two months, re-audit showed that 33.3% of patients were asked about driving. With consideration of delays in change implementation with large teams and shift work, a third data collection cycle was completed 4 months post intervention. This showed that 56.0% of patients were asked about driving.

The changes implemented have been effective in sustaining increased awareness on this important topic and facilitating discussion with patients. There is potential to increase awareness further by expanding this as a trust-wide, regional or national initiative whilst enhancing stakeholder engagement.