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.

Psychological distress is common in adolescence; even more so following traumatic events. On 15 March 2019, two mosques in Christchurch were targeted in an act of terrorism. This has had widespread repercussions in the Muslim and wider community in Christchurch and New Zealand. This protocol offers an integrated group treatment based on an indigenous Islamic Psychology framework incorporating components of established transdiagnostic interventions for increasing wellbeing and reducing psychological distress in teenagers. We aim to measure the effect size of the treatment effect on total difficulties, emotional difficulties, trauma symptoms, somatic symptoms and functional impairment in adolescents self-identifying as impacted by the terror attack. We will measure the degree of parental distress and somatic symptoms to explore whether an intervention for adolescents has an impact on parental wellbeing. We will determine the feasibility and acceptability of this approach to inform supports for similar populations and as an example of cultural adaptation of mental health services.

This is a randomised controlled trial with a waitlist-controlled design to measure the size of treatment effects on clinical outcomes, and the feasibility of this protocol. We aim to recruit 64 participant families. A 6-week group programme will be offered to teenage participants randomised to the study group and offered to the waitlist group following the study. The study will be community-based in one site. We will assess clinical outcomes including emotional difficulties and somatic symptoms in teenagers (aged 12–19) and parents at baseline, end of treatment and at 3-month follow-up, and measure the project's acceptability with participants and parents. Individuals’ experiences of the programme will be examined using qualitative analysis of participant interviews at the end of the programme. Statistical analysis will be a mixed method design including effect size difference calculations, quantitative measures of acceptability and qualitative analysis. Treatment data from participants randomised to the waitlist first will not be included in statistical comparison of treatment effects but will be used for the assessment of feasibility.

This study will inform whether this unique approach is feasible and easily accessible for adolescents impacted by traumatic events. Its design has been driven by community engagement and stakeholder consultation to consider recruitment, relational safety, screening, and risk management. The project has an emphasis on widening access to mental health supports in a minority faith community by maintaining cultural sensitivity and reducing stigma associated with mental illness.

Trial registration: ClinicalTrials.gov, NCT05030909. Registered on 8 September 2021.

Referrals for adult autism assessment to the Cambridgeshire Lifespan Autism Spectrum Service (CLASS) have increased from 430 in 2019 to 887 in 2023, with demand exceeding capacity. The team enrolled in the Royal College of Psychiatrists’ Quality Improvement (QI) Demand, Capacity and Flow (DCF) Collaborative. The agreed aim was to increase the number of diagnostic assessments by 51% per month.

Participants included the CLASS multi-disciplinary team (MDT), referrers, the provider improvement advisor and an autistic adult. Using the NHS Quality Service Improvement and Redesign (QSIR) six-step approach, a process map identified five key stages of the CLASS pathway. A project driver diagram was then used to identify change ideas in the referral, screening, pre-assessment, assessment and post-diagnostic stages.

Change ideas in the screening and assessment stages were prioritised and two Plan-Do-Study-Act (PDSA) cycles designed: PDSA 1) To reduce screening time by removing the first screening of referrals; PDSA 2) To increase the number of assessments conducted and completed in a single face-to-face appointment.

Data collected for PDSA 1 included: number of working days from date of referral to date added to waiting list and total screening time (minutes) per referral. Data were compared in a sample of 133 referrals from the two-stage screening process and 68 referrals from the one-stage process. Data collected for PDSA 2 included: average assessment time (minutes), average duration of open assessments, and the number of assessments completed within the same month. The data at Time 1 (before introducing PDSA 2) were compared with Time 2 (after PDSA 2) in a sample of 10 and nine referrals, respectively.

PDSA 1) Statistical Process Control (SPC) charts show a reduction in mean working days from 160 to 30 working days. The mean screening time per referral reduced from 33 minutes to 23 minutes. PDSA 2) SPC charts show that between Time 1 and Time 2 there was (i) a reduction in clinician time in minutes per assessment (m = 236.8 to m = 210), (ii) a reduction in working days assessment remained open (m = 39.4 to m = 6.4), (iii) a reduction in number of assessments involving multiple appointments (6 of 10 to 3 of 9), (iv) an increase in the number of assessments completed in the same month (3 of 10 to 7 of 9).

These results show promise towards increasing DCF across the pathway, but further PDSAs (e.g., digitalising reporting, refining the post-diagnostic pathway) need to be implemented to achieve the overall aim.

The prevalence of delirium among confirmed COVID-19 patients is around 12–33%. Delirium in COVID-19 patients is associated with worse functional outcomes; and associated with length of hospital stay, admission to ICU, and ventilator utilization. COVID-19 patients with delirium have a significantly higher risk for mortality than those who did not develop delirium. This study aimed to describe the risk factors, symptomatology, and predictors of mortality of COVID-19 patients presenting with delirium symptoms admitted between January and October 2021 to the Philippine General Hospital, a public tertiary hospital in the Philippines.

Medical records of adult COVID-19 patients admitted to the Philippine General Hospital were analyzed. Descriptive statistics were used to summarize the demographic and clinical history. Univariate and multivariate logistic regression were done to determine the variables that predict mortality.

One in five (20.01%) COVID-19 patients presented with delirium; of the 1,992 medical records reviewed, 400 patients had either presented with symptoms of delirium or were diagnosed with delirium.

Of the 400 patients, 36.5% were not diagnosed with delirium, only 7% were referred to Psychiatry, and 74% expired during admission. Patients referred to Psychiatry had lower mortality odds than those not referred (aOR = 0.069, p = 0.014). Before the COVID-19 pandemic, patients with psychiatric symptoms from organic causes are already less likely to be referred to psychiatrists. Furthermore, studies have shown that delirium is under-recognized among patients with COVID-19. Early referral to a psychiatrist for assessment and management may possibly be protective against mortality.

Those who received midazolam had higher odds of mortality (aOR = 3.112, p = 0.001). Currently, no literature supports the association between midazolam use and mortality among COVID-19 patients with delirium; however, it is known that midazolam use puts patients at increased risk for delirium and mortality.

Patients with decreased sensorium (aOR = 7.438) and decreased psychomotor activity (aOR = 3.857) had higher odds of mortality (p < 0.001). Decreased sensorium and decreased psychomotor activity are typical in patients with hypoactive delirium; hypoactive delirium is a known prognosticator for patient mortality. The only available studies on specific delirium symptomatology show that decreased sensorium and decreased psychomotor activity are common among COVID-19 patients with delirium.

Timely assessment and appropriate management are critical for COVID-19 patients with delirium symptoms, especially those at an increased risk for mortality. Clinicians dealing with COVID-19 patients presenting with delirium must be reoriented to delirium symptomatology, initial interventions, and indications for referral to psychiatrists.

Antipsychotic medications are commonly used in the management of psychiatric disorders, including in older adults. However, the use of these medications in older adults can be associated with a higher risk of adverse effects such as cardiovascular event and extrapyramidal symptoms.

This retrospective audit aimed to evaluate adherence to antipsychotic prescribing and monitoring guidelines in a Psychiatric Unit for Older Adult Females in Kent and Medway NHS and Social Care Partnership Trust (KMPT).

The audit criteria encompassed various aspects of documentation and medication management, including diagnosis documentation, indication, age, comorbidities, consent, baseline assessments, monitoring, review, and follow-up care. Data from two months’ records were analysed leading to an action plan with slight amendments to the user-friendly template for ward round and a physical health monitoring poster for junior doctors and ward staff. These initiatives aim to improve patient care, streamline documentation, while accommodating the rotation of junior doctors. A re-audit is planned post implementation.

This audit’s limitations included the study’s single-site nature, potential sample size constraints and reliance on accurate documentation.

The audit achieved 100% compliance in documenting patient age and MHA status, meeting legal requirements. Weight, BMI, and baseline blood pressure exhibited full compliance. Baseline ECGs had an 86.66% compliance rate, while QTc interval documentation reached 100%. Antipsychotic indication and weekly reviews were documented at 100%, with an 83.33% rate for rationale documentation for medication changes. Comorbidities were fully documented, but extrapyramidal symptom and sedation monitoring showed a 46.66% compliance rate. Baseline blood tests, including glucose, bA1c, lipid profile, electrolytes, renal and liver function, thyroid function, and prolactin levels, generally had high compliance, but lipid profile and liver function achieved 73.33%. Repeat blood tests varied, with electrolytes and renal function at 100%, while thyroid function and prolactin levels scored lower at 26.66% and 46.66%. Continued monitoring of weight, BMI, and blood pressure remained fully compliant. Compliance for repeating ECGs within recommended timeframes reached 53.33%, and recommendations to GPs for yearly ECGs and blood monitoring achieved 50%.

In summary, the audit identified areas of commendable high and medium compliance with antipsychotic prescribing guidelines in a Psychiatric Unit for Older Adult Females in KMPT. An action plan has been formulated to not only enhance patient care but also to refine the documentation process positively further, fostering continued progress in the provision of high-quality care.

To examine the legal framework governing psychiatric practice, specifically focusing on the Mental Health Act, within a singular psychiatric centre in Moshi, Tanzania. The primary objective was to explore the intersection of culture and legalities in shaping ethical practice within this emerging unit. Drawing on a comparative analysis of contents and the implementation of the MHA in Tanzania and in the UK, the study aims to understand the ways in which cultural contexts influence the legal and ethical dimensions of psychiatric care.

This was a multi-method study that combined literature analysis, structured interviewing, and structured reflective practice.

1. 1. Direct comparison of the UK and Tanzanian MHA.

2. 2. Evaluation of clinician understanding of the MHA through structured interviewing of clinicians with respect to their knowledge of the MHA, its existence, and its key components.

3. 3. Analysis of implementation of the MHA in liaison psychiatry in both centers. Compared through unstructured interviewing and reflective practice.

1. 1. The most striking difference is the length of the documents. The Tanzanian MHA is 27 pages while the UK MHA is 173. This additional length covers: Admission and Discharge Procedures, explanation of the Roles and Powers of Professionals, and further discussion on Safeguards and Rights of Individuals.

2. 2. When interviewed, only 15% of Tanzanian physicians could explain what the MHA is, compared with 100% of UK physicians (N = 40).

3. 3. In the UK, all doctors use the MHA and implement DOLS. In Tanzania, this falls under the role of liaison psychiatrists. This is likely because, the MHA is included in the UK's medical curricula but not in Tanzania's.

Lack of understanding of the MHA and other key laws in psychiatry is a global issue, not limited to the UK or Tanzania. However, physicians with strong understanding are more scarce in Tanzania. This scarcity puts additional pressures on psychiatric services, as psychiatrists are called to assess issues of capacity or consent that could be assessed by any doctors in the UK. However, this means that the MHA and MCA are almost solely used by psychiatrists and therefore often assessed to a very high standard. It must be considered that on reflection, I have also observed physicians with limited understanding of the MHA, capacity and consent within the NHS. Imposing a higher standard on another culture would be unethical. Efforts into educating medical students and professionals is required in the UK and Tanzania.

Total knee replacements (TKRs) are effective procedures for severe osteoarthritis. Some studies suggest that people with common pre-operative mental health problems are more likely to experience complications following joint replacement. This study aimed to determine whether people who described pre-operative anxiety or depression were more likely to report an adverse event, or outcome, following a TKR.

A prospective cohort of people undergoing TKR at a surgical centre in England between 2012–2013 as part of service evaluation were studied. Following informed consent, participants completed pre-operative sociodemographic questionnaires alongside several patient-reported outcome measures (PROMs): the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQoL Five-dimensions Descriptive System (EQ-5D-3L), and the Self-Administered Patient Satisfaction Scale for Primary Knee Arthroplasty. Participants were classified as exposed if they described moderate or extreme problems with anxiety or depression in the mental health subset of the EQ-5D-3L. The primary outcome was the presence of a patient-reported adverse event (bleeding, infection or fracture) at 3 months post-surgery measured through a short postal questionnaire. Repeat PROMs were assessed at 3- and 12-months post-surgery. Logistic regression was used to model the association between pre-operative mental health status and probability of an adverse event, or outcome, occurring following adjustment for age, sex and body mass index.

Of the 206 individuals studied, over a third (n 72/206, 35%) had reported problems with anxiety or depression before surgery. Among those returning completed follow-up questionnaires, 20% (n 34/168) described an adverse event at 3 months. Pre-operative anxiety or depression was not associated with an increased odds of reporting an adverse event (aOR 0.85, 95% CI 0.35–2.05) at 3 months post-surgery. People who described problems with anxiety or depression were more likely to have a greater degree of pre-operative functional impairment. Even after adjusting for a higher pre-operative symptom burden, exposed participants were more likely to report problems with activities of daily living (aOR 2.32, 95% CI 1.09–4.94) and pain or discomfort (aOR 5.58, 95% CI 1.77–17.60) at 3 months post-surgery. However, they did not have an increased odds of describing worse function, reduced health-related quality of life, or being dissatisfied with their TKR at 12 months post-surgery.

Despite having a higher burden of morbidity prior to undergoing surgery, pre-operatively anxious or depressed participants did not have an increased odds of reporting an adverse event at 3 months and went on to experience comparable improvements in PROMs at 12 months post-surgery.

Bipolar disorder is highly prevalent and consists of biphasic recurrent mood episodes of mania and depression, which translate into altered mood, sleep and activity alongside their physiological expressions.

The IdenTifying dIgital bioMarkers of illnEss activity and treatment response in BipolAr diSordEr with a novel wearable device (TIMEBASE) project aims to identify digital biomarkers of illness activity and treatment response in bipolar disorder.

We designed a longitudinal observational study including 84 individuals. Group A comprises people with acute episode of mania (n = 12), depression (n = 12 with bipolar disorder and n = 12 with major depressive disorder (MDD)) and bipolar disorder with mixed features (n = 12). Physiological data will be recorded during 48 h with a research-grade wearable (Empatica E4) across four consecutive time points (acute, response, remission and episode recovery). Group B comprises 12 people with euthymic bipolar disorder and 12 with MDD, and group C comprises 12 healthy controls who will be recorded cross-sectionally. Psychopathological symptoms, disease severity, functioning and physical activity will be assessed with standardised psychometric scales. Physiological data will include acceleration, temperature, blood volume pulse, heart rate and electrodermal activity. Machine learning models will be developed to link physiological data to illness activity and treatment response. Generalisation performance will be tested in data from unseen patients.

Recruitment is ongoing.

This project should contribute to understanding the pathophysiology of affective disorders. The potential digital biomarkers of illness activity and treatment response in bipolar disorder could be implemented in a real-world clinical setting for clinical monitoring and identification of prodromal symptoms. This would allow early intervention and prevention of affective relapses, as well as personalisation of treatment.

Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP) is a condition resembling schizophrenia, which has a first onset in individuals at age 60 or later. Understanding the risk factors associated with the development of this condition is crucial, given the increasing ageing population and the elevated mortality rate in VLOSLP patients compared with the general population. This scoping review aims to explore and map the risk factors associated with VLOSLP development and begin to identify potential mechanisms linking these factors through comprehensive literature searching, screening and data extraction.

Conducted as a scoping review; MEDLINE, Embase and APA PsycInfo were searched using the terms: “Very-Late Onset Schizophrenia-Like Psychosis”, “VLOSLP”, “Geriatric Psychosis” and “Geriatric Schizophrenia”. Inclusion criteria focused on psychosis with onset at 60 years or older and the identification of at least one potential risk factor. Studies were excluded which did not specifically refer to age of onset or concerned psychosis with an attributable organic cause. Thematic analysis was used to categorise risk factors into biological and psychosocial themes, followed by further organisation into specific subthemes.

Out of 326 initial results, 41 studies met inclusion criteria and underwent data analysis. Key risk factors included female gender, sensory impairment, social isolation, and migration, with potential interconnections identified between factors. Postulated mechanisms for the role of a risk factor in VLOSLP development recorded in the literature were included in the review. Mechanisms showed potential co-linkage between subthemes of risk factor. Migration status was also shown to impact gender as a risk factor, with male migrants experiencing higher rates of VLOSLP than their female counterparts. Thematic analysis highlighted how social isolation, a prominent risk factor, might be linked to, or reinforced by, sensory impairment, trauma, bereavement, and premorbid personality traits.

The scoping review revealed that risk factors for VLOSLP span across biological, social, and psychological domains, with the findings contributing to the broader understanding of schizophrenia-like psychoses in the elderly population. Social isolation emerged as a widely-cited factor, reiterating the importance of managing risk factors for VLOSLP in vulnerable individuals via a holistic and multidisciplinary approach. Results bring attention to the bi-directional relationships between risk factors and psychotic illness, with perceived risk factors a potential consequence of the psychosis. In response to this, future work may involve large-cohort longitudinal studies to outline temporal relationships between risk factors and symptom development.

In Pakistan forensic psychiatry lacks behind as far as formal training and separate departments are concerned. In spite the cases are ever increasing. To find out the magnitude of the burden of forensic cases, current study was conceptualized. This audit would highlight the burden and endorse the demand of specific training in this area. A retrospective study was designed to determine the frequency of various psychiatric disorders, reasons and sources of referrals of the cases coming for forensic opinion to a tertiary care unit.

All 174 cases admitted to inpatient psychiatry department, Faisalabad for opining about psychiatric condition were included in the study through consecutive sampling techniques, only repeated cases were excluded. As the study was retrospective, data files were retrieved and desired variables were enlisted in SPSS to calculate the frequency and percentage of different variables.

Majority cases were male. One third were referred in year 2018. 47 (27%) criminal cases were being referred while 25 (14.3%) civil cases were received; most of the cases 102 (58.6%) were departmental (cases of the employees of different public departments). As per source of referral 72 (41.3 96%) cases were referred from courts directly, 21 (12.2 96%) cases were directly referred from various departments while most the cases 81 (46.5%) were referred from other public hospitals, As per diagnoses schizophrenia, depression and intellectual disability (ID) were the most prevalent diagnosis with 47 (27%), 41 (23.5%) and 33 (18.9%) cases respectively while 26 (14.9%) cases had no psychiatric diagnosis. 40 (22.9%) cases were advised treatment and follow up, most of these cases 26 (14.9%) were diagnosed as having depression; 30 (17.2%) cases were granted guardianship, 20 (11.4%) out of these were intellectually disabled; 18 (10.2%) cases were referred to other departments for long term psychiatric care institutions, these cases were diagnosed as having schizophrenia, BAD and epilepsy; 9 (5.1%) cases were advised adjustments in jobs, these were diagnosed as depression, schizophrenia and BAD; only 6 (3.4%) cases were suggested to board out on the basis of illness.

Department of psychiatry and behavioral sciences, FUM, Faisalabad, Pakistan is burdened with forensic cases that may be managed at other appropriate places. Society and policy makers need to be sanitized in order to make a framework for patients having mental disorder to avoid them ending as criminals or being involved in other forensic issues.

To replace pre-existing paper-based and informal handover systems with a confidential electronic handover system for on-call doctors across a large South London mental health trust, thereby improving the safety and quality of handovers.

A quality improvement project was registered within our trust. At baseline, we surveyed core trainees, GP trainees, and locum doctors about their experiences using a paper handover system for on-calls at the Bethlem Royal Hospital and Lambeth Hospital, South London and the Maudsley NHS Foundation Trust (SLaM). Their feedback guided the implantation of a confidential and secure electronic handover system integrated into the trust's Microsoft SharePoint, using the Microsoft To Do app and then Microsoft Teams. We alerted doctors to these changes via formal and informal means, such as trust inductions, emails and through communication with trust junior doctor representatives. After a period of 8 and 24 weeks, we assessed the initiative's success by collecting both qualitative and quantitative data from on-call doctors about their experience with the handover system. Based on feedback, we made multiple adjustments to improve the system, which was later adopted at Lambeth Hospital. The Microsoft To Do app was then replaced by a channel on Microsoft Teams to ensure wider access.

15 doctors responded to the baseline survey. Handover practices were varied and included paper-based handovers, phone calls, and emails. Mean doctors’ ratings for the pre-existing handover systems were 3.2/5 for overall quality (1: very poor; 5: very good) and 2.7/5 for safety (1: very unsafe; 5: very safe). 60% (n = 9) of doctors said tasks would sometimes be missed in the pre-existing handover system. 21 doctors responded to 2 post-change surveys. Mean doctors’ ratings of overall quality were 4.6/5 and safety were 4.5/5. Qualitative feedback highlighted that a verbal handover was still necessary to complement the electronic system, and that locum doctors would need to have access to the system as well as consultants and registrars during periods of industrial action.

An electronic handover system was successfully implemented to replace a predominantly paper-based handover system at two large mental health hospitals in South London, and on-call doctors reported improvements in handover safety and handover quality. Future work aims to implement a consistent electronic handover system across other hospitals in SLaM and other trusts and transition fully to Microsoft Teams for broader accessibility.

When Kingfisher Mother and Baby Unit (MBU) opened in 2019 personality disorder and severe self-harming behaviours were exclusion criteria for admission. Complex Post Traumatic Stress Disorder (C-PTSD) with its emotional dysregulation, interpersonal difficulties and common presence of self-harm was similarly categorised.

Currently, C-PTSD presentations are frequently admitted to the MBU, making up around 45.9% of admissions. There is increasing understanding of the importance of effective and trauma informed treatment in admission outcomes, particularly in reducing trans-generational trauma. This requires appropriate skills and training in staff.

Service users were identified retrospectively over a 24-month period and categorised into C-PTSD traits (trait) and non-C-PTSD traits (non-trait). Comparisons of routine outcome measures (ROMs) identified higher distress in the C-PTSD group and reduced satisfaction. Staff survey highlighted areas of anxiety and low confidence in working with service users with C-PTSD traits.

Actions were divided into three streams – Admission, Transitions and Communication. Staff training needs were identified and training given. Admission processes were reviewed with a focus group including past service users and changes based on DBT principles were implemented. A leaflet was developed to aid communication with service users considering MBU admission via Outreach and Community Perinatal teams.

Surveys were the primary source of data before and after changes. As of September 2023 the majority of training had been rolled out but numbers completing the training survey were too small to draw conclusions. Anecdotal feedback was predominantly positive and the survey will be repeated at the same time as other data in March 2024.

Ward process changes started in late August 2023 and routine outcome measure data will be compared at 6 months (March 2024). Again anecdotal feedback is positive.

The leaflet was rolled out for use by community teams and service users in November 2023 and feedback via survey will be collected in March 2024.

Evaluation of routine outcome measures showed poorer outcomes and experiences for patients with traits of Complex-PTSD. Staff survey highlighted lack of confidence in managing the same. Consultation with a range of staff and past service users led to changes in admission practices, communication prior to admission via a leaflet, and staff training. Anecdotal feedback since implementation has been positive but we hope to see this confirmed in the Routine Outcome Measures and surveys 6 months after the changes were implemented.

To explore reasons why patients under the learning disability community psychiatry team were not attending their appointments.

To explore patient preferences for type of appointments offered (F2F, telephone or video) aiming to improve access and attendance, whilst promoting reasonable adjustments for patients with learning disabilities.

To improve efficiency in terms of number of patients seen and reduce wasted clinical and admin time in relation to DNA appointments, by reducing the ‘did not attend’ (DNA) rates by 20%.

With the support of the QI team using methodology including fishbone diagrams and PDSA cycles, electronic data on the number of DNA psychiatry appointments were collated from January 2022 onwards and recorded monthly.

Each DNA appointment was coded with a reason given for non-attendance. The data was then reviewed and analysed to identify any common themes around non-attendance.

A questionnaire was initially trialled with a small sample of patients who had not attended to explore reasons for non-attendance and preference regarding appointment type. The questionnaire was then sent to all CTPLDW patients who had missed appointments. An easy-read version was also sent to promote accessibility amongst the patient group. The data was collated and reviewed.

Most common reasons for patients not attending their psychiatry outpatient clinic appointments under the CTPLDW team were identified:

2022: 35 patients DNA – 28.6% citing communication/correspondence issues.

2023: 30 patients DNA – 33.3% citing communication/correspondence issues.

Additional reasons for non-attendance included issues with residential homes, sickness and transport.

An anecdotally high number of DNAs were noted by CTPLDW. The data collected thus far has helped us to define and understand the issues. The main factors identified revolve around communication and correspondence of appointment times.

The next step in our quality improvement project is to trial text reminders for patients and carers to assist in remembering appointments, to assess whether this change idea helps to decrease the number of DNAs.

Future change ideas include development of resources to support attendance (e.g. adjusted appointment letters with QR codes for access/maps, reminder letters in easy-read format and video tours).

CTPLDW would like to offer a more personalised approach with a service that promotes reasonable adjustments and reduces barriers to access, thereby reducing the number of DNA appointments.

The purpose of this study was investigating the differences in temperament, personality, and cognitive function among athletes and non-athletes, as well as differences within athlete groups participating in different-paced sports like baseball and basketball.

A total of 57 professional basketball players, 51 professional baseball players, and 44 non-athletes subjected to temperament and characteristics inventory assessments and computerized neurocognitive function test. One-way analysis of variance (ANOVA) was employed to analyze the average differences in demographic characteristics, temperament, personality traits, and cognitive functions among the three groups, followed by Bonferroni post hoc tests. Comparisons between starters and non-starters within the athlete groups were conducted using the Mann–Whitney U test.

In the analysis of temperament, the basketball and baseball player groups exhibited higher reward dependence and persistence compared with the control group. Additionally, in the assessment of personality traits, both basketball and baseball player groups scored higher in self-directedness and cooperativeness compared with the control group, whereas self-transcendence scores were lower. In cognitive ability assessments, baseball and basketball players outperformed the control group in emotional perception tests. Both baseball and basketball players showed lower card movement counts compared with the control group.

This study compared the differences in temperament, personality, and cognitive abilities between professional basketball and baseball players and non-athletes. These results provide valuable insights into the temperament, personality, and cognitive abilities of professional athletes, contributing important information for athlete development and coaching goals in the future.

Ward rounds are complex clinical interactions crucial in delivering high-quality, safe, and timely patient care. They serve as a platform for the multidisciplinary team to collaboratively assess a patient's condition and actively involve the patient and their caregivers in shared decision-making to formulate a care plan. Ward rounds involve an intersection of factors worthy of consideration separate from the wider literature on inpatient experience and multidisciplinary team meetings. With this review our primary aim is to systematically identify what methods and perspectives researchers are using to understand ward rounds.

The databases searched were Medline, CINAHL, British Nursing Index, PsychInfo, and ASSIA as well as reference and citation checking. The search terms used were psychiatr* AND (ward round OR “multi disciplinary team meeting” OR “clinical team meeting”). Studies were included if they were peer reviewed, included primary research on psychiatric inpatient ward rounds in which patients are participants with no restriction on the type of ward or hospital, patient group, country or methodology.

224 records were retrieved and screened from the database search and 10 from other sources. 35 full texts were reviewed for eligibility and 26 included in the review. 16 studies had no particular theoretical perspective, 2 were constructivist, 2 critical realist, 2 lean methodology, 1 systems research, 1 phenomenological, 1 trauma informed and 1 critical theory. 9 focussed on patient experience, 5 ward round structure, 3 on power relationships, 3 on efficiency, 2 on shared decision making and 4 had a unique focus. Though often not explicit, critical theory influenced discussion of power is common in papers focused on patient experience and ward round structure. Cross-sectional surveys, interviews, focus groups and audit cycles were the most common methods. Key themes which emerge are anxiety provoked by ward rounds, preparation and communication, and the negotiation of power structures. Key tensions identified include being multidisciplinary versus overcrowding, efficiency versus personalisation and reliability versus responsiveness.

For a central part of inpatient psychiatric practice there is a limited range of research on psychiatric ward rounds. The influence of critical theories’ focus on power was widespread with limited representation of other theoretical perspectives and concerns. There was no research using experimental methods, but there was some implementation research. Key tensions are highlighted which services may wish to consider when revisiting ways of working on inpatient psychiatric wards.

Early Intervention Services (EIS) are in a unique position to assess patients presenting with their first episode of psychosis. The possibility that an organic disorder may be underlying their presentation must be ruled out, often necessitating neuroimaging and/or input from neurology and neuropsychiatry.

We aim to improve the management of neuropsychiatric presentations in EIS. We will determine the incidence of cases, from the London Boroughs of Sutton and Merton, which warrant referral to neurology, neuropsychiatry and neuroimaging. We will then review referral pathways and provide justification for community services, such as EIS, to autonomously request referrals and neuroimaging.

We retrospectively reviewed the complete caseloads of EIS for Sutton and Merton (n = 121). We considered the neurological comorbidities of patients to determine the incidence of cases which warranted a referral to neurology, neuropsychiatry and/or neuroimaging. We reviewed how requests were made and the subsequent results.

15% of the EIS caseload had a neurological comorbidity. Migraine was the most common condition (8.3%), followed by traumatic brain injury (3.3%), headache (2.5%), and seizure (1.7%). There was one case each of epilepsy, stroke, transient ischaemic attack, cavernoma and cerebral venous thrombosis. 83% of patients with a neurological comorbidity had received neuroimaging and all imaging results were either normal or confirmed known pre-existing neurological disease. The 17% of patients who did not receive neuroimaging had only migraine as a neurological comorbidity. One patient was reviewed by neurology and diagnosed with psychosis presumed to be secondary to paraneoplastic syndrome. All patients that fulfilled criteria for a neuropsychiatry referral had this completed electronically. However, there was no clear pathway to request a review by neurology, and Sutton EIS had difficulties autonomously requesting and accessing the results of neuroimaging, delaying provision of appropriate care.

There is a small but significant burden of neurological comorbidity among EIS patients. In our brief study, we found one patient whose symptoms of psychosis were likely attributable to an organic cause. Accessible pathways to refer patients for neuroimaging, and subsequently to neurology and/or neuropsychiatry if indicated, are crucial in the assessment and management of first episode psychosis where an organic cause is suspected. Access to these resources should be efficient and autonomous for EIS. We are in the process of implementing referral guidance alongside a direct electronic referral process to request neuroimaging and further input from neurology and/or neuropsychiatry, to optimise care for patients and our service.

To provide a bespoke development program for foundation year (FY) trainees on rotation at CNWL NHS trust.

To increase interest in foundation trainees in choosing Psychiatry as a career.

Specific: 100% self-reported satisfaction with the FY development program by April 2024.

50% increase from baseline of self-reported interest in choosing psychiatry as a specialty by April 2024.

We designed an online, 12 session teaching program for each 4 month cohort of foundation year doctors on rotation at St Charles Hospital, CNWL. We collect data at baseline, after each teaching session and at exit via online questionnaires. These are reviewed at PDSA meetings (including nominees from foundation cohort) by team quarterly. First cohort started in May 2023, we are currently in our 3rd cohort of this project. Each cohort has approximately 15 Foundation year Trainees. Our curricula integrates principles of Co-Design: 2 of the 12 teaching slot topics are voted by each cohort of foundation trainees. Co-Production: 2 of the 12 slots are always for a carer, service user or expert by experience. Bespoke: Each teacher is provided a written guide outlining the training grade of foundation trainees and highlights the needs for transferrable skills as FY trainees may not pursue psychiatry as a career. Quality Improvement: iterative learning from each cohort, with robust data collection methods (dedicated time set aside for feedback completion) and regular reviews by team. Teachers are canvassed via trust emails, trainee Whatsapp groups and patient liaison services at CNWL.

Cohort 1= no data collected. Data collection methods required improvement.

Cohort 2= data collection of 3 responses (23% completion rate). Data collected insufficient. Data collection method improved.

Cohort 3= data collection of 13 responses (87% completion rate).

Self-reported satisfaction with training program: 95.3% Interest in choosing psychiatry as a specialty: 30.4% at baseline to 76.2% at time of submission.

This Foundation Year Development initiative provides a well-liked, bespoke and innovative approach to train foundation year doctors on placement at NHS trusts.

The majority of Foundation doctors (some surveys show 60%) are undecided on their specialty during foundation training and this is a unique opportunity to increase recruitment into psychiatry.

Huntington’s disease (HD) is a rare inherited disease in an autosomal dominant pattern, that is most prevalent among Caucasians.

Juvenile onset Huntington disease (JHD) is a rare subtype of the disease, defined by presence of the disease by the age of 20 or younger.

We report a case of a 28-year-old woman with JHD and discuss the challenges we faced in her diagnosis and management.

A now 28-year-old Arab woman, presented to the psychiatric hospital when she was an 18-year-old, complaining of restlessness and low mood. She was diagnosed to be having social phobia and panic attacks, and was given escitalopram. About 6 months after her first presentation, the patient's mother showed up reporting that the patient is doing well without the medication and that she is not going to take them anymore. However, the patient started developing anxiety symptoms two years later and started taking the same medication. Moreover, three years after her first presentation, the patient started developing movement symptoms and mentioned that her father passed away by Huntington's disease. The patient was immediately referred to a genetic lab and a Huntington disease diagnosis was given along with tetrabenazine and risperidone. Moreover, the patient attempted suicide multiple times after worsening of symptoms over the years. A brain magnetic resonance imaging of the patient showed bilateral caudate nuclei atrophy with similar changes affecting the putamen as well but to a lesser extent, changes that are associated with Huntington's disease.

Juvenile onset Huntington disease is rare, especially among people who are not of European ancestry. Therefore, clinicians are not likely to suspect the illness at an early stage. Late diagnosis not only can prevent patients from receiving the symptomatic treatments that they need, but it can also lead to misdiagnosis. Early referral to genetic testing is required among patients presenting with symptoms and a positive family history. However, risk of suicide is high among patients of Huntington's disease.

Juvenile onset Huntington disease is extremely rare. Initial symptoms of the disease could vary and can be misdiagnosed as epilepsy, mood or behavioral disorders, or schizophrenia. Genetic testing is controversial for patients below 18 years old. Having a low suspicion threshold in diagnosing patients with positive family history of HD who are presenting with such symptoms is recommended. There is no cure and treatment is symptomatic.

Therapeutic Patient Education (TPE) aims to help patients self-manage their chronic condition over their lifetime, adapting to their evolving circumstances, as well as changes in their condition and treatment. The National Institute for Clinical and Healthcare Excellence underscores the importance of patient education as a crucial part of early interventions for mental disorders. This systematic review aimed to review TPE programmes in managing psychiatric disorders, considering the diversity in delivering agents, intervention formats, targeted skills, and therapeutic outcomes.

Comprehensive database searches, including Web of Science, PubMed, and COCHRANE, were conducted from September 2019 to January 2023, yielding 514 unique records, with 33 making it through rigorous evaluation for full-text review. Eleven studies met the inclusion criteria, focusing on various psychiatric disorders such as depression, bipolar disorder, psychosis, and multiple serious mental illnesses. A total of 38 studies were included from our previous review to supplement the current database search.

Among 49 included interventions, 13 were aimed at bipolar disorder, depression (n = 12), multiple serious mental illnesses and comorbidities (n = 11), schizophrenia and psychoses (n = 13). A total of 21 interventions were delivered in groups followed by individual (n = 12), mixed format (n = 14) and electronically (n = 2).

TPE programmes exhibited diversity in delivering agents and intervention formats, with a notable presence of multidisciplinary teams and various professionals. The interventions prioritized coping strategies and disease management techniques, though the extent varied based on the disorder. Examining the different skills imparted during the interventions, the focus predominantly leaned towards the teaching of coping strategies. These encompassed both cognitive and behavioural coping skills, including areas such as self-confidence (n = 37), stress management (n = 39), critical thinking (n = 26), problem-solving (n = 18), goal setting (n = 31), situational awareness (n = 36), and self-care (n = 36), with unspecified coping skills also noted (n = 32).

Effectiveness was heterogeneous across studies; some interventions showed significant benefits in areas such as symptom management, coping, and functional improvement, while others reported no significant outcomes.

The findings underscore the potential of TPE in psychiatric care, revealing its multifaceted nature and varied impact. TPE not only addresses deficits but also leverages patients' existing strengths and capabilities. Despite the reported benefits, a portion of the interventions lacked statistical significance, indicating the necessity for continuous refinement and evaluation.