To investigate the themes within young people and parents/carers’ experiences of the admission process. A focus was placed on potential targets for change to improve experiences of CAMHS admission.

Young people and parents/carers with an experience of inpatient CAMHS admission within the past two years were approached by the Involvement team of an NHS trust. Focus groups and interviews were conducted capturing the views of 8 young people and two parents/carers. The notes and transcripts from these conversations were analysed using Braun and Clarke thematic analysis.

Two key themes were identified within the data. The first focussed on information provision and communication. This captured young people's experiences of both: what information was available to them, e.g., websites and leaflets, and how this information was conveyed to them. The second theme brought together the young people's interpersonal experiences during the admission process. Within this, the impact of consistent contacts as well as both positive and negative transient encounters was highlighted.

Admission to a psychiatric ward is often a highly distressing time for young people and their families. The provision of easily accessible, clear, and correct information can improve their expectations and initial impressions of a unit. How this information is presented is also important. Consistent staff support and response to distress and difficulties during this time can also shape the perspectives of young people and their parents/carers.

Clear, accurate, and young person friendly information about a unit and the admissions process could be an easily achievable change which units could make to improve young person experiences. Improvements to clinicians’ skills and response may represent a more complex and expensive goal.

Psychiatry is predominantly a community specialty, but large medical school cohorts and limited outpatient learning opportunities mean students report a lack of experience in community mental healthcare. They describe clinicians lacking time to teach in busy clinics, or patients declining student presence. Consequently, many Foundation Doctors will first experience working with outpatients when they sit down to their first clinic! Our aim, quite simply, was to remedy this gap.

The Psychiatry Teaching Unit at Derbyshire Healthcare is in the vanguard of patient involvement, with a large group of Expert Patients (EPs) having extensive lived experience of inpatient/outpatient psychiatric care, and medical education delivery.

We co-produced an Expert Patient Clinic to replicate a psychiatric outpatient clinic, with students acting as psychiatrists, reviewing Expert Patients. Students work in groups, taking turns as doctor/observer. Each ‘appointment’ is followed by tailored feedback.

The tasks are themed as follows:

Patient-specific review: a more ‘technical’ task e.g. reviewing medication changes and side effects, or using measurement tools to assess signs and symptoms.

Psychosocial review: considering social circumstances, activities of daily living and personal functioning.

Current mental health review: assessing mental state, subjective and objective signs and symptoms of mental health problems, and concerns, ideas and expectations for care and intervention.

Sessions are facilitated by a psychiatrist, Lived Experience Facilitator (EPs formally employed as educators) and a senior clinical nurse educator.

Pre- and post-session we ask students to assess/rate their confidence and competence in reviewing outpatients, discussing risk, and planning care, in an outpatient appointment.

Results so far are overwhelmingly positive with both written and numerical feedback acknowledging a significant improvement in student confidence and self-rated competence across the board. A chart in our poster shows the large increases in self-rated Likert scales measuring aspects outlined above. Qualitative verbal feedback outlines the value of having a session with real patients where they can try consultation techniques and receive instant feedback, and learning through discussing with EPs their individual stories and clinical histories. Accounts from EPs document their own learning from the sessions and development of skills in giving feedback.

The EP Clinic provides an opportunity for students to experience clinical responsibility and practise in a safe environment with real patients. It provides valuable, realistic and high quality experience in community psychiatry without the disappointments often unavoidable in live clinical services.

Bethlehem Psychiatric Hospital is the only psychiatric hospital in the West Bank. Gender differences aren't widely studied in medical Palestinian research, therefore, data on it is very scarce. This study aims to study gender-based patterns of clinical and demographic characteristics amongst patients admitted for the first time at Bethlehem Psychiatric Hospital over a year.

A retrospective cross-sectional study was conducted at the Bethlehem Psychiatric Hospital, reviewing the medical records of patients admitted for the first time between October 2022 and October 2023. First, data collection was conducted manually by residents transferring information from paper-based files to an Excel sheet. Next, sociodemographic and clinical variables were selected. Finally, the 21st version of IBM SPSS was used to analyze the role of gender factors.

For the 140 patients admitted for the first time to the psychiatric hospital between October 2022 and October 2023, the majority (70%) were male, with a mean age of 31.6 for males and 35 for females.

Most variables showed no significant differences between male and female patients. Of the variables that showed significantly (p < 0.05) higher occurrence in male patients were imprisonment, physical aggression (78.6% of males, 61.9% of females), smoking (84.4% of males, 14.3% of females), and substance use (36.7% of males, 2.3% of females). However, length of stay, clozapine prescription, and parents' consanguinity were significantly higher in women.

This is the first study conducted about gender differences in Palestinian psychiatric inpatients. Some elements pointing to antisocial traits (like imprisonment and substance use) were more common in males, while women stayed longer at the hospital. Studying these measures and their etiology is crucial for better understanding and management.

There is a need for more research on gender differences, and Palestinian psychiatry as a whole, integrating social-economic, cultural, and medical views, to provide better equitable care for patients, and be able to advocate better for them.

Long-acting benzodiazepine is the treatment standard for alcohol withdrawal and three regimens are defined – fixed-dose (for outpatient and inpatient settings with untrained staff), symptom-triggered (inpatient setting with trained staff) and front-loading (when a severe withdrawal state is anticipated). Standards in this regard are published by ASAM, NICE and guidelines by Govt. of India. A clinical audit was performed to explore the treatment strategy used in a de-addiction centre in India.

Description of the initial audit cycle.

Setting: Dedicated 10-bed de-addiction ward, attached to a general hospital, with an average of 15 admissions/month of patients with disorders of alcohol use. The centre was established as a special project (‘Vimukthi’) in 2018 and is serviced by a team of three nurses, one doctor and one clinical psychologist, and visited by psychiatrists from the general hospital.

Measurement of performance and comparison with standards: Measurement was done in May 2023 after the authors took charge of the ward. The centre used a fixed-dose regimen of short-acting lorazepam for all patients to manage withdrawal symptoms. There was no documentation of risk profiling. We therefore recommended that tailored treatment based on patient profile be introduced. Risk profiling based on symptoms, signs and history and a symptom-triggered regimen for withdrawal management using nurse-administered CIWA-AR rating could be incorporated into a standard operating procedure (SOP). An SOP was developed and after team discussion and training it was introduced in October 2023.

Re-audit of the implementation phase of SOP over three months (Oct 2023 to Dec 2023) was conducted. Case files were noted to document risk stratification as 34% low risk, 52% intermediate risk and 14% high risk. Symptom-triggered regimen was administered to all patients with added front-loading for all high-risk and some moderate-risk patients. Staff and patients expressed satisfaction with the new protocol. We noticed a significant reduction in the use of oral lorazepam (from 3324 mg for 63 patients during the comparative period of Oct 2022–Dec 2022 to 10 mg for 39 patients), while the use of injectable lorazepam increased by 25% (0.8 mg/patient to 1 mg/patient). Use of oral diazepam increased from nil to 170 mg with one patient receiving injectable diazepam.

Introducing an SOP that incorporated risk profiling, use of long-acting benzodiazepines, symptom-triggered and front-loading regimens and nurse-administered CIWA-Ar monitoring led to the reduced use of short-acting and uptake of long-acting oral benzodiazepines in inpatient alcohol withdrawal management. Decisions based on risk profiling led to an increase in the use of injectable benzodiazepines. We report that conducting this audit cycle led to the improvement of treatment standards in a specialized inpatient de-addiction centre in India.

All patients who are prescribed antipsychotic medications require annual blood tests which must include Full Blood Count (FBC), Urea and Electrolytes (U&E), eGFR, Lipids (Cholesterol & Triglycerides), Liver Function Test (LFT), HbA1c/Plasma glucose. Some patients also require prolactin blood test depending on their prescribed antipsychotic medication.

NICE and Maudsley guidelines recommend an annual check of the blood tests mentioned above.

This audit ascertained compliance in terms of annual blood test monitoring for patients who take antipsychotic medications and provided recommendations to improve where necessary.

Half of the caseload from two General Adult psychiatry Community Mental Health Teams (CMHT) were recruited from a sample population of 228 patients. Odd number randomisation was applied to select our sample (e.g., 1, 3, 5…). Sample size was of 114 patients, 8 of whom were not prescribed antipsychotic medications and excluded. Hence, 106 patients were identified as representative for inclusion in this audit.

Retrospective data collection was from clinical entries, clinic letters and blood test results.

Data obtained from these patients was collated and analysed using MS Excel spreadsheet.

The audit revealed that compliance was suboptimal for all required blood tests (Compliance 80% or above is recommended). The kidney function test of Urea & Electrolytes was the closest to recommended standards and best performance overall (77%), eGFR, was subpar at 60%. 74% of patients had the glucose monitoring tests (Plasma glucose/HbA1c) done while Full Blood Count and Liver Function Test were both completed in 76 patients (~72%). The worst performing category was Prolactin monitoring, of which only 9 of patients who required this had it done, recording a mere 31%.

Majority (66%) of the blood tests were done at General Practice (GP) surgeries, 25% by Mental Health Services, while the rest were contributed to by Accident & Emergency and Acute Hospital visits.

Following completion of this audit, recommendations were made to advise existing antipsychotic blood monitoring services (GP surgeries and private clinic affiliated with the Trust) of the recommended blood parameters for monitoring, and the need to update current systems. Also, Liaison with service managers and service leads to set up a dedicated physical health clinic for this purpose. The latter has been particularly successful as the Trust is now in the process of recruitment for the new physical health clinic team. A re-audit is planned in the near future.

The NHS England Core20PLUS5 aims to reduce national healthcare inequalities by identifying five clinical areas requiring accelerated improvement for the most deprived 20% of the population. Three of these clinical areas are: Severe Mental Illness (SMI), Early Cancer Diagnosis and Maternity Care.

Hackney has the highest proportion of areas within the most deprived 10% nationally. The Hackney Rehabilitation and Recovery Team is a specialist service for those with SMI. While the service does not provide maternity care it is uniquely placed for women's health outreach work in this population. Research has shown that lower participation by those with SMI in screening may make them 2.5 times more likely to die prematurely from cancer. Bearing this in mind, this project aimed to improve early cancer diagnosis and management of women's health to improve health inequalities for females with SMI in Hackney.

I audited cancer screening compliance from the medical records of the 19 female patients under the Hackney Rehabilitation and Recovery Team and obtained patient feedback to explore barriers to access screening. I used a pool of possible keywords to perform a search for any discussion of women's health issues during contact with mental health professionals. Encouraging a culture of ‘Making Every Contact Count’, I presented the results of this audit at a Team Education Session, after which attendees received a personalised list detailing their caseload's outstanding health needs as identified from the audit. I led a weekly physical health clinic which addressed women's health issues. I designed a referral pathway for patients with complex psychiatric needs with the local cervical screening service which allows for longer appointments.

16% of the female patients under the care of the Hackney Rehabilitation and Recovery Service had never had a discussion covering women's health issues. 73% of mammograms and 53% of smear tests were outstanding. Barriers to access include a lack of knowledge of cancer screening programmes and practical issues in booking appointments. Some cited a lack of confidence in travelling to appointments and communication issues (access to a mobile phone, email address or post) as an issue.

Designing interventions to boost the uptake of cancer screening appointments for female patients with SMI is a practical application of the CORE20PLUS5 approach. An MDT approach including patient participation and feedback is key when developing effective outreach initiatives.

We audited the adherence to part of the minimum admission standards for Mental Health, Learning Disabilities and Addictions Services (MHLDA) for 6 acute wards, across two sites (UHH and UHW) in NHS Lanarkshire. We focussed on the section of the standards that the admitting junior doctor/ANP is responsible for. This comprised:

• • An admission assessment (including presenting complaint, history of current episode of illness, medication, mental state examination and risk assessment).

• • Physical health assessment (examination, bloods, ECG, VTE assessment), medicine reconciliation and prescribing on HEPMA - within 12 hours.

Five individuals collected data across both sites and both cycles. For our first cycle, all admissions in March 2023 were retrospectively reviewed, a total of 94 admissions (UHH 47, UHW 47). Electronic notes/systems were reviewed (Morse, Clinical Portal, Hepma, Trakcare).

This first cycle demonstrated poor adherence to the minimum admissions standards. A proforma for admission statement was created, including prompts for the admission assessment and for the components of the physical health assessment, medicines reconciliation and prescribing. Presentations were made at postgraduate teaching and at ANP teaching. The majority of people were unaware of the existence of the admission standards or did not know where to find them. The admission standards document and the proforma were circulated via email and added to the shared R drive. A second cycle was completed, reviewing all admissions in July 2023, a total of 74 admissions (UHH 41, UHW 33). The proforma has now been included in the induction material for new doctors.

Following interventions, there was improvement in completion of admission statement (90% vs 81%). There was improvement in the inclusion of all components, most notably MSE (91% vs 71%) and risk assessment (59% vs 18%). Where the proforma was used (57%), all aspects of admission statement were present (97–100%). When not used, there was variable inclusion of the different components (7–90%). There was improvement in the completion of all components of physical health assessment (except small decrease in medicine reconciliation). In every case of missing components with no documentation as to why, the proforma had not been used.

Development of a proforma for admission assessment has led to improved completion of admission assessment, physical health assessment, medicines reconciliation and prescribing within 12 hours. Qualitative feedback is being sought on the proforma from junior doctors, ANPs and senior medics to guide next steps and further improvements. Review of the admissions standards guidance is now due.

To establish the usability and tolerability, as well as accuracy of measurements of a handheld KardiaMobile ECG device in an inpatient older adult dementia ward.

Between February 2023 and April 2023, KardiaMobile ECGs and 12-lead ECGs were taken for patients admitted within a dementia ward in Liverpool. The standard 12-lead ECGs were analysed as per current practice, by Broomwell Health Watch. The KardiaMobile ECGs were read manually, by two independent raters, for heart rate and QTc. The user-rated tolerability was measured out of 5, 5 being the most tolerable, and was measured for both KardiaMobile and 12-lead ECGs, allowing comparison. The QTc and heart rate were calculated for both methods, and then compared. QTc was calculated using Bazett's formula.

13 inpatients had a 12-lead ECG, and a KardiaMobile ECG performed. Both were tolerated by all patients, except one who tolerated neither, leaving 12 ECGs for comparison. KardiaMobile ECGs were quicker to obtain, more well tolerated, and easy to use. However, manual calculation of QTc, versus expert and computer analysis for 12-lead ECGs, led to some variability between QTc measurements. Inter-rater reliability between raters for the KardiaMobile QTc was poor, however, when both were combined, correlation with 12-lead ECG QTc was moderate. KardiaMobile ECGs were harder to obtain in those with tremors, and the lack of computerised readings made interpretation more difficult. 12-lead ECGs also offer reassurance in the form of a fully interpreted, more detailed ECG.

KardiaMobile devices are faster to use and as/more tolerable in a dementia ward setting than 12-lead ECGs. The ECG trace is fed back instantly to the mobile device, however, automatic interpretation is limited and QTc calculation relies on the operator. Visual inspection of QTc can be difficult, and unreliable. However, the combination of two different raters led to more reliable results. The device has potential for use in this setting, however, an increase in automatic interpretation, or interpretation by a third party such as with Broomwell Health Watch, would increase its usability.

Theoretically, OAMH services would be similar across all Welsh health boards but the reality can differ. To my knowledge, such data about OAMH services across Wales does not exist in a structured way. So I aim to explore these similarities/differences across different Welsh health boards.

A 20-question google forms survey was sent to 65 doctors from the seven Welsh health boards including long-term trust-grade doctors, middle-grade/SpRs and consultant psychiatrists. It is a box-ticking survey with comment fields for sharing potential thoughts.

Response rate is 50.7% (33/65) with representation from all health boards. Consultants represent 72.2% of responses.

There is some variation in MDT members. Large variation shows in number of organic and functional beds. 33.3% have wards with mixed-type patients. 66.7% have separate wards for each cohort of patients. 30.3% have no inpatient duty but those who have (69.7%), show a varied number of inpatients. Only one sector has long-stay beds.

63.6% indicate that outpatient duty is divided into functional and memory services. Number of clinics differs hence varied numbers of patients.

57.6% have support of COTE on request, some have their regular attendance and some struggle to have their support. 66.7% indicate that care-coordinators are CPNs, otherwise they are OTs, social workers, psychologists or consultants.

75.8% find it better to have one team providing care for the same patient in the community and as inpatients; one major factor being continuity of care.

72.7% have medical students shadowing them in a structured way.

63.6% do not have specialized clinics in the community, others state they have clinics for lithium, clozapine, depot, S117 after-care, antipsychotic review, MCI or neuropsychiatry.

60.6% of liaison services are old-age specific. Some comments state that even in ageless services, they have an older adult psychiatry consultant. One comment states that there are designated nurses to each age group but the consultant is not “old-age trained”.

90.9% of memory services are run by psychiatric service; 9.1% by other departments.

Variations are not only across different health boards but also in-between sectors in each health board. Responses indicate variation in structure of inpatient, outpatient, liaison service and community specialized clinics. There are different levels of support from COTE. Structured medical students’ placements are shown in majority of responses. Finally, satisfaction of subconsultant-level doctors is clear by their wish to continue in the same field.

1. 1. Measure compliance with NCEPOD Recommendations in the quality of physical healthcare provided to adult patients admitted to a mental health inpatient setting across the East and Central areas of North Wales.

2. 2. Guide further service development and improvement in the quality of physical health care provided in mental health inpatient settings in North Wales.

1. 1. A retrospective case notes audit of 10 patients each who were inpatient for at least one week duration on the adult mental health wards was conducted in April 2023 across the East and Central areas of North Wales.

2. 2. The audit was conducted using the NCEPOD audit Toolkit for “Physical Health in Mental hospitals”.

1. 1. Inpatients percentage (%) compliance against NCEPOD recommendation 1, 5, 6, 7, 9 and 11 was 0% for both East and Central areas of North Wales respectively.

2. 2. Recommendation 2 had 65% compliance for Central vs 61% for East.

3. 3. Recommendation 3 had 62% compliance for Central vs 25% for East.

4. 4. Recommendation 4 had 88% compliance for Central vs 40% for East.

5. 5. Recommendation 8 had 3% compliance for Central vs 20% for East.

6. 6. Recommendation 10 had 100% compliance for Central vs 94 % for East.

7. 7. Recommendation 12 had 72% compliance for Central vs 71% for East.

1. 1. Improve compliance with the NCEPOD recommendations in the quality of physical healthcare provided to adult patients in mental health inpatient settings.

2. 2. Develop a Trust wide policy document for physical health care in mental health inpatient settings in North Wales as per NCEPOD recommendations.

3. 3. Develop a new physical health assessment booklet for Betsi Cadwaladr University Health Board Mental Health and Learning Disabilities Division to be used by all inpatient staff for the provision of physical healthcare of mental health inpatients in line with the NCEPOD recommendations.

Antipsychotic-induced weight gain (AIWG) is a substantial contributor to high obesity rates in psychiatry. Limited management guidance exists to inform clinical practice, and individuals with experience of managing AIWG have had no or minimal input into its development. A lack of empirical research outlining patient values and preferences for management also exists. Recommendations addressing weight management in psychiatry may be distinctly susceptible to ideology and sociocultural values regarding intervention appropriateness and expectations of self-management, reinforcing the need for co-produced management guidance. This study is the first to ask: how do individuals conceptualise preferred AIWG management and how can this be realised in practice?

1. Explore the management experiences of individuals with unwanted AIWG. 2. Elicit their values and preferences regarding preferred management.

Qualitative descriptive methodology informed study design. A total of 17 participants took part in semi-structured interviews. Data analysis was undertaken using reflexive thematic analysis.

Participants reported that clinicians largely overestimated AIWG manageability using dietary and lifestyle changes. They also reported difficulties accessing alternative management interventions, including a change in antipsychotic and/or pharmacological adjuncts. Participants reported current management guidance is oversimplified, lacks the specificity and scope required, and endorses a ‘one-size-fits-all’ management approach to an extensively heterogenous side-effect. Participants expressed a preference for collaborative AIWG management and guidance that prioritises early intervention using the range of evidence-based management interventions, tailored according to AIWG risk, participant ability and participant preference.

Integration of this research into guideline development will help ensure recommendations are relevant and applicable, and that individual preferences are represented.

Up to 75% of dementia patients will experience behavioural (non-cognitive) symptoms in their lifetime. Therefore, it is important to ensure delivery of high level of quality care to these set of patients.

The NICE guideline recommends that:

1. 1. Non-pharmacological method should be used before pharmacological method in the management of behavioural symptoms.

2. 2. When antipsychotics are used, they should be started at low dose and increased slowly.

3. 3. Those started on antipsychotics should have follow up at least 6 weeks after commencement.

Aim: The audit aims to compare the care we give dementia patients with behavioural symptoms against the NICE guideline.

The objectives are:

1. 1. To assess use of non-pharmacological method before pharmacological method in the management of behavioural symptom in dementia patients.

2. 2. To assess antipsychotic prescriptions in the management of behavioural symptoms in dementia patients.

3. 3. To assess if patients started on antipsychotics were properly followed up.

Electronic records of 34 patients who met the inclusion criteria were assessed and information related to the objectives were extracted. Data was stored securely in the trust laptop. Analysis of the information was done using Microsoft Excel version 2022. Results were presented in charts.

The result showed that the commonest behavioural symptoms reported was agitation and verbal aggression which accounted for 34% and 29% respectively. About 24% of the patient were commenced on medication for their symptoms without trial of non-pharmacological methods. Out of the patient that were on medications, risperidone was the commonest medication prescribed accounting for 37%. Other medications prescribed included quetiapine, amisulpride and lorazepam. The result also showed that those started on medication were properly followed up according to the NICE guideline.

The audit showed that the NICE guideline is not fully followed, adherence to the guideline is around 75% overall. Efforts should be geared toward enlightening professionals about the need to follow the NICE guideline in managing this condition. It would be worthwhile to re-audit in 12 to 24 months.

To investigate risk assessment and management processes across a health board in the context of the implementation of a new risk screening tool and policy through use of staff focus groups to identify how teams make decisions related to risk and gain an understanding of how the new CRAFT tool is used.

In mental health services, risk assessment and management are key responsibilities for clinical staff. A risk management tool that is structured and evidence-based aims to assist staff in managing risks including violence, self-harm, suicide and self-neglect.

It is not clear whether risk tools have clinical utility in influencing risk-related decision making and previous reviews within the health board indicated that risk policy was not being adhered to, prompting a review of the policy. Furthermore, policy recommends service user and carer collaboration with staff in all areas of mental health in Scotland but despite these recommendations there is little evidence to suggest they are routinely involved in risk assessment and management processes.

The present study is an opportunity to explore how teams think about and discuss risk management.

A qualitative analysis was carried out of data from two staff focus groups. These groups were identified by contacting interested teams by email. Groups comprised clinical staff from different disciplines within the MDT including medical and nursing staff. Staff were questioned about their understanding of risk, thoughts regarding risk assessment and their experience of being trained in and using the CRAFT tool.

Themes emerging from the data indicate that staff felt the CRAFT had limited clinical utility or impact on their assessment of risk but may prove useful for communicating decisions about risk between staff and services. However, concerns were raised that the format of the tool made it difficult to complete and read, meaning that important information may not be adequately communicated. Staff reported feeling inadequately trained in the use of the CRAFT tool and felt there were inconsistencies in its use across the health board.

Staff focus groups have identified challenges with the completion of the current CRAFT tool and expressed a need for better training in order to improve consistency of use across the health board. An update to the tool is due to be rolled out across the board in an effort to address these issues and improve risk assessment completion on the whole.

Fourth-year medical students from Manchester University undergo a four-week Psychiatry rotation in Stockport as part of their curriculum. Placed in both community and inpatient teams within General Adult and Older Adult Psychiatry services, this placement offers a unique opportunity for students to gain clinical and educational experience in Psychiatry, potentially shaping their perception of the field. This quality improvement project aimed to enhance the overall experience of medical students during their Psychiatry placement in Stockport.

A retrospective review of quantitative and qualitative feedback from the March to April 2023 cohort (n = 4) involved a 5-point Likert scale and comments covering 10 domains. The feedback focused on aspects such as induction, orientation, learning objectives, patient assessment, procedural skills, supervisor feedback, access to resources, timetables, and the overall experience. An average total score was calculated.

Subsequently, strategies were implemented for the April to May 2023 cohort based on the feedback. Weekly check-ins, updated timetables, team introductions, additional teaching sessions, and opportunities for case presentations were among the interventions.

Quantitative and qualitative feedback from the April to May 2023 cohort (n = 4) were collected and compared with the previous cohort's feedback.

The feedback scores demonstrated improvement, with the average total score increasing from 4.1/5 (82%) in March – April 2023 to 4.7/5 (94%) in April–May 2023. Students praised the helpful staff, opportunities to present cases, and the tailored and useful nature of the placement. Feedback on improvements included addressing vague timetables, unannounced cancellations of teaching sessions, and limited opportunities for case presentations.

This quality improvement project demonstrated that the targeted interventions helped enhance the educational experience of medical students during their psychiatry placement. The increased feedback scores underscore the positive impact of targeted interventions. The findings emphasize the importance of continuous quality improvement in medical education, ensuring a more positive and enriching experience for medical students in Psychiatry rotations.

The skill of critical appraisal is mandatory for evidence-based psychiatric practice although the process of learning can be tough for busy psychiatrist trainees. Ironically, reading alone does not translate into skill acquisition. The accessibility to conventional journal clubs may also be limited for doctors working in busy non-academic training centres. Therefore, attending an intensive workshop on critical appraisal skills can be a viable solution. This study elucidated the experience of using an innovative approach, i.e. Multiple Mini Journal Clubs (MMJC), to improve Malaysian trainee psychiatrists’ critical appraisal skills.

A one-day workshop was conducted for 19 participants who were preparing for MRCPsych Paper B, using the combination of 1) a pre-recorded video lecture with a two-hour question and answer session; 2) three 45-minute stations in a group of three persons to practice critical appraisal of a cross-sectional, a validation, and a randomised controlled study. A standardised approach, i.e. Critical Appraisal in Five Expressed Steps (CAFES), was used by facilitators. CAFES involved asking and answering the following big heading questions while incorporating other standard critical appraisal techniques under each of the headings: 1) What is the research question; 2) Can the research methodology answer the question; 3) Does the result make sense; 4) Are the findings translatable to my setting; 5) How to improve the study if I were to conduct a similar study. Three formative assessments were carried out using Single Best Answer and Extended Matching Items. Qualitative feedback and informed consent were collected.

Hundred per cent of participants agreed that their objective of attending the workshop had been achieved through the MMJC, i.e. learned both the theory and skill of critical appraisal which allowed immediate translation into practice during the MMJC. Nevertheless, there was no statistical difference in participants’ achievement for pre-, mid- and post-workshop formative assessments, i.e. median of 7/25, 7/28, and 8/27 respectively. Positive responses toward MMJC included less performance anxiety in a small group, active interaction, individualised feedback, and fun. The challenges faced included the need for strict time management and a big group of facilitators. Suggestions for improvement included the extension of the workshop duration and breaking up the lecture into several sessions.

Further improvement and re-evaluation of the effectiveness of MMJC is required to optimise learning outcomes.

Graves’ disease, an autoimmune illness, is one of the most common causes of thyrotoxicosis and often presents with classic symptoms of hyperthyroidism. However, patients can rarely present for the first time with psychiatric symptoms, including psychotic and mood symptoms or a combination of both, and there is limited data on the most effective treatment.

Here, we report the case of a 24-year-old black British female who had no previous psychiatric or medical history, presenting for the first time with one week history of poor sleep, disordered thought, and bizarre and violent behaviour towards family. Collateral history describes her premorbid personality as “anxious and perfectionist”, with the only recent stressors identified being preparations for her best friend's wedding. Her mental state on presentation was remarkable for tangential and circumstantial speech, incongruent affect, and lack of insight into illness. She was admitted to an acute adult ward under Section 2 of the Mental Health Act (MHA) after being “medically cleared” but before the results of her thyroid function tests were available.

She was transferred back to the acute medical ward a day into psychiatric admission, where she was treated medically for thyrotoxicosis and discharged with the support of the Home Treatment Team after an almost complete recovery in her mental state. Initial symptoms recurred two weeks after discharge, culminating in another admission cycle initially to a psychiatric unit under the MHA, where she was treated with oral risperidone and a medical ward for further medical investigations. Her mental state improved significantly again, and she was discharged home to the concerted care of both a community mental health team and follow-up with the endocrinology team. On outpatient psychiatric review a year following discharge, the patient remains stable in her mental state and has achieved a euthyroid state with plans to taper off and withdraw risperidone gradually.

This case shows the importance of a thorough physical health assessment and investigation before making psychiatric management decisions. It also points out the drawback of the divide between physical and mental health services, the impact this has on patient care and experience within the National Health Service, and the mixed success of medical management in controlling psychiatric symptoms.

This case describes the rare presentation and successful management of psychosis induced by thyrotoxicosis in a female patient with Graves’ disease. It highlights the need for prompt, interdisciplinary care to diagnose and safely manage such patients correctly.