To reassess and compare whether changes to medications are being made based on the anticholinergic effect on cognition (AEC) score. To understand the impact and implementation of recommendations from the first audit and whether these have led to change.

Data on AEC scores were collected from one later life ward in Greater Manchester. The audit considered patients admitted September 2022 to January 2023 and the re-audit those admitted March 2023 to September 2023. The data was collected retrospectively by the auditors by going into the electronic notes of the initial ward round, the four week ward round and the patients' electronic prescription charts, information was then inputted into and analysed in Excel.

21 patients were included in the audit and 23 in the re-audit. Roughly 50% of patients in the initial audit scored 0 at 4 weeks, only 13% re-audit patients scored a 0. Eight more patients saw an increase in their AEC score within the re-audit than the audit. 5 patients had a lower anticholinergic burden during the audit, only 3 patients saw this decrease during the re-audit.

Unfortunately it appears the first audit's recommendations were not adequately implemented as no improvement was seen between audits. We must therefore try to increase awareness of the adverse effects of anticholinergic medications through posters, teaching sessions by pharmacists and information posters on the ward; the effectiveness of these interventions can be analysed through a future quality improvement project.

The second recommendation is that the AEC score is to be calculated routinely for all patients admitted to an old age ward within the GMMH trust. This information to be included in the junior doctor induction pack and as a subcategory in the ward round documentation proforma.

A final recommendation is for the electronic prescribing system to include a built-in AEC calculator and prompt at admission and 4 weeks with the AEC score.

Antipsychotic medications are one of the major iatrogenic causes of hyperprolactinaemia with the attendant short- and long-term effects and risks associated with it.

• • The audit sought to answer the question: Are we monitoring and managing hyper prolactinemia caused by anti psychotic medications appropriately?

• • A literature search for relevant data and standards with regards to monitoring and management of hyperprolactinaemia was conducted.

• • The audit was based on the standards derived from South West Yorkshire NHS Partnership Foundation Trust’s (SWYPFT) standards, NICE guidelines, and the Maudsley Prescribing Guidelines in Psychiatry (14th edition), focusing on the Trust's standards.

• • The total population under consideration included every patient under the care of the North Kirklees, Community mental health team (CMHT), Old age psychiatry services (OPS) that was using antipsychotic medication in the time period between 16 June 2022 and 15th July 2023.

• • Total patients 61

• • Female 30

• • Male 31

• • Age: 65 and above

• • Already on antipsychotic: 49

• • Started on antipsychotic: 12

• • Two or more antipsychotic: 2

• • Switch from one antipsychotic to other: 4

• • Prolactin monitoring not required: 27 because were already using olanzapine, quetiapine and aripiprazole

Monitoring required: 34

• • Initiation: 12

• • Prolactin level done 2/12

• • Prolactin level not done 10/12

• • LAI (long acting antipsychotic) 11

  Prolactin level done 7/11

  Prolactin level not done 4/12

  Not done: 75% were with Care coordinator

  25% Wellbeing team

• • On oral antipsychotic that require prolactin level monitoring: 11

• • Prolactin level done 5/11

• • Prolactin level not done 6/11

Patients who were on antipsychotics in community required prolactin monitoring. In more than 50% of patients prolactin were not monitored regularly because of communication gap between Psychiatrist and GPs as no clear instructions were mentioned from Psychiatrist to GPs, patients and care coordinators.

A small number of patients in whom prolactin was raised were highlighted to their respective medics and managed accordingly.

To illustrate the scale and impact of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) Psychiatry Interest Forum (PIF) ten years since its inception.

Member data from 2013–2023 was analysed alongside recent event and engagement activity survey results, as well as qualitative feedback from medical students and prevocational doctors who took part in PIF engagement activities.

PIF attracts and inspires the next generation of Australian and New Zealand psychiatrists.

It is a stepping stone into the RANZCP Fellowship program, and has a particular focus on increasing interest in rural careers and supporting more First Nations medical students and prevocational doctors into psychiatry.

PIF events, sponsorships, scholarships and information achieves this by:

• • providing a starting point for learning and exploring the specialty of psychiatry

• • fostering interest in psychiatry among medical students and junior doctors

• • creating a safe and enabling environment to explore the specialty, create networks, and build connections

• • challenging common misconceptions about psychiatry and reduce associated stigma

• • increasing applications to the RANZCP Fellowship program.

In 2023, the program achieved its highest annual number of new members joining to date, with 1,056 medical students and junior doctors choosing to join PIF. That year, 77% of all new trainees that joined the Fellowship pathway were former PIF members.

Survey data from PIF members who took part in the PIF program hosted at the Perth Congress in 2023 demonstrated that:

• • 100% reported an increase in psychiatry knowledge following Congress.

• • 82% reported their likelihood of pursuing psychiatry had increased following Congress, and 18% reported ‘no change’, as they reported strong certainty prior to the Congress attendance.

• • 75% reported that the PIF networking sessions helped clarify misconceptions or stigmas that they previously held about psychiatry following Congress.

‘My favourite part of the PIF Congress was the ability to interact with likeminded PIF peers and psychiatrists and trainees from all over Australia and New Zealand. Another PIF member had said “I feel like I've found my tribe” which is a comment I particularly resonated with.

Ten years on, PIF continues to expand its reach and impact to increase the pipeline of psychiatry trainees in Australia and Aotearoa New Zealand.

The prevalence and subsequent physical health burden of alcohol use disorder is on the increase in almost all age groups in the UK and nearly 1 in 5 of the population will drink at hazardous levels. Those who drink heavily often have limited or patchy engagement with physical health services and improving this should be a focus of drug and alcohol services.

Our aim was to audit the proportion of clients attending the alcohol service at Lorraine Hewitt House (LHH) who had completed a fibroscan, to audit the outcomes of those fibroscans and to audit the outcomes of the onward referrals where they had been made.

Since starting the liver clinic, more than 100 fibroscans have been completed. These are typically offered to clients in the alcohol pathway and where it can be facilitated, they are done on the day, or otherwise booked in for scheduled appointments.

We audited the results of the scans, for liver stiffness and liver steatosis. Additionally, for those who had abnormal results requiring onward referral, we audited the outcomes of these referrals.

Outcomes and overall physical health were subsequently discussed with each patient who underwent a liver scan.

A total of 100 fibroscans were audited. This represents approximately one third of the clients with alcohol as their primary problem substance at LHH.

Every client had the results of their scan explained and discussed with them and were given lifestyle advice and interventions.

A total of 37 scans (37%) had all their parameters within the normal range. 16 (16%) showed an increased liver stiffness of >10kPa and 15 people (15%) gave consent and were subsequently referred to our local liver clinic. 13% had stage 1 steatosis (238–260dB/M), 18% had stage 2 steatosis (260–290dB/M) and 29% had stage 3 steatosis (>290/dB/M).

Of the 15 referrals made to liver clinic, 10 (66.7%) attended their liver clinic follow up appointments and 9 of these clients are awaiting further interventions – the remaining 1 client has been discharged back to their GP.

Of the remaining 5 referrals made to liver clinic, 2 are awaiting appointment dates and 3 are pending triage.

The physical health of clients attending drug and addiction services is often complicated and in need of specific and targeted interventions. Liver health is particularly relevant to the alcohol client group and integrating fibroscans into drug and addiction services facilitates better engagement and early assessment and intervention.

Obsessive-Compulsive or Related Disorders (OCRDs) comprise a group of disorders characterized by repetitive thoughts and behaviours and are fairly less prevalent among children. The recommended treatment for OCRDs involves high doses of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), along with non-pharmacological management. However, evidence suggests that the risk of inducing mania with antidepressants may be especially high in children and adolescents aged 14 years and younger.

Here, we present a case of a nine-year girl, studying in fifth standard, with normal birth and development history, with no past/family history of psychiatric illness, presented with psychiatric illness of one-year duration and was diagnosed with Trichotillomania, Obsessive-Compulsive Disorder, Skin picking and Onychophagia as per the 11th revision of International Classification of Diseases (ICD-11). After initiating tab. escitalopram 5 mg for 10 days, child developed a manic episode, which leads to a diagnostic dilemma as well as difficulties in her further management. In view of the bipolarity, escitalopram was stopped and the child was started on tab. aripiprazole 2.5 mg which was gradually up-titrated to 7.5 mg/day, following which the manic episode completely resolved and there was also improvement in OCD, hair pulling and skin picking behaviour. Later for the remaining symptoms few sessions of Habit reversal therapy were held. Currently the patient is maintaining well on aripiprazole 7.5 mg for the last six months.

The uniqueness of this case is demonstrated through current limited literature on comorbid OCRDs and antidepressant coincident manic episode, especially in children in whom diagnosing manic episode possess a great challenge owing to various differential diagnosis. While deciding pharmacological therapy in children with OCRDs or Mania the efficacy as well as their safety profile should be considered. Currently there are no medications approved by FDA for treatment of acute manic episode in patients below 10 years of age and use of SSRI which are considered first line for treatment of some OCRDs may exaggerate the manic episode. In literature, second generation antipsychotics such as aripiprazole is found to be useful for the management of both manic episode (as monotherapy) as well as OCD (as an adjuvant). In this case aripiprazole monotherapy led to significant improvement in both groups of symptoms.

Thus, SSRIs should be used cautiously in children with OCRDs and aripiprazole along with other approved non-pharmacological management strategies can be considered as a good treatment option in children with OCRDs and anti-depressant coincident manic episode.

People who are forced to leave home often experience emotional suffering and may be disproportionately subjected to risk factors for suicide. Although it is a grave concern for the global public health community, it has not been understood in Ethiopia.

This study aims to assess the prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022.

From 23 May to 22 June 2022, a cross-sectional study design was conducted, and a sample of 765 participants was selected through simple random sampling. A structured interview was employed to collect data. Suicidal ideation and attempts were assessed using the Composite International Diagnostic Interview.

Out of 751 interviewed participants with a response rate of 98.2%, the magnitude of suicidal ideation and attempt was 22.4% (95% CI: 19.5%, 25.4%) and 6.7% (95% CI: 5.1%, 8.7%), respectively. People of female gender, having depression, family with a history of mental illness, and poor social support were significantly associated with both suicidal ideation and attempts. Furthermore, post-traumatic stress symptoms and the death of a family member were significantly associated with suicide ideation and attempt, respectively.

At least one in five of the displaced people in this population had experienced suicide ideation, and one in fifteen had attempted suicide. Therefore, strengthening early detection and intervention for individuals is recommended, especially for females with depression, post-traumatic stress symptoms, family with a history of mental illness, poor social support and the death of family members.

Aims – An Audit in the Older Adult Community Mental Health Team identified that there were inaccuracies in the Addenbrooke's Cognitive Examination-III (ACE-III) scoring used to help diagnose dementia. The aim of this Quality Improvement Project was to determine if ACE-III training delivered by a neuropsychologist would improve the accuracy and reliability of ACE-III scores used by the team to help diagnose dementia.

ACE-III surveys completed over a 6 month period were analysed to determine if they followed the ACE-III scoring guidelines provided by the ACE-III Administration and Scoring Guide (2012). ACE-III surveys were completed by different members of the multidisciplinary team. Following identification of inaccuracies and inconsistencies in scoring we delivered ACE-III training via a neuropsychologist to determine if this would improve ACE-III scoring (as per the ACE-III Administration and Scoring Guide) in the following 6 month period after the training was received.

Following ACE-III training delivered by a neuropsychologist in how to complete the ACE-III survey, surveys were analysed using the Administration and Scoring Guide (2012). ACE-III scores were more accurate in the 6 months following the ACE-III training delivered by a neuropsychologist to the team.

ACE-III training improved the accuracy of ACE-III scores in the multidisciplinary CMHT. This finding would advocate for ACE-III training to become part of our roles within Older Adult Psychiatry in order to improve service delivery to the patient.

Opioid dependence is associated with adverse physical health, mental health and social consequences. Daily oral opiate substitutes offer some treatment gains but several negative associations including daily dosage fluctuations, long-term reliance on services and negative impact on ability to work.

Long-acting injectable buprenorphine (LAIB) is a new treatment option, extensively used in Wales since 2020. We have shown the many gains, including increased treatment retention, reduced service reliance, improved patient satisfaction and increased capacity for people to move on in their recoveries, are likely to be due to LAIBs unique combination of allostatic μ-opioid receptor agonism (craving reduction) and sustained κ-receptor antagonism (anxiolysis). However, ~50% experience resurfacing of mental health and/or trauma symptoms on LAIB that impedes recovery. The Buvidal Psychological Support Service, commissioned by Welsh Government, seeks to develop the evidence base for provision of rapidly accessible, tiered psychological support alongside LAIB to address this. Here we present initial 9-month findings.

Tier 1 of the service offers 8 weekly individual therapy sessions, delivered flexibly over 2–6 months, with an experienced trained therapist focused on psychoeducation, co-production of a trauma and compassioned based formulation, and the development of skills to manage current mental health or trauma symptoms.

Pre- and post-evaluation programme assessed efficacy including: EQ5D-5L, Work and Social Adjustment Scale (WSAS), Clinical Global Impressions (CGI), PRO Severity and Clinical Outcomes in Routine Evaluation –10 (CORE-10).

The service launched in March 2023 with 100 referrals in the first 9 months.

35 patients have completed Tier 1, taking between 2 and 6 months to complete.

Patients who completed Tier 1 showed clinically significant reductions in psychological distress and improvements in global functioning, quality of life and perceived mental health difficulties.

These were statistically significant at p < 0.001 for all measures (EQ5D, ICECAPS, WSAS, CGI, PRO, CORE-10) (28< = n <=34).

Rates of retention in treatment are greater than expected amongst this complex client group and the significant global improvements support the notion that those on LAIB present with increased stability and ability to engage in therapy, and that a tiered flexible approach to therapy can promote psychological safety and engagement and sustained recovery.

We propose that a tiered trauma-focused psychology service is well placed to meet the needs of people on LAIB and should be a core component of LAIB treatment in the UK.

The NHS Southern Gambling Service (SGS) is a service providing evidence-based assessment and treatment for people affected by Gambling Disorder (GD) across the South-East of England. This service evaluation aimed to ascertain whether SGS was offering equality of access to treatment and suitable provision of treatment to ethnic minority communities, and whether there were barriers making it difficult for people from ethnic minority communities to access and engage in treatment for gambling harms.

Quantitative ethnic origin demographic data was obtained from 120 referrals to SGS between September 2022 and October 2023. These were statistically compared with the ethnic origin demographics of the general population in the same geographical area, as identified by Office of National Statistics (ONS) Census 2021 data. Qualitative data was collected through interviews with three participants from ethnic minority populations who were engaged in treatment with the service. Relevant themes in the qualitative data were identified using thematic analysis.

Quantitative data results indicated no significant statistical differences in most ethnic origin categories between the proportion of referrals to SGS from the ethnic origin and the recorded proportion of this ethnic origin in the general population. There was a greater difference for the “other ethnic group” category (chi square p,0.05, uncorrected), which was likely due to a difference in categorisation of ethnicity between SGS and ONS in 2021 Census.

The qualitative review identified themes of value of money, stigmatisation, different cultural attitudes towards gambling, and experiences of healthcare. GPs were identified as the first step towards seeking help for gambling.

These results suggested that SGS was offering equality of access to treatment for people from ethnic minority populations and that there were not significant barriers preventing people from ethnic minority populations accessing treatment. The reported positive experiences of participants' referral to and treatment with SGS indicates that for these participants suitable provision of treatment had been offered by our service.

With the thematic analysis identifying GPs as the first step towards seeking help for their gambling, this study indicates the importance of the gambling service working closely with primary care for the equitable access to treatment from gambling harms on a regional level.

These preliminary findings are based on a limited, small sample. Further research using a larger, more diverse sample to gain a deeper knowledge would be advised to further shape the service offer to ensure equity of access.

The Care Quality Commission report (Smiling matters: oral health care in care homes) showed that too many people living in care homes were not being supported to maintain and improve their oral health. Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs supporting people with enduring mental health illness to develop basic life skills so they can live supported in the community.

This is a quality improvement project aiming to improve oral health and to reduce the burden of oral diseases in people with mental disorders and ensure timely access to dental treatment in Lime Tree Gardens through meeting the NICE quality standards of care.

Auditing current implementing status of oral health procedures in place and comparing with NICE guidelines and quality standards: 1) Adults who move into a care home have their mouth care needs assessed on admission; 2) Adults living in care homes have their mouth care needs recorded in their personal care plan; 3) Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures. For each patient, their dental care plan is recorded and compared with NICE guideline.

There are challenges and space for improvement while implementing Oral health toolkit for adults in care homes at Lime Tree Gardens. A significant amount of patients (>90%) have unmet needs in terms having oral health.

There is a need to address the dental health challenges in this vulnerable population with recurrent and enduring mental illness. It is important to integrate and highlight dental health, as an important part of physical heath into the overall medical management of patients with severe mental illness in residential rehabilitation psychiatry.

To investigate if estrogen agents as an adjunct to antipsychotic medication are effective at treating psychosis in post-and perimenopausal females.

A digital search focusing on controlled clinical trials was conducted. Studies were assessed for quality using the Cochrane Risk of Bias tool and GRADE system. The Joanna Briggs Institute (JBI) tools were used to critically appraise articles. The total Positive and Negative Symptom Scale (PANSS) scores were synthesised using a meta-analysis.

Of the studies obtained (n = 11), two used estrogen HT as an augmentation agent, and nine used the SERM Raloxifene. Quality review and critical appraisal found inconsistencies in data and publication bias favouring trials that include Raloxifene. Meta-analysis results indicate Raloxifene plus antipsychotic did perform better than placebo [Std diff in means total = 0.340 (95% CI) p = 0.001] with a small effect size (g = 0.3392).

Though research appears promising, recommendations for the use of estrogen agent augmentation cannot be made at this time as more clinical trials that include a diverse range of treatments are needed.

Out-of-hours (‘on-call') work can be perceived as daunting by junior doctors. When psychiatry trainees progress from core trainee to higher trainee, what entails ‘on-call' work often shifts dramatically. Current allocation policy in Yorkshire and Humber Deanery means most of the higher trainees (HTs) begin their first on-call as a HT in a trust where they have never worked before. This frequently entails navigating an unfamiliar patient record system and various OOH care pathways in a new work environment, which can make the first few on-call shifts extremely stressful and potentially increase the risk of clinical errors.

We aim to evaluate the on-call experiences among higher trainees, collect feedback on ways of improving induction programme relating to OOH work and re-evaluation after the interventions implemented in the latest induction.

• • A short survey using Likert scale was designed to capture HTs' experience and knowledge in relation to OOH work plus free text feedback at the end of each question.

• • An online survey link was disseminated by email in May 2023 among HTs who joined LYPFT between August 2022 to Feb 2023.

• • Interventions: a) A face to face induction in August 2023 to replace the online induction; b) ‘A walkabout tour at Crisis office’ led by Crisis consultant as part of the induction programme.

• • Re-survey link was sent out in October 2023 to HTs who joined in August 2023.

1st Survey: 11 out 16 new HTs completed the survey. 5 out of 11 had never worked in LYPFT.

2nd Survey: 11 out of 19 new HTs completed the survey. 8 out of 11 had never worked in LYPFT.

2nd Survey showed significant improvement in HTs' level of familiarity to on-call office environment, awareness of the multi-agency S136 pathway and local policy as well as alternative local crisis provisions other than hospital admission, and the relevant referral procedures. HTs' confidence of navigating OOH local care pathway was markedly enhanced.

Overwhelming positive feedback were received regarding the ‘Walkabout tour' as part of the Induction programme.

• • Simple interventions at Induction programme can significantly improve HTs' confidence for OOH work.

• • HTs valued high on practical support such as the ‘Walkabout tour at Crisis office' and would like it to be expanded to other OOH services such as Seclusion unit and Acute Liaise Psychiatry Service.

We present a case of suspected Kluver-Bucy syndrome in an adolescent male, following a SARS-CoV-2 (Covid-19) infection. To the best of our knowledge, KBS has not been associated with Covid-19 before.

A 15-year-old male with a background of autism spectrum disorder (ASD) was reviewed in a children and adolescent mental health outpatient clinic. The young person was non-verbal, and history was taken from his next of kin. In the last four weeks, he had developed acute onset hyperphagia with weight gain (88th percentile for age), new onset physical and verbal aggression, and hyperorality, whereby the young person was exploring household objects with his mouth. A degree of hypersexuality was also noted in the form of rubbing and touching of the genital area.

There was no history of trauma or epilepsy; recent traveling or environmental change; psychosocial stressors or new medications, operations, or immunisations in the past year. The young person had a Covid-19 infection the month before the symptoms started. He was immunised against Covid-19 and this was the second time he contracted the infection, the first being 1 ½ years ago with full recovery.

The sudden onset of hyperphagia, aggression, hyperorality, and hypersexuality with the only known precipitating factor the recent Covid-19 infection, raised clinical suspicion for Kluver-Bucy syndrome. Six months later, the symptoms were milder but still present and no other cause had been identified. Due to ASD features, visual field testing, brain imaging, or routine blood tests were either not possible or required sedation and are being arranged with the support of his general practitioner.

Kluver-Bucy syndrome is a rare neurological disorder characterised by a distinct constellation of behavioural and cognitive symptoms resulting from bilateral lesions or dysfunction in the temporal lobes, particularly the amygdala. Patients often exhibit alterations in their behavioural repertoire, including hyperorality, hypersexuality, disinhibited behaviour, and visual agnosia. The presentation has been associated with temporal lobe infarcts, epilepsy, and herpes simplex encephalitis. The differential diagnosis was based on the fulfilment of clinical criteria for KBS, while other differentials included metabolic causes or behavioural manifestations related to ASD. Although investigations to explore other causes of symptoms are still being arranged, clinical suspicion for KBS was based on the presence of diagnostic criteria and the recent viral infection.

Research is needed to identify potential associations between SARS and neuropsychiatric manifestations, while clinicians should be aware of the possibility of such complications.

Electroconvulsive therapy (ECT) stands as a crucial intervention for severe and treatment-resistant schizophrenia. Despite being recognized as the most effective acute treatment for severe mood and psychotic disorders, its controversial nature persists due to misconceptions and a lack of familiarity among healthcare professionals regarding modern ECT techniques. This case explores the effectiveness of maintenance ECT in preventing relapse among individuals with schizophrenia, a dimension with scarce existing data.

A 28-year-old unemployed Caucasian male with treatment-resistant schizophrenia underwent multiple trials of atypical, typical, and depot antipsychotics, yielding no significant improvement in the Positive and Negative Syndrome Scale (PANSS) score. Two attempts with clozapine were hindered by neutropenia. With a baseline PANSS symptom score of 110, the patient struggled with severe auditory and visual hallucinations, preventing coherent conversations. Following 26 sessions of bilateral ECT, the PANSS scale score decreased to 65, prompting transfer to a Transitional Living Facility. After an additional 14 sessions, the patient exhibited significant symptomatic improvement, leading to discharge. The PANSS scale score, after 40 sessions, reached 50. Monthly bilateral ECT sessions and one antipsychotic medication now maintain the patient's reasonably functional lifestyle, encompassing employment, social outings, and assistance in farming with his father. ECT proved highly successful in alleviating both positive and negative symptoms, transforming the patient from severe conversational impairment to independent living and employment.

Empirical data validates clozapine's efficacy for treatment-resistant schizophrenia, yet its clinical use is limited by the substantial risks of agranulocytosis and neutropenia, relegating it to a third-line option. Neutropenia's onset in our case during clozapine trials prompted a therapeutic shift to electroconvulsive therapy (ECT). Aligned with American Psychiatric Association guidelines, our case underscored ECT's superior efficacy compared with traditional antipsychotics. Acknowledging a 40% non-response rate to clozapine across diverse studies emphasizes ECT's significance as a viable alternative. Despite challenges, contemporary ECT methods promise to overcome traditional constraints, reduce stigma, and improve treatment accessibility.

This case underscores the potential benefits of ECT as a valuable treatment modality for individuals with treatment-resistant schizophrenia, effectively managing both positive and negative symptoms and significantly improving daily functioning. The success observed in this case suggests that monthly bilateral ECT and one antipsychotic medication can play a crucial role in enhancing the quality of life for patients with treatment-resistant schizophrenia.