Promoting the well-being of staff is paramount within mental health services. However, a common issue arises where administrative personnel, often serving as the primary point of contact for service users, engage in mental health-related interactions without formal training. This deficiency can adversely affect their well-being, leading to diminished team morale and increased staff turnover, consequently impacting the quality of care provided by the Neighborhood Mental Health Team (NMHT). Moreover, it can contribute to dissatisfaction among service users, jeopardizing their rapport with the service. We aim to improve the wellbeing of staff and service users and to optimize service delivery at the local NMHT.

Data were gathered from a local NMHT catering to 1200 service users in the borough of Tower Hamlets in London. A pre- and post-implementation questionnaire was administered to both service users and six administrative staff members. The questionnaire highlighted several areas for improvement, including a lack of mental health understanding among administrative staff, reported low confidence when handling certain phone inquiries, and service user complaints. Change initiatives were then devised to address these concerns and evaluate their impact on enhancing the experience for both service users and administrative staff.

Administrative staff uniformly expressed the need for increased mental health training prior to commencing their roles. Implementation of targeted change initiatives led to noticeable improvements in service user satisfaction and staff confidence in managing phone interactions. These enhancements culminated in an overall advancement in service delivery.

Through the strategic implementation of change initiatives informed by our initial findings, we not only augmented mental health literacy among administrative staff and service users but also bolstered their well-being. Consequently, this directly translated into an amelioration of local service offerings. Further research is warranted to ascertain the long-term efficacy of these innovative interventions.

Background: Fahr's disease is a rare and complex neuropsychiatric disorder resulting from abnormal calcium deposition in the basal ganglia and cerebral cortex. It can have a profound impact on an individual's social functioning as well as causing a wide variety of neurological symptoms, cognitive deficits and motor impairment. A number of specific mutations have recently been identified in phosphate transporter and other genes, but around half of all cases have unidentified mutations. Impulsivity, aggression and violence may pre-date the other manifestations of the illness.

Case Report: Patient X is a 58 year old man currently detained in an independent hospital locked rehabilitation unit following the breakdown of a care home placement. His first admission to hospital was at the age of 18 when he was diagnosed with mania. He had multiple further hospital admissions as well criminal convictions for acquisitive and violent offences. In 2005 he threatened to stab a stranger if he did not give him a cigarette and he was arrested and admitted to a medium secure unit under Section 37 with diagnoses of bipolar affective disorder and emotionally unstable personality disorder. He remained in secure hospital care until 2018 when concerns about Parkinsonian symptoms led to him being referred to a neurologist and a diagnosis of Fahr's disease being made on the basis of his CT findings. He was transferred to a locked rehabilitation service in 2019 but continued to exhibit challenging behaviour on a daily basis. After a reduction in the frequency and severity of his behaviour he was discharged to a care home, but this broke down after a few months as his assaultive and sexually inappropriate behaviour re-emerged.

Discussion: Fahr's disease is traditionally thought of as a late life neurological condition, but as with Huntington's disease neuropsychiatric symptoms of irritability, sexually disinhibited behaviour, impulsivity and aggression can occur early and may pre-date any neurological manifestations. Treatment is often difficult because of sensitivity to antipsychotic medication.

It is important to consider neuropsychiatric conditions in the assessment of adults presenting with antisocial behaviours, especially when these are associated with a change in overall functioning and an absence of adolescent conduct disorder. There is as yet no specific treatment for Fahr's disease, but early identification allows appropriate risk management strategies to be adopted.

Patients walking out of ED during mental health crises are commonly encountered in Liaison Psychiatry. Responsibility for high-risk or vulnerable walkouts had predominantly fallen on the police due to resource pressures in health and social care services. In 2023, London's Metropolitan Police announced a new partnership model, the “Right Care Right Person” (RCRP) approach. This supported the withdrawal of police involvement in mental health crises and allowed health and social care agencies who have the expertise and authority to act, to fulfil their role. This QI project aimed to understand the extent of police involvement in ED walkouts prior to the implementation of RCRP, introduce a new protocol for managing these situations, and evaluate its impact in terms of resource use and patient outcomes.

The Trust's incident reporting system was used to identify mental health-related ED walkouts between May–August 2023, prior to the introduction of RCRP. Patients’ notes were reviewed to identify immediate actions taken following the walkout, including whether the police were involved, what action they took and patient outcomes. This was used to create a new Trust-wide ED walkout protocol, incorporating the Metropolitan Police's risk assessment tools. This was disseminated to frontline staff. A repeat analysis took place in November–December 2023, post-RCRP, to analyse how ED walkouts were being managed, and by which service. Furthermore, the analysis explored the nature of any patient harm which occurred following the incidents.

We found 29 walkouts from A&E between May–August 2023 (pre-RCRP), compared with 35 between November–December 2023 (post-RCRP). Police were called in 79% of cases pre-RCRP and 74% post-RCRP. Pre-RCRP police was not involved in 41% of cases, and in 81% of cases post-RCRP. Mental health services made first contact following walkout in 41% of cases pre-RCRP, and in 46% post-RCRP. LAS made contact in 29% of cases post-RCRP. Post-RCRP 26% of patients who walked out were admitted to a Mental Health Trust within 7 days. 20 patients had their treatment delayed, 5 suffered from neglect. 3 patient walkouts resulted in harm to others, and 2 resulted in self-harm.

As expected, police responded to fewer walkout reports, and our data shows this gap has been filled by other services. The Trust's risk assessment-based approach to managing walkouts has shown promising results. The next stage of the project will focus on developing local protocols for the identification and management of patients at high risk of walkout.

Mental and physical ill-health are both causes and consequences of homelessness. As the cost-of-living crisis forces more people out of their homes, it is imperative that medical students are informed and prepared for this health crisis. Discussions with or about homeless populations are largely absent from the current medical school experience, and are rarely accompanied by homelessness-specific on-the-ground exposure. This project aims to use contemporary literature and the personal experience of a UK medical student to formulate suggestions on how the curriculum can better address homeless health.

A literature search was performed, including recent work on medical education, inclusion health, and homelessness. Reflection on the author's personal experience at medical school was conducted and compared with existing literature to ascertain validity.

Whilst many students will walk past rough-sleepers on their way into university/hospital, homelessness is a seldom-addressed topic at medical school. In the author's personal experience, there can be a cognitive disconnect between the theoretical principles (e.g. social determinants of health, inclusion health) covered in lectures, and the on-the-ground realities of the isolation, discrimination, and violence that homeless populations face. Since medical students disproportionately come from privileged socioeconomic backgrounds, this disconnect may be due to a lack of exposure underpinned by the assumption that homelessness will never directly affect them.

A review of literature highlighted several worldwide initiatives aiming to develop medical students’ understanding of homelessness. Programmes involved students in health screening, education programmes, and street psychiatry placements. These have been shown to reduce bias and improve student preparedness.

Based on the overlap between literature and the author's own experiences, three focuses for curriculum improvement are proposed: supported exposure, compulsory education, and advocacy. Supported exposure would involve students having formal face-to-face contact with homeless populations, supported by supervision and debriefing. To prepare for these interactions and their potential challenges, students should receive trauma-informed training alongside teaching on inclusion health and social determinants of health. This should be emphasised by medical schools as mandatory, rather than a ‘special-interest’ topic that many students will not engage with. Finally, students should be encouraged to advocate for vulnerable patients both within the clinic, and on a broader systemic level.

This project stresses the urgent need for addressing homelessness within medical education. The proposed focuses aim to cultivate a deeper understanding among medical students about the health challenges faced by homeless populations, fostering empathy and competence in future healthcare professionals.

Local protein synthesis at the synapse is a key determinant of learning and memory and is predicted to be severely disrupted in Alzheimer's disease (AD). Omics approaches have played a key role in deciphering molecular mechanisms underlying AD pathology. However, isolating the transcriptome may be biased due to inherent variations in transcript levels, or by transcription-on-demand models employed by several genes, whereas mass-spec based proteomics approaches fail to capture low abundance peptides. The translatome bypasses these inherent limitations of other omics methods by capturing actively translating mRNA species trapped inside ribosomes and subjecting them to unbiased RNA-seq analysis capturing even very low abundance transcripts.

Isolating the neuronal ribosomes from human post-mortem brains without interference from non-neuronal cells remains a challenge. We used frozen brain tissue from Alzheimer's patients and healthy controls obtained from the Cambridge Brain Biobank. Synaptoneurosomal fractions were prepared using sucrose gradients in non-denaturing buffers with RNAse inhibitors to preserve ribosomal composition and trapped mRNA. We isolated functional ribosomes on affinity columns following recombinant RNAse digestion. Finally, actively translating ribosome-trapped mRNAs were sequenced using RNA-seq, aligned to human genome using STAR alignment and analysed for differential expression using DeSeq2 followed by pathway analysis.

We have successfully isolated ribosome-associated RNA transcripts in the dendritic spines from cortical neurons of postmortem Alzheimer's brains with little interference from glial and non-neuronal material. The novel AD translatome disruptions identified by isolating endogenous ribosome bound mRNA will help detect downstream molecular targets. We will also integrate targeted translatome data with published transcriptome and GWAS DNA variant data to identify novel biomarkers.

This is the first successful isolation of the dendritic translatome from human postmortem AD brains. Future studies will verify functional significance of key targets using gain- and loss-of-function studies in animal models of AD and human iPSCs.

Lithium is clinically indicated for use in the UK for treatment and prophylaxis of mania, bipolar disorder, recurrent depressive disorder and aggressive of self-harming behaviour. In patients who are prescribed lithium, several physical health checks and blood tests must be completed on a regular basis to ensure lithium remains safe and appropriate to continue. Lithium has a narrow therapeutic index and so close monitoring of serum lithium level is required.

This audit aimed to establish whether Mersey Care NHS Foundation Trust’s physical health check and blood test monitoring of patients prescribed lithium is in keeping with NICE guidelines and determine how the Trust’s performance compared with national performance as identified by the Prescribing Observatory for Mental Health (POMH) lithium audit.

A total of 127 patients under the care of the Trust who were prescribed lithium were identified. The POMH lithium audit tool was used to capture data for each patient as Mersey Care NHS Foundation Trust was participating in the POMH lithium audit. Each patient's electronic record was scrutinised to determine whether the following were measured every six months during maintenance treatment – Thyroid Function Tests (TFTs), serum calcium level, estimated Glomerular Filtration Rate (eGFR) and serum lithium level, and whether the patient had a weight/body mass index (BMI)/waist circumference within the last 12 months.

Of the 127 lithium patients included in the audit, 64% had a serum calcium level done every six months, 78% had TFTs done every six months, 83% had an eGFR done every six months, and 87% had a serum lithium level done every six months. 71% of patients had a weight/BMI/waist circumference within the last 12 months.

Trust performance for TFT monitoring and weight/BMI/waist circumference was above the national compliance level reported in the POMH lithium audit; Trust performance for serum lithium level, eGFR and serum calcium level was below the national compliance level. There is a need to ensure that medical and nursing staff are aware of the physical health checks and blood test monitoring required for patients maintained on lithium. A Quality Performance Alert will be sent to medical and nursing staff in the Trust to raise awareness and lithium monitoring will be included in the junior doctor Trust induction. Future auditing of Trust performance on physical health check and blood test monitoring for patients maintained on lithium will be conducted.

In conditions such as schizophrenia insight may be limited, leading to partial adherence to antipsychotic medication. This can result in lower remission rates in this group and increased disease burden. Depot injections allow close monitoring of treatment adherence and early intervention where needed.

We aimed to determine the treatment adherence of patients attending the outpatient depot clinic at the South Sefton Neighbourhood Centre (SSNC) for antipsychotic injections and compare adherence between depot medication administered at 1, 2, 3 and 4 weekly intervals.

We identified patients attending the depot clinic at the SSNC using depot cards. The RIO patient electronic record was used to find previous depot cards and to record the number of doses given each month and calculate the number of failed encounters over a twelve-month period.

We excluded patients receiving the injection at home and those where 12 months of data could not be collected.

42 (12 female, 30 male) patients were included. 18 had full adherence and 24 had partial adherence. Average adherence was 93%; 90% in the female group and 94% in the male group. We compared adherence to weekly (7 patients), 2 weekly (15 patients), 3 weekly (8 patients) and 4 weekly (12 patients) depot injections. Weekly and 2 weekly had an average adherence of 89%, while 3 and 4 weekly had an average adherence of 96% and 99% respectively. The average number of failed encounters was highest with the 2 weekly group and lowest in the 3 and 4 weekly group.

Adherence to antipsychotic depot treatment at SSNC is good with nearly half of the patients included having full adherence. 4 weekly depot injections showed the best adherence with an average of 99%. Following on from this study we would like to explore the reasons for partial adherence in the two weekly group as well as the impact this has had on this group of patients, looking specifically at relapse and readmission rates.

1. 1. To study the neural correlates of OCD using functional MRI.

2. 2. To compare the neural correlates of the pure washer dimension of OCD with other dimensions of OCD and healthy controls.

It was a cross-sectional, case-control study conducted from 2018 to 2021. OCD patients were recruited with purposive sampling from outpatient attendance at All India Institute of Medical Sciences, New Delhi following the inclusion and exclusion criteria. The patients were divided into two groups i.e. washing sub-type and non-washing/other sub-type based on dimensional YBOCS score. The healthy control group consisted of age and sex-matched healthy individuals. Each group had 10 individuals. The participants underwent functional MRI with resting fMRI and activation task-based MRI. Activation tasks included a cognitive task i.e. Stroop test and an affective task which included trigger words for OCD tailored according to the patient's triggers for OCD.

The results were studied for significance within a group and also compared among the three groups and between OCD patients and healthy controls as well.

In OCD-specific task using trigger words, the right frontal gyrus, right medial frontal gyrus, and left cingulate gyrus showed hyperactivation in the washer OCD subtype group. After correction for family-wise error, p-FWE (<0.05) corrected < 0.05, there was so significant result. The non-washing subtype had no significant areas of activity on the OCD specific task.

But the combined OCD patient group (compared with controls), had hypoactivation of the right inferior frontal gyrus and fusiform gyrus at p-unc (<0.001) in the OCD task.

In the Incongruent part of the Stroop task, the non-washer subtype had hypoactivation of the right caudate body compared with healthy controls at p-FWE (<0.05).

In the congruent Stroop task, washer OCD subtype, the right insula was found to be hyperactive at p-FWE (<0.05).

Previous studies comparing activation on cognitive tasks in OCD patients and healthy controls have revealed differences in CSTC circuits as well as cerebellum and parietal areas. The washing symptom dimension is associated with insular hyperactivity in both emotional and cognitive tasks. It is associated with stimuli related to disgust. The role of the insula is being researched in functions like attention and response inhibition. Our study, with all its limitations, could replicate the insular findings in washing-subtype of OCD. With a better sample size, we may be able to explore further the findings that have not attained levels of significance in our study.

Trainees on the psychiatry on-call rota at a London acute inpatient unit reported a lack of confidence in asking male patients about sexual dysfunction during clerking. Research shows that history-taking barriers include embarrassment, time shortage and task prioritisation. Sexual dysfunction is prevalent amongst the general population, markedly so amongst people with mental health diagnoses.

In response, we designed a quality improvement project (QIP) to improve confidence by addressing the need for good history-taking and the technique for doing so.

To gauge trainee confidence, we produced and disseminated an online questionnaire with a mixture of qualitative and quantitative questions.

Based on the data collected, we contacted a local sexual health consultant and requested a teaching session on the importance of sexual history-taking, the impact of not doing so, barriers to history-taking and how to ask about sexual dysfunction.

A follow-up questionnaire was produced and disseminated.

The results of the first questionnaire showed that 100% of respondents (n = 10) did not ask male patients questions about their sexual function, on admission. The main reasons for this were embarrassment for themselves (25%) and the patient (66.7%), lack of confidence on how to word these questions (50%), lack of time (58.3%) and feeling that these questions are not relevant (33.3%).

Following the teaching session, 71.4% of respondents said that they would ask male patients questions about symptoms of sexual dysfunction on admission. The majority of responses quoted that the teaching had increased their confidence, decreased their embarrassment in asking these questions, and helped them to understand the relevance of asking these questions. Two respondents queried the appropriateness of asking acutely unwell patients these questions on admission and if these questions could be asked during a patient's admission instead.

Limitations: Small sample size of results; slight drop in responses from first questionnaire to second questionnaire; questionnaire only asking questions about male patients, not female patients.

This QIP shows that a single, simple intervention can improve trainee confidence in the short term. This intervention can be applied across the UK. Online teaching can improve access to the expertise of local sexual health consultants. This QIP also provides a basis for further analysis: whether single interventions can improve trainee confidence in the long term, when is the best time to ask questions about sexual function and applying this intervention to female sexual function history-taking.

Neuropsychiatry, being at the interface between Neurology and Psychiatry, can fulfil the unmet needs of a cohort of people with complex presentations including psychiatry symptoms associated with neurological diseases and atypical psychiatry presentations with possible underlying aberrant brain processes. However, the development and provision of Neuropsychiatry services have lagged behind in the United Kingdom and some parts of the world, at the cost of ongoing symptom burden and reduced quality of life for vulnerable groups of patients. We set up a tertiary pilot service of Neuropsychiatry in Derbyshire from March 2022 and have been successfully operating both outpatient Neuropsychiatry clinics as well as inreach on to psychiatric wards. We set out to evaluate our service and explore the challenges and outcomes associated with our service development.

A mixed methods evaluation was completed, and the data were extracted from patient records and assessments. Feedback responses were obtained from referring clinicians and service users utilising structured feedback forms for each group. A thematic analysis approach was completed for qualitative responses. More than 140 patients have already been assessed by our Neuropsychiatry service to date, out of which we completed an initial analysis of records of 70 patients referred between March 2022 and February 2023. We further revisited the challenges (lack of resources including clinic space, admin and dedicated electronic medical records (EMR) section).

67% of referrals were from Neurology services with Functional Neurological Disorder (FND) predominating. 74% of patients referred had more than one diagnosis/symptom cluster. Patients reported significant benefits and overall positive experiences from the service. One patient reported, “After 3 years I finally not only have answers to my symptoms but also an explanation as to why. Without this service, I believe I would be still struggling.” Similar positive feedback was obtained from referring clinicians.

Our results demonstrate that a successful tertiary Neuropsychiatry service can be established and run even under challenging circumstances including lack of resources. Our service now has a dedicated clinic running every week, a dedicated EMR section and we are currently in the process of submitting business plans towards sustainable commissioning. Furthermore, our service has been instrumental in reducing the length of inpatient stay, facilitating early discharges, diagnosing and treating reversible conditions that mimicked primary psychiatric issues, as well as improving the quality of life of a vulnerable cohort of people previously diagnosed with complex conditions such as FND and personality disorders.

Several studies have shown that individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) have difficulties in maintaining their psychological well-being and are at risk of negative impacts on their psychological health during higher education. Consequently, it is crucial to introduce targeted interventions to promote self-esteem, quality of life, and overall well-being to minimise potential adverse outcomes. For this reason, the main objective of this systematic literature review was to identify and evaluate studies on the target population that explored the effects of psychosocial interventions on dimensions of psychological well-being, such as self-esteem, well-being, or quality of life.

A systematic literature review was conducted following the PICO approach and PRISMA guidelines. The electronic databases – MEDLINE, PsycINFO, Web of Science, PubMed, COCHRANE Central and Education Research Complete were searched for English-language studies published between 2013–2023 on interventions conducted in university-level ADHD students that impacted their psychological well-being. Exclusion criteria encompassed studies focusing on comorbid clinical diagnoses such as anxiety or depression outcomes and pharmacological interventions. Nine studies that met the inclusion criteria were identified.

Cognitive-behavioural therapy (CBT), interpersonal group therapy, and coaching emerged as interventions with the strongest evidence base for improving psychological well-being in university students with ADHD. The ACCESS (Accessing Campus Connections and Empowering Student Success) intervention, a CBT and mentoring programme, demonstrated increased well-being over time (p = 0.001, d = 0.45). Interpersonal group therapy yielded significant improvements in global self-esteem (p = 0.001, η2 = 0.12), with a significant difference from the control group (p = 0.01, η2 = 0.07), while the coaching intervention revealed significantly higher well-being scores in participants compared with the control (p = 0.05, R2 = 0.11).

This systematic review found psychosocial interventions focussing on CBT, interpersonal group therapy, and coaching were effective in improving the psychological well-being of university students with ADHD. Future intervention studies should establish a specific ADHD-focused CBT approach and have more extended follow-up periods to understand long-term effectiveness. This review also identifies priority areas for additional research.

The Capgras syndrome is one of the four disorders defined under Delusional Misidentification. In the Capgras syndrome the patient believes that someone close to them has been replaced by an imposter pretending to be that person; the abnormality is delusional and not hallucinatory. It is a specific delusion of a person with whom the subject has close emotional ties and towards whom there is a feeling of ambivalence at the time of the onset.

37 year old Caucasian female presented to the local emergency department 4 months after delivery of her baby. She presented with a suicidal attempt in which she cut her neck and drank bleach. She was convinced that her parents and daughters were replaced by a network and her ex-partner was part of this network. She also believed that the network was out to harm her. She showed other psychotic symptoms along with low mood and hopelessness. Despite being offered high doses of antidepressants and antipsychotics she did not show any improvement hence she was given 12 sessions of ECT. Though this treatment was seen to bring in some benefits, her beliefs were still observed to persist. As her delusions were resistant to treatment and lasted more than 3 months, she was diagnosed to have a Persistent Delusional Disorder.

A literature search showed that Capgras delusions rarely occur in postpartum psychosis. It generally poses a risk to baby's care and wellbeing since in most cases mother either refuses to care for baby or attempts to harm them. Interestingly in this case, mother met her daughter's physical needs but struggled with baby's emotional needs most of the time and was rarely observed to smile and play with her.

In this case report, we present the occurrence of different psychopathologies during postpartum psychosis including Capgras delusion. We underline that this case is different from other cases reported in the literature due to unusual nature of the bond between the mother and baby and the onset of the symptoms.

Addiction services in Essex are provided as a collaborative by NHS run Essex STaRS, Open Roads, SHARP and ARC provide psychosocial care. YPDAS supports the young people.

Observed gap: Pregnant women with addiction problems were running from pillar to post to receive care and support needed during this challenging phase of their life.

The one stop clinic provided an all-encompassing care pathway to fill the above need and improving outcomes for mothers and babies.

Description:

The new pathway was setup in 2019 on a hub & spoke model. The one stop clinic was at centre, comprising Substance Misuse, Midwifery and Obstetrics. The spokes included Perinatal-mental health, Neonatal, Adult, Child Social services, CMHTS, Police, Criminal Justice and primary care.

Simple entry criteria: 1. Substance Dependence 2. Positive pregnancy test with referral taken from any service. Patients receive comprehensive initial assessment covering addictions, mental health, social circumstances, obstetric history and physical health evaluation including foetal US scanning. Led by a team of psychiatrist, midwife, obstetrician and substance worker.

Evaluation identifies risks from mental, physical health, safeguarding, support needs and formulates an initial engagement and management plan. Referral into all necessary organisations. A staggered follow up plan per every trimester agreed.

Commencement or planned reduction of Opiate Substitution Therapy (OST), medication rationalisation, nutritional advice, enhanced antenatal monitoring. The regular follow-up via fortnightly midwife, drugs worker review. Monthly medial review in the clinic.

The support from perinatal psychiatry teams, CMHTS, Social services, Criminal Justice safeguarding teams is roped in when needed. Child protection, safeguarding issues are addressed. Clear multi-directional communication is maintained at all times. A safe delivery plan along good neonatal management ensured with appropriate outcomes for mother & baby are achieved.

Since 2019, this initiated 16 patients with various complexities. 12 women left hospital with their baby in their care. 1 left the area during the pregnancy. 2 babies were removed into care. 1 had a miscarriage, 1 had a false positive test. All women received contraceptive advice, one got tubectomy and many on long-term contraception. No significant mental health relapses or admissions. All managed to stabilize or reduce their opiates issues.

This One Stop Clinic has effectively addressed the complex needs of perinatal addiction patients. Centralised provision of care, duplication avoided, clear communication was a welcome relief for patients. Clinic has won a quality award.

Studies estimate that 90% of people with a diagnosis of autism experience sensory abnormalities. The majority of those affected will not have a psychotic illness, however young people with autism are three to six times more likely to develop schizophrenia than their neurotypical equivalents.

This report considers the diagnostic complexities, potential risks and challenges of navigating concurrent referral and treatment pathways for an adolescent awaiting an autism assessment, who has psychotic-like experiences.

An adolescent female was referred to our Tier 3 service for an autism assessment. Whilst on the waiting list, our service was contacted on three occasions by adults who knew the patient, expressing concerns that she had psychotic-like experiences, namely perceptual abnormalities which had not been included in the original referral.

On the third occasion, approximately six months after the initial referral was accepted, a decision was made to review the patient face-to-face to explore these symptoms further.

During this review she appeared to have positive and negative symptoms of schizophrenia, including perceptual abnormalities in all sensory modalities, thought block, paranoid ideation and a mood incongruent affect. Her sleep cycle was reversed and she had not attended school for several years.

She was subsequently referred to the Early Intervention Psychosis Service, underwent an eight week assessment and was discharged back to the autism service.

Young people in the UK are on average waiting nine months for an autism assessment, although some are waiting up to seven years for treatment. NICE recommends that young people referred due to first episodes of psychosis are seen within two weeks, as delays in treatment can negatively impact on the patient's response to treatment.

Diagnostic uncertainty can arise due to overlapping symptoms, clinician inexperience and difficulties with eliciting a thorough history. With waiting times for autism assessments growing, young people who may have psychotic symptoms are waiting longer to see a clinician. The referral pathways for neurodevelopmental and psychiatric disorders typically exist independently, but inclusion on one pathway can create barriers in accessing the other.

It is good practice for comorbid psychiatric disorders to be considered by the referrer, when referring a young person for an autism assessment.

Clinicians should avoid making assumptions regarding the aetiology of symptoms based on the original reason for referral, explore symptoms thoroughly and refer to alternative services if needed.

First Episode Psychosis (FEP) emerges at a young age, significantly shaping the trajectory of the disorder. Literature indicates a 60% increased risk of suicide within the initial year of diagnosis in FEP, early intervention in psychosis reduces the risk of suicide. Therefore, this study aims to co-adapt an existing culturally appropriate suicide prevention intervention (CMAP) and integrate this with a culturally adapted Cognitive Behavioral Therapy for Psychosis (CaCBTp) for individuals with FEP experiencing suicidal ideation and to test its feasibility and acceptability in Pakistan.

This is a mixed-method study that involves two stages. Stage 1 was co-adaptation of the CMAP intervention for people with FEP patients. This involved one-to-one, in-depth interviews with individuals with FEP (n = 5), carers (n = 5) and a focus group discussion with 10 healthcare professionals. The second stage involves feasibility testing of the intervention. Participants are being recruited (n = 90) from outpatient psychiatric units across the cities of Karachi, Lahore, Rawalpindi, Multan, and Hyderabad in Pakistan. Eligible, consented participants are being randomized into either of two trial arms; intervention arm or treatment as usual arm (TAU). All participants are being assessed at baseline and at 3-month post-randomization on assessing participants on severity of suicidal ideation, severity of symptoms, functionality and quality of life using different scales. The intervention is comprised of 12 one-to-one sessions delivered over 3 months by trained therapists. Participants (n = 15) from the intervention arm will be interviewed at the end of intervention to explore the acceptance.

Qualitative analysis of stage 1, utilizing thematic framework analysis, highlights barriers to help-seeking such as lack of awareness, inadequate social support, and mental health stigma. To adapt CMAP intervention, participants suggested changes in the use of Urdu words to make content simple for patients to understand, increase number of family sessions, include information about possible risk and protective factors of self-harm in this population and emphasize the addition of resilience-building messages in the manual. Stage 2 is currently ongoing, and we have successfully recruited healthcare facilities across all sites and randomized 12 participants into the trial.

This study will add valuable insights for refinement of existing interventions to address the unique needs of individuals with FEP in Pakistan. Intervention with suicide preventive strategies may help in reducing the risk of suicide. The culturally grounded approach ensures relevance, contributing to the global discourse on evidence-based mental health interventions.

1. 1. For all eligible general adult psychiatry and substance misuse inpatients at the Royal Edinburgh Hospital (REH) to be offered appointments at a pilot onsite sexual and reproductive health (SRH) clinic.

2. 2. To evaluate the need for this novel service using eligibility rates and attendance levels.

Eligibility of all inpatients on a substance misuse ward considered at admission, and a space in the clinic offered if appropriate. Reminder added to the clerking proforma.

Eligibility of general adult psychiatry (GAP) inpatients considered by their multidisciplinary team (MDT) weekly. Team 1 to trial this at ward round, and team 2 to trial it at rapid rundown.

A patient leaflet was created to explain the clinic.

General adult psychiatry: In team 1, 82% (120/147) of patients were considered by the MDT over 20 weeks, and in team 2, 65% (53/82) over 10 weeks. Of all GAP patients considered, 48% (83/173) were deemed eligible. Of those, 70% (61/83) were asked if they wished to attend, usually by the junior doctor leading the QI project. Thirty-six percent (22/61) of those booked into the clinic, of which 82% attended.

Substance misuse ward: Over 15 weeks, 85% (82/97) of patients admitted to the substance misuse ward were considered, deemed eligible and offered a space in the clinic at admission, of whom 15 accepted and 4 attended.

Nearly half of GAP inpatients were eligible to attend, with the total likely to be higher over time, as mental state improved. A high level of demand was demonstrated for SRH services in this population, where research also suggests a higher level of need and lower levels of access.

During weeks when the QI leads were absent, it was not recorded that any patients were considered at ward rounds or rapid rundowns. It was difficult to implement a process for this whilst the clinic was still at the pilot stage. The incorporation of a reminder into the ward round template would ensure that this is always considered.

A very high proportion of substance misuse patients were eligible for this clinic, highlighting higher levels of capacity. The main challenges for attendance were a high discharge rate, presence of withdrawal symptoms, and extensive passes off the ward.

Citalopram and escitalopram are commonly used serotonin-specific reuptake inhibitors (SSRIs) for the treatment of depression and anxiety. These medications are known to cause corrected QT interval (QTc) prolongation, with risks of further arrhythmias. In 2014, the Medicines Healthcare Regulatory Agency (MHRA) published guidance outlining this risk and advised decreased maximum daily doses of citalopram 20mg and escitalopram 10mg in the elderly population. The aim of this audit was to explore the prescribing patterns of citalopram and escitalopram in a community sample of older adults with psychiatric disorders, against MHRA guidance.

Older adults (aged >65 years) in the community mental health services in Wolverhampton, who were prescribed citalopram or escitalopram, were identified through a search of clinic letters in June 2023. We checked the medications, doses, history of QTc prolongation, concurrent medications that may prolong QTc, electrocardiogram (ECG) reviews, and any discussion about the risk. The data was collected by accessing the electronic patient record and related health records. In total 17 patients were included, with no exclusions.

Most of the patients (94.1%, n = 16) were on citalopram and only one patient was on escitalopram. The most common dose of citalopram was 20 mg (62.5%, 10/16), with one patient having a higher than the recommended dose (30 mg). Escitalopram was within the recommended dose. There was no history of QTc prolongation in any patient. Concurrent medications that could prolong QTc were identified in 35.3% (n = 6) of the patient population; all of these were antipsychotics. A small proportion (11.8%, n = 2) of the patients had documentation stating about QTc prolongation and arrhythmia risks for citalopram or escitalopram. A review of ECG when initiating or adjusting treatment was noted in only one patient.

Most of the older adults had citalopram and escitalopram within recommended limits. A considerable proportion of patients had concurrent medications with an additional risk of prolonging QTc and subsequent arrhythmia. It is essential to consider ECG in all elderly patients before starting medications with a risk of QTc prolongation. There is a need to discuss the cardiac risk associated with citalopram and escitalopram with the patients and improve documentation. It may be better to provide written information to the patients and caregivers regarding this.

Epidemiological studies have previously shown a link between cardiometabolic disease and severe mental illness. The extent and mechanisms behind this link are poorly understood currently but links to impairments in the stress response and cortisol regulation have been thought to play a significant role. BMAL1 is a circadian rhythm regulation gene found on chromosome 11 which has been associated with a variety of pro-inflammatory states as well as conditions such as depression, schizophrenia, type 2 diabetes mellitus and myocardial infarction. Our study aimed to investigate the genetic structure of the BMAL1 gene locus and its associations with both cardiometabolic and psychiatric traits and conditions.

We used genetic data from the UK Biobank which recruited ~500,000 participants. Of these we used a population of ~430,000 self-reported white British participants and data from a variety of questionnaires and investigations looking at severe mental illness and cardiometabolic traits. We performed association analyses using Plink 1.07 with Bonferroni correction being performed for multiple testing using a number of genetic variants. Our threshold for significance was defined as a p-value < 5.35 × 10−5. Conditional analysis was then performed to identify if there were multiple independent signals for each phenotype.

BMAL1 variants were associated with BMI, diastolic, systolic blood pressure, waist-hip ratio and neuroticism score, and risk of anhedonia, major depressive disorder and risk-taking behaviour. Multiple significant independent signals were identified for BMI and waist-hip ratio. Linkage disequilibrium (LD) analysis showed significant coinheritance of specific traits which could suggest a role for BMAL1 and the encoded protein as a link between cardiometabolic and mental health traits.

This is the first study that systematically investigated associations between the BMAL1 locus across a variety of different mental and cardiometabolic phenotypes in a population-level cohort. Our study has shown that there is a link between the BMAL1 locus and both cardiometabolic and mental health phenotypes. Further research is required to investigate the exact biological mechanism by which BMAL1 connects severe mental illness and cardiometabolic disease.

This project aims to increase confidence among Liaison Psychiatrists (LPs) in North East London Foundation Trust (NELFT) regarding their adherence to the prescribing guidelines for antidepressants by 25% in accordance with the standard set by Psychiatric Liaison Accreditation Network (PLAN).

Background The prescribing guidelines in this project are based on Standard 21 from 7th Edition Standards as devised by PLAN which states:

“When medication is prescribed, specific treatment goals are set with the patient, the risks (including interactions) and benefits are discussed, a timescale for response is set and patient consent is recorded.”

This project focuses on antidepressants because they are one of the widely used medications in psychiatry that doctors of all grades working in Liaison Psychiatry will be familiar with to some extent. Adhering to this validated guideline would promote gaining informed consent and patients’ involvement in their care, which studies have shown can increase adherence to treatment.

Circulated an eight-question survey by email based on Standard 21 of 7th Edition Standards document by PLAN to LPs in NELFT. Conducted two Plan-Do-Study-Act (PDSA) cycles. The first PDSA uses a teaching session as the intervention and explained the importance of antidepressant guidelines and what areas LPs need to address with patients. The second intervention uses a poster to reinforce the key points. After each intervention a reissued survey assesses the change in responses.

The baseline survey response rate was 10 out of 15 LPs, made up of seven consultants, two registrars and one foundation year doctor. The lowest levels of confidence were reported around providing patients with printed information on their prescribed antidepressant with the majority of consultants reporting the lowest level of confidence. The highest levels of confidence across all medical grades were reported around discussing a specific treatment goal and explaining the benefits of treatment with antidepressant medication.

From the baseline data, it can be concluded that providing patients with printed information on newly prescribed antidepressants is the area that LPs, particularly consultants, are the least confident about regarding their adherence to prescribing guidelines. Future cycles of this quality improvement project can assess how incorporating teaching on antidepressant prescribing guidelines into trust induction sessions impacts LPs confidence in their adherence.