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.

Mental Health Trusts have seen significant funding cuts in recent years resulting in higher admissions to acute medical hospitals due to psychiatric disorders. Little information is available on the quantity of such presentations and no studies have explored how confident acute medical doctors feel in managing patients with mental health disorders.

Primary objective: To evaluate whether acute medical doctors feel confident in the common psychiatry topics required to manage patients presenting to medical hospitals with mental health disturbances.

Secondary objective: To determine how frequently patients with mental health disorders are admitted to medical beds, either primarily due to their psychiatric disorder or due to another medical problem.

Acute medical doctors working in Merseyside, UK completed a self-report survey in which they rated their confidence level in relation to common psychiatric topics. Admission data for 4 large hospitals in Merseyside were analysed to determine the proportion of all patients admitted to medicine in a 1-year period who had a mental health disorder. Results were further broken down into primary diagnosis by ICD–11 code to determine which mental health conditions presented most frequently to general medical hospitals.

10 acute medical registrars and 33 acute medical consultants completed the survey. Most acute medical doctors felt at least partly confident in their psychiatry knowledge. However, around a quarter of doctors lacked confidence in managing psychotropic medications and performing risk assessments, with a third of acute doctors unsure how to access specialist psychiatric advice.

43.8% of all medical admissions had a mental health disorder. This was comprised of 3.1% who presented primarily due to a mental health illness, and 40.7% who had a mental health disorder but attended for a different reason. Substance misuse accounted for a significant proportion of these admissions.

Despite almost half of patients admitted to medical beds experiencing mental illness, many acute medical doctors lack confidence managing psychiatric ailments and half of the respondents felt their medical training has not prepared them sufficiently.

In addition, many doctors are unsure how to access specialist advice when needed. This leaves both doctors and patients at risk of harm and suggests a need for additional psychiatric training for acute medical doctors and improved access to support.

The GMC 2023 workforce report indicates that doctors with primary medical qualification (PMQ) outside United Kingdom (UK) made up 62% of new additions to the register in 2022, with international medical graduates (IMGs) from outside the European Economic Area accounting for a further 10%. In 2023, 49.8% of psychiatry trainees in West Midlands were IMGs.

We have enough evidence to show that IMGs experience significant differential attainment in both training and exams. They also have an added burden of adjusting to a new country, language, culture, and society, not to mention adapting to a novel medical system and work culture. Attempts have been made to address this through induction, clinical supervision, etc.

This survey aims to understand the challenges faced by West Midlands psychiatry IMG trainees and to identify how best to support their needs.

A questionnaire survey was designed using the Microsoft forms platform and disseminated via the West Midlands School of Psychiatry in October 2023 to all trainees whose PMQ was outside UK. The survey gathered feedback on quality of inductions received, clinical supervision, difficulties experienced in training/examinations and awareness of available IMG-specific resources.

36 trainees with PMQ from 14 countries outside the UK completed the survey. 31% of the respondents were CT1 trainees. 17% had less than a year of NHS experience. All respondents had attended their current job induction. 64% rated their workplace induction as ‘Good’ or above, 50% rated trust and deanery induction at ‘Good’ or above. Only 17% of respondents had received IMG-specific induction. Many felt that induction was an information overload in a short space of time. 83% received weekly, hourly supervision. 69.4% rated support from their supervisor as ‘Very good’ or above. Respondents reported difficulties in immigration, finances, systemic racism, cultural and language adaptation. Other difficulties include portfolio, research experience and audits. MRCPsych exam difficulties were reported in 46% respondents especially around study materials and preparation. Trainees wanted IMG specific induction and supervision, pastoral care, portfolio support, MRCPsych exam support, mentoring, guidance around career progression and research.

The survey results show that IMG trainees do not receive appropriate and necessary IMG-specific induction and supervision even though they make up nearly half of the trainee cohort. The Deanery, NHS trusts and clinical supervisors can utilize the results of this survey to inform strategies to support IMGs better. Focus groups are due to be held shortly to get further qualitative feedback.

Individuals with severe mental illnesses are at an increased risk of morbidity and mortality from cardiovascular diseases compared with the general population. Dyslipidaemia is a well-established contributor to CVD risk, alongside factors such as obesity, hypertension, smoking, diabetes, and a sedentary lifestyle. Many patients with severe mental illnesses often exhibit a combination of these risk factors. Notably, second-generation antipsychotics, particularly clozapine, are associated with a significant risk to elevate lipid levels. However, dyslipidaemia is a treatable condition, and various interventions are available to decrease the risk, ultimately reducing the associated morbidity and mortality. Therefore, NICE guidelines recommend monitoring of lipid profile initially at baseline, 3 months and then annually and cardiovascular risk assessment by validated tools like QRISK3 or Assign Score (validated tool used in Scotland).

The first aim of this audit was to see if a lipid profile had been done within the past 12 months in patients on clozapine treatments and second aim was to see if cardiovascular risk had been assessed using a validated tool i.e. Assign Score and lastly to check if lipid results and Assign Score had been communicated to the General Practitioner.

The audit included 40 patients receiving clozapine treatment under the care of this local CMHT. We excluded 13 patients who were already on statin medication, those newly initiated on clozapine within the last three months or those who were aged below 30 years or above 74 years. The data collection spans from October 2022 to October 2023. Our analysis focused on bloods results in the last 12 months. After that, we searched for the cardiovascular risk assessment in last 12 months of patients’ electronic notes. Additionally, a comprehensive review of all communication records with General Practitioners was undertaken.

Lipid profile testing was done in 22 of 27 (81.1%) of the audited patients, revealing that a significant proportion, 59.9% (13 of 22), exhibited elevated total cholesterol levels exceeding 5mmol/L. However, the assessment of cardiovascular risk within the specified timeframe was notably low, with only 1 of 27 (3.70%) of the audited patients undergoing this evaluation. Furthermore, communication with General Practitioners (GPs) regarding lipid profiles was observed in a mere 4 of 22 (18.18%) of cases where such testing was conducted.

The clinical audit showed a good level of compliance with lipid profile monitoring; however, notable deficiencies were noted in the assessment of cardiovascular risk and communication with GPs. These findings emphasized the need to enhance our compliance with protocols for a more comprehensive approach to safeguard the cardiovascular health of patients receiving clozapine. As a result, we have proposed improvement strategy at our local CMHT meeting involving the implementation of a structured process, wherein the clozapine clinic nurse initiates an electronic task for the relevant medic to review the results. The medic is then tasked with calculating the cardiovascular risk and communicating both lipid results and the risk assessment to the GP, ensuring their inclusion in the annual review correspondence and subsequent management. A repeat audit will be done after 12 months.

We undertook a service evaluation obtaining feedback from service users in an inpatient rehabilitation setting about a weekly Boxercise class. The aim was to assess the experiences of service users, and the role it has in their recovery.

We hypothesised that the class would be well received by service users in aspects of enjoyment, impact on biopsychosocial wellbeing and recovery based on positive comments made by service users.

There is an increasing trend to utilise physical activity as an adjunct to improve mental health within healthcare settings; to increase motivation, educate on healthier lifestyles and to enhance well-being outcomes. This Boxercise programme has been developed by the Healthy Living Advisor within the rehabilitation inpatient facility at Leeds and York Partnership Trust. The programme has run for one year, and there has been a large uptake of service users who participate in the group. The Boxercise classes aim to encourage discipline, communication, spatial awareness, and cognitive skills in a modality that is interesting to service users.

Service users who are regular participants in a Boxercise programme at an inpatient rehabilitation centre completed a questionnaire. A five-point Likert scale assessed participant views across seven domains. Participants were then asked to write three words that describe their feelings about the Boxercise programme, complete a drawing showing their thoughts after a Boxercise class and provide suggestions for improvement.

Eleven participants completed the questionnaire. Average scores for the domains were as follows: enjoyability 4.45/5 (89%), physical health 4.55/5 (91%), mental health 4.27/5 (85%), recovery 4.09/5 (82%), socialising 3.91/5 (82%), safety 4.64/5 (93%), continue after discharge 3.36/5 (67%).

The ‘three words' were put in a word cloud generator with highest weighted words: ‘Fun', ‘Good', ‘Energetic', ‘Confident'.

Common themes from the pictures shown were smiling faces and ‘strongman' images.

Six participants gave feedback that more equipment (pads and gloves) would help to improve their experience in the classes.

The Boxercise programme received positive feedback from participants that aligns with the hypothesis; particularly in safety, enjoyability, benefit to physical health and benefit to mental health.

The participants had positive views on the class as an adjunct to the management of their physical and mental wellbeing. The feedback from all the participants is that they felt safe during the classes.

This service evaluation indicates that the participants value the Boxercise classes as an enjoyable activity and as an adjunct to their treatment.

This audit assesses the adherence to and effectiveness of rapid tranquilization protocols in a tertiary care psychiatric facility in Pakistan, particularly focusing on the use of intramuscular (IM) haloperidol and promethazine. The evaluation also includes an analysis of how these practices align with the prescribed guidelines for managing psychiatric emergencies.

A comprehensive retrospective analysis of patient records from January to December 2023 was conducted. The focus was on assessing the sequence of interventions (de-escalation techniques, oral medication, IM administration), medication choices, adherence to protocol steps, and documentation of patient monitoring post-administration. Descriptive and inferential statistical methods were applied to analyze the data.

Among 482 patient records:

The primary diagnoses included schizophrenia (44%), bipolar disorder (29%), and severe depression with psychotic features (27%). IM haloperidol and promethazine were predominantly used, with 68% of cases bypassing oral medication or de-escalation attempts. Only 60% of cases showed adherence to the recommended protocol steps, including assessment for medical causes and optimization of regular prescriptions. In 12% of cases, a second injection was necessary, with the interval between injections undocumented in 15% of these cases. Vital monitoring post-administration was not recorded in 30% of cases. Medication unavailability was an issue in 8% of aggressive cases. Protocol deviations included the omission of recommended pre-treatments, such as ECG for haloperidol and the lack of alternative options like buccal midazolam or inhaled loxapine.

The audit reveals significant deviations from established guidelines in the rapid tranquilization process. The frequent omission of non-invasive interventions and the lack of consistent monitoring and documentation practices highlight areas needing immediate improvement. Training in de-escalation techniques, adherence to step-wise intervention protocols, and ensuring the availability of a range of medications are crucial. This study underscores the importance of aligning psychiatric emergency practices with established guidelines to ensure patient safety and effective treatment outcomes.

1. 1) To improve the confidence of the nursing team in ensuring initial assessment and escalation of physical health concerns on an organic old age psychiatry ward, Glade ward, Woodlands unit, RDASH Rotherham.

2. 2) To equip them with the knowledge needed to recognise and promptly escalate concerns about physical health to medics.

3. 3) To foster the relationship between the nursing team and medics to facilitate communication between both teams for the improvement of physical health care of mental health patients.

Eight weekly teaching sessions were organised and delivered by FY1 and CT1, with each session lasting 10–30 minutes. Short 10-minute teachings followed by questions and answers. Topics were at the request of nursing staff and included physical observations, sepsis, head injury etc.

Attendees included members of the nursing team and allied health professionals (ward managers, mental staff nurses, nursing assistants, student nurses, pharmacy technicians etc.).

Post-Teaching questionnaires filled out after each session rating understanding before and after teaching.

Topics included the commonest physical health conditions on old age mental health wards, including physical observations monitoring and interpretation.

One overall feedback questionnaire was also obtained at the end of all sessions.

Participants emphasised improvement in their level of knowledge and confidence in spotting signs and symptoms as well as derangements in all topics covered.

They reported feeling more included and heard as a member of the team, feeling more confident to escalate abnormal findings to ensure patient reviews. This is evidenced by comments and ratings on feedback forms.

All respondents believed that the teaching sessions should continue as 87.5% felt they were very helpful, while the remaining 12.5% rated it reasonably helpful (4/5).

While the physical health aspect of patients may be easy to overlook or neglect in mental health settings, continuous creation of awareness through interactive teaching sessions can improve staff knowledge and confidence. We need to re-emphasize the importance of a good working relationship between the nursing team and medics to improve the physical health of our patients (while caring for their mental health) and ultimately ensure patient safety at all times.