All medical staff working within NHS psychiatric hospitals in the UK are required to complete mandatory life support training. However, there is no such mandatory requirement for associated training around the effective use of the emergency medical equipment used during medical emergencies on inpatient psychiatric wards. This quality improvement project focused on developing a sustainable educational intervention aimed at all staff types within one London inpatient psychiatric hospital. Staff of all grades and roles encountered frequent difficulties and delays in relation to the emergency medical bags and equipment, including issues around skill and confidence.

A survey was initially sent to medical and nursing staff working on an inpatient psychiatric unit, which highlighted participants’ lack of confidence in using the equipment. It emerged that staff exclusively handled the emergency medical equipment during relatively rare emergencies. This resulted in unfamiliarity with the equipment and consequent difficulties in using it competently. A novel educational intervention dedicated to upskilling staff with emergency medical equipment was created, focusing on contents and use of individual equipment within the medical emergency bag. Pre- and post-intervention quantitative feedback regarding confidence and familiarity was obtained using feedback forms containing Likert scales. Qualitative feedback was also obtained.

More than six training cycles, each consisting of at least five training sessions, have now been completed with both qualitative and quantitative measures of improvement captured. Individuals noted on average a 31.62% (±3.605%) improvement in self-reported confidence and familiarity with equipment. The most frequently identified positive themes were that the intervention familiarised staff with equipment and was educational, whilst the most frequent suggestion for improvement were requests for additional sessions. From single idea to sustainable quality improvement, the team broadened and gained stakeholder support including clinical and nursing directors, pharmacy, junior doctors, nurses, and matrons.

The intervention has achieved sustainability and is being explored in other partnership psychiatric hospitals. Despite reported increased confidence in handling the emergency equipment, there is ongoing need to develop, maintain and practice these skills, across both the nursing and medical staff, to achieve better outcomes for psychiatric inpatients. Trainee psychiatrists intend to develop the project further, and the training will be incorporated as a mandatory requirement. The project links to the quality standards for mental health point 12 of the Resuscitation council UK. Next stage developments of the project include linking to feedback from emergencies as well as incorporating into existing simulation training.

The GMC Trainer's survey 2022 identified nearly two in ten (18%) trainers do not agree that their employer provides a supportive environment for everyone regardless of background, beliefs, or identity. A striking 52% of doctors working as trainers are identified as being at moderate to high risk of burnout. Surrey and Borders Partnership NHS Foundation Trust(SABP) has 63 active educational and clinical trainers.

We aim to enhance the overall experience of Educational and Clinical Trainers in SABP by gaining insights into their views and experiences and identifying key areas for improvement to support trainers in their roles, thereby contributing to a more resilient healthcare workforce.

We devised a 16 item questionnaire to gather anonymous data on trainers' experiences and views in their roles. Our study utilised an observational quantitative and qualitative cross-sectional design. Data capture was done on Microsoft Forms and analysed using Excel.

We had 70% response rate, 90% agreed or strongly agreed they had adequate support and training, 95% feel able to fulfil educational CPD for appraisal however only 83% were able to complete reflections on trainee feedback. 93% agreed or strongly agreed that they enjoy being a trainer but only 67% agreed or strongly agreed that they knew how to access support if they felt burnt out. Only 43% felt that they had adequate time in their schedule to provide supervision. Analysis of responses stratifying International medical graduates and years of experience being a trainer did not identify additional needs.

Effective trainers are fundamental in shaping future doctors. Our survey results highlighted that a high percentage of trainers enjoy their role. Based on the results, strategies were identified to improve support that can be implemented through trainers’ drop-in sessions, advertising trainers' training sessions with more notice and developing the resources on the intranet including improving content and adding videos of training sessions. We also identified that appraisal and revalidation requirements for trainers, trainee surveys needed to be better advertised to improve feedback rates. We recommended that a document on the online appraisal platform (SARD) be added to clarify the requirements for appraisal and revalidation, and how these can be met. We suggested that Associate Medical Directors consider the need to ringfence time for educational and clinical trainers in their job plans.

Audit had been completed with aim to review GP referrals to Perinatal Mental Health Services over a 6/12 month period.

Focus on medication, and information provided on referral proforma; prescribing via letters sent to Perinatal Mental Health Services.

The reason for undertaking this project is due to evidence of variance in practice in prescribing and documenting medications.

The project team retrospectively took 6 months of data each for the four localities and looked at the list from the weekly MDT during that period.

The team identified the GP referrals and then looked in detail at the referral in Carenotes System.

The data was collected on a proforma designed in Microsoft Word and was then sent to the Improvement Team for collation and analysis using Microsoft Excel.

66% used the referral proforma and 20% used the referral letter.

The majority (106) of referrals were for a routine review/nonspecific.

The majority (78) of referrals were post-natal. 25% of referrals did not indicate whether the patient was post-natal or antenatal and hence no Expected Date of Delivery [MS(CPT1] entered.

10% of referrals medication had been stopped. 24% of patients were to review to start medication.

Results show that sertraline had been initiated the most frequently. 65% unspecified. In 26%, sertraline had been most frequently prescribed.

Where medication had been stopped, the majority of proformas (64%) were incomplete. 9% of patients had Selective Serotonin Reuptake Inhibitors suspended such as sertraline and citalopram.

In most cases, the reason for referral was unclear.

Medication was often stopped unnecessarily – for most medications, it was not indicated whether medication was started/stopped.

If patients were started on medication, sertraline and citalopram were either started or stopped most frequently.

We also found that some of the referrals were illegible.

We presented the findings within our perinatal mental health team meeting.

We found the following to be actioned, including discussions with local GP practices and/or local GP educational forums.

We hope to re audit following the above action.

Bipolar disorder (BD) leads to marked disability, morbidity, and premature death. Although pharmacological agents are an essential part of BD treatment, psychosocial interventions have played an important role in enhancing treatment adherence, functioning and quality of life in patients with BD. Building on a successful pilot randomised controlled trial (RCT) of a Culturally adapted PsychoEducation (CaPE) intervention for BD, CaPE is currently being evaluated in a large multicenter RCT for its clinical and cost-effectiveness across Pakistan. However, innovations are urgently needed due to limited human resources and disproportionately high clinical needs to bring effective interventions to scale. This study aims to develop and test a mHealth iteration of CaPE, digital CaPE (dCaPE), to be delivered via a mobile app.

The study will utilise a two-phased approach to i) develop a user-centred dCaPE mobile application and ii) assess the feasibility and preliminary efficacy of dCaPE for people with BD in a randomised controlled trial in Pakistan. For application development, we have conducted discussion groups with stakeholders i.e., mental health professionals (psychiatrists, psychologists, nurses) (n = 8) and patients and carers (n = 10) to gauge their valuable insights for app design, visual elements, cultural sensitivity, motivational and mood-monitoring features, and app functionality to improve user experience.

The findings from discussion groups informed the importance of visual elements, specifically font size and style. Participants recommended the use of soft and soothing colours like white, grey, and soft shades of pink to prevent overstimulation. Additionally, participants highlighted the need for culturally and linguistically inclusive features, including emojis and audio messages for effective engagement and to address the challenge of low literacy. The mHealth approach was deemed highly valuable, especially given the prevalence of mental health challenges and associated stigma. Endorsed by participants, the dCaPE application will offer customized psychoeducation messages along with daily 5-item (mood, energy, sleep, medication, and irritability) screening, a weekly comprehensive test for manic and depressive episodes based on DSM–5 criteria; weekly reminders to regulate sleep and eating habits, and visual representations of weekly mood monitoring reports with the incentive of badges or rewards for goal achievers.

This research has the potential to enhance clinical outcomes, social and occupational functioning, and the overall quality of life for BD patients while addressing substantial mental health treatment gaps with impact and implications extending to various low-resource settings.

1. 1) To hear directly from women suffering from PMDD about their lived experiences of PMDD and the impacts that it has on their daily lives.

2. 2) To raise awareness about the impacts that PMDD can have on patients' quality of life, relationships, and productivity, to improve clinicians’ understanding of patients' needs.

3. 3) To identify a gap in research into PMDD within the UK and highlight the need for further research.

4. 4) To improve awareness of PMDD amongst diverse stakeholders, including women who are not yet diagnosed with PMDD, employers, and policymakers.

Participants were recruited from the UK's PMDD Patient Insight Group and screened using the Premenstrual Symptom Screening Tool (PSST) for PMDD. Eligible participants were purposively sampled, and 15 participants were invited to a semi-structured scheduled interview on Zoom. Interviews were transcribed using NVivo transcription software, and inductively analyzed using reflexive thematic analysis in NVivo 14.

Thirteen subthemes were identified and organised around four main themes: Theme 1: ‘Jekyll and Hyde’, Life with PMDD, Theme 2: ‘The Aftermath’, The Impact of Living with PMDD, Theme 3: ‘Surviving PMDD’, Coping Strategies, and Theme 4: ‘Seeking Treatment’, Experiences with Healthcare. The themes identified in this study highlight the negative experiences of women living with debilitating symptoms that appear during the luteal phase and disappear following the onset of menstruation. Themes also capture the immense burden PMDD places on a sufferer by uncovering how exactly these symptoms affect interpersonal relationships, career progression, quality of education received, and relationship with oneself. Theme 4 focuses on women's negative experiences with healthcare stemming from a lack of awareness of PMDD in the medical community.

The findings of this study highlight the critical importance of understanding the contextualized experiences of women living with PMDD in the UK and bringing to light the immense monthly burden sufferers face. To prevent women and Assigned Female At Birth (AFAB) individuals from experiencing severe and prolonged psychological distress which can have fatal consequences, there needs to be greater understanding and awareness of PMDD in both medical and lay communities. In addition to this, clinicians must be trained in PMDD assessment and research should be encouraged to introduce new treatments and to implement policies that minimize the burden of PMDD in the workplace.

We are a 17 bedded acute mental health ward in a busy inner-city hospital. A handover of all patients, with the multi-disciplinary team, takes place every morning (Whiteboard round). The clinical team felt that the information provided during this meeting needed a review, to ensure relevant patient information is being disseminated, and right clinical decisions are being made in a timely manner.

The team decided to focus on improving links with Community Mental Health Hubs (CMHH) to ensure continuity of care. The challenge the inpatient team faced is the need to interface with community mental health teams from two London boroughs, as the unit became the main admission hospital for Kensington & Chelsea and Westminster (KCW) patients.

The main aim is that 80% of KCW patients' CMHH (including new referrals) will be contacted within 24 hours of them being admitted onto the ward by April 2024.

As part of this QI project, weekly meetings were commenced, with a team comprising doctors, nursing staff (both inpatient and from local community team) and an Expert by Experience (EbE). A questionnaire was produced and circulated to ward colleagues about their views on the quality of whiteboard. A more focused questionnaire was then sent out around CMHH involvement in a patient's admission journey. We took a deep dive into the structure of the local community teams (at least 10 identified) and how referral processes work, as it was evident that staff were unclear at times on who/how to refer.

From this, the first change idea was formed: “information sheets” were produced showing which GPs correspond to which teams, and that patients can be referred this way. The Plan Do Study Act (PDSA) was applied to make these sheets visible to all staff. The outcome measure used was how many patients had CMHH referral/contact within 24 hours.

Data is being collected daily, by reviewing patients notes to see if CMHHs have been contacted. Since commencement of the first PDSA cycle in December 2023, of the twenty-three patients admitted, nineteen have been eligible. Of these nineteen patients, fifteen patients (79%) have had contact or referrals made to their CMHH within 24 hours.

Results suggest that the aim is on the way to being met. Our next change idea is to obtain formal feedback from staff and patients on this process.

During the perinatal period women are at increased risk for mental health illness. It is estimated that around 0.5 in 1000 deliveries will result in admission to the mother and baby unit (MBU). Recovery is achieved by combining pharmacological treatment with holistic approaches. The majority of MBU settings will offer a variety of sessions that aid relaxation, reflection, and bonding. We have chosen to trial an additional service – Yoga class. It is known that Yoga is beneficial not only for strength, flexibility, and chronic pain but also for improved concentration, relaxation, and anxiety reduction.

Service evaluation took place in 8 bed, inpatient MBU. Selection criteria included non-pregnant women who had 4–6 weeks postnatal health check, were interested in trialling the class and were willing to complete pre- and post-class selected questions from the Dialog scale. The total number of Yoga classes conducted was 9 but there was no set number of classes for patients to commit to. Sessions were run between October 2023 and February 2024. Dialog scale was selected as a well-established outcome measure within the ward. We measured 3 areas by a Dialog scale (physical health, mental health, and leisure). The rating range was 1–7 with 1 being totally dissatisfied and 7 totally satisfied. Questions were completed before and after the class.

In total 7 patients attended at least 1 Yoga class. We have calculated pre- and post-class average scores to measure change in selected outcomes. Physical health self-reported evaluation improved from 4.09 (SD = 0.79) to 4.48 (SD = 0.71). Mental health score improved from 3.61 (SD = 0.96) to 4.29 (SD = 0.99). Leisure score rose from 3.67 (SD = 1.3) to 4.34 (SD = 0.55). From the class record it was noted that overall, the uptake of the class was encouraging with 85% of patients returning to the Yoga with on average completion of 3 classes. 6 out of 7 patients did not attend further classes due to discharge or other commitments rather than withdrawing from classes.

From the collected data we can see that Yoga classes appear to be associated with moderate improvements in mothers’ mental and physical health, at least immediately post-class. Whether this translates into long-term benefits remains unknown. Our service evaluation indicates that Yoga can be a beneficial part of holistic management for mothers in the MBU setting. In the future, this study could also involve pregnant mothers, who are an important population within the MBU setting.

The contribution of mental illness towards total Disability Adjusted Life Years is increasing according to the Global Burden of Disease study. As the need for mental health services increases, technological advances are being deployed to improve the delivery of care and lower costs.

The emergence of Artificial Intelligence (AI) technology in mental health and companionship is an evolving topic of discussion. There have been increasing debates about the use of AI in managing mental health problems. As the AI technology and its use grows, it is vital to consider potential harms and ramifications.

There are very limited discussions about the use of chatbots and relevant AI by humans to commit crime especially in those suffering from mental illness. AI can potentially serve as an effective tool to misguide a vulnerable person going through a mental health problem e.g. encourage someone to commit a serious offence. There is evidence that some of the most used AI chatbots tend to accentuate any negative feelings their users already had and potentially reinforce their vulnerable thoughts leading to concerning consequences.

The objective of this study is to review existing evidence for harmful effects of AI chatbots on people with serious mental illness (SMI).

We conducted a review of existing evidence in five databases for relevant studies. The search sources were 4 bibliographical databases (PsycINFO, EMBASE, PubMed, and OVID), the search engine “Google Scholar” and relevant grey literature. Studies were eligible if they explored the role of AI and related technology in causing harm in those with SMI.

Initial searches constrained the scope of review to the harmful effects of AI use in mental health and psychiatry and not just the association with crime due to very limited existing data.

Whilst current AI technology has shown potential in mental healthcare, it is important to acknowledge its limitations. At present, the evidence base for benefits of AI chatbot in mental healthcare is only just getting established and not enough is known or documented around the harmful effects of this technology. Nevertheless, we are seeing increasing cases of vulnerable mental health patients negatively influenced by AI technology. The use of AI chatbots raises various ethical concerns often magnified in people experiencing SMI. Further research will be valuable in understanding the ramifications of AI in psychiatry. This will also help guide the developers of this important and emerging technology to meet recognised ethical frameworks hence safeguarding vulnerable users.

This re-audit of rapid tranquillisation (RT) practices in patients over the age of 65 at a district general hospital took place as part of a wider quality improvement project to assess whether practices had improved following previous audits.

Data was accessed using the hospital's electronic patient record system. Drug charts for patients over 65 admitted to six wards (total n = 172) were reviewed. The wards comprised three geriatric wards, two medical wards, and one surgical ward. Drug charts were reviewed using the audit tool developed in previous audits, which has been designed to collect relevant data according to the recognised standard (in this case the local mental health trust's RT guidance). Data was collected on RT type, RT frequency of RT, RT route, indication documentation, post-RT monitoring, nature of prescription (PRN, stat, or regular), underlying diagnosis of delirium or dementia, and involvement of specialist teams.

• • Of the 172 audited patients, 9 (5.2%) received RT, compared with 13 out of 297 (4.3%) in the previous 2022 audit.

• • PRN remained the most common prescription pattern, with two designated as stat and the remaining three mostly stat but occasionally incorporating PRN. Intramuscular administration continued to be the most common route in both cycles.

• • In the current cycle, the maximum frequency was indicated in 55.5% of cases, whereas it was not indicated in the previous cycle.

• • In the current cycle, indications were documented for 88.8% of prescriptions, a significant increase from 50% in the previous cycle. Furthermore, there was almost 100% compliance in nursing/medical documentation of RT administration in patient notes, which was lacking in the previous audit.

• • Psych liaison or dementia team involvement was observed in around 33% of cases in the current cycle, whereas it was not evident in the previous cycle.

• • Post-sedation monitoring in line with policy was not evident in either cycle.

Overall, both audits highlighted consistent challenges in prescription practices and post-administration monitoring, albeit with variations in compliance levels and team involvement. Since the completion of this re-audit, a new RT policy has been approved which has much clearer guidance for the general hospital. This RT policy will be launched with a programme of teaching and training for the hospital. We aim to track progress by conducting a re-audit within 6–12 months.

This pilot program aimed to enhance the psychiatry experience for foundation doctors (FYs) working at Ayr Hospital by identifying perceived areas where psychiatric support would benefit training, development or education. Subsequently strategies were aimed to be implemented by the psychiatry liaison service to enrich FYs' experience during their medical and surgical rotations. Feedback was aimed to be obtained to determine if the program would have value to other district hospitals and grades of junior doctors.

Unstructured interviews with 4 FYs were conducted in October 2023 to explore the current experience of psychiatry in medical or surgical placements at Ayr Hospital. Identified themes included barriers to completing supervised learning events (SLEs) for mental health cases (a requirement of the 2021 Foundation Curriculum), limited exposure to psychiatry teaching opportunities, and obstacles to pursuing development of interest in psychiatry (such as time to shadow psychiatry, or discuss career prospects in psychiatry).

A pilot program was initiated in November 2023 to improve the experience and education of psychiatry for FYs. This involved:

• • Providing dedicated time on wards for FYs to complete SLEs with a member of the liaison service.

• • Providing time for FYs to shadow the role of liaison psychiatry.

• • Providing additional teaching tutorials, focused on topics chosen by FYs.

• • Providing the opportunity to discuss and develop interest in psychiatry.

A survey to obtain both quantitative and qualitative feedback was sent to each FY that engaged in the program.

17 FYs engaged in the pilot program, with 13 providing feedback. All respondents felt the program increased their knowledge and confidence in approaching cases with a psychiatry element. They also all found the experience positive and a productive use of time. All deemed the program would be useful for other foundation trainees in medical hospitals. Free text feedback highlighted the program's value in facilitating case discussions, removing obstacles in completing mental health SLEs, providing useful relevant tutorials and providing opportunity to discuss further interest of psychiatry.

The pilot program successfully achieved its aim to improve FYs' experience of psychiatry. Although not measured in the survey, the program also appeared to foster positive relationships between the liaison service and junior medical staff. It also helped identify new appropriate referrals for the liaison service. An expansion of the program is planned to other district hospitals in Ayrshire and Arran, including consideration of expanding the participation to wider members of the junior doctor cohort.

According to The Medicines and Healthcare products Regulatory Agency (MHRA) Drug safety update in August 2020 regarding clozapine, monitoring blood clozapine levels for toxicity is now advised in certain clinical situations such as when a patient stops smoking or changes to e-cigarette.

Aim of this audit was to determine whether blood clozapine levels are being performed in patients on clozapine when there has been a change in patient’s smoking status from two localities, East and West Hull community mental health team.

Because there is a risk of significant blood clozapine change within 3–5 days post starting or stopping smoking which consequently increases the risk of toxicity, we also looked at whether a medical review was undertaken post change in smoking status in order to review if any adjustment was required in current clozapine dose.

A list of Hull CMHT patients on clozapine was obtained from local clozapine clinic. The data comprised patients who were on clozapine from both localities of CMHT between October 2022 to October 2023.

Data was obtained retrospectively from Trust's patient electronic record system.

Eligibility criteria was set for the patient on clozapine to be a current smoker, or have been a smoker over last 12 months. Non-smokers and the ones on clozapine without a change in smoking status over the duration period were excluded.

58 patients were identified to be smokers and taking clozapine. Change in smoking status was documented in 21 instances, and therefore included in final analysis of results.

42.86% patients had a clozapine blood level check post smoking status change.

19% of patients from our sample had a medical review after change in smoking status within the duration time of audit.

We concluded that compliance with current MHRA guidelines in relation to blood clozapine levels and change in smoking status is quite poor in Hull CMHT and measures are needed for improvement.

We recommend that every patient with a change in smoking status must have blood clozapine level checked within a week of any change in smoking status and a medical review in two weeks. We identified some scope of improving current clozapine monitoring form on electronic system and recommend changes by adding a section where change in smoking status is recorded.

A recent Cochrane review published in December 2023 concluded that “no trials found that interventions to reduce anticholinergic burden led to any other improvements in cognition compared to usual care”. We describe the case of a 62-year-old lady who developed significant cognitive decline following the initiation of a low dose of procyclidine, which was rapidly reversed upon stopping the medication.

We present the case of a 62-year-old lady with a diagnosis of schizo-affective disorder, whose symptoms had been stabilized on a regime of lithium carbonate 500mg nocte, sulpiride 400mg BD and fluoxetine 20mg OD. When the patient presented to the outpatient clinic, she was noted to have bilateral coarse tremors and slight cogwheel rigidity. Procyclidine was started at a dose of 5mg OD to manage these extrapyramidal side-effects.

Following this, family members reported that the patient had difficulty initiating and following conversations. Short-term memory was affected and she was observed to have reduced attention span. These problems were reportedly getting worse with time, with a simultaneous decline in functional abilities. She was no longer able to carry out her daily shop, and family members ensured that she was no longer driving as they had concerns about her road safety. She stopped taking procyclidine after 1 month and notably, these problems ceased within one week of stopping the medication.

Cognitive testing confirmed that the patient was cognitively intact after procyclidine was stopped. The patient scored 96 on the ‘Addenbrooke's Cognitive Examination’ scale, which falls within the normal range. The ‘Instrumental Activities of Daily Living’ scale was administered to assess functioning at the time of the cognitive impairment. This returned a score of 1/8, indicating that there was significant functional impairment secondary to cognitive impairment when prescribed procyclidine. The ‘Informant Questionnaire on Cognitive Decline in the Elderly’ was administered to objectively quantify the extent of cognitive decline as noted by family. This returned a score of 4.3, confirming that the patient's cognition had indeed been worse when compared with her baseline.

Our case report highlights the rapid improvement in cognition with the removal of anticholinergic burden in a 62-year-old female. Our report can, therefore, be a harbinger for more robust trials to determine the efficacy of interventions to reduce anticholinergic burden in preserving or improving cognition.

It is important to monitor for any change in cognition when prescribing anticholinergic medication in at-risk individuals.

Non-attended appointments can lead to adverse outcomes for a service and its users, including reduced service efficiency; increased waiting times; and impaired patient care. The audit objective was to explore whether DNA rates vary between the current modalities of face-to-face; virtual; and telephone. It was hoped that this would enable the service to better understand the reasons for patients not attending initial assessments and determine whether the modality may present a barrier.

A sample was obtained including all first assessment appointments between March 2022 and March 2023 (n = 386). Data included the modality for each initial appointment. Matched to this data, was whether the patient attended each appointment, creating a frequency of DNAs for each appointment modality across the year. Data analysis was conducted using Microsoft® Excel®. Beyond frequency and percentages, a chi-square test was used to assess for a statistical difference in appointment attendance between modalities.

For this one-year sample the overall attendance rate was 77%: with 299 appointments attended, and 87 ‘DNAs’. The DNA rates across the one-year sample were face-to-face (24%); virtual (22%); and telephone (23%).

The chi-square value produced when analysing the DNA rates between modalities was 0.92 (critical value 5.99). Hence, there was no statistically significant difference in DNA rates by modality.

Despite the absence of variation in DNA rates between modalities, the findings can be viewed as reassuring. The move to include multimedia alternatives to assessments does not appear to be impacting attendance when compared with assessments that continue to occur face-to-face. Balanced against this increased geographical inclusion afforded by remote appointments, is the competing equity issue of digital exclusion, highlighting the need for face-to-face appointment provision to remain accessible across the service.

This audit did not collect demographic data that may have provided insight into whether certain factors may have impacted attendance and could have acted as confounders, for example geographical location.

Introduction of a supportive reminder letter for patients, to bridge the wait between patient's referral and their initial assessment, was an outcome recommendation that was implemented by the service.

The aim of this systematic review is to identify and describe the experiences, barriers and provision of post-diagnostic support in UK rural areas; from the perspective of people living with dementia, healthcare professionals and informal family caregivers.

People living with dementia in rural areas experience numerous barriers to accessing post-diagnostic support.

Systematic Review.

Systematic searches will be conducted in the following databases; SCOPUS, PubMed, PsychINFO and CINAHL Plus. Systematic review tool Rayyan.ai will be used to screen titles and abstracts, prior to full-text review. Following data extraction, The Critical Appraisal Skills Programme (CASP) tool will be used to appraise the quality of studies and assess risk of bias. The data will be deductively analysed through the lens of the Candidacy Framework's 6 dimensions, with a secondary inductive analysis capturing any themes that fall outside of the framework.

242 papers have been screened by first and second reviewer. 15 papers included. Papers still being analysed for full review. Will be complete by March 2024.

This systematic review will help improve understanding of the rural barriers and experiences of post-diagnostic support, and allow researchers and stakeholders to develop and optimise specially tailored dementia interventions in line with the needs of people residing in UK rural communities.

First reviewer: Danielle Bilkey, Second Reviewer: Dr Ellena Businge, Supervisor: Dr Nicolas Farina.

To audit the recording of physical health parameters for the clients of Waverley Community Mental Health Recovery Service (CMHRS).

To ensure Trust and NICE guidelines are met for monitoring of:

1. 1) Psychiatric drug prescribing.

2. 2) Psychiatric disease monitoring.

3. 3) Past medical history and biophysical parameters relevant to prescribing decisions.

A random sample of 100 patients from Waverley CMHRS was analysed. The data was collected between November 2022 and January 2023. The process involved establishing the cohort, dividing the caseload for review, and applying an audit questionnaire. The questionnaire was applied to both SystmOne Electronic Patient Records and GP Shared Care Records to assess compliance with physical health monitoring in both secondary and primary care. All data collected were compiled onto an Excel Spreadsheet. The level of compliance for monitoring of each parameter was calculated and audited against Trust and NICE guidance.

For secondary care:

1. 1. Compliance with physical health monitoring requirements is consistently low.

2. 2. Higher levels of compliance (>50%) for height, weight, Audit C (Alcohol), Smoking status.

3. 3. Lowest compliance levels observed for: blood tests, ECG request, substance misuse status, sleep, medication side effects.

4. 4. Evidence of a comprehensive physical health review was found in 1% of patients.

For primary care:

1. 1. 95% of patients from our sample consented to giving access to their Shared Care Record.

2. 2. Compliance with physical health monitoring requirements in primary care was higher.

3. 3. Compliance was particularly high (> 87%) for: height, weight and BMI, BP, evidence of alcohol monitoring, evidence of smoking monitoring.

4. 4. Smoking monitoring is the parameter with the highest level of compliance (95%).

5. 5. Parameters are monitored more regularly.

The audit identified gaps in the documentation and assessment of physical health parameters within Waverley CMHRS. Compliance with monitoring requirements was significantly lower in secondary care, highlighting the need for intervention. Conversely, primary care demonstrated higher adherence to monitoring guidelines. The results show deficiencies in physical health monitoring that need to be addressed to ensure comprehensive psychiatric care.

The project was crucial in optimizing physical health monitoring within Waverley CMHRS. Recommendations include targeted training, improved communication between primary and secondary care, and the designation of physical health coordinators. An action plan was developed with assigned responsibilities and a timeline for implementation. A re-audit will follow to assess the impact of implemented changes.

The first medical textbook in Arabic, ‘Firdaus as-Hikmah’ (The Paradise of Wisdom) by Tabari (808–861) was composed in in year 848. Tabari's classification of insanity is simple and in term of psychosis, he talks about syndromes of ‘Hearing voices in the head’ (hallucinatory psychosis), ‘humm-al-hubbi’ (love fever) and ‘humm-al-sehr’ (fever from enchantment). The first classification of ‘junun’ (psychosis) comes from Râzī (854–925), who in his ‘Al-Hāwī fil Tib’ (The System of Medicine) divides ‘insanity’ (psychosis) into ‘al-junun al-thābet’ or ‘permanent madness’, and ‘a'rāz tābea-tu leamrāz’ or ‘symptomatic psychotic disorders'. The first medical textbook in Persian language, ‘Dāneshnāma’ (Medical Encyclopaedia) by Hakim Maysarī, completed in 978–9 mentions only melancholia and ‘rejā’ (pseudocyesis/pseudopregnancy) and no other psychotic conditions. Prospective generations of Arabic-inscribing physicians, including Majūsī, also known as Haly Abbas (949–990), Avicenna (980–1037), and Persian-inscribing physicians such as Bokhârī̄ (? −983) and Jorjânī̄ (1040–1137) are strongly influenced by Râzī̄ and use similar taxonomy of psychotic disorders. Moreover, the taxonomy introduced by Râzī̄ and other mediaeval physicians has been used in Arabic and Persian speaking medical communities until the past century. Nevertheless, these were substituted by Latin-based language vocabulary reflecting the International Classification of Diseases (ICD).

The aim of this work is to review the input of Arabic and Persian schools in the development of psychiatric knowledge and classification.

Literature search of ‘Firdaus-al-Hikmah’ of Tabari, ‘Kitāb al-Hāwī fī al-ṭibb’ of Râzī̄, ‘Kitābu'l Malikī’ (The Royal Book) by Majūsī, ‘Al-Qānūn fī al-Ṭibb’ (Canon of Medicine) of Avicenna in Arabic; and ‘Hidâyat al-Mutaʽallemin fi al-Ṭibb’ (A Guide for Medical Students) of Al-Akhwayani Bokhârī and 'Zakhīra-i Khwârazmshâhī' (The Treasure of Kwārazmshāh) and Al- ‘Aghrād'ul tibiyah wa'al-mabāhith'ul Ala'iyah’ (The Aims of Medicin) of Jorjânī in Farsi.

1. ‘Transient‘ or symptomatic psychotic disorders, resulting from direct or indirect brain damage:

1. 1.1. ‘Ekhtelāt-ul-takhayyol’ (disorder of perception), ‘when patients imagine perceptible things, such as seeing people, hearing sounds, or sensing smells that have no external reality’.

2. 1.2. 'Ekhtelāt-al-fekr’ (thought disorder), when the perception is intact and patients perceive the outside reality as it is, however, their thinking is impaired.

3. 1.3. ‘Ekhtelāt-al-aqhl’ ('corruption of the mind’), or ‘junun (madness), defined as a condition when patients say things they should not say, like things they should not like, wish unreasonable things, demand what is not demanded, do things they should not do, or hate things that they normally do not hate.

4. 1.4. 'Sobārā', portrayed as a form of agitated madness resulting from ‘sarsām’ (meningitis/encephalitis).

2. 'Permanent’ psychotic disorders also considered as primary ‘brain’ diseases:

1. 2.1. Mania, described as the worst kind of insanity, presenting symptoms of paranoia, constant anxiety, agitation, hyperactivity, vindictiveness, insomnia, hostility, and ferocity.

2. 2.2. ‘Dâ-al-kalb' (‘dog's disease'), portrayed as a mixed psychosis with a fluctuating picture of anger and playfulness, as well as hostility mixed with gentleness.

3. 2.3. 'Qutrub', outlined as a psychosis when affected individuals dislike people's company and run away from society, rarely resting, and aimlessly moving as if they were in fear of running from someone. Patients become forgetful, and their behaviours disorganised.

The Arabo-Persian classification of mental disorder was progressive and generated a common nomenclature in the Arabo-Persian speaking medical communities, serving the mutual understanding of experts. Moreover, the taxonomy developed was relatively precise and stable, corresponding to modern classification systems. Psychoses were categorised into ‘transient’ and ‘permanent’ disorders, which were considered as a primary ‘brain disease’ of multifactorial aetiology, a concept introduced by Griesinger in the 19th century, known as the ‘organic model’ of mental illnesses.

Child and Adolescent Mental Health Services (CAMHS) is a highly specialised service to which children with severe mental health problems are referred. The COVID-19 pandemic brought with it a lot of uncertainty, and healthcare systems across the UK struggled to cope with the added pressure. The aim of this systematic review is to analyse the literature exploring the effects of the COVID-19 pandemic on the severity of mental health conditions and referral rates to CAMHS services in the UK. The findings from this study will help the services understand the impact of the pandemic on referral rates to CAMHS, the severity of various mental health conditions, and how the services are managing.

An extensive search, following PRISMA guidelines, was undertaken across multiple electronic databases using a predetermined search strategy. Studies reporting on mental health conditions in children post-pandemic and on referral rates to CAMHS in the UK were included. Subsequently, data extraction, quality appraisal and qualitative analysis were performed in a descriptive style.

Initially, referrals to CAMHS decreased during the first lockdown, followed by a significant increase in referrals throughout the pandemic period. The referral rate to CAMHS remains steady until adolescence, with a rapid increase in referrals to the services during the teenage years. More adolescent girls were referred to CAMHS compared with boys and are at an increased risk of developing mental health conditions. A higher number of children and young persons presented with urgent referrals and heightened symptoms during the pandemic compared with the pre-pandemic levels. In particular, there was a significant increase in children presenting with eating disorder problems, accompanied by an increased severity of symptoms. Furthermore, there was an observed rise in depression and anxiety among children and young people, along with an increase in the use of antidepressant medication.

Referrals to CAMHS increased during the pandemic, with increased severity of symptoms observed, particularly in children and young people with eating disorders and neurodevelopmental conditions. Future research should explore the enduring impact of the pandemic on referral rates and presentations to CAMHS. This exploration is essential to aid senior managers and policymakers in decision-making, enabling the implementation of appropriate measures to manage the pattern of demands on CAMHS and shape the future service delivery of CAMHS in the UK.