Oculogyric Crisis (OCG) is one of the few presentations within psychiatry considered an emergency due to the potential features which can make OCG life-threatening. OCG is poorly understood and can be difficult to recognise due to other features which may mask the classical presentation of a fixed upper gaze of the eyes with associated anxiety and hallucinations. This case study looks at how we have managed a patient within a low secure forensic service with this presentation.

Our male patient in their 30’s was admitted with a working diagnosis of treatment resistant schizophrenia. There were frequent episodes of this gentleman becoming acutely unwell with vivid hallucinations and aggression directed towards staff and other patients. Due to staffing concerns regarding autonomic function, the associated eye movements were missed and as such this was not recognised as OCG which is an acute dystonic reaction.

During these episodes, there were many times where our patient would appear in an immobile state, with an inability to speak or follow commands with marked feelings of reference and ideas of persecution. This would include refusals to take prescribed medication because of visual hallucinations of seeing his medication and food and drink being contaminated. Episodes of seclusion were due to aggression towards others he believed were after him. Frequent emergency department attendances were required due to autonomic and conscious level disturbance.

Our patient was admitted on a regular depot of zuclopenthixol which we gradually reduced to nothing following the recognition of OCG. We also supplemented this with procyclidine, which helped to reduce symptoms.

Following these changes, we initially noticed a marked improvement in our patient’s presentation as he was engaging well with the ward staff and other patients. There was no longer any requirement for frequent hospital visits and the absence of a movement disorder.

However, they appear to have escalated again following complete cessation of the depot. We need to understand if this is an exacerbation of OGC, which the literature does document when antipsychotic medication is withdrawn or an exacerbation of the schizophrenia due to reduction in antipsychotic medication, even though he remains on an oral atypical antipsychotic known to have minimal risk for side effects.

OCG is a rare but serious condition. However, if it is recognised early, an individualised approach based on the patient and clinical picture may improve long term outcomes whilst considering alternative diagnoses.

There has been a recent increase in incidents in Pine Ward at Park Royal mental health unit. Feedback from staff/patients is that they don't feel safe and there has been staff sickness due to physical aggression towards them. We proposed to do this QI project in order to improve the staff and patient safety on the ward.

The aim of this QI project was to improve safety for patients and staff on Pine Ward by 20% by end of December 2025, to reduce incidents of violence and aggression and strengthen communication and team work.

Key changes: Weekly community meeting; Improve observation of patient positive strengths; Messages in nursing station on using soft words; and Section 17 leave flow chart given to patients.

Data collection (November–December 2025)

• We reviewed patient and staff safety on ward from mid November to end of December.

• We collected data on the following questions:

– Patient staff conflict survey.

– Patient safety feedback form.

– Staff safety feedback form.

Patient safety improved by 25% and staff safety improved by 30%.

Incidents of Verbal aggression in day shift decreased from 4 to 2 per shift.

Incidents of Aggression towards objects in day shift decreased from 2 to 1.

Decrease PRN psychotropic use in day shift from 4 to 2.

Communication between patients and staff is key for safety. Community meeting is a great opportunity to explore patient ideas and can be used for education about section 17 leave.

Thinking about patient qualities and strength affect how we perceive patient as person and influence positive therapeutic relations.

Verbal aggression against staff is a key concerns and needs to be worked on. Record of incidents of aggression on datix to be reviewed in future audit.

• • To provide patient with a method to give honest and protected feedback around activities offered on the ward and also to allow the improvement of activities offered on Waterton Ward, Newton Lodge.

• • To provide staff with the opportunity to identify gaps in service provision around activities offered on Waterton Ward, Newton Lodge.

A survey was conducted in person with patients on Waterton ward using a printed survey questionnaire between May and June of 2025. An anonymous staff survey questionnaire was printed and given to members of staff on the ward to complete between May and June 2025

The data were analysed by the project lead. Both quantitative and qualitative data were collected. Data were grouped into themes to aid the analysis and presentation of the results

• • The survey highlighted a disparity in awareness of available activities on the ward. While some activities, such as the Horticulture Garden, Community Sessions, and Walking Group, have full awareness among patients, others, such as the Lego Group and Driving Skills Group, have very low awareness.

• • Enjoying the activities, staff persistence, more awareness, and an additional occupational therapist are key motivators for engagement.

• • Patients expressed interest in additional activities, including vocational skills like painting and decorating, music groups, more gym time, and more frequent walking groups.

• • The responses emphasize a wide range of life skills patients believe will prepare them for reintegration into the community. Cooking, budgeting, shopping, banking, and IT skills are frequently mentioned, reinforcing the importance of practical education and independence.

• • Patient satisfaction with current activities on the ward appears varied–while some patients feel satisfied, a portion remain indifferent or dissatisfied

From the staff survey, staffing shortages was consistently mentioned across different staff roles as a barrier to providing rehabilitation services on the ward. Staff satisfaction with the ward activities was mixed with 55% of respondents expressing dissatisfaction.

The findings from the patient survey underscore a need for better communication and promotion of existing activities, improved scheduling, and staff availability. This project highlighted the need for patient and staff participation in improving the interventions and activities offered on the ward.

Functional neurological disorder (FND) frequently co-occurs with psychiatric conditions, most commonly anxiety, depression, and trauma-related disorders. The coexistence of FND and psychotic illness remains less well characterised, particularly in general hospital settings. The emergence of fixed persecutory beliefs in individuals with FND presents significant diagnostic, ethical, and management challenges, especially when such beliefs interfere with essential medical care. This case illustrates the complexity of assessing risk, decision-making capacity, and the role of compulsory psychiatric treatment when physical health deterioration arises from treatment refusal rather than suicidality

We describe a middle-aged man admitted to a general hospital with acute onset functional neurological symptoms, including rapidly evolving limb weakness, sensory disturbance, and functional paralysis, following significant occupational stress. During admission, he developed persistent persecutory delusions characterised by profound mistrust of healthcare professionals, beliefs of deliberate harm and surveillance, and accusations of abuse. These beliefs led to sustained refusal of nutrition, investigations, and treatment, resulting in significant weight loss, electrolyte disturbances, and functional decline. Extensive medical and neurological investigations supported a functional diagnosis, with no evidence of delirium or organic pathology to account for the psychiatric presentation. Multidisciplinary management was complicated by impaired engagement and contested use of mental health legislation.

This case highlights diagnostic uncertainty at the interface between FND and psychotic disorder, emphasising the importance of distinguishing illness-related beliefs from fixed delusions associated with behavioural consequences. Risk arose predominantly from malnutrition, immobility, and impaired decision-making rather than deliberate self-harm. While compulsory psychiatric treatment mitigated immediate physical health risks and resulted in partial behavioural stabilisation, it also appeared to intensify feelings of injustice and mistrust. Prolonged hospitalisation and adversarial dynamics may have reinforced persecutory beliefs, underscoring the need for early integrated neuropsychiatric formulation, consistent communication, and relational safety.

This case demonstrates that FND may coexist with psychotic illness, with significant implications for risk assessment, capacity evaluation, and treatment planning. Clinicians should remain alert to risks arising from treatment refusal and physical deterioration in the absence of suicidality. Early multidisciplinary collaboration and proportionate use of mental health legislation are essential to minimise iatrogenic harm and support recovery in medically complex patients.

This study aims to explore the prevalence and nature of moral injury amongst staff working with patients with intellectual disabilities in Long-Term Segregation (LTS) as well as identifying contributing factors as well as perceived support and coping strategies.

A mixed methods design was utilised in a learning disability assessment and treatment unit (ATU) setting. This involved the collection of qualitative and quantitative data utilising anonymous surveys. Quantitative data being collected using a modified moral injury rating scale to explore degree of moral injury and wellbeing. Qualitative data was collected through exploration of staff experiences as well as any ethical dilemmas and emotional responses to LTS at work. For the quantitative data we employed the use of correlational analysis. For the quantitative data, thematic analysis was utilised.

The results do indicate that there may be moral injury that is experienced by staff involved in the care of intellectual disability patients in LTS. There appear to be certain factors that do contribute to this including prolonged use of LTS, perceived lack of flexibility in the system as well as limited opportunities for reflective practice.

This piece of work clearly demonstrates the relevance of moral injury in staff working with individuals in LTS. It furthermore highlights the occupational risk for those involved as well as the importance of ensuring that this is addressed to note only prevent burnout, sickness absence and retention of staff but to chiefly ensure that standard of patient care are maintained. This work further highlights the need for more research into this area in order to improve the understanding of how moral injury develops and evolves over time.

Psychological factors play a critical role in rehabilitation after sports injury and may delay return to sport (RTS) despite physical recovery. However, the most prevalent psychological sequelae and the comparative effectiveness of rehabilitation strategies are not consistently integrated into clinical pathways. This study aims to identify common psychological outcomes following sports trauma and determine which evidence-based psychological interventions are most strongly associated with improved rehabilitation and RTS outcomes. We hypothesised that (1) functional psychological symptoms would be more prevalent than formal psychiatric diagnoses and (2) cognitive-behavioural approaches would show the strongest association with positive recovery outcomes.

A structured review of peer-reviewed literature published between 2014 and 2025 was conducted. PubMed and Google Scholar were searched using predefined keywords related to sports injury, psychological outcomes, and rehabilitation interventions. Studies were included if they assessed psychological symptoms, return-to-sport outcomes, or intervention effectiveness in injured athletes. Findings were synthesised narratively, with intervention effects grouped by therapeutic modality.

Functional psychological sequelae were common following sports injury, particularly fear of reinjury (50%), reduced confidence (45%), and sleep disturbance or hyperarousal (40%). These were more frequent than formally diagnosed psychiatric disorders such as PTSD (25%) or major depressive disorder (35%). Anxiety symptoms were the strongest psychological predictor of delayed RTS, while reduced confidence was consistently associated with poorer rehabilitation outcomes. Depressive symptoms were most evident during prolonged inactivity and career-ending injuries, where loss of athletic identity (25%) was prominent.

Among psychological interventions, cognitive behavioural therapy (CBT) demonstrated the highest reported effectiveness in reducing psychological symptoms and supporting RTS (28.6%, 95% CI [20.6–36.6]). Graded exposure showed the next greatest effect (23.2%, 95% CI [13.2–33.2]), followed by psychological skills training (17.9%, 95% CI [8.9–26.9]). Stress-management interventions improved adherence to physical rehabilitation, whereas arousal imagery techniques were linked to increased pre-RTS anxiety in some athletes.

Functional psychological symptoms are more prevalent than formal psychiatric diagnoses after sports injury, supporting our first hypothesis, while cognitive-behavioural interventions show the strongest association with improved psychological outcomes and RTS readiness, supporting our second. Routine psychological screening and targeted CBT-based support may enhance rehabilitation. A biopsychosocial approach incorporating ongoing psychological assessment, pre-injury profiling tools (e.g. Sport Mental Health Assessment Tool-1; Athletic Coping Skills Inventory-28) and a 4Ps framework supports tailored, preventative rehabilitation and promotes resilient RTS. Screening and data extraction by a single reviewer increases risk of selection bias.

The Medicines Reconciliation 'Med Rec' is a important, structured process which takes place on admission. It involves comparing the patient’s current medication list from various sources such as the primary care record, previous discharge letters and the patient themselves. This audit aims to highlight the invaluable support of the pharmacy department in ensuring safe prescribing for psychiatric inpatients - a population with a known potential for significant comorbid physical health conditions and high rates of polypharmacy.

NICE guidelines state that “people who are inpatients in an acute setting (including mental health inpatient wards) should have a reconciled list of their medicines within 24 hours of admission.” Sussex Partnership NHS Foundation Trust local targets specify that 60% of Level 2 (pharmacy-led) medicines reconciliations should be completed within 24 hours of admission, or 90% by the next working day by 5pm.

A total of 100 records were reviewed for patients admitted to Bodiam Ward, an adult male inpatient psychiatric ward in East Sussex, between 2024 and 2025. Of the records reviewed, 73 were retrospective admissions and 27 were prospective records.

In this audit, 66% of medicine reconciliations were completed within 24 hours, and 87% were completed by the next working day. The majority (84%) were completed by Pharmacy Technicians, with the remaining 16% completed by Pharmacists. Of the completed medicine reconciliations, 54% identified at least one omitted drug. The most omitted drug classes were analgesics (13.7%), benzodiazepines (13.1%), and regular oral antipsychotics (10.2%). Other notable omissions included physical health medications, such as cardiovascular drugs (including antihypertensives and statins), and medications related to alcohol dependence (such as thiamine and chlordiazepoxide). In addition, 7% identified ‘other errors’, including missing or incorrect doses, incorrect formulations (immediate-release versus modified-release), and in one instance, an entirely different medication being erroneously prescribed.

This audit demonstrates that medicine reconciliation is more than a 'tick-box exercise' and plays a critical role in identifying prescribing errors on admission. The findings emphasise the significant timely contribution of the pharmacy team to patient safety in adultin patient psychiatric settings. Based on these findings, future education could focus on reminding resident doctors to thoroughly review previous discharge summaries and primary care records when clerking a patient, and to liaise with the pharmacy team for a better standard of care.

Extended Discharge Documents (EDD) are central to safe transitions of care in forensic psychiatry, providing GPs and community teams with information on treatment, risk management, legal status, and followup plans. National standards recommend issuing the EDD within 7–14 days of discharge. A baseline audit in March–August 2025 at the forensic unit in Royal Cornhill Hospital showed low EDD completion and variation between wards. Several service changes were introduced, and a reaudit was conducted. The aim was to assess whether these changes improved EDD completion and timeliness for forensic discharges.

This was a retrospective clinical audit of all forensic inpatient discharges across two periods: the baseline cycle (March–August 2025) and the reaudit cycle (September 2025–January 2026). Patients transferred to other hospitals were excluded, as an EDD was not required for those cases. Data were collected from electronic records, including EDD eligibility, completion status, dispatch dates, and ward of discharge. The main outcome measures were the proportion of eligible discharges with a completed EDD, and the proportion completed within 14 days.

The intervention implemented between cycles included assigning each EDD to a named doctor at the point of discharge planning and reinforcing standards during induction for rotating trainees. A shared forensic handover template (digital and paper versions) was introduced to help track outstanding EDDs.

There were 42 discharge episodes in the baseline period, of which 41 required an EDD. Only 8 were completed (19.5%), and 1 of these (12.5%) was delayed beyond 14 days.

In the re-audit period, there were 29 discharge episodes, of which 27 required an EDD. Of these, 22 were completed (81.5%). Completion was consistently above 75% across all months, reaching 100% in January. The improvement was observed across most wards.

Timeliness remained a key concern. Sixteen of the 22 completed EDDs (72.7%) were issued more than 14 days after discharge, with higher delay rates noted in specific.

Introducing system-level changes like assigning named doctors at discharge, strengthening induction, and introducing a shared handover template were associated with a marked improvement in overall EDD completion, rising from 19.5% to 81.5%. However, delays in issuing the EDD remain frequent and represent the key area for further improvement. Strengthening early drafting, adding timeliness checkpoints, and embedding automated reminders may help close this gap in the next audit cycle.

To assess documentation of driving status and fitness to drive among older adult psychiatric inpatients, implement interventions, and evaluate subsequent improvement in both documentation and compliance with Driver and Vehicle Licensing Agency (DVLA) guidance.

Older adult psychiatric inpatients may be unfit to drive, yet documentation of driving status is often poor, posing patient safety and medico-legal risks. A retrospective review of electronic medical records was conducted for patients discharged from a single older adult psychiatric ward over two three-month audit cycles. Data collected included documentation of driving status, presence of psychiatric diagnoses relevant to DVLA guidance, and, where relevant, whether the patients had been advised about fitness to drive. Following the initial audit, interventions were implemented, including clinician education and addition of prompts within the ward round template. The audit was then repeated as a retrospective review of records for a separate three-month period to assess the impact of these interventions.

In the first audit cycle, 20 patients were discharged. Driving status was documented in only 5 patients (25%), despite 18 patients (90%) having diagnoses relevant to DVLA guidance. Among those with documented driving status, only 3 patients had recorded discussion of DVLA advice, allowing adherence to be assessed. For the majority of patients, adherence could not be reliably assessed due to missing documentation, highlighting a significant gap in clinical recording and medico-legal risk.

In the re-audit cycle, 11 patients were discharged. Driving status was documented in 10 patients (90.9%), and 9 patients (81.8%) had diagnoses relevant to guidance. 7 patients were documented as not driving. Both patients documented as driving and for whom guidance applied, had evidence that DVLA advice had been discussed. Adherence could not be assessed for one patient whose driving status was not recorded. These findings indicate improved documentation and consistent discussion of driving advice following targeted interventions.

This audit identified substantial deficiencies in baseline documentation of driving status and discussion of DVLA guidance, posing safety and medico-legal risks. Targeted interventions improved recording of driving status and consistent documentation of advice for those driving, demonstrating enhanced staff awareness and compliance with guidance. Some gaps remain, emphasizing the need for ongoing routine assessment, documentation, and staff education to ensure sustained patient safety and adherence to national guidance.

Depression and anxiety in geriatric inpatients are linked to functional decline and prolonged hospital stays. While antidepressants are the standard of care, polypharmacy and poor tolerability often limit their effectiveness. This study examined whether a six-week structured mind-body programme achieved greater symptom reduction than treatment as usual (TAU) in an older adult psychiatric inpatient setting.

This longitudinal, parallel, controlled study involved 26 in patients (aged 60 years or older) with a diagnosis of depression and comorbid anxiety. All participants were receiving standard antidepressant pharmacotherapy. Thirteen patients elected to participate in a structured mind-body programme, while 13 continued with TAU alone. The intervention consisted of weekly supervised sessions (3–5 sessions total based on clinical availability), integrating physical movement with mental engagement through yoga, tai chi, strength training, walking, and gardening. Symptoms were assessed via the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) at baseline and six weeks.

Data analysis involved paired-sample t-tests and Wilcoxon signed-rank tests for within-group changes, with between-group comparisons conducted using independent-sample t-tests or Mann–Whitney U tests as appropriate for the data distribution.

Baseline scores were statistically comparable between groups (p >0.05). Both cohorts demonstrated significant within-group reductions in symptoms over the six-week period (p <0.001). In the activity group, mean PHQ-9 scores decreased from 17.15 to 8.46(reduction 8.69, SD 3.54). In the TAU group, scores fell from 14.69 to 10.38 (reduction 4.31, SD 2.10).

Between-group analysis demonstrated a significantly greater reduction in depressive symptoms for the mind-body group (mean difference 4.38; 95% CI 1.99 to 6.77; p=0.001), with a large effect size (Hedges’ g=1.46). While anxiety symptoms improved in both groups (mean GAD-7 reduction 3.62 vs. 3.23), no significant between-group difference was observed (p=0.875; Hedges’ g=0.16).

Participation in structured mind-body activities was associated with greater reductions in depressive symptoms among older adult psychiatric inpatients compared with treatment as usual alone. While anxiety symptoms improved in both groups, no additional benefit was observed for anxiety reduction. Although self-selection should be considered, these findings suggest mind-body programmes may represent a feasible and potentially effective non-pharmacological adjunct for late-life depression in inpatient psychiatric settings.

The APOE-ε4 allele is the most significant genetic risk factor for developing late-onset Alzheimer’s disease (AD), with an estimated lifetime risk of 30% in ε4 heterozygotes. Previous guidelines have recommended against APOE genotyping based on its limited clinical utility in routine practice. This has changed with the advent of amyloid-targeting immunotherapies, multimodal interventions for reducing AD risk and commercially available APOE genotyping services. Given this changing landscape, there is a need to formulate APOE-ε4 genetic counselling tailored to the UK context. We set out to study the attitudes of UK adults to genetic testing and counselling for the APOE-ε4 gene.

We carried out a digital survey on the online POrtal for Patient and Public Engagement in Research (POPPED, https://popped.org.uk). This was advertised via research register mailing lists and is still ongoing. The survey queried respondent demographics, motivations and concerns regarding APOE-ε4 testing, content and format of genetic counselling, and willingness to undertake preventative interventions. Responses were collected with a combination of 5-point Likert scales, ranking and multiple choice questions. Ethical approval was obtained from a university ethics committee and all respondents consented to have their responses stored anonymously on a secure server.

794 responses were received from 7 January – 4 February 2026. Most respondents were aged 65–74 years (38.7%) or 75–84 years (23%), 66.9% were female, and 61.8% had a family member with dementia. 82.7% of respondents were ‘likely’ or ‘some what likely’ to get tested for the APOE-ε4 gene. The main motivations were to contribute to research (85.4%), to adjust life plans accordingly (71.9%) or to understand their dementia risk (70.9%). The main concerns were that no cure for dementia exists (50.4%), inaccurate risk estimation (50.4%), and emotional upset (44.1%). The preferred format of genetic counselling was a face-to-face appointment (86.1% rated this as ‘very appropriate’), and 73.4% of respondents would be likely to accept subsequent preventative lifestyle interventions.

A high proportion of our respondents would be likely to seek out APOE-ε4 testing and counselling, and to subsequently accept lifestyle interventions and be involved in research. While our sample may not be completely representative of the general population, these initial results suggest that there is a need to develop guidelines for face-to-face genetic counselling for UK adults who choose to undergo APOE-ε4 testing.

The clinical presentation of autism has been summarised in the 5th edition of the American Psychological Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM–5). Assessment tools such as the Autism Diagnostic Observation Schedule have been developed to provide clinicians with the practical means to diagnose autism according to DSM–5. These medicalised assessments are deficit-based, focussing on what the autistic person cannot do compared to a non-autistic person. This juxtaposition can adversely affect the mental health of the autistic person and those who support them. The assessment can also place emotional burden upon the clinicians conducting them. The wider implication of the negative framing used in traditional tools is to perpetuate the stigma surrounding autism. Neurodiversity-affirmative identification is a new approach for clinicians. This methodology reframes the tragedy narrative of Autism to offer clinicians the means to work in collaboration with their clients to explore their autistic identity and not only identify their specific support needs but also their strengths. An understanding and acceptance of one’s sense of self world facilitates nurturing good mental health and improved life trajectories. This novel study examined the effect of the neurodiversity-affirmative way of working upon clinicians and how they make sense of the experience.

The experiential qualitative methodology of interpretative phenomenological approach was used. Phenomenology is relevant as it is the philosophical study of what it is like to be human in our lived experiences and what matters to the individual. Secondly, and more specifically, interpretative phenomenology is appropriate as it is more than merely gathering a description, but an analysis of the participants’ attempts to interpret their personal and subjective lived experiences. Semi-structured, qualitative interviews were conducted with clinicians who are practicing neurodiversity-affirmatively between September and October 2025. The sample size of five clinicians complied with the usual approach for such qualitative projects.

Five Group Experiential Themes were identified: pressure to accept traditional framing of Autism, haunted by the past, wrong assumptions, more than a job, it’s a vocation and validating Autistic experience.

The impact of conducting medical model assessments has been long-lasting and traumatic upon the clinicians. The results charted their intellectual transitioning from passive acceptance of the traditional assessment status quo to actively questioning it and finally being resolute that it needs to be revised and reframed and that the neurodiversity-affirmative approach needs to be widely adopted to better validate the autistic people they serve.

This study explores the historical roots of phobic disorders through an analysis of Abu Zayd al-Balkhi’s ninth-century written venture into mental health and wellbeing, “Sustenance of the Soul”. It compares al-Balkhi’s descriptions, differentiation, and management of phobia with the current ICD-11 framework. Previous comparative research has demonstrated consistencies in his writings when compared to contemporary framework. As such, we hypothesised that al-Balkhi’s account would show substantial conceptual overlap with modern nosology while offering a more integrated phenomenological perspective that remains relevant to current psychiatric practice.

A multi-stage content analysis was undertaken using the manifest analysis method. First, relevant thematic premises were identified through examination of al Bakhli’s text. Second, focussing on aetiology, symptomatology, and therapeutic approaches, psychological terminology and their implied meanings were extracted. Finally, these findings were compared directly with the ICD-11 phobia-related classification and associated diagnostic constructs. The analytical process and mappings were independently cross-checked by a secondary researcher.

Al-Balkhi described phobia as an excessive, maladaptive fear response–referred in his work as “terror”–that exceeds the individual’s control and impairs functioning. He distinguished normative fear states from the pathological using description of threat appraisal and temporal proximity, paralleling modern distinctions between general anxiety and phobia. He also described symptoms of physiological arousal and cognitive interferences during fear states, including restricted clarity of thought. Management strategies included education regarding feared stimuli and desensitisation-like techniques, anticipating the core principles of contemporary psychological treatments.

Al-Balkhi’s account of phobia correlates to a significant degree with ICD-11 categorisations of anxiety and phobic disorders. Although some of the ideology lacks modern political correctness which reflects its era, the underlying clinical observations are notably consistent with modern phenomenology and psychologically informed care. These findings support the value of historical psychiatric scholarship in refining contemporary understanding and suggests that pre-modern consolidative models may still enrich current diagnostic and therapeutic approaches.

Hypoxia-ischaemia (HI) is one of the leading causes of neurological injury and death among newborns. In developed countries, its incidence is estimated in approximately 1/1000 neonates, while globally it can represent up to 23% of children’s mortality rate. In those who survive, long-term neuropsychological impairments may emerge as a consequence of HI, causing a significant impact in quality of life.

Using a preclinical model of neonatal HI, the aim of this study was to investigate whether a progression in HI severity (from moderate to severe) may be associated with worsened functional and psycho-behavioural performance.

Seven-day-old (P7) Sprague Dawley neonatal rats were randomly assigned to: i) HI-moderate (left common carotid artery ligation + 120 min of 8%O2/92%N2 hypoxia; n=13); ii) HI-severe (same surgical procedure and 150min of hypoxia; n=18); Sham (without HI, n=36). At P42 (early young equivalent) and P90 (adult), animals underwent three behavioural tests: the novel object recognition (NOR) test to analyse cognitive deficits in recognition memory, the cylinder test to measure sensorimotor asymmetries and deficits, and the T-maze test to evaluate possible cognitive disabilities.

When evaluating cognitive deficits in recognition memory with NOR test, both moderate (p<0.01) and severe (p<0.05) injured animals showed worse performance than sham at P42. At P90, this was also observed in moderate-injured animals (p<0.001). In the cylinder test, HI-moderate (p<0.01) and HI-severe (p<0.001) groups showed significant sensorimotor asymmetries when compared to sham at P42 and P90, which were independent of HI severity. Similarly, all HI-animals revealed a reduction in alternation in the T-maze test, thus suggesting cognitive disabilities in both moderate (p<0.05) and severe (p<0.0001)models vs sham. Again, no differences were found when comparing severities.

Psycho-behavioural assessments showed the development of cognitive deficits and neuromotor impairments in the long term after neonatal HI. Further studies may confirm if the absence of differences between moderate and severe HI models may relate to a critical threshold reached in the former and/or to possible compensatory mechanisms in the latter.

Innovative teaching methods and gamification are increasingly sought in medical education to promote active learning and engagement amongst students. This interactive andnovel approach has gained popularity within medical education and allows students to consolidate their clinical knowledge and apply their skills to unfamiliar scenarios.Students are encouraged to think in a holistic manner, and this teaching intervention facilitates experiential learning.

The aim of this study was to design and deliver a psychiatry-themed escape room for Fourth year medical students at Bushey Fields Hospital. This is a novel approach to undergraduate psychiatric teaching, which focused on consolidating clinical knowledge regarding basic principles of psychiatry and encouraging collaborative problem-solving.

A 45–60minute escape room was developed, centred around a fictional patient who was admitted to hospital after experiencing psychosis. Students were given a backpack with a padlock that contained clues and five tasks to solve. Working in groups of 3–5, students solved tasks centred around history taking, mental state examinations, assessing risk, physical health monitoring and contemplating management approaches.

A mixed method approach was undertaken, and pre- and post-session questionnaires (Likert scaled) assessed student-rated confidence regarding management of psychiatric situations, assessing risk, formulating differentials and management plans were distributed. Further qualitative data was gathered from students regarding their learning and experiences regarding the psychiatry-themed escape room.

Eighteen students participated over four escape room sessions. Post-session confidence scores increased across all measured domains, especially when undertaking risk assessments and knowledge of the Mental Health Act.

Qualitative data was thematically analysed and students reported that this was a useful opportunity to apply their skills and knowledge, using a simulated case.

The results of this study suggest that this approach helped students to engage with psychiatric teaching in a novel and innovative manner. Students reported that they felt that consolidating their psychiatric knowledge using a simulated case was a safe environment to learn further.

Students reported a greater appreciation regarding the use of legal frameworks, history taking skills and undertaking mental state examinations. These are key considerations and skills used within psychiatry, which will lead to resident doctors being well equipped with key psychiatric principles, improvement in future practice and patient care.

This psychiatry-themed escape room will be offered at other sites within the Trust, and future work includes possible expansion to resident doctors early within their training based locally.

People with severe mental health problems are affected by disparities in physical health outcomes compared to the general population. The risk of physical deterioration increases as patients grow older and comorbidities accumulate. This risk is particularly relevant in the population affected by functional and cognitive psychiatric disorders, where patients’ ability to detect and report symptoms can be impaired. This places a key responsibility on staff in older adult mental health services, who are well positioned to identify deterioration through routine physical health monitoring. However, confidence gaps exist amongst multidisciplinary team members in the recognition and escalation of physical health deterioration. To address this, the physical health teaching programme was implemented.

Hypothesis: The teaching programme will result in an improvement in the perceived confidence of staff in identifying physical health deterioration and escalating concerns.

Weekly teaching sessions were conducted in an older adult mental health service over a period of three months. All members of the multidisciplinary team across both inpatient and community settings were invited to participate. Teaching was delivered using posters and interactive worksheets, covering topics such as vital signs, fluid intake, bowel output monitoring and delirium. Pre- and post-teaching questionnaires were designed to evaluate confidence levels using a Likert scale and knowledge was assessed via multiple-choice questions.

Results were analysed from 17 participants who completed both pre- and post-teaching questionnaires. The first two teaching sessions focused on vital signs and fluid intake. Preliminary findings demonstrated an overall improvement in staff confidence. However, pre-teaching knowledge scores were high for these topics and minimal improvement was seen on repeating the multiple-choice questions. These findings demonstrate the feasibility of a targeted physical health teaching programme.

A physical health teaching programme can improve staff confidence in identifying and escalating physical health deterioration in an older adult mental health service.

The Balint group was established in the 1950s as an avenue for doctors to bring forththeir experiences and feelings relating to patient interactions, in a humanistic rather than clinical way. Commonplace in Psychiatry, the use of Balint groups is spreading. Building on a previous pilot, we ran a Medical Student Balint Group weekly in a confidential, consistent space. We aimed to assess their knowledge of Balint, empathy, and communication skills and style, at the start and end of the group. This was alongside a tool for assessment of Burnout levels at the start and end of the group.

A weekly Balint group cohort of 10 third year medical students was facilitated by a Core Trainee and supervised by a Consultant Medical Psychotherapist. The students were given a set of questions about the psychological factors pertaining to doctor-patient interactions, including 2 questions about their prior knowledge of these groups, and the same questionnaire was given at the end, but with 2 open-ended questions about their reflections of the process. A validated burnout self-test was also given at the start and end.

Weekly attendance varied slightly. All participants returned both initial questionnaires, with 8 returning both ending questionnaires. Burnout scores showed significant reduction, and students generally showed eagerness to attend Balint groups in future. On starting, half the students felt that the application of a Balint group was ‘interesting’ but afterwards most felt an expanded perspective on the doctor–patient relationship and able relate to patients better. Self-awareness and confidence with communication also improved. Qualitative results supported above quantitative results.

Balint groups for medical students now have an increased evidence base as part of the undergraduate medical curriculum. They enhance their ability to see their patients’ perspectives, improving empathy, and markedly reducing burnout. They also enhance self-awareness and communication in medical students.

People with severe mental illness have a life expectancy that is 10 to 20 years shorter than the general population. Cardiovascular disease plays a major role in this gap. Additionally, forensic inpatient population often experiences prolonged admissions and has limited access to community physical health services. QRISK3 is a tool that estimates an individual's 10-year risk of having a heart attack or stroke. This project aimed to assessQRISK3 scores in forensic low and medium-secure male wards and offer atorvastatin for primary prevention when appropriate.

A snapshot review was conducted in November 2025 among 59 inpatients in Brockfield House low and medium secure male wards. 5 patients younger than 25 years old were excluded as QRISK tool is only valid for patients aged 25–84 years. QRISK3 scores were calculated for all eligible individuals using Mobius (an electronic record system) and patient interviews. Patients with a QRISK3 score of 10% or higher were informed of their increased cardiovascular risk and offered atorvastatin based on primary prevention guidelines (https://cks.nice.org.uk/topics/cvd-risk-assessment-management).The collected data was saved in a password-protected Excelspreadsheet.

A total of 54 patients were included in the analysis. The mean age was 41.98 years (range 25–69).14% of patients were current smokers (n=8), 50% were ex-smokers (n=27), 31% had diabetes mellitus (n=17), and 11% were prescribed antihypertensive medication (n=6). The mean BMI was 32.33 kg/m², 91% of patients had a BMI ≥25 kg/m² (n=49), indicating overweight or obesity. 16 patients had a QRISK3 score ≥10%. Of these, 11 patients were already prescribed a statin. The remaining 5 patients were offered atorvastatin for primary prevention; 4 agreed to commence treatment following consultation, while one declined. QRISK3 scores were documented in Care Programme Approach (CPA) reports for all patients in whom they were calculated. On average, it took 12 minutes and 36 seconds to gather information and calculate the QRISK3 score.

This QIP demonstrates that cardiovascular risk assessment using QRISK3 in forensic psychiatric inpatient settings is practical, time-efficient, and clinically valuable.Integrating QRISK3 scoring into routine CPA documentation may improve identification of patients at increased cardiovascular risk and increase appropriate statin prescribing for primary prevention in line with NICE guidelines.

Under the Mental Health Act (MHA) 1983, patients detained under Section 3 must have their capacity to consent to treatment assessed on admission and reassessed at the three-month point. Failure to complete these assessments risks breaching patient rights, including those protected under the Human Rights Act, and undermines lawful and person-centred clinical practice.

Aims were (1) To determine compliance with documentation of capacity assessment at admission and at the three-month point for Section 3 inpatients; (2) to identify practical improvements to enhance compliance.

A retrospective audit was conducted on 13 inpatients detained under Section 3 on Vales Ward, Discovery House (LPFT). Admission dates and capacity-assessment records were extracted from the RiO electronic patient record for the period December2019–November 2022. The primary outcomes were the presence or absence of documented capacity assessment at admission and at the three-month review.

Capacity assessment at admission was documented in 46.2%(6/13) and not documented in 53.8%(7/13).

Three-month reassessment was documented in 7.7%(1/13) and not documented in 92.3%(12/13).

Compliance with MHA Section 3 statutory requirements for capacity assessment was poor, particularly at the three-month review. We recommend: (1) implementing automated RiO reminders to clinical and MHA administration teams at −1 month, −1 week, and −1 day before the three-month point; (2) delivering targeted staff education on the legal and clinical significance of capacity reassessment; and (3) providing patient information leaflets regarding consent and MHA rights. A reauditis planned to evaluate the impact of these interventions.