Background/Rationale

The military coup in Myanmar in February 2021 caused widespread disruption to medical education. Many psychiatry trainees and trainers joined the Civil Disobedience Movement (CDM), resulting in the suspension of formal postgraduate psychiatry training nationwide and posing a serious threat to the future psychiatric workforce. In response, Myanmar CDM psychiatrists, supported by the psychiatrist diaspora, developed an alternative pathway to sustain postgraduate psychiatry training in a conflict setting.

Aims/Objectives

To restore postgraduate psychiatry training while maintaining academic standards, clinical competency, and professional integrity through an innovative, digitally enabled, and internationally supported training model.

Biweekly online Continuing Medical Education (CME) sessions commenced in March 2021. By September 2023, CDM psychiatrists collaborated with retired academics and diaspora psychiatrists from the United Kingdom, United States, and Australia to develop a formal curriculum. The programme was finalised in December 2023 and approved by the Federal Health Professional Council and Interim University Councils. An online Master of Medical Science (Psychiatry) programme was launched on 15 January 2024. The programme focused on clinical knowledge development through weekly Zoom lectures and Moodle-based learning, and clinical skills development through supervised practice, CME case discussions, and workplace-based assessments. Research training was deferred due to safety concerns.

Trainee engagement was monitored through assignment completion, participation in synchronous teaching, and completion of supervised clinical attachments. Ten trainees enrolled. Assignment completion reached 100%, participation in teaching was at least 75%, and clinical attachment completion exceeded 90%. Between April and May 2025, seven trainees completed final assessments, including multiple-choice examinations and virtual clinical examinations with live assessors and simulated patients. All seven trainees passed and were certified as qualified psychiatrists. A 360-degree evaluation demonstrated high satisfaction among trainees, supervisors, and assessors.

Despite severe disruption, Myanmar’s CDM psychiatrists successfully revitalised postgraduate psychiatry training using a decentralised, digitally enabled, and internationally supported model. This experience demonstrates that high-quality postgraduate psychiatry education can be sustained in fragile and conflict-affected settings and offers a scalable framework for global mental health workforce development.

Acknowledgements: We acknowledge all Civil Disobedience Movement (CDM) mental health professionals in Myanmar and the Myanmar psychiatrist diaspora worldwide for their collective leadership, academic contribution, and unwavering commitment to sustaining postgraduate psychiatry training under conflict conditions.

Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, is characterised by the presence of two or more distinct personality states, often arising as a coping mechanism for severe and prolonged trauma. Based on the structural dissociation theory, Phase-Oriented Therapy is currently the treatment model recommended by the International Society for the Study of Trauma and Dissociation. It comprises three phases: Phase 1 (Stabilisation), Phase 2 (Trauma Processing) and Phase 3 (Integration and Rehabilitation). Despite its clinical significance, the evidence base remains limited, with phase-specific strategies underexplored. This review examines how dissociative parts are managed throughout the three phases of Phase-Oriented Therapy in individuals with DID, emphasising therapeutic goals, key techniques used, clinical challenges and treatment outcomes.

A narrative review was conducted using the SPIDER framework. Literature was sourced from databases such as PubMed, Wiley, EBSCO and Google Scholar using terms related to DID and Phase-Oriented Therapy. Included studies consisted of case reports, observational studies, systematic reviews and clinical guidelines.

Phase 1, the stabilisation phase, was consistently identified as foundational, with therapeutic aims including safety, emotion regulation and psychoeducation. Reported outcomes included improved affect regulation and self-control. However, many patients struggled to progress beyond this phase due to a significant level of symptoms or early dropout.

Phase 2 focused on trauma processing through exposure-based and cognitive restructuring techniques, including inner communication and grief processing. Outcomes included greater affect tolerance, reduced self-blame and improved internal communication between parts. However, several studies noted delayed symptom improvement, with treatment effects often emerging only during follow-up.

Phase 3 emphasised self-integration, functional adaptation and acceptance of functional multiplicity, defined as cooperative coexistence of parts without complete fusion. Patients showed improvements in daily functioning and a renewed sense of purpose, though some residual dissociative symptoms remained at the end of treatment.

Across studies, common challenges included high attrition rates, underdiagnosis and limited access to therapists trained in dissociation-specific approaches. Variations in treatment length,intensity and manualisation also contributed to inconsistent outcomes.

Phase-Oriented Therapy offers a structured, trauma-informed and clinically meaningful approach to managing DID. While current evidence highlights its clinical value, significant gaps remain, particularly around phase transition criteria, long-term outcomes and treatment standardisation. Future studies should prioritise controlled trials, longitudinal follow-up and more precise definitions of phase progression to strengthen the empirical foundation for this treatment model.

22q11.2 deletion syndrome (22q11.2DS), the most common chromosomal microdeletion disorder, is associated with a heterogeneous presentation including congenital anomalies and later-onset conditions, such as cognitive delay, behavioural changes, psychiatric disorders, autoimmune diseases, and palatal, gastrointestinal, and renal abnormalities (1). Assessing mental health changes is often complex due to overlapping physical and psychiatric symptoms, contributing to diagnostic uncertainty. Distinguishing psychiatric relapse from challenging behaviour or physical health complications, such as pain or infection, requires careful assessment and highlights the importance of a multidisciplinary approach.

Mr X is a 30-year-old male with mild intellectual disability secondary to 22q11.2DS and paranoid schizophrenia. He presented with several weeks of behavioural changes, including social withdrawal, fixed gaze episodes, “barking” vocalisations, erratic sleep, incongruent smiling, and attempts to leave his supported living accommodation. This was despite no apparent triggers and full adherence to risperidone. Investigations identified subclinical hypothyroidism, mild anaemia, suspected inflammatory bowel disease lost to follow-up, and recurrent otological pathology. Repeat neuroimaging was unremarkable. He had a history of positive response to temporary uptitration of risperidone during periods of relapse. There were clinical signs in keeping with psychotic relapse, however on this occasion uptitration of risperidone was not beneficial and resulted in upper extremity rigidity and increased drooling. Speech & Language Therapy input helped to clarify Mr X’s communication needs. Over time, episodes became shorter, less frequent & trigger-specific.Sleep improved with introduction of modified-release melatonin. Mr X has had a tympanoplasty, results are pending from an electroencephalogram, he is awaiting gastroenterology review and a sleep clinic assessment.

This case demonstrates the diagnostic complexity of psychiatric presentations in adults with 22q11.2DS, particularly in the context of intellectual disability and multimorbidity. Individuals with 22q11.2DS carry one of the highest known molecular risks for schizophrenia (prevalence 23.53–41%) (2), but behavioural, psychiatric and physical health factors increase the risk of diagnostic overshadowing. Adults with intellectual disability experience significant healthcare inequalities, with higher rates of avoidable mortality (3,4,5). For Mr X, proactive advocacy and coordinated multidisciplinary assessment were crucial in identifying organic contributors, supporting functional recovery, and avoiding inappropriate pharmacotherapy.

Behavioural and psychiatric changes in adults with 22q11.2DS can reflect complex interactions between bio-psycho-social factors. Advocacy, multidisciplinary input and judicious psychotropic prescribing are essential for holistic management. Mr X’s case reinforces the importance of person-centred, integrated care in navigating diagnostic uncertainty and optimising outcomes for individuals with intellectual disability and 22q11.2DS.

Large language models (LLMs) are increasingly evaluated and deployed in healthcare, yet unrecognised bias risks reinforcing inequities. This risk is particularly salient in psychiatry, where biased outputs could influence risk formulation, diagnostic reasoning, triage, and therapeutic communication. We examined whether and how bias is evaluated in studies of medical applications of LLMs, and summarised methodologies, reporting practices,and limitations of current bias detection and mitigation approaches to support safe and trustworthy implementation.

We searched databases (EMBASE, MEDLINE, PsycINFO, PubMed, ACL Anthology, ACM Digital Library, arXiv, medRxiv, and bioRxiv; 2017–June 2025), following PRISMA guidance. After de-duplication, >1,800 records were retrieved for title/abstract screening. We assessed 3,664 full-text articles against pre-specified eligibility criteria. Studies were included if they evaluated a medical application of an LLM and reported any explicit bias assessment. Studies that otherwise met eligibility for medical LLM evaluation but did not assess bias were recorded separately to quantify the evidence gap. Screening and data extraction were conducted by multiple reviewers with disagreements resolved by discussion. We extracted specialty (including psychiatry), use case (e.g. decision support, documentation, patient communication), evaluation setting (benchmark/vignette vs clinical data), protected attributes and bias targets assessed, bias methods/metrics, and mitigation strategies proposed or tested. Findings were synthesised narratively with descriptive counts across specialties and use cases.

Of 3,664 full texts screened, 278 studies met inclusion by explicitly assessing bias. A further 757 studies evaluated medical applications of LLMs and otherwise met eligibility criteria but did not report any bias assessment, indicating that most medical LLM evaluations omit bias evaluation. Included studies spanned clinical decision support, medical documentation, patient communication, education, and biomedical research across multiple specialties. Bias assessment rates varied by specialty: psychiatry 21/180 (11.7%), radiology 7/107 (6.5%), and oncology 5/51 (9.8%). Bias assessments most commonly examined demographic bias (gender, race/ethnicity, age) and variation in symptom or diseasepresentation. Methodologies included prompt-based probing (e.g. clinical vignettes), counterfactual testing, and red teaming to elicit biased responses; statistical comparisons of performance across groups (including fairness-adjusted performance metrics such as the FAP score); and clinician-led safety evaluation frameworks assessing output suitability. Proposed mitigation strategies included more diverse training data, reinforcement learning with human feedback (RLHF), direct preference optimisation, and ongoing human oversight.

Despite rapid growth in medical LLM research, explicit bias assessment remains inconsistent and frequently absent. Standardised, transparent bias evaluation across patient populations, tasks, and clinical contexts is needed to support safe implementation and ensure equitable provision.

Increasing rates of involuntary treatment in the UK and persisting ethnic disparities in detentions have led to the reform of the Mental Health Act (MHA) in 2025. The MHA bill introduces several new measures including the offer of Advance Choice Documents (ACDs) to people who wish to make them. ACDs are written statements of a person’s wishes and preferences for treatment and care, made when a person is well and has the capacity to do so. Systematic reviews show that ACDs can reduce detention rates by up to 25%. The South London and Maudsley NHS Foundation Trust (SLaM) rolled out ACDs as part of routine care, ahead of the MHA 2025. This study describes the implementation of ACDs as part of routine care at SLaM.

SLaM recruited independent senior mental health professionals (ACD facilitators) to lead the creation, use and review of ACDs. The facilitators underwent training and utilised resources previously developed through previous research. The resources included an ACD template, an ACD manual and role description for facilitators, simulation training and Recovery College courses. A clinical lead and clinical supervisor were also employed to provide oversight for the implementation project. Data on implementation were collected through case note reviews, and interviews with service users and staff. Analyses on how ACDs were created and used when people experienced crises were conducted.

At the time of abstract submission, 77 ACDs have been created with service users at SLaM. The implementation of ACDs has been aided by service user-led initiatives such as the Patient Carer Race Equality Framework, staff training, and Recovery College courses which enabled people to create ACDs with high fidelity to the evidenced interventions. Staff and service users report that the ACD creation process is a holistic experience that is empowering and beneficial for improving therapeutic alliance between service users and mental health professionals. The main barrier cited by staff was a lack of time due to large caseloads.Service users expressed scepticism about their ACDs being accessed and honoured during times of crisis.

Implementing evidence-based interventions in healthcare settings is complex. SLaM has replicated the implementation of ACDs with high fidelity to the intervention trials that reported reductions in Mental Health Act detentions and greater autonomy for service users. Our results show that multiple strategies are needed to accelerate the reach and adoption of ACDs in other Trusts.

The primary objective of this baseline audit was to evaluate the performance of mentalhealth and substance misuse services across all five Welsh prison sites against evidence-based quality standards.

The study sought to identify models of care, highlight areas of best practice, pinpoint thematic gaps requiring additional strategic resource or funding, and inform the development of a future network for prison mental health and substance misuse services in Wales.

The audit utilised a peer-review methodology developed by the Quality Network for Prison Mental Health Services (QNPMHS). Each service underwent a two-month self-assessment against 238 standards, followed by an intensive in-person review visit between September 2024 and July 2025.

Data collection involved 92 semi-structured interviews with frontline staff, prison colleagues, and patients, alongside environmental tours and documentation reviews. Compliance was measured against Mental Health (MH) standards and the 2024 Substance Misuse Treatment Framework.

Visits were undertaken by the College Centre for Quality Improvement (CCQI), commissioned by RCPsych Wales as part of the Prison partnership agreement between Welsh Government and HMPPS.

The audit revealed variable compliance levels, with average scores of 62.8% for mental health and 57.7% for substance misuse standards. Key findings included:

• • Service Models: Most services follow a nurse-led model, with significant gaps in access to psychology, occupational therapy, and psychiatry.

• • Substance Misuse: Only one prison (HMP Berwyn) maintained a full clinical SM team, while others relied on single practitioners managing high caseloads.

• • Neurodiversity: While “whole-prison” neurodiversity support managers exist, healthcare teams lack the commissioning to provide formal assessments or diagnoses for ADHD and Autism.

• • Operational Barriers: Challenges included a lack of confidential consultation rooms, insufficient IT resources, and inconsistent provision of monthly clinical supervision.

While pockets of good practice exist, particularly in collaborative duty worker roles, the Welsh prison estate faces systemic challenges regarding clinical multidisciplinary input and specialist pathways.

The report recommends immediate investment in specialist Substance Misuse staff, formalising neurodivergent care pathways, and enhancing clinical working environments.

Implementing adapted assessments for older adults and ensuring monthly clinical supervision are critical priorities to improve the quality and safety of care.

The review provides critical insight, informing the development of a future network for prison mental health and substance misuse services in Wales, commissioned by Welsh Government.

- Evaluating the current practice for management of insomnia in inpatient settings.

- Assessment of the current use of CBT- Insomnia for the treatment of sleep disorders in inpatient settings.

- Comparing the current practice with the NICE guidelines.

A retrospective review of electronic medical records of 45 patients who were currently admitted in the inpatient unit over a period of two weeks of data collection.

For each patient, documentation was examined to determine:

• Whether insomnia was reported or observed

• Whether sleep difficulties were noted in clinical records

• Whether nonpharmacological interventions (e.g., sleep hygiene) were offered

• Whether behavioural therapy (CBTI), which is considered the first line of treatment.

treatment for chronic insomnia was offered or signposted

• Whether hypnotic medication was prescribed, and if so:

Type of medication

Documentation of indication

Presence of review or stop dates

Out of the 45 current in-patients audited during the initial assessment of electronic records, 26 (58%) complained of sleeping difficulties; an additional 4 patients were observed to have sleeping difficulties according to the records. This makes the totalprevalence of insomnia 30 (66.6%). Of these patients, 23 (76.6%) had proper documentation of insomnia in their notes. As management, non-pharmacological interventions such as sleep hygiene discussion were done in 11 out of 30 (36.6%), and no patients (0%) were offered or signposted towards CBT-I. Pharmacological interventions of offering hypnotic medications were offered to 26 out of 30 (86.6%). The hypnotic medications offered included Z-drugs and/or in combination with benzodiazepine and antihistamines. None of the patients (0%) adhered to all criteria of NICE guidelines and Local Trust Policy (classifying insomnia according to duration of symptoms, trial of non-pharmacological intervention before using medications, clear indication documented before starting hypnotics, periodic review and documentation of stop date for said medications)

This audit highlights the need for a structured and consistent approach to managing insomnia across the hospital. Establishing a simple, standardized care pathway–prioritizing non-pharmacological strategies and applying a cautious, clearly justified approach to hypnotic prescribing–has the potential to enhance patient safety, minimize the risk of hypnotic dependence, and promote higher-quality clinical care. Ensuring insomnia is managed systematically and in line with NICE recommendations will support more effective and sustainable outcomes for our patients.

Online teaching is common practice in postgraduate medical education. For the past three years our trust has provided an optional postgraduate education programme in psychiatry to GPs and foundation doctors. This has been run online due to perceptions of increased learner convenience, reduced time-cost for busy clinician teachers and reduced financial cost to the organisation. However, the programme’s teaching faculty observed little learner engagement in interactive learning during online sessions and were concerned about the impact of this on the teaching and learning experience. It was postulated that in-person sessions might increase group proximity, cohesiveness and psychological safety leading to a more interactive learning and teaching experience and increased learner and teacher satisfaction.

We reorganized our regional teaching programme and changed 6 online sessions to one half educational day with 3 sessions, and a full day with the remaining 4 sessions. We delivered the first of these sessions in early January 2026. Session content included psychiatric emergencies, communication skills, and comparisons between psychiatry and other specialties.

7 out of 52 learners attended the first session, the majority of whom were based in Bristol placements. This attendance was lower than that observed for previous online sessions (between 8 and 15 attendees out of 52 invited) and could reflect commuting and obtaining time away from clinical duties. In contrast, online sessions had previously been attended bytrainees from across the region, raising potential equity and accessibility considerations. Despite the lower attendance, formal feedback from attendees was uniformly positive. Informal feedback indicated a preference for in-person teaching, with learners reporting improved concentration and greater ease of interaction with both faculty and peers. Teachers had the impression learners engaged more in the sessions in contrast to previous online ones, and had higher satisfaction with the format, which may have implications for teacher motivation and retention.

We have recently changed our GP and foundation doctors teaching programme from online to in-person sessions due to concerns about low engagement within sessions. Our early reflections include a better perceived experience from learners and teachers, although difficulties in attending sessions could limit success in the future. We have demonstrated satisfaction with returning to in-person teaching, and will continue to assess learners’ responses and feedback.

Tourette syndrome and chronic tic disorders are neuro developmental conditions characterised by sudden, repetitive motor movements and/or vocalisations–known as tics–that persist for at least one year. These disorders typically begin in childhood and can lead to significant distress, impair daily functioning, and reduce overall quality of life. Although pharmacological treatments and behavioural therapies are available, long-term use of medication is often associated with adverse side effects. Consequently, there is growing interest in non-pharmacological approaches. This systematic review therefore examined the effectiveness of Comprehensive Behavioural Intervention for Tics (CBIT) in children and adolescents diagnosed with tic disorders.

For this review, several electronic databases were searched, including ProQuest PsycInfo, Ovid Medline, Ovid Embase, Ovid Emcare, the Cochrane Library, PubMed, NICE, and BMJ Best Practice. Searches were limited to English-language publications and to studies involving children and adolescents under 18 years of age with tic disorders who received Comprehensive Behavioural Intervention for Tics (CBIT). Eligible study designs included case reports and case series, and both quantitative and qualitative research and Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. In total, five studies met the inclusion criteria. These studies examined the effectiveness of CBIT delivered in various formats–including group-based CBIT, tele-CBIT, and modified CBIT–in reducing tic severity among children and adolescents.

Two independent reviewers analysed the data and identified substantial heterogeneity, which prevented further meta-analysis. However, the findings were instead synthesised narratively under three themes: effectiveness of CBIT, wider benefits for tics and acceptability. Across studies, CBIT consistently reduced tic severity in children and adolescents. Several studies also reported broader improvements, including reduced anxiety and depressive symptoms, alongside enhanced self-esteem and cognitive reappraisal. Acceptability and patient satisfaction were high across delivery formats, with group-based, tele-CBIT, and modified CBIT demonstrating comparable outcomes to traditional face-to-face interventions.

The review was constrained by the small number of studies and limited sample sizes, which reduced the reliability and generalisability of the findings. However, the results highlighted the effectiveness of CBIT in reducing tic severity alongside wider benefits for children with tic disorders. Thus the effectiveness, acceptability, and satisfaction across different CBIT delivery formats suggest promising potential for implementation in resource-constrained settings, with the possibility of enhancing quality of life for young people with tic disorders. Further research is needed to evaluate CBIT in combination with pharmacological treatments and neuro-modulatory approaches.

This integrative thematic synthesis aims to synthesise evidence on (1) neurodevelopmental and relational mechanisms hypothesised to drive Parent-Mediated Intervention effects; (2) lived experience and acceptability of parents, and (3) feasibility of widespread implementation into early-years services. Results were shaped into a translational model to inform sustainable, scalable, and ethical early-intervention delivery.

A scoping review was conducted in-line with PRISMA-ScR guidance. The databases Medline, PubMed, Scopus, and PsycINFO were searched for studies published between 2010 and 2025. Eligible papers included infants up to 24 months old at increased risk of autism and reported on at least one of the following areas: proposed neurodevelopmental mechanisms, parental experience, or implementation and scalability. Two reviewers independently screened and synthesised data from qualitative studies, clinical trials, and service evaluations using thematic analysis and cross-domain integration.

Studies were excluded if they focused solely on pharmacological interventions or diagnostic procedures, as well as those only including children older than 24 months.

Studies that were not addressing the practical delivery or feasibility of the intervention within real-world service settings were also excluded. This approach enabled inclusion of both trials examining efficacy and underlying mechanisms, alongside research exploring lived experience and system-level implementation.

The thematic analysis identified three interconnected domains: (1) Parent-Mediated Intervention shapes early social attention and arousal regulation by increasing the predictability of caregiver social signals without altering core neuro development trajectories; (2) parental empowerment and stress regulation act as key mediators of sustained engagement and parent–infant synchrony; and (3) feasibility and equity are determined by delivery model, workforce capacity, accessibility and adaptability (for example, hybrid or telehealth models).

Heterogeneity in terminology, study design, intervention duration, and outcome measures (including criteria used to define autism likelihood) was acknowledged as a limitation constraining synthesis across the studies in this review.

Despite these limitations, findings were integrated into a Developmental-Relational-Implementation model to support clinicians and commissioners in selecting, timing, and delivering Parental-Mediated Interventions that are feasible and adaptable within real-world health systems.

The Developmental-Relational-Implementation model offers a pragmatic framework for clinicians, commissioners, and policymakers to guide the delivery of Parental-Mediated Intervention in early autism care. This review positions Developmental-Relational-Implementation-informed approaches as family-centred, equitable, and scalable by capitalising on relational engagement, developmental neuroplasticity, and the practical realities of healthcare delivery. To support scalable and sustainable expansion, furtherresearch should incorporate mechanistic markers, qualitative assessments of parental outcomes, and health economic evaluation.

Large language models (LLMs) are rapidly emerging as tools with potential applications across mental healthcare, yet their implications for psychiatric practice remain unclear. This systematic review explores and categorises LLM use cases in mental healthcare to inform clinicians, researchers, and policymakers about emerging applications, opportunities, evidence gaps, and safety challenges relevant to psychiatric assessment, risk management, clinical documentation, and patient-facing support.

We searched EMBASE, MEDLINE, PsycINFO, PubMed, the ACL Anthology, the ACM Digital Library, arXiv, medRxiv, and bioRxiv (2017–June 2025) and included empirical studies evaluating LLMs for mental healthcare tasks. Screening and extraction wereperformed in line with PRISMA. We summarised use cases using a predefined taxonomy and recorded study design, evaluation setting (synthetic vs clinical), and key safety/ethics issues.

We identified 120 studies, with some addressing more than one use case, reflecting a broad and rapidly expanding set of LLM applications in mental health care. The most common functions related to assessment and detection: symptom identification (14), early detection (15), risk stratification (e.g. suicidality) (9), individual-level risk prediction for developing mental health disorders (12), and analysis of clinical or patient-generated text (1). Patient-facing use cases included psychotherapy (10), conversational agents (15), patient education (6), mood and emotion monitoring (5), accessibility-focused digital interventions (2), and psychiatric rehabilitation (1). Clinician-facing functions included diagnostic support (18), disease classification (7), treatment outcome prediction (3), electronic health record summarisation (3), and documentation support (1). Additional work addressed healthcare policy (8), research (1), education (1), and training (1). Across domains, LLMs were frequently reported to perform comparably to existing automated approaches and, in standardised case evaluations, to human benchmarks. However, the evidence base was highly variable, most studies were exploratory or proof-of-concept and had limited evaluation in routine psychiatric practice. Recurrent concerns included hallucinated or inaccurate outputs, bias and cultural insensitivity, limited transparency and explainability, data privacy risks, and uncertain safety in high-risk clinical contexts.

Current evidence indicates that LLMs may support multiple areas in psychiatry, primarily as augmentative tools rather than replacements for clinical expertise. Promising near-term applications include assessment support, administrative efficiency, psychoeducation, and low-risk supportive interactions. However, clinical integration remainsat an early stage given limited real-world validation and persistent safety concerns. Future research should prioritise evaluation in routine care, strengthened governance and regulatory frameworks, and transparent systems co-designed with clinicians and service users to ensure safe and equitable implementation in psychiatric practice.

Oldham Early Intervention Team (EIT) observed olanzapine was frequently prescribed as first line treatment. FEP patients may be particularly sensitive to adverse effects such as sedation and metabolic dysfunction, which can impact tolerance and adherence. NICE guidelines recommend collaborative antipsychotic prescribing with careful consideration of benefits and side effects. This audit aimed to evaluate antipsychotic prescribing patterns, assess compliance with monitoring standards, and determine whether dissemination of initial audit findings influenced prescribing practice.

A retrospective clinical audit was conducted on patients accepted by Oldham EIT during two time periods: September 2023–March 2024 (initial audit, n=36) and April 2024–September 2024 (re-audit, n=33). Antipsychotic prescribing data was collected from electronic clinical records at baseline and six month follow up, alongside weekly weight monitoring over the first six weeks, in accordance with the Lester Tool. Initial audit findings were shared with Inpatient and EIT consultants prior to re-audit.

During initial audit, 35/36 (97%) patients were prescribed antipsychotics. Olanzapine was the most prescribed 19/35 (54%), followed by aripiprazole 12/35 (34%). Baseline weight was documented for 11/35 (31%) patients but weekly weight monitoring only for 1/35 (3%) patient.

At six-month follow-up, 31/36 (86%) patients were prescribed antipsychotics. Olanzapine remained the most prescribed 14/31 (45%), followed by Aripiprazole 9/31 (29%). Among those continuing olanzapine, 8/14 (57%) had their doses increased due to residual symptoms. 60% of those who discontinued antipsychotics had been taking olanzapine and 80% discontinued due to patient choice.

At re-audit, 31/33 (94%) patients were prescribed antipsychotics. Olanzapine remained the most prescribed, but use decreased to 11/31 (35%). Quetiapine became the second most prescribed (8/31, 26%). Baseline weight documentation improved to 20/31 (65%), though weekly weight monitoring remained low 2/31 (6%).

At six-month follow-up, 28/33 (85%) patients were prescribed antipsychotics. Aripiprazole became the most prescribed 12/28 (43%), followed by Olanzapine 7/28 (25%). One patient continuing olanzapine had their dose increased due to residual symptoms. All antipsychotic discontinuations were due to patient choice, with 80% symptom-free.

This audit cycle demonstrated improvements in antipsychotic prescribing for FEP within Oldham EIT. Olanzapine prescribing reduced and was replaced by aripiprazole as the most prescribed antipsychotic at six month follow up. Areas for improvement were identified, with weekly weight monitoring remaining suboptimal. Furthermore, improved documentation could clarify prescribing rationale and establish if treatment refusal was linked to adverse antipsychotic effects. Continued education and re-audit are recommended to sustain improvements in prescribing practice and shared decision-making.

First-episode psychosis with treatment resistance can present with diagnostic uncertainty and often necessitate complex psychopharmacological decisions alongside multidisciplinary interventions. Selecting effective antipsychotic treatment while minimising adverse effects is critical, particularly when initial monotherapy is unsuccessful. This case report reviews clinical management and functional improvements in a young woman admitted to an acute psychiatric ward following combination treatment with Cariprazine and Olanzapine, supported by multidisciplinary team interventions.

X is a young adult female with no prior secondary-care mental health involvement, a family history of schizophrenia. She presented following a 2.5 year deterioration marked by aggression, social decline, and psychotic symptoms. On admission, she was presenting with behavioural disturbance, exhibited prominent paranoia, persecutory delusions, and auditory hallucinations. Initial treatment with oral Olanzapine was limited by non-compliance.

Zuclopenthixol depot was initiated but discontinued due to extrapyramidal side effects. Subsequent treatment with Amisulpride resulted in limited symptom control and cognitive slowing. Clozapine was deferred due to abnormal inflammatory and cardiac markers. A switch and gradual increase to Cariprazine 4.5 mg/d led to an improvement in insight and behaviour, with low-dose Olanzapine 5 mg/d later added to address residual positive symptoms (auditory hallucinations).

MDT input included extensive collateral history, family involvement, and structured Occupational Therapy and Psychology interventions.

This case suggests that Cariprazine augmented with low-dose Olanzapine may be an effective and tolerable strategy in treatment-resistant psychosis when Clozapine is contraindicated. Improvements in functional and psychological outcome measures underscored gradual symptomatic recovery.Symptom severity, measured using the Brief Psychiatric Rating Scale (BPRS), reduced from 38 to 29, representing 23.7 % improvement with the most marked improvement observed in unusual thought content and hallucinations.

The Occupational Therapy Task Observation Scale (OTTOS) - total score improved from 121/200 (08/10/25) to 182/200 (09/01/26), representing a 50.4% increase. Task Behaviour improved by 39.7%, and General Behaviour by 62.1%, with marked gains in engagement, independence, and socialisation.

Autism Spectrum Quotient (AQ-50) score reduced from 22 to 15, a 31.8% reduction in self-reported autistic-type traits. The greatest improvements were observed in Social Skills (90% of items) and Communication (70%), indicating improved interpersonal functioning and cognitive flexibility.

GAP (Global Assessment of Progress) score improved from 29/70 on admission to 63/70, representing an absolute increase of 34 points and reflecting a 48.6% improvement across the different domains.

Combination treatment with Cariprazine and Olanzapine was associated with meaningful symptomatic, functional, and psychological improvement, demonstrating its potential role in complex treatment resistant psychosis.

Psychotic disorders display marked ethnic disparities in incidence in the UK, with Black African and Black Caribbean populations consistently shown to have elevated risk.Leicester City is one of the UK’s most ethnically diverse cities and hosts a large and long-standing Somali community. Clinicians within the Psychosis Intervention and Early Recovery (PIER) service have perceived disproportionate Somali representation. This study quantitatively examines whether Somali patients are over-represented in PIER relative to population size and compares this pattern with African and Caribbean groups.

• • To determine whether Somali patients are over-represented in the Psychosis Intervention and Early Recovery (PIER) service relative to their proportion in Leicester City’s population.

• • To compare Somali over-representation to that of combined Black African/Caribbean groups.

• • To quantify crude prevalence, odds ratios (ORs), confidence intervals (CIs), and statistical significance of observed over-representation.

A retrospective analysis was conducted using a Leicester-City-only EIP caseload dataset (n=310). Ethnicity categories were collapsed into Somali, African/Caribbean (African + Caribbean + Other Black), and Other groups. Population denominators were taken from ONS Census data, including 2150 Somali write-in responses in Leicester City and African/Caribbean proportions based on Black African (~4%) and Black Caribbean (~1.36%) census data. Statistical methods included crude proportions, ORs, 95% CIs, and χ² tests.

Somali patients accounted for 7.7% of the EIP case load but only 0.58% of the Leicester population. OR for Somali over-representation was 13.45, p <0.001. African/Caribbean patients accounted for 10.3% of cases vs 5.36% of the population, OR 1.93, p <0.001. Somali patients were markedly more over-represented than the broader African/Caribbean group.

Somali individuals are substantially over-represented in early psychosis service usage in Leicester. This pattern exceeds the known elevated risk observed in African and Caribbean groups. Findings highlight urgent public health, cultural, and service-access implications requiring further investigation.

Clozapine is a high-risk antipsychotic prescribed in secondary care, requiring accurate documentation in primary care records to ensure patient safety and continuity of treatment. Inaccurate recording of Clozapine dose and frequency may result in prescribing errors, treatment interruption, or adverse outcomes, particularly in emergency or out-of-area settings. An initial audit identified significant deficiencies in the accuracy of Clozapine dose and frequency documentation within primary care records for patients managed by a community mental health team.

An audit was conducted within the North Cornwall Community Mental Health Team assessing the accuracy of Clozapine documentation in primary care records. Standards were derived from the Cornwall Partnership NHS Foundation Trust “Procedure and Guidance for the Use of Clozapine” (MM/032/22). Following dissemination of findings and targeted liaison with GP practices, a re-audit was undertaken using the same patient cohort (n=15) and methodology. Summary Care Records were reviewed and compared against the most recent secondary care clinic correspondence to assess inclusion of Clozapine on GP repeat prescriptions and accuracy of documented dose and frequency.

In the initial audit, Clozapine was included on GP repeat prescriptions in 93% of cases; however, accurate documentation of dose and frequency was present in only 33%. The re-audit demonstrated sustained inclusion of Clozapine on repeat prescriptions (93%) alongside a substantial improvement in accurate dose and frequency documentation, rising to 80%. These findings indicate a marked improvement following intervention, representing a meaningful enhancement in patient safety. Residual inaccuracies persisted in a minority of cases, highlighting the ongoing importance of clear communication between secondary and primary care.

Completion of the audit cycle demonstrated that targeted intervention and improved liaison with GP practices significantly enhanced the accuracy of Clozapine dose documentation in primary care records. While overall documentation improved substantially, continued vigilance and clear communication following medication changes remain essential to minimise prescribing risk. Ongoing monitoring is recommended to sustain these improvements and ensure patient safety.

People with intellectual disability have a higher risk of developing dementia, yet assessment and diagnostic pathways can vary across services and regions. This service evaluation aims to evaluate how dementia referrals for people with intellectual disability are processed within Mental Health of Learning Disability (MHLD) services across Kent and identify opportunities to standardise referral and care pathways.

A retrospective review was conducted of all referrals received by MHLD services in Kent from June 2022 to May 2023. Referrals were included if they contained themes suggestive of cognitive decline: changes in memory or function, forgetfulness, and confusion. Data were collected on referral source, demographics, reason for referral, acceptance or refusal, assessing discipline, follow-up plans, diagnoses at initial assessment and at 3 months. Referrals were analysed by region.

A total of 47 referrals met inclusion criteria. Acceptance rates varied by region and accepted referrals were younger on average than refused referrals across all regions. Down’s syndrome was present in a substantial proportion of accepted cases. Regional variation was observed in diagnostic pathways. Initiation of medication for dementia varied by clinician with consultants more likely to commence treatment than trainees.

This evaluation highlighted regional variation in diagnostic pathways for people with intellectual disability and suspected dementia. The variation suggests a need for a standardised dementia referral and diagnostic pathway, guidance on in-house diagnosis, enhanced training for clinicians and allocation of wider resources to improve equity, efficiency and quality of care.

Discharge summaries are essential for safe communication with patients, carers, community teams and general practitioners, ensuring continuity of care following psychiatric inpatient admission. Delays increase the risk of medication errors, incomplete risk assessments, safeguarding failures and missed follow-up. This project aimed to improve the timeliness of discharge summaries from an inpatient Child and Adolescent Mental Health (CAMHS) unit by achieving a 50% relative increase in the proportion of letters meeting both national (within 1 day) and local (within 7 days) standards on re-audit over a 6-month period.

Baseline audit data showed compliance of 26.23% with the national 1-day standard and 54.1% with the local 7-day standard. Barriers to timely completion were explored through analysis of the previous 6 months data on delayed discharges with key themes to delay identified. Consistently multidisciplinary team (MDT) communication was found to be the primary issue, including resident doctors not being made aware of prospective discharge dates, and consultants not being informed when letters were uploaded for checking. As such, interventions included:

• • Teaching discharge standards and processes at Trust induction for rotating resident doctors

• • Identifying potential discharges during weekly MDT case planning to allow advance preparation of letters

• • Ensuring resident doctor attendance at discharge meetings to facilitate same-day completion

• • Supporting secretarial staff to send reminder emails to consultants when letter checking was delayed

Following implementation of these interventions, the 6-month re-audit evidenced that compliance was improved across both standards. National standard compliance (within 1 day) increased to 46.43%, an absolute improvement of 20.2% and a relative increase of 77.1%. Local standard compliance (within 1 week) increased to 89.29%, an absolute improvement of 35.19% and a relative increase of 65.0%. The project aim was met for both standards.

Delayed discharge summaries compromise the safety of patients and others, through miscommunication, medication errors and failures in risk management. Despite clear national and local standards, compliance was nearly 75% and 50% respectively below expected standards. Following analysis of the previous 6 months of data on delayed discharges, MDT communication was identified as the key barrier to compliance at this CAMHS inpatient unit. This project demonstrates that simple, low-cost interventions focused on anticipation, preparation and communication can significantly improve discharge summary timeliness. Ongoing work includes six-monthly re-audit, continued teaching at Trust induction, and embedding discharge discussion within structured case-planning templates to sustain improvements.

People with learning disabilities experience significant health inequalities, yetundergraduate medical education often provides limited opportunities for sustained,meaningful engagement with this population outside clinical settings. This cancontribute to anxiety, uncertainty, and communication barriers for future doctors. Thecollaboration between Transition2 (T2), a specialist education provision for youngadults with special educational needs and disabilities (SEND), and the PsychiatryTeaching Unit (PTU) at Derbyshire Healthcare NHS Foundation Trust was developedto address this gap. The projectaimed to embed experiential, learning disabilityfocused teaching within undergraduate psychiatry placements, prioritising livedexperience, communication, and relational learning.

During undergraduate psychiatry placements, medical students spent structured timeat Transition2, engaging with young adults with learning disabilities throughfacilitated sessions and informal interactions. Activities included shared discussions,collaborative tasks, and reflective conversations, designed to support authenticengagement rather than observational learning. Teaching was informed byexperiential education principles, including Kolb’s experiential learning cycle,enabling students to experience, reflect, conceptualise, and apply learning related toholistic, person-centred care. Sessions were co-designed with Transition2 staff toensure they provided a safe, respectful, and empowering environment for learners.

Evaluation was qualitative, drawing on feedback from students, staff, and Transition 2 participants.

Feedback from students and staff demonstrated improved communication skills,increased confidence, and deeper understanding of learning disability within a real-world context. Students valued the opportunity to engage openly with individuals withlived experience, describing learning that extended beyond traditional classroom orclinical teaching. Many reflected on feeling genuinely invested in learners’ journeysand reported enhanced empathy and awareness of how language, pace, andenvironment influence communication. Transition2 learners benefited fromopportunities to practise communication, express personal perspectives, and interactwith future clinicians in a collaborative, non-clinical setting. The partnershipaddressed a critical gap in medical education by enablingrelational learning rarelyachievable in standard placements and successfully translated experiential learning theory into meaningful practice.

The Transition 2 and PTU partnership demonstrates an innovative, exciting model for learning disability education within undergraduate psychiatry. By embedding livedexperience and fostering respectful, reciprocal relationships, the programme enhances communication skills, empathy, and confidence among future doctorswhile empowering young adults with learning disabilities. Similar partnerships couldbe embedded within community education settings, colleges, and supportedemployment services, contributing to a more inclusive, informed, and compassionatehealthcare workforce.

Functional Cognitive Disorder (FCD) is increasingly recognised within memory services, yet its non-organic symptom profile, subjective–objective mismatch, and inconsistent cognitive performance continue to pose diagnostic challenges. Although conceptual frameworks, such as those proposed by Harriet Ball et al. (2020), have advanced understanding of FCD, translation into routine clinical practice remains variable.

This six-month retrospective service evaluation examined the prevalence, clinical characteristics, and diagnostic pathways of FCD within the South Kent Coast Memory Assessment Service. The project assessed diagnostic reach, cognitive profiles, psychiatric comorbidity, and service timelines while evaluating the practical utility and limitations of current diagnostic frameworks.

A total of 550 consecutive referrals (October 2024–March 2025) were reviewed. Patients were evaluated against six operationalised criteria grounded in established FCD models: subjective cognitive concerns, objective–subjective mismatch, internal inconsistency, absence of neurodegenerative disease, psychological contributors, and functional impact. Demographic data, cognitive assessments (ACE-III, MMSE), neuroimaging, psychiatric comorbidity, and service outcomes were analysed descriptively.

Thirty individuals (5.4%) met operational criteria for FCD or FCD-like presentations, consistent with UK prevalence estimates. However, only seven received a formal FCD diagnosis; the remaining 23 were coded as Mild Cognitive Impairment or given non-specific labels despite exhibiting clear functional features, highlighting significant diagnostic drift. The cohort was predominantly female (60%), with a mean age of 67 years and high psychiatric comorbidity (77%).

Cognitive profiles showed preserved attention, language, and visuospatial abilities, with variable memory performance and disproportionately reduced phonemic fluency. Relatively intact encoding but impaired spontaneous recall, with strong cue dependence, supported positive diagnostic features of a functional cognitive profile. Neuroimaging revealed no progressive pathology.

The service pathway analysis revealed significant variability, with average durations from referral to assessment and referral to discharge being 138 and 156 days, respectively.

These findings reinforce FCD as a prevalent and clinically significant presentation characterised by preserved cognitive function disrupted by anxiety-related performance interference. They also highlight limitations within the Harriet Ball et al. framework. While conceptually valuable, the criteria depend heavily on clinician interpretation of constructs such as “internal inconsistency” and “distress,” which lack clear operational thresholds and may contribute to the variability observed in diagnoses. Additionally, documentation gaps and inconsistencies in coding suggest that the current criteria are insufficiently structured for routine clinical practice.

A shift toward positively framed, operationalised diagnostic criteria, enhanced clinician training, and integrated psychological pathways is urgently required to improve diagnostic accuracy, reduce uncertainty, and optimise care for individuals with FCD.