The National Institute for Health and Care Excellence (NICE) and local prescribing guidance recommend that, after titration and dose stabilisation, prescribing and monitoring of Attention Deficit Hyperactivity Disorder (ADHD) medication should be carried out under shared care arrangements with primary care. In practice, shared care requests are accepted to varying degrees, thereby increasing service burden for secondary care.

We aimed to estimate the current acceptance rate of shared care requests for ADHD medications in Hull and the East Riding, explore factors influencing uptake, and recommend improvements to shared care arrangements with primary care.

A retrospective exploratory audit was conducted using electronic patient records from the Children and Young People’s Neurodevelopmental Service.

The data capture period was from 01/07/2025 to 01/09/2025. The audit included a consecutive sample of all patients identified.

The patient’s ADHD medication, shared care request, outcome, and reasons for prescription decisions, despite a shared care agreement, were recorded in an Excel spreadsheet. Data were collected retrospectively in December 2025.

Of 114 patients identified, 62 (55%) had shared care requests, 50 (45%) had none, and 2 were not medicated. Of the 62 patients who had shared care requests, 43 (69%) were accepted, 13 (21%) received no response, and 6 (10%) were declined. 4 of the 6 patients whose shared care protocol was declined are from the same General Practitioner (GP) Practice, which cited local prescribing guidelines for declining to prescribe or monitor methylphenidate. There was no clear documentation regarding prescribing decisions despite a shared care agreement in place. Prescribing commonly followed dose changes, formulation changes, or drug holidays. 2 patients were still undergoing titration.

Shared care uptake in primary care could be improved primarily by increasing the rate and timeliness of requests from secondary care, implementing systematic follow-up, and targeting engagement with GP practices that are not responding to or declining shared care. These recommendations, along with routine documentation of shared care status in clinic letters and a clear rationale for prescribing despite a shared care agreement, have been communicated to all prescribers in the service and other relevant stakeholders. A re-audit is planned to assess the impact of the implemented recommendations on improving uptake, facilitating easier access to medication, reducing service burden, and increasing capacity for new patients.

Acknowledgements

We thank:

Dr Syed S. M. H. Naqvi, Consultant Child and Adolescent Psychiatrist, for supervision and guidance.

Jo Allison, Nurse Prescriber, for data support.

Patients with severe mental illness frequently present with complex physical health comorbidities, creating significant challenges for safe inpatient management on acute psychiatric wards. Patient’s impaired capacity and behavioural disturbance can further complicate engagement with essential medical care. This case highlights the importance of integrated physical and mental health management and multidisciplinary team collaboration in achieving positive outcomes.

X is a 46-year-old female with a diagnosis of Schizoaffective disorder and poorly controlled Type I Diabetes. She presented with a progressive deterioration in mental state following discontinuation of Clozapine and Lithium. Intermittent refusal of BG monitoring, erratic and unhealthy dietary habits, and variable cooperation with insulin administration led to significant glycaemic instability, requiring coordinated Multidisciplinary team (MDT) input to ensure patient safety. Patient was transitioned to Paliperidone depot injection due to the favourable metabolic profile.

A coordinated MDT approach was implemented. Nursing staff adhered to a structured rapid-acting insulin management plan, administering additional doses in response to BG readings. A Freestyle Libre continuous glucose monitoring sensor was introduced, with staff educating the patient, helping to set up alerts for hypo- and hyperglycaemia. Dietitian’s input was provided, alongside liaison with hospital catering services to facilitate healthier food substitutions.

As a result the patient’s glycaemic control improved markedly, with reduced BG fluctuations and decreased need for additional rapid-acting insulin. This improvement was reflected in a significant reduction in HbA1c from 92 mmol/mol (21/11/25) to 69 mmol/mol (14/01/26) within less than 3 months. The patient demonstrated sustained behavioural change, discontinuing takeaway food and adopting healthier eating habits.

Symptom severity, measured using the Brief Psychiatric Rating Scale (BPRS), reduced from 52 to 29, representing 44 % demonstrating a substantial reduction in psychotic, affective, and behavioural symptoms.

Occupational therapy task observation scale (OTTOS) total score increased from 61/200 to 190/200, representing 64.5% increase, indicating a substantial improvement in both task performance and overall functional behaviour.

GAP (global assessment of progress) score improved from 40/70 on admission to 59/70, representing an absolute increase of 19 points and reflecting a 27% improvement across the different domains, highlighting a marked improvement in clinical stability and functional engagement.

Integrated physical and mental health care is essential for patients with severe mental illness and complex comorbidities. This case demonstrates that even during acute psychiatric deterioration, effective management of complex physical health conditions is achievable through structured care plans, consistent nursing input, and strong multidisciplinary team collaboration.

This systematic review investigates the psychological phenomenon of Cancel Culture Induced Anxiety (CCIA) among Generation Z individuals aged 16–25. The primary aims are to synthesise empirical evidence from existing literature and develop an integrated conceptual model mapping the causes, pathways, and psychological effects of this condition.

A systematic review was conducted in accordance with PRISMA guidelines and the Cochrane Method. Comprehensive literature searches were performed across PsychINFO,PubMed, and Scopus to identify peer-reviewed, primary empirical studies. Ten studies were selected for inclusion based on a predefined Population, Exposure, Outcome (PEO) framework. Quality Assessment was then performed using Critical Appraisal Skills Programme (CASP) checklists. Finally, evidence was synthesised using the Temporal Need Threat Model, context collapse, and networked publics as theoretical foundations.

Findings indicate that CCIA manifests primarily as acute social anxiety, which frequently escalates to clinical depression, diminished self-esteem, and in severe cases, suicidal ideation. Key behavioural outcomes include avoidance, self-censorship, and both internal and external conformity. These effects are sustained through psychological mechanisms such as rejection sensitivity and rumination. The review establishes that CCIA is driven by simultaneous threats to four fundamental human needs: belonging, self-esteem, control and meaningful existence. Social media, shaped by the dynamics of context collapse, emerges as the dominant environment for CCIA, though its severity is mediated by cultural, socio-economic, and individual predisposing and protective factors. The identified coping strategies are predominantly reactive and individualised, highlighting a significant gap for systemic and preventative interventions.

The proposed conceptual model establishes a vital foundation for understanding CCIA across diverse cultural and social contexts. It offers practical guidance for psychiatrists and mental health professionals in designing targeted clinical interventions and institutional policies. Future research should employ longitudinal and mixed-method approaches to validate the model and inform preventative strategies, addressing CCIA as a systemic feature of the digital age.

Risperidone is prescribed to children and adolescents for psychotic conditions when non-drug interventions are insufficient. It carries a significant risk of hyperprolactinaemia, which may adversely affect growth, pubertal development, and bone health. This audit assessed adherence to local hospital guidelines on prolactin monitoring for child and adolescent patients on risperidone, which align with the National Institute for Health and Clinical Excellence (NICE) Guideline CG155, at the Behavioural Sciences Institute (BSI) in Al Ain, United Arab Emirates (UAE).

A retrospective clinical audit was conducted at the BSI, Al Ain Hospital. Electronic medical records were reviewed for patients aged 18 years or younger who were initiated on risperidone from January 2023 onwards and maintained on treatment for at leastsix months. Data were collected between April and July 2025. Patients who discontinued risperidone within six months or had incomplete follow-up were excluded. Audit standards were based on local hospital protocols aligned with national guidelines, focusing on documentation of prolactin measurements at baseline, 12 weeks, and six months after treatment initiation. Data were analysed descriptively and reported as frequencies and percentages.

Of 52 cases reviewed, 49 met the inclusion criteria. The sample comprised 42 males (86%), with ages ranging from 3 to 17 years (mean 9.6 years). The majority of patients (96%) had diagnoses of psychosis associated with neurodevelopmental conditions, including attention-deficit hyperactivity disorder, autism spectrum disorder, or intellectual disability. Baseline prolactin monitoring was performed more frequently than follow-up monitoring. Prolactin measurement at 12 weeks was documented in 12% of patients, with reasons recorded for non-monitoring in 8% of cases. Monitoring at the six-month interval was more commonly completed, although a substantial proportion of patients did not undergo recommended testing at this time point.

This audit identified partial adherence to prolactin monitoring guidelines in children and adolescents prescribed risperidone at a tertiary mental health service. While baseline and six-month monitoring were more frequently completed, monitoring at the 12-week interval and documentation of reasons for missed tests were suboptimal. These findings highlight the need for targeted quality-improvement strategies, including electronic reminders, staff education, and improved documentation practices, to ensure safer prescribing and early detection of antipsychotic-induced hyperprolactinaemia in this vulnerable population.

No financial sponsorship has been received for this project.

Depression is estimated to affect approximately 10% of patients in primary care. Timely follow-up is crucial for monitoring symptom progression, assessing suicide risk, and evaluating treatment response. NICE (2022) recommend review within 2–4 weeks of diagnosis, or within 1 week if suicide risk is identified, while the Quality and Outcomes Framework (QOF) provide a broader window of 10–56 days. Despite the integral role of primary care in the management of depression, adherence to these standards varies widely across UK practices, putting patients at risk of clinical deterioration and suicide.

Assessing compliance with NICE guidelines for depression can identify gaps and guide strategies to improve patient safety and clinical outcomes. This audit therefore evaluated adherence to NICE guidelines in a South London GP practice, with a focus on review timing and documentation of suicide risk assessment.

1. To determine the proportion of patients with newly diagnosed depression who received a follow-up review within 2–4 weeks

2. To assess documentation of suicidal risk assessment and subsequent follow-up.

A retrospective audit of EMIS records identified all patients diagnosed with “Depression” or “Mixed depressive and anxiety disorder” from January and May 2024 (n=70). Fourteen patients were excluded as the 4-week review window had not yet elapsed, leaving 56 patients for analysis. Data were collected across nine parameters, including review timing, suicide risk documentation, treatment initiation, comorbidities, and referrals to specialist or psychological services.

The sample included 56 patients (59% female, mean age of 39.6 years). A notable 59% of patients had no documented review, with nearly half having recorded comorbidities. Only 41% had a documented review (n=23), with just 25% (n=14) being reviewed within the NICE recommended 2–4-week timeframe, while 39% met the QOF target of 10-56 days. Suicide risk assessment was documented in 91% of cases; however, 27% of patients reporting suicidal ideation had no documented referral to specialist or psychological services.

Adherence to NICE-recommended follow up for depression in primary care was low, with significant gaps in referral for patients with suicidal ideation, posing concerns regarding patient safety. Targeted strategies such as staff training on guideline compliance, automated follow-up prompts within EMIS, and integration of mental health reviews within multimorbidity consultations may improve compliance and support safer depression management. Ongoing monitoring and larger multi-site audits are needed to guide quality improvement in depression management on a broader scale.

Timely and accurate admission clerking is essential for safe and effective care in inpatient psychiatric settings. In our adult acute inpatient psychiatric unit, admission clerking was frequently delayed and inconsistently completed, increasing risks to patient safety, delaying treatment initiation, and impairing multidisciplinary communication. This quality improvement (QI) project aimed to improve the timeliness and completeness of admission clerking by ensuring completion within 72 hours of admission and achieving at least 70% documentation completeness by December 2025.

A QI methodology using Plan–Do–Study–Act (PDSA) cycles was employed. Afishbone diagram and driver diagram were developed to identify contributory factors and guide interventions. Baseline data were collected to assess current performance and identify priority areas for improvement. Two change ideas were tested. The first involved extending the target timeframe for admission clerking completion to within 72 hours of admission, which was clearly communicated to all medical staff. The second involved introducing a standardized admission clerking template to ensure consistent documentation of key domains, including mental state examination, risk assessment, physical health, and social history. Data on timeliness and completeness of admission clerking were collected and reviewed across sequential PDSA cycles.

Following implementation of the first intervention, the initial PDSA cycle demonstrated a significant qualitative improvement in admission clerking completion rates, although quantitative variability in documentation quality remained. During the second PDSA cycle, the extended 72-hour target was retained and combined with the standardized clerking template. Over the final twelve weeks of data collection, this combined approach resulted in a sustained improvement in both timeliness and completeness, achieving a 100% admission clerking completion rate.

Clearly defined timeframes combined with standardized documentation tools can significantly improve the quality, timeliness, and sustainability of admission clerking in inpatient psychiatric settings. Plans are underway to scale this intervention across the wider trust and continue data collection to evaluate long-term impact and sustainability.

Obesity and eating disorders (EDs) are associated with high morbidity, mortality, and limited long-term treatment efficacy. Virtual reality (VR) interventions are increasingly used in these conditions, yet their effects on objective biomarker outcomes have not been systematically evaluated. This review aimed to synthesize and critically appraise evidence on the effects of immersive VR interventions on clinical and biomarker outcomes in obesity and EDs.

A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Web of Science, and PsycINFO were searched from inception to April 2025. Eligible studies evaluated immersive VR interventions targeting obesity or EDs and reported at least one biomarker outcome, including anthropometric, physiological/autonomic, endocrine/metabolic, or neurocognitive measures. Randomized controlled trials (RCTs), non-randomized trials, and observational studies were included. Risk of bias was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses were conducted when three or more RCTs reported comparable outcomes; otherwise, a structured narrative synthesis was conducted.

Twenty-three studies (N=1,413; obesity=11, EDs=12) were included. ED populations comprised individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Obesity: VR-enhanced cognitive–behavioural therapy (VR-CBT) promoted sustained weight loss, whereas VR-based exercise interventions produced short-term reductions in BMI and body weight. Meta-analysis of four RCTs revealed a significant pooled effect of VR versus control on anthropometric outcomes (Hedges’ g=−0.35, 95% CI [−0.61,−0.09], p=0.009; I²=0%), with stronger effects for VR-CBT. Long-term follow-up (6–12 months) confirmed sustained benefits (g=−0.39, 95% CI [−0.73,−0.05]). Within-group pre–post analyses consistently showed reductions in BMI and weight (g=−0.56).

Eating Disorders: VR-CBT consistently reduced body image disturbance and fear of weight gain, while VR cue-exposure therapy decreased binge-eating and purging behaviours. Eye-tracking measures revealed attentional biases toward disorder-relevant cues. Autonomic markers (heart rate, heart rate variability, skin conductance), endocrine biomarkers (cortisol, α-amylase, leptin), and enzymatic measures confirmed that VR reliably elicited measurable psychophysiological responses.

Immersive VR interventions show promise for improving clinical outcomes and eliciting measurable biomarker changes in obesity and EDs. Evidence supports VR-CBT for sustained anthropometric improvements and highlights VR’s potential for investigating autonomic and neurocognitive mechanisms. Larger, biomarker-integrated RCTs are needed to confirm efficacy and inform personalized, mechanism-driven treatment approaches.

Psychiatric consultations often involve emotionally challenging discussions that can be difficult for patients. In the event where tissue boxes are not available on hand, this can lead to interruptions and negatively impact patient engagement. The immediate availability of tissue boxes in clinic rooms is a simple yet powerful tool to achieve compassionate care and build rapport. As far as we are aware, there is no policy regarding this practice within our trust which is highly variable between sites. The immediate aim of the audit is to assess the availability of tissue boxes in psychiatric consultation rooms in a predefined week across three different community bases and to compare results to a consensually agreed set gold standard of 100% availability. The broader aim was to then evidence improvement in practice following a therapeutic intervention with a view to sustain good practice moving forward

A cross-sectional evaluation was conducted across three outpatient psychiatric settings during a predefined one-week period. Each clinic room was visited once, and the presence or absence of a tissue box was recorded. The evaluation was conducted against a set gold standard of 100% tissue box availability in all rooms. Results were analysed and as an intervention these were disseminated to relevant site managers with a recommendation to ensure all rooms are stocked with tissues. A re-audit was then conducted to assess improvement and compliance with our set gold standard.

A total of 33 clinic rooms across the different locations were assessed. Initially, it was found that 10/12 clinic rooms had a positive result (presence of tissue box in the room) in location (1) which equals an estimate of 83.4%. This result remained the same post intervention. For location (2), 8/9 clinic rooms (88.9%) had a positive result, and this also remained the same post intervention. It was found that location (3) had the lowest rate of positive results with only 5/12 rooms prior intervention (50%). This was reduced to 41% post intervention.

Whilst there are baseline differences between sites, the overall results evidenced good practice. The marginal improvement would suggest the need for a more robust intervention to produce consistent change across sites. The presence of tissue boxes in clinic rooms is likely to have a significant impact on positive patient experience. Therefore, moving forward, we hope to assess this practice across all HPFT and incorporate a policy guidance to ensure compliance.

To evaluate the implementation of autism and ADHD assessments within the Swansea Bay community perinatal team and mother and baby inpatient unit in South Wales, focusing on service outcomes and patient and staff experiences.

Perinatal inpatients and outpatients assessed for ADHD or autism from Feb 2024–Aug 2025 were identified. Assessment outcomes were captured, and all 22 patients were invited to provide feedback on experience and impact. MDT members from inpatient and community perinatal services also provided perspectives. Thematic analysis was applied to all responses.

Quantitative: Of 867 screened perinatal cases, 22 underwent assessment (7 inpatients, 15 outpatients). Among inpatients, 6 met diagnostic thresholds (4 autism, 2 ADHD); all 15 outpatients met thresholds (13 autism, 2 ADHD).

Qualitative: Feedback from 12 staff members highlighted that diagnosis improved patient self-advocacy and family relationships but reported gaps in post-diagnostic support, leavingpatients to interpret their diagnosis independently. Staff also noted the need to adapt practice and interventions for neurodivergent patients. Feedback also highlighted the need for internal gatekeeping to prevent oversaturation of the service and to avoid the service being used solely as an alternate pathway for quicker ADHD/autism diagnosis. Patient feedback (n=11) described benefits of validation, self-understanding, and stronger family relationships, praising the compassionate and personalised care received. Two patients highlighted the need for structured aftercare and follow-up.

Findings suggest a particular need for neurodivergence assessments during the perinatal period. Patient and staff feedback consistently reported improved self-understanding and family relationships but highlighted post-diagnostic gaps in support and aftercare, underlining areas for service improvement. This evaluation has highlighted the need for further development of the pathway for neurodivergence within the perinatal population ensuring the service provided is sustainable and adapted to meet patients’ needs.

The primary aim was to assess the quality of recording mental capacity assessments by the Chesterfield MHLT to ensure compliance with legal and ethical obligations. The audit aimed for 100% documentation of capacity assessments during all mental health reviews. Additionally, the project targeted a minimum Grade 2 standard (moderate detail) in documenting the four functional stages of capacity for all patients, ensuring that narrative and context regarding a patient’s capacity component were thoroughly recorded.

A retrospective review of 30 randomized electronic patient records (electronic system) was conducted for the Chesterfield MHLT for cases identified between January and February 2025. Data was analysed to determine the presence of broad capacity assessments and, crucially, to evaluate the quality of documentation regarding the four functional stages: Understanding, Retaining, Weighing-up, and Communicating information. A standardized grading scale (Grade 0-3) was utilized to measure the depth of narrative and the presence of direct patient quotes in the documentation

While a broad assessment of capacity was recorded in 90% of cases, the documentation quality regarding specific domains was inadequate. Only 37% of cases explicitly documented the specific decision being assessed, such as consent to medication or admission, representing a critical gap in compliance. Furthermore, the detailed assessment of the functional stages frequently failed to meet the required standard. For the functional domains of “Understanding” and “Communicating,” 50% of cases showed no evidence (Grade 0) of documentation. Similarly, 40% of cases showed no evidence of documentation for “Weighing-up” information, highlighting a significant discrepancy between broad capacity recording and the required detailed documentation of the assessment process

This audit highlights that while capacity is often broadly recorded, the specific, detailed assessment of how patients understand, retain, weigh up information, and communicate their decisions is frequently absent or insufficient. To enhance compliance, we recommend integrating mandatory MCA forms into the core assessment template on electronic and enforcing explicit, decision-specific documentation. A re-audit is planned in six months to measure the impact of these changes on documentation quality and patient autonomy.

The primary aim of this project was to assess the current knowledge and confidence levels of medical employees regarding the management of transgender patients within the Kent and Medway Mental Health NHS Trust (KMMH). Against a background of recent legal changes and scarce guidelines, we hypothesised that despite likely clinical exposure to this demographic, staff confidence and awareness of specific policies would be low. The results are intended to drive the development of a dedicated Trust policy and training curriculum.

This project was designed as a service evaluation utilising an anonymous electronic questionnaire distributed to medical staff by the medical education team. The survey consisted of five questions addressing clinical experience, self-reported confidence, training history, and awareness of gender reassignment processes and relevant guidelines. Qualitative data were also collected through free-text comments. Data collection and analysis focused on quantifying the gap between patient contact and provider preparedness.

A total of 43 completed responses were received from over 300 medical staff. The data revealed that while the vast majority of staff (83.7%) had been involved in the care of transgender patients, confidence remained low. Only 41.9% of respondents felt “quite confident” managing these patients in a mental health setting, with 58.1% reporting they were “not confident”.

Gaps in education and governance were prominent. Eighty-six per cent (86%) of respondents stated they had received no training in the management of transgender patients. Furthermore, 60.5% were unaware of current gender reassignment processes in the United Kingdom (UK), and 79.1% were unaware of any national guidelines or hospital policies regarding healthcare for this group. Qualitative feedback supported these figures, with staff requesting specific training on pronouns, legal frameworks, and “user perspectives” from the trans community.

The audit demonstrates a significant disparity between the high frequency of clinical contact with transgender patients and the low levels of staff training and confidence. The widespread lack of awareness regarding existing guidelines indicates an urgent need for the formalisation of Trust policies and the implementation of targeted educational workshops. Improving staff knowledge is critical to mitigating risk and ensuring effective, respectful care for transgender service users.

Individuals with severe mental illness experience a disproportionate burden of oral disease. Contributory factors include medication-induced xerostomia, cognitive deficits, and impaired motivation for self-care. Studies found that they are significantly less likely to engage in preventative dental behaviours or utilize services. Inpatient admission provides an opportunity to engage our service users in promoting their oral hygiene. Hence, an audit can provide valuable insights into current practices and identify areas for improvement and highlight gaps in service provision.

The study was conducted between April to May 2025 across inpatient mental health units within Derbyshire Healthcare NHS Foundation Trust. Electronic patient records were reviewed to assess completion of the ‘Eating, Drinking and Oral Health’ questionnaire and the standardized oral health risk assessment during their admission. The audit also examined the prevalence of documented dental issues and access to dental services. A structured data collection tool was developed to capture sex, gender, ward type, documentation of oral health assessments, completion of dental screening questionnaires and risk assessments, identified oral health issues, and access to dental care during their admission. Trust inpatient policy requires all inpatients to receive a comprehensive physical health assessment including oral health examination on admission, and dental hygiene included in ongoing nursing care reviews.

A total of 114 patients were included in this study, from acute working age (n=40), older adult (n=34), low-secure forensic (n=20), and rehabilitation ward (n=19), with a mean age of 53.6 years. 72/114 were male. Although the “Eating, Drinking and Oral Health” questionnaire was partially completed for 61.4% (n=70/114), full compliance was not achieved for any patient. Formal oral health examinations were recorded for only 10.5% (n=12/114), with the lowest rates observed in the forensic unit (0%). Notably, no patients had a completed oral health risk assessment. Of the 30 patients who presented with acute dental issues during their admission, 18 successfully accessed professional dental care, though access rates varied significantly between ward types with the service users in the forensic ward among the highest.

The audit demonstrates that current monitoring and documentation practices of oral hygiene in our local trust requires improvement. Immediate interventions should focus on increasing awareness, optimizing the accessibility of relevant assessment tools, and implementing clinical prompts to improve documentation quality. Long-term strategies must prioritize the integration of oral health into multidisciplinary care planning and the establishment of formal referral pathways with community dental providers to ensure holistic patient management.

Erotomanic delusions involve the fixed false belief that another person (often of higher social status) is in love with the individual. Although rare, erotomania is clinically significant due to its association with stalking, harassment, and, in some cases, serious violence. Risk assessment framework deficits have contributed to fragmented understanding of factors associated with violent escalation. Existing evidence is largely confined to case reports and case series, limiting systematic synthesis of clinical and contextual risk factors. This scoping review aimed to synthesise published case-level evidence on erotomania associated with stalking and/or violent behaviour. The primary objective was to identify individual, clinical, and contextual factors linked to stalking or violence in people with erotomanic delusions. Secondary objectives were to describe the nature and severity of violence and to identify gaps in the literature.

A literature search was conducted in January 2026 using six databases. Eligible publications included case reports, case series, and observational or qualitative studies describing erotomanic delusions in connection with stalking or violence. Data were extracted using Covidence capturing sociodemographic, clinical and criminological factors. Results were synthesised descriptively and reported as frequencies and percentages overall and by sex. Fifty publications comprising 87 cases were included.

The sample included 51 males (58.6%) and 36 females (41.4%), with a mean age of 36.0 years (SD 11.7). Most individuals were single, socially isolated and had unstable living arrangements. Erotomanic delusions were most commonly described in the context of a primary diagnosis of a psychotic illness (90.8%). Co-occurring delusional themes were common, particularly referential, persecutory, and grandiose delusions.

Stalking was reported in 88.5% of cases, typically involving a single object. Victims were predominantly female (64.5%) and most often professionals (e.g. clinicians, employers). Violence occurred in 49.4% of cases, with males significantly more likely to perpetrate severe violence. Common motivations included delusional beliefs of reciprocated love and perceived rejection. Criminal charges arose in over half of cases, particularly among male offenders.

Erotomania associated with stalking and violence represents a high-risk clinical and forensic phenomenon. The literature remains dominated by descriptive reports underscoring the need for structured risk assessment approaches, clearer diagnostic guidance, and targeted management strategies to prevent escalation and harm.

Autism spectrum condition (ASC) remains underdiagnosed in adults, particularly among women and individuals from marginalised and inclusion health groups. Contributing factors include masking, cultural stigma and inequities in service design. Skylight Psychiatry is an adult neurodiversity assessment service delivering NHS-commissioned and self-funded care through a hybrid diagnostic model, combining face-to-face ADOS-2 assessments with virtual clinical assessments and developmental history appointments. Although a range of reasonable adjustments and neuroaffirmative practices are embedded within the service, a formal evaluation of equality, diversity, and inclusion had not previously been undertaken.

This audit evaluates the inclusivity of an adult autism assessment service by analysing patient demographics and systematically reviewing assessment pathways, policies, and accessible information to identify strengths and areas for improvement.

A mixed-methods service audit was conducted. A voluntary demographic questionnaire was distributed to prospective referrals across two geographical cohorts, with quantitative findings compared against UK population demographics. A structured qualitative review examined policies and procedures, assessment pathways, and neuroaffirmative clinical practice and report writing. This was benchmarked against NHS inclusion health principles, NICE guidelines, and inclusive communication principles.

Quantitative findings demonstrated strong representation of women, gender-diverse individuals, and LGBTQIA+ patients compared with national averages, consistent with emerging literature on adult autism and camouflaging. Demographical representation from some ethnic minority and religious groups was lower than expected, suggesting potential cultural or systemic barriers to access. The qualitative review identified strengths in flexible, patient-centred assessment delivery and consistent neuroaffirmative approaches across appointments. Suggested areas for improvement included suggested evaluation of physical accessibility across clinic sites and consideration of the risks of digital exclusion. Findings suggested that there was some inconsistent use of inclusive language in some clinical documentation, which may be mitigated by the introduction of specific training centred around increasing inclusion and reducing potential diagnostic bias.

This audit demonstrates that a hybrid adult autism diagnostic model can support inclusive and patient-centred care when underpinned by reasonable adjustments and neuroaffirmative practice. However, disparities in access persist for some marginalised groups. It was suggested that the service should prioritise improving equality through the introduction of interventions, such as accessible correspondence, easy-read materials, and translated online content, alongside targeted workforce development. These recommendations are likely to improve access and mitigate adverse outcomes associated with delayed or missed diagnosis.

The aim of this audit is to assess compliance with physical health monitoring for patients admitted in an acute inpatient setting including weight, height, BMI, waist circumference. Also to assess if metabolic risk factors have been identified and whether appropriate risk mitigation measures were taken.

This is a retrospective audit design where electronic patient records of patients admitted in an acute inpatient unit between November 2024 and August 2025 were reviewed. Information was extracted to determine whether physical health monitoring including weight, height, BMI, waist circumference was completed at baseline (on admission), at 4 weeks, 8 weeks, 12 weeks and subsequently every 3 months. Data was only collected for the duration of the inpatient stay.

Drug charts were reviewed to see whether any changes were made to the treatment regime while inpatient. Discharge summaries were also reviewed specifically the section titled “Plan and Requested Actions” to determine any advice and follow up recommendation were made.

100 patients were admitted in the ward between November 2024 and August 2025. Waist circumference was not measured during the whole length of stay for any patient.

Base line weight was not recorded in 12 patients, height was not recorded in 14 patients. BMI was not calculated for 15 patients.4 patients were not on any psychotropic. Unclear documentation about medication for 3 patients.

37 patients were discharged/transferred before 4 week review.Among the remaining 63 patients, weight was not recorded in 21 (33.33%) patients, height was not recorded in 22 (34.9%) patients. BMI was not calculated in 23 (36.5%) patients. 2 patients didn’t have any psychotropics prescribed.

By 8 weeks, 30 patients were discharged/ transferred. Among the remaining 33 patients,weight was not recorded in 13 (39.39%) patients, height and BMI was not recorded in 14 (42.42%)patients. No psychotropics were prescribed for 1 patient

By 12 weeks, 15 patients were discharged/transferred. Among the remaining 18 patients, weight, height and BMI were not measured in 7 (38.8%) patients.

Before 3 monthly monitoring review point, 13 patients were discharged. Among the remaining 5 patients, weight was not monitored for 1 (20%) patients. 2 (40%) patients didn’t have their height and weight measured.

35 patients had documentation regarding their metabolic risk factor. No patient had clear documentation regarding action taken to mitigate these risks.

This audit shows the need for consistent weight monitoring and implementing a structured traffic-light risk category system to enable early identification and management of antipsychotic-induced weight gain.

Seclusion is highly restrictive and is a last resort to manage immediate risk of harm towards others. Therefore it requires high quality medical reviews and clear documentation to ensure patient safety.

• • To assess compliance with local trust standards for medical seclusion reviews in a inpatient mental health unit (Meadowbrook Unit, Salford, Manchester)

• • Evaluate the impact of quality improvement measures through an re-audit.

Trust policy outlines eight core review criteria: assessment of physical and psychiatric health, medication and adverse effects, observations, risks to others and to self, and the ongoing need for seclusion. This is alongside two best-practice criteria addressing harms of seclusion and steps required to end it/patient awareness.

Quality improvement measures(local teaching/presentations, communication to line managers, and a poster of trust standards in clinical areas) were implemented after an initial audit in July 2024. The re-audit was conducted in March 2025.

A retrospective audit of medical seclusion reviews was conducted using electronic clinical records within an inpatient mental health unit. Forty seclusion reviews from July–August 2024 were analysed against local trust seclusion review criteria. A re-audit of 56 seclusion reviews conducted between March and June 2025 was then undertaken to assess changes in practice.

The re-audit demonstrated higher quality seclusion reviews. No reviews met all eight criteria in 2024, but seven reviews did in 2025. The most common number of criteria met for each review increased from one criterion in 2024 (n=9) to four or five criteria in 2025 (n=12).

Documentation improved overall, including physical health (70% to 82%), psychiatric health (40% to 66%), and medication side effects (0% to 19%). Also, assessment of harms associated with ongoing seclusion improved (2% to 14%). Small declines were found in documentation of the decision to continue seclusion (97% to 91%) and steps to end seclusion or patient awareness (25% to 23%).

Limitations:

The 2024 audit had a smaller sample size (n=40) which was increased in the re-audit (n=56). The 2024 audit was also conducted shortly after a new doctors rotation. Patient sleep status(n=12), senior-led reviews (n=10), and undocumented reviews (n=3) in 2025 may have influenced findings however all reviews were included in the analysis.

The re-audit demonstrated improvement in patient safety through higher quality of documented medical seclusion reviews. There was an improvement in assessment of physical and psychiatric health, medication, and risk assessment. Minor reductions were observed in documentation of decisions to continue seclusion and steps to end seclusion/patient awareness.

Further re-audit across other trust sites should occur with measures to address undocumented reviews and asleep reviews. There should be continued integration of seclusion standards into doctor induction programmes and regular local teaching.

This re-audit shows low-cost, targeted interventions can improve patient safety and seclusion review quality which is transferable to other inpatient mental health settings.

This study evaluated the efficacy of an immersive Acceptance and Commitment Therapy (ACT)-based intervention in reducing subclinical depressive, anxiety, and obsessive–compulsive symptoms in medical students at Cardiff University.

A quantitative within-subjects repeated-measures design was employed using a single-group pretest–post-test approach. Participants completed baseline measures of obsessive–compulsive (OCI-R), anxiety (GAD-7), and depressive (PHQ-9) symptoms prior to engaging with the immersive ACT intervention, and the same measures were repeated post-intervention. Participants were recruited via the medical school’s student support unit and through advertising across all years of the undergraduate medical programme.

Seventeen participants completed all study components. No significant pre–postdifferences were observed on the total OCI-R, GAD-7, or PHQ-9 scores. However, subscale analyses revealed a significant reduction in the neutralising dimension of the OCI-R following the intervention (z=−1.941, p <0.05). Post-intervention differences were also identified between participants with high versus low depressive symptoms (PHQ-9), specifically in obsessional symptoms (z=−2.298, p <0.05). In addition, participants with high versus low anxiety scores (GAD-7) demonstrated a significant reduction in ordering symptoms post-intervention (z=−2.179, p=0.029).

Although no significant changes were observed on overall measures of obsessive–compulsive, anxiety, or depressive symptoms, targeted reductions were evident in specific symptom dimensions following the immersive ACT-based intervention. These findings suggest potential symptom-specific benefits for medical students with elevated obsessive–compulsive, depressive, and anxiety traits. While limited by a small, subclinical sample, the results support further investigation of immersive ACT interventions in larger and clinical populations.

This audit aimed to review patterns of psychotropic prescribing within a community LD psychiatry service in Caerphilly, focusing on medication type, dosage, documented clinical indication, and trends in medication change over time.

Psychotropic medications play a central role in the management of mental health conditions among individuals with Learning Disability. However, their use in this population requires careful consideration due to increased vulnerability to adverse effects, polypharmacy, and challenges in monitoring efficacy and safety. National guidelines, including those from NICE and the Royal College of Psychiatrists, emphasize the importance of regular review, clear documentation of indications, and adherence to best practice standards to minimize inappropriate prescribing.

A retrospective review of clinic and home visit letters for all patients seen by the community LD psychiatry service during the audit period was undertaken. Data were collected by 3 doctors on level of LD, presence of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), psychiatric diagnoses, psychotropic medications prescribed, antipsychotic dose expressed as a percentage of the British National Formulary (BNF) maximum, and medication changes over the audit period.

A total of 117 patients were included. 114 (97.4%) were prescribed at least one psychotropic medication. 77 patients (65.8%) were prescribed antipsychotics, mostcommonly risperidone (n=37). Antipsychotic doses ranged from 1.5% to 100% of the BNF maximum, with 47 patients (61.0%) prescribed doses at or below 25% of the maximum.

A clear mental health diagnosis supporting antipsychotic use was documented in 23 of 77 patients (29.9%), while behaviours that challenge were documented in a further 15 patients (19.5%). No clear indication for antipsychotic prescribing was recorded in the remaining 39 patients (50.6%). Antidepressants were prescribed to 44 patients; anxiety or depressive disorders were documented in 16 patients (36.4%), while 8 patients (18.2%) had no documented indication.

Over the audit period, psychotropic medication remained unchanged in 57 patients (48.7%), increased in 27 patients (23.1%), reduced in 23 patients (19.7%), and switched or cross-titrated in 6 patients (5.1%).

This audit demonstrates high rates of psychotropic prescribing within a community LD caseload, with substantial gaps in documentation of clinical indication, particularly for antipsychotic and antidepressant use. Although some medication reduction occurred, increases were more common than reductions. Improved documentation, structured medication review processes, and multidisciplinary approaches are required to support safe prescribing and align practice with national guidance.

Tier 4 CAMHS general adolescent inpatient services are required to monitor clinical outcomes using measures including CGAS, collected on admission and at discharge. This audit aims to evaluate the completeness of CGAS recording at admission and discharge, and describe CGAS distribution for young people admitted to a general adolescent inpatient unit over a nine-month period.

Data was collected over a nine-month period (30/01/2025 to 30/09/2025), giving n=50 admissions for analysis. Inclusion criteria was all completed admissions within the audit period, and exclusion criteria was any entries where the episode was incomplete or duplicated. For each admission, presence/absence of CGAS at admission, presence/absence of CGAS at discharge, CGAS score at admission (banded into 10-point ranges), and CGAS score at discharge (similarly banded) were extracted from patients’ admission forms and discharge summaries on MORSE healthcare electronic data.

CGAS was recorded on admission for 39/50 admissions. The admission CGAS completion rate of 78.0% did not meet the local target of ≥90%. CGAS was recorded on discharge for 29/50 admissions. The discharge CGAS completion rate of 58.0% was well below the local target of ≥90%. 56% had admission CGAS scores in the 31–40 band, indicating marked impairment in functioning. 16% scored 21–30, and 4% scored 11–20, reflecting very severe impairment. By discharge, a greater proportion of young people had scores in the 41–50 and 51–60 bands, and a small number reached 61–70 and 71–80, suggesting improvement in functioning for those with recorded scores. However, because discharge CGAS was missing or “TBD” for almost half of the sample, these figures may over-represent young people whose episodes were more complete or stable at discharge.

Where recorded, CGAS distributions indicate clinically meaningful improvement in functioning from admission to discharge, but missing discharge data in 21/50 cases weakens the ability to demonstrate outcomes for the whole cohort. Going forward, the Information Officer will routinely check discharge summaries (where no CGAS score is included, the author will be contacted) and the Medical Secretary will only accept discharge summaries that include a completed CGAS, querying any summaries where this is missing. A re-audit will be undertaken for all eligible admissions from 10/2025 to 02/26, using the same criteria and targets to assess whether CGAS completion at admission and discharge has improved towards or beyond the ≥90% threshold.