Psychotic symptoms occurring in the context of severe hypothyroidism, contemporarily referred to as myxedema psychosis (MP), have been described in numerous case reports. To date, no systematic primary research studies have been conducted to characterize MP within psychiatric inpatient populations.

We aimed to identify cases of MP using administrative data, determine its prevalence among first psychiatric admissions for psychosis, examine outcomes including risk of readmission, and explore the effect of antipsychotic treatment.

We conducted a retrospective cohort analysis, using provincial administrative databases, of patients admitted for first-presentation psychosis between January 1, 2012, and March 31, 2022. Cases of MP were defined by elevated thyroid-stimulating hormone (TSH) at admission across thresholds of ≥40, ≥60, and ≥80 mIU/L, with analyses repeated excluding patients ≥60 years of age. Patients with a first psychiatric admission with psychosis and normal TSH were used as controls. Cox proportional hazards models were used to compare hazards of readmission. Within the MP cohort, we examined the association of antipsychotic treatment with readmission risk.

The results of survival analyses using different TSH thresholds (with or without an age threshold) are shown in Table 1. At a TSH threshold of ≥60 mIU/L and age <60, MP cases had a significantly reduced hazard of readmission compared with controls. Using this threshold, we identified 28 MP cases, representing a prevalence of 0.12% of first psychiatric admissions for psychosis. Within the MP group, 13 of 28 patients were prescribed antipsychotics three months post-discharge. A non-significant trend was observed suggesting that antipsychotic use was associated with reduced readmission rates.Table 1.

Cox models of psychosis group with TSH and age conditions.

This study represents the first systematic characterization of MP within a psychiatric inpatient population. Our analysis suggested that there is a significant difference in 12-month readmission rates for cases of potential MP compared to matched controls when using criteria of TSH ≥ 60 mIU/L and age < 60. Our findings support preliminary criteria for defining MP and suggest that antipsychotics may help protect against readmission in these cases. Further research is needed to validate diagnostic thresholds and clarify optimal management strategies.

None Declared

Poor sleep quality is commonly reported by people regularly taking opioid agonists, usually in the context of chronic pain management or as substitution therapy for opioid-use disorder. This may be explained by pharmacological effects of the opioid itself (including respiratory depression and changes in sleep architecture) or by confounding factors including chronic pain, polysubstance misuse, personality traits and co-occurring mental and physical ill-health. Poor sleep quality predicts a poor quality of life, worse mental health, higher average opioid dose, relapse into recreational opioid use, and is a barrier to opioid discontinuation. Improving sleep quality for people regularly taking opioid agonists is therefore a clinical priority.

This systematic review aims to synthesise the evidence on the efficacy of interventions to improve sleep in people regularly taking opioid agonists.

This review was prospectively registered (PROSPERO: CRD42023464386). Structured searches for interventional studies among adults on a stable dose of an opioid agonist were conducted up until July 2025 in multiple databases. Single case reports were excluded, as were people with solely recreational use. Only studies using validated sleep measures were included. Study quality was assessed with standardised risk of bias tools, and unreported data was sought systematically from authors. Meta-analysis was conducted where 3 or more studies examined comparable interventions on comparable populations.

A variety of interventions ranging from treatments recommended for insomnia in the general population such as Cognitive Behavioural Therapy for Insomnia and sedating antidepressants, to herbal treatments and Chinese traditional medicine procedures were included. There were a great number of incomparable trialled interventions, albeit some of which are well conducted large randomised trials, with a small evidence base for each. Meta-analysis suggests trazodone may be a promising intervention. Overall, the evidence of specific treatments for sleep disturbance in opioid users is weak. There may be a more prominent role for psychological and social interventions such as CBT-I and peer activity groups to avoid adverse pharmacotherapy effects.

Given the high prevalence and impact of sleep disturbance in opioid users, future high-quality studies in this area are needed. There is only preliminary evidence to support the use of a range of pharmacotherapies, switching to buprenorphine based substitution therapies, psychosocial interventions or traditional medicine procedures to improve sleep disturbance in regular opioid users.

None Declared

To identify and characterise active national illicit drug use sentinel surveillance systems worldwide.

We conducted a scoping review to identify and characterise active sentinel surveillance systems for illicit drug use worldwide. Inclusion criteria: 1) articles describing or analysing data from sentinel networks with an established national scope, 2) supported by public agencies, and 3) data accessible via online repositories. We excluded articles on networks which did not have drug surveillance as their main designated objective.

Ten sentinel surveillance systems targeting recreational drug use at the national level were identified. Even though each has its own structure and functionality, they are often integrated in larger surveillance programmes. Although health professionals in emergency departments are the main informants, some systems also include information directly from people who use drugs or from community stakeholders. Systems also varied in their operational characteristics, including reporting frequency and methods used to disseminate findings.

Having similarities, awareness of these different characteristics makes it possible to improve the design of surveillance systems directed towards illicit drug use monitoring and surveillance.

Cognitive Behavioural Therapy-Ten (CBT-T) offers a briefer manualised approach to treatment of non-underweight eating disorders (EDs) compared with traditional therapy models, and has the potential to help services deliver timely access to care. This study evaluated CBT-T outcomes in a naturalistic setting, with a focus on session-by-session change patterns.

A total of 151 young adults received CBT-T in a no-threshold-to-access community ED service. Symptom trajectories were assessed using the ED-15 global scale and subscales (eating concern, weight/shape concern). Using intent-to-treat principle, linear mixed-effect models evaluated treatment effectiveness, and chi-squared and receiver operating characteristic (ROC) analyses explored associations between early symptom change and end-of-treatment remission.

Treatment led to significant reductions in ED symptoms and psychosocial impairment, with large effect sizes. Reliable improvement in Weight/Shape Concern – but not Eating Concern – on ED-15 at session 4 significantly predicted ED symptom scores below the clinical cut-off at the last session.

CBT-T is effective in reducing ED symptoms in young adults with non-underweight EDs. While engagement and progress prior to session 4 have been used to guide treatment planning, as stated in the treatment manual, only the change in weight/shape concern at session 4 appeared to be strongly predictive of outcome in this sample, whereas change in eating concern did not. Early changes in weight and shape concerns at initial sessions may be informative in predicting treatment outcome. The findings can support the future development of CBT-T and other brief ED interventions.

Promethazine is a phenothiazine compound first synthesised in the 1940s, with prominent sedative qualities. As a first-generation antihistamine, promethazine has strong affinity as an antagonist of H1histaminergic receptors of the tuberomammillary nucleus, as well as moderate antagonism of muscarinic cholinergic receptors, and weak-moderate affinity to receptors in the serotonergic, dopaminergic, adrenergic and glutaminergic systems. While in the UK promethazine is publicly available ‘over the counter’, it is not recommended by NICE guidelines for insomnia.

We narratively summarise the available evidence for promethazine’s benefit on human sleep outcomes with structured searches, as well as publicly available prescribing trends data from OpenPrescribing and published academic reports.

Promethazine is increasingly prescribed by primary care physicians and psychiatrists in United Kingdom as a treatment for all kinds of sleep concerns, with a near doubling of English GP prescriptions in the past 5 years. There is no good evidence for the clinical benefit of promethazine on sleep outcomes, with an absence of clinical trials or adequate measures of sleep. Use of promethazine as a sleep-aid is actively advised against in international expert consensuses, with evidence based alternatives available including the NICE guidelines’ first-line option, Cognitive-Behavioural Therapy for Insomnia (CBT-I).

For several reasons, it appears that promethazine is not an appropriate treatment for any flavour of sleep problem. First, because there is no clinical trial evidence. Secondly, it is important to remember that sedation is not sleep. These two states of reduced consciousness are different phenomenologically, physiologically, and appear different on EEG recordings. The multiple benefits of natural human sleep cannot be assumed to be achieved by this kind of artificial sedation. Histaminergic antagonism has a very complex pharmacodynamic profile, and psychiatrists cannot expect that there will be linear dose-effects. Third, the addictive nature of promethazine must be acknowledged: there are significant levels of recreational use of promethazine worldwide, in part because of its effects in potentiating opioid agents. Moreover tolerance develops quickly, with diminished sedative effects seen in as few as 3 days. Withdrawal symptoms are common, with rebound insomnia widely reported after long-term use. Finally, the side effect profile of promethazine is of concern including, QTc prolongation, weight gain, and the potent cholinergic effects have a causal effect on dementia. This poster concludes with a summary of alternative approaches for psychiatrists using promethazine in their practice, including CBT-I and alternative, more sleep problem-specific medication options.

Kent and Medway Medical School (KMMS), a new UK medical school, hosted the 2026 National Student Psychiatry Conference. The conference was organised and delivered by a student committee supported by faculty and the RCPsych Choose Psychiatry team. We describe the learning around the planning and delivery of the conference, and consider its wider educational and institutional impact.

A student organising committee was established with defined roles and responsibilities, supported by frequent planning meetings and oversight by faculty and the Choose Psychiatry team. A conference theme and associated social activities were agreed.

Twelve KMMS students from different year groups led the planning and delivery of the conference; roles included programme development, speaker liaison, sponsorship/budgeting, communications, accommodation, and logistics. Clear role allocation and regular meetings supported coordination of a complex project alongside academic commitments. The weekend conference received overwhelmingly positive feedback regarding organisation, atmosphere and session quality from the 103 delegates and 21 speakers (98% overall satisfaction).

Committee members described developing advanced professional communication, project management and leadership skills under time and resource constraints. Learning extended beyond individual task completion to coordinating interdependent workstreams, negotiating priorities, and responding collectively to challenges. They also described gaining practical experience of leadership within a complex system, including budget management, sponsorship planning, using organisational tools (e.g. spreadsheets, booking systems), and real-time problem solving to manage technical and timetabling issues.

Reflecting on this, students identified improvements for future events, including starting external communications earlier, longer breaks between sessions, ordering merchandise further in advance, and greater delegation on the day.

Despite the workload, students found the experience rewarding. Working as a team towards a shared goal, seeing plans come together, and positive feedback generated a strong sense of enjoyment and achievement, alongside practical learning opportunities rarely available within undergraduate medical education.

Medical students can develop meaningful leadership capability when trusted to lead complex, collective projects with appropriate support. Beyond promoting psychiatry, the conference provided experiential learning in systems-based working and medical leadership. For the medical school and RCPsych, the conference raised the profile of psychiatry within undergraduate training and strengthened national connections. Investing in student-led conferences provides a practical way to support engagement with psychiatry and contribute to long-term recruitment and workforce development.

The National Psychiatry Student Conference (NPSC) is an annual student-led conference supported by the RCPsych Choose Psychiatry programme. The 2026 NSPC was hosted by Kent and Medway Medical School. Understanding student perspectives of such enrichment activities is important to inform future conference design and maximise educational impact. This mixed-methods study aimed to examine students’ perceptions of thequality, relevance and impact of the conference, including attitudes towards psychiatry and future career intentions.

All student delegates attending the 2026 NSPC were invited to complete an anonymous post-conference questionnaire including Likert-scale items and free-text responses exploring overall experience, session quality and perceived impact. A purposive sample of respondents was invited to take part in semi-structured interviews to explore experiences in greater depth. Questionnaire data were analysed descriptively, and interview data were analysed using thematic analysis.

Of 103 delegates, 68 students completed the questionnaire and 11 were interviewed.

Questionnaire data indicated positive experiences of the conference overall (98% were satisfied or very satisfied), and of the individual programmed activities, with an average session score of 4.5/5. The most popular sessions included a consultant’s journey through their career and lived experience of mental illness, functional neurological disorder, interactive workshops, and a subspeciality panel Q&A. Ninety percent of respondents reported that the conference had increased their interest in psychiatry as a career.

Interview data aligned closely with these findings. Students described the conference as well organised, welcoming and engaging, and valued opportunities to hear directly from clinicians about career pathways and the breadth of psychiatric practice. Many reported that the conference challenged preconceptions about psychiatry and increased awareness of the range of subspecialties and research opportunities.

For many delegates, this was their first academic conference. Barriers to attendance included travel distance and cost, with subsidised accommodation and low-cost tickets described as important enablers of participation.

This mixed-methods evaluation demonstrates that a student-led national psychiatry conference was experienced as engaging and educationally valuable by attending, self-selecting students, with delegates reporting more positive attitudes towards psychiatry as a career and a deeper understanding of the specialty. Findings also highlighted practical barriers to participation, particularly cost and travel. Overall, the results support the value of student-led conferences within undergraduate psychiatry, and emphasise the importance of accessibility in maximising their impact and reach.