This study aims to explore the experiences of autistic adults who were previously diagnosed with Borderline Personality Disorder (BPD).

This interpretive phenomenological study aims to explore the experiences of autistic adults who were previously diagnosed with BPD. Data were collected using sixty-minute, one-to-one, virtual, semi-structured interviews. The audio-recordings of the interviews were transcribed and analysed using an interpretive phenomenological analysis.

Participants had autistic features since childhood which went unnoticed. Camouflaging, gender and lack of awareness of the spectrum nature of autism had contributed to missing autism in childhood. The commonality of trauma, suicidality and self-harm, in the context of wider systemic issues, resulted in participants receiving a diagnosis of BPD. It was revealed that the diagnosis of BPD was readily given and inappropriately disclosed. This diagnosis was emotionally damaging for participants and highly stigmatising. Treatment for BPD was inadequate, ineffective, and distressing. There were several negative impacts of the BPD label, including diagnostic overshadowing. Participants felt that misdiagnosis is preventable with various measures. Autism diagnoses were difficult to obtain in adulthood, but receipt of one was beneficial for participants in various ways. However, participants felt there was a need for more autism awareness and autism-friendly services.

The BPD label in autistic people can be harmful to their physical, mental and social health. In contrast, an autism diagnosis in adulthood can be beneficial despite the multiple barriers in receiving such diagnosis. Misdiagnosis is preventable by training clinicians, screening risk groups and developing dedicated autism services.

This service improvement project seeks to empower individuals diagnosed with Functional Neurological Disorders (FND) by delivering comprehensive information, facilitating informed choices about their care, and encouraging an active role in managing their health.

Information was gathered relating the concerns and expectations of FND patients upon receiving a diagnosis or attending the neuropsychiatric clinic at a regional neuroscience centre. The identification of a patient information leaflet as a valuable resource became apparent. Consequently, a meticulously designed leaflet was developed to educate patients about their condition, providing useful tips and resources. The content of the leaflets underwent a thorough series of reviews, incorporating input from various professionals within the multidisciplinary team, with additional consideration given to feedback from service users. To assess the impact of this intervention, feedback is required from both clinicians and end-users.

The patient information leaflet contains information designed to enlighten patients about their condition, incorporating psychoeducational content on self-help strategies and available treatment modalities. It also highlights support resources available to them. The leaflet can be conveniently stored in the neurology and neuropsychiatric clinic areas for easy clinician access and distribution to relevant patients. Additionally, it is available in PDF format, enabling clinicians to print it in satellite clinics, and medical secretaries can email it to patients along with clinic letters as directed by the clinicians. Initial feedback from patients and clinicians has been overwhelmingly positive, with many considering it an essential intervention.

This service improvement, realized through a relatively modest intervention, can lead to a substantial impact on patient care and satisfaction. Providing patients with pertinent information is crucial for fostering informed decision-making and empowering them to take an active role in their care. Especially for conditions historically stigmatized and misunderstood, it is imperative to disseminate up-to-date information, establishing a reliable and endorsed source to dispel stigma for both patients and their families.

Aim: The quality improvement (QI) project aimed to improve the response rate of teaching feedback from medical students at Queen Mary University of London (QMUL). Background information: Universities and health care settings use students' feedback to improve the teaching and other services. The feedback is a valuable source to evaluate a service delivery and improvement. Following the COVID-19 pandemic a large majority of teaching switched to being held online. Feedback plays an important role in evaluating these new methods of teaching. However, response rates were noted to be low. This QI project aims to improve the response rate from students.

The project was registered on LifeQI and carried out during the psychiatric teaching for 4th year medical students at QMUL. The team emphasized the importance of feedback to students and produced online feedback forms which are mobile-friendly and concise. These were provided to students immediately after lectures and in an email reminder. As a change idea, five multiple choice practice questions from the topics of the day were included as a follow-on activity from the feedback form, with the expectation that this would motivate the students to complete the feedback. The response rate was calculated as a percentage (number of responses/number of attendees x 100%) and compared before and after the change was introduced using the independent t-test.

Introducing practice MCQs at the end of the feedback form resulted in a significant improvement: the response rate increased from 22.3% to 50%, more than doubled. The independent t-test found a significant increase in the number of feedback forms returned from the original rates (M = 13.8, SE = 3.0) to rates after practice questions were introduced into feedback (M = 30.6, SE = 1.7), t= -4.9 p = 0.001.

Students’ motivation to complete feedback plays a major role in the response rate of medical students’ feedback at QMUL. Adding five MCQs on the topics of the day to the feedback form has significantly increased the response rate of 4th year medical students at QMUL. This project was limited to 4th year medical students who received online psychiatric lectures. It is important to try other change ideas in future in order to compare the outcomes.

To establish whether our practice is meeting NICE and Maudsley guidelines in establishing baseline prolactin levels in an inpatient set-up before starting treatment with antipsychotic medications with a medium or high-risk of causing hyperprolactinaemia.

Data were collected retrospectively from case notes of 127 patients from 9 wards at Surrey and Borders Partnership NHS Foundation Trust (SABP).

We reviewed if the baseline prolactin was measured for inpatients before commencing on antipsychotics with medium or high risk of hyperprolactinemia.

We reviewed if patients with elevated prolactin levels were assessed and managed appropriately.

SABP is currently achieving 43% in recording serum prolactin levels for inpatients who are on antipsychotics with medium or high-risk of hyperprolactinemia respectively.

Inpatient ward 76 patients out of total 127 were on antipsychotics with medium to high-risk of developing hyperprolactinemia.33 patients had their serum prolactin checked bringing the compliance to 43%,2 patients were excluded due to incomplete data bringing the sample size to 31.

3 had elevated prolactin. Out of 3 patients,1 patient was managed appropriately with MRI brain, followed by change of antipsychotic medication and repeat prolactin levels. For 1 patient, prolactin

level was rechecked. Unfortunately, no documentation of assessment of symptoms of hyperprolactinemia was found in all three patients case notes.

The trust is falling short of meeting NICE and Maudsley guidelines of monitoring prolactin level. It is possible to introduce a robust system within the Trust so that we are complaint with a NICE and Maudsley prolactin monitoring guidelines.

We need to local Trust guidelines for management of hyperprolactinaemia in line with NICE and Maudsley guideline of monitoring prolactin levels.

Safety netting advice and leaflets explaining symptoms of hyperprolactinaemia should be provided to all the patients on antipsychotics with medium to high risk of developing hyperprolactinemia.