Sodium Valproate is widely used in the treatment of epilepsy and is also commonly prescribed for psychiatric disorders, particularly Bipolar Disorder. Enuresis associated with sodium valproate has been reported in paediatric populations with epilepsy, and in a case report involving a paediatric patient with Bipolar Disorder. However, data in the adult psychiatric population remains limited.

This is a case report of a 20 year old gentleman diagnosed with Unspecified nonorganic psychosis. He had a four month psychiatric admission with first episode psychosis, which included 2 months in Psychiatric Intensive Care Unit (PICU). He was initially started on Olanzapine, which was titrated up to 20mg per day, however there was no response. Due to significant aggression, Sodium Valproate was introduced and increased up to 2500mg nocte. Due to lack of response with Olanzapine, antipsychotic medication was initially changed to Haloperidol during which he developed oculogyric crises which necessitated dose reduction. Due to persisting psychotic symptoms, it was changed to Zuclopenthixol. At discharge, he was on Zuclopenthixol depot 350mg every two weeks, Sodium Valproate 2500mg nocte and Procyclidine 5mg three times a day.

During follow up in the community by the Early Intervention Service, he was noted to have extrapyramidal side effects due to which the dose of Zuclopenthixol was reduced and Procyclidine was increased. He also reported nocturnal enuresis every night. There were no other urinary symptoms, and he had not had urinary incontinence or enuresis in the past. Initially, the dose of Sodium Valproate was split to 1000mg in the morning and 1500mg at night with a view to reduce nocturnal sedation, however the symptom persisted. The dose of Sodium Valproate was then reduced to 1000mg twice a day after which nocturnal enuresis resolved completely. During subsequent follow-ups, the dose of Sodium Valproate was reduced further, with a plan to gradually reduce and stop it in the long term. He remained free of psychotic symptoms during the period of follow up, without recurrence of enuresis.

The onset on nocturnal enuresis following initiation of Sodium Valproate, and resolution following dose reduction suggests a possible association between the two. This is in accordance with previous reports indicating enuresis as a dose related side effect of Sodium Valproate.

Nocturnal enuresis is a potentially under recognised side effect of Sodium Valproate. Clinicians should screen for this adverse effect as it may significantly impact quality of life and treatment adherence.

Resident doctor handbooks are a key system-level resource supporting safe, effective working and trainee induction. Within Lancashire and South Cumbria NHS Foundation Trust (LSCFT), variation was identified between the East and Central psychiatry locality handbooks, reflecting differences in site coverage and resulting in gaps in essential information. This inconsistency risked inefficiency, uncertainty, and increased anxiety for new starters. The aim of this quality improvement project was to improve the consistency, accessibility, and reliability of resident doctor information by identifying and addressing variation in handbook content and standardising guidance across the East and Central localities.

A baseline comparison of the East and Central resident doctor handbooks was undertaken to identify missing content, inconsistencies, and areas lacking sufficient detail. Content was reviewed against key trainee domains, including emergency management, risk and legal processes, physical health responsibilities, and routine ward duties. Identified gaps informed a structured programme of handbook revision. Iterative updates were discussed with the Central locality educational lead and reviewed with the consultant body at consultant meetings and within monthly college tutor meetings. Finalised content was reviewed with the East locality educational lead to validate accuracy and ensure parity across both handbooks.

The intervention resulted in a standardised handbook structure and improved content parity across the East and Central localities. Previously missing sections were added to the Central handbook, new clinically relevant sections were introduced to both handbooks, and existing sections were expanded to improve clarity and usability. Updates focused on psychiatric and medical emergencies, management of acute disturbance, risk and legalprocesses, physical health assessment, and practical ward guidance. Positive feedback was received from educational leads in both localities and from the consultant body, alongside informal positive trainee feedback regarding clarity and usability. The revised handbooks were distributed to new starters in August 2025, with planned redistribution to subsequent cohorts in February 2026.

This quality improvement project successfully addressed unwarranted variation in resident doctor handbook content across two psychiatry localities through standardisation and educational lead(s) co-production. Improving the consistency and accessibility of trainee information supports safer working, enhances trainee experience, and reduces uncertainty for new starters. Future work will include extending the intervention to the North locality, incorporating additional clinically relevant content such as venous thromboembolism assessment guidance, and ensuring parity across specialty-specific handbooks, including learning disability and forensic services.

Background

Women admitted to Psychiatric Intensive Care Units (PICU) frequently present with complex trauma histories, emotional dysregulation and heightened sensitivity to coercion, confinement and interpersonal authority. While restrictive boundaries may be required to maintain safety, poorly implemented or inflexible restrictions risk re-traumatisation, escalation of distress and disruption of therapeutic engagement. There is limited literature exploring how boundary implementation itself influences safety and engagement for women in PICU.

Aim

To explore how boundary-related clinical decisions influenced safety, emotional regulation and engagement in women admitted to PICU, and to identify gender-sensitive, trauma-informed approaches perceived by clinicians as helpful in practice.

Methods

A qualitative service evaluation using reflective thematic analysis was undertaken involving three anonymised female PICU admissions detained under the Mental Health Act. Cases were purposively selected to illustrate differing trajectories following boundary implementation: escalation, de-escalation and neutral outcomes. Data were derived from contemporaneous clinical documentation and multidisciplinary team reflections. The evaluation aimed to generate practice-based learning rather than generalisable outcomes.

Direct service-user interviews were not conducted to avoid placing additional demands on patients during acute admission. Findings reflect clinician interpretations of observed patterns of response to boundary setting.

Results

Three key patterns emerged:

Collaborative and relational boundary setting was associated with reduced agitation and improved engagement.

Blanket or rigid restrictions were more frequently linked with trauma re-experiencing, protest behaviours and escalation.

Necessary restrictive interventions, when poorly communicated, negatively affected dignity and delayed therapeutic re-engagement, even when clinically justified.

Gender-sensitive negotiation, preservation of autonomy where safe, and compassionate communication appeared clinically impactful.

Discussion

The findings suggest that in female PICU populations, how boundaries are enacted may be as influential as what restrictions are applied. Trauma-informed, collaborative approaches may mitigate escalation while maintaining safety. A reflective boundary-decision framework is proposed to support proportionality, transparency and restoration of autonomy.

Conclusion

Boundary implementation in female PICU settings has important implications for safety, emotional regulation and therapeutic alliance. Gender-sensitive, trauma-informed boundary practices may support safer care and improved engagement. Future work should incorporate co-produced evaluation and service-user perspectives to strengthen the evidence base.

The aim of the QIP is to reduce the average time between patient discharge and discharge summary completion from the current baseline (10–15 days) to within 7 days post discharge for more than 70% of discharges on Norman and Betts Ward.

We tried to achieve this by ensuring resident doctors have protected time to complete discharge summaries, providing a structured and standardized discharge summary template to improve consistency, and raising awareness among staff regarding the importance of timely discharge documentation to enhance communication with GPs and Community Mental Health Teams.

Baseline data were collected retrospectively between March and June 2025 on the Norman and April and July on Betts acute inpatient psychiatric wards, measuring the timebetween patient discharge and discharge summary completion. Post intervention data were collected prospectively over five months following the introduction of protected time for resident doctors.

An intervention was implemented to improve discharge planning, including protected time for resident doctors dedicated to discharge summaries, and a standardised discharge summary template.

The intervention began in July 2025 on Norman Ward and in August 2025 on Betts Ward, with data collected prospectively as the changes were implemented. The primary outcome measured was the proportion of discharge summaries completed within 7 days of patient discharge. Secondary outcomes included mean completion time of discharge summaries.

Data were analysed using SPSS with appropriate comparative tests. Informal staff feedback was collected to assess acceptability. The project was registered with Oxleas NHS Foundation Trust.

During the post-intervention period, a total of 95 patients were discharged from both wards. Both wards demonstrated a significant reduction in discharge summary completion times. Mean completion time decreased from 11.3 to 3.7 days on Norman Ward and from 15.4 to 6.2 days on Betts Ward. Mann–Whitney U test showed a statistically significant reduction in completion time for both wards (p <0.001).

Post intervention, 80% of discharge summaries on Norman Ward and 66% on Betts Ward were completed within 7 days, compared with 31% across both wards at baseline, demonstrating a marked overall improvement.

After the intervention discharge summary completion times significantlyreduced and increased the proportion completed within 7 days. The intervention is feasible, effective, and sustainable, with plans to initiate protected discharge summary time as routine practice and handover processes to future doctors to maintain continuity and patient safety.

To improve access to menopause healthcare for women with intellectual disabilities (ID) by August 2026 in Oxleas NHS Foundation Trust, by providing education and person-centred services. Objectives were for 90% of clinicians to feel confident in identifying menopause symptoms; perimenopause screening tool implementation; and development of menopause groups for patients and carers with attendees improving by at least one point using Likert scales.

Gynaecologist-led teaching on perimenopause and menopause in women with ID was delivered to Greenwich Learning Disability Team.

A baseline audit established perimenopause screening of women aged over 40 at psychiatric assessments in Greenwich Learning Disability Team. The Greene Climacteric Scale was developed into an easy-read perimenopause screening tool following Plan–Do–Study–Act (PDSA) methodology with patient and clinician collaboration. This tool and a prompt on the Psychiatry assessment template were implemented.

Menopause Groups were developed for women with ID, carers and relatives, using PDSA cycles with patient feedback. Groups addressed physical and emotional symptoms of perimenopause and menopause, treatment options and coping strategies, over three 1.5-hour weekly workshops. Practical activities included menstrual pads, flash cards and mindfulness alongside sharing of experiences.

31 clinicians attended menopause teaching and 100% deemed menopause as relevant to clinical practice with knowledge of perimenopause/menopause in PwID increasing from 9% to 70%. Confidence in discussing symptoms with patients increased from 57% to 80% and awareness of services increased from 17% to 90%. Thematic analysis revealed barriers included embarrassment, lack of knowledge, diagnostic overshadowing and poor patient understanding.

Of the 7 eligible patients from the baseline audit, none were screened for perimenopause, menopause or menstruation status between August 2024–August 2025.

6 patients and 6 carers attended the Greenwich Menopause Group. On a 3-point Likert Scale, all patients improved by >1 point. Knowledge of symptoms increased from 50% to 100% and confidence in getting help increased from 67% to 100%. On a 5-point Likert Scale, carers’knowledge increased from 4.3 to 4.8. Confidence in talking to their patients increased from 4.5 to 4.8. Patients enjoyed visual demonstrations and wellbeing activities, and carers appreciated open discussions and easy-read materials. Multi-disciplinary facilitators felt it was a rewarding and valuable initiative.

Menopause groups, screening and upskilling staff to support women with ID to navigate the menopause has improved the quality of patient care. Collaboration and dissemination of interventions across South East London and North London ID services, Primary Care and Mencap is ongoing to widen access.

To improve awareness, confidence, and engagement in research among psychiatry trainees. Our SMART aim was that by August 2026, at least 75% of trainees would report moderate or higher confidence in research on post-intervention Likert scale questionnaires.

Baseline data were collected using questionnaires distributed to Core (CT1–CT3) and Higher (ST4–ST6) trainees. Measures included awareness of research contacts, understanding of ARCP requirements, current involvement in research, and self-rated confidence. A fishbone analysis identified key barriers across people, process, workload, communication, training, and organisational domains. Stakeholders included Training Programme Directors, research-active consultants, Trust R&D teams, and academic partners. Interventions were designed using QI methodology and driver diagrams.

Interest in research was high across all trainees. However, core trainees demonstrated low awareness of research contacts, processes, and ARCP requirements, with limited active involvement. Higher trainees reported greater awareness and participation but continued to identify barriers including lack of time, mentorship, and clear guidance. Confidence scores were low–moderate in core trainees and moderate in higher trainees.

There is a clear gap between trainee interest in research and actual engagement. System-level interventions focusing on awareness, mentorship, and access to opportunities are expected to improve research confidence and participation. This project aims to foster a sustainable research culture within psychiatry training and support trainees in meeting curriculum and ARCP requirements.

The Medical Education Tariffs paid to healthcare providers to cover the costs of hosting and training medical students on clinical placements are not a direct payment for teaching quality, but a contribution to provider costs. In England, the 2024/25 allocations were set at £34,355 per medical student. Trusts are required to submit annual accountabilityreports to regulatory bodies on the use of this funding. However, accessing these reports or obtaining clarity on their content is very challenging and the quality assurance provided remains poor.

We sent a Freedom of Information request to all the mental health trusts and health boards in the UK and Northern Ireland in December 2025 to explore their management of the undergraduate medical education funding and their adherence to reporting tools in place.

The overall response rate was 89% from 70 trusts and health boards across the four nations that offer psychiatric placements to medical students.

England 87% response.

Wales 100% response.

Scotland 85% response.

Northern Ireland 80% response.

Ringfencing of funding specifically for psychiatric undergraduate education happens in 27% of responders across Scotland, Wales and Northern Ireland and 82% of responders in England.

Specific records on the use of funding are kept in 59% of responders across Scotland, Wales and Northern Ireland and 77% responders in England, but less than 5% were able to provide a full breakdown of costs.

Employment of Clinical teaching fellows was the most consistent use of the funds across the four nations.

Reporting tools are used by 90% of responders in Scotland, Wales and Northern Ireland and 69% of responders in England.

Reports are available for public viewing in just 23% responders in Scotland, Wales and Northern Ireland and 10% of responders in England.

There was significant variation in the use and monitoring of funds between the four nations. All providers need to fulfil their statutory obligation to provide detailed reports to the designated regulatory bodies on their management of the undergraduate education tariff. Effective, transparent management of the education budget is crucial to support the development of the future health workforce as discussed in the NHS 10-year plan. The College Undergraduate Education Forum is setting up a working group to develop guidance on the use of tariffs and will continue to encourage transparency and clarity on the process.

Strangulation is the commonest method of suicide for both males and females, accounting for 56.6% of completed suicide in England and Wales in 2024. The inpatient mental health setting is a high-risk period for suicide attempts and completed suicide. A mental health admission should offer service users a contained environment where potential risks are well managed. However, there is no formal teaching to core psychiatry trainee doctors at East London NHS Foundation Trust regarding managing ligature emergencies on the mental health wards. Therefore the aim of this project was to improve confidence of resident doctors in managing ligature emergencies on inpatient mental health wards.

A 1-hour teaching session on managing ligature emergencies was given to core trainee psychiatry doctors during their weekly teaching afternoon, which included theoretical teaching and a clinical simulation. This was run on three occasions across two sites at East London Foundation Trust. A pre- and post-session questionnaire usinga 5-point Likert scale: 1 (Not confident) to 5 (Completely confident) was formulated and provided to core traineepsychiatry doctors (n=20) to assess confidence across three domains of strangulation management: (1) removing a ligature, (2) an A to E assessment of a person who has tied a ligature and (3) recognising the red flags after a ligature. The self-perceived competence score was calculated as a percentage for each domain.

On average, scores improved by 2.33 (domain 1), 1.3 (domain 2) and 1.58 (domain 3). When we categorised into binary ‘Not confident’ (scores 1–3) and ‘Confident’ (scores 4–5) there was an improvement in confidence by 66.25% in domain 1, 49.6% in domain 2 and 83.75% in domain 3. The improvement between these categories was statistically significant with a p value of <0.05. Only one person had received any prior training regarding ligatures.

This simulation resulted in doctors’ confidence improving significantly in all three domains. This pilot project demonstrates there is a gap in training for doctors and that peer-lead simulation is an effective way to address this. This project is live and we are continuing to complete more cycles of data. With each cycle, we are refining the teaching and the simulation based on the feedback. We aim to integrate the strangulation teaching session into the resident doctor’s induction across all sites, with the plan for regional rollout in the future.

ADHD drivers have up to four times higher risk of being involved in road traffic accidents than other drivers. Symptom severity has some influence on risk but comorbidity, especially for antisocial behaviours and alcohol misuse are strong associations with risk. It seems that ADHD drivers engage in more distracting tasks while driving and there is also an increased risk of sleep-related accidents. ADHD drivers tend to drive faster and it has been suggested that this is a strategy to escape the boredom.

This study tests the hypothesis that those with ADHD choose faster cars and that this may be another factor explaining this group’s higher accident risk. In addition, since those diagnosed with ADHD in childhood are more likely to take up motor sport, which is associated with increased risk of road collisions, this study also looked for an association of ADHD with engagement with motorsport in adult life.

Participants, all employees at an NHS mental health trust, were invited to fill out an electronic questionnaire. A link was included within the weekly Trust newsletter. Questions covered demographic details, ADHD screening (ASRS), depression and anxiety screening (PHQ-4), two questions asking preference, if buying a car, between luxury and sports variants and three questions about motorsport interest. Research department advice, to use the NHS Health Research Authority’s “Is my study research?” decision tool, determined that the survey was not classified as research as results may not be generalisable. Power calculations suggested minimum n of 121.

In total 114 replies were received, 91 were female with a wide spread of age groups. Ninety-eight scored less than 6 on PHQ-4. Of these 27 scored on 4 or more items on ASRS, who were classified as ADHD group. More of the non-ADHD group chose the faster models, in fact for one of the two 31% chose the sportier version compared with only 7.4% of the ADHD group, p<0.05 (Chi squared). There was little difference in motorsport interest between groups. Of the 16 with higher PHQ-4 scores, 62% scored above ADHD cut-off.

Contrary to the hypothesis, reasons why the ADHD group seemed to choose the more sedate cars are discussed in terms of the intriguing possibility that strategies adopted enabling management of responsible employment may influence other aspects of living. The importance of removing those with higher anxiety and depression scores from analysis is emphasised.

South Asians are the largest ethnic minority group in the UK. Despite having an elevated incidence of psychotic disorders compared to the European-ancestry majority, this group remains underrepresented in genomic research.

The heritability of schizophrenia (SCZ) is high, with around one quarter attributable to common genetic variants. Polygenic risk scores (PRS) summarise their combined contribution. The NHS 10-year plan prioritises implementation of population-based PRS to facilitate early identification of common diseases. PRS are derived from largely European-ancestry genome-wide association studies (GWAS), raising questions about the transferability of the SCZ PRS in ethnic minority populations.

This study aimed to examine the association between SCZ PRS, SCZ diagnosis, and antipsychotic prescribing in a South Asian cohort. Additionally, it aimed to compare PRS between individuals prescribed any antipsychotic and those prescribed injectable antipsychotics or clozapine as proxies for illness severity.

We analysed data from Genes & Health, a community-based cohort with linked genetic and electronic health records for over 65,000 Pakistani and Bangladeshi individuals in the UK. PRS were derived from summary statistics from a largely European-ancestry SCZ GWAS. We examined associations between PRS, SCZ diagnosis, and antipsychotic prescribing, with secondary analyses of clozapine or injectable antipsychotic use.

SCZ PRS was associated with SCZ diagnosis (OR=1.51 per SD). However, SCZ PRS showed only a weak association with antipsychotic use in the full sample (OR=1.04 per SD).

SCZ diagnosis was strongly associated with antipsychotic prescribing (OR=28.4). Among those with SCZ, there was a stronger association between PRS and antipsychotic use (OR=1.45 per SD). Quintile analyses showed a pronounced extreme-risk pattern, with individuals in the highest PRS quintile having higher odds of antipsychotic use compared with those in the lowest quintile (OR=3.4). The PRS–antipsychotic association was modified by SCZ diagnosis (p=0.048). Among individuals with a diagnosis of SCZ and prescribed an antipsychotic, a higher PRS was associated with increased odds of clozapine or injectable antipsychotic use (OR=1.37 per SD).

SCZ PRS derived from European-ancestry GWAS is associated with a diagnosis of SCZ in a South Asian ancestry cohort and higher PRS scores were associated with antipsychotic prescriptions. In those with a diagnosis of SCZ, higher PRS scores were also associated with clozapine or injectable antipsychotic use. The absence of directly comparable European-ancestry dataset limits inferences about relative performance across ancestries. The next stage will address this through UK Biobank analyses.

The representativeness of study populations relative to the clinical populations they aim to reflect remains contested. Evidence suggests that some research cohort populations present with less severe symptoms compared to clinical populations. This phenomenon may also occur in studies investigating motivational impairment within schizophrenia, whereby recruited patients have less severe motivational impairment than typical patients. Thus, findings of studies investigating motivational impairments in schizophrenia may not fully generalise to the wider patient population.

We aim to assess the representativeness of participants diagnosed with treatment-resistant schizophrenia who volunteered for a study on motivation compared with patients attending the Cambridge Clozapine Clinic who did not volunteer for that study, across demographics and clinical outcomes, with a specific focus on motivation and pleasure.

The CHANSS (Characterising negative symptoms in schizophrenia) is a multi-centre international study aiming to characterise the cognitive mechanisms underlying motivational impairment within the negative symptoms of schizophrenia. Data used were collected from the CHANSS study (n=69 clozapine-treated) and from the Cambridge Clozapine Clinic, included in the ethically approved database (n=244 post duplicate removal). Statistical analysis was conducted via R to assess the difference in population demographics (Age, sex, family history, smoking, dose of clozapine) and outcomes (Outcomes were measured using the Positive and Negative Scale (PANSS), Brief Negative Symptom Scale (BNSS), Calgary Depression Scale (CDS) and Global Assessment of Functioning (GAF) Scale). BNSS-MAP, a measure of apathy, was the primary variable studied.

Clinical outcomes followed a non-normal distribution with unequal variance and high levels of heterogeneity. BNSS overall motivation and pleasure score (MAP), as well as its subcomponents of anhedonia, asociality and avolition, showed no significant difference. CHANSS participants taking clozapine had a significantly younger age. The CHANSS cohort showed significantly higher scores across several other symptom measures. CHANSS participants were more likely to have a higher positive score for positive symptom severity, expression, anhedonia, blunting and CDS total score. Power calculations for all significant results returned a high power above (all >0.9).

For the primary outcome of differences in motivation and pleasure, no significant differences occurred between the clozapine-treated CHANSS participants and the Cambridge clozapine clinic cohort. Thus, for studying motivational impairment, the CHANSS Study was successful in recruiting a study population representative of the wider patient population. However, demographic differences and higher symptom scores in domains beyond motivation and pleasure should be considered when interpreting any findings beyond motivational impairment.

This audit cycle evaluated adherence to recommended follow-up timeframes (NICE guidance/ RCPsych core standards) for patients discharged from a general adult psychiatry ward in Wales.

Cycle 1 assessed compliance with NICE guidance recommending review within 7 days for all patients and within 48 hours for those at risk of suicide.This included all patients discharged from Bryngofal ward between January to March 2024. Suicide risk was determined using the Wales Applied Risk Research Network (WAARN) formulation at discharge. The first scheduled post-discharge care contact was recorded.

Following staff education and clarification of local accepted standards, cycle 2 assessed compliance with the RCPsych core standards of review within 3 days for all patients. The audit was repeated for all discharges between November 2024 to January 2025 using the RCPsych standards.

Cycle 1: Of 44 patients, 42 (95%) received follow-up within NICE-recommended timeframes. Instances of non-compliance were related to transfer of care to another health board and incomplete discharge risk documentation. Interventions included reinforcement of discharge risk documentation and clarification of local follow-up standards. Based on evidence from the National Confidential Inquiry into Suicide and Safety in Mental Health (days 2–3 post-discharge is a high-risk period), our local health board aligned with the RCPsych core standards recommending review within 3 days.

Cycle 2: Of 19 patients, 18 (95%) received follow-up within 3 days. The single delayed review occurred due to a communication lapse between inpatient and community teams.Improved communication between ward and community teams was emphasised during ward round to support timely review.

Compliance with national standards for timely follow-up was high and sustained across both cycles. The findings highlight the critical role of effective communication and clear recording between inpatient teams, community mental health teams, and care coordinators to ensure timely follow-up and patient safety. Simple measures, including staff education, clear discharge risk documentation, enhanced multidisciplinary communication and clarification of local standards can support ongoing high quality follow-up care.

Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are diagnoses that are frequently comorbid; the DSM-5-TR notes that 25% of patients with ADHD combined type present with CD. CD is characterized by persistent dissocial, aggressive, and defiant behaviors that defy age appropriate expectations. NICE guidelines and literature suggest that psychostimulants, specifically Methylphenidate, are indicated in cases where ADHD and CD arecomorbid.

This is the case of a 15-year-old male adoptee referred to Tier 3 CAMHS for severe aggression, impulsivity, and domestic violence. The patient exhibited coercive control toward his mother, physical violence involving weapons, and property damage, necessitating police involvement and risking family placement breakdown.

Following a failure of psychosocial interventions, the patient underwent a Qb Test and Conners 4 assessments and review by a consultant psychiatrist confirming ADHD and Conduct Disorder Diagnosis. Methylphenidate (Concerta XL) was initiated and titrated to 36mg daily.

Outcomes were significant. Within one month, antisocial behaviors reduced markedly. At seven months, domestic violence had ceased, and social care involvement ended. The patient successfully completed his GCSEs. Repeat testing on medication showed normalisation of scores: Qb Test activity dropped to the 23rd percentile and impulsivity to the 21st percentile. on repeat parent-rated Conners 4 scores for Conduct Disorder dropped to zero.

This case highlights the importance of identifying and treating underlying ADHD in adolescents presenting with severe conduct issues. Higher doses of Methylphenidate are often cited as beneficial for CD symptom reduction, this patient achieved remission of aggression at 36mg/day. The case shows that delaying ADHD diagnosis in favor of solely managing behavioral conduct symptoms can risk education and family stability. Treating the ADHD effectively mitigated the emotional dysregulation and violence, and reduced the negative impact on this patient during a crucial period of his life as he was completing high school.

This case highlights the importance of considering comorbid ADHD and Conduct disorder in patients presenting with impulsive behaviours and aggression as their primary presenting complaints. As appropriate management with Methylphenidate could have a significant therapeutic effect on these patients and their antisocial behaviours.

Reflective practice and Balint groups are essential for psychiatrists’ professional development, enhancing clinician wellbeing and job satisfaction. While embedded in UK psychiatric culture and training curricula, international doctors may have limited awareness of, exposure to, and access to these tools.

This study assessed international psychiatry resident doctors' baseline familiarity with and access to reflective practice and Balint groups, and evaluated changes in engagement following an educational webinar.

Pre- and post-intervention surveys were distributed to international psychiatry doctors attending a webinar organized by the British Pakistani Psychiatrists’ Association (BPPA) on 22 November 2025. The pre-intervention survey assessed demographics, prior training in reflective practice, engagement frequency, workplace culture, and access to Balint groups. The post-intervention survey evaluated self-rated confidence and intended engagement in reflective practice. The intervention consisted of a one-hour webinar introducing reflective practice and Balint group principles, including a supervised Balint group demonstration led by a UK higher trainee.

The pre-session survey respondents (n=12) included 4 trainees and 8 non-training doctors, with 8 trained in Pakistan (6 practicing locally, 2 relocated to Ireland) and 4 from Malaysia, Botswana, Algeria, and Fiji. At baseline, most participants lacked formal training in reflective practice (83.3%) and access to Balint groups (91.7%), while 33.3% had no access to formal reflective platforms. Half perceived their workplace or training curriculum as placing low or no emphasis on reflection. Pre-session, 50% of attendees reported frequent engagement (often/always), primarily through supervisor meetings (58%), portfolio entries (25%), and team reflective meetings (25%), while two participants had never engaged in formal reflective practice.

Post-session, the participants reported high confidence in reflective practice (mean 4.25/5; 91.6% rated confidence ≥4/5), and 91.7% requested additional resources, reflecting heightened interest. Intended frequency of future engagement (often/always) increased to 75% post-session, compared with 50% reporting frequent engagement at baseline. Qualitative feedback demonstrated participants' intent to advocate for establishing local Balint groups and enthusiasm to integrate reflective practice into their daily clinical practice.

Reflective practice is essential for professional development and wellbeing, particularly for early-career psychiatrists. This study demonstrated that international psychiatry doctors have limited understanding of and exposure to reflective practice and Balint groups, with minimal emphasis within workplaces or training programmes. A brief online educational session improved confidence and intended engagement in reflection, highlighting the value of international educational collaborations in upskilling psychiatrists globally.

Eating disorders (ED) are serious mental health conditions characterised by disordered eating behaviour and associated emotional distress. EDs are associated with high rates of mortality and morbidity, yet rates of help-seeking remain low. There is a misconception that EDs only affect “skinny, white, affluent girls” (SWAG) although anyone can be affected. Likewise, despite similar rates in ethnic minorities, studies suggest that help-seeking from this population remain low. The aim of this paper is to identify key barriers and facilitators to accessing ED treatment in the UK and whether ethnic minority groups have different experiences from the majority population in accessing treatment. We hypothesised that barriers and facilitators would differ between ethnic minority and majority populations in the UK.

A systematic review of qualitative and mixed methods studies was conducted following PRISMA guidelines. PsycINFO, Embase, Medline and CINAHL databases were searched for relevant studies published since 2013. Two independent reviewers screened titles/abstracts and reviewed full texts. Eligible articles were coded in NVivo to generate themes following Braun and Clarke’s thematic synthesis guidelines.

Out of14 included studies, two focused exclusively on ethnic minority experiences. Across the studies, commonly shared barriers to accessing care included rigid ED guidelines, negative healthcare professional experiences, difficulty in self-recognising ED, low accessibility and awareness of services, and negative social relationships. Reported facilitators included improving education and recognition of EDs, informed and accessible delivery of care, and supportive communities. The two studies exploring the experiences of people of South Asian heritage highlighted additional barriers, such as concerns about doctor-patient confidentiality, and marriage-related pressures linked to beauty standards. Unique facilitators included suggestions for raising awareness of eating disorders through culturally relevant platforms.

A more holistic approach is required from services and guidelines to tackle stigma associated with EDs and make services more accessible. There is a lack of primary research focusing on ethnic minorities, and further research is required.

Pregabalin dependence and overuse are a major problem, with individuals often taking doses well above the licensed daily maximum of 600mg. Users frequently combine it with other substances, raising the risk of respiratory depression. The lack of guidance on managing withdrawal from high doses poses a significant challenge in hospital settings. Failure to treat acute withdrawal can lead to severe side effects, including seizures, and may result in patients prematurely discharging themselves.

This abstract reviews the limited guidance on assessing and treating pregabalin withdrawal in hospital settings, proposing a structured, evidence-based approach. Our hypothesis is that this approach can safely mitigate withdrawal symptoms and improve patient outcomes.

The assessment should include evaluating dependence severity and screening for co-existing substance use or mental health disorders. Clinicians should also review clinical notes for previous admissions and, with patient consent, speak with family members for insight into the patient’s drug use. Contacting the local addiction service is important, especially if the patient is on opioid substitute treatment. Point of Care Testing for pregabalin and other drugs can be used, with a positive result supporting a decision to prescribe.

When prescribing pregabalin, the reported dose and objective signs of withdrawal are key. For a reported daily dose of 300-600mg, prescribe 100mg three times daily. For doses over 600mg, an initial dose of 150mg three times daily is recommended, increasing to a maximum of 200mg three times daily if withdrawal persists. Due to common polysubstance use, prescribing diazepam 5mg four times daily is also often required.

Managing high-dose pregabalin withdrawal requires a cautious approach. Patients must be observed for sedation or respiratory depression. Referral to a Mental Health Liaison Service is crucial for advice on tapering and continuity of care. This approach facilitates safer withdrawal and improved outcomes.

To evaluate the educational impact of a structured CAARMS workshop on trainee confidence and knowledge related to the assessment of at-risk mental states.

A pre-post educational evaluation was conducted among participants attending a CAARMS workshop. Anonymous surveys were completed immediately before and after the session. Self-reported confidence and clinical skills were assessed using a workshop-specific questionnaire aligned with core CAARMS competencies, including symptom elicitation, differentiation of attenuated psychotic symptoms, threshold determination, risk assessment, formulation, and documentation. Knowledge was assessed using a curriculum-aligned multiple-choice questionnaire based on key CAARMS principles and common assessment pitfalls. Anonymous participant codes enabled paired analysis. Post-workshop feedback assessed perceived relevance and applicability to clinical practice.

Paired pre-post analysis demonstrated improvements across all assessed domains. The proportion of participants rating themselves as highly confident (≥7/10) increased from 28% pre-workshop to 76% post-workshop. The largest gains were observed in differentiating attenuated psychotic symptoms from anxiety, obsessive-compulsive phenomena, and culturally normative beliefs (22% to 74%), applying CAARMS threshold criteria (18% to 71%), and conducting structured risk assessments (31% to 82%). Knowledge performance improved, with 83% of participants achieving high post-training scores compared with 41% pre-training. Workshop acceptability was high, with 92% reporting the content as relevant to their clinical work and 94% indicating they would recommend the workshop to other trainees.

A structured, case-based CAARMS workshop was associated with substantial improvements in trainee confidence and knowledge related to at-risk mental state assessment. This simple pre-post evaluation approach provides a practical method for assessingeducational impact and may support earlier and more accurate identification of individuals at risk of psychosis across psychiatric training settings.

Understanding how clinical and social needs cluster across acute mental-health services is essential for improving flow, reducing delays, and designing targeted pathways. We hypothesised that trauma, complex emotional needs (CEN), and mood/anxiety disorders would frequently co-occur across Surrey and Borders Partnership NHS Foundation Trust (SABP) acute pathways, and social-determinant burdens such as no fixed abode (NFA)/insecure housing and unmet social care needs would be concentrated in high-acuity services, including psychiatric intensive care units (PICU) and long length-of-stay (LLOS) populations.

We conducted a cross-sectional audit of 99 service users across nine SABP populations including Safe Haven, Liaison Psychiatry, High-Intensity Users (HIU) in Home Treatment Team (HTT) and Liaison, HTT, inpatient wards, PICU, Health-Based Place of Safety (HBPoS), and LLOS. For each individual, binary coding captured clinical needs including frailty, psychosis/bipolar affective disorder, dementia, trauma, CEN, mood/anxiety disorders. Social determinants were also measured including substance use, offending/aggression, age 18–25, disordered eating, ethnicity non-white, NFA/insecure housing; social isolation; neurodevelopmental support; learning disability and unmet social care needs. We summarised prevalence and co-occurrence patterns across services.

Across the whole cohort, the most prevalent needs were mood/anxiety disorders 66.7%, CEN 60.6%, trauma 57.6%, substance use 55.6%, and neurodevelopmental support 50.5%. Co-occurrences were common including CEN + mood/anxiety disorders 50.5%, trauma + CEN 47.5%, and the trauma + CEN + mood/anxiety disorder triad in 42.4% of service users. Patterns varied across populations. HIU-HTT showed the highest combined clinical-need burden, with substance use 81.8%, mood/anxiety disorders 81.8%, CEN 72.7%, and trauma 72.7%. HIU-Liaison recorded 100% prevalence of trauma, CEN, and mood/anxiety with neurodivergence at 81.8%. As well as the highest percentage of psychosis/bipolar affective disorder 90.9%, PICU exhibited the greatest social-determinant burden, including NFA/insecure housing 27.3% and unmet social care needs 54.5%–the highest across all services. LLOS also showed elevated complexity, with neurodevelopmental support 81.8% and mood/anxiety disorders 72.7%. Safe Haven presentations were characterised by mood/anxiety disorders 90.9% and CEN 81.8%.

Across nine acute-care populations, co-occurring trauma, CEN, and mood/anxiety disorders constitute the dominant clinical complexity patterns, while PICU and LLOS carry the heaviest burden of housing insecurity and unmet social-care need. These findings support targeted operational interventions including prioritising senior discharge coordination for PICU and LLOS and implementing regular multi-agency escalation huddles to address social-determinant drivers of delayed flow. This mapping demonstrates where complexity lives in the SABP system and provides actionable insights for service improvement.

Aim:

To evaluate compliance with the local ADHD care pathway across eligibility, assessment, treatment, monitoring, and documentation standards, and to identify areas for improvement.

The audit was initiated to assess adherence to the local ADHD care pathway, ensuring consistent and standardised delivery of ADHD care in line with Trust policy. The Local Trust ADHD Pathway is based on NICE NG87 (2018) and includes standards for appropriate referral and inclusion criteria, holistic assessment and care planning, use of outcome measures (ReQOL, DIALOG, GBO), medication initiation and ESCA completion, as well as risk assessments, safety planning, and regular follow-up documentation. Adherence to these standards facilitates consistent, high-quality care and aligns with national gold standard guidance.

This was a retrospective audit of patients managed within the local ADHD care pathway. The audit population comprised 79 patients, with one excluded due to disengagement prior to assessment, resulting in a final sample of 78. Inclusion criteria were active cases on the ADHD pathway, while exclusion criteria were patients who disengaged prior to assessment. Data were collected from electronic patient records on Lorenzo.

All patients met pathway eligibility criteria and were allocated to a qualified keyworker. Initial ReQoL was completed in 64% of cases (50/78). A holistic assessment was completed for 88% of patients (69/78). Care plans were completed for all patients (78/78); however, only 49% included DIALOG and Goal-Based Outcomes. Risk assessments were completed in 99% of cases (77/78), while safety plans were documented for 76% (59/78). Medication was initiated in 76 of 78 patients, with ESCA documentation sent for 62 patients; 14 had not yet stabilised, and four ESCA requests were rejected by the same GP practice. All patients received 6-monthly reviews, although documentation of discussions regarding deprescribing or medication holidays was limited to three cases.

This audit demonstrated strong adherence to the local ADHD care pathway across referral, assessment, prescribing, and monitoring stages. High levels of compliance were observed for referral appropriateness, completion of assessments, medication prescribing, and structured follow-up. However, engagement with outcome measures was inconsistent, and variation in documentation practices limited standardisation. Limited documentation of discussions regarding deprescribing or medication holidays highlights an area for further clinical reflection and quality improvement.