Life expectancy in serious mental illness (SMI) can be reduced by 15–20 years on average. This is in part due to lack of integration between physical and mental health services.

Prior to this project, there was no formal referral system for mental health inpatients in Central Northwest London (CNWL) to seek advice or refer to physical health services. In the community, GPs use Electronic Referral System (eRS) for accessing secondary services. eRS provides an entirely paperless system for contacting other health professionals, using a secure system. This system also improves access and reduces the admin time required to make and chase appointments and advice requests. It is widely used by GPs.

The aim of our project was to introduce eRS onto all the wards within St Charles Hospital Mental Health Unit (MHU). This was intended to reduce the time between a referral being planned, and a response being received from physical health services, by 50% within a year.

The initial stage was to collect a baseline measurement of the number of days it took between a plan being made for physical health input and receipt of a response.

We engaged stakeholders including Information technology services, General Practitioners and physical health colleagues to implement eRS in the MHU.

We collected data of the number of days it took from a plan for a physical health referral being made to response prior to eRS. We then re-audited the number of days it took once eRS was in place. The first cycle involved one ward, Redwood ward, for older adults. Following each cycle we scaled the project up, and introduced eRS to all wards at St Charles MHU.

Once eRS was integrated the number of days between a plan being made for a physical health referral and a response being received reduced on average by 94% from 53.95 days to 3.2 days on Redwood ward. The ward doctors provided feedback, saying “the system is much better and easier to follow”.

Data collected in St Charles MHU showed the number of days between a plan being made for a physical health referral and a response received reduced on average by 79% from 20 days to 4.4 days.

eRS has shown itself to be helpful for improving access to physical health. There is now widespread awareness of the system among doctors at St Charles and eRS will improve integration between physical and mental health.

Challenging behaviours in individuals with intellectual disability and autism spectrum disorder are complex, multifactorial phenomena that often result in significant distress for patients, families, and caregivers. They are associated with poor quality of life, increased use of mental health services, and heightened risk of trauma for carers. Pharmacological management has traditionally favoured antipsychotics, with limited evidence supporting the use of antidepressants.

We report the case of a 26-year-old woman with moderate learning disability and autism spectrum disorder who exhibited severe challenging behaviours, including self-harm, aggression and property damage. These behaviours persisted despite trials of benzodiazepines, analgesia, and multidisciplinary behavioural interventions. Antipsychotics were avoided due to comorbid pituitary tumour.

Following a clinical review that identified anxiety as a perpetuating factor, trazodone was introduced and titrated to 50 mg three times daily.

Initiation of trazodone has resulted in marked reduction in the frequency and severity of challenging behaviours, improved identification of triggers, and enhanced engagement in structured ward activities. Residual incidents are shorter, less severe, and easily redirected, with fewer requiring physical intervention. The patient demonstrated improved participation in therapeutic activities, and staff reported greater confidence in managing residual behaviours.

This case highlights the potential role of trazodone, an antidepressant, in managing challenging behaviours in individuals with intellectual disability and autism spectrum disorder. It underscores the importance of individualized treatment approaches and contributes to the limited evidence base supporting alternative psychotropic strategies beyond antipsychotics. Further studies are needed to assess antidepressant efficacy in managing challenging behaviours.

To assess whether a structured psychiatry shadowing programme at Hamad Medical Corporation (HMC) is associated with improved clinical preparedness among trainees and to examine whether motivation and well-being modify the relationship between shadowing quality and preparedness.

In 2024, a comparative cross-sectional anonymous online survey was distributed to psychiatry trainees at HMC (N=45). Participants were grouped by completion of the shadowing programme. Preparedness was measured across core clinical domains including psychiatric interviewing, management of psychiatric emergencies, independent patient management, electronic medical record use, and multidisciplinary team collaboration. Perceived skills gained, satisfaction, and attitudes toward the programme were captured. Multiple linear regression assessed predictors of overall preparedness (shadowing quality, motivation, well-being). Moderation analyses examined whether motivation and well-being modified the association between shadowing quality and preparedness.

Of 45 respondents, 26 (57.8%) had completed the shadowing programme. Confidence in conducting psychiatric interviews increased significantly, with the proportion rating themselves as “confident” rising from 4.4% before shadowing to 28.9% after shadowing (χ²=15.556; p=0.016). The most frequently reported gains were familiarity with the electronic medical record system (48.9%) and psychiatric interviewing skills (46.7%). Shadowing quality was a strong predictor of preparedness (β=0.46; p<0.0001). Motivation and well-being were not independent predictors but significantly moderated this relationship (well-being: p=0.0012; motivation: p=0.030), indicating stronger benefits of high-quality shadowing among trainees with higher well-being and motivation. No adverse outcomes were reported.

As one of the first evaluations of a structured shadowing programme in a psychiatry residency context, this study demonstrates a meaningful association between high-quality shadowing and trainee clinical readiness. Findings support the integration of structured shadowing into early residency curricula, alongside parallel investment in trainee well-being and engagement to maximise educational impact.

The aim of this audit is to assess adherence to the local VTE (venous thromboembolism) risk assessment guidelines across inpatient older adult psychiatry care in the Black Country Healthcare NHS Foundation Trust (BCHFT). An update to the National Institute for Health Care and Clinical Excellence (NICE) VTE risk reduction guidelines in 2018 included specific guidance for assessing acute psychiatric patients. In line with this, the BCHFT VTE risk assessment guidelines were updated in 2024. These local guidelines state that patients should be risk assessed within 14 hours of admission, at first multi-disciplinary (MDT) review, and at any change in clinical condition during admission. Additionally, local guidelines include the assessment of psychiatry related risk factors for thrombosis.

The patient electronic records were reviewed retrospectively for all older adult inpatients (n=58) across the BCHFT trust on the 1st January 2026. All patients had been inpatients for at least one week. Data was collected on the time from admission to first risk assessment, whether risk assessments were updated at MDT review, and whether any risk assessments were updated due to change in clinical condition. Secondly, data was collected on the number of risk assessments that included psychiatric specific risk factors where appropriate.

69% (n=40) of patients had a VTE assessment completed. 55% (n=22) were female and 45% (n=18) were male. 64% (n=37) had their assessment completed within 14 hours of admission. 2% (n=1) of patients had an updated VTE assessment at first MDT review. 9% of patients (n=5) had another VTE assessment completed on re-assessment, due to change in clinical condition. 0% of VTE assessments (n=0) included psychiatric specific risk factors in their assessment, such as anti-psychotic use, severe depression or catatonia.

There is considerable scope for improvement in VTE risk assessment compliance across the BCHFT trust, particularly regarding VTE re-assessment at first MDT review. Additionally, incorporation of psychiatric risk factors in the assessment has not been implemented in practice, despite its inclusion in the local guidelines. Recommendations include updating the electronic patient record templates to be in line with local and national guidelines. Further education for MDT members is planned to ensure the completion of re-assessments within necessary time limits. These results are to be presented at local trust teaching, with the aim to re-audit in one year.

To compare Core Psychiatry training experiences in the UK of British and International Medical Graduates in the Northwest Deanery of England and identify challenges faced by each group across multiple domains.

A cross-sectional mixed method survey was conducted (Electronic and Paper) amongst core psychiatry trainees in the Northwest Deanery of England. The survey consisted of multiple-choice questions and free text box. Quantitative data was analysed using descriptive statistics (Chi square, Fisher’s exact andoddsratio) to compare BMG and IMG responses while the qualitative responses were analysed thematically using the Braun and Clarke the maticanalysis.

48 trainees responded (IMG:28, BMG:20). Burnout was reported more frequently by IMGs than BMGs. IMGs were significantly more likely to report cultural differences, perceived preparedness to enter training. Thematic analysis identified concerns around day-to-day training, prioritising clinical workload over learning, frequent changes in placements, social isolation and disruption in community building. Moreover, concerns around inequity in pay and inconsistent on call demands across trusts were identified.

IMGs experience a higher degree of burnout compared with their BMG counterparts, and more likely to report challenges like cultural differences, perceived preparedness to enter training. Challenges like increased workload, navigating the NHS systems, rota pressures and prioritising service provision over learning were commonly reported by both the groups.

Schizophrenia affects an estimated 24 million people worldwide, with around one third experiencing inadequate response to first-line antipsychotics. Clozapine is the most effective treatment for this group but is reserved as a last-line option due to serious adverse effects and intensive monitoring requirements. Its metabolism varies widely due to age, smoking, genetics and ethnicity. Significant risks include neutropenia, myocarditis, metabolic syndrome. We present the case of a patient with clozapine-induced dysarthria, an uncommon but debilitating side effect. The associated reduced speech intelligibility and difficulties in communication can cause considerable distress for patients who are already coping with the challenges of a psychiatric disorder, and increases the chances of poor adherence to the medication.

Patient A is a male in his 40s who developed schizophrenia during early adulthood. He was diagnosed with treatment-resistant schizophrenia; Clozapine trials were complicated by dose-related adverse effects, most notably that of sudden onset dysarthria for which no other cause was identified. Rechallenge was further complicated by adverse cardiovascular effects. Clozapine plasma levels were found to be consistently raised despite relatively low doses of Clozapine, suggesting that the patient was a poor metaboliser of the drug. Progressive dose reductions improved speech while maintaining psychiatric stability. The dysarthria subsequently improved on low-dose clozapine with adjunctive sodium valproate.

The presented case demonstrates a clear chronology of the development of dysarthria at sub-therapeutic doses of Clozapine, and its subsequent resolution with reduction of the dose. Existing literature describes similar clozapine-associated speech dysfluency, more commonly stuttering, often showing a dose-response relationship. Some cases link symptoms to orofacial dyskinesia, prior neurological vulnerability, or possible micro-seizure activity, even with normal EEG findings. Proposed mechanisms include reduced seizure threshold via dopaminergic selectivity, GABAergic inhibition, glutamatergic enhancement, and anticholinergic effects. Prophylactic sodium valproate may improve the dysarthria, and allow continuation of clozapine in selected high-risk patients.

This case emphasises dysarthria as a dose-related adverse effect of clozapine, particularly in patients with unexpectedly high plasma levels. It highlights the importance of close therapeutic drug monitoring during titration and consideration of individual metabolic factors such as ethnicity and comorbidities. When speech dysfluency emerges, clinicians should assess potential risk of clozapine-associated seizures and consider EEG investigation. Anecdotal evidence suggests sodium valproate may alleviate speech disturbance even without overt seizure activity. Further research is needed to clarify the mechanisms underlying clozapine-related speech dysfluency and to inform strategies that balance efficacy and tolerability in treatment-resistant schizophrenia.

People with severe mental illness (SMI) experience disproportionate cardiometabolicmorbidity and mortality. Antipsychotic medication contributes to metabolic risk, necessitating systematic monitoring and early intervention.

Aim: was to evaluate compliance with national metabolic monitoring standards and the local WISE framework for patients prescribed antipsychotics within an inpatient rehabilitation service.

A retrospective audit was conducted on 30 inpatients admitted between 16 May 2024 and 5 August 2025. Data were extracted from electronic records, laboratory systems, and a structured audit dataset. Outcomes included weight change, completion of metabolic monitoring, and documentation of interventions.

At admission, 76.7% were overweight/obese. Clinically significant weight gain (≥5%) occurred in 36.7% of patients. MUST screening occurred in 76.7% of cases, but only 16.7% had care plans referencing weight, and 3.3% had discharge summaries documenting weight-related plans. Metformin use was documented in 26.7% of cases with complete data.

Weight gain during admission was common, and documentation of interventions was limited. Strengthened monitoring templates, structured care plans, and clearer escalation pathways may improve adherence to national standards and continuity of care. MUST ≠ weight-gain surveillance: it scores BMI, unintentional weight LOSS and acute disease. For antipsychotic WEIGHT GAIN, use WISE + SMI checks (baseline, weeks 4/8/12, then quarterly; annual labs) with early intervention.

Treatment-resistant depression (TRD) is common and associated with substantial disability and economic burden. It is estimated to affect over 100 million people worldwide and approximately 2.7 million people in the United Kingdom. Ketamine has emerged as a novel therapy for TRD, with studies demonstrating rapid antidepressant effects. However, ketamine is also used recreationally and can result in multi-systemic morbidity, accidental injury, assault and death. In the past decade there has been a marked increase in people entering treatment for harmful ketamine use in the UK, alongside a significant rise in ketamine-related deaths. The Royal College of Psychiatrists Margaret Slack Travelling Fellowship aims to broaden Higher Trainee’s academic knowledge and experience in a centre of excellence.

Gold Coast Health’s (GCH) Specialist Neurostimulation and Mood Disorder Service is Queensland’s first public service, and one of Australia’s first, to establish a ketamine clinic for TRD. The service is the Queensland site for the TREK trial, a multi-centre randomised controlled trial comparing intranasal esketamine and subcutaneous racemic ketamine for TRD. The service has supported several other multi-centre studies on ketamine that have shown efficacy and safety.

The author was awarded the 2025 Margaret Slack Travelling Fellowship to visit GCH in August 2025, to observe the ketamine clinic, TREK trial, Alcohol and Other Drugs Service, and speak with multi-disciplinary staff and patients to develop clinical insights.

The author attended presentations by Prof Colleen Loo, Black Dog Institute, on “Extending Knowledge and Clinical Experience on the Use of Ketamine” and “Ketamine for the Treatment of Depression in Older Adults” by Associate Prof, Shanthi Sarma, GCH (11 and 15 August 2025).

The author delivered oral presentations at GCH, “Understanding Ketamine Use Disorder: Perspectives from England and Considerations for Ketamine Clinics”, and “Promoting Awareness on Ketamine Use Disorder: Enabling early identification, treatment and referral”, at the International Medicine in Addiction conference in Sydney (18 and 30 August 2025).

There is demonstrated interest from British and Australian clinicians in the use of ketamine to effectively and safely treat TRD, in addition to ketamine use disorder, its risks and systemic harms. This interest creates opportunities to strengthen collaboration and shared learning between psychiatry, urology, and addiction disciplines internationally. It also supports the development of improved services for people receiving ketamine for TRD and for those using non-prescribed ketamine, promoting safe, evidence-informed practice.

Psychiatry resident doctors in Aneurin Bevan University Health Board (ABUHB) reported difficulty locating and completing the paper clerking proforma in use in Older Adult Psychiatry wards, alongside inconsistent electronic availability of clerking information due to delays in scanning and uploading. In this project, we aimed to improve the completeness and accessibility of admission clerking for inpatients in ABUHB Older Adult Psychiatry services, while reducing printed paperwork. In order to achieve this, we introduced a new digital clerking proforma aligned with relevant Royal College of Psychiatrists recommendations and NICE guidance. We hypothesised that introducing a digital proforma would increase overall item completion from 50% to ≥80%.

This quality improvement project used three Plan–Do–Study–Act (PDSA) cycles. Baseline retrospective data covered 14 consecutive admissions (n=14). The primary outcome was the percentage completion per patient on a 16-item proforma with equal weighting. Process measures captured completion within the History (7 items), Assessment (5 items), and Plan (4 items) domains. Post-baseline data were collected prospectively for consecutiveadmissions during each cycle (n=10 in PDSA-1, n=12 in PDSA-2, n=34 in PDSA-3). In PDSA-1, a new Word proforma was introduced; in PDSA-2, accessibility was improved via shared-drive access; and PDSA-3 involved embedding the proforma to the electronic system, and also aimed at comparing clerkings completed using the electronic proforma with those completed using the previous method.

Median overall completion improved from 55.4% at baseline to 83.9% after PDSA-1, and 87.5% after PDSA-2, remaining stable at 85.7% in PDSA-3. In PDSA-3, completion reached a median of 100% when the electronic proforma was used, versus 53.6% with paper-based clerking.

The introduction of a practical and accessible digital proforma improved clerking completeness, with cost savings and sustainability benefits. Next steps include targeted teaching for resident doctors and senior clinicians, improving proforma usability, ongoing monitoring, and potential spread to other directorates.

Authors: Dr. Ahmad Maaen Aalater, Dr. Nirvana Swamy Kudlur Chandrappa, Dr. Faycal Walid Ikhlef, Dr. Suhair Mohammed Yousuf. Dr. Dina ElGhar, Dr. Zeeshan Aqeel Usman Sheikh, Dr. Majid Al-Abdulla,

To evaluate and compare prescribing patterns, safety practices, and clinical monitoring for patients with Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) patients across two audit cycles at Umm Slal Treatment and Rehabilitation Center (USTRC) and to identify areas for sustained quality improvement.

Two retrospective audits were conducted using inpatient records from 89 patients in 2022 and 79 patients in 2024 diagnosed with AUD or OUD. Extracted variables included medication indications, dose titration and adjustment, contraindications, adverse drug reactions (ADRs), drug-drug interactions, and completion of baseline investigations. The 2024 cycle was benchmarked against the prior audit to assess changes in prescribing safety and documentation.

In 2024, 46 patients had AUD and 19 had OUD, with most patients aged 20–29 years. Documentation of appropriate medication indications improved (AUD 72%; OUD 78.9%). Dose titration and dose adjustment remained consistently high (98–100%), and contraindications were appropriately avoided in nearly all cases. Baseline medical testing improved but remained incomplete, with 8.7% of AUD and 10.5% of OUD patients missing liver or renal function results. Adverse Drug Reactions (ADRs) were documented in 18% of AUD and 5.3% of OUD cases, predominantly extrapyramidal symptoms and sedation. Drug interactions were identified in approximately one-third of prescriptions, with 25-29% classified as higher-risk interactions requiring closer monitoring. Documentation gaps and limited multidisciplinary ADR reporting persisted across cycles.

As one of the first longitudinal prescribing-safety audits within a mandated addiction treatment service in the region, this study demonstrates strong adherence to dosing safety while identifying ongoing vulnerabilities in documentation quality, baseline testing, and interaction monitoring. Sustained staff education, structured electronic documentation fields, and continuous re-audit are essential to strengthening medication safety and supporting high-quality addiction care in compulsory treatment settings.

To compare artificial intelligence (AI)-generated and consultant-generated formulation and management themes using an anonymised case of treatment-resistant schizophrenia, and to explore AI’s potential future role as a clinician-supervised adjunct in psychiatry.

An anonymised longitudinal case summary of treatment-resistant schizophrenia was presented at a virtual academic meeting within the South Eastern Health and Social CareTrust, Northern Ireland, attended by approximately 50 clinicians including 32 consultant psychiatrists. No patient-identifiable information was used, shared, or processed in the case materials or subsequent write-up. Consultant priorities were captured and synthesised by the case presenter into core themes.

In parallel, the same anonymised case narrative was discussed within a single AI conversation using an OpenAI large language model (GPT-5.2 Thinking). The AI-generated themes were informed by the case narrative and an uploaded specialist prescribing reference (Maudsley Prescribing Guidelines, 15th edition). Themes were compared for overlap and difference with reference to evidence-aligned core domains relevant to treatment-resistant schizophrenia.

The consultant group focused on the clozapine pathway, including whether clozapine had received an adequate trial and whether a monitored re-challenge could be considered. Discussion revisited reasons for discontinuation and relevant physical parameters, including electrocardiogram findings and inflammatory and cardiac blood markers. A second theme was improving treatment delivery through adherence strategies, including long-acting injectable antipsychotics, particularly haloperidol depot based on prior tolerability. The consultant group also highlighted tertiary specialist input for complex clozapine risk–benefit decisions amid substance misuse, risk, and psychosocial complexity; this was not proposed by the AI output. Electroconvulsive therapy was not openly proposed by the consultant group but was identified by the AI output as a potential consideration. Augmentation options, such as allopurinol, were noted by both groups.

Overall, the AI output proposed a similar pattern of thinking across major priorities and added value through structure and sequencing.

The consultant group and AI-generated themes were broadly similar andreflected guideline-consistent common practice in treatment-resistant schizophrenia, with differences in emphasis and service-level options. The consultant group contributed a grounded sense of feasibility shaped by engagement patterns, service capacity, and psychosocial circumstances. AI’s benefit was structured presentation, with coherent formulation domains and sequencing of options and monitoring considerations.

This supports a role for AI as a clinician-supervised adjunct for formulation, treatment planning, documentation support, and education, without replacing clinician judgement or accountability. Future studies should plan the comparison in advance, use more than one independent rater, and test whether artificial intelligence support improves process measures under appropriate information governance.

The primary aim of this audit is to determine the extent to which falls risk assessments are completed within 24 hours of admission for patients in the Psychiatry of Old Age inpatient department, and to assess whether identified risks lead to timely and appropriate interventions. According to the Standards based on NICE guidelines (CG161)

All patients aged 65 years and older admitted to the 8-bed Psychiatry of Old Age inpatient unit during the audit period were included in this audit. Data was collected retrospectively using a standardized audit tool through review of admission notes, falls risk assessment documentation, multidisciplinary care plans, and incident reports. The audit tool captured patient demographics, date of admission, timing of completion of falls risk assessments, identified individual risk factors, and falls prevention interventions implemented during the inpatient stay. In addition, the number and timing of any falls occurring during admission was recorded to evaluate the relationship between risk identification, intervention implementation, and fall incidents. Patients transferred from another inpatient facility more than 48 hours after admission, where a falls risk assessment had already been completed prior to transfer, was excluded to ensure consistency in baseline assessment and care processes.

Falls risk assessments were completed for 5 patients. In 4 patients (80%), the assessment was conducted within 24 hours of admission, and identified risks were addressed through documented interventions within 48 hours. Clinical documentation, including progress notes, was present for all patients (100%).

A total of 4 falls were recorded during the admission period across all patients. All falls were appropriately documented in the clinical records (100%).

Overall, Cycle One findings were compliant with the agreed standards.However, education was provided to team members to reinforce the importance of timely and accurate falls risk assessment. Areas for improvement were also identified in relation to the quality and consistency of documentation. These points will be addressed and reviewed in the next audit cycle. Date collection of cycle 2 is under process.

To improve higher psychiatry resident doctors’ access to research opportunities in the West Midlands Deanery.

The updated training curricula in 2022 requires higher psychiatry resident doctors to demonstrate involvement with ethically approved research studies. Some residents were struggling to achieve this competency.

We commenced a QI project in November 2024 to support residents with research opportunities. We have implemented these four approaches.

1. Working Group: we meet as a working group every few months, chaired by the Head of School, to discuss strategy.

2. Research project document: we compiled a list of ethically approved research projects available in the region with contacts for each. This is accessible to resident doctors in the region via the learning platform PGVLE. We are currently on the second version and plan to update this document annually.

3. Linking residents with projects: we educate resident doctors on their research requirements at their teaching sessions. We meet with residents 1:1 at their request and link them to research projects in their area of interest.

4. Co-ordinating research engagement: we ensure members of the working group are involved in relevant projects run throughout the region. These include the annual Research Day in the Black Country NHS Trust, the MRCPsych course, the annual Medical Student Psychiatry Summer School in Birmingham, the monthly Regional Training Days for the higher resident doctors, and the funded Research and Academic Network Meetings in Coventry and Warwickshire NHS Trust.

A preliminary survey of satisfaction with the non-clinical elements of training was completed in October 2024 for the West Midlands General Adult Higher Residents (n=36) and repeated in October 2025 (n=11).

In 2024, 42% said they were somewhat or extremely unconfident in their knowledge about the portfolio requirements for research; in 2025 this was reduced to 18%. In 2024, 69% said they had not been given adequate opportunities to meet research training requirements; in 2025 this was 45%.

We have been working to support resident doctors in the West Midlands to achieve their research competencies during higher training. Satisfaction with the awareness of research requirements and the opportunities to achieve them have increased. We believe these approaches can be used in other regions.

To ensure content of letters to GPs contain, diagnosis, treatment plan and staff involved

To see if letters are copied to patients

To see if clinic letters are sent out within a week

To see if GP letters are copied to patients

A review of three months clinic letters at an old age psychiatry service north of London was carried out to see if the letters were sent out within a week, copied to patients and included relevant information like diagnosis and management plan. A proforma was designed to collect the relevant information.

In the period 1st May to 31 July, 163 clinic letters were sent out. The mean age of patients was 76.4 year and there were 96 (58.9%) female patients. In terms of diagnoses in the letters, 79 (48.5%) had dementia, 52 (31.9%) had depression and 14 (8.6%) had psychotic disorder (schizophrenia or delusional disorder). A management plan was included in 153 letters and 160 clinic letters were copied to patients or their carers.

11 of the 163 (6.7%) clinic letters were sent later than 7 days of clinic appointments

Areas of Good Practice:

All clinic letters except three were copied to patients

Over 90% of clinic letters were sent within a week of clinic appointment

Areas of Improvement:

To achieve the desired goal of 100% of clinic letters being sent out within a week.

It is expected with improving information technology, letters will be uploaded onto patients’ primary care records electronically and become immediately accessible to both patients and general practitioners once sent. This is already the case in many practices locally and will give a more accurate picture of when clinic letters are received. The disadvantage will be for those patients and carers who do not have internet access or IT skills to access their primary care records

Usage of antipsychotic medications in patients with dementia is associated with heightened incidence of adverse effects and mortality. Yet their prescription is on the rise to contain behavioural and psychological symptoms of dementia (BPSD). Thus the aim of thisstudy is to as certain patterns in antipsychotic prescribing over the years from 2019 to January 2025 among patients with dementia attending Deeghayu psychogeriatric clinic, at the National Institute of Mental Health, Angoda, the largest psychogeriatric clinic facility in Sri Lanka.

A descriptive cross-sectional analysis of the data extracted from the patient records was done.

Total of 493 patients had been viewed including 306 (62%) with dementia. Alzheimer’s, vascular and mixed aetiologies had been the commonest with a prevalence of 124 (40.5%), 69 (22.5%) and 92 (30.6%) respectively. Out of them 228 (74.5%) had BPSD. Among them 172 (75.4%) had been initiated on antipsychotics. Quetiapine, risperidone, olanzapine and aripiprazole had been prescribed for 84 (48.8%), 16, 8 and 1 patients respectively and 63(36.6%) were on a combination of 2 antipsychotics out of which majority 45 (71.4%) were on the combination of risperidone and quetiapine. Among those who were not on antipsychotics for BPSD, 49 (21.5%) were on antidepressants for depression and 7 (3.1%) were solely on behavioural management. Poor sleep, wandering, aggression/agitation, hallucinations, disinhibition, delusions and mania had been the indication for prescription of antipsychotics in 107 (46.3%), 71 (30.7%), 80 (32.6%), 51(22%), 31(13.4%), 26 (11.6%) and 19 (8.2%) patients respectively. Percentage with two types of BPSD were 37.2% while 20.2% had more than two types of BPSD. Out of those with depression 34 (69.4%) had been prescribed antipsychotics out of which 27(79.4%) were on quetiapine.

Antipsychotic prescription is of high prevalence. Identifying and addressing the underlying cause leading to BPSD and usage of non-pharmacological strategies as the firstline of management can minimize the usage of antipsychotics. Further research is warranted to evaluate tolerance and effectiveness of the prescribed antipsychotics.

To identify mental health inpatient wards that may not have the full range of physical health monitoring equipment in line with the Royal College of Psychiatrists (RCPsych) 2009 standards, and to highlight any gaps or deficiencies so they can be addressed appropriately as physical examination and physical examination monitoring are essential to all patients in psychiatry.

The audit was conducted at The Redwoods Centre, including the acute adults, older adults and the forensic wards. Community mental health services in Shropshire were excluded. The sample comprised seven inpatient wards, each containing a designated clinic room. The data was collected in August 2025. The audit tool consisted of a checklist based on Physical Health in Mental Health: Final Report of a Scoping Group (Royal College of Psychiatrists). The compliance standard was set to 100%. The data collection for the first audit cycle was completed within 1 a day. A re-audit to close the loop was planned for 6 months after the first cycle. The audit process and results were monitored through the South Staffordshire & Worcestershire (ST&W) Quality & Safety Sub-Committee. Results will be shared with South Staffordshire and Forensic Quality/Audit Committees colleagues for information.

All wards demonstrated greater than 80% compliance with required physical health monitoring equipment. Overall compliance across wards was 87%. Equipment such as alcometers, Snellen charts, ophthalmoscopes, and otoscopes were not permanently available on all wards but were borrowed from other wards as required. Neurological testing pins were absent on most wards, with the exception of one of the wards. Existing arrangements for sharing equipment between wards were reviewed and formally confirmed. Plans are in place to procure missing equipment where necessary to improve compliance and reduce reliance on borrowing.

All inpatient wards at The Redwoods Centre met a compliance threshold of 80%, with an overall compliance rate of 87% against RCPsych physical health monitoring equipment standards. While some essential items were not consistently available on all wards, interim measures such as equipment sharing were in place. The absence of neurological testing pins on most wards was identified as a key area for improvement. Planned procurement and formalised sharing agreements aim to address these gaps ahead ofthe re-audit cycle.

Sketchy discharge summaries are common, impacting on patients' ability to maintain a shared understanding of factors leading to their deterioration and their recovery. This project was designed to improve the quality of patient discharge summary letters from a psychiatry ward to achieve eight out of ten letters having all relevant categories of important information included and a clear support plan.

The project was conducted over a three-month period. Firstly, baseline diagnostics of the cause and extent of the problem was completed through observation, discussion with patients and colleagues, as well as use of tools like process map, fishbone diagram, and bar chart. The Model for Improvement informed design of the project based on these diagnostics. An aim was set, and a robust definition of measures was created with inclusion and exclusioncriteria. I completed a baseline run chart, sampling 20 discharge summaries. This gave me a median baseline to establish any statistically significant changes following implemented changes and subsequent sampling of all (20) further discharge summaries completed throughout the project. Using the Plan–Do–Study–Act (PDSA) methodology, I captured change ideas with my team and multi-faceted interventions were implemented. The discharge template was adjusted to include prompts for all relevant categories of the discharge summary. Additional interventions included early allocation of doctors to discharge summaries and education (via email, team doctors’ meeting, induction document about writing discharge letters, one-to-one teaching and feedback) for doctors writing discharge summaries.

The run chart showed that the targeted change ideas led to a statistically significant shift in the data (more than six data points above the median). Nine out of ten summaries were complete and had a detailed support plan. There was a sustained pattern of change above the median baseline.

This quality improvement project resulted in significantly increased proportion of complete discharge summary letters, illustrating the merit of utilizing quality improvement methodology alongside team engagement to improve clinical outcomes. Continued oversight will be needed to ensure changes are sustained. This project is being shared with other wards, aiming for wider implementation of changes.