Sodium valproate safety protocols historically focused exclusively on women of childbearing potential. However, 2024 Medicines and Healthcare products Regulatory Agency (MHRA) alerts represent a significant paradigm shift, extending safety requirements to include male patients due to emerging evidence of potential risks regarding male infertility and offspring congenital and neuro developmental disorders.

Recognising an ethical duty to ensure transparency and patient autonomy, the East Bromley Intensive Case Management in Psychosis (ICMP) team conducted this audit to:

Establish a clinical registry to monitor all valproate prescribing within the service.

Assess baseline compliance with national standards (risk communication, contraception advice, informed consent).

Deploy targeted interventions to strengthen shared decision-making and ensure regulatory adherence across all genders.

Cycle 1: A retrospective review of Electronic Patient Records for 330 patients was performed. A registry was established for all patients prescribed sodium valproate. Baseline data captured adherence to updated guidance, including documentation of risk discussions, contraception advice, informed consent, and Annual Risk Acknowledgement Form (ARAF) completion.

Interventions: Targeted interventions included clinician education, structured outpatient reviews (26 conducted), distribution of MHRA materials, and the creation of a live ARAF tracking system.

Cycle 2: A focused re-audit in July 2025 evaluated the impact of these interventions.

A registry of 46 patients was established (30 Males(M), 5 Females(F)<55, 11 F>55).

Baseline Compliance (Cycle 1): Data revealed a marked gender disparity in regulatory adherence, with male patients significantly falling behind:

• • Risk Discussions: 37% (F:80%, M:17%)

• • Contraception Advice: 15% (F:80%, M:3%)

• • Informed Consent: 61% (F:80%, M:20%)

• • MHRA Material Provision: 11% (F:60%, M:6%)

Dual-signed ARAF in eligible females: 0%

Post-Intervention (Cycle 2): Targeted interventions successfully bridged this gap, achieving marked improvements in the male cohort:

• • Risk Discussions: 17%→87%

• • Contraception Advice: 3%→83%

• • Informed Consent: 20%→87%

• • MHRA Materials: 6%→83%

The pathway for second-consultant sign-off was clarified, with 100% of eligible females reviewed.

Furthermore, 26 structured reviews directly influenced prescribing: 13% of patients transitioned to alternative treatments, and 9% deliberating alternatives, reflecting a significant shift toward active shared decision-making.

This project exposed and successfully closed a critical safety gap in male valproate prescribing by deploying targeted risk discussions and active clinical re-evaluation. The 13% treatment switch rate underscores the impact of shared decision-making, proving that informed consent is an evolving dialogue rather than a static achievement. Ultimately, this work reaffirms the clinicians’ ethical duty to challenge long-standing treatment plans in light of new evidence, ensuring psychiatric practice remains both evidence-based and ethically robust.

Multiple projects across the country are fortunately looking closely at violence and aggression happening to health and social care workers. This is a piece of work around experience of support made available to resident doctors in psychiatry following violence and aggression incidents.

This QI project aims to improve the quality of support and spread awareness about available channels to resident doctors following abuse incidents. A baseline survey was conducted to explore awareness of available channels, rate satisfaction with them, improve them as well as suggest new possible ways of providing support.

As a part of the QI project, we did a baseline survey to explore whether resident doctors had access to support after a violence and aggression incident and how satisfied they were with it. We then did a root cause analysis (RCA) workshop where resident doctors identified reasons for not accessing these channels.

41 resident doctors participated in the survey. 12 residents reported experiencing anincident of violence and aggression (1–2) times and 8 of these residents were in a junior entry level (CT1–CT3). 22 of these incidents were identified as verbal. 85.71% of residents were not aware of available channels of support in the trust. This coincided with 75% of residents not seeking support. Of the participants that did seek support, 2.44% graded the level of satisfaction with the type of support as 1 (very unsatisfied) and the follow-up answer was (due to lack of communication following the report and not knowing what the outcome of the report was). We then carried out an RCA and the resident doctors identified multiple causes to not seeking support including (not knowing how to access support, feeling speaking up is a burden, feeling the process is not followed through, feeling like they don’t belong due to rotating every 6 months) etc.

The residents have overall agreed there is room for improvement on the level of support available. We used the suggested themes in the RCA to come up with an action plan. Measures we have come up with are including all information around support channels in the induction file given to all new starting resident doctors, spreading awareness about available support on the trust intranet, liaising with the incident reporting system representatives in the trust to improve reporting process and include proper follow up. We are also still meeting regularly to discuss and improve our action plan.

There is clear evidence that Black men are disproportionately detained under the Mental Health Act (MHA). Our aim was to explore and characterise the clinical, social, organisational and structural factors contributing to this phenomenon, by examining the pathways to compulsory admission among Black adult males, and to generate hypotheses to inform future research and service improvement.

We completed a thematic analysis of Structured Judgment Reviews (SJRs) of a consecutive series of Black adult male patients detained under the MHA within a single NHS mental health trust. The MHA team provided ten consecutive cases organised by date of detention; two cases were excluded due to being minors, leaving eight cases. The reviews were completed by trained clinicians using NHS SJR methodology, to apply structured judgment and qualitative narrative across phases of care. We identified themes relating to routes to detention, (dis)engagement with services, quality of care and social context.

Most patients had psychotic diagnoses (schizophrenia or BPAD), with histories of multiple detentions. Patient-related themes included: disengagement from CMHT services, poor medication adherence, and substance misuse. Several patients experienced significant social adversity, including homelessness, socioeconomic deprivation, exploitation and limited support networks. Migration-related stressors, trauma and language barriers were also evident.

Regarding organisational factors, inpatient care was generally timely and of adequate or good quality, with appropriate multidisciplinary involvement. Transitions from inpatient to community care emerged as a consistent point of vulnerability. Communication difficulties between services, missed opportunities for assertive follow-up, inconsistent provision of interpreters, and delays in initiating substance misuse interventions were recurrent. In several cases, rapid relapse occurred within months of discharge, leading to repeated crisis presentations and subsequent detention.

Our analysis of the themes suggests that compulsory admission under the MHA disproportionately affect Black males due to cumulative interactions of clinical complexity, social deprivation and system-level gaps in care continuity, rather than care quality alone. Although our findings cannot establish generalisability or causation, they are supportive for the hypothesis that earlier, more tailored and integrated community care may reduce detention for Black men. Future work could practice on larger samples and lived-experience perspective to inform culturally responsive service models and ongoing MHA reform. The Trust’s Quality Committee welcomed the report, endorsed further exploration of the key theme, and agreed the recommendations would be progressed through relevant governance committees.

Delusional parasitosis is defined by a persistent belief of infestation despite absence of objective evidence and is classified as a somatic delusional disorder in ICD-11 and DSM-5-TR. It often arises where plausible environmental exposure interacts with affective vulnerability and pre-existing anxiety traits, blurring the line between obsessional preoccupation and psychotic conviction. Such cases provide insight into how real-world threats can crystallise into enduring delusional beliefs, exposing the limitations of rigid diagnostic categories.

Mrs X, a 65-year-old woman with a history of obsessive–compulsive disorder, agoraphobia, and depression, was referred for psychiatric assessment because of persistent concerns that insects inhabited her skin, clothing, and living environment. Her symptoms began following a suspected flea exposure while living in Cornwall, which she experienced as highly distressing. Despite relocation, repeated cleaning and environmental interventions, and multiple medical reviews showing no evidence of infestation, her conviction persisted.

She described ongoing sensations of particles entering her skin, ears, and face, with burning and itching, worsened at night. These experiences became central to daily life. She discarded most personal belongings, slept on inflatable mattresses, engaged in repetitive washing and decontamination rituals, and spent hours documenting “evidence” through photographs, videos, and microscopic examination. Progressive social withdrawal, disrupted sleep, reduced appetite, and secondary low mood developed as her preoccupation intensified.

Examination revealed only healing excoriations and minor skin dryness without objective signs of infestation or systemic illness. Mental state assessment showed anxiety, labile affect, circumstantial speech, and fixed somatic beliefs with limited insight. There were no hallucinations or formal thought disorder, and she denied suicidal ideation. While relapse of obsessive–compulsive disorder or severe health anxiety was considered, the persistence and rigidity of her beliefs supported a diagnosis of delusional disorder, somatic type.

This case illustrates how a plausible environmental event may catalyse the consolidation of somatic delusion, marking a transition from threat-based anxiety and obsessional monitoring to psychotic-level conviction. It highlights the phenomenological continuity between obsession and delusion and exposes the limitations of rigid diagnostic boundaries when symptoms evolve across domains. Clinically, the case underscores the profound functional impairment associated with somatic delusions and the therapeutic challenges posed by limited insight and partial engagement with treatment.

This presentation emphasises the need for integrative formulations that account for environmental triggers, affective vulnerability, and evolving belief structures. It supports a dimensional understanding of psychopathology and the value of multidisciplinary approaches in assessing and managing complex somatic delusional states.

This re-audit evaluated local management of acutely disturbed and violent patients against NICE guideline NG10 (2015) and aimed to develop a targeted action plan. It compared trends between an initial audit in 2024 and a re-audit in 2025, focusing on gender differences in RT use, clinical presentation, and post-intervention care.

A retrospective re-audit of 79 RT incidents between February 2024 and July 2025 was conducted on Mulberry Ward (Scunthorpe), an acute adult inpatient psychiatry ward and compared with 37 incidents from the 2024 audit (April 2022–July 2023). RT was defined per NICE NG10 (2015) as parenteral medication used for urgent sedation. Data were extracted from electronic medical records and Incident Report Form 1 (IR1). Analyses were performed using Microsoft Excel. Compliance with predefined standards of good clinical practice was assessed using a traffic-light system: green (≥80%), orange (60–79%), red (<60%). Gender-specific trends in demographics, RT frequency, clinical diagnoses, post-RT monitoring, and incident reporting were examined.

The 2024 audit included 17 patients (9 women, 8 men) and 37 RT incidents; the 2025 re-audit included 10 patients (7 women, 3 men) and 79 incidents. Female representation increased from 53% to 70%, with mean age decreasing from 43.8 to 30.3 years. RT frequency rose sharply among women (2.2 → 10.5 incidents per patient) and declined in men (2.0 → 1.5). Psychotic disorders remained common, but emotionally unstable personality disorder increased markedly (11.7% → 50%), predominantly affecting women. Secondary diagnoses, including poly-substance misuse (29.5% → 40%) and autistic spectrum disorder (23.5% → 40%), indicated rising clinical complexity.

Pharmacological management shifted substantially: lorazepam became the primary agent (43% → 69.6%), haloperidol-based regimens declined sharply, and aripiprazole injection increased (11% → 22.7%). Use of zuclopenthixol acetate and promethazine ceased in 2025. Self-harm (67%) and suicidal behaviour (13%) emerged as the main triggers for RT in women, while physical aggression declined to 16.5%. Seclusion use fell from 30% → 5%. NICE compliance remained excellent for risk assessment, patient rights, and documentation; however, post-RT monitoring, debriefing, medication review, and incident reporting remained below standard. Advance directives were absent in both audits.

The re-audit demonstrates strong adherence to NICE standards and reduced reliance on seclusion, but persistent gaps in post-RT care and governance remain. The substantial increase in RT frequency among younger female patients with complex comorbidities highlights the need for gender-sensitive strategies, preventive interventions, trauma-informed care, and enhanced multidisciplinary follow-up. Findings support targeted service improvements and the ongoing role of audit in acute psychiatric care.

Risky drinking causes substantial harm in Sri Lanka, yet despite WHO endorsement, brief interventions remain unevaluated in primary care settings. Sri Lanka’s outpatient departments record 55 million visits annually, representing an untapped opportunity for systematic opportunistic alcohol intervention delivery. This pilot randomized trial aimed to assess feasibility and acceptability of three brief intervention intensities, evaluate appropriateness of outcome measures including an innovative family member-reported burden measure, and generate preliminary data to inform a future adequately powered effectiveness trial.

One hundred and fifty adult male risky drinkers (AUDIT-C ≥4) presenting to the outpatient department of Teaching Hospital Peradeniya were randomized equally to three arms representing increasing intensity along a brief intervention continuum: Feedback on AUDIT-C (FOA, approximately 3 minutes), Unit of Alcohol education (UOA, approximately 5 minutes), or Adapted Brief Intervention (ABI, 15-30 minutes). Trained non-specialist research assistants delivered all interventions and followed up at six months. Feasibility was assessed through recruitment rate, retention at 6-month follow-up, and participant-reported acceptability. Drinking-related outcomes included AUDIT-C scores, binge drinking frequency, and Alcohol Problems Questionnaire (APQ) scores. Family burden was measured using the AFI-Net Family Member Questionnaire.

Target recruitment (n=50 per each arm) was achieved within approximately six weeks. Patient retention at 6-month follow-up was 92%, 84% and 90% for FOA, UOA and ABI arms respectively. Family member retention was 93.7% (74/79 enrolled), demonstrating feasibility of this novel dyadic design. All questionnaires were comprehensible and outcome measurement was feasible. Patient feedback was overwhelmingly positive across all three arms. Of the 133 who came for follow-up 111 (83.4%) were in precontemplation, at recruitment. Baseline scores in all outcome measures were comparable between the three arms. Pilot data indicate improvements in all outcomes in all three arms–change from baseline (mean±SD) in AUDIT-C score were −0.80±1.94, −1.55±2.50, and −2.36±2.81; in binge drinking days per month −1.99±6.20, −1.75±6.17 and −3.75±9.52; APQ score −2.23±5.84, −2.24±4.14 and −2.45±4.37; and family burden −3.65±6.37, −1.3±8.37 and −1.8±9.39, for FOA, UOA and ABI arms respectively.

This is the first alcohol brief intervention pilot trial conducted in Sri Lankan primary care. It is, to the best of our knowledge, also the first brief intervention study internationally to measure family member-reported burden as a primary outcome. All three intervention intensities proved feasible and acceptable in a high-volume, resource-limited outpatient setting. The observed dose-response pattern in patient-reported outcomes across intervention intensities is promising but warrants confirmation in an adequately powered efficacy trial.

A HSIB (2023) report highlights the substantial impact of menopause on mental health, with up to 40% experiencing depressive symptoms and a seven-fold increase in suicidal ideation risk. Despite this, menopause remains under-recognised in community mental health team (CMHT) psychiatric assessments, with symptoms often misattributed to, or exacerbating, severe mental illness. This quality improvement project aimed to enhance CMHT clinicians’ awareness and knowledge of the menopause–mental health link, targeting a 50% increase within the Barnet North Core CMHT, measured through clinicians’ understanding of its relevance to mental health, incorporation into assessments, and knowledge of NICE treatments guidelines.

Baseline knowledge of menopause and mental health among 35 CMHT healthcare professionals (HCPs) was assessed using a questionnaire. Targeted educational training was delivered to address identified knowledge gaps and support improved integration of menopause considerations into mental health assessments. Outcomes were measured via pre-training and post-training questionnaires. Supplementary interventions included: (1) review of existing Trust resources, (2) promotion of patient leaflets, (3) provision of screening and diagnostic tools, (4) development of a narrated menopause training module, and (5) display of reminder posters to reinforce learning.

All HCPs recognised the relevance of menopause to mental health pre- and post-training (100%), with awareness of its impact increasing slightly from 74% to 80%. Self-rated sufficient knowledge increased from 16% to 40%, although most continued to desire further training (100% pre; 93% post). Consideration of menopause in assessments was largely unchanged (68% to 60%), while incorporation into mental state examinations improved markedly (42% to 87%). Knowledge of appropriate treatment increased substantially from 23% to 80%, and awareness of available resources also improved, though gaps remained (8% to 40%).

Targeted CMHT training improved awareness of menopause’s impact on mental health, alongside enhanced knowledge of associated risks, clinical integration into mental state examinations and knowledge of NICE treatment guidelines. Despite these gains, only 40% of HCPs reported sufficient knowledge post-intervention, and 93% expressed a desire for further training.

These findings underscore the need for sustained educational interventions, particularly in the context of staff turnover, which may have limited engagement. To support sustainability, a narrated training module, validated tools, patient leaflets, and reminder posters were implemented. Persistent knowledge gaps highlight the importance of ongoing training, embedding menopause–mental health content within mandatory Trust programmes, and evaluating the impact of sustainability measures on improving knowledge and application of the menopause–mental health link in clinical practice.

Stimulant use disorder is associated with increasing morbidity, mortality, and high relapse rates, yet there is currently no approved pharmacotherapy. Relapse vulnerability is increasingly recognised as arising from dysregulation across dopaminergic, serotonergic, and noradrenergic neurocircuitry. Serotonin-Norepinephrine-Dopamine Reuptake Inhibitors (SNDRIs) modulate these monoaminergic pathways and represent a mechanism-informed pharmacological strategy. This review aimed to evaluate the neurobiological rationale, translational potential, and emerging clinical feasibility of repurposing SNDRIs for stimulant use disorder.

A review was conducted integrating preclinical neuropharmacological evidence, human neuroimaging and behavioural studies, and clinical trial data examining monoamine transporter modulation. Evidence relating to dopamine transporter (DAT), serotonin transporter (SERT), and norepinephrine transporter (NET) function was analysed to evaluate reinforcement neurobiology, relapse vulnerability, pharmacokinetic characteristics, and clinical safety data from candidate SNDRIs including dasotraline, centanafadine, and ansofaxine.

Psychostimulant reinforcement is strongly associated with DAT occupancy and dopamine elevation within mesolimbic reward circuitry. However, relapse vulnerability is increasingly linked to serotonergic and noradrenergic dysregulation contributing to stress sensitivity, affective instability, and cue-driven drug seeking. Preclinical evidence demonstrates that NET inhibition reduces stress-induced and cue-mediated stimulant seeking, while SERT modulation influences impulsivity and negative affective states associated with relapse. SNDRIs produce sustained, moderate monoaminergic modulation that normalises hypodopaminergic states observed during stimulant withdrawal without producing rapid dopamine elevations associated with abuse liability. Pharmacokinetic data demonstrates extended elimination half-lives supporting once-daily dosing and improved treatment adherence. Clinical trials investigating SNDRIs in attention-deficit/hyperactivity disorder and major depressive disorder demonstrate favourable tolerability and sustained monoaminergic modulation in human populations. Advances in transporter structural modelling and computational pharmacology support the use of dynamic transporter-ligand profiling to stratify therapeutic development and improve prediction of abuse liability.

SNDRIs demonstrate mechanistic plausibility and clinical feasibility as candidate pharmacotherapies for stimulant use disorder. Multi-transporter modulation may address both reward-driven reinforcement and relapse-related neuropsychiatric processes. However, current evidence remains indirect and derived primarily from mechanistic, preclinical, and non-addiction clinical populations. Targeted, stratified clinical trials in stimulant use disorder populations are required before treatment recommendations can be made.

To identify the use and prescribing of anxiolytics and hypnotics pre-admission, during the inpatient admission and on discharge and if such medications are reviewed during the inpatient admission on the adult mental health male and female wards.

A list of patients admitted from 01-Dec-2024-28-Feb-2025 were collated using IBM Cognost Analytics. The electronic patient records (EPR) were used to identify patients who were discharged after 28-Feb2-2025, and such patients were excluded from the audit. Medications prescribed pre-admission were identified using the medicines reconciliation in the EPR. Medications prescribed during the inpatient admission and on discharge were found on the electronic prescribing system and EPR. Microsoft forms were used to collate data and Microsoft excel was used for data analysis. Lorazepam, promethazine, diazepam and zopiclone prescriptions were analysed.

A total of 100 prescriptions on the female and 35 prescriptions on the male were prescribed during the inpatient admission. 26% (female) and 46% (male) of prescriptions were reviewed throughout the inpatient admission and documented. 6% (female) and 0% (male) of prescriptions were reviewed weekly. 9% (female) and 14% (male) prescriptions were changed in terms of dose, frequency and/or maximum dose.

A total of 48 (female) and 18 (male) prescriptions on the male wards were prescribed upon discharge. 71% (female) and 22% (male) prescriptions were changed in terms of dose, frequency and/or maximum dose. 74% (female) and 91% (male) of discharges had a documented plan regarding the review of benzodiazepines and/or z drugs.

To conclude, the audit demonstrates poor compliance of the TEWV trust policy regarding regular reviews of anxiolytics and z-drugs and documentation during the inpatient admission. The female ward had a greater number of patients and prescriptions, which was attributed to the high turnover of patients. However, on discharge there was a higher percentage of prescriptions that were reviewed, changed and documented. Evidenting that majority of prescriptions were reviewed at the point of discharge. This poses a risk to patient safety especially when discharged to a least restrictive environment in which symptoms of withdrawal cannot be closely monitored when compared to an inpatient setting. This audit encourages clinicians to ensure regular reviews are maintained through weekly reviews with the MDT and patient, and more training to staff, particularly doctors in training.

Methylphenidate is a relatively safe medication used frequently in ADHD with only a few dermatological side effects reported up-to-date. While direct relation between the medication and the dermatologic side effects on children are discussed and supported by the disappearance of reactions after medication withdrawal, other confounding factors such as parental stress and coping mechanisms, were indeed observed to have a direct impact on children’s wellbeing. The higher the maternal anxiety was related to the worse outcome in children with stress. This fact could explain recently emerged or prolonged skin reactions especially during the pandemic, as it provokes health-related anxiety, especially in vulnerable people.

Our case is a 9-year-old boy with ADHD who experienced digital desquamation after using methylphenidate-containing prescriptions. To the best of our knowledge, he was the first child having persistent non-pruritic, non-painful acral swelling and desquamation without any benefit from discontinuation of medications containing methylphenidate, and without any rheumatological condition.

There have been a few unusual adverse skin reactions to Methylphenidate reported, differing widely from general to local, pruritic to non-pruritic, and exfoliative to non-exfoliative. Our case had local non-pruritic exfoliation started 2 months after initiation of Methylphenidate -IR, however, the symptoms did not disappear after the withdrawal of prescriptions.

Persistent peeling after discontinuation of any Methylphenidate prescription was a unique situation. Thus, we investigated whether Methylphenidate has triggered and/or masked any rheumatologic condition especially juvenile rheumatoid arthritis and juvenile scleroderma. He was examined by a paediatrician with no anomaly found. Another reason for such prolonged skin reaction could be personal and parental stress. This could also explain why he has abdominal pain triggered only by going to school, as it may be related to parental expectations in addition to his ADHD and dyslexia comorbidity. The literature findings support the idea that high maternal anxiety elicits worse health outcomes in children with a neurodevelopmental disorder. Unfortunately, we could not have a chance to assess the anxiety level and coping mechanisms of the mother of our case, other than observing her stress-related behaviours as frequent doctor visits, to have a more concrete debate.

Any skin finding after methylphenidate prescription must be monitored closely to have early preventive measures, better adherence to treatment, and quality of life for both patients and their parents. Also, both children and their parents could be controlled for stress and coping mechanisms to diminish their negative effects on dermatological or any other health-related outcome.

Effective handover of patient care is essential for patient safety. In psychiatric inpatient wards, morning multidisciplinary team (MDT) handover is used to communicate information from previous shifts; however, this process was criticised locally for lack of structure, prolonged duration and omitted information. This quality improvement project aimed to reduce the duration of morning handover through implementation of a structured handover tool. A secondary aim was to explore the relationship between the number of attendees and handover duration.

The Model for Improvement methodology was used. Initial qualitative discussions with both junior and senior MDT members identified perceived problems with the existing handover process and informed potential change ideas. Baseline data were collected over approximately 1 month (N=17), recording total handover duration and number of attendees. Comparable data were also collected from four other inpatient wards where structured handovers were already implemented, providing benchmarking.

A structured morning handover tool based on the SBAR framework was developed and implemented, then disseminated to nursing staff responsible for leading the handover. Following implementation, handover duration and attendance were measured over a further one-month period (N=19), with additional data collection (N=5) during two separate weeks in subsequent months to assess sustainability. Qualitative feedback was obtained from the MDT to assess attitudes to the intervention.

Mean handover duration decreased from 68 minutes (range 35–102) to 52 minutes(range 38–78)following implementation, representing a 24% reduction. During months three and four, one-week samples showed mean handover duration of 53 and 48 minutes respectively, demonstrating sustained improvement.

With an average attendance of 9 staff members per handover, this reduction equated to 720 minutes (12 hours) of MDT clinical time released per week. Qualitative feedback was positive, comments included ‘continuous positive influence’, ‘a huge improvement’ and ‘concise without sacrificing thoroughness’.

Baseline handover duration on comparator wards, using alternative structured approaches, ranged from 35–47 minutes, suggesting that using a structured handover rather than the specific format used was the key factor associated with decreased duration, although ward differences likely also contributed.

Correlation coefficients between attendance and handover duration ranged from +0.13 to +0.69 across wards and time points, however no intervention targeting this was implemented.

Implementation of a structured morning handover was associated with a sustained reduction in handover duration and improved perceived quality. The findings suggest that implementing any structured approach is more important than the specific framework used. Increased attendance was associated with longer handover duration.

There are significant challenges to providing psychiatric care to people on the migratory route in Central America, including the low probability of face-to-face follow-up. However, there is a clear need for psychiatric care, for both pre-existing psychiatric conditions, and new onset conditions, some related to stressors experienced on the migratory route.

There is no literature providing clear guidance as to how to provide psychiatric care to people on the move. Therefore, this quality improvement project had the following aims:

1. To provide clinicians with greater clarity as to whether to offer psychiatric medication to people on the move

2. To improve continuity of care for people on the move taking psychiatric medication

Through a consultation process, four Médecins Sans Frontières (MSF) psychiatrists created five flowcharts to aid clinicians in assessing the benefits and risks of providing psychiatric treatment to a person on the move, in collaboration with the person. The flowcharts were piloted by clinicians, evaluated, and improved in a second cycle of change.

In consultation with mental health teams and patients from MSF’s projects across the region, a migrant health package was created, including psychoeducation leaflets, detailed medication labels, a regional map of clinics (MSF and non-MSF) providing psychiatric care on the migratory route, and a referral form. The package was implemented across four of MSF’s project sites.

A survey revealed that the flowcharts improved clinician confidence in deciding whether it was appropriate to prescribe psychiatric medication to people on the move.

In 2023, 78 patients were provided with the migrant health package. There were challenges in assessing whether the intervention increased continuity of care, as in many cases contact with the person was lost, and currently there is no regional patient database across MSF projects. However, of the 78 patients, 21% (16) were confirmed to successfully receive follow up at a clinic further along their route.

The project provided clarity for clinicians as to when it is appropriate to offer psychiatric medication to a person on the move. Further work is needed to evaluate whether the migrant health package improves continuity of care for people on the move receiving psychiatric care from MSF in Mexico and Central America. However, at least 21% of patients provided with the package were able to access face-to-face follow up following initial contact.

Antipsychotic medications are widely prescribed in child and adolescent mental health services (CAHMS) and carry recognised metabolic and cardiovascular risks. National Institute for Health and Care Excellence (NICE) guidance outlines minimum standards for physical health monitoring before and during antipsychotic treatment. This audit aimed to assess compliance with NICE-recommended physical health monitoring for children and young people prescribed antipsychotic medication within a CAHMS Head-to-Head (H2H) community service.

A retrospective audit of electronic patient records (Rio) was conducted. All patients under the CAHMS H2H team prescribed antipsychotic medication were identified. Physical health monitoring was assessed at baseline, six weeks, twelve weeks, and at six-monthly intervals thereafter. Six-monthly monitoring was analysed per eligible monitoring window, recognising that patients commenced treatment at different times. Patients admitted to inpatient wards when monitoring was due were excluded. Patients who had not yet reached eligibility for six-monthly monitoring were excluded from six-monthly denominators. Monitoring performed during medication titration or switching was outside the scope of this audit. Descriptive statistics were used to calculate completion rates.

Eleven patients were identified; two were excluded, leaving a final audit cohort of nine patients aged 15–18 years. Complete baseline physical health monitoring was documented in 0% of patients, although 44.4% had at least one baseline parameter recorded. Six-week weight monitoring was completed in 22.2% of patients, and complete twelve-week monitoring (weight, blood pressure/heart rate, and blood tests) in 22.2%. Seven patients were eligible for six-monthly monitoring, contributing a total of 25 eligible six-monthly monitoring windows. Completion rates for individual NICE-recommended parameters across these windows were low (height 20.0%, weight 20.0%, blood pressure/heart rate 16.0%, blood tests 20.0%, waist circumference 0%), with no window containing all recommended measures. Despite this, all patients had evidence of some ongoing physical health monitoring while prescribed antipsychotic medication, although this did not consistently occur within NICE-specified timeframes. No adverse physical health outcomes related to delayed or out-of-window monitoring were identified.

Formal compliance with NICE-recommended monitoring schedules was low when assessed against strict guideline timeframes. However, all patients received ongoing physical health monitoring and remained clinically safe. These findings highlight the challenges of implementing rigid monitoring schedules within CAHMS and support the need for systems that promote consistent, well-documented monitoring while accommodating real-world clinical and family circumstances.

Drug-related deaths in England and Wales continue to rise, with opioids remaining the most frequently implicated substances. Individuals receiving care from mental health services commonly experience co-occurring substance use disorders, with overdose risk heightened by increasing contamination of street drugs with potent synthetic opioids.

15% of service users under the care of Home Treatment Teams (HTTs) experience substance misuse, making this an important setting for harm-reduction interventions.

Take-home naloxone (THN), an opioid receptor antagonist used in emergency treatment of opioid overdose, is an evidence-based harm-reduction intervention. Patient Group Directions (PGDs) are legal frameworks that allow authorised non-medical healthcare professionals tosupply or administer specified medicines. Although PGDs have facilitated widespread THN provision in addiction services, implementation within HTT settings remains limited.

This quality improvement project aimed to increase access to THN for eligible service users within an adult HTT.

Electronic records for 30 consecutive service users receiving care from the HTT were reviewed to assess substance use patterns, eligibility for THN and whether THN was offered.

A PGD for THN supply was introduced in collaboration with pharmacy services. Readily accessible THN stock was established within the team’s medication cupboard to facilitate prompt provision. Multidisciplinary teaching sessions were delivered to staff, focusing on overdose risk, THN eligibility criteria and service user education.

Following implementation, electronic records for a further 30 consecutive service users were reviewed using the same criteria, and outcomes compared with baseline data.

At baseline, 13.3% of service users (n=4) met eligibility for THN, of whom 50% (n=2) were offered THN. In both cases, THN was supplied following medical review.

Following the intervention, 16.7% of service users (n=5) were eligible for THN, with 80% (n=4) being offered THN by a combination of medical and nursing professionals.

A clinically significant proportion of HTT service users were identified as being at risk of opioid overdose. The introduction of focused harm-reduction interventions, including a PGD, improved access to THN, and targeted staff education, was associated with increased provision of THN within the HTT setting. While THN is commonly used within addiction services, we are the first team providing care for general adults in our trust to implement this as part of routine care.

Further work is required to optimise service user uptake, address barriers including stigma and limited overdose awareness, and implement interventions across wider community mental health services. For interested teams, we recommend liaising with pharmacy services to explore local PGDs.

Mental Health Tribunal reports are documents written by psychiatrists to reflect the patient’s mental state and justifications for detention. They can be time-consuming and labour-intensive. Reports should include chronology, diagnosis, risk, statutory criteria and an actionable plan. Microsoft 365 Copilot may reduce drafting burden. Copilot-generated reports from clinical notes were assessed and scored to determine their performance.

Twenty-three questions were identified on a tribunal report which could be answered with an AI-generated response, such as forensic history, circumstances of admission and current progress. A scoring sheet was designed covering each question, scoring 0–5, with higher weights for critical domains. Prompts were refined after multiple runs until a prompt generating a comprehensive, accurate and human-like report was selected. Patient notes were supplied as uploaded Word files. Narrative quality was also scored separately to question performance across 8 domains (scoring 0–4 each) such as coherence, tribunal-appropriate tone and minimal redundancy. A combined final score weighted question performance (80%) and narrative quality (20%). A single clinician reviewer scored all reports.

Five patients were evaluated; 1 patient was generated 3 times to assess repeatability. Seven drafts were scored. All 23 questions were answered in every draft. The mean score per question was 4.9/5. The mean weighted question score was 98%. The average narrative quality was 28/32 (88%). Mean combined final score was 96% and all drafts met the “minor edits” threshold. For the repeated patient, weighted question scores varied minimally. The average time taken to generate a report was 30 seconds. One of the repeated reports contained a single hallucination concerning date of admission.

Copilot consistently produced quick and comprehensive tribunal reports under a structured prompt, but hallucination was found and is a risk. Clinician verification is required. As the prompt was being refined, it became clear that the reports altered significantly based on the prompt used. The quality of the reports signified potential use in generating community treatment orders (CTO) and medical recommendations. Limitations are that narrative scoring has a high subjectivity burden and this pilot only contained 5 patients. Further trials with a larger cohort and multiple assessors are required for more reliable results.

Kent and Medway Mental Health NHS Trust (KMMH) is a signatory to the Sexual safety charter but despite commitments to improving workplace culture, unwanted sexual behaviour remains prevalent within different healthcare settings. National Training Survey 2025 data indicate 9% of female doctors in training experienced unwelcome sexual comments or advances causing embarrassment, distress, or offence with 6% of females in psychiatry. This quality improvement project aimed to improve awareness, confidence and engagement with sexual safety principles among resident doctors and clinical supervisors within KMMH.

Two surveys were sent to trainees, locally employed doctors and consultants. The survey included questions around awareness of the Trust’s sexual safety policy, confidencearound escalating concerns, and confidence about whether concerns would be dealt with appropriately. The survey to the consultant group included similar questions around confidence in escalating resident doctor’s concerns appropriately. The surveys also included a option to provide additional comments.

The interventions included multiple sessions of Active Bystander training and Bullying, Harassment, Sexual Safety Seminar, additional workshop for lead clinical staff of the heads of school and wider deanery. A flowchart for the escalation process was also circulated.

A second survey was also sent out to the previous groups.

The total number of responses in the second survey were lower with fewer trainees in the second survey reporting being aware of the sexual safety policy. A small number reported attending the Bystander training and no reported attendances for the seminar. Higher numbers of consultants reported awareness (31% more compared to baseline) of the policy, with higher attendances in the interventions but less confidence (12.5% less than baseline) in the escalation process at follow-up. Trainee awareness of policy (10.5 to 0%), knowing who to escalate (12% more unconfident) and confidence in escalation process had dropped (36% more unconfident).

This project highlights a gap between sexual safety policy and doctors’ engagement with the policy with no question to support an understanding of whether the responding trainees had seen the flow chart or attended the interventions. While consultants demonstrated higher awareness, but lower confidence in escalation processes, engagement among trainees and locally employed doctors remained limited, with lower attendance at interventions and reduced policy awareness. Development of psychologically safe environments are required with future work focused on collaborative working with keystakeholders, improved communication and protected training time to ensure sexual safety principles are embedded across all professional grades.

Cognitive impairment is common in older adults, yet many cases of dementia remain undiagnosed on hospital admission. Cognitive impairment is associated with increased risk of delirium, long-term cognitive decline, and adverse outcomes in hospitalised patients, particularly in surgical patients. Early identification may support recognition of undiagnosed dementia, help prevent delirium or further cognitive deterioration, inform capacity and consent assessments, and enable targeted psychiatric interventions. Within the acute surgical pathway, we observed inconsistent completion of a locally embedded cognitive screening section in admission clerking booklets. We therefore audited compliance with a trust standard that all patients aged ≥60 years should have a cognitive screen completed on presentation to the surgical assessment unit.

The audit aimed to assess completion of cognitive screening on surgical admission and explore its association with operative intervention. 85 general surgical clerking booklets for patients aged ≥60 years admitted between February and July 2024 were reviewed. Data collected included documentation of cognitive screening, the presence of a known diagnosed cognitive impairment and progression to operative intervention within seven days of admission. Absence of clerking documentation was recorded where applicable. Data was analysed descriptively.

Of 85 surgical admissions aged ≥60 years, cognitive screening was documented in thirty-eight patients (45%). Thirty-seven patients (44%) had no documented cognitive screen, and nine patients (11%) had missing clerking documentation.

Of those with a documented screen, nineteen (50%) underwent an operative procedure within seven days, compared with eight of thirty-seven patients (22%) without a documented screen.

Three patients had pre-existing dementia. Cognitive screening was completed incorrectly in one case and classed as cognitive screen not documented.

Low completion rates of cognitive screening on admission were observed, including among patients who subsequently underwent surgery. As data collection was limited to initial admission clerking booklets, some screens may have been completed onlater assessments, or conduced without documentation, potentially underestimating overall completion. The focus of this audit was assessment at point of admission. While patients proceeding to surgery would have undergone formal capacity assessment and consent prior to the intervention, admission screening serves a broader purpose. Guidance such as NICE delirium recommendations emphasise early identification of patients at risk of cognitive change. Further work is needed to explore barriers to completion, support targeted education, and ensure at risk patients of cognitive decline receive appropriate attention and multidisciplinary input.

Social isolation and loneliness represent significant psychiatric determinants of cardiovascular disease, with emerging neurobiological evidence suggesting shared pathways for stress response and inflammation.

Social isolation reflects an objective lack of social contact while loneliness refers to the subjective perception of social disconnection. In practice, both frequently co-occur.

Current research inadequately examines the nuanced relationship between social disconnection and atrial fibrillation (AF) incidence. This paper aimed to systematically assess this relationship through a psychiatric lens.

A PRISMA-compliant systematic review was conducted across five databases. Five studies were selected, including large population-based cohorts from the UK Biobank, the Framingham Heart study and a nationwide heart failure cohort. Data on social isolation, loneliness, social network metrics and AF incidence were extracted. Narrative synthesis was performed due to the heterogeneity of populations and analytical methods.

Large observational cohort studies suggest that loneliness is associated with an increased risk of AF. In the UK Biobank, loneliness assessed via a composite score was associated with higher AF incidence (HR: 1.11, 95% CI 1.07–1.16). Subscale analyses demonstrated that this association was primarily driven by subjective feelings of loneliness, which showed a stronger association with AF (HR 1.20, 95% CI 1.14–1.26). This is supported by multistate modelling in a separate Biobank study. Social deprivation was also correlated with new-onset AF in a nationwide heart failure cohort.

In contrast, the Framingham Heart Study reported no association between overall social network index and AF incidence. When accounting for the competing risk of mortality, medium-low social connectedness appeared to have a lower AF incidence. This finding is likely attributable to survivorship and competing risk biases rather than a true protective effect. Furthermore, social group participation was associated with higher AF incidence, which may reflect increased healthcare access and consequent AF detection.

Most importantly, Mendelian Randomisation analysis in one study provided genetic evidence supporting a potential causal relationship between social isolation and AF risk, with no evidence of pleiotropy.

Overall, these findings indicate that survivorship bias, varying analytical methods and failure to consider competing mortality risks may obscure true associations between social disconnection and AF incidence.

Observational and genetic evidence support an association between social isolation and increased AF incidence. These findings highlight the need for novel AF prevention strategies such as psychosocial assessments and interventions to target loneliness and social disconnection, thereby emphasising the importance of a collaborative psychiatric-cardiology approach in clinical practice.

To determine whether exposure to a psychiatry specialty at medical school increases interest in pursuing psychiatry as a career.

Since 2017, the mental health workforce has seen a year-on-year expansion in numbers overall. Although between 2010 and 2023, the number of psychiatrists increased by 22% this was significantly lower compared to a 43% increase for doctors in the NHS overall. Recruitment into psychiatric specialties remains a key challenge with many psychiatric specialties facing under-recruitment year on year. According to ‘Stepping forward to 2020/21: The mental health workforce plan for England’ there are 5400 Consultant Psychiatrists with a vacancy rate of 13%.

Hertfordshire Partnership Foundation NHS Trust (HPFT) provide psychiatric placement for Cambridge medical students (Year 5). During a Quality Assurance cycle in 2025, HPFT was rated the best from the 5 Mental Health Trusts that provide psychiatry placement. Despite thisbetween 2014 and 2016 only 1.6% of graduates from the University of Cambridge pursued Psychiatry as a clinical speciality following graduation compared to 4.3% from Keele Medical school graduates.

Medical students attending a clinical placement in mental health between October 2024 and November 2025 were invited to complete a pre-placement and post-placement questionnaire that asked their likelihood of pursing Psychiatry for their foundation and/or core training choices. The questionnaire consisted of two questions that asked respondents to rate how likely they are in considering undertaking a psychiatry placement as part of their foundation/CT training on a Likert scale of Very likely, Likely, Neutral, Unlikely and Very Unlikely.

A total of 74 pre-placement and 77 post-placement questionnaire responses were received.

For FY choices: A 33% increase was observed in medical students very likely or likely to choose psychiatry as a foundation year option between pre-and post-placement.

For Core psychiatry training: A 20% increase was observed in medical students very likely or likely to choose psychiatry as a core trainee option between pre-and post-placement.

Medical students’ experiences during a clinical placement in Psychiatry appear to contribute to the consideration of a career in psychiatry.

Comorbid substance misuse is common in patients with mental illnesses, which are associated with challenges in diagnosis, management, poor outcomes, and increased risks. National Institute for Health and Care Excellence guidance recommends detailed history taking, biological testing, and early management. This audit aimed to assess the quality of substance use history taking, urine drug screening, and documentation of management plans for adult psychiatric inpatients.

Clinical audits were completed across four adult psychiatric hospitals in the Black Country Healthcare NHS Foundation Trust in April 2025 and January 2026. Patients were randomly selected and stratified by site and sex. Information about substance use, urine drug screening, type of substances, and management of substance use was collected along with relevant clinical history. The first 48 hours of admission documentation were reviewed. Data were collected using a predesigned questionnaire from the electronic patient records. Following the initial audit, efforts were taken to increase awareness among clinicians and provide recommendations.

There were 40 patients in each of the audits (age range: 19-73 years). Diagnoses were comparable: psychotic disorders (47.5% and 47.5%), mood disorders (40% and 30%), and personality disorders (12.5% and 22.5%). Most patients had a substance use history, 82.5% and 72.5% in the first and second audit, respectively. Urine drug screening within 48 hours of admission increased between cycles (42.5% vs. 50%); with more than half having positive results (58.8% vs. 55%).Commonly used substances were benzodiazepines (45.9%) and tetrahydrocannabinol (18.9%), along with opiates, ketamine, cocaine, and amphetamines. The reasons for lack of screening in the first and second audits were patient refusals (39.5%); there were delayed testing in 9.3%, and no documented reasons in 57.5% of cases. Drug use screening questionnaire usage remained low, but increased from 0% to 5%. There were changes in the documentation of related history such as accommodation (50% vs. 85%, p<0.001), personal history (57.5% vs. 65%), past medical history (92.5% vs. 87.5%), social history (82.5% in each cycles), and forensic history (60% and 75%) in first and second audit respectively. Discussion of substance use management was documented more frequently (35% to 75%, p<0.001).

More than half of the adult inpatients who underwent drug screening had a positive result. Substance use-related management discussion became significantly more frequent in the second audit. Patient refusals for drug screening remain a major concern. There is a continued need to monitor drug screening and management in adult psychiatry wards.