The Membership of the Royal College of Psychiatrists (MRCPsych) is a mandatory postgraduate qualification for progression in UK psychiatry training and is widely recognised internationally. International medical graduates make up over 40% of the UK psychiatry workforce. Given recent changes to recruitment processes and policies that prioritise UK medical graduates (UKMGs), it is important to examine motivations for pursuing MRCPsych among both UKMGs and IMGs.

This study aimed to examine motivations for pursuing the MRCPsych qualification among UKMG and IMG psychiatrists, and to explore perceived benefits and challenges among IMGs practising in the UK or Ireland, using a combination of quantitative and qualitative data.

A cross-sectional survey was conducted among participants attending an online psychiatry teaching programme for the Clinical Assessment of Skills and Competencies examination, delivered via the TresMentis platform by two MRCPsych qualified psychiatrists. Quantitative and qualitative data were collected using structured questions and free text responses. Of 169 responses received, 40 were excluded due to lack of consent, leaving 129 responses for analysis. Variables included country of practice, psychiatric experience, place of primary medical qualification, IMG status, motivations for pursuing MRCPsych, and experiences of working in the UK or Ireland. Qualitative responses were analysed thematically.

Of the 129 respondents, 47.3% were practising in the UK, with others based across South Asia, Africa, the Middle East and Southeast Asia. The majority were IMGs (86.0%), and most were early to mid-career psychiatrists. Common motivations for pursuing MRCPsych included career progression, improvement of psychiatric knowledge and skills, international mobility, and requirements for UK training progression. Qualitative analysis demonstrated clear differences between groups. UKMGs described MRCPsych as a necessary step within a linear UK training pathway. In contrast, IMGs viewed MRCPsych as a flexible and strategic qualification supporting diverse career trajectories, including progression outside formal UK training, recognition of prior experience, and opportunities across different healthcare systems. Among IMGs working in the UK or Ireland, positive experiences included structured training systems, while challenges included adapting to UK healthcare systems, communication barriers and understanding mental health legislation.

MRCPsych is not always pursued for the same reasons by UKMGs and IMGs.While UKMGs primarily undertake the qualification to meet mandatory requirements for progression within UK psychiatry training, IMGs regard MRCPsych as a desirable and versatile credential aligned with a broader range of career options. The desirability of MRCPsych has important implications for workforce planning, training design and recruitment strategies within UK psychiatry.

This service evaluation aimed to assess whether discrepancies exist in how functional symptoms are documented and discussed when compared to assessment of physical health symptoms.

The primary hypotheses were: (1) the documentation of functional symptoms would be less consistent than documentation of physical symptoms; (2) that functional diagnoses would be less likely to be documented as discussed with patients and their care givers than physical health symptoms; (3) physical health diagnoses were more likely to be recorded on the electronic diagnosis list than functional symptoms or diagnoses; and (4) that mental health professionals would demonstrate the most consistent approach in documentation and communication.

Patients (n=4) were identified by the trust’s consultant liaison psychiatrist. Selection criteria were; (1) have a recorded diagnosis of Functional Neurological Disorder or recorded functional symptoms and (2) have accessed care from a department at the tertiary centre in the last 12 months.

A systematic retrospective review of each patient’s electronic clinical record was conducted, examining all documented clinical encounters. Documentation was analysed across clinical letters, clinical notes, referrals, and the electronic problem list.

From each clinical document, the diagnoses recorded, the diagnostic language used, and the documented discussions were recorded. Tabulation allowed for comparison or quantitative data and summary narratives were composed to enable thematic analysis of qualitative data.

The evaluation demonstrated marked inconsistency in the documentation of functional symptoms compared to physical symptoms supporting the primary hypotheses. Differences also existed between clinician groups and the proportion of diagnosis discussions documented.

Functional diagnoses were less likely to be explicitly named, discussed with families, or recorded on the formal diagnosis list compared with physical diagnoses. Clinicians frequently used descriptive or tentative language when documenting functional symptoms. In contrast, physical symptoms were documented consistently, with clear diagnostic labels and subsequent discussions with patients and families. Mental health professionals showed greater consistency in documenting functional diagnoses than physical health specialists.

This service evaluation supports the hypothesis that functional symptoms are managed and documented less consistently than physical symptoms within tertiary paediatric care. The findings highlight a clear need for a standardised approach to the documentation of and discussion regarding all diagnosed medical conditions. Differences in the documentation approach from physical health and mental health specialists can be mediated by targeted local training and revisions to the electronic documentation systems. Establishing a dedicated functional service led by a specialist multi-disciplinary team may improve diagnostic confidence, documentation consistency, and patient experience.

The Membership examination of the Royal College of Psychiatrists (MRCPsych) is a postgraduate professional exam that doctors must pass to progress from core to specialist training in psychiatry in the UK. The MRCPsych courses refer collectively to a range of educational programmes, in England usually organised by different NHS Trusts, funded via postgraduate education through deaneries. There was a move to virtual teaching for the MRCPsych theory papers since the Covid-19 pandemic, providing greater accessibility. This came with challenges as trainers and learners struggled with engagement. This study examined an MRCPsych teaching programme delivered across three trusts, enrolling 121 resident doctors in 2023–2024 and 148 in 2024–2025, and aimed to systematically evaluate the programme, identify areas for enhancement through feedback and coproduction with residents, and assess the impact on curriculum delivery.

A mixed methods evaluation was undertaken for delivery of the theory paper teaching. Residents attending Paper A and Paper B MRCPsych teaching programmes in 2023–2024 (n=201) were asked to fill in post-session questionnaires comprising Likertscale items and some questions allowing free text answers. Quantitative data were pooled into descriptive categories, while qualitative responses underwent inductive content and thematic analysis. Themes were further explored and validated through resident focus groups and verified with a large language model for research triangulation. Insights informed a structured review of the 2024–2025 MRCPsych curriculum delivery involving a senior resident. The revised programme was reevaluated using the same methodology (n=237), enabling comparison.

In 2023–2024, residents rated content clarity, presentation quality and clinical relevance highly (≥83% “excellent” or “very good”). Suggestions included increased exam focus, more interactivity, improved time management, and provision of presession materials. Following curriculum revision, 2024–2025 ratings demonstrated further improvement, with ≥85% selecting “excellent” or “very good” across domains and reduction in “poor” responses. Candidates particularly valued enhanced exam-focused content, greater session interaction, and improved structuring and expansion of complex topics. At both time periods there was a request for increasing interaction in teaching and strengthening alignment with the MRCPsych syllabus.

Co-produced evaluation enabled systematic identification of ‘areas of improvement’ within the MRCPsych teaching programme, allowing targeted changes that yielded measurable improvements in satisfaction. This approach demonstrates circular evaluation of curriculum delivery through a continuous feedback loop within a quality assurance model that integrates curriculum design, teaching delivery, assessment, and outcomes. We recommend continued collaborative, resident-centred refinement of MRCPsych courses with mapping to the syllabus.

This quality improvement project explored the impact of targeted outreach teaching sessions delivered by the Early Intervention in Psychosis (EIP) Team in Warrington in addressing barriers between primary and secondary care, particularly around communication, culture, and clinical processes. A pre-and post-presentation survey was conducted to assesschanges in awareness of EIP pathways, co-working arrangements, criteria for amber-initiated medications, and mandatory antipsychotic monitoring. Results demonstrated a marked increase in familiarity across all domains.

This was an initiative informed by the Academy of Medical Royal Colleges’ findings that cultural and structural barriers between primary and secondary care such as differing professional cultures and communication challenges can hinder effective joint working. The Early Intervention in Psychosis (EIP) Team in Warrington and Halton delivered an interactive teaching session to local GP practices during protected learning time (PLT). During Halton GP PLT sessions, the EIP team delivered teaching covering service criteria, the role and impact of EIP, and case-based examples of clinical pathways. GPs completed pre-and post-session surveys on pathways of care in EIT, co-working arrangement, amber-initiated medication requirements and antipsychotic monitoring responsibilities. This was done via QR-linked online questionnaires. Responses were analysed descriptively in Excel and visualised using pie and bar charts to demonstrate changes in familiarity.

Prior to the presentation just over half of participants were familiar with pathways of care, fewer than a quarter understood co-working arrangements with primary care, just over half recognised the criteria for amber-initiated medications, and three quarters were aware of mandatory antipsychotic monitoring.

After the presentation, familiarity rose sharply across all areas. Understanding of pathways of care increased by 44 percentage points, familiarity with co-working arrangements improved by 73 points, knowledge of amber-initiated medication criteria rose by 35 points, and awareness of mandatory antipsychotic monitoring increased by 24 points, reaching full familiarity among all participants.

Targeted educational sessions delivered by specialist teams during protected learning time can significantly improve awareness among GPs of critical service pathways and responsibilities eliminating knowledge gaps around mandatory antipsychotic monitoring andco-working arrangements. This directly addressescultural and communication barriers identified by the Academy of Medical Royal Colleges. Further recommendations would be:

1. Expand Educational Interventions.

2. Foster Cross-organisational Dialogue.

3. Strengthen Co-working Arrangements.

4. Monitor and Evaluate Impact.

The prevalence of Autism Spectrum Disorder (ASD) varies across populations. Research shows that ethnicity and migration status may influence when and how ASD is diagnosed. Understanding ethnic differences in the prevalence of ASD and any associated drivers is important to ensure fair access to assessment and support. This review explores how ethnicity and migration background may influence ASD identification by examining theprevalence and incidence of ASD among ethnic minority groups in the UK, Sweden and the Netherlands. These countries have sizeable immigrant and minority populations. The review also compares patterns of ASD classification and diagnostic subtypes across these countries.

We conducted a systematic review of epidemiological studies that reported ASD prevalence or incidence by ethnicity, parental country of birth, or migration status in these countries. We searched MEDLINE, Embase, PsycINFO, CINAHL and PubMed, along with grey literature including Google Scholar. Reference lists of included studies were also screened for relevant studies.

Eight studies published between 1987 and 2025 met inclusion criteria. They drew on large population datasets such as education records, health and psychiatric registers, child health services and clinical service data. We summarised the findings with attention to study design, diagnostic criteria and methods used to identify ASD cases and patterns of ethnic differences.

Findings differed across countries and diagnostic subtypes. In the UK, most studies reported higher recorded ASD prevalence or incidence among some ethnic minority groups, particularly Black and South Asian children. These patterns were often linked to socioeconomic disadvantage and differences in how families accessed or were referred to services.

Swedish studies consistently found higher ASD prevalence among children of immigrant parents especially those from non-Northern European regions. These groups were more likely diagnosed as ASD with intellectual disability or more severe forms of autism.

Conversely, the Dutch study reported a lower overall incidence of ASD among children of immigrant origin. This was mainly due to fewer diagnoses of Asperger syndrome and PDD-NOS.

Across several studies, children whose families were immigrants from low and middle income countries showed lower recorded rates of high-functioning ASD but relatively higher rates of more severe ASD presentations.

Ethnicity and migration-related differences in ASD prevalence varied across countries and diagnostic subtypes. These patterns appear to reflect differences in diagnostic practices, service access and sociocultural factors. Thus, ethnicity data and cross-national comparisons of ASD prevalence should be interpreted cautiously, considering contextual and methodological factors.

The primary aim was to evaluate the anticholinergic burden (ACB) among adult patients in community intellectual disability (ID) psychiatry services. The objectives were to quantify ACB using the ACB Scale, assess adherence to best practices for medication review and side-effect monitoring, and identify variations in care to inform targeted quality improvement.

A retrospective audit of 146 randomly selected patient records was conducted across five community ID teams within PCNFT. Data was collected between March and May 2025. Key measures included the documentation of medication indication, evidence of MDT review, cognitive monitoring, and the recording of specific anticholinergic side effects.

The audit revealed marked inconsistencies in care. While two boroughs achieved 100% compliance for documenting medication indications, others were as low as 7.7%. Cognition was monitored in only 44.5% of patients, the use of validated side-effect monitoring tools was quite low (e.g., LUNSERS score documented in 0.7% of cases). The documentation of anticholinergic side effects was poor, being formally mentioned in just 7.5% of records, despite 15.1% of the cohort having documented hallucinations.

This audit provides clear evidence of deficiencies in the monitoring and management of anticholinergic burden. The findings confirm that ACB and its associated symptoms are not being monitored routinely. This reinforces the urgent need for a targeted quality improvement strategy, supported by effective resource allocation.

Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in hospitalised patients (Source: NHS England). Psychiatric inpatients are at an increased risk due to factors unique to our patient subset, such as reduced mobility, antipsychotic medication use, and illness-related behavioural changes including poor food/fluid intake, catatonia, being post-partum etc. Despite the NICE guidelines recommending VTE risk assessment including assessing psychiatric-specific risk factors for all hospital admissions, compliance within mental health inpatient settings remains variable. There also seems to be a focus on medical/surgical risk factors, and psychiatric-specific risk factors may get lost in this assessment. The aim of our QI Project is to evaluate compliance with national guidance on VTE risk assessment documentation on admission, and to identify potential gaps in assessment among patients with psychiatric-specific VTE risk factors.

A retrospective review of inpatient records at the Glenbourne Unit in Plymouth,which is an acute psychiatric inpatient unit with a General Adult Male and Female ward, and an Old Age ward. Data were collected from a sample of 47 inpatients in September 2025.

The primary outcome was clear documentation of VTE risk assessment on admission proforma of the Trust, recorded as ‘Yes’ or ‘No’, alongside brief clinical reasoning for prescribing or not deciding to prescribe VTE prophylaxis. Data collected included patient demographics, mobility status, antipsychotic use on admission, presence of psychiatric-specific VTE risk factors (such as antipsychotic medication use, reduced oral intake, and psychomotor retardation or catatonia), and also existing medical conditions or previous history of VTE.

Compliance was assessed against NICE guideline NG89, which recommends VTE risk assessment on admission, reassessment within 24 hours, and when clinical circumstances change. The remits of our audit were VTE assessment on admission and within 24 hours.

The mean patient age was 43.9 years (range of 18–84years), with 25.5% aged over 60 years (hence at an increased risk of VTE). Clear documentation of VTE risk assessment on admission was seen in only 40% of records, while 51% were marked as 'not applicable'.

Among patients with more than one psychiatric risk factor (n=39), 59% lacked clear documentation. Of those prescribed antipsychotic medication (n=35), 51% had no clear record of VTE risk consideration.

Documentation rates were higher in older adults (66%) compared to working-age adults (46%). Patients who were immobile had higher rates of VTE risk documentation (62%) than mobile patients (48.7%).

Documentation rates were noted to be lower amongst patients receiving antipsychotic medication and those with reduced mobility on admission.

Compliance with admission VTE risk assessment documentation in the Acute psychiatric inpatient unit was below the expected standard, including in patients with recognised psychiatric-specific risk factors. This highlights a need for improved awareness and to follow a structured assessment process. We believe that a number of factors might be at play for this, and a multi-step approach is essential.

We are currently due to start an intervention following the findings, to disseminate information, teaching sessions and presentation of our findings at a trust-level meeting so that this may trickle down into better compliance to the guidelines. We do have a built in VTE Risk Assessment Proforma on Systm One software, but this seems to be seldom used. Also, there needs to be more awareness to robustly consider psychiatric risk factors like we discussed above, to be considered for initial assessment of VTE risk.

Assessing compliance with guidance on high-dose antipsychotic treatment (HDAT) prescribing and monitoring in patients with severe mental illness (SMI) managed within a community mental health service. This includes identification and documentation of HDAT prescribing, completion of HDAT monitoring forms, and adherence to recommended baseline, early, and longitudinal physical health monitoring.

A retrospective audit was conducted of all patients under the SMI pathway (n= 391), in an outpatient clinic in North Staffordshire Combined Healthcare NHS Trust, who were prescribed high-dose antipsychotics over a 12-month period (January–December 2023). Data were extracted from electronic patient records. An electronic data collection tool,adapted from the Trust’s Standard Operating Procedures for HDAT prescribing and monitoring, was used. Collected data included documentation of HDAT status, completion of HDAT monitoring forms, and evidence of recommended investigations at the initiation phase (<12months) and continuation phase (>12 months) as well as side-effect monitoring using the Glasgow Antipsychotic Side-effect Scale (GASS). Compliance was assessed against Trust standards.

Of the 391 patients under the SMI pathway, 13 (3.3%) were prescribed high-dose antipsychotic treatment (HDAT). All patients on HDAT had a diagnosis of schizophrenia and were aged 49 years or older. Combination antipsychotic therapy accounted for 77% of HDAT prescribing, with 30% including a depot preparation. Olanzapine was the most frequently prescribed antipsychotic (n=6) and was associated with the highest dose exposure, reaching 150% of the BNF-licensed maximum dose for age and indication.

One patient was in the initiation phase of HDAT and had appropriate baseline investigations completed, including HDAT documentation, blood tests, ECG and physical observations: but not 3-monthly monitoring. The remaining 12 patients were in the continuation phase, of whom 91.7% had been identified. None, however, had completed HDAT monitoring forms or 3-monthly monitoring updates. While all patients received annual blood tests, ECGs and GASS assessments, 6-monthly monitoring was lacking. Factors contributing to incomplete documentation included inadequate identification of newly transferred patients already on HDAT, and record sharing barriers between GP’s and CMHS.

HDAT prescribing was uncommon, but its use was predominantly identified retrospectively, rather than clinical decisions to commence HDAT. These findings highlight gaps in systematic identification, documentation, and ongoing monitoring, underscoring the need for improved integrated care, clear shared responsibility, and adherence to HDAT monitoring protocols to optimise patient safety.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterised by cognitive decline, disruption of autobiographical memory and behavioural and psychological symptoms of dementia (BPSD), including anxiety, agitation, apathy and social withdrawal. This significantly affects quality of life and ethical care delivery in clinical and residential settings. Pharmacological treatments provide modest, time-limited benefits and are associated with adverse effects. Consequently, there is growing interest in non-pharmacological, person-centred interventions like music. However, its impact on behaviour, well-being and identity is relatively unexplored.

This paper evaluates music as a person-centred intervention for improving emotional well-being, reducing agitation and supporting a sense of self-identity in people living with AD. It hypothesises that music actively facilitates autobiographical memory recall rather than merely reflecting passive preservation of musical pathways by AD pathology.

This narrative review synthesised neurobiological, neuroimaging and behavioural studies examining the relationship between music-evoked autobiographical memory, emotional processing and self-identity in AD. Particular attention was paid to disease severity, distinctions between episodic and semantic memory and implications for care homes, specialist services and community-based practice.

Neuroimaging studies have shown involvement of the anterior cingulate cortex, medial prefrontal cortex and hippocampus in both music processing and autobiographical memory retrieval, supporting the existence of specific neural networks for self-identity activated by music. Evidence of music-related hippocampal activation, despite early atrophy in AD, suggests that music may actively preserve autobiographical memory pathways.

Music preferentially enhances episodic and self-defining memory recall, likely through emotional arousal, anxiety reduction and familiarity. Personalised interventions, including self-selected playlists or songs associated with positive emotions, resulted in stronger recall than researcher-selected music. In contrast, semantic memories were less influenced by music, which could create a dissociation between autobiographical memory and self-identity in advanced AD, limiting its effectiveness in later stages. Nevertheless, music reliably improves mood, reduces agitation and enhances social engagement across disease stages.

Music’s effects on autobiographical memory in AD are likely multifactorial and severity-dependent. Although music may not restore self-identity in advanced AD, it improves emotional well-being, reduces agitation and enhances quality of life. Given its non-invasive nature, absence of adverse effects and clinical benefits, music represents an ethically justified and implementable intervention for individuals living with AD. Furthermore, thisresearch suggests the possibility of other sensory cues like sounds, smells, tastes and environments being able to trigger autobiographical memories, highlighting a promising avenue for future research into non-pharmacological, person-centred interventions in AD.

Exploring an unusual, interesting case of Postictal Psychosis.

Gathering data from an encountered admission and previous hospital letters.

An interesting case that I had encountered through the initial 6 months of my training where a 46-year-old male was admitted for 2 years in hospital. He grew up living with his mother and two siblings. His premorbid personality described as extroverted, enjoyed reading books, playing bowls and watching the news. He is known to have trouble with dealing with frustration and coping with stress. He had a diagnosis of refractory epilepsy which limited his career to working in the family off licence shop, and also left school at the age of 16 due to bullying.

His past medical history included:

Severe Refractory Focal Epilepsy with Complex Parietal and Generalised seizures (Epilepsy first diagnosed at 15).

Right Temporal Cavernoma–surgical excision (2001), Hypothyroidism, Acute Myeloid Leukaemia (1986), Splenectomy, Bone Marrow Transplant, Iron Deficiency Anaemia.

He doesn't have any history of use of illicit drugs or alcohol.

He was first diagnosed with epilepsy at the age of 15. In the 2000s (Early) was having frequent seizures, family reported he’s reducing dose of AED on his own. He was admitted in November 2001 with complex partial status that required an ITU stay which led to a marked improvement in his seizure frequency. The week before admission he had become increasingly disturbed and developed psychotic behaviour. He was diagnosed with forced normalisation. He was given flupentixol.

He was trialled on most AEDs and was on 5 AEDs at the same time.

Mental health history included frequent admission under MHA and informally. He had frequent contact with Crisis team and ED and he was reported as a frequent caller. Hereported auditory and visual hallucinations specially after seizures. He was trialled onrisperidone, risperidone depot, haloperidol, lorazepam and diazepam, flupentixol.

He had multiple investigations throughout the years including MRI and CT head which didn't show any acute changes.

He was diagnosed eventually with Postictal Psychosis and Personality disorder according to Logsdail and Toone's criteria.

It is important to note the “herald symptoms” that occur hours before the psychosis sets in. The person becomes restless and irritable. They also usually develop insomnia.

Treatment includes: benzodiazepines, low-dose antipsychotic medication, RNS or deep brain stimulation. Surgery also may be an option, but risk must be calculated properly and the key is preventing seizures.

This case presentation explores an extreme form of self-harm by M, a woman in her late fifties, with historical diagnosis of schizophrenia, later revised to mixed personality disorder with anxious-avoidant, impulsive and antisocial traits. She experienced significant trauma in childhood in the form of physical abuse by father, needing hospital admission. Additionally, she has multiple medical comorbidities including Multiple Sclerosis and multiple transient ischaemic attacks, and two previous incidents of self-harm, including an intentional overdose requiring intensive care and tracheostomy. She has received trazodone and flupentixol depot intermittently since the 1980s, stopped in November 2025 by a covering consultant, against M’s wishes, due to absence of psychotic symptoms and worsening of physical health comorbidities.

M was admitted to the ward informally after presenting to the Emergency Department with suicidal ideation and thoughts of jumping in front of a lorry if not admitted. She quickly became comfortable in the ward setting but was noted to have personality changes compared to the community, including selective engagement with staff members. She became dependent on staff for Activities of Daily Living (ADLs), despite Occupational Therapy deeming her able of independent ADLs. Her behaviour became disruptive and challenging, including stripping naked, spreading faeces, and pulling her hair. This escalated to M attempting to remove her left eye from the orbit with her fingers, requiring an emergency lateral canthotomy and emergency repair of her ruptured globe in theatre, and resulted in loss of vision from that eye. M appeared to enjoy the attention she received during this incident. She has since attempted to remove her right eye, requiring close observation and frequent interventions by staff to prevent this.

M’s complex, lengthy psychiatric presentation and physical health comorbidities resulted in challenges in her management. Her presentation appears to be on the neurotic rather than psychotic spectrum, with antipsychotics prescribed for agitation. She has periods of lucidity before dissociation, with bizarre, disinhibited behaviour. Her distressed family queried the possibility of Munchausen Syndrome. Early severe trauma can present with challenging behavioural traits, emotional dysregulation and fight-flight response, leading to fluctuating withdrawal and aggression depending on context and perceived unmet needs.

This case is an example of a complex patient with multiple diagnostic and management challenges which culminated in rare and extreme self-harm resulting in loss of sight. It highlights the importance of collateral history and multi-disciplinary approach regarding diagnosis and management, contributing to the literature on mixed personality disorder.

This project aimed to develop and implement a structured inpatient admission support leaflet for individuals with Emotionally Unstable Personality Disorder (EUPD) and complex emotional needs (CEN), in line with NICE guidance (Borderline Personality Disorder: Recognition and Management, recommendation 1.4.1.3).

The leaflet outlines expectations, support processes, and a seven-day admission framework, integrating collaborative care planning, communication strategies, sensory needs, and a colour-coded Mood Intensity Meter.

The objectives were to improve clarity of inpatient processes, enhance engagement and emotional communication, promote collaborative risk and discharge planning, and support safe, time-limited admissions within a trauma-informed, person-centred model of care.

We piloted this intervention on Polaris Ward at Silverwood Hospital. Within the inpatient population we identified those with a diagnosis of EUPD with CEN and measured the average number of days from admission to discharge; patient wellbeing as reported through nursing staff reports and weekly ward reviews; and to what extent patients worked collaboratively with the clinical team. This data was collected between August 2025 to end January 2026. The CEN brochure was written based on NICE guidelines and trust policies and was presented at the community meeting to obtain feedback from service users with EUPD. This was distributed amongst new admissions fitting the patient population from February 2026 and the same parameters re-audited from February 2026 to August 2026.

Introduction of the CEN brochure and structured collaborative discussions was associated with improvements in several key areas. Nursing reports and ward reviews highlighted notable increases in patient engagement, with more patients actively participating in goal setting and ward round discussions. Patients demonstrated improved emotional regulation and wellbeing, reflected in more stable ward presentations and fewer episodes requiring unplanned staff intervention. Collaborative care planning improved as patients more consistently understood the purpose and expected duration of their admission, facilitating clearer shared expectations. While length of stay showed positive reductions, the greater impact appeared in the quality of collaboration and patient experience, suggesting that the intervention enhanced both the therapeutic relationship and the efficiency of care planning.

This intervention suggests that providing structured, accessible information tailored to patients with EUPD and CEN early in their admission can improve collaborativeworking, patient understanding and reduce the length of admission. This intervention was piloted in one inpatient working age ward, and should be trialled in further wards.

Senior medical reviews are essential for safe inpatient psychiatric care, supporting early risk assessment, treatment planning, and multidisciplinary team (MDT) coordination. National standards, including the Royal College of Psychiatrists’ Standards for Inpatient Mental Health Services – Fourth Edition (2022) and NHS England’s guidance on Acute Inpatient Mental Health Care for Adults and Older Adults, emphasise timely consultant involvement, structured review intervals, and high-quality documentation. This audit aimed to evaluate (1) whether senior medic reviews–conducted by consultants, specialty registrars (SRs), specialty and associate specialist (SAS) doctors, and multi-professional Approved Clinicians (ACs)–were completed within expected timeframes; (2) adherence to required review intervals; and (3) the quality and completeness of clinical documentation.

A retrospective audit of electronic clinical records was undertaken for psychiatric inpatients admitted to four acute wards at Roseberry Park Hospital during April 2025. Patients admitted for at least 24 hours were included. A structured audit tool assessed senior medic review within 24 hours of admission, completion of 72-hour formulation meetings and discharge reviews, documentation of senior presence in MDT meetings, integration of MDT recommendations, risk assessment, medication monitoring, and statutory documentation for detained patients. Percentages were rounded to the nearest whole number.

Senior medic assessment within 24 hours of admission occurred in 86%. Reviews at expected intervals were completed in 76%. Senior presence in key MDT meetings, integration of MDT recommendations, documentation of risk factors, contingency planning, and statutory requirements for detained patients all achieved full compliance. Documentation of senior medic reviews was clearly recorded in 80%. Clinical entries included diagnosis, risk assessment, treatment decisions, and progress updates in 97%. Medication adherence and side-effect monitoring were documented in 83%. Discharge planning was recorded in 97%. No criteria fell below the red compliance threshold. Areas requiring improvement included delayed initial reviews, inconsistent scheduling of review intervals, and incomplete documentation of progress reviews.

Overall compliance with national standards for senior medic reviews was high, with several domains achieving full adherence. The findings demonstrate strong MDT integration, robust risk documentation, and consistent statutory compliance. However, delays in initial senior reviews, variability in review scheduling, and gaps in documentation highlight opportunities for improvement. Strengthening administrative monitoring, introducing structured review checklists, and reinforcing documentation standards may enhance consistency, improve alignment with national expectations, and support safer inpatient care.

To review the utility of the traditional Mental State Examination (MSE) in identifying feeding or eating disorders (FEDs), and to propose a modernised approach that incorporates assessment of eating behaviours, nutrition, weight, and body image disturbance to improve detection and patient safety.

A narrative review of existing MSE frameworks was undertaken, examining their historical development and relevance to contemporary psychiatric presentations. The unique diagnostic challenges of FEDs were considered, alongside common barriers to detection such as stigma, ego-syntonic psychopathology and structural inequalities in the medical establishment. Our co-author provided lived experience accounts to provide a patient-led perspective on the limitations of the MSE in modern practice. Based on these gaps, a proposal was developed to integrate semi-structured questions on diet, weight, and compensatory behaviours into routine MSE practice.

The emphasis of the current MSE is seen to be heavily weighted towards traditional psychiatric presentations such as psychosis and affective disorders, inadequately capturing key psychopathology associated with FEDs such as eating behaviours, nutritional status, andbody image disturbance. This omission risks delayed diagnosis and compromised patient safety. Incorporating targeted, semi-structured questions into the MSE offers a feasible and systematic way to improve early recognition of FEDs across diverse populations. Additional benefits will be gained in safe psychotropic drug monitoring with early recognition of nutritional side effects.

Modernising the MSE to explicitly include assessment of eating behaviours and related psychopathology may enhance early detection of FEDs, reduce stigma through routine enquiry, and improve clinical outcomes and patient safety. Updates to medical training and everyday psychiatric practice are required in tandem to reflect the diverse presentations of modern mental health disorders.

Ultra-rapid cycling bipolar affective disorder (BPAD), defined by mood episodes occurring within weeks rather than months, is associated with significant morbidity and limited evidence-based guidance. Management becomes particularly challenging in women with pre-existing biological vulnerability factors such as hypothyroidism and pronounced sensitivity to antidepressants. This case highlights the complexity of balancing suicide risk, patient preference, and treatment-related mood destabilisation in ultra-rapid cycling BPAD.

We describe the case of a woman with a diagnosis of ultra-rapid cycling BPAD and a history of multiple prior admissions for mood instability. She had pre-existing hypothyroidism, neurodevelopmental comorbidity, and a past history of substance misuse, with no active substance use during admission. The patient experienced severe bipolar depressive episodes associated with high suicide risk, for which duloxetine was prescribed. However, even minor antidepressant dose changes were associated with mood elevation.

Lithium was optimised and maintained within the therapeutic range throughout admission, alongside initiation of clozapine for mood stabilisation. Following an inadvertent antidepressant dose escalation, the patient developed emerging manic symptoms, prompting urgent multidisciplinary medication review. Hypothyroidism management was concurrently reassessed, revealing suboptimal levothyroxine administration due to incorrect timing with food and other medications. Targeted education for the patient and staff was implemented, alongside dose escalation and regular thyroid function monitoring.

This case demonstrates pronounced antidepressant sensitivity in ultra-rapid cycling BPAD, with dose variability precipitating mood destabilisation even at low doses. Hypothyroidism represented a potentially modifiable biological vulnerability factor, with impaired medication absorption contributing to affective instability. A key clinical paradox emerged in which treatment required to mitigate suicide risk simultaneously increased the risk of manic relapse.

Shared decision making was central to management. Despite guideline based concerns regarding antidepressant use in rapid cycling BPAD, a consensus decision which was supported by wider acute consultant discussion and independent second opinion was made to continue antidepressant treatment at a reduced dose for a limited period, with close monitoring. Diagnostic clarity and coordinated multidisciplinary working were essential in maintaining therapeutic alliance and managing risk.

Ultra-rapid cycling BPAD necessitates highly individualised care. Antidepressants may destabilise mood even at low doses in biologically vulnerable patients, particularly women with comorbid hypothyroidism. Optimisation of physical health conditions, including attention to medication administration practices, can be clinically significant. This case underscores the importance of balancing guideline recommendations with patient-centred decision-making in complex, high-risk presentations.

Paediatric encephalitis is a medical emergency, and empirical treatment is used, given risk of neurological sequelae and death. Catatonia and first-episode psychosis can mimic encephalitis clinically, especially in medically complex children. This case describes an adolescent initially treated for suspected encephalitis.

A neuro-vulnerable 13-year-old refugee girl from Kenya presented to hospital with acute behavioural and mental state change with functional decline preceded by flu infection and major psychosocial stress due to deportation threat. Her medical history includes bilateral glaucoma, cataracts, basal ganglia calcifications, and left temporal arachnoid cyst. The initial working diagnosis was encephalitis and first-episode psychosis. IV methylprednisolone, cefotaxime, aciclovir, and immunoglobulin were commenced, followed by an oral prednisolone taper. Amlodipine 5mg once daily achieved good blood pressure control. Negative results from medical work-up (including neuro-inflammatory process and neuronal antibodies) led to immunotherapy being discontinued. During this time, catatonia developed (Bush-Francis Score of 14), 6kg was lost due to reduced intake, and psychotic symptoms continued. A lorazepam challenge showed substantial improvement in catatonia, engagement, and eating. Aripiprazole showed progressive reduction in psychotic symptoms. The patient was transferred to an adolescent mental health unit. Formulation: catatonia and psychosis in a highly neuro-vulnerable adolescent, triggered by acute psychosocial stress around asylum rejection and fear of return to an abusive environment. Lorazepam and aripiprazole were continued.

Since encephalitis is such a serious condition and takes several days of waiting on tests for diagnosis confirmation, treatment is initiated once encephalitis is suspected. Although it presents non-specifically, suggestive signs include fever, personality change, and reduced consciousness, which fit the case presentation. Subsequent treatment of IV steroids and anti-virals is in line with past literature although use of steroids (often initiated to control raised intracranial pressure) is under further research. Once encephalitis was ruled out, appropriate treatment for psychosis and catatonia was commenced. Due to complex medical history, a genetics test was ordered and results were suggestive of oculodentodigital syndrome (GJA1-related). Two variants of uncertain significance have been found in GJA1 and parental samples are being analysed.

Catatonia and first-episode psychosis can mimic encephalitis. Clinicians should treat suspected encephalitis urgently and maintain a low threshold to re-evaluate diagnosis, integrating psychosocial context (in this case, refugee status) and catatonic signs to guide psychiatric intervention. Constellations of symptoms can be indicative of syndrome diagnosis. Genetic testing should be initiated as required.

Emotional disorders are increasingly prevalent among medical students, significantly affecting their well-being and academic performance due to high levels of academic pressure. This study aims to assess emotional distress at Oman Medical College, addressing a gap in understanding mental health within this demographic and underscoring the need for targeted interventions.

Conducted from April to May 2025, this descriptive cross-sectional study utilized standardized surveys to evaluate emotional distress among medical students at the National University of Science and Technology in Oman. Data were collected through an online questionnaire from a convenience sample of 400 students, employing the General Health Questionnaire (GHQ-12) for mental health assessment. Statistical analysis was performed using SPSS to determine significance.

Of the 400 students invited, 336 completed the survey, yielding a response rate of 84%. The average age of participants was 21.6 years, with the majority identifying as female (89.6%) and Omani nationals (78.2%). Emotional distress was reported by 73% of respondents, with exam-related stress identified as a key contributing factor. Notably,students who received strong parental support exhibited significantly lower levels of emotional distress (p <0.05).

This study reveals a high prevalence of emotional distress among medical students in Oman, closely linked to academic stressors and mitigated by familial support. These findings highlight the urgent need for tailored mental health programmes and resilience-building interventions within medical education in Oman.

Large language models (LLMs) are increasingly proposed to support healthcare delivery, yet their ability to address the distinctive challenges of dementia care remains unclear. Dementia is characterised by progressive cognitive impairment, communication barriers, high caregiver burden, and substantial demands on memory services and old age psychiatry. We systematically reviewed and classified empirical applications of LLMs in dementia assessment and care, and critically appraised the maturity of evidence, intended users, and reporting of safety, fairness, and governance relevant to clinical implementation.

We searched EMBASE, MEDLINE, PsycINFO, PubMed, the ACL Anthology, the ACM Digital Library, arXiv, medRxiv, and bioRxiv (2017–June 2025). Eligible studies were empirical evaluations (simulation-based or experimental) of LLMs used for dementia-relevant clinical, caregiver-facing, or research tasks; non-evaluative commentaries were excluded. Titles/abstracts were screened by multiple reviewers, with full-text screeningconducted in accordance with PRISMA; disagreements were resolved by discussion. Using a standardised extraction form, we recorded study design, model attributes, input modalities, dementia-related use cases, evaluation setting (benchmark/vignette vs clinical data), outcomes, and reporting of ethics approval, bias assessment, and hallucination-related issues. Findings were synthesised narratively and grouped using a predefined taxonomy of clinical, patient-facing, and research-oriented applications.

We identified 35 dementia-focused studies, several covering multiple applications. The most frequently reported functions were screening/early detection (26/35) and diagnostic support (28/35), typically framed as classification tasks. Other common applications included research facilitation (19/35), evaluation/outcome measurement (19/35), information extraction (14/35), and prediction/risk stratification (13/35). Multimodal approaches were reported in (14/35). Intended users were most often researchers (22/35) and clinicians (20/35), with fewer studies targeting people living with dementia (10/35) or caregivers. Inputs included speech/audio (20/35) and free text (18/35); outputs most commonly included classification labels (26/35) and risk scores (11/35). Performance metrics were reported in 18/35. Reporting of safeguards was inconsistent: ethics approval (10/35, 29%), bias assessment (10/35, 29%), and explicit hallucination reporting (5/35, 14%).

LLMs show promising experimental performance for dementia-related classification and early detection tasks, suggesting potential roles in augmenting assessment workflows. However, evidence is largely preclinical, with limited real-world validation and inconsistent reporting of fairness, safety, and governance. Future research should prioritise prospective evaluation in memory services, robust bias and hallucination assessment, and co-designed implementation with people living with dementia and caregivers to support safe, equitable integration in psychiatric practice.

Use of amphetamines is linked to serious cardiovascular events such as tachyarrhythmias, QTc prolongation, myocardial ischemia, and even sudden death from cardiac arrest. The discontinuation of these substances will increase these risks, especially because of autonomic instability and the possibility of polypharmacy with psychotropic drugs. Although the American Heart Association (AHA) recommends using the ECG when withdrawing, there is no certainty that these procedures are followed in psychiatric withdrawal units. This audit was focused on assessing the adherence to the recommended ECG monitoring guidelines in amphetamine withdrawal inpatients and determining the gaps in the current practices that require quality improvement efforts.

A retrospective clinical audit was carried out at the Department of Psychiatry and Behavioral Sciences, Allied II Hospital, Faisalabad. A standardized checklist was used to examine the medical records of 70 inpatients admitted during a three-month time interval for amphetamine withdrawal, based on the AHA guidelines. The information was gathered, including demographic data, ECG performance, record of interpretation, repeat ECGs, and follow-up measures. The data were evaluated descriptively with Microsoft Excel, in which frequencies and percentages were computed to identify the adherence to each audit criterion.

The average age of the patients was 30.3 years (9.6), and the majority were males (97.1%). Even though all the patients confirmed taking amphetamine, only 7.1% of the patients were subjected to a baseline ECG at admission. Worryingly, none had recorded the results of ECG interpretations and QTc measurements. In addition, no repeat ECG checks or cardiac laboratory assessments were done, including the 37.1% of the patients who complained of cardiovascular symptoms. The compliance with AHA standards of monitoring was generally of low quality, which points to deep-seated flaws in the cardiac safety monitoring.

This audit has shown that there is a distressing absence of ECG checks and recording in the treatment of amphetamine withdrawal. In order to improve patient safety, it is important to introduce mandatory baseline ECG policies and staff education on the need to monitor and incorporate ECG prompts into admission workflows. It is highly advisable that a follow-up re-audit be done between 6 and 12 months after these corrective measures are put in place in order to determine how much compliance and patient outcomes have improved. With these efforts, it will be possible to protect the cardiovascular health of patients with amphetamine withdrawal symptoms in an effective way.