Valproic acid is an effective mood stabiliser but carries significant teratogenic risks when prescribed to women of reproductive age. Clinical guidance recommends that women are fully informed of these risks, advised on effective contraception, and that discussions are clearly documented as part of shared decision-making. This audit aimed to assess the extent and quality of documentation of counselling on teratogenic risks, pregnancy prevention, and informed consent in women of reproductive age prescribed valproic acid at a tertiary mental health service in the United Arab Emirates (UAE).

A retrospective clinical audit was conducted at the Behavioural Sciences Unit, Al Ain Hospital. Pharmacy records and electronic medical notes were reviewed for all female patients aged 18–50 years who were prescribed valproic acid during the audit period. Patients with intellectual disability, cerebral palsy, or severe cognitive impairment were excluded because of limitations in informed consent. Audit standards were derived from the National Institute for Health and Care Excellence (NICE) and Medicines and Healthcare products Regulatory Agency (MHRA) guidance on the Valproate Pregnancy Prevention Programme, focusing on documenting counselling about teratogenic risks, contraception, pregnancy prevention, and informed consent. Data were analysed descriptively as frequencies and percentages.

A total of 56 female patients of reproductive age were prescribed valproic acid during the audit period. Seven patients were excluded, leaving 49 for analysis. Documented counselling regarding the teratogenic risks of valproic acid, including congenital malformations and neurodevelopmental impairment, was present in 12 patients (24.5%). In these cases, documentation included discussion of pregnancy prevention and contraceptive advice. The remaining 37 patients (75.5%) had either partial documentation or no documented evidence of counselling regarding teratogenic risks, contraception, or pregnancy prevention. Documentation of partner involvement in discussions was noted in 5 cases (10.2%). Only 8 patients (16.3%) had a discussion of alternative treatment options recorded in the medical notes.

This audit found major gaps in documenting counselling and consent about valproic acid’s risks in women of reproductive age. While counselling may happen, poor documentation poses medicolegal and safety concerns. Interventions like electronic prompts, templates, multilingual leaflets, and clinician awareness are needed to boost guidance compliance. A follow-up is advised to evaluate these actions and ensure safer prescribing.

No financial sponsorship has been received for this project.

Antipsychotic-induced hyperprolactinaemia is a common adverse effect associated with dopamine-blocking medications. Persistently raised prolactin is linked to sexual dysfunction, infertility, and importantly, reduced bone mineral density and osteoporosis. Concerns were raised that prolactin monitoring within the service was inconsistent and that raised levels were not always acted upon, posing potential long-term risks.

• • Assess whether patients prescribed antipsychotics had prolactin levels appropriately monitored, during my psychiatry placement at the Early Intervention team in Adult psychiatry.

• • Determine whether elevated prolactin prompted clinical action.

• • Identify gaps in monitoring practice and associated risks to bone health.

• • Provide recommendations to improve standards of care.

A retrospective audit of referrals over a six-month period was performed usingRiOelectronic records.

• • Patients not on antipsychotics were excluded.

• • For eligible patients, the following were reviewed:

  1. Antipsychotic medication.

  2. Whether prolactin was checked.

  3. Whether levels were normal or raised.

  4. Documentation of any medication adjustment or follow-up.

• • Comments were added to highlight missed monitoring opportunities or incomplete documentation.

• • Total referrals reviewed: 43

• • Excluded (not on antipsychotics): 20

• • Included for audit: 23

Key Findings:

• • 6/23 (26%)hadno prolactin test despite being on antipsychotics.

• • 15/23 (65%) had normal prolactin results.

• • 2/23 (9%) had raised prolactin, with one severe elevation (4155.6 mU/L).

Only 1 patient had clear medication adjustment in response to raised prolactin

Implications for Bone Health:

• • Persistent or unmonitored hyperprolactinaemia increases osteoporosis risk.

• • No consistent documentation linking raised prolactin to bone-health outcomes (e.g., DEXA, vitamin D).

Overall, the team demonstrates good awareness and management of prolactin-related issues, with most patients receiving appropriate monitoring and normal results. When significantly raised prolactin levels were identified, clinicians acted promptly with medication review and plans for follow-up, reflecting good clinical practice.

The key learning point is the value of maintaining this strong standard while improving documentation clarity and ensuring timely follow-up of repeat prolactin testing. No major pathway changes are required; instead, small refinements can further strengthen already effective care.

The QIP identified only one patient with raised prolactin who had not yet received a medication adjustment.

Clinical depression is one of the most prevalent psychiatric illnesses, yet patient understanding of the condition is often lacking. Effectively educating patients on their diagnosis is a key communication skill for clinicians and future doctors.

This qualitative study aimed to compare how consultants and medical students, two ends of the medical hierarchy, differ when explaining depression to patients, whilst examining the potential clinical and educational implications.

Semi-structured online interviews were conducted with 12 final-year students and four consultants (two psychiatrists and two general practitioners). Participants were asked to role-play how they would discuss a suspected depression diagnosis to a lay patient, and explain the condition.

Linguistic and thematic analysis was conducted using Nvivo.

Consultants tended to avoid heavy neurobiological discussion, using simplifications and generalisations to explain things with brevity and relating back to a patient’s individual experience. One psychiatrist explained that this simplified description aimed to prioritise patient comprehension and acceptance to treatment, where ‘bogg[ing] them down with…scientific facts’ was feared to cause confusion or take emphasis from what the clinician deemed important.

In contrast, despite avoiding medical jargon, students gave more verbose biochemical explanations. All students referred to the neurobiological theory behind depression within their answers.‘Serotonin’ specifically was mentioned by three students, but not by any consultants. Students also showed difference in language style, often asserting a more declarative tone by informing a patient of their diagnosis, clearly separating themselves as the expert. Consultants framed explanations as a collaboration and promoted patient self-reflection, inviting the patient to follow their diagnostic conclusion, reducing doctor–patient asymmetry in the hypothetical consultation.

Students medicalised depression to properly inform patients and validate their experiences. Comparatively, consultants were succinct and practical for clarity, comprehension and mutual understanding. There is research to support this latter approach, which suggests that an overemphasis on the neurobiological basis of depression can cause a lack of focus on the social and emotional dimensions of the illness. This may even cause a favouring of pharmacological over cognitive therapies.

Communication skills training for these students has effectively taught them to avoid unexplained medical jargon, but may need greater emphasis on delivering practical, patient-centred information when educating patients on their psychiatric conditions. However, due to the limited scope of this study, further research would be needed with larger cohorts in a more clinically realistic setting.

The NHS Long Term Plan advocates for ambient voice technology (AVT) tools to alleviate administrative burden and improve patient access. However, psychiatric assessment relies heavily on linguistic nuance in culturally diverse presentations. Moreover, accent diversity may affect AVT speech recognition. This raises concerns about inaccurate records and the widening of health inequalities.

This study aims to evaluate the accuracy of three NHS-approved AVT tools–Company A, B, and C–in summarising psychiatric consultations across diverse cultural presentations and accents.

We evaluated three AVTs using test scripts (n=3) simulating depression, dementia, and psychosis. The study included:

1. Cultural Test: Scripts adjusted for British, Nigerian, Pakistani, and Polish presentations using standardised controlled speakers.

2. Accent Test: Participants (n=9) with diverse UK and international accents reading identical scripts.

3. Output summaries were evaluated against a gold-standard checklist. Errors were classified as ‘missing/incomplete’, ‘incorrect/misleading’, or ‘hallucination’ (information not stated in the script).

Data are presented as mean accuracy [95% CI].

Cultural test: Company B demonstrated the highest stability: British 85% [83–87], Polish 85% [78–91], Nigerian 81% [74–88], and Pakistani 79% [72–86]. Company A displayed some variability, performing better on Nigerian 76% [69–82] and Pakistani 75% [63–86] scripts than on British 65% [43–87] and Polish 61% [34–89]. Company C consistently underperformed, ranging from British 58% [41–75] to Nigerian 56% [40–72].

Accent test: Performance was notably more stable. Company B remained stable across local (South England 84% [79–89]) and international (Spanish 80% [76–84]) speakers. Company A peaked in South England 82% [78–86] but degraded for Nigerian 69% [60–78]. Company C generally mirrored this stability (e.g. Romanian 78% [68–88]) but suffered a technical speech recognition failure for the South England accent (19% [14–23]).

Error distribution per tool: Missing/incomplete errors (>92%) dominated across all tools; 98.1% of Company A’s errors were missing/incomplete, with minimal hallucinations (1%). Company B and Company C showed higher rates of active error: Company C recorded the highest percentage of both hallucinations (2.3%) and incorrect/misleading data (5.4%), followed by Company B (1.7% and 4.7%, respectively).

No statistically significant difference was found in overall accuracy acrosscultures or accents; however, Company B produced the most consistent summaries, while Company C produced the least. Limitations include small sample size, limited representation, and simulation design. Although seemingly robust across cultures/accents, incomplete summaries highlight the need for human oversight in clinical use. Future work must assess these tools in larger, live clinical settings to ensure safety for diverse populations.

The Pediatric Inventory for Parents measures the frequency and difficulty of parental disease-related stress. We describe the psychometric properties and evaluation of the Norwegian version for mothers of infants with CHD.

The Pediatric Inventory for Parents contains 42 items within four domains: (1) communication, (2) emotional functioning, (3) medical care, and (4) role function. Participants assessed the frequency and difficulty of disease-related stressful events over the previous seven days. Data were collected from 48 Norwegian-speaking mothers of infants with CHD one month after hospital discharge. The psychometric properties of the frequency subscale were explored using exploratory factor analysis, and the discriminant and concurrent validity of the total scale were examined.

Factor analysis revealed that some items had poor loadings in our sample of mothers of infants with CHD. Cronbach’s alpha in domains was between 0.69 and 0.90. The Pediatric Inventory for Parents discriminated between stress levels in CHD severity in both subscales and all domains (p-values 0.03 to 0.001). Difficulty of disease-related stress and symptoms of depression were moderately correlated (r = 0.56 to 0.63).

The domains on the frequency subscale were multidimensional, and some items had lack of relevance to the population studied. Despite this, the Pediatric Inventory for Parents differentiated between stress in different CHD severity groups and correlated moderately with symptoms of depression. We recommend developing an infant version of the instrument. If the original version is used in mixed populations, lack of relevance of some items to infants should be accounted for.

This retrospective quality improvement project audited how well children and young people (CYP) who presented with mental health concerns to Leicester's Paediatric Emergency Department (PED) were being assessed. During the audit period, Leicester's PED had two digital forms available to be filled out by the triaging clinical staff. One of the forms was titled the emergency department (ED) mental health risk assessment tool which determines what is needed to keep CYP safe while they wait to be seen, and a second form titled the ED mental health form which includes mental state examination and a dynamic priority score (DPS). Completion of these tools fits in with meeting the requirements of the NICE Guidance (NG225).

This was a retrospective audit of 59 patients who presented to the Leicester PED with acute mental health concerns in September 2024. Data collection took place onNerveCentre, which is the digital software Leicester's ED uses for the documentation of clinical activities.

The following data was collected:

1. Percentage of total completed mental health risk assessments using the assessment tool.

2. Percentage of ED mental health forms which were opened/started by staff.

3. Percentage of ED mental health forms which had a completed mental state examination.

4. Percentage of ED mental health forms which had a DPS score assigned.

1. 11.9% (7/59) patients had a completed ED mental health risk assessment using the assessment tool.

2. 62.7% (37/59) patients had an ED mental health form opened/started by staff.

3. 43.2% (16/37) of the ED mental health forms which were opened had a completed mental state examination.

4. 78.4% (29/37) of the ED mental health forms which were opened had a DPS score assigned to signify the level of risk.

The audit also revealed that the tool may not be as suitable for CYP (mentions of capacity rather than competence, high-risk outcome suggests rapid tranquillisation). Additionally, there is overlap between the tool and the form, which may be contributing to the lower completion rates of the tool.

This audit revealed that Leicester PED's initial assessment of CYP presenting with acute mental health concerns needs to be reviewed, with enhancements made to make the tools more applicable for CYP. Revamped tools can then be further embedded with education and training amongst staff to increase the department's adherence to the NICE Guidance (NG225).

The need for a clear, consistent handover process was identified amongst resident doctors covering Avon and Wiltshire Mental Health Partnership (AWP) Bristol inpatient sites, including at Callington Road Hospital (CRH).

Previously, the overnight doctor handed over to the daytime ward doctors using a variety of methods. This included email, face-to-face, or by ward phone. Face-to-face handovers were infrequent as it was impractical to visit 7 wards individually to hand over. Daytime doctors were difficult to reach by phone, due to concurrent morning MDT handovers.

Email was a widely used handover method. However, there was risk of delay in receiving and acting on information, with patient safety implications. Our aim was to make the inpatient handover system safer and more fit-for-purpose.

Our scoping questionnaire (December 2024–March 2025) found that most responders favoured face-to-face when giving (10 of 16) and receiving (11 of 16) handover. Only 25% agreed the existing system was fit-for-purpose and 19% agreed it was safe.

Based on this information, a weekday in-person handover was introduced at CRH from 9.00–9.15am.

We received backing from the Head of Bristol Inpatients, the Bristol, North Somerset and South Gloucestershire Medical Inpatient Lead, and CRH consultants to initiate a 2-month pilot.

The pilot was advertised amongst resident doctors and launched in May 2025. Feedback was gathered via online questionnaire and handover attendance monitored using a logbook.

82% attendance was achieved at the in-person handover during the 2-monthpilot (May–July 2025).

The 10 questionnaire responses during the pilot showed 80% agreed the new system was fit-for-purpose and 100% agreed it was safe.

Positive feedback included that there was a reduced chance of miscommunication, clarification was easier, and tasks were less likely to be missed. Night doctors found the new handover quicker, less stressful, and felt tasks were more likely to be actioned. Finally, resident doctors found the in-person handover more sociable. Suggestions for improvementincluded encouraging increased attendance, making locums aware of the new handover, and including the other 2 inpatient sites covered overnight in the handover process.

Overall, the in-person handover pilot was successfully implemented, with overall good attendance and positive feedback regarding its safety, efficacy, and social aspect. It has been incorporated into the locum induction and induction for resident doctors working at CRH for future rotations. We also plan to extend this project to the other 2 Bristol inpatient sites to create a streamlined handover system to positively impact patient safety.

Loss of emotional experience and expression, known as “negative symptoms”, can significantly impact people’s emotional, cognitive, and psychological functioning. However, available evidence suggests these symptoms are often missed due to overshadowing by other difficulties. Consequently, there is a dearth of evidence for effective management. The lack of prevalence data challenges treatment resource allocation within healthcare services. Thus, this audit aims to collect relevant data on negative symptoms among service users in an NHS Trust.

The aim of this project is to understand the prevalence, demographic profile and description of “negative symptoms” among a sample of AORT service users. It also investigates the allocation of resources for its management.

This is a mixed methods study. 100 service users who were open to AORT were randomly selected between 1 September and 31 November 2023 through the clinical record interactive search service (CRIS). Data relating to the demographics of the participants, their psychological and occupational therapy contact, and prescribed medications were extracted and anonymised. Two independent coders also read through the electronic patient journey system (ePJS) to record the language used to describe “negative symptoms” and identify occupational therapy contact.

Findings revealed that only 28% of the service users reported “negative symptoms”, with most of the reports among Black/Black British–Caribbean males. Among the study sample, only half were prescribed medication, and people with “negative symptoms” were less likely to receive occupational or psychological therapies than those without. However, no significant associations with age, gender, or race/ethnicity were found.

Low prevalence of therapeutic contacts among service users who report “negative symptoms” may be related to multiple factors such as complex diagnostic tools and priorities highlighted in management pathways. These factors may increase the difficulties of expressing service users’ needs, leading to a vicious feedback loop that may become complicated to manage without support.

Next steps: A better diagnostic process could uplift the “negative symptoms” management and resource allocation. This could be achieved through a co-learning workshop on topics such as the clinical presentation and impact of “negative symptoms” and co-creation of simpler assessment proformas. It is also important that “negative symptoms” are considered in risk assessments. Finally, peer support and psychological therapeutic groups can be facilitated by teams to improve the management of “negative symptoms”.

Addiction to over-the-counter (OTC) drugs is a poorly acknowledged clinical issue, especially in developed and developing nations when the regulatory supervision is less strict. Pheniramine hydrogen maleate (PHM) is an antihistamine of the first generation that is broadly used in allergic problems and can be freely bought without a prescription as Avil. Because of its sedative, anxiolytic, and euphoric effects, there is the possibility of misuse of pheniramine. Despite the description of psychological tolerance as well as withdrawal symptoms, there are very few reported cases of pheniramine dependence in the psychiatric literature. The case under consideration is a longitudinal dependence on pheniramine, which accentuates its clinical progression and withdrawal symptoms and explains the necessity of clinicians being aware of the abuse of the widely popular antihistamines.

A 35-year-old married businessman presented with symptoms of substance withdrawal such as restlessness, irritability, vomiting, diarrhea, headache, and insomnia following cessation of chronic pheniramine use. His past history of intravenous pheniramine (Avil) use dates back to 12 years, when he was taking 4–6 vials per day and at times 10 vials. He began using it when he was prescribed injectable pheniramine and dexamethasone to treat a chronic cough and body aches. He continued to self-administer even though he underwent routine investigations because he believed that he had recovered. He had several unsuccessful attempts at discontinuation. He had two years of abstinence after inpatient detoxification and asthma treatment but relapsed due to accidental exposure to pheniramine during his hospitalization. The mental status examination presented guilt, health preoccupation, and decreased attention. The ICD-10 criteria were used to diagnose Psychoactive Substance Dependence Syndrome (pheniramine) and comorbid bronchial asthma. He was in an action stage of the change model.

Pheniramine is also associated with the abuse potential due to its sedation and anticholinergic effects, specifically because of its use as an intravenous method of administration that enhances the bioavailability and the reinforcing effects. The likelihood of dependence emerged due to repeated self-medication of PHM for respiratory symptoms. The unexpected reexposure emphasized the importance of paying attention to medication history and pharmacovigilance.

Although rare, dependency on pheniramine is a severe and underestimated clinical issue related to OTC medications. This example highlights that combined multidisciplinary management, more stringent control over the sale of antihistamine products, and increased awareness of clinicians are required. Early psychiatric intervention, structured detoxification, and psychosocial support are essential in order to recover in the long term and prevent relapse.