To determine if treating ADHD in a busy inner city GP practice reduces the workload of GP’S and reduces frequency of missed appointments

Data was collected from a GP surgery in Belfast which prescribes ADHD medication according to Shared Care Guidelines. Patients were excluded if they had been on ADHD medication for less than 12 months (as of November 2024) or if they had received a diagnosis from childhood. 19 Patients were found to fit the criteria. Data was collected to compare the number of missed appointments pre vs post ADHD diagnosis and treatment, as well as comparing the number of consultations which patients required related to their mental health.

Results from this Audit found that there was no significant difference in the number of appointments which patients missed in the 12 months before ADHD treatment and diagnosis compared to after. On the other hand, it was found that the number of GP Consultations related to Mental Health almost halved (37 to 19) in the 12 months after ADHD treatment and diagnosis compared to the 12 months before.

Findings indicate that the diagnosis and treatment of patients with ADHD, reduces the burden which they place on Primary Care services, not only in time spent with the GP but also contacting receptionist, practice nurse prescriptions etc, never mind the benefits for the patient and their loved ones.

Achalasia is a rare oesophageal motility disorder in children and adolescents, presenting with vomiting, regurgitation, dysphagia, weight loss, and anxiety around eating. These features can closely resemble restrictive eating disorders or functional vomiting syndromes, leading to diagnostic uncertainty. Delayed diagnosis is well recognised and may result in severe malnutrition, aspiration, and secondary psychiatric morbidity. We describe an adolescent whose prolonged illness was initially managed within eating disorder pathways before achalasia was identified as the underlying cause.

At 12 years of age, the patient developed eating difficulties in the context of a known anxiety disorder. She reported progressive dysphagia, described as an acidic sensation in the throat and food sticking, alongside regurgitation, reduced appetite, and avoidance of eating at school. Vomiting increased over time, oral intake declined, and significant weight loss ensued.

She was admitted for investigation of possible physical causes. A barium swallow study was attempted but poorly tolerated and completed via nasogastric tube, resulting in inadequate visualisation of the oesophagus. Despite this limitation, the study was reported as normal and no gastroenterology follow up was arranged. Ongoing vomiting and nutritional compromise led to management within eating disorder services and admission to an inpatient eating disorder unit. Atypical anorexia nervosa was the initial working diagnosis.

With structured nutritional rehabilitation, she initially approached weight restoration and was generally engaged in treatment. A previously undisclosed history of self harm emerged, linked to eating related guilt and emotional distress, and fluoxetine was commenced. Although vomiting reduced in frequency, urges persisted and dietary adherence remained inconsistent. She was later diagnosed with ADHD and commenced on methylphenidate.

She subsequently deteriorated, with renewed weight loss, reduced dietary adherence during home leave, and worsening physical symptoms including regurgitation, nocturnal cough, and recurrent chest infections. Symptoms were attributed to reflux and rumination syndrome, and management remained conservative. Progressive nutritional compromise and recurrent infections necessitated nasogastric feeding and detention under the Mental Health Act. Further imaging demonstrated marked oesophageal dilatation with distal narrowing, confirming achalasia. She underwent laparoscopic Heller myotomy, after which regurgitation, vomiting, and chronic cough resolved. Postoperatively, she achieved sustained weight restoration and tolerated oral intake without dysphagia.

This case highlights how achalasia can closely mimic eating disorder presentations when early investigations are inconclusive. In adolescents with persistent dysphagia, regurgitation, vomiting, and weight loss refractory to eating disorder treatment, early reconsideration of gastrointestinal pathology may prevent prolonged psychiatric admissions and significant medical morbidity.

Neurodevelopmental disorders, including ASD and ADHD, are lifelong conditions that typically present in childhood. Early identification and timely diagnosis are essential to facilitate access to appropriate support, reasonable adjustments and evidence-based interventions to improve long-term outcomes. In recent years, health services across Wales have reported a substantial increase in referrals for neurodevelopmental assessment. This trend has been observed in ABUHB, placing increasing pressure on neurodevelopmental diagnostic services and contributing to prolonged waiting times.

The purpose of this service evaluation is to examine patterns in neurodevelopmental referrals and diagnoses amongst young people within ABUHB, and to assess whether existing diagnostic pathways meet expected quality standards. The evaluation aims to describe referral volumes, waiting times and diagnostic outcomes for the young people referred for neurodevelopmental assessments. In addition, it seeks to identify trends over time in the volume and nature of referrals, including demographic characteristics, and to assess service performance against national and local guidance, including NICE recommendations and Welsh Government neurodevelopmental targets.

To achieve these aims, a retrospective review of routinely collected service data from ABUHB’s neurodevelopmental pathway was undertaken. Quantitative analysis was used to evaluate referral rates, time from referral to assessment and diagnostic outcomes. Observational learning complemented the quantitative findings through attending neurodevelopmental assessment clinics and MDT meetings, providing insight into the clinical decision making, referral pathways and multidisciplinary working. Engaging with cliniciansinvolved in assessment further contextualised the findings and enabled deeper understanding of perceived challenges, service pressures and examples of good practice.

This service evaluation demonstrates increased demand for neurodevelopmental assessment, alongside extended wait times and variation in diagnostic outcomes across the pathway. Service data demonstrates a substantial rise in accepted referrals over time, rising from 1535 to 2221 between 2021 and 2023, with sustained high referral volumes after. These findings highlight areas where current practice aligns with recommended standards, and areas where service delivery may be constrained by capacity and resource limitations. The clinical observations provide valuable context regarding the impact of rising referral volumes on patient-centred care.

In conclusion, this service evaluation will provide a structured, data-informed overview of the current performance and pressures within the neurodevelopmental diagnostic services within ABUHB. Through integrating quantitative service data with qualitative clinical observations, the project aims to generate evidence-based recommendations to support service improvement. This evaluation highlights the role of service evaluation in supporting reflective clinical practice and continuous quality improvement within child and adolescent mental health services.

Year 5 medical students on paediatric placements at University College London Hospitals (UCLH) reported limited and inconsistent exposure to Child and AdolescentMental Health Services (CAMHS), with concerns that existing placements were not always relevant or applicable to undergraduate learning needs. This quality improvement project (QIP) aimed to improve Year 5 medical students’ self-reported confidence in assessing and communicating with young people in mental health settings through a structured simulation session integrating physical and mental health presentations.

The problem was identified through placement feedback surveys, discussions with student representatives, and analysis with undergraduate CAMHS and paediatric leads alongside a review of the Year 5 curriculum. In response, asimulation-based teaching afternoon was co-developed with CAMHS liaison psychiatrists, paediatric doctors, CAMHS liaison clinical nurse specialists, and a medical student representative to ensure educational relevance and clinical authenticity.

Four simulation scenarios were co-designed to reflect common CAMHS presentations while integrating physical health considerations, psychosocial assessment, and communication skills. Scenarios were selected based on evaluation of existing teaching sessions to avoid topic repetition and to cover areas of the curriculum that were not otherwise addressed. Role-players were volunteering doctors, briefed on each scenario and given time to review the scripts, ensuring the simulations were authentic, structured, and cost-effective. The session was delivered to a pilot group of twelve Year 5 medical students during their paediatric and CAMHS placements. Each scenario was followed by a structured debrief focusing on communication with adolescents, holistic assessment, and integration of physical and mental health care. Students completed anonymised pre-and post-session questionnaires using 5-point Likert scales and free-text feedback.

Pre-simulation questionnaires demonstrated low to moderate confidence. Only 50%of students felt confident communicating with adolescent patients, 25% felt confident managing consultations involving both physical and mental health issues, 25–33% felt confident using a structured psychosocial approach or asking sensitive questions, and 33–50% felt prepared for OSCEs.

Post-simulation feedback showed marked improvement across all domains. 92% of students reported increased confidence communicating with adolescent patients, 83% felt confident building rapport in time-limited consultations, 83% felt confident exploring psychosocial factors, 92% felt confident using structured psychosocial approaches, and 83% felt prepared for OSCEs involving mental health components. Students also rated the simulation as a highly useful method for developing communication skills.

Qualitative analysis identified two key themes. First, students valued practising difficult and sensitive conversations in a safe environment (“It was a good chance to practise how to phrase things in difficult scenarios”). Second, they highlighted the benefit of realistic scenarios integrating physical and mental health, enhancing understanding of holistic assessment (“Seeing how different physical health scenarios may play into psych”).

This QIP successfully co-developed and piloted a novel simulation-based teaching intervention addressing gaps in undergraduate CAMHS education. Pre-and post-session evaluation suggests it is effective in improving medical students’ confidence and perceived preparedness for working with young people in mental health settings. The simulation will be embedded into future CAMHS rotations at UCLH, with iterative refinement guided by learner feedback. This project demonstrates how co-designed simulation can enhance undergraduate psychiatric education and support integrated physical and mental health learning.

Clinicians working in perinatal psychiatric settings frequently encounter blood results that fall outside standard reference ranges due to the physiological changes of the “fourth trimester”. While information regarding accepted blood test levels throughout pregnancy is readily available, there is a lack of comprehensive, concise guidance for interpreting postpartum blood parameters and the time they require to return to baseline. This can lead to diagnostic uncertainty, unnecessary repeat investigations, and inappropriate specialist referrals. This Quality Improvement Project (QIP) was developed to address this gap in clinical confidence and reduce the burden of unnecessary medical interventions in the postnatal period. The project aimed to develop a comprehensive, evidence-based reference tool for postpartum blood parameter recovery timeframes and to evaluate its impact on clinician confidence and decision-making.

A reference guidance document was developed through review of published literature and clinical guidelines. This document summarized postpartum trends and accepted reference ranges for common investigations, including haematological, biochemical, and inflammatory markers (e.g., FBC, LFTs, U&Es, and thyroid function). To evaluate the impactof this intervention, an anonymous electronic survey was distributed to clinicians to assess their confidence levels before and after providing access to the guide. Improvement was judged based on clinicians’ self-reported confidence using a Likert scale, and qualitative analysis was performed on free-text feedback provided in the survey.

The survey was sent to 53 clinicians, with 25 responses received at the time of writing. Preliminary survey data demonstrated a marked increase in clinician confidence following the introduction of the reference guide. Participants reported greater clarity in distinguishing normal physiological postpartum shifts from true pathology. Early qualitative feedback suggests a reduced perceived need for specialist referrals and repeat blood tests, supporting the tool’s utility in streamlining clinical care. Data collection is ongoing.

This QIP highlights a need for accessible, postnatal-specific guidance for doctors working in psychiatry. The resulting reference tool is a low-cost, sustainable intervention that improves clinician confidence and supports appropriate resource allocation. This guidance is considered for inclusion in local induction materials for doctors on psychiatric perinatal wards, with next steps including dissemination to wards nationally and potential for broader application in primary care.

To analyse responses from a survey sent to current resident/SAS doctors and consultants who had received the updated induction handbook and also resident/SAS doctors and consultants who had received a previous version of the same.

The former induction handbook was updated after receiving feedback. A 20 question survey was sent out to all the current resident/SAS doctors and consultants working across North Wales along with the updated induction handbook.The questions included yes/no, multiple-choice and free flow text options.

There were 30 respondents of the survey of whom 22 had used a previous version of the induction handbook. The handbook achieved 100% satisfaction rate in the following categories:

• • Roles and Responsibilities.

• • Admission Guidance.

• • Acute Psychiatric Emergencies.

• • Discharge Processes.

• • Contact Details.

A very high level of satisfaction was noted in legal frameworks (97%), training essentials (93%) and practical information (93%).

Of the respondents who had used the previous version of the handbook, 81% rated it much better and 19% rated it slightly better in clarity and structure. 81% found it much better in usefulness and relevance and 80% noted it to be much improved in design and readability. 84% of the previous respondents stated it to significantly improve overall induction experience with the rest stating it to be somewhat better.

The most valued new sections were:

• • Psychiatric Emergencies and Rapid Tranquillisation.

• • Legal Frameworks including Mental Health Act and Mental

• • Capacity Act.

• • Old Age Clerking.

• • Detention in Forensic Sections.

Suggestions for improvements included:

• • Information on Electronic Prescribing.

• • Electronic Discharge Summaries.

• • Clinical Guidance/Brief Sections on:

• • Alcohol and Opioid withdrawal.

• • Prescribing Opiates.

• • Liaison Psychiatry assessment expectation.

• • Consistent Layout and Modern Formatting.

Additional subjective feedback showed a high level of gratitude from the resident doctors.

The results from the survey highlighted an overwhelmingly positive response to the new induction handbook from resident/SAS doctors and consultants. The handbook significantly enhanced the induction experience for new resident doctors and a high level of satisfaction was seen from clinicians who had used a former version of the handbook as well.

We will continue to make the requisite amendments based on the feedback and suggestions for the next PDSA Cycle.

In seeking treatment for children presenting with psychiatric symptoms, many families ask about use of complementary and alternative medicine (CAM), including herbal preparations, to help their child cope with mental health distress in addition or alongsideconventional care. This includes remedies to support their child through anxiety, sleep disturbance, low mood and attention difficulties. In UK paediatric populations, CAM use is widespread (41% in one tertiary survey), and 44.6% of families managing childhood ADHD report non-mainstream treatments. However, clinical evidence of their efficacy and tolerability is weak and rarely synthesised.

In today’s multidisciplinary healthcare system, an understanding of CAMs, including their psychiatric outcomes and safety sensitivity, will improve shared family decision-making in child and adolescentpsychiatry. Our aim is to map paediatric interventional and published trial evidence for 19 culturally used botanicals shortlisted for reputed psychiatric/behavioural benefits in children to be included in a systematic review.

We hypothesised the clinical literature would be sparse, heterogeneous, and majorly consisting of smaller studies.

Nineteen botanicals were shortlisted from commonly used traditional preparations with plausible tolerability in children and reputed benefits for psychiatric/behavioural symptoms. We conducted an evidence map of these herbs using two sources: (1) ClinicalTrials.gov (“Find Studies”) filtered to interventional studies, age group “child”, and status “completed”; and (2) PubMed searches using herb name/botanical name terms combined with child/adolescent terms and publication types “clinical trial” or “randomized controlled trial”. For each herb, we recorded trail counts and manually screened each record’s primary outcome/condition to retain only those with psychiatric/behavioural relevance. This includes anxiety, depression, ADHD (Attention-Deficit/Hyperactivity Disorder), sleep, mood, and cognition.

ClinicalTrials.gov identified 52 completed paediatric interventional records across11/19 herbs (median 1 per herb; range 0–19). Counts were highly skewed: lavender (19) and chamomile (8) accounted for over half of registry records; eight herbs had no completed paediatric interventional record. PubMed trial-type searches retrieved 36 publications across 11/19 herbs (median 1; range 0–9), similarly concentrated: lavender (9), moringa (8) and chamomile (7) comprise two-thirds of trial-type publications. Across both registries, studies had variable measurements of psychiatric/behavioural outcomes, and inconsistent reporting of adverse effects.

Paediatric interventional and published trial evidence for culturallyused botanicals with reputed psychiatric benefits is limited and unevenly distributed. Many candidates are supported by zero or single trials and heterogeneous outcomes. This evidence map will be used to inform a focused systematic review investigating mental health outcomes and tolerability and identify best candidates for further research.

Oculogyric Crisis (OCG) is one of the few presentations within psychiatry considered an emergency due to the potential features which can make OCG life-threatening. OCG is poorly understood and can be difficult to recognise due to other features which may mask the classical presentation of a fixed upper gaze of the eyes with associated anxiety and hallucinations. This case study looks at how we have managed a patient within a low secure forensic service with this presentation.

Our male patient in their 30’s was admitted with a working diagnosis of treatment resistant schizophrenia. There were frequent episodes of this gentleman becoming acutely unwell with vivid hallucinations and aggression directed towards staff and other patients. Due to staffing concerns regarding autonomic function, the associated eye movements were missed and as such this was not recognised as OCG which is an acute dystonic reaction.

During these episodes, there were many times where our patient would appear in an immobile state, with an inability to speak or follow commands with marked feelings of reference and ideas of persecution. This would include refusals to take prescribed medication because of visual hallucinations of seeing his medication and food and drink being contaminated. Episodes of seclusion were due to aggression towards others he believed were after him. Frequent emergency department attendances were required due to autonomic and conscious level disturbance.

Our patient was admitted on a regular depot of zuclopenthixol which we gradually reduced to nothing following the recognition of OCG. We also supplemented this with procyclidine, which helped to reduce symptoms.

Following these changes, we initially noticed a marked improvement in our patient’s presentation as he was engaging well with the ward staff and other patients. There was no longer any requirement for frequent hospital visits and the absence of a movement disorder.

However, they appear to have escalated again following complete cessation of the depot. We need to understand if this is an exacerbation of OGC, which the literature does document when antipsychotic medication is withdrawn or an exacerbation of the schizophrenia due to reduction in antipsychotic medication, even though he remains on an oral atypical antipsychotic known to have minimal risk for side effects.

OCG is a rare but serious condition. However, if it is recognised early, an individualised approach based on the patient and clinical picture may improve long term outcomes whilst considering alternative diagnoses.

There has been a recent increase in incidents in Pine Ward at Park Royal mental health unit. Feedback from staff/patients is that they don't feel safe and there has been staff sickness due to physical aggression towards them. We proposed to do this QI project in order to improve the staff and patient safety on the ward.

The aim of this QI project was to improve safety for patients and staff on Pine Ward by 20% by end of December 2025, to reduce incidents of violence and aggression and strengthen communication and team work.

Key changes: Weekly community meeting; Improve observation of patient positive strengths; Messages in nursing station on using soft words; and Section 17 leave flow chart given to patients.

Data collection (November–December 2025)

• We reviewed patient and staff safety on ward from mid November to end of December.

• We collected data on the following questions:

– Patient staff conflict survey.

– Patient safety feedback form.

– Staff safety feedback form.

Patient safety improved by 25% and staff safety improved by 30%.

Incidents of Verbal aggression in day shift decreased from 4 to 2 per shift.

Incidents of Aggression towards objects in day shift decreased from 2 to 1.

Decrease PRN psychotropic use in day shift from 4 to 2.

Communication between patients and staff is key for safety. Community meeting is a great opportunity to explore patient ideas and can be used for education about section 17 leave.

Thinking about patient qualities and strength affect how we perceive patient as person and influence positive therapeutic relations.

Verbal aggression against staff is a key concerns and needs to be worked on. Record of incidents of aggression on datix to be reviewed in future audit.

• • To provide patient with a method to give honest and protected feedback around activities offered on the ward and also to allow the improvement of activities offered on Waterton Ward, Newton Lodge.

• • To provide staff with the opportunity to identify gaps in service provision around activities offered on Waterton Ward, Newton Lodge.

A survey was conducted in person with patients on Waterton ward using a printed survey questionnaire between May and June of 2025. An anonymous staff survey questionnaire was printed and given to members of staff on the ward to complete between May and June 2025

The data were analysed by the project lead. Both quantitative and qualitative data were collected. Data were grouped into themes to aid the analysis and presentation of the results

• • The survey highlighted a disparity in awareness of available activities on the ward. While some activities, such as the Horticulture Garden, Community Sessions, and Walking Group, have full awareness among patients, others, such as the Lego Group and Driving Skills Group, have very low awareness.

• • Enjoying the activities, staff persistence, more awareness, and an additional occupational therapist are key motivators for engagement.

• • Patients expressed interest in additional activities, including vocational skills like painting and decorating, music groups, more gym time, and more frequent walking groups.

• • The responses emphasize a wide range of life skills patients believe will prepare them for reintegration into the community. Cooking, budgeting, shopping, banking, and IT skills are frequently mentioned, reinforcing the importance of practical education and independence.

• • Patient satisfaction with current activities on the ward appears varied–while some patients feel satisfied, a portion remain indifferent or dissatisfied

From the staff survey, staffing shortages was consistently mentioned across different staff roles as a barrier to providing rehabilitation services on the ward. Staff satisfaction with the ward activities was mixed with 55% of respondents expressing dissatisfaction.

The findings from the patient survey underscore a need for better communication and promotion of existing activities, improved scheduling, and staff availability. This project highlighted the need for patient and staff participation in improving the interventions and activities offered on the ward.

Functional neurological disorder (FND) frequently co-occurs with psychiatric conditions, most commonly anxiety, depression, and trauma-related disorders. The coexistence of FND and psychotic illness remains less well characterised, particularly in general hospital settings. The emergence of fixed persecutory beliefs in individuals with FND presents significant diagnostic, ethical, and management challenges, especially when such beliefs interfere with essential medical care. This case illustrates the complexity of assessing risk, decision-making capacity, and the role of compulsory psychiatric treatment when physical health deterioration arises from treatment refusal rather than suicidality

We describe a middle-aged man admitted to a general hospital with acute onset functional neurological symptoms, including rapidly evolving limb weakness, sensory disturbance, and functional paralysis, following significant occupational stress. During admission, he developed persistent persecutory delusions characterised by profound mistrust of healthcare professionals, beliefs of deliberate harm and surveillance, and accusations of abuse. These beliefs led to sustained refusal of nutrition, investigations, and treatment, resulting in significant weight loss, electrolyte disturbances, and functional decline. Extensive medical and neurological investigations supported a functional diagnosis, with no evidence of delirium or organic pathology to account for the psychiatric presentation. Multidisciplinary management was complicated by impaired engagement and contested use of mental health legislation.

This case highlights diagnostic uncertainty at the interface between FND and psychotic disorder, emphasising the importance of distinguishing illness-related beliefs from fixed delusions associated with behavioural consequences. Risk arose predominantly from malnutrition, immobility, and impaired decision-making rather than deliberate self-harm. While compulsory psychiatric treatment mitigated immediate physical health risks and resulted in partial behavioural stabilisation, it also appeared to intensify feelings of injustice and mistrust. Prolonged hospitalisation and adversarial dynamics may have reinforced persecutory beliefs, underscoring the need for early integrated neuropsychiatric formulation, consistent communication, and relational safety.

This case demonstrates that FND may coexist with psychotic illness, with significant implications for risk assessment, capacity evaluation, and treatment planning. Clinicians should remain alert to risks arising from treatment refusal and physical deterioration in the absence of suicidality. Early multidisciplinary collaboration and proportionate use of mental health legislation are essential to minimise iatrogenic harm and support recovery in medically complex patients.

This study aims to explore the prevalence and nature of moral injury amongst staff working with patients with intellectual disabilities in Long-Term Segregation (LTS) as well as identifying contributing factors as well as perceived support and coping strategies.

A mixed methods design was utilised in a learning disability assessment and treatment unit (ATU) setting. This involved the collection of qualitative and quantitative data utilising anonymous surveys. Quantitative data being collected using a modified moral injury rating scale to explore degree of moral injury and wellbeing. Qualitative data was collected through exploration of staff experiences as well as any ethical dilemmas and emotional responses to LTS at work. For the quantitative data we employed the use of correlational analysis. For the quantitative data, thematic analysis was utilised.

The results do indicate that there may be moral injury that is experienced by staff involved in the care of intellectual disability patients in LTS. There appear to be certain factors that do contribute to this including prolonged use of LTS, perceived lack of flexibility in the system as well as limited opportunities for reflective practice.

This piece of work clearly demonstrates the relevance of moral injury in staff working with individuals in LTS. It furthermore highlights the occupational risk for those involved as well as the importance of ensuring that this is addressed to note only prevent burnout, sickness absence and retention of staff but to chiefly ensure that standard of patient care are maintained. This work further highlights the need for more research into this area in order to improve the understanding of how moral injury develops and evolves over time.

Psychological factors play a critical role in rehabilitation after sports injury and may delay return to sport (RTS) despite physical recovery. However, the most prevalent psychological sequelae and the comparative effectiveness of rehabilitation strategies are not consistently integrated into clinical pathways. This study aims to identify common psychological outcomes following sports trauma and determine which evidence-based psychological interventions are most strongly associated with improved rehabilitation and RTS outcomes. We hypothesised that (1) functional psychological symptoms would be more prevalent than formal psychiatric diagnoses and (2) cognitive-behavioural approaches would show the strongest association with positive recovery outcomes.

A structured review of peer-reviewed literature published between 2014 and 2025 was conducted. PubMed and Google Scholar were searched using predefined keywords related to sports injury, psychological outcomes, and rehabilitation interventions. Studies were included if they assessed psychological symptoms, return-to-sport outcomes, or intervention effectiveness in injured athletes. Findings were synthesised narratively, with intervention effects grouped by therapeutic modality.

Functional psychological sequelae were common following sports injury, particularly fear of reinjury (50%), reduced confidence (45%), and sleep disturbance or hyperarousal (40%). These were more frequent than formally diagnosed psychiatric disorders such as PTSD (25%) or major depressive disorder (35%). Anxiety symptoms were the strongest psychological predictor of delayed RTS, while reduced confidence was consistently associated with poorer rehabilitation outcomes. Depressive symptoms were most evident during prolonged inactivity and career-ending injuries, where loss of athletic identity (25%) was prominent.

Among psychological interventions, cognitive behavioural therapy (CBT) demonstrated the highest reported effectiveness in reducing psychological symptoms and supporting RTS (28.6%, 95% CI [20.6–36.6]). Graded exposure showed the next greatest effect (23.2%, 95% CI [13.2–33.2]), followed by psychological skills training (17.9%, 95% CI [8.9–26.9]). Stress-management interventions improved adherence to physical rehabilitation, whereas arousal imagery techniques were linked to increased pre-RTS anxiety in some athletes.

Functional psychological symptoms are more prevalent than formal psychiatric diagnoses after sports injury, supporting our first hypothesis, while cognitive-behavioural interventions show the strongest association with improved psychological outcomes and RTS readiness, supporting our second. Routine psychological screening and targeted CBT-based support may enhance rehabilitation. A biopsychosocial approach incorporating ongoing psychological assessment, pre-injury profiling tools (e.g. Sport Mental Health Assessment Tool-1; Athletic Coping Skills Inventory-28) and a 4Ps framework supports tailored, preventative rehabilitation and promotes resilient RTS. Screening and data extraction by a single reviewer increases risk of selection bias.

The Medicines Reconciliation 'Med Rec' is a important, structured process which takes place on admission. It involves comparing the patient’s current medication list from various sources such as the primary care record, previous discharge letters and the patient themselves. This audit aims to highlight the invaluable support of the pharmacy department in ensuring safe prescribing for psychiatric inpatients - a population with a known potential for significant comorbid physical health conditions and high rates of polypharmacy.

NICE guidelines state that “people who are inpatients in an acute setting (including mental health inpatient wards) should have a reconciled list of their medicines within 24 hours of admission.” Sussex Partnership NHS Foundation Trust local targets specify that 60% of Level 2 (pharmacy-led) medicines reconciliations should be completed within 24 hours of admission, or 90% by the next working day by 5pm.

A total of 100 records were reviewed for patients admitted to Bodiam Ward, an adult male inpatient psychiatric ward in East Sussex, between 2024 and 2025. Of the records reviewed, 73 were retrospective admissions and 27 were prospective records.

In this audit, 66% of medicine reconciliations were completed within 24 hours, and 87% were completed by the next working day. The majority (84%) were completed by Pharmacy Technicians, with the remaining 16% completed by Pharmacists. Of the completed medicine reconciliations, 54% identified at least one omitted drug. The most omitted drug classes were analgesics (13.7%), benzodiazepines (13.1%), and regular oral antipsychotics (10.2%). Other notable omissions included physical health medications, such as cardiovascular drugs (including antihypertensives and statins), and medications related to alcohol dependence (such as thiamine and chlordiazepoxide). In addition, 7% identified ‘other errors’, including missing or incorrect doses, incorrect formulations (immediate-release versus modified-release), and in one instance, an entirely different medication being erroneously prescribed.

This audit demonstrates that medicine reconciliation is more than a 'tick-box exercise' and plays a critical role in identifying prescribing errors on admission. The findings emphasise the significant timely contribution of the pharmacy team to patient safety in adultin patient psychiatric settings. Based on these findings, future education could focus on reminding resident doctors to thoroughly review previous discharge summaries and primary care records when clerking a patient, and to liaise with the pharmacy team for a better standard of care.

Extended Discharge Documents (EDD) are central to safe transitions of care in forensic psychiatry, providing GPs and community teams with information on treatment, risk management, legal status, and followup plans. National standards recommend issuing the EDD within 7–14 days of discharge. A baseline audit in March–August 2025 at the forensic unit in Royal Cornhill Hospital showed low EDD completion and variation between wards. Several service changes were introduced, and a reaudit was conducted. The aim was to assess whether these changes improved EDD completion and timeliness for forensic discharges.

This was a retrospective clinical audit of all forensic inpatient discharges across two periods: the baseline cycle (March–August 2025) and the reaudit cycle (September 2025–January 2026). Patients transferred to other hospitals were excluded, as an EDD was not required for those cases. Data were collected from electronic records, including EDD eligibility, completion status, dispatch dates, and ward of discharge. The main outcome measures were the proportion of eligible discharges with a completed EDD, and the proportion completed within 14 days.

The intervention implemented between cycles included assigning each EDD to a named doctor at the point of discharge planning and reinforcing standards during induction for rotating trainees. A shared forensic handover template (digital and paper versions) was introduced to help track outstanding EDDs.

There were 42 discharge episodes in the baseline period, of which 41 required an EDD. Only 8 were completed (19.5%), and 1 of these (12.5%) was delayed beyond 14 days.

In the re-audit period, there were 29 discharge episodes, of which 27 required an EDD. Of these, 22 were completed (81.5%). Completion was consistently above 75% across all months, reaching 100% in January. The improvement was observed across most wards.

Timeliness remained a key concern. Sixteen of the 22 completed EDDs (72.7%) were issued more than 14 days after discharge, with higher delay rates noted in specific.

Introducing system-level changes like assigning named doctors at discharge, strengthening induction, and introducing a shared handover template were associated with a marked improvement in overall EDD completion, rising from 19.5% to 81.5%. However, delays in issuing the EDD remain frequent and represent the key area for further improvement. Strengthening early drafting, adding timeliness checkpoints, and embedding automated reminders may help close this gap in the next audit cycle.

To assess documentation of driving status and fitness to drive among older adult psychiatric inpatients, implement interventions, and evaluate subsequent improvement in both documentation and compliance with Driver and Vehicle Licensing Agency (DVLA) guidance.

Older adult psychiatric inpatients may be unfit to drive, yet documentation of driving status is often poor, posing patient safety and medico-legal risks. A retrospective review of electronic medical records was conducted for patients discharged from a single older adult psychiatric ward over two three-month audit cycles. Data collected included documentation of driving status, presence of psychiatric diagnoses relevant to DVLA guidance, and, where relevant, whether the patients had been advised about fitness to drive. Following the initial audit, interventions were implemented, including clinician education and addition of prompts within the ward round template. The audit was then repeated as a retrospective review of records for a separate three-month period to assess the impact of these interventions.

In the first audit cycle, 20 patients were discharged. Driving status was documented in only 5 patients (25%), despite 18 patients (90%) having diagnoses relevant to DVLA guidance. Among those with documented driving status, only 3 patients had recorded discussion of DVLA advice, allowing adherence to be assessed. For the majority of patients, adherence could not be reliably assessed due to missing documentation, highlighting a significant gap in clinical recording and medico-legal risk.

In the re-audit cycle, 11 patients were discharged. Driving status was documented in 10 patients (90.9%), and 9 patients (81.8%) had diagnoses relevant to guidance. 7 patients were documented as not driving. Both patients documented as driving and for whom guidance applied, had evidence that DVLA advice had been discussed. Adherence could not be assessed for one patient whose driving status was not recorded. These findings indicate improved documentation and consistent discussion of driving advice following targeted interventions.

This audit identified substantial deficiencies in baseline documentation of driving status and discussion of DVLA guidance, posing safety and medico-legal risks. Targeted interventions improved recording of driving status and consistent documentation of advice for those driving, demonstrating enhanced staff awareness and compliance with guidance. Some gaps remain, emphasizing the need for ongoing routine assessment, documentation, and staff education to ensure sustained patient safety and adherence to national guidance.

Depression and anxiety in geriatric inpatients are linked to functional decline and prolonged hospital stays. While antidepressants are the standard of care, polypharmacy and poor tolerability often limit their effectiveness. This study examined whether a six-week structured mind-body programme achieved greater symptom reduction than treatment as usual (TAU) in an older adult psychiatric inpatient setting.

This longitudinal, parallel, controlled study involved 26 in patients (aged 60 years or older) with a diagnosis of depression and comorbid anxiety. All participants were receiving standard antidepressant pharmacotherapy. Thirteen patients elected to participate in a structured mind-body programme, while 13 continued with TAU alone. The intervention consisted of weekly supervised sessions (3–5 sessions total based on clinical availability), integrating physical movement with mental engagement through yoga, tai chi, strength training, walking, and gardening. Symptoms were assessed via the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) at baseline and six weeks.

Data analysis involved paired-sample t-tests and Wilcoxon signed-rank tests for within-group changes, with between-group comparisons conducted using independent-sample t-tests or Mann–Whitney U tests as appropriate for the data distribution.

Baseline scores were statistically comparable between groups (p >0.05). Both cohorts demonstrated significant within-group reductions in symptoms over the six-week period (p <0.001). In the activity group, mean PHQ-9 scores decreased from 17.15 to 8.46(reduction 8.69, SD 3.54). In the TAU group, scores fell from 14.69 to 10.38 (reduction 4.31, SD 2.10).

Between-group analysis demonstrated a significantly greater reduction in depressive symptoms for the mind-body group (mean difference 4.38; 95% CI 1.99 to 6.77; p=0.001), with a large effect size (Hedges’ g=1.46). While anxiety symptoms improved in both groups (mean GAD-7 reduction 3.62 vs. 3.23), no significant between-group difference was observed (p=0.875; Hedges’ g=0.16).

Participation in structured mind-body activities was associated with greater reductions in depressive symptoms among older adult psychiatric inpatients compared with treatment as usual alone. While anxiety symptoms improved in both groups, no additional benefit was observed for anxiety reduction. Although self-selection should be considered, these findings suggest mind-body programmes may represent a feasible and potentially effective non-pharmacological adjunct for late-life depression in inpatient psychiatric settings.