Driving is a complex activity that may be significantly impaired by mental illness, acute psychiatric symptoms, cognitive impairment, and the side effects of psychotropic medication. In the UK, the Driver and Vehicle Licensing Agency (DVLA) provides clear guidance regarding fitness to drive for individuals with mental health conditions. Patients are legally responsible for informing the DVLA of any condition that may affect their ability to drive; however, clinicians have a professional duty to ensure that patients are appropriately advised, and that this advice is clearly documented.

Despite this, DVLA advice is often inconsistently delivered and poorly documented in discharge summaries. This creates risks including:

• Patients unknowingly driving when unfit to do so.

• Potential harm to patients and the public.

• Medico-legal risk to clinicians and the organisation.

• Poor continuity of care for GPs and community teams.

The primary aim of this Quality Improvement Project is:

To improve the delivery and documentation of DVLA driving advice for patients discharged from a mental health inpatient unit, thereby reducing medico-legal risk and improving patient safety.

This project followed the Plan–Do–Study–Act (PDSA) framework.

PDSA Cycle

• Plan: A baseline audit was conducted to retrospectively review discharge summaries for patient discharge on 1–31 August 2025 and showed no patients had DVLA advice given or documented in their discharge summaries.

• Do: A single, targeted intervention was implemented: An additional question was added to the discharge summary template prompting clinicians to consider and document DVLA driving advice. Effecting this change needed high level hospital management approval. The quality improvement idea was presented in different management meetings including Digital delivery group, corporate delivery group and clinical oversight delivery group before this change was approved and implemented.

• Study: Following implementation, a post-intervention survey was conducted to assess the delivery and documentation of DVLA advice. It showed that all the patient discharges in January 2026 so far have DVLA advice given and documented. This is a significant improvement from the pre-intervention survey.

Act: We confirm effectiveness and consider sustain ability and wider rollout by implement the change in other clinical areas of the hospital as appropriate.

Overall, the intervention was associated with improved compliance with DVLA guidance and safer discharge practice.

While this project has revolutionised how discharge summary is being written in the Trust by introducing a single and concise way of documenting DVLA advice, a more robust intervention could have been more appropriate, for example creating a different form specifically for DVLA advice on electronic medical records. But this would, however, need management financial approval and more paperwork for clinicians.

• • To ensure the Southwest Crisis Function Team (in HPFT) manages non-cognitive symptoms of dementia as per NICE guidelines, and provides appropriate non-pharmacological and pharmacological management options.

• • If not possible, identify reasons and challenges, and suggest methods for improvement, which could be implemented and re-audited.

1. All referrals received by CFT in a 12-month period were obtained through the SPIKE database.

2. 48-hour referrals and wrong referrals were excluded.

3. Only service users with a diagnosis of dementia AND were presenting with agitation, aggression, distress or psychosis were included. This information was obtained through PARIS.

4. Service users’ case notes were reviewed to ascertain whether they or their carers:

○ Had a structural assessment and had been offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for service users.

• Had been offered antipsychotics and:

• If they were at the time at risk of harming themselves or others, or were experiencing agitation, hallucinations or delusions that are causing them severe distress.

• If they had discussions about risks and benefits of antipsychotics.

• Had been started on the lowest effective dose possible and were recommended to be reassessed by the prescriber.

1. In 2023, a total of 247 new Service Users (SU) were referred to CFT. After excluding 48-hour follow up referrals and inappropriate referrals, A total of 55 referrals were for SUs who were diagnosed with dementia and were presenting with agitation, aggression, distress, or psychosis. 12 out of the 55 referrals were for 6 SUs who were referred twice at different times during the year.

2. 100% (55/55) of the included referrals received a structural assessment to 1- explore possible reasons for their distress, and 2- check for and address clinical or environmental causes. 100% (55/55) were also offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for SUs.

3. In 12/55 referrals, SUs were already on antipsychotics. In 7/55 referrals, SUs could not be managed without a new prescription of antipsychotics.

4. In these 7 referrals (12.7% of total eligible SUs), SUs received new prescriptions of antipsychotics as a pharmacological intervention and in all 7 referrals, the SUs were at risk of harming self or othersorwere experiencing agitation, hallucinations or delusions that are causing them severe distress.

5. 100% of the 7 referrals showed that SUs were started on the lowest effective dose of the prescribed antipsychotic.

6. However, out of the 7 referrals that received new prescriptions of antipsychotics, none of them (0%) had documentation on PARIS about discussions of risk and benefits of antipsychotics.

7. Finally, when looking at all the referrals where antipsychotics were used (19 referrals in total), there was clear documentation on PARIS about reassessment or a recommendation for reassessment of antipsychotic after 6 weeks in 4/19 referrals (21%).

• • 100% of referred SUs received a comprehensive, structural assessment.

• • The team offered psychosocial and environmental interventions to all SUs who were eligible.

• • The team offered antipsychotics only when necessary, in a small percentage of cases(12.7%), and followed NICE guidelines for initial doses and service user eligibility.

• • However, no documentation in any of the service user’s case notes mentioned discussions about risk and benefits of antipsychotics and only 21% had recommendations for reassessment of the antipsychotics within 6 weeks.

This quality improvement project sought to design and implement a new handover system for mental health hospitals in North Glasgow. The new system aimed to improve ease of access and editing, alongside reducing the frequency of missed tasks for resident doctors.

Resident doctors across Gartnavel Royal Hospital and Stobhill Hospital were surveyed (cycle 1) between 06/06/25 and 13/06/2025 regarding their opinions on their respective existing Microsoft Excel handover systems, as well as the frequency of missedtasks and their willingness to try a new system. A new system was designed for each hospital using the Planner task management software on Microsoft Teams, adapted from a similar successful pilot in South Glasgow. Training sessions were delivered over June and July 2025, and the new systems were implemented on 18/07/2025. Resident doctors were surveyed again (cycle 2) between 04/08/2025 and 12/08/2025 regarding their opinions on the new system, any missed tasks and whether they wished to keep the new system or revert to the previous one. Adjustments to systems were made as per respondents’ wishes. Guidance posters were displayed in each hospital between October 2025 and January 2026 to aid using the systems, and the doctors were surveyed once again (cycle 3) between 28/01/2026 and 04/02/2026 using the same questions.

Please note “easy” will be used where respondents rated the system easy or very easy. There were a total of 10 respondents in cycle 1: 70% found the now-previous system easy to access, only 50% found it easy to edit and 40% found they had missed tasks. Only 10% were opposed to trialling a new system. In cycle 2, there were a total of 22 respondents: 73% found the new system easy to access, 81% found it easy to edit and only 18% had missed tasks. 73% wished to keep the new system. In cycle 3, preliminary results show 10 respondents thus far: 100% found the new system easy to access and edit, only 10% had missed tasks and 100% wished to keep the new system. The system is now part of Standard Operating Procedure in North Glasgow.

A new digital handover system replaced previous systems for each North Glasgow mental health hospital. The new system improved ease of access and editing as well as reducing the frequency of missed tasks for resident doctors. Displaying guidance posters further improved each of these categories and all doctors wished to keep the new system.

This audit evaluates the prescribing and monitoring practices of sodium valproate, particularly in females of childbearing potential. Sodium valproate is a medicine that is commonly used in the treatment of bipolar disorder and epilepsy, and less commonly migraine prophylaxis. Valproate is an effective treatment for bipolar disorder, however there are significant risks that come with the use of valproate medication including the risk of teratogenic effects should pregnancy occur.

The audit aims to assess compliance with the Pregnancy Prevention Programme (PPP), share findings ahead of the June 2025 national audit, and highlight updated initiation steps post-April 2024.

The audit standards were derived from national guidelines including the Royal College of Psychiatrists CR210 and MHRA Prevent Programme. They are also a replica of the standards measured in the National POMH Valproate Audit. The purpose of auditing the standards is to review compliance prior to the next POMH Valproate audit which will take place in June 2025.

The audit reviewed documentation of prescribing rationale, annual reviews (therapeutic benefit, adverse effects, medication adherence), and PPP compliance including Annual Risk Acknowledgement Forms (ARAFs).

The sample included 22 female patients aged 12–55 currently prescribed valproate. These patients were identified by the Clinical Director of Pharmacy. Sample characteristics such as age and ethnicity were also explored.

• Rationale for prescribing was documented in 20 out of 22 cases (91%).

• Only 23% of patients had all elements of the annual review documented.

• ARAF compliance was poor:

- 9 non-compliant cases where pregnancy was possible.

- 10 non-compliant cases where pregnancy was not possible.

• Common issues included missing or incorrectly completed ARAFs and lack of documentation of Patient Guide distribution.

The audit revealed significant gaps in compliance with PPP requirements and documentation standards. There was confusion around when ARAFs are needed, especially for long-standing patients and those post-menopausal. Baseline checks prior to initiation (BMI, FBC, LFT) were not consistently documented. The findings suggest a need for improved education and communication among prescribers.

The audit highlights the need for better adherence to national guidelines in prescribing and monitoring valproate. Key areas for improvement include annual review documentation, proper completion of ARAFs, and baseline physical health checks. Recommendations include targeted education for consultants and improved documentation practices to ensure patient safety and regulatory compliance.

Eating disorders (ED) are associated with high morbidity, mortality, and relapse, yet access to evidence-based care remains limited. Digital interventions have improved scalability but often lack responsiveness to individual symptom profiles and changing clinical risk. Artificial intelligence (AI) has been proposed as a means of enabling personalised andadaptive interventions. However, the feasibility and safety of AI-enabled approaches in ED care remain unclear. This review evaluated the feasibility and safety of AI-enabled personalised interventions for anorexia nervosa, bulimia nervosa, and binge eating disorder, and explored potential clinical applications and evidence gaps.

A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, APA PsycInfo, and Global Health were searched alongside grey literature sources including ProQuest, OAIster, EthOS, and Overton for studies published between 2020 and 2025. Eligibility criteria were defined using the SPIDER framework to capture quantitative, qualitative, and mixed methods evidence. Included studies examined AI-based approaches such as machine learning, natural language processing, digital phenotyping, or conversational agents used to personalise ED interventions and report feasibility or safety outcomes. Methodological quality was assessed using the Mixed Methods Appraisal Tool, and findings were synthesised narratively.

Eight studies met inclusion criteria across four domains. The evidence suggests that AI-augmented approaches can feasibly support aspects of personalised ED care, although findings remain early and heterogeneous. Machine learning methods showed potential for individualised risk prediction, relapse monitoring, fidelity monitoring in digital therapies, and just-in-time adaptive interventions, with substantial variability in performance and limited generalisability. Sensor-based systems demonstrated promise for low burden, real-time behaviour detection, but were evaluated in very small samples. Conversational agents were generally acceptable and engaging, though safety and autonomy concerns were identified. Clinician and service user studies indicated cautious openness to AI use, alongside ongoing concerns regarding trust, transparency, empathy, and governance.

AI-enabled personalisation for ED is technically feasible and shows promise in enhancing risk monitoring, treatment augmentation, and continuity of care. However, clinical effectiveness and safety remain unestablished. Prospective trials, diverse samples, systematic monitoring of harms, and integration within ethically governed, AI-augmented, clinician-led models are required before routine clinical implementation.

Attitudes toward social engagement describe how individuals perceive, value, and participate in social interactions and communal activities. Currently upcoming trends such as Fear of missing out is governing social interactions but one may wonder are there accompanying trends such as Joy and Relief of missing out. Attitudes toward social engagement reflect how people navigate the tension between connection and independence and in this study, we aim to evaluate these attitudes based on Fear/Joy/Relief of missing out on social obligations. An exploration of balance between importance of internal values versus social acceptance is also explored.

A questionnaire on how social engagement is perceived by an individual was developed based on principles of anxiety feelings of being left out within social events compared to relief of missing social engagement and to satisfaction that comes from choosing not to participate in certain activities.

Alongside generic questions on autonomy as compared to social pressures were evaluated within survey.

There were 92 respondents on an online survey.

67% responders reported that they have moderate social interaction.

30% responders reported that they are affected by pressures of missing out.

Less than 20% responders reported comparison with others’ experiences.

15% reported distress on seeing others’ activities.

50–60% responders reported preference for solitude, time for oneself and own schedule.

45% responders reported satisfaction if they could decline obligations.

40% responders reported relief when they are excluded from social obligations.

45% responders reported relief if social plans fail.

There was evidence of empowerment when avoiding social media.

75% responders reported importance of internal values as opposed to social obligations.

Though 35% felt need to be a part of social group there was limited evidence on need for acceptance and even lesser on comparing with others.

Though Fear of missing out (FOMO) is an upcoming social trend within community interactions a generic survey indicated that a significant majority feel the need for importance of internal values, solitude and preference for time for individual activities as opposed to social obligations. Interestingly higher number of responders reported relief if excluded from social obligations and greater satisfaction if they could decline obligations. The survey also showed less importance for external validation from social circles with limited need for acceptance and even limited comparison with others’ activities. It may be interesting to note that a significant majority of responders felt a greater relief on missing outon social activities rather than the fear of missing out. One may wonder whether the Fear of missing out is overemphasized whilst in actuality there is relief or joy of being excluded.

Menopause is when a woman has not had a period for at least 1 year. The median age is 51.Perimenopause is a transitional period associated with fluctuating hormones and heightened vulnerability to mental health symptoms, including depression, anxiety, stress, and sleep disturbance. Fluctuating hormones are noted from the age of 35 years or so. Holistic, non-pharmacological interventions have emerged as potential strategies to address these symptoms, but evidence has not been systematically synthesised.

Aim and Objectives:

1. To review systematically and analyse the evidence on holistic interventions for the management of mental health difficulties in perimenopausal women.

2. To identify various holistic interventions, including psychological, lifestyle, mind-body connection and complementary therapies for perimenopausal mental health symptoms.

3. To evaluate the effectiveness of these interventions for common perimenopausal symptoms.

4. To assess the quality of evidence and to identify the gaps for future research and practice.

A systematic review of randomised controlled trials was conducted, focusing on holistic interventions for mental health symptoms in perimenopausal women. Databases were searched using MeSH and free-text terms related to perimenopause, mental health, and holistic or complementary therapies. Study quality was assessed using the Cochrane ROB 2 tool.

Twenty RCTs involving approximately 2,700 participants from the USA, Europe, and Asia were included. Interventions were categorised as psychological (CBT, MBCT, MBSR), physical activity-based (yoga,Pilates, tai chi,aerobic exercise), lifestyle modification, or complementary therapies (acupuncture,reiki, music therapy).

CBT-based interventions and mind–body practices consistently improved depression, anxiety, stress, sleep quality, and quality of life. Physical activity-based interventions demonstrated moderate benefits. Evidence for complementary therapies was limited and mixed. Most trials were at low or moderate risk of bias.

Holistic interventions are effective and person-centred approaches for managing mental health symptoms during perimenopause. Psychological and mind-body interventions yielded the most robust benefits. Limitations included heterogeneity of interventions, reliance on self-reported outcomes, and short-term follow-up.

Holistic interventions, particularly CBT, mindfulness, and structured physical activity, improve mental health in perimenopausal women. Future research should focus on larger, culturally diverse trials with standardised outcome measures and longer follow-up to strengthen evidence for clinical guidelines.

The growing number of elderly individuals living alone presents a major social issue, encompassing loneliness, isolation, economic and health challenges, and increased risk ofsuicide. This study aimed to identify factors associated with suicide risk among elderly individuals living alone in Jeju.

A total of 4,742 participants completed questionnaires to assess their sociodemographic characteristics. Depressive symptoms were evaluated using the Short Form Geriatric Depression Scale-Korean version (sGDS-K), with a cutoff score of eight indicating the presence of depressive symptoms. Suicide risk was assessed using the Mini-International Neuropsychiatric Interview-Plus. Multivariate logistic regression analysis was performed to identify significant correlates of suicide risk.

Multivariate logistic regression analysis identified the following factors as significantly associated with suicide risk: poor subjective health status (odds ratio [OR]=1.590, 95% confidence interval [CI]: 1.137–2.224), current drinking (OR=1.511, 95% CI: 1.119–2.042), hypertension (OR=1.419, 95% CI: 1.133–1.778), and sGDS scores ≥8 (OR=4.318, 95% CI: 3.408–5.469).

This study highlights the importance of intensive mental health services and socioeconomic support in preventing suicide among elderly individuals living alone. Targeted interventions should focus on those who have poor subjective health status, are current drinkers, have hypertension, or exhibit depressive symptoms.

To evaluate the impact of sleep interventions on sleep quality, duration, and efficiency in adults with psychotic disorders, and to assess secondary effects on psychotic symptoms, daytime functioning, and mental health stability.

A systematic review of studies published in the past 10 years was conducted, including meta-analysis, randomized and non-randomized trials, and observational studies. Eligible studies involved adults (≥18 years) with psychotic disorders and documented sleep disturbances. Interventions included pharmacological agents (melatonin, Z-drugs, antipsychotics), psychological therapies (CBT-I), and other complementary therapies (light, relaxation).

Twenty-three studies met inclusion criteria. Cognitive Behavioural Therapy for Insomnia (CBT-I), was the most frequently studied and consistently effective intervention across delivery formats. Pharmacological agents offered variable short-term benefits but raised concerns about side-effects, tolerance, and dependency. Adjunctive therapies such as music therapy, relaxation and exercise, light-dark rhythm modulation etc. demonstrated promise in specific subpopulations. Common limitations included methodological heterogeneity, small samples, and limited long-term follow-up.

CBT-I, adapted for psychotic disorders, appears the most robustly supported intervention. Integrated approaches combining psychological, pharmacological, and adjunct therapies may optimise outcomes. Large-scale, long-term studies and pathways for routine care integration are warranted, with inclusion in national guidelines.

Guided by the Model for Improvement, this project aims to increase the completion of core assessments and capacity-to-consent documentation in MHA referrals made by the MHLT to at least95% within six months. The ultimate objective is to enhance resource efficiency, ensure compliance with the MHA Code of Practice, and guarantee that formal detention is initiated only when legally and clinically justified.

A baseline diagnostic analysis of referrals from the Mental Health Liaison Team (MHLT) at Chesterfield Royal Hospital revealed that 33% (10/30) of MHA referrals did not result in detention. Critically, 90% of patients without a recorded core assessment and 70% without documented capacity were ultimately admitted informally or discharged. This diagnostic phase indicated a direct correlation between missing documentation and a lack of clinical necessity for formal detention, suggesting that a lack of structured assessment acted as a barrier to identifying less restrictive alternatives.

The project involved mapping the current MHLT referral process, identifying a lack of a structured, mandatory protocol as a key driver for poor-quality referrals. A driver diagram was developed to focus on staff competency and referral mechanics. Two PDSA cycles are currently being implemented:

• • System Mechanics: Introduction of mandatory digital fields in the referral pathway requiring confirmation of a core assessment, capacity assessment, and documented consideration of informal admission.

• • Staff Competency: Delivery of structured teaching sessions to MHLT staff regarding MHA principles and the introduction of visual aids prompting documentation prior to referral submission.

Based on the diagnostic phase, which showed that formal assessment was more frequently omitted in referrals that ultimately did not require detention, we expect a substantial improvement in referral quality by ensuring these steps are taken pre-referral. We are currently implementing these changes and monitoring process measures. A follow-up audit will be conducted to formally measure the increase in documentation compliance and the subsequent reduction in referrals not resulting in detention, aiming to demonstrate improved resource efficiency and adherence to the MHA Code of Practice.

This ongoing QI initiative indicates that structural changes to referral mechanisms, paired with targeted staff education, can be effective in improving documentation fidelity. By enhancing the decision filter for referrers, this project aims to ensure that MHA assessments are initiated only when legally and clinically justified

This project examines how mental health professionals perceive and engage with digital phone applications (apps) in clinical practice. ‘MindMeds’, a patient-developed mental health app at Southwest London and St George’s Mental Health (SWLSTG) Trust, was used as a case example. Findings will inform strategies to improve adoption of the MindMeds app, as well as embedding digital tools into clinical practice, workflow embedding and aligning with Trust digital health priorities.

A qualitative staff survey was distributed via Microsoft Office Forms to all SWLSTG Trust staff. Recruitment was conducted through mass email and Trust communications. The survey collected key demographic information and included Likert-scale items assessing digital confidence and familiarity with mental health apps. Semi-structured free-text questions explored staff awareness, attitudes towards digital apps, key enablers and barriers, clinical considerations of how apps fit into workflows, as well as wider systemic factors such as the Trust’s position on digital innovation.

Qualitative data were analysed using reflexive thematic analysis following Braun and Clarke’s six-step framework, with quantitative findings used to contextualise findings and gauge the prevalence of emerging themes.

31 responses were received and thematic saturation was achieved. Although reported digital confidence was high (median 8/10), awareness and regular use of digital apps (particularly MindMeds) was low. 45% of respondents had never heard of the app despite multiple publicity efforts.

Five key themes emerged: 1) Time and workload pressures; 2) Concerns regarding safe integration with electronic patient records; 3) Uncertainty regarding evidence base and regulation; 4) Limited awareness and visibility of Trust-endorsed apps; 5) Variable patient digital literacy and access.

Challenges were particularly pronounced in inpatient, crisis, and CAMHS settings. Clinicians consistently reflected that apps were more likely to be adopted when aligned with existingworkflows, had a clear clinical purpose, and allowed patient-generated data to be accessed within the electronic patient record.

Digital mental health apps remain poorly embedded in routine practice in SWLSTG Trust, with MindMeds gaining little traction despite extensive development. Uptake appears to be limited less by staff attitudes, and more by structural, governance, and workflow barriers. Improving adoption may require simplification of digital tools, integration with core clinical systems, and clear Trust-level governance, training, and operational support. Focusing on high-value use cases alongside co-design and targeted awareness efforts may enable more effective and equitable integration of digital apps into mental health care.

Multidisciplinary care is essential for safe and effective inpatient psychiatric treatment. Involvement of social work and psychology services supports psychosocial assessment, risk management, discharge planning, and continuity of care. This audit assessed compliance with local guidelines for multidisciplinary inpatient care, informed by the Royal College of Psychiatrists’ Core Standards for Inpatient Mental Health Services (Centre for Quality Improvement), which emphasise timely multidisciplinary involvement, including psychology and social work input, and clear documentation in multidisciplinary team reviews. We aimed to identify good practices and any gaps in early referral and documentation.

A retrospective audit at the Behavioural Sciences Institute (BSI), Al Ain Hospital, United Arab Emirates, reviewed electronic records of 193 psychiatric admissions. Four standards from the Royal College of Psychiatrists’ Core Standards were assessed: (1) social work referral within a week; (2) psychology referral within a week of admission; (3)documentation of social work input in multidisciplinary team (MDT notes; and (4) psychology input documented in MDT notes. Compliance was measured by percentage, stratified by unit type (male, female, forensic) to explore practice variation. Descriptive data analysis was used.

Social work referrals within one week were completed in 29.0% of admissions, and psychology referrals in 32.6%. Documentation rates were higher but still suboptimal: social work input was recorded in 38.3% of cases, and psychology in 44.0%. There was variation between units. The male unit had the lowest early referral compliance, with social work and psychology orders in 16.0% and 22.0% of cases, respectively. MDT documentation was higher but incomplete. The female unit performed better, with social work orders in 47.5% and psychology orders in 50.8%, though psychology documentation was low at 32.8%. In the forensic unit, early referrals were moderate for social work (34.4%) and low for psychology (25.0%), but MDT documentation was the highest, with social work noted in 75.0% and psychology in 56.3%. Overall, MDT documentation rates exceeded early referral rates, indicating delayed multidisciplinary involvement.

This audit found gaps in referral practices for social work and psychology in psychiatric inpatient care, especially early referral within a week of admission. Documentation in MDT notes was more frequent but still below standards, indicating delayed engagement. To improve care, structured admission pathways, automated referrals, standardised documentation, and staff education are needed.

No financial sponsorship was received for this project.

Adolescent suicide is a leading cause of mortality worldwide, yet prediction remains limited by symptom-based clinical assessment. This study aimed to synthesise genetic, biological, neuroimaging and sociocultural evidence to develop a mechanistically informed framework for adolescent suicide risk, moving beyond single-domain or correlational models.

We conducted a PRISMA-compliant systematic review and meta-analysis registered with PROSPERO (CRD420251020839). Searches of PubMed, EMBASE, PsycINFO, CENTRAL, Scopus and Web of Science identified studies published between 2005 and 2025 involving adolescents aged 10–19 years reporting suicidal ideation, suicide attempts or death by suicide. Eligible studies contributed data from at least one domain: genome-wide association studies or polygenic risk scores, neuroimaging, inflammatory or neurotrophic biomarkers, sociocultural risk factors, or treatment outcomes related to lithium, sodium valproate or electroconvulsive therapy (ECT). Random-effects meta-analysis generated pooled effect sizes, with heterogeneity quantified using I². Machine-learning analyses used harmonised study-level estimates only, employing XGBoost with nested cross-validation and SHAP interpretation. Mendelian randomisation was applied to explore genetically informed pathways.

A total of 140 studies comprising 1,526,000 adolescents from 80 countries were included. The pooled effect size for suicide risk across domains was d=0.71 (95% CI 0.58–0.83; I²=78%). Significant predictors included polygenic risk for major depressive disorder (r=0.21), elevated interleukin-6 (r=0.38) and C-reactive protein (r=0.32), ventromedial prefrontal cortex hypoactivity (r=−0.31), childhood trauma (r=0.42) and sexual and gender minority stress (r=0.44) (all p<0.001). An integrative Bio-Psycho-Social Suicide Risk Index achieved an internally validated area under the curve of 0.93, interpreted as hypothesis-generating. Mendelian randomisation supported genetically informed pathways linking liability to inflammation and neural dysfunction. Secondary exploratory analyses suggested associations between lithium and reduced inflammatory markers, sodium valproate and improved inhibitory neurotransmission, and ECT and increased hippocampal volume.

Adolescent suicide reflects interacting genetic, neurobiological and sociocultural processes. This global meta-analysis provides the most comprehensive mechanistic synthesis to date and proposes a biologically informed framework to complement clinical judgement. Prospective external validation is required before clinical implementation.

The aim was to create a visual representation of a patient's journey through an acute male unit within a medium secure setting at a specialist forensic mental health service. This poster would also be accompanied by leaflets about specific topics that patients can request if they would like further information. I noticed that many patients admitted onto the ward were asking the same questions to me and other staff during their ward rounds which identified an unmet need. Patients did not have a resource to find out answers or know who best to approach, so I wanted to resolve this. I aimed to improve patient experience on the ward which would improve outcomes and reduce frustration, the risk of getting incorrect information, aggression and complaints.

I organised focus groups with both patients and staff from each discipline of the Multidisciplinary Team to gather qualitative data about this topic, including thoughts on the idea of the poster itself, and what kind of information they would want included. I frequently joined patient Community Meetings and provided versions of the poster before it was printed so that they could continue to provide their opinions and contributions so it would be co-produced and to ensure the information was relevant.

Once the poster was on display on the ward, I organised further focus groups to collect qualitative data again from both patients and staff. The results were overwhelmingly positive. Some feedback from patients included comments such as “It is easy to understand”, “It is helpful to have a visual poster that I can refer to without having to ask staff”. Feedback from staff included comments such as “Great visuals and really clear to follow”.

This poster has so far had a positive outcome for both patients and staff. For patients it has helped to reduce confusion when admitted onto the ward and frustration regarding the ward processes and their next steps. They have felt more empowered in the knowledge that they can seek answers to commonly asked questions of their own accord. For staff it has allowed ward rounds to be more directed and they feel their role is more understood. The project has scope and is potentially in the process of being replicated in other wards within the service, and could also be replicated in other units nationally so that patients would be able to have a similar experience.

This Quality Improvement project aimed to ensure safer prescribing of antipsychotics in dementia by standardising information provision, enhancing clinician confidence, and promoting psychosocial interventions as first-line treatments.

We conducted an audit to assess the frequency of discussions regarding antipsychotic use and information provision to patients, families and carers. A structured intervention was introduced, including:

–Development and distribution of an evidence-based information leaflet.

–Staff training sessions on antipsychotic prescribing in dementia.

–Behaviour that Challenges (BtC) consultations to help caregivers understand distress triggers and alternative management strategies.

A sustained improvement was achieved, with 100% of patients and caregivers receiving information leaflets for seven consecutive months. We introduced BtC consultations which led to improved understanding of behavioural triggers and better management. After these interventions we reassessed reliance on antipsychotic prescriptions and found an overall reduction in the number of prescriptions.

This QI project successfully enhanced the safety of antipsychotic prescribing in dementia by improving information-sharing and prioritising non-pharmacological interventions. Future steps include expanding leaflet distribution across older adult services and continued collaboration with pharmacies and primary care teams.

The aim of this quality improvement project was for initial seclusion reviews completed by resident doctors to achieve 80% compliance when standardised against all domains featured in the Mental Health Units (Use of Force) Act 2018 between the dates of September 2025 and January 2026.

A quality improvement project was undertaken between September 2025 and January 2026. A driver diagram was developed at project initiation to identify primary drivers, which included improving clinicians’ understanding of documentation requirements, increasing access to relevant criteria and resources and enhancing multidisciplinary knowledge regarding patient seclusions. Secondary drivers included targeted education for new and current doctors, improving accessibility and usability of the seclusion review template and policy and strengthening multidisciplinary team communication. A fishbone diagram was created, highlighting contributing factors related to people (time pressures, burnout, unfamiliarity with the process), process (time-consuming steps, inadequate handovers, limited out-of-hours support) and environment (reviews occurring overnight, limited software support). Based on these diagrams, a total of 4 PDSA cycles were performed, implementing 4 change ideas: (1) increasing accessibility to the seclusion proforma in handover, (2) circulating the proforma via email, (3) incorporating teaching into the academic programme, and (4) providing core trainee teaching in small groups. Regular audits were undertaken at two weekly intervals, and data was analysed using a Statistical Process Control chart.

Despite the interventions, there was minimal change in the overall compliance rate. Of the reviews that met all required criteria, compliance increased from 75% to 83%. This is likely attributable to the small number of seclusion reviews occurring within each two-week period, as well as the random variation introduced by different on-call doctors. These factors produced substantial fluctuations in the results, depending on the doctors' level of training and the workload of their shifts. At the level of individual domains, documentation of risk assessment to self and others alongside subjective and objective assessments of physical health increased, indicating a positive change.

This quality improvement project demonstrates that achieving the target of 80% compliance with the seclusion review requirements set out in the Mental Health Units (Use of Force) Act 2018 is unlikely to be sustained through educational or individual-level interventions alone. More directive system-level approaches may be required for sustained compliance, such as mandatory completion of all domains prior to submission of a seclusion review and efforts to reduce the overall use of seclusion to allow adequate time for high-quality, reflective documentation. Improving compliance with seclusion reviews is central to patient safety and safeguarding the rights of service users.

People with eating disorders can find the experience of social eating difficult, and being able to eat socially can be an important part of recovery. In the context of mental health treatment, experiences of mastery within virtual reality (VR) can be transferred to real life, and previous qualitative research has identified that a VR café environment could be a useful treatment adjunct for people with eating disorders. The aim of this project was to develop a VR café intervention for people with eating disorders who find social eating challenging.

We used the Person-Based Approach to develop the VR café. In Study 1 we conducted qualitative interviews and focus groups with young people with personal experience of a range of different eating disorders (n=15), parents and carers (n=4), and clinicians from a variety of professional backgrounds (n=6), to inform the design of the intervention. In Study 2, the café was further developed through a series of development activities and think aloud interviews with people with experience of eating disorders (n=12).

Study 1 participants described a range of challenges associated with cafés, which were incorporated into the initial build of the VR café by our industry partners,Virtual Bodyworks (Kiin). These included challenges related to social interactions with café staff, the busyness of café settings, and around choosing and ordering food and drink from café menus. Study 2 participants further shaped the intervention, contributing to the scripts for VR café staff; helping to develop food and drink menus; providing feedback on measures for assessing the effectiveness of the intervention; and advising on the ways clinicians could helpfully support people using the VR café, including through the provision of feedback on a written guidance document. During think-aloud interviews, Study 2 participants also identified areas for improvement to the content and experience of the VR café.

By placing the perspectives and ideas of people with eating disorders at the heart of the design of the VR café, we have developed a safe space for people with diverse eating disorders to practice relevant challenges related to social eating whilst being supported by a clinician. The intervention aims to reduce anxiety, increase confidence, and improve tolerance of uncertainty around social eating settings, and will be offered to young people accessing eating disorder treatment in two participating NHS trusts, as part of a mixed methods feasibility trial.

The Mental Health Intensive Support Team at Cheshire and Wirral Partnership NHS Foundation Trust commissioned a bespoke, 8-day training programme centred on the principles and delivery of dialogical practice, informed by an Open Dialogue approach. The training was commissioned to support the embedding of these principles into the rehabilitative model of care, with consideration being given to how to adapt the approach to the clinical model.

The aim was to evaluate the experiences of the clinical staff participating in the training that was delivered between April 2025 and November 2025, across two training cohorts.

The training package was offered to clinical staff of all bandings who had not previously completed any formal training in Open Dialogue or dialogical practice.

Data was collected via questionnaires that were completed at key points throughout the training. A pre-training questionnaire was completed prior to starting the 8-day training programme, and a post-training questionnaire after each of the four 2-day training blocks. All questionnaires were optional and anonymous.

Data collected was collated and a reflexive thematic analysis was completed to identify core themes highlighting staff experiences.

Across both cohorts the self-rated knowledge scores consistently improved across each training block. Average scores went from 4/4.5 out of 10 prior to attending the training (cohort 1/cohort 2 respectively) to 8.6/8.4 out of 10 at the completion of training (cohort 1/cohort 2 respectively) across both cohorts. 100% of respondents felt that the training met their expectations, alongside 98% of respondents feeling that the training will improve their work.

A reflexive thematic analysis identified six core themes from the qualitative data: (1) feeling more comfortable – beginner to more competent, (2) the value of experiential learning, (3) growing through it, (4) learning together, (5) learning how to really listen and (6) empathetic hope for the future.

The data identified that participants, overall, had a resoundingly positive experience of the training. Participants’ knowledge and understanding of dialogical principles improved, alongside participants also reporting positive changes both personally and relationally. The latter wasn’t an intended outcome but aligns with experiences of Open Dialogue training reported in the literature. The evaluation demonstrated that many participants left the training feeling hopeful for a future where dialogical principles areembedded into care delivery, and where individuals and their networks have more opportunities to have their voices heard.

This study aimed to estimate the prevalence of Childhood trauma (CT) subtypes and problematic internet use (PIU) among Sudanese medical students and the association between them. It examined which subtypes of the CT are most significantly associated with PIU, it also assessed the demographic predictors for PIU.

A descriptive cross-sectional study was conducted using an online questionnaire, it was distributed among 430 medical students from six universities located in Khartoum and Al Jazeera states, Sudan. Childhood maltreatment was measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and problematic internet use levels were assessed using the Chinese Internet Addiction Scale-Revised (CIAS-R). Both instruments are internationally validated. Descriptive statistics were reported as frequencies and percentages for categorical variables, and as medians with interquartile ranges for non-normally distributed continuous variables; Spearman correlation and multiple linear regression were used to assess associations and identify predictors of PIU while controlling for trauma-related anddemographic variables. A significance level of p <0.05 was applied.

Emotional abuse appeared as the most common form of childhood trauma, 48.8% (n=210), followed by physical neglect, 40.5% (n=174), and sexual abuse, 34.0% (n=146).The prevalence of problematic internet use among the participants was 46.0% (n=198). Also, a significant positive association was observed between PIU and overall CT scores (ρ=0.189, p<0.001). Among childhood trauma subtypes, emotional abuse had the strongest association with problematic internet use (ρ=0.219, p<0.001), while physical neglect, emotional neglect, and physical abuse also contributed. Furthermore, fifth-year students had remarkably lower CIAS-R scores compared to first-year students.

Emotional abuse emerged as the strongest indicator of problematic internet use severity among medical students. These findings emphasize the necessity for trauma-informed interventions, including counselling services and awareness programmes, to indicate the influences of childhood trauma and minimize problematic internet use among Sudanese medical student populations. Future studies should assess the internal psychological factors through which emotional abuse influences problematic internet use; understanding these details will contribute to building more targeted interventions.

Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia accounting for approximately 10–20% of all dementia cases. The behavioural variant (bvFTD) is the most common presentation, comprising 50–57% of autopsy-confirmed FTD cases. bvFTD is highly heritable, and most implicated genes are MAPT, GRN (progranulin), and C9orf72.

We report a case of two brothers, the first brother, aged 62, was assessed in the memory service in 2022 following a five-year history of behavioural change including inappropriate behaviour, overeating, apathy, and memory impairment. His Addenbrooke’s Cognitive Examination (ACEIII) score was 56/100. CT brain imaging showed generalised atrophy, more pronounced on the right. PET CT demonstrated hypometabolism particularly in the right frontotemporal region. Amyloid PET imaging showed no abnormal amyloid binding.

The second brother, aged 64, was assessed in 2024 with a two-year history of progressive cognitive decline and pronounced frontal lobesymptoms including apathy, irritability, lack of insight, impaired executive function, and poor financial management leading to debt. He required family support for most activities of daily living and scored 24/100 on the ACE. CT brain imaging showed pronounced frontal and medial temporal lobe atrophy. FDG-PET demonstrated reduced uptake in the frontal, temporal, and parietal lobes.

Both brothers underwent whole genome sequencing and were found to be heterozygous for a GRN mutation. Predictive genetic testing was recommended to their children, and two of four tested positive for the mutation.

GRN mutations account for 35% of genetic FTD and around 10% of all FTD cases. GRN-FTD follows an autosomal dominant inheritance pattern. In our patients, there was no family history of FTD, although their father had possible undiagnosed dementia while their mother had Parkinson’s disease and Alzheimer’s disease. Notably, up to 13% of bvFTD cases carry a genetic variant despite no family history.

Genetic testing is a crucial diagnostic tool for defining the molecular pathology of the disease particularly in psychiatric settings where early bvFTD is often misdiagnosed as a primary psychiatric disorder. Furthermore, Identification of a GRN mutation is also essential for determining eligibility for clinical trials.

Predictive genetic testing for at-risk relatives enables them to make informed decisions regarding life and future care.

This case highlights the importance of whole genome sequencing and predictive genetic testing even in the absence of a convincing family history. This could improve both patient care and our overall understanding of the disease.