Online teaching is common practice in postgraduate medical education. For the past three years our trust has provided an optional postgraduate education programme in psychiatry to GPs and foundation doctors. This has been run online due to perceptions of increased learner convenience, reduced time-cost for busy clinician teachers and reduced financial cost to the organisation. However, the programme’s teaching faculty observed little learner engagement in interactive learning during online sessions and were concerned about the impact of this on the teaching and learning experience. It was postulated that in-person sessions might increase group proximity, cohesiveness and psychological safety leading to a more interactive learning and teaching experience and increased learner and teacher satisfaction.

We reorganized our regional teaching programme and changed 6 online sessions to one half educational day with 3 sessions, and a full day with the remaining 4 sessions. We delivered the first of these sessions in early January 2026. Session content included psychiatric emergencies, communication skills, and comparisons between psychiatry and other specialties.

7 out of 52 learners attended the first session, the majority of whom were based in Bristol placements. This attendance was lower than that observed for previous online sessions (between 8 and 15 attendees out of 52 invited) and could reflect commuting and obtaining time away from clinical duties. In contrast, online sessions had previously been attended bytrainees from across the region, raising potential equity and accessibility considerations. Despite the lower attendance, formal feedback from attendees was uniformly positive. Informal feedback indicated a preference for in-person teaching, with learners reporting improved concentration and greater ease of interaction with both faculty and peers. Teachers had the impression learners engaged more in the sessions in contrast to previous online ones, and had higher satisfaction with the format, which may have implications for teacher motivation and retention.

We have recently changed our GP and foundation doctors teaching programme from online to in-person sessions due to concerns about low engagement within sessions. Our early reflections include a better perceived experience from learners and teachers, although difficulties in attending sessions could limit success in the future. We have demonstrated satisfaction with returning to in-person teaching, and will continue to assess learners’ responses and feedback.

Tourette syndrome and chronic tic disorders are neuro developmental conditions characterised by sudden, repetitive motor movements and/or vocalisations–known as tics–that persist for at least one year. These disorders typically begin in childhood and can lead to significant distress, impair daily functioning, and reduce overall quality of life. Although pharmacological treatments and behavioural therapies are available, long-term use of medication is often associated with adverse side effects. Consequently, there is growing interest in non-pharmacological approaches. This systematic review therefore examined the effectiveness of Comprehensive Behavioural Intervention for Tics (CBIT) in children and adolescents diagnosed with tic disorders.

For this review, several electronic databases were searched, including ProQuest PsycInfo, Ovid Medline, Ovid Embase, Ovid Emcare, the Cochrane Library, PubMed, NICE, and BMJ Best Practice. Searches were limited to English-language publications and to studies involving children and adolescents under 18 years of age with tic disorders who received Comprehensive Behavioural Intervention for Tics (CBIT). Eligible study designs included case reports and case series, and both quantitative and qualitative research and Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. In total, five studies met the inclusion criteria. These studies examined the effectiveness of CBIT delivered in various formats–including group-based CBIT, tele-CBIT, and modified CBIT–in reducing tic severity among children and adolescents.

Two independent reviewers analysed the data and identified substantial heterogeneity, which prevented further meta-analysis. However, the findings were instead synthesised narratively under three themes: effectiveness of CBIT, wider benefits for tics and acceptability. Across studies, CBIT consistently reduced tic severity in children and adolescents. Several studies also reported broader improvements, including reduced anxiety and depressive symptoms, alongside enhanced self-esteem and cognitive reappraisal. Acceptability and patient satisfaction were high across delivery formats, with group-based, tele-CBIT, and modified CBIT demonstrating comparable outcomes to traditional face-to-face interventions.

The review was constrained by the small number of studies and limited sample sizes, which reduced the reliability and generalisability of the findings. However, the results highlighted the effectiveness of CBIT in reducing tic severity alongside wider benefits for children with tic disorders. Thus the effectiveness, acceptability, and satisfaction across different CBIT delivery formats suggest promising potential for implementation in resource-constrained settings, with the possibility of enhancing quality of life for young people with tic disorders. Further research is needed to evaluate CBIT in combination with pharmacological treatments and neuro-modulatory approaches.

This integrative thematic synthesis aims to synthesise evidence on (1) neurodevelopmental and relational mechanisms hypothesised to drive Parent-Mediated Intervention effects; (2) lived experience and acceptability of parents, and (3) feasibility of widespread implementation into early-years services. Results were shaped into a translational model to inform sustainable, scalable, and ethical early-intervention delivery.

A scoping review was conducted in-line with PRISMA-ScR guidance. The databases Medline, PubMed, Scopus, and PsycINFO were searched for studies published between 2010 and 2025. Eligible papers included infants up to 24 months old at increased risk of autism and reported on at least one of the following areas: proposed neurodevelopmental mechanisms, parental experience, or implementation and scalability. Two reviewers independently screened and synthesised data from qualitative studies, clinical trials, and service evaluations using thematic analysis and cross-domain integration.

Studies were excluded if they focused solely on pharmacological interventions or diagnostic procedures, as well as those only including children older than 24 months.

Studies that were not addressing the practical delivery or feasibility of the intervention within real-world service settings were also excluded. This approach enabled inclusion of both trials examining efficacy and underlying mechanisms, alongside research exploring lived experience and system-level implementation.

The thematic analysis identified three interconnected domains: (1) Parent-Mediated Intervention shapes early social attention and arousal regulation by increasing the predictability of caregiver social signals without altering core neuro development trajectories; (2) parental empowerment and stress regulation act as key mediators of sustained engagement and parent–infant synchrony; and (3) feasibility and equity are determined by delivery model, workforce capacity, accessibility and adaptability (for example, hybrid or telehealth models).

Heterogeneity in terminology, study design, intervention duration, and outcome measures (including criteria used to define autism likelihood) was acknowledged as a limitation constraining synthesis across the studies in this review.

Despite these limitations, findings were integrated into a Developmental-Relational-Implementation model to support clinicians and commissioners in selecting, timing, and delivering Parental-Mediated Interventions that are feasible and adaptable within real-world health systems.

The Developmental-Relational-Implementation model offers a pragmatic framework for clinicians, commissioners, and policymakers to guide the delivery of Parental-Mediated Intervention in early autism care. This review positions Developmental-Relational-Implementation-informed approaches as family-centred, equitable, and scalable by capitalising on relational engagement, developmental neuroplasticity, and the practical realities of healthcare delivery. To support scalable and sustainable expansion, furtherresearch should incorporate mechanistic markers, qualitative assessments of parental outcomes, and health economic evaluation.

Large language models (LLMs) are rapidly emerging as tools with potential applications across mental healthcare, yet their implications for psychiatric practice remain unclear. This systematic review explores and categorises LLM use cases in mental healthcare to inform clinicians, researchers, and policymakers about emerging applications, opportunities, evidence gaps, and safety challenges relevant to psychiatric assessment, risk management, clinical documentation, and patient-facing support.

We searched EMBASE, MEDLINE, PsycINFO, PubMed, the ACL Anthology, the ACM Digital Library, arXiv, medRxiv, and bioRxiv (2017–June 2025) and included empirical studies evaluating LLMs for mental healthcare tasks. Screening and extraction wereperformed in line with PRISMA. We summarised use cases using a predefined taxonomy and recorded study design, evaluation setting (synthetic vs clinical), and key safety/ethics issues.

We identified 120 studies, with some addressing more than one use case, reflecting a broad and rapidly expanding set of LLM applications in mental health care. The most common functions related to assessment and detection: symptom identification (14), early detection (15), risk stratification (e.g. suicidality) (9), individual-level risk prediction for developing mental health disorders (12), and analysis of clinical or patient-generated text (1). Patient-facing use cases included psychotherapy (10), conversational agents (15), patient education (6), mood and emotion monitoring (5), accessibility-focused digital interventions (2), and psychiatric rehabilitation (1). Clinician-facing functions included diagnostic support (18), disease classification (7), treatment outcome prediction (3), electronic health record summarisation (3), and documentation support (1). Additional work addressed healthcare policy (8), research (1), education (1), and training (1). Across domains, LLMs were frequently reported to perform comparably to existing automated approaches and, in standardised case evaluations, to human benchmarks. However, the evidence base was highly variable, most studies were exploratory or proof-of-concept and had limited evaluation in routine psychiatric practice. Recurrent concerns included hallucinated or inaccurate outputs, bias and cultural insensitivity, limited transparency and explainability, data privacy risks, and uncertain safety in high-risk clinical contexts.

Current evidence indicates that LLMs may support multiple areas in psychiatry, primarily as augmentative tools rather than replacements for clinical expertise. Promising near-term applications include assessment support, administrative efficiency, psychoeducation, and low-risk supportive interactions. However, clinical integration remainsat an early stage given limited real-world validation and persistent safety concerns. Future research should prioritise evaluation in routine care, strengthened governance and regulatory frameworks, and transparent systems co-designed with clinicians and service users to ensure safe and equitable implementation in psychiatric practice.

Oldham Early Intervention Team (EIT) observed olanzapine was frequently prescribed as first line treatment. FEP patients may be particularly sensitive to adverse effects such as sedation and metabolic dysfunction, which can impact tolerance and adherence. NICE guidelines recommend collaborative antipsychotic prescribing with careful consideration of benefits and side effects. This audit aimed to evaluate antipsychotic prescribing patterns, assess compliance with monitoring standards, and determine whether dissemination of initial audit findings influenced prescribing practice.

A retrospective clinical audit was conducted on patients accepted by Oldham EIT during two time periods: September 2023–March 2024 (initial audit, n=36) and April 2024–September 2024 (re-audit, n=33). Antipsychotic prescribing data was collected from electronic clinical records at baseline and six month follow up, alongside weekly weight monitoring over the first six weeks, in accordance with the Lester Tool. Initial audit findings were shared with Inpatient and EIT consultants prior to re-audit.

During initial audit, 35/36 (97%) patients were prescribed antipsychotics. Olanzapine was the most prescribed 19/35 (54%), followed by aripiprazole 12/35 (34%). Baseline weight was documented for 11/35 (31%) patients but weekly weight monitoring only for 1/35 (3%) patient.

At six-month follow-up, 31/36 (86%) patients were prescribed antipsychotics. Olanzapine remained the most prescribed 14/31 (45%), followed by Aripiprazole 9/31 (29%). Among those continuing olanzapine, 8/14 (57%) had their doses increased due to residual symptoms. 60% of those who discontinued antipsychotics had been taking olanzapine and 80% discontinued due to patient choice.

At re-audit, 31/33 (94%) patients were prescribed antipsychotics. Olanzapine remained the most prescribed, but use decreased to 11/31 (35%). Quetiapine became the second most prescribed (8/31, 26%). Baseline weight documentation improved to 20/31 (65%), though weekly weight monitoring remained low 2/31 (6%).

At six-month follow-up, 28/33 (85%) patients were prescribed antipsychotics. Aripiprazole became the most prescribed 12/28 (43%), followed by Olanzapine 7/28 (25%). One patient continuing olanzapine had their dose increased due to residual symptoms. All antipsychotic discontinuations were due to patient choice, with 80% symptom-free.

This audit cycle demonstrated improvements in antipsychotic prescribing for FEP within Oldham EIT. Olanzapine prescribing reduced and was replaced by aripiprazole as the most prescribed antipsychotic at six month follow up. Areas for improvement were identified, with weekly weight monitoring remaining suboptimal. Furthermore, improved documentation could clarify prescribing rationale and establish if treatment refusal was linked to adverse antipsychotic effects. Continued education and re-audit are recommended to sustain improvements in prescribing practice and shared decision-making.

First-episode psychosis with treatment resistance can present with diagnostic uncertainty and often necessitate complex psychopharmacological decisions alongside multidisciplinary interventions. Selecting effective antipsychotic treatment while minimising adverse effects is critical, particularly when initial monotherapy is unsuccessful. This case report reviews clinical management and functional improvements in a young woman admitted to an acute psychiatric ward following combination treatment with Cariprazine and Olanzapine, supported by multidisciplinary team interventions.

X is a young adult female with no prior secondary-care mental health involvement, a family history of schizophrenia. She presented following a 2.5 year deterioration marked by aggression, social decline, and psychotic symptoms. On admission, she was presenting with behavioural disturbance, exhibited prominent paranoia, persecutory delusions, and auditory hallucinations. Initial treatment with oral Olanzapine was limited by non-compliance.

Zuclopenthixol depot was initiated but discontinued due to extrapyramidal side effects. Subsequent treatment with Amisulpride resulted in limited symptom control and cognitive slowing. Clozapine was deferred due to abnormal inflammatory and cardiac markers. A switch and gradual increase to Cariprazine 4.5 mg/d led to an improvement in insight and behaviour, with low-dose Olanzapine 5 mg/d later added to address residual positive symptoms (auditory hallucinations).

MDT input included extensive collateral history, family involvement, and structured Occupational Therapy and Psychology interventions.

This case suggests that Cariprazine augmented with low-dose Olanzapine may be an effective and tolerable strategy in treatment-resistant psychosis when Clozapine is contraindicated. Improvements in functional and psychological outcome measures underscored gradual symptomatic recovery.Symptom severity, measured using the Brief Psychiatric Rating Scale (BPRS), reduced from 38 to 29, representing 23.7 % improvement with the most marked improvement observed in unusual thought content and hallucinations.

The Occupational Therapy Task Observation Scale (OTTOS) - total score improved from 121/200 (08/10/25) to 182/200 (09/01/26), representing a 50.4% increase. Task Behaviour improved by 39.7%, and General Behaviour by 62.1%, with marked gains in engagement, independence, and socialisation.

Autism Spectrum Quotient (AQ-50) score reduced from 22 to 15, a 31.8% reduction in self-reported autistic-type traits. The greatest improvements were observed in Social Skills (90% of items) and Communication (70%), indicating improved interpersonal functioning and cognitive flexibility.

GAP (Global Assessment of Progress) score improved from 29/70 on admission to 63/70, representing an absolute increase of 34 points and reflecting a 48.6% improvement across the different domains.

Combination treatment with Cariprazine and Olanzapine was associated with meaningful symptomatic, functional, and psychological improvement, demonstrating its potential role in complex treatment resistant psychosis.

Psychotic disorders display marked ethnic disparities in incidence in the UK, with Black African and Black Caribbean populations consistently shown to have elevated risk.Leicester City is one of the UK’s most ethnically diverse cities and hosts a large and long-standing Somali community. Clinicians within the Psychosis Intervention and Early Recovery (PIER) service have perceived disproportionate Somali representation. This study quantitatively examines whether Somali patients are over-represented in PIER relative to population size and compares this pattern with African and Caribbean groups.

• • To determine whether Somali patients are over-represented in the Psychosis Intervention and Early Recovery (PIER) service relative to their proportion in Leicester City’s population.

• • To compare Somali over-representation to that of combined Black African/Caribbean groups.

• • To quantify crude prevalence, odds ratios (ORs), confidence intervals (CIs), and statistical significance of observed over-representation.

A retrospective analysis was conducted using a Leicester-City-only EIP caseload dataset (n=310). Ethnicity categories were collapsed into Somali, African/Caribbean (African + Caribbean + Other Black), and Other groups. Population denominators were taken from ONS Census data, including 2150 Somali write-in responses in Leicester City and African/Caribbean proportions based on Black African (~4%) and Black Caribbean (~1.36%) census data. Statistical methods included crude proportions, ORs, 95% CIs, and χ² tests.

Somali patients accounted for 7.7% of the EIP case load but only 0.58% of the Leicester population. OR for Somali over-representation was 13.45, p <0.001. African/Caribbean patients accounted for 10.3% of cases vs 5.36% of the population, OR 1.93, p <0.001. Somali patients were markedly more over-represented than the broader African/Caribbean group.

Somali individuals are substantially over-represented in early psychosis service usage in Leicester. This pattern exceeds the known elevated risk observed in African and Caribbean groups. Findings highlight urgent public health, cultural, and service-access implications requiring further investigation.

Clozapine is a high-risk antipsychotic prescribed in secondary care, requiring accurate documentation in primary care records to ensure patient safety and continuity of treatment. Inaccurate recording of Clozapine dose and frequency may result in prescribing errors, treatment interruption, or adverse outcomes, particularly in emergency or out-of-area settings. An initial audit identified significant deficiencies in the accuracy of Clozapine dose and frequency documentation within primary care records for patients managed by a community mental health team.

An audit was conducted within the North Cornwall Community Mental Health Team assessing the accuracy of Clozapine documentation in primary care records. Standards were derived from the Cornwall Partnership NHS Foundation Trust “Procedure and Guidance for the Use of Clozapine” (MM/032/22). Following dissemination of findings and targeted liaison with GP practices, a re-audit was undertaken using the same patient cohort (n=15) and methodology. Summary Care Records were reviewed and compared against the most recent secondary care clinic correspondence to assess inclusion of Clozapine on GP repeat prescriptions and accuracy of documented dose and frequency.

In the initial audit, Clozapine was included on GP repeat prescriptions in 93% of cases; however, accurate documentation of dose and frequency was present in only 33%. The re-audit demonstrated sustained inclusion of Clozapine on repeat prescriptions (93%) alongside a substantial improvement in accurate dose and frequency documentation, rising to 80%. These findings indicate a marked improvement following intervention, representing a meaningful enhancement in patient safety. Residual inaccuracies persisted in a minority of cases, highlighting the ongoing importance of clear communication between secondary and primary care.

Completion of the audit cycle demonstrated that targeted intervention and improved liaison with GP practices significantly enhanced the accuracy of Clozapine dose documentation in primary care records. While overall documentation improved substantially, continued vigilance and clear communication following medication changes remain essential to minimise prescribing risk. Ongoing monitoring is recommended to sustain these improvements and ensure patient safety.

People with intellectual disability have a higher risk of developing dementia, yet assessment and diagnostic pathways can vary across services and regions. This service evaluation aims to evaluate how dementia referrals for people with intellectual disability are processed within Mental Health of Learning Disability (MHLD) services across Kent and identify opportunities to standardise referral and care pathways.

A retrospective review was conducted of all referrals received by MHLD services in Kent from June 2022 to May 2023. Referrals were included if they contained themes suggestive of cognitive decline: changes in memory or function, forgetfulness, and confusion. Data were collected on referral source, demographics, reason for referral, acceptance or refusal, assessing discipline, follow-up plans, diagnoses at initial assessment and at 3 months. Referrals were analysed by region.

A total of 47 referrals met inclusion criteria. Acceptance rates varied by region and accepted referrals were younger on average than refused referrals across all regions. Down’s syndrome was present in a substantial proportion of accepted cases. Regional variation was observed in diagnostic pathways. Initiation of medication for dementia varied by clinician with consultants more likely to commence treatment than trainees.

This evaluation highlighted regional variation in diagnostic pathways for people with intellectual disability and suspected dementia. The variation suggests a need for a standardised dementia referral and diagnostic pathway, guidance on in-house diagnosis, enhanced training for clinicians and allocation of wider resources to improve equity, efficiency and quality of care.

Discharge summaries are essential for safe communication with patients, carers, community teams and general practitioners, ensuring continuity of care following psychiatric inpatient admission. Delays increase the risk of medication errors, incomplete risk assessments, safeguarding failures and missed follow-up. This project aimed to improve the timeliness of discharge summaries from an inpatient Child and Adolescent Mental Health (CAMHS) unit by achieving a 50% relative increase in the proportion of letters meeting both national (within 1 day) and local (within 7 days) standards on re-audit over a 6-month period.

Baseline audit data showed compliance of 26.23% with the national 1-day standard and 54.1% with the local 7-day standard. Barriers to timely completion were explored through analysis of the previous 6 months data on delayed discharges with key themes to delay identified. Consistently multidisciplinary team (MDT) communication was found to be the primary issue, including resident doctors not being made aware of prospective discharge dates, and consultants not being informed when letters were uploaded for checking. As such, interventions included:

• • Teaching discharge standards and processes at Trust induction for rotating resident doctors

• • Identifying potential discharges during weekly MDT case planning to allow advance preparation of letters

• • Ensuring resident doctor attendance at discharge meetings to facilitate same-day completion

• • Supporting secretarial staff to send reminder emails to consultants when letter checking was delayed

Following implementation of these interventions, the 6-month re-audit evidenced that compliance was improved across both standards. National standard compliance (within 1 day) increased to 46.43%, an absolute improvement of 20.2% and a relative increase of 77.1%. Local standard compliance (within 1 week) increased to 89.29%, an absolute improvement of 35.19% and a relative increase of 65.0%. The project aim was met for both standards.

Delayed discharge summaries compromise the safety of patients and others, through miscommunication, medication errors and failures in risk management. Despite clear national and local standards, compliance was nearly 75% and 50% respectively below expected standards. Following analysis of the previous 6 months of data on delayed discharges, MDT communication was identified as the key barrier to compliance at this CAMHS inpatient unit. This project demonstrates that simple, low-cost interventions focused on anticipation, preparation and communication can significantly improve discharge summary timeliness. Ongoing work includes six-monthly re-audit, continued teaching at Trust induction, and embedding discharge discussion within structured case-planning templates to sustain improvements.

People with learning disabilities experience significant health inequalities, yetundergraduate medical education often provides limited opportunities for sustained,meaningful engagement with this population outside clinical settings. This cancontribute to anxiety, uncertainty, and communication barriers for future doctors. Thecollaboration between Transition2 (T2), a specialist education provision for youngadults with special educational needs and disabilities (SEND), and the PsychiatryTeaching Unit (PTU) at Derbyshire Healthcare NHS Foundation Trust was developedto address this gap. The projectaimed to embed experiential, learning disabilityfocused teaching within undergraduate psychiatry placements, prioritising livedexperience, communication, and relational learning.

During undergraduate psychiatry placements, medical students spent structured timeat Transition2, engaging with young adults with learning disabilities throughfacilitated sessions and informal interactions. Activities included shared discussions,collaborative tasks, and reflective conversations, designed to support authenticengagement rather than observational learning. Teaching was informed byexperiential education principles, including Kolb’s experiential learning cycle,enabling students to experience, reflect, conceptualise, and apply learning related toholistic, person-centred care. Sessions were co-designed with Transition2 staff toensure they provided a safe, respectful, and empowering environment for learners.

Evaluation was qualitative, drawing on feedback from students, staff, and Transition 2 participants.

Feedback from students and staff demonstrated improved communication skills,increased confidence, and deeper understanding of learning disability within a real-world context. Students valued the opportunity to engage openly with individuals withlived experience, describing learning that extended beyond traditional classroom orclinical teaching. Many reflected on feeling genuinely invested in learners’ journeysand reported enhanced empathy and awareness of how language, pace, andenvironment influence communication. Transition2 learners benefited fromopportunities to practise communication, express personal perspectives, and interactwith future clinicians in a collaborative, non-clinical setting. The partnershipaddressed a critical gap in medical education by enablingrelational learning rarelyachievable in standard placements and successfully translated experiential learning theory into meaningful practice.

The Transition 2 and PTU partnership demonstrates an innovative, exciting model for learning disability education within undergraduate psychiatry. By embedding livedexperience and fostering respectful, reciprocal relationships, the programme enhances communication skills, empathy, and confidence among future doctorswhile empowering young adults with learning disabilities. Similar partnerships couldbe embedded within community education settings, colleges, and supportedemployment services, contributing to a more inclusive, informed, and compassionatehealthcare workforce.

Functional Cognitive Disorder (FCD) is increasingly recognised within memory services, yet its non-organic symptom profile, subjective–objective mismatch, and inconsistent cognitive performance continue to pose diagnostic challenges. Although conceptual frameworks, such as those proposed by Harriet Ball et al. (2020), have advanced understanding of FCD, translation into routine clinical practice remains variable.

This six-month retrospective service evaluation examined the prevalence, clinical characteristics, and diagnostic pathways of FCD within the South Kent Coast Memory Assessment Service. The project assessed diagnostic reach, cognitive profiles, psychiatric comorbidity, and service timelines while evaluating the practical utility and limitations of current diagnostic frameworks.

A total of 550 consecutive referrals (October 2024–March 2025) were reviewed. Patients were evaluated against six operationalised criteria grounded in established FCD models: subjective cognitive concerns, objective–subjective mismatch, internal inconsistency, absence of neurodegenerative disease, psychological contributors, and functional impact. Demographic data, cognitive assessments (ACE-III, MMSE), neuroimaging, psychiatric comorbidity, and service outcomes were analysed descriptively.

Thirty individuals (5.4%) met operational criteria for FCD or FCD-like presentations, consistent with UK prevalence estimates. However, only seven received a formal FCD diagnosis; the remaining 23 were coded as Mild Cognitive Impairment or given non-specific labels despite exhibiting clear functional features, highlighting significant diagnostic drift. The cohort was predominantly female (60%), with a mean age of 67 years and high psychiatric comorbidity (77%).

Cognitive profiles showed preserved attention, language, and visuospatial abilities, with variable memory performance and disproportionately reduced phonemic fluency. Relatively intact encoding but impaired spontaneous recall, with strong cue dependence, supported positive diagnostic features of a functional cognitive profile. Neuroimaging revealed no progressive pathology.

The service pathway analysis revealed significant variability, with average durations from referral to assessment and referral to discharge being 138 and 156 days, respectively.

These findings reinforce FCD as a prevalent and clinically significant presentation characterised by preserved cognitive function disrupted by anxiety-related performance interference. They also highlight limitations within the Harriet Ball et al. framework. While conceptually valuable, the criteria depend heavily on clinician interpretation of constructs such as “internal inconsistency” and “distress,” which lack clear operational thresholds and may contribute to the variability observed in diagnoses. Additionally, documentation gaps and inconsistencies in coding suggest that the current criteria are insufficiently structured for routine clinical practice.

A shift toward positively framed, operationalised diagnostic criteria, enhanced clinician training, and integrated psychological pathways is urgently required to improve diagnostic accuracy, reduce uncertainty, and optimise care for individuals with FCD.

The purpose of this QIP was to increase the number of patients who had had the opportunity to discuss nicotine replacement therapy (NRT) with a member of the clinical team. This was to try and improve the rate of NRT prescriptions and to ensure the ward was aligning its’ care with the trust values of treating the patient as a whole person and focusing on patient’s total health and wellbeing needs and with being a smoke-free site.

Data for all 17 beds on the inpatient ward was collected from 14/10/25–01/12/25.The inclusion criteria were any current inpatients who were current smokers, non-smokers were excluded. A spreadsheet containing columns for the bed number, smoker/non-smoker, recorded conversation about NRT, NRT prescription, and options for long-acting and short-acting NRT, was used to collect data. Data was collected initially to obtain a baseline, then re-collected following the implementation of ward-based interventions.

Interventions to improve the number of conversations about and prescriptions of NRT included discussing this in the daily morning MDT meeting to improve awareness, putting posters about NRT in the ward and doctor’s office and adding a column for NRT to the patient list in the nursing station.

In the initial data collection, 15 patients were recorded. 1 of these patients was a non-smoker so was excluded. NRT conversations were only documented in 2 out of the 14 patients (14.3%). NRT was prescribed in 3 out of 14 patients (21.4%).

In the post-intervention data collection, 16 patients were recorded. 4 of the 16 patients were non-smokers and excluded. Documented NRT conversations occurred in all 12 patients (100%), however 0 of these patients had NRT prescribed due to declining the intervention.

Following the introduction of ward-based interventions, documentation of NRT conversations improved from 14.3% to 100%. This represents a significant improvement. However, this did not translate into increased NRT prescribing. In fact, there were fewer patients prescribed NRT in the second data collection due to patients declining the intervention. This suggests that in future, there could be a focus on understanding the barriersto uptake. Through strengthening patient education, we can help ensure that these conversations translate into increased NRT use, with a long-term aim of smoking cessation.

Psych Talk was developed by the British Indian Psychiatric Association (BIPA), a UK-based charitable organisation, to support doctors from diverse training backgrounds in developing effective psychiatric communication skills. The programme aimed to improve confidence in OSCE-style assessments and routine clinical encounters through structured exposure to realistic psychiatry case scenarios. Objectives included providing practical, exam-focused guidance relevant to MRCPsych examinations, strengthening rapport-building and therapeutic alliance skills, supporting the management of difficult conversations, and use of non-verbal communication.

Psych Talk comprised 13 online teaching sessions delivered between June and December 2025. Sessions were held on weekends, lasted 1.5 hours each, and were chaired by UK resident doctors with support from consultant psychiatrists. Each session focused on two to three OSCE-style scenarios across psychiatric subspecialties, explored through role play, group discussion, and structured feedback. Pre-session and post-session surveys collected demographic information, career stage, confidence levels, learning sources, and qualitative feedback, with all responses analysed anonymously. Descriptive analysis evaluated changes in confidence.

A total of 189 participants completed the pre-session survey and 403 completed post-session feedback, with more responses obtained post-session possibly as participants completed these to receive CPD certificates. Participants represented a diverse cohort, predominantly from the UK (n=74), India (n=39), and Pakistan (n=8), with additional representation from Ireland, Egypt, the UAE, Myanmar, Malaysia, and a mixed or unspecified group (n=58). Participants who did not disclose their career stage formed the largest group (49.7%), followed by core resident doctors (35.4%). Doctors in non-training UK posts accounted for 7.4%, and IMGs outside the UK for 6.3%. Before attending Psych Talk, only around one in five participants reported feeling confident or very confident; most described themselves as somewhat confident, and 13.8% reported no confidence. After completing the sessions, nearly two-thirds reported high confidence, and those reporting no confidence fell to 1.0%. Participants valued the practical, exam-focused approach, realistic OSCE scenarios, interactive format, and clarity of guidance. Chairing by resident and consultant psychiatrists was rated excellent by nearly 75% and good by a further 20%. Mostparticipants learned about the programme through social media (37%) or colleagues (29.3%), and nearly all expressed interest in future sessions.

Psych Talk was associated with a meaningful improvement in self-reported confidence in psychiatric communication among a globally diverse cohort. As a free and accessible charitable initiative, it highlights how shared learning environments can bridge gaps between UK and international training systems and support MRCPsych-related skill development.

Traditional Community Mental Health Team (CMHT) follow-up relies on clinician scheduled appointments at fixed intervals, which may not be responsive to individual patient needs. Patient-Initiated Follow-Up (PIFU) enables patients to request timely review based on symptom change rather than routine scheduling. This project evaluated implementation of a PIFU pathway for a cohort of patients within Aston and Nechells CMHTs, with Aston acting as a control using the conventional pre-scheduled follow-up model and Nechells implementing PIFU, to assess the impact on access, capacity and patient experience.

The pathway was designed using NHS England's published PIFU guidance and registered with the Trust’s Quality Improvement team. A dedicated PIFU category was created within the electronic patient record, clinicians were allocated weekly PIFU review slots, and relevant staff received training. Following clinical assessment, patients werescreened using agreed criteria to identify those with PIFU-suitable mental health presentations, adequate capacity and ability to self-initiate contact. The process was explained and informed consent obtained. All transfers to PIFU were discussed at multidisciplinary team meetings prior to implementation. Patients re-accessed care by contacting the CMHT directly and were offered appointments within seven days. Uptake of PIFU and its impact on routine appointment availability were monitored and compared between Nechells and Aston CMHTs. Vacant PIFU slots were repurposed for ad hoc reviews of patients attending Clozapine or depot clinic.

From February 2025 to May 2025, 183 patients had been placed on the PIFU pathway, with 31 PIFU reviews completed. In June 2025, Nechells CMHT demonstrated a 37.22% reduction in routine clinic waiting times compared with Aston CMHT, alongside improved capacity for review slots within 14 days. By December 2025, there were 311 patients on the PIFU pathway. Patient feedback demonstrated good understanding of the pathway, with 66.7% reporting clear understanding and 72.7% confidence in getting access. Since initiation, 31.5% of patients had contacted the team, with 68.2% finding access easy. Overall, 76.8% preferred PIFU and 92.6% wished to continue on the pathway, a small proportion expressed preference for the traditional model.

A PIFU pathway within CMHT for selected patients resulted in significant reductions in waiting times, improved clinic capacity and gave favourable patient satisfaction. The model supports timely access to care while optimising resource use. Following the results of this project, formal standard operating procedure was developed and trust-wide rollout of PIFU across all CMHTs within Birmingham and Solihull Mental HealthFoundation Trust is planned with further evaluation.

Children and adolescents with psychosis are more likely to have a poor prognosis and to experience treatment resistance, than adults. This is associated with a reduced quality of life, as well as increased care needs and economic cost. Clozapine is recommended for treatment-resistant psychosis because of greater efficacy than other antipsychotics, however this can be insufficient. Clozapine can be augmented with a range of different treatments, however there is relatively little data available for this in children and adolescents.

A systematic search was carried out of four databases (Embase, Medline, PsycInfo, CINAHL) from inception to February 2026, to identify studies of pharmacological and non-pharmacological clozapine augmentation strategies in children and adolescents, including psychotherapeutic or psychosocial interventions, neuromodulation, and nutritional or dietary supplements. To be eligible for inclusion, patients in the study needed to be prescribed clozapine prior to initiation of the adjunctive treatment, and to have outcome measures recorded before and after augmentation. The study was registered on PROSPERO (CRD42024564242).

Nine studies were found that reported on children or adolescents (n=59) receiving medications, ECT or other neuromodulation techniques to augment clozapine. The majority (6/9) were case reports or case series, retrospective chart reviews and one pilot RCT. Some clinical improvement was reported for a majority of patients in the included studies, however this was mostly short-term. No reports were found on adjunctive psychotherapeutic or psychosocial intervention, nor nutritional or dietary supplementation.

Some clozapine augmentation strategies may be effective in children and adolescents, but available evidence is limited and very weak. Of note, the search identified a number of studies which could not be included due to lack of outcome measures. This highlights the potential importance of routinely collected outcome data, in building an evidence base for rare presentations. Research into psychotherapeutic or psychosocial treatments was also lacking. Further high-quality, prospective research is needed to address this gap.

Acute mental health wards are emotionally intense environments where patients may experience sudden anxiety, distress, agitation, or feeling overwhelmed. In these moments, engagement with verbal therapy can be difficult, and staff often need safe, non-pharmacological options that support rapid emotional regulation while maintaining therapeutic connection.

Virtual Reality (VR), supported by Artificial Intelligence (AI), is increasingly used in healthcare, but it remains uncommon in routine acute mental health practice. This case study describes how an AI-supported VR programme was introduced at Cygnet Harrow as part of standard clinical care and explores feasibility, clinical usefulness, and early outcomes for patients and staff.

Cygnet Harrow introduced a VR therapeutic programme in partnership with XR Health, using Meta Quest 3 headsets integrated into routine ward care. Importantly, the intervention was delivered as part of Occupational Therapy (OT) activity and therapeutic engagement, rather than as a formal research project.

Staff received structured training covering safe equipment use, patient support, and how to embed VR meaningfully into daily OT-led interventions. Sessions were individualised and voluntary: patients experiencing acute anxiety accessed calming environments (e.g., nature-based, breathing-focused spaces), while those managing agitation accessed grounding-based environments designed to reduce distress and promote emotional regulation.

The VR system generated automated session reports including session duration, engagement indicators, and repeated session patterns, supported by AI-based analytics. Over a six-month implementation period, outcomes were monitored using routinely recorded staff-rated parameters: agitation (0–10), mood distress (0–10), and therapeutic engagement (0–10), alongside qualitative documentation of willingness to participate in wider therapeutic activity.

Eleven patients participated over six months (n=11), completing 94 sessions in total. Attendance was strong, with 82% session completion, and there were no serious adverse events.

Across the cohort, clear improvements were observed. Average agitation scores reduced from 7.1 to 4.2 (mean reduction −2.9 points). Mood distress reduced from 7.8 to 5.0 (mean reduction −2.8 points). Therapeutic engagement increased from 3.6 to 6.4 (mean increase +2.8 points).

In addition 8 out of 11 patients (73%) showed increased willingness to engage in broader therapeutic activity following VR sessions, including 1:1 OT engagement, psychology work, and group interventions. Staff reported VR was particularly useful for patients who were withdrawn, highly distressed, or reluctant to participate through traditional approaches. AI-generated summaries provided objective supporting information that complemented clinical observations and informed MDT decision-making.

AI-supported VR was feasible, safe, and clinically meaningful when delivered as part of routine OT activity in an acute mental health setting. It provided a practical non-pharmacological option for emotional regulation during crisis and supported improved engagement with wider treatment. With continued implementation, this approach may be transferable across other acute services.

Structured assessment frameworks can enhance quality of clinical assessment and improve patient care, but must be feasible to deliver consistently in psychiatric settings. Acute inpatient wards face fluctuating acuity, staffing pressures and competing clinical priorities, which can limit the implementation of structured assessments. The Mental State Examination (MSE) remains central to psychiatric assessment but few tools have been evaluated for routine use in ward environments. MINDY is a structured mental state and risk assessment tool intended for routine inpatient use.

The aim was to evaluate the feasibility of implementing MINDY on an acute psychiatric ward. We hypothesised that MINDY could be delivered consistently during routine clinical practice with acceptable completion rates and minimal item-level missing data.

This was a service-evaluation, retrospective and case-note review of clinical records on Opal Ward, Newham Centre for Mental Health - acute adult psychiatric inpatient service. Over a two-week period, three resident doctors completed MINDY assessments for patients under a single consultant team during clinical work, with one study day excluded due to staffing pressures. Implementation outcomes included rates of assessment completion, reasons for missed assessments and item-level completeness within submitted MINDY forms. Temporal trends across the study period and inter-individual variation were explored descriptively. All material was anonymised prior to analysis in accordance with NHS information-governance and General Data Protection Regulation (GDPR) policies. Analysis was performed by a fourth-year medical student, focusing on feasibility and implementation.

Of 66 expected assessments, 48 were completed (72.7%) across the two-week period. Reasons for 18 missed assessments included: patients on short-term leave (11/18; 61.1%), patient refusal (5/18; 27.8%) and lack of interpreter availability (2/18; 11.1%). Completion rates for MINDY assessments varied between individuals, ranging from 66.7% to 100%. No assessments were missed because of incomplete forms as item-level completeness within all completed MINDY assessments was 100%.

In routine acute inpatient practice, MINDY demonstrated good feasibility. Nearly three-quarters of expected assessments were completed despite operational barriers, patient leave and refusal. Crucially, when assessments were undertaken, all core items were completed, indicating strong usability and low administrative burden for clinicians. These findings support MINDY as a deliverable ward-based tool for repeated use in inpatient environments. Future work should focus on strategies to reduce missed assessments and evaluating scalability across multiple wards and clinician groups. Once validated, MINDY could be delivered by the wider multidisciplinary team, improving feasibility.

Simulation training is a type of experiential learning where individuals practice skills and decision-making in a safe, artificial environment that mirrors real-world scenarios.Transition points in medical careers, such as the step up from Core to Specialty Training in Psychiatry, are often viewed in a negative anticipatory fashion by doctors about to undertake a role change. A simulated workshop was created, with the aim to support Core Psychiatry Trainees (CTs) to develop their confidence in acting as the Specialty Registrar (SpR).

A pilot session was delivered at an Oxleas local Core Trainee teaching day. CTs were requested to bring cases that they had previously discussed with a SpR when on-call. 20 trainees in attendance were split into four groups, each with a Registrar/Consultant facilitator. In each group, the more senior CTs were asked to role play as the SpR, with the junior CTs presenting their cases to them. Feedback was provided on the content and communication skills of the CTs discussing their cases, and on the management plans of the CTs acting as the SpR. Additionally, to add to the fidelity of the simulation, vignettes of common scenarios requiring SpR input out-of-hours had been pre-prepared and the CTs taking on the SpR role were also asked to provide their advice on these situations.

A QR code for a survey was displayed immediately after the session finished. 15 Core Trainees responded (~75% completion rate), with all CTs reporting that the workshop was useful and engaging. Moreover, there was a considerable increase in trainee confidence of taking on the role of a SpR following the simulation, although final confidence levels remained mixed. Participants fed-back that they liked the concept, the structure and interactiveness of the session, as well as the realism of the scenarios. Feedback from the facilitators also echoed that of the CTs.

This was a successful pilot workshop utilising simulation to increase the confidence of Core Psychiatry Trainees in stepping up to the role of a SpR. Ideas forimprovement include the addition of scenarios illustrating dilemmas regarding the use of the Mental Health Act, as well as the option of a debrief between CTs and SpRs following the class where any on-call concerns can be discussed. Given the strong positive response, further work will be undertaken to refine the simulation session, with the ambition to continue its delivery locally, alongside rolling it out regionally.