To understand what leads young people to come to Sheffield Children’s Hospital for their mental health, and the barriers to discharge home. This may help guide the service in reducing the number of long admissions and their length of stay. For example, we may be able to identify at risk groups and give appropriate support before and during admission.

We gathered data showing admissions to the STAR team (Supportive Treatment and Recovery Team) from 2022-2024 and identified patients with a prolonged (>21 days) stay. Within their electronic record, notes were reviewed to identify: patient demographics, frequency of stays (related to mental health), length of stays (related to mental health), risk to self or others, involvement of other services or consideration of Tier 4 input, issues with sleep, school, substances, possible/confirmed neurodiversity.

Out of 753 patients identified in 2022-2024, 20 patients met the criteria for a prolonged admission. There was an even split by sex, with a mean age of 13.5 years. We identified demographic traits within the cohort having prolonged admissions.

Overall, it seems certain factors might increase the risk of a prolonged mental health admission, such as safeguarding concerns and violence and absconding risk. Using the risk factors identified, we have created an admissions tool. The aim is for this to allow professionals to score the amount of risk factors, and if meeting a certain threshold, trigger a case conference. This may help at the early stages to reduced potential frequent or prolonged admissions for a young person.

Essex partnership university Trust (EPUT) policy on Discharge and Transfer Clinical Guidelines (CG24) aims to provide a clear pathway for the transfer and discharge of all patients of EPUT from and within Mental Health, Learning Disability, Secure Services and Community Health Services. It also aims to ensure that a patient’s transition between areas of EPUT services and transfer outside of EPUT services is carried out timely, effectively and safely.

The aim of audit is to to evaluate if EPUT Policy on Discharge and Transfer Clinical guidelines CG24 was being followed in an inclusive inpatient setting.

Data was collected retrospectively on all discharges from 6 acute inpatient wards within the Mid locality of EPUT; in the Linden Centre, Chelmsford.Inpatient wards that were included were General Adult (Galleywood, Finchingfield, Topaz), Older Adult (Ruby), Perinatal Specialist (Rainbow) and Psychiatric Intensive Care Unit (Christopher Unit) using a custom built audit tool. All discharges in a 3-month period (from June 2025 to August 2025) were included. This information was gathered from the electronic record (PARIS) with sample size of 91 discharges.

1. 1. Copy of the brief discharge summary given to patient: 100%

2. 2. Copy of detailed discharge summary scanned onto electronic medical records: 98%.

3. 3. GP to receive brief summary about admission, treatment required and medications within 24 hours of patient leaving the ward: 86%

4. 4. Copy of brief discharge summary scanned onto electronic medical records: 86%

5. 5. GP to receive detailed discharge summary within 5 working days of patient leaving the ward: 81%

6. 6. Copy of the more detailed discharge summary sent to patient: 0%

This re-audit has highlighted good compliance with providing the brief summary to the patient directly and scanning detailed discharge summary onto electronic medical records. There is a slight decline in sending both the brief summary to the GP within 24 hours, and with sending the detailed summary to the GP within 5 days following discharge compared to previous audit cycle with 81 discharges (data collected February 2024 – April 2024).

Areas of Good Practice:

Wards were generally compliant at uploading detailed discharge summaries to the EPR (98%).

Nurses continued to provide patients with a copy of brief discharge summary. (100%)

All wards apart from Rainbow (Mother and baby unit) are using E discharge summary.

Areas for Improvement:

There was slight decline in sharing of the brief and detailed discharge summaries with the GP, and poor compliance in sharing detailed discharge summaries with patients.

Delayed discharges arise from multiple factors and are linked with poor health outcomes, increased systemic pressures and a higher financial burden. To tackle these problems, a simple screening system (The Holistic Concern Score, HCS) was developed to identify the nature and degree of case complexity, signpost discharge barriers and enable early parallel working between allied health services.

The scale was developed using pooled data over the longest-admitted patients to determine reasons for protracted stays. The two major phases of the project involved the development of the score, and subsequently a combined retrospective application to a case sample to review its efficacy and learning.

Ten factors were identified and placed into a novel scale with factors identified as either natural (for example treatment resistance, lack of capacity) or systemic (accommodation delays, funding problems). A preliminary complexity thresholdwas calculated to determine cut-off points for identifying cases for early escalation to senior management.

The same thirty cases were re-analysed approximately 3 months later to assess efficacy of the score in predicting admission duration.

The scale shows moderate strength in predicting length of inpatient stay and characterises discrete clusters of compounding issues signifying the need for assertive multidisciplinary management. The use of this scale at admission has led to improved holistic management of cases and provided clear therapeutic benefits, with the potential to reduce delayed discharge, improve health outcomes and relieve systemic and financial pressures.

Further work will be needed to refine the scale but it presents promise within any inpatient service pathway as a directive, prescriptive and effective approach to case management on multiple levels.

To improve access to the young person psychotherapy service by adapting intake requirements. National data indicates that there is an impact of ethnicity on accessing therapies. Our aims are to improve attendance of the initial pre-assessment consultation (PAC) appointments, but also to see if there is an improvement to PCREF diversity. To support the AYAS team in achieving the existing 4-week KPI target between referral and appointment by reducing DNAs and cancellations.

1) Data was collected during the period between April 2024–June 2025 on patients who either did not attend (DNA) or cancelled their initial pre-assessment consultation (PAC) appointments. Patient records were reviewed to understand the most common reasons why patients were unable to attend their appointments.

2) Stakeholder engagement was also sought by collecting opinions from staff members involved in the opt-in process.

3) Using the above data and feedback, a new opt-in template was developed that was user friendly, age appropriate, and helpful for booking appointments, thus improving the experience for patients and staff.

4) Following its implementation, data was collected on whether the new process was effective in achieving our initial aims and objectives. Continued feedback will be sought from patients and staff members to inform a new cycle of quality improvement in the future.

Data collected in the 14 months between April 2024–June 2025 found 21 DNAs and cancellations. The most common reason given for cancellations and DNAs was because their appointment clashed with college, work or other commitments (10). This was followed by being given too short notice (5) and sickness (4). Of the 304 appointments offered in 2024–2025, there were 42 first-appointment DNAs. Of these, the most common ethnicities were White British (10), White Other (6) and Black African (6). There was an improvement in the time it took for patients to respond once an opt-in was offered, which was supported by feedback from staff members involved in the opt-in process.

The new opt-in process for the Adolescent and Young Adult Service (AYAS) has demonstrated promising results in improving the rates of response for patients offered an opt-in to attend the pre-assessment consultation (PAC). Previous data suggests that there is no impact of diversity on attendance. Ongoing data collection is required to assess its longer-term impact on the service.

ADHD is treated in CAMHS and may involve non-pharmacological treatments, suchas behavioural therapy. It may also involve pharmacological treatments, such as methylphenidate, lisdexamfetamine, atomoxetine, and guanfacine. Medication side effects include hypertension, weight loss, arrhythmias, and loss of appetite, all of which are detrimental to childhood development. The aim of this closed-loop audit was to improve Attention Deficit Hyperactivity Disorder (ADHD) monitoring within the Child & Adolescent Mental Health Services (CAMHS) in West Glasgow. Patients’ height, weight, blood pressure, and heart rate, along with respective centiles and growth charts, were assessed in accordance with NICE guidelines.

In the initial audit, a retrospective data search using electronic health records identified a sample of 33 patients under 18 with a diagnosis of ADHD who took ADHD medication within the previous 6 months. The results of this initial audit were presented at a local department meeting. Posters of the NICE guidelines were then distributed. The same methods as the initial audit were used to identify 45 patients on ADHD medication for the follow-up cycle to assess improvement in monitoring.

In the initial audit, 97% of the 33 patients had their height and weight recorded, and 100% had their blood pressure and heart rate recorded. 85% of patients had their height centile, weight centile, and growth charts recorded. 10% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded. In the second cycle, 100% of the 45 patients had their height, height centiles, weight, weight centiles, heart rate, blood pressure, and growth charts recorded. 2% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded.

There was a significant increase in the monitoring of height, height centiles,weight, weight centiles, heart rate, blood pressure, and growth charts in the second cycle compared with the first cycle. However, blood pressure and heart rate centiles still did not meet NICE guidelines. This was clinically significant due to the variance in heart rate and blood pressure in children. The electronic health system’s inability to convert raw figures of blood pressure and heart rate to percentiles likely impacted the ability to monitor these specific percentiles.

To develop a peer group of clinical academic residents in the West Midlands Deanery.

The SPARK project (Supporting Psychiatric Academic Research for Knowledge) began in 2024 in the West Midlands Deanery to support resident doctors to achieve the research requirements of the higher training curriculum. From this work it became apparent that a smaller cohort of academicallyfocussed residents wanted support with applications and their additional training needs.

We started a series of meetings for clinical academic residents and doctors interested in academic psychiatry careers working in the West Midlands. We held our first hybrid meeting in October 2025 at the University of Birmingham. This consisted of a hot networking lunch, a career talk from clinical Associate Prof Dr Ben Perry, a talk on theclinical academic training pathway and time for networking. We created a WhatsApp group where we share funding and job opportunities as they arise.

A second meeting is booked for March 2026 and will feature a career journey talk from Prof Femi Oyebode. This will be held at the University of Warwick so residents get exposed to different universities in the Midlands.

At the first meeting we measured pre-and post-session awareness of, and interest in, clinical academic careers.

21 participants recorded their attendance at the first SPARK 2 meeting, 16 in person and five online. The attendees were a mix of ACFs, core trainees, higher trainees, a foundation doctor, a clinical research fellow, an SAS doctor and a medical student.

Participants were asked to respond to the statement “I know what a clinical academic is and what they do”; 58% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. Participants were asked to respond to the statement “I understand the typical training and career pathway for a clinical academic”; 41% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. After the session 100% of participants responded “Agree” or “Strongly agree” with the statement “The seminar improved my understanding of clinical academia”.

One resident stated afterwards “That event really was pivotal” to his subsequent appointment as an ACF.

SPARK 2 is a quality improvement project in the West Midlands to support clinical academic residents in the region. We run meetings and have created a WhatsAppgroup to allow for networking and the sharing of knowledge and resources.

Menopause is increasingly recognised as a contributor to mental health presentations. There is a lack of confidence amongst clinicians in investigating and managing menopause in psychiatric patients; up to 41% of psychiatrists reporting feeling “not confident at all” in responding to the hormonal health of female service users. We aimed to evaluate the acceptability and efficacy of a specialist service for menopause and menstrual disorders amongst patients in secondary mental health care.

We devised and ran a Menopause and Menstrual Health Clinic offering email advice, case discussions, and assessments. The clinic is staffed by a consultant with special interest in the field, admin, and with MDT discussion input from Community Gynaecology. We have administered tailored teaching sessions to clinical services across the trust. Pre- and post-intervention survey data has been taken from service users, clinicians, and teaching recipients.

Initial feedback from teaching sessions shows improvement in knowledge and confidence (both 100%, n=12) and a positive impact on clinical practice (100%, n=10).

In the first eight months of operation, the clinic received 43 referrals from 37 referrers across primary and secondary care services. Early quantitative and qualitative feedback from patients and clinicians is positive. 100% of clinicians (n=9) who have responded to date find the clinic has improved the care they offer their patients, naming the “expert advice”, “comprehensive feedback”, and holistic reviews offered as key components of the clinic’s efficacy. 100% of clinicians and patients surveyed found the clinic easy to refer to or attend.Six-monthly follow ups from initial reviews are ongoing, but 100% (n=3) of patients surveyed to date have found treatment changes advised by the clinic to have had a positive impact on their mental health.

Preliminary data suggests the clinic is beneficial to clinicians and patients, with strengths including discussion of novel treatment options, holistic assessment of needs, and open dialogue between professionals regarding hormonal symptomatology and management. Delivering teaching sessions for colleagues to introduce a hormonal lens to formulation and management plans further extends the reach and effectiveness of the clinic. Ongoing work is needed to embed this awareness in routine psychiatric practice, through the expansion of teaching provision and increasing the profile of the clinic’s criteria and referral process. Future research should consider the need to embed consideration of hormonal status into mental health assessments, as a step towards addressing inequitable health outcomes for women.”

The aim of the project was to formalise and structure reciprocal communication between GPs and Queen’s Park and Paddington community mental health hub (QPP CMHH), with the hope of streamlining mental health care, supporting GP colleagues with mental health management, and to improve the quality of referrals.

Three GP surgeries were selected on the basis that they constituted 80% of the referrals to QPP CMHH. A7-item questionnaire (consisting of 5 rating-scale questions, ranging from dissatisfied to very satisfied, and 2 free-text questions) was sent to the GPs at these practices. Both virtual and paper copies were used. GPs were then given access to a spreadsheet that allowed them to book in for patients that they wished to discuss with CMHH, where they provided patient details and the clinical question. Virtual meetings were held every 2 weeks to discuss the cases and for the GPs to receive advice.

A total of 15 pre-intervention questionnaires were returned, from 3 GP surgeries. A total of 13 post-intervention questionnaires were returned, from 1 GP surgery. There was overall improvement in the GP-CMHH relationship, with the greatest improvement seen in the domain ‘communications were being sent via the correct channels’.

Limitations include long-term sustainability, which depends heavily on the commitment and input of more permanent, often senior staff. Suggested areas for improvement included a bypass telephone number to expedite access to QPP professionals for better support for duty GPs, and integrating the discussion referral process into SystmOne, the software that both GP surgeries and CMHT use. Suggested next steps is to widen access to additional GP surgeries.

The aims of this audit are to assess compliance with local audit standards for: (1) documentation of driving status at initial assessment; (2) documentation of DVLA notification advice; and (3) documentation and follow-up of driving safety advice aligned with DVLA/regional guidance because young people with eating disorders (EDs) may experience physical and cognitive impairment (e.g., blackouts, hypotension, hypoglycaemia) that can compromise driving safety. UK Driver and Vehicle Licensing Agency (DVLA) guidance requires individuals to notify DVLA if an ED affects fitness to drive. Yet, no CAMHS-specific local process existed to guide systematic assessment and documentation of the risk that young people pose from driving, to ultimately maintain patient and public safety.

A retrospective electronic case-note review was undertaken within the North Yorkshire & York CAMHS ED Service. All patients aged ≥15 years 9 months up to October 2024 were screened (n=65); 48 met the inclusion criteria. An agreed proforma captured driving status documentation; presence and content of driving safety advice; how this aligned with DVLA/ NHS guidance; follow-up advice at specified intervals; and explicit documentation of DVLA notification advice.

No cases documented driving status at initial assessment (0/48). Any documented driving safety advice was present in 33.3% (16/48) of cases. Among those with documented advice (n=16), follow-up driving advice was recorded in 93.8% (15/16), and 100% had documented advice aligned with DVLA/NHS guidance (16/16). Explicit documentation that the patient should notify DVLA was present in 43.8% (7/16). The key areas for improvement were the lack of risk assessment regarding driving; documentation at initial assessment; and inconsistent DVLA notification advice.

This audit identified that the ED service was not adequately assessing the driving status of young people with ED and/or providing the necessary advice, which could have implications for patient safety. Where advice was documented, quality and follow-up were high, suggesting that introducing structured prompts would be beneficial.

A revised initial assessment pro forma incorporating a structured “Driving Status & Advice” section and visual reminders (a clinic poster) has been implemented; a co-produced CAMHS-specific ED and Driving patient leaflet and an updated follow-up review template are in progress. The second cycle will evaluate the impact of the changes and the standardisation of DVLA-related documentation across the pathway.

As guided by the General Medical Council and the Royal College of Psychiatrists, the inclusion of experts by experience is a required component of British undergraduate medical education and postgraduate psychiatry training. However, this has not been formally applied to the training of Mental Health Tribunal (MHT) and Special Educational Needs and Disability (SEND) Tribunal members who are advised on reasonable adjustments for patients and appellants through the Equal Treatment Bench Book, including guidance on Autism Spectrum Disorder (ASD).

This study aims to evaluate the impact of expert-patient input on tribunal members’ understanding of ASD following a dedicated training programme. We hypothesise that the training day will increase participants’ confidence regarding reasonable adjustments for patients with ASD and will be perceived as novel and valuable.

A multidisciplinary training day was delivered to MHT and SEND Tribunal members in England, jointly by clinicians and experts by experience. The training offered a multimodal overview of ASD and its treatment, and how reasonable adjustments can be made in tribunal hearings.

To evaluate the session, data was collected via online post-session feedback questionnaires. Items were selected to assess participants’ confidence with regard to the training’s learning outcomes, the perceived novelty and value of expert-by-experience involvement, and participants’ willingness to receive a follow-up email six weeks post-training to support consideration of reasonable adjustments.

The training programme was attended by 54 MHT and SEND Tribunal members, of which 24 were judges, 13 were consultant psychiatrists, and 17 were other specialists involved in the care of patients with ASD.

Ninety-four per cent of respondents reported feeling confident after the training session, an increase from retrospectively reported pre-session confidence of 50% (n=18). Over half had no prior exposure to expert-by-experience training (55%, n=47), while a large majority thought MHT and SEND tribunal training should include more input from experts by experience (89%, n=46). 68% of participants (n=45) opted to receive an email six weeks post-training to be prompted to continue to make reasonable adjustments for patients with ASD.

The findings reinforce the effectiveness of expert-by-experience input and highlight its lack of incorporation to date in tribunal training. The willingness of participants to receive a follow-up email six weeks post-training suggests an openness to reflection. Further work should explore how such involvement can be sustainably embedded within tribunal training to support awareness of mental health conditions, including ASD, and the implementation of reasonable adjustments in hearings.

1. To improve carer contact and involvement in Emergency Department (ED) assessments within Devon Partnership Trust (DPT) liaison teams, in line with Psychiatric Liaison Accreditation Network (PLAN) standards, NICE guidance on suicide and safety planning, and the Triangle of Care.

2. To increase carer contact during emergency assessments, and completion of the associated information-sharing form to 90% target.

We began with a baseline audit of 60 emergency assessments in September 2024 across three DPT liaison teams (Torbay, Exeter, and North Devon), using carer-related standards from PLAN and NICE. This revealed carers were not routinely contacted, the information-sharing form infrequently completed, and existing guidance was not consistently followed.

A Quality Improvement project team, including a carer representative, was formed to address these issues–initially focusing on increasing routine carer contact and appropriate documentation. A qualitative survey of team members identified key barriers, which then formed a driver diagram and change ideas implemented from October 2025. Workplace culture change around carer contact emerged as a central priority. A monthly rolling audit of 5 patients per team was implemented to monitor progress.

Initial SPC chart data indicated changes remained within normal variability, particularly in documentation rates. As a result, we maintained focus on early project targets rather than progressing on to the next targets. Nonetheless, recent data shows a positive trend, with updated data to be presented in our poster.

Carer involvement in ED assessments is essential for enhancing assessment quality and patient safety, and is supported by PLAN, NICE, and the Triangle of Care. However, achieving consistent change is complex, particularly in shifting workplace culture. Our ongoing strategies are beginning to show success, and the project will continue until September 2026.

This audit evaluated antipsychotic prescribing practices for behavioural management in Child and Adolescent Mental Health Services (CAMHS) against National Institute for Health and Care Excellence (NICE) guidelines and local protocols. We hypothesised that prescribing indications would be guideline-compliant, while adherence to physical health monitoring would be lower in community settings compared to inpatient units. We further anticipated that the use of standardised outcome measures would be suboptimal across both services.

A retrospective clinical audit was conducted on the electronic health records of 26 patients prescribed antipsychotics for behavioural management (13 from the Red Kite View inpatient unit; 13 from Leeds Community Healthcare community CAMHS). Data were collected between February 2023 and February 2025. Practice was measured against standards derived from NICE guidelines (NG11, CG155, CG170), the Maudsley Prescribing Guidelines, and local Trust protocols. Criteria included appropriateness of indication, specialist initiation, baseline and ongoing physical health monitoring, and the use of standardised outcome measures.

Compliance with indication and dosing guidelines was high, with 100% of cases documenting appropriate indications across both services. Specialist initiation was common (100% inpatient; 85% community). Documentation that psychological interventions were attempted prior to medication was lower in community settings (54%) compared with inpatient services (77%).

Significant deficits were identified in monitoring and outcome measurement. Standardised behavioural rating scales were not used in any cases across either setting (0%). Baseline movement disorder assessments were absent in community services (0%) and inconsistent in inpatient care (54%). Marked disparities were observed in baseline safety blood tests (full blood count, urea and electrolytes, liver function tests), completed in 92% of inpatient cases versus 38% in the community. Ongoing community monitoring demonstrated critical gaps, including 0% adherence to recommended weekly weight monitoring during titration and 0% completion of six-month liver function tests.

The findings support the hypothesis: while clinical decision-making around antipsychotic initiation is largely guideline-compliant, substantial systemic gaps exist in physical health monitoring, particularly in community CAMHS. Furthermore, the universal absence of standardised outcome measures limits the objective assessment of benefit. Targeted interventions are required, including strengthened community physical health monitoring pathways, mandatory baseline movement disorder assessments, and the routine use of standardised behavioural outcome tools.

The aim of the project is to explore resident doctors’ experience of workplace-based violence within Central and Northwest London NHS Foundation Trust. These findings will help:

1) To identify barriers to reporting incidents.

2) To improve access to wellbeing support provided to resident doctors.

3) To update serious incident policy for resident doctors.

Both qualitative and quantitative surveys were conducted among all the resident doctors in Central and Northwest London NHS Foundation Trust.

Quantitative Survey: Between January and February 2025, Resident Doctors within Central and Northwest London NHS Trust were invited to complete a 13-item quantitative survey. 34 responses were received.

Qualitative Interviews: Following responses from quantitative surveys, seven resident doctors who reported workplace-based violence through Datix agreed to participate in semi-structured qualitative interviews, consisting of 13 questions. All the interviews were conducted through Microsoft teams and transcribed. Interview responses were analysed through thematic analysis to identify common themes and subthemes of individual perception and reflection on their experience of violence.

Quantitative Survey:

34 resident doctors from different grades (foundation year doctors, GP trainees, core trainees, and higher trainees) across five different boroughs responded to quantitative surveys. Of these, five core trainees, three higher trainees, two foundation year trainees and two GP trainees reported the violence.

These resident doctors who experience violence are 40% from inpatient units and 60% from community clinics. Physical and non-physical violence are most common types of violence that resident doctors experienced. Only 7 out of 20 resident doctors who experienced workplace violence reported the incident through the incident reporting system called Datix.

Qualitative Survey:

Seven resident doctors participated in interviews exploring their experience of workplace-based violence. Participants include one higher trainee, one GP trainee and five core trainees. Participants highlighted there were significant impacts of violence or aggression on emotional wellbeing as well as professionally on career commitment. A common theme emerging from the semi-structured interviews was that resident doctors who experienced physical violence were preceded by non-physical or verbal violence.

Resident doctors experiencing workplace violence and aggression in the NHS is common across different specialities, among which unfortunately psychiatry resident doctors experience the most.

In addition, resident doctors in training do not have always access to the help and support that they need following these incidents. Quantitative survey and Qualitative thematic analysis of this project call for Improved access to various wellbeing resources and Individual support for all resident doctors who experience workplace-based violence.

The aim of this initiative was to provide a structured, high-quality psychiatry teaching programme to support our Trust’s nurses’ Continuous Professional Development (CPD) and revalidation. This programme sought to further improve nurses’ clinical knowledge, prescribing skills and legal understanding.

Since February 2025, monthly afternoon educational sessions were delivered face to face at Harplands Hospital, by experienced doctors, and open to all nursing staff, especially those pursuing higher education. Each session covers two clinically relevant topics, including psychosis, bipolar affective disorder, psychopharmacology, eating disorders, ADHD and medication monitoring. Attendees were encouraged to participate and to promote engagement and consolidate newly acquired knowledge, a Kahoot quiz was used each session.

Feedback was collected from attendees following each session. This questionnaire asked whether participants found the teaching helpful, whether the content was pitched at an appropriate level, asking for topic suggestions to cover in future CPD sessions, and what did they enjoy most about that day’s teaching. Open-text qualitative feedback is regularly analysed to determine quality of teaching and shape future topics.

Feedback has been consistently positive. The vast majority of nurses reported the sessions to be helpful and pitched at an appropriate level for their job role. Teaching was described as engaging, relevant, interactive, and supportive of their CPD and revalidation needs. Use of Kahoot and the enthusiasm of the teachers were frequently noted as being valued.

Analysis of feedback showed a recurrent theme among request including ADHD, ECG and blood test interpretation, clozapine monitoring, refeeding syndrome, mood disorders, and commoncomorbid physical health conditions. This feedback shaped subsequent teaching sessions, ensuring the programme continued to be response and learner-centred.

The feedback from this monthly psychiatry teaching programme has successfully provided medical education to support with nursing CPD and revalidation requirements. Engagement has always been high and consistently positive feedback demonstrated the value of the programme in enhancing nurses’ knowledge, confidence, and clinical practice. Subsequently, our Trust is exploring protected teaching time for our nursing colleagues further reflecting the Trust’s commitment to continued professional development and patient care. Future plans including expanding bespoke sessions tailored to service needs and inviting novel speakers with specialist knowledge.

To map emerging evidence on how endogenous female sex hormones influence ADHD symptom trajectories and treatment response, and to prioritise a concise, pragmatic research agenda that can be taken forward by clinicians and researchers.

We carried out a targeted narrative review of recent reviews, cohort studies, mechanistic reports and pragmatic clinical series published in the last decade. Selection emphasised studies that reported cycle-linked symptom data, used within-subject comparisons, incorporated endocrine assays, or described medication-adjustment strategies. The goal was to identify consistent clinical signals, methodological weaknesses, and high-yield research priorities rather than to perform an exhaustive systematic search.

Across menstrual, peripartum and perimenopausal windows a consistent clinical signal emerges: many women with ADHD report predictable worsening of attention, executive function and affective regulation during low-oestradiol states (late luteal/menstrual phase, early postpartum, and perimenopause). Mechanistic work indicates that oestrogen modulates dopaminergic and noradrenergic circuits implicated in attention and cognitive control, providing biological plausibility for these observations. Small within-subject and pragmatic reports suggest stimulant efficacy and tolerability may vary by cycle phase and that some clinicians achieve symptomatic benefit with cycle-timed dose adjustments; however, these data are preliminary. The literature is dominated by observational designs, retrospective self-report, small samples, inconsistent outcome measures and sparse serial hormone sampling. These limitations constrain causal inference and generalisability. Perinatal evidence highlights postpartum vulnerability but lacks robust registries linking medication decisions to maternal and infant outcomes. Perimenopausal findings are emerging but heterogeneous.

There is sufficient signal to warrant routine clinical enquiry about symptom cyclicity and to adopt a cycle-aware, flexible management approach in practice. To move from signal to guidance we recommend three priority studies: (1) short prospective menstrual-cycle cohorts with daily symptom tracking and serial oestradiol/progesterone assays; (2) within-subject medication response trials comparing follicular and luteal phases with pharmacokinetic sampling; and (3) perinatal registries documenting medication choices and maternal-infant outcomes. Implementing this focused agenda will accelerate translation of hormonal mechanisms into practical, gender-sensitive ADHD care.

Behavioural variant frontotemporal dementia (bvFTD) is characterised by early and progressive changes in behaviour, personality and executive functioning. Neuroimaging and biomarkers can support diagnosis, these investigations may be normal in the early stages, increasing diagnostic uncertainty and potential misattribution to primary psychiatric illness. In such cases, a comprehensive neuropsychiatric assessment and collateral history remains key to diagnosis.

A woman in her 50s was referred to neuropsychiatry with a 3-year history of disinhibition, emotional blunting, aggression, repetitive behaviours, and decline in social functioning. Assessment included neuropsychological testing (ACE-III and RBANS Update), brain MRI, FDG-PET, DAT scan, EEG, and CSF analysis (including autoimmune and infectious panels). Genetic testing was also undertaken. The case was reviewed by a dementia Neuroradiology multidisciplinary team and nuclear medicine consultant.

Despite clear and progressive behavioural and functional deterioration, structural and functional neuroimaging, EEG, and CSF investigations were initially unremarkable. Neuropsychological testing demonstrated multi-domain cognitive impairment, with particularly marked deficits in visuospatial ability and memory (≤1st percentile on RBANS). Behavioural features included public disinhibition, rigidity, aggression, loss of empathy, and impaired insight. No primary psychiatric disorder, delirium, or alternative neurological diagnosis was identified. A clinical diagnosis of probable bvFTD was reached based on the behavioural profile, collateral history, and progression. Minimal symptomatic improvement was observed with the prescription of Quetiapine and Carbamazepine. Subsequent genetic testing identified a pathogenic C9orf72 hexanucleotide repeat expansion, confirming the diagnosis.

This case highlights how behavioural variant frontotemporal dementia may be diagnosed clinically despite normal imaging and biomarker studies, with genetic testing serving as confirmatory tool. Careful behavioural evaluation, collateral history, and longitudinal follow-up remain essential in complex neuropsychiatric presentations. This case supports early consideration of genetic testing in diagnostically challenging cases of suspected bvFTD.

BACKGROUND

Neurological deterioration during alcohol detoxification is commonly attributed to alcohol-related complications, particularly Wernicke’s encephalopathy, withdrawal syndromes or side effect of detox treatment.While such diagnostic pathways are clinically appropriate, they may predispose to premature diagnostic closure. This case highlights the risk of diagnostic overshadowing when alternative neurovascular pathology presents with overlapping features.

AIMS

1. To examine diagnostic challenges associated with recurrent falls and neurological symptoms during inpatient alcohol detoxification

2. Highlight the clinical overlap between Wernicke’s encephalopathy and thalamic stroke, necessitating early neuroimaging

3. Emphasise the importance of structured reassessment and vigilance during week-two detox complications.

A retrospective single-case clinical analysis was undertaken within an inpatient addiction detoxification unit. Clinical records, nursing observations, withdrawal monitoring tools, medical reviews, and neuroimaging reports were examined to reconstruct the diagnostic trajectory, differential formulation, and escalation decisions.

Case Presentation:

A 60-year-old man was admitted for planned alcohol detoxification, reporting daily consumption of approximately 14 units of lager with a Severity of Alcohol Dependence Questionnaire (SADQ) score of 28. He had no prior detoxifications, no history of delirium tremens, and no active psychiatric comorbidity. Past medical history included thrombocytopenia and abnormal liver function tests attributed to non-alcoholic fatty liver disease. Baseline physical examination was unremarkable.

During week two of detoxification, he developed recurrent falls preceded by dizziness and a “funny head” sensation. One episode occurred after rising from bed; another followed standing from the toilet. There was no loss of consciousness, seizure activity, or incontinence. Subsequent review identified a new broad-based gait,nystagmus, left upper limb hypertonia, and subtle postural weakness, although other cranial nerve examination and speech remained intact. Cognitive biases (anchoring to withdrawal, premature closure, and diagnostic overshadowing) were identified as potential contributors to delayed escalation. Initial differentials included Wernicke’s encephalopathy, hypotensive episodes related to antihypertensive use, high dose in detox reducing regime and transient ischaemic attack. The patient initially declined emergency transfer due to lack of confidence in emergency department waiting times, but was urgently escalated for acute hospital assessment and a brain scan following clinical concern.

Emergency department evaluation noted nystagmus, gait ataxia, and memory impairment. MRI revealed anacute right thalamic infarct, with additional cerebellar microhaemorrhages and chronic small-vessel disease. The thalamic lesion explained the patient’s gait disturbance, postural instability, and subtle motor changes, which had initially mimicked Wernicke’s encephalopathy.

Outcome:

The patient was transferred to neurology, commenced on stroke-appropriate management, and referred for physiotherapy. He continued relapse-prevention work with our community alcohol services and was started on acamprosate. This case demonstrates how acute stroke can present with symptoms easily misattributed to alcohol withdrawal syndromes, underscoring the need for repeated assessment and a low threshold for neuroimaging when the clinical picture evolves.

This case underscores the potential for neurovascular events to mimic alcohol-related neurological syndromes during detoxification. Thalamic infarcts may present with gait disturbance, cognitive change, and ocular signs that overlap with Wernicke’s encephalopathy. Clinicians should maintain a broad differential when new focal signs, persistent/new ataxia, or incomplete response to thiamine therapy emerge. Early neuroimaging is essential to avoid diagnostic delay and optimise neurological outcomes.

The objective of this audit is to establish the baseline of how much physical health monitoring is being completed in a general adult outpatient mental health team for patients with severe mental health illnesses (SMI) in accordance with NICE Guidelines.

Data were collected from CMHT records and the Welsh Clinical Portal for patients who attended outpatient appointments in a CMHT in North Wales over a two-week period in September 2025.

Inclusion criteria:

Patients with a diagnosis that falls under SMI.

Patients prescribed antipsychotics or Lithium.

The Welsh Clinical Portal will be accessed to identify patients who have received a full or partial physical health check from primary care

Out of the 29 patients studied, the following parameters were monitored:

Pulse in 30.4%, Blood Pressure in 56.5%, Weight in 20.7%, Hbs-653C/Glucose in 41.4%, Liver Function in 58.6%, Renal Function in 65.5% and Lipids in 58.6%.

Of the 4 patients who required prolactin testing, 75% had their prolactin monitored.

Comparing patients on Lithium or Clozapine (11 patients) (as they were monitored in dedicated clinics) vs those on other antipsychotics (18 patients), weight was monitored in 45.5% vs 5.6%, Renal Function in 45.5% vs 77.8%, Liver Functions in 36.4% vs 72.2% HbA1c/Glucose in 27.3% vs 50.0% and Lipid Profile 45.5% vs 66.7%.

Comparing High Metabolic Risk Patients (on Olanzapine=5, Quetiapine=7 and Clozapine=3) vs those not on those (14), the monitoring of the parameters was -Weight: 18.8% vs 23.1%, Hbs-653c/Glucose: 50.0% vs 30.8%, Renal function: 75.0% vs 53.8%, Liver Functions: 68.8% vs 46.2% and Lipid Profile: 62.5% vs 53.8%.

Of the patients prescribed Lithium (9/29), Lithium levels were measured ≥4/year in 1/9 (11.1%), Urea and Electrolytes ≥2/year in 6/9 (66.7%), and Thyroid Function ≥2/year in 4/9 (44.4%).

Monitoring of physical health parameters has considerable scope for improvement among patients with SMI in CMHT. Compared with patients prescribed Clozapine or Lithium, those not receiving these medications had their weight monitored more frequently. Interestingly, Renal function, Liver Function, Hbs-653c/Glucose, and Lipids were monitored more closely in the latter group, even though patients receiving lithium and clozapine had dedicated clinics.

The CMHT is planning to allocate a dedicated health worker to monitor all patients with SMI being prescribed antipsychotics. Concordance with the monitoring protocol will be reassessed after this intervention.

The RCPsych Recruitment and Retention Charter identifies good quality inductions and creating a culture of belonging as strategies to improve workforce wellbeing.

The North Central and East London Child and Adolescent Psychiatry Higher Training (NEL CAP HT) scheme incorporates 19 placements across four different trusts. After thepandemic, inconsistent one-hour online inductions were provided by current trainees for new starters without formal protected time.

To address uncertainty towards placements, anxieties when starting on-call work and to prevent risk to patient safety, a quality improvement project was undertaken:

• • To improve NEL CAP trainee onboarding experienceby developing a standardised, mandatory, in-person induction.

• • To improve morale, build trustand cohesiveness amongst trainees and trainers.

Cycle 1 (August 2025) evaluated transition from fragmented online inductions to a structured half day, in-person session. Surveys measuring trainee confidence in onboarding andon-call experiences were completed by both previous trainees who had experience of online inductions and the new starters (n= 15).

Cycle 2 (January 2025) incorporated feedback from Cycle 1 to plan a full day in-person induction involving senior trainees and trainers, enriched with simulation case scenarios and a Microsoft Teams repository of relevant policies and protocols.

Quantitative data:

• • Confidence in managing out of hours on-calls increased by 16%.

• • Confidence in understanding the scheme structure and individual placements increased by 15%.

Qualitative themes:

Moving from an online to in-person induction led to a shift from trainees feeling isolated and anxious at the start of joining the scheme, to a sense of connectedness and reduced on-call anxieties.

Trainees frequently cited peer interaction and presence of trainers in the in-person induction as the most helpful part of their onboarding experience.

In-person induction improves the scheme onboarding experience for trainees by reducing their anxieties and ensures patient safety. Trainer presence in higher trainee induction boosts morale and improves psychological safety for new starters. A formal full day induction incorporating timely changes to the scheme and on-call workflows using simulation-based learning, is expected to further enrich content delivery.

The Bradford District Care NHS Foundation Trust IMG Network delivered a face-to-face workshop for International Medical Graduates (IMGs) on 29 September 2024, followed by a virtual workshop via MS Teams on 12 September 2025.

Both sessions focused on supporting IMGs in understanding career progression, one of the eight key pillars of IMG support. The workshop content was informed by the framework outlined in the School of Psychiatry Yorkshire and Humber Deanery’s Life in the UK as an IMG–A Psychiatrist’s Journey, ensuring alignment with regional expectations.

This Quality Improvement project built upon the 2024 in-person workshop to expand its impact. The primary aim was to determine whether a virtual format could improveattendance, offer greater accessibility, reduce costs, and compare favourably with in-person approach. By evaluating engagement and perceived value across both formats, the project explored whether virtual delivery could serve as a sustainable model for ongoing IMG support.

Focused areas of the workshop remained the same namely leadership, portfolio management, reflective practice, coaching and preparing for ARCP.

Workshop delivery transitioned from in-person to virtual (via Microsoft Teams).

Pre-and post-workshop surveys were conducted to quantify attendee experience and evaluate learning outcomes.

Cost to the trust was compared from 2024 in-person workshop with 2025 online workshop.

Direct costs for the 2025 virtual workshop were minimal and difficult to quantify. However, virtual delivery eliminated venue booking costs, avoided travel and mileage claims and reduced carbon footprint. For comparison, the 2024 in-person workshop cost was £1750 (venue and related expenses).

There was an increased average attendance from 10 (2024) to 26 (2025).

Virtual model of delivering workshop via MS Teams was more cost-effective, environmentally sustainable, and generated better attendance with wider regional participation without compromising on the educational quality of the workshop as demonstrated by post-workshop survey feedback.

Positive post-workshop feedback also supported and favoured continued provision of virtual IMG development workshops in comparison with in-person workshop.