• • To characterise patterns of problematic online gaming in autistic adults with mild ID within a locked rehabilitation ward.

• • To identify behavioural escalation triggers and staff interaction factors associated with gaming-related incidents.

• • To evaluate the impact of a structured, formulation-driven “gaming access plan” on incidents and engagement outcomes.

A prospective service evaluation was conducted in a locked rehabilitation inpatient service for adults with autism and mild ID. A structured pro-forma was implemented over a 12-week period to capture: (i) gaming access patterns (device type, duration, online vs offline), (ii) antecedents and triggers (including demand type and staff response style), and (iii) outcome measures (incidents, PRN administration, sleep disruption, and engagement in OT/rehabilitation activities).

Following baseline data collection, a standardised intervention was introduced comprising a personalised gaming plan (agreed daily access windows, visual time-limits, low-arousal staff scripts, and a supported transition routine), paired with consistent MDT implementation and alternative regulation activities. Descriptive statistics and pre/post comparisons were used.

Twelve Male patients were included (mean age 26 years). Online competitive multiplayer games were the most common activity (75%), and 67% of patients demonstrated daily gaming exceeding 4 hours. Gaming was predominantly used as an emotional regulation strategy and as an escape from demands.

Across baseline weeks, 61% of recorded incidents were temporally linked to gaming access or restriction. The most frequent escalation triggers were: (1) being asked to stop gaming mid-session (42%), (2) demand introduction during gaming (medication, hygiene, meetings) (28%), and (3) connectivity/game performance issues (e.g., lag, ranked loss) (18%). Escalation was more likely when limit-setting was delivered using direct instruction without warning compared with collaborative low-arousal approaches.

Following implementation of the structured gaming plan, total incidents reduced from 78 to 48 over comparable time periods (38% reduction). PRN use reduced by 29%, and OT engagement improved from 54% to 71% of planned sessions attended. Sleep disruption linked to late-night gaming reduced, with fewer recorded episodes of nocturnal dysregulation.

Problematic online gaming is a clinically significant driver of distress and behavioural escalation within autistic adults with mild ID in locked rehabilitation. Incidents were most consistently associated with transitions, demand introduction, and loss of gaming-related control. A structured, autism-informed gaming plan with consistent low-arousal staff implementation was associated with meaningful reductions in incidents and PRN use, alongside improved rehabilitation engagement. This work supports the integration of gaming formulations into Positive Behaviour Support planning and highlights the need for further research into gaming disorder phenotypes in inpatient autism/ID services.

This project aims to improve primary care clinicians’ understanding of modifiable dementia risk factors and increase the frequency of dementia prevention discussions within routine consultations. The hypothesis was that a concise, fact-based educational intervention would improve clinicians’ knowledge, confidence, and willingness to provide dementia risk reduction advice. An initial pilot phase has been completed, and based on this scoping work, we aim to expand the project especially across our immediate region with a target of 150 respondents.

The pilot phase originally included an online questionnaire anonymously completed by 50 primary care clinicians (GP trainees and registered GPs). It assessed clinicians’ current use of prevention advice, knowledge of dementia-specific modifiable risk factors, and perceptions of dementia preventability. Respondents then received a targeted educational package (post-survey submission) summarising up to date dementia risk evidence, including findings from the 2024 Lancet Commission, key modifiable risk factors, and practical clinical resources.

While the initial pilot was completed in November 2025, survey expansion to roughly 150 clinicians will take place between January and May 2026, with full results intended for dissemination by the end of May ahead of conference.

Pilot findings showed that while 74% of clinicians believed dementia is preventable, only about 42% routinely discussed prevention in consultations. Clinicians widely addressed cardiovascular risks with 96% compliance while risks specific to dementia were less frequently recognised. Significant knowledge gaps evident include: 66% were unsure aboutthe importance of hearing and vision loss; 50% were uncertain about the role of high HDL cholesterol; 54% did not know whether treating hearing loss reduces dementia risk; 80% were unaware of the increased risk among minoritized or low socioeconomic groups; and 86% were unsure whether risk reduction remains achievable in the presence of genetic predisposition. These results will be further evaluated and validated during the expanded phase, with the full dataset submitted at the time of final presentation.

The pilot phase of this survey reveals significant gaps in clinicians’ understanding of modifiable dementia risk factors. Expanding the project to a larger cohort will strengthen the validity of this pilot assessment findings. Small-scale educational interventions can positively influence clinical practice with a potential to support improvement of long-term cognitive health outcomes while integration of dementia prevention discussions particularly relating to hearing loss, cardiovascular health, lifestyle behaviours, and environmental risks may substantially enhance population level cognitive health. Ongoing evaluation and the broader adoption of prevention prompts within clinical templates are planned to ensure sustained and scalable improvements.

Aims (Background)

Clozapine is associated with severe gastrointestinal hypomotility, constipation, ileus, and bowel obstruction through anticholinergic and antiserotonergic mechanisms. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, delays gastric emptying and intestinal transit as part of its pharmacodynamic effect. Both agents independently impair gastrointestinal motility, yet their combined use is increasing as tirzepatide is prescribed to manage clozapine-associated metabolic dysfunction.

We hypothesised that the pharmacological combination of clozapine and tirzepatide may produce additive gastrointestinal hypomotility, increasing the risk of small bowel obstruction (SBO) in vulnerable patients.

Methods (Case Report)

We describe a single case (n=1) of a 54-year-old Black British woman with paranoid schizophrenia treated with clozapine since 2016, type 2 diabetes mellitus, and chronic constipation despite regular laxative therapy. Her medical history included extensive abdominal surgery for sigmoid volvulus with subtotal colectomy and ileostomy in 2012, followed by reversal in 2013.

Tirzepatide was initiated in March 2025 by the diabetes team for poor glycaemic control. Weight, glycaemic indices, clinical presentation, and radiological findings were reviewed using electronic health records.

Results (Discussion)

Following initiation of tirzepatide, significant metabolic improvement occurred, with weight reduction from 71.5 kg to 64 kg and Hbs-782c improvement from 86 mmol/mol to 43 mmol/mol within four months.

In May 2025, approximately two months after starting tirzepatide, the patient was admitted with acute abdominal pain and vomiting. Computed tomography (CT) imaging demonstrated markedly dilated small bowel loops (up to 63 mm) with an abrupt transition point, consistent with SBO. A second SBO occurred in October 2025, again confirmed radiologically with dilated loops and a transition point, without evidence of malignancy, perforation, or ischaemia.

There was no documented history of SBO in the years preceding tirzepatide initiation. Both episodes were managed conservatively. Tirzepatide was discontinued following the second obstruction.

Conclusion

This case highlights a potential pharmacodynamic interaction between clozapine and tirzepatide, resulting in additive gastrointestinal hypomotility and recurrent SBO in a high-risk patient. While tirzepatide provided substantial metabolic benefit, its use alongside clozapine may pose significant gastrointestinal risk. Careful patient selection, baseline bowel assessment, and close monitoring are essential when prescribing GLP-1/GIP agonists to individuals receiving clozapine.

The global burden of dementia is escalating rapidly, with prevalence estimates rising from 57.4 million in 2019 to a projected 152.8 million by 2050. This increase carries profound economic implications; direct and indirect costs are forecasted to consume approximately 0.5% of global GDP by 2050. Health economic evaluation can support efficient allocation of resources but key challenges remain in determining what outcomes are valued and how. We discuss critically the role of the life course approach in informing health economic evaluations.

Various methods exist for determining the relative costs and benefits of different treatment approaches. Relatively simple methods use pre-determined quality of life values for different stages of dementia to model the ‘utilities’ generated by treatment. The more recent ICECAP approach includes a broader range of outcomes than just health states by considering aspects of capability.

Despite these innovations in determining health outcome measures challenges remain. Models must account for complex interactions between symptoms, disease progression and quality of life. Another challenge is accounting for the “Proxy-Patient” gap, where caregiver reports often diverge from patient experiences. Furthermore,economic models can struggle with the valuation of “process utility” and the difficulties of extrapolating data from brief clinical studies into long-term disease models spanning many years.

The Life Course Approach:Our work proposes integrating a ‘life course’ perspective into health economic approaches to better understand dementia within the context of a patient’s entire life. By utilizing the concepts of “Trajectories and Transitions”,economists can evaluate how dementia disrupts expected life paths–such as the loss of a planned retirement or the inability to fulfil the role of a grandparent. Additionally, the concept of “Linked Lives” offers insight into the social interdependencies that shape the “Proxy-Patient” gap. Qualitive methods offer an important lens to investigate these problems.

Incorporating life course and qualitative approaches could provide a more robust framework for valuing preferences in dementia. By capturing the impact of disrupted life expectations and social interconnectedness, economic analyses can more accurately reflect the true impact of the disease, leading to more equitable and efficient resource distribution.

Hyponatremia is a well-recognised adverse effect associated with several classes of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–noradrenaline reuptake inhibitors (SNRIs). Older adults are at increased risk due to age-related physiological changes in renal function, reduced homeostatic reserve, polypharmacy, and the presence of multiple comorbid medical conditions. In the Psychiatry of Old Age inpatient setting, undetected hyponatremia can result in significant clinical consequences, including acute confusion, increased risk of falls, seizures, and overall increased morbidity and length of hospital stay. National and international prescribing guidance, including the NICE guidelines and the Maudsley Prescribing Guidelines, therefore recommend regular serum sodium monitoring in high-risk populations, particularly following the initiation or dose adjustment of antidepressant medication. The aim of this audit was to evaluate compliance with recommended sodium monitoring standards within the Psychiatry of Old Age inpatient unit.

A retrospective clinical audit was conducted involving all currently admitted inpatients aged 65 years and older on the Psychiatry of Old Age unit who were initiated on antidepressants or experienced antidepressant dose changes during their admission. Data were collected using a standardized audit tool through review of electronic health records, prescription charts, and the laboratory information system. Variables recorded included patient demographics, antidepressant type and dosage, dates of antidepressant initiation or dose escalation, dates of serum sodium measurements, and documentation of abnormal sodium results with associated clinical management.

All patients included in the audit were prescribed antidepressant medication, most commonly mirtazapine and venlafaxine. Baseline urea and electrolyte (U&E) testing was completed for all patients at the time of admission, demonstrating good compliance with admission assessment standards. However, follow-up monitoring within the recommended two to four weeks following antidepressant initiation was documented in only 50% of patients. Antidepressant doses were increased during admission in 50% of patients, yet follow-up U&E monitoring within four weeks of dose escalation was performed in only 16% of cases, indicating a significant gap in adherence to guideline recommendations.

Following presentation of the audit findings to the multidisciplinary team, a quality improvement intervention was implemented. Reminder stickers were introduced into each patient’s file to prompt clinicians to arrange timely sodium monitoring following antidepressant initiation or dose changes. Educational discussion also took place to reinforce guideline awareness and highlight the clinical risks associated with hyponatremia in this population. A second cycle of the audit is currently underway to assess the effectiveness of these interventions and determine whether compliance with sodium monitoring standards has improved.

The NEWS2 tool is integral to post-admission physical health monitoring, guiding baseline assessment and early detection of deterioration. It standardises observation recording and escalation. Trust Standard Operating Procedure and the Physical Health Policy provide detailed guidance for assessment, recording, and escalation, in alignment with NICE standards. Following an initial audit identifying documentation and escalation gaps, recommendations were implemented, including standardisation and increased electronic recording. This re-audit assesses the impact of these interventions.

Aim and Objectives

• • To compare re-audit results with the previous audit to assess progress against Trust standards.

• • To evaluate the impact of initial audit recommendations on correct NEWS2 utilisation.

• • To identify persistent issues in NEWS2 monitoring or recording and inform further action.

• • To enhance patient care and safety.

We conducted a comprehensive review of each section of NEWS2 charts using the same proforma as the initial audit for 35 patients admitted to wards 6 and 7 at Harplands Hospital over three weeks. Patients were aged 68–91 years with near-equal gender distribution, no pregnancies. Findings were analysed using SPSS and compared to both Trust standards and previous audit results to assess improvements in NEWS2 monitoring and recording.

In the re-audit, NEWS2 charts were completed on admission for 33/35 patients, compared with 37/39 previously. Electronic recording predominated, with all 35 patients having electronic charts, 12 of whom also had paper charts; previously, electronic charts were often left unfilled.

Documentation quality improved markedly: patient demographics, date, time, and assessor name were completed in 100% of charts. Previously, 12 charts were incomplete, 9 had illegible entries, 6 missing signatures,12 incomplete sections, 9 lacked demographics, 13 had date/time missing. All physiological observations, including blood glucose, were accurately recorded, paper chart dots joined, and NEWS scores correctly calculated for all patients. Two patients scored ≥3 on ACVPU, with appropriate Glasgow Coma Scale documentation, compared to incomplete GCS recordings in two charts previously.

Weekly NEWS monitoring occurred in 31/35 patients; the remainder had documented clinical justification. Escalation improved: NEWS scores 1–4 were reviewed by nursing staff in 20/21 escalated cases (previously inconsistently reviewed), and all scores >4 were escalated to medical staff, with emergency services contacted if medics were unavailable.

Implementation of previous recommendations improved consistent and correct NEWS2 use, supported by electronic documentation. Appropriate escalation of clinically significant scores strengthened patient safety. Performance improved across all domains, meeting Trust and national standards. Findings have been disseminated, with ongoing efforts to sustain performance.

This systematic review aims to synthesize the current literature on Artificial Intelligence (AI)-based interventions for improving sleep outcomes in individuals with neuropsychiatric conditions, excluding those with a primary diagnosis of insomnia.

This paper is a systematic review conducted in accordance with the PRISMA 2020 guidelines, with two independent reviewers conducting all stages using a double-blind method and conflicts being resolved after each section. A comprehensive electronic search was performed across EMBASE, Medline and PubMed using MeSH terms for Artificial Intelligence, Sleep and Neurological/Neuropsychiatric Conditions. Studies included were English-language, peer-reviewed primary research published between 2022 and November 2025, focusing on AI-based interventions for sleep outcomes in individuals with neuropsychiatric conditions (excluding primary insomnia). Data extraction used the Joanna Briggs Institute (JBI) systematic review framework.

Five studies met the inclusion criteria with wide variations in study type. Sample sizes ranged from 65 to 540 across studies conducted in the UK, USA and Australia. The interventions ranged from AI-based chatbots, mobile apps, wearable devices and sociallyassistive robots. Positive and statistically significant increases in participant engagement were observed, with two papers reporting interactive AI groups attending up to two additional sessions on average (b=1.65, p<0.001) and using the intervention up to 3.8 times longer (p<0.01) compared to the control group. However, overall sleep-related outcomes were mixed; the intention-to-treat analysis in the US randomised control trial (Paper 4) found no statistically significant difference, but post hoc analysis showed significant improvements in sleep quality in the high-device adherence subgroup. Conversely, a cluster randomised control trial (Paper 5) showed no evidence of improved sleep patterns but did note a significant reduction in daytime and night-time motor activity.

Positive and statistically significant increases in participant engagement were observed with the use of artificial intelligence interventions. However, the increased engagement did not result in statistically significant improvements in overall sleep outcomes. The effectiveness of AI interventions is limited by the lack of robust research and universally low sample sizes. Whilst AI interventions have shown to improve engagement, there is currently insufficient evidence to suggest AI interventions improve sleep outcomes in the population group studied.

Drug resistant first episode psychosis in a 17-year-old adolescent male with autism spectrum disorder presents with a significant diagnostic and therapeutic challenge especially with associated physical comorbidities. Medication intolerance, persistently low white cell count, partial response and early relapse after discharge remain the prominent risks. This case highlights the complex nature of therapeutic decision making and discharge planning in a high-risk young person.

A 17-year-old adolescent male who was admitted to the in-patient CAMHS unit with a 14-month history of progressive psychotic symptoms characterised by chronic auditory and visual hallucinations, paranoid delusions; alleging his parents to be impostors; depressed mood, anhedonia, and social withdrawal. With a diagnosis of autism spectrum disorder, history of significant trauma, years of school bullying and street robbery. He has a past medical history of cardiac arrest with unknown aetiology and on treatment with implantable cardioverter defibrillator.

During initial admission, he was polite, compliant with treatment although with partial insight. Family support was robust, and leave was utilized with no significant adverse incidents. Despite participation in ward activities his affect remained predominantly flat with persisting psychotic symptoms albeit with less intensity. Pharmacological management remained challenging, initially commenced on aripiprazole, titrated to 15mg which was discontinued due to significant restless legs symptoms requiring procyclidine. Olanzapine was initiated and gradually increased to a maximum of 12.5 mg with partial stabilization necessitating discharge to the community.

Weeks following discharge, worsening complex delusions and commanding hallucinations and high-risk behaviours in the community was noted. These include fire-setting and possession of weapons.

This led to re-admission and risperidone was trialled and gradually titrated to 5 mg with marked elevation of prolactin with minimal improvement.

Giving treatment resistance, clozapine was considered and is being approached cautiously due to his history of cardiac arrest, persistently low white cell counts and hyperprolactinemia with close psychiatric and cardiology consultation followed with gradual risperidone taper.

This case illustrates the complexity in managing treatment resistant first-episode psychosis in autistic adolescent with significant physical comorbidities.

Careful antipsychotic selection, robust discharge planning, and intensive multidisciplinary follow-up are essential to reduce relapse and serious harm.

Suicidal and homicidal behaviors are typically assessed as distinct risk domains, despite overlapping psychopathology in psychosis and severe mood disorder. We introduce the new concept Suicide by Proxy as a psychodynamic formulation in which homicide (or attempted homicide) represents a displaced enactment of suicidal intent when direct self-destruction is inhibited. Drawing on Freudian models of internalized aggression, persecutory superego dynamics, and object-related conflict (Oedipal/Electra configurations), we aim to illustrate how self-directed destructive drive may be externalized toward a symbolic other.

Three retrospective forensic psychiatric case reports were analyzed using a psychodynamic framework. All cases involved severe mental disorder (schizophrenia-spectrum or major depressive episode with psychotic features), documented suicidal ideation and/or attempts, and a homicide or attempted homicide. Data sources included clinical interviews, collateral histories, medical/legal records, and psychological testing (including MMPI and SIMS). Identifying details were removed or altered to preserve confidentiality without changing clinical meaning.

Case 1:A 26-year-old man with paranoid schizophrenia and persecutory delusions purchased a firearm intending suicide but reported inability to act. He subsequently killed an unknown man in a mosque, then left the weapon beside the body. The act is conceptualized as displacement of self-destruction onto an authority-linked symbolic target, enabling rebellion against a persecutory superego without direct suicide or parricide.

Case 2:A 39-year-old woman with psychotic depression and intense suicidal communications stabbed her sleeping father after planning to kill herself in his presence, then attempted self-stabbing. This is formulated as a negative Electra configuration: ambivalent attachment and rage toward a passive betrayer father, with psychosis collapsing boundaries between self-attack and object-attack.

Case 3:A 36-year-old woman with schizophrenia, shaming maternal criticism, and relapsed hallucinations broke a mirror and attempted to attack her mother with glass while concealing suicidal intent. The mother is conceptualized as a proxy self-representing the rejected, humiliated part of the patient targeted for annihilation.

Across cases, homicidal acts functioned as symbolic self-attacks emerging from internalized aggression, persecutory superego pressures, and unresolved parental-object conflict. Suicide by Proxy may help forensic clinicians integrate suicidality into violence formulations, prompting dual-screening for suicidal and displaced homicidal risk in severe mental disorder. Further empirical work is needed to test the model beyond case-series evidence.

To evaluate the effectiveness of case management for children and young people (CYP) with mental disorders, substance use, or neurodevelopmental conditions, and to identify components and contextual factors associated with improved outcomes.

This was a systematic review and multi-level meta-analysis of randomised controlled trials (RCTs). Databases were searched from inception to June 2025. Reference lists and prior reviews were hand-searched for additional studies. Eligibility criteria: RCTs involving participants aged 5–18 years with mental health, substance use, or neurodevelopmental conditions, comparing case management (or equivalent) to treatment as usual, waiting list, or a less intensive model in community/outpatient settings. Outcomes extracted were clinical and social outcomes (which included any outcomes related to symptoms and functioning), service use (which included any outcomes related to the numberof service contacts or treatments given, excluding differences in treatments offered due to the experimental conditions), satisfaction, and cost-effectiveness. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. Effect sizes (Hedges’ g) were pooled and meta-analyses were conducted for clinical and social outcomes and service use, applying a multilevel model to account for effect-size clustering within and between studies. Narrative review was conducted for satisfaction and cost-effectiveness. The certainty of evidence was rated using GRADE.

Fourteen studies were included, comprising 16 comparisons, most of which were conducted in the United States. Case management was associated with a small improvement in clinical and social outcomes (Hedges’ g=0.15; 95% CI 0.02 to 0.28) and a moderate increase in service use (g=0.68; 95% CI 0.20 to 1.17). Heterogeneity was high. Economic analyses suggested potential cost-effectiveness through reduced out-of-home placement and treatment dropout. Evidence for satisfaction was mixed. There were some concerns or high risk of bias in 10 out of 14 studies. The certainty of evidence using GRADE was very low for clinical and social outcomes and low for service use.

The review indicates that case management can improve engagement and service use among CYP with complex mental health needs, though clinical benefits are modest, and evidence quality is limited.

Acute inpatient services are experiencing increasing pressure on bed capacity, alongside a growing need for efficient and sustainable use of resources. As services transition towards the NHS ‘Home First’ approach, there is a need to critically review existing practices to further optimise patient flow and reduce discharge delays.

This service evaluation looked at how three acute general adult psychiatric wards in Sheffield utilised brief daily board meetings referred to as ‘Purposeful Inpatient Admissions’ (PIPA) meetings, and weekly multidisciplinary team (MDT) meetings. Phase 1 of the project aimed to gain an understanding of staff views on the existing daily PIPA/weekly MDT model. These findings will inform the development of the new ‘Daily Planning Meeting’ model and provide a meaningful comparator for phase 2 of the service evaluation following implementation.

An anonymised baseline survey was distributed via Microsoft Forms to staff across the three wards to capture multidisciplinary perspectives. The 21-question survey included Likert-scale and free-text items exploring views on the current model, including workload, communication, service user experience and suggestions for improvement. It remained open for three weeks between November and December 2025. Data were exported to Excel for quantitative and qualitative analysis.

Forty-six staff members responded, with nurses and medics comprising 63%, reflecting ward workforce composition. 52% of respondents found the current PIPA/MDT model ‘somewhat helpful’. 70% reported that PIPA/MDT ‘sometimes’ identified clear care goals. 57% thought that the current model ‘sometimes’ improved relationships with patients whilst 67% felt that it ‘sometimes’ enabled patient and family involvement. 9% of respondents felt the current model ‘never’ supported enthusiasm or engagement in patient-centred care. Most respondents agreed all professional roles should attend MDTs regularly.

Thematic analysis highlighted perceived benefits of the current model which included structured multidisciplinary collaboration, task prioritisation and shared decision making. However, significant challenges were identified. Both meetings were frequently described as time consuming. Communication gaps within and across teams, limited community team involvement and inconsistent patient and family engagement were recurrent themes. Staff advocated for clearer documentation processes, enhanced patient involvement and streamlined meeting structures as ways to improve the current model.

Phase 1 identified key strengths and limitations of the PIPA/MDT model. Recommendations include defining professional roles and responsibilities, improving task allocation and documentation as well as protecting time for meaningful patient engagement. Early involvement of community teams and encouraging patient and family participation are central to supporting the NHS Home First approach and improving patient flow.

Chronic alcohol dependence increases the risk of alcohol withdrawal syndrome, requiring prompt identification. Despite this, no locally endorsed clinical guidelines currently exist to support clinicians. This audit aims to evaluate the adequacy of alcohol screening and initial clinical assessment at admission to an acute psychiatric inpatient service, focusing on the identification and management of AUD, alcohol dependence, and alcohol withdrawal, and compares current practice with international standards.

A retrospective audit of all acute psychiatric admissions in March 2025 was conducted. Data were extracted in line with the American Society of Addiction Medicine Clinical Practice Guideline for Alcohol Withdrawal Management, including documentation of alcohol use, clinical history, withdrawal features, and relevant investigations. All data were anonymized following ethical approval.

Of the 217 total admissions, 190 patients were included in the final analysis. Among the analyzed cohort, alcohol use was documented in 132 patients (70%), with 36 individuals (27.3%) confirming regular consumption.

Notably, medical and surgical comorbidities were recorded in 100% of cases (n=36), followed by age at 95.6% (n=35), and suicide risk assessments at 91.7% (n=33). Clinicians also frequently screened for other substance use (100%) and history of mental illness (88.9%). Regarding consumption patterns, while the quantity of alcohol was frequently noted (88.9%), details regarding the duration of dependency and the specific time of last consumption were documented in only 8.3% of files.

Despite the use of CIWA-A scoring in 66.7% of regular users, documentation for previous withdrawal delirium, history of withdrawal seizures, and observed autonomic activation during the initial interview all stood at 0%.

Furthermore, urine toxicology was performed for 63.9% of patients. Metabolic and infectious screening was inconsistently and were documented as following; LFTs 52.8% (n=19), Albumen 41.67% (n=15), INR 27.8% (n=10), Ethanol 36.11% (n=13), Pregnancy test 10% (n=1 out of females in the cohort) and HIV and Hepatitis Screen within 5 years 55.56% (n=20).

In this retrospective audit, significant shortcomings were identified. These findings indicate incomplete adherence to internationally recommended assessment standards and may limit the early identification of alcohol withdrawal risk. Implementation of a locally adapted alcohol assessment guideline consistent with international best practice is therefore warranted. Re-audit is recommended to assess changes in clinical practice and to evaluate associations with patient-related outcomes. No financial support was received for this study.

This quality improvement project was aimed at enhancing the clinical discussion and documentation of side effects of psychotropic medications in psychiatry community settings to 100% over a span of 12 months.

This quality improvement project was carried out at the early intervention service Limbrick Centre. Sample included looking at 20 patients' first medical review under the EIS. The selection process was randomly done. Patients with a primary diagnosis of first-episode psychosis were selected using their hospital number. The audit included all patients who were referred to the EIS from 1 July to 31 December 2024. Anonymised patient data were used in line with the quality improvement initiative of this project and therefore informed consent was not applicable. Data was retrospectively obtained from outpatient electronic records over six months on patients who were newly prescribed psychotropic medications. The key standard for the baseline measurement was whether the communication of at least one side effect of a newly prescribed medication was documented by the doctor in the patient's electronic records. If electronic entries stated that side effects were 'discussed', these entries were not considered as objective evidence of discussions. The criterion for appropriate documentation was clear descriptions of specific side effects discussed and the minimum number of side effects that a doctor should discuss was set at one.

A random sampling method for data extraction was used, using the random number function in Microsoft Excel. Psychotropic medications included antidepressants, antipsychotics, benzodiazepines, mood stabilizers and hypnotics. Data was analysed using Microsoft Excel.

Forty percent of service users’ medical reviews had documentation of side effects of psychotropic medications. Sixty percent of service users’ medical reviews did not have documentation of side effects of psychotropic medications. Although out of this 60%, some doctors had written side effects discussed but the actual side effect discussed was not documented which therefore excluded these data.

This project served as a reminder that robust documentation of patient communication is at the very core of good clinical practice. Shared decision making involving patient in treatment decisions and embedding robust documentation into practice, in addition to enhancing care, confers added benefits to both individual healthcare providers and their employers through the potential diminution of medico-legal risks.

Dementia commonly affects older adults, with over 944,000 affected and one in eleven adults aged over 65 in the UK diagnosed. Due to the increasing number of referrals to memory clinics (MC), the recognition and management of reversible causes of cognitive impairment in primary care is essential. During the first cycle, missing information and blood tests were found to delay patient care and reduce efficiency. The National Institute for Health and Care Excellence (NICE) recommends the following: full blood count (FBC), urea and electrolytes (U&Es), liver function tests (LFTs), thyroid function tests (TFTs), glycated haemoglobin (Hbs-352c), serum calcium (Ca), erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and serum vitamin B12 and folate (B12/folate). The second cycle assessed whether a specialised proforma and education leaflets for primary care clinicians increased the availability of blood tests within two months of referral.

Patient information was extracted from referrals received over two twelve-week time periods, one and a half years apart. Cycle one was conducted between 10/10/2023 and 20/11/2023, and cycle two between 07/08/2025 and 28/10/2025. Data on referrals and blood tests, completed within two months of referral, were obtained from RiO and ICE West and analysed in Excel, with data anonymised. Patients with an existing dementia diagnosis or those referred directly by secondary care were excluded. After the first cycle, focus groups were held with the multi-disciplinary MC team, followed by the distribution of an information update letter and updated proforma to all primary care clinicians.

A total of 101 referrals were included. In Cycle one, only 11.9% of patient referrals had all recommended blood tests completed within two months prior to referral. 27.1% hadnone of the recommended tests. In Cycle two, 85.7% of referrals used the distributed proforma. The proportion of patients with all recommended blood tests completed increased to 23.8%. Of the referrals utilising the proforma, 80% included all relevant blood tests two months prior to the referral receival.

Overall, 85.7% of referrals used the MC proforma. Using the proforma improved referral quality by prompting inclusion of relevant information and blood tests, enhancing service efficiency. Notably, around 75% of referrals lacked vital blood tests, affecting the efficiency of MC services. Focus group discussions highlighted that MC staff should now refer referrals lacking up-to-date bloods back to primary care and that wider distribution of the proforma with clear blood test requirements may further increase compliance, suggesting a further audit cycle could be beneficial in future.

Lithium is the gold standard treatment for bipolar disorder, but its mechanism of action is not fully understood. Emerging research suggests structural and functional alterations in the retina of people with bipolar disorder and depression, including a thinner retinal nerve fibre layer and ganglion cell layer. Retinal structure and function can be characterised using several noninvasive imaging techniques, from which numerous quantitative metrics can be derived. We aimed to complete a systematic review of the literature to establish which parameters have been evaluated in relation to lithium use and what insights they provide into its potential retinal effects.

Searches using the terms ‘Lithium’ AND ‘retina’ were carried out to identify peer reviewed studies assessing the impact of lithium on retinal structure or function. These included those with or without a control group comparison, pre- and post-lithium comparisons and observational studies. There were no exclusions based on the quantity or preparation of lithium administered, or the length of administration. Any studies where lithium was administered in combination with another intervention were excluded, unless it was directly compared to the other intervention without lithium. The main outcome of interest was optical coherence tomography (OCT) derived metrics, but any measure of structure or function was included.

Seven studies reporting structural outcomes, and 10 reporting functional outcomes, were identified.Structural outcomes were derived from optical coherence tomography (OCT) imaging studies which had multiple limitations. There was no evidence of statistically significant difference in the retinal nerve fibre layer (RNFL) between people with bipolar disorder taking lithium and healthy controls in two studies with larger numbers, indicating a protective effect on the retina. In four studies looking at differences in people with bipolar taking lithium and those taking valproate, two showed no signs of difference and two evidence of statistically thicker RNFL in the lithium group, also in line with a potential protective effect. For all other OCT derived metrics, the evidence was limited.

Studies reporting functional outcomes were highly heterogeneous with multiple limitations and no clear trends. The majority reported a statistically significant effect of lithium on at least one functional measure, derived from electrooculography, electroretinography, and dark adaptation threshold procedures.

Trends indicate that lithium is likely to have an effect on both the structure and function of the retina, but significant limitations in all included studies mean that better designed and adequately powered prospective studies are required for both structural and functional measures of the retina.

The purpose of this review was to methodically assess data from randomised controlled trials (RCTs) that looked at how orange-spectrum or circadian-relevant light interventions affected sleep, behaviour, and circadian outcomes in patients with dementia. Synthesising important findings and critically evaluating methodological quality using the Cochrane Risk of Bias 2 tool were secondary goals.

A systematic research of PubMed was conducted from database inception to the most recent search date, using Medical Subject Headings and free-text terms related to dementia and light-based interventions. Only human RCTs were included. Outcomes of interest included sleep quality, agitation, circadian rhythm measures, and neuropsychiatric symptoms. Data were extracted into standardised tables, and methodological quality was assessed using the RoB 2 tool.

Five excellent RCTs satisfied the requirements for inclusion. People with moderate to severe dementia in residential care and community settings in the USA,UK and Europe were included in the study populations. Bright or circadian-effective lighting was the main intervention, though some studies also included less exposure to blue light in the evening. Agitation, sleep efficiency and circadian rhythm stability were the main results. The results showed mixed effects on agitation and behavioural symptoms, with only slight improvements in sleep and circadian outcomes. The overall risk of bias was rated as low to moderate, with blinding and selective outcome reporting being common issues.

Circadian-oriented lighting interventions showed potential advantages for sleep and behavioural regulation, even though no trials specifically assessed orange-spectrum light. A promising non-pharmacological strategy for treating sleep and behavioural issues in dementia patients may be circadian-friendly lighting interventions. To improve the body of evidence and guide clinical recommendations, high-quality RCTs that specifically look at orange-spectrum lighting are needed.

Behavioural-variant frontotemporal dementia (bvFTD) is a neurodegenerative condition that typically presents in mid-life with early behavioural and personality change,often in the absence of marked global cognitive impairment. This clinical profile substantially overlaps with primary psychiatric disorders (PPDs), contributing to frequent misdiagnosis and diagnostic delay. Cognitive screening is routinely used in early assessment, yet the choice and interpretation of tools is often clinician-dependent and inconsistently taught. This work aims to explore how limitations in commonly used cognitive screening tools contribute to diagnostic uncertainty between bvFTD and PPDs, and to emphasise the importance of structured education on when and how to escalate assessment to appropriate neuroimaging.

A case-based educational analysis was undertaken using a representative behavioural presentation as a teaching framework. The current literature on cognitive screening tools, including the Mini-Mental State Examination, Addenbrooke’s Cognitive Examination, and Montreal Cognitive Assessment, was reviewed with attention to their sensitivity for detecting executive and social cognitive dysfunction. Evidence relating to neuroimaging modalities used in suspected bvFTD was also examined, including structural MRI, FDG-PET, and amyloid PET, with emphasis on their relative diagnostic roles in resolving behavioural diagnostic ambiguity.

Global cognitive screening tools, which are weighted towards memory and orientation, demon3strate limited sensitivity for early bvFTD, where executive and social cognitive deficits often predominate. This contributes to frequent misclassification as psychiatric illness when screening results are interpreted in isolation. Structural MRI provides supportive but often non-discriminatory findings in early disease, particularly where subcortical involvement may precede overt cortical atrophy. FDG-PET offers greater diagnostic utility by identifying frontal and anterior temporal hypometabolism; however, findings are not entirely specific and require careful clinical correlation due to the incidenceof false positives. Amyloid PET does not directly differentiate bvFTD from PPDs but serves an important exclusionary role by ruling out Alzheimer’s disease in atypical behavioural presentations.

Effective differentiation of bvFTD from primary psychiatric disorders requires more than symptom recognition alone. Improved education in cognitive screening–specifically tool selection, interpretation, and limitations–combined with clearer escalation strategies for neuroimaging, is essential. Future educational and diagnostic approaches may benefit from integrating quantitative imaging techniques with emerging biological markers, including genetic testing in early-onset presentations and fluid biomarkers such as neurofilament light chain. Embedding these principles within medical training supports a multimodal diagnostic framework, with important implications for reducing misdiagnosis and improving patient outcomes.

This quality improvement project aimed to enhance staff morale within the Psychiatry of Intellectual Disability service at Lakeview Hospital, part of the Western Health and Social Care Trust. This was achieved through the development and implementation of a ‘GREATIX’ scheme designed to recognise and celebrate exemplary staff practice between April 2025 and June 2025.

Baseline staff morale was assessed using a Likert-style questionnaire distributed to the multidisciplinary team working within Lakeview Hospital. Following this, a ‘GREATIX’ nomination process was introduced, allowing staff to nominate colleagues for recognition. Fortnightly meetings were held with charge nurses to review nominations and determine successful recipients. Eligibility required nominees to demonstrate behaviours aligned with the Trust’s core values: working together, excellence, openness, honesty, and compassion. Successful nominees were awarded a ‘GREATIX’ certificate and a £5 voucher. In July 2025, following implementation of the intervention, a repeat Likert-style survey was circulated to reassess staff morale.

The baseline survey received 28 responses, while the post-intervention survey received 22 responses. Mean self-reported tiredness following a shift decreased from 3.71 atbaseline to 2.41 post-intervention (Likert scale: 1=not tired, 5=extremely tired). Perceived impact of work showed an improvement, with mean scores increasing from 3.54 at baseline to 3.73 post-intervention (Likert scale: 1=little difference, 5=huge difference). Feelings of collegial support also increased, with mean scores rising from 3.68 to 3.87 (Likert scale: 1=not supported, 5=well supported).

Both surveys included free-text responses regarding ward morale. Baseline responses described morale as “OK”, “pretty good”, and “adequate”. Post-intervention responses suggested a modest improvement, with comments such as “a little better” and one respondent describing the GREATIX scheme as “a lovely addition”.

Implementation of the GREATIX scheme was associated with improvements in staff-reported energy levels after shifts, perceived collegial support, and feelings of having made a positive contribution at work. These findings suggest that structured recognition initiatives may have a positive impact on staff morale. Further PDSA cycles are planned within the Western Health and Social Care Trust to build on these outcomes.

Delirium is frequently misdiagnosed as psychosis in general hospital settings, leading to inappropriate Psychiatry referrals and delays in medical management. This quality improvement initiative aimed to reduce the misdiagnosis of delirium as psychosis by improving early recognition across non-psychiatric departments. Secondary aims were to examine department-wise variation in misdiagnosis, assess uptake of the Confusion Assessment Method for the ICU (CAM-ICU), compare the effectiveness of different CAM-ICU teaching strategies, and evaluate changes in time to delirium management.

This quality improvement project was conducted in a tertiary care teaching hospital over six months and included referrals from Medicine, Surgery, Obstetrics & Gynaecology, Orthopaedics, and ICU. A baseline audit was undertaken over two months, including all inpatient Psychiatry referrals labelled “suspected psychosis” (n=130). Data collected included referring department, final diagnosis (delirium or psychosis), CAM-ICU use prior to referral, and time to initiation of delirium management. Pre-intervention CAM-ICU use was 0% across all departments.

A targeted educational intervention was delivered over four weeks. Departments received CAM-ICU training using different methods: didactic teaching sessions (Medicine, Surgery), bedside demonstrations (ICU, Orthopaedics), and visual quick-reference materials with brief ward-based teaching (Obstetrics & Gynaecology). A post-intervention re-evaluation was conducted over a further two months (n=126) using identical outcome measures. Department-wise changes in misdiagnosis rates, CAM-ICU uptake, and time to delirium management were analysed and compared across teaching modalities.

At baseline, 82 of 130 referrals (63%) for suspected psychosis were diagnosed as delirium. Misdiagnosis rates varied across departments: Medicine 70%, Surgery 68%, Orthopaedics 62%, Obstetrics & Gynaecology 58%, and ICU 45%. Mean time to initiation of delirium management was 22 hours.

Following the intervention, overall misdiagnosis was reduced to 39 of 126 referrals (31%). Department-wise misdiagnosis rates decreased to Medicine 38%, Surgery 42%, Orthopaedics 25%, Obstetrics & Gynaecology 34%, and ICU 18%. Overall CAM-ICU uptake increased to 56%, with highest use in departments receiving bedside-based training (ICU 72%, Orthopaedics 65%). Mean time to delirium management reduced from 22 hours to 11 hours.

This quality improvement initiative demonstrates that a substantial proportion of referrals labelled as psychosis represent delirium, with marked department-wise variation. Structured CAM-ICU training improved screening uptake, reduced misdiagnosis, and shortened delays to treatment. Bedside and interactive teaching methods were associated with greater improvements than didactic approaches alone. Embedding routine delirium screeninginto inpatient referral pathways is a feasible and effective strategy to enhance patient safety and consultation–liaison psychiatry practice.