Daily multidisciplinary team (MDT) meetings are essential for safe and effective inpatient psychiatric care. Across inpatient psychiatric wards within Surrey and Borders Partnership Trust (SABP), baseline audits using a Terms of Reference (TOR) self-assessment tool revealed low reliability in MDT processes, with only 53% adherence to core clinical discussion protocols. This highlighted significant variability in how risk, care planning and discharge planning were addressed. The aim of this QIP was for all wards to adhere to a 90% average using TOR self-assessment by the end of the study period.

Applying the Model for Improvement as a structural framework, a diagnostic phase utilized Pareto analysis to isolate the most critical MDT omissions. Process mapping visualized current practices, while Failure Mode and Effects Analysis (FMEA) identified domains carrying the highest clinical risk. To generate change ideas, weekly workshops using TRIZ methodology were held with three pilot wards. From this, the structured conversation tool ‘RADAR’ was developed.

RADAR directs MDT conversations around five domains: Risk; Action Plans; Discharge Plans; Assign Tasks; Review Previous Plans. Open-ended verbal prompts using these domains ensure key clinical areas are addressed, i.e.: “What is the risk?”, “Are thecurrent action plans effective?”, “Where are we with discharge planning?”, “Let’s assign tasks”, “Let’s review yesterday’s plan”.

Following initial positive testing on one ward, RADAR was rolled out across seven wards, including PICU, General Adult and Old Age Psychiatry. Compliance data was gathered weekly for three weeks using a TOR self-assessment tool, with data monitored via Statistical Process Control (SPC) charts.

Seven wards implemented RADAR. Average compliance for individual wards ranged from 63% to 94.3%. The overall mean compliance across the study period was 79.3%, and by the third week, mean compliance reached 84.7%. While this fell short of the 90% target, it represented a sustained upward trend and a 31-percentage-point increase from the original 53% baseline. Following this QIP, RADAR was incorporated into the Business-As-Usual (BAU) protocols across SABP.

RADAR was shown to be an effective tool for structuring clinical conversation, significantly improving compliance in areas such as risk and discharge planning. It facilitates a ‘closed loop’ by assigning tasks, and then reviewing tasks that were previously assigned each day. A memorable acronym that prompted open-ended questions likely aided its real-world effectiveness. Further research is required to assess its impact on Red-to-Green (R2G) bed days and its efficacy across wider clinical sub-specialties.

Previous studies have explored how international medical graduates (IMG) may face some barriers when it comes training in psychotherapy. This relates to cultural barriers when interacting with the patient or colleagues, or when working within a different system such as the National Health Service (NHS).

However few studies have explored their attitudes towards psychotherapy and how cultural factors may impact the way they think about therapy, training and the therapeutic alliance. Therefore, the aim of this study is to analyse transcripts from focus groups with IMGs to see what their thoughts are about psychotherapy and the training they received, and whether it is impacted by any cultural factors.

Initially, all IMGs were invited to join focus groups via email and 8 volunteered to take part. The inclusion criteria were: trainees were currently at a placement in psychiatry in Mersey care and needed to have gained their medical degree outside of the UK. Two focus groups were held, using semi-structured questions. Themes were allowed to emerge but also prompted by pre-planned questions. The interviews were recorded, transcribed and analysed using thematic analysis by three separate readers. Different themes emerging were identified and coded.

Results showed themes that were pertinent to all trainees regardless of cultural background and these included: the importance of psychotherapy to practice and training, lacking confidence in its delivery and acknowledgement of the need for psychotherapy training and supervision.

However, there were some cultural impacts on their views of psychotherapy. It was highlighted that psychotherapy as practice is more widely accepted in the UK and that perhaps there is still stigma associated with mental health illnesses worldwide. There may be religious and social structures that can support people in other cultures which may impact how patients seek care from the medical profession and how professionals respond. There were positive and negative aspects from cultural differences identified that impacted upon the therapeutic alliance, the ways IMGs deliver therapy and what they were expecting from training. The existence of paternalistic practices internationally was raised by many, with debate as to the balance required with this and whether it can serve to be a positive influence at times.

In conclusion, though cultural differences were identified that impacted IMG’s attitudes and delivery of therapy, they could be positive as well as negative. Solutions in the future, could perhaps be acknowledging and exploring these differences to strengthen delivery of therapy.

Novel psychoactive substances (NPS) present unpredictable pharmacodynamic and pharmacokinetic effects, which can complicate opioid substitution therapy (OST) and increase overdose risk. Understanding patterns of NPS use in OST patients is important for optimizing pharmacological management and harm reduction. This study aimed to identify the prevalence and types of NPS use among OST outpatients, describe associated pharmacological risks, and evaluate whether such use was documented in clinical notes.

A retrospective pharmacological review was conducted in an addictions psychiatry outpatient clinic. Adults aged ≥18 years receiving methadone or buprenorphine were included. Patients were excluded if clinical records were incomplete or if acute intoxication, withdrawal, or cognitive impairment precluded accurate reporting. Data were extracted from patient self-report, toxicology results, and clinical notes, focusing on type of NPS, concurrent substance use, OST dose, and documented adverse events such as sedation, withdrawal, or toxicity. Descriptive analyses summarized prevalence, pharmacological profiles, and documentation.

Among 120 patients (methadone n=75, buprenorphine n=45), 32 patients (27%) reported NPS use, most commonly synthetic cannabinoids (n=16) and cathinone derivatives (n=10). Polysubstance use occurred in 60% of NPS users versus 40% of non-users. Pharmacological complications were reported in 15 NPS users (47%), including enhanced sedation, withdrawal exacerbation, and increased craving. Notably, 23 of 32 patients (72%) had no prior documentation of NPS use in clinical notes, highlighting under-recognition of potential pharmacological risks.

NPS use is common in OST patients and presents significant pharmacological challenges, particularly in the context of polysubstance use. Systematic screening and documentation of NPS exposure is feasible and essential for safe OST management, dose adjustment considerations, and prevention of adverse pharmacological interactions.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents with an estimated prevalence of up to 5% in children. Since 2019 there has been an average annual increase of 18% nationally, in ADHD medication prescriptions. Therefore with the uncertainty around the long-term effects of medication use and the side effects as we currently understand them, there is the need for other interventions to be available for children with ADHD.

This research evaluated the feasibility of a yoga and mindfulness-based family programme developed specifically for children with an ADHD diagnosis; designed to reduce ADHD behaviours, improveparent-child relationships, and emotional regulation.

17 families with children aged 6–11 completed a 6-week yoga and mindfulness programme. Families completed the E SWAN assessment forms which include questionnaires for ADHD, Disruptive Mood Dysregulation Disorder, Depression, Anxiety and Panic Disorder. Families were also interviewed post intervention.

The quantitative findings were positive with significant outcomes: 94.1% of participants were reported to show an improvement in ADHD symptoms post intervention, with an overall 38.6% reduction in symptoms. The qualitative findings evidenced that post intervention the children were able to independently implement emotional regulation techniques, parents/carers were also able to implement strategies to regulate their own emotions, improving their ability to co-regulate their child.

This is the first study using this particular family intervention that has been developed specifically for children with ADHD diagnosis. The results highlighted the programme was effective in reducing ADHD symptoms, improving the parent-child relationship and emotional regulation.

The Amyloid-Tau-Neurodegeneration (ATN) framework defines Alzheimer’s disease using primarily biological markers of pathology rather than clinical presentation. Although ATN classification has improved biological characterisation, new evidence indicates that biomarker stage is frequently discordant with clinical severity, functional impairment and prognosis, limiting its utility for personalised management planning. This poster aims to critically evaluate the strengths and limitations of ATN-based diagnosis and explore the role and management implications of an integrated clinical-biological staging model as a potential future standardised approach to improve clinical decision-making in real-world practice.

A narrative synthesis of the Alzheimer’s disease literature was conducted to evaluate the relationship between ATN classification and clinical outcomes. Peer-reviewed studies were identified that examined ATN biomarkers across research and clinical settings, including longitudinal cohort studies, memory clinic populations and meta-analyses. Evidence was appraised to assess concordance and discordance between biological staging, cognitive severity, functional impairment and prognosis. Findings were synthesised thematically, focusing on clinical applicability, management implications and the potential role of an integrated clinical-biological staging model was evaluated.

Across many studies, the ATN framework demonstrated clear strengths in confirming Alzheimer’s disease pathology but consistent limitations in explaining clinical presentation. Amyloid positron emission tomography (PET) reliably confirmed underlying pathology but accumulated decades before symptom onset, therefore unable to predictcognitive severity. Tau PET and cerebrospinal fluid tau correlated closely with clinical symptoms but were limited by early sensitivity and spatial resolution. Neurodegeneration markers reflected synaptic dysfunction and brain atrophy but primarily represented late irreversible change. Overall, clinical symptoms and biomarker stage showed frequent discordance.

Evidence highlighted that discordant profiles were commonly influenced by resilience factors or additional co-pathologies not captured within the ATN framework. Integrated clinical-biological staging models map patients across two axes, which has been shown to better identify these profiles. Such models can more accurately reflect real-world heterogeneity.

This evidence-based analysis demonstrates that while ATN-based diagnosis provides a strong biological framework, it is insufficient when used in isolation to explain symptom severity, prognosis or clinical variability. Integrated clinical-biological staging offers a more meaningful approach with implications for more accurate prognosis and targeted management. However, the clinical utility of this approach is currently limited by restricted availability of co-pathology biomarkers and the need for validation of integrated models in diverse populations. Therefore, further research is required before widespread standardised implementation.

Depression is a recognised risk factor for cognitive decline and dementia, yet the long-term neurocognitive effects of antidepressant treatment remain uncertain. This study aimed to quantify the association between antidepressant use and risk of cognitive decline and dementia, and to explore potential mechanistic links through the brain–gut axis using emerging microbiome evidence.

We conducted a PRISMA-compliant meta-analysis prospectively registered with PROSPERO (CRD420251012092). The protocol development, literature search, data extraction and verification were completed over a six-month period. PubMed, EMBASE, PsycINFO and the Cochrane Library were searched from inception to March 2025 for randomised controlled trials and longitudinal cohort studies examining antidepressant exposure and cognitive decline or dementia outcomes. Two reviewers independently screened studies and extracted data using a pre-specified framework. All extracted data were manually cross-checked against the original full-text publications to ensure accuracy and consistency. Random-effects meta-analyses were performed to estimate pooled effects, with subgroup, sensitivity and meta-regression analyses conducted to explore age, treatment duration and antidepressant class. Randomised microbiome studies were narratively synthesised to examine potential brain–gut mechanisms.

Seventy-eight studies met inclusion criteria, comprising 102,584 participants (22 randomised controlled trials and 56 longitudinal cohort studies). Antidepressant use was associated with a significantly reduced risk of dementia (odds ratio 0.85, 95% CI 0.78–0.92) and slower cognitive decline (standardised mean difference 0.28, 95% CI 0.15–0.41). Subgroup analyses demonstrated stronger protective effects among individuals aged under 65 years and in those receiving antidepressant treatment for more than three years. Selective serotonin reuptake inhibitors showed the most consistent association with reduced dementia risk and cognitive decline compared with other antidepressant classes. Heterogeneity was moderate to substantial and consistent with differences in study design, follow-up duration and outcome definitions. Narrative synthesis of five microbiome randomised trials showed that antidepressant-associated increases in Bifidobacterium and reductions in inflammatory markers correlated with improvements in cognitive performance, supporting a potential gut–brain mechanism underlying observed neuroprotective effects.

Antidepressant use is associated with a modest but statistically significant reduction in dementia risk and slower cognitive decline, particularly with long-term treatment and selective serotonin reuptake inhibitors. Integration of emerging microbiome evidence suggests that anti-inflammatory and gut-mediated mechanisms may contribute to these effects. While causality cannot be inferred, these findings support further prospective and mechanistic studies to clarify the role of antidepressants in cognitive ageing and dementia prevention.

Young carers (YCs), estimated to comprise 2–8% of the child and young person (CYP) population in England, face numerous sociodemographic challenges that put them at increased risk of poor mental health (MH). The Covid-19 pandemic exacerbated challenges by increasing caregiving responsibilities. However, research on YCs in the pandemic era remains limited. This study is a secondary analysis of the NHS England 2020 Mental Health of Children and Young People (MHCYP) survey, investigating the characteristics, pandemic experiences, and MH outcomes of YCs aged 11–22 in England.

The NHS England MHCYP 2020 survey was a follow-up to the 2017 survey, taking place July/August 2020. The original 2017 cohort, selected through random probability sampling from the NHS Patient Register, included 9,117 CYP aged 2–19 and/or their parents. Of these, 3,570 (46%) completed the follow-up 2020 survey, now aged 5–22. The main measure of mental health in 2020 was the Strengths and Difficulties Questionnaire (SDQ), a broad measure of mental health difficulties. The 2020 survey included a range of questions about pandemic experiences, which were compared for YCs and non-YCs. Longitudinal regression analyses assessed whether YC status in 2017 predicted change in SDQ score between 2017 and 2020. Weighted analyses adjusted sequentially for baseline SDQ, demographics, and a comprehensive theoretically informed covariate set.

The analysis revealed some differences in demographic and pandemic-related variables between YCs and non-YCs. Parents of young carers were more likely to report that they could not afford food or had to use a food bank compared to parents of other young people (5.7% compared to 1.8%). Young carers were more likely than non young carers toreport that their household could not pay bills (5.5% compared to 1.8%). There was no evidence of difference in MH outcomes in 2020 as measured by the SDQ between YCs and non-YCs, nor did the longitudinal analysis indicate a greater deterioration in SDQ scores among YCs from 2017 to 2020.

These findings suggest that YCs as a group were more likely to face socioeconomic challenges during the pandemic, although we found no differences in mental health outcomes. This may reflect protective factors at play or reflect study limitations. There was considerable attrition between the 2017 and 2020 surveys, requiring weighted analysis and reducing power. Further research is warranted to explore the complex interactions between caregiving, socioeconomic factors, and MH, and to develop risk-mitigation and mental health promotion strategies.

Relapse following discharge from inpatient rehabilitation remains a major challenge in substance use disorder (SUD) care and is associated with significant clinical, social, and legal consequences. While relapse rates are well described, far less is known about the timing of relapse, particularly within mandated treatment systems where patients are referred through legal (Court) or regulatory pathways (General Persecution) and experience structured supervision and monitoring. Identifying periods of heightened vulnerability following discharge is critical for optimising aftercare strategies and allocating resources effectively. This study aimed to characterise the timing and distribution of relapse events following discharge from inpatient SUD rehabilitation in Qatar and to identify critical post-discharge periods for targeted preventive intervention within mandated treatment pathways. We hypothesised that relapse risk would be highest during the early post-discharge period.

A retrospective cohort study was conducted including 72 patients discharged from an inpatient SUD rehabilitation programmeoperating under a mandated treatment framework. All patients entered a structured aftercare pathway with routine follow-up and urine drug screening. Relapse was defined as a documented positive urine drug screen for illicit substances during follow-up. Time-to-relapse was measured from the date of discharge and tracked over a 26-week post-discharge period. Patients who did not relapse during follow-up were censored at their last negative drug screen. Kaplan–Meier survival analysis was used to estimate relapse-free survival and to describe the temporal distribution of relapse events across the follow-up period.

During the 26-week follow-up, 40.3% of patients (n=29) experienced relapse. The median time-to-relapse was 28 days, indicating that half of all relapse events occurred within the first four weeks following discharge. Relapse timing ranged from 7 to 182 days, demonstrating substantial inter-individual variability in post-discharge recovery stability. Kaplan–Meier survival curves showed the steepest decline in relapse-free survival during the first month after discharge, identifying this period as the highest-risk phase for recurrence. Beyond the initial four weeks, the hazard of relapse declined progressively over time, with fewer new relapse events observed in later follow-up.

This time-to-event analysis demonstrates that the first four weeks following discharge constitute a critical vulnerability window for relapse among patients undergoing mandated inpatient SUD rehabilitation. Findings support prioritising intensive early aftercare, enhanced monitoring, and rapid-response interventions during the immediate post-discharge phase. Targeting this high-risk period within mandated treatment pathways may reduce early relapse and improve longer term recovery outcomes.

Tic disorders are the most common movement disorder of childhood with a lifetime prevalence rate of 5% for transient tic disorders and 0.7% for Tourette syndrome. 20% of school-aged children may be affected by tics at some point. Most tic disorders are transient and do not require treatment. Chronic tic disorders if causing distress to the young person would require treatment.

Management of tic disorders requires a multidisciplinary approach with paediatricians, psychologists and psychiatrists working together depending on comorbidities. General practitioners are often unclear about the most appropriate service to refer young people to, causing delay in young people accessing the right support. This led to discussions about creating a pathway for children and adolescents with tic disorder in the community setting.

Aims were to create a referral pathway for children and young people with tic disorders in North Staffordshire; to provide a seamless service for young people, by developing a referral system with clear guidance to genera practitioners so that young people can access the right support in a timely fashion.

A working group was formed with Paediatricians (3 and 4) from University Hospital of North Midlands and a Psychiatrist (1) and Psychologist (2) from the CAMHS services. A general practitioner (5) who represented ICB was also part of the working group.

The group met regularly in 2023 and created a pathway which enabled the general practitioners to refer to the most appropriate team. A referral form was also created to guide the referring clinician. This was presented to a group of general practitioners and amendments were made accordingly. The pathway was approved by the ICB and implemented in March 2024.

Introduction of the tic disorder pathway helped primary care colleagues to make referrals to the right team and helped reduce waiting times.

Creation of this pathway helped primary care clinicians to assess and refer young people without referrals being redirected to different teams. This has reduced the time from referral to treatment for young people with movement disorders. The development of the pathway has positively impacted on working relationships between primary and secondary care colleagues.

Obsessive–compulsive disorder (OCD) is a chronic psychiatric illness associated with marked functional impairment and reduced quality of life (QoL).Although the adverse impact of OCD on QoL is well established,local data is limited.In light of limited relevant local literature, we planned our research to build a scientific database related to effect on quality of life in OCD patients due to several different types of obsessions and to establish which type of obsessions are more prevalent and affect more.

This cross-sectional study was conducted over a period of six months at the Department of Psychiatry and Behavioural Sciences, Allied Hospital II, Faisalabad, after approval from the Ethical Review Committee of Faisalabad Medical University. A total of 180 participants were recruited using probability consecutive sampling from the outpatient and inpatient services. Adults aged 18 years and above diagnosed with OCD according to DSM–5 criteria were included, while individuals with neurological disorders, significant cognitive impairment, acute psychiatric crises, or major comorbid psychiatric disorders were excluded. Written informed consent was obtained from all participants. Diagnosis and categorization of obsession types were established through structured clinical interviews based on DSM–5 criteria, and relevant data were recorded on a structured proforma. Data were analysed using SPSS version 25, with descriptive statistics calculated for demographic and clinical variables; differences in quality of life across obsession categories were assessed using analysis of variance (ANOVA), and simple linear regression analysis was performed to evaluate predictors of quality of life.

Of the 180 people who took part, 109 (60.6%) reported a poor quality of life, and 71 (39.4%) had a normal quality of life. There were 30 people in each group for each category of preoccupation. There was no statistically significant correlation between types of obsessions and quality of life (χ²=3.466, p=0.629). Nonetheless, QOL exhibited strong correlations with gender (p=0.038), employment status (p=0.022), disease duration (p=0.002), familial history (p=0.010), and OCD severity (p<0.001). A stronger link existed between worse quality of life and higher intensity and longer duration of illness.

Patients with OCD have a significant deterioration in their quality of life. The specific type of preoccupation does not directly influence quality of life; rather, clinical considerations, especially the severity of OCD and the length of the illness, are pivotal. These results underscore the significance of prompt diagnosis, thorough management, and severity-oriented interventions to enhance the overall well-being of individuals with OCD.

Gambling-related harm is under-recognised in patients receiving opioid substitution treatment (OST). This study aimed to determine the prevalence and severity of gambling harm in an OST outpatient population, explore associations with concurrent substance use (cocaine, cannabis, illicit benzodiazepines), and assess the feasibility of routine screening in clinical practice.

A cross-sectional service evaluation was conducted in an NHS addictions psychiatry outpatient service. Adults aged ≥18 years receiving methadone or buprenorphine were opportunistically screened during routine appointments, excluding those unable to engage due to acute intoxication, severe withdrawal, cognitive impairment, or acute psychiatric instability. Gambling-related harm was assessed using the Problem Gambling Severity Index (PGSI). Demographic data, opioid substitution treatment type, concurrent substance use, and psychiatric comorbidities were extracted from clinical records and patient self-report. Data were anonymised and analysed descriptively, with exploratory comparisons between patients with and without gambling-related harm.

A total of 62 patients were screened. Eighteen patients (29%) scored ≥3 on the Problem Gambling Severity Index (PGSI), indicating moderate-risk or problem gambling, while nine patients (14%) met criteria for problem gambling (PGSI ≥8). Gambling-related harm was more frequently observed among patients reporting concurrent cocaine use and illicit benzodiazepine use. The majority (82%) of patients with moderate or severe gambling harm had no prior documentation of gambling difficulties in their clinical records, suggesting significant under-recognition. Screening was feasible, added minimal time to routine assessments, and prompted clinically relevant discussions around financial stress and relapse risk.

Gambling-related harm appears common yet under-identified among patients receiving OST in addiction psychiatry outpatient services. Routine screening using brief validated tools such as the PGSI is feasible and may enhance holistic assessment and care planning. Integrating gambling harm assessment into standard addiction reviews may help address unmet clinical need and improve outcomes in this complex patient group.

To quantify anticholinergic burden among older adults newly referred to the Central Aberdeenshire Community Mental Health Team (CMHT) between February 2024 and February 2025, and to evaluate whether clinicians documented interventions to review or mitigate anticholinergic medications when the burden was clinically significant.

This quality improvement project reviewed all general practitioner referrals to the Central Aberdeenshire CMHT during the study period. Of 241 referrals, 30 deceased patients were excluded, leaving 211 patient records for analysis. Prescribed medications were reviewed and anticholinergic burden was calculated using both the German Anticholinergic Burden Score and the Anticholinergic Cognitive Burden (ACB) Scale; where discrepanciesoccurred, the higher score was used to prioritise patient safety. An ACB score ≥3 was considered clinically significant. For these patients, clinical records were examined to identify documented interventions, categorised as switching to less anticholinergic alternatives, suggesting a medical review, deprescribing, or dose adjustment/reduction.

Among the 211 patients (age range 61–101 years), 73% were prescribed at least one anticholinergic medication and 32.7% (N=69) had a clinically significant anticholinergic burden (ACB ≥3), with scores ranging from 0 to 11. Anticholinergic burden was strongly associated with polypharmacy: 63.9% of patients prescribed eight or more medications had an ACB ≥3, compared with 11.8% of those on fewer than five medications. High-burden medications most frequently prescribed included quetiapine, amitriptyline, and solifenacin.

Despite the prevalence of significant anticholinergic burden, 75.4% of affected patients had no documented intervention. Interventions included deprescribing (8.7%), dose adjustment or reduction (8.7%), suggesting a medical review (4.4%), and switching to a less anticholinergic alternative (2.9%).

Clinically significant anticholinergic burden remains common among older adults referred to CMHT services and is closely linked to polypharmacy. However, documented clinical interventions have declined compared with previous local audits, indicating a widening gap between risk identification and active management. Embedding routine anticholinergic burden calculation into assessments, prompting systematic medication review for patients with ACB ≥3, and supporting clinicians with targeted education may improve patient safety. A re-audit is planned to evaluate the impact of these interventions.

Weight-loss medications such as tirzepatide are increasingly prescribed, yet their potential psychiatric effects remain under-recognised. This case explores diagnostic uncertainty between personality pathology and hypomania following significant weight loss and exposure to tirzepatide in an individual with pre-existing narcissistic personality traits. The aim was to examine whether behavioural escalation represented an exacerbation of personality traits alone or a superimposed affective episode temporally associated with medication use.

A man in his late 40s with established Narcissistic Personality traits and no prior history of mood disorder was assessed following escalating behavioural concerns in the workplace. Prior to medication exposure, occupational functioning was stable, though interpersonal behaviour was characterised by inconsistency, criticality, and sensitivity to perceived errors in others.

Tirzepatide was initiated for weight loss at a starting dose of 2.5 mg and gradually escalated to 10 mg. Over approximately six months, the patient experienced rapid weight loss of 20 kg. Over the last three months of the treatment, marked behavioural changes were observed, including reduced need for sleep, increased energy, heightened grandiosity beyond baseline, impulsive decision-making, disinhibition, and poor insight into the impact of his actions on colleagues.

He demonstrated abrupt rule-breaking behaviour, including suspending colleagues without completing appropriate investigations or following established procedures, causing significant distress within the workplace. Symptoms were escalating rather than static. There were no psychotic symptoms, substance misuse, or alternative medical explanations identified.

The primary diagnostic considerations included exacerbation of narcissistic personality traits, hypomania, and medication-associated affective destabilisation. Several features supported hypomania over personality traits alone, including a clear change from baseline functioning, reduced sleep, increased goal-directed activity, behavioural disinhibition, and a marked reduction in insight. The temporal association with tirzepatide initiation and rapid weight loss raised the possibility of medication-related affective change in a psychologically vulnerable individual, despite no prior bipolar diagnosis.

This case highlights the diagnostic complexity of distinguishing personality pathology from emergent mood disorder in the context of metabolic pharmacotherapy. Clinicians should remain vigilant for affective destabilisation in patients prescribed GLP-1–based weight-loss agents, particularly those with underlying personality vulnerabilities. Careful longitudinal assessment is essential before attributing behavioural change solely to personality traits.

Many people with eating disorders experience body image disturbance, and there is evidence to suggest that body image difficulties not effectively addressed through eating disorder treatment can contribute to later relapse. Virtual reality (VR) interventions designed to target body image difficulties associated with eating disorders have begun to demonstrate promising evidence of efficacy. However, little is known about the perspectives of people with eating disorders and those who care for them around such interventions. This study aims to explore stakeholders’ views of factors that could impede or support use of such interventions.

Eleven young people with lived or living experience of eating disorders (PWLE), four parents/carers of people with eating disorders, and five clinicians with experience of treating eating disorders took part in semi-structured interviews or focus groups. Qualitative data was coded inductively and analysed using reflexive thematic analysis. Themes and subthemes were iteratively refined through discussions between the authors.

Five themes were generated. These were getting the timing right: highlighting the importance of timing within a person’s treatment journey, with suggestions for optimal timing; tailoring the intervention to the individual: all stakeholders agreed that individualisation to the person accessing treatment was critical; thoughtfully empowering agency: participants suggested that a degree of control over most aspects of the intervention would be helpful, with some key caveats; providing the right support: suggestions were made about both the necessity of support, and what this support might look like; and an overarching theme of on balance is it worth while? This overarching theme involved participants carefully weighing up the risks and benefits of using such an intervention. It included three subthemes: hope of efficacy; fear of difficulty; and desperate belief in necessity.

PWLE, parents and carers and clinicians shared valuable, detailed insights into how they view body image interventions in VR, the key challenging areas and suggestions for how they could be done well. They highlighted that getting these aspects right may make such an intervention on balance worthwhile. Ongoing co-production in order to optimise these components of the intervention should be utilised in the development of VR body image interventions, as they will likely make the difference as to whether people will choose to try them and whether they will be effective.

Sub-optimal prescribing of anti-dementia medications may compromise the cognition of patients with dementia. The aim of this audit was to assess the prescribing of anti-dementia medications, including Donepezil, Rivastigmine and Memantine, for patients diagnosed with dementia against local and national guidelines in relation to three domains: appropriate indication for dementia subtype, optimal dosage titration and recommended physical health monitoring. The target was to achieve a minimum of 90% adherence to guidelines for each domain.

This retrospective clinical audit was based at the Forget Me Not Unit, a specialist dementia intensive care unit in Worthing. The first audit cycle collected data from twenty patients discharged between February and May 2025. Data obtained from electronic medical records included dementia subtype and severity, pre-admission and inpatient-initiated anti-dementia medications, titration regimes, pulse checks and renal function profiles. Results were compared against Trust and Maudsley prescribing guidelines which served as standards. An action plan was subsequently implemented which included raising staff awareness of the audit, disseminating its results and placing visible audit reminders on ward lists. A second cycle was commenced in November 2025 to February 2026 which examined the data of twenty discharged patients following implementation of the action plan.

In the first cycle, thirteen out of twenty patients were prescribed pre-admission anti-dementia medications (65%) whilst seven out of twenty patients were candidates for an inpatient-initiated anti-dementia medication given their dementia subtype (35%). Six of these patients were offered an anti-dementia prescription of which five were clearly indicated (83%). All prescriptions were titrated according to guidelines but recommended physical health monitoring was only completed for five patients (83%). Similar results were demonstrated in the second cycle. Eleven patients were prescribed an anti-dementia medication prior to their admission (55%), six patients were candidates for an anti-dementiamedication (30%) but only four patients were prescribed an indicated drug during their admission (67%). However, all inpatient-initiated anti-dementia medications were titrated and monitored according to standards.

Anti-dementia medications are licensed treatments for dementia but may be underutilised as evidenced by this audit. Although the target was achieved by the second cycle in two out of three domains, the indication of anti-dementia prescriptions was not fully adhered to against guidelines. Further audit cycles and tailored action plans could raise the standards of anti-dementia prescriptions and thereby improve patient safety and care.

This audit aimed to determine the proportion of adults with Intellectual Disability (ID) residing at ‘Dar tal-Providenza’ residence, who had undergone genetic testing confirming a genetic diagnosis, assess documentation of genetic testing discussions or referrals, and evaluate alignment of current practice with national and international guidelines for genetic testing in neurodevelopmental disorders.

All adults under the care of the ID team with a documented diagnosis of ID and/or Autism Spectrum Disorder (ASD) were included. Electronic Patient Records were reviewed for demographic data, primary diagnoses, documentation of genetic testing or referral to genetics services, discussions with patients or carers, and documentation of results and follow-up actions in accordance with National Institute for Health and Care Excellence (NICE) and European Society of Human Genetics (ESHG) guidelines.

The cohort consisted of 80 adults aged ≥18 years, with a mean age of 50.4 years and a gender distribution of 49 males and 31 females. Most individuals had multiple co-existing neurodevelopmental, neurological, genetic, and mental health diagnoses. ID severity was mild–moderate in 23.75% (n=19), moderate–severe in 57.5% (n=46), and unspecified in 18.75% (n=15). An associated genetic syndrome was identified in 16.25% (n=13).

ASD was the second most common diagnosis (22.5%, n=18) and a frequent comorbidity with ID (16.25%, n=13). Other diagnoses included cerebral palsy (13.75%, n=11), trisomy 21 (11.25%, n=9), epilepsy (6.25%, n=5), Fragile X syndrome, Cri-du-Chat syndrome, and Peters-plus syndrome (each 1.25%, n=1). Challenging behaviour co-occurred in 8.75% (n=7). Mental health comorbidity was common, including bipolar affective disorder (6.25%, n=5), emotionally unstable personality disorder, post-traumatic stress disorder, schizoaffective disorder, anxiety disorder, and psychotic depression (each 1.25%, n=1).

Only 6 patients (7.5%) had a documented genetics referral, with genetic testing discussed in one case (1.25%). Among those referred, five had confirmed diagnoses, one was awaiting results, and no follow-up plans were documented.

This audit identified a highly complex cohort with extensive neurodevelopmental and mental health needs. Despite meeting NICE and ESHG criteria, genetics referral was low (7.5%) with minimal documented discussion or follow-up, highlighting the need for further training and collaboration between the Psychiatry and Genetics Department in Malta.

Background

Electroconvulsive Therapy (ECT) is among the most effective treatments for severe and life-threatening psychiatric illness, yet its use in medically complex patients demands refined clinical judgment.

With rising multimorbidity and increasing prevalence of implanted medical devices, clinicians are more frequently required to balance urgency against evolving physical risk.

This presentation introduces the concept of the therapeutic pause; not as delay, but as an active, patient-centered safety strategy, demonstrating how structured reflection and multidisciplinary collaboration can transform high-risk uncertainty into safe, timely intervention.

The aim is to highlight how deliberate pauses at critical decision points can improve both clinical outcomes and patient safety.

Case Reports

Two urgent liaison psychiatry referrals for ECT are presented.

Case 1 involved a 72-year-old man with schizophrenia and mild learning disability, admitted with catatonia, severe self-neglect, and nutritional failure requiring nasogastric feeding. He had a proximal deep vein thrombosis (DVT) diagnosed three weeks earlier and hyperkalaemia, raising concern about embolic risk and physiological stress during ECT.

Case 2 involved a 62-year-old woman with psychotic depression and catatonia, who had an implanted spinal cord stimulator (SCS) for chronic pain, creating potential risks of electrical interference and device damage.

In both cases, ECT urgency was balanced against medical risk using targeted investigations, literature review, consultation with the ECT Accreditation Service (ECTAS) Knowledge Hub, and early multidisciplinary input.

In Case 1, repeat Doppler imaging confirmed resolution of the proximal DVT and electrolyte abnormalities were corrected, allowing ECT to commence three days later. By the third and fourth treatments, the patient showed striking recovery: spontaneous speech, independent mobility, recognition of staff, and restoration of oral intake, facilitating discharge after completing the course.

For Case 2, collaboration with pain specialists and device manufacturers enabled safe deactivation, monitored ECT delivery, and post-treatment device integrity checks, followed by clear improvement in psychomotor function, affect, and nutritional status.

These cases demonstrate that ECT risk is rarely absolute; it is dynamic and often modifiable. In both cases, pausing prevented both premature exposure to harm and unnecessary therapeutic delay.

Pausing before ECT is not clinical indecision; it is clinical leadership. Individualized assessment, proactive multidisciplinary collaboration, and informed use of national guidance allow clinicians to navigate the interface between psychiatric urgency and physical vulnerability.

As ECT increasingly serves patients with complex comorbidity, reflective practice must replace routine automation. Thoughtful pauses protect patients, strengthen decision-making, and ultimately enable ECT to deliver its life-saving potential.

In complex ECT, the safest action may begin with a pause.

Effective communication and comprehensive history taking are core competencies in undergraduate medical education. Emerging digital technologies, including generative artificial intelligence (GenAI), offer novel opportunities to enhance experiential learning in this domain. This service evaluation explored the educational value of a GenAI-simulated virtual patient presenting with psychosis, integrated into psychiatry communication skillsteaching at Cardiff University School of Medicine. The primary aim was to assess student perceptions of the simulation as a learning tool.

A mixed-methods service evaluation design was employed. Quantitative and qualitative data were collected using pre- and post-intervention questionnaires assessing self-reported confidence in communication, history taking, and risk assessment, alongside usability and accessibility. Participants engaged with an AI-simulated virtual patient on the SimFlow.AI platform, receiving pre-task information and automated post-task feedback on performance. The simulation involved an acute psychotic presentation, requiring participants to conduct a psychiatric history and risk assessment. Participants were recruited from Years 2 through to 5 of the undergraduate medical programme at Cardiff University. The AI simulation was also embedded in a Year 2 unit of study to support students’ self-directed practice of communication skills.

Twenty participants completed all study components, including full engagement with the AI simulation and pre- and post-intervention questionnaires. Self-reported confidence in history taking and risk assessment increased significantly following exposure to the AI-simulated virtual patient (z=−3.750, p<0.001), with significant improvements observed across both junior and senior cohorts. All participants reported that the simulation facilitated clinically relevant skills practice, with 94% indicating that the platform helped them identify strengths and areas for improvement in their communication skills. Perceived authenticity was high, with 94% rating the AI responses as realistic and clinically plausible. All participants endorsed the platform as a useful adjunct to existing communication skills teaching. Where the AI simulation was embedded within a Year 2 unit of study, 74% of 93 respondents rated the AI virtual patient encounter as useful in practicing psychiatric history taking during self-directed learning time.

AI-simulated psychosis consultations appear to offer psychologically safe, accessible, and practical opportunities for communication skills rehearsal and reflective learning. Students supported the integration of AI simulations as a supplementary educational resource (particularly for OSCE/ISCE preparation) while emphasising that such tools should complement rather than replace patient actors.