To improve the quality, accuracy, and consistency of capacity assessments and their documentation in line with the Mental Capacity Act (2005) across inpatient psychiatric wards at The Harbour. The project aimed to ensure assessments were decision specific, clearly reasoned, and compliant with statutory standards, targeting at least 80% of assessments meeting all required components within 12 weeks following a targeted educational intervention.

This quality improvement audit was conducted across all wards at The Harbour, a 154-bed mental health hospital, including general adult, older adult, dementia, and psychiatric intensive care wards. A proportional, representative sample of 40 capacity assessments completed by resident doctors was randomly selected from the Trust’s Clinical Information System using a computer-generated randomisation function. Baseline data were collected over two weeks, with the same process applied post-intervention.

Assessments were audited using a bespoke toolkit based on the Trust’s SoP: MCA Policy and Deprivation of Liberty Safeguards Procedure, the Mental Capacity Act (2005), MCA Code of Practice (2007), and NICE NG97 Dementia (2018), providing measurable standards for documentation, reasoning, and functional testing.

In week three, resident doctors received a 30-minute targeted educational session covering MCA principles, diagnostic and functional testing, decision and time specificity, and correct completion of the Trust’s Capacity Assessment template. Reinforcement occurred through multidisciplinary discussions, handovers, and optional quick-reference guidance. A re-auditof 40 assessments was conducted in weeks nine and ten, with analysis and reporting completed in weeks eleven and twelve.

Baseline audit revealed consistent documentation of decision and time specificity (100%), but lower compliance in key areas: diagnostic test (77.5%), functional components: understand (70%), retain (70%), use/weigh (70%), communicate (70%); clinical reasoning (60%), correct template use (67.5%), and decision-specific framing (60%). Capacity outcome was explicitly stated in 92.5% of assessments.

Post-intervention audit showed marked improvements: diagnostic test documentation 95%; functional components: understand 92.5%, retain 90%, use/weigh 90%, communicate 100%; clinical reasoning, template use, and decision-specific framing all rose to 92.5%; with capacity outcome 97.5%.

A brief, targeted educational intervention substantially improved the quality, accuracy, and consistency of capacity assessments across inpatient psychiatric wards. Improvements in documentation, reasoning, template use, and decision-specific framing enhanced decision specificity and legal defensibility. By increasing familiarity with statutory requirements and structured templates, this low-cost, scalable intervention supports patient autonomy, strengthens clinician confidence, and can be readily applied in other psychiatric services where variability in capacity assessment persists.

This quality improvement project (QIP) aimed to evaluate the impact of a structured escalation framework on identifying, reviewing, and managing patients with prolonged length of stay (LOS) of more than or equal to 30 days in adult mental health inpatient settings from 1 August 2025 to 31 January 2026 in Cheshire & Wirral Partnership NHS Foundation Trust which has six acute inpatient wards where patients are either admitted informally or detained on mental health law.

This project was led by the Rehabilitation access team of Mental health Intensive Support team (MhIST) following the Trust policy to identify the escalation process for the prolonged length of stay. The policy had identified to trigger predefined LOS thresholds: ≥30, ≥40, ≥50, and ≥60 days. It was identified that patients stay due to extended period for clinical optimisation and red alert where they are clinically ready for discharge, but barriers identified internally through the clinical community teams or externally through Local authority. For all external delays, the cases were further escalated through Multiagency Discharge Escalation (MADE) meetings for the suitable pathway.

These barriers cause increased waiting time for admission from Accident & Emergency services leading to delay for appropriate treatment to be initiated and out of area admissions for acute care treatment that takes these patients away from their family and clinical team.

A Board Round framework incorporating the LOS thresholds in the weekly multidisciplinary in-reach meetings was arranged as an interface between inpatient and rehabilitation team. Key clinical and operational questions were embedded to support goal-directed care planning. Data were collected by designated care navigators, and followed by our team including LOS, reasons for delay, escalation actions, and outcomes.

Prior to this prolonged LOS weekly in-reach meeting, the average length of stay days in August 2025 was 74.3 and after the initiation of this meeting, it reduced to 54.2. It also showed the closure of all 29 out of area contracted acute beds. Out of a total of 548 patients, 39.5% (217) were identified as prolonged LOS. Seventy-eight percent (171) were due to clinical factors and 21.1% (46) were due to external delays. Majority (86.6%, 188) suffered with severe mental health illness. There was female predominance noted in both cohorts of delay.

This QIP has helped to identify and reduce the barriers in the discharge pathway, thus improving the inpatient flow. The continued multidisciplinary wider team involvement was the most effective intervention to help work collaboratively.

Lithium is a mood stabiliser primarily used for treatment and prophylaxis of bipolar disorder. Around 25% of people on lithium will experience renal impairment. There is little guidance around when to consult nephrology and psychiatry for consideration of discontinuing lithium. Prompt referral to nephrology can reduce mortality, decline in eGFR and enable initiation of renal replacement therapy.

We aimed to audit all older adults on lithium open to the older people’s community team at Cambridge and Peterborough foundation NHS trust to look at our adherence to standard renal monitoring.

The BNF suggests lithium levels should be monitored 3 monthly if ≥ 65 years old. The BNF recommends avoiding lithium in severe (eGFR 15-29 ml/min) chronic kidney disease (CKD). We looked at whether advice had been sought from nephrology or psychiatry.

NICE recommends repeat urea and electrolytes within 2 weeks if eGFR <60ml/min, urine albumin:creatinine (A:CR) and a urine dipstick to check for haematuria if new decline in renal function. NICE recommends a minimum if 1 urine A:CR if moderate CKD (eGFR 30-59 ml/min), 2 urine A:CR if severe CKD and 4 urine A:CR for end stage renal failure (eGFR <15ml/min) per year. We only looked at renal investigations and monitoring for patients with eGFR <60 ml/min.

7/73 patients had lithium levels checked >3 monthly. 24/73 had eGFR 30-59 ml/min, 2/73 had eGFR 15-29 ml/min and 1 person had an eGFR <15ml/min. Of the 3 with eGFR <30 ml/min, 1 was referred to psychiatry and nephrology, 1 referred to nephrology and 1 referred to neither. 4/27 had a new decline in renal function but none had all of the initial investigations. 23/27 had CKD but only 6 met recommended NICE urine A:CR testing frequency.

There is limited compliance with established standards. These audit results highlight the need for psychiatrists to work with General Practitioners (GP). We have updated laboratory lithium levels to reflect 0.4-0.8mmol/L for 65-80 years old and 0.4-0.7 mmol/L for >80 years old. Our guidelines for psychiatrists and General Practitioners have been updated to include investigations for new and established CKD and when to consult nephrology and psychiatry for discontinuation advice. However, we need a larger consensus to agree on a point at which renal function has deteriorated enough to trigger referrals to specialties to discuss discontinuation early so that patients have sufficient time to be involved in discussions.

Recently the therapies that utilize psychedelics have emerged as promising treatments for mood disorders, trauma-related disorders, and substance use disorders. While there is a growing body of research comparing various interventions directly, the majority of available research has been conducted in an indirect manner; therefore, Network Meta-Analysis (NMA), a statistical method for comparing the efficacy of multiple interventions at once, is well-suited to evaluate the available evidence and create a comparison of relative efficacy among the various psychedelic assisted interventions. This study aims to compare the efficacy of psychedelic-assisted interventions and provide a comparative efficacy ranking of each treatment modality using a Network Meta Analytic approach.

A contrast-based NMA was used to synthesize randomized and controlled trials of psychedelic-assisted interventions. Each treatment node was created based upon the type of drug being utilized (psilocybin, ketamine, MDMA) and the specific therapeutic context (psychotherapy) along with comparator treatments (escitalopram, active placebo, and waitlist). Means and standard deviations (SD) of continuous outcomes were obtained, standardized (as Hedges g) and incorporated into a fixed-effect inverse-variance weightedmodel. Trials with crossover designs contributed their data prior to crossover. Trials that reported binary or time-to-event outcomes were incorporated into the geometric structure of the network. Surface Under the Cumulative Ranking Curve (SUCRA) was used to estimate rankings of each treatment.

A total of six studies comprised the network and all but one study had psilocybin-assisted psychotherapy as the focus of the study. All studies demonstrated that psychedelic-assisted treatments were more effective than control groups (pharmacological, active placebo, and waitlist). Study-level estimates of treatment effect favoured psilocybin (range=−0.6 to −1.4) when compared to all other treatments. Psilocybin at high doses was found to be more effective than low dose psilocybin in reducing symptoms. A large and statistically significant pooled summary effect favouring psychedelic-assisted therapy was observed (−0.89, 95% CI: −1.07 to −0.72). Using SUCRA, psilocybin-assisted psychotherapy ranked highest among all treatments examined and both MDMA-assisted psychotherapy and ketamine-assisted therapy ranked higher than all control condition treatments.

In this network meta-analysis we present encouraging quantitative evidence supporting the clinical efficacy of psychedelic-assisted therapies, particularly psilocybin-assisted psychotherapy. These findings support the potential therapeutic utility of these treatments and suggest the need for additional head-to-head trials to provide more precise comparative effectiveness estimates and develop future clinical practice guidelines.

Procyclidine is frequently prescribed to manage extrapyramidal side effects (EPSE) associated with Long-Acting Injectable (LAI) antipsychotics. However, long-term use carries risks of anticholinergic burden and potential for misuse. Following a Serious Untoward Incident (SUI) involving a fatal procyclidine overdose, this quality improvement project aimed to assess and improve adherence to Kent and Medway Mental Health NHS Trust (KMMH) guidelines within the Dartford, Gravesham, and Swanley Community Mental Health Team (DGS CMHT). The primary hypothesis was that structured review prompts would increase the frequency of attempted dose reductions and withdrawal.

A retrospective clinical audit was conducted in two cycles using the Glasgow Antipsychotic Side-effect Scale (GASS) to monitor side effects. Cycle 1 (September 2023–January 2024) reviewed 36 patients on LAIs. Standards included: adherence to starting dose (2.5mg), regular reviews (3–4 monthly), and attempted withdrawal after 3 months of use. Following Cycle 1, interventions included team-wide dissemination of findings and the implementation of standardised prompts to encourage dose-reduction discussions during reviews. Cycle 2 (January 2025–December 2025) involved a re-audit of the caseload (n=100) to evaluate changes in prescribing and monitoring practices.

Cycle 1 identified 14/36 (39%) patients on regular procyclidine. Although 93% had recorded reviews, clinical inertia was evident: 0% adhered to the recommended BNF starting regimen, and no withdrawal plans were documented.

Cycle 2 (n=100 randomly selected patients on LAI) identified 18 patients (18%) currently prescribed procyclidine. Detailed analysis of these 18 cases revealed a shift toward active management. Successful dose reductions were achieved in 3/18 (17%) patients. Discussions regarding dose reduction were documented in a further 4/18 (22%) cases. Only 1/18 (6%) required a dose increase. Consequently, 44% of the procyclidine cohort in Cycle 2 received active interventions or discussions regarding de-prescribing.

This project demonstrated that there was significant improvement in documentation by clinicians prescribing procyclidine. There was also an observed procyclidine prevalence of 18% in the current cohort as compared to 39% from the previous cycle.

• • To identify and highlight the current practice of doctors at Campbell Centre relating to the driving status of the patients

• • To raise awareness of any deficiencies identified

• • To serve as stimulus for a change process – possibly via a Quality Improvement Project.

2 audits done retrospectively for the periods of 01 - 30 June 2025 and 01 - 30 November 2025.

Sample population drawn from both Hazel (male acute inpatient) and Willow (female acute inpatient) Wards in the Campbell Centre Milton Keynes.

Sample sizes: June 2025 - 62 patients (32 male, 30 female), November 2025 - 59 patients (33 male, 26 female)

Driving status of all patients admitted in those time periods was examined by checking Progress Notes on Electronic Medical Records (SystmOne) throughout that period.

Two categories of searches were conducted: 1. Whether patients were advised of the need to inform DVLA of their mental health status. 2. If it was confirmed from patients that the DVLA had been informed by them.

This data was then collated and presented in percentages of; DVLA Advised, and DVLA Informed. The results of the 1st Audit were presented on 15th October 2025 at the General MDT of the Campbell Centre with recommendations made.

The data for June 2025 and November 2025 were then compared to demonstrate improvement in another presentation done on 28th January 2026 with issues identified and further recommendations made.

June 2025:

• • DVLA Advised: Willow Ward - 7% compliance, Hazel Ward - 0% compliance

• • DVLA Informed: Willow Ward - 0% compliance, Hazel Ward - 0% compliance

November 2025:

• • DVLA Advised: Willow Ward - 27% compliance, Hazel Ward - 21% compliance

• • DVLA Informed: Willow Ward - 5% compliance, Hazel Ward - 0% compliance

• • There was some improvement in compliance after the 1st audit presentation - awareness has been created

• • Improvement was below expected level (50%) however and shows that this is not yet embedded as regular practice.

• • Current practice continues to fall short of expected standard however, and there is thus scope for improvement and need for further re-audits

Patients admitted to Older Adult Psychiatric Wards often have significant comorbidities putting them at increased risk of clinical deterioration. As MDT morale in managing these patients varied greatly, this project aimed to improve confidence and knowledge in recognising physical deterioration, escalating concerns and initiating Immediate Life Support (ILS).

A pre-intervention questionnaire was distributed to MDT, including nurses, healthcare assistants, student nurses and allied health professionals. The questionnaire assessed knowledge and confidence in recognising clinical deterioration, escalation pathways, contacting emergency services, situation-background-assessment-recommendation (SBAR), and initiating ILS. The questionnaires used a mixture of close-ended questions, Likert scale, predefined option selection and open-ended short-answer questions, to explore perceived challenges. An interactive teaching session was delivered, focusing on acute clinical signs, NEWS chart, escalation pathways, practical ILS skills and SBAR. A confluent patient scenario was paired with questions to encourage participants’ engagement and learning. A post-teaching questionnaire with the same format as the pre-teaching questionnaire was completed to reassess confidence, awareness, and perceived impact on patient safety.

16 staff-members completed the pre-intervention questionnaire and 13 completing post-intervention. Pre-intervention, 19% of staff rated themselves as confident (Likert score 4–5) in recognising physical deterioration, 25% in escalation of concerns and 20% in initiating ILS. Anxiety of “getting it wrong” was reported by over 70% of respondents being cited as a barrier to escalation. 38% felt current escalation and management processes were clear.

Pre-intervention, 69% reported knowledge of local escalation policies, ILS processes and paramedic handover. Post-intervention this had grown to 100%.

There was substantial improvement in confidence across all domains post-intervention.On recognising physical deterioration, 92% of respondents rated themselves as confident or very confident. On escalation and calling emergency services and on initiating ILS, confidence increased to 92% and 83% respectively. Confidence in delivering a comprehensive handover improved from 25% pre-intervention to 92% post.

Post-intervention, 100% agreed or strongly agreed that the intervention would improve patient safety on the ward. Across every domain there was growth in mean confidence scores (mean increase of a factor of 1.46).

Team knowledge and confidence in managing and escalating the acutely unwell patient was significantly improved following targeted ward-based teaching. Following staff feedback requesting visual prompts, a second PDSA cycle is planned to introduce informative posters around the ward to reinforce key learning points.

Multidisciplinary team (MDT) input is widely recommended in outpatient addiction services to address complex needs, but its use and impact in routine practice are poorly understood. This study aimed to identify which patients receive MDT interventions and examine their outcomes compared with those who do not.

A retrospective service evaluation was conducted in an outpatient addictions service over 12 months. All patients referred to the MDT for review were included (n=82), and compared with a matched cohort of patients not referred (n=130). Demographics, primary substance, comorbid mental health diagnoses, housing status, and treatment engagement were recorded. Functional outcomes (housing stability, employment/education, engagement with support services) were extracted from routine clinical records. Simple descriptive statistics and relative comparisons were used to identify patterns of MDT referral and benefit.

The MDT cohort had a mean age of 39 years; 64% were male. Primary substances included alcohol (41%), opiates (32%), stimulants (19%), and polysubstance use (8%). Comorbid mental health conditions were present in 57% of MDT patients versus 24% in non-MDT patients. Housing instability was more common in the MDT group (42% vs 18%). Functional improvements were observed in 61% of MDT patients, compared with 34% in non-MDT patients. The greatest gains were seen in patients with both comorbid mental illness and housing instability, particularly in engagement with social support services (46% vs 22% in non-MDT patients).

MDT input in outpatient addiction services is selectively applied to patients with complex social and mental health needs. These patients demonstrate substantially higherfunctional gains than non-MDT patients, highlighting the value of targeted MDT interventions. Structured referral criteria and routine evaluation may help maximise MDT effectiveness and ensure equitable access.

Aggression is prevalent in forensic psychiatric inpatient settings and poses significant safety risks to both patients and staff. A variety of interventions have been implemented to manage aggressive behaviour; however, no study has comprehensively synthesized and clearly summarized the existing evidence on these interventions. This scoping review aimed to identify and map the therapeutic interventions used to mitigate aggression among forensic psychiatric inpatients and to summarize the reported outcomes of these interventions.

This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the PRISMA-ScR guidelines. Database search was performed in MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, EMCARE, and Evidence-Based Medicine (EBM) Reviews, without restrictions on date or language to identify eligible reports. Study selection, data extraction, and quality assessment were performed independently by at least two reviewers.

Of the 1375 records identified, 58 studies were included in the final review. Psychological and behavioural interventions comprised nearly two-thirds of included studies and were generally associated with consistently positive outcomes. Approximately, 75% of studies reported reductions in the frequency and/or severity of aggression, most commonly assessed using observational measures. Interventions that were both staff- and patient-centred demonstrated the most favourable effects. However, substantial methodological heterogeneity and incomplete reporting limited comparability across studies.

Evidence suggests that structured, multi-component therapeutic interventions are beneficial in reducing aggression among forensic psychiatric inpatients. Future research should emphasize standardized outcome measures and more rigorous comparative study designs are needed to improve the clinical applicability of findings.

Anorexia nervosa (AN) is a severe psychiatric disorder with the highest mortality of any mental illness. While psychological therapies such as family therapy remain first-line, up to 30% of adolescents experience partial or non-recovery, prompting interest in adjunctive pharmacological options. Olanzapine, an atypical antipsychotic associated with reduced cognitive rigidity and anxiety and with restorative weight gain, is increasingly used off-label in adolescent AN despite limited evidence and lack of NICE endorsement. This review aimed to synthesise international evidence on olanzapine use in under-18s with AN, evaluating efficacy, safety, tolerability and applicability to UK NHS practice.

A systematic literature search was conducted across multiple bibliographic databases to identify peer-reviewed studies examining olanzapine use in patients under 18 years with anorexia nervosa for the period 2000 – 2025. Eligible study designs included randomised controlled trials (RCTs), open-label and observational studies, case series, audits and clinical guidelines. Findings were synthesised narratively to assess clinical outcomes, adverse effects and implementation within UK Child and Adolescent Mental Health Services (CAMHS).

Thirty-six studies met inclusion criteria. Evidence from adolescent RCTs was limited and underpowered, demonstrating modest effects on weight restoration and variable psychological benefit. In contrast, open-label and naturalistic studies consistently reported short-term improvements in body mass index and reductions in anxiety, rigidity and pre-meal distress, particularly at low doses (2.5 - 5mg/day). Sedation, increased appetite and mild metabolic changes were commonly reported and were generally reversible. A single case of neuroleptic malignant syndrome was identified. Engagement of families in shared decision-making was associated with improved adherence. UK prescribing data indicate ongoing off-label use within specialist CAMHS, reflecting a gap between clinical practice and formal guidance.

Available evidence supports cautious, short-term, low-dose olanzapine use as an adjunct to multidisciplinary care for selected adolescents with treatment-resistant AN, with benefits appearing greatest for psychological symptoms rather than sustained weight restoration. However, the evidence base remains limited by small sample sizes, heterogeneous outcome measures and short follow-up periods. Within UK NHS CAMHS, safe prescribing requires consultant oversight, family consent and metabolic monitoring in line with national standards. Further adequately powered UK-based RCTs are required to clarify efficacy, acceptability and long-term outcomes.

Behavioural and psychological symptoms of dementia (BPSD),though an integral feature of dementia leading to greater mortality and morbidity, remains understudied in low- and middle-income countries like Sri Lanka. Thus this study is performed to determine prevalence of BPSD and its association with quality of life (QoL) and care giver burden among patients attending Deeghayu clinic at the National Institute of Mental Health (NIMH), Angoda, the largest psychogeriatric facility in Sri Lanka.

A descriptive cross-sectional analysis was carried out at the first clinic visit over a period of one year from 2024 to 2025. Prevalence was as certained with Neuro Psychiatry Inventory (NPI).

Total of 72 patients were diagnosed with dementia, 27.8% were females with a mean age of 76.9 years (SD±11.1). Mean duration of untreated symptoms by the time of diagnosis was 2.07 years (SD±1.54). Prevalence was 61.1% in Alzheimer’s, 4.2% in vascular, 30.5% in mixed (Alzheimer’s with vascular), 1.4% each in Parkinson’s, Lewy body and fronto-temporal dementia. Frequency of severities were 43% mild, 41.7% moderate and 15.3% severe. Severity of dementia was positively correlated with NPI score (Pearson Correlation 0.09). Prevalence of BPSD was 95.8%. 33.3% had delusions, 47.2% hallucinations, 54.2% agitation/aggression, 47.2% depression, 25% anxiety, 15.3% elation, 47.2% apathy, 19.4% disinhibition, 44.4% irritability, 65.3% wandering behaviour, 75% sleep disorder and 47.2% loss of appetite. 15.3% of the patients were initiated on donepezil, 5.6% on memantine, 4.2% on both. 13.9% were initiated on quetiapine alone for management of BPSD and 61.1% on quetiapine along with one or two cognitive enhancers. 51.4% had mild to severe care giver burden according to ZaritCare Giver Burden Scalewhich was positively correlated with NPI score (Pearson Correlation 0.29). All domains of QoL assessed via World Health Association QoL in both care givers and patients were negatively correlated with NPI score except for patients’ social and environmental QoL.

Majority of the patients had BPSD at the time of diagnosing dementia associated with statistically significant heightened care giver burden and diminished QoL. This raises a concern that BPSD had led to accessing services rather than early cognitive and functional decline potentially indicating delayed diagnosis. Thus, this study underscores the need to enhance awareness and screening strategies to promote early detection of dementia in under-resourced settings such as Sri Lanka.

Background

In April 2025, city-wide changes to General Practitioner (GP) prescribing increased prescribing activity within the Community Learning Disability Team (CLDT). This audit evaluated the quality and consistency of prescribing documentation to determine whether current practice met local standards and to identify areas requiring improvement.

Aims

1. Assess adherence to documentation standards for prescriptions recorded in the electronic health record (Care Director), clinic register, and clinical notes.

2. Describe prescribing patterns across the team.

3. Develop a Standard Operating Procedure (SOP) to address gaps identified through the audit.

Records of 297 service users receiving prescriptions between 01/04/2024 and 31/05/2025 were reviewed. Outcomes included whether prescriptions were uploaded to Care Director (scan or photograph), whether entries were completed in the clinic register, whether prescribing was documented elsewhere (case notes or letters), and the site of prescription issue. Prescribing patterns were summarised.

A total of 319 prescriptions were issued to 147 patients. Of these, 65% (208/319) were uploaded to Care Director–half scanned and half photographed. Only 19% (58/300; clozapine excluded) were entered into the clinic register. Prescribing was documented elsewhere in 98% (314/319). Documentation occurred frequently but was inconsistent in format, location, and completeness.

Conclusions

The audit identified frequent but inconsistent documentation. The SOP provides a structured framework to improve accuracy, consistency, and audit-ability, with re-audit recommended at 6–12 months.

Actions

Based on the identified gaps, a SOP was developed. Key components included a scanfirst requirement, defined legibility standards, mandatory casenote entry confirming medication and dose, creation of a centralised electronic tracking register, quarterly monitoring, and data protection guidance.

Though the motives behind filicide had been extensively studied the factors that sow the seeds of those motives and how to take their edges off had rarely been investigated thus far in Sri Lanka and worldwide at large.Thus the aim of this study is to describe the demographic and clinical characteristics and associated factors in female patients referred following filicide to National Institute of Mental Health, the largest in patient forensic psychiatry facility in Sri Lanka over a period of 12 years.

Data was collected from the bed head tickets (BHTs) and descriptive statistics were analysed.

Total of 41 BHTs were examined. 92.7% of the mothers were aged 18–40 years, 78.7% were educated up to grade 11 or below. 61.1% were from rural areas. 17.1% wereemployed. 36.6% had been diagnosed with a psychiatric illness prior to the event with depression (31.3%) being the commonest. 75.6% had not been on treatment. 73.1% of the undiagnosed, had demonstrated symptoms of psychiatric illnesses but had been diagnosed only following the filicide. Harmful use of substances was evident in 44.7% of the fathers and 7.9% doubted the paternity. 61.1% of the mothers had been subjected to domestic violence by their husbands and 63.6% had considered the support received from husbands to be inadequate. Monthly income was <50,000 in 100%. 30.8%, 41% and 25.6% of victims were aged <24 hours, 0–1 year and 1–5 year respectively. 59.5% pregnancies were unplanned. 30.8% had attempted abortions. 28.9% had had home deliveries. 21.1% of the victims had had post-natal complications. 32.4% of the mothers had attempted suicide and 22.2% had attempted homicide of the victim. 23.7% of the victims had been abused; with mother (62.5%) being the commonest abuser. Commonest modes of filicide were drowning (42.9%) and strangulation (28.6%).

Beyond provision of the blanket defence and analysis of the maternal motives, prevention of filicide requires refining of several individual and social factors that have been overlooked.

There is an observed poor compliance with assessing venous thromboembolism (VTE) risk when patients are admitted to an acute male ward in Lambeth Hospital. NICE guidelines state that psychiatric patients should have this reviewed at least by first consultant review.

Psychiatric patients have unique risk factors for VTE – antipsychotic use, poor hydration/nutrition and possible use of physical restraint. It is therefore important to assess and treat risk as advised to minimise VTE occurrence. Through improving engagement with risk assessment tool, and documenting if patients are at risk, this will help identify patients who require prophylactic treatment.

Use electronic patient records (ePJS) to access ward patients’ medical records, every 2 weeks. For each patient carry out the following 1. Establish admission date. 2. Search 'VTE' 'vtrap' 'dvt' on notes. 3. Access VTRAP tool under assessment. Document if completedvs not completed. Change implemented through including VTE assessment in ward round proforma and creation of posters reminding resident (clerking) doctors to assess VTE risks.

18 bed male ward, with average length of stay 32. Baseline data showed 12% completion rate of VTE risk assessment prior to change implemented.

Following change (2 changes implicated of poster + VTE included in ward round proforma), every data collection was over 66%, with all but one being over 80%.

Causes for low compliance for VTE assessment of psychiatry inpatients include lack of knowledge of medical staff that this is a guideline/expectation when admitting patients and lack of knowledge of increased risk in psychiatric patients, and hence need for VTE risk assessment. Through education and engagement, this change has been effective in improving compliance of VTE screening. Improving assessment and education will hopefully in turn improve adherence to VTE prophylaxis and encouragement in improving dynamic risk factors (dehydration/immobility) by the whole MDT.

Assessing personality pathology in adolescence is crucial for early identification of issues that may manifest in adulthood. While adolescence involves typical “storm and stress”, some adolescents exhibit personality pathology beyond normative developmental challenges. Early assessment and intervention are key during this pivotal developmental period. The Shedler–Westen Assessment Procedure–Adolescent Prototypes (SWAP-AP) offers a promising clinical tool for assessing personality functioning. This study aimed to examine the construct validity of the SWAP-AP Emotionally Dysregulated prototype.

Adolescents and their parents (N=121) from a Long Island, NY suburban adolescent psychiatry outpatient clinic consented to participate in an assessment and treatment outcome study. Participants completed admission packets, including the BeckYouth Inventory (BYI), Inventory of Interpersonal Problems-32 (IIP-32), Youth Outcome Questionnaire (YOQ), and Youth Self-Report (YSR), prior to psychiatric evaluation. Intake psychiatrists independently completed SWAP-AP ratings based on clinical evaluation, before reviewing self-report or parent report data. Each SWAP-AP prototype describes a personality configuration in “experience-near” language, with clinicians rating the match on a 1–5 scale (5=prototypical example).

The sample included 52% male participants, 35% Caucasian, 32% African American, 23% Hispanic, 3% Asian, and 7% “other”, with an average age of 17.77 years (SD=3.23). Forty-five SWAP-AP ratings were completed by clinicians, paired with available patient and parent data. The Emotionally Dysregulated prototype significantly correlated with: BYI scales of self-concept (r =−0.33, p=0.03), anxiety (r=0.36, p=0.01), and depression (r=0.50, p <0.001); IIP-32 self-sacrificing (r=0.42, p=0.03) and intrusive/needy (r=0.37, p =0.05) scales; YOQ social isolation (r=0.48, p=0.01) and depression/anxiety (r=0.41, p=0.03); and YSR anxious/depressed (r=0.48, p <0.01), withdrawn/depressed (r=0.43, p <0.01), and social problems (r=0.41, p =0.01).

These results provide strong support for the construct validity of the SWAP-AP Emotionally Dysregulated prototype, which characterizes borderline personality pathology in adolescents. The observed correlations between clinician-rated SWAP-AP and patient self-reports align with theoretical expectations, indicating the prototype’s utility in capturing relevant psychopathology. Future research should investigate the predictive validity of the prototype matching approach and its sensitivity to treatment-related change.

Delusional Misidentification Syndromes represent disorders that are neuropsychiatric in nature. They include four main disorders: Capgras Syndrome, Frégoli Syndrome, Intermetamorphosis and Syndrome of Subjective Doubles. These syndromes are more noted in context of Schizophrenia but they can be encountered in other psychiatric disorders. Strokes and head traumas have also been implicated as contributing factors/causes for the development of these syndromes. Mainstay of treatment is antipsychotic medications.

75-year-old gentleman with no past psychiatric history, had a stroke that affected “posterior left insula and left temporal operculum”.A “right frontal and right parietal infarcts” were established on his head scan at the time. The right frontal infarct was present on an MRI three months prior but the right parietal one was not. Following the stroke, he presented with receptive and expressive dysphasia but no motor symptoms. There were elements of mild cognitive impairment but the main symptoms align with Delusional Misidentification Syndrome, subtype Syndrome of Subjective Doubles. He became convinced that there are people that look exactly like him, including “a brother who had facial surgery” to look like him. Of note, the patient does not have brothers. Another “double” is “someone who lives in a care home and is in a vegetative state”. Interestingly, the patient was residing in a care home for few months.

Timeline of events reflects that the patient lived alone independently in his home till he had a stroke and was admitted to hospital. Post-stroke rehabilitation efforts were not successful and he was discharged to a care home. After a while, the care home struggled to meet his needs due to emergence of frequent suspiciousness that led to aggressive episodes. He was later detained to a psychiatric ward for a period of assessment and treatment. The patient’s function and quality of life was clearly affected as a consequence of the stroke. Due to the patient’s dysphasia, it was difficult to understand his psychiatric symptoms. It took some time until his symptoms were pieced together indicating Delusional Misidentification Syndrome. Improvement noted once Olanzapine was started and dose increased up to 10mg.

Delusional Misidentification Syndromes are rare neuropsychiatric disorders that require treatment with antipsychotic medications. They also have some organic basis and some links to strokes and traumatic brain injuries. This case is vital in understanding the link between neurology and psychiatry and offers further notions to clinicians to reflect more on the organic nature of mental disorders.

Immersive virtual reality (VR) is increasingly being explored as a potential modality for the assessment and treatment of a range of mental health conditions, including anxiety disorders. To date, many of the VR interventions that have been developed for anxiety disorders draw upon the principles of exposure therapy, and a growing body of evidence has begun to demonstrate their efficacy. However, little is known about the ways in which the individuals for whom these interventions are designed perceive and experience them, despite the importance of understanding both patient and practitioner perspectives to enable effective intervention development and evaluation. The aim of this systematic review was to identify and synthesise the existing qualitative evidence-base in relation to exposure-based immersive VR interventions for the treatment of anxiety disorders.

We systematically searched PubMed, Scopus, Medline, Embase, PsychINFO, OVID interface, MedArXiv and PsyArXiv for qualitative and mixed-methods studies reporting patient and therapist perspectives, experiences and recommendations relevant to the focus of our review. In total, 9714 abstracts were screened and 954 full-text manuscripts were retrieved, with 12 studies meeting the review inclusion criteria. The qualitative results sections of articles were coded inductively line-by-line, and the data was synthesised using thematic synthesis.

Twelve descriptive themes and four analytical themes were generated through the analysis. The analytical themes were: 1. Contingent experiences of anxiety (facilitators of and barriers to experiencing symptoms of anxiety during VR exposure); 2. Learning beyond exposure (the ways in which participants experienced benefits from VR exposure that extended beyond the intended mechanisms of change underpinning exposure therapy approaches); 3. “Somewhere between being there and not being there” (the nature of an anxiety-provoking ‘reality’ that is virtual, and how experiences of the virtual world relate to experiences of anxiety in real life); and 4. The patient, the therapist, and the Head-Mounted Device (how VR exposure-based interventions might best be positioned and delivered in the context of psychotherapy, and how VR might present both benefits and barriers for patients, therapists, and for the therapeutic relationship).

This synthesis of the perspectives, experiences and recommendations of patients and therapists in relation to exposure-based VR interventions for anxiety disorders has a range of implications, for both practice and research. These include a number of recommendations for the design, delivery and evaluation of VR interventions for anxiety disorders, ensuring they better meet the needs of the people who use them.