Since 2022, rising living costs have intensified strain on families, leaving many families struggling to meet their basic needs. Economic instability increases the risk of adverse childhood experiences (ACEs), which are associated with long-term mental health (MH) challenges. This project aims to assess the impact of the cost-of-living crisis on children’s MH, focusing on the deprived area of Stoke-on-Trent. Following which, strategies to support children and families most affected will be explored both in terms of public health campaigns and strategies within mental health services.

Initially, a literature review evaluated national trends of the impact of cost-of-living crisis on child MH. More substantial qualitative data on such themes was then developed through interviews with local general practitioners, mental health charities, schools, family hubs, and community centres to gain a better understanding of the local impact so that targeted strategies could be developed.

The crisis has led to children more frequently exposed to neglect and other forms of abuse, increasing ACE exposure. Local charities noted higher food bank reliance among families, and GPs reported rising malnutrition cases. Adolescents in colder homes reported worsened MH symptoms, often due to effects of overcrowding and fuel poverty, including increased witnessing of domestic violence and increased risk of chronic respiratory infections, with chronic diseases known to have long-standing mental health implications. Children from financially unstable families faced bullying due to unclean uniforms, as heating and washing were unaffordable. Limited access to transport and technology prevented families from attending MH appointments, deepening health inequalities. Activities such as sports clubs or swimming lessons were often sacrificed to protect family finances, preventing young people from attending activities known to maintain their MH, and isolating them from their peers. Local community centres found their budgets affected, with cuts to adolescent substance misuse and violence programmes, contributing to increased numbers of first-time young offenders.

The cost-of-living crisis has amplified MH risks for many children, with more families experiencing financial insecurity and as such children experiencing ACEs. Recommendations to alleviate these effects include utilising principles of Make Every Contact Count, to identify and support struggling families as early as possible. Further considered are local programmes to expand school and community wellbeing services based on the ‘5 ways to wellbeing’ framework such as free activity programmes and social groups at family hubs. Furthermore, improving access to virtual MH appointments by supporting digital access through initiatives like ‘Tech 4 Families’.

Tobuild a Multiprofessional Neuropsychiatry educational network. To provide high standard educational meetings through complex case presentations which promote neuropsychiatry across the East Midlands.

Neuropsychiatry as a sub-speciality is not endorsed by the GMC, and as such formal training pathways do not exist for psychiatrists in the UK. The Neuropsychiatry Discussion Group (NPDG thereafter) is a monthly forum designed for clinicians across all levels and specialties to explore complex neuropsychiatric presentations. Each session a clinician presents a complex case that challenges diagnostic frameworks and treatment strategies. In the past 12 months we have expanded the network, hosted guest speakers from experts to trainees with an interest in neuropsychiatry and formalised the programme. We regularly have 70+ attendees across neighbouring trusts in the East Midlands and are continuously expanding the network to foster professional collaboration.

We base the programme on the RCPsych Faculty of Neuropsychiatry suggested syllabus to ensure curriculum coverage over the year and have developed a standardised feedback form for the sessions using a Likert scale as well as free text to collect data.

Analysis of participant feedback across multiple sessions demonstrated strongengagement and consistently high satisfaction with the educational content and delivery.The programme successfully incorporated a broad range of presenters spanning training grades and seniority, from CT1 trainees to Professors of Neuropsychiatry, reflecting an inclusive academic culture and exposure to varied perspectives. This breadth was frequently reflected in comments.

Quantitative data showed that participants rated the clarity of session objectives, clinical and academic relevance, and effectiveness of teaching methods predominantly at levels 4 and 5, indicating a high degree of perceived educational value and quality.

Qualitative feedback reinforced these findings. Attendees frequently emphasised the strengths of the case-based format, praising the sessions for their real-world clinical applicability, multidisciplinary input, and opportunities for collaborative discussion. The format was noted to support deep, reflective learning, particularly in areas where diagnostic and treatment paradigms are complex or evolving.

Ongoing evaluation will remain integral to the development of the group. We will continue to systematically collect and analyse participant feedback across sessions.

We are working with neighbouring trusts and organisations in order that attendance at the sessions can be used for CPD activity.

We aim to continue to widen the NPDG network, therefore fostering rich, cross-specialty dialogue. We wish to deepen clinical insight, share perspectives, and enhance collaborative care across the region.

A 38-year-old male with an 8-year history of schizophrenia presented with inadequate response to multiple antipsychotics and tardive dyskinesia. Tetrabenazine was initiated for dyskinesia, and Clozapine was started with gradual titration. On day 14, T. Clozapine was increased from 125 mg to 150 mg. Following this, the patient had an episode of sleep disturbances and purposeless motor movements that lasted for half an hour. Afterwards, the patient slept well, and the following day, his mental status examination revealed no new findings. The following night, 3 hours after receiving the second dose of Clozapine 150 mg, the patient developed disorientation, restlessness, and visual hallucinations. He was not cooperative with any instructions. Laboratory investigations, including haematological and metabolic parameters, were performed and were within normal limits. The acute onset of these clinical features supported the diagnosis of Clozapine-Induced Delirium.

Case Report

Management included immediate discontinuation of all medications. Pharmacological sedation with parental Lorazepam and Haloperidol was required. Even after this, the patient had to be retrained to start intravenous Ringer’s lactate for maintenance of hydration. Delirium subsided within 18 hours, and orientation returned without any residual deficits. S. Clozapine levels could not be done due to financial limitations. This adverse drug reaction suggests a probable link between Clozapine and Tetrabenazine, precipitating delirium, possibly through cholinergic-dopaminergic imbalance.

To the best of our knowledge, this is the first known case of its kind where the combination of Tetrabenazine with Clozapine, at relatively low dosage, has led to the life-threatening side effect of delirium. This case highlights the complexities of treating a patient who has become hypersensitive to both first-generation and second-generation antipsychotics, including Clozapine. While further research needs to be done regarding this unusual reaction, clinicians should remain vigilant for delirium during clozapine initiation, particularly when used alongside VMAT2 inhibitors such as tetrabenazine.

Dopamine agonists like cabergoline are considered first-line therapies for prolactin-secreting pituitary microadenomas. Although efficacious from an endocrinological perspective, the use of dopaminergic stimulation can potentially exacerbate or unmask psychiatric symptoms, including psychosis. The management of emergent psychosis in this scenario is a challenge, as antipsychotic dopamine blockade can potentially worsen hyperprolactinemia. Aripiprazole, a dopamine D2 partial agonist, is often preferred for its antipsychotic properties and relative prolactin neutrality; however, its efficacy in the treatment of severe psychosis while on dopamine agonist therapy is unclear.

A 29-year-old woman with a 12-year history of obsessive-compulsive symptoms, who had remained stable and had never been hospitalized, was diagnosed with hyperprolactinemia after the development of galactorrhea and menstrual disturbances. MRI showed a 6 mm pituitary microadenoma, and cabergoline 0.5 mg twice a week was started with good biochemical control. Shortly thereafter, she experienced severe psychiatric deterioration, including persecutory delusions, ideas of reference, refusal of food, severe self-neglect, and social withdrawal, requiring psychiatric hospitalization. Mental state examination showed prominent psychotic features coexisting with the patient’s previous obsessive phenomena.

Aripiprazole was started at 5 mg/day and gradually increased to 20 mg/day over three weeks, chosen for its partial dopamine agonist properties and prolactin-sparing action. Despite optimal dosing, good tolerability, and maintenance of prolactin levels, there was little relief from psychosis or behavioral disturbance. Because of persistence of severity, aripiprazole was stopped and olanzapine started at titrated upto 15 mg/day. An SSRI was continued for obsessive symptoms. Cabergoline was continued under strict endocrinological follow-up.

Within two weeks of the initiation of olanzapine, there was a marked improvement in persecutory delusions and behavioral disturbance, along with the return of appetite, sleep, and self-care, and partial recovery of insight. Serum prolactin levels remained within acceptable limits (46 ng/mL), and follow-up MRI at three months showed no progression of the tumor.

This particular case illustrates the shortcomings of aripiprazole in dealing with severe psychosis, especially in the setting of dopamine agonist therapy, even in the presence of theoretical endocrine benefits. In situations where endocrine function is substantially affected, psychiatric management may need to focus on effective antipsychotic therapy, with close interdisciplinary attention to minimize endocrine risk.

Starting a new post can be intimidating when induction varies between trusts. This project aims to look at doctors’ experiences with induction within different NHS trusts in the West Midlands. A secondary aim was to use the survey as a benchmarking exercise, comparing experiences at Birmingham Community Healthcare (BCHC) (psychiatry trainees rotate through intellectual disability (ID) placements) compared with other trusts. Initial audit identified limited understanding of MDT working in ID Psychiatry, highlighting need for greater support at induction.

An online survey was distributed to doctors who started posts in psychiatry across different NHS trusts. It had multiple choice and free text questions covering pre-start information, induction quality, IT systems and team inclusion. The standard was induction provides new trainees with timely IT access and clear understanding of MDT roles and referral confidence. Quantitative data was summarised as percentages, while free-textresponses were reviewed to identify common themes. Following identification of uncertainty around MDT working in BCHC a separate MDT confidence survey was distributed to assess trainee confidence in MDT referral process within ID service.

Initial survey comparing induction experiences across trusts in the West Midlands had 28 doctors respond. Clear pre-induction information reported by 61% of doctors. Overall induction rated as good by 64% with 21% rating it poor. 79% felt they had what they needed to be productive but access to key resources were delayed with 61% receiving laptop on day one, while 22% waited two weeks. Administrative issues reported by 57% of doctors in first week, 29% completed mandatory training in their time, but 93% of doctors felt welcomed. In contrast, BCHC implemented a structured induction and IT access at trust headquarters and appointments booked from the following week. The secondary survey focused on MDT confidence had nine resident doctors within BCHC complete it. 78% felt confident working within the MDT however confidence varied by referral type. 56% felt confident referring to physiotherapy compared to 44% for psychology and OT. 67% reported hesitating to refer, 56% delayed referrals and only 23% felt confident making timely referrals.

This benchmarking audit highlights a significant variation in induction experiences across trusts with lack of efficient processes. It highlights a lack of confidence to refer to our MDT colleagues within ID Psychiatry. Based on survey findings, targeted intervention of an MDT guide and teaching session for new trainees was conducted at BCHC for February 2026 intake. Survey on MDT confidence has been undertaken by the new cohort prior to the intervention and will be repeated in 6 weeks to assess impact of the new MDT guide for trainees.

To identify quantitative studies of patients with psychotic disorders prescribed second generation antipsychotics (SGAPs), measuring new-onset or worsening obsessive compulsive symptoms (OCS) after treatment, and to evaluate whether SGAPs induce or exacerbate these symptoms.

A systematic review was conducted using MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science, following PRISMA guidelines. Search terms covered psychosis, OCS and SGAPs. Of 2524 references retrieved, 1939 remained after duplicate removal. Screening by two independent reviewers identified 58 eligible abstracts, with 43 full-text studies included. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the most commonly used outcome measure.

Across 43 studies, 9044 participants with psychotic disorders were included, predominantly with schizophrenia (mean age 36 years). Clozapine was studied in 28 reports, with additional evidence for risperidone, olanzapine, ziprasidone and aripiprazole. Seventeen studies demonstrated statistically significant results, most associating clozapine with de novo OCS. Olanzapine was also linked to emergence or worsening of OCS symptoms, while adjunctive aripiprazole showed evidence of improvement in some cases. Most studies were observational, limiting causal inference.

Preliminary evidence suggests clozapine is associated with new-onset OCS, potentially mediated by 5HT2a and 5HT2c antagonism. The association is less clear for other SGAPs, though there is evidence that olanzapine can contribute to a worsening in severity of OCS or emergence of new-onset OCS, and evidence that adjunctive aripiprazole can improve OCS outcomes. Further longitudinal, prospective trials are required to clarify these associations.

To address (the outcome of) a survey (on patient safety) indicating resident doctors atthe Trust did not feel able to raise patient safety concerns, or that if they did these concerns would not be addressed.To increase resident doctor satisfaction by 20% in two years and improve two-way communication with Trust patient safety infrastructure.

This project utilised a sequential Quality Improvement (QI) methodology. The steps undertaken:

1. Baseline Assessment:Collated from the NHS national staff survey, Trust-wide DATIX reporting trends and specific survey for resident doctors to identify specific cultural and procedural barriers to safety reporting.

2. Governance and Advocacy:Representatives attended the monthly Trust Patient Safety Committee to represent frontline concerns. They acted as accessible points of contact for trainees, ensured “closed-loop” feedback on raised issues, and provided peer-led encouragement for formal DATIX reporting when indicated.

3. Closed-Loop Communication:A regular “Patient Safety Bulletin” was implemented to summarise key learnings, systemic issues, and specific resolutions using a transparent “You Said, We Did” framework.

4. Leadership Development:A programmewas launched allowing higher resident doctors to join internal Service Quality Reviews (SQR) as team members, to improve their experience of involvement in clinical governance.

5. Sustainability:To ensure project longevity, the representatives created a formal job description and offered the opportunity for resident doctors to undertake the role each year.

6. Evaluation:A repeat survey was distributed to resident doctors to measure the impact of the intervention against baseline metrics.

Resident doctors’ satisfaction with the reporting process rose from 13.5% (n=5/37) in 2025 to 65% (n=13/20) and confidence in effective action increased from 13.5% (n=5/37) to 60% (n=12/20) in 2026. 95% of resident doctors undertaking the survey found the trainee representative role and their actions helpful. Higher trainees provided positive feedback (n=7/7) on SQR involvement experience.

Other outcomes include resolution of a cross-site emergency protocol discrepancy, optimisation and promotion of ‘Consultant connect’ to enhance access to specialist physical health advice, and resident doctor representation at the Physical Health and Resus Committee.

Peer-led representation provides a structured mechanism to reconcile the gap between safety awareness and clinical action. By formalising the feedback loop through transparent communication and creation of opportunities for involvement, this model addresses the perceived futility of reporting and establishes a sustainable pipeline for medical leadership in (clinical) safety governance. This approach offers a reproducible framework for enhancing safety culture and trainee engagement across mental health services.

Current antipsychotic treatments in schizophrenia inadequately address negative and cognitive symptoms and are associated with significant metabolic side effects, contributing to poor adherence and relapse. This review evaluates and synthesises current evidence on the ketogenic diet in schizophrenia and identifies methodological limitations to inform future research.

A systematic search was conducted across PubMed, MEDLINE, Embase, PsycINFO, and Scopus using terms related to “ketogenic diet” and “schizophrenia”. Primary studies involving participants with schizophrenia receiving a ketogenic diet were included; animal studies, secondary analyses, non-ketogenic or exogenous ketone interventions, and non-English publications were excluded. Of 1177 records identified, 11 studies met the inclusion criteria and were appraised using Joanna Briggs Institute tools.

Across 11 studies involving 38 participants, with follow-up ranging from 2 weeks to 12 years, ketogenic diet interventions were associated with improvements in psychotic and mood symptoms, often observed within weeks. Several studies also reported improvements in metabolic markers and physical well-being and reduced antipsychotic use, including complete withdrawal in some participants. Greater adherence was reported when participants received structured support. Symptom relapse was reported following diet discontinuation, suggesting possible diet-dependence. Reported adverse effects were generally mild and transient.

Preliminary evidence suggests potential mental and metabolic benefits of the ketogenic diet in schizophrenia; however, current findings are limited by small sample sizes, reliance on case reports and pilot designs, and inconsistent adherence. Future large-scale, controlled trials should use standardised symptom measures and systematic reporting of psychiatric and metabolic outcomes to establish efficacy, safety, and comparability.

The authors have not received any financial sponsorship.

There is increasing recognition of the importance of personality functioning in children and adolescents. The introduction of a dimensional model to conceptualise personality disorders in the ICD–11 and the Alternative Model for Personality Disorders (AMPD) in Section III of the DSM–5, along with the removal of age as a criterion, enables personality disorders to be diagnosed in children and adolescents. This scoping review aimed to explore and map the existing research that included the assessment of the level of personality functioning in this population using an assessment tool.

This scoping review was pre-registered on Open Science Framework (OSF) Registries and conducted in accordance with JBI methodology for scoping reviews. Five databases were searched: Medline (EBSCO), PsycINFO (APA), CINAHL Complete, Embase, Cochrane Library. A limited search of grey literature from Google Scholar was conducted. Articles identified through citation searching of included sources of evidence were also included. A librarian was consulted to develop the search strategy. Key words and synonyms related to (i) children and adolescents, (ii) levels of personality functioning and (iii) assessment. Sources of evidence published up to 2025 and in any language were included. Screening was completed by two reviewers with conflicts resolved through consensus discussion and a third reviewer. One reviewer completed data extraction, and a second reviewer checked a proportion of the data. AI tools were used to translate articles notpublished in English. Covidence software was used to manage data and facilitate the identification of duplicate articles.

The search strategy retrieved 5191 sources of evidence, of which 544 duplicates were removed, 4501 were excluded during abstract screening, 90 during full-text review, and 2 were merged, resulting in a total of 55 sources of evidence in the final analysis. Publication dates ranged from 2011 to 2025, with 51% of publications since 2023. The majority (n=49) were research studies undertaken in 14 countries. Of which, 34 included a clinical population. Eighteen assessment tools were identified; 16 were self-report tools and were used in the majority (n=40) of research studies. The Levels of Personality Functioning Questionnaire for Adolescents (LoPF-Q 12-18) was the most frequently used measure in the studies (n=22).

There is increasing research on assessing levels of personality functioning in children and adolescents. Included sources of evidence report that future research should include larger, longitudinal evaluations, multi-informant data, and evaluate the utility of assessment tools across different clinical, demographic, geographical, and cultural settings.

Objective Structured Clinical Examinations (OSCEs) are a major component of summative assessment for final year medical students. Psychiatry OSCEs may pose particular challenges, including time management, rapport building and completing complex tasks such as capacity and risk assessment. A psychiatry OSCE practice course has been running for final year students at Brighton & Sussex Medical School for several years, but its ongoing impact and alignment with learner needs had not been formally evaluated. This quality improvement project aimed to evaluate the course and iteratively improve it using PDSA methodology, to ensure continued effectiveness and relevance.

Aim: To assess the impact of a psychiatry OSCE practice course on students’ self-reported confidence and preparedness, and to use structured feedback to inform iterative improvements to course delivery.

Pre- and post-course questionnaires were administered across multiple cohorts. Students rated confidence across relevant domains (psychiatry knowledge, psychiatry OSCE ability, preparedness for final OSCEs) and comparator domains (general OSCE ability, preparedness for final written exam) using Likert scales. Qualitative feedback was collected on perceived challenges, preferred case types and most useful elements of the course. Anonymised pre- and post-responses were paired using participant-generated identifiers. Following feedback, targeted changes were implemented between cohorts and evaluated through subsequent PDSA cycles.

Across cohorts, students reported increased confidence and preparedness following the course, with greater improvements in psychiatry-related domains than comparator domains. Confidence in psychiatry OSCE ability showed the greatest increase, improving by a mean of 1.4 points on a 5-point Likert scale. Examiner feedback and practice with repetition were consistently rated as the most valuable components.

Time management was the most frequently anticipated challenge and was in fact cited more often post-course. In response, two key changes were introduced for later cohorts: allowing up to two minutes for students to read OSCE instructions and choose when to begin, mirroring reasonable adjustments available in summative OSCEs; and providing a two-minute verbal warning before the end of the station. In cohorts following these changes, time management was less frequently cited as the most challenging aspect post-course.

This QI project demonstrates that a psychiatry OSCE practice course improves student confidence, and that iterative, learner-informed adjustments enhance realism, inclusivity and educational value. Simple changes to timing and communication addressed key student concerns, particularly around time management and accessibility. Ongoing evaluation will aid refinement and sustainability of the course. These findings may inform design of similar courses across other medical schools.

To increase the confidence of resident doctors in navigating pay, rota and ARCPrequirements, related to LTFT training following a targeted educational intervention at the August 2025 induction.

Around 25% of resident doctors in the UK now work LTFT (Less Than Full Time). However, many face issues with navigating training requirements, pay and rota arrangements.

A Quality Improvement (QI) approach was used to identify and address knowledge gaps among LTFT trainees.

A baseline questionnaire was first distributed to resident doctors at South West London and St George’s NHS Trust between June and July 2025 to identify common challenges. In response to these findings, a comprehensive induction presentation was delivered in August 2025 covering essential topics such as pay (nodal points, hourly rates, and flexible training premia), rotas (pro-rata leave and on-call obligations), and ARCP requirements (pro-rata assessments and adjusted completion dates). To evaluate the intervention’s impact, a post-induction questionnaire was subsequently administered to the August 2025 cohort of resident doctors at the Trust to measure improvements in trainee confidence levels.

Prior to the introduction of the Less Than Full Time (LTFT) induction session (June–July 2025), resident doctors reported low baseline confidence across all three areas of LTFT training evaluated, with mean scores of 2.3/5, 2.3/5 and 2.2/5 for pay, ARCP requirements and rota domains respectively.

Following the implementation of the LTFT induction session (August 2025), confidence levels showed a marked improvement among respondents. Mean confidence in navigating pay issues, ARCP requirement and the rota rose to 4.29/5, 3.9/5, and 4.3/5, representing an 86%, 68% and 95% increase from baseline respectively.

Qualitative feedback from the post-induction cohort was overwhelmingly positive, with 100% of trainees describing the presentation as “very clear and informative”.

Providing a dedicated LTFT session during induction significantly improves resident doctors' confidence in navigating the administrative hurdles of non-standard training. We are developing further guidance for resident doctors to be published on the Trust’s intranet.

Child and Adolescent Mental Health Services (CAMHS) are navigating a landscape of significant growth in service demand and increasing clinical complexity. To ensure long-term workforce sustainability and maintain the highest standards of patient care, it is essential to understand the various factors influencing staff well-being. This project, undertaken as part of the Royal College of Psychiatrists Leadership Fellowship, sought to evaluate the current well-being landscape across a multi-disciplinary CAMHS workforce. The goal was to identify existing protective factors and pinpoint areas where additional systemic support could be optimised to foster a resilient and stable work environment.

A baseline assessment was conducted involving 65 multi-disciplinary staff members, including practitioners, psychologists, psychiatrists, and administrators. Using the Copenhagen Burnout Inventory, the project measured three domains: Personal, Work-related, and Client-related well-being. Qualitative feedback was also gathered, identifying primary stressors and the visibility and perception of existing organisational support, providing a data-driven foundation for future Plan–Do–Study–Actcycles, ensuring that subsequent interventions are tailored to the service's needs.

Preliminary findings as of February 2026 indicate a large variation in response rates across teams. While staff remain committed to their roles, notable pressures exist regarding personal (Mean=65.4) and work-related (Mean=55.0) well-being. Significantly, client-related burnout was lower (Mean=40.8), suggesting that direct clinical work remains relatively rewarding. Data identified workload, case complexity, and administrative processes as primary areas for attention.

Qualitative themes highlighted interpersonal support as a significant strength; peer and line-manager relationships were the highest-rated positive influences on resilience. The assessment identified an opportunity to improve visibility of Trust-wide initiatives, as nearly half of respondents were either unaware of available offerings or felt they lacked CAMHS-specific tailoring. This has led to a proposal for creative arts therapies as a tailored resource; these interventions have shown promise in other settings. Feasibility, training, and impact assessment for these are currently under discussion.

CAMHS staff demonstrate high dedication despite systemic pressures. While the strong culture of peer support provides a vital foundation, workforce stability requires both increased resource accessibility and the development of newer, tailored support models. These findings will be shared with the Children and Young People’s Mental Health Board for collaborative action planning. Further breakdown of responses that are team and role-specific will help address locational and job-specific burdens, fostering closer engagement between the Trust and staff to mitigate attrition and ensure a sustainable model of care for the future.

Effectively adapting a SEDU in the management of patients with T1DE – challenges, multi-professional working, capacity, and consent in determining outcomes.

Background: Individuals with disordered eating and T1DE pose a challenge across services, due to complications that arise from the interplay of this two-in-one condition, which could be life threatening.

The insidious onset of disturbed eating and its progression to disordered eating behaviours has been recodified in newer diagnostic manuals. Patients with type 1 diabetes mellitus (T1D) remain a source of consternation to professionals and families. Type 1 diabetes mellitus and disordered eating (T1DE), previously known as diabulimia, is not uncommon.

The UK APPG on Eating Disorders emphasise the need for adequate resourcing with integration of services. In response, the Royal College of Psychiatry annexe to MEED addresses diagnoses by highlighting key criteria.

Re-adapting for T1DE involved: training on T1D with diabetic specialists regarding CGM devices, traditional finger-prick testing, insulin pen management, meal planning and insulin dosing, carb-counting (DAFNE); Implementing the T1DE Behaviour Checklist, and our Quick Guide to Diabetes Management in Patients with T1DE.

Other interventions: Medical - monitoring pre/post-meal BG, serum ketones etc., Psychology – EDE-Q, PHQ-9, GAD-7, fear hierarchy, OT – MOHO-based assessment of function including exposure, Dietetic - carb and calorie counting tools, Nursing care planning with physical monitoring. Family therapy, goal planning with community ED, PC and KCL national T1DE services and application of the MHA. Pre-screening for neurodevelopmental disorders, personality disorders and common mental health conditions.

150 admissions were recorded over 24 months with complexities such as ASD, ADHD, trauma, personality disorder and self-harm being prevalent. We admitted three of four T1DE referrals – one under section 2 of the MHA, rescinded prior to discharge, and the other informal reassessed and detained under section 3, subsequently rescinded five months later. The third remained informal throughout admission. Outcomes include improvement in binge purging or restriction (>6000kcal to approximate 1800kcal daily), HBs-489C by 30-40%, weight stabilisation, and adherence to insulin doses and administration. There were marked improvements in distress tolerance, EDE-Q and anxiety scores. Two patients returned to employment or university. They responded positively to reinstating antidepressants and one to stimulant treatment.

The service adapted, utilising expert support whilst exploring innovative interventions to facilitate treatment of T1DE. Challenges encountered reinforce the need for clinicians to address barriers and improve engagement by applying a reflective MDT approach. Aligning with patients and family goals is crucial for sustained outcomes.

Background: Armed conflict severely disrupts the continuity of psychiatric care, particularly for patients dependent on long-term psychotropic medication. During the recent Gaza war, widespread displacement of patients and medical personnel and destruction of the health service infrastructure created unprecedented barriers to treatment continuity. Mental health professionals were compelled to develop innovative, context-specific solutions to prevent clinical deterioration and safeguard patient stability.

Aims were to identify the main challenges affecting psychotropic medication adherence among war-affected patients in Gaza and to describe adaptive strategies that supported treatment continuity under crisis conditions.

This study was conducted between October 2023 and January 2024 within five community mental health centres and two psychiatric hospitals in Gaza. This was a mixed-methods study, that used triangulated data from semi-structured interviews with clinicians, focus group discussions with multi-disciplinary teams, clinical records and medication tracking data. Thematic analysis of interviews and focus groups was used to identify recurring patterns of non-adherence, contributing factors, and responsive interventions. Themes were identified and refined through iterative discussions to ensure they reflected clinical observations across sites. Descriptive statistics were used to describe reasons for medication interruption as recorded in clinical records.

Medication discontinuation was due to drug shortages (45%), forced displacement (33%), and restricted mobility caused by security risks (22%). Thematic analysis identified several adaptive strategies: decentralised medication distribution through NGO partnerships, telepsychiatry follow-ups, substitution with pharmacological equivalents, and family engagement in adherence monitoring. Clinicians reported that these strategies reduced relapse rates and preserved treatment stability in most high-risk cases.

Maintaining psychotropic medication adherence during armed conflict is both a clinical and ethical imperative. The Gaza experience demonstrates that flexible, community-driven, and ethically grounded models of care can sustain treatment continuity in extreme humanitarian settings. Strengthening emergency medication supply chains and integrating psychosocial support into humanitarian response frameworks are essential to protect psychiatric outcomes in conflict-affected populations.

The Mental Capacity Act (MCA) 2005 requires healthcare professionals to assess a patient’s capacity to make decisions about their treatment and care. When a patient lacks capacity, a best interest assessment (BIA) must be completed to guide safe and lawful decision-making. Ensuring timely and accurate completion of these forms is essential for safeguarding patient rights and maintaining compliance with legal and Trust-wide standards.

The aim of the audit is to evaluate the completeness and timeliness of Mental Capacity Assessments (MCA) and Best Interest Assessments (BIA) completed for all new admissions to older people’s Ward between 1 January and 30 June 2025, in alignment with the MCA 2005 and local Trust policy.

A retrospective review of the Trust’s patient information system was conducted to identify all admissions to older people’s Ward during the study period. Transfers from other mental health wards were excluded, and readmissions were counted once. For each admission, the following were recorded: admission status (informal, MHA sections, or DoLS), whether an MCA was completed within 24 hours, capacity outcome, and whether a required BIA was completed within 24 hours. Copies of completed MCA and BIA forms were reviewed for completeness and quality of documented rationale. Data were recorded and analysed using Microsoft Excel.

Thirtytwo patients were admitted during the study period. Most admissions were under section 2 of the Mental Health Act (75%), with additional admissions under section 3 (6%), DoLS (3%), and informal status (16%). MCA forms were completed within 24 hours for 84% of admissions, while 16% were not completed in the required timeframe. One patient (3%) required a BIA; however, this was not completed within 24 hours. All completed MCA forms demonstrated full completion of required sections with clear rationales documented.

The majority of patients admitted to older people’s Ward received timely and welldocumented capacity assessments; however, delays remain in a minority of cases, including the timely completion of BIAs. These findings highlight the need for improved consistency in meeting the 24hour documentation requirement and suggest potential areas for staff training, workflow improvement, and strengthened oversight to ensure full compliance with the Mental Capacity Act 2005.

Bangladesh is one of the most densely populated countries globally and carries a substantial burden of mental illness. National survey data estimate the prevalence of mental disorders at approximately 16.8–18.7% among adults and 13–14% among children, alongside a marked treatment gap, with over 90% of affected individuals not receiving formal mental healthcare. Public psychiatric services remain limited in capacity, are geographically concentrated in urban centres, and are often characterised by delayed presentation, prolonged inpatient stays, and poor continuity of care. In this context, private psychiatric hospitals are increasingly accessed in urban areas. There is little published evidence describing the service role, clinical acuity, and patient profile of private-sector psychiatry in low- and middle-income countries.

Aim: To describe the clinical, sociodemographic, and service characteristics of patients admitted to a private psychiatric hospital in Bangladesh and to contextualise these findings within international psychiatric service models.

A retrospective descriptive review was conducted of consecutive inpatient admissions to The HUB over a ten-month period (April 2025 – January 2026). Patients accessing only outpatient or triage services were excluded. Anonymised data were extracted from routine clinical assessment documentation, including age, gender, socioeconomic background, education and employment status, psychiatric diagnosis, prior treatment history, risk factors, legal status, and admission pathways. Data were analysed descriptively.

The cohort comprised 44 consecutive inpatient admissions. Patients were predominantly adults, with a male predominance of approximately 60%. Most patients were from upper or upper-middle socioeconomic backgrounds and demonstrated relatively high educational attainment, including undergraduate and postgraduate qualifications. Employment status was heterogeneous, encompassing professionals, business owners, students, and unemployed individuals.

Majority admissions reflected established psychiatric illness rather than first-episode presentations. The majority of patients had a documented history of prior psychiatric treatment, frequently within private healthcare settings. Notably, over three-quarters had previously received psychiatric care outside Bangladesh, indicating prominent international care pathways. Diagnostic profiles included mood disorders, psychotic disorders, anxiety-related disorders, and substance-related conditions, consistent with a broad general adult psychiatry case mix.

Clinically significant risk was common. Approximately one in six patients had a history of self-harm, and a similar proportion presented with behavioural disturbance or aggression. Suicidal ideation was documented in a subset of cases, although recording was variable across assessments. Admissions occurred via both planned and acute or crisis pathways. While many patients were admitted voluntarily, some required higher levels of containment and intensive risk management.

This study demonstrates that private psychiatric hospitals in Bangladesh manage patients with substantial clinical complexity, risk, and prior treatment exposure, challenging assumptions that private-sector psychiatry predominantly addresses low-acuity or elective care. The observed service and clinical profile shows important parallels with private services in high-income countries. These findings support the inclusion of private-sector data in global mental health research and highlight private hospitals as important components of mental health systems where public capacity is limited.

Clozapine is the most effective treatment for treatment-resistant schizophrenia but is associated with a high risk of constipation which can lead to serious and potentially fatal complications if not recognised and managed early. This Quality Improvement Project (QIP) aimed to enhance the monitoring of clozapine-related constipation on Sunstone Ward by increasing the proportion of clozapine-treated patients with a fully completed Bristol Stool Chart (BSC) and constipation symptom screening documentation to 100% by mid December 2025.

This QIP was conducted on Sunstone Ward, a 17-bed male high-dependency rehabilitation unit. Baseline data were collected in April 2025 through retrospective review of clinical documentation for clozapine-treated patients.

Four Plan–Do–Study–Act (PDSA) cycles were implemented between June and December 2025. Interventions included daily assigned nurse-led bowel movement assessments using the BSC, structured documentation prompts, routine review of BSCs during ward rounds, increased patient engagement in reporting bowel habits, and a targeted staff teaching session on clozapine-related constipation.

Outcome measures were the percentage of clozapine-treated patients with fully completed BSCs and constipation symptom screening documentation.

Baseline data showed poor monitoring, with only 25% of patients having a fully completed BSC and 37.5% having documented symptom screening. Following PDSA Cycle 1, modest improvements were observed (BSC 50%, symptom screening documentation 62.5%). In PDSA Cycle 2, BSCs were routinely reviewed during ward rounds, leading to marked improvement in compliance (both measures 87.5%). PDSA Cycle 3 focused on patient engagement, resulting in BSC completion reaching 100%, although symptom screening documentation plateaued at 87.5%. Following a targeted staff teaching session in PDSA Cycle 4, both BSC completion and symptom screening reached and were sustained at 100% by mid December 2025.

This QIP demonstrated that clozapine-related constipation monitoring can be significantly improved through daily assigned nurse-led bowel assessments, structured documentation prompts, routine review of BSCs during ward rounds, patient engagement and staff education. While early interventions improved compliance, patient engagement and staff teaching were key to achieving full and sustained monitoring. Embedding bowel monitoring into routine inpatient care enhances patient safety and reduces the risk of seriouscomplications. The approach is sustainable and transferable to other inpatient mental health settings whereclozapineis prescribed.

In the West Midlands, limited addiction placements and a shortage of suitably endorsed assessors have made it difficult for core psychiatry trainees to meet revised RoyalCollege of Psychiatrists (RCPsych) curriculum requirements, including completion of two addiction-specific workplace-based assessments (WPBAs). Without targeted intervention, trainees risk failing to demonstrate required competencies, with implications for future specialist workforce capacity as there continue to be fewer addiction psychiatrists working in substance misuse services.

Aims were to improve access to, and quality of, addiction psychiatry training opportunities for core psychiatry trainees in the West Midlands, with a particular focus on enabling completion of curriculum-mandated addiction workplace-based assessments (WPBAs).

Baseline data were obtained from a cross-sectional review of ARCP outcomes in December 2024 which showed trainees were struggling to meet their addiction workplace-based assessment (WPBA) requirements. We focused on four intervention methods: (1) assessor training in completing addiction workplace-based assessments (WPBAs), (2) development of a regional assessor network and addiction training plan for each Trust in the region, (3) experience and special interest days within addiction services with opportunities to complete assessments, and (4) expansion of addiction teaching within the MRCPsych programme.

Outcome and process measures included proportion of trainees meeting addiction WPBAs requirements, number of trained assessors, availability of more learning opportunities, and trainee feedback.

At baseline, none of 13 core trainees in the baseline data had completed the required two addiction WPBAs, although 11 had completed one. Assessor training sessions were organised which generated positive feedback and volunteers leading to the development of anaddiction training plan for each Trust with directory of assessors. Experience days enabled trainees to complete assessment of clinical expertise (ACEs) and case-based discussions (CBDs) with appropriate supervision and were associated with improved confidence and engagement with addiction psychiatry. By the June 2025 ARCP, all CT3 trainees had completed the required addiction WPBAs.

This project shows that practical, system-level changes can make a meaningful difference to trainees’ access to addiction training and their ability to meet curriculum requirements. In particular, developing assessor capability, prioritising experiential learning, and working collaboratively at a regional level were central to progress. Ongoing senior leadership is needed to sustain this momentum so that the changes can be embedded into routine practice, and to ensure equitable access across regions.

This case report reviews a rare presentation of a young male patient presenting with Catatonia, who was later diagnosed with Wilson’s Disease (WD), and explores the diagnostic challenges faced with atypical neuropsychiatric presentations and how this affects long-term outcomes.

A previously healthy Caucasian man in his early-30’s presented with acute-onset catatonia over 48 hours, characterised by social withdrawal, psychomotor retardation, staring spells, and posturing. He was initially diagnosed as having catatonia with depression and psychotic symptoms and treated with Lorazepam, Sertraline, Promethazine, and Olanzapine. Over the proceeding few months he deteriorated, showing signs of tremulousness, muscle rigidity with autonomic features, and hyper-reflexia. MRI Head demonstrated abnormal signal intensity in the corpus striatum, ventrolateral thalami, and brainstem, with basal ganglia and substantia nigra hypointensity on SWI sequences suggestive of iron or mineral deposition. Blood tests revealed low caeruloplasmin (0.1g/L), elevated 24-hour urinary copper excretion (5.37umol/24h), elevated CK (1907 U/L), and elevated ALT (105U/L). Kayser-Fleischer Rings were evident on ophthalmology assessment, Liver Ultrasound revealed a coarse irregular liver, and genetic studies confirmed mutations in the ATP7B gene. He had no family history of liver or movement disorders. He was treated with penicillamine, zinc supplements, muscle relaxants, and anticholinergics with no paradoxical worsening.

Wilson’s Disease (WD) is a rare inherited autosomal recessive disorder of copper metabolism resulting mainly in neurological and hepatic pathology. However, in 10-25% it can present with progressive neuropsychiatric symptoms, often resulting in delayed diagnosis for up to 65-months. Notable psychiatric manifestations include personality and mood disorders, sleep disturbance, cognitive impairment, and occasionally psychosis. Rarely, WD can present with Catatonia – a neuropsychiatric syndrome characterised by mutism, stupor, posturing and catalepsy, echolalia and staring. Research suggests that up to 65.6% of patients with WD are initially misdiagnosed, prolonging commencement of treatment and potentially worsening patient outcome. Copper chelation therapy with D-Penicillamine and Zinc can in some cases reverse neuropsychiatric manifestations in WD, and if these are not tolerated Trientine Dihydrochloride is a possible second line agent.

Wilson’s Disease (WD) is a rare condition with a vast range of clinical manifestations, and prompt diagnosis can improve patient outcomes. This case highlights the importance of having a high index of suspicion for WD, particularly during refractory acute-onset psychiatric presentations, and notably for those with no personal or familial psychiatric history. Diagnostic tools include testing for caeruloplasmin levels, 24-hour urinary copper excretion, ophthalmology assessment, MRI Head scanning, and ATP7B genetic testing for diagnostic confirmation.