Severe psychiatric illness (SPI), defined as schizophrenia and related psychoses, bipolar disorder (BPAD), and depression with psychosis, is associated with a reduced life expectancy of 15–20 years, largely attributable to physical illness.

SPI, and the sometimes-compulsory treatments, are associated with adverse effects on physical health, while other illness features like impaired decision-making ability, abnormal mood, and negative symptoms can impair engagement with health services. Consequently, regular monitoring and proactive management of physical illnesses are especially important. For these reasons, General Practice (GP) patient registers and outreach were previously considered necessary; however, the Quality and Outcomes Framework (QOF), which paid GPs to perform these roles, was withdrawn in Scotland in 2016 and cut back in England in 2025.

Therefore, we undertook a service evaluation of physical health monitoring in CMHT SPI outpatients. A constituent survey of contact with primary care services is reported here.

CMHT keyworkers recorded BMI and asked their SPI outpatients when they last saw their GP and when physical health was last discussed in primary care.

Schizophrenia (n=212): 41% obese; schizoaffective disorder (n=11): 70% obese; BPAD (n=23): 56% obese; depression with psychosis (n=6): 80% overweight or obese; and delusional disorder (n=2). Among SPI patients with BMI ≥30, 47.1% had not seen their GP in over a year; for BMI ≥35, the figure was 46.5%; and for BMI ≥40, 45%. Overall, 51%(n=134) SPI patients thought they had seen their GP in the previous year, and only 36% (n=94) reported discussing physical health with a primary care provider during that time.

32% of Scottish adults are obese, and 92% report seeing their GP at least annually, with contact rates higher among those with limiting long-term conditions. This contrasts with our SPI patient data, in which most were obese and only around half could recall seeing their GP within the past year, with only 36% recalling any discussion of physical health.

In 2012, SPI patients saw their GPs approximately three times annually. Our data suggest this level of engagement has declined markedly since then. As noted, the QOF incentives for GP management of the physical comorbidities associated with reduced life expectancy in SPI have been withdrawn in Scotland and cut back in England; this may have compounded an existing healthcare inequality and geographical disadvantage.

These data will be expanded to advocate for better community management of the physical health risks faced by people with SPI.

Psychiatry inpatient staff are frequently exposed to patient aggression, including verbal abuse and physical threats. While aggression is widely recognised as a workplace hazard, the relative contribution of different aggression types to staff burnout remains poorly explored. Therefore, we aim to examine the association between patient aggression exposure and burnout among psychiatry inpatient staff.

We conducted an anonymous cross-sectional survey of inpatient psychiatry staff (n=115) across multiple ward types. Burnout was measured using a 7-item composite scale (Cronbach’s α;=0.915), which was approximately normally distributed (Shapiro–Wilk p=0.147). Exposure to patient aggression over the preceding six weeks was assessed using frequency-based Likert items covering verbal aggression, threats of harm, attempted assault, physical assault, sexual harassment, and racist or discriminatory abuse. Analyses included Pearson correlation, one way ANOVA to assess dose response relationships, and multivariable linear regression adjusting for professional role group, years working in psychiatry, and work pattern. All statistical analyses were performed using IBM SPSS Statistics.

Mean burnout score was 1.92 (SD 0.87). Verbal aggression was reported by 93.9% of respondents, with 41.8% experiencing it weekly or more often. Other aggression types were also common, including threats of physical harm (73.9%) and physical assault (58.3%).In unadjusted analyses, burnout was positively correlated with verbal aggression frequency (r=0.21, p=0.024), but not with other aggression types. Mean burnout differed significantly across verbal aggression frequency categories (F (5,109)=2.43, p=0.040), demonstrating a dose response pattern. In multivariable regression, verbal aggression remained independently associated with higher burnout scores (B=0.16, 95% CI 0.03–0.29; p=0.014).

Among psychiatry inpatient staff, frequent verbal aggression is common and shows a dose response association with burnout. These findings highlight verbal aggression as a key occupational stressor and a potential target for prevention strategies in inpatient psychiatric settings.

Pineal cysts are frequently identified as incidental findings on neuroimaging and are generally considered benign. However, the pineal gland plays a central role in melatonin secretion and circadian rhythm regulation, processes closely linked to mood stability, sleep, and affective vulnerability. Neuropsychiatric presentations occurring alongside pineal cysts, particularly during hormonally and circadian-sensitive periods such as the perinatal phase, remain poorly understood.

This case report describes a 37-year-old woman, employed as a nurse, who experienced recurrent affective episodes over a ten-year period. A comprehensive psychiatric assessment was conducted. Neuroimaging findings were reviewed alongside neurological and psychiatric management. The patient’s clinical course across four episodes was documented, with particular focus on the most recent episode occurring in the postpartum period and managed using a multidisciplinary team approach.

The patient experienced four episodes characterised by manic symptoms such as elevated and labile mood, marked anxiety, reduced need for sleep, and transient psychotic features. No depressive episodes were reported. The most recent episode occurred approximately four months postpartum, following a stressful Caesarean section and significant sleep disruption related to infant care. There was a family history of depression but no history of neurological symptoms. Magnetic resonance imaging during the first episode identified a pineal cyst measuring 8 mm with a well-defined rim which remained stable on subsequent imaging and demonstrated no mass effect on adjacent structures. Neurological assessment concluded that no surgical or disease-specific intervention was indicated. Psychiatric management consisted of low-dose olanzapine, short-term sedative medication, and supportive interventions targeting sleep restoration, resulting in good symptomatic recovery after each episode. Prominent sleep–wake cycle disruption was a consistent feature across all presentations. Melatonin was not prescribed, though its potential role in sleep regulation and relapse prevention was considered.

This case illustrates the diagnostic complexity that arises when recurrent affective symptoms coexist with incidental neuroimaging findings. Although a causal relationship between pineal cysts and affective episodes cannot be established, the pineal gland’s role in circadian regulation suggests a possible indirect neuroendocrine contribution, particularly during the perinatal period. The case highlights the importance of integrating neurobiological, circadian, and phenomenological perspectives in psychiatric assessment and management.

Metabolic dysfunction is a major driver of excess morbidity and premature mortality in people with severe mental illness (SMI). Converging evidence suggests that disturbances in brain energy metabolism may contribute to psychiatric symptoms in SMI. Despite growing interest in metabolic psychiatry, research in this area has largely been shaped by academic priorities, with limited structured input from people with lived experience, carers, or front-line professionals regarding which metabolic interventions and outcomes matter most to them. Consequently, evidence to guide metabolic approaches that improve physical and mental health outcomes in SMI remains fragmented and poorly aligned with stakeholder priorities. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) for Metabolic Interventions in SMI was established to identify and prioritise research uncertainties that matter most to people with lived experience, carers, and professionals.

The PSP followed the five-stage JLA methodology: defining scope, gathering questions, refining and verifying uncertainties, interim prioritisation, and a final consensus workshop. An international open-call survey collected research questions from people with lived experience of SMI, carers, and professionals. Submissions were thematically synthesised into summary questions and checked against evidence through an umbrella review of meta-analyses to identify unanswered uncertainties. Verified uncertainties were ranked in an online survey. A structured, facilitated online workshop using nominal group techniques produced the final Top 10 priorities.

In the first survey, 456 participants submitted 1,439 research questions. After removal of out-of-scope submissions and qualitative synthesis, 51 summary questions across 13 thematic domains were generated. Evidence checking identified two questions as adequately answered, leaving 49 verified uncertainties. In the interim prioritisation survey, 317 participants ranked these uncertainties, producing a shortlist of 19 questions. Thirty stakeholders (16 with lived experience or carers; 14 professionals) took part in the final online workshop. The resulting Top 10 priorities focused on dietary interventions, combined lifestyle strategies, GLP-1 receptor agonists for medication-related weight gain and potential mental health benefits, micronutrient deficiencies, physical activity, metabolic effects of psychiatric medications beyond weight gain, gut-brain mechanisms, brain changes associated with metabolic improvement, and the role of ketone bodies in symptom improvement and remission.

This PSP establishes the first stakeholder-driven research agenda for metabolic psychiatry in SMI, identifying priorities that integrate diet, physical activity, pharmacological adjuncts, and mechanistic pathways linking metabolic and mental health. The Top 10 priorities provide a translational roadmap for future trials, mechanistic studies, and implementation research aimed at reducing cardiometabolic inequalities and improving psychiatric outcomes in SMI.

This work was funded by UK Research and Innovation (UKRI) through the Hub for Metabolic Psychiatry.

Depression is common amongst young adults and is frequently managed in primary care. Antidepressant medications are commonly initiated or adjusted, however the early stages following this are associated with an increased risk of suicidality in those aged 18-25 years, with the highest risk being observed within the first 28 days of treatment. NICE guidelines therefore recommend close monitoring of this group, including review within one week of initiation or dose increase, followed by further review no later than four weeks. The aim of this audit was to assess compliance with NICE guidelines for follow-up after initiation or dose increase of antidepressant medication in those aged 18-25 years in a primary care setting

A retrospective audit was conducted in a primary care setting. Electronic medical records were used to identify patients aged 18-25 who were either newly prescribed or had a dose increase of an antidepressant between October 2025 and January 2026. 95 eligible patients were identified, of which 55 were randomly selected. The data collected included the timing and mode of follow-up. The standards that were measured were if patients had been reviewed within one week and within four weeks of antidepressant initiation or dose increase.

3/55 patients (5.5%) were seen within one week and again within four weeks, thus fully compliant with the guidelines. However, only 4/55 patients (7.3%) were reviewed within one week and 8/55 (14.5%) were followed up within four weeks. 35 patients were reviewed during the study period, but not within the recommended guideline timeframes. 12 patients had no documented follow up review since medication initiation. Where reviews occurred, they were most commonly conducted via telephone consultation.

This audit identifies opportunities for improvement in adherence to NICE guidelines for follow-up of antidepressant treatment in young adults within primary care. Given the prevalence of antidepressant prescribing and recognised vulnerability of this age group, untimely follow-up may represent a patient safety concern at a population level. System based interventions to support routine early review may improve adherence, such as automatically booking a 1-week follow-up telephone review at the time of antidepressant initiation or dose increase. Followed by implementing clear pathways for urgent review and escalation if suicidal ideation is identified during follow-up.

We aimed to compare findings from the first year of the NHS Wales 111 Press 2 mental health service and the CAMHS Crisis Connect (CCC) service that had been developed by the CAMHS Service in the Government of Western Australia.

We aimed to explore the commissioning and evaluation of these services, identify cross-national learning opportunities, and develop future models of mental health care in Wales that align with a “no wrong door” approach to support.

We utilised a mixed-methods approach to evaluate service impact across two continents. For the Welsh 111 Press 2 service, researchers conducted a comprehensive review of 12 months of operational data (over 100,000 calls), utilising deprivation mapping against the Welsh Index of Multiple Deprivation (WIMD) to understand local need.

For the Western Australian CAMHS Crisis Connect (CCC) service, an Interrupted Time Series (ITS) analysis was employed to evaluate hospital resource utilisation - including emergency department (ED) presentations and inpatient admissions - between 2014 and 2024.

Findings were presented at a roundtable that was hosted by the Learned Society of Wales, and further visual illustration was provided to capture findings. The roundtable had input from experts by experience, policy professionals, researchers and clinicians from both Wales and Australia.

• • NHS Wales 111 Press 2: Over 100,000 calls were received in the first year, with 99% of callers reporting a reduction in distress following triage. Approximately 50% of cases were resolved with self-care advice, while 10% required immediate crisis intervention.

• • Western Australia CAMHS Crisis Connect: The ITS analysis demonstrated a 29% reduction in ED presentations for mental health concerns and a 28% decrease in inpatient admissions directly attributable to the service's introduction.

• • Geographic Insights: Deprivation mapping in Wales revealed unexpected call patterns, such as high rates of suicidal ideation calls from affluent areas, highlighting the need for localised awareness strategies.

We conclude that specialised mental health crisis lines can be effective in de-escalating distress and reducing the burden on acute hospital resources.

Future development should focus on co-production with young people, improving digital accessibility (e.g., via TikTok or WhatsApp), and utilising predictive analytics to manage demand during external events like climate hazards or economic shocks.

A formal partnership between Wales and Western Australia will continue to drive comparative research and data-driven service improvements.

Paternal postpartum depression (PPD) is an emerging concern globally but remains under recognized in low-resource and patriarchal societies. In Pakistan, sociocultural stigma and lack of mental health infrastructure may exacerbate this burden. This study aimed to assess the prevalence of paternal PPD, identify associated risk factors, and evaluate awareness among Pakistani fathers.

A cross-sectional, multicentre study was conducted across three provinces of Pakistan, enrolling 475 fathers of infants under one year of age. Participants completed the Beck Depression Inventory (BDI) and a structured questionnaire covering demographics, reproductive history, awareness of PPD, and psychosocial stressors. Statistical analyses included t-tests, chi-square tests, ANOVA, and Pearson correlation.

A BDI score ≥10, indicating mild or greater depressive symptoms, was observed in 70.1% of participants, while 10.1% had severe symptoms suggestive of clinical depression. Only 19.4% of fathers were aware that men could experience PPD. Significant associations were found between paternal depression and maternal PPD (p=0.002), adverse life events (p=0.003), and lack of family support (p=0.045). Age showed a weak positive correlation with depression severity (r=0.19, p<0.001). No significant associations were observed for occupation, number of children, awareness, or access to leave policies. A majority (94.7%) reported no access to paternal mental health services.

This is the largest study to date on paternal PPD in Pakistan, highlighting a substantial burden of depressive symptoms among new fathers. Cultural stigma, poor awareness, and lack of support structures contribute to under-recognition and under-treatment. Multi-level interventions to address paternal PPD, including but not limited to screening strategies, paternal-inclusive care, and public education are urgently needed

To understand the influence of adjuvant ketogenic diet on behavioural dysregulation in individuals with bipolar disorder through a review of the available literature.

A systematic review was conducted across the databases of Medline Ovid, PubMed, PsycINFO, the Cochrane Library, and the University of Sheffield Star Plus library, following the PRISMA guidelines. Relevant articles were identified using Inclusion and Exclusion criteria. Critical appraisal tools (the Critical Appraisal Skills Programme (CASP) and the Joanna Briggs Institute (JBI)) were used to assess the quality of the selected publications.

Twenty-two articles were identified as suitable for the review. Out of this, 10 were systematic reviews, and 6 were case reports. Eighteen publications have deduced that ketogenic diets aid in stabilising mood.

The review identified that ketogenic diets have the potential to reduce behavioural dysregulation in bipolar patients. The descriptive analysis suggests the need for additional clinical research, as the available studies were mainly uncontrolled and included a limited number of participants.

In a community mental health setting, we studied real-world relapse rates in patients with a history of psychosis, before and after switching from oral antipsychotics to a long-acting injectable antipsychotic (LAIA). We also aimed to evaluate the relevance of metabolic/demographic factors in relapse rate.

Twenty-five individuals with a past history of psychosis and variable medication concordance who were switched from oral antipsychotics to LAIAs were included in the study. Oral agents were converted to olanzapine equivalents whilst LAIA generics were converted to flupenthixol depot equivalents. The depot equivalent oral dose of olanzapine was calculated, assuming an oral bioavailability of 40%. Relapse-rates occurring over the time periods on oral therapy were compared with rates occurring following initiation of LAIAs. Relapse was defined as any psychiatric hospital admission.

A multivariable Poisson regression model including drug formulation/age/sex/smoking status/BMI were fitted with follow-up time as an offset to estimate adjusted incidence rate ratios and associations with relapse outcomes.

The mean±SD age of the 25 individuals was 50.6±13.9 years whilst 12 (60%) were male. Mean BMI of males/females was 28.1±9.3 kg/m2/ 32±6.4 kg/m2(higher in women) respectively. 65% of patients received either flupenthixol or zuclopenthixol depot with next most common depot being Risperidal Consta. The median (IQR) of daily oral olanzapine equivalent was 10mg (6.9 – 20.0mg)/day and after switching to depot was 16.0mg (5.4 – 40.7mg)/day. The 4-week depot equivalent dose for services users switched to depot was flupenthixol 480mg (200 – 1220mg) / 4-weeks.

Following adjustment for age/sex/smoking status/BMI, relapse rates were significantly lower during LAIA treatment compared with oral treatment (incidence rate ratio [IRR] 0.13, 95% CI 0.08–0.22, p<0.001). Thus depot antipsychotics were associated with an 87% reduction in relapse rates compared to oral therapy. Male sex/younger age/lower BMI were independently associated with higher relapse rates (Exp (beta) 1.9/0.98/0.94 respectively (p<0.05)).

In this real-world community mental health setting, this study highlights that depot antipsychotics provide a dramatic and sustained reduction of 87% in relapse rate for individuals with a history of psychosis. These findings support early prescription of LAIAs in prevention of psychosis relapse. Further evaluation is warranted to elucidate the potential of LAIAs as a treatment option after first presentation of psychosis.

Et al:

Ruth Parkman-Eason, Salford Royal Hospital, UK

Sophie Manttan, Salford Royal Hospital, UK

Yasitha llangasekera, University of Peradeniya, Sri Lanka

Discharge summaries (aka electronic discharge notifications, eDNFs) are a vital part of care, ensuring clear and timely communication between services and allowing for an accurate record of care to be maintained. If eDNFs are not completed in a timely fashion, or not completed at all, service users struggle to access follow-up care, repeat prescriptions and referrals to other services. In mid 2024, on Vincent Square Eating Disorders Unit (VSEDS), eDNFs were not being completed in a timely manner – many were not completed at all. From May 2024 to August 2024, of 15 patients discharged:

• • 5 had an eDNF completed at time of discharge (33.3%).

• • 3 had an eDNF completed late (20%).

• • 7 did not have an eDNF completed at all (46.7%).

Our aim: 70% of patients discharged from VSEDS will have an eDNF completed within 24 hours

This project ran from mid 2024 to early 2025. We implemented 4 PDSA cycles, which included:

PDSA 1: weekly scheduled meetings between ward doctors and pharmacists.

PDSA 2: discharge medications prescribed and email sent to pharmacy at time that decision to discharge is made.

PDSA 3: attempted implementation of protected time for ward doctors to complete eDNFs (unsuccessful).

PDSA4: On Wednesday mornings pharmacy notified of all potential discharges; all discharge medications prescribed at this time.

Our QI project included input from a number of Experts by Experience, service users who have had previous experience of discharge from VSEDS. They emphasized the importance of a timely, clear and concise eDNF and spoke about the impact on their ongoing care and wellbeing. Some of their feedback is represented in our poster.

From November 2024 to February 2025:

• • 14 patients were discharged from the ward.

• • All of these patients had a discharge summary completed within 72 hours of discharge.

• • 12 of these patients (85.7%) had a discharge summary completed within 24 hours of discharge.

Our first PDSA cycle was unsuccessful – we found that in practice this simply added another meeting without making a difference to efficiency. PDSA cycle 2 appears to have the most impact by allowing pharmacy to process TTAs without having to wait for ward doctors to write a lengthy discharge notification first. We were ultimately unable to implement PDSA 3 successfully. In PDSA 4, we attempted to systematise PDSA 2 by setting a once weekly notification process for pharmacy regarding upcoming discharges.

Adults living in deprived coastal communities face disproportionately high rates of self-harm and suicide, yet little is known about the barriers they experience when attempting to access preventative and mental health support. This study explored how Jaywick residents navigate existing support pathways, identified key barriers and unmet needs associated with accessing services for self-harm and suicidality, and examined approaches that may strengthen engagement and early intervention within this coastal setting.

Two stakeholder workshops were conducted with 14 participants from statutory health providers and community and voluntary organisations operating in Jaywick. Workshops were audio-recorded, transcribed verbatim, and analysed using reflexive thematicanalysis. Discussions focused on experiences of service navigation, barriers to accessing care for self-harm and suicidality, and opportunities for system improvement.

Three overarching themes were identified. First, access barriers: digital exclusion, low literacy, and poor signposting impeded residents’ ability to access mental health support, leaving many dependent on others for referrals. Second, social and cultural dynamics: deep-rooted mistrust of statutory services, normalisation of symptoms, and strong community tribalism hindered help-seeking and engagement. Third, vulnerability and risk: entrenched cycles of poverty, addiction, trauma, and isolation were prevalent, with migrants and refugees experiencing added disadvantages. Fragmented service provision meant that those with co-occurring needs frequently fell between service thresholds and were often only supported at crisis point.

Barriers to accessing support for self-harm and suicidality in Jaywick are complex, intersecting, and reinforced by long-standing structural inequities. Enhancing trust, embedding services locally, and reducing digital exclusion are essential to improving early intervention and access. Co-produced, community-based models, including health navigation and outreach approaches, offer promising routes to addressing the significant unmet needs within this coastal community.

Home Treatment Teams, first established in England in 2000, play a key role in delivering community-based psychiatric care. Socioeconomic deprivation has previously been linked with an increased risk of mental illness and poorer health outcomes. However, there is limited local-level research examining how deprivation shapes referral patterns and service utilisation.

This study aimed to investigate the association between socioeconomic deprivation and referral patterns to the Wandsworth Home Treatment Team at the ward level.

It was hypothesised that wards with greater deprivation would have higher referral rates.

A quantitative retrospective observational study was conducted using anonymised, routinely collected patient data from the Wandsworth Home Treatment Team for 2024. The dataset comprised 801 patients, of whom 685 were included in the analysis following exclusion of individuals residing outside the London Borough of Wandsworth. Ward-level population data were obtained from the 2021 Census.

Referral rates were calculated for each ward and standardised per 1,000 population. Socioeconomic deprivation was measured using a population-weighted average Index of Multiple Deprivation (IMD) score calculated from IMD deciles across the 22 wards of Wandsworth. Pearson’s correlation analysis was performed to examine the association between ward-level deprivation scores and referral rates.

Referral rates varied across wards within the London Borough of Wandsworth, ranging from approximately 0.9 per 1,000 population in the least deprived wards to 3.7 per 1,000 population in the most deprived wards. Lower ward-level IMD scores (reflecting greater socioeconomic deprivation) were associated with higher referral rates, demonstrating a strong negative correlation (Pearson’s r=-0.789, p <0.001).

The strong association between socioeconomic deprivation and higher Home Treatment Team referral rates underscores the importance of understanding how socioeconomic determinants and environmental context shape mental health need and service utilization. Integrating deprivation-informed approaches into both patient management and local service planning within psychiatric care frameworks may optimise resource allocation, enhance responsiveness to community-level mental health needs, and ultimately improve patient outcomes.

Sexual dysfunction is a commonly encountered adverse effect associated with the treatment of psychotropic drugs, particularly antidepressants and antipsychotics. This adverse effect causes significant challenges, as it can severely impact the quality of life and treatment compliance among patients.

This audit aims to evaluate the extent to which sexual dysfunction is assessed, discussed, and documented for adult patients assessed by a Liaison Psychiatry service and commenced on psychotropic medication.

A retrospective clinical audit was conducted of consecutive patient assessments undertaken by the Liaison Psychiatry service over six months from March 2025 to August 2025.The total number of patients was 1214, out of which 97 were started on psychotropic medication.

Inclusion criteria were. 1. patients ≥18 years of age 2. those who were assessed and commenced on, or reviewed for initiation of, psychotropic medication.

Exclusion criteria were those who were not started on psychotropic medication or were already established on psychotropics before assessment.

Clinical records were reviewed to identify documentation of discussion regarding sexual dysfunction, potential medication-related sexual side effects, and evidence of informed consent. All data were fully anonymised, and no identifiable patient information was recorded.

The audit standard was set at 100%, requiring documentation of the presence or absence of sexual dysfunction and/or evidence that advice regarding potential sexual side effects was provided at the time of medication initiation, in accordance with NICE guidance and local trust Policies.

The audit findings revealed

• • Consent for psychotropic medication initiation was documented in only 64% of patients.

• • Discussion of sexual side effects of medication was documented in only 4% of patients

• • Discussion and documentation of other side effects of medication were completed in only 19% of patients

These findings demonstrated significant gaps in assessment and documentation practice within the Liaison Psychiatry service and a lack of compliance with NICE guidelines. Addressing these deficits within the Liaison Service through clear documentation and education is vital to ensure patient-centred care in line with national guidelines and local trust policies.

A re-audit will be conducted within 8 months after recommendations are put in place, to assess improvement in compliance withNICE guidelines and local Trust Policies.

To establish a weekly Mentalization Based Art Psychotherapy Group on Kestrel Ward, North Wales Adolescent Service.

To achieve 75% attendance from young people admitted to the ward between May and September 2025.

We decided to use the Quality Improvement ‘Plan, Do, Study, Act’(PDSA) cycle to assist in evaluating the process of setting up and maintaining a sustainable and well-functioning Mentalization Based Art Psychotherapy Group.

We completed 4 PDSA cycles looking at establishing the group, engaging difficult to reach young people and promoting staff understanding of the group.

A weekly inpatient Mentalization-based art psychotherapy group was established, with 13 group sessions taking place over a period of 17 weeks. During this process facilitators reflected on how to adapt the group to both the setting and the patient cohort. There is no clear blueprint for this type of intervention within the inpatient setting and to establish the group it was necessary to innovate. This meant working in an adaptive manner based on the needs and opinions of the young people present on the ward at any given time.

Working the patients' way was clearly effective, but it was challenging to do so in a stressful and busy ward environment that was not always conducive to staff or patient's mentalizing processes.

The group has now become well established and sustainable with most young people who are admitted to the ward attending on a weekly basis. It is hoped that engagement will be further improved through continuity and gaining increased input from young people with regards to liked activities.

To ensure the on-going provision of the Mentalization Based Art Psychotherapy Group the facilitators recommend the following:

Group provision is continued on a weekly basis.

The availability of a practitioner with a background in psychological therapies/psychiatry is essential to co-facilitate alongside the art therapist (and this must consistently be the same person).

Dedicated specialist clinical supervision for group facilitators is provided monthly.

Active planning takes place in relation to provision of a suitable therapeutic group space and facilities.

There is provision of staff training and supervision based on mentalizing principles.

Type 1 diabetes (T1D) requires relentless self-management and carries a substantial psychological burden. In individuals with complex or disengaged diabetes, this burden frequently manifests as diabetes distress, anxiety, low mood, maladaptive coping behaviours, and disengagement from treatment. These presentations often overlap with psychiatric symptomatology yet remain under-recognised within mental health services. This study aimed to explore the lived psychological experience of adults with complex T1D and to examine changes in psychological distress following initiation of continuous subcutaneous insulin infusion (CSII) with hybrid closed-loop (HCL) technology.

This work formed part of a prospective Quality Improvement Project within an NHS diabetes service. Semi-structured psychosocial questionnaires were completed by adults with T1D and significant diabetes distress prior to initiation of CSII/HCL (n=12). A subset of participants (n=7) completed the same questionnaire six months after commencing CSII/HCL. Data were analysed using inductive thematic analysis, grounded in patient narratives. The project was conducted as a service evaluation with organisational governance approval; individual consent was obtained as part of routine clinical care.

Pre-CSII/HCL narratives revealed a profound psychological burden. Four dominant themes emerged: (1) chronic cognitive and emotional exhaustion driven by continuous monitoring and decision-making demands; (2) anxiety-driven behaviours, including intentional hyperglycaemia to avoid hypoglycaemia, driving risk, or social embarrassment; (3) depressive cognitions characterised by hopelessness, self-blame, and perceived inevitability of complications; and (4) identity disruption, stigma, and defensive disengagement from care.

Post-CSII/HCL questionnaires demonstrated consistent qualitative change. Participants described reduced mental load, improved confidence in diabetes management, decreased fear of hypoglycaemia, and greater emotional stability. Several reported improvement in mood and anxiety symptoms, re-engagement with daily activities, and enhanced quality of life without escalation of antidepressant or anxiolytic medication. While psychological distress was not eliminated, participants described a shift from crisis-driven coping to a more manageable and contained relationship with diabetes.

Apparent “non-compliance” in T1D often represents a defensive response to untreated psychological distress rather than behavioural failure. Hybrid closed-loop technology may function as both a metabolic and psychological intervention by reducing cognitive burden and restoring self-efficacy. These findings highlight a clear role for psychiatry in diabetes care: screening for diabetes-related distress, anxiety, and mood symptoms, supporting engagement with technology, and contributing to integrated care pathways where improving confidence in physical illness management can meaningfully improve mental health outcomes without default reliance on psychotropic medication.

Antipsychotics are the mainstay of treatment for severe mental illness (SMI) but cause metabolic side effects, such as rapid and clinically significant weight gain, hyperglycaemia, and hypercholesterolaemia, increasing the risk of type 2 diabetes and cardiovascular disease. Metabolic side effects develop through physiological mechanisms (e.g. plasma glucose dysregulation), but also through behaviour changes (e.g. increased calorie intake, sedentary lifestyle). This study aimed to characterise the behavioural determinants associated with developing metabolic side effects by exploring people’s experiences of taking antipsychotics for an SMI.

Participants (n=22) were recruited, as members of the public via Mental Health charities and an existing database of people who had been previously prescribed antipsychotic treatment for an SMI (n=20), and via National Health Service Trusts who were recently initiated on antipsychotic treatment for an SMI (n=2). Sociodemographic characteristics (age group, biological sex, ethnic group, index of multiple deprivation) were collected from participants to ensure a diverse sample. Individual, reflective interviews with a semi-structured style were undertaken to explore determinants associated with changes in behaviour when antipsychotics were initiated. Template analysis was undertaken, comprising an inductive approach and a priorithemes.

The following main themes were created which were associated with changes in behaviour influencing the development of metabolic side effects: environmental determinants (e.g. Covid-19 pandemic, weather, finances); social determinants (e.g. social exclusion, social support, provision of food from family/friends); emotional determinants (e.g. experience of trauma, low mood, shame); and motivation around healthy eating and physical activity (e.g.convenience, cravings, self-medication). Integrative themes included: impact of weight gain (e.g. on identity, quality of life, comorbidities); experience of being a mental health patient (e.g. clinical support, monitoring of side effects); and impact of medication/side effects on eating and physical activity behaviours (e.g. sedation, decreased energy, prior knowledge of side effects).

There are a variety of determinants influencing behaviours associated with developing antipsychotic-induced metabolic side effects. Current clinical practice is to treat side effects with pharmacological and/or non-pharmacological interventions once they have developed as per National Institute for Health and Care Excellence Guidelines and the Lester Tool. Interventions targeting specific behaviours and determinants should be implemented at the start of antipsychotic treatment to prevent metabolic side effects from developing. Further research should explore interventions and ongoing support appropriate to, and developed in partnership with, this population.

This study was sponsored by a University of Leicester PhD scholarship and Pharmacy Research UK.

The Dynamic Appraisal of Situational Aggression (DASA-IV) is a brief, structured tool designed to assess short-term risk of violence in psychiatric inpatients. Whilst it has been used by nursing staff in some settings, evidence regarding the impact of systematic implementation and the role of medical staff in initiating its use remains limited.

This audit evaluated the impact of introducing routine, doctor-completed DASA-IV assessments on a general adult inpatient ward, with the intention of presenting findings to nursing staff and informing potential ward-wide implementation to support incident reduction and patient safety.

The primary aim was to assess whether weekday doctor-led completion of the DASA-IV was associated with changes in recorded agitation, aggressive incidents, and observation levels on the ward.

The secondary aim was to assess the feasibility and potential value of routine DASA-IV use as a precursor to broader nursing-led implementation.

It was hypothesised that consistent doctor-completed DASA-IV assessments would be associated with a reduction in aggression-related incidents and indicators of elevated clinical risk.

A two-phase case-note review was conducted over four consecutive weeks on a general adult inpatient ward.

During the first two weeks (baseline phase), weekday nursing documentation was retrospectively reviewed to capture episodes of agitation, recorded aggressive incidents, andobservation levels, with no change to usual care.

During the subsequent two weeks (intervention phase), the ward doctor completed the DASA-IV daily on weekdays alongside routine clinical work, while the same outcome measures continued to be collected.

Data from the baseline and intervention phases were compared to explore changes temporally associated with the introduction of doctor-led DASA-IV assessments. Data collection was restricted to weekdays in both phases.

Across 84 patient-days (baseline n=44; intervention n=40), incident-day rates were similar (11.4% vs 10.0%), as were agitation-days (13.6% vs 12.5%). One-to-one observations occurred on one baseline day and none during intervention.

Forty weekday DASA-IV assessments were completed; scores were low overall (mean 0.7, median 0, range 0–5). Using standard thresholds, 80% were low risk, 15% moderate and 5% high. All incident- and agitation-days occurred with DASA-IV ≥2 (100% sensitivity). Specificity was 88.9% for incidents and 91.4% for agitation, with negative predictive values of 100%.

Doctor-led weekday DASA-IV use was feasible and provided actionable risk stratification, with no events on low-risk days. Over this short audit, it was not associated with reduced incidents or agitation. Larger, longer evaluations with planned nursing-led implementation are needed.

Enhance PF understanding.

To ascertain what PF is, when/how/why played, and the potential effects of a ‘game’, a composite definition was developed:

An ostensibly non-partisan issue or problem that politicians from different parties argue about, primarily in order to obtain advantage for themselves rather than seeking to resolve the issue per se, as to do so may entail disadvantage in terms of acceptance of blame/responsibility, or inadvertently reveal the true scale of the problem, and the resources needed to meaningfully address the same.

The (sporting) metaphor was extended.An established PF was selected for a worked example - youth offending (YO) in New Zealand (NZ) - in order to explore if an additional underlying psychological process could be identified.

PF should matter to psychiatry.Mental health is itself sometimes designated as a PF, and a psychological lens can help to dissect a phenomenon with potential to affect us all.

Whilst PF is at heart a calculated opportunity for political gain, it also appears to represent the psychological defenses employed by the player, with evidence of a projection-driven othering noted with respect to the worked example (given overwhelming evidence of almost ubiquitous childhood adversity prior to YO, it is hard to conceive that the governmental introduction of a ‘boot-camp’ for YO, can be anything other than a deliberate attempt to obscure confronting aspects of societal reality in favour of short-term political gain).

Unsurprisingly, media influences the perceived ripeness of an issue for PF selection.When a PF becomes perennial, it may intersect with other PF issues, and can even appear bigger than it actually is, like a super-moon (NZ YO decreased, 2014-2024).

Reducing a complex issue to binary terms, is also misleading.With respect to YO in NZ, PF robbed the general public of the chance to develop a view on what can be reasonably expected to work in a complex situation i.e. the populist proposal for a ‘boot-camp’ likely won ‘tough-on-crime’ votes, but without reference to the confronting evidence of societal drivers, risks being construed as disingenuous.

Blunt dissection can expose PF for what it actually is (shallow, self-interested psychologically insulated) and what it is not (meaningful, thoughtful, harmless). Thus PF stands as a - very human - obstacle to positive societal change. Better understanding of PF is therefore important, including with respect to the psyche of individuals playing for power.

Psychotropic medications are commonly used as an adjuvant to treat children having an eating disorder. Though there is little evidence on the rationale of use of psychotropic medications in eating disorder, they have often been used to address the associated psychiatriccomorbidities. While eating disorder owing to its complexities requires regular physical monitoring, introducing psychotropic medication makes it even more important for carrying out a regular monitoring. Hence the audit was designed as clinic practice mandatesits needs.

Data collected from patient records in two different timelines- Dec 2022-Jan 2023 and Dec 2023-Jan 2024. Trust and NICE guidelines on monitoring antipsychotic medications and NICE guidelines for antidepressant monitoring were taken as standard guidelines.

31 patients were started on psychotropic medications in these time periods with most prescribed drug being Fluoxetine, followed by olanzapine and sertraline.It was seen that the compliance for physical health parameters (Blood Pressure, Heart Rate, BMI etc) was almost 100% except for waist circumference which was not being done on a regular basis. With the bloods, there was a good compliance on LFT, U&Es, FBC, Blood glucose levels but lipid profile, creatinine phosphokinase was not being routinely done for the young people

The MEED monitoring is normally used in the eating disorder clinics which does not always coincide with the monitoring for psychotropics, for example - timing and/or type of investigations, therefore there is sometimes a gap in monitoring psychotropics. Waist circumference could be a difficult parameter to monitor because young people deal with body image concerns, hence this could be tricky to monitor. Based on the findings, we have designed a monitoring tool which the physical health team has been using from now. We are hoping to see better results when reaudit is done.