The aims of this audit are to assess compliance with local audit standards for: (1) documentation of driving status at initial assessment; (2) documentation of DVLA notification advice; and (3) documentation and follow-up of driving safety advice aligned with DVLA/regional guidance because young people with eating disorders (EDs) may experience physical and cognitive impairment (e.g., blackouts, hypotension, hypoglycaemia) that can compromise driving safety. UK Driver and Vehicle Licensing Agency (DVLA) guidance requires individuals to notify DVLA if an ED affects fitness to drive. Yet, no CAMHS-specific local process existed to guide systematic assessment and documentation of the risk that young people pose from driving, to ultimately maintain patient and public safety.

A retrospective electronic case-note review was undertaken within the North Yorkshire & York CAMHS ED Service. All patients aged ≥15 years 9 months up to October 2024 were screened (n=65); 48 met the inclusion criteria. An agreed proforma captured driving status documentation; presence and content of driving safety advice; how this aligned with DVLA/ NHS guidance; follow-up advice at specified intervals; and explicit documentation of DVLA notification advice.

No cases documented driving status at initial assessment (0/48). Any documented driving safety advice was present in 33.3% (16/48) of cases. Among those with documented advice (n=16), follow-up driving advice was recorded in 93.8% (15/16), and 100% had documented advice aligned with DVLA/NHS guidance (16/16). Explicit documentation that the patient should notify DVLA was present in 43.8% (7/16). The key areas for improvement were the lack of risk assessment regarding driving; documentation at initial assessment; and inconsistent DVLA notification advice.

This audit identified that the ED service was not adequately assessing the driving status of young people with ED and/or providing the necessary advice, which could have implications for patient safety. Where advice was documented, quality and follow-up were high, suggesting that introducing structured prompts would be beneficial.

A revised initial assessment pro forma incorporating a structured “Driving Status & Advice” section and visual reminders (a clinic poster) has been implemented; a co-produced CAMHS-specific ED and Driving patient leaflet and an updated follow-up review template are in progress. The second cycle will evaluate the impact of the changes and the standardisation of DVLA-related documentation across the pathway.

As guided by the General Medical Council and the Royal College of Psychiatrists, the inclusion of experts by experience is a required component of British undergraduate medical education and postgraduate psychiatry training. However, this has not been formally applied to the training of Mental Health Tribunal (MHT) and Special Educational Needs and Disability (SEND) Tribunal members who are advised on reasonable adjustments for patients and appellants through the Equal Treatment Bench Book, including guidance on Autism Spectrum Disorder (ASD).

This study aims to evaluate the impact of expert-patient input on tribunal members’ understanding of ASD following a dedicated training programme. We hypothesise that the training day will increase participants’ confidence regarding reasonable adjustments for patients with ASD and will be perceived as novel and valuable.

A multidisciplinary training day was delivered to MHT and SEND Tribunal members in England, jointly by clinicians and experts by experience. The training offered a multimodal overview of ASD and its treatment, and how reasonable adjustments can be made in tribunal hearings.

To evaluate the session, data was collected via online post-session feedback questionnaires. Items were selected to assess participants’ confidence with regard to the training’s learning outcomes, the perceived novelty and value of expert-by-experience involvement, and participants’ willingness to receive a follow-up email six weeks post-training to support consideration of reasonable adjustments.

The training programme was attended by 54 MHT and SEND Tribunal members, of which 24 were judges, 13 were consultant psychiatrists, and 17 were other specialists involved in the care of patients with ASD.

Ninety-four per cent of respondents reported feeling confident after the training session, an increase from retrospectively reported pre-session confidence of 50% (n=18). Over half had no prior exposure to expert-by-experience training (55%, n=47), while a large majority thought MHT and SEND tribunal training should include more input from experts by experience (89%, n=46). 68% of participants (n=45) opted to receive an email six weeks post-training to be prompted to continue to make reasonable adjustments for patients with ASD.

The findings reinforce the effectiveness of expert-by-experience input and highlight its lack of incorporation to date in tribunal training. The willingness of participants to receive a follow-up email six weeks post-training suggests an openness to reflection. Further work should explore how such involvement can be sustainably embedded within tribunal training to support awareness of mental health conditions, including ASD, and the implementation of reasonable adjustments in hearings.

1. To improve carer contact and involvement in Emergency Department (ED) assessments within Devon Partnership Trust (DPT) liaison teams, in line with Psychiatric Liaison Accreditation Network (PLAN) standards, NICE guidance on suicide and safety planning, and the Triangle of Care.

2. To increase carer contact during emergency assessments, and completion of the associated information-sharing form to 90% target.

We began with a baseline audit of 60 emergency assessments in September 2024 across three DPT liaison teams (Torbay, Exeter, and North Devon), using carer-related standards from PLAN and NICE. This revealed carers were not routinely contacted, the information-sharing form infrequently completed, and existing guidance was not consistently followed.

A Quality Improvement project team, including a carer representative, was formed to address these issues–initially focusing on increasing routine carer contact and appropriate documentation. A qualitative survey of team members identified key barriers, which then formed a driver diagram and change ideas implemented from October 2025. Workplace culture change around carer contact emerged as a central priority. A monthly rolling audit of 5 patients per team was implemented to monitor progress.

Initial SPC chart data indicated changes remained within normal variability, particularly in documentation rates. As a result, we maintained focus on early project targets rather than progressing on to the next targets. Nonetheless, recent data shows a positive trend, with updated data to be presented in our poster.

Carer involvement in ED assessments is essential for enhancing assessment quality and patient safety, and is supported by PLAN, NICE, and the Triangle of Care. However, achieving consistent change is complex, particularly in shifting workplace culture. Our ongoing strategies are beginning to show success, and the project will continue until September 2026.

This audit evaluated antipsychotic prescribing practices for behavioural management in Child and Adolescent Mental Health Services (CAMHS) against National Institute for Health and Care Excellence (NICE) guidelines and local protocols. We hypothesised that prescribing indications would be guideline-compliant, while adherence to physical health monitoring would be lower in community settings compared to inpatient units. We further anticipated that the use of standardised outcome measures would be suboptimal across both services.

A retrospective clinical audit was conducted on the electronic health records of 26 patients prescribed antipsychotics for behavioural management (13 from the Red Kite View inpatient unit; 13 from Leeds Community Healthcare community CAMHS). Data were collected between February 2023 and February 2025. Practice was measured against standards derived from NICE guidelines (NG11, CG155, CG170), the Maudsley Prescribing Guidelines, and local Trust protocols. Criteria included appropriateness of indication, specialist initiation, baseline and ongoing physical health monitoring, and the use of standardised outcome measures.

Compliance with indication and dosing guidelines was high, with 100% of cases documenting appropriate indications across both services. Specialist initiation was common (100% inpatient; 85% community). Documentation that psychological interventions were attempted prior to medication was lower in community settings (54%) compared with inpatient services (77%).

Significant deficits were identified in monitoring and outcome measurement. Standardised behavioural rating scales were not used in any cases across either setting (0%). Baseline movement disorder assessments were absent in community services (0%) and inconsistent in inpatient care (54%). Marked disparities were observed in baseline safety blood tests (full blood count, urea and electrolytes, liver function tests), completed in 92% of inpatient cases versus 38% in the community. Ongoing community monitoring demonstrated critical gaps, including 0% adherence to recommended weekly weight monitoring during titration and 0% completion of six-month liver function tests.

The findings support the hypothesis: while clinical decision-making around antipsychotic initiation is largely guideline-compliant, substantial systemic gaps exist in physical health monitoring, particularly in community CAMHS. Furthermore, the universal absence of standardised outcome measures limits the objective assessment of benefit. Targeted interventions are required, including strengthened community physical health monitoring pathways, mandatory baseline movement disorder assessments, and the routine use of standardised behavioural outcome tools.

The aim of the project is to explore resident doctors’ experience of workplace-based violence within Central and Northwest London NHS Foundation Trust. These findings will help:

1) To identify barriers to reporting incidents.

2) To improve access to wellbeing support provided to resident doctors.

3) To update serious incident policy for resident doctors.

Both qualitative and quantitative surveys were conducted among all the resident doctors in Central and Northwest London NHS Foundation Trust.

Quantitative Survey: Between January and February 2025, Resident Doctors within Central and Northwest London NHS Trust were invited to complete a 13-item quantitative survey. 34 responses were received.

Qualitative Interviews: Following responses from quantitative surveys, seven resident doctors who reported workplace-based violence through Datix agreed to participate in semi-structured qualitative interviews, consisting of 13 questions. All the interviews were conducted through Microsoft teams and transcribed. Interview responses were analysed through thematic analysis to identify common themes and subthemes of individual perception and reflection on their experience of violence.

Quantitative Survey:

34 resident doctors from different grades (foundation year doctors, GP trainees, core trainees, and higher trainees) across five different boroughs responded to quantitative surveys. Of these, five core trainees, three higher trainees, two foundation year trainees and two GP trainees reported the violence.

These resident doctors who experience violence are 40% from inpatient units and 60% from community clinics. Physical and non-physical violence are most common types of violence that resident doctors experienced. Only 7 out of 20 resident doctors who experienced workplace violence reported the incident through the incident reporting system called Datix.

Qualitative Survey:

Seven resident doctors participated in interviews exploring their experience of workplace-based violence. Participants include one higher trainee, one GP trainee and five core trainees. Participants highlighted there were significant impacts of violence or aggression on emotional wellbeing as well as professionally on career commitment. A common theme emerging from the semi-structured interviews was that resident doctors who experienced physical violence were preceded by non-physical or verbal violence.

Resident doctors experiencing workplace violence and aggression in the NHS is common across different specialities, among which unfortunately psychiatry resident doctors experience the most.

In addition, resident doctors in training do not have always access to the help and support that they need following these incidents. Quantitative survey and Qualitative thematic analysis of this project call for Improved access to various wellbeing resources and Individual support for all resident doctors who experience workplace-based violence.

The aim of this initiative was to provide a structured, high-quality psychiatry teaching programme to support our Trust’s nurses’ Continuous Professional Development (CPD) and revalidation. This programme sought to further improve nurses’ clinical knowledge, prescribing skills and legal understanding.

Since February 2025, monthly afternoon educational sessions were delivered face to face at Harplands Hospital, by experienced doctors, and open to all nursing staff, especially those pursuing higher education. Each session covers two clinically relevant topics, including psychosis, bipolar affective disorder, psychopharmacology, eating disorders, ADHD and medication monitoring. Attendees were encouraged to participate and to promote engagement and consolidate newly acquired knowledge, a Kahoot quiz was used each session.

Feedback was collected from attendees following each session. This questionnaire asked whether participants found the teaching helpful, whether the content was pitched at an appropriate level, asking for topic suggestions to cover in future CPD sessions, and what did they enjoy most about that day’s teaching. Open-text qualitative feedback is regularly analysed to determine quality of teaching and shape future topics.

Feedback has been consistently positive. The vast majority of nurses reported the sessions to be helpful and pitched at an appropriate level for their job role. Teaching was described as engaging, relevant, interactive, and supportive of their CPD and revalidation needs. Use of Kahoot and the enthusiasm of the teachers were frequently noted as being valued.

Analysis of feedback showed a recurrent theme among request including ADHD, ECG and blood test interpretation, clozapine monitoring, refeeding syndrome, mood disorders, and commoncomorbid physical health conditions. This feedback shaped subsequent teaching sessions, ensuring the programme continued to be response and learner-centred.

The feedback from this monthly psychiatry teaching programme has successfully provided medical education to support with nursing CPD and revalidation requirements. Engagement has always been high and consistently positive feedback demonstrated the value of the programme in enhancing nurses’ knowledge, confidence, and clinical practice. Subsequently, our Trust is exploring protected teaching time for our nursing colleagues further reflecting the Trust’s commitment to continued professional development and patient care. Future plans including expanding bespoke sessions tailored to service needs and inviting novel speakers with specialist knowledge.

To map emerging evidence on how endogenous female sex hormones influence ADHD symptom trajectories and treatment response, and to prioritise a concise, pragmatic research agenda that can be taken forward by clinicians and researchers.

We carried out a targeted narrative review of recent reviews, cohort studies, mechanistic reports and pragmatic clinical series published in the last decade. Selection emphasised studies that reported cycle-linked symptom data, used within-subject comparisons, incorporated endocrine assays, or described medication-adjustment strategies. The goal was to identify consistent clinical signals, methodological weaknesses, and high-yield research priorities rather than to perform an exhaustive systematic search.

Across menstrual, peripartum and perimenopausal windows a consistent clinical signal emerges: many women with ADHD report predictable worsening of attention, executive function and affective regulation during low-oestradiol states (late luteal/menstrual phase, early postpartum, and perimenopause). Mechanistic work indicates that oestrogen modulates dopaminergic and noradrenergic circuits implicated in attention and cognitive control, providing biological plausibility for these observations. Small within-subject and pragmatic reports suggest stimulant efficacy and tolerability may vary by cycle phase and that some clinicians achieve symptomatic benefit with cycle-timed dose adjustments; however, these data are preliminary. The literature is dominated by observational designs, retrospective self-report, small samples, inconsistent outcome measures and sparse serial hormone sampling. These limitations constrain causal inference and generalisability. Perinatal evidence highlights postpartum vulnerability but lacks robust registries linking medication decisions to maternal and infant outcomes. Perimenopausal findings are emerging but heterogeneous.

There is sufficient signal to warrant routine clinical enquiry about symptom cyclicity and to adopt a cycle-aware, flexible management approach in practice. To move from signal to guidance we recommend three priority studies: (1) short prospective menstrual-cycle cohorts with daily symptom tracking and serial oestradiol/progesterone assays; (2) within-subject medication response trials comparing follicular and luteal phases with pharmacokinetic sampling; and (3) perinatal registries documenting medication choices and maternal-infant outcomes. Implementing this focused agenda will accelerate translation of hormonal mechanisms into practical, gender-sensitive ADHD care.

Behavioural variant frontotemporal dementia (bvFTD) is characterised by early and progressive changes in behaviour, personality and executive functioning. Neuroimaging and biomarkers can support diagnosis, these investigations may be normal in the early stages, increasing diagnostic uncertainty and potential misattribution to primary psychiatric illness. In such cases, a comprehensive neuropsychiatric assessment and collateral history remains key to diagnosis.

A woman in her 50s was referred to neuropsychiatry with a 3-year history of disinhibition, emotional blunting, aggression, repetitive behaviours, and decline in social functioning. Assessment included neuropsychological testing (ACE-III and RBANS Update), brain MRI, FDG-PET, DAT scan, EEG, and CSF analysis (including autoimmune and infectious panels). Genetic testing was also undertaken. The case was reviewed by a dementia Neuroradiology multidisciplinary team and nuclear medicine consultant.

Despite clear and progressive behavioural and functional deterioration, structural and functional neuroimaging, EEG, and CSF investigations were initially unremarkable. Neuropsychological testing demonstrated multi-domain cognitive impairment, with particularly marked deficits in visuospatial ability and memory (≤1st percentile on RBANS). Behavioural features included public disinhibition, rigidity, aggression, loss of empathy, and impaired insight. No primary psychiatric disorder, delirium, or alternative neurological diagnosis was identified. A clinical diagnosis of probable bvFTD was reached based on the behavioural profile, collateral history, and progression. Minimal symptomatic improvement was observed with the prescription of Quetiapine and Carbamazepine. Subsequent genetic testing identified a pathogenic C9orf72 hexanucleotide repeat expansion, confirming the diagnosis.

This case highlights how behavioural variant frontotemporal dementia may be diagnosed clinically despite normal imaging and biomarker studies, with genetic testing serving as confirmatory tool. Careful behavioural evaluation, collateral history, and longitudinal follow-up remain essential in complex neuropsychiatric presentations. This case supports early consideration of genetic testing in diagnostically challenging cases of suspected bvFTD.

BACKGROUND

Neurological deterioration during alcohol detoxification is commonly attributed to alcohol-related complications, particularly Wernicke’s encephalopathy, withdrawal syndromes or side effect of detox treatment.While such diagnostic pathways are clinically appropriate, they may predispose to premature diagnostic closure. This case highlights the risk of diagnostic overshadowing when alternative neurovascular pathology presents with overlapping features.

AIMS

1. To examine diagnostic challenges associated with recurrent falls and neurological symptoms during inpatient alcohol detoxification

2. Highlight the clinical overlap between Wernicke’s encephalopathy and thalamic stroke, necessitating early neuroimaging

3. Emphasise the importance of structured reassessment and vigilance during week-two detox complications.

A retrospective single-case clinical analysis was undertaken within an inpatient addiction detoxification unit. Clinical records, nursing observations, withdrawal monitoring tools, medical reviews, and neuroimaging reports were examined to reconstruct the diagnostic trajectory, differential formulation, and escalation decisions.

Case Presentation:

A 60-year-old man was admitted for planned alcohol detoxification, reporting daily consumption of approximately 14 units of lager with a Severity of Alcohol Dependence Questionnaire (SADQ) score of 28. He had no prior detoxifications, no history of delirium tremens, and no active psychiatric comorbidity. Past medical history included thrombocytopenia and abnormal liver function tests attributed to non-alcoholic fatty liver disease. Baseline physical examination was unremarkable.

During week two of detoxification, he developed recurrent falls preceded by dizziness and a “funny head” sensation. One episode occurred after rising from bed; another followed standing from the toilet. There was no loss of consciousness, seizure activity, or incontinence. Subsequent review identified a new broad-based gait,nystagmus, left upper limb hypertonia, and subtle postural weakness, although other cranial nerve examination and speech remained intact. Cognitive biases (anchoring to withdrawal, premature closure, and diagnostic overshadowing) were identified as potential contributors to delayed escalation. Initial differentials included Wernicke’s encephalopathy, hypotensive episodes related to antihypertensive use, high dose in detox reducing regime and transient ischaemic attack. The patient initially declined emergency transfer due to lack of confidence in emergency department waiting times, but was urgently escalated for acute hospital assessment and a brain scan following clinical concern.

Emergency department evaluation noted nystagmus, gait ataxia, and memory impairment. MRI revealed anacute right thalamic infarct, with additional cerebellar microhaemorrhages and chronic small-vessel disease. The thalamic lesion explained the patient’s gait disturbance, postural instability, and subtle motor changes, which had initially mimicked Wernicke’s encephalopathy.

Outcome:

The patient was transferred to neurology, commenced on stroke-appropriate management, and referred for physiotherapy. He continued relapse-prevention work with our community alcohol services and was started on acamprosate. This case demonstrates how acute stroke can present with symptoms easily misattributed to alcohol withdrawal syndromes, underscoring the need for repeated assessment and a low threshold for neuroimaging when the clinical picture evolves.

This case underscores the potential for neurovascular events to mimic alcohol-related neurological syndromes during detoxification. Thalamic infarcts may present with gait disturbance, cognitive change, and ocular signs that overlap with Wernicke’s encephalopathy. Clinicians should maintain a broad differential when new focal signs, persistent/new ataxia, or incomplete response to thiamine therapy emerge. Early neuroimaging is essential to avoid diagnostic delay and optimise neurological outcomes.

The objective of this audit is to establish the baseline of how much physical health monitoring is being completed in a general adult outpatient mental health team for patients with severe mental health illnesses (SMI) in accordance with NICE Guidelines.

Data were collected from CMHT records and the Welsh Clinical Portal for patients who attended outpatient appointments in a CMHT in North Wales over a two-week period in September 2025.

Inclusion criteria:

Patients with a diagnosis that falls under SMI.

Patients prescribed antipsychotics or Lithium.

The Welsh Clinical Portal will be accessed to identify patients who have received a full or partial physical health check from primary care

Out of the 29 patients studied, the following parameters were monitored:

Pulse in 30.4%, Blood Pressure in 56.5%, Weight in 20.7%, Hbs-653C/Glucose in 41.4%, Liver Function in 58.6%, Renal Function in 65.5% and Lipids in 58.6%.

Of the 4 patients who required prolactin testing, 75% had their prolactin monitored.

Comparing patients on Lithium or Clozapine (11 patients) (as they were monitored in dedicated clinics) vs those on other antipsychotics (18 patients), weight was monitored in 45.5% vs 5.6%, Renal Function in 45.5% vs 77.8%, Liver Functions in 36.4% vs 72.2% HbA1c/Glucose in 27.3% vs 50.0% and Lipid Profile 45.5% vs 66.7%.

Comparing High Metabolic Risk Patients (on Olanzapine=5, Quetiapine=7 and Clozapine=3) vs those not on those (14), the monitoring of the parameters was -Weight: 18.8% vs 23.1%, Hbs-653c/Glucose: 50.0% vs 30.8%, Renal function: 75.0% vs 53.8%, Liver Functions: 68.8% vs 46.2% and Lipid Profile: 62.5% vs 53.8%.

Of the patients prescribed Lithium (9/29), Lithium levels were measured ≥4/year in 1/9 (11.1%), Urea and Electrolytes ≥2/year in 6/9 (66.7%), and Thyroid Function ≥2/year in 4/9 (44.4%).

Monitoring of physical health parameters has considerable scope for improvement among patients with SMI in CMHT. Compared with patients prescribed Clozapine or Lithium, those not receiving these medications had their weight monitored more frequently. Interestingly, Renal function, Liver Function, Hbs-653c/Glucose, and Lipids were monitored more closely in the latter group, even though patients receiving lithium and clozapine had dedicated clinics.

The CMHT is planning to allocate a dedicated health worker to monitor all patients with SMI being prescribed antipsychotics. Concordance with the monitoring protocol will be reassessed after this intervention.

The RCPsych Recruitment and Retention Charter identifies good quality inductions and creating a culture of belonging as strategies to improve workforce wellbeing.

The North Central and East London Child and Adolescent Psychiatry Higher Training (NEL CAP HT) scheme incorporates 19 placements across four different trusts. After thepandemic, inconsistent one-hour online inductions were provided by current trainees for new starters without formal protected time.

To address uncertainty towards placements, anxieties when starting on-call work and to prevent risk to patient safety, a quality improvement project was undertaken:

• • To improve NEL CAP trainee onboarding experienceby developing a standardised, mandatory, in-person induction.

• • To improve morale, build trustand cohesiveness amongst trainees and trainers.

Cycle 1 (August 2025) evaluated transition from fragmented online inductions to a structured half day, in-person session. Surveys measuring trainee confidence in onboarding andon-call experiences were completed by both previous trainees who had experience of online inductions and the new starters (n= 15).

Cycle 2 (January 2025) incorporated feedback from Cycle 1 to plan a full day in-person induction involving senior trainees and trainers, enriched with simulation case scenarios and a Microsoft Teams repository of relevant policies and protocols.

Quantitative data:

• • Confidence in managing out of hours on-calls increased by 16%.

• • Confidence in understanding the scheme structure and individual placements increased by 15%.

Qualitative themes:

Moving from an online to in-person induction led to a shift from trainees feeling isolated and anxious at the start of joining the scheme, to a sense of connectedness and reduced on-call anxieties.

Trainees frequently cited peer interaction and presence of trainers in the in-person induction as the most helpful part of their onboarding experience.

In-person induction improves the scheme onboarding experience for trainees by reducing their anxieties and ensures patient safety. Trainer presence in higher trainee induction boosts morale and improves psychological safety for new starters. A formal full day induction incorporating timely changes to the scheme and on-call workflows using simulation-based learning, is expected to further enrich content delivery.

The Bradford District Care NHS Foundation Trust IMG Network delivered a face-to-face workshop for International Medical Graduates (IMGs) on 29 September 2024, followed by a virtual workshop via MS Teams on 12 September 2025.

Both sessions focused on supporting IMGs in understanding career progression, one of the eight key pillars of IMG support. The workshop content was informed by the framework outlined in the School of Psychiatry Yorkshire and Humber Deanery’s Life in the UK as an IMG–A Psychiatrist’s Journey, ensuring alignment with regional expectations.

This Quality Improvement project built upon the 2024 in-person workshop to expand its impact. The primary aim was to determine whether a virtual format could improveattendance, offer greater accessibility, reduce costs, and compare favourably with in-person approach. By evaluating engagement and perceived value across both formats, the project explored whether virtual delivery could serve as a sustainable model for ongoing IMG support.

Focused areas of the workshop remained the same namely leadership, portfolio management, reflective practice, coaching and preparing for ARCP.

Workshop delivery transitioned from in-person to virtual (via Microsoft Teams).

Pre-and post-workshop surveys were conducted to quantify attendee experience and evaluate learning outcomes.

Cost to the trust was compared from 2024 in-person workshop with 2025 online workshop.

Direct costs for the 2025 virtual workshop were minimal and difficult to quantify. However, virtual delivery eliminated venue booking costs, avoided travel and mileage claims and reduced carbon footprint. For comparison, the 2024 in-person workshop cost was £1750 (venue and related expenses).

There was an increased average attendance from 10 (2024) to 26 (2025).

Virtual model of delivering workshop via MS Teams was more cost-effective, environmentally sustainable, and generated better attendance with wider regional participation without compromising on the educational quality of the workshop as demonstrated by post-workshop survey feedback.

Positive post-workshop feedback also supported and favoured continued provision of virtual IMG development workshops in comparison with in-person workshop.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aims (Background)

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

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

Methods (Case Report)

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

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

Results (Discussion)

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

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

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

Conclusion

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

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

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

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

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

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

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

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

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

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

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

Aim and Objectives

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

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

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

• • To enhance patient care and safety.

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

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

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

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

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

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

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

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

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