To improve compliance with Trust and NICE guidance requiring completion of venous thromboembolism (VTE) risk assessments within 24 hours of admission for adult psychiatric inpatients.

Baseline data were collected in May, 2025 from 20 inpatients to assess timeliness and documentation of VTE risk assessments following admission. Electronic records (RiO and NerveCentre) were reviewed to determine whether assessments were completed within 24 hours and whether reasons for delay were documented.

Following baseline measurement, a series of targeted quality improvement interventions were introduced. These included ward poster reminders, education during handovers and MDT meetings, VTE training incorporated into resident doctor inductions, routine MDT review of VTE status, addition of a VTE column to doctors’ handover sheets, ward-specific completion protocols, and reinforcement of documentation standards.

Post-intervention data were then collected retrospectively in November 2025 for 13 inpatients admitted after implementation of these measures. The same outcome measures were analysed to assess improvement.

Overall VTE assessment completion was 100% at both baseline and post-intervention. Timely completion within 24 hours improved from 50% (10/20) at baseline to 84.6% (11/13) post-intervention. Delayed assessments decreased from 50% to 15.4%. Documentation of reasons for delay improved from 20% to 100%. Mean time to assessment reduced substantially from 36 hours to 11.6 hours. Documented reasons for delay included patient refusal and the patient being asleep at the time of assessment.

Targeted, low-cost quality improvement interventions led to marked improvement in the timeliness and documentation of VTE risk assessments in an adult psychiatric inpatient ward. Although the NICE target of >95% completion within 24 hours has not yet been achieved, substantial progress was demonstrated. Sustained education, system prompts, and MDT oversight are expected to support further improvement and enhance patient safety.

Graves disease (GD) is an autoimmune thyroid disease and is the most common cause of hyperthyroidism in developed countries. Research suggests that patients with GD experience high levels of anxiety and depression. Until recently, this increased prevalence hasbeen attributed largely to Graves-induced hyperthyroidism, however even after achieving euthyroidism, many patients continue to suffer from neuropsychiatric symptoms. This suggests that the mood symptoms present in these individuals may be associated with the autoimmune inflammatory processes underlying GD. This relationship has yet to be fully understood, highlighting the need for an evaluation of the current literature. This systematic review aimed to assess the prevalence of anxiety and depression in GD patients and to identify associated risk factors.

The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024611942). EMBASE, MEDLINE, PsycINFO and the Cochrane Library were searched up to 31 October 2024. Papers were included providing the participants were diagnosed with GD and satisfied the diagnostic criteria for anxiety, depression or both; or provided symptomatology measures. Studies were quality assessed using Hawker’s tool. 29 studies were included and underwent data extraction. Studies using a case-control design were summarised separately.

Symptoms of anxiety and depression were consistently higher in the GD group versus healthy controls. GD patients displayed a higher baseline degree of anxiety and depression, compared with patients with other causes of hyperthyroidism. Depression and anxiety were more prevalent in relapsed hyperthyroid GD patients, compared with remitted euthyroid GD patients. Risk factors included body mass index (BMI), physical activity, gender, stress and smoking. A limitation of the review was the high study heterogeneity resulting from the variety of study designs included.

These findings highlight a population that may benefit from early psychiatric assessment. The higher prevalence of anxiety and depression observed in GD patients, including those who are euthyroid, reflects the complex interplay between autoimmune, endocrine and psychological processes underpinning the relationship between GD and mental health conditions. This pattern emphasises the need for a multidisciplinary, integrated and holistic approach when managing and treating GD patients. Future research establishing the mechanisms responsible for this increased prevalence could facilitate the development of targeted interventions and preventative treatments.

Funding: None.

Psychiatric conditions can impair fitness to drive, and clinicians have a professional duty to provide and document appropriate advice in accordance with DVLA guidance. This quality improvement project (QIP) aimed to evaluate adherence to DVLA guidelines regarding the provision of documented driving advice to patients with psychiatric conditions under the Home Treatment Team (HTT), firstly as a baseline measurement, and after meaningful intervention. Identifying disparities in compliance across different diagnosis, sex and age, to enhance patient’s safety and clinical practice.

An initial retrospective review of HTT electronic patient records was conducted over three months (June–August 2024) for a total of 86 patients. Variables collected included primary psychiatric diagnosis, age, sex and whether DVLA driving advice was documented as given. Standards were based on DVLA guidance “Assessing fitness to drive: a guide for medical professionals”. Following baseline measurement, a multi-strategy intervention package was implemented: (1) Multi-Disciplinary Team (MDT) checklist prompt to ensure driving status and advice were considered and recorded during the MDT, (2) Patient information leaflet summarising DVLA advice, (3) Presentation of initial findings at Learning-From-Excellent meeting, and (4) Staff education leaflet and teaching highlighting the clinical and medico-legal importance of driving advice. A second retrospective audit cycle was completed using identical methodology over four months (January–April 2025) for a total of 93 patients, again evaluating documentation of DVLA guidance being given.

Baseline documentation of driving advice was present in 25/86 records (29.1%), with 61/86 (70.9%) illustrating no documented driving advice. Following our intervention, documentation improved to 76/93 records (81.7%), with 17/93 (18.3%) lacking documentation, showing an absolute improvement of +52.6%.

In the second cycle (n=93), 59 records related to female patients and 34 to male patients. Driving advice was applicable in 54/93 cases (36 female; 18 male). Where applicable, documented advice was provided in 29/36 female cases (80.6%) and 14/18 male cases (77.8%), demonstrating comparable adherence across sexes. Among those given advice, the most common age group was 40–60 years for both females (12/29; 41.4%) and males (7/14; 50.0%).

This two-cycle QIP demonstrated substantial improvement in adherence to DVLA guidance documentation within HTT, increasing from 29% to 82% following low-cost meaningful interventions embedded into MDT workflow and staff education. Post-intervention data revealed similar compliance across sexes, with most documented advice delivered to patients aged 40–60 years. Future work should assess the quality of driving advice given and strategies to support consistent practice.

Opioid substitution therapy (OST) with methadone or buprenorphine is a cornerstone of treatment for opioid use disorder, with urine toxicology screening routinely used to monitor adherence and detect illicit opioid use. Unexpected positive opioid results can lead to clinical confusion, unnecessary dose adjustments, and potential strain on the therapeutic alliance. Dietary sources, particularly poppy seed–containing foods such as muffins, bagels, or pastries, have been reported to cause transient, false-positive opioid urine screens due to the morphine and codeine content of the seeds.

Despite being well-documented in pharmacology literature, awareness of this phenomenon in clinical addiction psychiatry remains limited, and it may lead to unnecessary interventions or patient distress. This case series aims to describe instances of poppy seed–induced false-positive opioid screens in patients receiving OST, highlight the clinical impact, and provide practical guidance for recognizing and managing this rare but important interaction.

Three adult OST patients (aged 28–45)–two on methadone, one on buprenorphine–were identified after routine urine toxicology unexpectedly tested positive for opiates (negative for 6-MAM). All had stable adherence, no illicit opioid use, and no recent dose changes.

History revealed recent consumption of poppy seed–containing baked goods: two muffins and one bagel. No other medications, supplements, or substances were reported. Patients were counseled, and repeat testing 48–72 hours later was negative for opioids, confirming dietary exposure. No withdrawal, overdose, or adverse events occurred, and OST adherence remained unchanged.

These cases illustrate a clinically important but under-recognized phenomenon: dietary intake of poppy seed–containing foods can produce transient false-positive opioid results in patients receiving OST. All three patients demonstrated positive urine screens despite stable adherence, no illicit opioid use, and absence of clinical signs of relapse. The temporal association with poppy seed consumption, together with resolution on repeat testing, supports the conclusion that dietary exposure was responsible.

False-positive opioid screens can have significant clinical implications, including unnecessary treatment adjustments, increased monitoring, or erosion of trust between patients and clinicians. Detailed dietary histories, patient counseling, and repeat testing when unexpected results occur can help distinguish between true non-adherence and food-related effects.

Poppy seed consumption can cause transient false-positive opioid urine screens in patients receiving opioid substitution therapy, potentially leading to clinical confusion and unnecessary interventions. Clinicians should consider dietary sources when interpreting unexpected opioid results, take detailed dietary histories, and provide patient education.

Schizophrenia affects 0.43% of global adults, with an estimated annual excess economic burden of $343.2 billion in the United States alone. The schizophrenia drug ecosystem is characterized by significant heterogeneity in patient responses, warranting continual drug discovery efforts to improve outcomes for patients responding suboptimally to existing treatments. Given the centrality of dopamine D2 receptor (DRD2) antagonism in current treatments, this study focused on (i) identifying strong DRD2 binders among Food and Drug Administration (FDA)-approved drugs as repurposing candidates and (ii) generating optimized variants of known antipsychotics as novel drug candidates.

We developed a computational drug discovery pipeline to score potential drug candidates based on DRD2 receptor binding affinity. Molecular docking scores were calculated by dockstring, a Python wrapper for AutoDock Vina, that automatically finds the best binding pose and returns its binding affinity to the receptor. Virtual screening was performed on:

1. ∼1,600 FDA-approved drugs, with emphasis placed on central nervous system-active drugs known to permeate the blood-brain barrier.

2. 450 variant ligands of six reference antipsychotics (haloperidol, trifluoperazine, fluphenazine, chlorpromazine, thioridazine, and risperidone), generated using SwissSimilarity.

A molecular weight threshold of 500 Da was applied to exclude large ligands, consistent with Lipinski’s Rule of 5 for oral bioavailability. Candidates achieving high binding affinity (≤-9.5 kcal/mol) were further evaluated against existing literature.

Among FDA-approved drugs, risperidone achieved the lowest docking score and therefore the best binding affinity (-11.9 kcal/mol), validating our pipeline by recapitulating a known antipsychotic. Several candidates with high predicted binding affinities (≤-9.5 kcal/mol) were identified, with two of particular interest:

• • Dolasetron. Other serotonin 5-HT3 receptor antagonists, especially ondansetron, have improved schizophrenic symptoms in previous studies, making this a promising line of investigation.

• • Trazodone. A population-based cohort study published last year offered evidence that trazodone reduced risk of re-hospitalisation for delirium in older patients as compared to other antipsychotics.

Ligand optimization yielded 4 distinct molecules with superior binding affinities relative to their parent compounds. The best-performing variant achieved -13.6 kcal/mol (risperidone-derived), while the largest improvement was observed for thioridazine (-12.7 kcal/mol versus -8.5 kcal/mol original).

An automated DRD2-focused docking workflow can recover known antipsychotics, surface plausible repurposing candidates, and propose optimized variants with improved predicted binding. While these computational hits require further ADMET analysis and experimental validation before strong conclusions are drawn about clinical potential, our results demonstrate the potential utility of computational drug discovery methods in expanding therapeutic options for schizophrenia.

Maladaptive daydreaming (MD) is a pattern of immersive and emotionally charged daydreaming that can significantly interfere with an individual’s social functioning and daily activities. MD is not formally recognised as a mental disorder in the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM–5–TR). This study aimed to determine the prevalence of MD and attention-deficit/hyperactivity disorder (ADHD) among medical students, identify the association of the two conditions, and assess the impact of socio-demographic factors.

A cross-sectional analytical study was conducted among medical students enrolled at the University of Rwanda and the University of Medical Sciences and Technology, with participants primarily residing in Rwanda, Tanzania, and other countries. Respondents were classified into two groups–maladaptive daydreamers (MDers) and non-maladaptive daydreamers (non-MDers)–based on the 16-item Maladaptive Daydreaming Scale (MDS-16). Data were collected using validated paper-based and online Google Forms self-administered questionnaires (MDS-16 and Adult ADHD Self-Report Scale [ASRS-v1.1]). Ethical approval was obtained, and data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.

Our study included 584 respondents (52.9% male, 47.1% female) with a mean age of 21.6 ± 1.7 years. The prevalence of probable MD was 22.9%, while ADHD was reported in 21.4% of participants. Among students with MD, 48% screened positive for ADHD,compared with 16.2% who did not meet criteria for ADHD. Both MD and ADHD were significantly associated with poor academic performance (p <0.003 and p <0.001, respectively). Using logistic regression, there was a strong positive correlation between MD and ADHD (p <0.001; R²=0.168).

MD and ADHD show a significant positive relationship, and their co-occurrence is associated with a measurable decline in academic performance as perceived by the participants. These findings underscore the need for early screening strategies, the provision of counselling and psycho-educational support for affected students. Future longitudinal and randomised studies are warranted to establish standardised diagnostic criteria and therapeutic guidelines for MD and to differentiate it from related attentional and behavioural disorders across diverse populations.

1. To synthesize fragmented evidence: The study seeks to bring together diverse research from community, hospital, and caregiver-focused studies to create a unified understanding of schizophrenia in Africa.

2. To guide clinical practice and service delivery: The study aims to provide evidence-based insights that help develop culturally appropriate healthcare and support services.

3. To evaluate research methodology and design: The review aims to examine how studies are conducted, focusing on study designs, diagnostic criteria (such as ICD–10 or DSM), and analytical approaches used across the continent.

4. To identify gaps in current literature: The study aims to highlight areas where evidence is lacking–specifically regarding interventional studies, caregiver burden, and long-term psychosocial outcomes.

5. To inform international policy and practice: The study aims to draw lessons for global mental health strategies, including care for African diaspora communities in high-income settings such as the UK.

We conducted a systematic review of observational and interventional studies on schizophrenia in Africa. Searches covered PubMed, Embase, PsycINFO, African Journals Online, and Web of Science (terms: “schizophrenia” AND “Africa” with no language restrictions). All studies provided were included, and overlapping cohorts were explicitly flagged but retained. Data were extracted using standardized tables aligned with PRISMA and MMAT-compatible reporting. Extracted variables included study design, setting, population characteristics, diagnostic criteria, data collection, and analytical approach.

A total of 24 studies (1987–2025) from East, West, Southern, and North Africa were included. Study designs comprised longitudinal cohorts (n=5), cross-sectional surveys (n=14), mixed-methods studies (n=1), and randomized or dyadic trials (n=4). Diagnosticapproaches varied, most commonly CIDI/SCAN, ICD–10, or DSM criteria. Community-based cohorts were concentrated in Ethiopia, while hospital-based studies dominated West and Southern Africa. Evidence on caregiver burden and psychosocial interventions is emerging but remains limited in scale and duration. Interventional studies are few, with small sample sizes and heterogeneity in outcome measures.

The African schizophrenia literature demonstrates robust observational foundations but limited interventional and caregiver-inclusive evidence. Heterogeneity in diagnostic and outcome measures constrains comparability. To improve clinical care, research should prioritize standardized assessments, scalable psychosocial interventions, and caregiver-inclusive approaches embedded in routine services. Future efforts should collaborate with African-led initiatives and integrate findings into WHO guidelines to enhance equitable schizophrenia care worldwide.

The period immediately following discharge from psychiatric inpatient mental health care is associated with heightened clinical vulnerability, including increased risk of relapse, crisis presentation and suicide. National standards from the National Confidential Inquiry into Suicide and Safety in Mental Health, NHS CQUIN targets and the Welsh Government Crisis Care Concordat recommend that all adult patients receive follow-up by a mental health professional within 72 hours of discharge and that discharge documentation comprehensively records risk, mental state, medication and care planning. A previous regional audit identified variable compliance and incomplete documentation across sites. This re-audit aimed to assess current adherence to these standards, evaluate whether implemented quality improvement measures had improved practice, and identify ongoing gaps to inform further service development.

A retrospective clinical re-audit was undertaken across three adult inpatient units (East, Central and West) within Betsi Cadwaladr University Health Board. All eligible discharges occurring during June–July 2025 were included. Electronic discharge summaries and 72-hour follow-up records were reviewed using predefined criteria. Standards assessed included completion of follow-up within 72 hours and documentation of risk assessment, mental state examination (MSE), medication information, and a comprehensive discharge plan, alongside the quality of follow-up notes. Cases recorded as not applicable or refused were excluded. Missing or undocumented items were classified as non-compliant. Compliance rates were calculated overall and by site and compared with baseline findings from the initial audit.

Thirty-eight discharges were reviewed. Overall compliance with 72-hour follow-up was 78.4% (29/37). Documentation of comprehensive discharge plans was highest (86.5%), followed by MSE (78.8%) and risk assessment (72.7%). Medication documentation remained comparatively low at 63.6%. Considerable inter-site variation was observed. The Central site achieved 100% follow-up compliance and consistently strong documentation across domains. In contrast, the East site demonstrated lower follow-up completion (57%) and particularly poor medication documentation (20%), while the West site showed moderate follow-up rates (66.7%) with weaker recording of risk (46.2%) and medication (53.8%). Compared with baseline data, overall follow-up and discharge planning showed modest improvement, but reliability of documentation remained inconsistent.

Although small gains were demonstrated following initial interventions, substantial variation persists between sites, indicating inconsistent processes and handover practices. Standardised electronic templates, discharge checklists, automated alerts and routine audit feedback have been introduced to improve reliability. Ongoing quality improvement and targeted site support are required to achieve consistent adherence to national standards and to enhance safety during the high-risk transition from inpatient to community care.

Other authors-Dr. Aanika Nawer Hoque,Dr Nur Efina Mokhtar,Dr Charlotte Hague-Roberts

Additional Author Dr Bethany Ranjit Consultant Psychiatrist.

To evaluate compliance with NICE national standards for physical health monitoring in adults receiving ADHD medication in the community setting along with reviewing the side effects profiles and follow up intervals.

NHS England commissioned a project to consider ADHD service provision.This highlighted a significant number of challenges our ADHD services face with increases in demand for ADHD services. In tandem with this NICE recommends that physical health monitoring (blood pressure, heart rate and weight) should take place prior to initiating medication and at a minimum of six-monthly intervals, alongside structured side-effect reviews. Given the significant increases in the outpatient ADHD patient caseloads, we were concerned about the documentation and monitoring requirements of this demographic of patients.

A retrospective cohort audit of 207 adults prescribed ADHD medication by YCC CMHT was undertaken. Data extracted included demographic details, medication type and dose, dates and completeness of physical observation checks, and physical comorbidities. Additional variables collected included duration on stable dose, carecoordination status and psychiatric comorbidities. These were included to assess suitability for sharedcare transition.

The sample included 105 males and 102 females, with a mean age of 36.1 years. Medications prescribed were Lisdexamfetamine 63.3%, methylphenidate XL 20.3%, methylphenidate IR 4.3%, guanfacine 3.9%, Atomoxetine 2.9% and Dexamphetamine 0.5%. 60% of patients had been on a stable dose for more than six months. Physical health observations were recorded for 174 patients 84.1%, although documentation was frequently incomplete, with missing pulse or weight entries. No standardised monitoring tool was used. Monitoring intervals were within NICE recommendations for 30.9%, whereas 28.5% were reviewed between 6–12 months, 24.6% beyond 12 months and 15.9% had no monitoring recorded. Psychiatric comorbidities were present in 37% of patients. Physical comorbidities included Asthma 7.2%, Hypertension 2.8%, Fibromyalgia 2.4%, Polycystic ovarian syndrome 1.9% and Hypothyroidism 1.9%.

A substantial proportion of patients did not receive physical health monitoring within recommended intervals, and documentation quality was inconsistent and varied in detail. The absence of standardised tools likely contributed to underreporting of relevant adverse effects. Operational challenges, including limited access to monitoring equipment and continued prescribing despite nonattendance, were notable barriers. Implementing electronic prompts and adopting standardised monitoring templates may improve adherence to guidelines and enhance patient safety. Whilst also enhancing patient suitability for shared-care transitions.

Catatonia is a treatable syndrome that can occur due to psychiatric and neurological pathology, such as hypoxic-ischaemic brain injury. Many neuroanatomical pathways may contribute to catatonia but no single pathway has been found to be the sole cause.

A systematic review assessing evidence of adult-only cases of catatonia after hypoxic-ischaemic brain injury and summarisation of the presentation, lesion location, treatment and outcome.

A PRISMA-2020 compliant PubMed/MEDLINE search of terms related to catatonia and hypoxia/ischaemia was carried out. Catatonia had to be explicitly diagnosed and must have been secondary to a hypoxic-ischaemic insult. Data were extracted based on lesion characteristics, timeline, treatment, and outcome.

Seven studies met the criteria and they were all case reports. Lesions were heterogeneous and included bilateral parietal watershed infarcts, basal ganglia, thalamus,corona radiata, extensive white matter disease, pontine and cerebellar infarcts, and fronto-insular atrophy with inferred hypoxia. Presentations ranged from stuporous catatonia to delirium and affective disorders with catatonic features. Outcomes were generally good and catatonia resolved; however, post-neurological consequences of hypoxic-ischaemic insult remained in a few.

The evidence was limited to case reports and no single lesion causing catatonia was found.The findings supported the disrupted cortico-striato-thalamo-cortical motor pathway and the disconnection pathway as a possible cause for catatonia. There was also evidence for the involvement of neurochemical pathways such as GABA, dopamine and NMDA as a potential cause or treatment focus. Further studies with standardised catatonia measures and imaging are required.

To improve the quality of psychiatric history taking and mental state examination by psychiatric trainee doctors in North Wales.

A retrospective psychiatric case note audit was conducted across three acute psychiatric inpatient units in North Wales (Wrexham, Rhyl and Bangor sites). A total of 35 inpatient records were reviewed (Wrexham n=15, Rhyl n=10, Bangor n=10) against standards derived from the Oxford Textbook of Psychiatry chapter on history taking and mental state examination. Quality was scored (0–2) against 60 essential criteria.

The aggregate compliance to the standards was 50.6%, demonstrating significantly less than the 100% target for full documentation. While administrative tasks (84.3%) and objective MSE findings (68.5%) were relatively well-documented, complex narrative elements such as HOPC especially core symptoms of anxiety (10.0%), depression (26.8%),and past psychiatric history (22.9%) showed critical gaps. The History of Presenting Complaint achieved only 26.4% compliance. Most significantly, while risk assessment was documented in 58.1% of cases, the translation into an actionable risk management plan was documented in only 8.6% patients.

There was variation in quality standards achieved at all the three acute psychiatric sites in North Wales. The resident trainee doctors used different admission clerking proformas at the three sites. The details captured in the admission clerking for new psychiatric admissions did not fully align with the details expected in a psychiatric history taking scenario as per the standards in the Oxford Textbook of Psychiatry. The missing information in history taking can contribute to suboptimal patient care including suboptimal risk management and such missing information and detail in history taking is seldom fully rectified later in the admission. We argue that the solution is not merely the introduction of another “tick-box” proforma, but the implementation of a standard with clear expectations to follow traditional detailed psychiatric history taking and mental state examination with clinical reasoning and synthesis, regardless of tool used for completing the clerking. Training sessions are being planned to be delivered to the trainee doctors with the aim of achieving 100% compliance in the re-audit ensuring that the “full story” is captured for every patient, every time.

The purpose of this audit was to ensure that patients who are receiving long acting injectables of antipsychotic medication are having their prolactin monitored as per national and Trust guidelines.

Prolactin is a hormone responsible for lactation, breast development, and other actions needed to maintain homeostasis. Hyperprolactinemia is defined as an increase in prolactin level above the normal range that is sustained. The Trust guidelines outline that a baseline prolactin must be established before starting or changing an antipsychotic. The patient must then be evaluated for symptoms of hyperprolactinemia and prolactin serum level re-checked 3 months later.

This was a retrospective review using the serum prolactin levels available on ICE test results system and information available from clinics letters and documentation. All patients were above the age of 18 and receiving regular depots at the community depot clinic. All patients presented to the depot clinic between the 1st May 2024 and 31st May 2024.

A study sample was obtained using a list of patients from the depot clinic. Out of that list, 108 patients present to the depot clinic within the set timeframe. 31 patients were excluded as they were on an Aripiprazole depot, which does not requiring monitoring of prolactin levels as per NICE and Trust guidelines. A further 18 patients were excluded as the depot was started before 2014, and a start date was unobtainable. 2 patients started the depot in a different Trust and 2 patients started the depot in South Essex, therefore a baseline prolactin was unobtainable. A total of 55 patients were finally included in the study sample.

The target for compliance was 100%.

Of the 55 patients commenced on long-acting injectable treatment, 33 (60%) did not have a baseline prolactin level measured prior to initiation, and 22 (40%) did not have prolactin levels checked within the preceding year. Sixteen patients (29%) had neither a baseline nor a follow-up prolactin measurement. Physical health checks within the last year were completed and documented in 37 patients (67%). Overall compliance was 40% for baseline prolactin monitoring, 60% for annual prolactin monitoring, and 67% for annual physical health checks.

There was inadequate monitoring of prolactin levels in community patients receiving long acting injectables, as the target for compliance was not met. As need for monitoring needs to be highlighted, the results of this audit were presented to the community team and at the local teaching.

To review CT and MRI head scan reports of patients aged 65 years and over referred to the Mental Health Liaison Team, focusing on whether dementia-relevant features were consistently reported.

To examine the presence and reporting of cerebral atrophy, vascular changes and infarcts, and to compare acute hospital discharge diagnoses with final community psychiatric diagnoses in order to identify gaps in early recognition of dementia.

This quality improvement project reviewed a randomly selected sample of 14 patients aged 65 years and over referred to the North Mental Health Liaison Team at Chesterfield Royal Hospital between 1 November 2025 and 31 January 2026. CT and MRI head scan reports requested during the acute admission were reviewed.

All data were anonymised in line with information governance requirements. Imaging reports were assessed for documentation of acute pathology, cerebral atrophy, vascular change and established infarcts. Acute hospital discharge diagnoses were compared with subsequent diagnoses made by community mental health services. Data were collected using a structured Microsoft Forms tool and analysed descriptively using Microsoft Excel.

Confusion was the primary indication for neuroimaging in approximately 90% of cases. Over 90% of scans reported no acute intracranial pathology. Cerebral atrophy, either global or focal, was documented in over 80% of scans, whilst vascular changes were reported in approximately 90%. Established infarcts were less consistently described, with variable emphasis on their relevance to cognition. At the point of acute hospital discharge, around 40% of patients were given a functional psychiatric diagnosis. Following community follow-up, approximately 40% of patients were ultimately diagnosed with dementia, indicating a significant shift in diagnostic formulation over time.

Older adults presenting acutely with confusion frequently demonstrate chronic neuroimaging changes relevant to dementia, even when acute pathology is excluded. The proportion of patients later diagnosed with dementia suggests that opportunities for earlier recognition exist during the acute admission. More consistent and structured reporting of dementia-relevant imaging features, alongside closer collaboration between radiology and liaison psychiatry, may support earlier referral to memory services, improve continuity of care and reduce unnecessary repeat investigations.

1. To improve General Adult/Older Adult Higher training experience across North London Foundation Trust at 80% at 1 year.

2. To increase Higher trainee engagement with rotation evaluation survey to 80% at 1 year.

We ran an initial survey amongst NLFT higher trainees, exploring their level of wellbeing in their current posts in 2024. Areas of improvement were identified and mappedusing a fish-bone diagram. During 2025, we held a series of iterative meetings, including with directors of medical education, training programmedirectors, higher trainees and reps to agree on concrete actions for improvement. We ran a second survey in 2025 to re-audit.

We achieved over a 80% satisfaction with the current SpR posts, however, re-audit survey was answered by fewer respondents than expected.

An iterative process involving meetings with different stakeholders (trainees, clinical supervisors, training programme directors, etc.), openly discussing areas for improvement, and implementing small changes can improve trainee wellbeing. However, increasing participation in surveys remains a challenge.

CQC (2018, 2019) is concerned about the high numbers of patients situated a long way from home which could result in social detachment and cut off from the local services that will provide care following discharge. Cheshire and Wirral Partnership NHS Foundation Trust was identified by CQC (2018) as being in the top twenty NHS mental health trusts with the highest number of patients placed in a mental health rehabilitation ward funded by a different provider. Rehab case management provides key worker responsibility, utilising expertise and specialist skills for patients in hospitals in line with NHS England commissioner guidance (2024) to improve quality and ensure services are effective, evidence based and safe. Thus, weekly multi-disciplinary team (MDT) meetings with rehab case management and Cheshire and Wirral Integrated Care Boards (ICBs) were set up in August 2024 to monitor the key components of the admission and discharge planning.

Community mental health transformation is at the heart of the approach where a guiding principle of the rehab case management team is community based by default, inpatient by exception. A data analysis review was undertaken through comparing the results of pre-and post-setting up the MDT with a focus on purpose of admission, defined therapeutic interventions and estimated date of discharge. An admission should only be as long as necessary with emphasis on improved reporting of patients who are clinically readyfor discharge (CRFD). Rehab case management fosters shared-decision making through patient-reported outcome measures including DIALOG and Goal-Based Outcomes to monitor progress, guide treatment and facilitate discharge planning. The Friends and Family Test offers a mechanism for evaluating patient experience and improving quality.

The review demonstratedeffectiveness of collaborative working between rehab case management and Cheshire and Wirral ICBs to reduce the number of patients in out of area hospitals. Improvement in mental health rehabilitation pathways is gleaned through the lens of ‘in sight and in mind’. There have been 14 patients from Cheshire discharged and 14 patients discharged since the inception of the MDT.

The findings suggest that the collaborative working with ICBs has significantly helped improve patient flow, reduce discharge delays and provided a structured, data-driven approach to managing inpatient stays. It is this focus that has achieved the objectives of the NHS England commissioner guidance and the NHS 10 Year Health Plan for England to reduce the reliance on inpatient care and deliver interventions in the least restrictive setting.

Sleep difficulties affect up to 58% of individuals with Functional Neurological Disorder and other neuropsychiatric presentations. The Triangle of Sleep is a clinician-led pilot psychoeducational intervention combining learning points from Cognitive Behaviouralmodel for Insomnia (CBT-I), with behavioural principles for restructuring of day-routine and mindfulness-based exercises, designed to improve sleep. This quality improvement project worked alongside the intervention team to independently collect staff team and patient feedback using two co-production cycles to implement improvements in design and delivery of the intervention.

Participants with sleep difficulties were recruited from the East Kent Neuropsychiatry Clinic to attend three one-hour group sessions covering sleep hygiene, day structuring, and mindfulness. The Plan–Do–Study–Act method was used to guide the approach. An initial scoping review identified how existing guided self-help interventions were quality assured. A questionnaire was developed using andragogy, and self-directed learning (SDL) principles to evaluate participant experiences. Verbal feedback was gathered from semi-structured interviews based on the questionnaire. The data was analysed by five reviewers and discussed with clinicians to produce a consensus document identifying feasible improvements, which were implemented over two PDSA cycles.

The first cycle received responses from 2 patients and 3 student observers. Key themes included clarity of learning objectives (LOs), limited discussion opportunities, repetition, optimal SDL material utilisation, and desire for an additional session. Themes were discussed with clinician facilitators resulting in a consensus document of proposed changes. Revisions included promotion of SDL materials and session restructuring to include clear LOs and discussion opportunities. An additional session was not implemented due to resource constraints.

Before the second cycle, the questionnaire was refined for sustainability of continuous improvement. The second pilot retained 8 participants, with 5 patient feedback responses. There was limited consensus between participants unlike the previous cycle. A key improvement was a 20% increase in use of SDL materials compared to the previous cycle.

A co-production model proved effective for quality assuring a psychoeducational intervention. Iterative patient feedback enabled feasible, patient-centred improvements to acceptability and clarity. While immediate reflections on motivation in applying theories taught were mixed, the use of SDL materials suggests improved self-efficacy for long-term implementation of principles and potential for sleep improvement. The ‘Triangle of Sleep’ pilot provides a foundation for upscaling and the development of digital or AI-supported delivery models to increase reach and sustainability. In areas with less access to formal CBT-i this intervention could provide specialist insomnia treatment with lower clinician burden.

Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist used for anaesthesia and analgesia, with increasing interest in its rapid antidepressant effects. This case evaluates the feasibility, tolerability and clinical response to subcutaneous ketamine in a medically frail older adult with psychotic depression, hypothesising that ketamine would rapidly improve engagement and depressive burden to support nutritional intake and medical recovery.

A 77-year-old man with a prior severe episode of psychotic depression had previously achieved full recovery after eight sessions of electroconvulsive therapy (ECT). In the current episode, he presented similarly with disorientation, nihilistic beliefs, poor engagement, self-neglect and severe weight loss from reduced oral intake, consistent with a depressive relapse with psychotic features.

His case was complicated by medical instability with suspected delirium, as well as limited adherence to and response from conventional antidepressant treatment. Anaesthetic risk in the context of acute physical illness, led to ECT being deferred and subcutaneous ketamine being used as a practical ward-based intervention when urgent treatment was required.

Following multidisciplinary and family discussion, subcutaneous ketamine was initiated as a rapid antidepressant intervention. Three doses were administered over approximately ten days (two at 0.25 mg/kg, followed by escalation to 0.5 mg/kg due to limited initial response). Depressive symptoms were rated using the Cornell Scale for Depression in Dementia (CSDD), alongside serial clinical assessments of mental state, engagement and oral intake.

Treatment was well tolerated, with no dissociative or behavioural adverse effects observed. CSDD scores showed modest change, decreasing from 15 at baseline to 12 after the first dose and to 10 after the third and final dose, with transient improvements in engagement and acceptance of care that were not sustained and did not translate into lasting improvement in overall mental state or nutritional intake.

Subcutaneous ketamine was a feasible and well-tolerated option in this medically frail older adult but did not achieve a clear or sustained antidepressant response in this case. Given the patient’s prior robust response to ECT and the limited benefits observed with ketamine, referral for ECT was re-initiated once anaesthetic risk was acceptable, highlighting the potential role of subcutaneous ketamine as a short-term bridging intervention when ECT is temporarily high-risk and the need for further evidence in older adults with psychotic depression and comorbid physical illness.

To estimate lifetime, 12-month, and 30-day prevalence of OCD in Qatar; characterise symptom profiles and comorbidity patterns; identify sociodemographic correlates; and examine sex differences in functional impairment.

To estimate lifetime, 12-month, and 30-day prevalence of OCD in Qatar; characterise symptom profiles and comorbidity patterns; identify sociodemographic correlates; and examine sex differences in functional impairment.

Weighted lifetime prevalence of OCD was 2.9% (95% confidence interval 2.4–3.5) and was higher among females (3.8%) than males (2.3%; p=0.007). The most commonly reported symptom types were checking (68.2%), religious scrupulosity (65.7%), and cleaning (60.0%). Nearly all individuals with lifetime OCD had at least one psychiatric comorbidity (91.0%), most frequently mood disorders (68.5%), post-traumatic stress disorder (71.3%), and other anxiety disorders (45.9%). Female sex was associated with OCD in an unadjusted model (odds ratio 2.05; p=0.002) but not after controlling for comorbidities (odds ratio 1.24; p=0.397). Compared with ages 18–29 years, ages 30–39 years had the highest odds of OCD (odds ratio 3.1; p=0.006). Qatari nationality was also associated with OCD (odds ratio 1.71; p=0.049). High functional impairment was observed in 76.9% of affected individuals, with significantly greater impairment in home and social domains among females than males.

As the first national epidemiological study of OCD in Qatar, these findings provide a critical baseline for service planning, early detection strategies, and resource allocation. OCD is prevalent, highly impairing, and characterised by extensive psychiatric comorbidity, supporting the need for integrated and culturally responsive care pathways.

South West London and St George’s Mental Health (SWLStG) hospitals operate a 12-hour pathway for mental health patients (MHPs) requiring admission from the A&E. However, prolonged waits beyond this timeframe have been frequently observed, with some patients remaining in A&E for more than 72 hours following the decision to admit (DTA). This audit aimed to determine the proportion of MHPs waiting longer than 72 hours for a psychiatric inpatient bed from a district general hospital A&E over a 13-month period. Secondary aims were to establish the average waiting time for this cohort and to explore whether bed wait duration differed between detained and informal admissions.

Hospital administrative records were retrospectively reviewed for all MHPs awaiting inpatient psychiatric admission from a district general hospital A&E between October 2024 and November 2025. Data collected included time of DTA and time of transfer to an inpatient psychiatric bed. Length of stay (LoS) was calculated from DTA to admission.

During the audit period, 642 patients were assessed as requiring psychiatric admission. Of these, 105 patients (16%) waited longer than 72 hours for an inpatient bed. The mean LoS for this cohort was 5 days, 23 hours, and 12 minutes, with a maximum LoS of 24days, 20 hours, and 39 minutes. Patients detained under the MHA (n=47) experienced longer waiting times compared with informal admissions (n=62), with an average additional delay of 4 hours and 38 minutes (mean LOS 6 days, 1 hour, 8 minutes vs 5 days, 20 hours, 30 minutes respectively).

This audit demonstrates persistent difficulty in achieving timely psychiatric admission from A&E, with 16% of MHPs waiting over 72 hours following DTA. Patients with higher clinical acuity, reflected by detention under the MHA, experienced longer bed waits. Contributing factors are likely multifactorial, including reduced inpatient bed capacity, increasing mental health demand, limited community alternatives, and A&E environments that are poorly resourced for prolonged psychiatric care. Nationally, psychiatric inpatient bed numbers have reduced by approximately 73% over the past three decades, alongside a substantial rise in mental health presentations post Covid pandemic. Future work should replicate this audit across multiple A&E sites to better characterise systemic delays and inform service-level planning.