Prescribing stimulant medication for Attention-Deficit/Hyperactivity Disorder in patients with Postural Orthostatic Tachycardia Syndrome presents a recognised clinical dilemma due to the potential for stimulants to exacerbate tachycardia and autonomic instability. There is limited practical guidance on how such prescribing can be undertaken safely within psychiatric inpatient settings. This case aims to demonstrate how structured multidisciplinary collaboration, robust monitoring protocols, and clear system ownership can enable safe initiation of stimulant treatment in a patient with POTS, while highlighting vulnerabilities in protocol implementation within complex care systems.

A woman in her early twenties was admitted to an acute psychiatric ward with complex psychiatric and medical comorbidities, including POTS (stable on Ivabradine), Epilepsy, and Schizoaffective disorder. Following comprehensive assessment, she was diagnosed with ADHD using the DIVA-5 diagnostic interview.

Given the cardiovascular risks associated with stimulant medication, extensive liaison was undertaken with multiple consultant cardiologists at a tertiary NHS trust. Cardiology confirmed stable POTS, a normal recent ECG, and no evidence of structural heart disease, advising that Lisdexamfetamine 20 mg once daily could be initiated with appropriate precautions.

A detailed monitoring protocol was developed and disseminated, including baseline and thrice-daily lying, sitting, and standing heart rate and blood pressure measurements, NEWS2 scoring, predefined red-flag thresholds, and a clear escalation plan. The patient received structured education regarding symptom reporting, and informed written consent was obtained. The plan was shared with nursing staff and on-call medical teams to support safe implementation.

Lisdexamfetamine was initiated without cardiovascular complications. During the initial two-week intensive monitoring period, no tachycardia, blood pressure instability, or worsening of POTS symptoms were observed. The patient reported significant subjective improvement in ADHD symptoms, corroborated by staff observations. Ongoing weekly monitoring continued following dose changes.

A systems-based challenge was identified when elements of the monitoring protocol were not implemented consistently during a period of medical handover, despite prior written communication. This highlighted a critical gap between protocol dissemination and execution, underscoring the importance of clear ownership and active follow-up when implementing high-risk prescribing plans.

This case demonstrates that stimulant medication can be safely initiated in selected patients with POTS when supported by specialist cardiology input, structured monitoring, and robust multidisciplinary collaboration. However, safe prescribing extends beyond clinical decision-making alone; system-level safeguards, clear accountability, and effective handover processes are essential to mitigate risk. Patient education and proactive MDT engagement are pivotal in ensuring both safety and therapeutic benefit in complex psychiatric prescribing.

The weekly Local Academic Programme (LAP) at Mersey Care NHS Foundation Trust is part of the MRCPsych programme. It aims to prepare psychiatry trainees for theirMRCPsych exams, and within Mersey Care receives positive feedback from attending resident doctors. To support exam practice, multiple-choice questions (MCQs) were introduced in 2024. We decided to extend further support as trainee leads and introduced didactic (maximum 5 minutes) explanations of complex exam topics every session, using different audio/visual technologies. The aim was to cater to different learning methods; Visual, Audio, Reading/Writing, Kinaesthetics.

The quality improvement project used mixed methodology. We used convenience sampling to collect quantitative and qualitative data. Before the start of the semester, a pre-intervention survey was sent to trainee doctors using Google Forms, in February 2025. After 5 MCQs for the audience to practice in the LAP, one of the authors (LAP trainee leads) explained a chosen topic for 5 minutes. We used power point presentations or videos using graphics or white board function on Zoom to explain examinable topics. Paper A and Paper B curriculums were used to select the topic for discussion. Throughout the semester and at the end, we sent out surveys to gather feedback using Smart Surveys until July 2025.

Initial survey data indicated that most trainees struggled to digest concepts in standard MCQ banks and believed they would benefit from short (5-minute) discussions on complex examinable topics, such as biostatistics (e.g. ANOVA vs. ANCOVA) during our sessions.

Following the implementation of the new LAP format, 60.7% found MCQ based explanations helpful. Regarding delivery style, 35% of respondents preferred a mixture of MCQs and whiteboard/video explanations, while 33.33% favoured MCQs with standard explanations. None of the respondents wanted whiteboard/video-based teaching alone.

Qualitative feedback was highly positive, with trainees noting that the explanation of statistical methods was “particularly good” and “very helpful for revision” for Paper B. Participants specifically praised the “simplified” explanations to consolidate learning.

The trainees found the new sessions useful for their organisation, interactivity, and clarity on difficult to understand examinable topics. To support the greatest benefit in MRCPsych examination preparation, trainees preferred a combined approach of MCQ style questions alongside whiteboard/video explanations for more complex topics. Catering to different learning methods and differential attainment in local medical education programmes could potentially improve MRCPsych success rates for resident doctors in psychiatry training.

Psychoeducation is a key evidence-based component of treatment for psychosis, improving insight, adherence, and relapse prevention. The Orygen Psychosis Psychoeducation framework “A Shared Understanding: Psychoeducation in Early Psychosis” emphasises accessible, developmentally appropriate resources for young people and carers. Beechcroft, the regional Tier 4 adolescent inpatient unit for Northern Ireland, regularly admits young people experiencing psychosis. In 2022, a Serious Adverse Incident (SAI) at Beechcroft identified that a young person and their family felt insufficiently informed about a diagnosis of first-episode psychosis. This highlighted a gap in psychoeducational provision within the service and prompted the development of structured, age-appropriate psychoeducation workbooks.

In response to the SAI, two psychoeducation workbooks were developed collaboratively by the Beechcroft team: one for young people, and one for parents and carers. The young person’s workbook is designed for use during the early recovery phase of inpatient admission and includes psychoeducation on the nature of psychosis, risk factors, symptom recognition, relapse indicators, treatment options, and relapse prevention planning. Delivery typically occurs over 4–6 sessions by a doctor, or alternatively could be delivered by another member of the multidisciplinary team (MDT) with appropriate training. The carer version provides parallel content adapted for families, with additional emphasis on understanding psychosis, managing relapse, and addressing feelings of guilt or self-blame. The psychoeducation workbooks have been piloted in Beechcroft with 3 young people and their carers. Qualitative feedback was collated in order to evaluate the effectiveness of our project to date.

Feedback from young people indicated that the workbook improved their understanding of psychosis, enhanced motivation for recovery, and encouraged engagement with treatment planning. Carers described the psychoeducation sessions as empowering, reporting greater confidence in recognising early warning signs and knowing when to seek professional help. Parents expressed relief in understanding that they were not responsible for their child’s illness, which facilitated a more supportive family environment.

The introduction of structured psychoeducation workbooks in Beechcroft has strengthened communication between professionals, young people, and families while embedding NICE and Orygen aligned best practice into routine care. Early feedback suggests that the intervention enhances illness understanding, relapse management, and familyconfidence. Future plans include formal evaluation using outcome measures and exploring adaptations for community use and general adult psychiatric settings. The project demonstrates how learning from an SAI can drive meaningful service improvement and promote recovery-oriented practice in adolescent mental health inpatient units.

A 77-year-old male with no prior contact with psychiatric services, and a medical history of a myocardial infarction and osteoarthritis, presented in 2022 with a 10-week history of psychotic symptoms. These included auditory hallucinations as well as persecutory and somatic delusions. He was diagnosed with Very Late Onset Schizophrenia-Like Psychosis (VLOSLP) and detained under the Mental Health Act due to non-adherence and risk.

Since 2022, several antipsychotics (olanzapine, aripiprazole oral and depot, risperidone) have been trailed, however symptoms persisted with repeated relapses linked to non-adherence. Zuclopenthixol decanoate led to partial stabilisation but with residual psychosis. In June 2023, he attempted suicide by hanging, requiring admission to Intensive Care Unit. Antidepressants (sertraline and then later mirtazapine/vortioxetine) were added for comorbid depressive symptoms.

From September 2023, clozapine was initiated due to treatment-resistance. Titration was limited by hypotension, sedation, constipation, and poor engagement, compounded by persistent psychotic symptoms and delusional beliefs about blood loss and poisoning. Magnetic Resonance Imaging of the brain and autoimmune encephalitis screening were normal.

Between 2024 and 2025, recurrent crises occurred due to non-adherence and entrenched delusions. Clozapine was intermittently stopped and restarted with cardiology input following concerns about heart failure. The multidisciplinary team decided on slow clozapine titration, with use of intramuscular clozapine when non-adherent, and to continue this long-term.

VLOSLP is defined by a patient’s first episode of psychosis after 60 years of age. VLOSLP poses significant diagnostic challenges as up to 60% of cases are secondary to organic causes, and there are significant overlapping features between VLOSLP and neurodegenerative disorders, although the pathophysiology still remains unclear. After 60, the incidence of schizophrenia increases around 11% every 5 years. Clinically, VLOSLP has a lower prominence of negative symptoms and formal thought disorders, and a higher prominence of partition and persecutory delusions, multimodal hallucinations and cognitive impairment. Management requires cautious use of antipsychotics at lower doses due to increased morbidity and mortality risks associated with elderly patients. The literature shows treatment-resistant VLOSLP may benefit from options such as clozapine, electroconvulsive therapy, or neuromodulation strategies.

Currently, the patient remains under inpatient management on clozapine, targeting a serum clozapine level of 0.35-0.45mg/L, with ongoing monitoring for side effects. He still experiences fixed delusions and auditory hallucinations, requiring ongoing encouragement for adherence, with occasional use of intramuscular clozapine. Overall, there is limited evidence on VLOSLP and treatment-resistant VLOSLP, and further research is required for optimal diagnostic and treatment pathways.

Following the military coup in February 2021, Myanmar has experienced widespread human rights violations, insecurity, economic hardship, and disruption of essential services, resulting in a substantial deterioration in population mental health. Media-reported suicides have increased, alongside rising mental health presentations within TeleKyanmar, a nationwide telemedicine service operating under the Ministry of Health, National Unity Government (MOH-NUG). In response, TeleKyanmar launched the Zero Suicide Campaign (ZSC), Myanmar’s first national suicide prevention hotline, in September 2023.

The primary objective of ZSC is to reduce suicide risk through timely crisis intervention. Secondary objectives include narrowing the mental health treatment gap and facilitating rapid referral to appropriate mental health services for individuals at risk.

The preparation phase (December 2022–August 2023) involved multi-stakeholder consultation with mental health and MHPSS experts, followed by three rounds of virtual suicide prevention training (April–June 2023). A total of 168 Civil Disobedience Movement (CDM) professionals completed foundational training, from whom 50 were selected for advanced applied training. The applied programme comprised 24 hours of structured teaching and supervised skills practice, focusing on suicide risk assessment, safety planning, empathic listening, crisis hotline ethics, and operational challenges.

The hotline was launched on World Suicide Prevention Day (10 September 2023) using the Telegram platform. It operates seven days a week across two daily shifts, with three parallel lines. Trained volunteers provide crisis support, supported by live and bi-weekly psychiatric supervision. Standard Operating Procedures guide case management and referrals. Suicide risk is assessed using the Columbia Suicide Severity Rating Scale (C-SSRS) and safety planning is conducted using the Stanley–Brown Safety Plan.

Currently, 41 trained volunteers provide the service. Individuals assessed as medium or high suicide risk are referred to TeleKyanmar mental health clinics within 24–72 hours, while those at lower risk are signposted to community-based online counselling services. The hotline enables anonymous, stigma-reduced access and functions as an effective gateway into structured mental healthcare.

The Zero Suicide Campaign represents a scalable, low-cost public health intervention in a conflict setting. It provides immediate crisis support, reduces barriers to care, and strengthens suicide prevention pathways within a disrupted health system. The model demonstrates how telemedicine-linked crisis services can mitigate suicide risk in humanitarian emergencies.

Acknowledgement: We acknowledge all Civil Disobedience Movement mental health professionals and members of the Myanmar Psychiatrist Diaspora whose voluntary commitment made the Zero Suicide Campaign possible.

Promethazine is a phenothiazine compound first synthesised in the 1940s, with prominent sedative qualities. As a first-generation antihistamine, promethazine has strong affinity as an antagonist of H1histaminergic receptors of the tuberomammillary nucleus, as well as moderate antagonism of muscarinic cholinergic receptors, and weak-moderate affinity to receptors in the serotonergic, dopaminergic, adrenergic and glutaminergic systems. While in the UK promethazine is publicly available ‘over the counter’, it is not recommended by NICE guidelines for insomnia.

We narratively summarise the available evidence for promethazine’s benefit on human sleep outcomes with structured searches, as well as publicly available prescribing trends data from OpenPrescribing and published academic reports.

Promethazine is increasingly prescribed by primary care physicians and psychiatrists in United Kingdom as a treatment for all kinds of sleep concerns, with a near doubling of English GP prescriptions in the past 5 years. There is no good evidence for the clinical benefit of promethazine on sleep outcomes, with an absence of clinical trials or adequate measures of sleep. Use of promethazine as a sleep-aid is actively advised against in international expert consensuses, with evidence based alternatives available including the NICE guidelines’ first-line option, Cognitive-Behavioural Therapy for Insomnia (CBT-I).

For several reasons, it appears that promethazine is not an appropriate treatment for any flavour of sleep problem. First, because there is no clinical trial evidence. Secondly, it is important to remember that sedation is not sleep. These two states of reduced consciousness are different phenomenologically, physiologically, and appear different on EEG recordings. The multiple benefits of natural human sleep cannot be assumed to be achieved by this kind of artificial sedation. Histaminergic antagonism has a very complex pharmacodynamic profile, and psychiatrists cannot expect that there will be linear dose-effects. Third, the addictive nature of promethazine must be acknowledged: there are significant levels of recreational use of promethazine worldwide, in part because of its effects in potentiating opioid agents. Moreover tolerance develops quickly, with diminished sedative effects seen in as few as 3 days. Withdrawal symptoms are common, with rebound insomnia widely reported after long-term use. Finally, the side effect profile of promethazine is of concern including, QTc prolongation, weight gain, and the potent cholinergic effects have a causal effect on dementia. This poster concludes with a summary of alternative approaches for psychiatrists using promethazine in their practice, including CBT-I and alternative, more sleep problem-specific medication options.

To discuss the potential role of artificial intelligence (AI) in different diagnostic interventions in dementia.

A literature search was conducted in PubMed on 6 February 2026 using the terms “artificial intelligence” AND “dementia”. The search identified 5257 records, which were limited to publications from 2021–2026, yielding 3598 records. Filters for free full-text availability and study type (clinical trials, randomized controlled trials, systematic reviews, meta-analyses, and reviews) were applied, resulting in 303 articles.

Inclusion criteria were: (1) studies focused on the application of artificial intelligence in dementia; (2) human studies; (3) peer-reviewed articles; (4) publication within the last five years; and (5) availability of full text in English. Exclusion criteria included: (1) non-dementia populations; (2) non-AI-based methodologies; (3) conference abstracts, editorials, letters, and commentaries; and (4) animal or simulation-only studies.

Titles of the 303 eligible articles were screened for relevance, resulting in 50 studies included for further analysis.

Dementia is a clinical outcome of complex neurological disorders with a multitude of aetiologies and risk factors. Conventional methods in early diagnosis and management of dementia pose several risks and costs. Integrating AI with a sophisticated learning model can provide a comprehensive assessment in the diagnosis of dementia. Early diagnostic efforts can be achieved through a combination of AI-based neuroimaging such as MRI, PET, and CT scans, genetic and metabolic biomarkers supported by a robust pattern recognition algorithm. Incorporation of AI in dementia diagnosis can enable early recognition, leading to a 40% risk modification.

However, a number of methodological constraints should be noted when using AI for diagnosis like lack of algorithm development and standard definitions. Other challenges include difficulties in integrating healthcare systems, as well as data privacy and ethical concerns.

Artificial intelligence has significant potential to enhance the diagnosis and prognosis of dementia by improving early detection and reducing costs. Despite methodological, ethical, and integration challenges, effective collaboration between AI and medical professionals and the development of standardized approaches are essential for successful implementation in clinical practice.

To assess compliance with recommended baseline physical, laboratory, and additional investigations prior to initiation of atypical antipsychotics in psychiatric inpatients, identify deficiencies in practice, implement targeted interventions, and evaluate subsequent improvement in adherence.

ET AL AUTHORS : Dr.Subhash Chandar (Email: dr.sbhalwani@gmail.com) - Psychiatry PGR Suleman Roshan Medical College,Tando Adam, Sindh, Pakistan.Dr Muhammad Zubair (Email: Muhammadzubair1103@gmail.com) - General Practitioner

A prospective closed-loop clinical audit was conducted in the Psychiatry Department over two months, comprising pre- and post-intervention phases. A total of 50 patients newly started on atypical antipsychotics were included. Baseline parameters assessed were:

Physical: weight/BMI, waist circumference, blood pressure

Laboratory: complete blood count (CBC), liver function tests (LFTs), renal function tests (RFTs), fasting blood glucose or Hbs-738c, fasting lipid profile, creatine phosphokinase (CPK), serum prolactin

Additional: ECG and pregnancy test (females of reproductive age)

Pre-intervention data were collected via review of medical records. Interventions included staff education, introduction of standardized baseline investigation checklists, visual reminders, and improved coordination with laboratory and ECG services. Post-intervention data were collected using the same proforma to assess improvement.

Pre-intervention (n=25; 10 males, 15 females):

Weight/BMI was documented in 16 patients (64%), blood pressure in 7 (28%), and waist circumference in none (0%); no physical assessments were recorded in 7 patients (28%). Laboratory investigations showed low compliance: CBC in 14 (56%), LFTs and RFTs in 13 each (52%), glucose/HbA1c in 11 (44%), lipid profile in 12 (48%), while CPK and prolactin were not documented in any patient; no laboratory investigations were recorded in 11 patients (44%). ECG was performed in 10 patients (40%), and no pregnancy testing was documented.

Post-intervention (n=25; 9 males, 16 females):

Weight/BMI documentation increased to 17 patients (68%), blood pressure to 19 (76%), and waist circumference to 12 (48%), with no physical assessments missing in 80% of patients. Laboratory monitoring improved markedly: CBC 25 (100%), LFTs 22 (88%), RFTs 21 (84%), glucose/HbA1c 19 (76%), lipid profile 15 (60%), CPK 12 (48%), and prolactin 15 (60%), with only 2 patients (8%) lacking laboratory investigations. ECG documentation increased to 17 patients (68%) and pregnancy testing to 14 females (88%).

Overall, physical assessments improved from 30.7% to 64%, laboratory investigations from 36% to 76.6%, and additional investigations from 20% to 62%. Combined compliance improved from approximately 29% pre-intervention to 68% post-intervention, representing an absolute improvement of 39 percentage points.

Baseline monitoring prior to initiation of atypical antipsychotics was initially suboptimal. Implementation of simple, low-cost interventions resulted in substantial improvements across physical, laboratory, and additional monitoring domains, demonstrating the effectiveness of structured quality improvement measures in enhancing patient safety and adherence to recommended standards.

PRN (pro re nata, or ‘as required’) psychotropic medications are commonly given by nurses based on patients’ needs to manage sudden psychiatric symptoms effectively. While these medications are essential in quickly relieving acute distress, inappropriate usage can cause issues such as excessive medication, unnecessary multiple drug prescriptions, and potential patient dependency. Therefore, strict compliance with prescribing guidelines is crucial.

This audit was conducted to check whether PRN psychotropic medication prescriptions on an adult psychiatric inpatient ward met the Trust’s guidelines (PHARM-0041-v4.2) and were prescribed safely.

Retrospective audit of all PRN psychotropic prescriptions on Danby Ward, Cross Lane Hospital (TEWV NHS Trust) in the Electronic Prescribing and Medicines Administration (EPMA) system between 13 March and 5 April 2024 (registration 7482AMH23). Fifteen prescriptions comprising 32 PRN medicines were assessed against protocol-derived criteria (standard=100%): indication; dose/formulation/frequency; minimum dosing interval; maximum 24-hour dose; documented review date; first-/second-line guidance when more than one PRN option was prescribed for the same indication; and review/discontinuation if not administered for four weeks.

Indication and dosing parameters met the standard in all cases (32/32, 100%). No PRN medicine had a documented review date (0/32). Where more than one PRN option was prescribed for the same indication (18/32 medicines), first-/second-line guidance was absent in all applicable prescriptions (0/18; not applicable 14/32). Among medicines prescribed for four weeks or more without administration (8/32), none were reviewed or discontinued (0/8; not applicable 24/32).

Non-compliance with PRN review standards is a medication-safety risk, with potential for delayed optimisation, avoidable polypharmacy/adverse interactions, and prolonged PRN use without a clear ongoing rationale. Improvements should focus on EPMA-enabled review prompts, routine pharmacy-led checks, targeted prescriber education, and clearer documentation to support consistent review and rationalisation.

Post-audit actions are largely completed Trust-wide: PRN oral and IM regimens now include an automatic 14-day review date; PRN guidance has been updated to clarify first-/second-line options and implemented across inpatient settings with updated EPMA content and training materials; EPMA has been upgraded to v3.3 to support Mental Health Act consent requirements; and EPMA e-learning plus a Quick Reference Handbook for medicines review/discontinuation have been produced. One action remains in progress: customisation of regimen dose screens, with change requests under discussion with Civica. The re-audit will assess compliance after full implementation.

This re-audit aimed to evaluate the Ageless Psychiatric Liaison Service (PLS) by: (1) assessing older adult (OA) and working age adult (WAA) referrals in terms of source, triage, assessments, and outcomes; (2) evaluating psychiatric admissions, including reasons for admission, senior medic involvement, observation levels, medical clearance, and bed management; and (3) appraising alternatives to admission, such as referrals to Crisis House and Home Treatment Teams (HTT).

A retrospective review was conducted over three months (April–June 2025) using electronic psychiatric (SystmOne) and hospital (EPIC) records. A random sample of 50 patients (25 OA, 25 WAA) was selected, with two young-onset dementia cases included in the OA group. Data were extracted systematically using a structured Excel sheet capturing referral details, clinical assessments, management, and outcomes.

WAA presentations predominantly involved acute psychiatric crises, including self-harm and suicidal ideation, with short hospital stays (mostly 1–2 days) and low observation requirements. Referrals were primarily crisis-driven, with 88% medically optimized for discharge at the time of referral, and were largely managed through a nurse-led model by Band 6 and 7 nurses. Most WAA patients were discharged to community services, including HTT, CMHRS or GP with only a small proportion requiring acute hospital admission.

In contrast, OAA presentations were more complex, involving cognitive, behavioural, and medical comorbidities, resulting in longer and more variable hospital stays and needing one-to-one nursing in nearly half of cases. Management was multidisciplinary, involving old age specialists, Band 7 nurses, and PLS medics in 92% of cases. Half of OAA patients were referred to CMHT-OP for ongoing management, while 20% awaited psychiatric admission due to limited bed availability. Delays in transfer to psychiatric beds ranged from 23 hours to 21 days, reflecting a scarcity of psychiatric beds.

The re-audit highlighted effective nurse-led crisis management for WAA, whereas OAA patients presented with complex needs requiring multidisciplinary input and longer hospital stays. The lack of an established older adult crisis pathway contributes to reliance on CMHT-OP and prolonged admission. These findings underscore the need for tailored crisis pathways and resource allocation to better support the complex needs of older adults while confirming the efficiency of current approaches for working-age patients. The PLS ageless model and mix of clinicians of various experience and background need to reflect the patient population that is served. There is a clear need for WAA and OA specialism within the ageless model.

Electroconvulsive therapy (ECT) remains the most effective and potentially life-saving treatment for severe psychotic depression, particularly in older adults with treatment-resistant illness and high suicide risk. However, delivery of ECT may be rendered impossible by repeated failure of peripheral venous access, leading to premature discontinuation of an otherwise effective intervention. This case aims to highlight the ethical, clinical and practical considerations of using a totally implantable venous access device (Port-a-Cath) solely to enable continuation of ECT in an exceptional, high-risk psychiatric context.

We report the case of a 76-year-old woman with recurrent, severe psychotic depression and baseline mild cognitive impairment, known to psychiatric services for over six years with multiple admissions under the Mental Health Act. She had a clear and consistent historical response to ECT, including resolution of psychotic symptoms and recovery of cognitive function to baseline. During a prolonged relapse marked by nihilistic somatic delusions, profound functional impairment and persistent suicidal ideation requiring constant 1:1 observations, ECT was recommenced but had to be abandoned due to repeated failure of peripheral venous access. Alternative strategies, including ultrasound-guided cannulation, midline and PICC lines, were deemed unsuitable or unsustainable. Following multidisciplinary discussion, a Port-a-Cath was inserted to enable reliable anaesthetic access and continuation of ECT.

The Port-a-Cath was inserted without complication and successfully facilitated recommencement of ECT after a short healing period. Subsequent treatments were delivered reliably, with good-quality seizures and no device-related adverse events. Over the course of ECT, the patient demonstrated gradual but meaningful improvement in psychomotor retardation, thought blocking, affective reactivity and somatic delusions, alongside a reduction in suicidal ideation. Cognitive functioning improved in parallel with mood, consistent with her prior illness trajectory. The device remained functional and unobtrusive, reducing repeated procedural distress and eliminating risks associated with repeated cannulation in a highly vulnerable patient lacking capacity to consent.

This case demonstrates that, in exceptional circumstances, a Port-a-Cath may be a safe, ethical and effective means of enabling access to life-saving ECT when standard venous access options have failed. Careful multidisciplinary decision-making, proportionality and ongoing risk–benefit evaluation are essential. Innovative approaches to treatment delivery may be justified to uphold patient dignity and maximise recovery in severe, otherwise intractable psychiatric illness.

The co-occurrence of delusional parasitosis (primary Ekbom syndrome) with idiopathic Parkinson’s disease is considered rare. Most literature consists of individual case reports or small series, indicating it is an uncommon but recognised clinical phenomenon. The rarity is compounded by the therapeutic challenge it presents.

A 74-year-old gentleman of Caribbean origin, with a longstanding diagnosis of persistent delusional disorder (delusional parasitosis, F22.0), was admitted under Section 3 of the Mental Health Act. He had a history of non-concordance with olanzapine for three years, resulting in significant clinical deterioration. Comorbidities included idiopathic Parkinson’s disease (also non-concordant with medication) and prostate cancer in remission.

On presentation, he exhibited classic Ekbom syndrome: believing bugs infested his body, he applied yoghurt to his skin and stored debris. Profound self-neglect, hoarding of soiled items and out-of-date food, and environmental squalor were noted. Significant weight loss, worsening mobility, and cognitive decline were reported.

Management was complicated by the contraindication of many antipsychotics in Parkinsonism, where they exacerbate motor symptoms. Olanzapine was briefly restarted but poorly tolerated. Aripiprazole was initiated cautiously at a low dose (max 25mg daily) with monitoring for akathisia. Procyclidine effectively managed resultant hypersalivation. His Parkinson’s medications were recommenced.

Pharmacological guidance, per Maudsley’s guidelines, restricts options. Risperidone and typical antipsychotics like flupentixol are contraindicated due to high extra-pyramidal side effect risk. While quetiapine has marginal efficacy, it is often trialled before clozapine. In this case, aripiprazole was selected as a potentially safer atypical agent.

This case illustrates the complex interplay between psychotic illness and neurodegenerative disease, highlighting the severely limited and high-risk antipsychotic options available. Multidisciplinary management, including SALT input (showing dietary improvement), remains essential for this vulnerable patient with concurrent severe mental illness, physical comorbidity, and challenging medication non-adherence.

Educational, clinical and psychiatric supervision play a crucial role in the development of psychiatric trainees, contribute to safe clinical practice, and promote trainee wellbeing. Whilst resident doctors express high levels of satisfaction with supervision within the National Training Survey, the lived experience of psychiatric trainees of supervision is not well understood; evidenced within a systematic review of the literature. Thus, the aim of this project was to explore the experience of psychiatric trainees in Kent and Medway Mental Health NHS Trust (KMMH) of supervision, with a focus on key factors affecting their satisfaction.

A focus group, qualitative methodology was used. Fifteen core and higher psychiatric trainees were recruited through purposive sampling. Four focus groups were conducted via Microsoft Teams. Anonymised transcripts were verified through member checking. Data saturation was achieved. Ethical approval was granted from the University of Kent.

Participants described beneficial aspects of supervision and areas that were more challenging. Data was analysed using reflexive thematic analysis. Five themes emerged:

Scheduled Regular Supervision: Not only being able to access regular supervision, but for this to be scheduled, enabling trainees to plan the agenda in advance.

Knowledge of Supervision: For supervisors and trainees to understand the value of a shared agenda and the remit of supervision, specifically the distinction between clinical and educational supervision. Participants described difficulties when supervision was trivialised through supervisors equating brief informal discussions with required weekly reflective one-to-one supervision.

Support Across the Training Journey: Adapting the supervisory offer in response to differing levels of experience and key transition points was perceived as helpful, particularly for international medical graduates.

Fostering Mutual Respect: Enablers of a mutually respectful relationship were flattening the traditional power hierarchy and engaging in bi-directional feedback; barriers to providing feedback were described.

Psychological Safety: Adopting a non-judgemental stance towards trainees was recognised as important, alongside supervisors making genuine efforts to ‘check in’, avoiding comparing trainees to others, and conducting supervision in a private space.

The project has contributed to a deeper understanding regarding psychiatric trainees’ experience of supervision, not only factors perceived as helpful but also the complexity and nuance required; captured adeptly by a trainee “that's why there's such an art to supervision”. Recommendations are proposed: To foster conditions that promote helpful supervisory behaviours; to empower trainees within their supervision; and co-create feedback systems that recognise and respond to unhelpful supervisory behaviours without fear of adverse repercussions.

Psychiatry trainees experience high workload and emotional demand. Peer-to-peer connection and the use of safe reflective spaces are protective factors, but access can be inconsistent. We used PDSA cycles to test whether an ongoing mental health-themed filmclub session (film, followed by facilitated discussion) was associated with immediate (same-evening) improvements in self-reported wellbeing and peer connection, and an immediate reduction in feelings of burnout.

Setting: an open-to-all, mental health-themed film club with attendees including psychiatry trainees, other clinical staff, and non-clinicians. Intervention: film screening followed by a facilitated group discussion. Measures: brief anonymous surveys completed immediately pre- and post-session. Outcomes were: self-reported wellbeing, peer connection, and level of burnout. The post-session survey included an assessment of psychological safety during the session, plus free-text feedback for qualitative assessment. Likert responses in each domain were converted to numerical scores (1–5) and analysed quantitatively. After session 1, PDSA was used including reviewing qualitative feedback to inform refinements and confirm the post-film discussion as a key component.

Two cycles were completed with different films: Aftersun (2022) (session 1) and Taste of Cherry (1997) (session 2). Session 1: pre n=12, post n=11. Mean wellbeing increased from 3.17 to 4.00 (+0.83). Mean peer connection increased from 3.25 to 4.55 (+1.30). Mean burnout decreased from 2.92 to 2.73 (−0.19). Discussion comfort was high (mean 4.64/5). Session 2: pre n=13, post n=12. Mean wellbeing increased from 3.69 to 4.17 (+0.47). Mean peer connection increased from 4.38 to 4.75 (+0.37). Mean burnout decreased from 3.23 to 2.83 (−0.40). Psychological safety in the discussion remained high (mean 4.58/5; median 5). Free-text responses across both cycles repeatedly identified the post-film discussion as the main impact, describing peer-to-peer connection, widening of cultural perspectives, and a non-judgemental atmosphere.

Across two QI cycles, a psychiatry film club was feasible to run and evaluate and was associated with immediate improvements in wellbeing and peer connection, with modest reductions in burnout feelings. These are key issues facing the mental health workforce and a film club represents a creative way to improve measures. Psychological safety ratings were consistently high and qualitative feedback suggests facilitated discussion as the key active component. Future cycles will look at sustained improvements in wellbeing. A future goal is to expand to other regions and embed into the core training curriculum.

Political violence, detention and torture cause severe psychological morbidity. During a period of political instability in Sudan between December 2018 and June 2019, civilians were exposed to extreme cumulative trauma, yet data on post-traumatic stress disorder (PTSD) in this population remain limited. This study aimed to estimate the prevalence of PTSD among detainees, examine symptom characteristics and psychometric properties of the PTSD scale, and identify predictors of PTSD in a conflict-affected population.

A cross-sectional study was conducted among 246 Sudanese individuals who experienced detention, torture or related trauma in Khartoum State between December 2018 and June 2019. PTSD symptoms were assessed using DSM–IV criteria, including functional impairment. Demographic characteristics and trauma exposure variables (type, number and timing of events) were examined. Psychometric analyses included internal consistency testing and receiver operating characteristic (ROC) analysis to determine a screening cut-off. Multivariate logistic regression with stepwise selection was used to identify predictors of probable PTSD.

Participants were predominantly male (89.8%), aged 20–29 years (72.0%) and students (54.1%). Trauma exposure was extensive and cumulative: 45.5% reported exposure to all four trauma categories, and 87.2% of torture survivors experienced multiple torture methods. PTSD prevalence was high, with 65.9% meeting symptom criteria and 38.2% meeting diagnostic criteria including functional impairment. The most commonly reportedsymptoms were irritability (77.8%), re-experiencing symptoms (71.1%) and concentration difficulties (67.9%). The PTSD scale showed good internal consistency (Cronbach’s α=0.82). ROC analysis identified a threshold of ≥7 symptoms as the optimal screening cut-off (area under the curve 0.84). In multivariate analysis, exposure during the most intense period of violence in June 2019 (3–30 June) was the strongest PTSD predictor (adjusted odds ratio 4.99), followed by witnessing trauma, exposure to shocking events involving family or friends, intense emotional response and direct exposure to beating or torture. A clear dose–response relationship was observed between cumulative trauma exposure and PTSD severity.

PTSD prevalence among detainees during this period of political instability in Sudan was alarmingly high, particularly among those exposed during peak violence. Temporal context, indirect trauma involving loved ones and cumulative exposure were stronger predictors than demographic factors. These findings highlight the urgent need for trauma-informed mental health services, screening and psychosocial support for survivors of political violence in Sudan and similar conflict-affected settings.

Every fifth pregnant person experiences mental health problems during pregnancy and the puerperium. The Joint Perinatal Mental Health Clinic (JPMHC) at Milton Keynes University Hospital was established to offer multidisciplinary team (MDT) support to patients with a complex mental health background during this time. Here, patients are supported by a team, including a psychiatrist, an obstetrician and a specialised midwife. Plans are made for pregnancy, delivery and follow-up. We aimed to audit the outcomes of this clinic between July 2023 – July 2024.

Data were extracted from electronic patient records, for all patients booked into the JPMHC in July 2023 – July 2024. Data were analysed and figures were generated using Microsoft Excel.

35 patients were given an appointment with 83% attending all their appointments. Patients booked into clinic were 29.5 years old on average (19-39). 17% patients were from ethnic minority backgrounds, 74% were from a white background and 9% from other backgrounds.

Of the 32 patients that attended at least one appointment, 94% were seen by at least 3 MDT members. 74% of these patients had a perinatal mental health plan recorded. 28% were seen with at least one relative present.

82% of all patients had two or more psychiatric diagnoses recorded. The most common mental health backgrounds were affective disorders (31 diagnoses), anxiety disorders (29 diagnoses) and history of trauma or adverse life experiences (31 diagnoses). 69% of patients were on at least one psychotropic medication. 26% were on 2 or more psychotropic medications. The most used medications were SSRIs (16 prescribed), and antipsychotics (11 prescribed).

This audit highlights the value of MDT input to address the needs of pregnant patients with complex mental health backgrounds. Being seen in a joint clinic allowed for clear communication with patients, their relatives and between relevant healthcare teams. This allowed for detailed perinatal mental health plans to be made. Close collaboration in the MDT promotes safety, for example when considering teratogenicity risks or adverse effects on neonates with the use of psychotropic medication. MDT members provide expert guidance on patients in their care, which is essential in the context of psychotropic polypharmacy and a multitude of psychiatric diagnoses.

The JPMHC helps pregnant people look after their physical and mental health as well as their growing child’s wellbeing in a vulnerable time in life. Going forward, we aim to design a standardised template and create a clinic model for other sites to implement.

Attention Deficit Hyperactivity Disorder (ADHD) commonly co-occurs with psychotic disorders. First-line treatment for ADHD involves stimulant medications, which increase dopaminergic transmission and may exacerbate psychotic symptoms in vulnerable individuals. Patients within Early Intervention in Psychosis (EIP) services who are prescribed stimulant medication therefore represent a potential prescribing safety risk, particularly when antipsychotics are co-prescribed.

Aims were to assess documentation of stimulant-associated psychosis risk and monitoring practices in patients with comorbid ADHD and psychosis within an EIP service, and to identify areas for quality improvement.

A retrospective cross-sectional review of electronic patient records was conducted for all patients under the North Kent EIP service. Patients with at least one episode of psychosis and a formal diagnosis of ADHD were identified. Data collected included ADHD and psychosis diagnoses, prescribed stimulant and antipsychotic medications, documentation of stimulant-related psychosis risk within risk assessments, evidence of monitoring plans, and records of stimulant discontinuation or medication review due to psychotic symptoms.

Of 152 patients under the EIP caseload, 16 (10.5%) had a confirmed diagnosis of ADHD. Four patients were prescribed stimulant medication, two of whom were concurrently prescribed antipsychotic medication. No risk assessments documented the potential for stimulant-associated psychosis exacerbation, and none included a specific monitoring plan addressing this risk. ADHD was referenced as a comorbidity in 75% of risk assessments. No cases of documented stimulant discontinuation due to psychosis were identified.

Although ADHD was frequently recognised as a relevant comorbidity, risk assessments did not address the potential for stimulant-associated psychosis exacerbation or include monitoring plans. This represents a gap in prescribing safety within EIP services. A targeted educational intervention has been developed to improve staff awareness and documentation so that improvements can be made in the safety of prescribing amongst this underrepresented group.

Exposure to acute psychiatric referrals from the Emergency Department (ED) and acute hospital wards is a core component of psychiatry training. With the expansion of Liaison Psychiatry services, many assessments are now managed by non-medical practitioners, raising concerns about reduced trainee involvement. This project aimed to assess current psychiatry trainee exposure to ED and acute ward referrals across liaison services, identify barriers to involvement and supervision, and implement service-level changes to improve training opportunities.

A two-stage mixed-methods audit was conducted across multiple sites within a large NHS mental health trust. In the first quantitative cycle, an anonymised electronic questionnaire was distributed to psychiatry trainees completing or commencing placements, assessing frequency of exposure to ED and acute ward referrals, supervision quality, and confidence in achieving required competencies (n=44). Following identification of low and variable exposure, a qualitative component was undertaken using semi-structured feedback from liaison psychiatry consultants (n=7) to explore perceived barriers and potential service improvements. Findings were triangulated and presented to the Trust’s Postgraduate Medical Education Committee to inform intervention planning.

The majority of trainees reported limited or infrequent exposure to ED and acute hospital psychiatric referrals despite participating in on-call rotas. Although most trainees described some level of support, a significant minority felt under-supervised. Only a modest proportion expressed confidence in achieving competency in managing acute referrals by the end of placement. Qualitative analysis identified key barriers, including workload pressures,ward prioritisation during on-call shifts, rota structures lacking formal liaison integration, nursing-led triage models limiting trainee involvement, role ambiguity, and trainee anxiety related to confidence and safety.

Following review, Trust-level service changes were approved, including a mandatory one-month liaison shadowing period for new trainees and structured trainee involvement in ED and acute ward referrals with supervision.

This audit demonstrated a system-wide reduction in psychiatry trainee exposure to emergency and acute hospital referrals within liaison services, driven by structural, operational, and behavioural factors. The mixed-methods approach enabled the identification of modifiable barriers and informed the implementation of targeted service redesign to enhance training opportunities.

A planned second audit cycle will evaluate the impact of these interventions on trainee exposure, supervision quality, and confidence. This project highlights the importance of aligning service models with training needs to ensure competency development in acute psychiatric care.

Ethnic minority children and adolescents are consistently under-represented in UK mental health services. Accurate ethnicity recording is essential for monitoring equity of access and informing service improvement. A baseline clinical audit conducted in 2020 across East Lancashire Child and Adolescent Mental Health Services (CAMHS) identified incomplete ethnicity recording and significant under-representation of Asian service users relative to the local population.

This re-audit reassessed the original audit standards by evaluating ethnicity recording completeness and whether the ethnic composition of CAMHS service users reflected the local under-18 population. It tested the hypotheses that ethnicity recording completeness would improve following the 2020 audit and that service use would reflect local population demographics.

A re-audit was conducted using electronic health records for all open CAMHS cases (n=1626) across East Lancashire Child and Adolescent Services as of 6 May 2025. Analyses were undertaken at locality level (Blackburn with Darwen; Burnley and Pendle; Hyndburn, Ribble Valley and Rossendale). Descriptive statistics were used to assess ethnicity recording completeness. Population-based access rates per 1,000 children were calculated using 2011 Census under-18 population denominators, and observed and expected numbers of Asian CAMHS service users were compared using chi-square goodness-of-fit tests.

Ethnicity recording completeness improved overall between 2020 and 2025, increasing from approximately 78% at baseline to 88% at re-audit, with improvement seen in most localities. Despite this, Asian children and adolescents remained significantly under-represented among CAMHS service users. Access rates for Asian children were consistently lower than those for non-Asian children across all localities (approximately 2–5 vs 12–18 per 1,000 children, respectively), and observed numbers were significantly lower than expected based on population proportions (χ² goodness-of-fit, p < 0.001).

This re-audit demonstrates measurable improvement in ethnicity recording completeness within East Lancashire CAMHS since the 2020 baseline audit, indicating partial completion of the audit cycle. However, improved data quality has not translated into equitable access to CAMHS, with Asian children remaining under-represented and access rates persistently lower than expected.