Psychiatric conditions and psychotropic medications can significantly impair driving ability through sedation, impaired judgment, or delayed reaction times. According to DVLA and GMC standards, clinicians must advise patients when their mental state or medication may affect driving, inform them of their duty to notify the DVLA, and clearly document this advice. This audit assesses compliance with these requirements on two psychiatric inpatient wards.

A retrospective review of 20 discharge summaries (10 from Edisford Ward, 10 from Hyndburn Ward at the Royal Blackburn Hospital) dated up to 15/09/2025 was conducted. Data were extracted under the following domains: diagnosis, driving status, medication class, evidence of driving advice on discharge, and evidence of DVLA contact on behalf of the patient.

Across both wards, 20 patients were reviewed in total. The vast majority (n=19, 95%) were prescribed psychotropic medications that may impair driving, including antipsychotics, antidepressants, benzodiazepines, and mood stabilisers.

Only 1 patient had documented evidence that driving advice was given at discharge. No cases recorded that the clinician contacted the DVLA on behalf of the patient, even where severe psychiatric illness (e.g. schizophrenia, bipolar disorder, or mania) was present.

Discussion:

The findings demonstrate a clear gap in documentation regarding driving advice in psychiatric inpatient discharges. Despite all patients being prescribed medication with potential to impair driving, almost none had documented advice, and there was no evidence of clinician escalation to the DVLA.

Recommendations:

Provide ward-based education sessions on DVLA standards and GMC responsibilities. Ensure driving advice is provided to patients on discharge and is clearly documented. Re-audit after 1 month to assess improvement.

This audit highlights poor compliance with national guidance regarding driving advice and documentation at discharge. Improved awareness and systematic prompts are required to ensure patient and public safety and to maintain medico-legal standards.

Local Clinical Governance (LCG) provides a structured framework through which healthcare organisations are accountable for continuously improving service quality and patient safety. A multi-site audit conducted between September and December 2024 across mental health hospitals identified variability in leadership engagement, multidisciplinary team (MDT) attendance, safety reporting, and documentation of clinical effectiveness. This re-audit aimed to evaluate the impact of targeted quality improvement interventions implemented following the initial audit, assessing whether governance standards improved across participating sites.

A closed-loop re-audit was conducted between September and December 2025 across 27 mental health hospital sites. Data were collected from Local Clinical Governance meeting minutes using a structured audit tool aligned with national clinical governance standards and the STEELL agenda (Safety, Training, Effectiveness, Experience, Leadership, Lessons Learned). Key domains assessed included meeting leadership and attendance,pharmacy involvement, safety and incident reporting, care-plan and GAP compliance, dissemination of lessons learnt, and patient and carer engagement. Findings were compared with the baseline audit conducted during the same months in 2024.

The re-audit demonstrated measurable improvements across multiple governance domains. Leadership accountability improved following the introduction of mandatory co-chairing of LCG meetings by Medical Directors and Hospital Managers, with leave planning structured around monthly governance meetings. Pharmacy attendance improved, strengthening oversight of medication safety. Enhanced contraband confiscation processes and improved dissemination of lessons learnt were observed across sites. Clinical effectiveness improved, with GAP consistently completed at admission and discharge, and care-plan triangulation optimised through integration of risk assessments, clinical documentation, and governance review. Patient and carer engagement improved through structured carer events, facilitating better communication between families and clinical teams. Some inter-site variability persisted, highlighting areas for continued improvement.

This closed-loop re-audit demonstrates that targeted, leadership-driven quality improvement interventions can significantly enhance Local Clinical Governance processes across mental health services. Strengthening leadership accountability, MDT engagement, and systematic learning contributes to improved safety, clinical effectiveness, and patient and carer experience. These findings highlight the value of re-audit cycles in embedding sustainable governance improvements and offer transferable learning for other mental health providers.

Burnout is a recognised risk factor for workforce attrition in healthcare. In psychiatry in patient services, where retention pressures are high, understanding the relationship between burnout and staff intentions to leave or reduce working hours is critical for service sustainability. There we examine the association between burnout and workforce withdrawal intentions among psychiatry inpatient staff.

An anonymous cross-sectional survey was completed by 115 inpatient psychiatry staff. Burnout was measured using a validated composite score. Workforce withdrawal intentions were assessed using two Likert-scale items measuring likelihood of leaving the current role and likelihood of reducing working hours within the next 12 months due to work-related stressors. Multivariable linear regression models adjusted for professional role group, years working in psychiatry, and work pattern. All statistical analyses were performed using IBM SPSS Statistics.

Higher burnout was strongly associated with increased intention to leave the current role within the next 12 months (adjusted B=0.94, p < 0.001), with the model explaining 47% of variance in turnover intention (adjusted R²=0.47). Burnout was also independently associated with intention to reduce working hours (adjusted B=0.62, p < 0.001; adjusted R²=0.21). Staff characteristics, including professional role, years of experience, and work pattern, were not significant predictors of workforce withdrawal intentions.

Burnout is a powerful predictor of workforce withdrawal intentions among psychiatry inpatient staff. Addressing burnout may be critical to improving staff retention and maintaining workforce capacity in inpatient psychiatric services.

To evaluate the appropriateness, quality, and outcomes of referrals to the Enhanced Team East (ETE) in order to ensure that the service is effectively targeted to individuals with complex mental health needs who require intensive, multidisciplinary community support.

Retrospective review of referrals processed by ETE over the defined period (January 2025 - June 2025), focusing on Single Point of Access (SPA)-received referrals, duty system triage, and MDT decision-making. it was designed to evaluate referral patterns, adherence to inclusion criteria, and outcomes, while identifying opportunities for process improvement.

• • A total of 60 referrals were received over the 6-month period, showing steady demand for the Enhanced Team East (ETE). Most of the referrals were from the wards and SPA.

• • Only 31.7% were accepted, suggesting many referrals may not meet the threshold or that SPA/teams may need clearer guidance on referral criteria.

• • Significant proportions were transferred to Core teams(traditional CMHT) (23.3%) or discharged (18.3%), indicating opportunities for improved triage or alternative pathways before referral.

• • The processing time for accepted referral ranged from 7 days to 94 days, with an average of 32.6 days.

• • Most of the referrals were from the wa

• • The evaluation shows that the Enhanced Team East receives a steady flow of referrals, but only a subset of these referrals meet the threshold for acceptance.

• • Processing-time analysis reveals variability in responsiveness, indicating potential workflow delays within triage and allocation processes.

• • Improving clarity around referral criteria, strengthening collaboration with referring teams, and reviewing triage processes could enhance the efficiency and appropriateness of referrals.

• • Overall, the findings provide a strong basis for targeted service improvements and support the need for future reaudit to measure progress

The patient is a 76 years old female without any past psychiatric history. She was married for 50 years and her husband died a year ago. Since then she became withdrawn and stopped eating, drinking. She was admitted to general hospital with hyponatremia.

The patient was reviewed by Liaison psychiatry, she had symptoms of anhedonia, self-neglect, guilt, paranoia and psychomotor retardation. She was diagnosed with severe depressive episode with psychotic features and treated with Mirtazapine 45mg and Quetiapine 100mg.

There was no improvement on medication. She continued to decline food, water and had frequent hypoglycaemic attacks. Her BMI was 12.9. Bifrontal Electroconvulsive therapy (ECT) treatment was decided. During pre-ECT check-up her CRP was 38.

During the first episode, she didn’t have seizure on 10% stimulus. On 15% stimulus she had 109 seconds seizure on EEG. Post-ictal suppression was poor.

During the second episode, on 15% stimulus she had 77 seconds seizure on EEG.Post-ictal suppression was fair. Etomidate 10 mg was used as anaesthetic for both episodes.

While in recovery the patient was nonresponsive. Her blood sugar level was 4.6 mmol/L and she was given Dextrose. It rose to 9.9 mmol/L and she started to have seizure.

She had two observed seizures lasting 42 and 20 seconds. Her third seizure lasted 94 seconds while connected to EEG. She was given Propofol 20mg to stop the seizure.

She had a CT head without any acute findings. Chest X-ray showed shadow on the right base. Her CRP was 43 and sodium was 131.

Tardive seizure is a rare complication of ECT. It is a spontaneous seizure after ECT, there should be full recovery of consciousness before the onset.

Lansari et el (2025) found several factors associated with tardive seizure such as treatment that lowers the epileptogenic threshold, anaesthesia with Etomidate, prolonged seizure, and poor post-ictal suppression.

Another differential is that the seizure didn’t fully terminate after ECT, it became focal and later manifested as general tonic-clonic seizure. It is unclear if the patient fully recovered consciousness after ECT.

The patient was started on Lamotrigine and remained seizure free. Due to her deteriorating physical health, she didn’t receive further ECT. There were some improvement to her mood and appetite with Mirtazapine and Venlafaxine.

Repeated ECT has been safe for many patients even after tardive seizure. Only 15% of patients developed further tardive seizure after restarting ECT (Warren et el 2022).

Deeghayu clinic at the National Institute of Mental Health, Sri Lanka is in the forefront of serving psychogeriatric disorders which are in the rise. A project was launched in the latter half of 2023 to improve quality of diagnosis made there. It included implementation of best practices such as limiting number of patients seen per day while increasing days of contact to increase time spent on each and number viewed per week, usage of Montreal Cognitive Functional Assessment scale(MoCA) and Bristol scale in all the patients and other cognitive, functional and disease-specific assessments only as required and presenting a multidisciplinary assessment to the Consultant Psychiatrist to arrive at a diagnosis. Thus the aim of this study is to assess improvement in diagnostic precision made after implementation of best practices.

Two audits were done comparing clinical diagnosis made before (first six months of 2023) and after implementing best practices (first 6 months of 2024).

Total number of patients viewed had soared from 43 to 95. Proportion of patients who had undergone MoCA and Bristol scale had soared from 86% and 39.5% respectively to 104.2% (including re-assessments to ascertain response to therapy) and 95.7%. Variety of diagnosis made had risen from identifying 22, 1, 1, 5 patients with Alzheimer’s, vascular, Lewy body and mixed dementia to identifying 10, 14, 5 patients with mild, moderate and severe Alzheimer’s dementia respectively and 10, 7, 1 patients with mild, moderate andsevere vascular dementia, 5 other varying types of dementia and 5 with mild cognitive impairment. Identifying 14 with depression in 2023 had risen to 11, 11 and 3 with mild, moderate and severe depression.

Multidisciplinary approach, provision of adequate time per each patient and doing essential assessments in all patients and others as required to supplement the diagnosis can improve the precision and quality of diagnosis made despite a lack of sophisticated facilities and infrastructure. Thus this represents a scalable model that can be replicated across other low-income country settings as well.

There have been long-standing challenges associated with recruitment into psychiatry internationally. In the UK, this issue has inevitably led to a shortage of practising mental health consultants which impacts upon training opportunities, patient care and staff morale. This study aims to explore existing psychiatric trainees’ perspectives on their career choice and the educational experiences that impacted upon their decision.

This is a qualitative research study using semi-structured interviews to explore the perceptions of trainees within psychiatry on their educational journey and the interactions with role models that ultimately influenced their career aspirations. Thematic analysis was used to organise the findings into three overarching themes and various subthemes that aimed to interpret and explain meaning across the dataset.

Thirteen participants were interviewed demonstrating a range of ideas that were broadly grouped into three main themes. Theme one, entitled attitudes and behaviours towards and within psychiatry encompassed the importance of role models within psychiatry, a humanistic approach to patient care and to trainees themselves, and the trainees' experiences of professional stigma. Theme two, influential educational experiences within psychiatry explored the impact of specific teaching and learning experiences, potential barriers and unique and influential opportunities available. Theme three, perspectives and perceptions of psychiatry as a specialty concerned the trainees’ perceptions of how others viewed them as psychiatrists and involved discussion of common misconceptions, access to the specialty prior to application and visibility of the specialty in other contexts.

Exploring trainees’ experiences in the lead up to choosing psychiatry as a career provided valuable insight into existing positive experiences and highlighted aspects of learning and training that could be further developed. The results can be used to provide a platform from which to enhance the educational experiences of future potential psychiatrists.

This study explores the relationship between depressive symptoms and emotional regulation–specifically emotional attention, clarity, and repair–among Pakistani medical students, with an emphasis on gender-based differences.

A cross-sectional study was conducted among 216 medical students at a single medical college in Pakistan. Participants completed the Beck Depression Inventory (BDI) and the Trait Meta-Mood Scale (TMMS). Data on demographics, physical activity, and hobbies were also collected. Gender-stratified chi-square analyses were used to assess associations between depression severity and emotional regulation.

Moderate to severe depressive symptoms were reported by 41.6% of students, while 58.4% exhibited minimal to mild symptoms. Females were significantly more likely to report insufficient emotional attention (12.6% vs. 2.5%,p=0.038), while males more frequently reported sports as a primary hobby and higher levels of vigorous physical activity. No significant gender differences were found in depression severity, emotional clarity, or emotional repair. Overall, 91.7% of students demonstrated adequate or excessive emotional attention, 82.4% had excessive clarity, but a striking 79.6% reported insufficient emotional repair. Lifestyle patterns were also concerning, with 58.3% of students engaging in less than two hours of moderate physical activity per week. Emotional repair was consistently poor across all depression categories and both genders, suggesting a universal deficit in emotion regulation rather than a gender-specific trend.

High levels of depression and emotional dysregulation were observed across the student body, regardless of gender. Within Pakistan’s context of limited mental health services, academic pressure, and cultural stigma, these findings highlight a critical need for institutional support structures. Emotion regulation training, particularly targeting emotional repair, and broader access to psychological services should be prioritized. Given the sample was drawn from a single institution, the generalizability of findings is limited.

Prolonged waiting times for ADHD assessment in child and adolescent mental health services (CAMHS) present a significant challenge. While outsourcing can address immediate waiting list pressures, it may simply shift the bottleneck back to the core CAMHS service. This service evaluation aimed to examine the effectiveness and cost implications of the in-house waiting list model in West Galway CAMHS, with a view to informing management decisions on developing and appropriately resourcing the team for sustainable long-term service delivery.

This service evaluation reviewed CAMHS patients from West Galway who were awaiting ADHD assessment between January 2025 and January 2026. A random sample of 30 patients managed via the in-house waiting list initiative was compared with 28 patients managed through an outsourced model. Outcomes assessed included time to assessment, discharge to GP (without transfer to core CAMHS), diagnosis rate, and subsequent need for CAMHS follow-up. Data were analysed using simple descriptive comparisons to explore differences in service outcomes between the two models.

Direct comparison of time to assessment was limited by differences in team structure and staffing: the in-house waiting list team was newly established and consultant-led, while the outsourced model comprised a well-established external agency with longstanding experience in the UK. Notably, 70% of patients in the in-house team were discharged back to their GP without transfer to core CAMHS, compared with 0% in the outsourced group. Consequently, only 30% of in-house patients required ongoing CAMHS follow-up, versus 100% in the outsourced model. Diagnosis rates are currently being further analysed to examine the detection of comorbidities. These preliminary findings suggest that while outsourcing addresses immediate assessment capacity, the in-house model may offer opportunities for developing a sustainable, consultant-led service with longer-term oversight, provided adequate resourcing.

This service evaluation highlights that a well-structured in-house waiting list team has the potential to improve downstream flow to the core CAMHS service, reducing the secondary bottleneck and minimising repetition of work through clear, consultant-led care plans. Effectiveness is dependent on having the right staffing skill set and staff-to-patient ratio, as limitations in these areas impact throughput, consistency, and the ability to meet service expectations across teams. These findings suggest that appropriately resourced, consultant-led in-house services could provide sustainable improvements in assessment and care delivery, supporting the case for expanding the service.

Specialist dementia inpatient units provide care for individuals with complex neuropsychiatric and behavioural needs. Understanding admission outcomes within these settings is essential for service planning and optimising patient flow. The aim of this service evaluation was to evaluate admission outcomes over a one-year period for all inpatients admitted to a 30-bed specialist dementia intensive care unit including diagnoses, length of stay, discharge destinations and mortality.

A retrospective service evaluation was conducted of all inpatients admitted to Sage, Rosemary and Thyme ward in the Forget Me Not Unit in Worthing between March 2024 and March 2025. Data were extracted from electronic patient records and anonymised prior to analysis, which included demographic data, diagnoses and dementia subtype, legal status upon admission and discharge, proportion of prescribed psychotropic medications, length of stay, time taken to be declared medically optimised for discharge (MOFD), discharge destination and mortality. Descriptive statistical analysis was performed for each ward and for the unit overall.

There were 88 inpatient admissions across all three wards within one year (34% female). This inpatient cohort had a mean age of 80 years (median 81 years) with most admissions being facilitated under section 2 of the mental health act (76%) and a minority under section 3 (15%). Alzheimer’s disease was the most common diagnosis at discharge (42%) followed by mixed dementia (28%) and a smaller proportion of vascular dementia (7%), Lewy body dementia (6%) and frontotemporal dementia (2%). On average, patients were declared MOFD after 63 days (median 49 days) and were subsequently discharged after a mean of 61 days (median 59 days) leading to an average length of stay of 124 days (median 113 days). Approximately 55% of all patients were discharged to a care home, 15% were discharged home and 5% died during their admission. Mortality within twelve months post-discharge was high at 22% with half of these deaths occurring within three months of discharge.

This service evaluation highlights the complexity of care, prolonged admissions and high post-discharge mortality associated with specialist dementia inpatient services. Delays between patients being declared medically optimised and subsequently being discharged from the unit highlight an important area for service improvement, particularly within adult social care. These findings offer a useful baseline for future comparisons which may guide local quality improvement, workforce planning and multidisciplinary team working.

High dose antipsychotic therapy (HDAT) refers to prescribing a single antipsychotic at a dose above the maximum British National Formulary (BNF) limit, or prescribing more than one antipsychotic in combination where the combined percentage of each drug’s maximum BNF dose adds up to more than 100%. The potential additional benefit of surpassing recommended doses of antipsychotic therapy is limited and may be associated with higher rate of adverse effects. HDAT should only be used as a last resort after all other treatments have been exhausted, and the benefits must outweigh the risks. The decision to initiate and continue HDAT prescribing must be clinically justified and robustly documented on a regular basis. The audit aimed to assess compliance of a local community mental health team (CMHT) against trust procedure which requires regular clinical review and physical health assessments to be completed every 6 months.

A retrospective audit was completed of 40 patients who were prescribed HDAT on a single date in February 2025 when the caseload was accessed. Data was collected on clinical reviews, physical investigations and risk assessment forms, using the trusts electronic patient record and shared electronic GP records. Data was collected using a standardised audit tool and analysed in Microsoft Excel.

Of 40 patients prescribed HDAT, 26 (65%) had a review of HDAT completed within the past 6 months. 8 out of 26 reviews (31%) included justification for the continued use of HDAT. Risk assessment forms were completed for 1 out of 26 (4%) patients who had been reviewed. 339 out of 519 (65%) of all physical health assessments were completed in the last 6 months. Overall compliance with trust procedure was 60%.

Adherence to trust standards for prescribing of HDAT was below target. Possible factors identified included difficulty identifying and tracking patients on HDAT, and a lack of system in place for carrying out routine physical health assessments. Recommendations include the creation and maintenance of a live HDAT register, collaboration with physical health team and increasing the awareness of standardised risk assessment forms amongst clinicians.

Previous project conducted within the trust hypothesised and found that a tailored General Practitioner (GP) teaching programme was preferred by trainees and met GP training needs when given in addition to the general teaching programmethat is available to all psychiatric and GP trainees. The recommendation at the time was to develop a wide range of topics within this programme that were aligned with the GP curriculum for psychiatry.

The aims of this project were to evaluate if the current programme is useful and relevant to GP trainees as well as aligned with GP curriculum. To make amendments to the programme to ensure this and therefore, improve the overall quality.

I conducted two cycles with two GP trainee cohorts. In cycle 1: edited PowerPoints from previously designed GP programme with pre-chosen topics, delivered 6 teaching sessions and collected post session feedback on relevance, usefulness as well as qualitative data on what went well and what could be improved.

In cycle 2: Made changes to topics from previous cycle feedback and mapped topics against GP curriculum, formalised a timetable and information letter which was disseminated for smoother process, delivered 6 teaching sessions, modified feedback forms to collect both pre session feedback on confidence in topic and expectations and post session feedback on confidence in topic, expectations, relevance, usefulness and qualitative data on what went well and what could be improved.

The results in cycle 1 showed 88% found the teaching on risk assessment useful and100% found it relevant. However, it reached 100% positive response for usefulness and relevance by the end of cycle 2. Furthermore, the teaching on Balint groups was rated relevant by 50% of trainees and 0% found it useful. Therefore, it was replaced with teaching on personality disorders, which reached 100% positive response for usefulness and relevance in cycle 2.

Overall, in cycle 2, confidence rating increased after the teaching session for all trainees. In the qualitative feedback, overall satisfaction was high and some minor adjustments were asked for, mostly to include more sessions with more sub-speciality specific teaching.

Possible direction for the future would be to take the recommendations from qualitative feedback forward into the next cycle. All topics to continue into the next cycle with additional topics, if possible on subspecialities. Another would be to continue mapping learning objectives to GP curriculum to maintain relevance.

Population ageing in the Gulf Cooperation Council region is accelerating, yet epidemiological data on older adults accessing specialist mental health services remain scarce. This study aimed to describe the demographic profile, diagnostic distribution, psychotropic prescribing patterns, and service utilisation among older adults receiving specialist psychiatric care in the United Arab Emirates (UAE), and to identify predictors of polypharmacy and acute service use.

A retrospective cohort study was conducted including all patients aged ≥60 years who had contact with a tertiary psychiatric hospital in the UAE between January 2018 and December 2025. Service modalities included outpatient, telehealth, emergency, and inpatient care. Demographic, diagnostic, and prescribing data were extracted from electronic records. Descriptive statistics summarised clinical and service characteristics. Multivariable logistic regression was used to identify predictors of polypharmacy (≥3 concurrent psychotropic medications), inpatient admission and 30-day readmission, while negative binomial regression examined predictors of emergency presentations and overall service utilisation.

The cohort comprised 1,363 patients (mean age 68.7 ± 8.2 years; 57.4% female) representing 55 nationalities. Neurocognitive disorders were the most prevalent diagnosis (31.0%), followed by depressive disorders (23.0%) and schizophrenia spectrum disorders (20.0%). Psychotropic medication was prescribed to 89.8% of patients, with polypharmacy in 58.6%. Second-generation antipsychotics (61.7%) and benzodiazepines (59.6%) were the most frequently prescribed classes. Across the study period, 77.2% of patients received outpatient care, 65.8% used telehealth, 42.3% presented to emergency services and 23.2% had at least one inpatient admission; telehealth accounted for 45.2% of all recorded encounters. Bipolar disorder was the strongest predictor of inpatient admission (adjusted odds ratio [aOR] 6.91, p<0.001) and polypharmacy (aOR 4.88, p<0.001). Substance-related and schizophrenia spectrum disorders were also consistently associated with higher odds of hospitalisation and complex prescribing. Psychiatric comorbidity predicted both emergency presentations (incidence rate ratio 2.64, p<0.001) and 30-day readmission (aOR 2.21, p<0.05). Median inpatient length of stay was 22.6 days.

This large older adult psychiatry cohort from the UAE demonstrates high psychotropic exposure, substantial polypharmacy and significant use of acute services. Bipolar, substance-related and schizophrenia spectrum disorders emerged as key drivers of hospitalisation and complex prescribing. Telehealth constituted nearly half of all clinical encounters, challenging assumptions about low digital engagement among older Arab populations. Priorities for service development include medication optimisation and governance, crisis prevention pathways for high-risk diagnostic groups, and culturally responsive expansion of geriatric telepsychiatry.

No financial sponsorship was received for this project.

• • To understand the perspectives of mental health professionals on the management of neuropsychiatric patients and their access to mental health services

• • To identify key themes that could help improve collaboration between neurology, neuropsychiatry and broader mental health services

• • To enhance mental health care for patients with neurological conditions

An online survey was designed and sent to multidisciplinary team members in working age and older adult services in South West London and St George’s (SWLSTG) and Surrey and Borders NHS Trusts (SABP) which collected both qualitative and quantitative data.

There were 29 respondents to the survey with 21 from SWLSTG and 8 from SABP. The majority of respondents were doctors with the largest group being consultants (10) and resident doctors (8) followed by psychologists (5), nurses (3) and other (3). 79.3% of respondents have had 5 or more years of experience working in mental health services and most work in community teams (38.0%) and Liaison (28.0%).

93.1% of clinicians have cared for someone with co-occurring mental health conditions and neurological disorders in the last 12 months. 96.6% of respondents felt confident in assessing the mental health of patients in their day to day practice. However, confidence reduced to 55.2% when assessing the mental health of someone with a neurological disorder.

Crucially, 79.3% of respondents do not feel the service they work in is well designed to look after patients with neurological conditions and co-existing mental health problems. While only 20.7% agree they have access to specialised resources or support for managing such patients, 69.0% do feel supported by their colleagues and seniors in these circumstances.

The majority of respondents think it is harder for someone with a co-occurring mental health issue and neurological condition to access their service compared to those with common or severe mental health conditions. Over 75% of respondents do not think that routine general adult mental health services are well equipped to manage patients with neurological disorders and do not feel there is enough input from neurology services.

There is a gap in service delivery and clinician confidence for patients with neurological conditions who require mental health care. Better access to neuropsychiatric services for advice and co-working opportunities were identified as key areas for improvement. The next steps will involve liaising with local services to create a network of secondary care and third sector organisations and consider the development of guidelines.

Methamphetamine-induced psychosis (MIP) is a severe psychiatric condition increasingly reported in low- and middle-income countries like Pakistan. It manifests with positive, negative, and general psychopathological symptoms, often mimicking primary psychotic disorders. Understanding predictors of severity is crucial for early intervention and prevention of chronicity. The aim is to quantify symptom severity in MIP using the Positive and Negative Syndrome Scale (PANSS) and identify demographic and substance-use-related predictors of higher PANSS scores.

A cross-sectional analytical study was conducted over six months at DHQ/Allied II Hospital, Faisalabad. Ninety-three adults diagnosed with MIP as per DSM–5 criteria were assessed using PANSS. Data on demographics, age of onset, duration, frequency, and route of methamphetamine use were collected. Statistical analyses included correlation, ANOVA, and multivariate linear regression (p < 0.05).

The mean total PANSS score was 88.4 ± 14.2, indicating moderate-to-severe psychosis. Negative symptoms predominated (mean=24.5). Intravenous (IV) use, onset before age 25, and use duration > 2 years were independent predictors of higher total PANSS scores (β=12.8, 7.2, and 9.4, respectively; all p < 0.01). IV users had significantly higher scores than oral or smoking users (p < 0.001).

MIP in this cohort is moderately severe, with negative symptoms notably elevated. Early initiation, prolonged use, and IV administration significantly worsen psychosis severity. These modifiable risk factors highlight targets for public health interventions and early clinical screening in substance use settings.

To evaluate adherence to the Sheffield Health Partnership University NHS Trust (SHPU) clozapine monitoring Standard Operating Procedure (SOP) which requires that patients on clozapine have their plasma levels checked yearly at their annual clozapine review.

To investigate the clinical utility of annual plasma assays in informing dose adjustments.

A retrospective audit was conducted on a random sample of 30 patients drawn from a total population of 108 clozapine-treated patients at the South Recovery Community Mental Health Team (CMHT). To be included, patients had to be under the South Recovery CMHT and on clozapine for at least one year at point of data collection. Data were extracted from an electronic record system, focusing on the completion of annual patient reviews, the requesting of clozapine assays as per protocol, and subsequent clinical actions taken based on results of these assays.

80% of patients were reviewed by a psychiatrist within a 12-month period. Full compliance with the SOP was achieved in 40% of the sample.

Major barriers to compliance included:

• • Psychiatric Reviews: 20% were overdue by at least four months

• • Assay Requests: 23% were not marked as required, often without documented reasoning.

• • Completion: 17% of requested assays were never performed, frequently due to coordination issues between the CMHT and General Practice (GP) services.

Regarding the clinical utility of clozapine assays: Of the nine results outside the therapeutic threshold levels (six low, three high), only three led to a change in dose. This illustrated that the decision to change a patient’s clozapine dose does not entirely depend on the assay result. There can be other factors that determine whether a dose is changed or not such as patient response and preference.

While annual plasma assays led to dose changes in only a small minority of patients, they remain a critical safety tool for identifying extreme outliers and monitoring adherence. Current compliance is hindered by administrative issues. Adherence could be improved by automating review reminders and synchronizing plasma assays with annual physical health blood draws to reduce the risk of them being missed. Clearer protocols are required to define responsibility for requesting and chasing blood results as currently this remains ambiguous. Further investigation with a larger sample size is needed to fully quantify the impact of assays on psychiatrist decision-making.

Post-traumatic stress disorder (PTSD) is associated with autonomic nervous system and hypothalamic–pituitary–adrenal axis dysregulation, both of which are implicated in cardiovascular pathology. Individuals exposed to conflict-related trauma frequently experience long-term mental and physical health comorbidity. This service evaluation aimed to examine the prevalence and timing of atrial fibrillation (AF) among service users with PTSD who were exposed to conflict-related trauma during the Northern Ireland conflict (“The Troubles”), and to assess whether observed patterns align with established biological mechanisms linking chronic psychological stress to cardiac arrhythmia.

A service evaluation was conducted using secondary analysis of fully anonymised, routinely collected health questionnaire data from service users accessing WAVE Trauma Centre, a specialist organisation supporting individuals affected by conflict-related trauma arising from the Northern Ireland conflict. Use of the data was undertaken with organisational permission from WAVE Trauma Centre. Data included demographic variables, reported PTSD diagnoses or symptoms, physical health conditions, and the temporal relationship between trauma exposure and medical diagnoses. The prevalence of atrial fibrillation among service users with PTSD was compared with published population-level prevalence estimates for Northern Ireland. Relevant neurobiological and cardiological literature was reviewed to contextualise findings.

Ninety-eight service users with PTSD were identified within the dataset, of whom nine had a diagnosis of atrial fibrillation (9.2%). This represents an approximately four-fold higher prevalence compared with the estimated 2.3% prevalence of atrial fibrillation in the general Northern Ireland population. In the majority of cases, atrial fibrillation was diagnosed following exposure to conflict-related trauma. A greater proportion of service users with PTSD developed atrial fibrillation before the age of 65 compared with population-based data, suggesting earlier onset. These findings are consistent with reports from large trauma-exposed cohorts demonstrating increased incidence and earlier onset of atrial fibrillation among individuals with PTSD.

This service evaluation identifies an increased prevalence and earlier onset of atrial fibrillation among service users with PTSD following exposure to conflict-related trauma during the Northern Ireland conflict. The findings support existing evidence linking chronic stress-related neurobiological dysregulation to cardiac arrhythmogenesis. Increased awareness of cardiovascular risk within trauma-informed services may facilitate earlier detection and more integrated physical and mental healthcare for individuals with PTSD.

Kent and Medway Medical School (KMMS), a new UK medical school, hosted the 2026 National Student Psychiatry Conference. The conference was organised and delivered by a student committee supported by faculty and the RCPsych Choose Psychiatry team. We describe the learning around the planning and delivery of the conference, and consider its wider educational and institutional impact.

A student organising committee was established with defined roles and responsibilities, supported by frequent planning meetings and oversight by faculty and the Choose Psychiatry team. A conference theme and associated social activities were agreed.

Twelve KMMS students from different year groups led the planning and delivery of the conference; roles included programme development, speaker liaison, sponsorship/budgeting, communications, accommodation, and logistics. Clear role allocation and regular meetings supported coordination of a complex project alongside academic commitments. The weekend conference received overwhelmingly positive feedback regarding organisation, atmosphere and session quality from the 103 delegates and 21 speakers (98% overall satisfaction).

Committee members described developing advanced professional communication, project management and leadership skills under time and resource constraints. Learning extended beyond individual task completion to coordinating interdependent workstreams, negotiating priorities, and responding collectively to challenges. They also described gaining practical experience of leadership within a complex system, including budget management, sponsorship planning, using organisational tools (e.g. spreadsheets, booking systems), and real-time problem solving to manage technical and timetabling issues.

Reflecting on this, students identified improvements for future events, including starting external communications earlier, longer breaks between sessions, ordering merchandise further in advance, and greater delegation on the day.

Despite the workload, students found the experience rewarding. Working as a team towards a shared goal, seeing plans come together, and positive feedback generated a strong sense of enjoyment and achievement, alongside practical learning opportunities rarely available within undergraduate medical education.

Medical students can develop meaningful leadership capability when trusted to lead complex, collective projects with appropriate support. Beyond promoting psychiatry, the conference provided experiential learning in systems-based working and medical leadership. For the medical school and RCPsych, the conference raised the profile of psychiatry within undergraduate training and strengthened national connections. Investing in student-led conferences provides a practical way to support engagement with psychiatry and contribute to long-term recruitment and workforce development.

Executive dysfunction is central to the core symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and reflects complex, goal-directed behaviours linked to psychosocial and cognitive outcomes. There is a gap in understanding the impact of practical, skills-based interventions on executive functioning in adults with ADHD. This review aimed to evaluate the effectiveness of skills-based interventions on executive functioning, with a secondary focus on psychosocial outcomes.

The review was conducted according to PRISMA guidelines. Searches were conducted on 4 July 2025 across PsychINFO, Medline, Web of Science, Embase and Scopus for studies published from 2013. Peer-reviewed studies examining the effects of skills-based training interventions on executive and psychosocial outcomes in adults with ADHD were eligible. The methodological quality of included studies was assessed for risk of bias and certainty of evidence (GRADE).

The search yielded 12 studies testing the efficacy of interventions,grouped into four categories: goal-orientated interventions (k=4), occupation-focused skills training (k=2), cognitive training with executive coaching (k=2), and Emotion regulation interventions (k=4). Goal-orientated interventions showed mixed results. Only one controlled study found limited between-group improvements, while the others showed none. Non-controlled studies reported several within-group gains, at follow-up but without control groups, improvements cannot be attributed to the intervention alone. Psychosocial outcomes varied, with two controlled studies showing improvements compared to controls, while the remaining studies showed only within-group change. Non-controlled studies showed within-group improvements across psychosocial outcomes, with effects in emotion-regulation interventions, but without control groups, these gains cannot be attributed to interventions. Occupation-focused skills training demonstrated the most consistent within-group improvements, with both studies reporting significant pre-post gains across executive fucntioning domains and quality of life. Cognitive training and executive coaching produced improvements invisuo-spatial working memory, but little evidence of change in daily functioning. Emotion-regulation interventions showed stronger effects, with improvements in executive functioning and moderate-to-large effects compared with self-guided controls, but psychosocial outcomes were less consistently improved.

Skills-based interventions show potential for improving executive functioning and, to a lesser extent, psychosocial outcomes in adults with ADHD. Occupational-focused and emotion-regulation based interventions demonstrated the most consistent benefits while cognitive and goal-orientated interventions showed mixed results. Small samples, heterogeneity in intervention type, study design and outcome measures restrict conclusions. Future research should prioritise robust controlled designs, larger and more diverse samples, and direct comparisons of different skills-based approaches to clarify which interventions yield the greatest impact.

The Alcohol Dependence Guidelines provide the standard for assessment and management of alcohol withdrawal for inpatient units in Nottinghamshire Healthcare NHS Foundation Trust. Compliance with this guideline on the Cedar ward has been inconsistent. This could potentially impact patient safety. Using a problem-focused, collaborative approach, this project aimed to initially measure baseline compliance, identify barriers, and implement changes to improve compliance with the guideline by the end of March 2026.

A retrospective analysis of admissions from August 2025 to March 2026 was used to establish baseline compliance across the various guideline domains (documentation, monitoring, prescribing, and clinical interventions). Data has been collected prospectively to evaluate the impact of implemented change ideas. Multidisciplinary team meetings, survey questionnaires and one to one staff conversations were used to identify barriers for guideline compliance. Changeideas collaboratively identified using a driver diagram included structured teaching sessions for nursing staff and resident doctors, incorporation of alcohol-withdrawal guidance into nursing induction, electronic prescribing notifications prompting CIWA-Ar completion, integration of CIWA-Ar and SADQ tools into the Trust electronic record, and liaison with the Nottinghamshire Area Prescribing Committee to review andupdate existing guidance. Agreed changes were introduced using Plan–Do–Study–Act(PDSA) cycles, with ongoing communication with clinical teams.

Baseline audit findings showed low compliance with several core components of the guideline. Weekly alcohol intake (SADQ score) was documented in 44.4% of cases. Regular chlordiazepoxide prescribing in accordance with guidelines was noted in 55.6% cases, with much lower compliance for as required chlordiazepoxide prescriptions. Escalation of appropriate concerns for clinical review was documented in only 25% of cases. CIWA-Ar was completed in 23.97% of cases. A questionnaire survey of resident doctors identified gaps in awareness and challenges related to processes on the inpatient ward. This suggested that both knowledge gaps and systemic barriers contributed to the problem.

The initial audit confirmed poor compliance with alcohol withdrawal guidelines on Cedar ward, with gaps in documentation, clinical knowledge and awareness identified as key root causes. Implemented changes, such as multidisciplinary teaching on the ward, inclusion of teaching in nursing induction, and prompts in electronic records have improved clinician confidence, recognition, and documentation of withdrawal symptoms. Several process changes being implemented including updating the current guidelines. This is expected to address the root causes of poor compliance with a potential for wider Trust-wide adoption.