People with severe mental illness experience significant physical health morbidity and are vulnerable to diagnostic overshadowing. This may be particularly relevant where reproductive health factors overlap with psychiatric symptoms. This case study describes an unrecognised pregnancy identified during admission for psychotic relapse in a woman with schizoaffective disorder and explores learning points for inpatient, community and antenatal care. The hypothesis underpinning this work is that routine pregnancy testing and proactive consideration of reproductive health in women of childbearing potential may reduce the risk of delayed pregnancy recognition and associated harm.

A 35-year-old woman with schizoaffective disorder was managed in the community on a Community Treatment Order with depot antipsychotic medication. She developed persecutory beliefs that her food was being poisoned, reported altered taste and smell, alongside nausea and vomiting, and gradually reduced her food intake, leading to weight loss and non-attendance for depot medication. Due to increasing self-neglect and psychotic relapse, she was recalled to hospital under the Mental Health Act. During admission, antipsychotic treatment was recommenced and partial insight returned. As part of routine physical health monitoring, she was noted to weigh under 50 kg. Medical review identified an unexplained abdominal mass, prompting urgent ultrasound, which demonstrated a previously unrecognised 27-week pregnancy.

Retrospective reflection suggested that first-trimester pregnancy symptoms may have interacted with psychotic experiences. Symptoms consistent with hyperosmia and hypergeusia, recognised features of early pregnancy, may have contributed to altered taste perception and heightened sensitivity to food. Nausea and vomiting associated with morning sickness may have further reinforced persecutory beliefs that food was being poisoned. This cluster of physical symptoms appeared to coincide with increasing fearfulness of professionals, medication non-concordance and subsequent psychotic relapse, highlighting the complex, bidirectional relationship between physical health symptoms and psychopathology. The pregnancy was identified incidentally rather than through routine screening, illustrating how pregnancy-related physiological changes may be misattributed to psychiatric illness in both community and inpatient settings.

This case illustrates the risk of diagnostic overshadowing at the interface of physical and mental health in severe mental illness. It highlights the importance of routine pregnancy testing for women of childbearing potential on admission and maintaining clinical curiosity when physical changes accompany psychiatric deterioration. In community settings, emerging physical symptoms, weight change or non-attendance should prompt consideration of pregnancy and clearer screening pathways. While individual circumstances vary, proactive physical health screening may support safer, more holistic psychiatric and antenatal care.

This quality improvement project aimed to improve junior doctors’ confidence and consistency in performing physical health examinations within a mental health hospital. Additional objectives included improving awareness of escalation pathways to acute medical services and supporting safer, more timely identification of physical health concerns.

The project was conducted at Chase Farm Hospital, part of North London NHS Foundation Trust, which includes older adult, general adult, and forensic inpatient wards. A baseline questionnaire was distributed to junior doctors (Foundation Year, GP trainees, and Core Psychiatry trainees) to assess prior training, confidence levels, and awareness of escalation thresholds when managing physical health issues in psychiatric settings. Based on the findings, a Plan–Do–Study–Act (PDSA) cycle was implemented. Two structured flowcharts were developed: one outlining the expected components of physical examinationin a mental health setting, and another detailing criteria and processes for referral to Accident & Emergency. These resources were disseminated electronically, and a follow-up questionnaire was used to evaluate their perceived usefulness and relevance.

Eleven doctors completed the baseline questionnaire. Eight reported low confidence in performing physical examinations in mental health settings, and all respondents felt that additional structured teaching at induction would be beneficial. Six doctors completed the follow-up questionnaire after introduction of the flowcharts. All respondents found the flowcharts helpful and agreed they would have been valuable at the start of their rotation. There was unanimous support for including the resources in junior doctor induction and displaying them in on-call areas.

This quality improvement project demonstrates that brief, targeted educational tools can significantly improve junior doctor confidence and clarity regarding physical health assessment and escalation in psychiatric inpatient settings. Embedding structured guidance into induction programmes has the potential to enhance patient safety, trainee experience, and multidisciplinary collaboration. Future work will focus on Trust-wide implementation and evaluation of longer-term clinical impact.

Adolescent boys experience high rates of suicide, substance-related harm and school exclusion compared to other genders. However, large-scale studies report lower prevalence of common mental health disorders in boys, raising concern that boys’ mental distress is under-recognised in research and clinical settings. We aimed to examine how constructions of masculinity influence the expression, recognition and measurement of mental distress in adolescent boys aged 10–16. We explored whether current research tools adequately capture male-typical presentations of mental distress, with implications for psychiatric research, clinical assessment and service provision.

A critical narrative synthesis approach was used, using research from adolescent psychiatry, men’s health and public health literature. Evidence from large population-based studies of young people was considered alongside qualitative and epidemiological studies looking at gendered patterns of symptoms, help-seeking behaviour and clinical recognition. Masculinity was conceptualised as a socially constructed and context-dependent set of norms that interact with biological and structural factors. Disordered eating and body image concerns were used as a focused case study to illustrate how male-typical expressions of distress may not be captured by common questionnaires used clinically and in research.

The literature suggests that adolescent boys are more likely to express mental distress through externalising behaviours, irritability, risk-taking, and body-focused practices, which are less likely to be identified by commonly used mental health questionnaires. Survey items frequently reflect female-typical symptom profiles and ideals when assessing body dysmorphia and disordered eating, potentially contributing to an under-detection of eating disorders in boys. Masculine norms around emotional restriction, physical strength and self-reliance may influence how boys experience, interpret and report symptoms, while professional biases and service structures can limit recognition and care when boys do seek help. These factors contribute to a cycle of poor identification, research support, and outcomes.

Current gender-blind measurements of adolescent mental health risk systematically under estimate clinically significant mental distress in adolescent boys. Greater attention to how masculinity affects the expression, reporting and identification of psychiatric symptoms is needed to improve the accuracy of research and psychiatric assessment to ensure boys’ needs are adequately recognised. Incorporating male-typical presentations into screening tools and engaging boys in the design of research measures may improve how boys’ mental health is conceptualised and measured. Addressing these gaps has significant implications for child and adolescent mental health services, prevention strategies and psychiatric training – which has the potential to benefit not only boys, but everyone whose distress does not align with typical diagnostic criteria.

The Mental Health Emergency Centre (MHEC) at Northwick Park Mental Health Unit serves people who present in an acute mental health crisis, most commonly via the emergency department (ED). The MHEC receives several patients a day. To inform service planning, we aimed to describe patient characteristics and clinical interventions delivered.

The study was approved as a service evaluation by the clinical governance department. Records of patients admitted to the MHEC from February 15, 2023, to October 26, 2023, were reviewed. Using a predefined template, two psychiatry residents extracted information from the records of 50 patients each, including patient demographics, attendance, diagnoses, comorbidities, and reattendance to the ED within 28 days. Incomplete records were excluded.

Ninety-six records were included; 94% came via the ED pathway and 6% admitted directly by the Home Treatment Team (HTT). The mean age was 38 years and 58% of patients were men. The most common ethnicity was white (42%) followed by Asian (18%). The most common primary diagnoses were psychotic disorders (39%). The median time from ED arrival to a decision to admit to the MHEC was 11.8 hours, and the median time from ED arrival to discharge from the MHEC was 62.4 hours. The median length of stay (LOS) from the decision to admit until discharge from the MHEC was 2 days. Reattendance to the ED within 28 days was seen in 28% of patients. Medication management was the main intervention offered (62.5%), followed by brief psychological intervention by a trained psychologist (23%). Only four patients did not have a follow-up.

The MHEC is a valuable addition to the urgent and emergency mental health care pathway. Although the patients were not rapidly transferred from ED, the multidisciplinary service allowed brief and intense interventions to be delivered, including psychological therapies, diagnostic review, and medication management.

Lithium and Valproate remain established mood stabilisers with strong evidence for efficacy in bipolar disorder and affective instability. Contemporary clinical practice increasingly reflects a shift towards alternatives such as lamotrigine and atypical antipsychotics. This shift appears driven not only by clinical considerations but also by regulatory, safety and service-level factors. Valproate prescribing has declined markedly among women of childbearing age due to teratogenic risks and regulatory restrictions, while lithium use is challenged by monitoring requirements and systemic barriers within services. These influences may contribute to the underutilisation of effective treatments, raising concerns about the impact of administrative burden, risk management, and evolving prescribing culture on real-world pharmacological practice.

Aim: This study aimed to examine prescribing patterns of lithium, valproate, and alternative mood stabilisers within an AOT cohort across two time points six months apart. It sought to quantify changes in the use of lithium, valproate, and lamotrigine and to explore whether observed trends reflect broader clinical, regulatory, and service-related influences on prescribing practice.

A retrospective observational review of clinical records was conducted including all patients under the care of the AOT at two defined points, six months apart. Patients prescribed mood stabilisers were identified. Data collected included current mood stabiliser (lithium, valproate, lamotrigine, or other), demographic characteristics (age and sex), clinical indication, and changes in prescribing between time points. Descriptive statistics were used to calculate the proportion of patients receiving each mood stabiliser at both time points. Changes in prescribing patterns over the six-month period were analysed and compared across medication groups to identify emerging trends.

The AOT caseload increased from 73 patients in July 2025 to 85 patients in January 2026. Lithium prescribing decreased slightly from 6 patients (8.2%) to 5 patients (5.9%), while valproate use remained numerically stable at 5 patients (6.8% vs 5.9%). Lamotrigine prescribing increased from 3 patients (4.1%) to 6 patients (7.1%), representing the most notable change over the study period. Carbamazepine use declined from 1 patient (1.4%) to none. Overall, lithium and valproate use remained stable or declined slightly, while lamotrigine use increased despite changes in caseload and patient turnover, indicating a gradual shift in mood stabiliser prescribing patterns within the AOT population.

Findings mirror wider trends in psychiatric prescribing, characterised by a relative decline in lithium use due to monitoring and systemic barriers, regulatory driven constraints on valproate, and increasing reliance on lamotrigine and alternative agents. These results suggest that effective mood stabilisers may be underutilised not because of reduced efficacy but due to evolving regulatory frameworks, risk management priorities, and service-level pressures. Understanding these influences is important for informing prescribing practice and ensuring that clinical decision-making remains balanced between safety, feasibility, and therapeutic effectiveness in complex mental health populations.

• • To monitor adherence to the General Medical Council professional standards in prescribing unlicensed medications for patients open to the Stanley Treatment and Intervention team.

• • To identify areas of unlicensed prescribing that require improvement in order to communicate this with prescribers to raise awareness of the professional standards and reinforce them.

• • To ensure good practice in decision-making around treatment choice in conjunction with parents and carers

• • To allow use of unlicensed or off-label medicines in line with recognised clinical practice and/or published evidence

• • To minimise risk associated with unlicensed and off-label use of medicines.

A search was conducted on clinic letters by medical staff in the Stanley Treatment and Intervention Team in community mental health between 1 July 2024 and 31 October 2024. We randomly chose 27 clinic letters.

To complete this audit, we reviewed all 27 patient’s electronic record to identify unlicensed medication use practice using the audit tool.

The total number of patients included in this audit was 27.The number of patients who were initiated on unlicensed medications was 2 out of 27 . Out of these, 2 patients records had clear documentation of discussion of the use of unlicensed medication with the patient, 2 patients records had a clear documentation of the rationale for prescribing a medicine off-label or prescribing an unlicensed medicine and 2 patients records had a clear documentation of the benefit vs risk of unlicensed medication use.

Subsequently, 2 patients records had documentation of clear, accurate and legible record of all medicines prescribed, 2 patients records had clear documentation that sufficient information about the medicines were given to patient, or their parents or carers. Lastly, there were no patients considered to be in a vulnerable group such as children and adolescents, women of childbearing age and elderly patients.

The Stanley Treatment and Intervention Team in community mental health was found to be 100% compliant with the General Medical Council standards. Compared to a previous audit in the inpatient ward, we identified this was due to improved documentation, open discussions with patients and clearly documented rationale. We suggest practices to have a set proforma to support doctors identifying a rationale, prescribing and documenting commencement of unlicensed medications.

Body Dysmorphic Disorder (BDD) is overrepresented in aesthetic medicine (prevalence up to 18.6% in aesthetic cohorts versus ~1.7–2.9% in the general population). Professional bodies recommend psychological assessment before cosmetic intervention and referral to mental health services if BDD is suspected.

We aim to examine post-assessment care by:

• Quantifying the gap between recommended assessment/referral standards and real-world practice.

• Assessing how well the literature captures referral conversion (screening to specialist assessment).

• Identifying patient, clinician, and system barriers that prevent completion of specialist mental-health assessment.

A targeted review was conducted using evidence from aesthetic-surgery meta-analyses, dermatology and plastic surgery guidelines, aesthetic-practice safety documents, insurer psychological-risk frameworks, and psychiatric assessment resources. Sources were reviewed for prevalence data, referral expectations and realities, and documented barriers to mental-health engagement.

Although BDD prevalence in aesthetic settings is consistently studied and reported,published literature rarely captures how many screen-positive patients are referred for psychiatric assessment.

Despite the presence of several high-accuracy validated BDD screening tools, recent database evidence highlights ongoing missed detection: in a cohort of 226,374 cosmetic-surgery patients (from August 2002–August 2022), 52.1% of BDD diagnoses occurred only after procedures.

Literature shows that barriers span patient-level (denial, doctor-shopping), clinician-level (concerns about conflict, reputational or financial impact, limited training), and system-level (lack of structured referral pathways, limited multidisciplinary integration, absence of warm-handover mechanisms). However, there are minimal quantitative studies measuring these factors.

UK-based literature documents BDD prevalence and outcome risk in cosmetic seekers and provides validated screening tools and professional standards, but there is minimal evidence reporting UK metrics on referral-conversion or psychiatric follow-through.

Professional guidelines recommend that suspected BDD requires specialist evaluation, yet referral completion rates remain unmeasured and pathway implementation inconsistent across aesthetic practice settings. The absence of referral-conversion data and evidence of missed diagnoses, highlight a critical knowledge and safety gap. Priority actions include: auditing current screening and referral practices in regulated aesthetic settings, establishing clear referral triggers and destinations, implementing warm-handover mechanisms, and developing integrated pathways between aesthetic and mental health services to improve early detection and patient safety.

Cardiac arrest on ward–post incident review and reflections identified recognition and escalation of the physically deteriorating patient as a key improvement target to improve staff morale and confidence moving forward in context of incident.

SMART goals:

Specific – Improve nursing staff and allied health professionals’ ability in recognising, managing, and escalating physically unwell patients.

Measurable – with results measured via standardized questionnaire scores.

Achievable – through a specialized teaching programme developed by ward doctors.

Relevant – in context of recent significant incident on the ward.

Time specific – in a 6-month timeframe.

Teaching sessions targeting initial assessment and escalation of the physically deteriorating patient were delivered on a two-weekly basis over a time of 4 months, each session was 30 minutes in duration. Subdivision of broad topics was introduced to address nuanced scenarios. Domains were chosen based on common clinical queries and situations that were identified on the ward from a survey of both doctors, nursing staff and allied health care professionals. Session content was pitched at a role-specific level. Session topics included–Airways, NEWS2, SBAR, hypoglycaemia, fluid monitoring, pain, seizures, stroke, UTI.

Data was collected via pre-/post-course questionnaires. The questionnaire consisted of 9 questions in SBA format, following a short clinical scenario stem – 1 question for each clinical domain. Confidence scores (Likert scale) were assessed for each of the 9 domains.

Confidence improved across all wards following the teaching sessions. Small but notable decline in clinical performance post-training in some areas. Persistent performance gap between RMNs and HCAs.

Teaching sessions were delivered in modality of one live session per topic – making it difficult to ensure that all surveyed staff had attended all sessions. There were limited opportunities for staff to review the teaching material after a session, or especially if a session was missed due to rota or clinical commitments.

Therefore an opportunity was identified to develop e-learning modules focusing on weakest domains (Airways, NEWS, SBAR, UTI, hypoglycaemia).

Mode of delivery would be changed to e-learning modules on a digital learningplatform. This allows for easy access for staff in their various schedules, the ability to revisit the material, as well as increased ease in collecting data, adjusting the teaching materials and maintaining consistency in quality of teaching across time.

In Qatar, there are currently no published local data and no standardised inpatient policy/care pathway for personality disorder (PD) management. This creates variability in assessment, crisis planning, psychological input, and prescribing practice. We aimed to establish a baseline epidemiological profile of inpatient PD presentations and describe current inpatient management processes to inform service development. We hypothesised that borderline personality disorder (BPD) would be the most frequent PD diagnosis and that care processes would show wide variability in the absence of a local guideline.

We conducted a retrospective audit within Hamad Medical Corporation Mental Health Services using electronic health record review (Cerner) and structured case-note abstraction. All eligible psychiatric admissions between January and December 2025 were included (N=171). Extracted variables included PD diagnosis and type, documentation supporting BPD diagnostic criteria, MDT review, crisis planning, documented individual and group psychotherapy sessions, inpatient self-harm incidents, documented substance use, and psychotropic prescribing.

A personality disorder diagnosis was recorded in 83 of 171 admissions (48.5%); the remaining 88 admissions (51.5%) did not carry a documented personality disorder diagnosis during the admission period. BPD was the most frequent PD diagnosis (54/83, 65.1%), followed by antisocial PD (13/83, 15.7%). Mean age was 26.8 years (SD 10.9); 55/83 (66.3%) were female and 49/83 (59.0%) were readmissions. For BPD admissions, documentation supported ≥5 diagnostic criteria in 40/54 (74.1%) (median 6 criteria). MDT review was documented in 72/83 (86.7%) and a crisis plan in 51/83 (61.4%). Individual psychotherapy session counts were recorded for 48/83 (57.8%); of these, 26/48 (54.2%) had zero documented sessions. Group psychotherapy session counts were recorded for 51/83(61.4%); of these, 34/51 (66.7%) had zero documented sessions. Self-harm incidents occurred in 21/83 (25.3%), and substance use was documented in 33/83 (39.8%). Antipsychotics were prescribed in 58/83 (69.9%) and benzodiazepines in 33/83 (39.8%).

This first inpatient PD audit in Qatar shows a substantial service burden dominated by BPD, high readmission rates, limited documented psychological input, and incomplete crisis planning. In the context of no local policy/guideline, the findings support developing a standardised inpatient PD pathway by adopting international guidance (with cultural adaptation for the region), strengthening crisis planning and psychological interventions, and reviewing prescribing practice–particularly reducing benzodiazepine use and promoting safer alternatives.

To design, deliver, and evaluate a structured six-month teaching programme for resident doctors and multidisciplinary team (MDT) members within an Old Age Psychiatry service. The objective is to improve clinical knowledge and confidence in key areas of psychiatric care in older adults.

Teaching topics were selected following consultation with senior clinicians and MDT colleagues to ensure clinical relevance. A monthly teaching programme was then implemented in theOld Agepsychiatry department at Birch Hill Hospital between August 2025 and January 2026, aimed at resident doctors hospital-wide and departmental MDT colleagues. Sessions covered physical health investigations in psychiatry, psychosis in older adults, antipsychotics and metabolic side effects, depression in older adults, clinical cases of rarer dementias, and management of alcohol misuse and insomnia. Structured feedback was collected after each session including Likertscale ratings assessing relevance, usefulness and tutor knowledge, as well as self-rated confidence before and after sessions. Free-text responses were analysed qualitatively using thematic analysis. Numerical data were analysed quantitatively to calculate mean scores, mean differences, and paired t-test statistics in the case of self-rated confidence.

From the 49 feedback survey responses, the programme was highly rated across all domains. Likert scale mean scores (where 1=lowest e.g. not very relevant, 5=highest e.g. very relevant) showed 4.90 for relevance, 4.83 for usefulness, and 4.86 for tutor understanding. Self-rated confidence increased from a mean of 3.39 pre-teaching session to a mean of 4.55 post-teaching session, where there was a statistically significant difference (p<0.001) with a large effect size (d=1.07). Qualitatively, thematic analysis identified overarching themes including high clinical relevance, improved understanding of clinical presentations, greater knowledge of pharmacology and medications, appreciation of clear and structured teaching, and the value of group engagement for team cohesiveness.

This six-month structured teaching programme improved knowledge and confidence on a variety of clinical topics among resident doctors and MDT colleagues inOldAgepsychiatry. Qualitative themes highlighted that the programme was very well received and also showed the value of group discussion in teaching for team building, demonstrating broader benefits of such educational interventions. This teaching programme model should be replicated across other services and extended within this department to encourage the development of highly knowledgeable and confident clinicians.

Effective outpatient addiction care depends on patients understanding and retaining clinical advice. However, the extent to which patients recall guidance after appointments is poorly studied. This evaluation aimed to assess patient recall of advice immediately after consultation and one week later, and to explore factors associated with retention.

A prospective service evaluation was conducted in a UK outpatient addictions clinic. Consecutive patients attending a routine follow-up over 6 months were invited to participate (n=121). Demographics (age, gender, primary substance, housing status) and appointment characteristics (clinician continuity, consultation length) were recorded. Recall was assessed via brief structured questionnaires immediately post-consultation and at one-week follow-up, covering key treatment advice, harm-reduction strategies, and safetyguidance. Data were analysed descriptively and associations with patient or appointment factors explored.

Mean age was 40 years; 59% were male. Primary substances included alcohol (46%), opiates (29%), and stimulants/polysubstance use (25%). Immediate recall of all key advice was 68%, but this dropped to 42% at one week. Recall was higher among patients with continuity of care (47% vs 35%) and those attending longer consultations (>30 minutes: 52% vs <30 minutes: 38%). Housing instability and polysubstance use were associated with lower recall. Clinician confidence in patient understanding consistently exceeded actual recall.

Patient recall of clinical advice in outpatient addiction services declines sharply within one week. Continuity of care and longer consultations are associated with improved retention. Simplifying messages, repeating key advice, and providing written or digital reinforcement may enhance understanding and engagement, with implications for treatment planning and service effectiveness.

To evaluate compliance of lithium monitoring practices at Kilbarrack East CMHT with NICE guidelines and identify areas for improvement to enhance patient safety.

This quantitative audit comprised a retrospective initial audit, where data was collected from August 2024 to February 2025 from patients on lithium therapy. Following the initial audit results, which highlighted significant gaps, a multidisciplinary team (MDT) meeting was held to discuss the findings with all clinical stakeholders. Interventions were implemented in March 2025, including a green sticker system for patient identification, a lithium monitoring sheet for tracking assessments, patient monitoring lists to define responsibilities, a lithium blood clinic, and a new Clinical Nurse Specialist reporting system. A prospective follow-up audit was conducted from May to October 2025, with the overall audit concluding in November 2025. Compliance with NICE guidelines was assessed through indicators such as the frequency of lithium level testing as well as renal and thyroid function tests. Statistical analysis was performed to compare compliance rates between the initial and follow-up audits.

The first audit (Cycle 1) revealed that only 12% (3 out of 25) of patients were compliant with all relevant lithium monitoring guidelines. Although all compliant patients had urea and electrolyte (U&E) levels and thyroid function tests conducted, none had calcium levels tested or BMI measured. In the follow-up audit (Cycle 2) in October 2025, the overall compliance improved, with 68% (17 out of 25) compliant, but significant gaps remained; 32% (8 out of 25) did not have their lithium levels tested, and 44% did not undergo U&E or thyroid function tests. Only 8% had calcium levels tested, and no patients had their BMI recorded. These findings indicate that while there was some progress, critical areas still need attention.

The audit cycle demonstrated substantial deficiencies in compliance with NICE guidelines for lithium monitoring at Kilbarrack East CMHT. While some changes led to improvements, significant gaps remain, underscoring the necessity for continuous quality improvement initiatives. A patient education leaflet was introduced after the second audit to enhance adherence to lithium monitoring protocols. Implementing the recommended action plan aims to enhance adherence to monitoring protocols and improve patient safety in lithium therapy management. Regular audits will continue to check progress and make sure guidelines are followed.

Obsessive–compulsive symptoms (OCS) are a reported complication of clozapine treatment but remain under-recognised. Real-world data on their prevalence and clinical correlates in the UK remain limited.

This cross-sectional service evaluation was conducted within a centralised clozapine clinic serving adult secondary care services across Suffolk. Patients receiving clozapine were invited to complete the Obsessive–Compulsive Inventory–Revised (OCI-R) as part of routine clinical assessment. Demographic, clinical, and service-use data were extracted from electronic health records. Illness severity and symptom domains were assessed using the Clinical Global Impression–Schizophrenia scale (CGI-SCH), and functioning using the Global Assessment of Functioning (GAF).

A total of 187 clozapine-treated patients (mean age 46.6 years, SD=12.4; 70.1% male) completed the OCI-R, which showed good internal consistency (α=.87); the mean OCI-R OCD score was 13.2 (SD=9.8).

Overall, 52.4% met criteria for OCS (OCI-R OCD ≥ 12), yet only 8.6% had OCS documented by a psychiatrist in the preceding 18 months, with poor agreement between measures (p < .001), indicating substantial under-recognition. Among patients meeting OCI-R criteria, overall OCS severity did not differ between recognised and unrecognised cases (p=.153); however, clinician recognition was uniquely associated with higher checking subscale scores (p=.004), suggesting preferential identification of more overt compulsive behaviours.

Multivariable linear regression predicting OCI-R OCD scores was statistically significant (p < .001), with higher CGI-SCH positive and cognitive symptom subscale scores independently predicting greater OCS severity after adjustment for demographic, clinical, and treatment-related variables, suggesting that OCS may cluster with a more severe psychosis phenotype and/or shared cognitive-control deficits.

To examine whether positive symptoms inflated OCS scores via overlap with obsessing items, a separate regression predicting the OCI-R obsessing subscale was conducted (p < .001). Higher obsessing scores were independently associated with CGI-SCH positive (p < .001) and depressive symptom severity (p=.019), indicating that OCS severity cannot be explained solely by overlap with positive psychotic symptoms.

OCI-R hoarding subscale scores were modestly associated with CGI-SCH cognitive symptoms (r=.21, p=.005), with no other significant associations, consistent with literature linking hoarding behaviours to cognitive and executive dysfunction rather than psychotic or affective pathology.

OCS were common yet substantially under-recognised in clozapine-treated patients. Their severity was independently associated with positive and cognitive psychotic symptom domains, supporting a clinically meaningful schizo-obsessive phenotype and highlighting the need for routine screening and proactive monitoring within clozapine services.

Language deficits present early in Alzheimer’s disease, with symptoms ranging from word-finding difficulties to non-coherent speech. These can be assessed in high-income countries using picture description tasks (PDT). However, they are culturally specific, so have a reduced utility in Sub-Saharan Africa (SSA). The dementia incidence in SSA is increasing but there is a substantial diagnostic gap. Therefore, there is a need for accessible and culturally acceptable cognitive measures. Also allowing for detection of impairments at an earlier stage and for use in prevention studies. This study aims to determine the diagnostic accuracy of a culturally adapted PDT in Tanzania.

This was a cross-sectional validation in socio economically different communities in Kilimanjaro, Tanzania. Eleven PDT scoring methods were adapted from existing literature. Participants were asked: “tell me everything you can see happening in this picture”. Responses were audio-recorded, transcribed and translated. General cognition was assessed using the Identification and Intervention for Dementia in Elderly Africans (IDEA) screen. Participants with a low IDEA score (≤9) underwent a blinded gold-standard clinical dementia assessment alongside 10% of controls (IDEA >9). Visual acuity was also assessed using a Landolt C near vision chart.

A total of 465 individuals ≥60 years were recruited. 378 individuals were included in the analysis due to 37 refusals and 50 methodological/technical exclusions. All PDT scoring methods, apart from implausible details and words per content unit, correlated with the IDEA screen, age, education and frailty. The scoring method of content units (CUs) showed the greatest correlation. Males, those with greater educational attainment, and a previously skilled occupation performed better. The scoring methods with the highest area under the receiver operating characteristic (AUROC) curve for identification of IDEA score ≤9 were CUs 0.740, CUs and additional details 0.742 and total objects 0.764. The prevalence of dementia was 3.79% (n=8/211). The scoring methods with the highest AUROC curve for identification of dementia were global length of text 0.743 and additional details 0.767.

The diagnostic accuracy was acceptable for three scoring methods to identify cognitive impairment as measured by the IDEA and for two methods in identifying clinical dementia diagnosis. A culturally adapted PDT could be used to support assessment of language in those with cognitive impairment, as part of a wider cognitive testing battery. However, dementia prevalence was very low in this community, potentially biasing findings.

Methamphetamine-induced psychosis (MIP) is recognised in both ICD-11 and DSM-5-TR as a substance-induced psychotic disorder which is associated with severe agitation, violence risk, and medical complications. In Pakistan, MIP presentations to inpatient addiction services have increased recently, however, data on service impact and adherence to best-practice standards remain limited. This audit aims to describe monthly trends and proportions of MIP admissions among all inpatient addiction ward admissions, and to evaluate compliance with international best-practice standards for assessment and management of MIP, in order to identify areas for quality improvement.

A mixed-method clinical audit was conducted in the inpatient addiction ward at Allied Hospital II, Faisalabad. A descriptive service-activity review examined all inpatient addiction admissions over a six-month period (01 July–31 December 2025) to quantify monthly MIP admissions. Subsequently, an admission-based case-note audit assessed consecutive MIP admissions against predefined standards derived from NICE guidance, the Maudsley Prescribing Guidelines, and international recommendations. Adults (≥18 years) admitted with a clinical diagnosis of MIP were included. Admissions with primary psychotic disorders, delirium, psychosis attributable to another substance, or incomplete documentation were excluded. Data were extracted from clinical notes using a structured audit tool.

During the audit period, 82 inpatient addiction admissions were recorded, of which 19 (23.2%) were for MIP. Monthly MIP admissions ranged from 2 to 4 cases, representing 18.2% to 33.3% of total admissions, indicating a sustained and clinically significant service burden. In the standards audit (n=19), documentation of stimulant use history (94.7%), temporal relationship between methamphetamine use and psychotic symptoms (89.5%), exclusion of delirium or medical causes (100%), baseline physical observations (94.7%), and mental state examination (94.7%) met audit targets. Prescribing details and adverse-effect documentation were complete in all cases (100%). Areas of lower compliance included objective toxicology confirmation (42.1%), baseline blood glucose measurement (52.6%), structured risk assessment (78.9%), documentation of de-escalation prior to medication (73.7%), medication safety checks for contraindications or interactions (78.9%), post-medication monitoring (84.2%), and timely reassessment following intervention (73.7%).

Methamphetamine-induced psychosis accounted for nearly one-quarter of inpatient addiction admissions over six months, highlighting a substantial and ongoing clinical burden. While core diagnostic assessment and prescribing practices were generally well documented, important gaps were identified in toxicology confirmation, metabolic screening, structured risk assessment, and post-intervention monitoring. These findings informed the development of a standardized MIP admission checklist and targeted staff education, with re-audit planned to assess the impact of these quality improvement interventions.

Research and literature on female offenders are relatively scarce compared to their male counterparts. In Singapore, female offenders are remanded either at the only local psychiatric hospital (Institute of Mental Health) or at Changi Prison. The judge remands them for between two to three weeks at the first instance to determine if these offenders with suspected mental disorders have the ability to plead in court and to determine if their suspected mental health conditions have any contribution to their offending behaviour. Legal determinations of unsoundness of mind at the time of offence and fitness to plead at the time of trial carry significant implications for criminal responsibility and case disposition. The psychiatrist also has to instruct the court about the nature of the mental disorder, the risk of reoffending and recidivism and whether treatment is possible and also feasible in each remandee. This study reviews the psychiatric and legal characteristics of female remandees assessed at the Institute of Mental Health (IMH), Singapore, over a one-year period.

A retrospective review of the electronic records was conducted by psychiatric doctors posted to the IMH. The details and medical records of the female remandees referred to IMH for forensic psychiatric assessment over one year was assessed by computer and a template for data extraction filled in manually. Demographic data, psychiatric diagnoses, offence characteristics, substance use history, and legal opinions on unsoundness of mind and fitness to plead were record, examined and analysed. Diagnostic distributions were analysed within the groups assessed as of unsound mind and/or without fitness to plead, with attention to overlap and discordance between these legal constructs.

Out of 280 female remandees assessed over 12 months, 12 (4%) were assessed as of unsound mind and 13 (≈5%) as unfit to plead. Schizophrenia was the most common diagnosis in both groups, followed by major neurocognitive disorder. Most individuals in both categories were charged with non-violent offences, and none had a documented substance use history. While there was substantial overlap between unsoundness of mind and unfitness to plead, several discordant cases were identified, illustrating the temporal and conceptual distinction between these determinations. Major neurocognitive disorder was particularly prominent among those unfit to plead, reflecting the central role of current cognitive capacity in trial competence. These findings challenge assumptions that forensic psychiatric morbidity is primarily associated with violence or substance misuse and highlight the relevance of endogenous psychiatric and neurocognitive conditions in female remandees.

Female remandees assessed as of unsound mind or unfit to plead constitute a small but highly vulnerable population. Their comparatively small numbers compared to male offenders has meant that most programmes and services on the whole tend to be geared towards the majority male population. However women remandees represent female offenders, who have unique issues and needs different from their male counterparts, characterised by severe psychotic and neurocognitive disorders, predominantly non-violent offending, and absence of substance use. Clear differentiation between mental state at the time of offence and present fitness to plead is essential. This would be crucial in the future development of gender-specific programmes for incarcerated women orgender-responsive programming for female offenders. To do so, we would need to assess choices and attitudes that lead to the commission of the crime but also address these factors in the context of central issues specially for women, specifically, history of trauma and violence, substance abuse and economic marginality.

To improve mental health staff confidence in recognising and assessing common physical health conditions (hyponatraemia, deep vein thrombosis (DVT)/pulmonary embolism (PE), cellulitis/sepsis, neuroleptic malignant syndrome (NMS), serotonin syndrome, and extrapyramidal side effects (EPSEs)) through a structured teaching programme on an acute psychiatric ward.

Mental health inpatients have significant physical health comorbidities and face increased risk of acute physical deterioration. Nursing and allied health staff on psychiatric wards are often the first to notice clinical changes but informally reported low confidence in recognising and initially assessing physical health emergencies. Early identification by ward staff is crucial for timely escalation to medics and improved patient outcomes.

This quality improvement project was conducted on an acute adult mental health ward within Merseycare. A three-month teaching programme was implemented, consisting of six short (<15 minutes) educational sessions covering the above conditions. Sessions were designed for busy ward staff, adapted to areas of weakness identified on the ward, and each session was paired with a summary poster that was displayed in the clinic room to enable access across all shifts. Staff on the ward were sent a pre-teaching questionnaire and a post-teaching questionnaire to identify improvement in self-reported confidence levels.

10 staff members completed post-intervention questionnaire, representing a response rate of 66.7%.

Mean confidence scores across all six clinical conditions improved from 2.6 pre-intervention to 4.3 post-intervention, representing a 65.4% increase.

Individual condition improvements:

• • Hyponatraemia: [2.5] to [4.2].

• • DVT/PE: [3.1] to [4.3].

• • Cellulitis/sepsis [2.6] to [4.4].

• • NMS: [2.6] to [4.3].

• • Serotonin syndrome: [2.3] to [4.4].

• • EPSEs: [2.1] to [3.8].

• • Confidence in escalating physical health concerns [3.9] to [4.4].

• • Confidence in advocating for physical health investigations [3.7] to [4.4].

Brief, accessible teaching sessions combined with visual reference materials significantly improved mental health staff confidence in recognising and assessing common physical health problems and emergencies within psychiatry. This low-cost, sustainable intervention addresses an important training gap in psychiatric settings and may facilitate earlier detection and escalation of physical deterioration, improving patient outcomes.

Entering core psychiatry training presents multiple challenges, including adapting to new clinical environments, learning trust-specific systems, and understanding training and portfolio requirements. These pressures can negatively affect trainee confidence and wellbeing, particularly early in training. A Buddy Scheme was introduced to provide structured peer and near-peer support by linking new CT1 trainees with senior core and higher trainees within a “psychiatry family”. Initially piloted in February 2025, the scheme was expanded for the August 2025 intake and continues for February 2026. This abstract describes the development of the scheme, its refinement, and early trainee outcomes.

A semi-structured focus group with trainees from a previous cohort exploredcommon challenges encountered at the start of training. Thematic analysis informed the design of the Buddy Scheme, including mentor composition, focus areas, and recommended contact patterns. Baseline questionnaires assessed trainee background, self-reported confidence, and familiarity with clinical systems and training processes. For the August 2025 cohort, a trainee-led peer-to-peer guidebook was developed to complement interpersonal support, providing trust-specific guidance. Follow-up feedback was collected several months into training to evaluate perceived impact, confidence, and usefulness of both the scheme and guidebook. The model continues to be refined for subsequent intakes.

All trainees joining the trust in 2025 (n=5) completed baseline surveys. Initial self-reported confidence was low, with mean scores of 2.4/5 for on-call duties and 2.8/5 for clinical skills and overall readiness for psychiatry training. Trainees also reported limited familiarity with key systems, particularly the RCPsych portfolio, prescribing platforms, and exception reporting.

Post-intervention evaluation surveys were completed by 75% of participants. At three months post-entry, respondents reported increased confidence across domains, with mean scores rising to 3.25/5 for on-call duties and 3.5/5 for clinical skills and overall readiness. Familiarity with clinical systems and training requirements also improved. The Buddy Scheme was rated as highly helpful (mean usefulness score 4.25/5), with peer relationships and access to near-peer and senior trainees consistently identified as central to benefit. The peer-to-peer guidebook was described as accessible, well-targeted, and more useful than standard trust handbooks.

Areas for development included clearer portfolio guidance and improved signposting to support and learning resources.

A structured Buddy Scheme, supported by peer resources, can enhance confidence and early training experiences for new psychiatry trainees. Delivery across multiple cohorts has enabled refinement and demonstrated sustained relevance. Further evaluation will explore longer-term effects on trainee wellbeing, confidence, and training progression, and assess potential for wider implementation.

Autism Spectrum Disorder (ASD) is associated with social communication deficits, atypical social cognition, and behavioural regulation difficulties, which can complicate forensic evaluations of criminal responsibility. This case study aims to illustrate the assessment process and clinical reasoning used to determine criminal responsibility in a young offender with ASD and below-average intellectual functioning.

A 17-year-old male was referred for forensic psychiatric assessment following an alleged vehicle theft and reckless driving. A multidisciplinary evaluation was undertaken including psychiatric assessment (developmental, behavioural, substance use history and mental state examination) and clinical psychological testing. ASD assessment used ADI-R and ADOS; cognitive functioning was assessed using the Stanford-Binet Intelligence Scales (Fifth Edition).

Assessment findings supported a diagnosis of ASD with moderate symptom severity and significant social communication deficits. Cognitive testing showed below-average intellectual functioning (Full-Scale IQ 82) with relative strengths in visual-spatial processing and weaknesses in quantitative reasoning and knowledge domains. Clinically, the patient demonstrated limited insight into broader social consequences and reduced emotional reciprocity, without evidence of psychosis. Despite neurodevelopmental vulnerabilities and contextual risk factors (including alcohol use), the forensic conclusion was that the capacity to distinguish right from wrong at the time of the alleged offence was preserved, and criminal responsibility was not negated. The case highlights how ASD-related impairments may affect judgement and impulsivity while still allowing intact understanding of wrongfulness, underscoring the need for structured, ASD-informed forensic formulation.

Forensic assessments of adolescents with ASD should integrate developmental history, structured ASD measures, cognitive profiling, and careful analysis of moral/legal understanding at the material time. This case supports a nuanced approach that balances legal accountability with neurodevelopmental formulation and recommends tailored interventions (e.g., behavioural therapy, social skills work and family psychoeducation) to reduce future risk.

St Andrews Healthcare in Northampton is a tertiary psychiatric hospital with multiple divisions, aiming to lead Complex Mental Health care. It includes secure units across 3 divisions, in varying security levels and specialist needs.

Resident doctors identified through a survey that the current induction process does not support new doctors. Three main areas of concern were identified: information about their job roles, feeling confident for on-calls, and feeling welcomed. Some doctors commented that it took up to one year for them to feel comfortable in their duties.

A Buddy programme was developed with formalised sessions to support a new non-consultant doctor. These included Speciality Doctors, Clinical Teaching Fellows and Associate Specialists and all eligible new doctors participated. It began as a 6-month pilot in Medium Secure Unit before launching to the whole of Northampton site. It ran between March 2024–December 2025. A comprehensive information booklet was created to support the Lead Buddies of each division on subjects to cover with their colleague. Feedback included pre-and post-intervention survey with binary answers, a Buddy feedback form, and additional feedback through e-mails. It was sponsored by one of the Associate Medical Directors and with the approval of all Clinical Directors.

The pre-programme survey noted only 18% of Resident doctor shaving enough information during their induction.

Post-intervention survey increased this to 100%. Confidence about their role has increased from 25% to 100%.

Despite the increase of confidence for starting on-calls, there was still remaining anxiety noted about the complexity. All doctors scored for anxiety about the on-calls in the pre-questionnaire. Post-intervention feedback noted remaining anxiety due to the size of the site. The programme enhanced the preparedness for on-calls by 57%.

Feeling welcomed had increased from 60% to 100% by the end of the programme.

Buddy programme had an overwhelmingly positive effect for new Resident doctors. There are identified areas for future improvement. The organisational changes of the size of the site are likely to resolve one of these. The remaining areas include further analysis of the complexity of cases during on-calls and the turnover rate of non-consultant doctors.