Bitesize teaching is a short session delivered on a specific topic to enhance the knowledge and confidence of practitioners and to support practical application of clinical knowledge. In psychiatry, bite-size teaching has been suggested for training ward staff in physical health-related topics. However, it has been used in a wide range of topics in different teams. We intended to see the effectiveness of bite-size teaching across different professional groups in a range of clinical settings, covering a variety of topics relevant to mental health professionals.

We compared the change in knowledge of a topic and skill, confidence, and comfort level in performing a related task through a pre- and post-session assessment using the Teaching Effectiveness Questionnaire (TEQ), and open-ended questions about learning. The teaching sessions included different professional groups such as doctors, nurses, and allied health professionals; and covered various topics.

There were 149 attendee responses, over the range of topics covered in the bitesize teaching, e.g. role of exercise, green spaces and mental health, diagnostic formulation, metabolic disorder, suicidality management, dementia prevention, Mental Health Act, community treatment order, etc. in multiple sessions. Most of the attendees were doctors(65.1%), followed by nurses (17.4%), and the rest were allied health professionals. The content of the sessions was reported to be very good in 47.0%, and good in 37.6%; session delivery was observed as very good 50.3%, and good 38.9%. There were positive correlations between years of experience and knowledge, skill, and confidence in performing, comfort level, and teaching the task. Pre and post-teaching scores in these domains also positively correlated. Cronbach's alpha of the TEQ for the sample pre-teaching was 0.97, suggesting an excellent level of internal consistency. There were significant changes pre- and post-teaching session in all the domains, such as knowledge (3.3±1.1 vs. 4.0±0.8), skills (3.2±1.1 vs. 3.9±0.8), confidence (3.2±1.1 vs.4.0±0.8), comfort level (3.3±1.1 vs. 4.0±0.8), confidence in teaching others (3.0±1.1 vs. 3.8±1.0), respectively. The overall change was from 16.0±5.2 to 19.7±4.0 (p<0.001). This was consistent across topics and professional groups. Qualitatively, attendees perceived this method as a quick refresher of existing knowledge, and a source for relevant new information that is useful in clinical practice, especially while supporting patients and families.

It appears that the bitesize teaching is an effective method for training on diverse clinical topics. Post-session responses showed positive changes in domains of knowledge, skills, and confidence. Further studies are required about the persistence of the effectiveness over time.

Hyperglycaemia is common among psychiatric inpatients due to comorbid diabetes, medication side-effects, and challenges in self-care. Poor recognition and escalation increase risk of diabetic emergencies.

There is also the ongoing dilemma of Insulin misuse and poor glucose management, as a form of self-harm in a subset of psychiatry patients. These factors lead to increasing difficulties in managing patients with Diabetes admitted on inpatient wards.

This audit aimed to assess compliance with the Trust’s Inpatient Hyperglycaemia Guideline for episodes of blood glucose >15 mmol/L on an Acute male inpatient Ward in Nottinghamshire.

• • Retrospective audit of RiO electronic records

• • Records reviewed over a 6 month period, spanning January–August 2025

• • 30 hyperglycaemic episodes (>15 mmol/L) in 7 patients.

• • Results collected, organized and analysed using Microsoft excel.

• • Standards assessed: ketone testing, wellness status reviews, escalation to medic, clear documentation, insulin use and repeat monitoring.

• • Standards were devised based on the Nottinghamshire Healthcare NHS Trust’s “Inpatient guide for acute Hyperglycaemia in Diabetes Type 1 or 2”,

• • Ketones checked in14/30 (46.7%)

• • Wellness status documented in 14/30 (46.7%), NEWS2 recorded only 3/30(10%)

• • Escalation gaps: 7/25(23.1%) episodes with BG >18 mmol/L not escalated to a medic.

• • No documentation of pre-meal glucose review in all cases.

• • Insulin dosing appropriate in 36.7% of cases with an indication.

• • BG rechecked at 2h in 10/30(33.3%), at 4h in 7/30 (23.3%)

• • Cause identified in 10/30 (33.3%), mostly dietary

Compliance with inpatient hyperglycaemia management standards was variable, with significant gaps identified in ketone assessment, clinical monitoring, documentation of pre-meal trends, documentation of wellness status and escalation practices. These findings highlight the ongoing challenges of delivering consistent physical healthcare within mental health inpatient settings. Targeted system-level interventions, including staff education and structured patient-centred care planning, may improve adherence to guidelines and reduce risk of preventable metabolic complications.

This has led to ongoing collaborative plans to develop an individualised diabetes care plan template, along with improved referral systems to Diabetes specialist nurses.

Lithium is a highly effective mood stabiliser but has a narrow therapeutic index. Inadequate monitoring increases the risk of toxicity, renal impairment and thyroiddys function. Consequently, NICE and local shared-care guidelines mandate structured baseline assessment and regular biochemical monitoring for all patients prescribed lithium.

This quality improvement (QI) project aimed to systematically evaluate adherence to NICE and local guideline standards for lithium monitoring within the inpatient rehabilitation service at the Royal Edinburgh Hospital (REH). The project sought to identify specific gaps in baseline and ongoing monitoring, assess the timeliness and completeness of required investigations. A further objective was to use these findings to inform targeted, sustainable interventions to improve compliance with monitoring standards, enhance patient safety and reduce the risk of preventable lithium-related adverse events within this high-risk population.

A retrospective review was undertaken of all inpatients prescribed lithium across five rehabilitation wards at REH between July 2023 and July 2025. Ten patients met inclusion criteria. Data were extracted from electronic health records, the electronic prescribing system, laboratory results and Lothian Quality Improvement, Safety, Teaching, Supervision, Audit and Evaluation (QISTSAE) adverse event reports. Collected variables included patient demographics, lithium initiation, duration of treatment, the completion and timeliness of required monitoring investigations. Compliance was assessed against NICE guidance and local shared-care protocols.

Significant gaps in lithium monitoring were identified across the cohort. Urine albumin–creatinine ratio (uACR) testing, recommended for early detection of lithium-associated renal damage, was consistently absent in all patients reviewed. Serum calcium and thyroid function tests were missed in approximately 60% of cases. In addition, timeliness of monitoring was suboptimal, with several patients having overdue lithium levels, renal function tests or thyroid investigations. Renal function was not consistently rechecked following elevated lithium levels despite explicit guideline recommendations and over 10%of the results recorded supratherapeutic lithium concentrations during the review period, representing a clear safety concern.

Lithium monitoring within the inpatient rehabilitation setting was inconsistent and frequently failed to meet guideline standards exposing patients to avoidable risk. uACR testing, calcium monitoring and thyroid surveillance represented particular areas of deficit. These findings highlight the need for system-level interventions to support safer lithium prescribing.

Planned next steps include expansion of the project to other inpatient and outpatient services, development of standardised lithium initiation and monitoring order sets in collaboration with laboratory services, targeted educational interventions for multidisciplinary teams to improve awareness, compliance and patient safety.

Kawasaki disease is a systemic vasculitis of unknown aetiology that is usually seen in children younger than five years of age. In our study, the demographic, clinical, laboratory, and echocardiographic characteristics of children diagnosed with Kawasaki disease were evaluated, and patients were compared between complete and incomplete Kawasaki disease, as well as according to the presence or absence of coronary artery involvement.

This retrospective study included 35 paediatric patients diagnosed with Kawasaki disease. Patients were classified as having complete Kawasaki disease or incomplete Kawasaki disease and were further stratified based on the presence or absence of coronary artery involvement. Laboratory parameters were compared between patients with and without coronary artery involvement before treatment and one week after treatment.

The study included 35 patients, 71.4% of whom were male (n = 25). Complete Kawasaki disease was diagnosed in 68.6% of patients, and coronary artery involvement was detected in 37.1%. Patients with complete Kawasaki disease had more frequent extremity changes (p = 0.011), higher C-reactive protein (p = 0.014), and lower alanine aminotransferase levels (p = 0.014) than those with incomplete Kawasaki disease. Patients with coronary artery involvement were younger (p = 0.001), had longer hospitalisation (p = 0.020), prolonged fever before intravenous immunoglobulin treatment (p = 0.003), and delayed defervescence (p = 0.028) compared to patients without coronary artery involvement. Before treatment, erythrocyte sedimentation rate (p = 0.033), lymphocyte (p = 0.022), and platelet (p = 0.001) were higher in patients with coronary artery involvement, whereas no significant differences were observed after treatment.

Patients with coronary artery involvement in Kawasaki disease were younger and exhibited more pronounced inflammatory findings compared with those without involvement; however, these inflammatory differences disappeared after treatment. This finding supports the importance of early and effective treatment during the acute phase.

This quality improvement project aimed to improve resident doctors’ self-reported confidence and preparedness for managing clinical, legal, and safety-related aspects of Psychiatric Intensive Care work through a structured teaching intervention.

A scenario-based teaching session titled Safe Working on PICU was developed and delivered across two teaching cycles (February and September 2025). Anonymised pre- andpost-session questionnaires assessed confidence across key domains using a 1–5 Likert scale and free-text feedback. Iterative refinement of the teaching content was guided by Plan–Do–Study–Act (PDSA) methodology.

Across two teaching cycles, improvements in self-reported confidence were observed in 6 of 7 assessed domains. Mean confidence scores increased by between 0.2 and 0.65 points on a 5-point Likert scale, with the largest gains seen in understanding of seclusion processes, Intensive Care Unit roles, management of aggression, and multidisciplinary collaboration. Confidence relating to Section 5(2) showed a small reduction following more detailed legal teaching, interpreted as increased awareness of legal complexity. Qualitative feedback consistently highlighted improved clarity, relevance to on-call practice, and the value of case-based discussion.

A structured, scenario-based teaching intervention can meaningfully improve resident doctors’ perceived preparedness for Psychiatric Intensive Care work. Teaching-based QI offers a practical approach to addressing safety-critical learning needs in high-acuity psychiatric settings, with potential for wider implementation and sustainability.

Alzheimer’s disease (AD) diagnosis is shifting from clinical diagnosis to a biomarker-guided pathway. An estimated 60% of people with dementia receive a diagnosis and 25-30% are misdiagnosed showing need for optimized diagnostic approaches. Blood-based biomarkers (BBBMs) may identify AD before symptoms and differentiate between AD from other dementia subtypes, with similar accuracy to CSF and PET biomarkers. This paper examines whether access to clinical trials can contribute to improved dementia diagnosis for service users at a National Health Service memory assessment service.

An audit was registered with the local NHS Trust. Data was retrospectively collected from 69 participants screened for dementia drug trials by the Research & Development service between May 2024 and October 2025, healthy volunteers, people with Mild Cognitive Impairment (MCI) due to AD and Mild AD. Medical records from memory clinic assessment and trial data were anonymised and analysed.

Of 69 participants, 6% were healthy volunteers. At memory clinics, 93% underwent Addenbrooke’s Cognitive Examination-III and 80% brain imaging, mostly MRI (42%), 28% CT, 7% MRI and FDG-PET. Following memory service assessment, AD was lead diagnosis (42%), MCI (30%), 7% no diagnosis.

During trial screening, 75% of participants received a plasma p-tau test (28% had positive results). 52% had brain imaging, mostly MRI head plus amyloid PET (42%). 28% had positive amyloid PET scans and 13% had positive tau-PET scans.

Following screening, 83% of participants retained their initial diagnosis. 10% received a new diagnosis while, 7% of participants await reassessment.

17% of study participants’ diagnoses changed course in clinical trials, possibly due to access to additional investigations. This paper highlights the potential benefit of NHS participation in research and a need for serial assessment and reversal of diagnosis pathways in dementia and for further research in this area.

Various antipsychotics and antidepressants have pharmacogenomic guidelines available from international sources, recommending dose adjustments and/or alternative drug selection based on a patient’s genetic profile. However, pharmacogenomic implementation remains limited in UK healthcare.

Genetics and Environment in Mental Health Study (GEMS) is a prospective study of pharmacogenomic testing in psychosis; the first in the UK. Adults taking an antipsychotic medication have been recruited across England. Participants provided a DNA sample for genotyping on a multi-gene panel, selected from evidence-based pharmacogenomic guidelines. Pharmacogenomic reports, displaying the participants’ genetic profile and any alterations to usual prescribing guidelines were delivered to the prescribing clinician. Any changes to the participants’ prescription were at the discretion of the clinician.

A diverse sample of 584 people taking an antipsychotic medication has been recruited so far, consisting of participants aged 18-82 years, with an even split of male and female participants, and 32.5% of the sample from Black, Asian, and Minority Ethnic (BAME) backgrounds.

Across the four genes with pharmacogenomic guidelines in psychiatry (CYP2D6, CYP2C19, CYP2B6, and CYP3A4), 90.4% of the sample carried at least one actionable variant. At the time of recruitment, 20.9% of participants carried a pharmacogenomic variant that (based on current guidelines) was actionable for the antipsychotic and/or antidepressant they were currently prescribed. By medication class, 6.8% were taking an antipsychotic and 15.1% were taking an antidepressant for which they had a pharmacogenomic recommendation. A further 69.5% of the sample would have a recommendation for at least one antipsychotic or antidepressant medication.

Based on the estimated population prevalence of pharmacogenomic actionable variants and prescription data in England, approximately 45% of people would be expected to carry an actionable variant for antipsychotic medications and at least 61% would be expected to carry an actionable variant for antidepressants. This equates to approximately 285,000 people currently taking an antipsychotic medication that could have a pharmacogenomic recommendation and at least 4.2 million people taking an antidepressant with a pharmacogenomic recommendation in England.

Pharmacogenomics has the potential to personalise medication prescriptions and improve patient outcomes. Workforce training and implementation barriers present a challenge. However, in line with the NHS 10 Year Plan goal of 50% of healthcare interventions being genomics-informed by 2035, psychiatry is one of the most promising areas for the implementation of pharmacogenomic-guided prescribing.

Adherence to opioid substitution therapy is critical for treatment success, yet missed doses and unsupervised take-home doses can increase relapse or overdose risk. This service evaluation aimed to assess patterns of missed supervised doses and take-home medication use, identify factors associated with non-adherence, and evaluate potential service improvements.

A retrospective service evaluation was conducted in an addictions psychiatry outpatient clinic. Adults aged ≥18 years receiving methadone or buprenorphine for at least three months were included. Patients were excluded if they had transferred care during the evaluation period, had incomplete pharmacy records, or were unable to engage in routine clinic follow-up due to acute intoxication, severe withdrawal, cognitive impairment, or acute psychiatric instability. Data were extracted from clinic and pharmacy records, including supervised dose attendance, take-home dosing patterns, demographic information, concurrent substance use, and housing status. Descriptive statistics were used to summarise missedsupervised doses, take-home medication issues, and associated factors, with exploratory comparisons between patients with and without polysubstance use.

A total of 120 patients on opioid substitution therapy (methadone n=75, buprenorphine n=45) were included in the service evaluation. Missed supervised doses were common, with 36 patients (30%) missing ≥2 doses in the preceding month and 18 patients (15%) missing ≥4 doses. Issues with take-home medication were documented in 22 patients (18%), including misplacement (n=12) and suspected diversion (n=10). Polysubstance use was prevalent, with 52 patients (43%) reporting concurrent use of cocaine, cannabis, or illicit benzodiazepines; missed supervised doses were more frequent among these patients (42% vs 21%, p<0.05). Younger age (<35 years), unstable housing, and high polysubstance use were associated with higher rates of missed doses. In 28 of the patients with frequent missed doses, additional adherence support was documented, including increased supervised dosing and motivational interventions. Review of clinic and pharmacy records demonstrated that systematic evaluation of adherence patterns is feasible and provides clinically actionable information for optimizing patient safety and treatment outcomes.

Missed supervised doses and take-home medication issues are common among patients receiving opioid substitution therapy, particularly in those with polysubstance use, younger age, or unstable housing. These findings highlight the importance of structured adherence monitoring, targeted support interventions, and careful supervision of take-home doses to optimize treatment outcomes and reduce harm. Routine evaluation of adherence patterns is feasible in outpatient addiction services and can provide actionable insights for improving patient safety and the overall quality of care.

To evaluate whether a structured perinatal psychiatry teaching series delivered during Obstetrics & Gynaecology (O&G) placements improves medical students’ awareness of perinatal mental health services, understanding of common and severe perinatal psychiatric conditions, knowledge of psychotropic safety in pregnancy and breastfeeding, and confidence in recognising and managing perinatal mental illness.

An online perinatal psychiatry teaching series was delivered to 5th-year medical students during their O&G placements. Sessions covered: (1) an introduction to perinatal psychiatry and services, (2) common perinatal psychiatric conditions, (3) severe perinatal mental illness, and (4) psychotropic medication in pregnancy and breastfeeding. Pre- and post-session questionnaires assessed self-reported understanding and confidence using Likert-scale responses. Qualitative feedback explored students’ perceptions of relevance and educational value.

Across the four teaching sessions, 99% of students (85/86) reported the sessions were useful. Following the introductory session, 100% of respondents (34/34) agreed that perinatal mental health teaching should be incorporated into O&G placements, and 85% of students (29/34) reported being at least ‘somewhat likely’ to consider perinatal mental health in their future clinical practice. Significant improvements in self-rated understanding were observed across all sessions. For the introductory session, the proportion of students reporting ‘moderate’ to ‘very good’ understanding increased from 32% (9/28) pre-session to 95% (35/37) post-session. For the session on common perinatal psychiatric conditions, ‘good’ or ‘very good’ understanding increased from 23% (5/22) pre-session to 94% (15/16) post-session. Understanding of severe perinatal mental illness improved from 14% (3/21) of students rating their understanding as ‘good’ or ‘very good’ pre-session to 87% (20/23) post-session. Prior to the psychotropics session, no students reported ‘good’ or ‘very good’ understanding (0/12); following the session, 92% (12/13) rated their understanding as ‘good’ or ‘very good’, with no students reporting ‘no’ or ‘basic’ understanding post-session. Qualitative feedback consistently highlighted the clinical relevance of the teaching and perceived value of the programme.

A structured perinatal psychiatry teaching programme delivered during O&G placements is feasible, highly acceptable to students, and associated with substantial improvements in self-reported understanding and confidence. Embedding perinatal mental health teaching into undergraduate O&G curricula may support earlier recognition of maternal mental illness and strengthen multidisciplinary maternity care.

Seizures can manifest with different symptoms including motor, autonomic, behavioural, cognitive, emotional, or sensory dysfunction. Non motor seizures can therefore be referred to a psychiatrist or missed. This study looks at a similar case where seizure disorder was mistaken for a cognitive disorder and sun downing in dementia.

An 81-year-old gentleman was referred to the memory clinic due to concerns about his memory and behavioural changes occurring mostly at night. At initial review he reported having episodes of disorientation, with associated behavioural changes like wandering, attending to chores e.g. cleaning, hoovering, with confusion and scored score 85/100 on ACE III. Further history revealed a previous episode of collapse, preceded by patient doing household chores at 3 am, lip smacking, urinary incontinence and retrograde amnesia of events. Diagnosis of cardiac syncope was made at the hospital, following ECG with dynamic changes but no rise in troponin. EEG showed no positive findings and He was then asked to inform Neurology if there are further episodes . Unfortunately, he had several episodes with similar behavioural symptoms but not motor manifestation which delayed treatment as family did not report them to neurology. He was then seen in psychiatry clinic for MCI review where a diagnosis of likely seizure disorder, with behavioural manifestation was made and was referred to the neurologist who prescribed lamotrigine with significant reduction in the frequency of these episodes.

The case highlights again, epilepsy as watershed between neurology and psychiatry. Seizure episodes may present with behavioural symptoms which can be referred to mental health specialists.

Mental health specialists should take detailed history, consider various differential diagnosis and complete a holistic review including medical history to avoid missing focal and complex partial seizures without motor manifestation.

Background:

Sexual safety is a core component of providing a safe and therapeutic inpatient mental health environment. Devon Partnership NHS Trust's (DPT) Sexual Safety Policy (C60) outlines responsibilities to protect patients from sexual harm, promote consent, and ensure appropriate sexual health assessment. National guidance from NICE, the CQC, and the Sexual Safety Collaborative highlights the importance of routine sexual history taking, trauma-informed care, and safeguarding, particularly for vulnerable inpatient populations.

Aim: This audit aimed to evaluate compliance with DPT's Sexual Safety Policy (C60) on Haytor Ward by assessing documentation of sexual health and sexual safety during inpatient admissions, and to explore resident doctors’ knowledge, attitudes, and practices regarding sexual history taking.

A retrospective review of ten inpatients admitted to Haytor Ward in May 2025 was conducted using System One (s1). Patients were selected using a randomised bed-number approach. Documentation within physical health clerking, the assessment tab, and tabbed journal entries was reviewed using predefined search terms aligned with Trust policy requirements. In addition, a qualitative and quantitative survey of South Devon resident doctors was undertaken using Google Surveys to assess awareness of policy, clinical practice, and perceived barriers. The survey was open for 30 days and achieved a 50% response rate.

Documentation of sexual health and sexual safety was below expected Trust standards. Sexual history was inconsistently recorded, largely due to the absence of a sexual health section within the routinely used admission clerking proforma. The existing Sexual Health template on s1 was not easily accessible and did not capture several policy-required elements, including gender identity, sexual orientation, sexual safety understanding, historyof sexual harm, and MAPPA/safeguarding status. Patients who were acutely unwell on admission were less likely to engage in sexual history discussions. Only 50% of surveyed doctors were aware of the Sexual Safety Policy, and most reported not routinely undertaking sexual history taking, citing time pressures, patient distress, lack of training, and system-level barriers.

Sexual safety assessment on Haytor Ward is inconsistently documented, primarily due to IT system limitations and reduced staff awareness. Improving S1 templates, enhancing training, and embedding sexual safety into routine admission processes are essential to align practice with Trust policy and national guidance, and to ensure patient dignity, safety, and safeguarding.

Literature identifies South Asians as reporting significantly higher rates of mental health stigma compared to other ethnic groups. A significant component of this is ‘courtesy stigma’, where family members experience collective shame regarding an individual’s diagnosis. While low Mental Health Literacy (MHL) is cited as a primary driver of stigma, this study investigates the paradox: the persistence of stigma among ‘mentally literate’ South Asian households. The study aims to explore the lived experience of individuals navigating mental health while being raised by parents with high MHL, questioning whether MHL effectively translates into appropriate support.

This qualitative study utilizes semi-structured interviews via Zoom (Howe, Tickle & Brown, 2014). Participants were recruited through snowball sampling for their unique perspectives: All participants (2 males, 4 females) have parents with professional healthcare backgrounds or are in the field of psychology. Data was analysed using narrative thematic analysis to capture the various stigmas faced within familial dynamics.

Four core themes emerged: Denial, Courtesy Stigma and Labelling, Paradoxical Resistance to Treatment, and Stigmatised Protection and Exclusion. Denial was most prominent, where a psychiatrist father’s clinical expertise failed to overcome a “refusal to see” of his son’s diagnosis. Courtesy Stigma and Labelling, for example where the “mad person’s daughter” label, created such a traumatic environment of social shaming. Paradoxical Resistance to Treatment, where even high levels of MHL fail to ensure support. A pharmacist,well-versed in the efficacy of medication, discouraged treatment due to the specific stigma of psychiatric drugs. Noteworthy to mention an exceptional instance of supportive parents, including a psychiatrist father who encouraged medical treatment for her OCD from a young age, the participant still felt stigmatised. Stigmatised Protection and Exclusion, were evident when adults discouraged younger family members from interacting with the participants, ultimately leading to social exclusion.

This case series demonstrates that stigma within South Asian communities remains a structural force dictating family behaviour independent of clinical knowledge. MHL does not inherently mitigate cultural shame. Clinicians, for instance, should not assume that parents with medical knowledge will be more accepting of a child’s diagnosis. Recognising this will be key in tailoring effective, culturally sensitive care. Larger-scale studies are required to fully understand the broader population’s cultural barriers and the persistence of stigma in “literate” households. Several participants have channelled their experiences with stigma into advocacy, pursuing careers in psychology or engaging in public awareness efforts to bridge these gaps.

Journal Club Presentations (JCPs) are a mandatory component of the Royal College of Psychiatrists (RCPsych) portfolio requirements for Annual Review of Competence Progression (ARCP), with trainees required to complete at least one JCP per training year. At Mersey Care NHS Foundation Trust, JCPs are delivered within the weekly Local Academic Programme (LAP), but trainees frequently report reduced engagement, particularly during statistical discussions. Baseline LAP feedback identified difficulty understanding statistics, limited interactivity, and low perceived examination relevance as key contributors. As critical appraisal and research methods form a substantial component of the MRCPsych Paper B examination, this Quality Improvement Project aimed to enhance engagement by integratingbrief MRCPsych-style multiple-choice questions (MCQs), targeting a 25% improvement from baseline.

This prospective quality improvement project used a pre-post descriptive design within the weekly LAP. Baseline data were obtained from routinely collected LAP feedback surveys (August–September 2025; pooled n=427), assessing engagement, barriers to participation, and acceptability of MCQs. From 16 September 2025, MRCPsych-style MCQs were incorporated into every JCP. Presenters were asked to include 1–3 MCQs focused on statistical or methodological concepts relevant to the paper, taking no more than five minutes. Post-intervention evaluation was conducted at two predefined time points in December 2025 (pooled n=211). Outcomes included self-reported engagement on a 10-point Likert scale, understanding of journal articles, perceived knowledge retention, and interactivity. Data were analysed descriptively.

At baseline, 25–30% of respondents rated engagement as average, 40–50% reported difficulty understanding statistics, and 30–40% requested greater interactivity. Post-intervention, 65–70% reported a moderate to very significant increase in engagement (≥7/10), exceeding the 25% improvement target. Improved understanding of journal articles was reported by 63–65%, with up to 39.5% reporting better statistical understanding and overall comprehension. Knowledge retention improved for 69–70%, and interactivity for approximately 67%. Only 3–6% reported minimal or no improvement. Qualitative feedback was strongly positive, with requests to continue and expand MCQ use.

Sustained integration of MRCPsych-style MCQs into JCPs was associated withmeaningful improvements in engagement, understanding, retention, and interactivity. This lowcost, scalable intervention exceeded its primary objective and has now been embedded into routine teaching practice. Incorporating brief, exam-relevant interactive elements represents an effective strategy for enhancing postgraduate psychiatric education.

Feedback was collected from Core Trainees (CTs) working at Black Country Healthcare Foundation Trust to survey their satisfaction with the way that ECT was being delivered at the time. Primary aim was to assess/rectify CT issues that were causing difficulties in achieving their ECT competencies with secondary aims to improve delivery of ECT from a patient/trust perspective as well.

Initially a prequestionnaire was delivered to determine the extent of the need and whether CTs would be positive towards a separate rota.

Afterwards we implemented a new specific rota for ECT clinic, over a trial period of 3 months, where a dedicated CT would cover the entire ECT list rather than the rostered on-site on-call doctor (if that doctor was agreeable to this). This was tracked via a live Excel document that was regularly updated to show the ECT clinics that were and weren’t available and CTs were able to put themselves down for available clinics.

We then performed a post-trial survey with comparable questions to assess for benefit of the rota and then asked the cohort for their views on the ECT rota itself and whether it should be reimplemented (as well as advice on improving that process if it were to restart).

Pre-trial responses showed that 65% and 71% of CTs had not received ECT induction or had competencies signed off, respectively. Over half had difficulties achieving competencies and 94% thought a more structured programme would help with achieving these.

Post-trial feedback was overwhelmingly positive with significant improvements in all measured parameters. Particular highlights being how 100% of CTs surveyed had now performed ECT vs 65% previously; and 94% favoured re-introducing the ECT rota. The percentage of CTs that had their ECT competencies signed off more than doubled (from 36% to 67%) and the vast majority felt the ECT rota made things better and less stressful whilst it was running.

Our conclusion was that a separate ECT rota was required going forward, particularly considering the Royal College's current ECT training requirements for CTs. Itwas recommended – and agreed to – that a centralised rota managed through the postgraduate medical rota coordinators would be beneficial. These findings were discussed and presented at the Tutors and Trainees meeting, attended by College Tutors and the Head of School.

This project evaluated a new service for CAMHS patients with Eating Disorders within Avon and Wiltshire Mental Health Partnership Trust. The service (‘the Redcap clinic’) was commissioned in 2024, and began operating in January 2025, providing physical health review (physical observations, bloods, ECGs) for ED patients under 18. The clinic is run at the Bristol Royal Hospital for Children by paediatricians specialising in Eating Disorders, and interpreted results are shared with locality CAMHS teams. The key aim of the clinic is to safely and effectively assess the physical health needs of this patient cohort, facilitating collaborative clinical decision-making between paediatrics and psychiatry. This project aimed to explore clinicians’ views of the new service.

A nine-question electronic survey was disseminated amongst CAMHS and paediatric staff referring to, or running, the clinic. The survey ran over 90 days (September – November 2025), using convenience sampling. Mixed methods were used to interpret the results; the first five questions were analysed using descriptive quantitative methods. The latter four questions elicited free-text responses, on which the lead researcher conducted a thematic analysis based on Braun and Clarke’s method of thematic analysis.

In total, 24 responses were received from members across the MDT in both CAMHS and Paediatrics. 100% of respondents felt that the clinic provided joined-up care, and 95% of respondents felt that the clinic allowed faster access to investigations. Views of respondents indicated that the clinic: 1) provided joined-up care between paediatrics and psychiatry; 2) allowed patients faster access to tests compared to appointments in primarycare; 3) was convenient for patients compared to having tests at the GP; 4) saved clinicians’ time; 5) had a robust and effective system for results feedback. Qualitative analysis of free-text responses generated five themes of the clinic’s impact on professionals – ‘saving time in community CAMHS’, ‘meeting patient needs’, ‘confidence in the system’, ‘facilitating safer decision-making’, and ‘connection with experts’. Regarding the impact of the clinic on patients and families, qualitative analysis of responses yielded four themes – ‘accessibility’, ‘containment’, ‘appropriate/adapted’ and ‘continuity’.

Overall, clinicians’ feedback on the Redcap clinic was positive; the clinic was felt to facilitate safe, effective, and joined-up care for a vulnerable group of young people with specific physical and psychological health needs. These results have supported local efforts for ongoing commissioning. Suggestions for further service development are discussed, as are future plans to explore feedback from young people and families using the service.

Mentalisation-Based Therapy-Introduction (MBT-I) is a brief, structured psychological intervention designed to enhance reflective functioning and emotional regulation, and to prepare individuals for longer-term psychotherapeutic work. Despite increasing use across NHS services, evidence relating specifically to MBT-I remains limited. This quality improvement project (QIP) aimed to evaluate the characteristics, engagement, and outcomes of participants enrolled in MBT-I groups within Leicestershire Partnership NHS Trust (LPT). Objectives included describing demographic and clinical characteristics, examining referral pathways and engagement, assessing post-intervention outcomes, and identifying service gaps and future needs for MBT group provision.

A retrospective audit was conducted across three MBT-I cohorts delivered in October 2023, July 2024, and February 2025. Referrals were accepted from primary care, secondary mental health services, Central Access Point, and self-referral pathways. Forty-eight individuals were considered for MBT-I. Groups were delivered weekly over 10–13weeks, co-facilitated by two MBT-trained clinicians. Data were collected at pre-intervention, during treatment, and post-completion using routinely recorded clinical information. Variables included demographics, mental health history, risk and safeguarding data, attendance, completion rates, and onward referrals.

Participants represented a clinically complex cohort (mean age 40.2 years; 77.1% female). Historical risk to self was present in 66.7% and 91.7% had previously engaged in psychological therapies. Most participants (85.4%) had no prior psychiatric admissions. Engagement was good, with a median attendance of 8.5 sessions with attendance ranging from 0 to 13 and low rates of non-attendance. Inpatient admissions during MBT-I were rare (2.1%). Following MBT-I, 20.8% completed and were referred for further psychological therapy, 12.5% completed and required no further intervention, and 4.2% were signposted to alternative services. A minority (22.9%) did not complete the programme, while 37.5% did not commence following assessment. Referrals predominantly originated from secondary mental health services, with minimal primary care referrals.

MBT-I appears to be a feasible, acceptable, and resource-efficient intervention for individuals with complex emotional and interpersonal difficulties. Findings demonstrate good engagement and low inpatient admission rates, supporting its safe delivery within high-risk populations. MBT-I may function both as a gateway to longer term psychological therapy and, for some individuals, as a sufficient standalone intervention. Non-commencement and drop-out highlight the importance of robust assessment and exploration of barriers to engagement. Future service development should prioritise routine outcome measurement, improved data quality, and clearer integration of MBT-I within stepped-care psychological therapy pathways. These findings align with NICE guidance and support further evaluation,expansion, and integration of MBT-I provision within NHS psychotherapy services nationally sustainably.

To verify whether clozapine and lithium plasma levels were monitored in accordance with trust guidelines in inpatient psychiatric settings.

A retrospective audit was conducted across eight inpatient wards.

Fifteen inpatients prescribed clozapine and/or lithium were included.

The audit period covered December 2024 to March 2025.

Data sources included clinical notes, WebICE, EPMA, and clozapine monitoring report form

Standards and Criteria

Clozapine: Plasma levels taken immediately before the morning dose (for twice-daily dosing) or 10–12 hours post-dose (for once-daily night dosing), after at least three days on a stable dose.

Lithium:Plasma levels taken 5–7 days after initiation, sampled 12–14 hours post-dose, with weekly monitoring until stable therapeutic levels are achieved.

Target compliance: 100%.

Clozapine (n=6): All patients had plasma levels checked after at least three days on a stable dose. Four patients (66.67%) had samples taken within the recommended post-dose time window. For two patients (33.33%), compliance could not be confirmed due to missing uploaded laboratory reports. Two patients were within the therapeutic range, while four were outside the target range. Dose adjustments were made for two patients; no changes were required for two due to good clinical response or increased cigarette use. Repeat plasma levels were obtained where clinically indicated.

Lithium (n=9): Seven patients (77.8%) had lithium levels checked within 5–7 days of initiation. Two patients (22.2%) did not meet the recommended initiation timing. Two patients had samples taken outside the recommended 12–14-hour post-dose window. Eight patients had plasma levels outside the therapeutic range, prompting dose adjustments and repeat testing. One patient had a therapeutic lithium level and required no dose adjustment.

Summary: Only 66.67% of patients on clozapine or lithium were fully monitored in line with trust guidelines. Missing clozapine monitoring forms limited the ability to assess compliance. Inconsistent plasma sampling times were identified.

Recommendations and Action: Plan Improve staff awareness by displaying trust guidelines on wards and providing targeted teaching sessions. Educate patients on the importance of adherence to plasma monitoring schedules. Emphasise the importance of uploading clozapine monitoring forms and assign clear accountability. Work with IT services to address technical issues related to report uploads.

This audit demonstrated partial compliance with trust guidelines for clozapine and lithium plasma monitoring. Improved documentation practices and targeted staff education are recommended to enhance patient safety. A re-audit is planned to assess the impact of these interventions

Discharge summaries are essential documents that promote continuity of care and patient safety and communication between inpatient and outpatient providers. They are especially important in the psychiatric setting since they need to contain accurate records of the mental status of the patient, risk evaluation, and the education of both the patient and caregiver to avoid relapses and adverse events. This audit aims at evaluating the quality of psychiatric discharge summaries in our hospital and finding out the main areas that need improvement to be used in quality improvement initiatives

This clinical audit was conducted to determine the completeness and quality of 80 discharge summaries of patients admitted to the Psychiatry Department of Allied-2 Hospital, Faisalabad, using a structured checklist based on Royal College of Physicians (RCP) guidelines, between January and June 2025. The main components were patient identifiers, diagnosis, mental state at discharge, risk assessment, treatment summary, medications, follow-up plan, counseling documentation, and legibility. The data analysis was done descriptively using frequencies and percentages, with 100 percent compliance considered the gold standard.

The degree of compliance with RCP standards was overall 47.5, which was significant. There were high scores in the elements of administrative data such as admissions and discharge dates (100), final psychiatric diagnosis (100), a review of treatment (100), discharge medications (100), and patient identifiers (98.75). Nevertheless, compliance among critical psychiatric-specific elements was very low: presenting complaint (0%), examination of mental state at discharge (0%), documented risk assessment (1.25%), patient and care giver counseling (1.25%), and typed/legible discharge summaries (0%). There were critical deficiencies in five components that had a great impact on patient safety, continuity of care, and managing risks.

A review audit should be conducted to assess the effects of this intervention and to ensure that the RCP standards are followed so that psychiatric discharge paperwork and patient outcomes are improved. The absence of documentation of the mental state examination, risk assessment, and counseling places patients at a significant safety risk. To be able to deal with these issues, electronic discharge summaries and standardized templates with mandatory psychiatric assessments, structured counseling protocols, and targeted training of personnel should be introduced.