Schizophrenia is associated with abnormalities in mismatch negativity (MMN), an event-related potential linked to sensory memory and information-processing deficits. MMN has been widely studied as a biomarker for disease progression. This review and meta-analysis examines the magnitude of MMN abnormalities in schizophrenia and explores factors associated with these effects. In addition, this study evaluates a large language model approach for automated data extraction, with potential applications for future meta-analyses.

MEDLINE, Embase and PsycINFO databases were searched from inception to 14 November 2025. A total number of 2493 articles investigating auditory MMN in patients with an established diagnosis of schizophrenia, first-episode psychosis, high-risk groups, and first-degree relatives was identified. Manual data extraction was compared to an automated data extraction using OpenAI’s GPT5 model. The mean effect size of auditory MMN in patients compared to controls was calculated. Subgroup analyses for deviant type and auditory paradigm were conducted. The effects of age, sex, illness duration, symptom severity and antipsychotic dose were analysed.

A total of 140 studies were included in the analysis. Compared to the controls, patients with schizophrenia showed reduced auditory MMN amplitudes (g=0.72, 95% CI [0.63–0.82]). MMN impairment increased significantly (p<0.0001) across illness stages from high-risk individuals (g=0.37) to first-episode psychosis (g=0.50) and chronic schizophrenia (g=0.85). Subgroup analyses by deviant type and auditory paradigm showed no statistically significant differences in effect sizes. Auditory MMN amplitude was not significantlyreduced among first-degree relatives. Meta-regression analyses found that both antipsychotic dose (p<0.0001) and illness duration (p<0.0001) significantly moderated MMN effect sizes, while sex, symptom scales’ scores and patient age were not significant modulators. OpenAI’s GPT5 model accurately extracted data across 95% of fields.

This large meta-analysis confirms that auditory MMN amplitude is reduced in schizophrenia and modulated by both duration of illness and antipsychotic dose. This is present in high-risk groups, intensifying with progression to first-episode psychosis and chronic schizophrenia. These findings reinforce MMN as a potential biomarker of neurophysiological dysfunction in schizophrenia across stages of illness. Additionally, automated data extraction provided promising feasibility for accelerating future large-scale meta-analytic workflows.

Administration of clozapine is challenging in treatment-resistant schizophrenia (TRS) patients who refuse to take it orally; enforced treatment with clozapine, either naso-gastrically (NG) or intramuscularly (IM), may be required in such situations. There are a few existing case-series and reports in this area. This service evaluation aimed to add to this pool of data and to understand the illness profile of patients who received IM clozapine, tolerability, their longer-term outcomes etc.

The evaluation was of a retrospective longitudinal observational nature and included all patients under the care of Mersey Care NHS Foundation Trust who were prescribed IM clozapine from 01/01/2017 till 31/12/2023. Pseudonymised data was derived from the patient records.

The sample included a total of 30 patients. All patients suffered from chronic psychotic illnesses. Average duration of psychotic illness prior to being prescribed IM clozapine was 19 years. 80% of patients were in seclusion or segregation at the time of IM clozapine being prescribed. Over 40% patients suffered from cardiometabolic or other physical comorbidities. 21 of the patients (70%) belonged to the initiation group and were prescribed IM clozapine to initiate and establish the patient eventually on oral clozapine. 10 (47.6%) of them accepted oral clozapine without receiving any injections. 9 of the patients (30%) belonged to the maintenance group and were prescribed IM clozapine as an adjuvant to maintain their compliance. A total of 428 doses of IM clozapine were given in the study to 17 patients, and each dose was given as 1-2 injections. 7 patients (41.2%) who received IM clozapine developed injection-site nodules or lumps without abscess; average number of doses received was 43. 10 patients (52%) required restraints by PMVA-trained staff; these were uneventful. Around 90% of patients in the initiation group were established on oral clozapine at end of follow-up. Around 2/3rds of patients in the initiation group who established on oral clozapine had seclusion/ segregation terminated, moved to lower securitymeasures and were on clozapine at time of discharge.

Administration of IM clozapine is fairly safe and well tolerated and it should be prescribed in patients earlier in their course of treatment-resistant-schizophrenia where oral compliance is not possible: nearly half of initiation group accepted oral clozapine without a single IM injection, improvement in patient outcomes was noted and majority were established on oral clozapine. Rotation of injection sites is recommended to prevent and avoid injection site nodules.

Care homes were noted to refer residents with Behavioural and PsychologicalSymptoms of Dementia (BPSD) without behavioural charts, which limited the development of appropriate care plans. Some referrals were also made to secondary mental health services before trial of local behavioural strategies. This project aimed for 80% of referrals to Kent and Medway Mental Health Trust for BPSD to include a medication chart and completed behavioural chart prior to assessment. A further aim was to design and deliver training on Dementia, BPSD and effective behavioural chart completion within two pilot care homes, with the longer-term intention of reducing referrals.

A multidisciplinary team (MDT) mapped the referral pathway and collected baseline patient data, including whether behavioural charts were provided on referral, and chart quality from psychology and medical perspectives. A 3-hour MDT training package was developed, combining presentation, written materials and interactive case discussion. Topics included understanding Dementia, recognising behaviours experienced as challenging, communication strategies, use of behavioural charts with example walkthroughs, and approaches to supporting wellbeing and quality of life. Training was delivered on-site in two pilot homes, with staff encouraged to cascade learning. Trust referral screeners were also asked to request missing behavioural charts. Equivalent referral data was collected post-training.

Thirteen attendees provided feedback. All rated the training 10/10 for usefulness. Self-rated understanding of Dementia improved from 4.2/5 to 5/5, and confidence with completing behavioural charts improved from 6.8/10 to 9.8/10. Attendees included HCAs, Team Leaders and Managers. Qualitative comments highlighted learning around triggers for behaviours that challenge, completion of behavioural charts and behavioural strategies to potentially use for their residents with Dementia.

At baseline, 16 referrals for BPSD were accepted over four weeks in March, with two including behavioural charts. Requested charts from the two pilot homes scored low for structure (1.6/5) and clinical usefulness (1.4/5). After the training, five referrals were accepted over four weeks in June, none from the pilot homes. In the following two months, no new patients were taken on from one pilot home and two from the other, one accompanied by a completed behavioural chart. Although new patient numbers decreased, too few charts were therefore submitted to evaluate quality improvement.

The training was well received and increased staff confidence. Wider rollout is recommended, though individual home-based delivery was resource-intensive. An annual centralised session may be more efficient.

Distinguishing primary functional disorders from psychiatric illness arising secondary to chronic physical symptoms remains a significant clinical challenge, particularly when structural pathology is absent. Failure to make this distinction risks premature psychological attribution, diagnostic overshadowing, and invalidation of patient experience. Although ICD-11 offers updated frameworks for understanding disorders at the brain–body interface, their application to complex presentations requires careful clinical judgement to avoid misinterpretation of psychiatric risk.

Case Report

We present a case that illustrates this diagnostic tension. A 48-year-old woman with high premorbid functioning and no prior psychiatric history developed a progressive multisystem physical illness following international travel. Symptoms included gastrointestinal dysmotility, bladder dysfunction, autonomic instability, and sleep disruption. Despite extensive investigation, no unifying structural or neurodegenerative diagnosis was identified.

As the physical illness persisted, the patient developed a severe depressive syndrome with suicidality. Notably, affective symptoms emerged only after the onset of physical decline and fluctuated in parallel with physiological distress, rather than following an autonomous psychiatric course.

This case highlights the importance of distinguishing primary functional disorders from psychiatric illness that is reactive to chronic physical dysfunction. Contemporary models conceptualise functional conditions as disorders of brain–body interaction, characterised by altered interoceptive processing and maladaptive predictive mechanisms. In such cases, these processes are central to symptom generation and represent appropriate targets for psychiatric intervention.

By contrast, secondary psychiatric illness arises in response to prolonged physical uncertainty, loss of bodily predictability, and erosion of trust in physiological functioning. In this context, the depressive syndrome does not account for the physical symptoms but develops as a consequence of them. Temporal sequencing is therefore a key diagnostic marker. Failure to recognise this distinction risks premature psychological attribution, erosion of the therapeutic alliance, and misinterpretation of suicide risk. In such cases, suicidality is often driven by existential distress related to persistent physical suffering and fear of irreversible decline, rather than affective pathology alone.

Not all distress associated with unexplained physical symptoms is somatoform. Psychiatry’s role is not to resolve medical uncertainty through psychological explanation, but to locate distress accurately within the patient’s causal narrative. Careful formulation, grounded in phenomenology and temporal sequencing, is essential for ethical practice and effective risk management - and in cases such as these can prove to be life saving

Melatonin is an endogenous hormone used to manage insomnia in children with neurodevelopmental disorders. Within the Tees, Esk & Wear Valleys NHS Foundation Trust, the Shared Care Guideline (PHARM-0025-V5) mandates specific standards for prescribing and documentation. Following an initial audit in March 2024 that identified partial compliance, this re-audit aimed to assess progress in the York CAMHS ADHD team’s adherence to these guidelines.

A retrospective clinical re-audit was conducted between October 9th and 12th 2025. Data were collected from 50 electronic patient records (CITO) for children diagnosed with ADHD who were commenced on Melatonin between March 2024 and October 2025. The audit tool assessed five key criteria: documentation of prescribing rationale, provision of oral/written information, advice on short-term use/treatment breaks, and adherence to correct licensed formulations (Adaflex/Slenyto).

Significant improvement was noted in prescribing correct formulations, rising from 70% in the first cycle to 90% (45/50). Documentation of the rationale for formulation switches also improved to 50% (2/4 applicable cases). However, compliance remained low in other areas:

Prescribing Rationale: Stable at 76% (38/50) compared to 77% in the first cycle.

Information Provision: Recorded evidence of oral/written information declined from 33% to 18% (9/50).

Short-term Use Advice: Remained low at 8% (4/50) compared to 10% in the previous cycle.

The re-audit demonstrates that targeted feedback effectively improved technical prescribing adherence regarding medication choice. However, a significant “documentation gap” persists concerning patient-centered communication and review planning. Proposed actions include delivering team-teaching sessions to emphasize the necessity of documenting patient discussions and implementing standard phrases in electronic notes to ensure comprehensive record-keeping.

Clozapine-induced gastrointestinal hypomotility (CIGH) is a serious and potentially life-threatening adverse effect, with constipation representing an early warning sign. During clozapine titration, clinical attention may be disproportionately focused on haematological monitoring, risking under-recognition of gastrointestinal side effects. This audit aimed to assess adherence to Trust guidelines for monitoring constipation following clozapine titration in a working-age adult inpatient setting. It was hypothesised that formal completion of Glasgow Antipsychotic Side Effect Scale for Clozapine (GASS-C) at 30 days post-titration would be limited. Secondary objectives were to explore whether constipation was identified and documented through alternative clinical means and whether appropriate treatment was initiated when constipation was present.

A retrospective audit was undertaken across working-age adult inpatient wards at Farnham Road Hospital. Patients registered with the Clozaril Patient Monitoring Service between October 2023 and October 2024 were identified with support from the hospital pharmacy clozapine service. Patients aged over 65 years and those maintained on an established dose of clozapine were excluded. Electronic patient records were reviewed to determine whether GASS-C had been completed at 30 days following clozapine titration, whether constipation was documented elsewhere in clinical notes at that time point, and whether laxatives had been prescribed.

Fourteen patients were identified, of whom eight met inclusion criteria (six male and two female). GASS-C was completed at the 30-day endpoint in three patients (37.5%). Constipation was documented in the clinical notes of six patients (75%), and seven patients (87.5%) were prescribed laxatives. The modal clozapine dose reached at 30 days was 300 mg.

This audit demonstrates that formal monitoring for constipation using GASS-C following clozapine titration is inconsistently implemented. However, constipation was commonly identified and treated through routine clinical documentation, suggesting awareness of risk despite poor adherence to the recommended monitoring tool. Embedding GASS-C into clozapine titration workflows may support more consistent and systematic monitoring. A re-audit is planned to assess the impact of these interventions.

This project aimed to explore the experiences and acceptability of individuals prescribed clozapine regarding both traditional 12-lead ECGs and the handheld Kardia Mobile 6-lead ECG device.

Initial data on 12-lead ECG compliance was analysed across two clozapine clinics using Business Intelligence. 213 patients were prescribed clozapine; however, only 40% (n=85) had an ECG recorded within the previous 12 months.

A quantitative survey using Likert scales was developed and distributed to patients attending clozapine clinics. Participants were offered the handheld Kardia Mobile 6-lead ECG and subsequently completed the patient survey. All participants had previously been offered a standard 12-lead ECG as part of their annual physical health monitoring. A total of 37 patients participated.

Ethical approval was not required as this project was classified as a clinical audit; approval was granted by the KMMH Clinical Audit and Effectiveness Committee (Ref: 6689-25).

Of the 37 participants; 16% reported finding 12-lead ECG’s difficult or very difficult, 38% reported it was neither easy nor difficult, and 46% reported it was easy or very easy. In contrast, 97% of participants reported the Kardia 6-lead ECG to be easy or very easy, with only 3% reporting it as neither easy nor difficult. These findings suggest the handheld ECG was perceived as significantly more convenient and acceptable than the traditional 12-lead ECG.

When asked about preference, 84% of participants strongly preferred the Kardia 6-lead ECG over the traditional 12-lead ECG, and 92% reported they would be more likely to consent to the 6-lead ECG. However, confidence in the accuracy of the Kardia device varied: 21% of participants rated their confidence at moderate or below, while 78% reported high or very high confidence. This indicates that although acceptability and likelihood of consent were high, some uncertainty regarding diagnostic accuracy remains.

The findings demonstrate that the Kardia 6-lead ECG was perceived as more convenient and more acceptable than the 12-lead ECG, with a strong association between ease of use and increased willingness to consent to monitoring. This suggests that the introduction of handheld ECG devices may help address existing barriers to ECG completion in community clozapine clinics and potentially improve annual monitoring rates.

However, it is important to note that the results also highlight while overall confidence in the 6-lead ECG was high, a notable minority expressed uncertainty, emphasising the need for clear patient education and communication regarding the reliability and limitations of handheld ECG devices.

There is increasing evidence that suggests that different subtypes of major depressive disorders, particularly treatment-resistant depression and anhedonia-predominant forms, have dysregulation in reward processing and chronic neuroimmune activation. Low-dose naltrexone (LDN), which is administered at low doses (1–5 mg/day), modifies both the signalling from the body’s endogenous system and the inflammatory pathways of microglia and thus can be used as a potential therapeutic for depression. This mechanistic systematic review aims to evaluate the dual mechanism of Low Dose Naltrexone in Treatment-Resistant Depression. This study aims to provide an analysis of the human clinical and biological effects of low dose naltrexone (LDN) in depression based upon a mechanistic convergence framework.

Human studies examining the effects of LDN on outcomes such as mood, fatigue, pain, quality of life, inflammatory markers, or opioid-related variables, published in PubMed, EMBASE, Scopus, Web of Science, the Cochrane Library, or Google Scholar, wereidentified. The quality of randomized controlled trials was evaluated according to the Risk of Bias 2 tool, and the quality of non-randomized studies was evaluated according to the Risk Of Bias In Non-randomized Studies–Instrument (ROBINS-I). Results from studies of human subjects were synthesized narratively using a mechanism-based approach.

Improvements in quality of life, fatigue, and mood-related symptoms in disorders characterized by immune activation and central sensitization (e.g. fibromyalgia, multiple sclerosis) were observed across randomized trials, observational cohorts, and case reports after administration of LDN. Biomarkers of inflammation (pro-inflammatory cytokine levels) were lower in human studies after administration of LDN. Indirect indicators of enhancement of endogenous opioid function (e.g. improved pain tolerance, decreased consumption of analgesics and psychotropics) were also reported in human studies after administration of LDN. The mechanisms by which LDN exerts these beneficial effects occur in the same patient population and therefore suggest a biological convergence of immune suppression and opioid-mediated reward modulation.

The results from the literature support a “Dual Mechanistic Model” where LDN suppresses inflammation by activated microglia and at the same time increases signalling of endogenous opioids, both of which have been implicated in the pathophysiology of depression and anhedonia. Thus there is a strong mechanistic basis for testing LDN as a treatment for patients who have failed to respond to current treatments for depression.

This quality improvement project aimed to strengthen the timeliness, consistency and quality of post-fall medical assessments and documentation across older adult inpatient wards. National standards, including NICE Quality Standard 86 and Royal College of Physicians’ recommendations, emphasise prompt review and comprehensive assessment following inpatient falls. Local incident reviews, however, indicated delays in medical examination, inconsistent documentation, and variation in practice. The project aimed to evaluate current practice, identify gaps, and inform the development of an improved post-fall medical review template, as well as contribute to the revision of the Trust’s Falls Policy.

A retrospective review of 30 inpatient fall incidents was conducted across six older adult mental health wards at the Julian Hospital and Carlton Court Hospital over a three-month period. Data were extracted from incident reports and clinical records, focusing on:

• Whether a post-fall medical review was completed.

• Time from fall to medical assessment.

• Completeness and quality of documentation.

• Differences between witnessed and unwitnessed falls.

• Variation by time of day.

Performance was compared against NICE QS86 (statements 4, 5, 6), Trust Falls Policy C86, and national audit benchmarks.

Medical reviews were not consistently completed, with approximately 40% of falls lacking documented medical assessments. Among documented reviews, median time toassessment was 8.7 hours, within the 12-hour standard but indicating avoidable delay, especially for unwitnessed falls and out-of-hours incidents. Documentation quality varied significantly, with omissions in neurological examination, pain assessment, medication review, and rationale for monitoring. Reviews conducted during evening/night shifts tended to be shorter and less comprehensive. Unwitnessed falls showed higher rates of missing neurological observations and inconsistent application of Trust guidance. Overall, substantial variation existed across wards.

The current post-fall medical assessment practice showed significant gaps in both timeliness and documentation quality, creating potential risks for undetected injuries. This highlighted the need for a more structured and standardised approach across older adult psychiatric wards.

Based on the findings of this QI project, a new, user-informed post--fall medical review template was developed to support clearer, more comprehensive documentation. Alongside this, a wider rewrite of the Trust’s Slips, Trips and Falls Policy (C86) is underway. This ongoing work aims to make the policy more detailed, practical, and clinically informative, ensuring staff have clearer guidance when managing both witnessed and unwitnessed falls.

Next steps include staff engagement, implementation of the revised tools, and a re-audit after three months to measure improvement in timeliness, consistency, and quality of post-fall medical care.

To identify effective treatment approaches for ARFID in children and young people with Autism and to highlight the importance of family-based and multidisciplinary interventions to improve nutritional intake, mealtime behaviours, improve quality of life for children and caregivers and reduce long-term clinical burden through early intervention.

Review of existing literature on ARFID and Autism Spectrum Disorder. Sources included Systematic review, Treatment protocols, Clinical trials and Peer review journals.

Evidence suggests there is high prevalence of ARFID in children with ASD. Parental acceptability and responsibility remains the core and significant area in the treatment journey.

Family based Treatment (FBT-ARFID) is very much effective and is the leading evidence-based manualised treatment for children that are of school-going age and adolescents. It helps the chosen family to re-establish healthy eating in their loved ones and also reduce the symptoms of the disorder–parents take lead in helping children recover with the help of multi-disciplinary approaches.

Family-based treatments and Unified protocol programmes (combination of FBT and CBT) to manage anxiety, food rigidity and sensory sensitivities, make mealtimes less stressful and help with an increase in the oral intake. Many studies have shown that children undergoing FBT have shown progressive gain in weight and also have reduced symptoms,giving parents and family hope in re-feeding their child.

Many school-going children and young adults can also have benefits from individual Cognitive behavioural therapy (CBT). CBT helps people change their thinking patterns and behaviours to cope with changes in mood and help them cope overall.

ARFID and ASD co-occur due to shared sensory, cognitive rigidity and behavioural traits.

Early, individualised treatment can prevent severe nutritional and medical complications. Family-based interventions including family-based therapy and CBT are key to successful outcomes.

Investing in a structured ARFID-Autism service represents a high-impact, cost-effective solution. Combination of Family basedtreatment, early screening, and multi-disciplinary approaches can offer improved clinical outcomes for children and families.

This case reports aim to describe the clinical presentation, diagnostic evaluation, and treatment response of an adolescent male with Kleine-Levin Syndrome, thereby increasing clinical awareness and contributing to the limited evidence on effective management strategies for this rare condition.

A 16-year-old adolescent male with a one-year history of recurrent episodes of hyperphagia, excessive sleepiness, hypersexuality, cognitive impairment, and behavioural disturbances was evaluated. Each episode lasted approximately one week and recurred every 2-3 months, with complete inter episodic recovery. Detailed clinical history and comprehensive physical, neurological, and psychiatric examinations were performed. Laboratory investigations, karyotyping, brain magnetic response imaging, and electroencephalography were conducted to exclude alternative neurological, metabolic, and psychiatric diagnoses. The diagnosis of Kleine-Levin syndrome was established based on clinical features and fulfilment of the International Classification of Sleep Disorders, Third Edition (ICSD-3) criteria. Pharmacological treatment with methylphenidate and carbamazepine was initiated, and the patient was followed up at two-month intervals to assess treatment response.

Baseline investigations, including laboratory tests, MRI, and EEG, were unremarkable. Following treatment initiation, the patient demonstrated significant clinical improvement. The duration of hypersomnia episodes decreased from approximately seven days to three to four days, and episode frequency reduced from every 2-3 months to every 4-5 months. The severity of associated hypersexual behaviour, cognitive disturbances, and irritability also diminished. Inter episodic functioning and overall quality of life improved, with no reported adverse effects from treatment.

This case highlights the importance of considering Kleine-Levin syndrome in adolescents presenting with recurrent episodic hypersomnia and behavioural changes. Early diagnosis and appropriate pharmacological intervention may reduce symptom severity and episode frequency. Further research is required to better understand the pathophysiology and establish standardized treatment guidelines for KLS.

Our patients are referred locally and out of area but it was noted relapse prevention plans were not documented in sufficient detail. We wanted to improve relapse prevention and post-discharge care. Our aims were to:-

• • Audit details of alcohol relapse prevention work started pre-admission and post-discharge plans

• • Assess if alcohol relapse prevention work was considered from a bio-psycho-social perspective.

Retrospective audit of electronic referral forms for patients admitted between 3rd November 2025-28th November 2025. We reviewed referrer details, preparatory work, relapse prevention plans, relapse prevention medication (RPM), psychological support, mental health and social situation.

22 patients were admitted between 3rd November 2025-28th November 2025. 19 (86.36%) were out of area and 3 (13.64%) were from the local service.

Information on preparatory work was not available in 16 of the 22 referrals (72.73%). There were written plans in 15 of the 22 referrals (68.18%). Of the 7 going to rehab, 2 did not have a written plan (28.57%).

RPM was mentioned in 18 of the 22 referrals (81.82%). 12 (54.55%) had requested acamprosate. 2 (9.09%) had requested disulfiram and 1 (4.55%) had requested naltrexone. Two or more options were considered in 2 referrals (9.09%) and 1 was undecided (4.55%).

13 of the 22 referrals (59.09%) mentioned psychological support. Relapse prevention plans included 1:1 sessions, group work, rehab and skills training. Groups included support groups, formal recovery groups, local groups and community groups. Skills included workshops, psychology and employment support. One was homeless and they had a housing plan (100%).

Mental health was mentioned in 19 of the 22 referrals (86.36%). Of the 19, 4 (21.05%) were known to a local mental health team (LMHT) and 1 (5.26%) mentioned plans to refer to LMHT. 13 (68.42%) did not mention plans to refer to LMHT and 1 (5.26%) had declined a referral. Information on mental health was not available in 2 of the 22 referrals (9.09%).

The majority of patients were out of area, which made it difficult to access clinical notes. Therefore, it is important preparatory work and a robust relapse prevention plan is provided.

RPM was well documented but more information was needed on mental health and pre-admission. Following this, we refined the form to capture more detail on preparatory work and to prompt consideration for any mental health support required.

Genetic factors are thought to play an important role in antipsychotic-induced weight gain (AIWG). Polygenic risk scores (PRS) could provide a measure of genetic predisposition to antipsychotic drug induced weight gain (AIWG). We conducted a study to examine how a PRS, generated using SNPs, identified from a recent meta-analysis, related to weight-change over time in people with first episode-psychosis (FEP).

The PRS included SNPs in six different genes, identified as having significant associations (p<0.05) with AIWG. These were HTR2C rs3813929; MTHFR rs1801133; ADRA2A rs1800544; MC4R rs489693; LEPR rs1137101 and CNR1 rs1049353. An additive PRS and a risk allele based weighted PRS were created based on risk allele counts and presence or absence of risk alleles respectively. The additive PRS was also used to create low/high genetic risk groups for analysis. The association between PRS and weight gain per day (WGPD) in grams/day as well as BMI percentage change (=>7%) was investigated using regression models.

In multiple regression analysis, the additive PRS significantly predicted AIWG in females (adjusted r²=0.59, B: unstandardised regression coefficient=24.4 grams/day p <0.05), but not in males. ANCOVA showed that high genetic risk groups had greater WGPD (p=0.018), with significant PRS gender interactions driven by markedly higher WGPD in high-risk females (p=0.039).

Follow-up comparisons indicated that in females, those with ≥7 risk alleles had substantially higher WGPD scores (adjusted Mean=138.8 grams/day, 95% CI [99.6, 178.1]) compared with those with ≤6 alleles (adjusted Mean=40.4 grams/day, 95% CI [−5.5, 86.2]). In males, WGPD scores were not significantly different across genetic risk categories.

We report a PRS that is predictive of weight gain in women treated for first episode psychosis, accounting for 59% of the variance daily weight-gain over time. Validation of the PRS in an independent cohort is required, as is determining whether it is feasible to apply the PRS prospectively in real world clinical settings to inform lifestyle measures and pharmacotherapeutic decisions in the treatment of FEP

‘et al’

Dr Adrian Phillipson, Sheffield Hallam University

Prof. Gavin P. Reynolds, Sheffield Hallam University

Prof. Caroline Dalton, Sheffield Hallam University

Type 1 diabetes mellitus (T1DM), an autoimmune disease resulting in insulin deficiency and hyperglycaemia, is associated with a considerable burden of psychiatric comorbidities, particularly mood, anxiety and eating disorders. As such, regular mental health screening for T1DM patients has been recommended to allow earlier intervention. This audit aimed to investigate whether T1DM patients in our trust (County Durham and Darlington Foundation Trust, CDDFT) had received psychological screening at time of diagnosis and within the past year.

A questionnaire consisting of six clinician-designed self-report items assessing patient recall of mental health screening at diagnosis and within the past year was distributed at regular T1DM clinic appointments at University Hospital of North Durham and Chester-Le-Street Community Hospital by clinicians involved in T1DM care. All patients with T1DM under regular follow-up within these centres were eligible; there were no defined exclusion criteria regarding age or other demographic factors.

A total of 23 responses were received, of which four were excluded due to inconsistencies. Of the 19 included responses, 32% (n=6) stated that they had received mental health screening at diagnosis. When analysed further by age, it was found that none of the seven individuals diagnosed before the age of 18 had received screening at diagnosis. Overall, only 26% (n=5) of respondents indicated that they had received mental health screening as part of their T1DM care within the past year. Interestingly, only 21% (n=4) of respondents stated that they would appreciate more frequent mental health screening, while 32% (n=6) did not answer this question, with one individual responding “Only if it meant extra support”.

Given the high impact of a T1DM diagnosis on psychological wellbeing, and the strong link to various psychiatric conditions, the reported low levels of mental health screening are concerning. At present, mental health screening in T1DM care at CDDFT is clinician-dependent with no standardised process. It is interesting to consider whether factors such as a lack of awareness, time pressure within appointments, or a perceived ‘helplessness’ on the part of the clinician in terms of organising appropriate mental health follow-up, are resulting in the low rates of screening identified, although limitations including risk of recall bias and small sample size are important to take into account. Going forward, we aim to present this data to clinicians involved with T1DM care within the trust and recommend starting all consultations with a short, validated screening tool such as the Diabetes Distress Scale.

Stable housing is a key determinant of mental health outcomes. Discharge from acute psychiatric inpatient services into temporary accommodation may reflect system pressures and can threaten recovery, continuity of care, and social stability. Despite this, limited data is available on discharge to temporary accommodation among psychiatric inpatients.

This service evaluation aims to describe patterns of discharge to temporary accommodation from acute adult inpatient psychiatric wards within one NHS Trust during the 2023–2024 financial year. We identified the types of temporary accommodation used, associated psychiatric diagnoses, and patient demographics.

All patients discharged from acute adult inpatient wards to temporary accommodation between April 2023 and March 2024 were identified. We reviewed electronic patient records to identify primary diagnosis, discharge destination, and patient demographics. Temporary accommodation was grouped into categories including bed and breakfast (B&B) or hotel, supported living, care homes, and other temporary housing. Descriptive analysis examined distributions across accommodation type, diagnosis, and demographics.

During the 2023–2024 financial year, 146 patients were discharged from acute adult inpatient mental health wards to temporary accommodation. Psychotic disorders were the most common diagnosis (n=77), followed by personality disorders (n=38) and non-psychotic affective disorders (n=16). The remaining patients had diagnoses including dementia, anorexia nervosa, substance use disorders, or no recorded mental disorder.

Over half were discharged to B&B or hotel placements (n=77). Other discharge destinations included family or friends (n=27), interim housing (n=14), supported living (n=9), care homes (n=8), or no fixed abode (n=5). A small number were discharged to other temporary arrangements.

Patients with psychotic disorders formed ~50% those discharged to B&B or hotel accommodation (n=38), followed by patients with personality disorders (n=27). Of those discharged with no fixed abode, 3 had a diagnosis of personality disorder, 1 had a psychotic disorder, and 1 had a substance use disorder.

Over half of patients discharged to temporary accommodation were placed in B&B or hotel settings, with psychotic disorders comprising ~50% of these patients. This highlights a notable amount of patients with severe mental illness being discharged to temporary, non-therapeutic accommodation. Patient discharge is a complex interplay of system pressures, clinical presentation and social support, yet stable housing is vital in holistic, patient-centred care. These results identify a need for further review of discharge pathways and raises the importance of the biopsychosocial model in understanding the relationship between mental health and social context.

This quality improvement project aimed to assess and improve NR legal understanding, confidence, and perceived emotional support within Springs Services. The primary objective was to increase the proportion of NRs who felt adequately informed about their role under the MHA to at least 80%.

Nearest Relatives (NRs) have a statutory safeguarding role under the Mental Health Act (MHA) 1983; however, existing evidence indicates that many feel inadequately informed about their legal rights and responsibilities. Prior research describes inconsistent explanations and assumptions of prior knowledge, contributing to uncertainty and distress during compulsory admissions. These challenges may be particularly pronounced in autism-informed inpatient services, where families are often navigating complex clinical and legal processes simultaneously.

A structured baseline survey was distributed to NRs of patients admitted to Springs Services. The questionnaire included Likert-scale items assessing understanding of the NR role, clarity of MHA explanations, involvement in care and discharge planning, confidence in raising concerns, and emotional support, alongside yes/no questions and free-text comments. Twenty completed responses were analysed descriptively. Qualitative feedback was reviewed thematically to identify priority areas for improvement. Informed by baseline findings, service-level interventions were introduced, including an autism-informed NR information leaflet, a standardised admission explanation script, a brief NR support check-in, and focused staff guidance on trauma and autism informed communication.

Baseline data demonstrated variable NR experiences. While approximately 60% of respondents agreed or strongly agreed that they understood their role as an NR, fewer (around 45%) reported confidence in their legal rights or a clear understanding of the distinction between Nearest Relative and Next of Kin. Only around 50% recalled receiving written information about their role at the point of admission. Communication from the ward was rated positively by approximately two-thirds of respondents; however, lower scores were reported for emotional support (around 40%) and involvement in discharge planning(approximately 35%). Confidence in speaking up or asking questions was reported by just over half of respondents. Free-text comments highlighted confusion about legal processes, uncertainty about who to contact for advice, and a desire for earlier, clearer explanations delivered in accessible language.

This project identified measurable gaps in NR legal literacy, confidence, and emotional support within an autism-informed inpatient service. Baseline findings support the need for structured, accessible information and proactive engagement with NRs to strengthen safeguards under the MHA. Ongoing data collection will evaluate whether these targeted interventions increase the proportion of NRs who feel adequately informed and supported, with the aim of embedding sustainable improvements in statutory practice and family involvement.

Adult ADHD remains largely defined by behavioural criteria developed for childhood presentations. In adult psychiatric practice, however, many individuals present with burnout, anxiety, or emotional exhaustion rather than overt attentional complaints. These patients often describe functioning well in some contexts but struggling disproportionately with routine, low-urgency, or poorly defined tasks. This work aims to explore whether adult ADHD is better conceptualised as a disorder of salience and arousal regulation rather than a simple deficit of attention or impulse control, and whether such a formulation better accounts for late diagnosis and masked presentations.

This work draws on repeated clinical observations from general adult psychiatricpractice, including experience in adult ADHD assessment services, synthesised into anonymised composite vignettes to identify recurring patterns of cognition, behaviour, and emotional experience. These observations were considered alongside established executive, motivational, and salience-based models of ADHD, and contemporary neurobiological accounts of dopamine and noradrenaline modulation, sensory gating, and time perception, to develop a clinically coherent formulation. An exploratory evolutionary perspective was used cautiously to illustrate environmental mismatch rather than ancestral advantage.

Consistent features extended beyond standard diagnostic criteria and included reliance on urgency or interest to initiate tasks, development of highly personalised systems of working, rapid associative thinking alongside episodes of task paralysis, conversational working-memory bottlenecks, and difficulties maintaining awareness of objects or people once out of view. Many individuals also described strong internal value systems and high personal standards, with particular sensitivity to inefficiency or perceived unfairness. Hyperfocus and distractibility could be understood within a single salience-arousal framework rather than as opposing phenomena. Functional decline commonly occurred at points of developmental or occupational transition and following additional stressors, consistent with cumulative compensatory fatigue rather than late onset.

Conceptualising adult ADHD as a regulation phenotype provides a clinically useful account of context-dependent functioning, burnout, and late diagnosis. This framework supports improved recognition of masked ADHD across adult services and encourages formulations that integrate pharmacological treatment with psychoeducation and environmental adaptation. Moving beyond checklist-driven assessment towards pattern-based clinical understanding may reduce secondary morbidity and improve long-term functional outcomes in adults with ADHD.

We wanted to develop a dedicated pathway to support people through their rehab journey from the start of their inpatient admission until 18 months post discharge. The overarching aim of this pathway is to improve the service user journey whilst saving the trust money at the same time.

A thorough service evaluation across the five boroughs within North London Foundation Trust (NLFT) in order to map out the current processes in place and discrepancies between services.

Literature review of current practices in rehabilitation psychiatry across the country, cross referenced with NICE guidelines to establish the best evidence-based pathway.

Most importantly qualitative research from interviews with service users, carers and staff in order to develop a co-produced pathway that is driven by the needs of those we are trying to support.

The above methods were used to co-produce a pilot rehabilitation pathway in Haringey which began in May 2024.

Our pilot project has reduced the number of rehab bed days by 2695 (projected for end of May 2026), which is a reduced Integrated Care Board (ICB) spend of £1540,000 (based on average cost of rehab bed of £4000/week).

Our re-admission shows 302 days saved at a cost saving of £172,571.

Our qualitative data shows service users under the pathway are able to live more independently, are engaging with our Occupational Therapy (OT) and psychology groups, have reductions in their package of care needs and as a result of the reduction in out of area beds we are able to deliver our care, closer to home.

The Haringey Rehabilitation Pathway is an excellent example of a co-produced pathway that addresses the needs identified from a robust service evaluation.

The outcomes of the pilot pathway show considerable financial savings to the trust and ICB. There has been a dramatic reduction in the number of rehabilitation bed days, out of area placements and readmission rates and our service users feedback is proof that this pathway is supportive and enables independence by focussing on relationship building and development of life skills.

Future developments include rolling out our pathway across the whole trust.

Data on survival rates of patients with dementia is sparse in Asian populations. Thus the aim of this study is to determine rates of survival of patients with dementia in Sri Lanka.

A descriptive cross-sectional analysis of data was done using the data of patients who have registered at the National Institute of Mental Health Sri Lanka, Older Persons Mental Health Clinic (largest governmental psychogeriatric service provider in Sri Lanka) from 2021 to 2023.

Total registries were 366. Prevalence of Alzheimer’s, vascular and mixed aetiology were 149 (40.41%), 83 (22.67%), 112 (30.6%) respectively. 203 (55.46%) had defaulted up to 2025. Out of 163 under regular follow up 17 (10.43%) had passed away. Mean years of survival with the disease was 3.7 years. Cause of death was dementia and related complications in 13 (76.47%) and vascular events in the rest. Mean age of death had been 77 years and male to female ratio was 0.7. Out of the defaulted 74 (36.45%) had beencontactable. Out of them 57 (77.03%) had passed away. Mean years of survival had been 2.01 years. Cause of death was dementia and related complications in 39 (68.42%) and vascular events in the rest. In the 146 surviving patients under regular follow up mean age was 73. Male to female ratio was 0.55. Mean years of life they had been living with dementia was 4.03 up to 2025. Among 17 surviving contactable patients who had defaulted it was 3.18 years. Odds of death in patients under regular clinic follow up compared with defaulted was 0.035 (Fisher’s exact p-value 2.5´ 10−24)

Regular clinic follow up is associated with a statistically significant lower rate of death compared to defaulters among patients with dementia.