A number of subtypes of obsessive-compulsive disorder (OCD) have been described, one of which is religious OCD (ROCD), also referred to as Scrupulosity Disorder. Whilst there is an expanding literature which investigates the link between OCD and religion, there is very little research which examines the impact of clergy attitudes and intervention upon a sufferer of ROCD. The study aims to begin the task of developing an understanding of how those in Christian pastoral ministry in the UK typically view ROCD, how they are likely to deal with it in someone for whom they have pastoral care, and whether such interventionsare compatible with current models of clinical care.

The study involved conducting in-depth interviews with six respondents working professionally in pastoral ministry. The respondents were interviewed using a questionnaire comprising a series of open questions. The initial phase of the interview was designed toencourage discussion as to how a respondent might react to someone with typical ROCD symptoms, having had such explained to them. The nature of ROCD as a psychiatric diagnosis was then explained, including some cognitive theory and a description of typical treatment. The remainder of the interview concerned itself with exploring respondents’ views on these matters.

There was general consistency of thought between correspondents; all were willing to give credence to a psychopathological attribution of ROCD and the implication that a psychological approach is useful in its management. All were clear that an empathetic and sensitive approach is necessary and that a response which conveys a sense of judgement is to be avoided. Recommendations were generated which would broadly be viewed as psycho education from a clinical standpoint: reflection on the nature of God; an explanation that obsessions do not confer culpability nor are they indicative of an underlying spiritual or moral deficit; an exploration of the dissonance created by the sufferer’s unsuccessful attempts to resist compulsive behaviour.

The principal source of conflict between pastoral care and treatment occurs when a minister seeks to offer reassurance to combat the doubts and anxieties of a sufferer. Conversely, respondents’ recommendations are clearly well suited to pastoral intervention, being of a theological nature. It is here, with the ‘theological examination’ of a sufferer’s negative appraisal of obsessions, that the minister might best use the authority invested in him/her, rather than by the giving of permission to follow the edicts of the therapist.

In long-stay dementia psychiatry settings, multidisciplinary team (MDT) documentation frequently accumulates extensive historical detail, which can obscure current clinical priorities, hinder longitudinal tracking of progress, and reduce clarity around accountability for care planning. Improving the structure and accessibility of MDT records is therefore essential for maintaining continuity of care in complex, chronic inpatient populations. This Quality Improvement Project (QIP) aimed to enhance the clarity, structure, and continuity of weekly MDT documentation in a long-stay old age psychiatry unit. Specific objectives were to ensure clear differentiation of current and resolved issues with explicit progress tracking, consistent use of closed-loop communication with named responsibility and timeframes, and improved accessibility of MDT plans to support ward handover.

Baseline analysis assessed the presence of core clinical information, identification of current issues, progress tracking, and action accountability within MDT documentation. Astructured MDT template was co-designed with the multidisciplinary team to prioritise current issues, document progress using a standardised framework (better/same/worse), and assign actions to named individuals or teams with review dates. Weekly MDT summary sheets were produced and made available in the nurses’ office to support continuity during daily handovers. Interventions were implemented iteratively using Plan–Do–Study–Act cycles, with re-audit following each cycle.

At baseline, MDT documentation was highly inconsistent, with key clinical elements recorded in only 0–15% of cases. Following introduction of the structured template, completion of core documentation fields increased to 84–100% after the first cycle and reached 100% across all measured domains by the second cycle. Accountability measures improved markedly, with documentation of responsible teams increasing from 1.67% at baseline to 100%, and inclusion of review dates rising from 0% to 100%. The introduction of closed-loop communication and weekly MDT summaries improved the clarity of MDT plans and facilitated information transfer to ward staff, evidenced by unprompted use of summaries by nursing staff during handovers.

This QIP demonstrates that a simple, structured approach to MDT documentation can produce substantial and sustained improvements in clarity, accountability, and continuity of care within a long-stay dementia psychiatry unit. The interventions were low-cost, acceptable to staff, and readily integrated into routine practice. These findings support the wider applicability of structured MDT documentation to improve care coordination in long-term psychiatric inpatient settings, although further work is required to assess sustainability and patient-centred outcomes.

Individuals with first-episode psychosis (FEP) have a high prevalence of obesity and cardiometabolic abnormalities, compounded by antipsychotic-related metabolic side effects and unhealthy lifestyle behaviours, including tobacco smoking, physical inactivity, poor dietary habits, and substance use, resulting in an elevated risk of premature mortality. Black and minority ethnic populations exhibit elevated cardiometabolic risk, with ethnicity influencing the onset, progression, and outcomes of cardiometabolic disease. To mitigate these risks, the National Clinical Audit of Psychosis (NCAP) – Early Intervention in Psychosis standards require routine monitoring of body mass index (BMI) and intervention when thresholds are exceeded: BMI ≥25 kg/m² for the general population, compared with the lower threshold of BMI ≥23 kg/m² for South Asian and Chinese populations.

This audit aimed to establish a baseline understanding of BMI distribution within the Northamptonshire Early Psychosis Service (NSTEP), with a focus on ethnic groups at increased cardiometabolic risk, to inform future quality improvement initiatives.

A retrospective audit was conducted on cross-sectional caseload data from NSTEP North and South as of 11th March 2025. BMI and ethnicity were recorded, with BMI categorized as <20 kg/m², 20–24.9 kg/m², 25–29.9 kg/m² (overweight), and ≥30 kg/m² (obese); for South Asian and Chinese patients, BMI ≥23 kg/m² was also noted. Antipsychotic prescribing patterns from a previous quality improvement project (September 2024) were included to contextualize metabolic risk.

Of 187 patients, 182 (97%) had BMI recorded; BMI was <20 kg/m² in 6%, 20–24.9 kg/m² in 28%, 25–29.9 kg/m² in 34%, and ≥30 kg/m² in 29%, with approximately two-thirds of the total caseload (64%) falling in the overweight or obese range, and a higher prevalence in NSTEP North than South (68% vs. 63%). Among South Asian/Asian patients, 68% (13/19) had BMI ≥23 kg/m² while Black Caribbean/African patients showed 68% (23/34) prevalence of overweight or obesity. Approximately half of patients across both services were either not prescribed antipsychotic medication or were treated with Aripiprazole, a relatively weight-neutral antipsychotic.

This audit demonstrates that two-thirds of NSTEP patients are overweight or obese, with particularly high prevalence among South Asian/Asian and Black Caribbean/African populations, despite weight-neutral antipsychotic prescribing. These findings highlight the need for targeted, culturally informed lifestyle and weight management interventions. The plan is to introduce resource packs containing diet and exercise guidance, promote local NHS exercise and weight management programmes, encourage NSTEPactivity groups to incorporate exercise, and collaborate with the NHS Diabetes Prevention Programme to improve patient access.

To understand the frequency, nature and location of medical emergencies at the Royal Edinburgh Hospital, (REH) a stand-alone psychiatric institute, between May 2018 and January 2025.

Resident doctors at the Royal Edinburgh Hospital are part of a small crash team responding to medical emergencies across the Royal Edinburgh Hospital, a stand-alone psychiatric facility in Edinburgh with 29 wards and approximately 570 beds. Inpatient units included acute adult wards, an intensive psychiatric care unit, rehabilitation and psychiatry of old agewards. Additionally, there are specialist day services for young patients, a medium secure forensic unit, residential unit for learning disability patients and an acquired brain injury unit.

As a non-acute site, access to emergency medications and resources is limited. Additionally the site is large, complex and difficult to navigate. Knowing what medical emergencies occur and where could help resident doctors prepare for their on-calls and improve the patient outcomes.

2222 medical emergency calls made between May 2018 and January 2025 were reviewed by checking yellow forms completed after a medical emergency and collecting information from switchboard.

The frequency of medical emergencies increased between May 2018 and January 2025 with an average of 5–6 calls per month by January 2025.

The most common 2222 call sites were the acute adult wards, followed by psychiatry of old age wards and the rehabilitation wards.

The most common cause of an emergency was seizure (20.9%), followed by choking (11.8%), ligature (10.6%), overdose (6.9%) and unresponsive episodes (6.5%).

Little published research appears to exist on medical emergencies at stand-alone psychiatric hospitals.

These findings have been shared locally and resulted in multiple interventions, for example the creation of a new seizure protocol which better reflects the skills and background of the responding team, a new trainee site map, amended simulation training which is tailored to staff working in different areas, new trainee induction talk and 2222 focused site tour for rotating doctors.

New resident doctors have reported increased confidence in approaching their on-calls and attending medical emergencies as a result of these interventions.

Child and Adolescent Mental Health Services (CAMHS) face unprecedented demand, with many referrals rejected due to incomplete clinical information. Standardized digital tools like the Development and Well-Being Assessment (DAWBA), that generate algorithm-based probable diagnoses from multi-informant symptom reports, could improve referral outcomes. However, thereal-world impact of these tools on referral outcomes remains underexplored. In this context, the current study aimed to examine whether diagnostic probabilities generated by the DAWBA predict referral acceptance in CAMHS. It also explored how the information available to triage team, including referral source, influences referral outcomes.

We conducted a secondary analysis of anonymised data extracted from a randomized controlled trial conducted across eight NHS Trusts in England. The sample included 483 participants aged 5–17 years with documented DAWBA diagnostic probabilities and referral outcomes. Sociodemographic characteristics and clinical variables were also examined.

Overall, 54.5% (n=263) of referrals were rejected. There were no significant differences in referral acceptance by sex, ethnicity, deprivation, or referral source. Referral acceptance was associated with older age, higher Strength and Deficit Questionnaire (SDQ)parent-rated impact scores, history of previous CAMHS referral, and study recruitment site. Binomial logistic regression showed higher parent impact scores (OR=1.1, 95% CI: 1.01, 1.21) and previous CAMHS referral (OR=2.3, 95% CI: 1.38, 3.69) increased odds of referral acceptance. Referral acceptance also varied with recruitment site. However, a high to very high probability of DAWBA generated diagnoses did not increase chances of referral acceptance with 54% emotional disorders, 78.6% behavioural disorders, or 52.9% comorbid emotional and behavioural disorders being rejected.

This study highlights key gaps in the current CAMHS referral process. While previous CAMHS referral and parent-rated SDQ impact scores were associated with referral acceptance, DAWBA diagnostic probabilities were not. This suggests that children with clinically significant difficulties, identified via standardised assessment, may still face barriers in accessing care. Significant site-level variation in referral acceptance underscores the need for more equitable referral processes.

Early Intervention in Psychosis (EIP) services play an important role in improving outcomes after a first-episode psychosis. Some UK EIP services include adults aged ≥36. Given the cardiometabolic risks associated with antipsychotic treatment and a higher prevalence of hypertension in this cohort, physical health monitoring including blood pressure (BP) is essential. This audit aimed to assess adherence to national NICE guidelines (NICE NG136, CG185, CG178) and establish a baseline understanding of the detection and management of elevated BP in patients ≥36 in the Northamptonshire EIP service.

Retrospective case note review of all EIP caseload patients aged ≥36 on 27th of February 2025. Records from 28th February 2024-27th of February 2025 were evaluated. Data collected included ethnicity, completion of an annual physical health check (PHC), including BP; presence of elevated BP (≥140/90 mmHg), documented actions by EIP following elevated readings, known hypertension diagnosis, antihypertensive treatment, and antipsychotic prescribing.

The total EIP caseload: 185; 58 patients aged ≥36 (31.3%; 34 female and 24 male).PHC completed within the past year 45/58 (77.5%); 13/58 did not have a recorded PHC due to missed appointments, recent referrals, close timing exclusion, having an inpatient PHC, or missing BP documentation. Among the 45 who underwent PHC, 17 (37.7%) showed elevated BP (≥140/90 mmHg). Actions taken by EIP were documented for 3 of these 17 cases (17.6%). These included GP referral, repeat BP arrangement, or advised home monitoring. Of the 17 identified, five had a pre-existing diagnosis of hypertension, and four were prescribed antihypertensive medication. Fifteen of the 17 identified with elevated BP were prescribed antipsychotics: aripiprazole (n=8), quetiapine (n=4), and olanzapine (n=3).

Annual PHC completion for adults aged ≥36 in EIP was moderately high (77.5%), but a relevant cohort (37.7%) had elevated BP reading and clinical follow-up was limited (17.6%) and varying actions. The audit results indicate a gap between detection and management of hypertension within EIP care. Recommendations included dissemination of results and stakeholder engagement. In collaboration with primary care colleagues, we have developed - and are now implementing - a concise hypertension pathway/visual guide for identifying and managing elevated BP. The guide specifies clear BP thresholds, referral routes, and documentation standards to ensure reduction in delay to reduce delays in diagnosis and treatment of hypertension.

Background: Female acute inpatient wards manage dynamic clinical risk, including self-harm, violence and security-related incidents. Beyond incident reduction, developing a culture of care, learning and multidisciplinary ownership is essential to achieving sustainable improvements in safety and patient experience.

Aim: To review incident trends over a 12-month period on a female acute ward (Hooper) at Cygnet Beckton and to describe MDT practices, learning processes and cultural factors associated with improvement and sustained low incident levels.

A retrospective descriptive review of Datix-reported incidents was undertaken for January–December 2025. Incidents were analysed monthly across violence and aggression, self-harm, security incidents (including AWOL and attempted AWOL), medication-related incidents, and injury or accident events. MDT practices, learning approaches and service developments were identified through ward-level reflection and review.

A total of 613 incidents were recorded (monthly range 22–98).

Violence and aggression incidents totalled 182, including 85 episodes of actual physical violence, with a clear reduction across the year from 23 incidents in January to 1 incident in December.

Self-harm incidents totalled 258, primarily head banging (141) and cutting (27). Monthly self-harm peaked in May (48 incidents) and reduced to 18 incidents in December.

Security incidents remained comparatively low (47 total), including attempted AWOL/abscond (8) and AWOL (2). Medication-related incidents totalled 19, while injury and accident-related incidents totalled 47.

MDT good practice and learning culture:

Quality improvement approach and MDT practice:

As part of the national accreditation-aligned QI programme, Culture of Care, Hooper ward embedded a structured culture of learning and improvement, rather than isolated incident response. MDT-led After Action Reviews were routinely undertaken following incidents, enabling systematic analysis of contributory factors, identification of improvement actions, and dissemination of lessons learned across the team.

QI interventions included care-plan-based ward rounds, shared decision-making regarding medication, patient involvement in MDT discussions (including chairing ward rounds where appropriate, chairing community meetings), co-produced safety and risk formulations, and strengthened MDT communication and escalation pathways. Learning from AARs directly informed changes to observation, engagement and care planning.

The nationally aligned QI programme, culture of care was associated with sustained reductions in violence and self-harm on a female acute ward. Structured MDT learning, accreditation-driven standards and routine After Action Reviews supported safer, more consistent and person-centred care.

Virtual RAMPPS - An Online Simulated Teaching Method of the RAMPPS Model

We delivered two separate half day courses, each including three scenarios to groups of Foundation Trainees, GP Trainees, Core Trainees and Trust Grade Doctors.Sessions were delivered on MS Teams and participants could answer next steps in their assessment/management anonymously using Slido.

Physical health emergencies covered included: Ligature Strangulation

Clozapine Induced Bowel Obstruction

Wernicke’s Encephalopathy

Neuroleptic Malignant Syndrome

Opioid Overdose

Venous Thrombo-Embolism

There was opportunity for debrief and discussion at the end of each clinical scenario, where personal and systemic factors affecting management of the cases were addressed along with questions from participants.

The study results were derived from qualitative feedback obtained from participants, which was analyzed to identify distinct themes regarding the simulation training. The findings were categorized into two primary domains: Personal Factors and Systemic Factors.

Under Personal Factors, the analysis highlighted the importance of early recognition, familiarity with guidelines, and case-specific confidence, which directly influenced the management of specific clinical scenarios such as cardiac problems, hypo- and hyperglycaemia, wound management, and overdoses.

Systemic Factors focused on operational elements, including resources, staffing, team knowledge, and the availability of senior psychiatric colleagues and nursing teams.

The results also mapped the complex logistical challenges faced by staff, such as the practicalities of transferring patients to acute hospitals, remote management, access to patient background information, and the specific limitations of medical provisions available on-site.

Positive feedback demonstrates Virtual RAMPPS is a valuable learning tool, helps with personal factors like knowledge and skills, but also develops participants ability to deal with systemic factors. We intend to expand the course to include additional cases. Consideration will be made into expanding the audience to include physical healthcare practitioners and wider MDT.

To evaluate the quality of suicide risk assessment documentation in outpatient consultations against NICE NG225 and Local Trust standards, and to assess whether a focused feedback intervention improved documentation quality.

A retrospective baseline audit reviewed the first 50 consecutive outpatient consultations from 1 December 2025. Findings were summarised and fed back to clinicians. A re-audit examined 50 subsequent consultations from 23 January using the same structured assessment criteria. Core criteria included documentation of suicidal ideation, plan, intent,access to means, history of self-harm, risk formulation, and safety planning. Additional criteria assessed shared decision-making and communication with the General Practitioner.

Substantial improvement followed the feedback intervention. Documentation of consent and confidentiality increased markedly (from 4% to 76%), reflecting greater attention to patient involvement and transparency. Recording of history of self-harm, a key predictor of future risk, improved significantly (from 28% to 76%). Protective factors, often under-recorded locally, increased from 52% to 78%, strengthening overall risk formulation. General risk formulation itself showed a notable improvement (62% to 82%), showing a clearer integration of dynamic and historical factors.

Among patients expressing suicidal ideation (baseline 28%, re-audit 50%), documentation of suicidal plan and intent improved from 0% at baseline to 84% post-intervention–representing one of the most clinically meaningful changes observed. Despite improvement in several domains, access-to-means exploration remained low (6% to 14%), identifying an important area requiring further attention. Documentation of shared decision-making showed some decline (98% to 84%), suggesting that emphasis on risk-specific domains may have inadvertently reduced focus on collaborative discussions.

Targeted feedback led to clear and meaningful improvements in several domains central to high quality suicide risk assessment, particularly self-harm history, protective factors, overall risk formulation, and documentation of plan and intent among patients with suicidal ideation. Persistent gaps in assessing access to means highlight a priority area for additional intervention. Future work would focus on embedding structured reminders within clinical templates, reinforcing collaborative practice, and conducting further re-audits to sustain improvement.

To describe the clinical complexity of an adolescent presenting with severe restrictive eating, emotional dysregulation, and high-risk behaviours where the diagnosis of Anorexia Nervosa (AN) remained uncertain within Child and Adolescent Mental Health Services (CAMHS). Additional objectives include examining how social adversity and fluctuating engagement shaped the evolving formulation and management needs.

A retrospective review of clinical notes, inpatient episodes, Mental Health Act assessments, and multidisciplinary documentation was undertaken. Key events were organised chronologically, including physical health parameters, episodes of self-harm, social context, and engagement with services.

An adolescent known to services for a few years, demonstrated early self-harm, restrictive eating, purging, and excessive exercise. Over the years, the young person (YP) experienced multiple overdoses, admissions under the Mental Health Act, nasogastric feeding, and medical instability related to low food intake.

Although YP exhibited low weight, calorie restriction, and distress related to body image, co-existing mood instability and relational stress made the diagnosis of Anorexia Nervosa uncertain throughout CAMHS involvement. Interventions included selective serotonin reuptake inhibitors, antipsychotics, crisis work, therapy and multi-agency safeguarding involvement.

Periods of stabilisation alternated with relapse and disengagement. YP was transitioned to the adult services when 18.

This case highlights the need for flexible, formulation driven care where restrictive eating coexists with high risk behaviours. Diagnostic ambiguity should not delay intervention, instead, consistent relational work, coordinated safeguarding, and careful transition planning are essential to support recovery.

Postpartum depression (PPD) affects 10–25% of women worldwide, contributing to maternal morbidity, infant developmental issues, and elevated suicide risk. While PPD is widely recognised as multidimensional within the biopsychosocial model, comprehensive syntheses that integrate biological, psychological, and social determinants are limited. This umbrella review aims to identify and classify the strength and certainty of biological, psychological and social risk factors associated with PPD.

This PRISMA-compliant umbrella review was prospectively registered on PROSPERO (CRD420251241065). Medline, Embase, PsycINFO, Scopus were searched from inception to November 2025. Systematic reviews and meta-analyses examining risk factors for PPD were included. Two independent reviewers screened titles/abstracts and full texts, with a third resolving discrepancies. Methodological quality was assessed using AMSTAR-2. Credibility was evaluated via umbrella review criteria (URC: Class I [convincing] to IV [weak]), and certainty using GRADE (high to very low).

Seventy-seven systematic reviews with meta-analyses, comprising 1658 studies and 25,737,929 women were included. Studies varied in quality and certainty. Biological factors associated with increased PPD risk included gestational diabetes mellitus (pooled OR/RR 1.3–2.7), caesarean section (OR 1.26–1.48), preterm birth/low birth weight (OR 1.79–1.97), perinatal pain (OR 1.29–1.75), and sleep disorders (OR 2.36–3.69). Psychological factors included antenatal depression (OR 4.58–7.70) and anxiety (OR 2.64–7.07), history of depression (OR 3.09–4.82), adverse childhood experiences (OR 2.31), and prenatal stress (PR 1.82). Social factors included intimate partner violence (OR 2.5–4.4), unintended pregnancy (OR 1.53–3.46), lack of social/family support (OR 2.57–5.96), and poor marital relationship (OR 3.47–3.56).

Across biopsychosocial domains, obstetric complications (biological), antenatal mental health (psychological), and intimate partner violence (social) emerge as potential risks. High heterogeneity reflects variability in PPD definitions, timing, measurement tools and populations. Reliance on observational data precludes causality. Future research should focus on identifying and clarifying these risk factors to target screening and early intervention for at-risk mothers in varied contexts. Clinically, these findings support multidisciplinary interventions to mitigate PPD burden and improve maternal-infant outcomes.

Our aim was to evaluate the psychiatric service provided by NHS Lothian, specifically the Royal Edinburgh Hospital (REH), which provides inpatient care for patients in Edinburgh, East Lothian and Midlothian.

Data was collected from NHS Lothian analytical services, the Director of Public Health Annual Report 2024, NHS Benchmarking Network findings (2022/23), the Scottish Government Mental Health Inpatient Census 2024, the National Records of Scotland and the World Health Organisation (WHO). Data was anonymised in line with NHS Information Governance Policy.

We evaluated the service provided for working age adults (18-64 years old) in REH using key performance indicators (KPIs) including bed occupancy, re-admission rates, length of stay (LOS) and staffing. Results were compared with other health boards in Scotland.

The relevant population is approximately 480000 people. Since 2001, East Lothian, Midlothian and Edinburgh are the fastest growing populations in Scotland (27.7%, 23.4% and 18.2%).

In 2014, European Union members had on average 77 beds per 100000 population. The United Kingdom had 46 beds per 100000 population. In 2015, the REH was rebuilt with a 20% reduction in capacity, with 105 acute adult beds. This equates to 22 beds per 100000 population (Scotland mean=28/100000).

The Royal College of Psychiatrists recommends a maximum safe bed occupancy of 85%. Mean bed occupancy for acute adult beds in REH has increased from 96.2% in 2021 to 109.5% in 2025. This was last under 100% in March 2022.

Over the same timescale, mean LOS has increased (19 days to 27 days) and mean admissions per month have fallen (154 to 131).

11% of patients required re-admission within 30 days of discharge (Scotland mean=8%). Lothian had the highest percentage of compulsory admissions at 33% (Scotland mean=19%).

Turnover of hospital staff was 18% (Scotland mean=15%). Community teams had 33 staff per 100000 population (Scotland mean=76/100000) with 20% vacancies (Scotland mean=17%).

There has been a failure across all KPIs. Re-admissions, compulsory admissions and staffing are all worse than the Scottish average and bed occupancy has not been below 100% for 4 years.

Population growth puts pressure on all services, but NHS Lothian has failed to adjust for this to provide safe and effective inpatient care. Low community staffing only exacerbates the problem.

These findings indicate the need for review of managerial and funding decisions for psychiatric services in NHS Lothian to optimise patient care.

Patients with neurological disorders frequently present with co-occurring psychiatric symptoms, often requiring assessment within specialist neuropsychiatric services. This study aimed to describe the spectrum of psychiatric presentations seen in a specialist neuropsychiatry outpatient population and evaluate the prevalence and severity of anxiety and depressive symptoms among patients attending a tertiary neuropsychiatry clinic.

A descriptive cross-sectional study was conducted in a tertiary regional neuropsychiatry outpatient clinic in London. Consecutive patients attending the service were invited to participate. Participants completed a standardised questionnaire collecting demographic data and standardised measures of mood and anxiety were administered using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7). Of those invited, 79 participants were included in the final analysis.

High levels of psychiatric comorbidity were observed across the neuropsychiatric cohort, with substantial variability between diagnostic groups. Patients diagnosed with functional neurological disorder (FND) demonstrated the greatest affective symptom burden: 92% reported at least mild depressive symptoms and 83% met criteria for clinically significant anxiety. Other neuropsychiatric subgroups similarly exhibited notable levels of anxiety and depression although to a lesser extent than the FND group.

This study demonstrates a substantial and heterogeneous psychiatric symptom burden among patients attending a specialist neuropsychiatry outpatient service. The particularly high prevalence of affective symptoms in individuals with FND highlights the need for comprehensive, integrated, and multidisciplinary approaches to assessment and treatment. Improved recognition and management of psychiatric comorbidities may have important implications for clinical outcomes, patient experience, and long-term prognosis within neuropsychiatric populations.

Zopiclone is licensed for the short-term management of insomnia, with recommended treatment durations of 2–5 days for transient insomnia, 2–3 weeks for short-term insomnia, and not exceeding four weeks including tapering, in line with NICE TA77 guidance. Elm Ward’s initial audit (Oct–Dec 2023) identified widespread prescribing beyond these limits. This re-audit provides updated patient-level data to assess progress following practice changes introduced after the initial audit.

The re-audit aimed to:

1. Evaluate current zopiclone prescribing patterns.

2. Compare durations of use with the 2023 audit.

3. Assess compliance with recommended maximum treatment duration.

4. Identify remaining gaps in documentation and review processes.

The first audit included 48 patients, of whom 22 received zopiclone. The re-audit sampled 43 patients from Elm Ward (Dec 2025–Feb 2026), identifying 12 prescribed zopiclone. Data sources included Kardex, EPMA, and CITO. Variables collected included demographics, indication, dose, start/stop dates, duration, review documentation, and use of alternative or non-pharmacological interventions. Where stop dates were missing, an end date of 05/02/2026 (the re-audit completion date) was applied to allow duration calculation.

In 2023, the mean duration of zopiclone use was 7.7 weeks (median 8.3; range 0.2–16), with only 27% (6/22) within the recommended ≤4-week limit. In the re-audit, 12 of 43 patients (27.9%) were prescribed zopiclone, with a mean age of 40 years. Using the audit end-date assumption, the mean duration was 3.42 weeks (~24 days), the median 1.29 weeks (~9 days), and the range 0.14–20.29 weeks. Overall, 83.3% (10/12) were within the ≤4-week maximum, and 16.7% (2/12) exceeded it. Indications were predominantly short-term insomnia, though documentation was incomplete in some cases. When judged against indication-specific NICE time windows, 30% of evaluable cases met the appropriate duration. Three patients received alternative sleep medications, and no non-pharmacological sleep interventions were documented. Dose was recorded in 83.3% (10/12), all at 7.5 mg.

The re-audit shows a substantial improvement in prescribing duration compared with 2023, with most patients now receiving treatment within the recommended four-week limit. However, missing stop-date documentation continues to affect duration calculations and contributes to misclassification of treatment length. Persistent gaps remain in documenting non-pharmacological interventions, indications, and review plans. Continued reinforcement of documentation standards, pharmacist-led review prompts, and a repeat audit in 12 months are recommended to ensure sustained improvement.

Clozapine is the gold-standard treatment for treatment-resistant schizophrenia but carries serious cardiac risks, including sudden cardiac death (SCD). Specific risk factors for SCD in clozapine-treated patients remain poorly defined.

Aims were to systematically identify and synthesise evidence on risk factors for SCD and sudden unexplained death (SUD) in clozapine-treated patients, to guide clinical monitoring.

We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420250646384). Five databases were searched from inception to 13 October 2025. Studies reporting SCD or SUD in clozapine-treated patients were included without restrictions on study design, demographics, or diagnosis. Two reviewers independently screened studies and extracted data. Quality was assessed using JBI checklists and ROBINS-E tools. Given study heterogeneity, we performed structured narrative synthesis.

Twenty-one studies (1989–2023) were included, comprising 498 cases of SCD/SUD in clozapine-treated patients. Risk factors were grouped into four categories: treatment intensity (high doses 525 mg/day, rapid titration), drug interactions (valproate, benzodiazepines, polypharmacy), lifestyle factors (smoking, obesity, diabetes, substance use), and monitoring. Two patterns emerged: early inflammatory myocarditis (weeks 2–6) and late-onset cardiomyopathy (months–years).

Clozapine-associated SCD appears multifactorial. These findings suggest a role for gradual titration, avoidance of high-risk co-medications, baseline biomarker monitoring, and ongoing management of metabolic and cardiovascular risk factors. Increased multidisciplinary surveillance may help identify patients at higher risk and inform clinical decision-making in clozapine-treated patients.

Patients discharged from inpatient mental health services can experience multiple adverse outcomes, including a 191-fold higher suicide risk within three months of discharge from inpatient mental health services. The SAFER-MH intervention was co-designed to improve quality and safety in this vulnerable period. Preliminary research suggests it is feasible, acceptable, and offers vital support during inpatient and pre-discharge phases. However, its use is limited to secondary care. This study aimed to strengthen SAFER-MH by co-producing a community follow-up element of the intervention to enhance continuity of care post-discharge.

A three-phase sequential design was used. Phase 1 involved focus groups with patients, carers, and professionals from primary and community care to explore current practices. Phase 2 used a Nominal Group Technique (NGT) workshop to generate and prioritise feasible solutions. Phase 3 consisted of a co-design workshop with the stakeholder groups described above to collaboratively refine and assess the feasibility of proposed interventions.

Seventeen participants took part across three workshops: Phase 1 included fourindividuals from three abovementioned stakeholder groups; Workshops 2 and 3 added three inpatient professionals and two replacements for those who withdrew. Six themes emerged in Phase 1, including fragmented communication and coordination between services, inadequate discharge preparedness, service limitations and inequalities, patient/carer related barriers, quality and safety concerns and pharmacological care challenges. The NGT workshop generated 33 potential solutions, with 17 receiving votes. Top priorities included a one-stop hub and peer support, assuming no resource or implementation constraints. In Phase 3, participants focused on which elements would be feasible as part of SAFER-MH and the top three interventions included adopting a true multidisciplinary team approach to care, improving medication follow-up, and devising a community peer support element.

This study highlighted shared problems faced by all stakeholder groups post-discharge centring around communication breakdowns, medication challenges, and limited patient involvement. Integrating multidisciplinary teamwork, medication follow-up, and peer support within SAFER-MH is feasible and could enhance continuity and safety during transitions from inpatient to community care.

This study was co-designed and co-produced with patient and public contributors and key stakeholders throughout all stages, resulting in a strengthened SAFER-MH intervention that is now ready for evaluation in a national randomised controlled trial.

The use of antipsychotics in behavioural and psychological symptoms of dementia (BPSD) increases the risk of cerebrovascular adverse events and mortality. The aim is to check whether the use of antipsychotic medications for BPSD is in accordance with the NICE guidelines, i.e.,

1. Documentation of specific BPSD.

2. Exclusion of clinical or environmental causes.

3. Use of non-pharmacological interventions prior to commencing antipsychotics.

4. Use of structured assessment such as an ABC chart for assessing BPSD.

5. Antipsychotic review every 6 weeks to consider the need for continuation of antipsychotics.

The audit was carried out across the care homes, nursing and residential homes under the Older Adult Community Mental Health Services in West Essex (Epping, Uttlesford, and Harlow). The data collection was done between July to September 2025, and the information was retrospectively gathered from SystmOne records between 01/10/2024 and 31/03/2025. The patients with a formal diagnosis of dementia prescribed with antipsychotics were included in the study. They were excluded if prior to the first 6-week review of antipsychotics they were transferred out of area, moved out of a care homes, nursing and residential homes, deceased, or had the antipsychotics discontinued. A specially designed data-collection tool was used to collect the data by the data collectors.

Of the 78 patients assessed, the majority were females and in their 80’s. The most common diagnosis was Dementia in Alzheimer’s disease, mixed type. The documentation of BPSD showed full compliance with the guidelines. There was good compliance (91%) with evidence of investigations undertaken to exclude organic conditions and delirium. However, the documentation regarding excluding environmental causes of BPSD and the use of non-pharmacological methods prior to commencing antipsychotics was unclear and hence could not be audited. The evidence of use of ABC chart for assessing patients with BPSD was found only in 38.5%. Two- thirds of the patients were on Risperidone, followed by Quetiapine (14%) and Aripiprazole (9%). A total of 59 (75.6%) patients received an initial 6-week review and only 43 (55.2%) patients had subsequent reviews at 6-weekly intervals.

The audit revealed that the review of patients with Dementia prescribed with antipsychotics was not found to be concordant with the NICE guidelines. Implementing a standardised antipsychotic review record may help improve documentation and support the setting of a tentative review date, thus reducing non-compliance to the standards and thus ensuring safety and a better quality of life for patients with Dementia.

To investigate (1) the prevalence of anxiety and depression, (2) the association between physical activity (PA) and these mental health outcomes, and (3) the mediating role of social support in this relationship among college students, while controlling for gender and age.

Nationwide cross-sectional online survey (March 2024–May 2025) of 1,069 college students recruited through student-union mailing lists in China (92.7% response rate, mean age=21 years, 68.2% female). PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and categorized into low, moderate and high levels; continuous MET-min/week scores were also used. Anxiety and depression were measured by the Zung Self-Rating Anxiety Scale (SAS) and Depression Scale (SDS), reported as binary outcomes (SAS≥50, SDS≥53) and standard scores. Social support was evaluated using the Social Support Rating Scale (SSRS). Analyses included binary logistic regression and mediation analysis using PROCESS Model 4 with 5,000 bootstrap samples, controlling for gender and age.

Overall, 34.0% of participants screened positive for anxiety (10.5% moderate, 5.5% severe) and 43.5% for depression (9.4% moderate, 1.0% severe). Logistic regression showed that compared to high PA, low PA was associated with significantly higher risks of anxiety (OR=2.21, 95% CI:1.58–3.09) and depression (OR=2.91, 95% CI:2.10–4.01). Higher social support was associated with lower risks of both anxiety (OR=0.95) and depression (OR=0.96). Mediation analysis revealed that social support partially mediated the PA-mental health relationship: for anxiety, total standardized effect of PA β=−0.127 (p<0.001), indirect effect through social support β=−0.044, 95% CI [−0.062,−0.028] (34.2% mediated); for depression, total effect β=−0.173 (p<0.001), indirect effect β=−0.053, 95% CI [−0.073,−0.035] (30.5% mediated). Gender and age were not significant covariates in the mediation pathways.

This study identifies social support as a significant partial mediator in the PA-mental health relationship among college students.The mediating effect is proportionally larger for anxiety, although the association of social support is stronger for depression.These findings suggest that interventions should integrate PA promotion with social support enhancement to maximize mental health benefits.

Older adult psychiatric patients frequently present with significant physical comorbidities and frailty when admitted. Despite national DNACPR guidance emphasising proactive, individualised resuscitation planning and shared decision-making, advance care planning is often given lower priority in mental health inpatient settings. The Mental Capacity Act (2005) mandates structured capacity assessment and best interests decision-making where appropriate, yet documentation of resuscitation status can remain unclear orabsent. Baseline review on a 10-bed older adult male psychiatric ward demonstrated that 0% of patients had documented DNACPR status or recorded evidence of resuscitation discussions, representing potential clinical, ethical and governance risk. This quality improvement project aimed to achieve 100% documentation of DNACPR status and increase documented patient and/or family discussions within a two-month period (December 2025–January 2026).

Baseline measurement confirmed absence of DNACPR documentation or recorded discussions across all inpatients. Data were obtained retrospectively through electronic clinical record (RiO) review. Two sequential PDSA cycles were implemented. Cycle 1 embedded mandatory DNACPR status review into weekly multidisciplinary ward rounds, with documentation recorded in the electronic clinical record for all patients. Cycle 2 introduced clinician-led discussions with patients and/or families regarding resuscitation preferences; where patients lacked capacity, decisions were guided by Mental Capacity Act principles, including documented capacity assessment and best interests reasoning, and formal DNACPR documentation was completed where clinically appropriate. Outcome measures included: (1) percentage of patients with documented DNACPR status; (2) percentage with documented patient or family discussion; and (3) percentage with an active DNACPR form in place. Sustainability was supported by incorporating DNACPR review into the ward round documentation to embed the intervention within routine clinical review.

Following Cycle 1, documented DNACPR status increased from 0% to 100% of inpatients. Following Cycle 2, 50% of patients had documented resuscitation discussions and 30% had an active DNACPR order in place (baseline 0%). Discussions clarified previously undocumented patient preferences and facilitated structured best interests decision-making inpatients lacking capacity. Documentation compliance remained at 100% at four-week follow-up after completion of the intervention period, demonstrating sustained change beyond the initial implementation phase.

Embedding DNACPR review within routine weekly ward processes resulted in rapid and sustained improvement in documentation and initiation of advance care planning in an older adult psychiatric setting. The intervention strengthened alignment with national guidance, improved preparedness for medical deterioration, and enhanced governance standards within the inpatient service. Although limited by small sample size and short follow-up duration, the project demonstrates a low-cost, scalable model for improving parity between physical and mental healthcare. We plan to extend this approach to a 20-bed female older adult ward on the same site and a 20-bed mixed older adult ward at another Trust site to promote consistent advance care planning practices across services.