Antipsychotic medicines can cause QT prolongation, are pro-arrhythmogenic (specifically, they can increase the risk of torsade de pointes) and are linked to sudden cardiac death. The Maudsley prescribing guidelines advise patients being treated with antipsychotic medications should have an ECG both on admission and before discharge if their medication regime has changed. The aim of this audit was to establish current adherence to national guidance in the Acute Mental Health Inpatient Centre (AMHIC) in the Belfast Health and Social Care Trust (BHSCT).

The decision was made to collect data based on all the discharges from AMHIC. Data was retrospectively collected using the H&C numbers of the patients discharged in the entire month of December. The unit consists of 5 acute inpatient wards and in December there was a total of 42 discharges. Of these 42 patients, 8 were not on any antipsychotic medicines so they were discounted from the data set. A further 2 patients had no changes made to their antipsychotic during inpatient admission, so they were also not included. This left 34 patients on which to base the review. We collected information for 34 patients, including whether patients had an admission ECG, how long it took to get their admission ECG during admission and if this was being done in a ‘timely fashion’ (defined as within one week of admission for the purposes of this audit) and if patients got a discharge ECG.

100% of patients did not have a discharge ECG prior to them leaving hospital.

1. 20.59% (7/34) of the patients had no ECG completed during admission.

2. 50% (17/34) of patients did not have ECG completed within 7 days of admission to AMHIC.

Results suggest that recommended ECG monitoring for patients on antipsychotic medicines is not being completed consistently at ward level. This has helped to assess areas for improvement and to put together plans for future interventions for ensuring patient safety while on antipsychotic medications. Interventions are required to improve timely ECGs both at admission and discharge within the inpatient setting. We have arranged a teaching session during the monthly patient safety meeting to communicate our findings to our medical and nursing colleagues. We have made reminder posters for each ward nurses’ station and clinical room. We plan to address this issue by using the PDSA model for effective change management.

Objective structured clinical examination (OSCE) is a key method used widely in undergraduate medical education since 1975 to assess clinical competencies. While OSCEs have relatively high relatability, validity and objectivity, evidence shows that OSCEs are amongst the most anxiety provoking assessments. In psychiatry OSCEs, medical students often report limited understanding of examiner expectation of a competent performance, as an anxiety trigger.

Providing opportunities to medical students to assess OSCEs from an examiner perspective could help clarify expected performance standard, improve confidence and reduce OSCE-related stress.

The aim of this project was to develop video-based psychiatry OSCEs with accompanying marking rubric as a revision resource, that can be used by medical students to learn by observing and assessing performances from an examiner’s perspective.

Commonly examined psychiatry scenarios at undergraduate level were selected. Candidate instructions and actor briefs were written for each selected scenario.

OSCE stations were filmed using trained actors as patients and resident doctors at various grades of training who volunteered as candidates. Candidates performed unscripted consultations after reading the candidate instructions, replicating real OSCE conditions.

For each scenario, a structured marking rubric was developed. It was specifically designed for medical students who will use it to assess the OSCE candidates while observing the recorded performances. Whilst not identical to the official examination marking scheme, the marking rubric highlights specific skills and competencies students are assessed on for each scenario and the common pitfalls.

All scenarios, candidate instructions, actors' briefs, marking rubrics and videos that were created, underwent multiple rounds of peer review to ensure accuracy, user friendliness, educational value and alignment with Kent and Medway Medical School(KMMS) examination standards.

Ten psychiatry OSCE station videos with corresponding marking rubrics have been created. The marking rubrics are designed to facilitate self-directed learning with ease ofstudent use in mind. This resource offers a flexible, repeatable approach to OSCE preparation.

This collection of psychiatry OSCE videos and accompanying marking rubrics, have the potential to reduce assessment-related anxiety and improve OSCE performance. Furthermore, the added advantage of this resource is that it will be accessible to medical students who can utilise it at their own pace from any location.

Next steps include piloting the resource with third year KMMS medical students to evaluate educational impact.

This audit aimed to evaluate adherence to the Community Child and Adolescent Mental Health Services (CAMHS) Physical Health Standard Operating Procedure for monitoring patients prescribed antipsychotic medication within Centenary House CAMHS. The hypothesis was that recommended physical health monitoring would be incomplete for a substantial proportion of patients.

A retrospective service evaluation was conducted of all patients under medical care at Centenary House CAMHS who were prescribed antipsychotic medication during the audit period (n=13).

Electronic clinical records were reviewed using structured searches within the SystmOne electronic health record and ICE blood results system. Evidence of baseline physical health monitoring was sought; where baseline data were unavailable (for example, due to out-of-area initiation), monitoring within the preceding six months was assessed.

The parameters audited were appropriate blood tests for antipsychotic monitoring, electrocardiogram (ECG), height and weight, blood pressure and pulse, documented neurological examination for EPSEs, and allergy status. No patients meeting inclusion criteria were excluded.

This work was undertaken as a service evaluation audit with appropriate local approval and anonymisation of patient data.

Thirteen patients were identified; ten prescribed aripiprazole, two quetiapine and one risperidone. Documented compliance rates were 77% (10/13) for blood tests, 85% (11/13) for electrocardiogram, 62% (8/13) for height and weight, 62% (8/13) for blood pressure and heart rate, and 62% (8/13) for allergy status. No patient had a documented neurological examination for EPSEs. Only six patients had all required physical health parameters documented either at baseline or within the previous six months. Prolactin monitoring was absent in the single patient prescribed risperidone.

Physical health monitoring for children and young people prescribed antipsychotics within this community CAMHS was variable and frequently incomplete, particularly for neurological assessment and consistent documentation. Service improvements are required to standardise monitoring and improve patient safety.

Proposed next steps include

1. Implementation of electronic reminders

2. Introduction of a structured antipsychotic monitoring template

3. Targeted teaching for medical staff and

4. Planned re-audit within six to twelve months to assess improvement.

As per NHS Forth Valley Psychiatry Emergency plan 2023, any patient admitted to the mental health unit should have a senior review within 48 hours of admission, regardless of the day of the week. A senior review is defined as either a higher trainee, i.e. ST4-6, or a consultant psychiatrist. Previous audits have reviewed compliance of this in the years 2021 and 2022. The aim of this re-audit was to review the compliance of the 48-hour senior review policy between 2023 to 2025.

Electronic patient records of patients admitted to five mental health wards in Forth Valley Royal Hospital were reviewed to determine whether there was a clear documentation of senior review within 48 hours of admission, in line with the existing policy. This was done biannually for the duration between August 2022-- August 2025 in a retrospective manner.

In 2025, all wards achieved 100 percent compliance with 48 hour senior review policy. Overall average of compliance in duration from Aug 2022 - February 2023 was 97 percentage which increased to 100 percentage between August 2024 - August 2025. One ward which showed low compliance (78%) in the time period August 2022 - February 2023, demonstrated progressive improvement in the re-audit cycles in February 2024 (89%), August 2024 (90%) and further 100 % compliance in both audit cycles in 2025. Interestingly, the Intensive Psychiatric Care Unit, which has the most acutely unwell patients, had showed full compliance with the 48-hour policy in all audit cycles since 2021.

Sustained improvement in compliance to 48 hours senior review policy was demonstrated by this audit, with all wards achieving full compliance in2025. To improve quality of care, a new audit process is being planned for the introduction of a standardised senior review template. Additionally, discussions are ongoing within the trust to adopt a 24-hour senior review policy which is the standard practice in medical wards.

Autistic females are less likely to receive an autism diagnosis in childhood than autistic males. In recent years, increasing numbers of adults have come to identify as autistic prior to, or in the absence of, a formal diagnosis. While existing research has examined experiences of receiving an autism diagnosis in adulthood, comparatively little is known about how adults come to self-diagnose, the meanings they attach to this process, and how self-diagnosis shapes decisions about seeking formal assessment.

This qualitative study involved 30 female participants aged 18–43 who had, at some point, identified as autistic without holding a formal diagnosis. Participants took part in one-to-one, online, semi-structured interviews exploring their understandings of autism, pathways to self-diagnosis, perceived barriers and facilitators, attitudes towards both self- and professional diagnosis, and intentions regarding formal assessment. Interview transcripts were analysed using Framework Analysis.

Framework Analysis identified six interrelated themes.

First, participants described self-diagnosis as a prolonged sense-making process involving extensive reflection and information-seeking, challenging portrayals of self-diagnosis as impulsive or trend-driven.

Second, accounts reflected heterogeneous social representations of autism: older, male-centred stereotypes were frequently rejected, while gender differences were instead mapped onto alternative frameworks such as high–low functioning distinctions.

Third, self-diagnosis was commonly experienced as an “aha” moment of epistemic and affective clarity following extended uncertainty, countering social contagion narratives.

Fourth, an economy of legitimacy shaped participants’ experiences. Structural barriers to professional diagnosis, including gendered underdiagnosis and lengthy waiting lists, positioned self-diagnosis as a necessary substitute for institutional validation, while media discourses framing self-diagnosis as “trendy” or as social contagion undermined its credibility and generated self-doubt.

Fifth, participants adopted a reflexive stance towards self-diagnosis, emphasising its provisional status, distancing themselves from “frivolous” self-identification, and expressing ambivalence about the label; social media was viewed as both informative and epistemically suspect.

Finally, attitudes towards professional diagnosis were ambivalent: a strong desire for validation coexisted with fears of dismissal, misrecognition, or gendered misdiagnosis, shaped by material and emotional barriers and mediated by social relationships influencing disclosure and decisions about seeking assessment.

Self-diagnosis functions as a meaningful response to diagnostic exclusion rather than a trivial or trend-driven practice. Recognising its role has important implications for clinical practice, service access, and how autism is understood beyond traditional diagnostic pathways.

To foster wellbeing, resilience, and professional integration through structured peer support, storytelling, and reflective practice, and to provide a model that can be replicated across clinical teams or patient support groups for mental health conditions.

Transitions in professional life–such as starting the UK Foundation Programme–are high-stress periods that can impact mental health, emotional resilience, and professional confidence, particularly for international medical graduates (IMGs). One Step Closer is an online community I founded to provide peer-led guidance, emotional support, and reflective learning for early-career doctors. Beyond supporting foundation doctors, the principles underpinning this model are applicable to healthcare teams, patient peer-support groups, and wider mental health interventions.

The initiative combines online community engagement with reflective dialogue and storytelling shared via social media. Content focuses on professional preparedness, emotional resilience, and practical guidance during transitions into clinical practice. Participation from other foundation doctors enhances collective learning, normalizes emotional experiences, and strengthens community cohesion. The structured, peer-led approach is easily adaptable for workplace teams, multidisciplinary groups, or patient-led support networks in mental health care.

Participants reported enhanced confidence, sense of belonging, and access to emotional and practical support. The community facilitated reflective practice, resilience-building, and peer mentorship. By providing a structured yet flexible framework, the initiative demonstrates how small, intentional acts of support can improve wellbeing and integration, while being replicable across different professional or clinical contexts.

One Step Closer exemplifies how peer-led storytelling and structured support networks can promote mental health, professional development, and reflective practice. The approach is scalable and adaptable to healthcare teams, patient support groups, or mental health interventions, offering a practical framework for enhancing wellbeing, representation, and peer support in diverse clinical and educational settings.

Women with infertility and those diagnosed with gynaecological malignancies experience significant psychological distress. While infertility-related suicidality has been increasingly studied, suicidal risk among women with gynaecological oncology remains underexplored, particularly in low- and middle-income settings. This study aimed to compare depression, anxiety, quality of life, and suicidal ideation between women with gynaecological oncology and women with general infertility.

Women with infertility and those diagnosed with gynaecological malignancies experience significant psychological distress. While infertility-related suicidality has been increasingly studied, suicidal risk among women with gynaecological oncology remainsunderexplored, particularly in low- and middle-income settings. This study aimed to compare depression, anxiety, quality of life, and suicidal ideation between women with gynaecological oncology and women with general infertility.

Women with gynaecological oncology demonstrated significantly higher levels of depressive symptoms and anxiety compared to women with infertility, as measured by BDI and BAI scores (p <0.001). The oncology group also showed significantly greater global psychopathology on the SCL-90 Global Severity Index. Quality of life scores across physical functioning, emotional wellbeing, social functioning, and role limitations were markedly lower in the oncology group on the SF-36. Suicidal ideation was significantly more prevalent among women with gynaecological oncology compared to infertile women (p <0.01), indicating a higher level of suicidal risk in the oncology population.

Women with gynaecological oncology demonstrated significantly higher levels of depressive symptoms and anxiety compared to women with infertility, as measured by BDI and BAI scores (p <0.001). The oncology group also showed significantly greater global psychopathology on the SCL-90 Global Severity Index. Quality of life scores across physical functioning, emotional wellbeing, social functioning, and role limitations were markedly lower in the oncology group on the SF-36. Suicidal ideation was significantly more prevalent among women with gynaecological oncology compared to infertile women (p <0.01), indicating a higher level of suicidal risk in the oncology population.

The National Institute for Health and Care Excellence (NICE) has approved Tirzepatide, a glucagon-like peptide-1 (GLP-1) receptor agonist, for obesity management inadults with Body Mass Index (BMI) ≥35 and one of the following weight-related comorbidities: Type 2 Diabetes Mellitus; hypertension; dyslipidaemia; cardiovascular disease and/or obstructive sleep apnoea. Antipsychotic medications are known to be associated with weight gain and an elevated risk of cardiometabolic disorders. The aim of this audit was to determine prevalence of weight related morbidity and eligibility for Tirzepatide in an acute psychiatric inpatient population prescribed antipsychotics in Northern Ireland.

Inpatients in one acute adult psychiatric hospital prescribed at least one antipsychotic medication were audited. Demographics, antipsychotic use, BMI, and weight-related comorbidities were extracted. Frequencies and proportions of weight-related comorbidities and of patients eligible for Tirzepatide are presented. Group comparisons were made by sex and antipsychotic type. Statistical significance was performed using chi-squared tests.

Seventy-five patients were audited, 41 females and 34 males. The mean age of the cohort was 46.1 years. Fourteen (18.7%) had a BMI ≥35 and thirty-one patients (41.3%) had at least one weight-related comorbidity. Eleven patients (14.7%) met both criteria for Tirzepatide eligibility.

13 different antipsychotics were prescribed across the 75 patients. The most common antipsychotics used included Olanzapine (15), Aripiprazole (15), Quetiapine (11), Amisulpride (9), Risperidone (9) and Clozapine (9).

Weight-related comorbidities were more prevalent in those prescribed Olanzapine (66.7%, 10/15) compared to other antipsychotics (35.0%, 21/60 (χ²=4.96, p<0.05)).

Of the patients prescribed only a single second-generation antipsychotic 20.4% (10/49) met NICE criteria for Tirzepatide compared to 0% (0/10) of patients prescribed a single first-generation antipsychotic (χ²=2.49, p=0.11) and 9.1% (1/11) on aripiprazole only (χ²=0.95, p=0.33).

Weight-related comorbidities were more prevalent in patients prescribed Olanzapine compared to other antipsychotics. Up to 14% of this acute psychiatric inpatient population prescribed antipsychotics in Northern Ireland may be eligible for Tirzepatide for management of obesity.

Patients requiring off-label treatment with high-dose antipsychotic therapy (HDAT) are at greater risk of metabolic, cardiovascular and extrapyramidal side effects. Close monitoring is essential to ensure safety. Pennine Care Foundation Trust’s (PCFT) guidelines for the initiation and monitoring of HDAT are divided into 8 domains: (1) consultant initiation, (2) patient consent procedures, (3) blood tests, (4) ECG monitoring, (5) annual clinic review, (6) identification of reported side effects, (7) GP notification and (8) HDAT form completion. 100% compliance is required in all domains. This audit evaluates whether a HDAT register improves adherence to initiation and monitoring requirements.

A closed-loop two-cycle audit of patients at a PCFT general adult community mental health team service was conducted by reviewing medical records to identify HDAT patients using an online medication regimen analysis tool. A retrospective baseline audit was undertaken in December 2024 assessing adherence to local PCFT guidelines on HDAT initiation and monitoring. A HDAT register was created locally based on these findings requiring biannual review by resident doctors. A re-audit with identical methodology was conducted in January 2026.

2.13% and 2.06% of patients received HDAT in the baseline audit and re-audit respectively. Baseline audit confirmed 60.6% compliance with local guidelines on average across all domains. Following implementation of a HDAT register and biannual review, compliance increased to an average of 77%. Compliance rose in 5 domains with 100% compliance in domains 2, 5, 6 and 7. Compliance increased from 0% to 67% in domain 8. Compliance remained at 83% in domain 1 across both audits. There was a 25.4% and 75.1% relative reduction in compliance with blood tests (domain 3) and ECG monitoring (domain 4) respectively due to inconsistencies in patient engagement and in requesting physical health tests on initiation of HDAT. Notably, HDAT was discontinued in 50% of patients identified in the baseline audit following review of the HDAT register.

The HDAT register improved compliance with guidelines in 5 out of 8 domains. Registration enabled review of indication for continued therapy leading to treatment cessation in 50% of the initial cohort. The register improved record keeping with HDAT form completion rising to 67%. Biannual review of the register highlighted the need for further improvements in completing blood tests and ECGs. Solutions involve issuing all required tests as patient held request forms in standardised bundles prior to initiation, in addition to increasing review of the register to quarterly and improving coordination with primary care.

Gender differences are hypothesized to influence the reporting of attachment styles and psychological symptoms. Culturally, masculine characteristics are often linked with physical and aggressive tendencies, while feminine characteristics are associated with internalizing problems such as depression and anxiety. Some theoretical perspectives suggest that attachment styles may reflect different gender-specific mating strategies. This study investigated gender differences in self-reported adult attachment and psychological symptoms within a sample of patients from a cardiology outpatient clinic.

A total of 186 patients awaiting consultation at a private outpatient cardiology clinic completed a packet of self-reports. The sample comprised 55.7% males (one participant did not report gender) and 85.5% Caucasian individuals, with an average age of 66.2 years. We analysed gender differences in adult attachment using the 12-item Experiences in Close Relationship-Short Form (ECR-SF) and scores on the SPECTRA: Indices of Psychopathology, a broadband self-report measure of psychopathology.

Males scored significantly higher than females on several measures. Specifically, males reported higher ECR-SF attachment anxiety [t(139)=2.12, p=0.03], and higher scoreson SPECTRA’s severe aggression scale [t(120)=2.21, p=0.03], antisocial tendencies [t(120)=2.51, p=0.02], externalizing spectrum [t(120)=2.48, p=0.01], grandiose ideation [t(119)=2.93, p<0.01], and reality impairing spectrum [t(119)=3.00, p<0.01].

Our findings indicate that males reported higher scores on several psychological symptom scales, many of which align with theoretically externalizing strategies (e.g. aggression). More surprising findings included higher male scores on grandiose ideation and the reality impairing spectrum of the SPECTRA. Additionally, males exhibited higher attachment anxiety, which is unexpected given that females typically score higher on this dimension in most samples, with the exception of some Asian populations. Future research is warranted to further investigate these findings and enhance our understanding of gender differences in self-reports.

Child and adolescent mental health services (CAMHS) and child development clinics (CDCs) in the UK are facing unprecedented demand, resulting in prolonged waiting times for assessment of neurodevelopmental conditions, including autism spectrum disorder andattention deficit hyperactivity disorder. Delayed diagnosis and intervention are associated with poorer outcomes, with administrative burden being a key contributor to limited assessment capacity. Emerging digital health technologies like ambient voice technology (AVT) can reduce this burden and improve service efficiency. This second-phase study builds upon the authors’ previous AVT proof-of-concept pilot.

The objectives were to:

1. Assess the performance of AVT across a broad range of use cases in CAMHS outpatient clinics and a CDC.

2. Assess the impact of AVT on quantitative and qualitative clinical outcomes, including administrative burden.

3. Explore clinician, patient and carer perceptions towards AVT in clinical settings.

We conducted a mixed-methods pre-post service development pilot from January to July 2025. The study was conducted across three outpatient sites: two CAMHS outpatient clinics and one CDC. Clinicians spanning CAMHS and neurodevelopmental roles were invited to participate, testing 13 use cases, mostly diagnostic assessment components for neurodevelopmental conditions. Clinician participants completed both baseline (manual documentation) and intervention (AVT-assisted documentation) phases. The primary outcome measure was self-reported time taken to complete administrative tasks per clinical encounter. Secondary outcome measures included qualitative clinician experience and patient/carer perception and acceptability of AVT. Data was analysed using descriptive statistics and mixed linear regression.

37 clinician participants provided baseline and intervention timesheet data. Mostwere full-time working mental health nurses, aged 25–34 and female. A total of 1,085 clinical appointments were recorded, with 50% (n=543) using AVT. Across all use cases, the mean time taken for administrative tasks was 28% less in the AVT group compared to manual documentation (p<0.001). However, satisfaction with documentation accuracy and confidence in documentation quality were significantly higher with manual documentation (93% and 100%, respectively) compared with AVT (60% and 56%). No significant differences were found in perceived efficiency of seeing patients or completing administrative work. Data from patient/carer surveys revealed no significant differences between AVT and manual documentation across any measures.

AVT significantly reduces documentation burden in neurodevelopmental assessments and is acceptable for patients and carers. However challenges including documentation accuracy and quality must be addressed. Further evaluation across other mental health and neurodevelopmental settings is necessary to validate these findings.

Psychiatry is a rewarding career which has grown in popularity in recent years. Despite psychiatry training posts recently achieving high fill rates, the specialty has consistently faced long-standing recruitment difficulties, with associated negative perceptions and low interest from medical students. Exposure to extracurricular enrichment programmes has been suggested as a potential method to improve student attitudes, increase engagement, and encourage early career interest in psychiatry. Extracurricular enrichment programmes offer medical students the opportunity to engage with psychiatry beyond the mandatory curriculum, such as through summer schools, special study modules and mentoring schemes. This systematic review aims to evaluate the current literature on extracurricular psychiatry enrichment programmes for undergraduate medical students.

The review was registered with PROSPERO (CRD420251025990) and followed PRISMA guidelines. Four databases were searched (Embase, Ovid MEDLINE, APA PsycInfo and ERIC) using pre-determined search strings. Records were screened and data extracted independently by two authors. Extracted data included programme characteristics, student experiences, attitudes towards psychiatry and mental illness, career intentions and eventual specialty outcome. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity in study designs and outcomes, findings were synthesised narratively to identify patterns and themes.

Of 731 articles screened, 65 full reports were assessed for eligibility and 27 were included. These studies were conducted across 10 countries, most commonly the USA and UK. Programme duration and format varied from single-day events (n=2) to longitudinal mentoring schemes spanning medical school (n=5). Summer schools were most common (n=10). Other schemes included mentoring, elective courses, special study modules, student-led clinics and film/media-based activities. Student feedback was positive, particularly for mentoring and film/media initiatives. Most studies reported improved attitudes towards psychiatry and mental illness, with several reporting statistically significant improvements using validated tools. Of 18 studies assessing career intentions, 16 reported increased interest in a career in psychiatry, and six studies reported higher subsequent match rates into psychiatry specialty training.

Although potential self-selection bias may arise from programmes that are both voluntary and extracurricular in nature, the available literature suggests that these programmes provide positive student experiences, and foster improved attitudes and early interest in psychiatry through meaningful learning opportunities. However, longitudinal research is needed to clarify the long-term impact, particularly on those without prior interest. Despite study heterogeneity, this review highlights the importance of enrichment programmes to support recruitment, provided inclusivity and accessibility are considered during programme development.

Hallucinogen Persistent Perception Disorder (HPPD) is characterised by a recurrence of hallucinogen-induced perceptual symptoms after the cessation of hallucinogen use, leading to clinically significant impairment in functioning. It remains difficult to diagnose due to multiple comorbid diagnoses and poor understanding in psychiatry. For these reasons documented incidence also remains low. There are currently no established guidelines on treatment of HPPD which is a major gap in existing literature. This review aims to assimilate current evidence on treatment of HPPD, and suggest avenues for further systematised research into this complex disease.

Our inclusion criteria was any review article, meta-analysis, randomised control trial, case report, and letter to the editor on treatment of HPPD published in English until December 2025. Research databases PubMed and GoogleScholar were searched using the key words “Hallucinogen Persistent Perception Disorder” yielding 111 articles. These were then screened to meeting inclusion criteria and relevance to aim. 34 studies were included in our final review.

Our review of studies on HPPD treatment found that several (n=9) advocate for α2 adrenergic agonists (particularly clonidine) orbenzodiazepines (particularly clonazepam) to be effective. These target the distress and anxiety associated with HPPD. The perceptual symptoms of HPPD have shown good response to anti-epileptic drugs (particularly lamotrigine) in case reports (n=5). Studies (n=5) on treatment with antipsychotic agents counterintuitively demonstrated poor response and worsening of perceptual symptoms. Two case reports (n=2) demonstrated improvement on combination therapy (olanzapine with fluoxetine and risperidone with escitalopram) however selective serotonin reuptake inhibitors alone (n=1) have not shown improvement.

Anecdotal treatments in literature include conservative measures, psychotherapy, eye movement desensitisation and reprocessing, onabotulinum toxinA, and naltrexone.

Neuromodulation has been successful at treating HPPD in two case reports using transcranial direct current stimulation and repetitive transcranial magnetic stimulation, with sustained responses at 4 weeks and 4 months respectively. More robust studies with longer term follow-up are needed.

Treatment modalities recommended for HPPD have a weak evidence base. The ambiguity of HPPD presentation, frequent comorbid conditionsinfluencing pharmacological choice and variability in response to treatments make it difficult to draw large-scale conclusions from these results. Larger scale and case-controlled studies remain a challenge owing to diagnostic and ethical considerations. We propose that, given the safety and efficacy of neuromodulation, this should be explored further. Additionally, more research needs to be done for pharmacological treatments to confirm efficacy.

Prolonged inpatient psychiatric admissions are unlikely to benefit individuals with Emotionally Unstable Personality Disorder (EUPD)/Complex Emotional Needs (CEN) and may even be counterproductive, disrupting daily routines, weakening stabilizing relationships and social roles, reinforcing avoidance of psychosocial stressors, and increasing risk behaviours aimed at maintaining institutional attachments or eliciting care, ultimately impeding recovery.

The Northamptonshire Healthcare NHS Foundation Trust (NHFT) CEN guideline outlines an Inpatient Personality Disorder Pathway enabling ‘Goal Focused Admissions’, requiring pre-admission goals and recommendations, care planning and engagement contracts within 24 hours, consultant review within 72 hours, and brief admissions under 14 days. This audit studied adherence to the CEN guideline.

Patients with EUPD admitted between 1 January and 28 February 2025 wereincluded; those with comorbid diagnoses were also included if EUPD was the primary reason for admission and remained the primary discharge diagnosis. Referral letters were audited for legal status and short and long-term treatment goals while electronic records were audited for time from admission to documentation of admission goals, engagement contracts, discharge planning, first psychiatrist review, and total length of stay.

Twenty-one patients were included; 81% were informal admissions and the remainder were detained under Section 2 of the Mental Health Act. Crisis resolution was the most frequently cited admission goal (in 48% of cases with documented goals); however, around half of all patients lacked clearly documented admission goals. Admissions were primarily for risk and safety management (42%), followed by medication review (37%), psychological input (16%), multidisciplinary liaison and/or social support (17%), and diagnosis review (5%) were also suggested, with recommendations for referral to other services (CMHT, Personality Disorder Hub etc). Admission goals were documented within 24 hours for 57% of patients, though only 9.5% had engagement contracts completed and 48% had discharge dates recorded within this timeframe. First consultant reviews occurred within the 72-hour target for 48%; delays ranged from 4 to 10 days for the remainder. Only 21% remained inpatient for ≤2 weeks, while 26% of patients stayed 5 weeks or longer.

This audit demonstrated low adherence to the CEN management guideline. Referrals lacked clear admission goals, delaying care planning, engagement contracts, and consultant reviews while extending hospital stays and undermining the collaborative planning and clear therapeutic boundaries fundamental to working with individuals with EUPD. Recommendations include staff training in Structured Clinical Management, group supervision and case discussions with community PD services, and greater guideline awareness among clinicians. Re-audit is advised to monitor improvement.

The aim of this quality improvement project was to improve the documentation of driving status and, where relevant, driving advice in patients’ electronic record during admission in one acute adult mental health inpatient unit by 10% within 8 weeks.

Two outcome measures were established: (A) Driving status documented in notes and/or discharge letter, (B) Driving advice for drivers documented in notes and/or discharge letter.

The electronic notes and discharge letters of patients discharged from the unit each week were retrospectively audited and weekly proportions of each measure calculated.

Using Plan, Do, Study, Act cycles, three interventions were implemented sequentially: (1) Education session delivered to resident doctors on driving regulations for psychiatric disorders; (2) Displaying a poster prompt in the resident doctors’ communal workspace; and (3) Addition of a mandatory field for driving status check to the standardised discharge meeting template.

Data was analysed using run charts with baseline and post-intervention medians.

Retrospective audit of 164 patients’ records was completed, with 85 patients from the 8-week baseline period and 79 from the 9-week intervention period.

In the baseline period, 48 patients had driving status documented. In the intervention period, 53 patients had driving status documented. The median documentation of driving status improved from 60% to 83%. There was a shift on run chart analysis with all 9 data points in the intervention period remaining above the baseline median.

Driving advice was documented in 10 out of 20 drivers during the baseline period and 17 out of 27 in the intervention period. The median of documented driving advice given to known drivers improved from 50% at baseline to 80% post-intervention. However, there was substantial week-to-week variability and multiple weeks of zero compliance.

The results indicate that the three interventions produced sustained improvement in documentation of driving status, reflecting system change, and meeting the aim of this project. These three simple interventions could be replicated quickly and at low cost to other acute inpatient psychiatric units to spread this improvement beyond the single unit involved in this project.

Although the median of documented driving advice to drivers improved, to meet the aim of the project, the lack of shift on run chart analysis reflects that the interventions did not create sustainable system change. Further work is required to ensure patients who drive have been given the appropriate advice and had it documented in their electronic record, prior to discharge from this acute adult mental health inpatient unit.

Perinatal hypoxia–ischaemia (HI) is a major cause of neonatal mortality and, importantly, of long-term neurodevelopmental morbidity. Children who suffered perinatal asphyxia show a higher risk of developing a wide spectrum of psychiatric disorders, alterations that often coexist with sensorimotor deficits and cognitive problems. Therefore, perinatal HI is increasingly recognized not only as a neurological condition but also as a strong developmental risk factor for later psychopathology.

To evaluate behavioural outcomes closely linked to psychiatric vulnerability (specifically motor function and different memory domains) and to examine possible sex-dependent differences in neonatal rats subjected to a preclinical model of severe HI and treated with the epigenetic modulator Tubastatin-A (Tub-A).

Seven-day-old (P7) Sprague Dawley rats were randomly assigned to: i) HI (left common carotid artery ligation + 150 min of hypoxia (8%O2/92%N2); n=18, 10 males, 8 females); ii) HI + Tub-A (25 mg/kg; one i.p. dose immediately after HI and three more doses spread over the next 72 hours; n=18, 9 males, 9 females); iii) Sham (without HI; n=18, 9 males, 9 females). At P8 and P14, the animals underwent righting reflex, negative geotaxis, and front limb suspension tests to analyse their sensorimotor abilities. At P40 and P90, the animals underwent the cylinder test (to measure sensory-motor deficits), novel object recognition (NOR, to analyse the non-spatial memory) and T-maze test (spatial memory and learning ability). These domains are fundamental for adaptive behaviour and are frequently compromised in psychiatric conditions.

In short-term tests, P8 animals in the Tub-A-treated group showed a better motor response in the front limb suspension test (p=0.004), and especially in males (p=0.0033). At P40, the cylinder test revealed differences in females in the HI group and those treated with Tub-A (p=0.044). In the NOR test, a notable improvement was seen in all treated animals (p=0.0001 vs HI), independent of sex (males: p=0.0022; females: p=0.0012). At P90, the improvement in NOR was maintained overall (p=0.0462) and in males (p=0.0004), but not in females. In the T-maze test, Tub-A-treated males had better results (p=0.0404) at P40, whereas this improvement was enhanced at P90 for both sexes (males: p=0.0083; females: p=0.0423).

Perinatal HI-induced long-term behavioural impairments related to psychopathologies may be improved after Tub-A treatment.

To evaluate the safety, feasibility and acceptability of reducing clozapine blood monitoring frequency from monthly to three-monthly in patients established on clozapine for at least one year, while maintaining monthly physical health reviews.

Clozapine is the most effective treatment for treatment-resistant schizophrenia but remains underutilised in the United Kingdom (UK). One of the key barriers to clozapine continuation is the stringent long term haematological monitoring. A review of the literature examined the incidence and timing of clozapine-associated neutropenia and agranulocytosis, international monitoring practices and findings from services using reduced monitoring schedules. The literature suggests that the risk of clozapine-induced agranulocytosis is highest within the first year of treatment, raising concerns that current UK guidelines may be overly restrictive beyond this point. The review findings guided the implementation of a pilot service evaluation at East London NHS Foundation Trust. Between May and September 2025, 32 patients meeting eligibility criteria were enrolled. Eligibility criteria were adults aged 18 to 65 years, stable on clozapine for more than one year, with capacity to consent to less frequent monitoring and awareness of infection symptoms. Participants received full blood count monitoring every three months alongside ongoing monthly physical health reviews and medication supply. Safety outcomes included haematological results and clinic attendance. Patient and staff experience were assessed monthly using a five-point satisfaction scale (1 = very dissatisfied; 5 = very satisfied) with free-text feedback collected.

During the evaluation period, no abnormal haematological results were recorded; all blood results remained within the green range. Two patients (6.25%) were withdrawn as aprecaution due to deterioration in physical health unrelated to blood monitoring frequency. There were no dropouts, no concerns regarding clinic attendance and all participants continued monthly physical health reviews. Mean patient satisfaction was 4.88/5, with feedback highlighting reduced anxiety, improved convenience and decreased distress related to venepuncture. Mean staff satisfaction was 4.96/5, with reported benefits including reduced patient distress, improved clinic efficiency and resource savings.

In this pilot cohort, reducing long-term clozapine blood monitoring to three-monthly intervals was safe, well-tolerated and highly acceptable to both patients and staff when combined with ongoing monthly physical health reviews. This approach may reduce barriers to clozapine continuation, minimise invasive investigations and improve patient experience without compromising safety. Wider implementation and longer-term evaluation are warranted to support future service development and guideline review.

Stalking is an under-recognised occupational hazard within mental health services and disproportionately affects women clinicians. Boundary violations by current or former patients can pose risks to clinician safety, disrupt professional identity, and generate significant emotional distress. Experiences of stalking are often under-reported, and clinicians may feel uncertain about how best to seek support.

This case study reflects on the professional, organisational and emotional learning arising from a single experience of stalking encountered by a female psychiatrist during her Core Psychiatry training in Yorkshire, UK. The hypothesis underpinning this work is that, for this clinician, early institutional support, clear boundary-setting and access to protected reflective spaces mitigated psychological harm and supported resilience.

The case involved escalating stalking behaviour from a former patient, targeted towards a female Core Psychiatry trainee. This progressed from letters and unsolicited gifts to persistent social media contact, culminating in messages containing threats of harm and suicide. As a result, the clinician experienced fear, hypervigilance and moral tension between compassion for a mentally unwell patient and the need to preserve personal safety. The experience was explored using a narrative-reflective approach and supported through clinical and educational supervision, Balint group discussion, police involvement, advice from specialist stalking services, and implementation of digital-safety measures.

Reflection on this case identified learning points specific to the author’s experience. Early reporting reduced isolation and enabled coordinated risk management. Clear documentation supported organisational responses and escalation. Proactive digital-identity management increased perceived safety. Explicit acknowledgement of gendered vulnerability was validating and reduced self-blame. Supervision and Balint groups provided emotional containment and helped reframe vulnerability as professionalism rather than weakness. For this clinician, maintaining clear boundaries supported wellbeing without undermining compassionate patient care.

This reflective case highlights how stalking may affect clinician safety, professional identity and emotional wellbeing within psychiatric training. While experiences and responses will vary, this account suggests that organisational openness, supervisory support and access to reflective spaces were helpful in this instance. Sharing individual experiences may support awareness and encourage dialogue about clinician safety and boundary-violating behaviour within mental health services.