This is a comparative study between two unusual and distinct cases of catatonia, managed by the Liaison psychiatry team that helped us to broaden our thinking and explore variable differential diagnoses for patients’ management.

Case1: Mr.P is a 74-year-old male who was admitted following unusual behaviour, including shouting with slurred speech outside his house. During his admission, he was non-verbal, non-compliant with oral intake including medication and demonstrated bradykinesia and stiff joints. His initial investigations were unremarkable.

Mr. P has a background history of Paranoid Schizophrenia and been treated with Aripiprazole 30mg. Four months prior, he had a lengthy hospital admission with a similar presentation, and he was conservatively managed for hypoactive delirium.

Our differential diagnoses included hypoactive delirium, catatonia, CNS infection and NMS. When the physical health issues were ruled out, a Lorazepam challenge test was initiated; this was effective and made a significant change in his presentation. Thus, we diagnosed him with Catatonia and treated him with high dose of Lorazepam according to the policy. At discharge he had returned to his baseline.

Case2: Mrs.Q is a 78-year-old female who was admitted to hospital after concerns of self-neglect and confusion. Her initial investigations showed an AKI and raised inflammatory markers. Thus, she was treated with IV fluid and antibiotics. Collateral from daughter suggested that Mrs. Q had a rapid decline in her presentation prior to the hospital admission.

Mrs.Q has a background history of depression and been treated with Mirtazapine 15mg.

Despite optimisation in her physical health, Mrs. Q did not show significant improvements. She had minimal engagement, minimal oral intake, very slow movements, and significant thought block. Initially, it was presumed that Mrs.Q had a slowly resolving delirium, however as she was not improving as expected so a Lorazepam challenge test was trialled. Mrs Q responded well to the lorazepam challenge, thus, she was diagnosed with catatonia and treated accordingly.

Catatonia is a neuro-psychiatric condition characterised by marked changes in muscle tone or activity that may alternate between extremes of movement deficits (stupor) and excessive movement (excitement). According to DSM-5 and ICD-11, a diagnosis requires the presence of three or more of the 12 clinical features.It can be validated through BFCRS or KCRS. Catatonia is not a disease, but a syndrome associated with various conditions.Its management includes Benzodiazepams, and/or ECT and supportive care.

Weekend medical handover across Central Norfolk acute psychiatric services has historically been inconsistent and poorly structured, contributing to delayed reviews, duplicated tasks, reduced situational awareness, and resident doctor isolation. This Quality Improvement Project aimed to introduce a standardised weekend handover system to improve clinical safety, timeliness of care, and on-call doctor experience. Objectives included establishing a reliable weekend handover meeting, improving information completeness,facilitating early identification of unwell patients, and reducing inappropriate tasks passed to out-of-hours teams.

Using PDSA cycles, we implemented: (1) a 09:00 Saturday and Sunday multi-site Teams handover for Tier 1 and Tier 2 doctors; (2) pre-arranged invites and reminders; (3) a structured digital handover log covering admissions, unwell patients, investigations, and tasks; and (4) a centralised Teams channel for document access. Surveys at two timepoints assessed communication, clarity, task appropriateness, and perceived support. Clinical outcomes from 63 weekend admissions (March–May 2025) were compared pre-intervention and post-intervention, including time to first medical review, senior review, and medication administration.

Baseline survey responses (n=16) showed moderate satisfaction (mean ≈3), with good supervision (3.6) but poor perceived handover structure (2.3). Willingness to attend weekend handover was 56%. Qualitative feedback reported improved communication, reduced isolation, and better planning for the day. Post-intervention data demonstrated improvements in time to first medical review (10.7%), physical-health medication (10.2%), and psychotropic administration (33.0%). Time to senior face-to-face review increased (97.2%). The reasons for this deterioration are unclear and likely multifactorial. One interpretation is that collective discussion of all new admissions during morning handover increased Tier 1 doctors’ sense of support, reducing perceived need for immediate escalation. Indirectly, this may reflect improved resident doctor confidence and adequacy of remote senior input, though further exploration is required. Barriers included technological unfamiliarity, variable engagement, and inappropriate task shifting from weekday teams.

A structured weekend handover system is both feasible and beneficial for improving communication, early clinical planning, and aspects of patient care. Importantly, qualitative feedback highlighted a strong positive impact on resident doctors’ wellbeing, with many reporting reduced isolation, improved support, and greater confidence in managing weekend workloads. Next steps include automated invites, refining the digital handover log, and establishing a routine senior weekend review pathway, with potential for wider trust adoption.

The positive effects of exercise on wellbeing are well established, and an increasing body of evidence suggests feelings of nature connectedness and exposure to ‘blue space’ (aquatic environments) may also benefit wellbeing. Maintaining wellbeing is important for resident doctors who face high levels of academic and clinical stress, risking burnout. The author hypothesises that surfing, which combines exercise, nature immersion, and blue space, may benefit wellbeing. This preliminary research aims to evaluate resident doctor perceptions of their wellbeing, and how they felt it was impacted by surfing.

Participants were recruited from the ‘Bristol Psych Surf Soc’, a surfing society for doctors. Respondents were predominantly psychiatry trainee doctors, although also includedwere foundation doctors and trainee doctors in other specialties. A six-question digital questionnaire measured how the doctors rated their wellbeing, how recently they had last surfed in the ocean, their perceptions of the effect of surfing on their wellbeing, beliefs on how surfing affected work-related stress, how surfing impacted feelings of connection to nature, and possible mechanisms by which surfing affected wellbeing. Responses were a mix of numerical rating scales, 5-point Likert scales, and free-text boxes.

15 responses were gathered. The mean wellbeing score was 7/10 (1=low, 10=high), with a range from 3–9. There was no correlation between time from last surf and wellbeing score (R²=0.13). 93% of respondents rated surfing as having a positive or strongly positive effect on their wellbeing, and 80% felt that surfing specifically reduced work-related stress. 93% of respondents reported surfing increased feelings of connection to nature. Free-text themes included mindfulness during surfing and increased feelings of connection to nature being beneficial for wellbeing, and surfing acting as a ‘reset’ with a subsequent uplift in feelings of wellbeing.

While there was no clear correlation between recency of surfing and ratings of wellbeing, this preliminary research shows that participants nearly unanimously reported that surfing has a positive impact on their wellbeing and reduces work-related stress. Potential mechanisms for this effect are suggested by the free text responses. Limitations include the small sample size, potential sample bias due to participants being selected from a society for people who are enthusiastic about surfing, and a lack of a control group who did not surf. Further research could assess in more depth which aspects of surfing might provide the perceived positive impact on wellbeing, and whether surfing in wave pools could have similarly positive impacts.

The transition of young people who have turned eighteen from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a challenging and high-risk time for patients and their families. There is currently no regional policy for young people transitioning between inpatient services in Northern Ireland. The TRACK Study outlines best practice recommendations in creating a smooth transition for these young people. This audit aims to identify if Beechcroft, Northern Ireland’s Regional CAMHS inpatient Unit, is adherent to these recommendations when transitioning from inpatients to AMHS.

The electronic records of all Beechcroft inpatients who have turned eighteen and transitioned to AMHS in the past four years were reviewed. Demographics, including diagnosis, length of Beechcroft admission, and time awaiting transfer post-eighteen were collected, as well as data to audit against the four key TRACK recommendations: evidence of transition planning meetings, information transfer, joint working, and continuity of care post-transfer. This allowed us to determine if an optimal transition had taken place for each young person.

Eleven patients were referred from Beechcroft to AMHS and 100% were accepted for a further period of acute care. The majority (91%) were accepted for inpatient care, whilst one young person was accepted by a home-treatment team. Primary diagnoses for young people included psychosis (45%) and depression (36%), with 72% having psychiatric comorbidity. There was a delay in transition of greater than two weeks for 36% of patients. In 100% of cases, adequate information transfer was carried out between CAMHS and AMHS. AMHS attended 91% of transition planning meetings, however, only met with 54% of young people in person prior to transfer. Continuity of care post-transfer, including adult inpatient admission, home treatment, and community mental health team, was maintained for greater than ninety days for 82% of young people.

Young people who turned eighteen in Beechcroft had complex needs, and all required ongoing input from adult acute care. When transitioning patients from Beechcroft to AMHS across Northern Ireland, transition planning meetings and adequate information transfer were consistently carried out. However, we have identified areas for improvement related to transition planning, continuity of care and contact between AMHS and the young person prior to transfer. Results of this audit will be used to develop regional transition guidelines with AMHS to standardise and optimise the transition of young people between CAMHS and AMHS, ensuring the patient remains central throughout this process.

There is an oxymoronic state of our country's paediatric inpatient units treating anorexia nervosa, a deadly illness deeply rooted in restriction and control. These hospitals, which are meant to be places of safety and support, can be some of the most restrictive and unsafe environments patients have found themselves in, being stripped of too many things that make us feel human.

The emergence nationally known cases such as the death of Ruth Szymankiewicz in 2022, who was being looked after in an NHS paediatric inpatient unit for anorexia nervosa, have highlighted gaps in the mental health system that threaten patient safety. However, more needs to be done to protect our most vulnerable, and making a national inter-disciplinary effort to review inpatient hospital policies and procedures for treating anorexia nervosa is an essential step in making that change.

The aim of this report is not to blame people or institutions, but to highlight accounts of systematic failure faced by our paediatric patients that have been ignored for too long and that could have been prevented.

I composed an online questionnaire, firstly outlining eligibility, then explaining the purpose of the questionnaire and the potential uses of the data they share, then gaining consent to share the information in my report, before proceeding to the questions.

They were then invited through a series of questions to reflect on how they felt they were treated during their inpatient stay and how they feel their experiences impacted them. Due to the age and sensitivity of the topic, the questionnaires were filled in anonymously, and any other identifiable information has been omitted.

Even acknowledging the impact illness can have on memory, there are still several harrowing accounts shared in the report of excessive abuse, infringement on safety, including toilet supervision of female minor patients by male staff, and physical and mental harm, including accounts of patients being refused treatment and the ability to see family, all not conducive to recovery.

Whilst the NHS prides itself on equality, these accounts reveal the varying levels of care and negligence received in units where patients as young as 8 can be admitted. Some recall outstanding support from staff and their hospital environment, and I believe it is our duty as healthcare professionals to ensure that every child battling anorexia nervosa has their needs and rights to feel safe and valued, not endangered met.

Clozapine-induced gastrointestinal hypomotility is a common and potentially fatal adverse effect, yet bowel monitoring and timely escalation remain inconsistently implemented despite national guidance. Following the removal of an electronic prescribing bowel-monitoring prompt in a medium secure women’s forensic service, concerns arose regarding reduced detection of constipation and increased patient safety risk.

This project aimed to evaluate baseline bowel monitoring and escalation practices for patients prescribed clozapine, explore staff and patient perspectives on existing monitoring systems, and assess the impact of introducing a structured paper-based bowel monitoring intervention on documentation quality and clinical escalation.

A mixed-methods quality improvement project was conducted between April and August 2025 in the Women’s Pathway at Newton Lodge. Baseline practice was assessed via retrospective review of ward documentation and Clinical Team Meeting (CTM) notes for all patients prescribed clozapine. Staff questionnaires explored perceptions of monitoring systems, safety, and usability. Semi-structured patient interviews examined acceptability and communication preferences. An iterative paper-based bowel monitoring chart was introduced, refined following staff feedback, and re-audited against national standards.

Seventeen patients prescribed clozapine were included in the documentation audit. Baseline recording of bowel status in the CTM notes occurred on approximately 10% of inpatient days. Seventeen staff responses were obtained across nursing and medical disciplines. Fifteen staff members (88%) reported that the previous electronic prescribing prompt improved patient safety, and the majority perceived increased risk following its removal. Initial uptake of a detailed paper bowel monitoring chart was low, with completion rates of approximately 25% over four weeks. Following simplification of the chart, completion increased to nearly 100% and was sustained on re-evaluation. Documentation of bowel status in the CTM notes improved from approximately 10% pre-intervention to almost 100% post-intervention. Escalation and documented clinical review for patients with more than 48 hours without bowel movement increased from approximately 60% at baseline to 100% following intervention. Five patient interviews demonstrated general acceptability of bowel monitoring, with preference for simple, discreet questioning methods.

A simplified bowel monitoring intervention significantly improved documentation and escalation of clozapine-related constipation. Integration into electronic prescribing systems, alongside staff training and standardised escalation thresholds, is recommended to ensure sustainable patient safety improvements.

This audit aims to assess adherence to RCPsych guidance regarding timely admission blood tests (performed within 24 hours of admission), and what blood tests were performed as part of this. In addition, we aimed to evaluate adherence to Trust policy regarding vitamin D and calcium assessment and appropriate management of deficiency.

Retrospective case audit evaluating admissions to an inpatient adult working age psychiatry unit in December 2025 (excluding PICU patients). Records of 19 patients were reviewed (10 female, 9 male). Clinical notes and ICE records were used to obtain data. Information gathered included date of admission, date and results of admission blood tests, documentation of these blood results on the clinical system and medication prescriptions and discharge letter details.

Of 19 patients, 79% had bloods done within 24 hours of admission. For 1 patient, these samples were in adequate and so a repeat sample was treated as their admission set for purposes of this audit. Of those with a delay >24hrs, 75% had a reason documented.

The most common admission bloods performed were full blood count, urea & electrolytes and liver function tests (84%), followed by thyroid function tests and haematinics (79%), lipid and calcium profiles (74%), HbA1c and prolactin (63%), with glucose done least commonly (53%). Vitamin D levels were checked in 68% of patients (including 1 patient who did not initially have vitamin D levels checked, but levels were subsequently done).

Of those with a reported vitamin D level, 23% had sufficient levels, 31% had mild deficiency, and 54% had significant deficiency.

Of those with significant deficiency, all had vitamin D loading doses prescribed. However, only 50% of those with mild deficiency had vitamin D prescribed. At the point of data collection, 26% of the patients involved in this audit had been discharged; 67% of those discharged had a significant vitamin D deficiency, but only 75% of these patients had ongoing supplementation provided. None of these patients had a plan to re-check serum calcium as per guidelines on their discharge letter.

In conclusion, although the majority of new inpatient admissions had some form of bloods taken within 24hrs of admission, the type of bloods they had done was variable. Vitamin D levels were checked in 74% of patients, with 50% of those having a significant vitamin D deficiency. Initial prescription of loading dose therapy had a high compliance but follow up appeared poor, representing an area of possible improvement.

Community Treatment Orders are legal powers within community mental health services designed to support patient compliance with medication and overall continuity of care while maintaining the least restrictive principles of care. Their effective use, however, is dependent not only on effective clinical decision-making but also on accurate and timely completion of Community Treatment Order reports, which are essential for tribunal reviews and renewal decisions. Capacity assessments regarding whether the patient can consent to such a legal process are another important step in safeguarding the patient’s human rights, and their completion is fundamentally essential to the whole process.

In practical reality, however, the Community Treatment Order process is often experienced by doctors and nurses as administratively complex, with unclear processes and procedures, and reports frequently required in a time-pressured fashion. This can lead to breaches of legal requirements for reviews. MHT Medway is an example of this, where concerns were raised about delays in report completion rates by locality, leading to tribunal delays, increased clinician workload, and governance concerns. This prompted a retrospective audit to understand the status quo and initiate a system change.

A twelve-month retrospective audit covering January 2025 to January 2026 was conducted across the three localities in Medway Community Mental Health Team (Gillingham, Chatham, and Rochester). Anonymised data collected included the Community Treatment Order start date, report completion status, completion date, and type of report submitted (full medical report or addendum), capacity forms to consent, the clinician who completed the report, and the responsible clinician for each patient. Data were collected manually by reviewing physical and digital records and entered into an Excel spreadsheet for analysis.

There appeared to be variation in report completion rates across localities, withChatham at 66.7%, Gillingham at 73.3%, and Rochester at 33%. Report completion was unevenly distributed across the months, with clustering around periods when reviews were due. Full medical reports accounted for 74% of completed reports, addendum reports accounted for 16%, and the remainder were combined reports.

In more than two-thirds of cases, capacity forms appeared to have been completed, with rates ranging from 100% in Rochester to 66% in Chatham. Of the six clinicians in the team, only three were completing reports, accounting for approximately 100% of completions. Completion rates were 73% and 50% across the two responsible clinicians. Access to previous reports was inconsistent. Physical and digital copies of current documentation were not available for some patients, and communication between localities regarding current caseload lists was limited.

This audit highlighted system-level variation in medical report completion, clinician and locality differences in completion rates, and timing of reports being closely linked to review dates. These findings informed the implementation of a centralised communication system, improved documentation access, and enhanced administrative processes. A further audit is planned to evaluate the impact of the intervention.

The Haringey Community Rehabilitation team has a high burden of patients on depot antipsychotic medication (n=45). This quality improvement project aims to increase the proportion of depots being administered on time to ensure treatment is delivered as intended, reduce time spent in MDT meetings identifying depot due dates and improve staff-reported ease of tracking depots.

A baseline audit of depot administration was conducted over four weeks in November 2025. Weekly counts of missed depot administrations found that, on average, 16% of depot injections were either missed or not administered on the scheduled date. In response, a spreadsheet tracking tool, “the depot tracker”, was developed which recorded patient name, depot name and dose, date last administered, date next administration due and named carecoordinator. A traffic-light system was used to indicate depot status: green (due that day), orange (due within seven days), and red (overdue). This allowed prompt identification of which depots are due and which are overdue and facilitated weekly forward planning, including cover during care coordinator leave.

The depot tracker was implemented in December 2025 and incorporated into the weekly MDT meeting agenda with resident doctors updating the tracker weekly. A follow-up audit was conducted post-implementation to reassess rates of timely depot administration. Pre-and post-implementation staff surveys were conducted to assess staff views on ease of tracking when depots are due, including when care coordinators are on leave, and whether tracking depots took up time in MDT meetings. The survey gathered quantitative (5-point Likert scale) and qualitative (free text question) data.

Prior to the depot tracker being introduced a weekly average of 16% of depots were not being administered on time. This reduced to an average of 10% of depots being missed, based on eight weeks of post-implementation data. Regarding improving ease of tracking when depots are due there was a 71.4% improvement noted by MDT members (n=10) and a 66.6% improvement in tracking depots when care coordinators are on leave. In addition, there was a 46.8% improvement in time taken during MDT meetings to look up depot information (n=10).

Following implementation of the depot tracker there has been a reduction in frequency of depots being missed, as well as improvements in staff-perceived ease of depot tracking including improved continuity of depot delivery during care coordinator leave, and increased time efficiency of MDT meetings.

Undergraduate medical students frequently have limited exposure to acutely unwell psychiatric patients, resulting in reduced confidence and practical competence in psychiatric history-taking and Mental State Examination (MSE). This study describes the development, delivery, and evaluation of a single-site simulation-based psychiatric teaching programmeaimed to deliver realistic and structured simulation experiences. The primary aims were to enhance students’ skills in psychiatric assessment, differential diagnosis, and initial management planning, whilst also strengthening understanding of mental health law and pharmacological treatment.

A three-hour simulation session was delivered to small groups of third- and fourth-year medical students during their psychiatry placement, with 3–5 students per session. Each student conducted a focused psychiatric history and MSE with a simulated acutely unwell patient, followed by presentation of findings, differential diagnosis, and an immediate management plan. Sessions incorporated structured multi-source feedback from peers, facilitators, and the simulated patient actor. Pre-and post-session questionnaires measured baseline and post-session self-efficacy, knowledge, and learner perceptions. Comparative placement evaluation data were reviewed between cohorts with and without embedded simulation teaching. Session design was informed by experiential, constructivist, and adult learning principles, with careful attention to cognitive load and psychological safety.

Students demonstrated substantial improvements in self-efficacy across all assessed domains. Pre-session ratings averaged 2–3/5 for psychiatric history-taking, MSE, and communication with acutely unwell patients, increasing to 4–5/5 post-session, representing a 90% increase in self-reported confidence. Cohorts with embedded simulation reported consistently higher satisfaction with their psychiatry pathway than cohorts without simulation, including higher ratings for overall week quality (mean 4.3–4.5 vs 3.0), usefulness of the introduction (mean 4.7–5.0 vs 3.9), and feedback in clinical reasoning (mean 4.0–4.7 vs 3.0). Qualitative feedback described the session as “the most helpful thing of the placement”,highlighting realistic acting, varied scenarios, and the value of structured feedback within a supportive, non-judgemental environment. Following positive evaluation, the programme progressed from a pilot to integration within the University of Plymouth undergraduate psychiatry pathway, with planned expansion to affiliated hospitals.

Simulation-based psychiatric teaching effectively addresses gaps in undergraduate exposure to acutely unwell patients, improving confidence, practical skills, and reflective practice. This sustainable and scalable model demonstrates how locally developed simulation can enhance placement quality and achieve wider institutional adoption, offering an innovative and transferable approach to undergraduate psychiatry education.

To systematically evaluate the structural and functional capacity of mental health services in Gaza following over 2 years of active conflict (Oct 2023–Jan 2026), quantify infrastructure and workforce losses, and identify critical service gaps requiring humanitarian response prioritization.

This service evaluation utilized triangulated data sources: (a) official Ministry of Health Mental Health Department records (Oct 2023–Jan 2026); (b) field observations carried out by World Health Organization (WHO) fieldworkers (Oct 2024–Nov 2025); (c) Mental Health and Psychosocial Support (MHPSS) Technical Working Group coordination data and facility assessments (Oct 2023–Jan 2026). The evaluation was conducted using standardised MHPSS assessment toolkits adapted to the local context. Evaluation scope encompassed all governmental psychiatric facilities, community mental health centres, selected local and international non-governmental organisation (NGO) service points, workforce capacity, medication supply infrastructure, and service accessibility across Gaza Strip. Analysis employed descriptive statistics and thematic categorization of operational barriers. Data sources comprised aggregated, non-identifiable service statistics and infrastructure assessments.

Gaza's sole functional psychiatric hospital (39-bed capacity, 2,200 annual emergency presentations, 719 annual admissions pre-conflict) sustained structural damage, rendering it non-operational since November 2023. A replacement psychiatric hospital that was planned before the war and was due to open in 2024 sustained damage before activation. All six governmental Community Mental Health Centres (serving approximately 100,000 annual service users) were destroyed (during April 2024–2025).

Workforce capacity declined critically: over 10 mental health professionals were confirmed killed, with only three Board-certified practicing psychiatrists remaining in Gaza (two more projected upon completion of the current training cohort in 2026). Pre-war, there was a single Board-certified child and adolescent psychiatrist, currently unable to practice within Gaza. Multiple NGO facilities sustained destruction or damage. Psychotropic medication supply chains were severely disrupted following the destruction of the WHO's pharmaceutical warehouse. Health information infrastructure, including electronic medical record systems and referral pathways, became non-functional. Several key service restoration priorities were identified, including: establishing minimum psychiatric referral capacity for acute presentations; securing sustainable psychotropic medication supply and implementing clinical supervision and psychological support systems for the remaining workforce.

Findings demonstrate structural collapse of specialized mental health service capacity. Feasible mechanisms to support the identified priorities for service restoration include integrating MH inpatient services in primary and secondary health facilities, context-specific capacity building, international tele-supervision partnerships and workforce protection measures as integrated response components.

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological developmental disorder that involves a criterion which requires an onset of symptoms before 12 years of age for clinical diagnosis (American Psychiatric Association, 2013).

Be that as it may, longitudinal studies have identified cohorts of adults with symptoms of ADHD but also lack a clear childhood history of symptoms. This phenomenon challenges the core diagnostic criteria described in the DSM–5 and creates notable uncertainty clinically (Moffitt et al., 2015).

This systematic review aims to critically analyse and evaluate the published evidence that both supports and contradicts the validity of adult-onset ADHD being a diagnostic construct, as well as to investigate other possible causalities for this type of clinical presentation.

Following PRISMA guidelines (Page et al., 2021), a comprehensive search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed studies that have been published from 2000 onwards, exploring late-onset ADHD. Studies were screened by one reviewer. Due to the heterogeneity of the studies, a narrative synthesis was performed usingthe extracted data to arrange findings into arguments based on the various topics that materialised, pertaining to methodology, aetiology, and differential diagnosis.

The synthesis identified a notable conflict in the evaluated literature. Multiple longitudinal studies provided evidence supporting a late-onset ADHD presenting subtype. Nevertheless, this evidence is countered by literature arguing that findings in support of adult-onset ADHD are attributable to limitations in methodology, including both recall bias when patients self-report retrospectively as well as the failure to detect “masked“ childhood symptoms (Faraone et al., 2016). Moreover, a significant amount of literature explores the idea that there may be an overlap of symptoms with conditions that present similarly to ADHD such as complex trauma, emotional dysregulation and misuse of substances.

The evidence analysed and evaluated for a distinct late-onset neurological developmental subtype of ADHD remains inconclusive. These adult presentations outline a complex reality facing the clinicians of which require further meticulous and thorough assessment. This systematic review shows a need for this late-onset ADHD subtype to be further explored and studied with more subjects, as well as investigating possible strategies that could be implemented to mitigate undiagnosed or misdiagnosed patients. Healthcare professionals should make conducting a comprehensive differential diagnosis and recording collateral history a priority, in order to avoid a patient remaining undiagnosed and to distinguish ADHD from similar presenting and/or mimicking conditions.

The value and utility of psychiatric diagnoses have been heavily debated within the literature, with proponents advocating that they offer evidence-based treatment and ease of professional communication. The role of social determinants of mental health has been gaining traction, and one alternative to psychiatric diagnoses has been proposed to use phenomenological codes within the current medical system to record both symptoms and the social determinants that service users report. The literature suggests that this approach has been minimally used, however, to date, no research has explored mental health professionals’ views on using this within clinical practice. This research had two broad aims: to elicit the views of psychiatrists working within general adult mental health services on the use of psychiatric diagnoses and alternatives to these, with a focus on using phenomenological codes and to explore how these alternatives may be utilised within clinical practice, specifically focusing on the positives and challenges.

14 Consultant Psychiatrists were recruited from three NHS sites across the North West of England from a range of adult mental health services. Semi-structured interviews were completed either virtually or face-to-face which included a video explaining the idea of using phenomenological codes. The interviews were recorded with consent, transcribed, and analysed using reflexive thematic analysis.

Six overarching themes and 18 subthemes were generated from the interviews. These included: psychiatric diagnoses are imperfect but practical, coding may be helpful but impractical, we are all just stuck in the system, psychological input is helpful but a luxury and moving forwards towards best practice. The results demonstrated the multitude of factors that both impacted on views of psychiatric diagnoses and the ability to implement potential alternatives within NHS mental health services.

Overall, participants demonstrated enthusiasm towards non-diagnostic approaches and exploring the role of social determinants, however felt that coding would be logistically challenging. Participants discussed the complexity of this area, exploring both the impact of personal and professional views shaped by experience alongside wider systemic factors such as professional identity and the constraints within NHS services. Future research could explore further how to integrate medical and non-diagnostic approaches to highlight the role of social determinants in the development of mental health difficulties and how this can be effectively applied within clinical services.

Primary: To increase the proportion of A&E referrals to the Mental Health Liaison Team (MHLT) at a medium-sized district general hospital with documented reasons for breaching the one-hour response target. Secondary: To improve the team's shared understanding of breach causes.

The MHLT 'A&E Assessment' proforma separately records referral time and assessment initiation time from which monthly ‘breach’ statistics are produced. November 2025 data was audited to establish whether ‘breach reasons’ were consistently recorded. During early November open-forum team consultations occurred where frequent breach codes were agreed, these were: 1: Multiple referrals within 1 hour, 2: Staffing levels–shortages/sickness, 3: Patient not medically fit, 4: Patient left department, 5: Other, specify. The proforma was amended accordingly and was emailed to all team members on 17.12.2025. All were advised of the audit and encouraged to use the new proforma, with posters in the MHLT office acting as a further reminder. Data was re-audited between 18.12.25–17.1.26 to determine overall breaches (with reason recorded) and percentages per category.

In November 2025 (30 days) MHLT accepted 97 A&E referrals. 32 breached the one-hour target (33%), 10 recorded a breach reason (30%).

From 18 December 2025–17 January 2026 (31 days) MHLT accepted 44 A&E referrals. 20 referrals breached the target (45.5%), 9 recorded reasons (45%) as follows: Code1: 1 (11%), Code2: 6 (67%), Code3: 0 (0%), Code4: 1 (11%), Code5: 1 (11%).

The re-audit showed a 50% increase in recording of breach causes. Team agreement on common breach reasons supported engagement, and the project showed that embedded prompts can improve recording. Documentation rates remain low however, reflecting ongoing service pressures (see Code2 results). It is suggested that further reinforcement through amended team systems will support improved documentation e.g. staff induction, education and embedded prompts. Notably 50% fewer referrals were accepted during the re-audit phase. An influencing factor might be audit timing (Christmas/New Year). Re-auditing over a longer period is advised whilst cross-referencing against staffing levels.

In 2023, 75% of resident psychiatry doctors (n=210) in Southeast England had experienced verbal abuse, 50% physically threatened, and only 33% felt confident in workplace security measures. A similar survey was carried out within South London and Maudsley NHS Foundation Trust (SLAM) in 2023, which found 70% of Foundation Doctors had experienced verbal or physical abuse from patients. Measures were put in place to improve safety, however were not clearly defined, and a review of their effectiveness has not yet occurred. This research aimed to bridge this gap by understanding the safety measures currently in place, and to determine whether doctors feel safe within their psychiatry placements.

We conducted a cross-sectional survey of SLAM Foundation Doctors on psychiatry placements between August 2025 to February 2026, to explore perceptions of safety during their training. The survey was distributed electronically and comprised of both quantitative and qualitative items, including closed-ended and free-text questions. Using this data, we identified areas that need improvement, and now aim to implement strategies to aid in improving foundation doctor experiences.

A total of 8 doctors responded to the survey. 62.5% of doctors feel unsafe or somewhat safe in their psychiatry placement. 87.5% did not receive any personal safety or breakaway training on starting their job. Only 25% of doctors received a safety induction for their ward or hospital, including how to locate emergency buzzers and staff alarms. 62.5% of doctors have been verbally assaulted, and report experiencing something they found traumatic during the rotation.

Qualitative data highlighted fears surrounding being left alone with acutely unwell patients due to a lack of safety induction and information on personal safety alarms.

Our research highlights that a high proportion of foundation doctors report feeling unsafe during their psychiatry placements. Most respondents did not receive personal safety or breakaway training, and only a minority received a local safety induction. Qualitative findings reinforced these findings, highlighting concerns around being left alone with acutely unwell patients, alongside a lack of safety and de-escalation training. Experiencing violence or aggression alongside a lack of safety training may adversely affect doctors’ experiences, engagement with learning opportunities, and ability to deliver a high standard of care. Identifying gaps in safety provision is therefore essential to inform targeted quality improvement initiatives and enhance both doctor training experiences and patient outcomes.

A Quality Improvement Project (QIP) aimed to reduce the pharmacological interventions for behavioural and psychological symptoms of Dementia(BPSD) by 40–60% on Bryngolau Ward, a specialist Old Age Psychiatry unit in Prince Philip Hospital, Llanelli; through optimised non-pharmacological strategies.

Using the Model for Improvement and Plan–Do–Study–Act (PDSA) cycles, the project implemented a combination of interventions including staff education, sensory room utilisation, guideline promotion, and structured assessment tools (e.g., ABC charts). Baseline data (two 15-day periods) were compared against four PDSA cycles (15 days each)measuring BPSD incidence, use of pharmacological and non-pharmacological interventions, and falls.

Pharmacological interventions decreased from 44.3% (baseline) to 23.5% (Cycle 4), exceeding the target (average reduction: 42.5%). Non-pharmacological interventions rose from 55.7% to 76.5%. BPSD incidents dropped by 56% (Cycle 4), and falls reduced by 76% (Cycle 3). Variability in Cycle 3 highlighted situational challenges, but overall trends demonstrated sustained improvement.

The QIP successfully shifted practice towards non-pharmacological BPSD management, reducing medication use and improving patient safety; adhering to national guidelines. Key drivers included staff training, sensory resources, and iterative PDSA refinements. Recommendations include embedding these strategies into standard practice, ongoing staff development, and expanding monitoring to ensure sustainability. This project provides a replicable framework for dementia care settings aiming to minimise pharmacological reliance.

Dissociative fugue is a rare dissociative disorder characterised by sudden, reversible loss of autobiographical memory, identity disturbance, and purposeful wandering, often precipitated by acute psychological stress. Due to its infrequency and overlapping presentation with psychosis, delirium, and substance-induced amnesia, dissociative fugue is frequently misdiagnosed. We present a case of dissociative fugue in a previously high-functioning adult, highlighting diagnostic clarity, multidisciplinary management, and the critical role of family involvement in recovery.

A man in his late thirties with no known psychiatric or medical history was brought to hospital by police after being found wandering outdoors inadequately dressed during winter. He was unable to identify himself, his personal history, or recognise family and friends, although he adopted an alternative name. He appeared emotionally neutral about his identity loss and demonstrated preserved ability to follow ward routines independently. Orientation to time was impaired, with reduced awareness of seasonality, while orientation to place was intact. There were no hallucinations, delusions, thought disorder, or features of delirium. Physical observations remained stable throughout admission.

Extensive investigations, including neuroimaging and blood tests (including infection and metabolic screening), were normal. Urine toxicology was negative, with no evidence of intoxication or withdrawal. Organic, psychotic, neurological, and substance-induced causes were excluded, and a working diagnosis of dissociative fugue was formally established. Psychosocial assessment revealed a sudden relationship breakdown preceding symptom onset alongside occupational stress. Psychological formulation conceptualised the presentation as trauma-related dissociation with identity fragmentation.

Management focused on psychological and systemic interventions rather than pharmacological treatment. Input included trauma-informed psychological therapy, occupational therapy with graded re-exposure, and structured family involvement. Identity reintegration was facilitated through in-person family visits, video calls, photographs, familiar language cues, and supported visits to the patient’s home. A marked emotional breakthrough occurred during the third week of admission, when the patient became tearful upon seeing his brother, coinciding with gradual restoration of autobiographical memory. Retrospective consent was obtained once capacity returned.

This case demonstrates that dissociative fugue is not merely a theoretical diagnosis but a real and reversible clinical presentation in contemporary psychiatric practice. Preserved executive functioning, emotional neutrality towards identity loss, and absence of psychotic features were key diagnostic clues. Without early diagnostic clarity, the patient was at significant risk of misdiagnosis as dementia, psychosis, or substance-induced amnesia, potentially leading to unnecessary pharmacological treatment or prolonged institutionalisation. Coordinated multidisciplinary care, early collaboration with police and community services, and family involvement were central to recovery.

Following a serious untoward incident (SUI) involving a service user under the care of the Intensive Home Treatment Team for Older People (IHTT) in Leeds, a learning need was identified around the recognition of medication overdose, particularly in community mental health settings. Debrief around the incident highlighted a gap in confidence and awareness, particularly among non-medical staff in recognising potential overdose presentations outside acute hospital environments.

To address this, we designed and implemented a targeted teaching session with the aim of strengthening clinical vigilance and early identification of possible overdose and provide practical, scenario-based education for frontline staff, to ultimately reduce the risk of similar incidents by improving knowledge, confidence and decision-making.

A teaching session was developed by resident doctors in response to the SUI learning. It was designed for delivery to non-medical, community-based mental health staff and focused on recognising overdose presentations, including atypical or non-specific symptoms. Teaching sessions were delivered across a 1-hour format and incorporated case-based discussion, practical scenarios, and guidance around escalation and response. Feedback was collected through online forms in addition to informal verbal and email responses. Quantitative and qualitative analyses were performed to evaluate the quality, relevance andperceived impact of the teaching.

More than 50 staff members have attended the sessions so far, with more sessions planned. Quantitative analysis showed high levels of satisfaction and perceived benefits: 100% of respondents rated the quality, clarity and relevance of the session as 5/5. Participants reported a significant improvement in understanding of overdose presentations (mean score 4.83/5) and 94% reported increased confidence in responding to suspected overdose situations (mean score 4.39/5). Qualitative feedback highlighted strong engagement with the session content, with particular value placed on worked case examples. Suggestions for improvement included covering additional scenarios, proving an accessible quick-reference document and shortening the session to allow wider staff engagement.

This project successfully addressed an identified learning gap following an SUI and was positively received by community mental health staff. Early feedback suggests it improves confidence and awareness in recognising potential overdose presentations in community settings. Future plans include wider and sustained implementation through a concise 15-minute core teaching package, development of a quick-reference guide, and further delivery to additional community teams, as well as inpatient units that have expressed an interest.

The initiative demonstrates how structured, reflective learning from adverse events can translate into meaningful improvements in frontline clinical practice.