This service evaluation reviewed the distribution of intramuscular and intranasal naloxone between January 2025 and January 2026 within Richmond Community Drug and Alcohol Services, as part of a harm reduction approach for people with opioid use disorder. Naloxone is a well-established opioid antagonist used to reverse opioid-related respiratory depression in emergency situations. The evaluation was particularly relevant to the London Borough of Richmond upon Thames, where drug-related deaths continue to occur despite lower prevalence overall, and where polysubstance use and exposure to potent synthetic opioids increase the risk of overdose among people accessing local services.

A retrospective review of anonymised naloxone distribution records was undertaken, capturing all kits issued over the 12-month evaluation period. Data included the total number of kits provided and the formulation supplied, either intramuscular or intranasal. Naloxone was offered in line with UK national guidance to people using opioids alone or with others, individuals who inject drugs, those assessed as being at increased risk of overdose, and people likely to witness an overdose. Distribution was supported by brief, practical harm reduction advice. This focused on using low doses and increasing gradually, especially when using a substance for the first time, allowing time for effects to be felt, and recognising that drugs may act at different speeds or vary in strength despite similar appearance. Individuals were also encouraged to inform others when using substances, access buddy or telephone support if using alone, and seek emergency medical help when concerning symptoms occurred. Findings were summarised using descriptive analysis.

During the evaluation period, a total of 237 naloxone kits were distributed. Of these, 75 kits (31.6%) were intramuscular naloxone, and 162 kits (68.4 %) were intranasal naloxone. Intranasal naloxone accounted for the majority of kits provided. This reflects its ease of administration, lower risk of needlestick injury, and suitability for use by people without medical training. Distribution occurred within a population characterised by established opioid dependence, where polysubstance use and exposure to synthetic opioids were an identified risk.

This evaluation supports sustained naloxone distribution as an effective harm reduction measure, with intranasal naloxone facilitating wider access and rapid overdose response. Given its short duration of action, repeat dosing and urgent medical assessment remain essential, particularly with long-acting or synthetic opioids.

Perinatal depression is a significant public health concern with far-reaching consequences for mothers, their infants, families, and society. The economic burden is substantial; in the UK, the estimated lifetime cost of perinatal depression is £75,728 per woman with an average cost of £8,500 per birth. The Thinking Healthy Programme (THP) is a community based intervention integrating cognitive and behavioural strategies into the routine work of community health workers (CHWs). An accessible, practical, and cost effective approach for low resource settings.

This scoping review aims to analyse the effectiveness of the THP in reducing depressive symptoms, improving long-term maternal and child outcomes, and assessing its cost-benefit, cultural adaptability and scalability.

The methods followed the framework outlined by Arksey and O’Malley and were reported based off the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Eligible studies included all forms of original empirical research evaluating interventions including: pilot studies; randomised control trials (RCTs); retrospective cohort studies reporting on THP in pregnant women and new mothers in low-and middle-income countries (LMICs). The Web of Science database search was limited to THP-specific studies published between 2008 and 2023 in English. Key data extracted included study design, population, setting, delivery mode, helper characteristics and training, safety, acceptability, feasibility, scalability, clinical and cost-effectiveness, and implementation barriers and facilitators.

Twelve studies evaluating THP were included, published between 2008 and 2023, conducted in six LMICs. Sample sizes ranged from 38 to 1,731 participants, with most studies conducted in rural or semi-urban settings. Eight studies (67%) were RCTs. The intervention was primarily delivered face-to-face, in ten studies. One study employed a remote/technology-assisted format, and another used a mixed delivery model combining face-to-face and digital methods.

Primary outcomes included depression severity measured using PHQ-9 (Patient Health Questionnaire-9) in nine studies, child development outcomes in two, delivery agent competency using the ENACT (Enhancing Assessment of Common Therapeutic Factors) rating in one, and cultural appropriateness in a qualitative study. Secondary outcomes measured included anxiety, disability and social support (five studies), cost-effectiveness (two studies), and child socio-emotional development (two studies).

The THP has demonstrated effectiveness in reducing perinatal depression among women in low-resource settings. Its success across diverse contexts highlights its adaptability, cost-effectiveness and scalability. However, while THP improves maternal mental health, its impact on child developmental outcomes appears limited. Ongoing refinement is essential to broaden its impact on family wellbeing.

Core Psychiatry Training is designed to provide structured clinical experience, supervision, and professional development while supporting trainee wellbeing and progression. However, the lived experience of trainees within training programmes, particularly in relation to supervision, workload, assessment burden, and support for examinations, is less frequently explored in depth. Understanding these experiences is important for maintaining training quality and supporting trainee confidence and retention.

This study explores the experiences of doctors enrolled in Core Psychiatry Training across core Psychiatry rotation, focusing on the quality of supervision, workload pressures, assessment burden, well-being support, and perceived preparedness for examinations and progression.

An anonymous cross-sectional survey was distributed to all 47 Core Psychiatry Trainees (CT1–CT3) within the South Yorkshire Rotation. The questionnaire covered key aspects of training, including induction, clinical and educational supervision, teaching access, workload and working patterns, workplace-based assessments and portfolio requirements, ARCP experience, wellbeing support, inclusion, and career development. Responses were analysed using both descriptive statistics and thematic synthesis to identify patterns and tensions across placements. This study did not meet the NIHR “What is Research” criteria and therefore did not require NHS Research Ethics Committee review.

Thirty of the 47 eligible trainees responded. Trainees’ experiences wereheterogeneous and strongly placement dependent. Supervision was generally valued when accessible, particularly for clinical decision-making and risk management; however, the frequency, consistency, and scope of supervisory support varied considerably. Educational supervision was more commonly experienced as administrative than developmentally proactive, with limited structured support for examination preparation or career planning.

Workload pressures were frequently reported, with many trainees working beyond contracted hours and experiencing difficulty taking breaks. Portfolio and assessment requirements were widely viewed as time-consuming, contributing to stress around ARCP preparation despite general perceptions of procedural fairness. Support for examination preparation was often informal or self-directed, influencing trainee confidence and increasing reliance on peers rather than supervisors.

Awareness of wellbeing support varied, and feeling supported did not always correlate with knowledge of available resources. While most trainees reported feeling respected within their teams, some lacked confidence in seeking help around exams or performance concerns.

This evaluation highlights substantial variation in the lived experiences of Core Psychiatry Trainees within core training Rotation. While trainees value supervision and support when available, inconsistencies in engagement, exam-focused guidance, workload protection, and wellbeing support impact confidence, stress, and perceived preparedness for progression. Capturing trainee experience in this way provides an important foundation for reflective review of training delivery and trainee support.

The Mental Capacity Act 2005 provides a statutory framework to empower and protect individuals who may lack the capacity to make specific decisions for themselves. Capacity assessments are essential to safeguarding the autonomy and rights of individuals, especially those with cognitive impairments, learning disabilities, or mental illness.

The rationale behind this audit is to ensure that capacity assessments are not only being completed when required, but that they are being carried out and clearly recorded in accordance with Mersey Care MC01 policy and the principles of the Mental Capacity Act (2005).

By identifying whether the assessment was done, and whether all steps were clearly recorded, this audit aims to promote compliance, improve clinical quality, and uphold patient rights across Mid Mersey Care LD services.

This is a retrospective audit.

The inclusion criteria:

1. New referral to the team.

2. Adults aged 16 years or older lacking capacity / under the care of Intellectual Disabilities Community Mental Health team – Mid Mersey Care NHS Foundation Trust.

3. Cases where a significant decision was required (consent to treatment).

The exclusion criteria:

1. Not a new referral to the team.

2. Adults aged 16 years or older having capacity / NOT under the care of Intellectual Disabilities Community Mental Health team – Mid Mersey Care NHS Foundation Trust.

3. Cases where a significant decision was NOT required (consent to treatment).

The sample identified from an In-House Assessment Database and the data will be extracted from the electronic system (RIO).

Sample of 21 patient was identified.

Of the 21 cases audited, 18 had an assessment completed and 3 did not. Compliance level of 86%.

Of the 21 cases audited, 10 had clearly documented steps, 8 did not and 3 were N/A. Compliance level of 56%.

While the Capacity Assessment was carried out and completed in the majority of cases. The clear documentation of all steps was only recorded in around half of them.

There is still a room for improvement by raising awareness during multidisciplinary team meeting and increase the completion of the existing capacity form on the electronic system and/or documentation of all capacity assessment steps during the patient review.

Self-injurious behaviour (SIB) is a substantial and challenging behavioural issue among individuals with intellectual disabilities (ID), resulting in heightened morbidity, caregiver stress, and healthcare consumption. Data from low- and middle-income nations, such as Pakistan, continue to be scarce,with intellectual disabilities admitted to a tertiary care psychiatric institution in Faisalabad, Pakistan.Aims were to as certain the prevalence, trends and correlating factors of self-injurious conduct in patients.

This cross-sectional study was performed in the Department of Psychiatry and Behavioural Sciences, Allied Hospital II, Faisalabad, over a duration of six months. A total of 96 patients, aged 8 years and older, diagnosed with intellectual disability under DSM–5 criteria, were recruited by non-probability consecutive sampling. Demographic data, severity of intellectual disability, existence and kind of self-injurious behaviour (SIB), severity, triggers, and interventions were gathered using a structured proforma. We used SPSS version 27 to do the statistical analysis. We used chi-square tests to look at associations, and a p-value of 0.05 or less was considered statistically significant.

35.4%of the subjects engaged in self-injurious conduct. All instances of self-injurious behaviour (SIB) were seen among the 8–20-year age demographic, with a notable prevalence in men (91.2%). SIB was not present in people with mild intellectual disability but had a significant correlation with moderate, severe, and profound disability (p < 0.001). The most common types of SIB were beating oneself, head-banging, and biting oneself. Sensory overload, difficulty with communicating, and behaviour that seeks attention were some of the most common triggers. Despite the clinical burden, most of the people who were impacted did not get structured behavioural or pharmaceutical help.

Self-injurious behaviour is a prevalent and clinically relevant issue among younger individuals with moderate to severe intellectual disability. To have better results for this vulnerable group, it is important to find them early, train caregivers, and make mental health treatments stronger.

There is a high prevalence of concentration and cognitive functioning problems in people with depression. Research evidence indicates that transcranial direct current stimulation (tDCS) can improve cognitive functioning, and an aspect of cognitive functioning is the ability to concentrate. Flow FL-100 is a tDCS device self-administered at home.

The aim was to investigate the impact of 1, 2, 3, 6 and 10 weeks of Flow Neuroscience AB FL-100 tDCS use on self-reported concentration problems in people with depression, using the Montgomery–Åsberg Depression Rating Scale Self (MADRS-S) concentration problem question.

A retrospective analysis of Montgomery–Åsberg Depression Rating Scale (MADRS-S) self-report data collected between 2020 and 2024.

Out of 20,197 tDCS users with self-reported depression at baseline, 10,888 had concentration problems (53.9%). Among those who adhered to the tDCS protocol, theproportion who moved from having concentration problems to not having them was 29.3% at one week, 37% at two weeks, 45.2% at three weeks, 54.7% at six weeks, and 57.4% at ten weeks. Concentration problems strongly correlate with depression.

The results show that tDCS can reduce concentration problems in those with self-reported depression. Some people experience concentration problems despite addressing lifestyle and environmental factors that can negatively affect concentration. There are negative side effects of some methods of improving concentration, for example, the use of stimulants. tDCS could be a valuable alternative approach to reducing concentration problems in people experiencing depression. Concentration problems are symptoms of other mental illness diagnosis, for example, schizophrenia and tDCS could be used. Appropriately designed and powered randomised controlled trials (RCTs) are warranted to investigate the impact of tDCS on cognitive functioning and concentration.

Patients assessed by liaison psychiatry frequently have mental health conditions or are prescribed medications that may impair fitness to drive. General Medical Council (GMC) and Driver and Vehicle Licensing Agency (DVLA) guidance require clinicians to assess driving status, provide appropriate advice, and document this clearly. Local observations suggested that this aspect of assessment was frequently omitted, posing patient safety and medico-legal risks.

Aims were to improve the identification, documentation, and communication of driving status and DVLA advice in liaison psychiatry assessments within an acute hospital setting.

A baseline audit of 20 consecutive liaison psychiatry assessments was conducted to assess documentation of driving status and DVLA advice when indicated. A series of Plan–Do–Study–Act (PDSA) cycles were implemented. Interventions included the addition of a “Driving Status and DVLA Advice” prompt to the assessment template, regular verbal and email reminders to the multidisciplinary team, sharing real-case learning points, and displaying visual prompts within the team office. Weekly re-audits were undertaken to assess change over time.

At baseline, driving status was documented in 5% of assessments, and no patients received documented DVLA advice when indicated. Following sequential PDSA cycles, documentation of driving status improved progressively to 50% by week three. Provision of DVLA advice also increased, reaching 13.6% of assessments by week three. Improvements were most marked following repeated reinforcement strategies alongside system-level prompts. Persistent gaps were identified in consistently providing DVLA advice once drivingstatus was confirmed.

Simple, low-cost system and behavioural interventions led to meaningful improvements in documenting driving status and DVLA advice in liaison psychiatry assessments. Sustained improvement required repeated reinforcement and team engagement. Embedding prompts into assessment templates and incorporating DVLA guidance into staff induction are key to long-term sustainability.

MHCAS is a new NHS service that manages patients with an acute mental health crisis, ensuring they are turned around quickly and safely, relieving pressure on hospital wards.

A prolonged patient stay in MHCAS indicates high-risk patients who cannot be discharged safely within 72 hours. Identifying factors associated with delayed discharge can help us characterise high-risk patients and inform safe and efficient patient management strategies. This information can be useful for future MHCAS services across the NHS, aiding in service development and resource allocation.

We aim to identify the key reasons for delayed patient discharge (>72 hours) in MHCAS.

A retrospective data analysis of 96 admissions lasting >72 hours between July and September 2025 was conducted. The main factors examined were discharge destination, borough of origin, diagnoses, and suicidality. The cumulative hours were analysed by discharge destinations as well as the diagnoses based on ICD-10 and averaged per case.

For discharge location, 19.79% were discharged to temporary residence, contributing 141.10h per patient; 42.71% to wards, contributing 139.53h per patient; and 35.42% to their usual place of residence, contributing 120.87h per patient in MHCAS.

For diagnoses, patients with Schizophrenia Spectrum and Psychotic Disorders contributed the longest average stay per admission (138.84h), followed by Trauma and Stress related disorders (133.33h) and Bipolar Spectrum Disorders (128.83h). Schizophrenia Spectrum and Psychotic Disorders were the most common diagnoses (23%), followed by Depressive Disorders (20%) and Anxiety and Somatoform Disorders (12%).

The majority of patients came from CNWL boroughs (88.37%), and Westminster was the biggest contributing borough (30%).

Most patients with prolonged stays were admitted via emergency pathways, primarily A&E or the Home Treatment Team (83%), indicating that these admissions largely reflect high-risk presentations.

Regarding suicidality, 39 patients reported suicidal ideation, 41 did not, and 16 cases were undocumented. Suicidal patients spent 8.52 hours more in MHCAS on average.

Prolonged stays in MHCAS are influenced by multiple factors. Ward admissions and temporary accommodation contributed significantly, showing that delays in beds availability or social services played a key role. Patients with more severe diagnoses, such as schizophrenia, are high-risk, therefore requiring more prolonged care. Information transfer from non-CNWL boroughs could also have resulted in delays in care planning.

Contrary to expectations, suicidal ideation was only associated with a modest increase in length of stay, indicating suicidality alone is not a primary driver.

Anthracyclines are indispensable in paediatric oncology but are associated with well-recognised dose-dependent cardiotoxicity that may result in progressive cardiomyopathy and late heart failure. Dexrazoxane has emerged as a potential primary cardioprotective strategy; however, concerns regarding safety, secondary malignancies, and possible interference with antitumour efficacy have historically limited its widespread adoption.

To critically review current evidence regarding the efficacy, safety, and clinical applicability of dexrazoxane in children receiving anthracycline-based chemotherapy, including region-specific implications for Latin America.

Narrative review of randomised controlled trials, observational studies, systematic reviews, meta-analyses, and international guideline statements evaluating cardiac outcomes, survival, toxicity profiles, and second primary malignancy risk.

Dexrazoxane consistently demonstrates cardioprotective effects, including reduced biomarkers of myocardial injury and improved preservation of left ventricular systolic function, particularly among patients exposed to higher cumulative anthracycline doses. Available data indicate no significant adverse impact on relapse rates, event-free survival, or overall survival. Although early studies raised concerns about increased second primary malignancies, subsequent investigations have yielded inconsistent results, leaving residual uncertainty.

Dexrazoxane represents an effective cardioprotective strategy in selected high-risk paediatric patients. A risk-adapted approach balancing cardioprotection, oncologic safety, and healthcare resources is warranted.

Qualified doctors are required to manage complexity and uncertainty. This can arise with the co-occurrence of mental and physical health conditions in psychiatric settings. In response, this exploratory study was conducted to generate insights into how medical students respond to co-occurring mental and physical health problems in simulated psychiatric settings. It is hoped this can provide insights into how medical educators can better prepare the next generation of doctors for recognising and managing the complexity and uncertainty of encountering co-occurring mental and physical health problems in their clinical practice and increase awareness of the risk of diagnostic overshadowing, especially in the psychiatric patient population.

This study also seeks, through grounded thematic analysis, to gather and analyse the nuanced views of medical students at two diverse institutions on a simulation intervention; medical students’ nuanced views have historically been overlooked in medical educational interventions and are useful for medical educators to guide their practice.

Fourth-year Birmingham and Aston medical students undertake a psychiatric simulation session. This high-fidelity session, which students undertake in pairs with the others observing, is on a simulated inpatient psychiatric ward with an actor as the simulated patient and facilitators as a psychiatric nurse and as senior support via telephone. One of the cases contained co-occurring mental and physical health problems. The researcher conducted the debrief of this case using a supplementary topic guide. These debriefs were recorded, transcribed and anonymised. A grounded thematic analysis of the resultant transcripts was then conducted.

Twelve debriefs were conducted involving 110 students. Grounded thematic analysis of transcripts resulted in three overriding themes: Using previous simulation experience, Recognising and managing feelings, and View of Psychiatry.

The findings of this thematic analysis inform medical educators on how students respond and explain their responses to managing co-occurring physical and mental health problems in simulated psychiatric settings. The resultant discussion of these themes explores potential explanations for these responses, providing insights into how medical educators, especially within psychiatry, could better ensure that graduating medical students can manage complexity and uncertainty on qualification and increase awareness of the risk of diagnostic overshadowing, especially in the psychiatric patient population.

Catatonia is a neuropsychiatric condition that is frequently under-recognised in children and adolescents and may co-occur with a range of psychiatric and neurodevelopmental disorders, including autism spectrum disorder (ASD). Diagnosis is often challenging due to symptom overlap with neurological and psychotic conditions. In individuals with ASD, catatonia may be precipitated or exacerbated by environmental stressors and disruption to established routines. This case report aims to describe the presentation, diagnostic process, treatment, and longer-term management of catatonia in an adolescent with ASD, with particular emphasis on pharmacological treatment, electroconvulsive therapy (ECT), and psycho-ecological interventions.

We report the case of a 16-year-old female who presented with a five-month history of mutism, immobility, unsteady gait, and markedly reduced oral intake, resulting in significant weight loss, nasogastric feeding, and hospital admission. Extensive investigations, including CT and MRI brain imaging, EEG, autoimmune encephalitis screening, metabolic testing, chromosomal microarray, and whole genome sequencing, were unremarkable. A lorazepam challenge produced a marginally positive reaction, thus supporting the catatonia diagnosis. The lorazepam dosage was escalated to 12 mg per day, which yielded partial improvement, though this was limited by sedation. Due to the inadequate response, electroconvulsive therapy (ECT) was commenced.

The first six ECT sessions did not produce any improvement; however, from the seventh session onwards, a substantial and sustained recovery was noted, marked by the resumption of speech, mobility, and functional autonomy. Rehabilitation strategies incorporated structured physical activity and social engagement. Despite the initial progress, symptoms later recurred, including psychomotor retardation and confusion. Fluoxetine and quetiapine were subsequently introduced based on collateral history, resulting in partial improvement. A subsequent neurodevelopmental assessment confirmed a diagnosis of ASD, along with learning difficulties.

Following discharge, a relapse occurred several months later, which was linked to stopping lorazepam and less social interaction. When the patient was readmitted, a psycho-ecological approach was emphasised. This approach focused on organising the environment, managing sensory input, establishing predictable schedules, and helping the patient reintegrate socially. All psychotropic medications were stopped due to low efficacy, except lorazepam. Gradual improvement was seen, along with increased involvement in psychosocial activities.

This case highlights the importance of catatonia as a significant but treatable condition in adolescents with ASD. Although lorazepam and ECT were effective for quickly controlling symptoms, lasting recovery depended on psycho-ecological approach with consistent environment, structured routines, family involvement, and ongoing social interaction.

The Independent Review of the Mental Health Act (MHA) (2018) by Sir Simon Wessely and subsequent MHA White Paper (2021) recommended promoting patient choice, autonomy and least restrictive practice and suggested quality improvement (QI) programme. NHS England led National MHA QI Programme (July 2024– March 2025) across 52 trusts including Saunders ward, Cygnet Stevenage. The aim was to enhance patients’ reported sense of autonomy, strengthen patient voice, and improve relational engagement with staff by March 2025 through co-production and implementation of an individualised “My Story” booklet.

The project was supported by an NHSE QI Coach and Cygnet Executives. We used an evidence-based change approach to identify a local quality gap and targeted improvement ideas. Baseline information was gathered through equity huddle discussions, apre-QI patient questionnaire, and the Fearless Organisation survey to explore staff psychological safety. The key areas of inequity identified: underrepresentation of patient’s views, lack of support to identify strengths, and communication gaps with the staff especially non-permanent staff.

To address these, PDSA cycle was used to co-produce a patient-led, individualised “My Story” booklet. Five patients participated in the pilot, creating booklets describing their interests, personal journeys and future goals. The booklets were confidentially stored and made accessible to all staff to support personalised and relationally informed interactions. By making patients’ identities and preferences visible, the intervention was intended to enable more personalised interactions, thereby supporting relational engagement and patient autonomy.

Following implementation of “My Story” booklet, patients reported improved relational engagement with staff during routine day-to-day interactions. Post-intervention questionnaires demonstrated improvement across targeted domains, ability to express preferences and interests to staff (60%). Qualitative feedback indicated that staff, including agency staff, initiated more personalised conversations, such as enquiring about patients’ activities or future goals. Given the small pilot sample (n=5) limited statistical significance, patient testimonies reflected increased confidence in engaging with staff and a desire for continued involvement and further development of their “My Story” booklet.

This co-produced QI intervention supported aims of MHA reform by enhancing patient autonomy and relational engagement within a low secure setting. By making patients’ identities and preferences visible to all staff, the intervention facilitated more personalisedand meaningful interactions. As a small-scale pilot, the project demonstrates potential value of simple, patient-led tools in strengthening relational security and supporting less restrictive, person-centred care. Future work will focus on embedding the intervention into routine practice and exploring its applicability across other secure inpatient settings.

Valproic acid is an effective mood stabiliser but carries significant teratogenic risks when prescribed to women of reproductive age. Clinical guidance recommends that women are fully informed of these risks, advised on effective contraception, and that discussions are clearly documented as part of shared decision-making. This audit aimed to assess the extent and quality of documentation of counselling on teratogenic risks, pregnancy prevention, and informed consent in women of reproductive age prescribed valproic acid at a tertiary mental health service in the United Arab Emirates (UAE).

A retrospective clinical audit was conducted at the Behavioural Sciences Unit, Al Ain Hospital. Pharmacy records and electronic medical notes were reviewed for all female patients aged 18–50 years who were prescribed valproic acid during the audit period. Patients with intellectual disability, cerebral palsy, or severe cognitive impairment were excluded because of limitations in informed consent. Audit standards were derived from the National Institute for Health and Care Excellence (NICE) and Medicines and Healthcare products Regulatory Agency (MHRA) guidance on the Valproate Pregnancy Prevention Programme, focusing on documenting counselling about teratogenic risks, contraception, pregnancy prevention, and informed consent. Data were analysed descriptively as frequencies and percentages.

A total of 56 female patients of reproductive age were prescribed valproic acid during the audit period. Seven patients were excluded, leaving 49 for analysis. Documented counselling regarding the teratogenic risks of valproic acid, including congenital malformations and neurodevelopmental impairment, was present in 12 patients (24.5%). In these cases, documentation included discussion of pregnancy prevention and contraceptive advice. The remaining 37 patients (75.5%) had either partial documentation or no documented evidence of counselling regarding teratogenic risks, contraception, or pregnancy prevention. Documentation of partner involvement in discussions was noted in 5 cases (10.2%). Only 8 patients (16.3%) had a discussion of alternative treatment options recorded in the medical notes.

This audit found major gaps in documenting counselling and consent about valproic acid’s risks in women of reproductive age. While counselling may happen, poor documentation poses medicolegal and safety concerns. Interventions like electronic prompts, templates, multilingual leaflets, and clinician awareness are needed to boost guidance compliance. A follow-up is advised to evaluate these actions and ensure safer prescribing.

No financial sponsorship has been received for this project.

Antipsychotic-induced hyperprolactinaemia is a common adverse effect associated with dopamine-blocking medications. Persistently raised prolactin is linked to sexual dysfunction, infertility, and importantly, reduced bone mineral density and osteoporosis. Concerns were raised that prolactin monitoring within the service was inconsistent and that raised levels were not always acted upon, posing potential long-term risks.

• • Assess whether patients prescribed antipsychotics had prolactin levels appropriately monitored, during my psychiatry placement at the Early Intervention team in Adult psychiatry.

• • Determine whether elevated prolactin prompted clinical action.

• • Identify gaps in monitoring practice and associated risks to bone health.

• • Provide recommendations to improve standards of care.

A retrospective audit of referrals over a six-month period was performed usingRiOelectronic records.

• • Patients not on antipsychotics were excluded.

• • For eligible patients, the following were reviewed:

  1. Antipsychotic medication.

  2. Whether prolactin was checked.

  3. Whether levels were normal or raised.

  4. Documentation of any medication adjustment or follow-up.

• • Comments were added to highlight missed monitoring opportunities or incomplete documentation.

• • Total referrals reviewed: 43

• • Excluded (not on antipsychotics): 20

• • Included for audit: 23

Key Findings:

• • 6/23 (26%)hadno prolactin test despite being on antipsychotics.

• • 15/23 (65%) had normal prolactin results.

• • 2/23 (9%) had raised prolactin, with one severe elevation (4155.6 mU/L).

Only 1 patient had clear medication adjustment in response to raised prolactin

Implications for Bone Health:

• • Persistent or unmonitored hyperprolactinaemia increases osteoporosis risk.

• • No consistent documentation linking raised prolactin to bone-health outcomes (e.g., DEXA, vitamin D).

Overall, the team demonstrates good awareness and management of prolactin-related issues, with most patients receiving appropriate monitoring and normal results. When significantly raised prolactin levels were identified, clinicians acted promptly with medication review and plans for follow-up, reflecting good clinical practice.

The key learning point is the value of maintaining this strong standard while improving documentation clarity and ensuring timely follow-up of repeat prolactin testing. No major pathway changes are required; instead, small refinements can further strengthen already effective care.

The QIP identified only one patient with raised prolactin who had not yet received a medication adjustment.

Clinical depression is one of the most prevalent psychiatric illnesses, yet patient understanding of the condition is often lacking. Effectively educating patients on their diagnosis is a key communication skill for clinicians and future doctors.

This qualitative study aimed to compare how consultants and medical students, two ends of the medical hierarchy, differ when explaining depression to patients, whilst examining the potential clinical and educational implications.

Semi-structured online interviews were conducted with 12 final-year students and four consultants (two psychiatrists and two general practitioners). Participants were asked to role-play how they would discuss a suspected depression diagnosis to a lay patient, and explain the condition.

Linguistic and thematic analysis was conducted using Nvivo.

Consultants tended to avoid heavy neurobiological discussion, using simplifications and generalisations to explain things with brevity and relating back to a patient’s individual experience. One psychiatrist explained that this simplified description aimed to prioritise patient comprehension and acceptance to treatment, where ‘bogg[ing] them down with…scientific facts’ was feared to cause confusion or take emphasis from what the clinician deemed important.

In contrast, despite avoiding medical jargon, students gave more verbose biochemical explanations. All students referred to the neurobiological theory behind depression within their answers.‘Serotonin’ specifically was mentioned by three students, but not by any consultants. Students also showed difference in language style, often asserting a more declarative tone by informing a patient of their diagnosis, clearly separating themselves as the expert. Consultants framed explanations as a collaboration and promoted patient self-reflection, inviting the patient to follow their diagnostic conclusion, reducing doctor–patient asymmetry in the hypothetical consultation.

Students medicalised depression to properly inform patients and validate their experiences. Comparatively, consultants were succinct and practical for clarity, comprehension and mutual understanding. There is research to support this latter approach, which suggests that an overemphasis on the neurobiological basis of depression can cause a lack of focus on the social and emotional dimensions of the illness. This may even cause a favouring of pharmacological over cognitive therapies.

Communication skills training for these students has effectively taught them to avoid unexplained medical jargon, but may need greater emphasis on delivering practical, patient-centred information when educating patients on their psychiatric conditions. However, due to the limited scope of this study, further research would be needed with larger cohorts in a more clinically realistic setting.

The NHS Long Term Plan advocates for ambient voice technology (AVT) tools to alleviate administrative burden and improve patient access. However, psychiatric assessment relies heavily on linguistic nuance in culturally diverse presentations. Moreover, accent diversity may affect AVT speech recognition. This raises concerns about inaccurate records and the widening of health inequalities.

This study aims to evaluate the accuracy of three NHS-approved AVT tools–Company A, B, and C–in summarising psychiatric consultations across diverse cultural presentations and accents.

We evaluated three AVTs using test scripts (n=3) simulating depression, dementia, and psychosis. The study included:

1. Cultural Test: Scripts adjusted for British, Nigerian, Pakistani, and Polish presentations using standardised controlled speakers.

2. Accent Test: Participants (n=9) with diverse UK and international accents reading identical scripts.

3. Output summaries were evaluated against a gold-standard checklist. Errors were classified as ‘missing/incomplete’, ‘incorrect/misleading’, or ‘hallucination’ (information not stated in the script).

Data are presented as mean accuracy [95% CI].

Cultural test: Company B demonstrated the highest stability: British 85% [83–87], Polish 85% [78–91], Nigerian 81% [74–88], and Pakistani 79% [72–86]. Company A displayed some variability, performing better on Nigerian 76% [69–82] and Pakistani 75% [63–86] scripts than on British 65% [43–87] and Polish 61% [34–89]. Company C consistently underperformed, ranging from British 58% [41–75] to Nigerian 56% [40–72].

Accent test: Performance was notably more stable. Company B remained stable across local (South England 84% [79–89]) and international (Spanish 80% [76–84]) speakers. Company A peaked in South England 82% [78–86] but degraded for Nigerian 69% [60–78]. Company C generally mirrored this stability (e.g. Romanian 78% [68–88]) but suffered a technical speech recognition failure for the South England accent (19% [14–23]).

Error distribution per tool: Missing/incomplete errors (>92%) dominated across all tools; 98.1% of Company A’s errors were missing/incomplete, with minimal hallucinations (1%). Company B and Company C showed higher rates of active error: Company C recorded the highest percentage of both hallucinations (2.3%) and incorrect/misleading data (5.4%), followed by Company B (1.7% and 4.7%, respectively).

No statistically significant difference was found in overall accuracy acrosscultures or accents; however, Company B produced the most consistent summaries, while Company C produced the least. Limitations include small sample size, limited representation, and simulation design. Although seemingly robust across cultures/accents, incomplete summaries highlight the need for human oversight in clinical use. Future work must assess these tools in larger, live clinical settings to ensure safety for diverse populations.

The Pediatric Inventory for Parents measures the frequency and difficulty of parental disease-related stress. We describe the psychometric properties and evaluation of the Norwegian version for mothers of infants with CHD.

The Pediatric Inventory for Parents contains 42 items within four domains: (1) communication, (2) emotional functioning, (3) medical care, and (4) role function. Participants assessed the frequency and difficulty of disease-related stressful events over the previous seven days. Data were collected from 48 Norwegian-speaking mothers of infants with CHD one month after hospital discharge. The psychometric properties of the frequency subscale were explored using exploratory factor analysis, and the discriminant and concurrent validity of the total scale were examined.

Factor analysis revealed that some items had poor loadings in our sample of mothers of infants with CHD. Cronbach’s alpha in domains was between 0.69 and 0.90. The Pediatric Inventory for Parents discriminated between stress levels in CHD severity in both subscales and all domains (p-values 0.03 to 0.001). Difficulty of disease-related stress and symptoms of depression were moderately correlated (r = 0.56 to 0.63).

The domains on the frequency subscale were multidimensional, and some items had lack of relevance to the population studied. Despite this, the Pediatric Inventory for Parents differentiated between stress in different CHD severity groups and correlated moderately with symptoms of depression. We recommend developing an infant version of the instrument. If the original version is used in mixed populations, lack of relevance of some items to infants should be accounted for.

This retrospective quality improvement project audited how well children and young people (CYP) who presented with mental health concerns to Leicester's Paediatric Emergency Department (PED) were being assessed. During the audit period, Leicester's PED had two digital forms available to be filled out by the triaging clinical staff. One of the forms was titled the emergency department (ED) mental health risk assessment tool which determines what is needed to keep CYP safe while they wait to be seen, and a second form titled the ED mental health form which includes mental state examination and a dynamic priority score (DPS). Completion of these tools fits in with meeting the requirements of the NICE Guidance (NG225).

This was a retrospective audit of 59 patients who presented to the Leicester PED with acute mental health concerns in September 2024. Data collection took place onNerveCentre, which is the digital software Leicester's ED uses for the documentation of clinical activities.

The following data was collected:

1. Percentage of total completed mental health risk assessments using the assessment tool.

2. Percentage of ED mental health forms which were opened/started by staff.

3. Percentage of ED mental health forms which had a completed mental state examination.

4. Percentage of ED mental health forms which had a DPS score assigned.

1. 11.9% (7/59) patients had a completed ED mental health risk assessment using the assessment tool.

2. 62.7% (37/59) patients had an ED mental health form opened/started by staff.

3. 43.2% (16/37) of the ED mental health forms which were opened had a completed mental state examination.

4. 78.4% (29/37) of the ED mental health forms which were opened had a DPS score assigned to signify the level of risk.

The audit also revealed that the tool may not be as suitable for CYP (mentions of capacity rather than competence, high-risk outcome suggests rapid tranquillisation). Additionally, there is overlap between the tool and the form, which may be contributing to the lower completion rates of the tool.

This audit revealed that Leicester PED's initial assessment of CYP presenting with acute mental health concerns needs to be reviewed, with enhancements made to make the tools more applicable for CYP. Revamped tools can then be further embedded with education and training amongst staff to increase the department's adherence to the NICE Guidance (NG225).

The need for a clear, consistent handover process was identified amongst resident doctors covering Avon and Wiltshire Mental Health Partnership (AWP) Bristol inpatient sites, including at Callington Road Hospital (CRH).

Previously, the overnight doctor handed over to the daytime ward doctors using a variety of methods. This included email, face-to-face, or by ward phone. Face-to-face handovers were infrequent as it was impractical to visit 7 wards individually to hand over. Daytime doctors were difficult to reach by phone, due to concurrent morning MDT handovers.

Email was a widely used handover method. However, there was risk of delay in receiving and acting on information, with patient safety implications. Our aim was to make the inpatient handover system safer and more fit-for-purpose.

Our scoping questionnaire (December 2024–March 2025) found that most responders favoured face-to-face when giving (10 of 16) and receiving (11 of 16) handover. Only 25% agreed the existing system was fit-for-purpose and 19% agreed it was safe.

Based on this information, a weekday in-person handover was introduced at CRH from 9.00–9.15am.

We received backing from the Head of Bristol Inpatients, the Bristol, North Somerset and South Gloucestershire Medical Inpatient Lead, and CRH consultants to initiate a 2-month pilot.

The pilot was advertised amongst resident doctors and launched in May 2025. Feedback was gathered via online questionnaire and handover attendance monitored using a logbook.

82% attendance was achieved at the in-person handover during the 2-monthpilot (May–July 2025).

The 10 questionnaire responses during the pilot showed 80% agreed the new system was fit-for-purpose and 100% agreed it was safe.

Positive feedback included that there was a reduced chance of miscommunication, clarification was easier, and tasks were less likely to be missed. Night doctors found the new handover quicker, less stressful, and felt tasks were more likely to be actioned. Finally, resident doctors found the in-person handover more sociable. Suggestions for improvementincluded encouraging increased attendance, making locums aware of the new handover, and including the other 2 inpatient sites covered overnight in the handover process.

Overall, the in-person handover pilot was successfully implemented, with overall good attendance and positive feedback regarding its safety, efficacy, and social aspect. It has been incorporated into the locum induction and induction for resident doctors working at CRH for future rotations. We also plan to extend this project to the other 2 Bristol inpatient sites to create a streamlined handover system to positively impact patient safety.