Annually, 1 in 4 people in the UK will experience a mental health problem. Alongside the approach of increasing awareness of the issue amongst the general population, there is a drive to deliver training and education on the recognition and management of mental health crises. Limited resources exist to aid healthcare professionals in delivering mental health first aid (MHFA), with the vast majority focussing on lengthy training courses. Small group problem-based learning (PBL) is utilised widely in medical education and this modality offers advantages in deliverability, audience participation and experiential learning. Our aim was to deliver and explore the effectiveness of a PBL MHFA workshop to various healthcare professionals.

As part of an Emergency Medicine Mental Health Education day, we delivered four 30-minute PBL MHFA workshops. These involved an introduction to MHFA, followed by an interactive discussion of 4 mental health simulated cases, whereby participants anonymously answered a range of questions using the web-based platform Mentimeter. We devised a simple MHFA A,B,C,D,E acronym to bring structure to problem solving. Pre- and post-workshop questionnaires were used to assess outcomes using Likert scales to measure various aspects of MHFA (1 = strongly disagree and 5 = strongly agree). Statistical significance was calculated using T-Test with P < 0.05 defining statistical significance.

A total of 28 professionals attended the workshops, 20 (72%) completed both the pre and post workshop questionnaire. 19 (76%) were nurses (5 Registered Mental Health Nurses and 14 Registered General Nurses), 3 (12%) were doctors, 2 (8%) were HCA's and 1 was a policeman. 15 (75%) of the participants reported historically having had the need to deliver MHFA but only 3 (15%) had previously received training. After the workshop, participants reported significantly increased understanding [3.0 to 4.3 (p < 0.05)] and confidence in delivering MHFA [3.05 to 4.30 (p < 0.05)]. There was significantly improved confidence in assessing risk [3.03 to 4.05], calling for appropriate help [3.45 to 4.35] and de-escalation techniques [3.05 to 4.15].

To our knowledge this is the first mini PBL-based MHFA workshop. We have demonstrated that the PBL workshop setup is an effective means to deliver training on MHFA. We recognise the importance of MHFA training reaching a larger audience and its potential value if incorporated into national healthcare training programmes and made available to the general public.

We aimed to assess the impact of the current pandemic on the mental well-being of undergraduate medical students of Alexandria Faculty of Medicine, Egypt.

We designed a structured anonymous online questionnaire and encourage students to fill it in on social platforms. The questionnaire is composed of seven parts, each one includes multiple choice questions aimed to measure the impact of the pandemic on different aspect of daily activities namely: academic performance, social and family relationship, eating and smoking habits, sleep pattern, physical activity and the Depression, anxiety and stress scale (DASS-21). The last part was an open question where participants can state their comments about the experiences during the quarantine and how they affected their mental health.

A total of 1181 students from the six academic grades responded. Females and students in the third academic year showed the highest prevalence of depression, anxiety and stress. Overall, most respondents reported that the current pandemic had negative impacts on their academic performance (71%) and social relationship (67.5 %). The majority of the students stated that they became less physically active (74.6%) and 52.2% experienced a weight gain. Despite that 60% of the studied population rated their sleeping quality as ‘’very good’’ and ‘’fairly good’’, 45.3% and 39.6% suffered from increased sleeping hours and disturbed sleep respectively. Based on students’ responses of the DASS-21, over half of the participants (62.2%) were experiencing moderate to extremely severe stress and over 33% were consistent with symptoms of extremely severe anxiety. In respect of depression, nearly half of the sample (46.4%) can be described as having extremely severe depression according to the cut-off points of the DASS-21.

The current pandemic has increased the challenges and burdens on undergraduate medical students. These impacts can be more profound in developing countries such as Egypt. The levels of psychiatric symptoms are alarming compared to previous local and international studies. These unprecedented consequences should be addressed promptly through students’ counselling and psychiatric assistance. To date, this is the largest psychiatric and survey-based study conducted on Alexandria Faculty of Medicine.

Financial disclosure: The study was not funded by any organization, the authors did not receive any financial aids.

This poster reflects how the experience of staying with people of diverse nations and cultural background helped the stranded IMGs cope with this agony in a foreign land during an unprecedented tumultuous situation. The aim is to show that despite diversity among people, the hard times made them unite and overcome countless difficulties.

The COVID 19 pandemic has been a period of global health crisis and has exponentially affected mental health issues in the world population. In these difficult times, several International Medical Graduates (IMGs), who had come to the UK to attend their PLAB exams, were left stranded as the exams were postponed, flights cancelled and borders sealed. Faced with huge uncertainty their mental health was of great concern.

At this time the British Association of Physicians of Indian Origin (BAPIO) came forward to help this cohort of stranded doctors in terms of accommodation, finances, mental health support, preparation for exams to the extent of liaising with General Medical Council (GMC) and Home Office. The virtual support group provided a platform for IMGs from different nations and cultures to get in touch with each other helping overcome mental burden and stress.

The stories presented in the poster show how unity in diversity helped these young doctors deal with mental trauma amidst the Pandemic.

276 doctors from 27 countries were looked after by BAPIO. From those excerpts taken from 26 IMGs, personal narratives was used as a method for qualitative assessment.

The percentage of IMGs clearing their exams and getting jobs in the NHS has been used for quantitative assessment.

Qualitative: The personal narratives of the IMGs show how they were positively impacted by staying together albeit different nationalities and cultural background.

Quantitative: A total of 21 IMGs out of the 26 cleared their PLAB 2 exams and got registration under General Medical Council giving a percentage of 81.7%. 20 IMGs have successfully joined the NHS in various posts giving a job success rate of 95.2%.

The experience of living and sharing housings with people from different nationalities, has increased appreciation and also prepared them to work in the NHS which has a diverse work force. This learning experience has been integral for all of us in shaping our life in the UK making everyone more compassionate.

Our aim is to study factors influencing attitudes of medical students towards pursuing Psychiatry as a career. We hypothesise that the minimal exposure and/or importance given to Psychiatry during medical school is insufficient to let a student truly experience and appreciate the specialty.

Studies report an annual decline in Psychiatry Trainees in many parts of the world. This deficiency is projected to create gaps between mental health service needs and providers. Studies have also explored the crisis in recruitment and the positive impact a short course can have in promoting engagement in Psychiatry by students.

An anonymous questionnaire was distributed amongst medical students, from years 1 to 5, in the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Factors assessed in the survey included demographics, specialty ranking, acceptance ratios, role models and personal experiences, among others. Those who didn't express interest were asked about the lack of exposure to Psychiatry during medical school along with other influential factors that have been studied elsewhere, including those that we hypothesise to be of significance in our study population.

A total of 153 students responded. Positive views towards Psychiatry increased linearly by year (50% in Year 1 to 90% in Year 5). 33% of students selected psychiatry as a top 3 choice with the most significant factors being a unique patient-doctor relationship (P < 0.05), and the challenges faced in the specialty (95%).

Of the 67% of students who did not prefer Psychiatry, insufficient exposure to ward experiences and the specialty as a whole were unanimously agreed upon factors. Other deterring factors included lack of instant gratification when treating a psychiatric patient (72%), and an underestimation by the non-medical community of a Psychiatrists role (26%).

Our findings give an optimistic view towards the future of Psychiatry in the region, given the large number of students (33%) who consider it in their top 3 choices for a career. However, a larger number of students continue to have a negative view towards Psychiatry, especially due to the lack of exposure to the specialty during medical school. The factors identified in our study should be tackled by medical schools or curriculum provision authorities, as this has shown to be of benefit in studies in other parts of the world.

To assess the impact of Psychiatry School on the attitudes towards psychiatry in Pakistani medical students (MS) and junior doctors (JD).

Inspired by the Royal College of Psychiatrists’ ‘Choose Psychiatry’ campaign, an online event by the name of ‘Psychiatry Autumn School Pakistan’ was held on the 1st of November 2020. The event was promoted through social media and medical students and junior doctors from across Pakistan were invited to attend. Moreover, a panel of British and Pakistani psychiatrists belonging to different sub-specialties was invited to deliver talks. The attendees were provided an insight into psychiatry as a viable career option and were introduced to the training pathways, research opportunities, and the various sub-specialties present within the field.

Participants were requested to complete the 'Attitudes Towards Psychiatry' (ATP-30) questionnaires before and immediately after the event. Individual scores on the questionnaire can range from 30 to 150 and a high score indicates a positive attitude. Statistical analysis was performed using a paired t-test.

41 attendees (MS = 30, JD = 11) completed the pre-and post-school survey. The respondents were majorly female (76%) and from public sector universities (76%), with an average age of 23 years. The mean ATP score before the course was 119 (MS = 117, JD = 121) which increased by 9 points to 128 (MS = 126, JD = 131) after the event. When the two samples were compared using a paired t-test, the difference was statistically significant p < 0.005.

We conclude that a psychiatry school can positively influence attitudes towards psychiatry in medical students and junior doctors and our findings are consistent with similar studies done in other countries.

In Pakistan, unfortunately, only 2–4% of undergraduate students opt for a career in psychiatry owing to insufficient knowledge and awareness about the available treatment modalities and advancement in the field. Hence, such an intervention can greatly enhance recruitment within the profession as it makes psychiatry more accessible and visible as a career choice, generates awareness about the effectiveness and evolution of psychotherapeutic practices, and eradicates misconceptions about the field that prevail among young doctors.

This was the first psychiatry school held in Pakistan and the findings of the study as well the feedback received from the participants and the speakers motivate us to continue campaigning for ‘Choose Psychiatry.’

To determine the prevalence and correlates of depression and quality of life and their relationship among primary caregivers of patients with schizophrenia in a psychiatry specialist hospital.

A total of 138 caregivers of patients diagnosed with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Aro, Abeokuta were recruited. Sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI-PLUS) (depressive module) and World Health Organization Quality of Life-Bref (WHOQOL-Bref) were administered on the caregivers while Brief Psychiatric Rating Scale (BPRS) was used to measure symptoms severity in the patients.

The mean (±SD) age of respondents was 48.3 years (±14.7), 53.6% were females and 33.3% were without partners. The prevalence of depression among the caregivers who participated in the study was 13.8%. Female gender (χ2 = 5.68, df = 1, p = 0.02), hailing from a minority tribe (χ2 = 9.78 df = 1, p < 0.01), and Previous treatment for mental illness (χ2 = 8.24 df = 1, p < 0.01) were associated with depression. Female gender (ß = 1.35, OR = 3.86, p = 0.03), minority tribe (ß = 1.95, OR = 7.03, p < 0.01), and previous treatment for mental illness (ß = 3.19, OR = 24.21, p = 0.01) were independently predictive of depression in the caregivers.

Independent predictors of lower quality of life (QOL) were: Parents/siblings relationship for social relationship domain (ß = −7.076, p = 0.037) and spending more than 35 hours per week for Environmental domain (ß = −5.622, p = 0.028).

Finally, a significant correlation was also found between Depression and Psychological Domain of QOL (t = 3.048, p < 0.01) and Social Domain of QOL (t = 2.154, p = 0.03).

This study shows that primary caregivers of patients with schizophrenia have high prevalence of depression and poor quality of life. There is need to pay attention to the psychological wellbeing and quality of life of caregivers who come in contact with psychiatric services, and not just the patients they accompany.

Description of a model to improve care for patients with Medically Unexplained Symptoms (MUS) by small targeted investment and maximisation of existing resources.

Treatment of MUS presents several challenges including a lack of clarity on the best models of care and limited service provision. Patients typically present with a physical complaint to physical health outlets: here limited confidence in professionals around how to address these often leads to poor patient/doctor experience, inappropriate use of resources and repeated attendance. Evidence shows that integration of care, psychological interventions and upskilling physicians in interventions such as positive communication, can significantly improve outcomes. Psychiatric Liaison Teams (PLT) are positioned at the interface of mental and physical health services and can play a crucial role for these patients, when provided with the right skill-mix.

1FTE Clinical Psychologist specialising in MUS was integrated into the PLT. Pathways to triage between primary, secondary psychology and the new service were agreed, alongside channels of communication and supervision. The job plan included integrated sessions in Gastroenterology, Rheumatology and PLT. The activities included: assessments, formulations and discharges; brief psychological interventions; group sessions for patients; one-day long courses to GP trainees and physicians, and input in specialities MDTs. Clinical outcomes, numbers of patients seen and signposted, teaching sessions and simulation training delivered were collected.

Over 20 months the service was able to process 237 referrals, 35 were managed over the phone. Referral sources: Gastroenterology 32%, Rheumatology 37%, Psychiatric liaison 28%.

116 patients attended 315 face to face appointments and 21 phone contacts were made. Core-10 data show reduction from moderately severe to mild psychological distress in a sample of patients. 58% of patients were referred on for continuing care. The service ran 8 patient groups including sessions on pain management and joint sessions with Rheumatology. It ran 9 one-day long courses for GP and physician trainees, training a total of 120 doctors: feedback showed increased confidence in managing and recognising MUS. Attendances to Emergency Departments covered by Barking Havering and Redbridge and Bart's Health Trusts combined (5 sites) reduced by 22%, saving an estimated £19,200, while ambulance usage in the cohort dropped by 29%, saving an estimated £9072.

The integration of a specialist psychologist with a mix of educational, advisory and clinical role to a PLT can provide an effective and efficient stepped-up model to increase the provision of care for patients with MUS

1.To generate a Natural Language Processing (NLP) application that can identify mentions of perinatal self-harm among electronic healthcare records (EHRs)

2.To use this application to estimate the prevalence of perinatal self-harm within a data-linkage cohort of women accessing secondary mental healthcare during the perinatal period.

Data source: the Clinical Record Interactive Search system. This is a database of de-identified EHRs of secondary mental healthcare service-users at South London and Maudsley NHS Foundation Trust (SLaM). CRIS has pre-existing ethical approval via the Oxfordshire Research Ethics Committee C (ref 18/SC/0372) and this project was approved by the CRIS Oversight Committee (16-069). After developing a list of synonyms for self-harm and piloting coding rules, a gold standard dataset of EHRs was manually coded using Extensible Human Oracle Suite of Tools (eHOST) software. An NLP application to detect perinatal self-harm was then developed using several layers of linguistic processing based on the spaCy NLP library for Python. Evaluation of mention-level performance was done according to the attributes of mentions the application was designed to identify (span, status, temporality and polarity), by comparing application performance against the gold standard dataset. Performance was described as precision, recall, F-score and Cohen's kappa. Most service-users had more than one EHR in their period of perinatal service use. Performance was therefore also measured at “service-user level” with additional performance metrics of likelihood ratios and post-test probabilities. Linkage with the Hospital Episode Statistics datacase allowed creation of a cohort of women who accessed SLaM during the perinatal period. By deploying the application on the EHRs of the women in the cohort, we were able to estimate the prevalence of perinatal self-harm.

Mention-level performance: micro-averaged F-score, precision and recall for span, polarity and temporality all >0.8. Kappa for status 0.68, temporality 0.62, polarity 0.91. Service-user level performance: F-score, precision, recall all 0.69, overall F-score 0.81, positive likelihood ratio 9.4 (4.8–19), post-test probability 68.9% (95%CI 53–82).

Cohort prevalence of self-harm in pregnancy was 15.3% (95% CI 14.3–16.3); self-harm in the postnatal year was 19.7% (95% CI 18.6–20.8). Only a very small proportion of women self-harmed in both pregnancy and the postnatal year (3.9%, 95% CI 3.3–4.4).

NLP can be used to identify perinatal self-harm within EHRs. The hardest attribute to classify was temporality. This is in line with the wider literature indicating temporality as a notoriously difficult problem in NLP. As a result, the application probably over-estimates prevalence, to a degree. However, overall performance, given the difficulty of the task, is good.

Bearing in mind the limitations, our findings suggest that self-harm is likely to be relatively common in women accessing secondary mental healthcare during the perinatal period.

Funding: KA is funded by a National Institute for Health Research Doctoral Research Fellowship (NIHR-DRF-2016-09-042). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. RD is funded by a Clinician Scientist Fellowship (research project e-HOST-IT) from the Health Foundation in partnership with the Academy of Medical Sciences which also party funds AB. AB's work was also part supported by Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities, as well as the Maudsley Charity.

Acknowledgements: Professor Louise M Howard, who originally suggested using NLP to identify perinatal self-harm in EHRs. Professor Howard is the primary supervisor of KA's Fellowship.

To compare the feasibility and acceptability of delivering a simulation-based learning (SBL) programme for Junior Doctors virtually versus face to face.

The Nottinghamshire Healthcare Simulation Centre has been delivering a SBL programme for Foundation Year 2 doctors on behalf of Health Education East Midlands for the past three years. Since face to face teaching was not possible during the COVID-19 pandemic the programme was delivered online using the same content and format as for prior cohorts. Feedback questionnaires from 128 face to face participants (F2F) and 133 virtual participants (V) were compared.

There was a decrease in Likert scale ratings across all domains in the virtual group. This was most apparent when examining the ‘strongly agreed’ responses: the venue/remote format was suitable for the session 34% decrease, the course length was appropriate 24% decrease, the pace of the course was appropriate 20% decrease, the simulation was helpful and relevant 15% decrease, the content of the course was organised and easy to follow 13% decrease, the learning objectives were met 10% decrease, the presenters were engaging 6% decrease, the trainers were well prepared 3% decrease. The virtual group included responses in the ‘strongly disagree’ and ‘disagree’ categories relating to the virtual format, length and pace, which did not occur in any domain for the F2F group.

Combining the ‘strongly agree’ and ‘agree’ statements also showed a decrease in satisfaction with 72.5% of responses falling into this category for the V group and 88.3% for the F2F group. Fewer participants in the V group would recommend the course to a colleague (98% V vs 99% F2F).

Providing the SBL programme using an online format was feasible while also being acceptable to most participants. However, participants did not rate this experience as highly as face to face teaching. The largest decreases in satisfaction were in areas related to the virtual format. An interesting finding is that participants rated the pace and length of the online course as less agreeable, despite the content and scheduling being the same as for the face to face group.

Based on these findings face to face teaching should resume when practicable. In the meantime, the virtual delivery may be improved if the course length was reduced. Analysis of qualitative feedback may provide insights into why participants did not rate the virtual simulation as highly as the face to face equivalent.

The scope of this audit is to look at the:

1. 1. Completion rates of standard 12 lead electrocardiograms (ECGs)

2. 2. Completion rates of physical examinations

3. 3. Analysis of the reported findings elicited from physical examinations

4. 4. Completion rates of Blood borne virus (BBV) screens; for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV)

Physical Examination: All patients’ physical GSSMS notes were checked for a Medical Assessment sheet. If no physical examination documentation was found, the generic clinical notes were examined for evidence of a physical examination. All findings were recorded in Microsoft Excel for descriptive analysis. Findings were then grouped into generic categories such as infectious, cardiac, etc. (see Figure 7).

ECG: All patient notes were examined in the ‘Investigations’ section to determine if an ECG was included. Print outs of ECGs done by other agencies/teams were accepted as long as they were within date. If a patient had an ECG on Clinical Workstation (CWS) within date it was not included in the audit unless the ECG was printed and filed in the ‘Investigations’ section.

BBV Screen: All patient notes were investigated to find evidence of the BBV consent sheet or print out of the results. If no evidence was found, CWS was checked for evidence of a blood borne virus screen. 5 Analysis of BBV screen results and completion of consent sheets were beyond the scope of this audit. If a patient had a BBV screen that was different to the standard GSSMS screen, such as a screen with HIV only or a BBV screen as part of an ante-natal screen, it was still included as a completed BBV screen.

Total patients initially included (n = 125). Patients included in analysis (n = 121). Patient notes not on site (n = 2). Patients assessed on ward but did not engage with service afterwards (n = 2)

Physical Examinations

Received a physical examination by GSSMS (n = 60)

Has not received a physical examination by GSSMS (n = 61)

An abnormality was detected in 77% of patients, charts to be added to display the findings to poster.

Most common findings were Hypertension (n = 9) and Abdominal Tenderness (n = 9).

ECG

Had an ECG (n = 37)

Did not have an ECG (n = 84)

BBV Screen

Had a BBV test in the last 6 months (n = 62)

Did not have a BBV Test in the last 6 months (n = 59)

Areas of Good Practice

1. As opposed to previous practice, physical examination rates have risen from 0% to 50%. The 50% rate also likely underestimates true practice as patients were included in these numbers if they: a. Disengaged prior to a medical examination but after a nursing assessment. b. Refused a physical examination

2. The vast majority of physical examinations elicited positive findings, identifying health needs and risks

3. ECG completion rate of 31%, despite being low, represents a significant improvement as the team did not have an ECG machine prior to the audit. Establishing a baseline ECG would also be of clinical value even if normal, as it would allow for future comparisons of QTc intervals compared to pre-treatment baselines. Patients may have had an ECG on mental health wards or in general hospital with the results/ECG being communicated to GSSMS staff, although it would not have been included in the audit as a completed ECG unless a copy was filed in the notes.

4. As previous BBV screen completion rate had not been quantified to obtain a baseline, it is difficult to compare current BBV screen completion rate. 66% of patients had had a BBV screen in the last year. This audit did not account for patients who disengaged prior to their BBV screen or patients who refused a BBV screen. This audit also includes all patients under GSSMS and BBV completion rates included alcohol dependent/neverinjecting patients which would be of lower risk as opposed to Injecting Drug Users. With that context in mind, a completion rate of 66% likely reflects good practice.

Areas for Improvement/Recommendations

1. Development of a checklist which can be placed on the front of a patients notes with dates that can be documented for ECG, Physical Examination, etc. as well as non-physical health documents such as risk assessments and care plans to ensure documents stay in date.

2. Further audits with more data would reveal further information with regards to the needs of patients under GSSMS. If current trends continue with improvements in detection, a larger pool of analysable data would be available. Based on current limitations of this audit a re-audit would benefit from: a. Quantifying BBV screen results to identify percentage of patients who are antibody and PCR positive; this can be done as a standalone project. b. Quantifying actions taken as a result of physical examination findings as that would indicate what additional service requirements (if any) need to be highlighted. The current method of auditing does not comment on severity or chronicity and does not account for the actions taken as a follow-up to the physical examination which may indicate acuity.

3. Further audits may require alterations to data collection may be allow for more specific measurement of health risks and needs. Eg. Highlighting if a patient is injecting substances or on a QTc prolonging medication. This would allow for more specific analysis of patients at risk of adverse outcomes. It is unclear if the improvement in monitoring is targeting GSSMS patients at higher or lower risk of adverse health outcomes.

Lessons Learnt

• • Patients under GSSMS commonly were found to have physical examination findings, most commonly abdominal tenderness, potentially highlighting a significant pathology of the abdominal organs. ECG and physical examination completion rates are improving

• • BBVs are being done frequently for the majority of patients

• • Further recommendations for yearly re-audit would allow for targeting specific questions such as what percentage of patients require hepatology interventions or what percentage of patients are of high risk of cardiac events on Methadone

The audit aimed to identify: The percentage of patients with Initial Physical Examination (IPE), ECG and bloods on admission being completed; If IPE, bloods and ECG result are documented on PHIT; To identify reasons for these interventions not being completed and review if refusal is being appropriately documented.

“The Five Year Forward View for Mental Health NHS” report highlighted the poor physical health of those with mental health problems when compared to those without. In order to improve the identification and treatment of physical health problems within mental health inpatients, blood test results, physical examination and ECG results should be recorded and reviewed regularly. Within Greater Manchester Mental Health trust, the electronic records system PARIS contains a specific care document to record physical health interventions, known as the PHIT tool. The inpatient unit Park House, had recently changed to the PARIS system prior to this audit and the use of PHIT tool to monitor physical health parameters was considered a priority by the management team.

All admissions to Park House inpatient unit, Manchester in April 2019 were audited. Patients were identified using a report prepared by Business Intelligence. Electronic notes were reviewed for evidence of physical interventions on admission and input of these data to the PHIT tool. Using a retrospective review of electronic notes, relevant information was anonymised and collected to a spreadsheet for further analysis. Inclusion/exclusion criteria was based on local conditions and practical consideration.

An initial sample of 140 was reduced to 89 patients following application of inclusion/exclusion criteria. Of the 89 patients included, 73% had an IPE, 84% of patients had admission blood tests and 74% had an admission ECG. Recording of parameters on the PHIT tool was lower than expected with information recorded in 33–42% of patients. Where patients had refused IPE, ECG or bloods, a valid reason for refusal was documented between 63–91% of patients.

The initial audit identified that most patients had IPE, ECG and bloods but this was documented appropriately in less than 42% had this appropriately documented.

Interventions to improve this rate were developed, focussing on increasing completion of IPE, ECG and bloods as well as improving documentation. The completion of PHIT document is now monitored regularly. The re-audit to identify the magnitude of improvements from these interventions is currently underway.

The disease burden of cognitive impairment is significant and increasing. The aetiology of cognitive impairment can be structural, such as in mild cognitive impairment (MCI) due to early Alzheimer's disease (AD), or in functional cognitive disorder (FCD), where there is no structural pathology. Many people with FCD receive a delayed diagnosis following invasive or costly investigations. Accurate, timely diagnosis improves outcomes across all patients with cognitive impairment. Research suggests that analysis of linguistic features of speech may provide a non-invasive diagnostic tool. This study aimed to investigate the linguistic differences in conversations between people with early signs of cognitive impairment with and without structural pathology, with a view to developing a screening tool using linguistic analysis of conversations.

In this explorative, cross-sectional study, we recruited 25 people with MCI considered likely due to AD, (diagnosed according to Petersen's criteria and referred to as PwMCI), 25 healthy controls (HCs) and 15 people with FCD (PwFCD). Participants’ responses to a standard questionnaire asked by an interactional virtual agent (Digital Doctor) were quantified using previously identified parameters. This paper presents statistical analyses of the responses and a discussion of the results.

PwMCI produced fewer words than PwFCD and HCs. The ratio of pauses to speech was generally lower for PwMCI and PwFCD than for HCs. PwMCI showed a greater pause to speech ratio for recent questions (such as ‘what did you do at the weekend?’) compared with the HCs. Those with FCD showed the greatest pause to speech ratio in remote memory questions (such as ‘what was your first job?’). The average age of acquisition of answers for verbal fluency questions was lower in the MCI group than HCs.

The results and qualitative observations support the relative preservation of remote memory compared to recent memory in MCI due to AD and decreased spontaneous elaboration in MCI compared with healthy controls and patients with FCD. Word count, age of acquisition and pause to speech ratio could form part of a diagnostic toolkit in identifying those with structural and functional causes of cognitive impairment. Further investigation is required using a large sample.

Evidence from genetics, post mortem and animal studies suggest that N-Methyl-D-Aspartate Receptor (NMDAR) hypofunction has an important role in the pathophysiology of psychosis. However, it is not known if NMDAR activity is altered in the early stages of psychosis or if this links to symptom severity. Our aim was to investigate NMDAR availability in first-episode psychosis (FEP) and determine if it links to symptom severity. The NMDAR hypofunction hypothesis of schizophrenia was initially proposed in the 1990s on the basis of observations that ketamine and phencyclidine (PCP) induced the full range of schizophrenia-like symptoms (positive, negative and cognitive) when given to healthy participants and also that they worsen symptoms in patients with schizophrenia.

We recruited 40 volunteers, including 21 patients with schizophrenia from early intervention services in London (12 antipsychotic-free and 9 receiving antipsychotic medication) and 19 matched healthy controls. The uptake of an NMDAR selective ligand, [18F]GE179, was measured using positron emission tomography (PET) and indexed using the distribution volume ratio (DVR) and volume of distribution (VT, in millilitres per cubic centimetre) of [18F]GE179 in the hippocampus and additional exploratory regions (anterior cingulate cortex (ACC), thalamus, striatum and temporal lobe). Symptom severity was measured using the Positive and Negative Syndrome Scale (PANSS).

A total of 37 individuals were included in the analyses (mean [SD] age of controls, 26.7 [4.5] years; mean [SD] age of patients, 25.3 [4.9] years). There was a significant reduction in hippocampal DVR in the patients with schizophrenia relative to healthy controls (p = 0.02, Cohen's d = 0.81). Although the VT of [18F]GE179 was lower in absolute terms in patients, there was no significant effect of group on VT in the hippocampus (p = 0.15, Cohen's d = 0.49) or the exploratory brain regions. There was a negative association between hippocampal DVR and total PANSS symptoms (rho = –0.47, p = 0.04), depressive symptoms (rho = –0.67, p = 0.002), and general PANSS symptoms (rho = –0.74, p = 0.001).

These results indicate lower hippocampal NMDAR levels in schizophrenia relative to controls with a large effect size, and that lower NMDAR levels are associated with greater levels of symptom severity. These findings are consistent with the role of NMDAR hypofunction in the pathophysiology of schizophrenia; however, further work is required to test specificity and causal relationships.

The aim of this study is to assess the level of alexithymia, coping strategies and stress contribution to illness in patients with psoriasis and atopic dermatitis in order to increase effectiveness of dermatological treatment.

59 patients with atopic dermatitis, 67 with psoriasis and 65 healthy control group individuals were included in the cross-sectional study. Predominant complains of the patients: itching, widespread rashes and rashes on the open areas of the skin. In 85% patients with skin pathology onset of the disease and relapses were associated with stress, in 15% other factors.

“The 20-item Toronto Alexithymia Scale” was used to assess alexithymia. “The Ways of Coping Checklist, Lazarus” was used to assess coping-strategies. “The Holmes and Rage Stress Inventory” was used to assess stress contribution to illness. Significance level: p < 0,05.

The levels of alexithymia (p = 0.002), difficulty identifying feelings subscale (p = 0.02) and externally-oriented thinking subscale (p = 0.002) in patients with skin pathology (especially in those with psoriasis) were higher than in the control group.

Patients with skin pathology turned out to be more susceptible to stress factors (p = 0.025) and less often use coping strategy “seeking social support” (p = 0.037).

Patients with skin pathology with high levels of alexithymia and difficulty identifying feelings subscale more likely to use maladaptive “escape-avoidance” coping (p = 0.001).

Patients with atopic dermatitis who find difficult to describe feelings are more likely to use maladaptive coping “distancing”(p = 0.002).

In patients with psoriasis high levels of alexithymia and externally-oriented thinking subscale scores are associated with less common use of the adaptive coping “problem solving”(p = 0.001). Moreover, in patients with psoriasis high levels of difficulty identifying feelings subscale are associated with more common use of maladaptive “escape-avoidance” coping (p = 0.001).

The results of the study confirm the need to include psychological assessment and psychotherapy in the treatment plan for patients with psoriasis and atopic dermatitis in order to improve emotional awareness and to develop more adaptive coping-strategies in patients.

Healthcare triage for those subject to section 136 powers (MHA 1983/2007) remains challenging. Camden and Islington NHS Foundation Trust opened a dedicated Health-Based Place of Safety (HBPOS) in 2020, situated separately from an emergency department (ED). There was concern that this may lead to physical health problems going unrecognised. We aimed to design a simple, efficient algorithm to be used by non-medically-trained staff to identify those who are subject to s.136 powers who would benefit from medical clearance before being admitted to the HBPOS

We chaired a consensus meeting with nursing staff, police and emergency medicine consultants when designing the algorithm. Case notes of those presenting under s.136 to the POS over 1 calendar-month in 2019 were reviewed, and the proportion of those who the algorithm would have diverted for medical clearance was calculated. We then reviewed the proportion of cases sent for medical clearance during a single calendar month in 2020, after the HBPOS had opened, to see whether there was a significant difference.

37 patients were admitted to the ED-based POS in July 2019, of which 36 records were analysed. 9 patients (25%) were referred for medical clearance, with 2 (6%) requiring medical admission. 8.6% were identified as needing medical clearance when the algorithm was applied retrospectively (positive predictive value 66%, negative predictive value = 79%).

Review of records over 1 calendar-month after the HBPOS was established showed 30.6% of patients had been diverted for medical clearance prior to entering the HBPOS. Of the 65 patients, 1 (2%) required transfer to ED within 48 hours of entry. No statistical difference in the proportion of patients sent for medical clearance was observed since the formation of the HBPOS away from the ED (Chi-squared = 0.549, p = 0.458), suggesting the algorithm successfully identified those patients who needed medical clearance prior to admission.

We observed high rates of intoxication amongst those admitted (30–40%).

The algorithm showed high specificity and negative predictive value, allowing for a degree of confidence when admitting those deemed at low-risk of physical deterioration, though it does not eliminate the need for clinical judgement. Interpretation of the results is complicated by the COVID19 pandemic in 2020, which was not accounted for in the algorithm, which possibly led to deviations from the algorithm in real-world clinical practice.

We sought to develop a teaching pilot to help year 2 medical students meet the following learning outcomes: Develop a better understanding of patient and carer experiences of mental illness; Recognise and challenge unhelpful attitudes towards people with mental illness; Promote a broader understanding of cultural issues surrounding mental illness, including stigma and discrimination.

337 medical students were invited to attend a lecture by author LQ, a documentary photographer who presented a narrative of his brother Justin's lived experience of schizophrenia (louisquail.com/big-brother-introduction). 197 students attended the session, which was recorded and made available online. Students were invited to enter a competition to win a signed copy of LQ's book, ‘Big Brother’ and asked to submit either a 500-word written reflective piece, or a creative work accompanied by a 200-word statement. 13 submissions were received, including paintings, drawings, collage, photography, and poetry, all of which were blind rated by authors SR and GB, based on originality and quality of reflection. Of the six shortlisted, three winning entries were chosen by author LQ.

All reflections moved away from a technical understanding of schizophrenia, towards person-centred interpretations, with dominant themes of ‘stigma’, ‘disempowerment’, ‘understanding people as individuals’, ‘subjective experience of mental illness’, ‘inclusion’ and ‘healing power of nature’.

The three prize winners (authors GY, AK and KT) used different mediums: GY painted an osprey over a chaotic collage of disordered and stigmatizing words (the osprey representing empowerment and the “reservoir for wellbeing in nature”); AK's sonnet began as an ode to the chaos of Justin's experience, but the concluding lines reframed this struggle, conveying feelings of hope and beauty; and KT's self-portrait, produced with a slow shutter-speed photograph, powerfully conveyed a sense of disorientation and disturbance. She reflected on how the stigma of mental illness affects self-perception. The talk was well-attended, and reflections were of high quality. A limitation of this pilot was that only a small proportion of students completed the reflective assignment.

Innovative teaching strategies are needed to address negative attitudes towards mental illness and psychiatry, which are prevalent amongst the medical profession. This pilot provides a model for combining carer-led, reflective, and creative elements in undergraduate psychiatry teaching, with the aim of challenging stigma. This model will be evaluated in a further study involving fifth year medical students, which will use a validated scale to measure change in students’ attitudes towards mental illness and psychiatry.

We aimed to investigate the adherence to the Mental Health Act Code of Practice and the adequate documentation of consent to treatment across three forensic low secure inpatient units.

Our sample included all inpatients detained on three forensic wards at The Newsam Centre. This included a total of 31 patients with an age range of 25 to 59 years. The Mental Health Act Code of Practice was used as criteria for audit standards. Data were collected using Microsoft Excel and analysed using descriptive methods.

We found that 28 patients out of 31 had been admitted for over three months and of these patients 12 were subject to a T2 and 16 subject to a T3. A total of 24 patients had their CTT medication list documented on the online drug chart; with a remaining seven patients who did not. As per guidelines, 27 patients had the appropriate medications prescribed as per their CTT, however one patient did not. The audit revealed a total of two patients currently on a Section 62. Of the qualifying T3 forms, four patients had this reviewed every two years whilst there was one patient who had not.

We found that the adherence to Mental Health Act Code of Practice was overall positive with the majority of service users being reviewed appropriately and documented as per guidance. However, areas identified for improvement included the recording of CTT on online drug charts as well as reviewing T3 every two years. This audit highlights the need for easy access to guidance, appropriate documentation as well as frequent checking of adherence. A leaflet has been created outlining the guidelines and will be distributed to all staff working within the forensic settings and placed in easily accessible locations. As further recommendations from this audit we advise all wards to plan weekly checks during team meetings to ensure information is up to date and that all staff are aware of any discrepencies. A re-audit is planned in the coming months to re-assess adherance after implementation of the interventions.

Self-harm and eating disorders are often comorbid in clinical samples but their co-occurrence in the general population is unclear. Given that only a small proportion of individuals who self-harm or have disordered eating present to clinical services, and that both self-harm and eating disorders are associated with substantial morbidity and mortality, we aimed to study these behaviours at a population level.

We assessed the co-occurrence of self-harm and disordered eating behaviours in 3384 females and 2326 males from a UK population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants reported on their self-harm and disordered eating behaviours (fasting, purging, binge-eating and excessive exercise) in the last year via questionnaire at 16 and 24 years. At each age we assessed how many individuals who self-harm also reported disordered eating, and how many individuals with disordered eating also reported self-harm.

We found high comorbidity of self-harm and disordered eating. Almost two-thirds of 16-year-old females, and two-in-five 24-year-old males who self-harmed also reported some form of disordered eating. Young people with disordered eating reported higher levels of self-harm at both ages compared to those without disordered eating.

As self-harm and disordered eating commonly co-occur in young people in the general population, it is important to screen for both sets of difficulties to provide appropriate treatment.

To examine the relationship between depression, anxiety and wellbeing in doctors.

The relationship between doctor wellbeing and mental health diagnoses is not well evidenced in the literature. There is a lack of comparable measurement of wellbeing in doctors within the National Health Service, meaning the effectiveness of wellbeing interventions is unknown.

A cross-sectional survey containing the PHQ9, GAD7 and WEMWBS questionnaires to measure depression, anxiety and wellbeing respectively, was advertised online nationally. The relationships between the total scores were explored using Spearman's rho correlation coefficients and Chi square tests. Thematic analysis of semi-structured interviews offered further insights.

Sixty-seven doctors returned completed questionnaires. 29.9% had PHQ9 scores >5 and 41.8% had GAD7 scores >5. Therefore, over a quarter of the participants had a score that would suggest a management plan was needed for depression, and a third for anxiety. Moderate negative correlation between the total WEMWBS scores and the total PHQ , rs= –0.775, p = 0.00, N = 67 and GAD7 scores rs= –0.724, , p = 0.00, N = 67 was seen. Statistically significant differences between those with low wellbeing scores (WEMWBS < 40) and normal wellbeing scores (WEMWBS ≥ 40) in relation to the need for a management plan for depression (PHQ9 > 10) X2 (1, N = 67) = 12.395, p = 0.00 and anxiety (GAD7>10) X2 (1, N = 67) = 5.611, p = 0.018 were seen. The main themes identified from the interviews (n = 10) were the importance of social support outside of work, cynicism about an NHS plan check-in and a tendancy to neglect wellbeing until it has dipped.

There is a moderate negative correlation between anxiety, depression and wellbeing, but they are not opposites and separate measures for wellbeing should be used. It is clinically useful to note that only those with a WEMWBS score of <45 had a PHQ9 score suggesting the need for treatment of depression.

The aim of this audit is to assess communication between the general and psychiatric hospital. This audit was prompted after a number of patients were transferred to Udston Hospital, a community hospital with two older adult acute mental health wards, with no written communication. This led to several significant issues including medication errors, ambiguity regarding patient escalation plans and uncertainty regarding what had been discussed with families.

Over the course of one month eight patients were identified who had been transferred from the acute site to Udston Hospital. Three were new admissions to Udston, four were returning after treatment for physical illness, and one returned following assessment in ED. Data were collected by examining paper and electronic notes, and analysed using Excel. The results of this audit were discussed at the local clinical governance meeting. A 2nd cycle was performed. Eight transfers were identified. Four were returning after an assessment in ED, two were new admissions to Udston and two were returning after treatment for physical illness.

Initial audit found that 38% of patients were transferred with their medical notes, 50% were transferred with no written documentation whatsoever, and none of the patients were transferred with a transfer letter. The second cycle found that 88% of patients had a transfer or discharge letter. 12% of patients came with no written documentation.

The initial audit found significant deficiencies in communication. Highlighting the need for all patients to have a transfer letter at a local management meeting seems to have led to an improvement. However, differences between the samples in the 1st and 2nd audit cycle could be distorting the results. Further audits would be useful given the small sample size and due to the differences between the sample populations.