Somaliland is a de facto state in the horn of Africa. It unilaterally declared independence from rest of Somalia in 1991. Medical education in Somaliland started in the year 2000.

Aim of the study is to explore the feasibility of teaching program for the country by its future potential psychiatry educators. The initiative started in 2019 to seek trainees with interest in academic psychiatry and support them with medical education skills. This is intended to prepare them for leading future teaching roles in both undergraduate and residency/fellowship in psychiatry

Amoud University wanted to empower junior doctors at the university to have teaching skills needed to set up residency program. The Somaliland government asked Ethiopian ministry of health to offer psychiatry residency program for general practitioners in Somaliland to have future residency and fellowship in psychiatry. Several psychiatry trainees worked with the visiting professor from the United Kingdom who joined Somaliland medical school as visiting professor in psychiatry

The visiting professor supported the trainee in setting up a psychiatry undergraduate training curriculum in line with Somaliland medical school curriculum. Before the teaching methods were didactic and role play based. The faculty introduced different teaching methods including flipchart, small/large group teaching which was student centered education. Students received a online survey to reflect on psychiatry teaching they received. post course survey was conducted at the end of the teaching to evaluate the teaching initiative.

Survey revealed interesting pattern that students preferred class room based teaching in comparison to online teaching. 90 percent of the attendees showed interest in flipchart teaching compared to didactic model. They expressed increasing understanding of the subject matter when they read and discuss among themselves instead of lectures. 70% of students prefer more clinical teaching compared to online sessions.

52% liked the new teaching module compared to the lecturing sytle.

Supervision of early career psychiatrists to undertake future academic psychiatry roles is an important step in building psychiatry faculty in medical schools. As the case of Somaliland this retains trainees in teaching roles in the future to teach undergraduates mental health courses. The other benefit is empowering them to set up psychiatry training program to close the service delivery gap with skilled psychiatrists in the future. Somaliland plans to set up its psychiatry residency/fellowship programs soon after this initiative.

To suggest a link between sertraline and urinary side effects in a Sheffield Child and Adolescent Mental Health Service population.

Evidence suggests that Serotonin has an important role in bladder control through central and peripheral neurological pathways. Increased serotonergic activity leads to parasympathetic inhibition, which results in urine retention. It is through this mechanism of action and their effect on pre-synaptic serotonin 1A and peripheral 5-HT3 receptors that SSRIs were observed to have anti-enuretic effect. At low 5-HT concentrations, micturition is inhibited whereas at high levels, an excitatory effect is achieved. This may suggest a dose-dependent relationship between Sertraline and urinary side effects.

Inclusion criteria:

Under 18 years of age

On Sertraline

Reported urinary side effects

Exclusion criteria:

Above 18 years

Not on Sertraline

Associated urinary problems

Did not report urinary side effects

Clinical records of eligible patients were accessed to gauge temporal relationship between initiation of sertraline and reported urinary side effects.

Three cases were identified in the authors’ clinical practice at Sheffield CAMHS that were suggestive of a link between sertraline and urinary side effects.

It's important for clinicians to bear in mind the genitourinary side effects of SSRIs, which may be debilitating for patients in the CAMHS population. It's equally important for us as clinicians to educate young people and their parents about these potential side effects and how they can be managed. It has also been observed that higher doses of Sertraline have shown a possible link between onset of urinary side effects.

Psychiatric disorders are associated with fatigue and with impairment to a range of cognitive domains, including executive functioning, learning, memory and complex attention. Similar impairments are seen in autonomic nervous system (ANS) dysfunction. The aetipathogenic significance of this for psychiatric disorders is unknown. The main aim of the cap-mem study was to characterize the relationships between ANS and cognitive function in a sample of none-clinical controls and people with mental health, neurodevelopmental and neurodegenerative disorders. The potentially confounding role of medication was included within this analysis.

The sample was recruited via secondary care mental health trusts. ANS function was assessed using self-report measures of ANS dysfunction symptoms (COMPASS-31) and fatigue (VAFS). Cognitive ability in various domains was measured using a validated, computerised assessment tool (THINC-IT). Psychiatric status and medication status were self-reported, and where possible, disorder severity measured using a rating scale (CGI-S).

Participants with depression had a significantly higher COMPASS-31 and VAFS scores (higher being more severe), with effect sizes being medium to large. Medication did not fully explain the associations observed. Overall, participants with mental health disorders, when compared to healthy controls, had significantly higher levels of cognitive impairment. Levels of ANS dysfunction significantly and positively correlated with cognitive impairment. The severity of the psychiatric disorder significantly correlated with both ANS dysfunction (p < 0.001) and cognitive impairment. These results were found across all cognitive tests (p < 0.05), other than reaction times in the N-back test, a measure of working memory.

Our results show significant association between ANS dysfunction, psychiatric disorders and cognitive impairments. This is consistent with previously published data. There is now a need to understand the underlying mechanisms and the directionality of the associations. If these mechanisms are shared and relate to autonomic dysfunction, targeted treatments addressing this directly could be helpful with mental health disorders and associated burdensome symptoms, such as cognitive impairments and fatigue. This study is part of a wider project assessing cognitive ability and autonomic functioning in psychiatric populations, and investigating treatments that directly address autonomic dysfunction in psychiatric samples, such as non-invasive transauricular vagus nerve stimulation (taVNS).

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening complication of antipsychotic medication. There are no gold standard tests to diagnose NMS, however various diagnostic criteria have been suggested. NMS is typically reported in patients who have recently commenced an antipsychotic or had a change in dose. This case report describes an elderly female who developed NMS after being treated with the same dose of antipsychotic for 7 years. We aimed to establish whether similar cases are commonly reported, and what the key learning outcomes are.

This case presents an 82-year-old female taking the same dose of zuclopenthixol for 7 years. She was admitted with increased confusion and was initially prescribed antibiotics for a possible infection. She later became pyrexial and developed hypertonia, at which point NMS was suspected. Her creatinine kinase titre was significantly elevated, and her antipsychotic was discontinued. A potential trigger was a significant rectal bleed occurring a few weeks prior with no other obvious triggers noted. She was switched to quetiapine but developed NMS again when this dose was increased.

There are few reports of NMS occurring in patients taking a long-term and stable antipsychotic dose. One case describes NMS developing after 30 years on Clozapine with no clear trigger. Another reports NMS after 7 years on Olanzapine, however this was triggered by dehydration. This case is an example of NMS in an elderly patient with a complex medical history who was initially misdiagnosed with sepsis before NMS was suspected. This shows the importance of considering NMS not only in those who have recently commenced antipsychotics or recently changed dose, but also those who have been stable on medication for a number of years. In suspected NMS, we should aim to stop relevant medication immediately and commence conservative management. It is important to highlight these atypical presentations so that NMS can be recognised without delaying treatment, thereby reducing mortality and improving patient outcomes

This report highlights the importance of considering NMS in patients who have been prescribed the same dose of antipsychotic for an extended period. Awareness of potential risk factors such as medical comorbidity that may trigger an episode of NMS even in those on established antipsychotic treatment is vital. Symptoms may mimic infection and it is important to raise awareness of atypical presentations to effectively identify, and treat, NMS earlier to improve outcomes.

To establish if there were any significant changes in the number of referrals for psychiatric assessment or prescribing rates of psychotropic medication in the South Edinburgh tier 3 CAMHS team during the first year of the COVID-19 pandemic compared to the previous year. To explore factors that might be responsible for these changes.

Referrals to the Psychiatric Assessment Clinic were analysed between the periods of 23rd March 2019 and 22nd March 2020 and 23rd March 2020 to 22nd March 2021. Using the unique numeric patient identifier, data from these referrals was gathered retrospectively by looking at clinical documentation on the healthcare information system used across NHS Lothian. Data were gathered for 243 patients.

Data were collected on psychiatric diagnosis and, if medication was prescribed, what class of medication this was. Information on potential confounding factors was also gathered including sex, age, co-morbid psychiatric diagnoses, history of self-harming behaviours and suicide attempts, family set-up, schooling and other support services involved. Information was stored anonymously.

Data were coded. Statistical analysis was undertaken using SPSS (statistical package for the social sciences).

Referrals for psychiatric assessment almost doubled from 83 pre-pandemic to 160 during the first year of the pandemic. Referral rates for most psychiatric disorders increased. The proportion of patients prescribed psychotropic medication increased significantly during the first year of the COVID-19 pandemic compared to the year preceding (P=0.031).

Analysis of possible confounding factors was completed. Anti-depressant prescribing rates for those from non-nuclear families increased significantly in the year during the pandemic (P=0.012). Other differences were observed but these were not statistically significant. The numbers of patients who self-harmed, attempted suicide or carried out both increased from 42 to 79.

Findings add to the existing body of literature highlighting an increase in referrals to mental health services and prescribing of psychotropic medications in the first year of the pandemic in comparison to those pre-pandemic. No clear conclusions could be drawn about factors responsible for change. Continuing to monitor referrals and confounding factors over time would be useful from a public health perspective. It would allow trends to be drawn so that planning can be carried out for future pandemics.

Healthcare workers are exposed to both physical and mental demands in the hospital environment; recently intensified by overstretching staff and resources during the current COVID-19 pandemic. Despite healthcare workers banding together, physician burnout is more prevalent than ever before due to emotional, physical and mental exhaustion. Firstly, this poster aims to expose the prevalence of burnout among healthcare workers during the COVID-19 pandemic. Secondly, to highlight the interventions and strategies to help minimise burnout among healthcare workers.

I will focus on reviewing clinical trials with a particular focus on healthcare workers affected by burnout within the COVID-19 pandemic timeframe. Therefore, narrowing my search to 20 trials within the past 12 months using the following restricted search criteria: ‘burnout’, ‘covid-19’ and ‘healthcare’. Furthermore, commenting on strategies and interventions to minimise burnout by stretching my criteria to interventions trialled within the last 24 months. This is due to limited data and trial evidence for burnout strategies within the last 12 months of the COVID-19 pandemic.

Burnout is on the rise among healthcare workers across the globe, 47% of healthcare staff are expressing an element of burnout worldwide. With growing concerns of healthcare staff developing long term mental health implications as a result of work-related stress. At present, one third of frontline staff are experiencing depression and distress; which must be addressed. Reviewing recent trials has highlighted a number of successful strategies for approaching burnout including: app technology, talking therapy, staff support and internet-based resources. App-related technology and web resources have shown to be particularly beneficial among recent trials, with limited participation and engagement for support groups/talking therapy.

A significant rise in physician burnout and distress during COVID-19 has been noted in various trials. Interventions specifically related to burnout within COVID-19 are limited due to a low yield of completed trials; however, a couple of trials have found an improvement in COVID-19 related stress among healthcare workers using app-related technology. Internet based intervention is cheap, widely accessible and a non-judgemental method for seeking help, especially within a profession where burnout is heavily stigmatized.

A Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.

ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.

The first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.

In the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.

Creating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.

The older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions.

Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust.

All referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS).

Total number of patients referred – 193

11 patients excluded due to unavailable/incomplete medication records.

Study number: 182

Polypharmacy:

• 79.67% (n = 145) were prescribed 5 or more medications.

• 44.51% (n = 81) prescribed 5–9 medications.

• 23.08% (n = 42) prescribed 10–14 medications.

• 8.79% (n = 16) prescribed 15–19 medications.

• 1.67% (n = 3) prescribed more than 20 medications.

• 37.36% (n = 68) prescribed an anticholinergic.

• 6.59% (n = 12) prescribed more than 1 anticholinergic.

• 29.67% (n = 54) prescribed an anticholinergic.

• 7.699% (n = 14) prescribed more than 1 anticholinergic.

Polypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.

Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.

Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.

Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult.

To identify the number of patients currently on melatonin

To determine the average duration of use of melatonin in patients under the care of S-CAMHS in ABUHB

To investigate whether behaviour interventions were tried and reinforced from time to time

To identify any areas of improvement

Data were collected at St. Cadoc's hospital, in January, 2021. S-CAMHS database was used. Out of total 346 patient currently being managed with pharmacological therapies, 115 (33.2%) are currently on melatonin. 57/115 were randomly selected as a sample for this this project. Patient notes and EPEX software were also used to collect information regarding the sleep management practices.

During analysis, it was noticed that within the sample, only 46 patients were actively on melatonin. Melatonin is prescribed for sleep related issues in ASD (8/46), ADHD (15/46), ASD and ADHD (10/46), ADHD and mood disorder (0/46), ASD and mood disorder (6/46), ADHD and behaviour difficulties (2/46), ASD with behaviour difficulties (1/46), mood disorder (4/46).

39/46 patients are currently on melatonin for more than a year (85%). These patients also include 10 patients who have been using melatonin for 5 years or more.

35 patients (76%) reported improved sleep or some benefit from melatonin.

Evidence for implementation of parent-led sleep behavioural interventions:

Prior to commencing melatonin- Clear evidence available for 35 patients only (76%). These interventions were however not deemed helpful by most of the service users.

While prescribing melatonin- Clear evidence available for 39(85%) patients. Evidence base for melatonin was also discussed during this visit.

During last follow-up visit- Evidence available for 31 patients only (67%).

Majority of patients under S-CAMHS ABUHB remain on melatonin therapy for longer than one year. Most of these patients have reported benefit from this therapy and preferred to remain on it despite being informed about evidence base for melatonin. Also, there is evidence for implementation of sleep behavioural interventions prior to prescribing melatonin, however their benefit remains unclear.

Recommendations:

The quality of education on sleep hygiene offered should be assessed and improved if needed

Formal group sessions/workshops on sleep hygiene/parent-led sleep behavioural interventions at regular intervals might be useful in reducing the chances of long term polypharmacy or unlicensed drugs

Use of outcome measures such as Child Sleep Habits Questionnaire at intervals can be helpful in identifying any improvement from educational/pharmacological interventions

S-CAMHS database (for patients actively on medications) needs a review and update

Trait dissociation has not been examined from a structural human brain mapping perspective in healthy adults or children. Non-pathological dissociation shares some features with daydreaming and mind-wandering, but also involves subtle disruptions in affect and autobiographical memory.

To identify neurostructural biomarkers of trait dissociation in healthy children.

Typically developing 9- to 15-year-olds (n = 180) without psychological or behavioural disorders were enrolled in the Developmental Chronnecto-Genomics (DevCoG) study of healthy brain development and completed psychological assessments of trauma exposure and dissociation, along with a structural T1-weighted magnetic resonance imaging. We conducted univariate ANCOVA generalised linear models for each region of the default mode network examining the effects of trait dissociation, including scanner site, age, gender and trauma as covariates and correcting for multiple comparison.

We found that the precuneus was significantly larger in children with higher levels of trait dissociation but this was not related to trauma exposure. The inferior parietal volume was smaller in children with higher levels of trauma but was not related to dissociation. No other regions of interest, including frontal and limbic structures, were significantly related to trait dissociation even before multiple comparison correction.

Trait dissociation reflects subtle cognitive disruptions worthy of study in healthy people and warrants study as a potential risk factor for psychopathology. This neurostructural study of trait dissociation in healthy children identified the precuneus as an essential brain region to consider in future dissociation research.

To provide a fresh insight into the extent digital phenotyping methods have been employed to measure or detect social behaviour in patients with SMIs; with a closer look at those used in Bipolar Disorder (BD); to give findings on the validity, reliability, acceptability and tolerability of these digital phenotyping methods.

Using specified search terms relating to digital phenotyping metrics and terms related to SMIs, a thorough literature search strategy for studies was employed across the following electronic databases: PubMed, Embase, and PsychINFO - from inception to July 2021.

Included studies employed digital phenotyping methods, collecting either passive, active or mixed-modal data, which in principle reported metrics representing social behaviour on patients with an SMI. Here we present a preliminary analysis of studies reporting results for patients with BD, with a particular focus on tolerability and acceptability.

Of 4,646 records initially screened, a subgroup of 9 studies (n = 474) directly focusing on patients with BD are reported here. Across the studies, we find a modest adherence rate towards these applications by patients, ranging from 72.6% to 89.2%. Methods used by the studies include the frequency of phone calls and text messages, and self-reported and observer ratings of social and interpersonal functioning. The collection of such digital phenotyping data appears tolerable and acceptable to participants with BD, with patients reporting them to be supportive and only mildly intrusive.

Our preliminary analysis suggests that digital phenotyping of social behaviour may be acceptable and tolerable to participants with Bipolar Disorder. In an increasingly digital world, digital phenotyping methods of social behaviour may assist physicians with clinical assessment and prediction of clinical outcomes including relapse. Future analyses will assess the reliability and validity of the data that such methods yield, and their potential therapeutic value.

Homosexuality was declassified as a mental illness in 1973 however LGBTQ+ (lesbian, gay, bisexual, transgender, queer inclusive) service users still face discrimination within modern mental health services. This project assessed homophobia and LGBTQ+ abuse among service users on an acute male psychiatric ward. Our aims were to quantify the incidence of abuse, to explore staff attitudes toward LGBTQ+ abuse and to identify targets to improve LGBTQ+ service users’ experience. We hypothesised that incidents of abuse are common and not always challenged or escalated using appropriate channels.

Using a mixed methods approach we explored staff perceptions of LGBT+ abuse: quantitative data were generated from a questionnaire survey and qualitative data from a focus group.

Rates of homophobic incidents were assessed by analysing clinical documentation from two inpatient samples (n = 20), covering 2020–21 and 2021–22.

Analysis of clinical documentation found three incidents from the 2020–21 sample and two from 2021–22; only one of these was reported via DATIX.

The survey captured the views of the ward team including nurses, healthcare assistants (HCAs), doctors and psychologists (response n = 13). Staff attitudes towards LGBTQ+ were rated as “positive” by 77% of responders and “neutral” by 23%; 100% stated it was their professional duty to respect and protect LGBTQ+ clients. Almost two-thirds (62%) had witnessed homophobia on the ward however a similar proportion (61%) had never directly challenged homophobia. Whilst all staff felt able to care for LGBTQ+ clients, and all were familiar with key LGBTQ+ terminology, only 50% felt they had received adequate training to fully support LGBTQ+ clients.

The focus group identified a nursing “lead” for LGBTQ+ issues and agreed to incorporate a “diversity statement” into ward admission rules. LGBTQ+ visibility measures were promoted including LGBTQ+ posters across the ward and staff uptake of the Rainbow Badge Initiative.

Our findings suggest homophobia is prevalent in the male inpatient psychiatric setting and management is suboptimal. Enhanced LGBTQ+ training is required to support staff to challenge every homophobic incident and escalate appropriately.

Simple steps to increase LGBTQ+ visibility are feasible and popular among staff. Future work should assess the impact of such interventions, however measuring change may be hampered by underreporting.

Further evaluations are needed to assess female wards and patient perspectives to build a full picture of inpatient LGBTQ+ abuse.

The ‘at-risk mental state’ (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk.

To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria.

A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period.

From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort.

This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.

This observational study aims to describe the course of the admission and clinical characteristics of admissions to the PICUs in the Phoenix Care Centre, Dublin, Ireland. The authors hypothesised that the length of stay (LOS) would be shorter in male patients as compared to females.

This retrospective cohort study was carried out at the Phoenix Care Centre Dublin, Ireland. Informed consent was not sought as this was a retrospective chart study involving anonymised clinical data which was collected as part of routine clinical care and no items of information were reported that would enable the identification of any subject. We described primary outcomes using frequencies, percentages, mean and standard deviations, median and interquartile ranges (IQR). Between groups comparisons were made using x2 tests for categorical variables; t-tests, ANOVA tests, or Kruskal-Wallis tests, for continuous variables; All analyses were two-tailed, and a P-value ≤ 0.05 was considered statistically significant

Over the study period from Jan 2014 to Jan 2017 inclusive, there were 96 admission episodes to the PICU. The mean age of admitted cases was 37.1 (SD = 11.3) years (range 18–63 years). The mean length of stay (LOS) was 59.3 (SD = 61.0) days (median 39.5 days). All patients were admitted under the Mental Health Act legislation. We identified assault as the primary risk factor for pre-admission 62% (n = 62) to the PICU. Antipsychotic polypharmacy was used in 61% (n = 55) of the admission. The mean daily antipsychotic dosage was 139.4 % (SD = 65.1) of BNF maximum daily dose. A diagnosis of acute psychotic disorder (B= -1.027, p = 0.003, 95% CI: –1.691 to –0.363) was associated with reduced LOS in PICU. Majority of admissions 43% (n = 39) had a diagnosis of schizophrenia, followed by Bipolar affective disorder BPAD 21% (n = 21), schizoaffective disorder 18% (n = 18), and acute psychotic disorder 9% (n = 9).

Psychiatric Intensive Care Unit is an essential service for the severely ill psychiatric patients and is a progressively developing sub-speciality. An important finding from our study describes the cohort of patients admitted being predominantly male, younger-aged, single, with a diagnosis of schizophrenia, legally detained, and from an Irish background. The primary indication for a referral is the risk of assault, showing the need for the intensive and secure treatment model that a PICU can provide.

Attention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder originating in childhood comprising of a constellation of features including inattention, impulsivity, and hyperactivity. The National Institute of Clinical Excellence (NICE) Guidelines 2018 recommends methylphenidate as a first line pharmacological agent for treatment of children aged 5 years and over with ADHD. Lisdexamfetamine, dexamfetamine and atomoxetine are recommended in this order if methylphenidate is not tolerated or if symptoms did not respond to separate 6-week trials. Our aim was to, assess the transition of methylphenidate to atomoxetine, the reasons for switching and its clinical outcome in order to make recommendations to current practice regarding treatment of ADHD.

The study examined a total of 53 children between 0-16 years of age who were being treated for ADHD with atomoxetine at CYPS till September 2018. Data was collected from patients’ files retrospectively by using a proforma based on the NICE guidelines 2018 ADHD: diagnosis and management.

Out of 53 patients’ on atomoxetine in September 2018, 49 were included in the study. Results recorded side-effects as the main reason for switching from methylphenidate to atomoxetine. Unwanted side-effects were documented in 71.7% of patients of which 57.9% exhibited more than 1 side-effect with the two commonest side-effects documented being weight loss and decreased appetite. The audit highlighted the fact that the correct dose of atomoxetine was only administered in 17.2% of children with 56.9% of patient's being given a higher dose than recommended. Initial weight was not documented in 19% and hence, ideal dose could not be calculated. Overall, atomoxetine was shown to be an effective treatment. Out of the 40 patients documented to have hyperactivity this symptom was decreased in 82.5% whilst 82.9% were shown to have increased concentration. 35 patients had documented impulsivity and this was decreased in 62.9% of cases. 11 patients had documented anxiety with 72.7% being treated effectively with atomoxetine. 31% of patients’ had documented side-effects with 16% of these being tics. 20% of patient's required augmentation.

The results indicate that the majority of doctors at CYPS in Malta adhered to the NICE guidelines 2018 and atomoxetine was proven to be efficacious as a second line drug in the treatment of ADHD. However, better adherence to NICE guidelines is required when it comes to the calculation of appropriate dosage. Our prediction is had dose recommendations according to weight been adhered to there may have been less side-effects documented.

Alcohol-related brain damage (ARBD) is used to describe a variety of clinical syndromes associated with excessive intake of alcohol. It can present with cognitive and neurological syndromes, including Wernicke's encephalopathy, Korsakoff's syndrome, alcohol dementia, cerebellar atrophy and frontal lobe dysfunction, Central pontine myelinolysis and Marchiafava Bignami disease. In up to 25% of cases ARBD can be complicated by traumatic head injury and brain blood supply disturbances. In the absence of clear national guidelines, standards or established pathways of care across most of the UK, most patients are unable to access appropriate service provision. The North Derbyshire mental health liaison team (MHLT) provides assessment and diagnosis of acute alcohol related brain injury, assess severity (based on clinical presentation, investigation findings, cognitive assessment) and provide a care plan with follow-up to various community services. Aim and objectives: To find out the discharge outcome for patients with ARBD diagnosis by the north MHLT, help us identify service gaps and look at ways to improve patient's care in this group.

We retrospectively analysed 300 patients who were referred to liaison team for drug and alcohol problems and were seen by the drug and alcohol lead nurse within the liaison team. Patients who were given a diagnosis of ARBD by the liaison team were included in the study.

We looked at

1. 1. Age and gender distribution

2. 2. Team who gave the initial diagnosis

3. 3. Discharge destination

4. 4. Community follow-up and engagement

We identified 17 patients who were given diagnosis of ARBD. There was relatively equal distribution of male to female patients. Majority of diagnosis’ were given by liaison team. The discharge destination was variable with around half referred to ARBD rehabilitation unit and Derbyshire recovery partnership. Engagement was poor with only 20% of patients engaging with services.

Recommendations:

1. 1. Detailed cognitive tests need doing for screening and to establish severity

2. Consideration for which neuroimaging modalities can help aid diagnosis, if any, should be made.

1. 3. ARBD leaflets to be given

2. 4. ARBD diagnosed patients who do not need rehabilitation unit, should be referred for social care assessment as an inpatient and / or be followed up in the community under Care Act

5. Considerations with the Multi Disciplinary Team for ways to improve engagement in the community, perhaps with more frequent and robust follow-ups.

The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented.

To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops.

The service evaluation used a pre–post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive–behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data.

Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops.

The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.

Patient and public involvement (PPI) groups can provide valuable input to create more accessible study documents with less jargon. However, we don't know whether this procedure improves accessibility for potential participants.

We assessed whether participant information sheets were rated as more accessible after PPI review and which aspects of information sheets and study design were important to mental health patients compared with a control group with no mental health service use.

This was a double-blind quasi-experimental study using a mixed-methods explanatory design. Patients and control participants quantitatively rated pre- and post-review documents. Semi-structured interviews were thematically analysed to gain qualitative feedback on opinions of information sheets and studies. Two-way multivariate analysis of variance was used to detect differences in ratings between pre- and post-review documents.

We found no significant (P < 0.05) improvements in patient (n = 15) or control group (n = 21) ratings after PPI review. Patients and controls both rated PPI as of low importance in studies and considered the study rationale as most important. However, PPI was often misunderstood, with participants believing that it meant lay patients would take over the design and administration of the study. Qualitative findings highlight the importance of clear, friendly and visually appealing information sheets.

Researchers should be aware of what participants want to know about so they can create information sheets addressing these priorities, for example, explaining why the research is necessary. PPI is poorly understood by the wider population and efforts must be made to increase diversity in participation.