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.

Cognitive impairments are well-established features of psychotic disorders and are present when individuals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population.

To investigate whether omega-3 polyunsaturated fatty acid (n−3 PUFA) supplementation improves cognitive functioning among individuals at ultra-high risk for psychosis.

Data (N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n−3 PUFA levels predicted change in cognitive performance.

The placebo group showed a modest greater improvement over time than the omega-3 supplementation group for motor speed (ηp2 = 0.09) and BACS composite score (ηp2 = 0.21). After repeating the analyses without individuals who transitioned, motor speed was no longer significant (ηp2 = 0.02), but the composite score remained significant (ηp2 = 0.02). Change in erythrocyte n-3 PUFA levels did not predict change in cognitive performance over 6 months.

We found no evidence to support the use of omega-3 supplementation to improve cognitive functioning in ultra-high risk individuals. The biomarker analysis suggests that this finding is unlikely to be attributed to poor adherence or consumption of non-trial n−3 PUFAs.

Bipolar disorder is highly prevalent and consists of biphasic recurrent mood episodes of mania and depression, which translate into altered mood, sleep and activity alongside their physiological expressions.

The IdenTifying dIgital bioMarkers of illnEss activity and treatment response in BipolAr diSordEr with a novel wearable device (TIMEBASE) project aims to identify digital biomarkers of illness activity and treatment response in bipolar disorder.

We designed a longitudinal observational study including 84 individuals. Group A comprises people with acute episode of mania (n = 12), depression (n = 12 with bipolar disorder and n = 12 with major depressive disorder (MDD)) and bipolar disorder with mixed features (n = 12). Physiological data will be recorded during 48 h with a research-grade wearable (Empatica E4) across four consecutive time points (acute, response, remission and episode recovery). Group B comprises 12 people with euthymic bipolar disorder and 12 with MDD, and group C comprises 12 healthy controls who will be recorded cross-sectionally. Psychopathological symptoms, disease severity, functioning and physical activity will be assessed with standardised psychometric scales. Physiological data will include acceleration, temperature, blood volume pulse, heart rate and electrodermal activity. Machine learning models will be developed to link physiological data to illness activity and treatment response. Generalisation performance will be tested in data from unseen patients.

Recruitment is ongoing.

This project should contribute to understanding the pathophysiology of affective disorders. The potential digital biomarkers of illness activity and treatment response in bipolar disorder could be implemented in a real-world clinical setting for clinical monitoring and identification of prodromal symptoms. This would allow early intervention and prevention of affective relapses, as well as personalisation of treatment.

This study aimed to assess the level of satisfaction patients feel towards their experience of attending for psychotherapy, in order to inform local management on the service being offered by the department.

This survey was conducted as part of routine service provision analysis by the psychotherapy department. It aimed to assess the level of satisfaction patients feel towards their experience of attending for psychotherapy, in order to inform local management on the service being offered by the department. Ethics committee confirmed this fulfilled “Service evaluation” criterion and the project was registered with the local NHS quality improvement register.

Patients who completed an episode of therapy were invited to complete a survey form. This consisted of a Client Satisfaction Questionnaire (CSQ-8) as well as four additional questions pertaining to patient satisfaction. The patient's therapist would inform administration staff of the patient's final appointment; administration staff would then issue the patient with a questionnaire which they were invited to complete and return in their own time. The questionnaires were completed anonymously and no reward was offered for completing the questionnaire. The therapies included group analysis, psychodynamic individual and Cognitive Analytic Therapy.

22 patients who had completed psychotherapy in 2018–2019 returned a completed questionnaire. The average and range responses were examined.

The average response was “4: Excellent” for the overall rating of the service received, and for 5 other questions on the CSQ-8 the average score was the highest possible. The average response was slightly lower on the question about whether the service met their needs “3: Mostly”, and on the question: Has the service you received helped you to deal more effectively with your problems? (3 yes, somewhat). The additional questions highlighted how important the setting and administration role played in the experience of therapy. The questionnaire also included a free text box giving the patient the opportunity to offer any other comments. Many of these included messages of gratitude and remarks on the impact therapy has had on their general wellbeing.

In general it is encouraging to see that feedback provided through this survey was extremely positive. This was reflected both in the Likert scale questions and the free text box. Patients are described themselves as very satisfied with their experience within therapy and reflected a positive experience of the holding environment provided by the department as a whole.

(NO Funding received)

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool designed to probe the strength of inhibitory and excitatory neurotransmission in the cortex. Combined with electromyography, paired-pulse TMS paradigms have revealed a deficit in inhibition mediated by GABA-A receptors in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a more detailed examination of cortical excitability and may shed more light into the pathophysiology of schizophrenia. Of the various peaks of the TMS-evoked EEG signal, responses at 45 (N45) and 100 ms (N100) likely reflect GABA-A and GABA-B receptor-mediated inhibition, respectively. Responses at 25 ms (P25) are affected by voltage-gated channel ligands, whereas glutamatergic processes may be related to the P70 component. We here aim to systematically investigate the role of these neural processes in patients with schizophrenia by using TMS-EEG.

TMS-evoked EEG potentials (TEPs) were recorded in patients with schizophrenia (n = 19) and in age-matched healthy controls (n = 17). 150 TMS pulses at 90% of resting motor threshold were applied over the left primary motor cortex during EEG recording. Differences in TEPs between the two groups were analysed for all electrodes and for time windows corresponding to each TEP (P25: 0.015-0.035 ms; N45: 0.035-0.06 ms; P70: 0.035-0.06 ms; N100: 0.09-0.14ms) by applying multiple independent sample t-tests. Further, a cluster-based permutation analysis approach was implemented to correct for multiple comparisons.

Compared to controls, patients showed amplitude reduction for the P25 (negative and positive cluster; p < 0.001 and p = 0.04, respectively), N45 (negative and positive cluster; p < 0.001 and p = 0.001, respectively) and P70 component (negative and positive cluster; p = 0.04 and p = 0.004, respectively).

There results extend on previous literature about impairment of GABA-A receptor mediated inhibition in schizophrenia, as demonstrated by the N45 amplitude reduction, whereas no significant differences in GABA-B index (i.e., N100) were revealed. Our results also showed that, although specific mechanisms underlying P25 and P70 have not been fully elucidated yet, excitatory neurotransmission is altered in this clinical population. To conclude, TMS-EEG may provide a more comprehensive view of the inhibitory and excitatory mechanisms involved in the pathophysiology of schizophrenia.

Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees.

This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors.

Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores.

The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.

To translate Young's Internet Addiction Test (IAT) to Sinhalese and validate for use in a Sri Lankan population. Following validation of the questionnaire, to use the validated questionnaire to assess the prevalence of internet addiction in a school going population in the Western province of Sri Lanka and identify characteristics of those addicted to the internet.

The internet is widely used across the world and in Sri Lanka. Though essential for everyday life there are many negative aspects of internet use. Addiction to the internet is one such problem and identified to exist among the general population and students in other countries. The most common tool used to measure internet addiction is Young's internet addiction test. The phenomena of internet addiction has not been scientifically studied in Sri Lanka according to our knowledge.

A school-based cross-sectional analytical study conducted in two stages among students aged 15 to 19 years. In stage 1 of the study, 200 students were administered the Sinhalese translation of the IAT and internal consistency and test retest validity assessed. Once validation of the scale was established the translated scale was used on a sample of 2800 students to assess presence of internet addiction.

The Sinhala translation of the Internet addiction test showed good reliability and validity The Chrohnbach's alpha value was 0.78 and Pearson correlation coefficient of 0.85 and therefore suitable to use in a Sinhalese speaking population in Sri Lanka.

Internet addiction was identified among the study population. 8% of the entire study sample and 12.6% among those using the internet showed features of internet addiction. The majority of cases of internet addiction identified were mild 8.2% followed by moderate internet addiction in 3.6% and only 0.9 % having severe internet addiction. There were no significant demographic or internet use related features identified among those with internet users and those not addicted to the internet.

This study demonstrated that the Sinhala translation of Young's IAT is suitable to assess internet addiction in Sri Lanka. It also identified that there are students in Sri Lanka who are addicted to the internet. This will possibly impact negatively on their lives at a crucial stage of development and have immediate as well as long term detrimental effects. More studies are required to identify characteristics of those who are addicted to the internet and to plan interventions.

Bedside teaching is one of the most important modalities in medical education. Sir William Osler stated, “Medicine is learned by the bedside and not in the classroom”. Despite this, the use of bedside teaching in the undergraduate curriculum has been declining, potentially due to changes in course design, increasing clinical workloads and reducing inpatient numbers. In my role as a Clinical Teaching Fellow (CTF), I have aimed to maximise bedside teaching and promote it as the primary approach for student learning.

As a CTF, I deliver teaching to students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. Weekly teaching is provided to groups of 2-4 students, with around 50% of sessions delivered ‘at the bedside’.

Within psychiatry, there is a vast range of potential bedside teaching topics. Given the length of time required to conduct a full psychiatric history and mental state examination (MSE), teaching sessions instead focus on one specific component of the patient interview, for example, assessing perceptual abnormalities or delusions, conducting a substance use history or exploring social circumstances and the functional impact of illness. This approach allows for more focussed feedback and teaching. Session structure is based upon Cox's model of bedside teaching, which I have modified slightly for the psychiatry setting.

Student feedback has been collected via an anonymous electronic end-of-block questionnaire.

Qualitative feedback reveals that students in NHS Lanarkshire value bedside teaching, with one student describing it as “informative, comprehensive and relevant for upcoming exams and clinical practice”.

There are a number of potential barriers to consider when delivering bedside teaching in psychiatry. These include issues identifying suitable patients who can provide informed consent to participate and the ethical concerns regarding exploring difficult subjects such as suicide risk assessment with patients for purely educational purposes.

These issues can be overcome; in inpatient units, there is usually a small cohort of patients who are able to consent and engage in student teaching, and difficult subjects can alternatively be addressed during role-play or simulation sessions.

Despite its challenges, bedside teaching can be an enjoyable and rewarding approach in undergraduate medical education, with feedback revealing it is positively received in NHS Lanarkshire. By utilising Cox's model and focussing on specific aspects of MSE and history-taking, bedside teaching is more accessible and an invaluable tool for psychiatric teaching. Clinicians and educators are encouraged to keep the patient at the centre of student learning.

Psychiatric illnesses are prevalent in general hospitals and associated with length of stay (LOS). Liaison psychiatry teams provide psychiatric care in acute hospitals and can improve mental health-related outcomes but, to achieve ambitious policy targets, services must understand local need.

Using electronic patient records, we investigate associations between psychiatric diagnoses and LOS in South East London hospitals.

Patient records were extracted using the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register Interactive Search system. There were 6378 admissions seen by liaison psychiatry aged <65 years between 2011 and 2016. Linear mixed-effects models investigated the impact of psychiatric diagnoses on LOS. Potential confounders included medical diagnoses, gender, age, ethnicity, social deprivation, hospital site and investment per admission.

According to marginal means, longer LOS is associated with primary diagnoses of organic disorders (mean: 23 days, 95% CI 20.39–25.61), depressive disorders (mean: 11.03 days, 95% CI 9.74–25.61) and psychotic disorders (mean: 10.63 days, 95% CI 8.75–12.51). Shorter LOS is associated with personality disorders (mean: 6.28 days, 95% CI 4.12–8.45), bipolar affective disorders (mean 6.81 days, 95% CI 3.49–10.14) and substance-related problems (mean 7.53 days, 95% CI 6.01–9.05).

Psychiatric diagnoses have differential associations with in-patient LOS. Liaison psychiatry teams aim to mitigate the impact of psychiatric illness on patient and hospital outcomes but understanding local need and the wider context of care provision is needed to maximise potential benefits.

M.H. is a consultant liaison psychiatrist for King's College Hospital adult liaison psychiatry team. At the time of writing, H.T. was senior business manager at SLaM psychological medicine and integrated care clinical academic group. These may be considered financial and/or non-financial interests given the implications of findings for service funding.

Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear.

To describe the emergency department presentation patterns of a help-seeking youth mental health cohort.

Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12–30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other).

During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86–0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086–1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation.

Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.

Obsessive-Compulsive Disorder (OCD) describes a mental health condition in which affected patients experience persistent obsessions, which may often, but not always result in compulsions, causing major distress and anxiety. Obsessions are defined as intrusive thoughts with a high emotional valence, whereas compulsion are repetitive actions, which demonstrate the attempt to eliminate obsessive thoughts.

When speaking of OCD, risk of suicide is rarely a topic of concern. There is still no consensus about whether OCD and suicide are associated. Early schools of clinical sciences propose a low risk of harm, which was taught to most mental health practitioners currently working in health services. Moreover, the World Health Organisation currently classifies OCD as the 11th leading cause of nonfatal burden, indicating that despite the potential for causing significant disabilities, OCD does not pose any serious health risks. Contemporary evidence, however, suggests that the risk for suicide may be underestimated.

This literature review aims to cumulate evidence for the risk of suicide in OCD and its associated underlying factors to clarify and resolve the discrepancies that currently exist regarding this topic.

To identify eligible studies, the databases MEDLINE(R), PubMed, and PsycINFO are used. Selected studies provide data on suicide rates, attempts, and risk factors. Grey literature is included in the review to consider results from studies which may not have qualified for publishing. This literature review is conducted according to the PRISMA guidelines.

After deduplication, 653 studies could be found out of which 15 studies meet the inclusion criteria. Rates of suicide attempts appear to lie between 12% and 27%. Death-to-suicide rates in OCD are shown to range from 0.7% to 1.4%. Associated risk factors for suicide in OCD include, mistrust and unacceptable thoughts, depression, and comorbid substance use disorders. The strongest predictor for death caused by suicide is having a history of previous suicide attempts. Higher education and comorbid anxiety disorders act as protective factors. Lastly, gender differences remain unclear since some studies classify female sex as a protective, and some as a risk factor.

This review provides a good overview of the actual risk for suicide in OCD. Current evidence suggests high suicidality in patients with OCD, leading to suicide attempts in affected patients, but not necessarily resulting in death, as the death-to-suicide rates are low. Genetic heritage and comorbidities of further mental health disorders may increase the risk for suicide in OCD.

This study aims to find out how alcohol use disorder (AUD) correlates to personal well-being and life satisfaction.

AUD is prevalent and leads to significant physical, physiological, and social-occupational impairment. Mental well-being involves the overall positive psychological state of a person – being well adjusted, socially engaged, and emotionally healthy. Despite the paradigm shift from purely treating mental illness to promoting positive mental health, there is limited literature describing the relationship between alcohol use disorder and mental well-being.

This cross-sectional study was conducted in a general hospital in Singapore. Patients admitted across a span of two years were screened for possible alcohol use disorder. Patients were included if they were male, aged 21 years and above, and had the mental capacity to give consent. They were excluded if they had illicit drug use, acute mental illness, inability or refusal to give consent, or if they were already receiving intervention for addiction issues. Participants were administered the Alcohol Use Disorders Identification Test (AUDIT). Those who scored 8 or above were classified as being at risk for AUD, while those who scored 7 or less were classified as at low risk. They were also administered the Personal Wellbeing Index (PWI) and the “Satisfaction with Life as a Whole” question. The PWI measures individuals’ subjective well-being across seven domains. The “Satisfaction with Life as a Whole” question measures, on an eleven-point Likert scale, how satisfied the respondent feels with life in general. Demographic data were also collected and STATA v. 12.1 was used for statistical analysis.

Among a total of 134 participants, 25 of them scored ≥8 on the AUDIT and 109 scored 7 or less. On the PWI, the group at risk scored significantly lower at 71.3 (95% CI: 66.0–76.7) compared to the group not at risk at 77.9 (95% CI: 75.8–79.9), p < 0.01. The results were similar on the “Satisfaction with Life as a Whole” item. The group at risk had a mean of 6.72 (95% CI: 6.03–7.41) while the group not at risk had a mean of 7.67 (95% CI: 7.41–7.93), both p < 0.01. The differences between the high risk and low risk groups remained statistically significant even after adjusting for differences in age, race, education level, and employment status.

This study demonstrated a statistically significant association between AUD and personal well-being as well as satisfaction with life among males.

Errors in the pathology sampling process can be costly for all stakeholders in any clinical setting; however, this process is often overlooked within psychiatry. Over the space of just a few short months at Hollins Park Psychiatric Hospital (HPH) such errors were reported to be numerous with staff raising multiple issues relating to the pathology sampling process. These issues often had a negative impact on patient care, leading to outcomes such as as re-bleeding of patients and delays in interventions. Here, we aim to identify the predominant sources of error in this process and suggest possible improvements to minimise these errors in the future.

Initially, we mapped and analysed each step of the sampling process as it is currently performed in order to identify areas of possible improvement. We then distributed questionnaires to all junior doctors - who are responsible for the handling of samples within the clinical setting – in order to establish error type and frequency. Questions also assessed individual confidence and familiarity with the sampling process.

When mapping the sampling process, we identified all key steps required when sending samples from HPH to Warrington and Halton Hospitals laboratory. This included one pathway for sending routine bloods, and one pathway for urgent bloods. The process for sending routine bloods required more steps and ultimately took longer for samples to reach the laboratory – as expected. Of the issues identified during mapping of the pre-analytical phase, a majority of 77.7% of clinicians reported samples had gone missing or were unreported – with the reasons for this being undetermined in most cases – and 55.5% reported their samples never reached the lab. While on the whole participants were comfortable with the steps involved in sending samples to the laboratory, 77.7% were not aware of the requirement to log samples as they were being sent.

The reasons underlying errors in the sampling process at HPH were multifactorial and included a lack of clinician familiarity with correct procedure, poor sample recording/tracking and lengthy transit times between the patient and laboratory. Here we outline some simple evidence-based recommendations (including education of staff and improved tracking through an electronic requesting system) to help reduce errors and streamline the sampling process in the hopes of improving both efficiency and accuracy, reducing the financial and clinical impact.

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency.

We aimed to investigate the interrater reliability of the HoNOSI.

Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes.

Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7).

There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

To evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.

Reducing the prevalence of depression continues to be a major public health challenge.

Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.

A retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.

Key results include:

• The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).

• Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.

• Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).

• Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.

• A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.

• Risk assessments were out of date for 71% of patients.

• 100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.

Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.

CMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.

To assess the documentation of medication across all Child and Adolescent Mental Health Service (CAMHS) teams in the south region of Derbyshire Healthcare NHS Foundation Trust against a locally agreed protocol. The aim is to ensure accurate and timely documentation of medication history in a standardised way to reduce the risk of medication errors.

We randomly selected 78 patients across seven teams within CAMHS that were currently prescribed medication as of November 2020. We reviewed each patient to see if medication history had been recorded in the specified section of the trust's patient database PARIS. We then cross referenced this information with the patient notes, clinic letters and prescriptions to review accuracy of information in terms of recording of drug name, dose, frequency, and whether the medication was regular or as required. We compared the data to the results of a previous audit in 2017 which used the same methods.

Of the 78 patients, 74% (n = 58) had medication recorded in the correct section of PARIS compared to 13% in the 2017 audit. We found that compliance varied between different CAMHS teams ranging from 0% to 100%. Of those with medication history recorded, 86% had all drug names listed correctly, 79% had all drugs listed at the correct dose, 71% had the correct frequency recorded and 81% had whether the medication was regular, or PRN recorded.

Although we have seen improvement in standardised documentation of medication history since 2017, it remains difficult to rely on this information being up to date and reliable. There was a wide range of compliance in documentation of medication history across different teams, possibly reflecting how effectively the teaching following the previous 2017 audit had been delivered to each team. We have completed more teaching for medical and non-medical prescribers across all localities to highlight the importance of timely and standardised documentation. This is particularly important in CAMHS where the prescribing of medication often remains the responsibility of secondary care, with clinicians regularly prescribing on behalf of colleagues from other teams. Our findings support the move within the Trust towards a system where medication can be both documented and electronically prescribed in the same place (System One).

To evaluate a multidisciplinary inpatient treatment programme for Functional Neurological Disorder (FND) and Non-Epileptic Attack Disorder (NEAD), focussing on clinical effectiveness and patient experience. To produce recommendations for service development and future evaluation.

We conducted a service evaluation of the multidisciplinary inpatient programme for FND and NEAD at the Rosa Burden Centre. We contacted all inpatients discharged between December 2019 and March 2020 via telephone in August/September 2020. Quantitative outcomes were gathered on quality of life and psychological distress using the EQ-5D-5L and Core10 tools. Scores were compared to those gathered routinely at admission and discharge, using Wilcoxon's test for differences. Qualitative feedback on patient experience was gathered using open-ended prompts, and thematic analysis of this data was conducted independently by two researchers. Approval was gained from Southmead Clinical Audit Department (CE10237).

19 of 22 patients successfully completed the service evaluation. Quantitative results tended toward improvement on all measures between admission and discharge. Following discharge, there was a mixed pattern - sustained improvement in overall quality of life, but regression in other scores. Improvement in overall quality of life between admission and follow-up was statistically significant (p = 0.012, Z = 2.52). Changes in psychological distress (Core10) were also statistically significant, reducing between admission and discharge (p = 0.004, Z= –2.84) and increasing between discharge and follow-up (p = 0.016, Z = 2.42). Changes in other scores were not statistically significant at the p < 0.05 level. Qualitative results highlighted the value of the individual therapies offered, the multidisciplinary approach, and the supportive environment. Participants reported improved understanding of their diagnosis, and of self-management strategies. There was demand for greater access to psychological therapies, and increased provision of follow-up post-discharge. Some expressed dissatisfaction with the ward round format and excess “down-time”. The programme was described as a “turning point” for 9 participants.

Quantitative results suggest the programme is associated with global improvement in quality of life, and post-discharge, some benefits are sustained while others are transient. However, interpretation is limited by sample size. We recommend further evaluation with a larger sample to replicate findings, assess effect sizes, and assess which patients or symptoms benefit most. To support this, we recommend improved collection of outcome measures, including routine collection of follow-up data. Positive qualitative findings highlight the strengths of the service and its value to patients. Recommendations for service development include recruiting a psychologist to provide further psychological therapy sessions; expanding the nurse-led follow-up service; and adjustments to the ward round format and activity programme.

Previous studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking.

To compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use.

The study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18–35 years during 2007–2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression.

Refugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82–0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk.

Our findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

Mental health transition-related disengagement is a major public health problem. This study aims to review children in care (CIC) and adopted children's transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). This study aims to illustrate the often overlooked complexities that are associated with this population's transitions.

It is hypothesised that this population is at an increased risk for disengagement post-transition. Such is hypothesised as a result of the population's increased prevalence of complex mental health problems, neuro-developmental needs and developmental trauma. This population would benefit from a transition (optimal), as opposed to a transfer of care (suboptimal).

This retrospective case study included young people from Lewisham CAMHS's team for looked after and adopted children. Optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.

A total of 34 cases (male = 14, female = 20) were included, 88% of which were CIC (12% were adopted children). 85% of the cases included reports of at least one form of abuse and/or neglect. 59% of the cases were categorised as having more than one diagnostic group of mental health problems.

30% (n = 11) of the cases were discharged and were not recorded to have re-engaged with Lewisham AMHS. 12% of the cases had an outcome as 'unknown' due to miscellaneous reasons.

Only 18% (n = 6) of the cases had an ‘optimal’ transition. 18% (n = 6) had a suboptimal transfer and of those cases, 66% (n = 4) did not engage with AMHS beyond three months post-transfer. 21% (n = 7) were re-referred to Lewisham AMHS after being discharged from CAMHS. None of the re-referred cases engaged with AMHS post-referral.

In conclusion, these findings demonstrate that this population is highly complex and can often experience suboptimal transitions from CAMHS to AMHS. Anything less than an 'optimal' transition yields a low ratel of therapeutic engagement. Recommendations for clinical practice includes an extended period of ‘overlap time’ between CAMHS to AMHS for CIC and adopted children. This overlap period will enable mental health practitioners to provide more informed and consistent support that incorporates the needs of CIC and adopted children. Such a provision will enhance therapeutic engagement and subsequently, promote better outcomes for CIC and adopted children. These findings have important resource implications for both CAMHS and AMHS teams.