Aims: Parkinson’s disease is a neurodegenerative condition with a lifetime risk of 2.7%, with a rise in prevalence expected in line with an ageing population. Whilst characteristically associated with motor symptoms, it is a multi-system disease with neuropsychiatric sequelae which are frequently missed by non-psychiatric specialists. Patients face barriers to access psychiatric services.

We describe a 15-month pilot of a novel integrated service for people with Parkinson’s disease in the Bristol Royal Infirmary. A monthly joint outpatient clinic was established whereby old age psychiatrists from the later life liaison psychiatry team and geriatricians saw patients within the same appointment. Additionally, we collaborated for weekly multidisciplinary team (MDT) meetings, inpatient reviews and wider liaison. Our aim was to develop a holistic integrated service with the hypothesis that this would offer value to our joint patient cohort and the wider healthcare service.

Methods: Patients were identified through triage of outpatient referrals, as inpatients and at MDT meetings. Clinical outcomes from the integrated clinic were measured using the Clinical Global Impressions (CGI) scale. Patient and professional quantitative feedback was gathered. Hospital admission data was measured against baseline admission rates for similar outpatient groups.

Results: Between November 2023 and January 2025, eleven integrated clinics were run and 33 patients attended; some patients were seen on multiple dates. The rationale for integrated working included new psychiatric symptoms (17%), pre-existing psychiatric diagnosis complicated by dopamine treatment (28%), cognitive conditions (39%) and complex psychotropic prescribing (33%). Major treatment outcomes included medication adjustment (78%), diagnostic reformulation and psychological therapy provision. There was a clear positive trend in CGI data showing benefit to patients, with overwhelmingly positive patient and professional feedback. Formal analysis of data looking at hospital admissions was inconclusive – but case series analysis shows examples of admission avoidance.

Conclusion: We believe the development of this service shows that close working between psychiatrists and physicians enhances patient care in Parkinson’s disease. Our integrated service is acceptable and beneficial for patients. It is valued by professionals and appears to be cost-effective through medication rationalisation and admission avoidance. In terms of future direction, we have applied for additional funded psychiatrist hours from the Trust to ensure sustainability of the clinic and are in the process of developing linked psychological therapy and clozapine prescribing services as a result of the success of the pilot clinic.

Aims: This observational case series describes 11 patients who underwent emergency ECT under the care of the later life liaison psychiatry team at the Bristol Royal Infirmary over a 12-month period between February 2024 and January 2025. This represents a 5-fold increase in ECT delivery from previous years. We describe patients who required ECT treatment for their psychiatric illness but were deemed to be too medically unwell or too high risk for a general anaesthetic outside of surgical theatres in an acute hospital setting. The aim of this case series was to evaluate the volume of patients requiring emergency ECT and to understand the various clinical rationales for this.

ECT is an evidence-based intervention which is recommended for the treatment of severe depression, psychosis, catatonia and other conditions. Typically, ECT is delivered by psychiatrists in dedicated ECT suites located apart from acute hospitals – as is the case in Bristol. General anaesthesia is required to safely deliver ECT.

Methods: Case notes of the patients who underwent ECT in acute hospital surgical theatres were retrospectively reviewed and data was extracted on demographic features, medical and psychiatric history and details of ECT treatment. Clinical outcomes were measured using the Clinical Global Impressions (CGI) scale.

Results: 9 out of 11 patients who required emergency ECT in theatres were older adults (>65 years) with a skew towards advanced old age (>80). The most common reason for this treatment was severe depression and/or catatonia with associated need for enteral feeding due to not eating and drinking which required acute medical admission and increased anaesthetic risk. Other medical and surgical concerns included severe heart failure and uncontrolled Parkinson’s disease. Overall clinical improvement was seen across 9/11 of patients. 2 patients died within one month of undergoing ECT due to physical morbidity.

Conclusion: This case series which was conducted to evaluate a service being offered by the liaison psychiatry team illustrates the challenge of treating severely mentally unwell patients due to their associated poor physical health. We contend that ECT can (and sometimes should) be offered in the acute hospital when patients are too severely unwell or high risk to receive ECT in peripheral settings, which will particularly benefit those multimorbid older adults who stand to gain the most from ECT.

Given the volume of ECT being delivered and the apparent clinical necessity for this service, next steps will include additional training and service considerations including training liaison nurses in ECT skills.

Aims: Over 300,000 people in England and Wales reside in care home settings, with a large proportion of these people thought to have memory difficulties. Within North Kent (Dartford, Gravesham and Swanley) there are 31 care homes, with around 1,540 residents over 65 years old. The North Kent community psychiatric service therefore aims to meet their clinical needs through an in-built care home service, comprised of medical, nursing and support staff. The service facilitates medical reviews and memory assessments, liaises with social care and psychological services, offers care home-based training for staff and supports family carers. The aim of this review was to better understand the patients being supported by this service and interventions being utilised.

Methods: A review was completed of the service caseload, documenting patients’ demographics, diagnoses and current medications as of November 2024. Clinical notes were also reviewed to better understand when and why patients had been referred, and what prior contact they may have had with services.

Results: Fifty-two caseload patients were identified (around 3% of North Kent older adults in care homes), residing across 20 care homes. All were aged above 60, with the majority in their 80s (44%). Referral was mainly from GP practices (73%), most frequently for support with behavioural or psychological symptoms of Dementia. This can include verbal or physical aggression, agitation, psychotic symptoms and mood disturbance. Referrals were also received for memory assessments, medication advice and support with functional symptoms. Most patients (81%) had never been under the service previously. At the point of caseload review, the majority of patients had formal diagnoses of Dementia (81%). Ongoing intervention was predominantly for medication adjustment and response monitoring (56%). Patients were also receiving behavioural and psychology interventions, and support with depot administration.

Across the caseload, 52% of patients were on antidepressants or mood stabilisers, 42% on benzodiazepines or promethazine and 38% on antipsychotics. NICE guidance advises that for people with Dementia, antipsychotics should only be used if they are severely distressed and at risk of harming themselves or others. We therefore also analysed this for patients with diagnoses of Dementia, of which 33% were on antipsychotics, including risperidone, olanzapine and quetiapine.

Conclusion: Through identifying where patients reside, why they were referred and their ongoing needs, we can better understand the population accessing this service, develop links with other community health services and adapt training offered to care home staff to improve the care received by their residents.

Aims: Eating disorders represent a major challenge for psychiatric and broader medical care. The rate of hospitalisation has almost doubled in recent years and anorexia has a higher mortality rate than any other mental illness. Beat Eating Disorders has made recommendations for educating medical students. When making the recommendations, they did not receive responses from Cardiff or Swansea Medical Schools. This review assesses the provision of eating disorder teaching and whether it is sufficient for effective medical training.

Methods: Clinical lecturers in Cardiff and Swansea Medical School reviewed each other’s medical curricula and compared the prevalence and extent of eating disorders in each. From 1 December 2024 to 5 February 2025 we reviewed the types of learning provided, opportunities for self-directed learning, and other areas where eating disorders could arise. We compared this against the guidelines recommended by Beat for an effective curriculum. We also reviewed the schools’ official exam guidelines to assess whether eating disorders are listed as a topic in psychiatry or the broader curriculum.

Results: In Cardiff there is a dedicated lecture on eating disorders in the Year 4 psychiatry rotation, which covers all major eating disorders. There is also an optional online module written by an Eating Disorders Consultant which goes into further detail. There is no practical training in examining or communicating with a person with eating disorders.

In Swansea there was no mention of eating disorders in the curriculum yearbook. There is a lecture in Year 2 and Year 3, each an hour long. Eating disorders exist on the GMC MLA content map, so can come up in the final year OSCE (CPSA) but it is not clear whether this happens in practice in Swansea or Cardiff.

Across South Wales, clinical attachments with eating disorder services were haphazard and locality-dependent. Beat would classify both medical schools as providing “insufficient” education.

Conclusion: Medical students in Wales are not receiving education on eating disorders that satisfies the Beat recommendations. Despite achieving proficiency in academic teaching, neither medical school provides the practical experience necessary to examine, support, and treat someone with eating disorders.

Greater emphasis on eating disorders is required, not just within psychiatry, but within broader medical teaching such as cardiology and gastroenterology. Eating disorders should be better incorporated into communication stations, practical examinations, and psychiatric teaching. Better access to Eating Disorder Services for medical students would also allow them to meet patients and build vital clinical experience

Aims: To examine the referrals in a newly established Living Well service at Dales community mental health team, Derbsyhire.

Methods: A retrospective review of notes on SystmOne (electronic patients records) referred for a period of 6 months from April–October 2024.

The source and rationale of the referral to the living well team, acceptance by the team, written communication to the referrer and the processes leading to the outcomes of the referral were examined.

Results: 75% of the referrals were from GP, 9% were from community IAPT teams.

67% of the referrals were accepted for input by living well teams.

70% of the referrals had a written letter sent to the referrer.

96% of the referrals led to a triage-based MDT meeting.

96% of accepted referrals had allocated member of staff making contact with the patient. 71% received a welcome call.

18% of the referrals had an outcome of being referred to the outpatients clinic.(as a long-term offer), 10% had psychology input as an outcome.

10% of the referrals were deemed after MDT discussion not to be appropriate for the service.

8% didn’t engage leading to discharge from the living well team.

15% of the referrals were due to symptoms of low mood, 14% with symptoms of anxiety, 12.2% of the referrals related to emotional dysregulation.

Conclusion: Two thirds (67%) of the referrals were accepted for a short-term offer by the team in providing support indicating a role of the living well team to provide prompt interventions regarding the mental health of patients.

A multidisciplinary approach in the team consisting of varied professionals has helped manage a lot of referrals with community-based support. 96% of the referrals were discussed with MDT approach.

A high proportion (70%) of the referrals had a letter written to the referral independent of the outcome. Written communication to the referrer is to be improved upon regardless of outcome of the referral.

A further qualitative review of the process to take place in 12 months time.

Aims: Referrals to Old Age Community Mental Health Team (CMHT OP) Guildford/Waverley have increased in number and workload. The purpose was to see the number of referrals received and how to improve the referral allocation practice concerning delegation to manage the workload burden on staff.

Methods: 1230 referrals were reviewed. The quantitative data was primarily taken from allocation meeting documentation. Additionally, information was gathered from senior staff and relevant documentation of allocation meetings on the electronic patient records when there was vague information.

Results: The data shows that during the first cycle from April to September 2023, CMHT OP Guildford and Waverley received 579 referrals. 90% (521) of the referrals were accepted, and 10% (58) were declined due to inappropriate referrals. There were 412 routine, 65 sooner and 92 urgent referrals received. Senior team members assessed and stepped down 21 of the urgent referrals. 459 patients were referred due to organic conditions, 76 patients were referred due to functional conditions, and 23 patients were referred for a mix of functional and organic conditions. 85 patients were transferred to the Care Home Pathway (CHP) service, 18 patients were transferred to the Young Onset Dementia (YOD) service, and 25 patients were transferred to the Integrated Care Team (ICT). The first cycle of the audit was presented to the team, and steps of interventions were agreed upon for the second cycle. The re-audit data shows that from October 2023 to March 2024, there were 651 referrals. 88% of the referrals were accepted, and 12% were declined due to inappropriate referrals. There were 510 routine, 57 sooner and 84 urgent referrals received. Senior team members stepped down 26 of the urgent referrals. 523 patients were referred due to organic conditions, 88 patients were referred due to functional conditions, and 48 patients were referred for a mix of functional and organic conditions. 76 patients were transferred to the CHP service, 15 patients were transferred to the YOD service, and 51 patients were transferred to the ICT.

Conclusion: The audit data objectively reflects an increasing trend in referrals between the first and second cycles. Intervention after the first audit cycle showed increased use of advice and guidance services for declined referrals, increased step-down of urgent referrals and an increased number of patients delegated to other services, particularly the integrated care team, which shows a more confident referral allocation process.

Aims: The electrocardiogram is a non-invasive test used to assess cardiac function. Certain psychotropic and antidementia medications can cause bradycardia, heart block, or prolonged cardiac repolarization, worsening pre-existing conditions. Evaluating cardiac function before treatment initiation is essential. However, in the North Older People Service (NOPS), the lack of electrocardiogram availability at the time of assessment has led to significant delays in treatment initiation, particularly for patients referred for cognitive assessments. These delays not only affect individual patients but also reduce clinic efficiency, limiting access for other patients awaiting assessment.

Aims were to evaluate how the availability of ECG at the time of patient’s assessment impact on the commencement of treatment.

Methods: A retrospective review of electronic health records was conducted for patients referred to the North Older People Service, between January and February 2023. Of 62 accepted referrals, 5 patients were deceased, and 2 had not yet been assessed, leaving 55 for analysis. Data collected included referral dates, assessment dates, electrocardiogram availability, whether an electrocardiogram was required before treatment, treatment initiation dates, and diagnoses.

Results: Of the 55 patients analysed, 70.9% were started on new medications, while 29.1% were not due to mild cognitive impairment, existing treatments, or diagnoses such as vascular dementia. Among those who commenced treatment:

10.25% had an electrocardiogram at assessment and were started on treatment immediately.

71.79% did not require an electrocardiogram and were initiated on treatment without delay.

17.94% required an electrocardiogram before treatment initiation. Of these, 85.7% had dementia.

The waiting period ranged from 4 weeks and 6 days to 30 weeks and 2 days, with an average delay of 18 weeks and 2 days.

Conclusion: The findings support the hypothesis that the absence of an electrocardiogram at the time of assessment contributes to significant treatment delays, particularly for dementia patients. To address this issue, referring clinicians should include electrocardiograms in pre-assessment investigations, and the triaging team should ensure that electrocardiograms are requested when necessary. Implementing these measures could reduce delays, improve efficiency, and enhance patient outcomes.

Aims: People with intellectual disabilities have higher rates of mental health difficulties than those without. The physical health inequalities and premature mortality that they experience is even more pronounced. In the United Kingdom, physical healthcare has traditionally been co-ordinated and delivered through primary healthcare settings. There is a case that physical health inequalities for those with intellectual disability and mental health difficulties can be reduced further if primary care interventions are supplemented by Enhanced Physical Health Clinics (EPHCs) co-located in mental health outpatient settings.This paper describes the structure and setting up of an EPHC for people with intellectual disability and mental disorders and an evaluation of its first 2 years.

Methods: The EPHC database which contains patient demographics and process data for the clinic regarding tests and interventions completed was utilised for this study. This includes sociodemographic, psychiatric, and physical health diagnoses, prescribed medication, physical health assessments and interventions.

Results: During its first two years, the clinic saw 463 patients. The mean age was 44 years and 62% were male. There was considerable developmental and psychiatric comorbidity, with high rates of autism and major mental illness. The most common physical health diagnoses were epilepsy, hypothyroidism, diabetes, hypertension, and asthma. A range of previously unidentified unmet healthcare needs that warrant further assessment and treatment was identified.

Conclusion: The EPHC was effective in promoting physical health monitoring and screening in a population which experiences significant health barriers. Recommendations regarding clinical practice and future research are provided.

Aims: The cost to the NHS of missed appointments each year is highly significant. PIFU is an alternative to the conventional follow-up model where patients request appointments as-needed in attempt to reduce this cost, and is part of the Outpatient Recovery and Transformation Programme component of the NHS Long-Term Plan. This model is well established in chronic conditions under secondary care like gynaecology and rheumatology outpatients but has more recently been brought into psychiatry. Currently, there is minimal research on the suitability of this model in psychiatry. The Exmouth CMHT in Devon have had a PIFU model for the last 4 years, and this project evaluated this model and analysed the associated costs.

Methods: We present the model used to form the PIFU service in Exmouth. A service evaluation was conducted of the Exmouth PIFU model and is presented in this poster looking at the team constructed, pathways into the service, and the hours this service provided for patients. Patients under the service also have given feedback on their experience of the service. We then compare the costs of this service with equivalent referrals through primary care.

Results: In the absence of a standardised PIFU model for psychiatry, the Exmouth CMHT model was compared with the PIFU model described in the NHS Long-Term Plan. Our service evaluation demonstrates that limited staffing and budget can provide a suitable PIFU service for our patients. Patients gave positive feedback about their experience of PIFU and felt this had benefited their care. Cost comparisons demonstrate the relative costs, overall demonstrating savings to the NHS.

Conclusion: Despite a lack of research to guide the transition of PIFU into psychiatry, the Exmouth CMHT have created an effective model for their team that patients have found helpful. This model was adapted to the changing needs of the service over the years, demonstrating flexibility in the model, but despite this, it could be used as a template for the implementation of PIFU in other services. Cost comparisons demonstrate the saved time in primary care is most significant. Further research is planned to develop an evidence-based model for PIFU, and to look at staff perceptions of PIFU implementation.

Aims: Substance misuse is a common comorbidity in severe mental illness, contributing to increased morbidity and poorer clinical outcomes. Effective management requires accurate documentation and structured interventions. However, existing practices in psychiatric inpatient care are often inconsistent, necessitating a thorough evaluation to inform service development.

Aims were to assess the prevalence of substance misuse and evaluate its documentation and management among patients admitted to Willow Suite Psychiatric Intensive Care Unit (PICU), Pinewood (male acute ward), and Cherrywood (female acute ward) at Littlebrook Hospital between June and July 2024.

Hypothesis: Substance misuse is prevalent among psychiatric inpatients and is under-documented and sub-optimally managed across acute and PICU settings at Littlebrook Hospital.

Methods: A retrospective review of clinical records for 96 consecutive admissions (Willow Suite PICU: n=28, Pinewood: n=35, Cherrywood: n=33) was conducted. Data collected included demographics, diagnoses, substance misuse history, documentation practices, and management interventions such as care planning, multidisciplinary team (MDT) discussions, CPA meetings, referrals to specialist services, and psychoeducation.

Results: Of the 96 patients, 53% (n=51) had a history of substance misuse, with current misuse documented in 33% (n=32). PICU had the highest prevalence (60%, n=17), followed by Pinewood (51%, n=18) and Cherrywood (48%, n=16). Cannabis was the most frequently reported substance (100% in Willow Suite, 29% in Pinewood, 33% in Cherrywood), followed by cocaine (45%), alcohol (14%), and opiates (10%). Polysubstance use was noted in 47% of Willow Suite patients, 45% in Pinewood, and 44% in Cherrywood.

Across the wards, substance misuse was documented in 34% of core assessments and 42% of progress notes. Care plans addressed substance misuse in only 12% of cases, while MDT reviews and CPA meetings discussed it in 22% and 13%, respectively. Referrals to external substance misuse services were rare (3%, n=3). Psychoeducation was offered to 15% (n=15) of patients.

Conclusion: Substance misuse is highly prevalent among inpatients, yet its management remains inconsistent. Gaps in documentation and limited referrals to specialist services indicate the need for improved screening, structured care planning, and closer collaboration with external agencies. These findings highlight an urgent need for targeted service improvements to enhance care for this vulnerable population.

Aims: Clozapine is an effective treatment for adults with schizophrenia, who have not responded to two other antipsychotic medications. However, there are challenges prescribing when patients who take clozapine in the community are admitted to a General Hospital for physical health reasons. These challenges can include physical health co-morbidities, medication interactions, blood dyscrasias, changes in smoking status and bowel movements, infection, missed or incorrect doses of clozapine prescribed, and clozapine toxicity.

Our aim was to evaluate the management of clozapine for patients admitted to a General Hospital, including the interaction with Liaison Psychiatry.

Methods: Data were collected retrospectively, between January 2022 and January 2023, from two General Hospitals in England. There were a total of 45 admissions to a General Hospital for 34 patients who were identified as prescribed clozapine in the community. Electronic records were accessed for the community, General Hospital and Mental Health service. Records were reviewed to assess if the clozapine prescription was correctly recorded on the community record, and if a referral to Liaison Psychiatry was made on admission. Within the Liaison Psychiatry review, records were reviewed for documentation of full blood count, medication concordance, smoking status, bowel movements, physical health concerns, medication interactions, signs of clozapine toxicity and recommendations for a clozapine level.

Results: The clozapine prescription was documented correctly in 16% (7/45) of occurrences in community records.

On admission to a General Hospital, 49% (22/45) of patients were referred to Liaison Psychiatry. The mean time for referral from admission was 41.07 hours. Of the 22 admissions that were referred, 68% (15/22) were seen within 24 hours by Liaison Psychiatry.

On review with Liaison Psychiatry, the frequency of documentation seen was: full blood count (65%), medication concordance (65%), smoking status (50%), bowel movements (41%), physical health concerns (91%), medication interactions (38%) and signs of clozapine toxicity (18%). Advice regarding a clozapine level was documented for 35% of patients.

Conclusion: Local education was arranged for the community, General Hospital and Mental Health Trust. A Trust-wide policy was written for the General Hospital to utilise for patients that are prescribed clozapine. This included the importance of referring immediately to Liaison Psychiatry to reduce disruption in treatment and the need to monitor for bowel-related complications. A clozapine admission checklist was introduced for local Psychiatry teams to use when reviewing a patient who takes clozapine. With these measures now implemented, data will be collected to review the effectiveness.

Aims: The WHO estimated that 1 in 5 people living in conflict areas have some form of mental disorder. On top of this, limited access to mental health care in these areas continues to amplify the issue. However, hope can be found through the increased use of telehealth during the COVID-19 pandemic, which has opened the opportunity to apply the platform in conflict zones.

The pre-existing need of mental health services in Myanmar was aggravated by the 2021 coup and the ongoing COVID 19 pandemic. The Ministry of Health (MOH) of the National Unity Government (a chosen government formed with democratically elected MPs) developed a system of free telehealth care. The Tele Health Clinic was initially composed of healthcare workers from the liberated borders of Myanmar and later joined by local/international clinicians. The Tele Mental Health (MH) Clinic was then opened in August 2021 to address the devastating mental health burden superimposed by the combination of coup and pandemic.

Objective of the Study: To describe the development of a telepsychiatry clinic amidst the current political turmoil in Myanmar.

Methods: Review of the historical data of Myanmar civil war, military coup in 2021 and Civil Disobedience Movement.

Review of UNHCR data on the impact of current conflict.

Literature review of mental health in conflict zones and role of telepsychiatry in conflict settings.

Review of the process of development of the Tele Mental Health Clinic in Myanmar.

Descriptive analysis of one year data of the clinic.

Results: The Tele-Mental Health clinic was developed following the collapse of the healthcare system after the 2021 military coup in Myanmar. The clinic uses innovative ways to recruit clinicians and to provide psychiatric services. While there is ongoing risk of military junta’s persecution, arrest and torture, the clinic continues to thrive and expand.

Conclusion: Telepsychiatry can be used as a safe and effective way to bridge the barriers to mental health care throughout the current political turmoil in Myanmar. The evidence on the effectiveness, cost-effectiveness, process of implementation and long-term measures to overcome challenges are areas of future research interests.

Aims: There are high rates of Neurodevelopmental Disorders (NDD) and mental health needs in young people who engage in offending behaviours. Incompletely assessed development can be a factor in engaging with legal proceedings and with those involved in their care. Young people open to the three Gwent Youth Offending Services (YOS) and Tier 3 Gwent Forensic Child & Adolescent Mental Health Service (FCAMHS) have previously been identified as having traits indicative of an underlying NDD. No specific ND assessment pathways exist within YOS for suspected Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD); those requiring assessment are referred to the CAMHS ND Team. Some cases are Not in Education, Employment or further Training (NEET), may not reside with family, and can struggle to engage in typical referral pathways.

An evaluation is taking place regarding the use of existing Gwent CAMHS and YOS resources for piloting a Tier 3 Gwent Forensic CAMHS Neurodevelopmental Assessment Pathway (FCAMHS NDAP).

Methods: Gwent FCAMHS is a small Multidisciplinary Team (MDT):

One part-time Consultant Forensic Child & Adolescent Psychiatrist.

Four Psychiatric Nurses.

One part-time Forensic Psychologist.

Between December 2023–December 2024 the number of YOS cases referred for and receiving ND assessment were logged. Assessment outcomes were considered with ongoing discussions with each of the YOS to ascertain ongoing roll-out of a pilot FCAMHS NDAP.

Results: Between December 2023–December 2024:

7 cases were referred (5 for possible ADHD, 2 for ASD).

6 of the referrals were not in mainstream education or NEET.

6 ND assessments were completed.

5 resulted in an NDD diagnosis (ADHD=4, ASD=1).

2 cases necessitated ADOS-2 assessment and 1 case was assessed using the Qb Test protocol.

Upon diagnosis, 2 elected to trial ADHD medication.

Referrals originated from all three YOS in Gwent: Newport (2), Blaenau Gwent-Caerphilly (4) and Monmouthshire-Torfaen (1).

Conclusion: Cases were diverted from the CAMHSND waiting list to FCAMHS. YOS support in case engagement and obtaining information was vital for the assessments. YOS managers recognise the role an FCAMHS NDAP has for some cases in the Gwent YOS who would struggle to engage in the typical pathway. Requests have been received for YOS staff training in NDD.

A formal roll-out of a Gwent FCAMHS NDAP pilot with specific inclusion criteria has been agreed with the YOS teams and Gwent FCAMHS, commencing January 2025. Quality Improvement methodology is utilised and training packages for YOS staff are being developed.

Aims: This audit aimed to evaluate the initial assessment, investigation, management, and communication strategies for paediatric patients presenting with Functional Somatic Symptoms at Alder Hey Children’s Hospital. The audit addressed a significant gap in existing national NHS and local guidelines for guidance of medical professionals in diagnosing and managing Functional Somatic Symptoms presenting to paediatric services.

Methods: A parallel-running retrospective analysis was performed jointly by the General Paediatrics team and the Child Health Psychology (Liaison) team on young people admitted under General Paediatrics and/or attending outpatient Psychiatric services over a four-month period. Summary narratives were generated for each patient detailing the journey from first presentation with functional symptoms to diagnosis and management. This was then interpreted by systematic data analysis – both qualitative and quantitative.

Results: The audit’s key finding was the absence of a standardized approach to the assessment, investigation, and management of Functional Somatic Symptoms. Patients underwent excessive investigations across multiple departments without coordinated multidisciplinary team (MDT) involvement. Furthermore, very few received a formal diagnosis of Functional Somatic Symptoms by discharge; communication and psycho-education around this diagnosis with young people and their families was distinctly lacking.

Conclusion: These findings highlight an urgent need for the development of both national and local structured guidelines and integrated care pathways to improve the management of Functional Somatic Symptoms in children and young people across physical and mental health services. This is needed to ensure timely diagnosis, psycho-education, appropriate intervention, and better long-term outcomes for affected young people and their families.

Aims: Sexual disinhibition, a neuropsychiatric symptom characterised by inappropriate sexual comments and/or behaviours, remains poorly understood in a general adult population. The absence of standardised assessment tools and limited measures to capture disinhibition may contribute to underestimating its prevalence and clinical significance. This study aimed to (1) determine the prevalence of sexual disinhibition on an acute all-male adult inpatient ward and (2) identify potential predictors of its occurrence.

Methods: Data from 55 patients was collected prospectively over a six-month duration to evaluate the prevalence and predictors of sexual disinhibition on an acute male inpatient ward. Included diagnoses encompassed psychosis, bipolar disorder, anxiety, depression, autism spectrum disorder, schizophrenia, schizoaffective disorder and personality disorders. Dichotomous variables included sexual disinhibition (current and past), delusions of a sexual nature, substance misuse, forensic history, history of abuse and medication use, including benzodiazepines, antipsychotics, mood stabilisers, antidepressants and depot medication. Scale variables included age. Family history of mental illness, age of onset, disease duration and unilateral parenting were excluded as a result of missing data. A binomial logistic regression was performed to examine the effects of these factors on the likelihood of sexual disinhibition.

Results: In total, 55 male patients, of whom 45.5% presented with sexual disinhibition, were included in our service evaluation (age: 44±14 years, detained under the MHA: 96.3%, previous sexual disinhibition: 61.8%, delusions of a sexual nature: 25.5%). Psychiatric diagnoses included psychosis (69.1%), bipolar disorder (16.4%), anxiety (18.2%), depression (27.3%), autism spectrum disorder (14.5%), schizophrenia (40.0%), schizoaffective disorder (21.8%) and personality disorder (25.5%). Presence of substance misuse was observed in 52.7% of patients, whilst forensic history was seen in 63.6%. Abuse was reported in nearly half of the patients (49.1%). The model was statistically significant (χ2(20)=45.329, P<0.001), explaining 75.1% (Nagelkerke R2) of the variance in sexual disinhibition and correctly classified 87.3% of cases. Only one variable was significant, delusions of a sexual nature (χ2(1) = 4.228, P=0.040).

Conclusion: Our findings highlight a positive association between sexual disinhibition and delusions of a sexual nature. Clinicians should recognise sexual disinhibition as a potential indicator of sexual delusions, aiming to assess these symptoms comprehensively and non-judgementally to better understand individual patient psychopathology. Educating patients and caregivers on this association may reduce stigma and aid understanding towards the patient. Future research should investigate the mechanisms of this relationship with larger sample sizes to minimise the risk of type II errors.

Aims: Antenatal depression significantly impacts maternal and foetal health outcomes, yet it remains underdiagnosed and undertreated. The Psychological Resilience in Antenatal Management (PRAM) programme at KK Women’s and Children’s Hospital in Singapore was established in December 2022 as a strategy to identify antenatal depression early among pregnant patients. Under the PRAM programme, universal antenatal depression screening is integrated into the routine care programme for pregnant patients, using a modified version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire during their routine obstetric check-up in the second trimester, for early intervention by the perinatal mental health team.

This qualitative study explores the lived experiences of pregnant women who have undergone screening and intervention under the PRAM programme. It seeks to understand their perceptions of the screening and intervention process, identify barriers and facilitators to help-seeking, and examine effective components of the therapeutic process.

Methods: Using an Interpretative Phenomenological Analysis (IPA) approach, semi-structured interviews were conducted with 10 women who have participated in the PRAM programme between November 2023 to January 2025. Interviews were completed either virtually over Zoom (N=8) or in person (N=2). The interviews explored participants’ experiences with antenatal depression screening, subsequent interventions, and their overall pregnancy journey while managing mental health concerns.

Results: Preliminary analysis reveals several key themes in participants’ experiences. For half of the participants (N=5), the screening process served as an opportunity for self-evaluation and mental health awareness. Obstetricians have also been identified to be crucial facilitators, serving as the initial point of psychiatric referral and influencing women’s decisions to seek support. A significant barrier identified by four participants was the stigma associated with psychiatric diagnoses and receiving psychiatric help. Additionally, participants emphasised the importance of spousal involvement in the therapeutic process, with several women expressing a desire for greater partner participation in their mental health journey.

Conclusion: Understanding women’s experiences with the PRAM programme contributes to improving screening protocols and developing more effective, patient-centred approaches to managing antenatal depression. The findings highlight the need for integrated care pathways that address stigma, enhance partner involvement, and strengthen the role of obstetricians in perinatal mental health care. These insights can inform the development of more comprehensive and accessible mental health support services within perinatal care settings.

Aims: Our aims for this project were to examine how long-acting antipsychotics are prescribed in the various teams (both inpatient, community and specialist services) across BCUHB, with a view to identify any emerging trends, and to compare this with data on efficacy and cost-effectiveness obtained via a systematic search of the available literature.

Methods: Data on depots prescribed across BCUHB was provided to us by the mental health pharmacy team for the year April 2023–March 2024. We extracted our points of interest from this data and demonstrated this graphically using Microsoft Excel.

We also completed a literature search of Ovid, Cochrane Library and Google Scholar on the topic, to identify relevant systematic reviews which included studies comparing depot antipsychotics head-to-head. This returned 1500 articles, of which 15 were shortlisted by title relevance, and 4 included following full-text analysis.

Results: According to the available research, there is no demonstrated clear superiority in efficacy of specific long-acting antipsychotics. The data on cost-effectiveness was somewhat conflicting; in that risperidone was found in a recent systematic review to be the most cost-effective in most studies apart from included UK studies; but that also paliperidone was more cost-effective than the typical antipsychotics. Our data showed that the three most commonly prescribed in BCUHB are typical antipsychotics, and interestingly, the unit price per depot for paliperidone in BCUHB was significantly higher than any other.

Conclusion: ‘Cost-effectiveness’ in the systematic review we looked at was defined by QALYS (‘one year of life in perfect health’). To look at the BCUHB ‘price per depot’, you may, incorrectly, assume that prescribing paliperidone would be a waste of money (with it being 173 times more expensive than the highest dose of the cheapest depot available). This suggests that use of paliperidone may make cost-savings in the longer-term, for example, in preventing admissions to hospital which are costly. In BCUHB, paliperidone is commonly prescribed to patients with learning disabilities, but is not a commonly prescribed depot amongst general adult groups (either inpatient or community).

There is limited guidance on choice of antipsychotic depot and given the absence of significant differences in their efficacy, it is generally down to clinician choice, taking into account patient preferences and drug tolerability profiles. As mentioned, cost does not equal cost-effectiveness and having an awareness of this may influence local guidance and decision-making.

Aims: The Mental Welfare Commission (MWC) released a report in February 2024 recommending the use of audit to ensure good clinical practice in the use of community Compulsory Treatment Orders (cCTO) as part of the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA). One particular area of concern was the use of care plans under section 76 of the Act.

An audit was performed across NHS Lanarkshire Mental Health services to determine if all patients on cCTOs had Section 76 care plans in place that were valid and compliant with the minimum standards set out by the MWC.

Methods: Medical records administration staff were contacted across all of the psychiatry specialities within the health board, to supply a list of patients on cCTOs. Their electronic medical records were reviewed and relevant data collated by the authors to determine if the appropriate paperwork was in place, was valid, and met the minimum standards, as set out by the MWC.

Results: Within NHS Lanarkshire, there were 89 patients on cCTOs. 87 of these had a Section 76 care plan in place, though one of these was considered invalid.

Only 24% of the care plans were found to meet all of the minimum standards. There was noted to be a high degree of variability in which of the minimum standards were met, how the care plans were documented and the quality of the information contained within them, across the specialties and between individual psychiatrists.

Conclusion: This was the first audit looking at cCTO Section 76 care plans carried out in NHS Lanarkshire. It demonstrated there is a need for standardisation of these care plans across mental health services, to ensure that as a minimum, all statutory information is documented.

Recommendations from the audit included the use of a proforma to capture the information required to meet the minimum standards, as well as provide prompts for additional information to improve the quality of the care plans. It has also been recommended that each psychiatry specialty sets up their own annual audit of care plans, and an audit tool for this has been provided.

Aims: To establish baseline data on melatonin use.

To compare the patterns of use with national guidelines.

To make recommendations to the teams.

Methods: A retrospective audit of patient records under the CAMHS services in Lincolnshire was undertaken to identify patients on melatonin as of June 2024. Data was collected from medical records between June and July 2024. Patients under 19 years and prescribed melatonin were included. Patients previously on melatonin but discontinued by June 2024 were excluded.

This audit was inspired by the POMH melatonin audit.

Results: 54 patients were identified, 23 males and 31 females. About half of the patients had been on melatonin for over one year (n=25).

Autism/autistic spectrum disorder was the most common diagnosis/comorbidity – 36 patients, 29 patients had an anxiety disorder, 21 patients had diagnosed/comorbid hyperkinetic disorders, 12 patients had mood disorders while 14 patients did not have a diagnosed neurodevelopmental disorder.

In 84.6% of prescriptions, evidence-based non-pharmacological measures were tried first.

The target symptom(s) for melatonin treatment was clear in 55.6% of cases. Sleep latency was the most common target, followed by reducing night-time awakening.

Licensed melatonin preparation was used in 46.3% of prescriptions. The preparation was however not clearly documented in most of the cases. (Licensed use covers insomnia with autism spectrum disorder (Slenyto), insomnia with Smith–Magenis syndrome (Slenyto), insomnia associated with behavioural disorders in children and adolescents (Adaflex)).

86.7% of prescriptions were reviewed for efficacy within 3 months while tolerability (side effects) was reviewed in 46.7%.

The need for continuing melatonin treatment was reviewed annually in 80.8% of cases while tolerability was reviewed in 30.8%.

Conclusion: The audit revealed high rates of prescription in certain areas of the county, it also showed that documentation of indication and target symptoms was not always available, similarly review of tolerability (side effects) was not always available.

The findings were presented to the CAMHS consultants. The high rates were thought to be related to shift in practice over time, perhaps due to consultants shortage.

Documentation of efficacy was more often done than review of tolerability. One reason for this could be that melatonin was being monitored by the community paediatrics team or the GP.

The need for clear documentation can therefore not be overemphasized.

The audit did not consider those who were able to stop melatonin. This could be useful to support patients.

Aims: The audit aimed to evaluate the effectiveness of transitioning from paper-based patient prescription charts (Kardex) to an electronic prescribing and medication administration system (EPMA) in improving compliance with safe deprescribing practices on inpatient psychiatric wards. Specific objectives included assessing adherence to Trust guidelines, reducing incidents of incorrect medication deprescription, and enhancing clarity regarding medication changes.

Methods: This audit was performed in May 2024 on all psychiatric inpatient wards utilising the EPMA system. This system had been in use for over a year in the Trust following a phasing out of the paper Kardex. During this period, the EPMA records of inpatients were evaluated. The findings were compared with that from a previous audit, which examined Kardex records in March 2022. The comparative analysis centred on deprescribing practices, examining whether medications were properly discontinued, entries were completely filled, and justifications for deprescribing were noted. The audit complied with Trust protocols and ethical governance requirements.

Results: The transition from the Kardex system to EPMA resulted in significant improvements in safe deprescribing practices. There was 100% compliance in details on the system corresponding to most of the standards measured in the previous audit, including name crossed, row crossed fully, ID, code (reason) and stop date. The sole exception to this was observed when utilising the 'other’ option in EPMA’s dropdown menu, where adherence to providing a stated reason was 94.5%, a metric not evaluated in the initial audit as this was not facilitated by the paper Kardex. In this audit, all the standards were met and the medications were considered safely deprescribed. This stands in contrast to the previous audit where less than 33.88% of deprescribed medications met the standards.

Conclusion: The EPMA system demonstrated substantial progress in promoting safe deprescribing practices aligned with Trust guidelines. The notable improvement in compliance clearly demonstrates the significant influence of technology on clinical practice and patient safety in relation to medication prescription and administration in this case.