As of 2018, there were over 11 million people imprisoned globally. Suicide and self-harm rates have been found to be markedly elevated among imprisoned individuals, however there is much less literature reporting on risk factors for suicide and self-harm following prison release. The immediate post-release period has been found to be a particularly high-risk period for suicide and self-harm. Since many more people are released into the community every year than people kept imprisoned, released prisoners' health is a matter of public health concern. With the societal impact of this topic in mind, this systematic review aims to collate the risk factors for suicide and self-harm upon release from prison.

PubMed, PsycINFO, MEDLINE, and Cochrane were systematically searched using keywords relating to prison release, self-harm and suicide for articles published since 1/1/12. Studies were included if they reported data on risk factors for self-harm or suicide and followed prespecified inclusion criteria. Articles were screened by the author and uncertainty was settled by two independent reviewers. Included studies were evaluated using standardised quality assessment tools. Quantitative data were narratively synthesised due to a high level of heterogeneity in between studies.

248 articles were identified in total. 10 articles were included, reporting data on self-harm and suicide risk factors from 5 countries. Studies ranged from moderate (n = 2) to high quality (n = 8). Risk factors were categorised into the following: demographic characteristics, psychiatric history, conviction type, and imprisonment history. Risk factors which did not fit into any of these categories were categorised into an ”other” group. It was found that there were many non-modifiable factors such as violent convictions, female sex, Indigenous (Torres Strait Islander or Aboriginal) ethnicity, and single relationship status which increase self-harm or suicide risk upon release.

To our knowledge, this is the first systematic review to collate the risk factors for suicide and self-harm following prison release. The results show a complex variety of risk factors. The high mortality rate in this group necessitates the need for strategies to intervene before community re-entry. Study into risk factors post-release may guide identification of at-risk groups to target with proactive, coordinated care pre- and post-release. It is likely this will require a multifactorial approach including health, social and community programmes.

Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. (Osborne et al, 2022). Northeast England continues to have the highest morbidity /mortality with regards to substance use (ONS, 2022). Therefore, it is essential that staff in addiction health settings innovate to address physical health.

A review of the literature identified little research relating to physical health care in addiction and recovery settings. Our service protocol for blood testing was used to set the audit standards. The blood testing assessed electronic communication and electronic records. Physical health nurses take blood on request and email blood results to a medical/clinician inbox. The total sample was 1128 since pathway inception in March 2022.A sample size of 70 was selected via systematic sampling using n-15th person. Descriptive analyses of data followed by qualitative exploration with the physical health team was completed. The audit was registered locally.

Of the sample size of 70 whose records were reviewed, we noted that blood tests were reviewed by medics (100%) with 98.6% of these reviews being within 6 hours of notification by the physical health team. Action plans were documented for blood results requests and communicated by email to physical health team (100%). 84.3% of the action plans were completed by physical health team on receipt of emails. Non completion of action plans in 15.7% of cases was related to client being hospitalised or disengaging from services (which might include relocation out of area or transfer into the criminal justice system).

Within our service, we have patients who struggle to attend conventional pathways e.g., GP. In view of the previously stated morbidity and mortality it is important that we are able to offer blood testing with timely follow up and action plans when appropriate to these patients.

Our service has good liaison with local services and bespoke partnerships to cater for the homeless amongst other subgroups. We used this audit to also improve processes and patient safety with plans for a re-audit. There was no previous nor national comparison for these data.

The aim of the study was to investigate the potential association between gambling disorder and symptoms of sleep problems including insomnia and hypersomnolence. Gambling disorder is a behavioural addiction featuring persistent, recurrent gambling resulting in distress and impairment of function. Lifetime prevalence of gambling disorder is estimated at 0.6–0.9%, though high quality data in the UK are lacking. Psychiatric comorbidity is common; as are physical health problems such as hypertension. The association between sleep problems and other addictions such as alcohol misuse disorder, smoking and substance misuse has been established; however, research into gambling disorder and sleep problems is limited. It was hypothesised that, compared to controls, individuals with gambling disorder would have significantly greater disturbance of sleep, as indicated by increased scores in: 1) specific sleep items on the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Rating Scale for Depression (HAMD), 2) total score on the HAMA and HAMD and 3) the Epworth Sleepiness Scale (ESS).

A secondary analysis of a subset of previously published data by Grant and Chamberlain (2018) on gambling and impulsivity. A total of 152 non-treatment seeking adults, aged 18–29 years, who had gambled at least five times in the past year were recruited. Individuals were stratified into three groups: controls, those at risk of gambling disorder, and those with gambling disorder, as per DSM-5 criteria. One-way ANOVAs with post-hoc tests were conducted. These were used to show whether the three groups differed significantly in their scores in the sleep items and total scores of the HAMA and HAMD, and the ESS.

The HAMD scale demonstrated a significant increase in all patterns of insomnia for members of the disorder group, when compared to controls. The increase was particularly marked for middle and late insomnia. The HAMA item score demonstrated significantly worse sleep quality in the disorder group, compared to at risk and control groups. Total scores on the HAMA and HAMD scales were also significantly higher in the disorder group, reaching the thresholds for clinical significance for anxiety and depression. ESS scores were not significantly different between groups.

Global disruptions in sleep, as well late- and middle-insomnia, were found to be significantly higher in gambling disorder than controls. Symptoms of anxiety and depression were also significantly higher in the gambling disorder group. Further research could have implications for the identification and treatment of sleep disorders and psychiatric comorbidities in gambling disorder.

To compare people with diabetes developing severe mental illness (SMI) to those with diabetes alone with respect to risk status, diabetes care receipt, and diabetes-relevant outcomes in primary care.

Data from mental health care (Clinical Record Interactive Search; CRIS) linked to primary care (Lambeth DataNet; LDN) were used. From patients with a type 2 diabetes mellitus (T2DM) diagnosis in primary care, those with a new SMI diagnosis were matched (by age, gender, and practice) with up to five randomly selected controls. Mixed models were used to estimate associations with trajectories of recorded HbA1c levels; Poisson regression models compared total and cardiovascular comorbidity levels and number of diabetes complications; linear regression models compared BMI and total cholesterol levels; conditional logistic regression models investigated microalbuminuria, receipt of a foot or retinal examination, use of statins and receipt of insulin; Cox proportional hazards were used to model incident microvascular and macrovascular events, foot morbidity and mortality.

In a cohort of 693 cases with SMI (122 bipolar disorder, 571 schizophrenia and related) and T2DM compared to 3366 controls, all-cause mortality was increased substantially in the cohort with SMI (adjusted hazard ratio 4.52, 95% CI 3.73–5.47; for bipolar 5.59, 3.37–9.28; for schizophrenia 4.42, 3.60–5.44). However, for all the other outcome comparisons, the only significant findings were of reduced foot examination (adjusted odds ratio 0.75, 0.54–0.98) and reduced retinal screening (0.77, 0.61–0.96).

Higher mortality suggests increased risk of adverse outcomes for people with pre-existing T2DM who develop SMI, and reduced foot/retinal examinations suggest disadvantaged healthcare receipt. However, other potential explanations for the mortality difference could not be identified from the outcomes analysed, so further investigation is needed into underlying causal pathways.

Since 2020, the number of asylum-seekers residing in hotels sourced by the UK Home Office, termed Contingency Accommodation, has increased by over 20,000. Reports suggest that the risk of poor mental health in this population is high. The aim of this study was to help inform improvements to mental healthcare provision for UK asylum-seekers living in contingency accommodation by gaining a greater understanding of perceived barriers and facilitators to accessing care.

Seventeen semi-structured interviews were conducted remotely with Healthcare Service Providers between June and August 2022. Study Participants were recruited using purposive and snowball sampling to include stakeholders from primary care, secondary care, and third sector organisations. Data were analysed initially using deductive analysis based on the Levesque et al Conceptual Framework. Further emergent themes were identified using inductive analysis conducted sequentially on the data.

Twelve themes relating to barriers and three to facilitators to mental healthcare access were identified. The most dominant themes were language barriers and long referral wait times, particularly to access specialist services for torture survivors. Other emergent themes included differing explanatory models of mental distress between Service Users and Providers and fear of authorities and data sharing. Within hotels, there was a lack of standardisation to facilitate mental healthcare access and a reliance on outreach organisations to explain the structure of the health system. Digital exclusion was described in the form of poor reception in hotel rooms and lack of privacy for remote consultations. Perceived mental health complexity was found to act as a barrier to referrals for low intensity psychological therapies such as IAPT being made and accepted. There was a lack of consensus amongst stakeholders about the appropriate time in the asylum journey to refer for trauma-focused therapy. Voluntary and community services (VCS) were described as plugging gaps in mental healthcare, but their role was ill-defined and concerns were expressed about sustainability.

This study identified complex and intersecting barriers at individual, community, health-system, and structural levels which, if addressed, could improve access to mental healthcare. Further work is required to quantify the burden of mental ill health amongst this group and to triangulate findings from this study with views of the asylum-seeking population. Specifically, this study highlights the need to establish exactly how VCS are meeting mental healthcare needs and how they can be better integrated into the healthcare system. Further research exploring the timing of trauma-focused therapy is also warranted.

1. To evaluate demand, capacity and flow of an integrated community learning disability service in a peri- and post-COVID-19 pandemic setting. 2. To improve flow of a community learning disability service. 3. To improve staff and service user satisfaction by engaging them and identifying common priorities.

We collected demand and capacity data of all disciplines in a community learning disability service for 2021–2022.

We carried out focus groups with service users and their carers (N = 5) and surveyed them with a questionnaire consisting of 6 quantitative and 2 qualitative questions (N = 63), investigating the impact of waiting times on service user experience.

We surveyed staff from all disciplines (N = 20) with a questionnaire consisting of 3 qualitative questions, to identify their views on waiting times and areas to optimise.

We performed thematic analysis on all qualitative responses. We analysed quantitative data with descriptive statistics.

From 2021–22, the number of accepted referrals to individual disciplines increased: for example referrals to psychiatry increased by 51.6% and referrals to OT increased by 32%.

With regard to flow, the ratio of discharges to accepted referrals in the psychiatry discipline decreased from 1.5:1 to 0.6:1.

A significant proportion of service users reported waiting months (31%) or years (16%) to be seen by the learning disability team. 28% of service users reported additional problems while waiting to be seen. 31% were unaware whether they were on a waiting list or not. Quantitative data showed average waiting times for psychiatry services did not change from 2021–2022 (23.1 and 23.3 days respectively).

Thematic analysis from service users’ responses revealed an anxiety about needs not being met; a feeling of problems deteriorating while waiting; and communication issues.

Staff responses revealed desires to intervene sooner to prevent unnecessary deteriorations; and to increase team working between disciplines.

Quantitative data analysis suggests a greatly increased demand for our service following the COVID-19 pandemic.

Our thematic analysis identifies concern of deterioration secondary to prolonged waiting times. It also highlights that communication could be improved.

As a result of this mixed-methods approach, the following change ideas were generated and are now being tested:

1. 1. Improve communication with patients on waiting lists by testing an accessible customisable letter.

2. 2. Organise more joint assessments and reviews of service users with multiple disciplines.

3. 3. Short-term allocation of more urgent casework via a new integrated health and social care duty system.

To examine the effects of a peer-supported recovery-focused self-management of Psychosis (PRSP) modified from the Crisis-resolution-team Optimisation and RElapse Prevention (CORE) programme (Johnson et al. 2018) for psychotic patients’ recovery, mental state, problem solving ability and other patient outcomes over 18 months follow-up, compared with either a psychoeducation/treatment-as-usual group.

A assessor-blinded, three-arm multicentre RCT was conducted. A list of 198 Chinese patients with recent-onset psychosis randomly selected from four Community Centers for Mental Wellness in Hong Kong (2021–2022) and randomly assigned into one of the three study groups (PRSP, psychoeducation or treatment-as-usual group) by matching with computerized random numbers. After four-month interventions, the patient outcomes were measured at immediately, 9 months and 18 months post-intervention, and analysed on intention-to-treat basis using Generalised Estimating Equation test.

Significant interaction (Group × Time) treatment effects of the PRSP were found on six outcomes (recovery, psychotic symptoms, functioning, problem-solving, and service satisfaction) between three groups at post-test, Wald χ2 = 7.05–21.87, p = 0.02-0.001, with moderate to large effect sizes (η2) of 0.12–0.24, compared to treatment-as-usual. Level of recovery, problem-solving and service satisfaction of the PRSP were also significantly greater improved than psychoeducation group at 9 and 18 months follow-ups with moderate effect sizes (0.07–0.10).

The findings can provide evidence about the long-term effectiveness of the peer-facilitated, recovery-based self-management programme in early psychosis on improving patients’ recovery and mental condition, functioning, and service satisfaction. Self-learning of illness management through effective problem-solving strategies, together with peer-support, are increasingly useful in recovery-focused intervention for early psychosis in views of inadequate healthcare resources/staffs.

Surgically implanted vagus nerve stimulation (VNS) is a recognised treatment for depression. The vagus nerve can also be stimulated non-invasively via its auricular branch, using transauricular vagus nerve stimulation (taVNS). Heart rate variability (HRV) is a putative biomarker of autonomic nervous system (ANS) engagement. We aimed to test the impact of taVNS on the ANS of healthy volunteers by measuring HRV using a double-blind, sham-controlled, longitudinal design to acquire data over 7 days using wearable cardiac sensors.

taVNS was delivered to the left ear of healthy volunteers using a transcutaneous electrical nerve stimulation (TENS) device via a custom clip electrode (developed at Newcastle University). All participants were stimulated at 10 Hz, with pulse widths of 300 ms and variable current outputs, depending on perceptual thresholds. We delivered double-blinded active and sham taVNS for hour-long periods, in the morning and evening. We also recorded an electrocardiogram (ECG) lead I using a VitalPatch for 7 consecutive days. Python scripts were developed to produce HRV timeseries and plot data. ECG frequency domain parameters – low- (LF) (0.05–0.15 Hz) and high-frequency (HF) power (0.15–0.4 Hz) – were calculated for each stimulation period. The LF/HF ratio was used as a marker of autonomic modulation. The Wilcoxon signed-rank test was used to compare LF/HF ratio distributions.

Initial data from the wearable sensors were used to develop interpolation scripts to improve the processing of noise, missed R waves and ectopic beats, to reduce errors when estimating HRV from the heart rate signal. Initial results from 97 individual 1-hour long stimulation periods, from 18 participants, show that active stimulation in the morning, when compared with sham stimulation in the same period, significantly reduces the LF/HF ratio. The median and interquartile range (IQR) of the LF/HF ratio for the active and sham periods was, respectively, 1.72 (1.99) and 2.75 (2.82), a statistically significant difference (p = 0.043).

taVNS modulates HRV frequency domains, suggestive of vagal cardiac effects, and replicates findings from previous taVNS studies. Reductions in the LF/HF ratio are suggestive of increased parasympathetic tone. As the auricular branch of the vagus does not have any direct cardiac efferents, this suggests central ANS modulation using taVNS. Secondly, it suggests that cardiac ANS modulation could be used as a proxy measure of afferent vagal stimulation, which could be of clinical utility. These effects warrant exploration in a larger cohort study, including wider demographics (including age range) and improved processing pipelines.

Between 2018–2021 there was a downward trend in study leave applications and the total spending on trainee study leave activities. There was concern that trainees may not be maximising educational opportunities. The authors were aware of anecdotal evidence indicating barriers to applying for study leave and therefore sought to objectively explore this. We aimed to evaluate qualitative and quantitative responses amongst psychiatric trainees within the West Midlands deanery regarding study leave applications. We also endeavoured to identify positive aspects and barriers, to improve knowledge and confidence in the process and identify areas for improvement in making the system more accessible.

The authors met with Health Education West Midlands to clarify current processes and gather objective data regarding study leave applications between 2018 and 2021. A survey was distributed to all Psychiatric trainees in the West Midlands in December 2021. The survey was open for three weeks and contained closed and open questions. Data were analysed and a thematic analysis was completed independently by the authors to allow for triangulation.

There were 62 responses (response rate of 27%) from trainees ranging from CT1-ST7+. 55% were unclear about the study leave application process, and of these, 79% said this had prevented them from applying. Only 37% of trainees found the process ‘very’ or ‘moderately easy’, with 23% finding it ‘very difficult’. When exploring barriers, worryingly 69% of trainees did not know where to find the list of approved courses. Other themes included too many signatures being required, long delays in forms being returned and money being reimbursed.

The majority of respondents were unclear about the study leave process or found it difficult. This acts as a barrier to application in the majority of cases and may have a knock-on effect on the overall quality of training. By identifying these barriers, we are now able to address these more directly.

The results were presented at a deanery wide level leading to a better understanding of the reduction in spending of study leave funding. Phase two of the project will see the introduction of an electronic application system, aiming for an easier and shorter process, in addition to creating consistency across trusts. There may have been some confounding factors, such as COVID-19 that may have contributed to the decline in study budget being utilised.

The Royal College of Psychiatry introduced a new postgraduate training curriculum in August 2022. One of the main changes is the introduction of a new collaborative tool between supervisor and trainee, the placement-specific personal development plan (PSPDP). The aim of this project is to locally explore trainee's views and experiences with the PSPDP.

We explored the views and experiences of seven psychiatry trainees within the South London and Maudsley NHS Foundation Trust in a single 60-minute focus group, co-facilitated by two authors over Microsoft Teams. The participants were purposively identified to have started core and higher training under the new curricula and a snowballing approach was used to recruit them. The data were recorded, transcribed, and analysed in line with ethical guidelines. The analysis was done by using Clarke and Braun's approach to thematic analysis.

Three overarching themes were identified:

1. 1. Positives of using a collaborative tool with a psychiatric supervisor (PS),

2. 2. Challenges in implementation and

3. 3. Trainees’ perspectives on directions forward.

The most notable subtheme of theme one was the improved curricular alignment between learning opportunities, curriculum content, and assessment tools. As one participant mentioned: “When we were going through [the PSPDP], it definitely guided us, what we wanted to (…) get out of this placement in particular, and also the kind of workplace-based assessments needed.”. The time-effective and structured approach to learning, regular progress follow-up, as well as improved motivation to engage with the placement were further subthemes mentioned. Examples of subthemes emerging from theme two were lack of PS knowledge about the PSPDP, as well as lack of training and information for trainees. Participants commented that “supervisors really didn't know what they were supposed to do” and that “the information [shared during induction] was outdated”. One example of subthemes from theme three was the need for additional training both for trainees and PSs. As one participant mentioned: “Training is required for supervisors (…) and for us as well to get really used to the system. Because it's a good system if we know how to use it.”

To the best of our knowledge this is the first study exploring trainees’ views on the new PSPDP. Whilst trainees appreciated the potential benefits of working through the PSPDP together with their supervisor, significant challenges remained and may hinder its meaningful use. Our next steps are designing and running a hybrid questionnaire to gather views from a larger sample.

Differences in static and dynamic resting-state functional connectivity have been identified in patients with schizophrenia, individuals at high risk of psychosis and those with psychotic-like experiences. Analysis of dynamic connectivity is important to understand the temporal fluctuations in functional connectivity. Studies of dynamic functional connectivity have been conducted using methods such as the sliding-window technique and co-activation patterns (CAPs). In this study edge-centric analysis has been used to examine differences in time-varying connectivity in patients with schizophrenia compared to healthy controls. This method overcomes some of the limitations of other methods as it has higher temporal resolution and unwraps the data without applying additional modelling or requiring user-defined specification of parameters.

We analysed resting-state fMRI data from 67 patients with schizophrenia and 81 healthy controls using the Center for Biomedical Research Excellence (COBRE) dataset. The edge-time series for these subjects was calculated by omitting the averaging step when calculating the correlation between time series at each node. This effectively unwrapped the functional connectivity correlations and produced a measure of cofluctuation at each timeframe. The edge time series can be aggregated into a single measure of dynamic whole brain co-fluctuation by calculating the root sum square (RSS). We analysed the frequency and amplitude of the high amplitude peaks of cofluctuation and the patterns of activity seen during peaks and troughs.

The results showed that mean peak amplitude was lower in patients with schizophrenia compared to controls (t-stat= -3.13, p = 0.0021). Patients with schizophrenia also had significantly less frequent peaks (t-stat= -2.80, p = 0.0058).The pattern of activation at peaks in controls was more homogenous between control subjects compared to patients with schizophrenia. We identified networks that were significantly less activated in patients than in controls during peaks, troughs and transitionary time points.

This study suggests that in patients with schizophrenia the whole brain cofluctuations during resting-state are less frequent and lower in amplitude. This is in keeping with previous studies which have identified that patients with schizophrenia spend significantly less time than healthy controls in states of large-scale connectivity. Further studies looking at larger transdiagnostic samples and antipsychotic naïve patients will be important to build on these results.

Hypercalcaemia can lead to many neuropsychiatric symptoms from fatigue, lethargy, anxiety, irritability, and insomnia to impaired concentration and memory, depression, delirium, and psychosis. Primary hyperparathyroidism (PHPT), which is the most common cause of hypercalcaemia, is a relatively common disorder affecting 1 in 500 women and 1 in 2000 men aged over 40 years. A patient, with a diagnosis of Alzheimer's disease, subtype mixed, had hypercalcaemia on admission which wasn't corrected until 4 months of the admission had passed. Calcium correction precipitated a marked improvement in the patient's mental state. In order to learn from this incident, an audit was carried out to look at possible gaps in performing blood tests, and how abnormal calcium levels can affect patients’ mental states.

Retrospective data collection was performed to obtain blood results for all patients -aged 40 years or above- admitted to inpatient wards in South Essex within a six month period (from April 2022 to September 2022). A total number of 333 patients (173 males and 160 females) were identified.

Bone Profile was checked in 248 patients (127 males and 121 females). Twelve patients were found to have hypercalcaemia on admission - mean age 65.7 years, female: male ratio of 3:1. No patients were found to have hypocalcaemia.

Hypercalcaemia was addressed in only 2 of 12 patients. Parathyroid hormone (PTH) was tested either before or during admission to mental health services in 6 patients, PTH was found to be elevated (greater than 9.3 pmol/L) in 4 patients (2 males and 2 females), below the midpoint of the reference range in one patient, and below the lower limit of the reference range in one patient.

Patients with hypercalcemia had different diagnoses - anxiety, depression, adjustment disorder, mania, psychosis, and dementia. It was the first admission for three patients with a mean age of 76 years. Six patients were known to services but it appeared that the recent admissions were associated with hypercalcaemia. Active management of hypercalcaemia in 2 patients resulted in improvement in their mental state.

We found that risk of PHPT in mental health inpatients aged over 40 years old was increased by 1.45% (95% CI: -0.0620% to 5.6256%, P = 0.0390) in females, and was increased by 1.52% (95% CI: 0.3573% to 5.5031%, P < 0.0001) in males. Hereby, testing for bone profile should be routinely recommended for mental health patients.

People with Parkinson's disease psychosis (PDP) have reported cognitive and executive deficits. However, it is unclear whether these deficits are different depending on psychosis severity. Here, we aimed to compare cognitive performance between PDP patients with varying severity of their psychosis symptoms (such as delusions and hallucinations), relative to patients with Parkinson's disease without psychosis (PDnP), using a meta-analytical approach.

Searches were conducted on PubMed, MEDLINE, Web of Science, PsycINFO and SCOPUS. Standard mean differences between PDP and PDnP patients on cognitive and executive function tests were expressed as Hedges’ g effect sizes from eligible studies (K = 23). PDP patients were classified based on the severity of their psychosis symptoms into formed and unformed hallucinations, and hallucinations with/without insights. Separate multi-level meta-analyses were conducted for symptom severity groups of PDP patients, and for different cognitive domains due to studies contributing to multiple cognitive domains. Meta-regressions were conducted to examine the effect of age. Analyses were conducted in R (version 4.2.2).

Hedges’ g effect sizes were negative in all analyses, suggesting that PDP patients with formed hallucinations (n = 317) showed a significantly worse performance than PDnP patients (n = 734) across all domains (global cognition, g=−0.853, p < 0.001; language, g=−0.602, p < 0.001; episodic memory, g=−0.899, p < 0.001; executive functions, g=−0.543, p = 0.007; processing speed, g=−0.698, p < 0.001). There was presence of significant heterogeneity across all the analyses (all p < 0.05), except for language (p = 0.053) and processing speed (p = 0.077). There was also presence of significant publication bias (assessed with Egger's regression test) in all analyses (all p < 0.001), except for global cognition (p = 0.656). PDP patients with unformed hallucinations (n = 135) performed worse relative to PDnP patients on the same domains but these results were not significant. Publication bias was not significant for global cognition for results of unformed hallucinations (p = 0.4054). Age was shown to be a significant moderator for all domains except global cognition (global cognition, b=−0.02, p = 0.13; language, b=−0.042, p = 0.037; episodic memory, b=−0.055, p = 0.001; executive functions, b=−0.098, p < 0.001; processing speed, b=−0.048, p = 0.022). Relative to PDnP patients (n = 322), both PDP patients with/without insights had worse scores on global cognition tests (no insights, n = 37, g=−2.747, p = 0.021; insights, n = 83, g=−0.942, p = 0.019). Due to the low number of studies (k < 7), Egger's test was not applied.

Decreased cognitive performance may underlie presence of impairments in PDP patients. Formed hallucinations and lack of insights are associated with greater cognitive deficits. In addition, older age could result in worse cognitive scores.

Racial microaggressions occur when subtle or often automatic exchanges of aversive and covert racism are directed towards people identifying as racialized groups. Consequently, affecting individuals' mental and physical health. Healthcare professionals are a vulnerable group to the effects of racial microaggressions, given the high prevalence of burnout. The aim of the review was to explore healthcare professionals and students' experience of racial microaggressions in healthcare settings

A PROSPERO registered scoping review was conducted using the PRISMA extension for scoping review guidelines. The literature search was undertaken in August 2020, of five databases, MEDLINE, EMBASE, CINAHL, PsycINFO, EMCARE and we also searched the ‘grey literature.’ Studies featuring primary data on racialized or migrant microaggressions towards professionals or students in healthcare settings were included. We excluded studies that were not in English. QDA Miner was used to analyse the data, using a non-essentialist perspective, which suggests that ‘culture’ is a movable concept used by different people at different times to suit purposes of identity, politics and science.

Our search identified 8 papers (5 qualitative, 2 mixed and 1 quantitative) on the experience of microaggressions towards healthcare professionals and students (n = 602). Almost all (87.5%) were conducted in North America and only one (12.5%) in the UK. The primary themes were as follows:

Intersectionality: Individual and group social categorizations of race, class, and gender were described as interconnected, leading to interdependent systems of discrimination or disadvantage. Healthcare professionals indicated that increasing diversity and racial representation can reduce bias and thus microaggressions among stakeholders in the culture of work.

Workplace culture and lack of senior support: The healthcare curriculum, and the manner of its delivery were found to propagate ideas encouraging racial microaggressions. Seniors behaving as role-models by challenging microaggressions could encourage an open and accountable environment. Supervision was a tool for allyship that reduced the threat of negative race-related incidents.

Intervention: Acknowledging racial microaggressions within healthcare, as well as quantifying their presence with tools, encouraged a stronger and more effective response from institutions. Teaching curriculum also served as a useful platform to teach and address microaggressions.

Racial microaggressions were experienced as having a detrimental impact on healthcare professionals’ well-being and mental health. Consequently, this affected the efficiency, the workplace culture, patient outcomes and job satisfaction. Given the multifaceted nature of racial microaggressions, tackling them requires a complex and wide-ranging response from institutions.

Analysis of the Annual Report of Examination Results published by General Medical Council (GMC, 2020) revealed that trainees of West Midlands School of Psychiatry didn't perform well in written components of MRCPsych exams and showed pass rate between 2014 and 2019 as 54.6%. Therefore, this qualitative study was conducted to assess West Midlands School of Psychiatry core psychiatry trainees’ perception of factors that influence the outcome of MRCPsych Paper A and Paper B.

Qualitative research methodology with a grounded theory approach was used to systematically analyse the data and to evolve the theory rather than appraising the existing theory. The purposive and theoretical sampling strategies were used. Study population included all core psychiatry trainees in the West Midlands School of Psychiatry in 2021 who were invited via email for a semi-structured focus group interview. The participants’ information sheet and consent forms were sent with the interview invite. A total of 38 participants contributed. The data were collected through 3 focus groups and 2 one-to-one interviews. The interviews were recorded using the recording and transcription feature of Microsoft Teams. The transcription was checked manually for accuracy. The data were collected and analysed simultaneously till the point of theoretical saturation, thereafter a thematic analysis was conducted.

Themes emerged were grouped under challenges faced by the participants such as work and time pressures, financial constraints, and lack of family support. Other challenges were related to virtual learning, a mismatch between local teaching course and exam schedule and lack of contextualisation in local course content. Most of the trainees had to rely on private courses which were adding financial burden. The majority felt that social isolation due to COVID-19 had a negative impact on their well-being. Participants suggested various recommendations for their local course content and delivery.

The study highlighted the need for the local course content to be contextualised and tailored to the examination course. This could be achieved by including a variety of multiple-choice questions, case-based discussion, and small group teaching for the purpose of preparing and practising examination questions/scenarios. It also highlighted trainees’ need to utilise the study leave budget for private courses to ease financial burden. The International Medical Graduates (IMG) cohort identified that they need extra support and feedback about the examination preparation from the early beginning of the training to overcome differential attainment.

Traumatic brain injury (TBI) is highly prevalent in prison populations, with an estimated prevalence of 51%-82% according to a 2018 review. TBI has been linked to higher rates of interpersonal violence, recidivism, suicide, higher drop-out rates in rehabilitation programmes, and lower age of first conviction. Attention deficit hyperactivity disorder (ADHD) has been shown to be associated with an increased risk of interpersonal violence, and previous TBI. Little is known about prevalence of TBI or ADHD amongst inpatients in secure psychiatric settings in the UK. We aimed to estimate the prevalence of TBI and ADHD in inpatients admitted to a psychiatric intensive care unit (PICU) and to low and medium secure units across three London mental health NHS trusts.

60 male participants were identified through prospective purposive sampling. Three questionnaires were administered: the Brain Injury screening Index (BISI); Adult ADHD Self-Report Scale v1.1 (ASRS); and the Brief-Barkley Adult ADHD Rating scale (B-BAARS). We also reviewed medical records of participants, age, psychiatric diagnoses, level of education, and convictions for violent and/or non-violent offences, number of admissions, and length of current admission. Ethical approval was granted by the local research ethics committee

67.8% of participants screened positive for a history of head injury, and 68.3% and 32.2% screened positive on the ASRS and B-BAARS respectively. 38.33% recorded greater than one head injury on the BISI. The most commonly recorded psychiatric diagnoses were schizophrenia (43.33%), schizoaffective disorder (23.33%), Bipolar Affective Disorder (11.67%), and Unspecified Non-Organic Psychosis (10.00%). Screening positive on ASRS was associated with screening positive for previous head injuries BISI (p = 0.01, ꭕ2). No other statistical associations were identified.

A relatively high proportion of participants screened positive for head injury and ADHD in this population. A history of head injury was associated with positive screening on the ASRS, which is consistent with previously reported associations between these conditions in other populations. A similar relationship was not seen with the B-BAARS however, and it is notable that fewer participants in the sample screened positive on the B-BAARS than using the ASRS. Few (n = 5) patients were able to provide detailed descriptions of head injuries using the BISI, suggesting that the BISI may not be suitable in this specific population as a screening tool.

To improve Antipsychotic weight monitoring for patients within the Homeless Outreach (START) team.

All adult patients accepted by the START team (Lambeth, Southwark, and Croydon locations) between June and October 2022 that had been initiated on Antipsychotic medication were identified retrospectively (n = 11).

Electronic notes (ePJS) of these patients were subsequently reviewed to assess the following:

1. 1. Was there compliance with NICE weekly weight monitoring (for the first 6 weeks) following Antipsychotic initiation?

2. 2. Was weight measured at least once following Antipsychotic initiation?

3. 3. Was a Physical Health Screen documented following Antipsychotic initiation?

During the audit period a total of 56 patients were accepted by the START team. Of these 11 (20%) were initiated on Antipsychotic medication. 0 patients had weekly weight monitoring compliant with NICE guidelines. 0 patients had their weight measured at least once following Antipsychotic initiation. A Physical Health screen was documented for 4 (36%) patients following Antipsychotic initiation.

This audit highlighted the poor compliance of weight monitoring in this cohort of patients, which can be attributed to several reasons. The homeless population are known to have poor engagement with health services. This coupled with reduced staff awareness of NICE antipsychotic monitoring guidelines can act as a barrier to carrying out appropriate physical health checks.

1. 1. The following interventions were implemented:

2. 2. To address staff awareness, START team members were given a presentation on the importance of Antipsychotic monitoring and current NICE guidelines.

3. 3. An alert will be added to patient notes (ePJS) on initiation of Antipsychotic medication to remind staff to carry out required weight monitoring.

4. 4. Portable weighing scales were purchased for the team to ensure patients’ weight can be measured on outreach reviews.

An extracurricular clinical communication course called PsychED Up, with a focus on Psychiatry, met with challenges during the COVID-19 pandemic and the associated social distancing requirements. The course is usually delivered face-to-face by a small team of doctors, medical students, actors and lived-experience practitioners, and consists of large-group teaching on a weekly topic, followed by small group simulations. A small-scale study was performed to evaluate whether conducting clinical communication teaching and simulation online was acceptable, effective and feasible.

Twelve students and ten faculty members participated in the online session, performing live clinical scenarios with simulated patients, over a two-hour period. Pre-and post-course questionnaires were designed with quantitative measures of confidence and qualitative questions about participants’ experience. Eight students completed both questionnaires. Questionnaire answers were analysed using a mixed-methods approach, with themes identified from the qualitative long answers, and statistical analysis of quantitative answers was also performed.

Students found the session beneficial, with all indicating that they would sign up for a full online course. Based on answers to the quantitative questions, 50% of students felt more prepared for their clinical examinations. (p = 0.046). However, all participants noted a reduction in their ability to read non-verbal cues and body language. Returning students found they were less attentive during the session compared with the original face-to-face teaching (p = 0.05). Actors and faculty members found that the online course was feasible, acceptable and effective. However, most agreed that it was not preferable to teaching clinical communication skills face to face. Technological issues were minimal.

The majority of students and faculty found the session both beneficial and enjoyable, but felt face to face sessions would be more helpful in teaching clinical communication. Student attentiveness and awareness of non-verbal cues were highlighted as concerns. However, students generally responded positively to the online course, particularly the quality and diversity of peer feedback. Teaching clinical communication virtually has the potential to be successful, and has implications for future undergraduate medical teaching.

The primary aim of this project was to explore the attitudes of doctors employed by Leeds and York Partnership NHS Foundation Trust (LYPFT) towards climate change and sustainability issues. Secondary aims were to ascertain psychiatrists’ knowledge of current efforts to mitigate the impact of healthcare on the climate, and to identify barriers to action against the climate crisis.

This was a cross-sectional study using a self-completed questionnaire designed by the team on an online platform (Survey Monkey, www.surveymonkey.co.uk). It was open from 23 August to 19 September 2022 and shared via email with doctors of all grades employed by LYPFT (n = 211). Likert-scale and multiple-choice responses were analysed using descriptive statistics and two-sided t-tests. Free-text responses were analysed independently by four researchers (DH, DR, HO, GS) using thematic analysis. Participants were required to agree to an online consent statement before proceeding. The study was carried out in accordance with University of Leeds ethical protocols.

66 doctors completed the questionnaire (31.3% response rate) of whom 24 (36.3%) were consultants and 42 (63.6%) were junior doctors. 57 (86.3%) respondents agreed that climate change is harmful to mental and physical health. 42 (63.6%) indicated that the climate emergency was relevant to their role, and 46 (69.7%) felt that climate and sustainability issues should be included in educational curricula for all healthcare professionals. Only 4 (6.1%) were aware of the Trust's strategies to mitigate its impact on the climate, and 7 (10.6%) were familiar with the remit and content of the Greener NHS Plan. There were no statistical differences in responses to these questions between consultants and junior doctors.

The most commonly perceived barriers to reducing the Trust's impact on the climate were a lack of willingness to change current practice (n = 28, 42.4%), poor awareness of the impact of the healthcare industry on the climate (n = 16, 24.2%), and an absence of guidance on sustainable practice (n = 15, 22.7%). Three themes emerged among free-text responses to this question: clinical priorities taking precedent, extensive use of pharmaceuticals and a lack of appropriate infrastructure and resources.

LYPFT doctors appreciated the significance of the climate crisis and its relevance to their role as healthcare professionals. However, there is a lack of awareness of local and national efforts to mitigate the impact of healthcare on the climate. Future work should raise awareness of the association between planetary and human health and encourage stakeholders to prioritise sustainability issues.

The last few years have witnessed dramatic increases in presentations of eating disorders to mental health services for children and adults, which could relate to a greater number of people seeking help or to an increase in eating disorders at the population level. Aims: To evaluate the feasibility of online completion of a single module of the compare the Development and Well-Being Assessment (DAWBA) and to estimate the population prevalence of eating disorders among children and young people aged 6 to 19 years in 2017 and 2021, and to estimate the prevalence of eating disorders among emerging adults aged 20 to 23 years in 2021.

The Mental Health of Children and Young People in England was a cross-sectional survey of a probability sample that recruited 9,117 children and young people in 2017. Follow-up surveys were conducted in 2020, 2021 and 2022. The DAWBA, a multi-informant standardised diagnostic assessment, was completed by parents, teachers and young people aged 11 years or more in 2017. It covered all common mental health conditions, including eating disorders. In 2021 and 2022, parents and young people aged 11 years and over completed the five initial DAWBA screening items to assess eating difficulties as part of the follow-up questionnaire. In 2021, parents and young people who screened positive (n = 1030) were invited to complete the DAWBA eating disorder module online, and a small team of clinical raters reviewed their reports to assign diagnoses according to DSM 5.

There was a year delay in the provision of contact details to contact screen positives, and the response rate was 37% overall, comprising 28% of children aged 11 to 16 years, 23% of young people 17 to 25 years and 19% of parents initially invited. Our results illustrate the large and sustained increase in screen positives between 2017 and the follow-up surveys. We are currently quality-checking the clinical rating for the 2021 data, so we are close to a final prevalence of eating disorders for 2021.

There was an increase in the proportion of children aged 11–16 years with eating difficulties between 2017 (8.4% girls, 5.1 % boys) and 2021 (17.4 % girls, 8.4 % boys), which was maintained in 2021 and 2022 (17. 4% girls, 8.4 % boys). There were similar findings for young people aged 17 to 19 years (60.5% girls, 29.6% boys 2017, 76 % girls, 46% boys 2022)).

Inviting multiple informants provided data on more children and young people although many only had a single report from the person who screen positive. Wave 4 (2023) will integrate the eating disorder module into the original questionnaire to improve response rates. We suspect that the increase in the prevalence of eating disorders will be small despite the large and worrying increase in eating difficulties.