Multiple sclerosis (MS) is an autoimmune disease characterized by focal demyelinating lesions that can affect any part of the central nervous system. The highlight of the disease is the wide range of neurological deficits; however, psychiatric manifestations are not uncommon. MS is associated with psychiatric comorbidities, such as depression and anxiety disorders. This is due to either its disease process or its therapies that have been well documented in the literature. However, the link between psychosis as a prodrome and MS remains understudied and relatively uncommon.

We present a 40-year-old gentleman who developed isolated psychiatric manifestations for about 10 years in the form of progressive behavioral changes, social and occupational dysfunction, coupled with persecutory delusions. No personal or family history of mental illnesses. He was diagnosed and treated as a case of schizophrenia by a psychiatrist with multiple antipsychotics with a minimal improvement of his symptoms. Three months before our assessment the patient had a history of difficulty walking associated with urine and fecal incontinence. On examination, he had restricted affect and was easily agitated. Neurological examination revealed hypertonia and hyperreflexia in his left upper and lower limbs with normal power bilaterally. T2-weighted magnetic resonance imaging (MRI) brain showed multiple non-enhancing characteristic demyelinating lesions with typical shape and distribution. Further work-up was done to confirm the diagnosis of MS and exclude differentials, including a negative autoimmune screen, anti-aquaporin-4 (AQP4), and Myelin oligodendrocyte glycoprotein (MOG) antibodies. Visual evoked potentials documented bilateral severe disturbance in the visual pathway in both eyes, suggesting axonal loss. The patient is a candidate for a disease-modifying therapy for MS. Natalizumab or Ocrelizumab was selected based on his clinical criteria and will be started after proper preparation.

Psychiatric comorbidities in MS are associated with reduced compliance to disease-modifying therapies and lower quality of life. Studies reported that lesions in the periventricular area in the temporal region may be associated with psychosis, but not as an isolated presentation in patients with MS.

MS is one of the differentials of psychotic disorder due to a medical condition, and rarely may present with pure psychiatric manifestations preceding any obvious neurological deficits, leading to delay in the diagnosis. Despite being uncommon, a high index of suspicion should be kept in patients with atypical presentations associated with limited response to multiple antipsychotics. This highlights the importance of conducting a thorough physical examination and work-up to exclude an organic pathology, necessitating proper management.

Clozapine is an atypical antipsychotic used in the management of Treatment-Resistant Schizophrenia (TRS). Despite its efficacy, Clozapine is associated with rare but clinically important haematological side effects of neutropenia and agranulocytosis, thus warranting regular monitoring of full blood count (FBC) white blood count (WBC) and neutrophil count (NC).

Clozaril Patient Monitoring service (CPMS) supervises the prescribing of Clozapine and haematological testing for patients. Amber and Red alerts are issued by the CPMS when WBC and NC values fall below specified levels, Clozapine treatment is either suspended or discontinued completely.

We present a case of 35-year-old Caucasian lady with a history of schizophrenia who was maintained on Clozapine treatment for 10 years and whose Clozapine was necessarily stopped because of red alerts. This lead to a significant deterioration in her mental state and level of functioning necessitating a prolonged hospital admission.

• • Detailed retrospective review of this patient's CPMS results over a 2-year period identified consistently higher levels of WBC and NC, when the blood tests were conducted in the afternoon compared to mornings.

• • Literature review supported the phenomenon of a diurnal variation of WBC and NC levels in a proportion of patients prescribed Clozapine.

• • With clear knowledge of this patient's diurnal trends in WBC and NC count, it was possible to liaise with CPMS and restart her Clozapine treatment, leading to a significant improvement in her mental state and level of functioning.

• • We recommend that clinicians consider this phenomenon of diurnal variation in blood parameters in patients with frequent amber and red alert results who are at risk of having their Clozapine medication discontinued.

• • Close collaboration with CPMS and haematological advice may lead to a more nuanced approach to blood sampling, whereby afternoon samples are used in certain at-risk patients.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by repetitive, undesirable thoughts or acts. With the pandemic being on the rise, public health authorities have urged people to take proper health measures, specifically around hand washing and social distancing. It is hypothesised that such sudden change would cause excessive hygiene habits in people predisposed to OCD. Our study aimed to measure how COVID-19 pandemic affected the prevalence of OCD-like symptoms among the UAE population. Furthermore, we explored the correlation between these symptoms and demographic factors.

This was a quantitative cross-sectional study that used an online survey platform to collect responses from male and female adult UAE residents (aged between 18 and 60 years). The self-administered questionnaire included Yale-Brown Obsessive compulsive scale (YBCOS) to test the severity of obsessions and compulsions, in addition to demographic questions. People with a previous diagnosis of obsessive-compulsive disorder were excluded. Data were analysed using SPSS 23. A bivariate analysis to examine the correlation between the severity of the reported symptoms and sociodemographic characteristics, age, and ethnicity was conducted. A p-value <0.05 was considered statistically significant.

A total of 343 questionnaires were completed and used for analysis; 244 of which were females and 99 were males. 63.5% of females had no symptoms of OCD, 24.6% had mild symptoms, 9% had moderate symptoms, 2.5% had severe symptoms, and 0.4% had extreme OCD symptoms. In males, 75.8% had no OCD symptoms, 18.2% had mild OCD, 6.1% had moderate OCD, and 0% had severe or extreme OCD. A significant correlation was found between the Emirate of residence and the severity of OCD-like-symptoms (P = 0.042). The most significant scores of OCD symptoms were in Sharjah, with 10 people out of 108 displaying moderate to extreme symptoms, Abu Dhabi with 9 out of 115 and Fujairah with 7 out of 56. Level of education, occupation and age had no significant role in the exhibition of the symptoms.

To our knowledge this is the first study to investigate the prevalence of OCD-like symptoms within the UAE residents during COVID-19 pandemic. The symptoms of potential clinical significance of OCD are high, especially in females compared to the global prevalence studies prior to COVID-19, although a within-subject comparison is not possible. Further research is warranted to investigate the long-term effect of COVID-19 on OCD-like and other neuropsychiatric symptoms and elucidate possible mechanisms.

Experiential learning, such as simulation-based training, is widely used in health education. Dramatic self-expression adds another layer through enacted perspective taking, and embodied self-exploration of interaction with others, to foster situated learning. We describe the evaluation of an innovative drama-based experiential learning project involving collaboration between multidisciplinary mental healthcare staff and people with lived experience of mental illness. The programme was facilitated at East London NHS Foundation Trust by a theatre company experienced in delivering workshops with service users. A weekly group programme took place online over 8 weeks during the COVID-19 pandemic and included activities of improvisation, embodied enactments and debriefing. The programme led to co-production of a drama piece that was filmed and distributed online. It was hypothesised that the experiential learning might result in individual benefits for all participants, such as improved well-being and increased mutual understanding of each other's experience of mental health care. The project aimed to improve relationships between healthcare disciplines, and between staff and service users. Additionally, aims were to empower service users, and support staff to practice core interpersonal skills. Objectives of the evaluation were to study the impact of the experiential learning, understand participants’ experience, and explore challenges and benefits.

A mixed methods approach was taken to evaluate the programme. Following completion of the project, participants were invited to complete a questionnaire utilising a Likert scale rating of overall satisfaction with the project, perceived benefit and impact on specific domains such as working with others. One-to-one semi-structured interviews were conducted according to a topic-guide, and qualitative data were analysed using open & axial coding for thematic analysis.

11 participants, including Psychiatrists, Occupational Therapists and current service users, completed the experiential learning and filming. Questionnaire data suggested participants were highly satisfied with the learning and felt it would be valuable to others. Themes include the positive experience of creativity, dismantling of hierarchy, improved empathy, confidence and connection. Potential challenges were digital inequality and lack of dedicated time for professional development.

A drama-based experiential learning group programme for healthcare staff and service users is a highly beneficial learning experience. Participants describe changes on a personal level as well as improved understanding of others’ perspectives. This form of experiential learning features collaborative working that aligns with principles of co-production and supports the development of interpersonal skills; the findings suggest that drama-based experiential learning is a useful method in health education to complement knowledge acquisition.

Fife FCMHT offer two forms of liaison; a court liaison service and a consultation service open to any professional requiring guidance on managing a person with mental disorder and offending behaviour. Our aims are to evaluate these services by analysing the number of referrals, reason for referral and outcomes in order to assess how our services are being used and help identify any areas for improvement.

Details about each referral made to the court liaison and consultation services and outcomes were recorded from January 2011 to December 2021. Data were analysed in excel.

Court Liaison Service

1044 referrals were made; 778 of these were assessed. 98.7% were seen on day of referral. 76 required inpatient admission, 9 of whom had to be remanded in custody to await appropriate bed. Age ranged 15–78 years. Of those deemed fit to continue through court, 33% were felt to require further mental health input.

Consultation Service

280 referrals were made. Age ranged 15–83 years. The majority of referrals to this service came from criminal justice social work and NHS fife services. The majority of referrals were for specific advice or help with risk assessment and management. The average time between referral and consultation was 9.4 days.

Reassuringly, our team responds promptly to referrals.

25.5% of referrals made to the court service did not require assessment after triage. Only 7.3% of referrals required diversion away from the court system. Whilst 33% of those deemed fit to continue were identified as requiring further mental health input, this was often in the form of signposting to local services. As referrals are usually seen by health care in custody, this suggests mental health training for these teams would be of benefit to prevent delays in court proceedings and prevent unnecessary referrals.

Of concern are those patients remanded in custody to await a psychiatric bed. Whilst numbers are small, it is an unacceptable outcome for these patients. This occurs due to no bed being available or a requirement for assessment by the admitting unit. This mirrors findings from the Barron Report.

Our consultation service sees requests from a vast array of professionals. We believe this to be an efficient way for services to access the expertise within our team, avoiding unnecessary referrals causing delays to patient care. The majority of these referrals were for advice over a specific matter which can be dealt with succinctly by the team.

Biliary Atresia (BA) is a progressive inflammatory liver disease and the most frequent indication for pediatric liver transplant. There is a strong association between BA in adulthood and reduced cognitive abilities, however, data on neurodevelopmental outcomes at an early age are scarce, with small participant numbers. Hence, the neurodevelopmental difficulties in BA are poorly understood in childhood even though the brain development and maturation occur in parallel with the time-course of BA. This study aimed to characterize the cognitive and behavioral phenotype within BA infants from the age of 14 months to 4 years and investigate the extent to which this group deviates from children of typical development.

42 infants with BA that were diagnosed and treated at Kings College Hospital were recruited into this study. These infants ranged from 14 months to 4 years (mean age = 3 Years, 1 month). Out of the 42 infants, 19 had received a liver transplant, 22 were stable on their native liver, and 1 was on the transplant waiting list. 36 Mullens Scale of Early Learning assessments and 42 Vineland Adaptive Behavior Scale Interviews were collected. 42 typically developing infants (TD) were also recruited into the study, matched for age and gender to the BA population. First, we compared the whole group with BA to TD; then we compared children with BA on their native liver to those with a transplant.

Across the cohort with BA, infants scored significantly lower on the Vineland Summary T-Score compared to age-matched TD control children (t(82) = −5.05, p < .001) and across all domains of the Vineland. They also scored significantly lower than TD children on the Mullens Development Assessment (t(66) = −6.52, p < .001), and this was also across all domains. BA children on their native liver scored lower on both instruments than children who had received a liver transplant, however, this difference did not reach significance.

Individuals with Biliary Atresia, regardless of their transplant status, show lower levels of development across all aspects, suggesting a global delay. These findings suggest that all of these young children remain at significant risk for neurodevelopmental difficulties. These findings emphasize that special attention to neurodevelopment needs to be given as part of a holistic approach to care in a serious life-long illness. Work is ongoing to understand the trajectory of brain maturation in these children to ensure neurodevelopmental needs are addressed alongside physical health.

We present the case of SN, a 25-year-old woman with diagnosis of anorexia nervosa, OCD, Generalized Anxiety Disorder (GAD) and depression. She has extensive history of contact with mental health services spanning more than 10 years. She has had 1 inpatient stay in an eating disorders unit lasting more than 6 months. Her treatment included various classes of medications, psychological therapy and social prescribing with little or no benefit. She has been referred to rTMS. The aims of the study are to determine the effect of rTMS in treatment of a patient with depression comorbid with OCD, understand the value of q-EEG in rTMS treatment and to treat OCD symptoms using rTMS guided by QEEG.

SN had a total of 56 rTMS sessions targeting standard depression and anxiety areas; F3 (left sided excitatory) and F4 (right sided inhibitory). Following this her depression and anxiety improved but her OCD worsened. She then underwent a Q-EEG to be able to understand the physiological cause of her symptoms and suggest meaningful further neuromodulation that is tailored to her. This indicated dysregulation within the default mode network. Spindling beta waves were detected over the posterior electrode suggesting a tendency towards ruminations. There was clear hyperactivity in the supplementary motor area. SN had further 30 rTMS sessions targeting the OCD circuit (FC1 and FC2).

Rating scales showed a reduction in Patient Health Questionnaire-9 (PHQ-9) score from 22 to 14 (36%) in second course compared to an increase of PHQ-9 score from 9 to 15 (66.6%) in first course; indicating an overall 102% improvement in PHQ-9. It also showed reduction of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in second course from 34 to 8. It was not done in the first course but there was a clinical increase in OCD symptoms following the end of the first course. These results were corroborated clinically.

A repeat q-EEG showed that the areas previously highlighted in red at FC1 and FC2 had now all reverted to green, indicating normal neuronal connectivity.

rTMS can provide timely and adequate response to depression and anxiety especially one that has not responded adequately to medications and psychotherapy. Q-EEG is useful to direct the plan, create a personalized plan and achieve accurate results. The use of q-EEG, whilst useful, should be balanced with other considerations as financial constraints. It should be reserved to patients who have not responded favorably to standard rTMS treatment.

Clozapine, a well-established treatment of choice for treatment-resistant schizophrenia is known to reduce suicidality, lessen the risk of tardive dyskinesia and reduce relapse risk. It contributes to a higher quality of life by reducing cognitive clouding. Patients taking Clozapine have improved social and work functioning. But Clozapine's significant side effects require regular, intense monitoring to minimize mortality and morbidity. To improve current practice of clozapine prescribing and monitoring, a systematic audit of service practices against guidelines of local hospital / Monash Health Clozapine patient management guidelines and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines will identify any deficits and inform measures to overcome them.

An audit was conducted to compare the current clozapine prescribing practice and monitoring process compared with local hospital / Monash Health Clozapine patient management guidelines and RANZCP clinical practice guidelines among clozapine prescribed patients in an Australian community mental health service.

Medical records of thirty-three eligible adult patients on clozapine were audited. All the patients were prescribed dosages within the recommended daily clozapine range. Clozapine was used for appropriate indications (treatment of treatment resistant-schizophrenia or schizoaffective disorder). Of the 33 patients, clozapine level was subtherapeutic on 54.5% of patients. 54.5% of patients were on an adjunct psychotropic with clozapine. Aripiprazole and sodium valproate were used by eight patients each, and nine patients were identified using selective serotonin reuptake inhibitors. The most common side effect was hypersalivation (57.6%), followed by weight gain (39.4%), sedation (21.2%) and constipation (12.1%). Monthly weight monitoring, physical examination, medical officer monthly review and full blood examination, at 97% compliance met these standards. However, monitoring of Body Mass Index (BMI) (66.7%) and six-monthly consultant reviews (42.4%) showed poor compliance (<70%) with the standards. Most metabolic blood investigations were in moderate compliance (70–90%) except for relatively high compliance for lipid profile (90.1%). Monitoring cardiac functions by echocardiogram were only 75.8% met the standard.

Most patients in this clinic receive recommended monthly monitoring practice but for BMI monitoring, six-monthly consultant review, most blood investigations and annual or 2 yearly echocardiogram findings indicated need for improvement. Polypharmacy of psychotropics increases the side effect burden and further increases the need to closely monitor the physical health and prescriptions of this cohort of patients. The next stage of this project will involve a codesign approach to developing a response to these findings that will be outlined here.

Current NICE guidance states that Children and Young People (CYP) with suspected Eating Disorders (EDs) should be immediately referred to specialist services on their first presentation to primary care. This audit assessed whether these standards were being met across Greater Manchester and what general practitioners felt would be helpful in supporting them to correctly refer patients. Aim 1: Analyse information from referral forms on all patients referred to Manchester Foundation Trust Community Eating Disorders Service (MFT-CEDS) from primary care between 17th December 2020 – 17th June 2021. Aim 2: Gain insight into how confident GPs in Greater Manchester feel identifying suspected EDs in CYP, their knowledge of guidelines regarding referral, and how they would like to be supported to improve referrals of suspected CYP-ED.

Quantitative data on all primary care referrals made between 17th December 2020–17th June 2021 were analysed. Referrals were classified as correct if they were made both immediately and directly to the correct service. Subgroup analysis of data by geographic region of Greater Manchester was also undertaken. Qualitative data were collected through a survey which was sent to General Practitioners across Greater Manchester. The survey assessed knowledge of current guidelines and views on what training materials could be helpful to improve the referral process.

A total of 69 patients were referred to MFT-CEDS by their GP between 17th December 2020 and 17th June 2021. 35% of GP referrals to MFT-CEDS were documented as being made correctly as per current guidelines. 43.5% of all referrals were not initially made to MFT-CEDS. 58% of referrals were documented as being made immediately. North and South Manchester had the lowest rates of correct referrals of 10% and 8% respectively. There were 10 survey respondents, of which the majority did not know current referral guidelines and did not feel confident in identifying suspected Eating Disorders in CYP.

The majority of primary care referrals of CYP with suspected eating disorders to MFT-CEDS were not made in line with current NICE guidance.

The following recommendations were made based on the findings of this audit:

1) Create an information document and video regarding identification and referral guidelines for suspected EDs in CYP, 2) Design an easy-to-use referral template for GPs, 3) Conduct interviews with GPs working in North and South Manchester to help identify what additional support they need, 4) Re-audit referral data once quality improvement measures have been in place for 6 months.

The sodium valproate PREVENT programme was introduced by the Medicines and Healthcare products Regulatory Agency (MHRA) in March 2018, and is now a legal requirement due to valproate's risks in pregnancy. This project had two main aims: 1) To assess clinician knowledge of PREVENT, and identify deficiencies in current education. 2) To assess the barriers psychiatrists face in achieving compliance with PREVENT.

Knowledge and awareness of PREVENT was assessed through an online survey sent to local consultants and specialty doctors in February 2021. The survey included ten questions, four were Likert style to assess attitudes, two assessed local arrangements and four were knowledge based. A free-text section allowed respondents to describe challenges faced implementing PREVENT. Results were analysed, an educational presentation given at local teaching and a poster was created and distributed - both targeting areas of weakest knowledge. A repeat survey was sent out in June 2021, and results collected to reassess.

The pre-teaching survey received twelve responses, the post teaching survey received eleven. In both, 75% of respondents represented general adult services, and 25% represented intellectual disability services.

There was an improvement in confidence of knowledge with all respondents being either “somewhat” (55%) or “very confident” (45%) post-teaching compared to 75% being “somewhat” confident, 10% “unsure” and 17% “very confident” prior to intervention. Pre-teaching, 10% of respondents were unaware that a risk acknowledgement form must be signed annually, while post-teaching 100% correctly identified this should be annual.

Respondents correctly identifying “highly effective” forms of contraception rose from 83% to 100% following teaching. Post-teaching there was an increase of 31% in the number of respondents correctly identifying the necessary documentation where a patient declines the PREVENT programme.

Pre-teaching, half of respondents were unsure if their team had a reminder system for risk acknowledgement forms, and 42% reported having no system. Post-teaching, 27% of respondents reported now having a reminder system in place, and 27% had plans to implement one.

Initial results showed variable knowledge of the PREVENT programme, and a lack of awareness of the administrative requirements including risk acknowledgement forms. Results demonstrated an improvement in knowledge and organisation to help support compliance with the PREVENT programme. Respondents highlighted that knowledge of the PREVENT programme quickly deteriorates given how rarely it is used. Further work includes a full audit of compliance with PREVENT across the health board, as well as considering “refresher” sessions to prevent atrophy of knowledge.

The authors designed a simulation training programme for foundation doctors beginning psychiatry placements across a large mental health trust. The simulation training aimed to improve the confidence, competence, and well-being of foundation doctors through exposing them to realistic psychiatry scenarios and teaching clinical skills in a safe environment.

Four clinical scenarios were filmed with a 360-degree camera, professional actress, and doctors working in psychiatry. The scenarios depicted the journey of a patient being admitted onto a psychiatry ward from the community. Various clinical skills were embedded into the videos including psychiatric history taking, risk assessment, managing acute distress, managing comorbid physical and mental health problems, using the Mental Health Act, and teamwork with colleagues. All videos were delivered to learners using simulation with head-mounted-displays (HMDs). Each video lasted 6–8 minutes and was accompanied by pre-briefing and de-briefing with experienced psychiatrists for a further 15–20 minutes. Participants rated their confidence regarding several skills in psychiatry on Likert scales from 1 to 5 immediately before and after the session. Wilcoxon signed rank tests were conducted to detect statistically significant differences in learner's median confidence ratings before and after the training. Free-text questions explored trainee's most and least favourite aspects of the simulation. A survey also was distributed to learners 2-months after the training to assess how it had influenced their clinical practice.

20 foundation doctors completed the training and provided feedback. Following the simulation training, there were statistically significant improvements in foundation doctor's confidence in: completing psychiatric assessments (p < 0.01), managing physical health problems in psychiatry (p < 0.05), managing acute distress (p < 0.01), reporting information to senior colleagues (p < 0.05), and containing anxiety when communicating with patients (p < 0.05). Trainees highlighted the debriefing, group discussions, and “interactive” simulation videos as the most useful aspects of the training. Some trainees enjoyed viewing the 360-degree videos, whilst others found the HMDs difficult to use. Of the 8 trainees who completed feedback 2 months after the training, 7 (87.5%) felt that it had helped them in their current roles. All trainees agreed (37.5%) or strongly agreed (62.5%) that the simulation scenarios were closely aligned to real-life clinical encounters.

Simulation training in psychiatry using 360-degree videos and HMDs is generally well-received amongst foundation doctors. Embedding simulation training into placement induction can improve the confidence and skills of junior doctors starting psychiatry placements.

Psychiatric readmissions cause a burden on the healthcare system, incur a monetary cost and cause additional distress to acutely unwell patients. This project explores the use of the free-text of electronic patient records to predict inpatients in psychiatric hospitals at risk of readmission using predictive models generated by machine learning.

Free-text was extracted from the electronic patient records of patients admitted to hospitals in Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) during the five years 2015–2019 inclusive. The anonymised records were obtained via the CRIS (Clinical Record Interactive Search) database. A total of 17208 records were extracted.

The free-text entered by clinicians during an admission was extracted and processed using techniques of natural language processing to generate input vectors suitable to be used with machine learning algorithms. tf-idf (term frequency-inverse document frequency) vectors were used.

A selection of algorithms were used to train predictive models. Two-thirds of the records were used as training data with the remainder as test data. Baseline model performance was assessed and then best-performing candidates underwent hyperparameter optimisation using five-fold cross-validation to improve performance. Bayesian optimisation was used to automate hyperparameter tuning during cross-validation. Hyperparameters were optimised on the log loss function. As the dataset was imbalanced with negative instances outnumbering positive instances to a significant degree, various techniques such as random undersampling of negative instances in the training data were used to deal with class imbalance throughout this process. Following cross-validation, the best-performing models underwent performance analysis.

Models were used to make predictions on the test data. Performance was assessed using F1-measures, precision-recall curves and the average precision metric (equivalent to area under the precision-recall curve). These metrics were chosen due to their suitability in assessing models trained on imbalanced datasets.

The best F1 score obtained was 0.233 using a Random Forest model trained using unigram tf-idf vectors of 500 token dimension.

The best average precision obtained was 0.157 using a Support Vector Machine trained using unigram tf-idf vectors of 2000 token dimension.

Both the above results required the use of random oversampling of positive instances to improve performance on the imbalanced dataset.

The performance indicates that the models generated are unlikely to have significant practical utility. Nevertheless, this exploratory project has produced a processed dataset with knowledge about its characteristics. This could be used for the further development of models using more complex techniques such as language modelling using neural networks.

Research demonstrates greater mortality and physical health morbidity in those with mental illness, as compared to the general population. National Health Service (NHS) England has introduced policies to reflect this and promote improvements in physical healthcare for mental health patients. Inpatient admission provides a valuable opportunity to action such recommendations and offer a detailed health review, guided by local frameworks. A new annual audit commenced in Cheshire and Wirral Partnership NHS Foundation Trust (CWP) assesses admission physical health screening on its adult acute inpatient wards.

Audit standard was 100% compliance to CWP's admission pathway (Policy CP35). Parameters included doctor's review, medical history, physical examination, drug history, medication chart, allergy status, venous thromboembolic risk, blood tests, electrocardiogram (ECG), physiological observations, smoking history, body mass index (BMI) and falls risk. Data were collected retrospectively for all patients admitted or transferred to Juniper Ward, an acute adult inpatient unit in Bowmere Hospital in Chester, during October 2020 (cycle 1) and September 2021 (cycle 2). Different months were assessed due to senior staff changes in October 2021.

30 patients were identified in 2020 and 37 in 2021. In 2020 the most consistently achieved parameters were, in order, medication chart/drug history, doctor's review and past medical history. In 2021 the most consistently achieved parameters were medication chart/drug history, smoking status and past medical history. Across both years completion of the cardiometabolic tool was lowest, although this improved from 6.7% to 16.2%. In 2020 there were 5 parameters achieving <50% compliance (cardiometabolic, physiological observations, smoking status, BMI and falls risk). In 2021 this reduced to 3 parameters (doctor's review, cardiometabolic tool, falls risk). Local policy was updated following the 2020 results, amending the criteria for doctor's review from commenced within 6 hours, to completed within 12 hours. Improvement was seen in all other areas in 2021, with medication chart/drug history documentation achieved in 100% of admissions.

Generalised improvement was seen following the 2020 audit, although only one parameter reached 100% compliance and most remained under 75%. The first cycle led to a policy change with respect to the doctor's review timeframe, although this limited direct comparison between years. A flow chart will be trialled on Juniper Ward, highlighting required tasks and assigning ownership to specific team members. The local Medical Education team were also made aware of the results to inform junior doctor induction. The audit will be repeated in Autumn 2022.

To determine the mental impact the second wave of COVID-19 has had on health care professionals working in the National Health Services (NHS), United Kingdom.

A cross-sectional descriptive web-based survey was conducted among the staff of National Health Services (NHS) in Poole, United Kingdom. Two tertiary care hospitals staff were part of this study. The study was spanned over a duration of 6 months, October 2020 to April 2021. A standard GAD-7 and PHQ-9 questionnaire along with demographic information was uploaded on google docs for data collection. All healthcare staff working in the hospitals were included. Any person that did not fill the questionnaire completely was excluded. Data collected were analysed using SPSS for descriptive statistics and the chi-squared test was done keeping p < 0.05 as significant.

A total of 160 health care professionals took part in the survey, with a mean age of 37.36 (SD = 11.51) years, predominantly females (58.8%). The majority of participants were not depressed (78.1%, p = 0.004) nor were they anxious (85%, p = 0.008). A significant difference (p = 0.050) was seen in participant's anxiousness regarding the source of information. All other demographic parameters were not significant for differences in depression or anxiety (p > 0.05). 33.6% of the respondents agreed and 9.6% totally agreed to being terrified of contracting the coronavirus. 40.4% disagreed while 16% did not have an opinion. A similar trend was seen for the other statements. More than half (56.3% and 56.9%) of the participants answered in the affirmative that they were worried about contracting the disease and getting their living place contaminated, a staggering 91.3% were anxious about affecting their families.

The second wave of COVID-19 has had minimal effect on the mental health of health care workers in the NHS.

In the second half of 2020 patients admitted to Highgate Mental Health Centre had to isolate in their rooms until a negative SARS-CoV-2 test result was obtained. This was stressful for both patients, who were unwell in their mental state, and staff. Swabs for PCR testing were only being collected by junior doctors which meant that out of hours, this responsibility would fall exclusively upon the duty doctor. There were often significant delays to obtain a sample. We decided to train non-medical staff on an old age ward so that the responsibility of collecting samples could be shared with nurses and healthcare assistants.

In November 2020 we held one training session with several members of staff from our ward. In the following days we did one to one training sessions with the members of staff who, due to their shifts, were not available for the original training session. We excluded admissions that happened prior to SARS-CoV-2 being mandatory, those where the patient refused to be swabbed, and those patients who were transferred from another institution already with a pre-admission swab.

There were 37 admissions, of which we included 30 based on the exclusion criteria. 17 admissions occurred prior to training and 13 after the training sessions. Prior to training, it took 1.059 days to obtain a sample and it took 0.846 days after the training sessions.

Providing a training session to enable nurses and healthcare assistants to take samples for SARS-CoV-2 testing reduced the amount of time between admission and obtaining a swab sample. We therefore shortened the first step of the process that leads to obtaining a negative result and enable a patient to come out of isolation.

Intensive treatment for eating disorders include day treatment programme and specialist inpatient. COVID-19 pandemic led to lockdown in the UK on the 23rd March 2020. Adult Eating Disorders Day Treatment Programme in Surrey started delivering their care on the virtual platform from that date. It offered a combination of ‘virtual’ only and ‘blended’ care (virtual and in person) for more than a year. This service evaluation examined the safety of delivering intensive eating disorders treatment on the virtual platform.

Data from March 2020 to March 2021 were retrospectively collected from Electronic patient record. Two clinicians collected the data on age, referral origin, accommodation, employment status, diagnosis (subtype), length of illness, comorbid mental and physical health diagnosis, duration of day care treatment, medication, admission weight and BMI, discharge weight and BMI, changes in bloods and ECG, acute hospital admission, risk-to-self events, admissions to Specialist Eating Disorders Unit and reasons for discharge.

Data indicated that 21 patients were admitted in day treatment programme over 1 year period. 10 patients had solely virtual treatment and 11 patients had blended day treatment programme. 11 patients had anorexia nervosa restrictive subtype, 5 patients had Anorexia Binge purge subtype and 5 patients had Anorexia Nervosa, Unspecified.

Average length of illness was 4.49 years. Mean age for the group was 24.7 years and most patients lived with family (n 18) and were unemployed (n 11). More than 2/3rd (76%) patients had comorbid mental health diagnosis and 48% (n 10) had comorbid physical health diagnosis.

Average length of admission was 5.26 months. Mean BMI on admission was 15.3 (Range 12–19) and mean BMI on discharge was 16.9 (Range 13.65–22).

Safety and outcome data indicated that there were no serious incidents recorded in that time period. 1 (5%) patients required admission to acute hospital as their physical health deteriorated. 8 (38%) patients required specialist inpatient admission as the day care did not affect any changes to their eating behaviours, and 4 (19%) patients had events indicating self harm episodes(19%).

Our service evaluation data indicated that it is relatively safe to deliver day treatment programme on the virtual platform. Weekly face to face physical health monitoring (weight, BP, Pulse, temperature) and regular physical health investigations (Blood tests and ECG) were integral part of managing risks to health. On the other hand, delivering day treatment programme on the virtual platform has enabled the day treatment programme to prevent any significant outbreak of COVID-19 in a vulnerable group of patients and allowed them to receive uninterrupted support during pandemic.

Lewy Body Dementia (LBD) is predicted to be under-diagnosed in the general population. RBD is one of the four core clinical criteria for the diagnosis of LBD. Longitudinal studies of RBD show strong association with LBD, so there is potential for early identification of LBD and subsequent management. We aimed to screen 100% of patients referred to Trafford MATS for RBD.

We performed three Plan-Do-Study-Act (PDSA) cycles; in the first cycle we introduced a validated RBD screening question, from the DIAMOND-Lewy study, to the initial memory assessment proforma. This asked ‘Have you ever been told that you “act out your dreams” while sleeping (punched or flailed arms in the air, shouted or screamed)?’

In the second PDSA cycle, we delivered a RBD and LBD educational package to the specialist memory nurses who undertake the initial assessments. In the third PDSA cycle reminders were sent to the team to use the new assessment proforma.

We collated data from patients who had undergone an initial memory assessment between 06/04/21- 22/06/21 from the trusts electronic database.

Initial baseline data showed that 0% of initial assessments screened for RBD; at the end of PDSA one this was 100% and 75% at the end of PDSA two. This increased to 100% at the end of the last PDSA cycle. The main reason for non-completion of the screening question was use of the old proforma.

4/152 patients screened positive; patients were diagnosed with Alzheimer's disease, delirium, vascular dementia and mixed Alzheimer‘s disease and vascular dementia, respectively.

The introduction of a RBD screening question into the MATS initial assessment proforma improved screening for RBD. We think the variation in screening compliance rates was likely due to practitioners using old assessment proformas, hence sending reminders of the new proforma.

A limitation of the project was that some patients did not have a bed partner, which makes identification of the disorder more difficult.

Since the completion of the project, we have circulated a news bulletin through the Dementia United charity to raise awareness of our QI project nationally and also discussed the project with the Lewy Body society. Whilst our project has not yet identified a patient with LBD, we feel that introducing this screening question is a very easy and reproducible change to implement and RBD should be screened for in all memory patients.

The Oxford City and NE Oxon Adult Mental Health Team (AMHT) is an adult mental health team receiving referrals from GPs for most cases suspected to have a mental health illness requiring secondary mental health services’ input in Oxford city. In January 2020, the team was remodelled with care coordinators working in separate functions based on the duration AMHT support was required for, i.e. an assessment team and a treatment team, but with medics covering both functions of the team. This quality improvement project examines AMHT referrals over 2020/21, hypothesising a reduction in the proportion of inappropriate referrals following the remodelling compared to a 2018/19 pre-remodelling audit.

The project covers a total of 2803 referrals the team has received from 13/01/2020 to 12/01/2021. The outcomes measured included the number of inappropriate referrals returned to the GP, referrals only requiring a single assessment, the proportion of these referrals as university students in Oxford, and the diagnostic groupings of the referrals in students vs non-students. These outcomes were measured pre- and during the COVID-19 pandemic over 2020/21.

A reduction in the total number of referrals to the team was noted over 2020/21 but this was compared to an 11 month audit in 2018/2019. During the study period, 19.5% (546/2803) of referrals were deemed inappropriate compared to 21% of referrals received in 2018/2019. Of 2803 referrals, 14.7% (97/658) were inappropriate pre-COVID-19 vs 20.9% (449/2145) during the pandemic. Of the total number of referrals, 32.9% were returned to the GP following a single assessment.

The top 3 diagnostic categories in ‘non-students’ were mood/affective disorders (33.7%), anxiety/stress related disorders (17.2%), and neurodevelopmental disorders (7.8% total - ADHD was 3%). A significant increase in ADHD referrals and mood disorders amongst students compared to non-students is notable with the top 3 diagnostic categories for students being mood/affective (24.7%), neurodevelopmental disorders (19.5% - ADHD 17.7%), and anxiety/stress related disorders (13.4%). Students constituted 26% of the total number of referrals.

It was notable that during the pandemic there was a higher proportion of inappropriate referrals.

Our project demonstrates a reduction in the proportion of inappropriate referrals sent to the AMHT following remodelling as compared to 2018/19. Further work is necessary to elucidate the contributing factors and reduce inappropriate referrals even further. An innovation is planned to automate the logging of referral outcomes to expedite a re-audit.

Little is known about the experiences of individuals presenting with complex mental health needs and the provision of care they receive for suicide and self-harm behaviours. There are limited data describing the support individuals receive from services and, where they do, how this support is provided. Research suggests that those presenting with a more complex clinical presentation may have a history of both suicide attempts and self-harm. The aim of the study is to explore the experiences of individuals with complex mental health needs in respect of their self-harm and suicidal behaviours, and experiences of support received from mental health care services.

A semi-structured interview methodology was used to generate qualitative data. Representative participants with complex mental health needs were recruited from across Cheshire and Wirral Partnership NHS Foundation Trust, UK. Ten participants were interviewed for the study. Interviews were audio-recorded and transcribed verbatim. A transcript-based conceptual analysis was conducted to identify and explore emerging themes.

The following three themes emerged from the service user interviews: (i) Service users discussed suicide attempts following inappropriate discharge; Service users spoke about feeling unsupported and not listened to by care staff, particularly as inpatients; and (ii) Service users expressed a necessity for staff training to improve understanding of self-harm and suicide attempts, having experienced negative consequences of staff handling when they may have self-harmed.

This study highlighted the following recommendations for future suicide prevention for mental health services treating service users with complex mental health needs: increasing staff awareness of suicide or self-harm related issues; improving training and risk assessment skills; providing appropriate support for service users following discharge from inpatient settings; improving liaison and collaboration between services to provide better service user outcomes; and increasing awareness in listening to service users’ distress about suicidal or self-harm thoughts for each individual's situational context.

Due to the demand for increased flexibility of working there is an ever-increasing number of trainees working Less Than Full Time (LTFT). The Royal College of Psychiatrists supports LTFT training and careers within the specialty. However, applying for and working LTFT can be a challenging and at times overwhelming process to navigate. This project's aims are to improve written information provided to trainees when commencing LTFT training. To assess interest for a LTFT training educational event and to plan this event based on trainees preferences for content and timing.

Questionnaires via SurveyMonkey were sent to higher trainees in all regions of the Yorkshire and Humber Deanery in October 2021 by the Medical Education Departments. A covering email invited those working or interested in LTFT to complete the questionnaire.

Questions assessed the need for further written information on LTFT training in the region and interest in an educational event. Trainees already working LTFT were asked what they valued most out of support already in place.

Of 40 trainees who responded, 100% stated when commencing LTFT training they would wish to receive more information. Respondents were asked which areas they would like included: practicalities (100% of respondents), LTFT mentor (85%), peer support (83%), weblinks to information (70%), recommended reading (53%). Those already working LTFT were asked what they had found helpful, the most common themes were mentoring, peer and supervisor support.

85% of trainees surveyed confirmed they would be interested in attending a LTFT focused educational event. Based on trainee preferences the areas to be included were job planning (78%), choosing a job (81%), clinical lead views (78%), finances (86%), Out Of Programme opportunities (61%) and emotional aspects (61%). Further questions clarified preferences for a virtual Vs face-to-face meeting and timing to maximise attendance.

There is a need for further information to be provided to trainees on LTFT training in the region. The content has been guided by trainees and will be incorporated into the Higher Trainee Handbook.

For those training LTFT the most helpful aspect has been mentoring, peer and supervisor support. We have subsequently linked with the established mentoring scheme and those new to LTFT are matched with an established LTFT trainee. We recommend 3 monthly LTFT peer and Training Programme Director meetings continue.

There is considerable interest in an educational event focused on LTFT working. This has been organised for May 2022 and the content guided by trainee's preferences.