OCD is a chronic and debilitating psychiatric illness. Current first-line treatments include serotonin reuptake inhibitors and cognitive behavioural therapy, but a substantial minority of patients fail to respond adequately, requiring further forms of intervention usually provided in a sequenced algorithm. Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses passed through a coil placed on the scalp to stimulate the underlying brain region. Clinical trials of r-TMS in OCD have produced conflicting results, possibly related to the variability in the site of stimulation, protocols used, and variability in the selection of patients. We perform an updated systematic review and meta-analysis of the effectiveness of rTMS for the treatment of OCD aimed to determine whether certain rTMS parameters (i.e. site, duration, protocol etc.) or patients’ characteristics (i.e age, duration of illness, illness severity, treatment resistance etc), are associated with effectiveness. Our overarching aim is to determine the place of rTMS in the sequenced OCD care-pathway.

The meta-analysis is pre-registered in PROSPERO (ID: 241381). Potentially relevant studies will be retrieved using the MEDLINE, PsycINFO, and Cochrane Library databases using the parameters [‘obsessive compulsive disorder’ or ‘OCD’ or ‘obsessions’ or ‘compulsions’] AND [‘transcranial magnetic stimulation’ or ‘TMS’]. The reference lists of retained articles will also be scrutinized for additional relevant publications. Only full text English language articles will be included in the review. The methodological quality of the studies will be assessed using CONSORT criteria. A summary of the study's quality as a randomized clinical trial will be produced.

Our preliminary analysis shows some efficacy for r-TMS in non-treatment resistant OCD than treatment resistant OCD. Detailed results will be presented in the poster at the event. Effect measure will be either categorical (e.g. relative risk (RR) or odds ratio (OR) or continuous (mean difference or standardized mean difference - Hedge's g or Cohen's d - when taking into consideration the severity of the disorder as a dimension). These outcomes will be measured through validated instruments, in the form of both self- rated scales and observer rated scales including semi-structured interviews.

This meta-analysis will identify the patient, illness and protocol parameters that determine clinical outcomes, as guide to optimizing the role of rTMS in the care of patients with OCD.

Pharmacological management of Obsessive-Compulsive Disorder (OCD) presents a challenge in modern psychiatry. While most patients respond preferably to serotonin re-uptake inhibitors (SRI), the response is usually delayed by several weeks leading to an insufficient short term management of anxiety. It is also frequently inadequate and needs higher doses and augmentation in many instances. Investigating newer pharmacological strategies to address such treatment gaps has always been of interest. Buspirone is a novel anxiolytic medication with additional weak antidepressant and poor anti-psychotic effects. It is the only medication in its category, i.e. azapriones. It has comparable anti-anxiety efficacy to that of benzodiazepines without their sedating or habit forming effects, and has been demonstrated to moderate serotonin and other monoamine neurotransmission with a favourable safety profile.

We reviewed the literature pertaining to the use of Buspirone in OCD for both as a primary anti-obsessive agent and for a potential secondary role in management of chronic anxiety and/or anxiety disorders comorbid to OCD.

The results of a number of case reports and open trials have been positive while controlled trials have shown contradictory results. In a double blind RCT comparing clomipramine and buspirone, significant improvement was found in both groups with no differences between the two. Further two trials observing buspirone augmentation of clomipramine and fluoxetine treatment respectively, in a double-blind placebo controlled design reported significant improvement in the treatment as opposed to the placebo arm. Another double-blind placebo controlled study of buspirone augmentation of fluvoxamine resistant patients did not show significant benefits as an anti-obsessional agent, but notable anxiolytic effects were reported. In all the trials buspirone was largely well tolerated and did not pose any significant interactions with other psychotropic agents or dependence potential.

Buspirone is a pharmacologically unique agent with a good safety profile. Given the robust anxiolytic effects of this Peron along with complex neurotransmission modulatory effects coupled with a favourable tolerance and dependents profile might make buspirone an attractive novel pharmacological agent for augmentation in OCD . Further controlled studies to better establish effectiveness and deciphering if certain patients may respond to its use over others, are warranted

To collate experiences of international medical graduates (trained psychiatrists) on the Medical Training Initiative (MTI) and equivalent programs (International Medical Fellowship (IMF)/CESR Fellowships) in the United Kingdom and to understand shared themes.

Three psychiatrists with the experience of being part of MTI/IMF program, for a minimum of 1 year, participated in theme guided, focussed discussions to understand common experiences. These discussion where limited to 3 broad headings. Opportunities to grow, what we wish the college knew and what we wished the trusts and supervisors knew. The experiential accounts were captured and circulated among a group of 20 MTI/IMF/CESR fellowship doctors and rated on a 5 point Likert scale varying between strongly agree to strongly disagree.

The findings suggest that the expectations and experiences of the psychiatrists on such programs share some common themes. Most of them had varied experiences under the theme ‘opportunities to grow’. The suggestions for what these doctors ‘wished the trusts, college and supervisors knew’ had a good concordance among the 20 doctors who reviewed the themes and suggestions. The details of the themes and commonalities will be discussed at the conference.

The expectations and experiences of the doctors on MTI/equivalent program share common themes. Bridging the gap between MTI experience to an excellent MTI experience would involve identifying such shared experiences, that could potentially guide development of processes, thereby making these training fellowships better tailored to each trainee.

Engagement with members is an important issue for the Royal College of Psychiatrists (RCPsych) and an area for ongoing development. This is an issue that extends to Psychiatry trainees and the Psychiatric Trainees’ Committee (PTC) has adopted increasing engagement as one of its key aims. Divisional representatives in different areas of the UK had noted that trainees had limited knowledge of the PTC or its roles and projects both within the College and local areas. To improve this it was decided to pilot a project that established a social media platform for trainees to improve communication between the PTC, it's representatives and trainees. It was decided that Workplace (a professional version of Facebook) would be used. This had already been established in the Severn Deanery.

Northern Ireland (NI) and the East of England (EoE) deaneries were selected as pilot areas for the project. Preparation for the project included collaboration with trainees from the Severn deanery and meeting with the RCPsych Digital team. A scoping questionnaire was circulated to trainees in each deanery.

Following this, two closed groups were initiated on Workplace in August 2019 for Northern Ireland and East of England trainees.

Results from the survey sent prior to the social media pages being established indicated there was appetite among trainees for the project. The pages were established in July 2019. The pilot project was promoted by representatives.

In the initial phases, approximately 40% of trainees signed up. Information regarding college and local events, committee meeting updates and training opportunities was disseminated on the platform. There was evidence of early use by trainees outside of the representative group.

This however was not sustained and gradually use of the platform reduced over the pilot period, both in postings and membership. A further questionnaire circulated in July 2020 highlighted trainees’ concerns relating to the platform, including concerns around data protection and a high number of notifications associated with the Workplace medium. The ultimate impact on engagement was also felt to be minimal.

Following feedback and increasing usage costs by Workplace, it was decided not to continue with a nationwide role out of the project. COVID-19 has seen the successful use of platforms such as Microsoft Teams and these may be considered in the future, given their integration with existing trust systems.