Legal epidemiology is an emerging field that examines how laws and policies influence human rights and health outcomes, particularly in areas such as in-patient psychiatric treatment, community treatment orders and child maltreatment, This editorial highlights contributions from BJPsych Open that apply legal epidemiological methods to assess issues relevant to child maltreatment and coercion in psychiatric care. Findings emphasise the need for early intervention, standardised evaluation measures and reforms that prioritise human rights and well-being. Legal epidemiology can offer a scientific basis for improving legal frameworks, as well as promoting equitable and effective mental healthcare.

Aims: Functional Neurological Disorders (FND) are common but poorly understood causes of disabling symptoms including limb weakness, seizures, fatigue and memory difficulties. Children as young as 5 years old may suffer from the condition and middle adolescence is the most common age of onset. Children with FND are likely to have more difficulties with education and mental health disorders and have experienced more adversity in childhood such as physical, emotional, and sexual abuse. Despite the severity and chronicity of this condition, the literature about FND in children is poor. Children with FND often fall between paediatric and CAMHS services and thus understanding the condition can be better done through cases referred to specialist services. Here we aim to describe the clinical characteristics of referrals made to the sole National and Specialist paediatric liaison service which assesses and treats children with FND.

Methods: Through the South London and Maudsley NHS Foundation Trust, Electronic Patient Journey System, an electronic case record search was completed for all patients who were given a diagnosis of ICD–10 Dissociative Disorders which was made before the patients were 18 years old. From 2015–2025, a total of 196 patients were identified. Individual case records were assessed for demographic and clinical information.

Results: In the group of 196 patients, patients ranged from 7–17 years old (mean 14.11 and mode 15). Sixty-eight per cent (69) of the patients were female. Forty-nine (25%) were coded as dissociative motor disorder, 54 (27.6%) dissociative convulsions, 6 (3%) dissociative amnesia, 71 (36.2%) had mixed or unspecified dissociative symptoms. Sixty-eight per cent of patients reported comorbid anxiety symptoms and 29% of patients reported comorbid depression. Fifty-eight per cent reported experiencing bullying at school.

Conclusion: Children with FND present with a high degree of disability, psychiatric comorbidity and social adversity. A limited evidence base exists as to best practice for paediatric FND yet treatment is essential for positive outcomes in both childhood and subsequent adulthood. Further research should include controlled trials in this age group and an increase in funding specialist services.

Aims: Functional Neurological Disorders (FND) are common but poorly understood causes of disabling neurological symptoms. Children with FND are likely to have more difficulties with education and mental health disorders and have experienced more adversity in childhood such as physical, emotional, and sexual abuse. Emergence of FND in childhood can predict long-standing difficulties into adulthood. Predictors of poor outcomes in adults include a long duration or very severe symptoms, comorbid depression, personality disorder, chronic pain, dysfunctional family dynamics, perceived stigma about FND and social isolation. Each of these represents potential therapeutic targets for children and adolescents with FND.

However, literature about FND in children is poor and few studies describe outcomes and optimal models of care. Here we aim to analyse outcomes of FND in children to look for clinical and demographic predictors of prognosis and potential treatment targets.

Methods: Through the South London and Maudsley NHS Foundation Trust (SLaM), Electronic Patient Journey System, an electronic case record search was completed and 196 patients were identified who had a diagnosis of ICD–10 Dissociative Disorders given before the age of 18 between 2015–2025. Of these patients, 133 have a Dissociate Disorder as their primary diagnosis. Individual case records were assessed for demographic and clinical information and outcomes were defined through case record descriptions.

Results: In the group of 133 patients, 68 (51.1%) were discharged with a favourable outcome, 13 (9.8%) were transferred to adult FND services, 5 (3.7%) were admitted as psychiatric inpatients, 11 (8.3%) discontinued treatment and outcome data is not available, 15 (11.3%) remain under the care of the specialist service for ongoing treatment. Twenty-four (18.3%) were seen for consultation but managed under non-SLaM services. Therefore, in cases with known outcomes, 68/109 (62%) were favourable. Predictors of transfer to adult FND services or psychiatric admission include comorbid self-harm and depression, duration of symptoms prior to referral to paediatric FND services and family unwillingness to accept the diagnosis of FND.

Conclusion: Evidence from this cohort would suggest that positive clinical outcomes can occur in a high number of cases. These patients appear to benefit from specialised services which may include psychoeducation, family and individual therapy and multidisciplinary working. Early diagnosis of FND and treatment of comorbid psychiatric issues may further enhance prognosis. Further controlled studies would highlight specific therapeutic targets and interventions for children with FND.

Aims: This study’s primary aim was to explore carers’ views of psychotropic medication prescribing in children and adolescents with intellectual disability (ID) followed up at Malta’s Intellectual Disability Clinic (IDC). It also aimed to identify carers’ views on nonpharmacological management of challenging behaviour (CB), experiences of Malta’s Child IDC and perceptions of mental illness in children with ID.

Methods: A literature review was carried out to gather data on previous research on the topic. Ethical and Departmental approval were obtained. Purposive sampling was used to recruit thirteen caregivers of children and adolescents with a diagnosis of a mild, moderate, or severe ID and/or moderate or severe autism spectrum disorder who were prescribed psychotropic medication and attending the Child IDC. Semi-structured interviews were carried out using an interview guide written by the primary researcher. These were recorded digitally and then transcribed verbatim. A reflexive and inductive thematic analysis approach was taken to analyse and interpret data.

Results: Seven themes were generated, with the predominant theme being ‘Medication is a necessary evil’. The other themes were 1) Medication helps them cope, 2) A last resort, 3) The doctor knows best, 4) Medication falls short of expectations, 5) A cure for all the family, 6) Medication: The missing piece to society’s puzzle.

Overall, psychotropic medication was perceived as beneficial, as it improved the children’s quality of life, their functioning within their roles within the family and within society. Parents experienced a lot of barriers when accessing services, social benefits and struggled with inclusion in society. Parents were aware that medication did not come without adverse effects, some of which proved to be of detriment to these children and their families.

Conclusion: This study highlighted the need for increased psychoeducation and parental support. Parental burnout, child’s distress, and fear of exclusion from society may contribute to perceived need for medication. The lack of streamlined services and familial support further exacerbate parental struggles, leading them to resort to medication. Further research is needed to discover prevalence rates of mental health disorders in the Maltese cohort. Improvements to the IDC include provision of family counselling, parenting programmes and support groups. Access to Positive Behaviour Support at the Child IDC Services may allow for alternatives prior to resorting to psychotropic medication for CB.

Aims: Psychosis is a severe mental health condition characterised by a loss of contact with reality, often manifesting in symptoms such as paranoid delusions and hallucinations. Research has shown that the prevalence of psychosis is significantly higher among individuals from ethnic minority backgrounds compared with White Britons in the UK. Additionally, people from these backgrounds tend to experience more discrimination and identity-related challenges than their White counterparts. However, few studies have explored how discrimination and ethnic identity intersect to influence psychosis rates.

This study aims to examine the relationship between discrimination and paranoia in ethnic minority populations, exploring whether ethnic identity may help protect individuals from the negative impact of discrimination on psychosis. It is hypothesised that people from ethnic minority backgrounds will face more discrimination and exhibit more severe symptoms of paranoia compared with White Britons, with the relationship between ethnicity and paranoia being mediated by discrimination. Furthermore, it is predicted that the association between discrimination and paranoia will be moderated by social identity, such that higher social identification will attenuate the positive association between discrimination and paranoia.

Methods: The study involved a secondary analysis of two cross-sectional datasets, including African and African Caribbean participants (N=355) and a student sample (N=1747), using validated measures of paranoia, psychosis symptoms (paranoia, dissociation, and hallucinations), discrimination, and ethnic identity.

Results: A moderated multiple regression indicated that the positive association between discrimination and paranoia was moderated by social identity, such that the effect was weaker and non-significant when people had stronger identities. We further found that discrimination mediated the effect of ethnicity (ethnic majority vs ethnic minority) on paranoia.

Conclusion: Strong social identities buffered ethnic minority people from the negative effects of discrimination on paranoia symptoms. Further, the higher rates of paranoia observed among ethnic minority participants may be explained by their more severe experiences of discrimination.

Aims: Vicarious trauma (VT) is a significant concern among psychiatry trainees due to their frequent exposure to patients’ traumatic experiences. This exposure can lead to psychological distress, including symptoms resembling post-traumatic stress disorder (PTSD), emotional detachment, and burnout. This review explores the prevalence and impact of VT among psychiatry trainees and evaluates the effectiveness of support mechanisms such as supervision, peer support, and resilience-building strategies. By highlighting risk and protective factors, this paper informs psychiatry training programmes on safeguarding trainees’ well-being.

Methods: A literature review was conducted using databases including PubMed, PsycINFO, CINAHL, and Scopus. The search focused on peer-reviewed studies examining VT in mental health professionals, particularly psychiatry trainees. Key search terms included “vicarious trauma”, “psychiatry trainees”, “compassion fatigue”, and “support strategies”. A total of 39 studies were analysed, covering empirical research, qualitative investigations, and theoretical discussions.

Results: Findings indicate VT is widespread among psychiatry trainees, with many experiencing emotional distress, anxiety, and reduced professional efficacy. Risk factors include frequent exposure to trauma, high caseloads, inadequate supervision, and personal trauma history. VT impacts not only mental health but also professional relationships and career sustainability, with some trainees experiencing emotional exhaustion and compassion fatigue.

Several strategies help mitigate VT. Regular supervision provides a structured space for processing experiences, while peer support programmes reduce isolation and encourage shared coping mechanisms. Resilience-building strategies, such as mindfulness, self-care training, and structured debriefing, help trainees manage emotional challenges. Some experience vicarious resilience, where their work enhances professional fulfilment and emotional strength.

While research supports these interventions, methodological limitations – such as reliance on self-reported measures and cross-sectional designs – restrict definitive conclusions on long-term effectiveness. More robust, longitudinal studies are needed to assess sustained impacts.

Conclusion: Vicarious trauma significantly affects psychiatry trainees’ well-being, professional development, and retention. However, structured support – through supervision, peer networks, and resilience training – can mitigate its effects. Future research should assess the long-term effectiveness of interventions and explore how training institutions can better integrate trauma-informed approaches into curricula. By prioritising trainee well-being, psychiatry programmes can promote a more resilient mental health workforce.

Aims: The Long-Term Illness Scheme (LTI), funded by Ireland’s Health Service Executive (HSE), provides free prescriptions at the primary care level for 16 specified physical and mental health conditions. This scheme is non means tested and is facilitated under the Primary Care reimbursement service via the HSE. It was initiated in 1970 under the Health Care Act and was last revised in 1975. This survey aimed to assess Child and Adolescent Psychiatrists’ knowledge of the scheme, its usage, and the perceived barriers or enablers to its utilization.

Methods: A mixed-methods cross-sectional survey was conducted among Consultants and Higher Specialist Trainees in Child and Adolescent Psychiatry in Ireland (N=60) on an anonymous, opt-in basis.

Results: The findings revealed low levels of knowledge and utilization with a minority (41%) of respondents reported being somewhat aware of the scheme. 58% felt uninformed about the medications reimbursable. Qualitative analysis highlighted significant barriers, including restrictive and confusing inclusion criteria, administrative burdens, and time constraints in clinical practice.

Conclusion: These results underline the need for national training on the LTI scheme, a systematic review of inclusion criteria to align with international best practices, and streamlined administrative processes. Addressing these gaps could reduce barriers for clinicians and improve access to psychotropic medications for children and adolescents with mental illness. Such measures are crucial to enhancing equitable care and alleviating administrative strain on consultants, ultimately benefiting both clinicians and young patients in Ireland. Equipping psychiatrists with the necessary tools and knowledge is essential to effectively utilize health reimbursement schemes and advocate for better mental health care.

Aims: Antipsychotic medications are essential in treating patients with severe mental illness (SMI), but they are associated with rapid weight gain, significantly increasing the risk of cardiovascular disease and diabetes. These physical health complications contribute to reduced life-expectancy and development of preventable physical health conditions. The NIHR-RESOLVE study (REF:HSDR131871) explored non-pharmacological interventions for antipsychotic induced weight gain, and highlighted the urgent need for a structured, preventative pathway to support patients at risk.

Fragmentation between physical and mental health services, can leave patients with SMI without adequate physical health support. Despite national guidelines recommending annual physical health checks, interventions often come too late, typically after significant weight gain has already occurred. Additionally, stigma surrounding weight gain exacerbates mental health difficulties.

Methods: IMPLeMENT, an impact study funded by Aston University, facilitated three online workshops, and one in-person event to co-produce a person-centred preventative pathway to manage antipsychotic-induced weight gain. In collaboration with The McPin Foundation, sessions were attended by psychiatrists, dieticians, occupational therapists, policymakers, managers, commissioners, pharmacists and service users. Findings from RESOLVE served as a foundation for discussions, and healthcare professionals from the UK and international mental health services (including learning disabilities, forensic psychiatry, and early intervention in psychosis) shared experiences and discussed how they may implement change in local settings.

Results: Thematic analysis of workshop transcripts and notes revealed key challenges and opportunities in developing an effective preventative pathway. Stakeholders highlighted several areas for improvement:

Holistic approaches – current interventions are often fragmented, lacking integration across services.

Shared Responsibility – The need for collaborative care among different HCPs and services was emphasised.

Improved access to information – service users and professionals expressed the importance of psycho-education and clear, accessible resources to facilitate proactive management.

As a direct result of this work, multiple healthcare organisations are implementing and evaluating preventative weight management pathways tailored to their local needs and available resources. These quality improvement (QI) projects mark a significant step toward embedding sustainable change in routine care.

Conclusion: This work has emphasised the need for a novel preventative pathway to mitigate the risks of antipsychotic weight gain. Future research will work alongside these organisations to examine real-world implementation, identifying facilitators and barriers to integrating preventative pathways into everyday clinical practice. By doing so, this initiative aims to bridge the gap between physical and mental healthcare, improving long-term health outcomes for individuals living with SMI.

Aims: This systematic review sought to compare the effect of assisted dying options on self-determination, patients’ quality of life, and specific/ethical concerns including suicidality for adults with severe psychiatric disorders and psychiatric or palliative care.

Methods: The data sources gathered for this review were PubMed, EMBASE, CINAHL and Cochrane databases. The search terms consisted of different forms of assisted dying to which various forms of psychiatric and mental health-related terms were added. The papers were restricted to systematic reviews and meta-analyses as these give high-quality evidence. Out of 343 studies after strict criteria such as ROBINS 1, ROB2 and AMSTAR, only 3 studies qualified for the review. The review centred on adults with severe psychiatric disorders, specifically patients with eating disorders who had assisted dying between 2012 and 2024.

Results: The present review estimated that at least 60 individuals with eating disorders who received assisted dying between 2012 and 2024 were reported across 10 peer-reviewed studies and 20 government reports. Clinical rationales for granting assisted dying requests fall into three main domains: non-treatability, prognosis and request of the patient. Most of the reports highlighted two aspects: that the patients had a terminal or untreatable disease, as well as sufficient decision-making abilities. Still, only a few reports were available for the government and many of them failed to provide adequate data on psychiatric conditions.

The review showed that there were significant gaps in reporting assisted deaths for psychiatric patients and ministers questioned accountability and patient safety. Some clinical justifications were void of rigour or evidence indicating the plausibility of the irremediability or lack of decisional capacity in psychiatric relatedness.

Conclusion: The findings of this systematic review can be concluded as indicating the lack of procedural clarity and strengthened precaution measures for assisted dying in the field of psychiatry. The results imply the applicability of the ethical principles as well as clinical considerations call for incremental case-by-case analyses. The study should be extended to propose improved reporting systems for assisted dying and to confirm clinical justification for several patients who received help in psychiatric practices, with the consideration of patient rights and safety.

Aims: Postnatal Depression (PND) is the most prevalent mental health disorder during the postpartum period. Evidence suggests that clinical practice guidelines (CPGs) have the potential to improve the mental well-being of these women. A systematic review of the CPGs for PND, addressing both pharmacological and non-pharmacological recommendations, is currently lacking in the literature. We aim to identify the existing CPGs for the management of PND and to collect the specific recommendations reported by them.

Methods: We conducted this review following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed in 5 electronic databases (Medline, Embase, PsycINFO, TRIP, and Epistemonikos) and guideline-specific websites (GIN, NICE, SIGN, and WHO) to identify the currently available English language CPGs for the management of PND, published between 2012 and 2023. General characteristics of the CPGs, as well as reported pharmacological and non-pharmacological recommendations, were extracted. The AGREE-II instrument was used to assess the methodological quality of CPGs based on a cut-off point of 70% and above.

Results: The search strategy identified 1096 records of which 71 were assessed for full text. We identified 19 CPGs: with only one from a lower-middle-income country (Lebanon). All CPGs recommended cognitive-behavioural Therapy (CBT) as the preferred psychological therapy based on level 1 evidence (Systematic review and meta-analysis). Pharmacological interventions were included by 17 CPGs with Selective Serotonin Reuptake Inhibitors (SSRIs) being the most recommended medication based on level 2 evidence (Randomized control trial). Nine CPGs used the “GRADE Criteria” for the determination of the strength of the recommendations. Only three CPGs incorporated Patient and Public Involvement and Engagement in the form of an advisory group. Six CPGs matched the criteria of adequate quality by achieving an overall score of ≥70%.

Conclusion: This review highlights the lack of evidence-based CPGs in lower-middle-income countries (LMICs), which have the largest burden of disease. The application of CPGs from higher-income countries in LMICs is challenging due to significant cultural differences and the availability of evidence from their own settings. CBT and SSRIs were the most common pharmacological and non-pharmacological interventions reported in these CPGs.

Aims: Historically, healthcare professionals were prone to experiencing turmoil of emotions prominent to psychological trauma due to the nature of their work. The healthcare professionals were subjected to elevated risks of psychological elements, leading to mental health implications due to the aftermath of the COVID-19 pandemic. By extension, these mental health repercussions can highly affect the patients’ care as they profoundly affect the healthcare professionals from offering the best quality of care. Different types of digitalised psychological interventions exist and seem to be making an increased trend into being added into the medical field. They are becoming increasingly popular for mental health improvements due to their cost-effectiveness, their scalability, their ability to offer greater anonymity and stigma reduction compared with traditional interventions. Randomised controlled studies (RCTs) were systematically reviewed to explore the effectiveness of digital interventions which are available for healthcare professionals who experience psychological trauma.

Methods: A comprehensive search was conducted across four electronic databases, Pubmed, Medline Ovid, Embase Ovid, PsychINFO Ovid, resulting in a total of six RCTs that met inclusion criteria. Assessment of study quality and risk of bias were conducted using the Jadad scale and Cochrane Risk of Bias Tool respectively. Whilst the RCTs included in the review investigated the efficacy of interventions on healthcare professionals’ wellbeing, the modalities of the interventions varied. Interventions included smartphone-based stress management modules, resilience training, smartphone applications focusing on emotional skills, cognitive-behavioural therapy exercises and psychoeducation, as well as computerised Eye Movement Desensitisation and Reprocessing (EMDR) intervention and internet intervention enhancing self-efficacy. As a result, a meta-analysis was not applicable to be carried out.

Results: Based on the findings, digital interventions had positive impacts on reducing the mental strain experienced by healthcare professionals. Some studies proved that the improvements were of statistical significance. The results of the RCTs in this review looked promising for the future of digital interventions targeting the mental wellbeing of healthcare professionals. In particular, the computerised EMDR intervention and the self-guided internet intervention targeting self-efficacy or social support, illustrated the potential benefits in its results. However, other studies indicated the need for further research before definitive conclusions can be drawn. The majority of the studies used a smartphone-based intervention. However, there was no correlation between the efficacy of these RCTs and this feature of their modality.

Conclusion: The scarce literature available in relation to this topic displayed promising evidence that digital interventions helped healthcare professionals experiencing psychological trauma.

Aims: To explore the physical health of YP admitted to adolescent inpatient mental health units and reflect on any differences over the following 6 months.

Research Questions: 1. To assess physical health of young people upon admission to adolescent inpatient services (cardiovascular risk factors e.g. BMI, blood pressure, blood glucose and lipids). 2. To assess current lifestyle behaviours of young people upon admission to adolescent inpatient wards (e.g. physical activity, diet, smoking rates). 3. To assess changes in physical health/lifestyle 3 months and 6 months post-admission. 4. To understand the impact of inpatient care environment on lifestyle behaviours and physical health of adolescents admitted to inpatient units. 5. To understand the experiences and beliefs about physical health in adolescents admitted to inpatient units. 6. To establish the feasibility of monitoring physical health in a cohort of young people upon admission to an adolescent inpatient unit.

Methods: We aimed to recruit young people aged 14+ from each participating site within 6 weeks of admission to the unit. The young person needed to be able to give informed consent and be well enough to take part (severe anorexia/eating disorder excluded). Physical and mental health assessments were completed by a researcher in conjunction with the clinical team. Assessments completed at three time points: Baseline on admission; 3 months post admission; 6 months post admission. Participants given £10 voucher at each timepoint as a thank you (total £30).

Measures collected included: Demographic information, e.g. age, gender, ethnicity, education, diagnoses, previous admissions, medication, length of admission; Physical Health Outcomes, e.g. BMI (centiles), BP, routinely collected blood tests (random glucose, lipids, etc), ECG; Behavioural Outcomes, e.g. physical activity levels, smoking status, diet, physical fitness (six-minute walk & questionnaire), substance use, comorbid physical health disorders and concurrent treatments; Mental Health Outcomes, e.g. Health of the Nation Outcome Scales for Children and Adolescents (HONOSCA), World Health Organization Wellbeing Index (WHO-WI).

Results: Physical health outcome (Weight): Baseline – 64.5. 3 months – 67.7. 6 months – 69.3. Behavioural outcome: Low levels of physical activity (average 20 mins sport and 1 hour walking per day); High levels of sedentary behaviour; Most common substances used were alcohol (n=11, 44%), tobacco (n=10, 40%) and cannabis (n=6, 25%); Most YP self-reported average fitness levels; Consumed on average 1.8 meals per day (ranged from 1–5).

HONOSCA outcome: 80% lack of concentration (68% severe); 75% self-harmed; 56% difficulties with relationships at home (30% severe); 88% anxious or low mood (44% severe); 64% impairments with educational ability; 64% stopped attending education.

Qualitative interviews (thematic analysis): Outcomes on Young peoples knowledge, Autonomy, environment, sources of support, independence and facilitators.

Conclusion: Young people on CAMHS inpatient units have multiple factors affecting their physical health; Already showing some signs of compromised physical health, likely to worsen; Observed lots of challenges with transitory care and barriers to following people up after discharge; Future work will focus on breaking down some of the barriers experienced to living well; Working on refining a physical health intervention.

Aims: The relationship between depression and dementia represents a complex clinical phenomenon that continues to challenge our understanding of neurodegenerative disease progression. This review synthesizes the most recent evidence examining whether depression serves as a risk factor, prodromal marker, or common confounding comorbidity in dementia development.

Methods: A comprehensive review of recent research studies analysing the psychiatric markers associated with dementia onset were reviewed to develop a clinical framework for understanding and analysing the degree to which these psychiatric phenotypes are representing either risk factors, prodromal psychiatric markers or simply overlapping psychiatric comorbidity.

Results: Recent longitudinal research has revealed that mental disorders, particularly depression, significantly increase dementia risk, with symptoms manifesting up to two decades before dementia diagnosis. This research demonstrated that depressive symptoms often emerge as early as 15 years before formal dementia diagnosis, suggesting its potential role as a prodromal marker. These findings align with recent meta-analytic evidence confirming depression as an independent risk factor for dementia development.

Research has identified specific inflammatory pathways linking depression and neurodegeneration, with elevated inflammatory markers serving as a potential biological bridge between these conditions. This neuroinflammatory process appears to be bidirectional, with depression potentially increasing inflammatory markers that may accelerate cognitive decline, while neurodegenerative processes can trigger inflammatory responses that exacerbate depressive symptoms. These biological markers suggest shared pathophysiological pathways between depression and neurodegenerative processes, with inflammation playing a central role in both conditions.

Conclusion: The synthesis of research findings has significant implications for understanding and developing appropriate clinical practice and preventive strategies. The identification of depression as a risk factor, confounding variable and potential prodromal marker, is generally supported by robust longitudinal evidence and biological mechanisms and emphasizes the need for early intervention and regular monitoring of cognitive function in individuals with late-life depression. The evidence suggests a complex multifactorial interplay where depression may serve as a risk factor, comorbidity and an early manifestation of neurodegenerative processes, highlighting the importance of comprehensive assessment and long-term monitoring of depressed elderly patients for cognitive decline.

Aims: Preparation for the MRCPsych CASC exam can present unique challenges for psychiatry trainees, including limited access to structured practice, real-time feedback and standardized patient interactions. This project aimed to develop the MRCPsych CASC Simulator (MCS), a custom AI-powered tool designed to enhance exam preparation by providing interactive clinical simulations, structured feedback and objective performance assessment.

Methods: The simulator incorporated three core roles – Doctor (candidate), Patient (actor), and Examiner – to create realistic CASC exam stations. MCS was trained in the functional aspects of the CASC, the requirements of both doctor and patient roles, along with the psychiatric expertise, knowledge and resources required. To test performance, we utilized validated assessment tools, including the examiner’s marking sheet for the CASC, Simulated Patient Rating Scale (SPRS), Objective Structured Clinical Examination (OSCE) the Communication Assessment Tool (CAT) to ensure objective and standardized evaluation. The simulator was tested in two roles, doctor and patient, by two different human assessors. The interactions were recorded and replayed for each assessment. Five stations were completed for each role from various psychiatric specialties. These scores were used to compare MCS with stock ChatGPT and to gain an overall understanding of MCS’ performance. Additionally, assessors requested MCS for immediate feedback on their questioning style, response phrasing, diagnostic accuracy and communication skills to gauge MCS’ effectiveness in providing feedback.

Results: The assessors found that MCS was competent in psychiatric assessments and patient simulation. MCS provided comprehensive learning support including mnemonics, diagnostic frameworks and summaries which facilitated differential diagnosis, clinical reasoning and memorisation. MCS provided real-time performance tracking, allowing potential candidates to refine their skills through iterative practice and targeted improvements.

MCS proved to be a significantly more effective tool for CASC practice than stock ChatGPT, scoring higher in both doctor and patient roles. MCS outperformed stock ChatGPT by an average 58% in doctor roles and 25% better in patient roles. Overall, the assessors found MCS to be a vital tool in CASC preparation.

Conclusion: MCS offers a novel and effective approach to psychiatric exam training by providing structured, objective and interactive practice opportunities. Its ability to provide tutoring, simulate realistic patient interactions and offer personalized feedback enhances clinical reasoning, communication skills and exam preparation.

Aims: Emerging evidence suggests that disruptions in brain energy metabolism – including impaired insulin signalling, altered glucose utilization, and mitochondrial dysfunction – may contribute to psychiatric and neurodevelopmental disorders such as bipolar disorder, schizophrenia, depression, post-traumatic stress disorder (PTSD), and autism spectrum disorder (ASD).

Ketogenic metabolic therapies (KMTs) provide the brain with an alternative energy source in the form of ketone bodies, which have been hypothesized to restore metabolic balance and improve psychiatric symptoms. Here we review the potential therapeutic effects of KD for mental health.

Methods: A structured review of recent clinical research was conducted to evaluate the influence of KMT on psychiatric and neurodevelopmental disorders. Relevant studies were identified through a manual selection process.

Results: Across studies, KMTs were associated with improvements in both psychiatric and metabolic outcomes. Patients with severe mental illness – like schizophrenia and bipolar disorder – demonstrated symptom reduction, decreased psychotropic medication use, and, in some cases, remission. Individuals with metabolic impairments experienced resolution of metabolic syndrome criteria alongside psychiatric symptom improvements. Case series also indicate that KMTs may support symptom remission in depression and anxiety. Early clinical research and preliminary findings indicate the feasibility and potential benefits of KMTs in PTSD and ASD. Most studies monitored adherence to KMT through ketone testing, recognizing adherence as a key factor in achieving therapeutic outcomes.

Conclusion: These findings highlight the potential of KMTs as adjunctive treatments in psychiatry. Symptom improvements across mood disorders, PTSD, and ASD, along with metabolic benefits, warrant further clinical investigation. Metabolic psychiatry presents a novel approach to understanding and treating these conditions by targeting brain energy metabolism.

Aims: ‘Flow’ is a transcranial direct current stimulation (tDCS) treatment for depression that patients use at home. Meta-analyses of randomised sham-controlled trials (RCTs) show tDCS is safe, easy to use, and associated with significant improvements in depressive symptoms and high rates of clinical response and remission relative to placebo sham stimulation. Flow is BSI and CE-marked for treating depression in the UK, with NICE guidance for use in the NHS.

Flow incorporates an evidence backed healthy lifestyle behaviour training software app, and depression symptom tracking that enables users and their clinicians to monitor progress/symptoms. Training modules on: ‘Behaviour activation’, ‘Mindfulness’, ‘Exercise for your brain’, ‘An anti-depression diet’, and ‘Therapeutic sleep’.

In a first for the NHS, Northamptonshire Healthcare NHS Foundation Trust’s (NHFT) Specialist Perinatal Mental Health and Maternal Loss Psychology Service offered Flow to their patients with a diagnosis of depression and evaluated the feasibility and impact.

Methods: The patient self-administers Flow tDCS treatment, sessions last for 30 minutes, and are repeated 5 times weekly for 3 weeks, and after the initial 3-week period, patients self-administer 3 sessions per week for 3 weeks, and then as long as required. Outcome measure data collection from baseline to 6-week follow-up point. Self-report measures used were depression: Personal Health Questionnaire (PHQ-9); health related quality of life: EQ-5D-5L; and real-world functioning: Work and Social Adjustment Scale (WSAS). In-depth interviews were undertaken with 14 patients.

Results: There has been high level of adherence in the 25 participants to treatment protocol. There has been statistically significant improvements in depression symptoms (large effect size), real-world meaningful functioning, and health-related quality of life. Reliable improvement and remission rates for PHQ-9 were 64% and 52% respectively. In in-depth interviews most participants described a positive impact on depressive symptoms, sleep, social life, and functioning.

Conclusion: Flow has been successfully integrated into Perinatal Mental Health and Maternal Loss Psychology Service depression treatment offer. It is important to offer NHS patients an evidence-backed alternative to existing depression treatments (antidepressant medication and talking therapies), many patients stop antidepressants when they become pregnant, and many do not tolerate antidepressants side effects or wish to try due to side effects and withdrawal issues. Findings provide support for the approach of delivering both tDCS and on-line wellbeing behaviour therapy training to patients with experience of depression.