As guided by the General Medical Council and the Royal College of Psychiatrists, the inclusion of experts by experience is a required component of British undergraduate medical education and postgraduate psychiatry training. However, this has not been formally applied to the training of Mental Health Tribunal (MHT) and Special Educational Needs and Disability (SEND) Tribunal members who are advised on reasonable adjustments for patients and appellants through the Equal Treatment Bench Book, including guidance on Autism Spectrum Disorder (ASD).

This study aims to evaluate the impact of expert-patient input on tribunal members’ understanding of ASD following a dedicated training programme. We hypothesise that the training day will increase participants’ confidence regarding reasonable adjustments for patients with ASD and will be perceived as novel and valuable.

A multidisciplinary training day was delivered to MHT and SEND Tribunal members in England, jointly by clinicians and experts by experience. The training offered a multimodal overview of ASD and its treatment, and how reasonable adjustments can be made in tribunal hearings.

To evaluate the session, data was collected via online post-session feedback questionnaires. Items were selected to assess participants’ confidence with regard to the training’s learning outcomes, the perceived novelty and value of expert-by-experience involvement, and participants’ willingness to receive a follow-up email six weeks post-training to support consideration of reasonable adjustments.

The training programme was attended by 54 MHT and SEND Tribunal members, of which 24 were judges, 13 were consultant psychiatrists, and 17 were other specialists involved in the care of patients with ASD.

Ninety-four per cent of respondents reported feeling confident after the training session, an increase from retrospectively reported pre-session confidence of 50% (n=18). Over half had no prior exposure to expert-by-experience training (55%, n=47), while a large majority thought MHT and SEND tribunal training should include more input from experts by experience (89%, n=46). 68% of participants (n=45) opted to receive an email six weeks post-training to be prompted to continue to make reasonable adjustments for patients with ASD.

The findings reinforce the effectiveness of expert-by-experience input and highlight its lack of incorporation to date in tribunal training. The willingness of participants to receive a follow-up email six weeks post-training suggests an openness to reflection. Further work should explore how such involvement can be sustainably embedded within tribunal training to support awareness of mental health conditions, including ASD, and the implementation of reasonable adjustments in hearings.

South Asians are the largest ethnic minority group in the UK. Despite having an elevated incidence of psychotic disorders compared to the European-ancestry majority, this group remains underrepresented in genomic research.

The heritability of schizophrenia (SCZ) is high, with around one quarter attributable to common genetic variants. Polygenic risk scores (PRS) summarise their combined contribution. The NHS 10-year plan prioritises implementation of population-based PRS to facilitate early identification of common diseases. PRS are derived from largely European-ancestry genome-wide association studies (GWAS), raising questions about the transferability of the SCZ PRS in ethnic minority populations.

This study aimed to examine the association between SCZ PRS, SCZ diagnosis, and antipsychotic prescribing in a South Asian cohort. Additionally, it aimed to compare PRS between individuals prescribed any antipsychotic and those prescribed injectable antipsychotics or clozapine as proxies for illness severity.

We analysed data from Genes & Health, a community-based cohort with linked genetic and electronic health records for over 65,000 Pakistani and Bangladeshi individuals in the UK. PRS were derived from summary statistics from a largely European-ancestry SCZ GWAS. We examined associations between PRS, SCZ diagnosis, and antipsychotic prescribing, with secondary analyses of clozapine or injectable antipsychotic use.

SCZ PRS was associated with SCZ diagnosis (OR=1.51 per SD). However, SCZ PRS showed only a weak association with antipsychotic use in the full sample (OR=1.04 per SD).

SCZ diagnosis was strongly associated with antipsychotic prescribing (OR=28.4). Among those with SCZ, there was a stronger association between PRS and antipsychotic use (OR=1.45 per SD). Quintile analyses showed a pronounced extreme-risk pattern, with individuals in the highest PRS quintile having higher odds of antipsychotic use compared with those in the lowest quintile (OR=3.4). The PRS–antipsychotic association was modified by SCZ diagnosis (p=0.048). Among individuals with a diagnosis of SCZ and prescribed an antipsychotic, a higher PRS was associated with increased odds of clozapine or injectable antipsychotic use (OR=1.37 per SD).

SCZ PRS derived from European-ancestry GWAS is associated with a diagnosis of SCZ in a South Asian ancestry cohort and higher PRS scores were associated with antipsychotic prescriptions. In those with a diagnosis of SCZ, higher PRS scores were also associated with clozapine or injectable antipsychotic use. The absence of directly comparable European-ancestry dataset limits inferences about relative performance across ancestries. The next stage will address this through UK Biobank analyses.

Psychiatry is a rewarding career which has grown in popularity in recent years. Despite psychiatry training posts recently achieving high fill rates, the specialty has consistently faced long-standing recruitment difficulties, with associated negative perceptions and low interest from medical students. Exposure to extracurricular enrichment programmes has been suggested as a potential method to improve student attitudes, increase engagement, and encourage early career interest in psychiatry. Extracurricular enrichment programmes offer medical students the opportunity to engage with psychiatry beyond the mandatory curriculum, such as through summer schools, special study modules and mentoring schemes. This systematic review aims to evaluate the current literature on extracurricular psychiatry enrichment programmes for undergraduate medical students.

The review was registered with PROSPERO (CRD420251025990) and followed PRISMA guidelines. Four databases were searched (Embase, Ovid MEDLINE, APA PsycInfo and ERIC) using pre-determined search strings. Records were screened and data extracted independently by two authors. Extracted data included programme characteristics, student experiences, attitudes towards psychiatry and mental illness, career intentions and eventual specialty outcome. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity in study designs and outcomes, findings were synthesised narratively to identify patterns and themes.

Of 731 articles screened, 65 full reports were assessed for eligibility and 27 were included. These studies were conducted across 10 countries, most commonly the USA and UK. Programme duration and format varied from single-day events (n=2) to longitudinal mentoring schemes spanning medical school (n=5). Summer schools were most common (n=10). Other schemes included mentoring, elective courses, special study modules, student-led clinics and film/media-based activities. Student feedback was positive, particularly for mentoring and film/media initiatives. Most studies reported improved attitudes towards psychiatry and mental illness, with several reporting statistically significant improvements using validated tools. Of 18 studies assessing career intentions, 16 reported increased interest in a career in psychiatry, and six studies reported higher subsequent match rates into psychiatry specialty training.

Although potential self-selection bias may arise from programmes that are both voluntary and extracurricular in nature, the available literature suggests that these programmes provide positive student experiences, and foster improved attitudes and early interest in psychiatry through meaningful learning opportunities. However, longitudinal research is needed to clarify the long-term impact, particularly on those without prior interest. Despite study heterogeneity, this review highlights the importance of enrichment programmes to support recruitment, provided inclusivity and accessibility are considered during programme development.

To examine how musicians express mood states through music and how these expressions are interpreted by media narratives, and how cultural analysis can be used as an educational tool to enhance psychiatric understanding of mental state, stigma and patient engagement.

A qualitative analysis was conducted using a comparative cultural analysis approach. Publicly available materials related to four artists (Amy Winehouse, Kurt Cobain, Stormzy and Florence Welch) were used. These artists were selected to reflect variation across genres, eras, genders and cultural contexts. Materials, such as song lyrics, interviews and media reporting, were thematically analysed using the Braun and Clarke framework. Patterns in emotional expression, representations of mental distress, and media framing were found. Identified themes were mapped to core psychiatric training domains, including mental state variations, stigma and culturally informed care. As no primary clinical data were collected and all materials were in the public domain, ethical approval was not required.

Three consistent themes were identified. First, musicians frequently expressed emotional distress and vulnerability using metaphors, tone and narrative rather than explicit clinical language. This suggests music can provide insight into subjective emotional states and serves as a tool for understanding the meaning and the context of an experience or emotion. Second, media portrayals often simplified or moralised these expressions, particularly in relation to substance abuse, reinforcing stigma and overshadowing the complexity of co-occurring mental health challenges. Third, disparities were observed in how distress was framed, dependent on gender, race and genre, with some artists’ experiences pathologised to a greater extent, whilst others were relatively contextualised or minimised. These findings demonstrate how cultural material can be used in education to show the limitations of symptom-only interpretation and the importance of contextual formulation – including social environment, occupational pressures and media influence. This pedagogical approach aligns with the RCPsych curriculum by enhancing reflective practice and improving cultural competence, pivotal for managing complex presentations in diverse populations.

Music and media analysis offers a potentially useful framework to augment psychiatric training by highlighting how emotional distress is expressed, interpreted and socially constructed. While music cannot be used to diagnose mental illness, it can enhance engagement and facilitate conversations around stigma, identity and help-seeking. Incorporating culturally relevant case analyses through simulated formulation workshops into education may improve recognition of non-verbal expressions of distress, encourage reflective engagement with stigma and media narratives, and promote culturally informed practices.

Objective Structured Clinical Examinations (OSCEs) are a major component of summative assessment for final year medical students. Psychiatry OSCEs may pose particular challenges, including time management, rapport building and completing complex tasks such as capacity and risk assessment. A psychiatry OSCE practice course has been running for final year students at Brighton & Sussex Medical School for several years, but its ongoing impact and alignment with learner needs had not been formally evaluated. This quality improvement project aimed to evaluate the course and iteratively improve it using PDSA methodology, to ensure continued effectiveness and relevance.

Aim: To assess the impact of a psychiatry OSCE practice course on students’ self-reported confidence and preparedness, and to use structured feedback to inform iterative improvements to course delivery.

Pre- and post-course questionnaires were administered across multiple cohorts. Students rated confidence across relevant domains (psychiatry knowledge, psychiatry OSCE ability, preparedness for final OSCEs) and comparator domains (general OSCE ability, preparedness for final written exam) using Likert scales. Qualitative feedback was collected on perceived challenges, preferred case types and most useful elements of the course. Anonymised pre- and post-responses were paired using participant-generated identifiers. Following feedback, targeted changes were implemented between cohorts and evaluated through subsequent PDSA cycles.

Across cohorts, students reported increased confidence and preparedness following the course, with greater improvements in psychiatry-related domains than comparator domains. Confidence in psychiatry OSCE ability showed the greatest increase, improving by a mean of 1.4 points on a 5-point Likert scale. Examiner feedback and practice with repetition were consistently rated as the most valuable components.

Time management was the most frequently anticipated challenge and was in fact cited more often post-course. In response, two key changes were introduced for later cohorts: allowing up to two minutes for students to read OSCE instructions and choose when to begin, mirroring reasonable adjustments available in summative OSCEs; and providing a two-minute verbal warning before the end of the station. In cohorts following these changes, time management was less frequently cited as the most challenging aspect post-course.

This QI project demonstrates that a psychiatry OSCE practice course improves student confidence, and that iterative, learner-informed adjustments enhance realism, inclusivity and educational value. Simple changes to timing and communication addressed key student concerns, particularly around time management and accessibility. Ongoing evaluation will aid refinement and sustainability of the course. These findings may inform design of similar courses across other medical schools.

Immersive virtual reality (VR) is increasingly being explored as a potential modality for the assessment and treatment of a range of mental health conditions, including anxiety disorders. To date, many of the VR interventions that have been developed for anxiety disorders draw upon the principles of exposure therapy, and a growing body of evidence has begun to demonstrate their efficacy. However, little is known about the ways in which the individuals for whom these interventions are designed perceive and experience them, despite the importance of understanding both patient and practitioner perspectives to enable effective intervention development and evaluation. The aim of this systematic review was to identify and synthesise the existing qualitative evidence-base in relation to exposure-based immersive VR interventions for the treatment of anxiety disorders.

We systematically searched PubMed, Scopus, Medline, Embase, PsychINFO, OVID interface, MedArXiv and PsyArXiv for qualitative and mixed-methods studies reporting patient and therapist perspectives, experiences and recommendations relevant to the focus of our review. In total, 9714 abstracts were screened and 954 full-text manuscripts were retrieved, with 12 studies meeting the review inclusion criteria. The qualitative results sections of articles were coded inductively line-by-line, and the data was synthesised using thematic synthesis.

Twelve descriptive themes and four analytical themes were generated through the analysis. The analytical themes were: 1. Contingent experiences of anxiety (facilitators of and barriers to experiencing symptoms of anxiety during VR exposure); 2. Learning beyond exposure (the ways in which participants experienced benefits from VR exposure that extended beyond the intended mechanisms of change underpinning exposure therapy approaches); 3. “Somewhere between being there and not being there” (the nature of an anxiety-provoking ‘reality’ that is virtual, and how experiences of the virtual world relate to experiences of anxiety in real life); and 4. The patient, the therapist, and the Head-Mounted Device (how VR exposure-based interventions might best be positioned and delivered in the context of psychotherapy, and how VR might present both benefits and barriers for patients, therapists, and for the therapeutic relationship).

This synthesis of the perspectives, experiences and recommendations of patients and therapists in relation to exposure-based VR interventions for anxiety disorders has a range of implications, for both practice and research. These include a number of recommendations for the design, delivery and evaluation of VR interventions for anxiety disorders, ensuring they better meet the needs of the people who use them.

Lithium is a highly effective mood stabiliser but has a narrow therapeutic index. Inadequate monitoring increases the risk of toxicity, renal impairment and thyroiddys function. Consequently, NICE and local shared-care guidelines mandate structured baseline assessment and regular biochemical monitoring for all patients prescribed lithium.

This quality improvement (QI) project aimed to systematically evaluate adherence to NICE and local guideline standards for lithium monitoring within the inpatient rehabilitation service at the Royal Edinburgh Hospital (REH). The project sought to identify specific gaps in baseline and ongoing monitoring, assess the timeliness and completeness of required investigations. A further objective was to use these findings to inform targeted, sustainable interventions to improve compliance with monitoring standards, enhance patient safety and reduce the risk of preventable lithium-related adverse events within this high-risk population.

A retrospective review was undertaken of all inpatients prescribed lithium across five rehabilitation wards at REH between July 2023 and July 2025. Ten patients met inclusion criteria. Data were extracted from electronic health records, the electronic prescribing system, laboratory results and Lothian Quality Improvement, Safety, Teaching, Supervision, Audit and Evaluation (QISTSAE) adverse event reports. Collected variables included patient demographics, lithium initiation, duration of treatment, the completion and timeliness of required monitoring investigations. Compliance was assessed against NICE guidance and local shared-care protocols.

Significant gaps in lithium monitoring were identified across the cohort. Urine albumin–creatinine ratio (uACR) testing, recommended for early detection of lithium-associated renal damage, was consistently absent in all patients reviewed. Serum calcium and thyroid function tests were missed in approximately 60% of cases. In addition, timeliness of monitoring was suboptimal, with several patients having overdue lithium levels, renal function tests or thyroid investigations. Renal function was not consistently rechecked following elevated lithium levels despite explicit guideline recommendations and over 10%of the results recorded supratherapeutic lithium concentrations during the review period, representing a clear safety concern.

Lithium monitoring within the inpatient rehabilitation setting was inconsistent and frequently failed to meet guideline standards exposing patients to avoidable risk. uACR testing, calcium monitoring and thyroid surveillance represented particular areas of deficit. These findings highlight the need for system-level interventions to support safer lithium prescribing.

Planned next steps include expansion of the project to other inpatient and outpatient services, development of standardised lithium initiation and monitoring order sets in collaboration with laboratory services, targeted educational interventions for multidisciplinary teams to improve awareness, compliance and patient safety.

Patients admitted to Older Adult Psychiatric Wards often have significant comorbidities putting them at increased risk of clinical deterioration. As MDT morale in managing these patients varied greatly, this project aimed to improve confidence and knowledge in recognising physical deterioration, escalating concerns and initiating Immediate Life Support (ILS).

A pre-intervention questionnaire was distributed to MDT, including nurses, healthcare assistants, student nurses and allied health professionals. The questionnaire assessed knowledge and confidence in recognising clinical deterioration, escalation pathways, contacting emergency services, situation-background-assessment-recommendation (SBAR), and initiating ILS. The questionnaires used a mixture of close-ended questions, Likert scale, predefined option selection and open-ended short-answer questions, to explore perceived challenges. An interactive teaching session was delivered, focusing on acute clinical signs, NEWS chart, escalation pathways, practical ILS skills and SBAR. A confluent patient scenario was paired with questions to encourage participants’ engagement and learning. A post-teaching questionnaire with the same format as the pre-teaching questionnaire was completed to reassess confidence, awareness, and perceived impact on patient safety.

16 staff-members completed the pre-intervention questionnaire and 13 completing post-intervention. Pre-intervention, 19% of staff rated themselves as confident (Likert score 4–5) in recognising physical deterioration, 25% in escalation of concerns and 20% in initiating ILS. Anxiety of “getting it wrong” was reported by over 70% of respondents being cited as a barrier to escalation. 38% felt current escalation and management processes were clear.

Pre-intervention, 69% reported knowledge of local escalation policies, ILS processes and paramedic handover. Post-intervention this had grown to 100%.

There was substantial improvement in confidence across all domains post-intervention.On recognising physical deterioration, 92% of respondents rated themselves as confident or very confident. On escalation and calling emergency services and on initiating ILS, confidence increased to 92% and 83% respectively. Confidence in delivering a comprehensive handover improved from 25% pre-intervention to 92% post.

Post-intervention, 100% agreed or strongly agreed that the intervention would improve patient safety on the ward. Across every domain there was growth in mean confidence scores (mean increase of a factor of 1.46).

Team knowledge and confidence in managing and escalating the acutely unwell patient was significantly improved following targeted ward-based teaching. Following staff feedback requesting visual prompts, a second PDSA cycle is planned to introduce informative posters around the ward to reinforce key learning points.

To investigate (1) the prevalence of anxiety and depression, (2) the association between physical activity (PA) and these mental health outcomes, and (3) the mediating role of social support in this relationship among college students, while controlling for gender and age.

Nationwide cross-sectional online survey (March 2024–May 2025) of 1,069 college students recruited through student-union mailing lists in China (92.7% response rate, mean age=21 years, 68.2% female). PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and categorized into low, moderate and high levels; continuous MET-min/week scores were also used. Anxiety and depression were measured by the Zung Self-Rating Anxiety Scale (SAS) and Depression Scale (SDS), reported as binary outcomes (SAS≥50, SDS≥53) and standard scores. Social support was evaluated using the Social Support Rating Scale (SSRS). Analyses included binary logistic regression and mediation analysis using PROCESS Model 4 with 5,000 bootstrap samples, controlling for gender and age.

Overall, 34.0% of participants screened positive for anxiety (10.5% moderate, 5.5% severe) and 43.5% for depression (9.4% moderate, 1.0% severe). Logistic regression showed that compared to high PA, low PA was associated with significantly higher risks of anxiety (OR=2.21, 95% CI:1.58–3.09) and depression (OR=2.91, 95% CI:2.10–4.01). Higher social support was associated with lower risks of both anxiety (OR=0.95) and depression (OR=0.96). Mediation analysis revealed that social support partially mediated the PA-mental health relationship: for anxiety, total standardized effect of PA β=−0.127 (p<0.001), indirect effect through social support β=−0.044, 95% CI [−0.062,−0.028] (34.2% mediated); for depression, total effect β=−0.173 (p<0.001), indirect effect β=−0.053, 95% CI [−0.073,−0.035] (30.5% mediated). Gender and age were not significant covariates in the mediation pathways.

This study identifies social support as a significant partial mediator in the PA-mental health relationship among college students.The mediating effect is proportionally larger for anxiety, although the association of social support is stronger for depression.These findings suggest that interventions should integrate PA promotion with social support enhancement to maximize mental health benefits.

Psychiatric conditions can impair fitness to drive, and clinicians have a professional duty to provide and document appropriate advice in accordance with DVLA guidance. This quality improvement project (QIP) aimed to evaluate adherence to DVLA guidelines regarding the provision of documented driving advice to patients with psychiatric conditions under the Home Treatment Team (HTT), firstly as a baseline measurement, and after meaningful intervention. Identifying disparities in compliance across different diagnosis, sex and age, to enhance patient’s safety and clinical practice.

An initial retrospective review of HTT electronic patient records was conducted over three months (June–August 2024) for a total of 86 patients. Variables collected included primary psychiatric diagnosis, age, sex and whether DVLA driving advice was documented as given. Standards were based on DVLA guidance “Assessing fitness to drive: a guide for medical professionals”. Following baseline measurement, a multi-strategy intervention package was implemented: (1) Multi-Disciplinary Team (MDT) checklist prompt to ensure driving status and advice were considered and recorded during the MDT, (2) Patient information leaflet summarising DVLA advice, (3) Presentation of initial findings at Learning-From-Excellent meeting, and (4) Staff education leaflet and teaching highlighting the clinical and medico-legal importance of driving advice. A second retrospective audit cycle was completed using identical methodology over four months (January–April 2025) for a total of 93 patients, again evaluating documentation of DVLA guidance being given.

Baseline documentation of driving advice was present in 25/86 records (29.1%), with 61/86 (70.9%) illustrating no documented driving advice. Following our intervention, documentation improved to 76/93 records (81.7%), with 17/93 (18.3%) lacking documentation, showing an absolute improvement of +52.6%.

In the second cycle (n=93), 59 records related to female patients and 34 to male patients. Driving advice was applicable in 54/93 cases (36 female; 18 male). Where applicable, documented advice was provided in 29/36 female cases (80.6%) and 14/18 male cases (77.8%), demonstrating comparable adherence across sexes. Among those given advice, the most common age group was 40–60 years for both females (12/29; 41.4%) and males (7/14; 50.0%).

This two-cycle QIP demonstrated substantial improvement in adherence to DVLA guidance documentation within HTT, increasing from 29% to 82% following low-cost meaningful interventions embedded into MDT workflow and staff education. Post-intervention data revealed similar compliance across sexes, with most documented advice delivered to patients aged 40–60 years. Future work should assess the quality of driving advice given and strategies to support consistent practice.

Effective communication and comprehensive history taking are core competencies in undergraduate medical education. Emerging digital technologies, including generative artificial intelligence (GenAI), offer novel opportunities to enhance experiential learning in this domain. This service evaluation explored the educational value of a GenAI-simulated virtual patient presenting with psychosis, integrated into psychiatry communication skillsteaching at Cardiff University School of Medicine. The primary aim was to assess student perceptions of the simulation as a learning tool.

A mixed-methods service evaluation design was employed. Quantitative and qualitative data were collected using pre- and post-intervention questionnaires assessing self-reported confidence in communication, history taking, and risk assessment, alongside usability and accessibility. Participants engaged with an AI-simulated virtual patient on the SimFlow.AI platform, receiving pre-task information and automated post-task feedback on performance. The simulation involved an acute psychotic presentation, requiring participants to conduct a psychiatric history and risk assessment. Participants were recruited from Years 2 through to 5 of the undergraduate medical programme at Cardiff University. The AI simulation was also embedded in a Year 2 unit of study to support students’ self-directed practice of communication skills.

Twenty participants completed all study components, including full engagement with the AI simulation and pre- and post-intervention questionnaires. Self-reported confidence in history taking and risk assessment increased significantly following exposure to the AI-simulated virtual patient (z=−3.750, p<0.001), with significant improvements observed across both junior and senior cohorts. All participants reported that the simulation facilitated clinically relevant skills practice, with 94% indicating that the platform helped them identify strengths and areas for improvement in their communication skills. Perceived authenticity was high, with 94% rating the AI responses as realistic and clinically plausible. All participants endorsed the platform as a useful adjunct to existing communication skills teaching. Where the AI simulation was embedded within a Year 2 unit of study, 74% of 93 respondents rated the AI virtual patient encounter as useful in practicing psychiatric history taking during self-directed learning time.

AI-simulated psychosis consultations appear to offer psychologically safe, accessible, and practical opportunities for communication skills rehearsal and reflective learning. Students supported the integration of AI simulations as a supplementary educational resource (particularly for OSCE/ISCE preparation) while emphasising that such tools should complement rather than replace patient actors.

Social isolation and loneliness represent significant psychiatric determinants of cardiovascular disease, with emerging neurobiological evidence suggesting shared pathways for stress response and inflammation.

Social isolation reflects an objective lack of social contact while loneliness refers to the subjective perception of social disconnection. In practice, both frequently co-occur.

Current research inadequately examines the nuanced relationship between social disconnection and atrial fibrillation (AF) incidence. This paper aimed to systematically assess this relationship through a psychiatric lens.

A PRISMA-compliant systematic review was conducted across five databases. Five studies were selected, including large population-based cohorts from the UK Biobank, the Framingham Heart study and a nationwide heart failure cohort. Data on social isolation, loneliness, social network metrics and AF incidence were extracted. Narrative synthesis was performed due to the heterogeneity of populations and analytical methods.

Large observational cohort studies suggest that loneliness is associated with an increased risk of AF. In the UK Biobank, loneliness assessed via a composite score was associated with higher AF incidence (HR: 1.11, 95% CI 1.07–1.16). Subscale analyses demonstrated that this association was primarily driven by subjective feelings of loneliness, which showed a stronger association with AF (HR 1.20, 95% CI 1.14–1.26). This is supported by multistate modelling in a separate Biobank study. Social deprivation was also correlated with new-onset AF in a nationwide heart failure cohort.

In contrast, the Framingham Heart Study reported no association between overall social network index and AF incidence. When accounting for the competing risk of mortality, medium-low social connectedness appeared to have a lower AF incidence. This finding is likely attributable to survivorship and competing risk biases rather than a true protective effect. Furthermore, social group participation was associated with higher AF incidence, which may reflect increased healthcare access and consequent AF detection.

Most importantly, Mendelian Randomisation analysis in one study provided genetic evidence supporting a potential causal relationship between social isolation and AF risk, with no evidence of pleiotropy.

Overall, these findings indicate that survivorship bias, varying analytical methods and failure to consider competing mortality risks may obscure true associations between social disconnection and AF incidence.

Observational and genetic evidence support an association between social isolation and increased AF incidence. These findings highlight the need for novel AF prevention strategies such as psychosocial assessments and interventions to target loneliness and social disconnection, thereby emphasising the importance of a collaborative psychiatric-cardiology approach in clinical practice.

Clozapine-induced gastrointestinal hypomotility is a common and potentially fatal adverse effect, yet bowel monitoring and timely escalation remain inconsistently implemented despite national guidance. Following the removal of an electronic prescribing bowel-monitoring prompt in a medium secure women’s forensic service, concerns arose regarding reduced detection of constipation and increased patient safety risk.

This project aimed to evaluate baseline bowel monitoring and escalation practices for patients prescribed clozapine, explore staff and patient perspectives on existing monitoring systems, and assess the impact of introducing a structured paper-based bowel monitoring intervention on documentation quality and clinical escalation.

A mixed-methods quality improvement project was conducted between April and August 2025 in the Women’s Pathway at Newton Lodge. Baseline practice was assessed via retrospective review of ward documentation and Clinical Team Meeting (CTM) notes for all patients prescribed clozapine. Staff questionnaires explored perceptions of monitoring systems, safety, and usability. Semi-structured patient interviews examined acceptability and communication preferences. An iterative paper-based bowel monitoring chart was introduced, refined following staff feedback, and re-audited against national standards.

Seventeen patients prescribed clozapine were included in the documentation audit. Baseline recording of bowel status in the CTM notes occurred on approximately 10% of inpatient days. Seventeen staff responses were obtained across nursing and medical disciplines. Fifteen staff members (88%) reported that the previous electronic prescribing prompt improved patient safety, and the majority perceived increased risk following its removal. Initial uptake of a detailed paper bowel monitoring chart was low, with completion rates of approximately 25% over four weeks. Following simplification of the chart, completion increased to nearly 100% and was sustained on re-evaluation. Documentation of bowel status in the CTM notes improved from approximately 10% pre-intervention to almost 100% post-intervention. Escalation and documented clinical review for patients with more than 48 hours without bowel movement increased from approximately 60% at baseline to 100% following intervention. Five patient interviews demonstrated general acceptability of bowel monitoring, with preference for simple, discreet questioning methods.

A simplified bowel monitoring intervention significantly improved documentation and escalation of clozapine-related constipation. Integration into electronic prescribing systems, alongside staff training and standardised escalation thresholds, is recommended to ensure sustainable patient safety improvements.

The Membership examination of the Royal College of Psychiatrists (MRCPsych) is a postgraduate professional exam that doctors must pass to progress from core to specialist training in psychiatry in the UK. The MRCPsych courses refer collectively to a range of educational programmes, in England usually organised by different NHS Trusts, funded via postgraduate education through deaneries. There was a move to virtual teaching for the MRCPsych theory papers since the Covid-19 pandemic, providing greater accessibility. This came with challenges as trainers and learners struggled with engagement. This study examined an MRCPsych teaching programme delivered across three trusts, enrolling 121 resident doctors in 2023–2024 and 148 in 2024–2025, and aimed to systematically evaluate the programme, identify areas for enhancement through feedback and coproduction with residents, and assess the impact on curriculum delivery.

A mixed methods evaluation was undertaken for delivery of the theory paper teaching. Residents attending Paper A and Paper B MRCPsych teaching programmes in 2023–2024 (n=201) were asked to fill in post-session questionnaires comprising Likertscale items and some questions allowing free text answers. Quantitative data were pooled into descriptive categories, while qualitative responses underwent inductive content and thematic analysis. Themes were further explored and validated through resident focus groups and verified with a large language model for research triangulation. Insights informed a structured review of the 2024–2025 MRCPsych curriculum delivery involving a senior resident. The revised programme was reevaluated using the same methodology (n=237), enabling comparison.

In 2023–2024, residents rated content clarity, presentation quality and clinical relevance highly (≥83% “excellent” or “very good”). Suggestions included increased exam focus, more interactivity, improved time management, and provision of presession materials. Following curriculum revision, 2024–2025 ratings demonstrated further improvement, with ≥85% selecting “excellent” or “very good” across domains and reduction in “poor” responses. Candidates particularly valued enhanced exam-focused content, greater session interaction, and improved structuring and expansion of complex topics. At both time periods there was a request for increasing interaction in teaching and strengthening alignment with the MRCPsych syllabus.

Co-produced evaluation enabled systematic identification of ‘areas of improvement’ within the MRCPsych teaching programme, allowing targeted changes that yielded measurable improvements in satisfaction. This approach demonstrates circular evaluation of curriculum delivery through a continuous feedback loop within a quality assurance model that integrates curriculum design, teaching delivery, assessment, and outcomes. We recommend continued collaborative, resident-centred refinement of MRCPsych courses with mapping to the syllabus.

People with severe mental illness (SMI) die on average 15–20 years earlier than the general population, largely due to poor physical health. NICE guidance mandates annual physical health checks (PHCs) for individuals with SMI, including the “Core 6” parameters (alcohol and smoking status, blood pressure, body mass index, lipid profile and HbA1c or blood glucose). NICE also requires regular physical health monitoring for those prescribed antipsychotic medication. This audit aimed to assess PALT’s compliance with NICE standards and identify barriers to completion.

A retrospective clinical audit was conducted. 100 patients under the care of PALT for at least 12 months who were prescribed antipsychotic medication were included. Data was obtained from patient records between March–April 2025. Outcomes measured included completion of coded annual SMI PHCs, completion of Core 6 components, antipsychotic monitoring blood tests, and ECGs within the preceding 12 months. Engagement with PALT and evidence of invitation to SMI PHCs were also recorded. Results were analysed and compared against NICE standards and previous audits.

Overall, 59% of patients had an SMI PHC in the preceding 12 months, despite 98% engaging with PALT during the same period. Among those without a completed PHC, 95% had recent contact with PALT. Of the 41% who did not attend SMI PHC, only 34% had documented evidence of invitation.

Completion of individual ‘Core 6’ components was higher, ranging from 78–84%. Annual antipsychotic blood test monitoring showed good compliance at 79–84%, demonstrating improvement from previous audits. However, only 63% had an annual ECG. Even for antipsychotics with moderate-high risk of respective side effects, metabolic monitoring was suboptimal (46%), and prolactin monitoring was low (27%).

Although compliance with antipsychotic blood monitoring is improving, completion of annual SMI PHCs remains suboptimal. Better completion of individual ‘Core 6’ components suggests that this activity is being carried out, but in a fragmented manner. The high engagement with PALT relative to SMI PHC completion suggests a missed opportunity to integrate PHC with mental health appointments. Our recommendations focus on improving awareness and accurate identification of patients requiring SMI registration and physical health monitoring as well as strengthening communication with primary care and the SMI PHC team. Additionally, building capacity within PALT to deliver physical health assessments, blood tests and ECGs, may improve engagement and completion. Continued audit and wider dissemination of findings is needed for sustained improvement in physical healthcare for people with SMI.

The global burden of dementia is escalating rapidly, with prevalence estimates rising from 57.4 million in 2019 to a projected 152.8 million by 2050. This increase carries profound economic implications; direct and indirect costs are forecasted to consume approximately 0.5% of global GDP by 2050. Health economic evaluation can support efficient allocation of resources but key challenges remain in determining what outcomes are valued and how. We discuss critically the role of the life course approach in informing health economic evaluations.

Various methods exist for determining the relative costs and benefits of different treatment approaches. Relatively simple methods use pre-determined quality of life values for different stages of dementia to model the ‘utilities’ generated by treatment. The more recent ICECAP approach includes a broader range of outcomes than just health states by considering aspects of capability.

Despite these innovations in determining health outcome measures challenges remain. Models must account for complex interactions between symptoms, disease progression and quality of life. Another challenge is accounting for the “Proxy-Patient” gap, where caregiver reports often diverge from patient experiences. Furthermore,economic models can struggle with the valuation of “process utility” and the difficulties of extrapolating data from brief clinical studies into long-term disease models spanning many years.

The Life Course Approach:Our work proposes integrating a ‘life course’ perspective into health economic approaches to better understand dementia within the context of a patient’s entire life. By utilizing the concepts of “Trajectories and Transitions”,economists can evaluate how dementia disrupts expected life paths–such as the loss of a planned retirement or the inability to fulfil the role of a grandparent. Additionally, the concept of “Linked Lives” offers insight into the social interdependencies that shape the “Proxy-Patient” gap. Qualitive methods offer an important lens to investigate these problems.

Incorporating life course and qualitative approaches could provide a more robust framework for valuing preferences in dementia. By capturing the impact of disrupted life expectations and social interconnectedness, economic analyses can more accurately reflect the true impact of the disease, leading to more equitable and efficient resource distribution.

Treatment-resistant depression (TRD) is common and associated with substantial disability and economic burden. It is estimated to affect over 100 million people worldwide and approximately 2.7 million people in the United Kingdom. Ketamine has emerged as a novel therapy for TRD, with studies demonstrating rapid antidepressant effects. However, ketamine is also used recreationally and can result in multi-systemic morbidity, accidental injury, assault and death. In the past decade there has been a marked increase in people entering treatment for harmful ketamine use in the UK, alongside a significant rise in ketamine-related deaths. The Royal College of Psychiatrists Margaret Slack Travelling Fellowship aims to broaden Higher Trainee’s academic knowledge and experience in a centre of excellence.

Gold Coast Health’s (GCH) Specialist Neurostimulation and Mood Disorder Service is Queensland’s first public service, and one of Australia’s first, to establish a ketamine clinic for TRD. The service is the Queensland site for the TREK trial, a multi-centre randomised controlled trial comparing intranasal esketamine and subcutaneous racemic ketamine for TRD. The service has supported several other multi-centre studies on ketamine that have shown efficacy and safety.

The author was awarded the 2025 Margaret Slack Travelling Fellowship to visit GCH in August 2025, to observe the ketamine clinic, TREK trial, Alcohol and Other Drugs Service, and speak with multi-disciplinary staff and patients to develop clinical insights.

The author attended presentations by Prof Colleen Loo, Black Dog Institute, on “Extending Knowledge and Clinical Experience on the Use of Ketamine” and “Ketamine for the Treatment of Depression in Older Adults” by Associate Prof, Shanthi Sarma, GCH (11 and 15 August 2025).

The author delivered oral presentations at GCH, “Understanding Ketamine Use Disorder: Perspectives from England and Considerations for Ketamine Clinics”, and “Promoting Awareness on Ketamine Use Disorder: Enabling early identification, treatment and referral”, at the International Medicine in Addiction conference in Sydney (18 and 30 August 2025).

There is demonstrated interest from British and Australian clinicians in the use of ketamine to effectively and safely treat TRD, in addition to ketamine use disorder, its risks and systemic harms. This interest creates opportunities to strengthen collaboration and shared learning between psychiatry, urology, and addiction disciplines internationally. It also supports the development of improved services for people receiving ketamine for TRD and for those using non-prescribed ketamine, promoting safe, evidence-informed practice.

The national recruitment process for higher psychiatry training in the UK includes a self-assessment section that recognises applicants’ experience and achievements outside of their usual work. Evidence is uploaded by applicants then reviewed by verifiers using a standardised scoring system. The total awarded score ultimately influences applicants’ priority ranking when training offers are allocated. The aim of this study is to identify trends in self-assessment scoring inaccuracies and explore the reasons for these. This will inform future improvements to the self-assessment process and scoring guidance.

Anonymised data was provided by the National Psychiatry Recruitment Office for all applicants to higher psychiatry training in February and August 2025. Counts were summarised overall and by group using descriptive statistics. Thematic analysis was conducted to explore reasons for scoring adjustments and appeals across the ten assessed domains. Coding was cross-checked by a second researcher to enhance validity.

There were 1,025 applicants across the two recruitment rounds, with 76% having completed core psychiatry training or being in their final year of training. Fifty-nine per cent of applicants were non-UK graduates. The findings highlighted frequent errors in both applicants’ evidence submissions and in verifiers’ reviews. Common applicant error themes included submitting inappropriate, excessive, or incomplete evidence, misunderstanding current guidance, and incorrect domain allocation. Upheld appeals highlighted several instances of incorrect verifier scoring due to misinterpretation of submitted evidence and verification guidance. This resulted in frequent misalignment between candidates’ self-assessments and verifiers’ scoring, with 16% of applicants appealing their scores. Most scoring errors were identified in domains 6 (Clinical Governance, Audit and Quality Improvement as a postgraduate), 8 (Teaching), and 10 (Presentations and Poster Presentations). Scoring errors disproportionately affected applicants with non-UK qualifications and those submitting evidence obtained abroad as documents often did not conform to UK formats, contributing to scoring misalignment.

These findings highlight several challenges in translating applicants’ achievements into standardised scores in the current Higher Psychiatry Training recruitment process. Frequent scoring errors by both applicants and verifiers indicate that the current guidance may lack sufficient clarity, particularly regarding evidence requirements, domain boundaries and scoring thresholds. There is a need to develop the applicant and verifier guidance to include clearer definitions, descriptions, and examples to reduce error rates and improve equity and consistency in portfolio scoring.

Ethnic minority children and adolescents are consistently under-represented in UK mental health services. Accurate ethnicity recording is essential for monitoring equity of access and informing service improvement. A baseline clinical audit conducted in 2020 across East Lancashire Child and Adolescent Mental Health Services (CAMHS) identified incomplete ethnicity recording and significant under-representation of Asian service users relative to the local population.

This re-audit reassessed the original audit standards by evaluating ethnicity recording completeness and whether the ethnic composition of CAMHS service users reflected the local under-18 population. It tested the hypotheses that ethnicity recording completeness would improve following the 2020 audit and that service use would reflect local population demographics.

A re-audit was conducted using electronic health records for all open CAMHS cases (n=1626) across East Lancashire Child and Adolescent Services as of 6 May 2025. Analyses were undertaken at locality level (Blackburn with Darwen; Burnley and Pendle; Hyndburn, Ribble Valley and Rossendale). Descriptive statistics were used to assess ethnicity recording completeness. Population-based access rates per 1,000 children were calculated using 2011 Census under-18 population denominators, and observed and expected numbers of Asian CAMHS service users were compared using chi-square goodness-of-fit tests.

Ethnicity recording completeness improved overall between 2020 and 2025, increasing from approximately 78% at baseline to 88% at re-audit, with improvement seen in most localities. Despite this, Asian children and adolescents remained significantly under-represented among CAMHS service users. Access rates for Asian children were consistently lower than those for non-Asian children across all localities (approximately 2–5 vs 12–18 per 1,000 children, respectively), and observed numbers were significantly lower than expected based on population proportions (χ² goodness-of-fit, p < 0.001).

This re-audit demonstrates measurable improvement in ethnicity recording completeness within East Lancashire CAMHS since the 2020 baseline audit, indicating partial completion of the audit cycle. However, improved data quality has not translated into equitable access to CAMHS, with Asian children remaining under-represented and access rates persistently lower than expected.

Increasing rates of involuntary treatment in the UK and persisting ethnic disparities in detentions have led to the reform of the Mental Health Act (MHA) in 2025. The MHA bill introduces several new measures including the offer of Advance Choice Documents (ACDs) to people who wish to make them. ACDs are written statements of a person’s wishes and preferences for treatment and care, made when a person is well and has the capacity to do so. Systematic reviews show that ACDs can reduce detention rates by up to 25%. The South London and Maudsley NHS Foundation Trust (SLaM) rolled out ACDs as part of routine care, ahead of the MHA 2025. This study describes the implementation of ACDs as part of routine care at SLaM.

SLaM recruited independent senior mental health professionals (ACD facilitators) to lead the creation, use and review of ACDs. The facilitators underwent training and utilised resources previously developed through previous research. The resources included an ACD template, an ACD manual and role description for facilitators, simulation training and Recovery College courses. A clinical lead and clinical supervisor were also employed to provide oversight for the implementation project. Data on implementation were collected through case note reviews, and interviews with service users and staff. Analyses on how ACDs were created and used when people experienced crises were conducted.

At the time of abstract submission, 77 ACDs have been created with service users at SLaM. The implementation of ACDs has been aided by service user-led initiatives such as the Patient Carer Race Equality Framework, staff training, and Recovery College courses which enabled people to create ACDs with high fidelity to the evidenced interventions. Staff and service users report that the ACD creation process is a holistic experience that is empowering and beneficial for improving therapeutic alliance between service users and mental health professionals. The main barrier cited by staff was a lack of time due to large caseloads.Service users expressed scepticism about their ACDs being accessed and honoured during times of crisis.

Implementing evidence-based interventions in healthcare settings is complex. SLaM has replicated the implementation of ACDs with high fidelity to the intervention trials that reported reductions in Mental Health Act detentions and greater autonomy for service users. Our results show that multiple strategies are needed to accelerate the reach and adoption of ACDs in other Trusts.