Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool designed to probe the strength of inhibitory and excitatory neurotransmission in the cortex. Combined with electromyography, paired-pulse TMS paradigms have revealed a deficit in inhibition mediated by GABA-A receptors in patients with schizophrenia. Combined TMS-electroencephalography (TMS-EEG) provides a more detailed examination of cortical excitability and may shed more light into the pathophysiology of schizophrenia. Of the various peaks of the TMS-evoked EEG signal, responses at 45 (N45) and 100 ms (N100) likely reflect GABA-A and GABA-B receptor-mediated inhibition, respectively. Responses at 25 ms (P25) are affected by voltage-gated channel ligands, whereas glutamatergic processes may be related to the P70 component. We here aim to systematically investigate the role of these neural processes in patients with schizophrenia by using TMS-EEG.

TMS-evoked EEG potentials (TEPs) were recorded in patients with schizophrenia (n = 19) and in age-matched healthy controls (n = 17). 150 TMS pulses at 90% of resting motor threshold were applied over the left primary motor cortex during EEG recording. Differences in TEPs between the two groups were analysed for all electrodes and for time windows corresponding to each TEP (P25: 0.015-0.035 ms; N45: 0.035-0.06 ms; P70: 0.035-0.06 ms; N100: 0.09-0.14ms) by applying multiple independent sample t-tests. Further, a cluster-based permutation analysis approach was implemented to correct for multiple comparisons.

Compared to controls, patients showed amplitude reduction for the P25 (negative and positive cluster; p < 0.001 and p = 0.04, respectively), N45 (negative and positive cluster; p < 0.001 and p = 0.001, respectively) and P70 component (negative and positive cluster; p = 0.04 and p = 0.004, respectively).

There results extend on previous literature about impairment of GABA-A receptor mediated inhibition in schizophrenia, as demonstrated by the N45 amplitude reduction, whereas no significant differences in GABA-B index (i.e., N100) were revealed. Our results also showed that, although specific mechanisms underlying P25 and P70 have not been fully elucidated yet, excitatory neurotransmission is altered in this clinical population. To conclude, TMS-EEG may provide a more comprehensive view of the inhibitory and excitatory mechanisms involved in the pathophysiology of schizophrenia.

Smartphone addiction is a new concern due to its progressive global usage. Since this phenomenon occurs in adolescents and young people, especially in students, causing many problems in interpersonal relationships, occupational and educational performances, evaluation of smartphone addiction in this population seems to be necessary. Accordingly, this study aimed to examine the prevalence of smartphone addiction in Tehran university students for determining the risk factors associated with this issue.

This analytical cross-sectional survey was carried out on university students in Tehran between 2016–2018. A study sample of 382 students from various faculties of Tehran universities was chosen by random multi-stage cluster sampling. The participants simultaneously completed a researcher-made questionnaire on demographic characteristics and risk factors, the Smartphone Addiction Scale (SAS), and Young's Internet Addiction Test (IAT). After checking the smartphone addiction questionnaire, smartphone-addicted individuals were identified, and a comparison with the non-addicted group was performed in terms of risk factors.

In this study, the participants were given written consent forms. Questionnaires were anonymous and the information was kept confidential. This study was registered at the Ethics Committee of Shahid Beheshti University of Medical Sciences with a code of 1395,309.

Our findings indicated that the frequency of smartphone addiction was 28.8%. The frequency of smartphone addiction in women (32.5%) was higher than that in men (23%) (p = 0.04). The highest incidence of smartphone addiction occurred in the age range of less than 20 while the lowest was found above the age of 40. (P = 0.001). The prevalence of smartphone addiction in the single population was 34.1% Vs 16.1% in married. (P = 0.000) The most prominent educational field of smartphone addicts was technical and engineering. (P = 0.007). Smartphone addiction was significantly more in internet service and social networking users. (P = 0.025) There was a significant relationship between the history of psychiatric illness and smartphone addiction. (P = 0.035) The most common psychiatric diseases were found to be obsessive-compulsive disorder (41.7%), followed by anxiety disorders. (33.3%)

Smartphone addiction has a significant frequency among university students in Tehran, associated with access to internet services and social networking. It was more common in women, single adults, and younger ages. There was a significant relationship between the history of psychiatric illness and smartphone addiction. The highest frequency of psychiatric illnesses in the addiction group was obsessive-compulsive disorder and anxiety disorders. No relationship was found between smartphone addiction and history of substance use, as well as smoking and alcohol.

Compulsory admission is commonly regarded as necessary and justified for patients whose psychiatric condition represents a severe danger to themselves and others. However, while studies on compulsory admissions have reported on various clinical and social outcomes, little research has focused specifically on dangerousness, which in many countries is the core reason for compulsory admission.

To study changes in dangerousness over time in adult psychiatric patients admitted by compulsory court order, and to relate these changes to these patients' demographic and clinical characteristics.

In this explorative prospective observational cohort study of adult psychiatric patients admitted by compulsory court order, demographic and clinical data were collected at baseline. At baseline and at 6 and 12 month follow-up, dangerousness was assessed using the Dangerousness Inventory, an instrument based on the eight types of dangerousness towards self or others specified in Dutch legislation on compulsory admissions. We used descriptive statistics and logistic regression to analyse the data.

We included 174 participants with a court-ordered compulsory admission. At baseline, the most common dangerousness criterion was inability to cope in society. Any type of severe or very severe dangerousness decreased from 86.2% at baseline to 36.2% at 6 months and to 28.7% at 12 months. Being homeless at baseline was the only variable which was significantly associated with persistently high levels of dangerousness.

Dangerousness decreased in about two-thirds of the patients after court-ordered compulsory admission. It persisted, however, in a substantial minority (approximately one-third).

None.

Identifying neuroimaging biomarkers of antidepressant response may help guide treatment decisions and advance precision medicine.

To examine the relationship between anhedonia and functional neurocircuitry in key reward processing brain regions in people with major depressive disorder receiving aripiprazole adjunct therapy with escitalopram.

Data were collected as part of the CAN-BIND-1 study. Participants experiencing a current major depressive episode received escitalopram for 8 weeks; escitalopram non-responders received adjunct aripiprazole for an additional 8 weeks. Functional magnetic resonance imaging (on weeks 0 and 8) and clinical assessment of anhedonia (on weeks 0, 8 and 16) were completed. Seed-based correlational analysis was employed to examine the relationship between baseline resting-state functional connectivity (rsFC), using the nucleus accumbens (NAc) and anterior cingulate cortex (ACC) as key regions of interest, and change in anhedonia severity after adjunct aripiprazole.

Anhedonia severity significantly improved after treatment with adjunct aripiprazole.

There was a positive correlation between anhedonia improvement and rsFC between the ACC and posterior cingulate cortex, ACC and posterior praecuneus, and NAc and posterior praecuneus. There was a negative correlation between anhedonia improvement and rsFC between the ACC and anterior praecuneus and NAc and anterior praecuneus.

Eight weeks of aripiprazole, adjunct to escitalopram, was associated with improved anhedonia symptoms. Changes in functional connectivity between key reward regions were associated with anhedonia improvement, suggesting aripiprazole may be an effective treatment for individuals experiencing reward-related deficits. Future studies are required to replicate our findings and explore their generalisability, using other agents with partial dopamine (D2) agonism and/or serotonin (5-HT2A) antagonism.

Previous studies suggest that migrants tend to utilise antipsychotics less often than their native-born peers. However, studies examining antipsychotic use among refugees with psychosis are lacking.

To compare the prevalence of antipsychotic drug use during the first 5 years of illness among refugees and Swedish-born individuals with a newly diagnosed non-affective psychotic disorder, and to identify sociodemographic and clinical factors associated with antipsychotic use.

The study population included refugees (n = 1656) and Swedish-born persons (n = 8908) aged 18–35 years during 2007–2018, with incident diagnosis of non-affective psychotic disorder recorded in the Swedish in-patient or specialised out-patient care register. Two-week point prevalence of antipsychotics use was assessed every 6 months in the 5 years following first diagnosis. Factors associated with antipsychotic use (versus non-use) at 1 year after diagnosis were examined with modified Poisson regression.

Refugees were somewhat less likely to use antipsychotics at 1 year after first diagnosis compared with Swedish-born persons (37.1% v. 42.2%, age- and gender-adjusted risk ratio 0.88, 95% CI 0.82–0.95). However, at the 5-year follow-up, refugees and Swedish-born individuals showed similar patterns of antipsychotic use (41.1% v. 40.4%). Among refugees, higher educational level (>12 years), previous antidepressant use and being diagnosed with schizophrenia/schizoaffective disorder at baseline were associated with an increased risk of antipsychotics use, whereas being born in Afghanistan or Iraq (compared with former Yugoslavia) was associated with decreased risk.

Our findings suggest that refugees with non-affective psychotic disorders may need targeted interventions to ensure antipsychotic use during the early phase of illness.

Mental illness has a significant impact not only on patients, but also on their carers’ capacity to work.

To estimate the costs associated with lost labour force participation due to the provision of informal care for people with mental illness in Australia, such as income loss for carers and lost tax revenue and increased welfare payments for government, from 2015 to 2030.

The output data of a microsimulation model Care&WorkMOD were analysed to project the financial costs of informal care for people with mental illness, from 2015 to 2030. Care&WorkMOD is a population-representative microsimulation model of the Australian population aged between 15 and 64 years, built using the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers data and the data from other population-representative microsimulation models.

The total annual national loss of income for all carers due to caring for someone with mental illness was projected to rise from AU$451 million (£219.6 million) in 2015 to AU$645 million (£314 million) in 2030 in real terms. For the government, the total annual lost tax revenue was projected to rise from AU$121 million (£58.9 million) in 2015 to AU$170 million (£82.8 million) in 2030 and welfare payments to increase from AU$170 million (£82.8 million) to AU$220 million (£107 million) in 2030.

The costs associated with lost labour force participation due to the provision of informal care for people with mental illness are projected to increase for both carers and government, with a widening income gap between informal carers and employed non-carers, putting carers at risk of increased inequality.

Suicide is one of the leading causes of mortality worldwide, and the majority of suicide deaths occur in low- and middle-income countries.

To evaluate the demographic and clinical characteristics of individuals who have presented to health services following self-harm in Pakistan.

This study is a cross-sectional baseline analysis of participants from a large multicentre randomised controlled trial of self-harm prevention in Pakistan. A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals in five major cities in Pakistan. The Beck Scale for Suicide Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Suicide Attempt Self Injury Interview assessment scales were completed.

Most participants recruited were females (n = 544, 60.4%) in their 20s. Compared with males, females had lower educational attainment and higher unemployment rates and reported higher severity scores on BSI, BDI and BHS. Interpersonal conflict was the most frequently cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most frequently reported motive of self-harm (N = 776, 86.1%). Suicidal intent was proportionally higher in community-presenting patients (community: N = 318, 96.9% v. hospital: N = 458, 79.9%; P < 0.001). The most frequently reported methods of self-harm were ingestion of pesticides and toxic chemicals.

Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicidal intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of suicide.

Despite the availability of effective therapies, many patients with major depressive disorder (MDD) develop treatment-resistant depression (TRD).

To evaluate and compare prescribing patterns, contact with specialist services and treatment outcomes in patients with MDD and TRD.

This was a retrospective analysis of linked primary and secondary care National Health Service data in the north-west London Discover-NOW data-set. Eligible patients were adults who had diagnostic codes for depression and had been prescribed at least one antidepressant between 2015 and 2020.

A total of 110 406 patients were included, comprising 101 333 (92%) with MDD and 9073 (8%) with TRD. Patients with TRD had significantly higher risks of suicidal behaviour and comorbidities such as anxiety, asthma, and alcohol or substance misuse (all P < 0.0001). Citalopram, sertraline, fluoxetine and mirtazapine accounted for 83% of MDD and 71% of TRD prescriptions. Use of antidepressant switching (1% MDD, 7% TRD) and combination therapy (1%, 5%) was rare, whereas augmentation occurred more frequently in the TRD group (4%, 35%). Remission was recorded in 42 348 (42%) patients with MDD and 1188 (13%) with TRD (P < 0.0001), whereas relapse was seen in 20 970 (21%) and 4923 (54%), respectively (P < 0.0001). Mean times from diagnosis to first contact with mental health services were 38.9 (s.d. 33.6) months for MDD and 41.5 (s.d. 32.0) months for TRD (P < 0.0001).

There appears to be a considerable difference between treatment guidelines for depression and TRD and the reality of clinical practice. Long-term treatment with single antidepressants, poor remission, and high relapse rates among patients in primary care highlight the need to optimise treatment pathways and access to newer therapies.

Auditory Verbal Hallucinations (AVH) are a hallmark of psychosis, but affect many other clinical populations. Patients’ understanding and self-management of AVH may differ between diagnostic groups, change over time, and influence clinical outcomes.

We aimed to explore patients’ understanding and self-management of AVH in a young adult clinical population.

35 participants reporting frequent AVH were purposively sampled from a youth mental health service, to capture experiences across psychosis and non-psychosis diagnoses. Diary and photo-elicitation methodologies were used – participants were asked to complete diaries documenting experiences of AVH, and to take photographs representing these experiences. In-depth, unstructured interviews were held, using participant-produced materials as a topic guide. Conventional content analysis was conducted, deriving results from the data in the form of themes.

Three themes emerged:

1. (1) Searching for answers, forming identities – voice-hearers sought to explain their experiences, resulting in the construction of identities for voices, and descriptions of relationships with them. These identities were drawn from participants’ life-stories (e.g., reflecting trauma), and belief-systems (e.g., reflecting supernatural beliefs, or mental illness). Some described this process as active / volitional. Participants described re-defining their own identities in relation to those constructed for AVH (e.g. as diseased, 'chosen', or persecuted), others considered AVH explicitly as aspects of, or changes in, their personality.

2. (2) Coping strategies and goals – patients’ self-management strategies were diverse, reflecting the diverse negative experiences of AVH. Strategies were related to a smaller number of goals, e.g. distraction, soothing overwhelming emotions, 'reality-checking', and retaining agency.

3. (3) Outlook – participants formed an overall outlook reflecting their self-efficacy in managing AVH. Resignation and hopelessness in connection with disabling AVH are contrasted with outlooks of “acceptance” or integration, which were described as positive, ideal, or mature.

Trans-diagnostic commonalities in understanding and self-management of AVH are highlighted - answer-seeking and identity-formation processes; a diversity of coping strategies and goals; and striving to accept the symptom. Descriptions of “voices-as-self”, and dysfunctional relationships with AVH, could represent specific features of voice-hearing in personality disorder, whereas certain supernatural/paranormal identities and explanations were clearly delusional. However, no aspect of identity-formation was completely unique to psychosis or non-psychosis diagnostic groups. The identity-formation process, coping strategies, and outlooks can be seen as a framework both for individual therapies and further research.

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

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

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

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

Physical activity, sleep, mental health, physical health, well-being, quality of life, cognition, and functioning are interconnected factors. Compared to general population average, people experiencing psychosis have lower levels of physical activity, high levels of sedation, and more sleep problems (Soundy et al. 2013; Vancampfort et al. 2015). This is linked to symptoms of depression, lower well-being, hopelessness, lower quality of life and physical health conditions, such as: cardiovascular disease (CVD), stroke, hypertension, osteoarthritis, diabetes, and chronic obstructive pulmonary disease (COPD) (Rhodes et al. 2017; Schuch et al. 2017). Engaging in physical activity is associated with improved quality of life, psychotic symptomatology, cognition, functioning and physical health for people with psychosis experience (Mittal et al. 2017). To be effective, interventions need to be individualised (Griffiths et al. 2021). An early intervention in psychosis (EIP) service intervention was delivered: the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance, motivational interviewing, workbook goal setting through three sessions with a clinician. EIP service staff used Fitbits themselves, sharing experiences with patients. Aim was to improve sleep, physical activity, well-being, and prevent weight gain.

Outcome measure data collection from baseline to 6 week follow-up. Change in physical activity, sleep, mental health, well-being and physical weight were assessed in 50 participants, and fifteen participants were interviewed. People with lived experience of psychosis were part of the research team and contributed to design, analysis and reporting.

Improvements were found in physical activity, sleep, mental health, and well-being, and there was no weight gain. Most patients actively used the Fitbit and its software apps, guidance and workbook to set goals and to make positive changes to their lifestyle and daily routines to improve motivation, quality of sleep, and level of physical activity.

Healthy effective sleep and physical activity/exercise is important to EIP service patients’ well-being and mental and physical health. EIP staff successfully and fully integrated the Well-Track intervention into routine service provision. The project has better allowed staff to effectively engage with and discuss issues around sleep, physical activity, well-being and mental health and reducing weight gain. The intervention was beneficial, relatively easy and low cost to implement, and well-liked by patients and staff; and therefore could be offered by all EIP services. EIP services should consider and assess sleep and physical activity/exercise issues and promote healthy effective sleep and physical activity/exercise within recovery focused practice.

Screening for asymptomatic health conditions is perceived as mostly beneficial, with possible harms receiving little attention.

To quantify proximal and longer-term consequences for individuals receiving a diagnostic label following screening for an asymptomatic, non-cancer health condition.

Five electronic databases were searched (inception to November 2022) for studies that recruited asymptomatic screened individuals who received or did not receive a diagnostic label. Eligible studies reported psychological, psychosocial and/or behavioural outcomes before and after screening results. Independent reviewers screened titles and abstracts, extracted data from included studies, and assessed risk of bias (Risk of Bias in Non-Randomised Studies of Interventions). Results were meta-analysed or descriptively reported.

Sixteen studies were included. Twelve studies addressed psychological outcomes, four studies examined behavioural outcomes and none reported psychosocial outcomes. Risk of bias was judged as low (n = 8), moderate (n = 5) or serious (n = 3). Immediately after receiving results, anxiety was significantly higher for individuals receiving versus not receiving a diagnostic label (mean difference −7.28, 95% CI −12.85 to −1.71). On average, anxiety increased from the non-clinical to clinical range, but returned to the non-clinical range in the longer term. No significant immediate or longer-term differences were found for depression or general mental health. Absenteeism did not significantly differ from the year before to the year after screening.

The impacts of screening asymptomatic, non-cancer health conditions are not universally positive. Limited research exists regarding longer-term impacts. Well-designed, high-quality studies further investigating these impacts are required to assist development of protocols that minimise psychological distress following diagnosis.

The COVID-19 pandemic highlighted the importance of wellbeing amongst healthcare professionals. Medical professionals, notably junior doctors, are at increased risk of developing poor mental health and burnout. The GMC Barometer Study in 2020 showed that 32% of doctors found the first wave of the COVID-19 pandemic detrimental to their wellbeing and mental health.

The aim of this quality improvement project was to assess and improve hospital wellbeing support available to foundation doctors within Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) by learning and reflecting on the impact of COVID-19.

After identifying a lack of resources within GHNHSFT, wellbeing information boards were displayed in communal areas and distributed by email. These encompassed trust wide support, practical information including childcare and relaxation resources concentrating on mindfulness, exercise and culture. A survey of foundation doctors was completed to assess doctors’ focus and approach to wellbeing. Questions assessed influential factors in maintaining wellbeing, access to current hospital resources and future interventions.

94% of respondents recognised that their focus on wellbeing increased during COVID-19. One third of foundation doctors found it challenging to maintain their wellbeing, with 40% reporting difficulty accessing hospital support and advice. The most important factors foundation doctors identified in maintaining wellbeing were exercise, cooking and baking, and social networks. Colleagues were a significant source of wellbeing support, followed by notice boards, email resources and social media.

COVID-19 highlighted the importance and burden on wellbeing of foundation doctors, with a significant number struggling to access support. Future recommendations include the use of a ‘buddy system’, regular and accessible exercise classes and improved communication of wellbeing support and resources to staff members.

Buddy systems have already shown success amongst teams however it is important these are accessible to all foundation doctors and universally offered within the trust. A weekly yoga class is being reintroduced to be available to all doctors.

A particular focus has been the development of a health and wellbeing section to feature in the trusts weekly communications, with the aim to regularly signpost staff to ongoing wellbeing resources and support.

Social networking and media were highlighted as important in both maintaining wellbeing and accessing resources. A future goal is to develop an official GHNHSFT Instagram or Twitter account focused on wellbeing. We hope to continue to learn from the impact of COVID-19, improving the availability of wellbeing support at GHNHSFT that will continue into the future.

As part of continuity, prevalence of Autism Spectrum Disorder (ASD) is nearly the same in adults as children and is associated with other comorbid psychiatric disorders that have substantial impact on their life and complex the intervention. This study aimed to examine psychiatric comorbidity in referred adult ASD patients compared to non-ASD psychiatric patients. It has been hypothesized that comorbid psychiatric disorders were higher among patients with ASD than patients without ASD.

In total, 36 adults with ASD referred in the year 2019 in a psychiatric consultation center in Dhaka city were included in the study. They were derived from the case register of the center. Similar number of age and sex-matched adult psychiatric patients without ASD were selected for comparison. All patients were referred for psychiatric consultation. Socio-demographic variables were collected from the patients’ record. Diagnosis of psychiatric disorders including ASD was made by an experienced psychiatrist. It was done clinically based on all available information, examination and relevant investigations. Diagnoses were assigned according to DSM-5. Then comparisons of psychiatric disorders were made between the two patient groups.

The cases were ranged from 18-41 years with the mean of 26.72 ± 6.5 years. Among them, 22 were male and 14 were female. Male-female ratio was 1.6:1. Most of the subjects received no education and were from middle income family with urban background. Mean number of comorbid psychiatric disorders was 1.92 in patients with ASD and 1.67 in patients without ASD and the difference was significant (P = 0.04). Most two frequent comorbidities among ASD patients were Obsessive Compulsive Disorder (27.77%) and Major Depressive Disorder(25%) followed by Specific Phobia(19.44%), Social Phobia and Intermittent Explosive Disorder(16.67%) for each, Attention Deficit Hyperactivity Disorder(13.89%) and Conduct Disorder(11.11%). All these disorders were significantly higher than patients without ASD. Conversely, Major Depressive Disorder (30.55%) was most frequent among the patients without ASD and that was even significantly higher than patients with ASD. Other frequent disorders like Bipolar Disorder, Schizophrenia, Generalized Anxiety Disorder and Substance Related Disorder were also higher among non-ASD patients.

This research shows that comorbid psychiatric disorders were frequently found in patients with ASD. Subsequent broad-based studies using extensive measures of psychopathology are required to confirm these preliminary findings. Greater understanding of the presence of other psychiatric disorders in ASD patients will turn this awareness into action.

The audit aimed to assess, when 3rd and 4th line medications were prescribed for ADHD, if practice was compliant with Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) prescribing guidelines and the updated NICE Guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management 2018.

The audit was conducted in the four Teesside Child & Adolescent community teams during April/May 2018. Each team identified all patients prescribed 3rd and 4th line ADHD medications leading to 30 responses (n = 30).

Information was collected from electronic and paper medical records using a designated audit tool compiled from the above evidence based guidelines. The data were analysed for compliance against standards using an excel spreadsheet and reviewed by the audit lead.

There were many areas of good practice demonstrated in the audit including diagnostic recording, pre-treatment non-medical interventions where ADHD was not severe, and use of Methylphenidate as first line medication in accordance with BNF limits. In the majority of records reviewed, there was good evidence of a variety of NICE recommended non-medication interventions which were often continued post medication initiation.

There was also very good evidence of comprehensive verbal and written information and psychoeducation including benefits and potential side effects of medication (92% verbal and 58% written).

A pre-treatment assessment was completed in all but 3 cases, 1 of which had no assessment documented and 2 cases were transferred from out of area.

Issues identified by the audit, where there was deviation from guidelines, included 4 cases where Methylphenidate was not prescribed as first line, of these, 3 were prescribed Atomoxetine due to parental choice and one was due to contraindications, suggesting patient choice was an important factor in selection of 2nd line medication.

The audit demonstrates that clinical practice had moved away from the previous guidance in NICE CG72 (to prescribe atomoxetine 2nd line) towards the prescription of Lisdexamfetamine 2nd line (75%) as reflected in the new NICE guidelines: NG87, 2018 (updated 2019).

This audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced good practice in areas such as pre-assessment, information and psychological education, initial use of Methylphenidate, use of Lisdexamfetamine 2nd line, as well as consideration of patient choice. Importantly the audit highlighted that implementation of updated NICE compliant trust guidance, followed by a planned trust-wide audit will promote continuous improvement in patient care.

Accurate and timely handover of clinical information is of great importance to continuity and safety of care. Psychiatry doctors typically cover a number of sites across a catchment when they are on-call. Consequently, handover between on-call teams and day teams in psychiatric hospitals is reliant on using the nursing staff as an intermediary to flag concerns or relying on the day teams proactively checking the notes on daily basis for outstanding tasks.

The key objective of this project was to use Microsoft teams to establish a handover system that is efficient, safe, reliable, easy to use and replicable.

A microsoft teams group was created comprising of all the medical staff members working at inpatient units across three sites that are part of Birmingham and Solihull Mental Health Trust. These members were divided into two groups - the ‘on-call team’ and the ‘day team’. Within the ‘day team’, every consultant was grouped with their junior doctors to form multiple subgroups.

A system was established wherein the two teams could communicate with each other by posting a message and tagging the appropriate team. A provision was made to create a channel for every ward to allow for easy segregation and monitoring of tasks.

Qualitative information about the use of the tool was monitored by monthly focus group meetings. A formal review of the messages was conducted after 8 weeks to assess the following parameters:

Number of messages posted

Number of messages acknowledged

Number of safety-related incidents

Initial evaluation of the results suggests that the new handover system was perceived to be safe, accurate and efficient while being intuitive and hassle-free. This increased the quantity and enhanced the quality of communication between the ‘on-call’ and the ‘day teams’ and allowed for early completion of tasks while reducing the number of safety-related incidents.

The Microsoft teams proved to be a viable alternate tool to create a virtual handover process that is efficient, safe, reliable and user-friendly. It also has the potential to enhance the communication between inpatient and community teams.

Previous research suggests the prevalence of mental health conditions among medical inpatients may be as high as 38%. Anecdotally, junior doctors report lacking the confidence, knowledge and skills to assess and treat patients with psychiatric conditions. Identifying this unmet need offers potential to improve standards of care and achieve parity of esteem between psychiatric and medical conditions within the general hospital. Aims:

To assess self-reported preparedness of newly-qualified Foundation Doctors to care for patients with acute or chronic psychiatric symptoms in comparison to physical health conditions.

In September of each year (2017, 2018, 2019), a survey was cascaded to all incoming Foundation Year 1 Doctors. For each respective year there were 1673, 961 & 1301 respondents. Respondents were asked to rate their agreement with statements on a Likert scale. Statements pertaining to mental health included “a) I am competent in acute mental health care provision, b) I am competent in chronic mental health care provision” and “I feel confident in prescribing the following drugs; c) drugs for mental health problems”. Comparison statements assessed confidence caring for medically unwell patients, performing practical procedures and prescribing drugs for physical health conditions.

Preparedness for acute and chronic mental health were lower than both physical health comparison items; preparedness to care for patients with critical illness (acute: r = 0.794, p < 0.001, chronic: r = 0.556, p < 0.001) and preparedness to perform practical procedures (acute: r = 0.724, p < 0.001, chronic: r = 0.433, p < 0.001).

Confidence prescribing mental health drugs was lower than all other comparison items (simple analgesia: r = 0.854, bronchodilators: r = 0.789, antimicrobials: r = 0.772, inhaled steroids: r = 0.720, intravenous fluids: r = 0.702, oral anti-diabetics: r = 0.611, anticoagulants: r = 0.515, narcotics: r = 0.514, insulin: r = 0.206; p < 0.001)

These results identify a disparity in foundation doctors’ self-reported preparedness to treat acute and chronic mental health conditions and prescribe psychotropic medications, compared to a variety of physical health domains. To our knowledge this is the first large-scale study to empirically test a potential discrepancy between newly-qualified doctors’ preparedness to treat patients’ mental and physical health needs. Medical school education and foundation training may therefore present a fruitful opportunity to improve care for patients with psychiatric conditions within general hospital settings.