The aim is to understand whether the online video based psychiatric consultation skills toolkit, which was developed to attempt to address some of the differential attainment seen amongst International Medical Graduates (IMGs) within psychiatry, is feasible, effective and acceptable by running a pilot amongst core psychiatric trainees in the North West prior to a full roll out.

19 trainees sitting the 2022 North West formative skills test were invited to take part by email. 7 trainees accessed the toolkit. Performance from the skills test was analysed in excel looking at averages of individual domains across all stations. Results from those who used the toolkit prior to the skills test were compared with those who did not access the toolkit. Toolkit completion rates were obtained and feedback was accessed from an online survey. Data were analysed in excel, rigour was ensured by the supervisor reviewing data and results.

There were 7 trainees who accessed the toolkit, 3 IMGs and 4 UK graduates. 12 trainees sat the skills test but did not access the toolkit, 9 IMGs and 3 UK graduates.

Regarding acceptability of the toolkit, IMGs completed 92.7% of the toolkit on average and UK graduates completed 87.8%. 86% of trainees strongly agreed that the toolkit was easy to use and 14% agreed. 57% of trainees strongly agreed that the toolkit had helped develop their communication skills and 43% agreed. 86% of participants strongly agreed and 14% agreed that they would recommend the toolkit to a colleague suggesting they found it helpful and acceptable to use.

The highest percentage improvement in scores with toolkit use was in clinical skills amongst IMGs of 29.4%, followed by communication skills amongst international medical graduates with a 25.5% improvement to their counterparts who did not use the toolkit.

On average, across all domains, IMGs improved by 25.3% and UK graduates by 20% in their average score.

The results above suggest that the toolkit has been well completed and deemed acceptable by those who accessed it during the pilot period.

Although the results statistical significance cannot be determined at present due to small sample size, it is hoped when the project is fully rolled out this will be demonstrated and the initial findings showing some improvement in both IMGs and UK graduates are encouraging.

It appears that this toolkit could go come way to addressing the differential attainment seen between IMGs and UK graduates.

The Midlands’ Charter outlines commitment to prioritise the restoration of postgraduate medical education and training impacted during the COVID-19 pandemic . The support provided must be accessible, inclusive, and culturally sensitive, with a greater understanding of current barriers that the trainees face to achieve this goal. This project aims to identify the barrier of receiving well-being support and to enhance psychiatry higher trainee's well-being in the trust by following the principles of Midland's Charter.

We designed an anonymous electronic survey, where multiple choice questions and Likert scales were used to quantify respondents’ levels of agreement with a range of statements. Questions were selected to capture baseline characteristic, rating of current well-being score, access to well-being support, barriers, and suggestion of improvement.

The survey was open for one month and was distributed to all psychiatry higher trainees working in BSMHFT.

We identified a response rate of 81%.

One of the main themes of the survey that came up repeatedly was that trainees are struggling with clinical workload that sometimes overspilled to their personal time, which means family time is affected. More than half of the trainees reported that they do not know how to access well-being support in the trust. While the result was split in half when the trainees were asked if they have a well-being concern whilst working for the trust. Trainees said that there is very little support given to attend any nonrelated work engagement and they made grievance on the difficulty of accessing the trust occupational health and well-being services.

Since the inception of the survey, several recommendations were trialled. This include raising awareness among clinicals supervisors, where a video was uploaded on to the Trust intranet outlining the tips of becoming a good clinical supervisor. A well-being booklet was introduced as part of trainees’ induction, and this was also made available on the intranet. Lastly, an awareness on ST representative role was also highlighted so that they can continue to facilitate an ST forum meeting as platform to raise concerns.

There are no clear guidelines for the optimal organisation of psychiatry placements for medical undergraduates. Moreover, the UK needs to enrol more psychiatry trainees. This service evaluation aimed to show that an efficient psychiatry placement can improve attitudes of students towards psychiatry and increase their likelihood to choose psychiatry.

We evaluated the efficacy of a new strategy for the psychiatry placement of 24 fourth-year medical students from the University of East Anglia during the academic year 2021/2022. The strategy consisted of having a 4-week placement in one of 3 wards at the Norfolk and Suffolk Foundation Trust Woodlands Unit (PICU, acute male and female wards) with brief (one- to two-day) rotations across the wards, as well as the community team and individual areas of interest. This afforded students exposure to different settings, pathologies and levels of severity, with enough time in one service to allow integration into the team, participation in clinical and therapeutic activities and most important, observation of patient longitudinal improvement. Multidisciplinary teams were included by presenting the training as a win-win, and we relied on a good teaching culture at our Trust. We also offered a programmed induction day, a mid-placement meeting and an end-of-placement debrief. We evaluated the efficacy of the strategy using the Attitude Towards Psychiatry Questionnaire before and after the placement, as well as measuring overall satisfaction.

The overall satisfaction score on a 5 point Likert scale was very good (M = 4.58; SD = 0.58). Mean ATP total score significantly improved from 116.50 (SD 9.49) to 133.00 (SD 8.68) over a maximum attainable score of 150 (F(1;23) = 69.70, p < .001, ηp2= .75), with 23 out of the 30 items having significantly improved individually as well. The reliability of the scale was high with a Cronbach's alpha of .81 before and .84 after the psychiatry placement. The question “I would like to be a psychiatrist” improved significantly from 2.54 to 3.25 on the 5 point Likert scale (F(1, 23) = 16.33, p < .001, ηp2= .42) with an increase in students answering “agree” or “strongly agree” from 16.7% to 45.8%. This improvement was significantly positively correlated with the overall satisfaction score (R = .528, p < .01).

Psychiatry placement for medical undergraduates is a valuable opportunity to improve their attitudes towards psychiatry and their likelihood of choosing psychiatry as a specialty. We present our strategy as a model toward these goals.

Cardiac Rehabilitation (CR) is a multidisciplinary intervention for people after an adverse cardiac event to improve their physical, psychological and social functioning. The risk factors of cardiac disease and dementia are similar. This cross sectional study aims to determine whether adding memory assessment to a CR program would improve early detection of cognitive impairment. Therefore, the research question is- “Can adding a memory assessment to the cardiac rehabilitation program improve early detection of cognitive impairment in people with cardiac disease?”.

Study ethical approval was granted by Yorkshire & The Humber - Sheffield Research Ethics Committee (reference 20/YH/0146) and the NHS Health Research Authority (project reference 273763). The Lancashire & South Cumbria NHS Foundation Trust accepted the role and responsibilities of study sponsorship. Participants underwent cognitive screening and the data obtained was divided into: - 1- History of memory problems before and after the adverse cardiac event. 2- No memory problems before but presents after. 3- No memory problems before and after.

During the study period, 48 participants who were at the cardiac rehabilitation program expressed their interest to patriciate in the study. Out of 48 participants who expressed their interest in participating in the study, 30 of them did not engage beyond expressing their interest and 18 out of 48 completed the assessment. The studied sample was categorized into three groups according to the relation between the onset of the cognitive decline and the onset of the cardiac condition: those with no history of cognitive decline (22.2%), cognitive decline following the onset of the cardiac condition (27.8 %) and cognitive decline before and after the onset of the cardiac condition (50 %). Comparing the number of the participants in the studied sample who has history of cognitive decline revealed that there was statistically significant difference between the number of participants who have history of cognitive decline and the other group which demonstrated no decline in their cognitive function (p = 0.031). On correlating medications variables with all domains of cognitive functions assessments done by using ACE-III, we found that participants who are taking statins as regular medications had higher mean scores for visuospatial subtest than the other group of participants who are not taking statins and this difference was statistically significant (p = 0.012).

This study indicate that CR could potentially enable early detection of cognitive impairment, which could be either reversible or irreversible. However, a longitudinal study of larger scale is required for proper implementation of cognitive assessment in cardiac rehabilitation.

To explore the phenomenon of non-suicidal self-injury (NSSI) in adolescent patients and to assess adolescent-parent attachment and childhood trauma in relation to NSSI behaviour through a case control comparison between adolescents with and without NSSI.

NSSI group included 30 adolescent patients presenting to psychiatry outpatient clinic with history of NSSI. Controls were 30 non-psychiatric adolescent patients recruited from other specialties outpatient clinics. Tools applied were: Semi-structured Psychiatric Interview, Structured Clinical Interview for Diagnostic and Statistical Manual (DSM IV-TR) Axis I and II Disorders (SCID-I and II), Brief Non-Suicidal Self-Injury Assessment tool (BNSSI-AT), Inventory of Parent and Peer Attachment (IPPA)-Parent form, Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire (CTQ). Patient-rated tools were translated into Arabic language.

Self-cutting was the primary method of NSSI in 86.7% followed by interference with wound healing in 73.3%. Of NSSI group, 60% met the criteria for diagnosis of borderline personality disorder (BPD) while 16.7% showed only traits. Moreover, 40% were diagnosed with depressive disorders. While 93.3% used NSSI to deal with anger, 80% used it to cope with uncomfortable feelings or to relieve stress and pressure. In addition, 73.3% reported self-injuring because of their self-hatred. The main motivation for initial NSSI was negative feelings such as being upset (90%), being angry at oneself (73.3%) or at someone else (53.3%). Also, 36.7% reported seeing it in media or reading about it while 40% of the motivations were found related to peer pressure. NSSI group scored significantly lower than controls in their attachment to parents (particularly to mothers). A positive correlation was found between perceived parental care and attachment to parents (mainly trust and communication). A statistically significant difference was found between both groups regarding severity of childhood trauma experiences. In NSSI group, emotional neglect was reported in 80%, emotional abuse in 63.3%, sexual abuse in 50% and physical abuse in 46.7%. Perceived emotional neglect was positively correlated with sense of alienation from fathers and negatively correlated with trust in mothers.

Females constituted 80% of the NSSI group, primarily with the diagnosis of BPD. The most common method of NSSI was “self-cutting”. A significantly high percentage of adolescents with NSSI described their attachment to parents as insecure. The majority of NSSI patients perceived their relationship to both parents as “affectionless control”. A significant correlation was found between perceived parental care and security of attachment. Results also suggest that different types of child maltreatment might predict later NSSI.

Sexual harassment among adolescents is a hidden epidemic with far-reaching consequences. This is because adolescence is a period of identity formation, exploration, and initiation of intimate relationships. Reviews have demonstrated causal associations between any type of victimization at school and adolescent well-being and later-life health, economic and social outcomes. The study was aimed at determining the prevalence of sexual harassment and identifying the psychological correlates of sexual harassment among a sample of Nigerian high school adolescents.

A multistage stratified sampling was used in this cross-sectional study to recruit 960 high school adolescents out of which 918 provided valid responses (mean age = 15.1 +/- 1.36 years). They answered questionnaires that assessed sociodemographic variables, sexual harassment (Sexual Harassment Questionnaire), overall well-being (General Health Questionnaire-12(GHQ-12), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale (HADS), self-esteem (Rosenberg's Self-Esteem Scale (RSES), resilience (Connor-Davidson Resilience scale (CD-RISC) and positive ideation/negative suicide ideations (Positive and Negative Suicidal ideation Scale (PANSI-PI/NSI). Descriptive and inferential analyses were conducted with statistical significance set at p-value <0.05.

Females constituted 51.4% of the sample. About a quarter (26.1%) of our participants reported that they had experienced sexual harassment in their lifetime. The mean total scores on the sexual harassment, overall well-being, anxiety and depressive symptoms, self-esteem, resilience, negative suicidal ideation, and suicide ideation scales were 32.64 (SD = 13.64), 1.91(2.32),17.01(SD = 6.37),18.76(SD = 4.41), 21.78(SD = 8.40), 13.14(SD = 6.33) and 16.84 (SD = 6.23) respectively. Sexual harassment scores were positively correlated with GHQ-12 scores (r = 0.34, p < 0.001), HADS (r = 0.30, p < 0.001), and PANSI-NSI (r = 0.50, p < 0.001) and negatively correlated with RSES (r = −0.20, p < 0.001) however the correlation with resilience was not significant (r = −0.06, p = 0.76).

Sexual harassment is a pervasive problem among adolescents that is associated with low well-being, low self-esteem, the presence of depressive and anxiety symptoms, and increased suicidality. It is therefore essential for relevant stakeholders to develop and implement appropriate policies that would assist in identifying and addressing this menace among school students. Adequate psychological intervention should also be provided for affected individuals.

Weight gain, cardiometabolic complications and psychosis are implicated in significant reduction in life expectancy.While there is current research to uncover a shared aetiology for mental illness and metabolic diseases, people with FEP are especially vulnerable to rapid weight gain during the early stages of treatment due to the side effects profile of many antipsychotic medications. Physical exercise along with lifestyle and dietary modifications have proven efficacy in weight reduction, improving metabolic profile and mental well-being and may be valuable interventions during the early stages of a psychotic illness.Our aim was to find evidence to support the use of non-pharmacological interventions in managing weight gain in people with FEP.

We conducted a systematic review of electronic databases; MEDLINE, EMBASE and PsycINFO on 06/01/2023. We included all studies that looked at non-pharmacological interventions in the management of weight gain for people diagnosed with FEP. Findings are reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two authors independently assessed the included studies’ methodological quality using The National Institute of Health (NIH) quality assessment tool for cohort and cross-sectional studies and all included studies were rated as good.

Our search identified 221 studies and 5 met our inclusion criteria. All studies had a control group that received treatment as usual (TAU) and a test group with Interventions such as dietetic support and exercise programs. Four of the studies demonstrated reduced weight gain on follow up with lifestyle interventions that were statistically significant while the remaining one study did not show a significant difference between groups. One study showed sustained improvement in diet quality with no significant weight change at 2 year follow up. The essential lifestyle interventions that led to reduced weight gain included psychoeducation on healthy lifestyle, dietary modifications and exercise.

Three studies included cardiovascular risk factors such as lipid profile and blood glucose. One of them demonstrated increased cardiometabolic risk factors at baseline which worsened initially but improved after 1 to 2 years of intervention. Another study found increased cholesterol in the intervention group and increased glucose levels in the TAU group and the third study did not find a significant difference between the groups.

Lifestyle weight-management interventions have the potential to reduce weight gain in patients with FEP receiving antipsychotic treatment, but research evidence is very limited at present.

To study the implications of proposed changes in guidelines in ICD-11 in Alcohol and Opioid Use Disorder patients. To evaluate the concordance of ICD-11 with ICD-10 and DSM-5. To compare endorsement of various criteria for dependence between ICD 11 and other systems. To examine the agreement between ICD-11 and other systems with regard to the severity of dependence. To compare the application of WHO ASSIST in screening across systems.

A cross-sectional study among newly registered, adult male patients attending NDDTC OPD, or community clinics and using the substance in the last week. N = 200 (100 each of Alcohol and opioids). Instruments: Semi-structured proforma, CIDI 3, ASI-lite, WHO-ASSIST, AUDIT. Items of CIDI were used to make the diagnosis according to various systems. The diagnostic agreement was assessed by Kappa. Endorsement frequencies of the criteria were compared across diagnostic systems. Scores of scales across systems were compared using Two Independent sample t-test.

The highest prevalence of Dependence was found using ICD-11. Almost perfect agreement between ICD-11 and ICD-10 for both Use Disorder and Dependence for all substances (kappa >0.8) except Inhalants. Agreement for AUD, CUD, and IUD between ICD-11 and DSM-5 was substantial but less than almost perfect. Similar findings for ICD-11 Dependence and DSM-5 Moderate-Severe Use Disorder in Benzodiazepines and Inhalants (kappa ranging from 0.693–0.790). High endorsement frequencies of Salience for Alcohol and Opioids, and Craving and Tolerance for all substances (ICD Dependence); Inability to cut down or control, Craving, and Tolerance (DSM-5 UD). Mean scores of AUDIT and ASSIST were generally lower in participants who received the diagnosis according to ICD-11 (sig. difference for CUD and Cannabis Dependence).

There are significant implications of the changes in ICD-11, and further testing of the impact of these changes needs to be done.

In a majority of low and middle-income countries, the mental health system is weakened due to poor resources as well as poorer recruitment and retention rates in psychiatry among junior doctors. The present study utilizes a mixed-methods approach to explore the factors associated with low recruitment and retention of junior doctors in Psychiatry.

This study utilized an online survey administered among medical students and postgraduate trainees in psychiatry in Pakistan. The survey was open for 5 weeks for data collection from Nov 21st to Dec 31st, 2022. The survey was distributed conveniently using social media platforms and supplemented by snowball sampling procedures. This survey explored common myths about mental illness and psychiatrists using close-ended questions. Open-ended questions were asked to probe the participants on solutions to improve recruitment into psychiatry be improved.

A total of 103 responses were received on the online survey, with the majority (83, 80%) of respondents being females. A majority (66, 64%) of respondents were medical students and 37 (36%) were junior doctors. Most responses were received from the two largest government sector medical universities in Karachi Pakistan, Jinnah Sindh Medical University (67%) & Dow University of Health Sciences (23%).

A total of 62 (60%) respondents reported a lack of exposure to Psychiatry in medical students, to make it a career choice. A larger proportion 57 (55%) felt working in Psychiatry can affect their own mental health. A total of 43 (40%) were not sure if Psychiatry is fulfilling enough as a career and 58 (56%) felt that job satisfaction in psychiatry is difficult to achieve. Around 60% were concerned that mental health conditions are chronic and enduring psychiatrists may not have many options for treatment. In open-ended responses, several common themes emerged. Most respondents commented about their lack of exposure to psychiatry as medical students, which accounts for their reluctance to choose Psychiatry.

Psychiatry forms a very limited part of the medical school curriculum and students' placements. Myths and stigma around mental illness can lead to low recruitment in Psychiatry and stigma can be challenged with more exposure to psychiatry during medical university years. Early medical study years have an influence on career choice and Psychiatry should be introduced relatively early as clinical placement. Psychiatry conferences, seminars and workshops on the local and national level can help in inspiring Medical students and junior doctors.

High rate of psychotropic medications use in elderly people has been reported in the literature. Potentiality inappropriate prescriptions (PIPs) is very common as well. This issue has not been investigated in Oman previously. The aim of our study was to assess the patterns of psychotropic medications prescribed for older adults in the psychiatry clinics in Oman, screen for PIPs and plan for future actions to minimize inappropriate prescriptions.

This is a cross sectional descriptive study using the information in patient's medical records. It was conducted in 12 health care institutions which equally represent all Governorates of Oman. All patients who aged ≥ 60 years old who attended psychiatry clinics from January 2019 to June 2021 and were prescribed psychotropic medications were included. All psychotropic drugs were evaluated including: antidepressants, antipsychotics, Mood stabilizers and hypnotics. STOPP criteria were applied to detect PIPs.

1409 patients (70%) out of 1995 elderly patients who attended the psychiatry clinics in the study period as a new case were prescribed psychotropic medications. Rate of polypharmacy in our study is 38.9%. The most common medications prescribed were risperidone (18.1%) from the antipsychotic category, citalopram (23%) from the antidepressant group and promethazine (30.1%) from the hypnotics group. Regarding the use of sedative medications,18.5% of the patients were prescribed a benzodiazepine and 35.6% of them were prescribed an antihistamine. When assessed the pattern of medications prescribed in healthy people compared to people with different categories of major medical morbidities, no differences were observed. We found 130 (9.3%) potentially inappropriate prescriptions in our study based on STOPP criteria which included use of long-acting benzodiazepine (Diazepam), prescription of anticholinergic medication to treat extrapyramidal side effects (procyclidine) and use of tricyclic antidepressants in specific categories of medical diseases.

The patterns of psychotropic prescriptions for older adults in the outpatient setting in Oman raise concerns about 2 main issues: psychotropic polypharmacy and high rate of benzodiazepines and antihistamines use. This warrants further investigation of these issues in separate studies to identify risk factors. We also recommend implementing certain actions to minimize inappropriate prescriptions including reviewing the availability of appropriate psychotropic medications for this age group in Oman, creating a national guideline for prescribing and providing continuous medical education to the physicians in the primary and secondary health care institutions regarding this aspect.

One of the top causes of death and injury among adolescents and young adults is suicidal behaviour. Indeed, suicide is the second leading cause of death among individuals aged between 15 and 24 years worldwide. Studies on the prevalence of suicide among university students in the UAE are scarce. Importantly, the extent of awareness and experience of suicidality among this group is still unknown. We aimed to ascertain the knowledge and attitudes towards suicidal warning signs and symptoms amongst university students in the UAE.

An online self-administered questionnaire platform was used to collect data from UAE university students in a quantitative cross-sectional study. In addition to demographics, experience regarding suicidal thoughts and behaviours, efficacy expectations, and outcome expectations and values were evaluated. Data were analysed using SPSS, setting a p-value of <0.05 as statistically significant.

A total of 392 participants completed the questionnaire, 233 (59.4%) were males and 159 (40.6%) were females. Based on the knowledge scale, only 35.3% of total participants were identified as knowledgeable of the warning signs of suicide. Expectedly, out of the knowledgeable group, a vast majoring of 83.3% were medical students. When they were asked about what they would do if a friend told them that they are thinking about ending their life, many of the students chose to talk to their friends without getting anyone else's help. There was no statistically significant correlation between being educated regarding suicide and being knowledgeable of suicidal signs and symptoms (P = 0.1). Surprisingly, the degree course students enrolled in was not found to play a significant role in their level of confidence regarding suicidal signs and symptoms.

To our knowledge this is the first study to investigate awareness and attitudes about suicidal thoughts and behaviours among university students in the UAE. Knowledge regarding suicidal signs and symptoms among university students in the UAE is notably low. According to the results, self-reported education did not play a major role in appropriately managing suicidal signs and symptoms. The nature of the education provided to students needs to be further investigated to explore the gaps in the knowledge provided.

To explore the relationship between the menstrual cycle and mental health-related symptoms in women admitted as psychiatric inpatients. To explore the acceptability and feasibility of enquiry. Background: Despite the increasing global burden of mental disorder among women* of reproductive age, there has been little focus in research or clinical practice on the role of reproductive hormones in the pathogenesis, maintenance and treatment of mental disorder in women. Yet a significant proportion of women are vulnerable to fluctuations in sex hormones (for example in the premenstrual or perimenopausal periods).

1. 1. 21 patients were asked a series of questions about their menstrual cycle by ward doctors, during their inpatient admission. Descriptive statistics were generated. Data from free text questions were analysed using thematic analysis.

2. 2. A focus group was facilitated by the ward occupational therapist on 1st November 2021, involving seven patients.

The project ran between November 2021 and February 2022. Mean age of respondents was 38 years and 57% (n = 12) were of Black ethnicity. 76% (n = 16) reported having a period in the last 12 months. Of these, 10 women felt their mental health changed throughout the month in relation to their menstrual cycle. Themes elicited from free text questions related to symptoms experienced during the pre-menstrual phase and included increased suicidality, anger, low mood and unusual experiences. Of the seven women who had not had a period in the last 12 months, over half (n = 4) reported menopausal symptoms. During the focus group those women who had gone through the menopause noted they had limited knowledge about it and how it may affect their mental health.

With regards to feasibility of enquiry, the focus group indicated that women would like to discuss their menstrual cycle, how it can affect their mood and additional support available. However, they would prefer this took place in a one-to-one setting outside of ward round, ideally with a female doctor.

A number of female psychiatric inpatients likely experience an increase in mental health-related symptoms pre-menstrually. Enquiry about menstruation is likely to be feasible in the inpatient setting, given it is done sensitively. Such enquiry could provide opportunities to discuss areas of concern to the patient and discuss specific issues such as menopause and pre-menstrual dysphoric disorder. It could also provide data for future research and guide the development of clinical practices that recognise the relationship between the menstrual cycle and women's mental health.

Frequent readmissions present a challenge to both community and inpatient mental health services and are frequently used as a quality indicator. Service users who are readmitted also tend to have a poorer prognosis and can be characterised as ‘revolving door’ patients. Determining modifiable factors that affect rates of readmission may allow mental health services to target interventions such as to improve outcomes and service users’ experiences

The caseload of an inner-city NHS community rehabilitation team was examined for psychiatric admissions over the period from January 2022 to January 2023. This was divided into an admission group and a readmission group. Readmission was defined as service users who were admitted within ninety days of the index admission. A variety of factors related to the index admission and subsequent discharge were examined and compared between the two groups to identify factors associated with readmission.

The community rehabilitation team caseload comprised of 122 care-coordinated service users. The readmission rate to an inpatient psychiatric ward between 1st January 2022 and 1st January 2023 was 37.5%. Factors that appeared to be protective against readmission were positive engagement with therapies during the index admission, such as dual diagnosis team, psychology, and occupational therapy. Additionally, service users who were discharged on a Community Treatment Order had significantly reduced rates of readmission. A shorter index admission was also associated with reduced rates of readmission. Involvement of the Home Treatment Team and medication changes in the week prior to discharge were not associated with reduced rates of readmission

The results of this study suggest that the provision of therapies by allied healthcare professionals should be prioritised in inpatient settings. Service users should be strongly encouraged to engage, and poor engagement may be considered an indication that the service user is not yet ready for discharge. Community Treatment Orders, where appropriate, should be considered to be protective against readmission. Longer inpatient stays may be associated with readmission since these service users are more likely to be severely unwell. Nevertheless, service users who require longer admissions are at high risk for readmission and interventions should be considered to mitigate this risk.

Gordon Moody offers Tier 4 treatment for harmful gambling. This poster will look at the differences between male and female harmful gamblers who apply for treatment with Gordon Moody between 2015 and 2022, and consider how treatment should reflect these differences.

An opportunity sample (n = 3,241) are analysed and discussed. Data are anonymised and men and women will be compared for: mental health diagnosis; years spent gambling; methods of gambling; average monthly amount spent gambling; and job/relationship loss due to gambling. Statistical tests are run to ascertain whether any differences are significant.

Initial analysis found that on average females applying for treatment (n = 769) start gambling at 25.2 years old, and began gambling in a problematic way at 31.8 years old. In contrast, men (n = 2,472) began gambling on average at 17.5 years old, and began gambling in a harmful way at 22.7 years old. Younger women were more likely to gamble online (i.e. online casinos; online games), whilst older women preferred gaming machines in bingo halls, bookmakers, casinos or adult entertainment centres. Men were most likely to gamble at bookmakers, which does not differ with age. On average, men estimated that they spend nearly £2,000 a month before applying for treatment (£1,980), whilst women estimated that they spend 15% less (£1,680). 14.8% of women and 58.5% of men had lost a job due to harmful gambling. 49.2% of women and 69.1% of men had lost relationships due to harmful gambling. These data will be further analysed in SPSS to ascertain any significant differences.

Men and women tend to gamble in different ways, and therefore treatment may need to be tailored for each sex. The poster will discuss differences implemented by Gordon Moody to account for sex differences. Whilst women tend to begin gambling at an older age, it still takes a similar length of time for at-risk people to develop harmful gambling practices. Women are less likely to lose jobs and/or relationships due to harmful gambling practices before they seek treatment. Key limitations of the study include the opportunistic nature of the sample, the different sample sizes, and the fact that there are insufficient applicants who identify as transgender/non-binary/other to include in analysis.

Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns.

The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021.

Inclusion criteria:

• • Any measure of prevalence or incidence of alcohol use among FSWs aged 18 years or older.

• • Countries defined as LMIC in accordance with the World Bank income groups 2019.

• • Study designs: cross-sectional survey, case–control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use.

Pooled prevalence estimates were calculated for:

1. 1. Any hazardous/harmful/dependent alcohol use

2. 2. Harmful/dependent alcohol use only, both overall and by region

3. 3. Daily alcohol use.

4. 4. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use.

In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31–51%), and of daily alcohol use was 26% (95% CI: 17–36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01–2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15–1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24–4.80), but not with HIV, violence or mental health problems.

We found a high burden of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with HIV risk factors such as inconsistent condom use, STIs and other drug use. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment

With advancing technology, there are many online resources available for people with mental health problems. Smartphone software applications are an emerging resource for mental health conditions, for which further research is crucial in understanding its role in the wider community.This study aims to appraise the literature available, surrounding mental health apps (applications) in the UK. Individual applications are studied, for disorders such as Depression, Anxiety, ADHD, Autism and Dementia for patients, carers and clinicians for either assessment or treatment.

A comprehensive literature search was completed in September 2021, involving the following databases: Cinhal, MEDLINE, Psychinfo, EMBASE, PubMed, Google Scholar, Cochrane and Nice guidelines. Studies involving multiple apps and non apps technology, duplicate studies studying the same app, apps not targeting assessment or treatment and ones that were not in the English language were omitted. Studies performed on those below 18 years of age and ones based outside of the UK were also excluded.

A total of 515 articles were identified, out of which 8 apps were deemed eligible as per our inclusion criteria. 4 apps were based on dementia, 3 for depression, out of which 1 was for antenatal depression and 1 for anxiety. It was then analysed whether some apps investigated assessment, treatment or both. 5 apps were used for the treatment of mental health disorders including 1 for both assessment and treatment and 2 focused on the research, still including assessment of mental health disorders.

This review only looked into apps that are currently available to download in the UK and some apps studied are currently in use in NHS mental health trusts.

In general, digital apps could offer the ability to respond quickly and efficiently and can reach people over great distances with minimal mobility requirements, thus, guided by a rigorous evidence-based approach, apps could be the solution to combat large waiting lists in the NHS.

We report electroencephalography (EEG) results from a non-patient pilot study conducted whilst developing a neuromodulation approach for improving visual spatial working memory (vSWM) in people with schizophrenia. Working memory impairments are common in people with schizophrenia yet respond poorly to current drug treatments. Transcranial magnetic stimulation (TMS), a minimally-invasive, well-tolerated, brain stimulation technique that is performed whilst a person is awake and alert, may improve working memory performance. However, results have been inconsistent, possibly because TMS was delivered during the heterogenous “resting-state”. We delivered TMS to left dorsolateral prefrontal cortex time-locked to specific events in a vSWM task, aiming to modulate functional networks involved in encoding spatial data into working memory.

Each trial in the vSWM task started with a 2-second-long sample display containing either three or four coloured circles positioned at random locations. This was followed by a 2-second delay period. At the end of the delay period, a visual cue appeared, indicating the target colour. Participants moved a crosshair to the screen location where the target had appeared. We recorded 64-channel EEG throughout. In Experiment 1, twelve participants completed three- and four-item task versions. In Experiment 2, eighteen participants completed the four-item task in three separate blocks within a single session. Between blocks, they completed a short task version alongside TMS. TMS (intermittent theta burst stimulation, 600 pulses, 3.3 minutes) was delivered over the F3 electrode position. Each stimulation on-phase was synchronised to coincide with the onset of sample display. In a random order, one TMS block was active, and one was sham (90° coil rotation).

In Experiment 1, EEG showed decreases (“desynchronisation”) in beta (13–30 Hz) power during sample display and increases (“synchronisation”) during the delay period. Both effects were greater in the four-item condition, and in posterior electrodes. In Experiment 2, posterior beta desynchronisation during sample display was greater following either active or sham stimulation. However, synchronisation during the delay period reduced following sham and increased only following active stimulation. Likewise, performance declined following sham but remained stable or improved following active stimulation.

We examined the effects of TMS on electrophysiological signals evoked during a spatial working memory task. We found that beta-band oscillatory activity, thought to safeguard stored information during memory delays, was increased by memory load and maintained or restored in blocks following active TMS. These effects were greatest over parietal/occipital areas. It is suggested that this beta activity serves to protect memory traces from distractors (in the current case, internal distractors). Notably, if TMS enhances delay activity within areas of the brain involved in stimulus representation that are distal from the stimulation site, then its effects are best understood as network level modulations of brain activity.

The Dynamic Appraisal of Situational Aggression (DASA) is one of a few instruments designed for the prediction of violence specifically for inpatient populations. It is important that risk assessment tools demonstrate clinical utility, and that barriers to successful implementation are addressed. If successful, the tool should not only predict risk, but lead to the utilisation of interventions intended to manage and reduce risk. The aim of this study is to learn more about the acceptability of the tool (adherence), it's outputs (nursing interventions), and the outcomes (inpatient aggression and violence). Understanding more about the relationship and processes between an intervention and its outcomes is a key step in intervention evaluation.

Data were collected over a three-month period within a medium secure forensic hospital. A total of 43 patients were included for analysis.

Categories of nursing intervention were coded and content analysis of electronic health records analysed. Incidents of aggression/violence to others was recorded as aggression to patient and aggression to staff. Data were gathered on the completion of the DASA score for all patients for each 24-hour period. A DASA score of 2–3 for moderate risk and ≥4 for high risk was used. The change in DASA score (before and after intervention) and frequency of incidents was calculated for each intervention implemented.

The average adherence of the DASA tool was 58.82% (Range 1.09% - 90.02%). The most frequent intervention following a moderate and high DASA score was that no interventions were provided. The second most frequent outcome following a high score was a focussed discussion with the patient, the use of increased monitoring and the use of seclusion. For those patients that recorded a high score on the DASA tool, eight of those scores were followed by an incident of aggression (n = 8 / 50%). There was no statistically significant difference between the change in DASA scores between interventions implemented, for both high and moderate scores.

The ultimate goal of risk assessment is the management and prevention of risk. Thus, if a high score does not result in strategies for intervention, it renders the assessment process worthless. A recommendation for future clinical practice would be the systematic recording of interventions and risk management strategies when in receipt of a high score on the DASA. Greater operationalisation of risk management strategies and their ability to reduce aggression is needed to enhance risk assessment research and clinical practice.

The Transitional Support Unit (TSU) is a unique 10-bed state-wide service and currently operates as one of two community-based long-term mental health services in Victoria. TSU is geared towards adults with complex mental health disorders in addition to a co-occuring intellectual disability or acquired brain injury--also referred to as a dual disability (DD). The aim of this project is to identify the benefits of this service to participants in order to improve the current structure and also to encourage development and expansion of similar services in Australia or globally.

The project was performed at the TSU. Participants included all previous and current residents of the TSU program (N = 24). Data were collected from three different evidence-based measures; the Health of the Nation Outcome Scales (HoNoS), Lifestar, and the Life Skills Profile (LSP). Each participant had these scales performed on admission, at time of discharge, and at 91 day intervals throughout their stay at TSU. The change in the measures were used to determine what clinical benefit, if any, resulted from undergoing engagement with the TSU program. Inclusion criteria was broad and encompassed any adult who had a DD and was admitted into TSU. Exclusion criteria was defined as any TSU resident with no completed discharge scales for comparison.

On review, it was found that on average, there was an overall decrease in HoNoS scores from admission to discharge of 4 points. For the LSP, there was an average decrease of 10 points in TSU participants and the Lifestar was found to have an average increase of 20 points. Within Lifestar specifically, participants were found to have an average improvement between 1.64 and 2.94 in each individual category assessed. No TSU participants were observed to suffer from any decline or step back in categories related to how they spent their time, feeling good about themselves, or the people they knew.

TSU does appear to have notable benefit for adults with DD, particularly in improving overall mood, social interaction, and development of a routine as well as activities throughout the day. The least improvement was found in categories such as physical health and communication. The data were limited by participants who have not yet been discharged from TSU, therefore any discharge scales were unavailable for comparison.

The aim of this project was to evaluate the impact of ECT on depression and mood symptoms.

50 patients who were treated with ECT within NSFT (2020–22) were assessed using extended Hamilton Depression Rating Scale (HDRS, observer rated depression scale). This rates depression out of a possible 40, with higher scores indicated more severe depression: under 7 indicating no depression, 8–16 mild depression, 17–23 moderate depression and over 24 as severe depression. Cognition was also assessed (using Mini Ace) .

HDRS was carried out at the start, mid point (session 6–8) and end of ECT, and scores were then evaluated.

All patients showed a significant drop in HDRS scores and an improvement in depressive symptoms (even the ones who were no being primarily treated for depression). This effect was most notable between start and mid point of ECT.

Mean scores at start of ECT were 24/40 (range 11–36), mean at mid point was 11 (range 4–25) and mean at end of treatment was 7 (range 0–14).

This Project would seem to reflect the findings from functional neuroimaging: that the greatest impact of ECT on neurophysiology and anatomy (including on brain structures) occurs in about the first 6- 8 sessions. This positive effect continues with subsequent treatment but at a reduced gradient. The effect is noted to be statistically significant for this project/sample.

In Conclusion: all 50 patients started ECT depressed (again, even those who were not being primarily treated for depression) and all patients improved with ECT. At the end of ECT, only 7 patients scored over 7 on HDRS and none over 14 (i.e. only 7 (14%) of patients were assessed as having mild depression compared with 50 (100%) at the start of ECT treatment).

This project would further support that ECT is a highly effective treatment for depression, especially when a rapid response is required due to severity or threat to life (such as catatonic or not eating/drinking, as was the case 6 patients seen) or for psychotic depression (12 patients). It is notable that all patients had a reduction in depressive symptoms, even those not presenting with depression or marked mood symptoms.