The MRCPsych (Membership of the Royal College of Psychiatrists, United Kingdom) parallel training pathway has been introduced in Malaysia to produce competent psychiatrists to deliver evidence-based psychiatric care. Certain training centres faced specific challenges during the process of implementation, including the lacking of supervisors with experience in the MRCPsych examination, over-reliance on self-study and existing continuous medical education (CME), logistic difficulty in accessing specific training courses, the sustainability of local training, and loss of manpower due to frequent mobilisation of trainees. This article is aimed to illustrate the Northern STARS (Supervision, Training, and Reflective System) project, i.e. a project implemented as a solution for those challenges and an effort to develop a sustainable model of training for the local talents in Perlis, a northern state in Malaysia.

The Northern STARS initiatives included: setting up a library with more MRCPsych-related materials; introducing trainees to virtual MRCPsych support groups; organizing both physical and virtual training locally, collaborating with local and international experts for consultation and teaching, and the introduction of protected study time. Virtual platforms were used innovatively to minimise cost. Ongoing data were collected for programme evaluation and quality improvement. Trainees were actively involved in the process to facilitate the development of leadership and administrative skills.

A total of seven courses covering both skill and theory training had been organised: Ultra-brief Psychological Intervention Workshop, Dialectic Behavioural Therapy workshop, Personality Disorder Workshop, Critical Appraisal Workshop, MRCPsych Lecture Series, Addiction Psychiatry Lecture, and Basic Revision Course on Electroconvulsive Therapy. An estimated amount of twenty thousand Malaysian Ringgit had been generated and channelled into the community mental health centre, accounting for the indirect cost of a subscription to ZoomTM and the intangible cost of labour effort. Overall feedback revealed a high level of satisfaction together with some specific suggestions on areas of improvement, including the timing of course and coverage of the curriculum. To date, six medical officers are pursuing this pathway with three of them passing one paper and another two pursuing the final part.

The Northern STARS project is an ecosystem of training solutions while generating income and producing more local talents to expand this project further. More long-term evaluation from the perspective of human resource and health economics can be considered to understand the efficiency of the current initiative.

One in 57 children are diagnosed with autism in the UK, and the estimated cost for supporting these children in education is substantial. Social Stories™ is a promising and widely used intervention for supporting children with autism in schools and families. It is believed that Social Stories™ can provide meaningful social information to children that can improve social understanding and may reduce anxiety. However, no economic evaluation of Social Stories has been conducted.

To assess the cost-effectiveness of Social Stories through Autism Spectrum Social Stories in Schools Trial 2, a multi-site, pragmatic, cluster-randomised controlled trial.

Children with autism who were aged 4–11 years were recruited and randomised (N = 249). Costs measured from the societal perspective and quality-adjusted life-years (QALYs) measured by the EQ-5D-Y-3L proxy were collected at baseline and at 6-month follow-up for primary analysis. The incremental cost-effectiveness ratio was calculated, and the uncertainty around incremental cost-effectiveness ratios was captured by non-parametric bootstrapping. Sensitivity analyses were performed to evaluate the robustness of the primary findings.

Social Stories is likely to result in a small cost savings (–£191 per child, 95% CI −767.7 to 337.7) and maintain similar QALY improvements compared with usual care. The probability of Social Stories being a preferred option is 75% if society is willing to pay £20 000 per QALY gained. The sensitivity analysis results aligned with the main study outcomes.

Compared with usual care, Social Stories did not lead to an increase in costs and maintained similar QALY improvements for primary-aged children with autism.

Lithium is an effective mood stabiliser for the treatment of the bipolar disorder. Its utility is not restricted to acute mania and prophylactic treatment of the bipolar disorder. Another well-known indication for its use is the treatment of refractory depression. Lithium can cause several adverse effects, and typically the side effects are dose-related. Unlike antipsychotic medications, lithium is rarely associated with drug-induced Parkinsonism.

We present a case of 78 years old gentleman who was assessed due to complaints suggestive of cognitive impairment. His past psychiatric history revealed that he was admitted to a psychiatric inpatient unit with a diagnosis of treatment-resistant depression in 1991. Lithium therapy was commenced during this admission, and he remained on lithium for 27 years. The patient was clinically stable in terms of the symptoms of depression; however, he reported bilateral postural tremors 20 years after the initiation of lithium therapy. Initially, he was diagnosed with lithium-induced tremor; however, in the following months, his symptoms had worsened, and he developed new motor disturbances, although the serum levels of lithium were within the therapeutic range. On examination, he had classic parkinsonian signs of shuffling gait, muscle rigidity in all four limbs and freezing of gait. DaT-SPECT imaging clarified the diagnosis as drug-induced Parkinsonism. As the daily lithium dosage was stopped, the patient's motor symptoms improved significantly; nevertheless, some of the symptoms persisted.

The pathophysiological mechanism behind lithium-induced Parkinsonism is unclear. The condition may develop with or without frank lithium toxicity and have diverse presentations. Literature suggests that the risk factors for lithium-induced Parkinsonism appear to be the patients' age, duration of lithium therapy, and serum lithium levels. It has been suggested that older patients have a more permeable blood-brain barrier and decreased renal clearance; hence, serum lithium levels can appear therapeutic, but brain lithium levels may be much higher. Pharmacokinetic drug-drug interactions might also contribute; thus, careful monitoring is essential.

Drug-induced Parkinsonism improves with discontinuation of the offending medication; however, 10% of patients will develop a persistent and progressive parkinsonian syndrome.

This report aims to emphasise the need to consider lithium-induced Parkinsonism when Parkinson Disease symptoms appear in chronic lithium users and close monitoring of lithium levels in geriatric populations. It is essential to recognise the condition, avoid misdiagnosis and prevent inappropriate use of anti-dopaminergic medications.

This project aimed to assess the effects of COVID-19 on the mental health of adolescents, reflected through their presentations to A&E departments in NHS Lanarkshire.

The psychiatry liaison database was searched for referrals of 17 year olds and under from April until August 2020.

All referrals to all acute hospital sites in Lanarkshire received from any source were included. The only exclusion criteria applied were age over 17 and unavailable assessment information.

The sources searched for information were: patient's electronic notes, Mental Health Assessment forms, Mental Health Risk Assessment forms and electronic letters. The following information was gathered:

• – patient's age

• – date, source and reason for referral

• – hospital site of assessment

• – outcome of assessment

• – Between April and August 2020, the number of CAMHS A&E referrals increased every month except in July.

• – The age range of CAMHS patients presenting to A&E were 12-17 years, with 17 being the most common age seen.

• – 87% of referrals were from A&E.

• – The two most common reasons for referrals were drug overdose and suicidal ideation.

• – The most common outcome of assessment was a CAMHS referral.

• – COVID-19 was a trigger for an adolescent's presentation to A&E in 31% of cases, the most common cause being struggling with the lockdown/restrictions.

The mental health charity YoungMinds carried out several surveys throughout the COVID-19 pandemic's first wave. They demonstrated a detrimental effect on young people's mental health in the UK.

YoungMinds surveys revealed that 32% and 41% of young people experienced “much worse” mental health due to COVID-19. The findings of NHS Lanarkshire were similar, with 31% of adolescents presenting to A&E as a result of COVID-19.

No adolescent included in this review had contracted COVID-19 at any point. Their mental health was therefore impacted by the indirect effects of COVID-19 rather than the direct effects of infection. For the 31% of CAMHS presentations to A&E which were due to COVID-19, most young people struggled with the lockdown/restrictions.

The number of presentations to A&E increased every month between April and August 2020 except for July. This could be due to people's initial fear of coming to hospital and catching COVID-19. However, as infection and death rates decreased towards the summer, people may have regarded hospitals as safer. The general increase in referrals every month may also be a reflection of the worsening of young people's mental health the longer the pandemic extended.

To assess whether direct access to a 45 minute screen appointment in a Consultant Psychiatric clinic, based in General Practice, affects; the number of contacts patients have with secondary care pre and post being seen; whether the General Practitioner (GP) would have referred to secondary services if the clinic had not been in operation; the GPs’ views on how helpful the clinic was in understanding the patients’ problems and managing the problems outside of secondary care.

A Consultant Psychiatrist in Leeds offered bespoke 45 minute screening appointment clinics in three sister GP practices, accepting direct referrals from GPs without requiring referrals to the local Community Mental Health Team (CMHT). This model was created to reduce the number of patients moving repeatedly between GP and secondary mental health services as this was leading to patient dissatisfaction and increased GP and CMHT workloads.

We compared the number of mental health contacts (per month), for each of the 57 patients who had been referred to the clinic, in the months pre and post being seen in the clinic. We also asked the involved GPs to complete a brief survey for each patient who had been referred to determine whether, they would otherwise have been referred to the CMHT and whether the clinic has helped with their understanding and management of the patients’ problems.

The mean number of contacts with secondary services before being seen in clinic was 3.30 per month compared to 0.44 after being seen. The mean difference of 2.86 is statistically significant on a paired-test with a P Value of 0.0149 (95% confidence intervals of 0.58 to 5.13). We received 22 survey responses from GPs of patients referred to the clinic including for patients who did not attend. All 22 responses indicated that the patient would have been referred to the CMHT if the clinic had not been available. 95% were rated as being very helpful or moderately helpful in understanding the patient's problems. 91% were rated as very helpful or moderately helpful in managing the patients’ problems outside secondary care.

Our evaluation has demonstrated that a model of direct access for GPs to a Consultant Psychiatric clinic can reduce referrals and patient contacts with secondary mental health services. GPs have found this model helpful in understanding patients’ problems and managing the problems outside of secondary care.

GMC defines clinical supervisor as a trainer who is responsible for overseeing a specified trainee's clinical work throughout a placement in a clinical or medical environment and is appropriately trained to do so¹.

This AUDIT aimed to review the frequency, content and quality of clinical supervision for psychiatric trainees within Somerset NHS Foundation Trust. Both Severn deanery and Somerset NHS Foundation Trust both recommend psychiatry trainees have one hour of supervision per week, involving exploration of trainee clinical and educational needs.

All trainees working in Somerset NHS Foundation Trust psychiatry from February 2020 were invited to participate. A survey was designed to quantify the frequency of supervision amongst this cohort. Survey online software, SurveyMonkey, was chosen for the accessibility and user friendly modality and disseminated via email to all junior doctors (n = 27). Survey responses were collected in the last month of the placement (July–August 2020).

Questions on accomplishing workplace based assessments (WPBA), managing e-portfolio requirements were asked, with Likert scale responses available. Quality of supervision was explored via white space answers.

Surveys were reviewed by the AUDIT authors and descriptive data collected.

63% trainees responded (17 out of 27). Educational objectives were discussed at the beginning of the placement. Over half the respondents stated that time was not set aside to look at e-portfolio.

Workplace based assessments (WBPAs), and Case based discussions (CBDs) were more frequently achieved than observed assessments of clinical encounters (ACEs/Mini-ACEs) (assessment of clinical encounter).

30% core psychiatry trainees respondents (4 out of 7) discussed their audits/QI projects with their supervisors most/always. 42% (3 out of 7) had a discussion sometimes.

2 GP and foundation trainees stated they were unable to obtain community mental health experience. The response rate to this question was disappointing and we think it may be secondary to the pressures of the pandemic.

100% respondents described educational supervisors as supportive and approachable.

Whilst all respondents found their supervisors approachable and supportive, completion of formal WPBAs and portfolio reviews was suboptimal.

Following regional presentation of results, the pertinence of these findings for all trainees was highlighted. A supervision template has been created and extension of this initial audit to a regional quality improvement project is underway.

Specific recommendations included brief and regular supervisor check-ins with trainees regarding projects and psychotherapy competencies and a mid-placement review of portfolio.

Over the last decade, there have been significant developments in the use of simulation for undergraduate medical education. Despite simulation's diverse applications across the medical school curriculum, it has thus far been underutilised within psychiatry teaching. Psychiatric simulation can support students to develop strategies to elicit psychopathology, de-escalate an aggressive patient or perform a risk assessment. Such experiences can be difficult to encounter during clinical placements and may expose a student or patient to an unacceptable level of risk. We have therefore developed an immersive simulation course that aims to enhance undergraduate psychiatry training.

Our course was developed by medical education faculty and psychiatry staff. The course handbook includes storyboards, patient scripts and debrief guidelines. Clinical scenarios are mapped to university intended learning outcomes and include; conducting a risk assessment for a patient with emotionally unstable personality disorder and comorbid depression, managing a manic patient in the Emergency Department and assessing a patient with obsessive-compulsive disorder who has developed skin damage due to hand washing.

The one-day course is delivered to groups of 4-8 students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. The course takes place in a simulation suite and is facilitated by psychiatrists and medical education faculty. Students each take the lead role during a clinical scenario in which they will encounter a simulated patient. Live video from the simulation is broadcast to other candidates. Scenarios last 10-15 minutes with a 20-30 minute group debrief immediately afterwards. The debrief utilises the PEARLS framework (Promoting Excellence and Reflective Learning in Simulation) and provides the opportunity for peer and facilitator feedback, as well as discussions regarding mental state examination, diagnosis and management.

Qualitative and quantitative feedback has been collected via an anonymous electronic post-course questionnaire. To date, the course has received universally positive feedback. 93% of candidates rated the overall quality of the course as a learning experience as ‘excellent’. Students reported that the course helped them develop communication skills which they could apply to future clinical situations. In addition, candidates felt participation had increased their confidence in taking a psychiatric history and performing a risk assessment.

Immersive simulation is an underutilised tool in psychiatry education. Our course complements the existing educational programme of lectures and ward-based teaching and has been positively received. It provides the opportunity for students to develop interview techniques and communication skills in a safe, controlled environment.

Early assessment, diagnosis and management for people living with dementia is essential, both for the patient and their carers. We recognised delays in established local pathways when patients had unplanned acute hospital admissions preventing them from attending memory diagnostic appointments. The Psychiatric Liaison Team (PLT) Memory Pathway was introduced as we had the skills and expertise to resume the process and to find new undetected patients.

Our aim was to determine how well the newly implemented PLT Memory Pathway follows the standards outlined in the National Institute of Health & Care Excellence (NICE) Clinical Guideline 97 (CG97): Assessment, management and support for people living with dementia and their carers.

A retrospective analysis of all PLT referrals from July 2018 to February 2020 (20 months) was performed to identify patients on the community memory pathway and those with possible undetected cognitive impairment. Data were collected from electronic patient records which included demographics, primary and collateral history, cognitive testing and imaging, dementia type among others. Results were analysed using Microsoft Excel.

41 patients were included (59% female). 80% of patients were referred for memory problems or confusion. 63% had previous referrals to a memory service and was on the community memory pathway at the time of the referral. 34% were on anticholinergic medication but in only 14% were this documented as reviewed. 100 % were offered and had head imaging. A finding worthy of note was the absence of any from the ethnic minority background. 63% of patients were given a memory diagnosis and 34% had anti-dementia medication started. Patients’ families were made aware of the diagnosis in 83% of cases, due to the absence of next of kin details in the patient record. Primary Care was made aware in 100% of cases; post-diagnostic support was 100%.

The PLT is well placed to bridge the service gap between the acute care trust and established community memory services when dealing with patients with dementia. A dedicated Memory Pathway has helped to close this gap and adherence to NICE CG97 standards was good, but there is room for improvement. A particular focus will be on improving documentation of anticholinergic medication review and exploration for the absence of ethnic minority patients. Aiming to achieve 100% family involvement is also recommended.

This study has been submitted to the Royal College of Psychiatrists' Faculty of Old Age Annual Conference 2021.

The objectives/aims of the Audit include:

1. 1. To standardize and implement ICP for service users attending DNCC CAMHS team in accordance with the established policy.

2. 2. To achieve greater involvement of service users/parents in ICP.

3. 3. To standardize and improve treatment of care involving all members of one team.

Every patient should have a care plan. Each care plan has a set of needs and goals. These are agreed between the service user and key worker and are assessed and measured frequently. Consultation with each service user/parents, as far as practicable is important. Specification of treatment and care required in accordance with best practice should be recorded. Identification of the necessary resources should be recorded and discussed with service user and key worker. Records kept in one composite set of documentation, and a signed copy should be made available to the service user/parents.

First Cycle commenced 15th October 2019. 166 files were selected from CAMHS team. Data were collected from clinical records from time of admission into CAMHS service to the time of audit. The audit report was prepared on the 6th December 2019, and intervention discussed at the multidisciplinary team meeting and wider DNCC CAMHS academic meeting. Second Cycle 23rd March 2020. 30 files randomly selected and audited. Data were collected by Dr Uchechukwu Egbuta, Mr Cillian Howley, Dr Anitha Selvarajoo, under supervision of Dr Muhammad Iqbal and Dr Diana Meskauskaite.

Method of data input/analysis is IBM SPSS.

For each ICP, the following were looked at: Files with ICP, Identifiable key worker, Formulation, Goals, Action plan, Copy of ICP to young person/parents, Next Review Date, Projected discharge date.

Overall compliance shows 62% in first cycle, and 68% in second cycle after intervention.

There was a 6% quality improvement of ICPs in terms of overall compliance in applying the various components of ICP.

Each service user should have an individual care plan. Each individual care plan should be measured regularly. To develop a therapeutic individual care plan, a formulation of the case from history taking is essential looking at the bio-psychosocial model and should be service user focused. Care plans are part of clinical governance, therefore continuous re-audit every three months was recommended. The follow-up audit will be carried out by the multidisciplinary team members.

Depression remains an exceedingly ubiquitous entity that significantly depreciates the quality of life and disease prognosis among end-stage renal disease (ESRD) patients. Even though the deleterious effects of depression on ESRD patients are well-established in the literature, the predictive factors that predispose such patients to depression need to be explored. Our study thus aims to gauge these factors and create a predictive model for optimal psychiatric and medical management of such patients.

All ESRD patients with a disease duration of at least one year underwent a complete psychiatric evaluation based on DSM-V guidelines preceded by a cognitive evaluation by Mini-Mental State Examination (MMSE). A total of 73 patients diagnosed with moderate to severe major depressive disorder were selected as cases. Patients suffering from recurrent psychotic episodes, having a past or family history of psychiatric illness, being already treated for depression, having any substance abuse (current or past), were excluded from the study. Following the similar guidelines, and exclusion criteria, 146 patients (two controls for each case) having no depression were selected as controls. The cases and controls were studied and matched for a myriad of sociodemographic factors. The various risk factors for depression were evaluated using univariate and multivariate binary logistics analysis.

The significant risk factors for depression among hemodialysis patients were age (OR = 1.79, CI = 0.47–3.81), comorbidities (OR = 2.13, CI = 0.51–3.96), duration of renal disease (OR = 2.54, CI 0.63–4.28), duration of hemodialysis (OR = 2.36, CI = 0.89–4.11), unemployment (OR = 2.33, CI = 0.79–3.88), and being unmarried (OR = 1.93, CI = 0.44–3.53). Prospect of survival, financial instability, social stigmatization, and effect of comorbidities on ESRD were major concerns for the cases that attributed to their depressive symptoms.

The factors that herald the onset of depression among hemodialysis patients include increasing age, presence of comorbidities, unemployment being unmarried, and increasing duration of hemodialysis. These factors will aid the clinicians to identify high-risk patients that require psychiatric consultation. We recommend prompt psychiatric intervention (pharmacologic or non-pharmacologic) and appropriate patient counseling so that the depressive symptoms can be alleviated and dismal disease prognosis can be prevented among such high-risk patients.

To examine links between Adverse Childhood Experiences (ACE) categories and diagnosis of antisocial personality disorder (ASPD) in this population; it is predicted that there will be a positive association between number of ACEs and ASPD. The effectiveness of high secure hospital admission and treatment in reducing number of risk incidents was also examined. ACEs are known to impact significantly on the development of the personality and future psychiatric risk. Currently, research into links between distinct ACE categories and the diagnosis of ASPD in the high-secure inpatient population is limited.

Data were collected from a sample (n = 221) including all patients in the Mental Health, Personality Disorder and Women's Services at a high-secure hospital. Records were examined for evidence of abuse/neglect during childhood, and a number of markers of household dysfunction. The statistical relationship between each ACE category and subsequent diagnosis of ASPD was examined through paired t-tests. Frequency of incident reports (IR1s) involving violence was compared in the first, third and fifth years post-admission.

Significant associations with adult diagnosis of ASPD were seen in categories of childhood physical abuse, sexual abuse, divorced/separated parents, Looked After Child (LAC) status and parental substance misuse, and total number of ACE categories present overall. Significant reductions in frequency of IR1s were seen in all services between first- and fifth- year post admission.

A significant association between ACEs in specific domains and ASPD in adulthood was found. The importance of detailed exploration of childhood circumstances in this group is highlighted, as well as the need for further investigation of the psychological and social mechanisms underlying.

The aim of this study is to assess the level of alexithymia, coping strategies and stress contribution to illness in patients with psoriasis and atopic dermatitis in order to increase effectiveness of dermatological treatment.

59 patients with atopic dermatitis, 67 with psoriasis and 65 healthy control group individuals were included in the cross-sectional study. Predominant complains of the patients: itching, widespread rashes and rashes on the open areas of the skin. In 85% patients with skin pathology onset of the disease and relapses were associated with stress, in 15% other factors.

“The 20-item Toronto Alexithymia Scale” was used to assess alexithymia. “The Ways of Coping Checklist, Lazarus” was used to assess coping-strategies. “The Holmes and Rage Stress Inventory” was used to assess stress contribution to illness. Significance level: p < 0,05.

The levels of alexithymia (p = 0.002), difficulty identifying feelings subscale (p = 0.02) and externally-oriented thinking subscale (p = 0.002) in patients with skin pathology (especially in those with psoriasis) were higher than in the control group.

Patients with skin pathology turned out to be more susceptible to stress factors (p = 0.025) and less often use coping strategy “seeking social support” (p = 0.037).

Patients with skin pathology with high levels of alexithymia and difficulty identifying feelings subscale more likely to use maladaptive “escape-avoidance” coping (p = 0.001).

Patients with atopic dermatitis who find difficult to describe feelings are more likely to use maladaptive coping “distancing”(p = 0.002).

In patients with psoriasis high levels of alexithymia and externally-oriented thinking subscale scores are associated with less common use of the adaptive coping “problem solving”(p = 0.001). Moreover, in patients with psoriasis high levels of difficulty identifying feelings subscale are associated with more common use of maladaptive “escape-avoidance” coping (p = 0.001).

The results of the study confirm the need to include psychological assessment and psychotherapy in the treatment plan for patients with psoriasis and atopic dermatitis in order to improve emotional awareness and to develop more adaptive coping-strategies in patients.

Transference-focused psychotherapy (TFP) is a manualized evidence-based treatment for severe personality disorders (PDs) based on a psychodynamic approach that focuses on object relations theory. It has been used as a teaching tool in different psychiatric settings. Psychiatry trainees are often the “first-responders” in multiple services, and they have to deal with patients with PDs in various settings. Yet there is a documented gap in psychiatry trainees’ education regarding the assessment and management of patients with PD pathology. The aim of our study was to evaluate whether a series of teaching sessions on TFP theory and techniques as applied to PD could improve the attitude and technical confidence of psychiatric trainees in the clinical encounter of a patient with a PD.

Two cohorts of psychiatry trainees in Tower Hamlet's East London Foundation Trust received four teaching sessions, each of one hour duration, on TFP theory and techniques. All the sessions were delivered online, using video teleconferencing software. 14 Trainees completed 2 questionnaires, pre- and post-teaching: the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence with Personality Disorder Questionnaire (CCPDQ). The APDQ asks the responder to score from 1–6 the frequency they experience certain feelings towards patients with PD. In the absence of a suitable instrument, we developed the CCPDQ consisting of a set of 13 questions rated on a 6-point Likert scale addressing key issues identified in TFP including establishing and maintaining the treatment frame and in implementing the 4 main techniques. We also conducted a 1-hour focus group post teaching which was videorecorded, transcribed, and analysed thematically.

On quantitative analysis, the Wilcoxon signed-rank test indicated statistically significant improvements in the total APDQ score (P = 0.003, r = 0.81) and in the CCPDQ questionnaires (P = 0.001, r = 0.88).

The thematic analysis showed an overall positive effect of the TFP teaching on trainees’ attitude and confidence: they felt it improved their understanding of the nature of personality disorder, their awareness and management of countertransference, awareness of object relations and relation dyads at play in the encounter.

Training junior doctors about TFP theory and techniques as applied to PD can significantly improve their attitude towards these patients and their technical confidence in the clinical encounter. Of note, our workshop is resource light and can easily be delivered by remote teaching. Based on these findings, teaching of TFP in the core psychiatric training curriculum should be considered.

Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes.

The aim of this paper is to describe the educational evaluation of the National Extension for Community Healthcare Outcomes – Adults with Intellectual and Developmental Disabilities (ECHO-AIDD), a programme for service providers working with adults with IDD during COVID-19.

The programme consisted of six sessions, conducted weekly, over two cycles. Each session included didactic teaching by hub team members, COVID-19 news updates, wellness check-ins and a brief mindfulness activity, followed by a 30 to 45 min case-based discussion. The hub structure had an inter-professional approach to team expertise. Those with lived experience were an integral part of the content experts’ hub. Pre-, post- and follow-up evaluation data were collected.

Care providers from health and social care sectors (n = 230) participated in the programme. High levels of engagement and satisfaction were reported. Self-efficacy ratings improved from pre- to post-, and were maintained at 8-week follow-up; improvement from pre- to post- was significant (P < 0.0001).

Exposure to National ECHO-AIDD educational intervention led to improvement in perceived competencies. This study also shows the valuable role of people with lived experience in fostering adaptive expertise in learners. The outreach and scalability support the feasibility of building a national virtual community of practice for IDD service providers. Future studies should focus on studying the impact of these programmes on the health outcomes of people with IDD.

None.

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.

This study aimed to assess the level of satisfaction patients feel towards their experience of attending for psychotherapy, in order to inform local management on the service being offered by the department.

This survey was conducted as part of routine service provision analysis by the psychotherapy department. It aimed to assess the level of satisfaction patients feel towards their experience of attending for psychotherapy, in order to inform local management on the service being offered by the department. Ethics committee confirmed this fulfilled “Service evaluation” criterion and the project was registered with the local NHS quality improvement register.

Patients who completed an episode of therapy were invited to complete a survey form. This consisted of a Client Satisfaction Questionnaire (CSQ-8) as well as four additional questions pertaining to patient satisfaction. The patient's therapist would inform administration staff of the patient's final appointment; administration staff would then issue the patient with a questionnaire which they were invited to complete and return in their own time. The questionnaires were completed anonymously and no reward was offered for completing the questionnaire. The therapies included group analysis, psychodynamic individual and Cognitive Analytic Therapy.

22 patients who had completed psychotherapy in 2018–2019 returned a completed questionnaire. The average and range responses were examined.

The average response was “4: Excellent” for the overall rating of the service received, and for 5 other questions on the CSQ-8 the average score was the highest possible. The average response was slightly lower on the question about whether the service met their needs “3: Mostly”, and on the question: Has the service you received helped you to deal more effectively with your problems? (3 yes, somewhat). The additional questions highlighted how important the setting and administration role played in the experience of therapy. The questionnaire also included a free text box giving the patient the opportunity to offer any other comments. Many of these included messages of gratitude and remarks on the impact therapy has had on their general wellbeing.

In general it is encouraging to see that feedback provided through this survey was extremely positive. This was reflected both in the Likert scale questions and the free text box. Patients are described themselves as very satisfied with their experience within therapy and reflected a positive experience of the holding environment provided by the department as a whole.

(NO Funding received)