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Aims1) To hear directly from women suffering from PMDD about their lived experiences of PMDD and the impacts that it has on their daily lives.2) To raise awareness about the impacts that PMDD can have on patients' quality of life, relationships, and productivity, to improve clinicians’ understanding of patients' needs.3) To identify a gap in research into PMDD within the UK and highlight the need for further research.4) To improve awareness of PMDD amongst diverse stakeholders, including women who are not yet diagnosed with PMDD, employers, and policymakers.MethodsParticipants were recruited from the UK's PMDD Patient Insight Group and screened using the Premenstrual Symptom Screening Tool (PSST) for PMDD. Eligible participants were purposively sampled, and 15 participants were invited to a semi-structured scheduled interview on Zoom. Interviews were transcribed using NVivo transcription software, and inductively analyzed using reflexive thematic analysis in NVivo 14.ResultsThirteen subthemes were identified and organised around four main themes: Theme 1: ‘Jekyll and Hyde’, Life with PMDD, Theme 2: ‘The Aftermath’, The Impact of Living with PMDD, Theme 3: ‘Surviving PMDD’, Coping Strategies, and Theme 4: ‘Seeking Treatment’, Experiences with Healthcare. The themes identified in this study highlight the negative experiences of women living with debilitating symptoms that appear during the luteal phase and disappear following the onset of menstruation. Themes also capture the immense burden PMDD places on a sufferer by uncovering how exactly these symptoms affect interpersonal relationships, career progression, quality of education received, and relationship with oneself. Theme 4 focuses on women's negative experiences with healthcare stemming from a lack of awareness of PMDD in the medical community.ConclusionThe findings of this study highlight the critical importance of understanding the contextualized experiences of women living with PMDD in the UK and bringing to light the immense monthly burden sufferers face. To prevent women and Assigned Female At Birth (AFAB) individuals from experiencing severe and prolonged psychological distress which can have fatal consequences, there needs to be greater understanding and awareness of PMDD in both medical and lay communities. In addition to this, clinicians must be trained in PMDD assessment and research should be encouraged to introduce new treatments and to implement policies that minimize the burden of PMDD in the workplace.

AimsTo improve the overall experience of IMG Doctors at BSMHFT. To demonstrate this, we targeted an increase in percentage of doctors rating their experience as excellent in our survey.MethodsEmploying the “Model for improvement”, we co -produced all aspects of project with subject matter experts (IMGs).• What are we trying to accomplish? We co-produced process map/aim.• How will we know that a change is an improvement? Co-produced survey, circulated monthly, data collected and analysed.• What change can we make that will result in an improvement: Co-produced change ideas from process map, survey data and weekly meetings. Commenced testing some change ideas in this phase.Other QI tools utilized include Driver diagram and family of measures.• Change strategies (PDSA cycles):These include:◦ IMG specific session at Trust Induction. 15 minutes slot allocated to introduce project and encourage involvement.◦ IMG whatsapp group.◦ IMG Forum.◦ Dedicated Email Inbox.◦ Learning/career progression sessions.◦ Social events.◦ IMG representative.Following organised sessions number of attendees recorded and feedback obtained via survey.ResultsOutcome measure (Aim) - 5 months of survey data obtained. An average of 10 IMGs responded to monthly survey. Data presented on statistical process chart (SPC) revealed a median value of 33% of respondents (IMGs) rated their experience as excellent.Process measures –• Trust Induction – 2 PDSA cycles completed. 15 IMGS joined the Whatsapp group following induction sessions. 24 IMGs joined the IMG mailing list.• Whatsapp group – Completed 9 PDSA cycles. Average of 3 IMGs joined per week. 69 members at present. Data indicates informal posts, planned activities, information sharing, and spontaneous queries encouraged engagement.• IMG Forum – one PDSA cycle completed. 20 IMGs attended. Feedback was obtained and 63% of respondents rated the effectiveness of the session as excellent.• Social event – one event arranged; 16 IMGs attended.ConclusionFrom this phase of the QI project, we have been able to foster an increased sense of community peer support and camaraderie amongst IMGs. This is highlighted by increased numbers in WhatsApp group, mailing list and attendance at events.The change ideas positively impacted participation, engagement, and satisfaction with the project providing a previously unavailable psychological safe space.33% of respondents rated their overall experience as excellent from the monthly surveys that were sent out.In terms of next steps, we aim to implement other change ideas and aim to increasing respondents’ rating as excellent to 50% by December 2024.

AimsWe aim to see whether DNAR discussions are being undertaken at an appropriate time for our patients, as well as seeing whether these are recorded formally and regularly reviewed, as per local protocol. We also aim to see whether the immediate medical/nursing teams are aware of the local guidelines, as well as which of their patients have a DNAR in situ, and how to find this out. As an old-aged psychiatric unit, this is very important.MethodsWe used 2 methods of data collection. One was questionnaires that we gave out to medics, nurses, and HCAs on our wards. We collected quantitative data from them on whether they knew where DNAR forms were and which of their patients had DNAR forms. We then also collected quantitative data from our online notes, looking into which patients had DNARs, whether these were recorded online and in a physical copy, whether it was discussed on clerking, and whether it was regularly reviewed and documented in MDTs. We used data from 51 inpatients over 3 wards.ResultsOver 30% of patients have a DNAR in situ across the 3 wards. The dementia-focussed wards have a higher number of DNARs in place. All patients with a DNAR had a purple form completed and kept on the ward. 75% of staff knew where these were. Only 20% of those with DNARs had these documented online as per local guidelines; only 45% of staff knew where to find this information online. Only 8% of patients had their DNAR status discussed on admission, and 10% in their first MDT. Only 60% staff knew which patients had a DNAR in situ.ConclusionThere is evidence that purple forms are completed appropriately and stored well. The main issue is the online record-keeping; staff either don't know how to or that they can document this online. This is reiterated as many did not know where the information was online. This demonstrates a lack of knowledge and education.DNAR conversations are not occurring in the first place; the status is not being regularly reviewed, leading to issues where these conversations are rushed during acute events. It is important to think about these things earlier to ensure everyone, patient, family and staff, understands the process and rationale.Lack of staff knowledge on which patients have DNARs in situ could be a great issue if an acute event were to occur, and compromises patient safety.

AimsThe aim of this audit was to review the availability of recommended resuscitation equipment in Prospect Park Hospital (PPH), a psychiatric hospital based in Berkshire.The objective was to improve patient safety standards and address staff concerns by ensuring that recommended resuscitation equipment was accessible and fit for purpose.Our hypothesis was that the current standard of resuscitation equipment at PPH was unsatisfactory.BackgroundThis review followed concerns by doctors who struggled to obtain the necessary equipment required for emergency situations, particularly during their out of hours shifts.This project was significant as within the previous year there had been two incident reports and extensive anecdotal evidence of equipment failure/absence.Whilst each ward had been tasked with completing a weekly checklist issued by the Resuscitation team, these had not been audited to ensure that standards were being met.MethodsData was collected from ten locations at Prospect Park Hospital from 9th May to 15th May 2023.Information was obtained by two doctors visiting the specified wards, reviewing the resuscitation bag equipment based on the standardised checklist.The standards used were from local trust policy and Resuscitation Council UK policy.Results7/10 locations did not meet the standards for resuscitation equipment, including missing or expired equipment such as adrenaline, suction devices and oxygen masks.4/10 wards had not completed the weekly emergency drug checklist within the stipulated time frame.70% of staff completed checklists were incorrect.ConclusionOur hypothesis was proven to be correct, in that the current standard of resuscitation equipment at PPH was unsatisfactory.We worked closely with the Resuscitation lead to recommend improvements, including an updated, more detailed checklist, a standardised procedure for ward managers and regular future audits.Due to the significance of the findings, this has since been re-audited and is in the process of being rolled out Trust-wide, including all inpatient and community settings.As a result of this audit, the Resuscitation team have been granted additional staffing to action these changes and increased their remit to monitoring equipment in addition to training.These findings demonstrate that it is vital that the recommended resuscitation equipment is available and suitably maintained, particularly in a community hospital setting with limited resources where it can be life-saving.

AimsDVLA guidance is very clear about patients not driving during or shortly after episodes of acute mental illness. There is an obligation for patients to inform the DVLA if they are unwell. The obligation for doctors to inform the DVLA if the patient chooses not to, and continues to drive when they should not, is also well known.This audit aims:1. To identify the number of patients whose driving status was recorded following their admission to an acute psychiatric ward.2. To identify the number of patients discharged with correct DVLA compliant advice.3. To identify the number of patients whose notes reflected correct driving status information on discharge.MethodsPatient ward notes and discharge summary documents relating to their admission on to the PICU ward were examined retrospectively for recorded evidence of patient's driving status and any documented DVLA advice given. Patients admitted from November 2022 and April 2023 were reviewed. 68 patients were identified and systematic sampling techniques identified a sample of 30 patients.Keyword search included “Driving”, “License”, “Car”, “Driving license”, “DVLA”.Results30 patients were reviewed in total.40% of sample patients had no driving status recorded on their notes.Of the 60% of sample patients who were confirmed to be driving/held license, nearly half (47%) had no recorded advice documented regarding the DVLA or driving after an acute MH illness on discharge.A third (33%) of sample patients were recorded as having been given generic advice regarding driving only.Only 20% of sample patients recorded to be driving, were documented as having been given correct advice as per DVLA guidance on discharge.ConclusionThis audit demonstrated that driving status is currently poorly recorded in patients admitted to PICU and documentation of correct DVLA-compliant driving advice being given on discharge to relevant patients is also poor. Patients may not be receiving important information that they need.Providing correct and accurate advice to patients regarding the DVLA rules and psychiatric illness should be part of a safe and robust discharge plan, and forms part of the clinical teams obligations to the patient. Identifying patients as drivers and improved documentation of driving status and evidencing appropriate advice being given is key.A number of interventions were implemented and a re-audit will be undertaken in Spring 2024. If successful at improving rates of DVLA compliant advice being given, it would be hoped these interventions could be shared across the trust.

AimsThe burden of mental health difficulties is a global problem and preventing them from childhood is paramount. Children living in challenged and underserved settings can suffer various harmful lifelong consequences including alcohol and substance abuse, low self-esteem, health issues, poor school performance, self-harm and suicide. This study aims to assess the feasibility, acceptability and efficacy of the culturally adapted Strong Families program in improving child behaviour and family functioning in families living in a challenged setting i.e. Gilgit-Baltistan (GB), Pakistan.MethodsThis is a two-arm, multisite feasibility randomised controlled trial with 90 families (n = 45 in intervention, and n = 45 in waitlist group) including a female primary caregiver (mostly mother) and at least one of their children between the age of 8–15 years in three districts of GB. There will be three raters’ blind assessments: at baseline, week 2, and 6 weeks after Strong Families Program sessions.ResultsStrong Families Program is a brief evidence-based prevention programme designed to improve parenting skills, child well-being and family mental health. The primary outcome measures include the feasibility of Strong Families, as determined by families' recruitment, attendance rates, and program completeness (mean number of sessions attended, attrition rates). Additionally, purposefully selected participants, including up to 5 caregivers from each study site, researchers, and facilitators delivering the intervention, will be interviewed. Descriptive statistics will be used to analyse primary and secondary outcomes. The process evaluation will be conducted in terms of program context, reach, fidelity, dose delivered and received, implementation, and recruitment.ConclusionThe findings from this feasibility trial hold the potential to carry out the large multicentre trial of clinical and cost-effectiveness and scale-up across Pakistan and other similar settings to meaningfully impact child behaviour and family dynamics in culturally diverse contexts.

AimsFloatation-REST (restricted environmental stimulation therapy) has shown promising potential as a therapeutic intervention in psychiatric conditions such as anxiety and anorexia nervosa. We speculate that the sensory deprivation might act as a kind of interoceptive training. Within our lab, interoceptive trait prediction error has been used to predict states of anxiety in autistic adults. There is also emerging research conceptualising interoceptive mismatches potentially playing a role in fatigue. Our aim was to run a feasibility study assessing the tolerability of Floatation-REST for participants with disabling fatigue. We also aimed to establish the feasibility of gathering data on mechanistic measures, such as heart rate variability (HRV) and interoception, during floatation.MethodsParticipants were recruited via online advertisements and were screened to check they scored at least 36 on the Fatigue Severity Scale (FSS). Pertinent medication changes and previous float experience within the last 6 weeks were amongst the exclusion criteria. Baseline measures included: Modified Fatigue Impact Scale (MFIS); Body Perception Questionaire; hypermobility questionnaire and Tellegen Absorption Scale. Participants completed four 90 minute sessions of floatation-REST across a 2–6 week period with 1 week of ecological momentary sampling (EMS) before and after. Immediate pre and post float measures included testing interoceptive sensibility, accuracy and awareness. HRV was measured during floatation. Change in energy was measured by retrospective subjective assessment, changes in validated fatigue scales and EMS.ResultsBaseline MFIS scores (median = 67.5; range = 55–77) indicated a high degree of severity of participant fatigue. 15 participants were recruited to the study. 13 participants started the float intervention and 11 completed all four sessions. No drop out was due to poor tolerability. Most adverse events were mild, expected and related to the pre/post float testing. HRV data was successfully captured throughout all sessions. Participant surveys described improvements in energy levels, sleep and relaxation and 73% “strongly agreed” to an overall positive effect. Furthermore, both statistically and clinically significant reductions were noted in the mean FSS scores (56.9 to 52.6; p = 0.044) and the MFIS scores (67.0 to 56.4; p = 0.003). Detailed energy assessment was obtained by EMS with 37 to 86 data points per participant.ConclusionFloatation-REST appears to be a feasible intervention for people with severe fatigue. EMS, HRV data, interoceptive data and other measures were reliably recorded. Reported subjective benefits were supported by an improvement in objective fatigue scores, though the lack of a control group makes these improvements speculative at present.

AimsTo carry out systematic literature search on an international medical database to find what the emerging categories in which the word hatred is used in medical literature are, and to gather information regarding the generation of the emotion of hatred in human beings by thematically analysing the relevant collected data.MethodsTo identify the information on hatred relevant for mental health professionals, we performed a systematic review using a systematic approach and criteria.ResultsSix themes regarding generation of hatred identified.Theme one: Targets of hatred.Theme two: Self-hatred.Theme three: Self-perceived hatred.Theme four: Hatred towards inanimate objects.Theme five: Reasons for hating other humans.Theme six: Internal reasons for development of hatred.ConclusionThe word ‘hatred’ is used in medical literature in a multiplicity of meanings that range from using it in its literal sense to describe a subtle attitude such as a phobia-philia relationship, or to describe a unique outcome that is generated as an interplay of several different kind of factors. These may include cognitions, behaviours, social interactions, attitudes, sentiments, developmental backgrounds, psychodynamic interactions with others in real and virtual worlds etc. Hatred is more like a mind-set that people can develop towards themselves, towards others and towards inanimate objects or situations too. Fear, anger and disgust are primary emotions (that we are born with); human psyche is naturally prone to several inevitable cognitive errors; human thought is subjected to unavoidable logical fallacies; and human ego cannot avoid utilising unhealthy ego-defence mechanisms. Every child is born in a family and culture that has its own unique background and history. We humans are prone to the generation of the hateful mindset as an unavoidable outcome in a variety of scenarios. Keeping these generational patterns in view, it would be reasonable to say that an early detection and addressing the early warning signs towards development of the hateful mind-set would be helpful for ourselves and for others. As the word is used in several different meanings, the background information, context, and overall scenario of the discussion needs to be kept in mind whilst attempting to draw any meanings about the use of hate/hatred in a verbal or written expression. In each case where the word ‘hatred’ is used, needs to be approached with epistemic curiosity and in some instances, it may need detailed epistemic inquiry to fully comprehend the meaning of this word in any given expression.

AimsObjectives: In youth and young adults, it is common to encounter non-medical use of benzodiazepines, defined as use without a prescription or use for reasons other than that for which the medication is intended. Benzodiazepine use disorder remains understudied and overlooked, especially in youth and young adults. The primary objective of our study was to highlight the proportion of youth and young adults with aberrant use of benzodiazepines and diagnosed with benzodiazepine use disorder in a single centre. The secondary objective was to determine factors associated with aberrant benzodiazepine use and benzodiazepine use disorder in that sample.MethodsThis retrospective chart review screened for benzodiazepine use in 310 adolescent patients aged 12–19 seen for the first time in a concurrent disorders clinic, at a tertiary care clinic in Canada. Of those 310 patients, 167 were included in the final chart review.Results97.6% of patients who used benzodiazepines demonstrated aberrant use, and 39.3% of patients received a diagnosis of benzodiazepine use disorder.ConclusionThis review showed that a substantial percentage of youth and young adults in a concurrent disorders clinic in Canada are presenting with aberrant benzodiazepine use and are being diagnosed with benzodiazepine use disorder. Despite this prevalence, there is little by way of literature to guide treatment of benzodiazepine use disorder in this population.

AimsTo create an information poster for the doctors’ on-call room and doctors’ office at Fieldhead Hospital (a Psychiatric Inpatient Hospital in Wakefield) to improve readily available practical information to doctors whilst on-call.Background – Psychiatry on-call shifts can feel daunting, especially if this is the clinician's first (and perhaps only) exposure working as a doctor within this specialty. Psychiatric hospitals are not equipped to deal with physically unwell patients which can be challenging especially as the only junior doctor on-call out of hours. Although there is a comprehensive induction programme, doctors in training raised concerns that there is insufficient, readily available practical information whilst on-call.MethodsSurveys were sent out to doctors in training to ascertain their initial viewpoints about producing a poster and which information they feel should be included. Doctors included were foundation years, GP and core trainees on their psychiatry placement in the South West Yorkshire Partnership NHS Foundation Trust. Both qualitative (free text responses) and quantitative information (yes/no responses) were obtained via SurveyMonkey. An initial draft poster was produced and sent out to all doctors in training as well as the project lead and clinical lead. The poster was amended accordingly. The posters were printed and displayed in the on-call rooms and doctors’ office.ResultsFour respondents responded to our initial pre-poster survey. They were highly receptive to the suggestion that this information would be in poster format to provide easily accessible information to help whilst on-call. Key topics identified for the poster included navigating logistical issues and information on-site, clerking new admissions and the relevant investigations required, important telephone numbers, personal safety and where and how to access relevant information and guidelines.Feedback regarding the initial draft poster survey and the included information was also positive. Seven respondents replied and overall, they felt that the poster provided the relevant information. The project supervisor and clinical lead also provided constructive feedback and identified that locating risk assessments and discussing with a consultant when a patient is recalled to hospital on a CTO should also be included. The initial draft poster was amended following this feedback.ConclusionIn conclusion, we found that there was an unmet need for easy to access logistical information regarding on-call work. The on-call poster provided the necessary information in a succinct and clear manner which the trainees benefited from.