Poster abstracts from the International Congress of the Royal College of Psychiatrists

Tuesday 24 June 2014
EDUCATION AND TRAINING
1 Psychiatric Consultant Posts The trainees perspective
Dr Conor Davidson, Psychiatry consultant, Leeds & York partnerships foundation trust;
Dr Kevin Anakwe, Psychiatry consultant, Tee Est & Weir Valley Foundation Trust
Aims & Hypothesis
To survey UK psychiatry higher trainees regarding their expectations and experiences of
applying for consultant posts.
Background
We are two psychiatry higher trainees at or near CCT. Current NHS budget constraints
mean that the job market for CCT holders is becoming more hostile. Given such a
gloomy national picture, when one of us applied for a substantive consultant post it was
scarcely a surprise but no less deflating for it - to find out 29 candidates had applied for
a single job. In light of this, we decided to survey psychiatry higher trainees on their
experiences and expectations of the post-CCT job market.
Methods
In June 2012 we sent an email invitation to an online survey to all higher trainees
registered with the Royal College of Psychiatrists. The survey asked about
demographics, training, experiences of applying for consultant posts, and career plans.
Results
We had 476 respondents with representation from all psychiatric specialties. 95.3%
hoped to work as a consultant psychiatrist in the NHS. For trainees who had applied for
consultant posts, the median number of applicants was 18 (range 2-80).
Only 8.6% of total respondents were ‘confident’ or ‘very confident’ that they will get a
substantive consultant post in the subspecialty and geographical region they want.
32.8% were confident/VC they would get any substantive consultant post.
If unable to get a consultant post, respondents most favoured strategies are to extend
training or apply for a post in the private sector. Retraining in a different specialty,
giving up medicine, or taking up a staff grade post were all unfavoured. A large number
of free text comments reinforced the perception that trainees are very anxious about
their future career prospects in the current NHS financial climate. Suggested remedies
included increasing the length of training/grace period, better workforce planning,
introduce a junior consultant grade, and encourage existing consultants to retire.
Conclusions
Our findings show there is considerable anxiety amongst higher trainees about the
availability of consultant posts for CCT holders.
Declaration of interest
Since this research was completed both CD and KA have been lucky enough to find
substantive consultant posts.

2 When psychiatrists move countries: A model to analyse and modify interview
skills
Dr Dhushan Illesinghe, Psychiatry consultant; Ms Olga Maxwell, PhD student, University
Of Melbourne; Ms Belinda Bull, Occupational Therapist
Aims and hypothesis
Many overseas-trained psychiatrists experience difficulty in modifying their interview
style to suit the needs of patients in their host country. No existing programs were
identified that addressed these issues, therefore this program was developed in a large
metropolitan mental health service in Melbourne, Australia. The objectives were: a) to
develop a feedback tool aimed at identifying psychiatrists’ individual skill levels and
needs; b) to enhance communication and interview skills in the clinical context and c) to
develop a framework that is transferrable to other clinical settings.
Background
It is common for psychiatrists to move countries during their career. Being a language-
rich medical specialty, their ability to communicate in a culturally appropriate manner is
important in day-to-day practice as well as in attaining the standard expected in
assessment exams. Traditionally, training support focuses on clinical content rather than
doctor-patient interaction and language skills.
Methods
Twenty participants carried-out a 60-minute diagnostic interview which was
independently rated by a linguist and a psychiatrist, using standardised templates. Based
on feedback from these interviews, a program was developed to address identified needs
within small group and individualised sessions using experiential learning techniques.
Results
The program enabled the participants to gain a better understanding of interview styles,
identify techniques and develop culturally more appropriate clinical interview skills.
Participant feedback included increased self-awareness of, and confidence in the data
gathering process, interview management, expression of empathy as well as everyday
conversational language.
Conclusions
This program demonstrated the benefits of including language and communication skills
as a component of acculturation training and support for psychiatrists who move
countries. Manualising this approach may enable health professionals in a variety of host
cultures to modify their interview skills.
3 Training Focused on the Integration of Cognitive Behavioural Therapy (CBT)
into Daily Clinical Practice among Psychiatrists: feasibility and perceived impact
Dr Steve Moorhead, Psychiatry consultant, Northumberland Tyne and Wear NHS
Foundation Trust
Aims and Hypothesis: to determine feasibility and clinical impact of a workshop that
focused on training doctors in daily practice-integrated CBT competencies. Workshop
training in these should facilitate their application in routine practice.
Background: The psychiatric training curriculum in the UK requires trainees to develop
the skills to ‘foster a good therapeutic alliance with patients’. It cites learning skills to
deliver and the delivery of psychotherapies as part of the experience to achieve this.
The superordinate Intended Learning Outcome (5) is that these skills become integrated

into everyday treatment. Other work has identified desirable components of such
integration.
Method: 13 psychiatrist participants were surveyed before a workshop focusing on how
to integrate CBT into routine clinical practice, after the workshop and at 3-month follow
up. Understanding, confidence and perceived utility of implementing these competencies
were assessed as well as frequency of use.
Results: participants reported improved knowledge of how to implement these
competencies and confidence to do so following the workshop. This was maintained at 3-
month follow up when a modest increase in median frequency of use was shown.
Perceived helpfulness of such integrated skills also increased.
Conclusions: training, specifically aimed at competencies of CBT integrated in daily
clinical practice, is feasible for psychiatrists. They report that it brings patient benefit.
Greater clarity of training goals for CBT integrated into daily practice could help focus
training activity. An associated need for supervision was identified.
4 Consent for Contact (C4C): SLaM research register. Making psychiatric
research easier
Mr Bartlomiej Pliszka, Project Worker, South London and Maudsley NHS Foundation
Trust; Ms Caroline Morris, Project Manager, BRC Institute of Psychiatry at King’s College
London; Mrs Sherifat Oduola, Project Manager, BRC Institute of Psychiatry at King’s
College London; Dr Daniel Robotham, Senior Researcher, Institute of Psychiatry at
King’s College London; Mr Bartlomiej Pliszka, Project Worker, Biomedical Research
Centre at South London and Maudsley NHS Foundation Trust; Dr Konstantina Papoulia,
Research Worker, Institute of Psychiatry at King’s College London; Prof Thomas
Jamieson-Craig, Psychiatry Consultant, Institute of Psychiatry at King’s College London
AIMS: We are aiming for the most effective way of recruiting service users into mental
health research conducted by the Biomedical Research Centre (South London and
Maudsley NHS Foundation Trust (SLaM) & Institute of Psychiatry at Kings College
London). Consent for Contact (C4C) is a direct link between service users and
researchers, with an aim to become a primary research recruitment gateway in the
Europe’s largest mental health research centre.
BACKGROUND: There are many services users that wishes to take part in research and
are very keen to have research developed in their field but they are not aware of how to
go about getting involved. Many patients also report that they would like to take part in
research if only their clinician would recommend them to do so.
METHODS: Since May 2012 a phased education and training programme (supported by
multimedia and intranet resources) has been rolled out by the C4C team to SLaM clinical
teams. Clinicians ask their service users about participation in C4C and document
outcome in the clinical record. A C4C digital form was added on the SLaM electronic
Patient Journey system (ePJs) for clinicians to document that C4C has been discussed,
capacity ascertained and the service user decision noted.
Additionally, an initial feedback survey for service-users was created for evaluation
purposes (n=90).

RESULTS: 100 clinical teams have incorporated C4C so far. 3329 C4C approaches have
been recorded on ePJs. 2468 (74%) of service users consented to be contacted about
research and 861 (26%) declined.
Additionally, the feedback survey revealed (n=90) that service users’ main reasons for
consenting to C4C was that they: ‘Wanted to use their own experience to help others
with similar problems’. A common reason for declining was: ‘Wanting to be away from
mental health services after discharge’.
CONCLUSIONS
Approaching mental health service users for C4C is feasible and acceptable to both
service users and clinicians.
Most clinicians feel comfortable offering C4C to service users.
There is no single approach for asking: Each service user is an individual case.
Most service users want to help with mental health research.
5 An innovative dementia communication skills teaching programme for clinical
medical students
Ms Beatrice Cockbain, Medical student, University of Oxford; Dr Pamina Mitta, Psychiatry
Consultant, Oxford Health; Dr Sanja Thompson, Consultant Geriatrician, Oxford
University Hospitals Trust; Dr Lola Martos, Consultant Psychiatrist; Dr Helen Salisbury
Aims and hypothesis To improve the ability of new clinical medical students to
communicate effectively with patients with dementia, an innovative teaching method
was trialled at Oxford University Medical School as part of a collaboration between the
Psychiatry and Geratology departments.
Background
Dementia prevalence is increasing in the UK and medical students often feel ill-equipped
to communicate effectively with such patients.
Methods
Medical students were divided into small groups with each group allocated a facilitator
and an actor. Three scenarios were used to demonstrate different techniques used in
communicating with patients with dementia, including non-verbal interaction, triadic
interviewing and de-escalation of aggressive behaviour. Feedback forms were collected
from all 80 students involved both before and after the session to assess how the
communication skills teaching had improved student perceptions of their confidence in
such situations. Confidence was assessed using a four point Likert scale from low to
very high. On average, there was a one point improvement in confidence, most
commonly from low to moderate, although around a fifth of the improvement noted was
from low to high.
Results
Positive comments from the feedback forms indicated that students most appreciated
the teaching of non-verbal communication skills and triadic interviewing techniques.
Both of these are notoriously difficult to present in a lecture based environment, which
has remained the mainstay of medical student education at the University.

Conclusion
The use of actors and faciliators gave students a safe environment in which to practice
these types of communication skills prior to starting clinical attachments in both the
general hospital and psychiatric settings. Actors have been used previously in basic
communication skills teaching at this medical school, however, this was the first time
they have been used for formally teaching more specialist communication skills. The
increasing prevalence of dementia within the population makes such communication
skills teaching vitally important and this programme demonstrates a simple, yet effective
means of providing such an education. There are plans for this programme to be
extended to cover communication skills teaching pertinent to other mental health
conditions, such as learning disability or acute psychoses.
RESEARCH
6 Possible Involvement of Janus Kinase-Signal Transducers and Activators of
Transcription (JAK/STAT) Signaling Pathway in N-Acetylcysteine-Mediated
Anti-depressant-Like Effects in a Rat Depression Model
Ms Marwa Al-Samhari, Teacher assistant, Department of Pharmacology and Toxicology,
College of Pharmacy, King Saud University; Dr Nouf Al-Rasheed, Associate Professor,
Department of Pharmacology and Toxicology, College of Pharmacy, King Saud
University; Dr Salim Al-Rejaie, Associate Professor, Department of Pharmacology and
Toxicology, College of Pharmacy, King Saud University; Dr Rasessa Ahmed, Associate
Professor, Department of Anatomy, College of Medicine, King Saud University; Dr Nduna
Dzimiri, PhD, Department of Genetics, King Faisal Specialist Hospital & Research Centre
Aim and Hypothesis: The JAK/STAT signalling pathway plays a key role in inflammation,
and subsequently, conditions that induce inflammatory responses, such as depression.
Thus, this study aims to investigate whether the anti-depressant like effects of N-
Acetylcysteine (NAC) are mediated through modulation of STAT3 and SOCS3 signaling
pathways in depressed rats.
Background: Advances in depression research have targeted inflammation and oxidative
stress to develop novel types of treatments. It is well known that NAC has a powerful
anti-oxidant action. The JAK-STAT signaling pathway is a family of proteins plays pivotal
roles in autoimmune and autoinflammatory responses. Therefore, this study addresses
the contribution of anti-inflammatory mechanisms to NAC-mediated anti-depressant like
effects.
Methods: Depression was induced in rats by exposed them to forced swimming test
(FST). Depressed rats were given NAC (50mg/Kg, i.p.) three times a day. The immobility
time was recorded and the stress and oxidative biomarkers were assessed. The mRNA
expression of STAT3 and SOCS3 were detected using RT-PCR.
Results: NAC showed significantly decreased immobility time compared with depressed
control group [91.67±23.0 vs. 190.8±31.61 seconds.
7 Efficacy of add-on topiramate in reducing withdrawal symptoms in opioid-
dependent patients in comparison with placebo
Dr Farhad Faridhosseini, Assistant Professor, Mashhad University of Medical Sciences; Dr
Alireza Zahiroddin, Professor, Shahid Beheshty Medical University; Dr Jamal Shams,

Assistant Professor, Shahid Beheshty Medical University; Dr Hanif Sadeghy, Psychiatry
consultant, Shahid Beheshty Medical University
Aims and hypothesis: The pharmacological profile of topiramate proposes it as a
potential effective agent for opiate withdrawal, as it acts through inhibition of alpha-
amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors, which play an
important role in the withdrawal-induced activation of the locus coeruleus (LC).This
research aimed to assess the efficacy of Topiramate in reduction of opioid withdrawal
symptoms in opioid-dependent patients.
Background: A case series and an open trial have demonstrated topiramate as effective
and tolerable agent in decreasing withdrawal symptoms. To our best knowledge, this is
the first randomized placebo controlled study to test the hypothesis.
Methods: In this double-blind clinical trial in Mashhad, the second largest city located in
northeast of Iran (2012-13) the efficacy of added topiramate in patient undergoing
methadone detoxification treatment for opiate withdrawal compared to placebo in
duration of 2 weeks. The statistical community consisted male substance dependents
referred to Addiction inpatient center of a psychiatric ( Ibn-e-Sina ) hospital. Forty two
inpatients (20-61 years), who met DSM-IV-TR criteria for opiate dependence were
included and then randomly in two groups (topiramate 100mg/day and placebo, during
two weeks). Outcome measure to assess the severity of subjective withdrawal
symptoms was the Subjective Opiate Withdrawal Scale conducted at five stages (1st,
3rd, 5th, 7th and 14th days). The collected data analyzed by descriptive and analytical
statistic test such as ANOVA.
Results: In both groups the severity of withdrawal symptoms decreased significantly but
there was no significant difference in topiramate group compared to placebo (P<0.05).
Conclusion: Added Topiramate (100mg/day for two weeks) in our double blind placebo-
controlled study did not show any significant decrease in acute subjective withdrawal
symptom in opioid dependents.
8 Anxiety Disorders and Quality of Life among individuals with Breast Cancer in
Lagos, Nigeria
Dr Olamijulo Fatiregun, Psychiatry consultant, FMCP Psych; Dr Olubunmi Arogunmati,
Public Health; Dr Andrew Olagunju, Psychiatry consultant, Lagos University Teaching
Hospital; Dr Honza Luzny, Psychiatry consultant, Czech Republic
Aims and Hypothesis
To evaluate the relationship between anxiety disorders and quality of life (QOL) among
individuals with breast cancer.
(Is there is a significant association between anxiety disorder and quality of life in
patients with breast cancer, such that any intervention addressing anxiety would
improve the quality of life).
Background
This cross sectional study was conducted among 200 individuals with breast cancer
attending an oncology unit of a Lagos based tertiary hospital.

Methodology
Participants were recruited using systematic random sampling following their informed
consent. Assessment using a two-phase epidemiological study design was done.
Hospital Anxiety and Depression Scale (HADS) was used for screening, whilst the
Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was applied to those with
significant anxiety symptoms (HADS cut-off score of 8) to diagnose anxiety disorders.
Thereafter, evaluation of QOL using European Organization for Research and Treatment
of Cancer Quality of Life Questionnaire (EORTC-QLQ) was done. Data were analyzed with
SPSS-16.
Results
The mean age of study participants was 49.6±11.2years. Overall, anxiety disorders was
significantly associated with lower mean scores on the EORTC-QLQ as well as its breast
specific supplement domains, and in particular, the global health status (p= 0.047), and
functional scale domains. On the Symptom scale, those with anxiety disorders had
higher scores (i.e. poor functioning) than those without. Significant association was
noted in the fatigue (p=0.001), pain (p=0.001), insomnia (p=0.001), appetite loss
(p=0.028), diarrhoea (p=0.016) and financial difficulties (p=0.005) domains.
Conclusion
Incorporation of mental health and QOL assessments into breast cancer care is
indicated. Also, multidisciplinary approach (with full complement of psychosocial
dimension) should be considered in oncology clinics to enhance optimal care and QOL.
9 Bipolar Affective disorder in Suicide Attempters admitted in tertiary care
hospital
Dr Abdul Majid Gania, Psychiatry consultant, Assistant Professor, SKIMS Medical College,
Srinagar, India; Prof A W Khan, Psychiatry consultant, Department of Psychiatry, SKIMS
Medical College; Prof Mushtaq Margoob, Psychiatry consultant
Bipolar affective disorder which one of the commonest psychiatric disorders with life time
prevalence between 1% to 5% has high risk of suicide in particular. Around 10% of
BPAD patients die by suicide and as many as 40% attempt suicide. Statistics from civil
war zones/ conflict zones has suggested increase in suicide rates in Bipolar patients due
to continued exposure to environmental stressors.
Aim: The present Study was aimed at studying the prevalence of bipolar affective
disorder in suicide attempters. Assessment of Sociodemographic characteristics and risk
factors in particular reference to present turmoil was done.
Material and Methods: The Study was Conducted on 300 suicide attempters admitted in
the multispecialty Tertiary care hospital of the valley over the period of two years
between 2010 and 2012. The patients were diagnosed by M.I.N.I plus.
Results: Total of 58% (n=174) had psychiatric comorbidity and out of them 32.18%
(n=56) had BPAD as comorbid diagnosis. Majority of patients belonged to 18-38 year
age group, lower and middle class, unmarried and Divorced, uneployed and significantly
more than 17% attributed their suicidal attempt directly to persistent environmental
stress due to turmoil.
Conclusions: Significant number of suicide attempters had bipolar affective disorder as
diagnosis at the time of their suicide attempt. Keeping in view significant number had

attributed their suicidal attempts to be precipitated by present turmoil, proper evaluation
and management of patients with BPAD in civil war zone is needed to prevent suicidal
Attempts.
10 Psychiatric co-morbidity in patients under treatment for Multidrug-Resistant
Tuberculosis
Dr Muhammad Irfan, Psychiatry consultant, Peshawar Medical College, Pakistan; Ms
Sumaira Mehreen, Clinical Psychologist, Lady Reading Hospital, Pakistan; Dr Anila Basit,
Pulmonology Consultant, Lady Reading Hospital, Pakistan; Mr Mazhar Khan, M Phil
Student, Lady Reading Hospital, Pakistan; Dr Afsar Khan, Medical Doctor, Lady Reading
Hospital, Pakistan; Prof Arshad Javaid, Professor, Lady Reading Hospital, Pakistan
Objective: To find out psychiatric co-morbidity in patients under treatment for Multidrug-
Resistant tuberculosis.
Methodology: The data source is an ongoing study being conducted at Lady Reading
Hospital Peshawar on all newly diagnosed MDR-TB patients registered from 1st May 2012
to 31st August 2013. Psychiatric assessment based on clinical interview, present state
examination and Hamilton Rating Scale for Depression was conducted at baseline and at
every monthly follow-up visit. The data however is represented in quarterly manner (3rd
and 6th month), for the convenience of readers.
Results: The mean age of study subjects was 29.37+14.56 years with a majority of
females (n=136, 54%). Out of 252 registered patients, 154(61.1%) had psychiatric co-
morbidity at baseline while 72(28.6%) and 52 (22.2%) respectively had it at 3rd and 6th
month follow up. Depression was commonest, present in 152(60.3%) at baseline,
69(27.4%) at 3 month and in 54(21.4%) patients at 6 month follow-up. Majority were
mild depression (115, 60 and 53 respectively). Severe depression was reported in
7(2.8%) cases, all at baseline, out of which 4(1.6%) reported suicidal wishes and
1(0.4%) suicidal ideation. There was a dual diagnosis of Anxiety disorder in 1(0.4%)
case of Depression at baseline. Conversion Disorder was dually diagnosed with
depression in 4(1.6%), 2(0.8%) and 1(0.4%) case respectively at baseline, 3rd and 6th
month follow-up. One (0.4%) case each of Bipolar Affective Disorder and Psychosis was
reported at baseline, 3rd and 6th month follow-up.
Conclusion: The rate of baseline psychiatric co-morbidity especially depression is higher
in MDR-TB patients than the normal population which is estimated to be 25% in our
setup. The possible reasons may be prolonged illness, hopelessness and social stigma.
Second line Anti-tuberculous drugs may have a role in the causation. Psychiatric
evaluation and treatment of these patients, if necessary, has an important role in view of
relatively large number of psychiatric co-morbidity in MDR-TB.
11 Management of children and adolescents with attention deficit hyperactivity
disorder in the United Kingdom and across Europe from a physician perspective
Mrs Lisa Mangle, Senior Medical Science Liaison, Shire, Basingstoke, United Kingdom; Dr
Moshe Fridman, Consultant, AMF Consulting, Los Angeles, CA, United States; Dr Regina
Grebla, Project Manager, Shire Wayne PA United States; Dr Juliana Setyawan, Director,
Shire Wayne PA, United States; Mrs Lisa Mangle, Senior Medical Science Liaison, Shire,
Basingstoke, United Kingdom
AIMS AND HYPOTHESES: We aim to compare patient characteristics, treatment patterns
and physician-assessed outcomes among children and adolescents with attention deficit

hyperactivity disorder (ADHD) in the United Kingdom (UK) and other European
countries.
BACKGROUND: Although ADHD management varies across European countries, whether
the characteristics of children and adolescents with ADHD differ in the UK is unknown.
METHODS: A retrospective chart review of patients aged 6-17 years diagnosed with
ADHD between 2004 and 2007 was conducted in six countries (France, Germany, Italy,
Netherlands, Spain, UK). Patient characteristics included ADHD symptom impairment
(0’“10 scale), psychiatric comorbidities at diagnosis and treatment modality. Physician
assessment of symptom control, medication adherence, and treatment satisfaction were
examined at the time of review. Fisher’s Exact, Chi-square or t-tests were used for
descriptive comparisons.
RESULTS: Of 779 patients studied (mean age 12.1 years), 18.7% were British.
Compared with ADHD patients in other European countries, British patients had higher
rates of impulsivity (4% vs 62%).
12 Remission from schizophrenia; a message of hope
Prof Wayne Miles, Psychiatry consultant, Waitemata DHB and University of Auckland; Ms
Deborah Campbell, Research Nurse, Waitemata DHB
Aims and hypotheses
To determine whether people obtaining remission from schizophrenia maintain that
remission and to examine factors that are considered by them to support remission.
Background
For many years psychiatrists supported a negative view of outcome from schizophrenia;
Kraeplin’s “Dementia Praecox” typifying that view. More recent longer term studies have
begun to cast a more promising possibility for outcome. The development of
standardised internationally accepted criteria for defining remission in schizophrenia
(RSWG. Am J Psychiatry 2005; 162; 441-449) has assisted exploration of outcome.
The existence of a well established research clinic for treating psychosis and access to
very complete electronic records via NHI allowed us to explore remission maintenance.
Methods
Subjects were people with schizophrenia being treated in antipsychotic medicine trials
over the period 1995 to 2007. Participants who achieved remission according to RSWG
criteria at the end of the study period were followed up to see whether that remission
had been sustained. A subgroup of those participants was interviewed to elicit their
views about what helps and hinders remission
Results
39 of 116 participants achieved remission. Of these 35 were contactable. 30 were still
meeting RSWG remission criteria at follow up.
Factors identified as contributing to remission included having a significant person (s) in
your life; having honesty from others, especially clinicians; having activities of daily life
including work, and activity. Working on your own recovery was also seen as key, as was
establishing a sustainable relationship with medication.

Conclusion
These results suggest that good outcomes can be achieved when treating schizophrenia.
The take home message is well stated by a quote from a subject: “If your doctor doesn’t
think you can get better then how the hell can the patient think they will”
Supported by a Pfizer Investigator Initiated Research grant.
13 Work Stress and Cortisol Level among Medical Residents
Prof Nahla Nagy, Psychiatry consultant, Ain Shams University,Cairo; Prof Mona ElShiekh,
Psychiatry consultant, Ain Shams University; Dr Dalia Abd Elmoneim, Ain Shams
University; Dr Aya Sakr, Ain Shams University; Sherine Hatem, Medical student, Ain
Shams University
Background: Professional stress is significant and overlooked component of a medical
residency. The degree of change in cortisol levels in response to stress is due to
dysregulation of hypothalamic pituitary-adrenal (HPA) axis activity that leads to
impairing conditions like depression, anxiety and cognitive impairment.
Hypothesis and Aim of the work was to study the association between work stress in
medical residents and salivary Cortisol level ,psychological morbidity anxiety , depression
and cognitive impairment.
Methods: 47 residents who works in Ain Shams University Hospitals, were divided into
two groups: (patient centered specialties) including; internal medicine- surgery and
(non patient centered specialties) .Each resident was subjected to Structured Clinical
Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Consultants’ Job Stress &
Satisfaction Questionnaire (HCJSSQ), Social Readjustment Rating Scale to exclude social
stress in residents, Hamilton anxiety scale (HAM-A), Beck Depression Inventory (BDI),
Wechsler memory scale ,three salivary samples were collected from each resident within
24 hours to measure the salivary Cortisol level at 9:00 am, 4:00 pm, 10:00 pm (tested
by ELISA).Results : showed that 59.6% of the residents have moderate to severe
depression, (55.3%)have mild to moderate anxiety symptoms with no significant
changes in cognitive functioning. (61.7%) had severe work stress. The most stressful
aspect to residents was having too great overall volume of work (78.7%) .On examining
the correlation between residents dealing with patients/not dealing with patients groups
regarding: salivary cortisol , Wechsler memory scale , Hamilton anxiety scale , Beck
depression inventory , the Consultants’ Job Stress and Job Satisfaction Questionnaire .
There was no statistically significant correlation except for the Consultants’ Job Stress
and Job Satisfaction Questionnaire (overall work stress).
Conclusion: medical residents showed high level of work stress significantly correlated
with abnormal salivary cortisol sequence of rise.
14 Comparing psychopathology and cognition in children with genetic
syndromes linked to high risk of Autism Spectrum Disorder and schizophrenia.
Dr Maria Niarchou, Research Associate, MRC Centre for Neuropsychiatric Genetics and
Genomics, Cardiff University; Prof Michael Owen, Psychiatry consultant, MRC Centre for
Neuropsychiatric Genetics and Genomics, Cardiff University; Dr Marianne van den Bree,
Reader in Psychological Medicine, MRC Centre for Neuropsychiatric Genetics and
Genomics, Cardiff University

Aims and hypothesis: To compare the psychiatric and cognitive phenotype of children
with deletions in 22q11.2 (del22q11.2), and 16p11.2 (del16p11.2) and duplications in
16p11.2 (dup16p11.2). We hypothesized that there will be phenotypic differences
between the groups reflecting differences in the genetic substrates associated with risk
of Autism Spectrum Disorder (ASD) and schizophrenia.
Background: Certain Copy Number Variants (i.e., deletions and duplications of genetic
material) (CNV) are associated with high risk of schizophrenia and ASD. Large CNV
studies have indicated that del22q11.2 and dup16p11.2 are highly significantly more
common in patients with schizophrenia (0.29% and 0.35%, respectively) compared to
controls. Similarly, ASD occurs more frequently in patients with del22q11.2 (0.07%) and
deletion (0.42%) and duplication (0.39%) of 16p11.2. However, no study has compared
the psychopathology and cognitive features of children with these CNVs.
Methods: We compared children with del22q11.2 (n=105), del16p11.2 (n=31) and
dup16p11.2 (n=10). Psychiatric assessments included the Social Communication
Questionnaire and the Child and Adolescent Psychiatric Assessments. Cognitive
assessments included tests from the Wechsler Abbreviated Scale of Intelligence, and
tests associated with ASD and schizophrenia (Cambridge Neuropsychological Test
Automated Battery and Wisconsin Card Sorting Test).
Results: 30% of del22q11.2 children met the cut-off for ASD diagnosis compared to 67%
of del16p11.2 children (p<0.001) and 90% of dup16p11.2 children (p<0.001). 9%
of del22q11.2 children reported PEs compared to 11% of del16p11.2 (age-adjusted
p=0.74) and 30% of dup16p11.2 children (age-adjusted p=0.12). Full-scale and
performance IQ was similar, except that del22q11.2 children had higher verbal IQ
(79.0(13.6)) compared to del16p11.2 (71.1(12.7)) (p=0.01). Preliminary correlation
analyses indicated similar associations between cognitive and psychiatric features.
Conclusions: Our findings are in line with the rates of these CNVs in patients with
schizophrenia and ASD and improve our understanding of the extent of impairments
associated with different CNVs with potential implications for the wider psychiatric field
15 EXPERIENCE OF TRAINED PRIMARY HEALTH CARE WORKERS IN MENTAL
HEALTH SERVICE DELIEVERY ACROSS OGUN STATE NIGERIA
Dr Lucky Umukoro Onofa, Psychiatry consultant, Neuropsychiatric Hospital Aro, Nigeria;
Dr Timothy Adebowale, Psychiatry consultant, Neuropsychiatric Hospital Aro, Nigeria; Dr
Akin Akinhanmi, Neuropsychiatric Hospital Aro, Nigeria; Dr T.A Ogundele, Psychiatry
consultant, Neuropsychiatric hospital Aro, Nigeria; Dr Mofoluwake Majekodunmi,
Psychiatry trainee, Department of Psychiatry, University College Hospital (UCH), Ibadan,
Nigeria; Mrs Modupeoluwa Olopade, Neuropsychiatric Hospital Aro, Abeokuta, Nigeria
AIMS: To determine the experience of trained primary health care (PHC) workers in
mental health service delivery across Ogun State South west Nigeria.
BACKGROUND: In developing countries with shortage of mental health professionals,
paramedics are trained in the delivery of mental health services. Knowledge of the
experience of the trained health workers is useful in evaluating output of service and
restructuring training package.

METHODS: Aro Primary Care Mental Health Program (APCMHP) was developed for the
training of 80 PHC workers across the state using adapted mhGAP intervention guide to
assess and treat/ refer five priority conditions: Psychosis, Depression, Epilepsy, Alcohol
& Substance Abuse and Other Significant Emotional Complaint (OSEC). Appropriate
ethical approval was obtained. Data was collected on their experience 12 months after
commencement of service delivery. Descriptive statistics were used and appropriate
ethical approval was obtained.
RESULTS: Out of the 80 PHC workers, attrition was 25 (31.3%). 54 valid questionnaires
were analyzed. There were 52 (96.3%) females and 90.7% were nurses. The mean
(SD) age was 42.4 (16.3) years. A total of 473 patients were seen with diagnostic
breakdown as follows: Psychosis (45.9%), Epilepsy (38.3%), Depression (10.1%), OSEC
(3.2%) and Alcohol & Substance Abuse (2.5%). Diagnostic and treatment difficulty was
reported for the following: Psychosis (23.1%), Depression (22.0%), Epilepsy (3.7%),
OSEC (52.2 %) and Alcohol & Substance Abuse (57.1%). Personal fulfillment in mental
service delivery was reported by 88.5%, while 94.3% reported that the program was
helpful to the community. Good attitude of clients and relatives towards the program
was identified by 86.8% of the PHC workers.
CONCLUSION: Our study revealed a high personal fulfillment of the trained PHC workers
in mental health service delivery. There is need for re-training of the PHC workers
towards effective service delivery.
16 The borderline of bipolar: opinions of patients and lessons for clinicians on
the diagnostic conflict
Ms Emma Richardson, MSc Graduate, Oxleas NHS Foundation Trust; Dr Derek Tracy,
Psychiatry consultant, Oxleas NHS Foundation Trust
Aims and hypothesis: A phenomenon has been identified of individuals self-diagnosing
with a bipolar affective disorder; many of whom are later diagnosed with a borderline
personality disorder. Understanding the knowledge-base, thoughts, and concerns of
those we treat improves engagement and clinical outcomes. We hypothesised that media
exposure, stigma, and attribution of responsibility would be key factors affecting patient
understanding and opinion in both their initial self-diagnosis, and also their perceptions
of subsequent re-diagnosis.
Background: A clinical similarity between many aspects of a borderline personality
disorder and a bipolar affective disorder has long been recognised - particularly mood
instability and in the public arena there is on-going debate about the fundamental
validity of current diagnostic systems. There are data on neurobiological and
neuropsychological overlaps between these disorders, though most work supports their
being distinct conditions. Despite the significant existing work on genetic, neuroimaging
and neuropsychometric similarities and differences, no previous work has explored the
opinions of those caught at this diagnostic interface.
Methods: Qualitative methodology was used to interview eight individuals, four new to
mental health services, who self-presented believing they suffered from a bipolar
affective disorder, only to be formally diagnosed with a borderline personality disorder.
Interview transcripts were evaluated using thematic analysis methods.

Results: Six core illness differentiating themes emerged: public information, diagnosis
delivery, illness causes, illness management, stigma, and relationship with others.
Individuals did not ‘want’ to be bipolar, but wished for informed care.
Conclusions: This qualitative study is the first work to explore the views of patients
caught at this diagnostic interface. Understanding patient perspectives will allow clinical
staff to better appreciate the difficulties faced by those we seek to help; to identify gaps
in care provision; and should stimulate thought on our attitudes to care and how we
facilitate provision of information including around diagnosis.
17 Relationship between physical health and depression: stability over 14 years
from three national surveys
Dr Anoop Saraf, Psychiatry consultant, KMPT
Aims and Hypothesis: To investigate changes over 14 years in the strength of
association between worse physical health, depression and common mental disorder
(CMD).
Worse physical health will be significantly and independently associated with depression
and common mental disorders at all three survey periods.
After adjustment, the strength of this association will have increased over time.
Background: 20,503 Adults aged 16-64 living in private households in England.
Methods: Analysis of three cross-sectional national mental health surveys carried out in
1993, 2000 and 2007 using comparable sampling methods and identical physical health
assessments.
CMD were ascertained by the revised Clinical Interview Schedule (CIS-R) which
generated a common mental disorder category, based on symptom scores above a cut-
off, and ICD-10 diagnoses of depression, generalized anxiety disorder, panic disorder
and phobia. Recent serious physical illness was measured as part of the List of
Threatening Experiences schedule. As a comparator, bereavement (first degree relative)
was also ascertained from the same scale. Analyses were adjusted for age, sex, marital
status, gender, social class and ethnicity.
Results: showed that association after adjusting for confounders was significant and had
increased across three national surveys over a 14 year period. This was observed for
both depression and common mental disorders, although the change in the strength of
association between serious illness and common mental disorders was more significant
compared to depression over time which could possibly be due to a statistical power
issue because depression was a lot rarer.
Conclusions: In this study I investigated and found consistent and increased association
over time within a given community. There is a need for time series analysis from just
studying prevalence of physical health and mental disorders to looking at associations
over time. What might also be worth looking in the future is further in-depth work into
the meaning of physical illness and factors influencing that vulnerability.
18 Efficacy of Cognitive Behaviour Therapy -v- Anxiety Management for Body
Dysmorphic Disorder: a randomised controlled trial

Dr David Veale, Psychiatry consultant, Institute of Psychiatry, KCL and South London
and Maudsley NHS Foundation Trust; Dr Martin Anson, Clinical Psychologist, Institute of
Psychiatry, KCL and South London and Maudsley NHS Foundation Trust; Ms Sarah Miles,
Research Worker, Institute of Psychiatry, KCL and South London and Maudsley NHS
Foundation Trust; Dr Ana Costa, Clinical Psychologist, Institute of Psychiatry, KCL and
South London and Maudsley NHS Foundation Trust; Dr Nell Ellison, Clinical Psychologist,
Institute of Psychiatry, KCL and South London and Maudsley NHS Foundation Trust
Aims: To determine if Cognitive Behaviour Therapy (CBT) is more effective than anxiety
management (AM) for treating Body Dysmorphic Disorder (BDD) in an out-patient
setting. Background: The evidence base for the effectiveness of CBT in BDD is weak with
only three trials of CBT against a wait list in unrepresentative population.
Methods: A single blind, stratified parallel-group randomized controlled trial. The primary
endpoint was at 12 weeks, and the Yale Brown Obsessive Compulsive Scale for BDD
(BDD-YBOCS) was the primary outcome measure. Secondary measures for BDD included
the Brown Assessment of Beliefs (BABS), the Appearance Anxiety Inventory (AAI) and
the Body Image Quality of Life Inventory (BIQLI). The outcome measures were collected
at baseline and week 12. The CBT group, unlike the AM group, had 4 further weekly
sessions that were analysed for their added value. Both groups completed measures at
1-month follow-up. Forty-six participants, with DSM-IV diagnosis of BDD including those
with a delusional beliefs were randomly allocated to either CBT or AM.
Results: At 12 weeks, CBT was found to be significantly superior to AM on the BDD-
YBOCS (Î² = -7.19, S.E. (Î²) = 2.61, p < .01, C.I. = -12.31, -2.07, d 0.99) as well as
the secondary outcome measures of the BABS, AAI and BIQL. Further benefits occurred
by Week 16 within the CBT group. There were no differences in outcome for those with
delusional beliefs or depression. Conclusions: CBT is an effective intervention for people
with BDD even with delusional beliefs or depression and is more effective than anxiety
management over 12 weeks. Further research is required to determine effects of CBT in
adolescents and of augmenting CBT with a SSRI.
Sponsorship: The study was funded by the Biomedical Research Centre at the Institute
of Psychiatry
19 Characteristics and outcome of women seeking labiaplasty: a cohort study.
and Maudsley NHS Foundation Trust; Dr Ertimiss Eshkevari, Research Associate,
Institute of Psychiatry, KCL and South London and Maudsley NHS Foundation Trust; Dr
Nell Ellison, Clinical Psychologist, Institute of Psychiatry, KCL and South London and
Maudsley NHS Foundation Trust; Prof Linda Cardozo, Consultant ur-gynaecologist, Kings
College Foundation Trust Hospital; Mr Dudley Robinson, Consultant Gynaecologist, Kings
College Foundation Trust Hospital
Background: Labiaplasty is an increasingly popular surgical intervention in the NHS and
private sector. However little is known about the characteristics and motivation of
women who seek the procedure or the outcome.
Methods: Fifty-five women seeking labiaplasty were compared with 70 women who did
not desire labiaplasty. Various general measures of psychopathology as well as specific
measures of genital appearance satisfaction, the Childhood Trauma Questionnaire and
perception of teasing were used.

Results: Women seeking labiaplasty did not differ from controls on measures of
depression or anxiety. They did, however, express increased dissatisfaction towards the
appearance of their genitalia, with lower overall sexual satisfaction, and a significantly
greater frequency of avoidance and safety seeking behaviours. Ten of the 55 women
seeking labiaplasty met diagnostic criteria for Body Dysmorphic Disorder. Approximately
a third of the labiaplasty group recalled specific negative comments towards their labia
compared to 3% in the control group. However, women seeking labiaplasty were no
more likely to have a history of neglect or abuse during childhood.
On follow up after the procedure 24 out of 25 (96%) women showed a reliable and
clinically significant improvement on the Genital Appearance Satisfaction scale 3 months
after the procedure; and 21/23 (91.3%) showed an improvement at the long-term follow
up. Small effect sizes were found for improvements in sexual functioning. Eight out 9
had lost their diagnosis of BDD at the 3-month follow-up. Conclusions: This is the first
controlled prospective study to describe some of the characteristics and motivations of
women seeking labiaplasty. We identified various avoidance and safety seeking
behaviours, which could be used clinically as part of a psychological intervention for
women seeking labiaplasty. However a labiaplasty appears effective in improving genital
appearance and sexual satisfaction even in participants with BDD.
20 Psychosocial risk factors for developing penile dysmorphic disorder
compared to men anxious about their penis size and to controls: a cohort study
and Maudsley NHS Foundation Trust; Ms Sarah Miles, Research Associate, Institute of
Psychiatry, King’s College London and South London and Maudsley NHS Foundation
Trust, London; Mr Gordon Muir, Consultant Urologist, Kings College NHS Foundation
Trust; Prof Kevan Wylie, Psychiatry consultant, Sheffield Health and Social Care NHS
Foundation Trust
Aims: To determine risk factors for the development of Penile Dysmorphic Disorder
(PDD). Background: Men with PDD are preoccupied with the size or appearance of their
penis, causing them to experience significant shame or handicap. They attend urologists
or purchase enhancers and potions on the Internet for solutions. Little is known about
the psychosocial risk factors in the development of PDD and whether this is different for
men who are worried about their size (Small Penis Anxiety) but do not meet criteria for
PDD. Methods: Using a cohort group design, men with PDD (who fulfilled criteria for
Body Dysmorphic Disorder (BDD) (n=24) were compared to men with SPA (n= 26) and
an unconcerned control group (n=30), on the Childhood Trauma Questionnaire,
Perception of Appearance and Competency Related Teasing Scale, length of their flaccid
penis, body mass index, specific genitalia teasing and past medical conditions.
Regression modelling was used to find predictors of scores on the Cosmetic Procedure
Screening Questionnaire (COPS-P) (a screening measure for BDD), and a diagnosis of
BDD. Results: Men with PDD had a significantly higher frequency of specific genitalia
teasing, emotional and physical abuse and neglect, perceived appearance and
competency teasing, increased age, higher Body Mass Index, and smaller flaccid penile
length compared to SPA and controls. Specific genital teasing, appearance teasing and
penile length predicted COPS-P scores and diagnostic group membership. Conclusions:
Men with PDD appear to have specific risk factors in comparison to those who are
anxious about their penile size or those who are unconcerned. These results may be
important in understanding the development of BDD in general. Further research is

required to develop and evaluate interventions for men with PDD or SPA, as there are no
effective solutions to increase penile size.
SERVICE EVALUATION/AUDIT
21 Audit of the diagnosis, investigation and treatment of stage 1 and 2
hypertension of patients after admission onto a Mental Health Services of Older
People (MHSOP) inpatient ward at Millbrook Mental Health Unit, Mansfield
Dr Lucy Baker, FY Doctor, Nottinghamshire Healthcare Trust; Dr Nisha Mokashi,
Psychiatry consultant, Nottinghamshire Healthcare Trust
Audit of the diagnosis, investigation and treatment of stage 1 and 2 hypertension of
patients after admission onto a Mental Health Services of Older People (MHSOP)
inpatient ward at Millbrook Mental Health Unit, Mansfield.
Aims and Hypothesis: The aim of this audit was to demonstrate compliance with
hypertension NICE guidelines on the Mental Health Services of Older People (MHSOP)
wards at Millbrook Mental Health Unit, Mansfield. The hypothesis was that the
hypertension NICE guidelines were not currently being adhered to.
Background: Hypertension is a major preventable cause of premature mortality and
morbidity in the UK - it is a risk factor for ischaemic/haemorrhagic strokes, myocardial
infarction, heart failure, chronic kidney disease, cognitive decline and premature death.
It has previously been shown that the incidence of hypertension increases with age and
some mental health illnesses.
Methods: A retrospective audit was performed of patient notes on two MHSOP wards, on
04/02/2014, using NICE guidelines on hypertension to construct a proforma sheet.
Criteria included: blood pressure taken on admission, repetition of blood pressure
reading, investigations instigated for formal diagnosis of stage 1 or 2 hypertension
(ambulatory blood pressure monitoring being the gold standard investigation), anti-
hypertensive treatment commenced as a result of investigation and if cardiovascular risk
of patients had been calculated. 32 patients were audited, with no exceptions.
Results: 97% (n=31) patients’ blood pressure were recorded on admission, of these
35% (n=11) were hypertensive. No ambulatory blood pressure monitoring was
performed to formally diagnose stage of hypertension (n=0), therefore no anti-
hypertensives were commenced due to this work-up (n=0). Cardiovascular risk was not
calculated once high blood pressure was identified (n=0) as recommended.
Conclusions: The NICE guidelines for investigating, diagnosing and treating hypertension
were not complied with on the MHSOP wards audited. The proposed action plan includes:
carrying out audit of other sites to check reproducibility of results, an educational
presentation for junior doctors, provision of quick reference NICE guideline on wards and
Intranet, and provision of an ambulatory blood pressure monitoring cuff at Millbrook
Mental Health Unit.
22 Benzodiazepines Prescribing
Dr Muhammad Arshad Faridi, Specialty Doctor, The Junction Drug and Alcohol Service,
Central and NorthWest London NHS Foundation Trust; Dr Alexandra Moore, Psychiatry
consultant, The Junction Drug and Alcohol Service, Central and NorthWest London NHS
Foundation Trust

Introduction
Benzodiazepines are extensively used in clinical practice. The Committee on Safety of
Medicines (CSM) and National Institute of Clinical Excellence (NICE) guidelines do not
recommend long-term use. Despite these guidelines and the knowledge of alternatives
such as SSRIs and CBT, many patients remain on long-term prescription of
benzodiazepines
Aims
We set out to determine what proportion of our patients who were prescribed long term
benzodiazepines a) had a plan to address this and b) whether this plan was adhered to.
Methods
We identified patients on active prescription of benzodiazepines from the prescription
database and looked for evidence of a plan to reduce or stop this prescription. Case
notes were examined and key workers were interviewed. The sample was re-analysed
six months later to explore whether these plans had been followed.
Results
6.7 % (17 / 253) patients were on active benzodiazepine prescriptions. 100% had a
documented plan for dose reduction or detoxification 70% (12/17) of these plans had
been initiated, 30% had not with no reason given. 17.6 % (3 / 17) had completed a
detoxification, 17.6 % (3 / 17) were adhering to the original plan. 64.8 % (11/17) had
been unable to adhere to their plan. The reasons given included anxiety around stopping
benzodiazepines, insomnia and life events.
Conclusion
The Junction Service is fortunate in having ready access to a range of services including
psychiatric review, CBT and other psychosocial interventions. This study illustrated the
difficulties inherent in reducing or stopping long term benzodiazepine prescriptions even
when there is access to alternatives and there is a focus on reduction in benzodiazepines
prescriptions. Key work sessions can be used to explore difficulties and barriers, such as
targeted intervention around sleep.
23 Blood Tests: Time from Needle To Result
Dr Karim Fazal, Psychiatry trainee, South London and Maudsley NHS Trust; Dr Richard
Haslam, Psychiatry consultant, South London And Mausdley NHS Trust
Aims and Hypothesis
To look at the basic processes and timings of blood samples going from The Ladywell
Unit to University Hospital Lewisham, to see if there were significant delays at the
Ladywell Unit Site.
Background
Physical health monitoring including blood tests form an important investigation in
psychiatric patients. It has been noted by many of the doctors at The Ladywell Unit that
there has been long delays waiting for blood results, which may result in a delay in
clinical management
Methods
I analysed blood results over a three week period in December 2012 from two wards on
the Ladywell Unit.

I looked at two separate time intervals to ascertain if there were delays in the transfer of
bloods from The Ladywell Unit to University Hospital Lewisham or in the processing and
authorisation of blood results within the pathology lab.
Altogether 43 samples were analysed. N=43
Results
In 13 cases, there was an over four hour time delay between the bloods being taken and
being booked in by the pathology lab (30% of cases).
With regards to the processing and authorisation of blood results, 5 cases took over four
hours to be authorised (11.6% of cases).
Conclusions
In a high proportion of cases (30% of cases) there is a significant delay in the transfer of
bloods between The Ladywell Unit and University Hospital Lewisham pathology lab. This
may result in a delay in the management of physically unwell patients.
With regards to the authorisation of blood results, four of the five samples that were
delayed, were due to one of the biochemistry analysers being out of work on those days
delaying all hospital work.
I have proposed a few interventions to the service providers at The Ladywell unit to
improve this service, so that patient care may not be compromised.
24 An audit of metabolic monitoring in patients on antipsychotics.
Dr Jessica Foster, SHO, Waitemata District Health Board, Auckland, New Zealand; Dr
Jasminka Milosevic, Psychiatry trainee, Waitemata District Health Board, Auckland, New
Zealand
Aims and hypothesis:
This audit aimed to determine compliance of Early Psychosis Intervention (EPI) staff with
2008 New Zealand Metabolic Monitoring Guidelines and establish whether compliance
has improved over time. Our target compliance was 70%, three years after publication
of the guidelines.
Background:
Second generation antipsychotics (SGA) are considered first-line treatment for psychosis
(RANZCP). Recognized side-effects of weight gain and altered metabolism can
predispose to obesity-related morbidity, impacting on health and wellbeing. EPI provides
care for 16 to 25 year old New Zealanders, including people of Polynesian, South Asian,
Maori, and African ethnicity. Young, neuroleptic naïve patients, especially non-
Caucasians, are at greater risk of developing metabolic syndrome.
Methods:
We reviewed all EPI referrals from 2009 and 2012. We excluded patients not accepted by
EPI, not treated with SGAs, or treated for less than 8 weeks. We examined electronic
databases for data on weight, height, BMI, abdominal circumference, medication and
blood test results. Of 222 referrals reviewed, 119 met the inclusion criteria (68 in 2009,
51 in 2012).

Results:
Overall compliance with metabolic monitoring guidance improved from 27.6% in 2009 to
38.8% in 2012 (X2=16.611, p<0.0001). Adherence to individual guidelines ranged from
13.2% (baseline waist circumference and BMI) to 58.8% (baseline glucose, p<0.0001) in
2009 and from 15.7%% (baseline BMI) to 68.6% (baseline glucose, p<0.0001) in 2012.
Significant increases in compliance were seen in the measurement of baseline waist
circumference (13.2% vs. 33.3%, p=0.009), baseline BMI (13.2% vs. 37.3%, p=0.002)
and annual weight (20.6% vs. 43.1%, p=0.008).
Conclusions:
Compliance with metabolic monitoring guidance was initially poor and, despite significant
improvement, remained poor. Strategic interventions to optimise compliance must be
sought and practice re-audited. Proposed interventions include in-service teaching, a
designated responsible departmental individual, regular progress updates at quarterly
service meetings, accurate recording of occasions when consent is withheld for
measurements.
25 Treatment outcomes among mentally-ill patients seen at primary health care
centres across ogun state, Nigeria.
Dr Lucky Umukoro Onofa, Psychiatry consultant, Neuropsychiatric Hospital Aro, Nigeria;
Dr Timothy Adebowale, Psychiatry consultant, Neuropsychiatric Hospital Aro, Nigeria; Dr
Akin Akinhanmi, Psychiatry consultant, Neuropsychiatric Hospital Aro, Nigeria; Dr
Richard Gater, Lancashire Care NHS Trust; Dr Mofoluwake Majekodunmi, Department of
Psychiatry, University College Hospital (UCH), Nigeria.; Mr Samuel Olarinde,
Neuropsychiatric Hospital Aro, Nigeria
AIMS: This study was undertaken to describe the outcomes of treatment among
mentally ill patients seen at the primary health centres across Ogun State, Nigeria.
BACKGROUND: One of the major challenges of successful integration of mental health
into Primary Health Care (PHC) is shortage of mental health professionals at the PHC
level. Training of PHC workers is known to result in improved mental health services
delivery but with few studies on the outcomes of such services.
METHODS:: Following the development of Aro Primary Care Mental Health Programme
(APCMHP) for Ogun State, 80 PHC workers were trained using adapted mhGAP
intervention guide to assess and treat/refer 5 priority conditions: Psychosis, Depression,
Epilepsy, Alcohol and Substance abuse and Other Significant Emotional Complaints
(OSEC).
We reviewed caseload of patients managed by trained PHC Workers within 12 months of
the programme using descriptive statistics. Appropriate ethical approval was obtained.
RESULTS: A total of 473 patients was seen. The mean (SD) age of the patient was 40.3
(13.6) years. There were 289 (61.1%) females while 42.6% were single. A majority of
the patient had primary school education and less (67.5%) while 63.6% were within
unskilled occupational status. Diagnostic breakdown include: Psychosis (45.9%),
Epilepsy (38.3%), Depression (10.1%), OSEC (3.2%), and Alcohol and Substance abuse
(2.5%).

Majority (87.5%) were on monotherapy with conventional antipsychotics, tricyclic
antidepressants and antiepileptic medications. Only 3.2% were on depot medications.
About 60% had experienced 30% symptoms reduction and 63% were still attending
while 4.2% were referred to Psychiatrist. About 60% returned to their work.
CONCLUSION: Our study shows an improved mental health service delivery with good
outcomes of care. Mental health training of PHC workers is essential for reducing the
mental health service gap in Nigeria.
26 Psychiatric Triage: Establishing patients’ care pathways for improved
interface between NHS mental health services, and provision of health
economic improvements.
Mr Bartlomiej Pliszka, Project Worker, South London and Maudsley NHS Foundation
Trust; Dr Jonathan Beckett, Psychiatry consultant, South London and Maudsley NHS
Trust
AIMS: Improved allocation of resources leading to most efficient and adequate care for
very large inpatient population. Lowering the time spent on the inpatient ward.
Evaluation of clinician’s compliance in regards to Trust guidelines on completing
compulsorily records as necessary measure for better care pathways management.
BACKGROUND: Preliminary results showed that Psychiatric Triage model has reduced
bed occupancy, leading to more-efficient throughput, with positive feedback from
patients and staff.
METHODS: We used Clinical Records Interactive Search (CRIS) database at South
London and Maudsley NHS Foundation Trust, and analysed two years (2012-2013) of
clinical records from 1913 admissions. Main search criteria: referrals to and from Triage,
MHA status, length of stay, diagnostic clusters, HONOS score.
In addition to presented below descriptive statistics, we are using Logit Regression for
further analysis.
RESULTS:Referrals: 38% from community mental health teams and 19% came from
A&E or Liaison Teams.
Compulsory admissions: 61% of all; Section 2 MHA (32%) and Section 3 (12%) and
Section 5(2) (9%). 45% of patients were transferred from Triage under the compulsory
circumstances: 31% on Section 2, 11% on Section 3 and 3% on Section 5(2).
Main diagnostic presentations: Schizophrenia (16%), Depressive disorder (12%) and
Personality disorder (12%). 40% (768) of admissions did not have discharge/transfer
diagnosis structurally recorded.
Length of stay: 70% of patients were discharged or transferred to appropriate service
within 7 days, 30% of patients stayed beyond seven days, with 7% spending more than
two weeks.
Care continuity: 49% (943) patients were transferred to acute inpatient of their locality,
16% (303) continued their care at their local community team, and 12% (224) were
discharged with no further care necessary.

CONCLUSIONS:
1. Psychiatric Triage has mostly managed to comply with 7 days length of stay
policy, however still nearly a third of admissions stay longer.
2. Community mental health services are the most frequent ways of referrals to
Triage hence an on-going improvement of interactive interface is key.
3. Compulsorily admissions account for majority of Triage admissions.
4. Appropriately recorded discharge/transfer diagnosis may help with care pathways
management.
27 Identifying factors influencing gender role reversal in transitioned adult
patients attending the Charing Cross Gender Identity Clinic
Dr Sharmini Rajenthran, Psychiatry consultant, West London Mental Health NHS Trust;
Dr Andrew Davies, Psychiatry consultant, West London Mental Health NHS Trust; Dr
Beatrice Cockbain, FY Doctor, Oxford University
Introduction
The Charing Cross Gender Identity Clinic is the longest established adult clinic in the
United Kingdom, managing over 3000 patients and is the largest publicly funded service
of its kind internationally. A mainstay of treatment is a sustained change of social gender
role, sometimes known as the Real Life Experience. This allows individuals to experience
the psychosocial implications of transition and thus informing decision making before
progressively irreversible physical changes.
The recently introduced Interim Protocol for Gender Dysphoria from NHS England now
condenses treatment pathways for hormone and surgical interventions over shorter time
periods without taking into account the heterogeneity and complexity of some patients
with Gender Dysphoria.
There is insufficient evidence from psychiatric literature on the prognosis of adults with
gender dysphoria which considers co-morbidities and psychosocial adaptation in
transition and how this impacts treatment pathways and long term outcomes.
Aims
The aims of this audit were to:
 Identify relevant themes and co-morbidity in patients who reverse transitioned
gender roles
 Incorporate the above into assessment and therefore inform individual treatment
pathways
 Utilise these themes and co-morbidities to develop clinical pathways for patients
with Gender Dysphoria
Methods
Retrospective Case note review. Sample of 30 obtained by GIC clinicians identifying
relevant patients from their individual caseload. Themes and co-morbidities were
extracted by consensus review by 2 person teams of Psychologists and Psychiatrists at
the clinic. Data is grouped according to age, natal gender, duration and quality of full
time transition and stage of treatment (hormonal and surgical intervention).

Key findings and conclusions
Our findings suggest the majority patients reverting back to their natal gender were
male to female transsexuals with gender dysphoria of later onset. Most patients reverted
gender roles after 12-18 months of transition, having at that point undergone some
hormonal interventions and in some cases surgery. Other factors that emerged included
difficulties negotiating religious, family and societal obligations. Our conclusions suggest
treatment should be nuanced and individualised rather than being timeline focused as is
suggested by the current protocol, in order to minimise the risk of avoidable harm.
28 NICE Self-Harm Guidance - MIND THE GAP
Dr Esther Sabel, post CCT, Tavistock and Portman NHS Trust; Dr Rani Samuel,
Psychiatry consultant, South London & Maudsley NHS Foundation trust (SLaM); Dr Peter
Hindley, Psychiatry consultant, South London & the Maudsley NHS Foundation trust
(SLaM); Dr Andrew Hill-Smith, Psychiatry consultant, Surrey and Borders Partnership
Foundation NHS Trust
Aims:
To identify practices across UK of 16-17 year old adolescents following self-harm
presentations to acute hospitals.
To identify Child and Adolescent Psychiatrist’s views nationally on routine hospital
admissions of 16-17 year old adolescents following self-harm.
To identify the extent to which Child and Adolescent Psychiatrist follow NICE guidelines
across the UK in the management of children under 18.
Hypothesis:
Self-harm management practices may vary across the UK depending on resource
implications, local policies and practices.
Background:
Self-harm NICE guidance (CG16) for the whole population contains a short section on
children/young people which is headed ‘Special Issues for young people’•. In this
section they advise hospital admissions for under 16 year old children but do not
comment on 16-17 year old adolescent children. The Royal College of Paediatrics and
Child Health raised concerns about this group in the appendix of the NICE guidelines
stating, this group is vulnerable and poorly served; also that adult services are not well
adapted to the needs of this group and urged for an update of the guidelines.
Methods:
A questionnaire to collecting Child and Adolescent Psychiatrist’s local practices and views
on self-harm management in line with the aims, were sent in August 2013 to 1316 Royal
College members.
Results:
15% of Child and Adolescent Psychiatrists from across the UK responded (n=191). 68%
who responded routinely admitted children 16 years and under who presented acutely.
Fewer respondents admitted 16-17 year old adolescents and various management
options were employed in other instances. 80% respondent’s thoughts that 16-17 year
old adolescents presenting with self-harm should be offered routine admission.

Conclusion:
NICE Self-harm guidance may not be routinely practiced in children aged 16 and under.
The management of adolescent aged 16-17, presenting with self-harm do not have a
clear pathway and the practices vary across UK. A significant GAP in the NICE self-harm
guidance needs addressing.
29 Benzo the devil you know?
Dr Natasha Shah, GPST1, SABP NHS Trust; Dr Jessica Gough, FY Doctor, SABP NHS
Trust; Dr Emmalene Fish, FY Doctor, SABP NHS Trust; Dr Ramin Nilforooshan, Psychiatry
consultant, SABP NHS Trust
AIMS
1. Ascertain prevalence of benzodiazepine/hypnotic prescription prior to and during
admission.
2. Review discharge prescriptions of benzodiazepines/hypnotics.
BACKGROUND
Benzodiazepines/hypnotics are frequently prescribed but have the propensity to cause
addiction if used long-term. However, they are indicated in a number of acute psychiatric
presentations.
This study aims to establish whether we are reviewing patients’ prescriptions of these
particular medications during admission.
METHODS
Data was collected for 269 working age admissions to SABP NHS Trust from May-July
2013, of which 247 were suitable.
Data was gathered retrospectively, using an electronic database (RiO). Information
regarding benzodiazepine/hypnotic prescription before, during and after admission was
collated. This was subsequently analysed using the statistics programme.
RESULTS
Of the 247 patients deemed auditable, 71 patients were admitted on a benzodiazepine
and/or hypnotic and very few (22.5%) had these medications stopped on discharge.
Of the 176 patients not admitted on any sedative, 123 (70%) were subsequently started
on benzodiazepine/hypnotics as inpatients and 73 patients (41.48%) were discharged on
them.
In total, 106 (42.91%) patients were discharged on at least one benzodiazepine and/or
hypnotic. Of these, 39 (36.8%) were discharged on benzodiazepines only, 41 (38.7%)
on hypnotics only and 32 (30.2%) on a combination of the two.
CONCLUSIONS
A large proportion of new admissions are found to be on sedatives prior to becoming an
inpatient. Perhaps this is due to community doctors preferring to prescribe
benzodiazepines/hypnotics compared to anti-psychotics.
Furthermore, our results suggest that we are failing to discontinue benzodiazepines and
hypnotics during admission and at discharge.

Inpatient teams have an opportunity and responsibility to reduce sedative prescriptions
during admissions. More thorough consideration needs to be given to medications
supplied at discharge and a clear plan needs to be outlined for doctors within the
community so that sedatives can be weaned off safely and appropriately.
30 Patient engagement with Primary Health Care following discharge from
Community Mental Health Services
Mr Ryan Stangroom, Public Health Student, University of Auckland; Dr Ian Soosay,
Psychiatry consultant, University of Auckland; Mrs Molly Morriss, Nurse, Auckland
District Health Board
AIMS AND HYPOTHESIS We aimed to measure the level of engagement with General
Practitioners following discharge from Adult Community Mental Health Services (CMH).
We hypothesised that engagement would vary with population demographics, specifically
that males, more socioeconomically deprived individuals, and 18-34 year olds would
respectively engage less than females, less deprived individuals and individuals 35 years
and older.
BACKGROUND Increasing pressure is being placed to facilitate CMH patient’s discharge
to primary care, with an emphasis on shorter episodes of specialist psychiatric care.
However, engagement following discharge is under-researched.
METHODS Primary care teams (GPs and practice nurses) for 55 randomly selected
service users, from individuals discharged from CMH centres in Auckland, New Zealand
between July and December 2012, were approached as part of an audit and asked to
provide information regarding engagement with GPs. 50 responses were received giving
a response rate of 91%
RESULTS The median number of GP visits per year was 3.7 (IQR = 4.4) and the mean
was 4.41 (SD = 3.54). 72% had contact with their GP at least every 3-4 months,
however 8% did not engage with their primary care team at all following discharge. We
did not find differences in primary care attendance following discharge based on age or
diagnosis.There was a suggestion that patients from more deprived socioeconomic
backgrounds are better attenders, and that patients where GPs had responsibility for
ongoing prescribing had more frequent visits.
CONCLUSION Generally, individuals engage with their GPs well, a minimum of every 4
months, a level many clinicians would be comfortable with. The expected gender and
engagement correlation was seen. The null hypothesis failed to be rejected for age, and
there was a suggestion that reverse relationship was found for deprivation than what
was expected, which is important in the New Zealand health system where primary care
co-payments are perceived to be a barrier to access. There is a significant proportion of
the population that does not engage at the minimum level, which requires further study,
along the nature and content of contacts discharged individuals have with GPs.
31 Using tele-psychiatry to bridge the mental health service gap in India
Dr Lakshmi Venkatraman, Psychiatry consultant, SCARF India; Mr Sujit John, Research
co-ordinator, SCARF India; Mr Kotteswara Rao, Community Mental Health Co-ordinator,
SCARF India; Dr Thara Rangaswamy, Director, SCARF India

AIM AND OBJECTIVES
1. Estimate the geographical reach of the newly initiated tele-psychiatry service
2. Compare the reach of the Mobile Tele-psychiatry (MT) service versus the Fixed-
line Tele-psychiatry (FT)service
3. Evaluate the effectiveness of treatment through tele-psychiatry
BACKGROUND
India’s psychiatric services are predominantly based in the cities leading to poor mental
health service access in the remote and rural parts of India. SCARF, a non-governmental
organization has attempted to bridge this gap by using tele-psychiatry. The STEP
Programme (SCARF Telepsychiatry in Pudukottai ) delivers mental health care to an
impoverished population in Pudukottai district of Tamil Nadu state in India.
METHODS
A two-stage door-to- door survey was conducted to identify persons with psychoses .The
proportion accessing the tele-psychiatry service was determined. The reach of the
services of mobile and fixed-line was compared. A subset of patients with schizophrenia
was assessed with PANSS and GAF at baseline (within 1 month of registration) and
subsequently again at 1 year to evaluate the effectiveness of treatment through tele-
psychiatry.
RESULTS
423 of the 154,270 (adjusted prevalence: 5 per thousand ) screened were found to have
psychoses through the survey. 40% of the identified cases accessed the tele-clinics.
Less than one third of newly registering patients had not been identified during the
survey.
MT (61%) was found to provide better coverage when compared to the FT (49%).
On a subset of 82 patients the baseline mean PANSS rating reduced from 80 (SD 28) to
47 (SD 25) at 12 month follow-up demonstrating a significant reduction in
psychopathology. Similar trend was seen on sub-scale analysis also.
CONCLUSION
The study shows that tele psychiatry can be used as an effective strategy t o bridge the
mental health gap in areas with poor access to mental health services in developing
countries.
32 Prevalence of High Functioning Autistic Disorders within Medium Secure
Units
Dr Kalpnan Dein, Psychiatry Consultant, Cygnet Health; Dr Angela Hassiotis, Psychiatry
Consultant, UCL; Dr Marc Woodbury-Smith, Psychiatry Consultant, McMaster University;
Dr Rachel Squires, Assistant Psychologist, St Andrews’ Healthcare; Dr Ashimesh
Roychowdhury, Psychiatry Consultant, St Andrews’ Healthcare
Aims and hypothesis: To estimate the prevalence of High Functioning Autistic Disorders
(HFA) amongst male inpatients on 3 medium secure wards (MSU). It is hypothesised
that men with HFA will be over-represented in MSUs.
Background: Previous studies have suggested an increased prevalence of HFA within
high secure units in England (at least 1.68%; n=22) (Hare et al, 1999), amongst female

inpatients in a special hospital (Mills et al, 2006), a secure unit for patients with learning
disabilities (Elvish, 2007), amongst forensic referrals in Sweden (Siponmaa et al, 2001;
Soderstrom et al, 2004) and amongst referrals to the Dangerous Severe Personality
Disorders(DSPD) unit in HMP Whitmoor (Hawes, 2003).
Method: The study employed a cross-sectional method. Male inpatients on 3 MSU wards
were approached to participate in the study following ethical approval. Patients who met
the inclusion criteria and consented were screened for HFA using the AQ and the EQ.
Patients who scored above the cut-off were subject to diagnostic assessments.
Results: Out of a total of 46 patients, 16 were excluded because of not having capacity,
being unwell, not being fluent or not being literate. Out of the remaining 30 patients, 15
patients (50%) consented to participate, and were screened for HFA. There were 3
patients with previously diagnosed Asperger’s Syndrome, suggesting a prevalence of
10%. Descriptive statistics were employed.
Conclusions: The results suggest that the prevalence of high functioning autistic
disorders is ten times the prevalence of Autism in the general population as estimated by
Brugha et al (2012). These findings are surprising as the rate of conviction of people
with Asperger’s Syndrome (in a Danish sample) were found to be similar to those of
people without (p=0.89)(Mouridsen et al, 2007).
The authors offer their views about why this is the case. This is the first study to our
knowledge that has estimated the prevalence of HFA within MSUs in England.
Funding: This study was supported by a grant from St Andrew’s Healthcare, the UK’s
leading provider of secure specialist care for people with Autistic Spectrum Disorders.
33 Sleep disturbance in adjustment disorder and depressive illness
Dr Anne Doherty, Psychiatry Consultant, University College Dublin; Dr Faraz Jabbar,
Psychiatry Consultant, University College Dublin; Prof Patricia Casey, Psychiatry
Consultant, University College Dublin
Aims and Hypothesis
We hypothesised that patients with adjustment disorder are as likely to suffer from sleep
disturbance as those with a diagnosis of depression, and sought to identify if sleep
disturbance is associated with suicidal ideation in these diagnostic groups.
Background
Depression is associated with, among other symptoms, disturbance of sleep. Although
adjustment disorder may present with many if the symptoms seen in depression, there
is a paucity of evidence regarding the prevalence of specific depressive symptoms.
Methods
We examined sleep disturbance in 185 patients with adjustment disorder, and compared
them with 185 patients with a diagnosis of depression, using the sleep disturbance items
on the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) and the Inventory of
Depressive Symptoms – Clinician-rated-30 (IDS-C30).
Results
Patients with a diagnosis of adjustment disorder were less likely to report disturbed sleep
than those with a diagnosis of depression. However, the pattern of disturbance differed
in the 2 groups, with patients with adjustment disorder less likely to report early
wakening (p<0.001) or hypersomnia (p<0.01). Patients with adjustment disorder were
significantly less likely to have been prescribed hypnotics. On multivariate analysis, sleep

disturbance was significantly associated with reduced energy levels (p<0.05) in
adjustment disorder and with reduced appetite (p<0.05) and reduced energy (p<0.05)
in depression. On multivariate analysis, functional disturbance due to sleep disturbance
was significantly associated with single marital status in adjustment disorder (p<0.05)
and with overall severity of depressive symptoms (p<0.01) and with negative life events
(p<0.05) in depression
Conclusions.
Disturbance of sleep is a significant symptom in adjustment disorder, but as anti-
depressant medications are not indicated, may pose treatment challenges. With further
research, patterns of sleep disturbance may be useful in differentiating adjustment
disorder from depression.

Wednesday 25 June 2014
EDUCATION AND TRAINING
1 What impact does service reorganisation have on doctors training,
supervision and academic activities?
Dr Donna Arya, Psychiatry trainee, West London Mental Health Trust; Dr Ritesh
Bhandarkar, Psychiatry consultant, National Centre for Brain Injury, St Andrew’s
Healthcare, Northampton
Aims
To evaluate the impact of service reorganisation on supervision, training and academic
activities of trainees (CT1-3/ST4-6), GP trainees, Foundation trainees and non training
grade doctors working on affected sites across West London Mental Health Trust
(WLMHT). To assess the impact of our recommendations of the initial survey in 2013.
Background
Guidelines from the Royal College of Psychiatrists and General Medical Council state that
trainees should be aware of, and have access to a range of learning resources. Trusts
are responsible for speciality training and ensure that it is delivered according to
requirements.
Service reorganisation involved changes in structure, transfer of clinical and non clinical
staff and site changes across different sites of the WLMHT.
Method:
An anonymous online survey consisting of multiple choice questions and opportunities
for open text, was conducted among doctors of training and non-training grades at
different hospital sites in WLMHT. The surveys were conducted in January 2013 and
January 2014. Responses were analysed using SNAP, SurveyMonkey and Microsoft Excel.
Initial survey results were discussed with management.
Results:
A total of 56 responses were received. 48% of participants had experienced service
reorganisation. Initially 67% and then 48% of respondents in 2014 did not get an
induction to local service reorganisation. 29% (compared to 15% in 2013) reported an
effect of service reorganization on clinical supervision. Service reorganisation has led to
29% of doctors having difficulties in attending local academic programs, with many
giving ‘work commitments’ as a reason.
Conclusions:
Service reorganisation has considerable impact on supervision and training of psychiatric
trainees. It is imperative that measures should be taken to involve trainees in all stages
of reorganisation and mandatory induction should be provided in conjunction with any
service changes. The impact of service reorganisation on trainees needs to be monitored
and adequate support provided throughout the process.
2 Psychiatrists on Film
Dr Karyn Ayre, Psychiatry trainee, South London and Maudsley NHS Foundation Trust

Aims and hypothesis
The explosion of smartphone use and the ability to publish videos online has changed
society and directly affects how we practice. The Royal College has recognised this is a
growing issue and recently published guidelines for clinicians wishing to use social
media. However, what should clinicians consider when it is not they who are utilising it,
but their patients? This poster summarises the ethical issues and specifically obtained
guidance from leading professional bodies.
Background
There is guidance for clinicians seeking to use social media and make recordings, but
none regarding the issue of patient-made recordings. As it is becoming increasingly
common in everyday life, there is a gap in the guidance literature.
Methods
Royal College guidelines were consulted. Leading professional bodies were consulted
directly: the General Medical Council, the Medical Defence Union, the British Medical
Association
Results
The BMA’s view is that ‘any mechanism likely to assist patients to remember and
cooperate actively with medical advice should be supported’ although notes that ‘doctors
may feel that such a request is symptomatic of a lack of trust or an intention to bring a
complaint later’.
The issue of capacity is crucial. Patients may lack of insight, meaning the publication of
the film may compromise their dignity.
Filming situations out of context may augment stigma.
Patients other than the one filming could also be unwittingly broadcast. The MDU
indicates that ‘where an image of another is subsequently used by a patient’ then laws
relating to confidentiality, harassment...and libel...may be engaged’.
Conclusions
Social media can be a useful tool for psychiatric patients and clinicians should be aware
of the potential benefits. However clinicians should also keep in mind the risk covert
recordings pose to other patients and the key issue of patient capacity.
3 Inspiring the undergraduate: the 2014 National Student Psychiatry
Conference
Ms Rachel Barker, Medical student, University of Birmingham; Ms Rajinder Johal, Medical
student, University of Birmingham; Ms Maneeka Ubhi, Medical student, University of
Birmingham; Dr Lisa Jones, Senior Lecturer, University of Birmingham
Aims and hypotheses
Exposure to Psychiatry at undergraduate level has been shown to positively impact upon
recruitment to the speciality. Birmingham University’s student led Psychiatry Society
hosted the second National Student Psychiatry Conference in February 2014, with the

aim of positively influencing medical students’ attitudes towards Psychiatry as a career,
in particular the attitudes of students from under-recruiting areas of the UK.
Background
Psychiatry is not an attractive career prospect for many UK medical graduates; a 2011
study found only 4% of medical students voted Psychiatry as their preferred career
choice. Furthermore, in 2012 only 78% of Core Trainee 1 jobs were filled. The
recruitment crisis is not equally spread: some postgraduate deaneries recruited more
candidates than vacancies whilst North Western and West Midlands deaneries were
unable to fill their vacancies by a significant number.
Methods
The Conference was held at Birmingham Medical School. Plenary speakers and workshop
leads were from a variety of grades, from Foundation Year trainees to Academic
Professors and officers of the Royal College. Research was promoted throughout the
event and a student poster competition was held. Networking between Psychiatry
Societies, students and speakers was encouraged.
Results
156 delegates registered for the event. 143 (91.7%) of the delegates were medical
students from 28 universities. Following the conference 99 students provided feedback.
64 (64.64%) explained that following the conference they were more likely to choose a
career in Psychiatry, compared to before. 32 (32.32%) stated their thoughts unchanged,
but the majority stated this was because prior to the conference they were certain they
would pursue a career in Psychiatry.
Discussion
The second National Student Psychiatry Conference was successful in positively
influencing medical students’ attitudes towards Psychiatry. This corroborates the findings
from the 2013 conference and confirms the event should be held annually.
4 Supporting Higher Trainees in delivering teaching an initiative to change
practice
Dr Xanthe Barkla, Psychiatry trainee, Northern Deanery; Dr Corrine Reid, Psychiatry
trainee, Northern Deanery
Background:
Traditionally the final year Child and Adolescent Psychiatry (CAP) teaching has allowed
little ownership of sessions by the Specialist Trainees (STs) delivering the teaching, and
little opportunity for student interaction. We identified a need to change the
undergraduate teaching, given the student and trainee feedback. We presented out
initiative to change practice at the 2013 international congress. We now present our
findings following the change.
Aims and methods:
The aim was to create a community of practice in which STs developed teaching skills
working within the theoretical framework of the zone of proximal development. We held

an initial seminar for STs in order to explore the undergraduate curriculum, discuss
lesson planning and model teaching techniques.
STs then developed a teaching session and delivered this four times across the cohort.
They were allocated to a mentor to aid lesson planning, and observe teaching sessions to
provide feedback. We collated student and ST feedback.
Results:
174 students completed evaluations. The student evaluations showed 100% of students
liked the teaching style, 97% finding it interesting and 79% felt their learning needs had
been met. The free text comments showed enthusiasm for the new style of teaching.
We held a focus group to obtain ST and consultant (mentor) feedback. The experience
was positive, particularly the allocation and feedback of an experienced mentor. It
highlighted the need for an allocated coordinator and dedicated time to be given to
preparation of teaching sessions.
Conclusions:
We have successfully developed a community of practice which encourages skill
development, use of innovative teaching methods and reflective practice. Students have
responded positively to the changes.
Teaching is an important part of medical practice today, and encouraging development
of skills in this area is a key factor in delivering a high standard of undergraduate
medical education.
5 The use of clinical simulation to increase staff confidence in the assessment
and management of medical emergencies arising within the psychiatric
inpatient population
Dr Steven Birrell, Psychiatry trainee, Department of Psychological Medicine, Royal
Infirmary of Edinburgh; Mr Colin Halliday, Resuscitation Officer, Resuscitation
Department, Royal Edinburgh Hospital; Dr Rachel Harvey, Specialty Trainee in
Anaesthetics, Department of Anaesthetics, Royal Infirmary of Edinburgh; Dr Simon
Edgar, Director of Medical Education
BACKGROUND: While the role of clinical simulation in mental health education has been
established, there is limited published work demonstrating the utility of simulation for
training members of the multidisciplinary team in the assessment & management of
medical emergencies occurring within the psychiatric inpatient population. Anecdotal
evidence and previous qualitative research has demonstrated a need to improve
participant confidence during assessment and management of medical emergencies
within the psychiatric inpatient setting.
AIMS & HYPOTHESIS: The aim of this project was to improve the confidence in
managing medical emergencies of mental health professionals responsible for carrying
the emergency pager within the Royal Edinburgh Hospital, with the overarching goal of
improving emergency care and patient safety. The authors hypothesised that a half-day,
scenario-based, clinical simulation session with learning objectives mapped to relevant
postgraduate curricula would improve participants’ confidence in the assessment and
management of medical emergencies.

METHODS: Both quantitative and qualitative data was gathered via paper evaluation
forms immediately after each session. Quantitative data was analysed using descriptive
statistics. Themes were extracted from qualitative data using word repetition methods.
RESULTS: 22 responses were collected. 96% agreed or strongly agreed that the
scenarios were realistic; 96% agreed or strongly agreed that the session improved their
confidence in the assessment & management of medical emergencies; and 96% agreed
or strongly agreed that they would recommend this course to a colleague. From the
qualitative date, participants tended to like the hands-on and non-threatening aspects of
the session; they tended to dislike the stress of the scenarios; and tended to want more
scenarios.
CONCLUSIONS: A half-day, scenario-based clinical simulation session was received very
positively, and improved the self-reported confidence in participant abilities to assess
and manage medical emergencies arising in the psychiatric inpatient setting.
6 Autoimmune encephalitis:the hidden realm of organic psychosis
Dr Anand Mathilakath, Consultant Psychiatrist, Abraham Cowley Unit, SABP NHS
Foundation Trust; Dr Blerta Cenko, Psychiatry trainee, SABP NHS Foundation Trust; Dr
Ramin Nilforooshan, Consultant psychiatrist, Brain Science Unit, Surrey and Borders
Partnership NHS Trust
Aims
To highlight the presentation of autoimmune encephalitis with predominantly psychiatric
symptoms in a patient with Asperger syndrome.
Background
The term autoimmune encephalitis is used to describe a group of disorders characterized
by symptoms of limbic and extra-limbic dysfunction occurring in association with
antibodies against synaptic antigens and proteins localized on the neuronal cell surface.
Methods
We would like to present the case of a patient with a diagnosis of Asperger syndrome,
who presented to acute psychiatric services with psychotic symptoms, which appeared to
be due to autoimmune encephalitis.
Results
A 17-year old Caucasian male with a diagnosis of Asperger syndrome, Obsessive
compulsive disorder and depression presented to acute psychiatric services with
deterioration in his mental state (low mood, preoccupied thoughts, cognitive decline) as
well as neurological symptoms (drooling, head twitching, urinary incontinence). He was
seen in A&E and also by a neurologist with the view that his symptoms were largely
psychogenic.
He continued to deteriorate (worsening confusion, deterioration in memory, labile mood)
with intermittent verbal and physical aggression. He was expressing suicidal thoughts as
well as being tormented by sexual thoughts about children and images of murdering
people.
On the acute psychiatric unit, he lost his eyesight partially in one eye and became
pyrexial.

Immunological serum screen showed GABA+ve results confirming a diagnosis of
autoimmune encephalitis.
Further investigations showed no focal abnormality or neoplasia. He was treated with
plasma exchange for 5 days and patient improved significantly.
Conclusions
Consideration should be given to sudden atypical psychiatric and neurologic changes
with strong suspicion for organic causes such as autoimmune encephalitis as this can
otherwise be missed. Autoimmune encephalitis should also be considered in the
differential diagnosis in patients who present with atypical symptoms as this is
potentially treatable if diagnosed early.
7 Undergraduate Teaching and Recruitment in Child and Adolescent Psychiatry
Miss Rebecca Hodnett, Medical student, Kings College London; Dr Sarah Bernard,
Psychiatry consultant, South London and Maudsley NHS Trust; Dr Benjamin Baig,
Psychiatry trainee, Institute of Psychiatry
Aims and Hypothesis: Do medical students carry negative attitudes to Child Psychiatry?
What is the evidence base for methods of teaching of Child Psychiatry?
Background: Recruitment problems in Psychiatry are well known and may be due to
stigma and poor undergraduate experience. Of all subspecialties, in 2013 child
psychiatry has the second lowest competition ratio for specialist training. Recruitment
strategies include improving the undergraduate experience but child psychiatry has
traditionally featured less on most undergraduate curricula and little is known about
specific attitudes to child psychiatry.
Methods: This study included two components. Firstly a systematic review of
undergraduate child psychiatry teaching containing key words: [child, adolescent,
psychiatry] and [teaching, education, curriculum, recruitment, undergraduate, medical
student and medical school]. Secondly, an empirical study looking at attitudes. The
Attitudes to Psychiatry 30 (ATP-30) is a 30 Likert scale assessment which has been well
validated in undergraduate populations. Here, we modified the ATP-30 to see how each
question related to attitudes to Child and Adolescent Psychiatry. Students in Kings
College London receive one half day of Child psychiatry teaching and over one year all
452 students in a year group were asked to complete this questionnaire.
Results: 11 studies were identified which related to specific research on teaching
undergraduate child psychiatry. These studies emphasized the need to introduce the
subject earlier and support clinical exposure as a means of enthusing students. 211
students completed the Child ATP-30. Attitudes were similar to the rest of psychiatry
where scepticism existed as to the scientific basis and importance of the specialty on a
medical curriculum.
Conclusion: Further research should be conducted to look at how attitudes to child
psychiatry can be improved and whether this can and should be done through the
undergraduate curriculum.
8 CBT by Psychiatric Trainees- Can a little
Dr Eric Kelleher, PhD student, Department of Psychiatry, Trinity College Dublin; Dr

Michael McDonough, Psychiatry consultant, Department of Psychiatry, Trinity College
Dublin and St Patrick’s University Hospital, Dublin; Melissa Hayde, Department of
Psychiatry, Trinity College Dublin and St Patrick’s University Hospital, Dublin; Yvonne
Tone, Department of Psychiatry, Trinity College Dublin, St Patrick’s University Hospital;
Iulia Dud, Department of Psychiatry, Trinity College Dublin; Colette Kearns, Department
of Psychiatry, Trinity College Dublin and St Patrick’s University Hospital, Dublin; Mary
McGoldrick, Department of Psychiatry, Trinity College Dublin and St Patrick’s University
Hospital, Dublin
AIMS & HYPOTHESIS: We hypothesised that Psychiatry trainees can perform
competently as CBT therapists if well supervised and allocated uncomplicated cases. Our
aims were (I) To retrospectively review all available structured supervisor reports for
trainees who delivered CBT to patients for the first time. (II) To investigate if a ‘˜gold
standard’ tool- the revised-Cognitive Therapy Scale (CTS-R), where completed,
supported the supervisors’ structured reports.
BACKGROUND: There is little research on the competency of psychiatry trainees to
actually deliver CBT to patients. Yet it has gained increasing prominence in mental health
services. This study took place in a National Psychiatric Hospital in Ireland with a well
developed psychotherapy service. Following the completion of therapy, supervisors
complete a structured report rating trainees using a simple likert scale incorporated from
the CTS-R. Items rated are (a) Establishing a therapeutic relationship, (b) Ability to
apply CBT model, (c) Understanding of model preparation, (d) Use of supervision time
and (e) Overall. A result of 3 or over for each item indicates competence. The CTS-R is a
gold standard tool used on post-graduate courses. An overall average result between 36-
48/72 establishes competency in that assessment.
METHODS: Following ethical approval, we reviewed all available structured supervisors’
reports, and CTS-R rating scales from an 8.5 year period. We analyzed our findings
using SPSS.
RESULTS: 55 trainees treated a patient using CBT (55% male, mean [range] age 31
years [25.1-42.8]). All were psychiatry trainees pre-membership (MRCPsych) with no
previous experience of delivering CBT. Trainees had spent a mean (SD) of 15 months
(8.2) in psychiatry training. The average results for 52 (100%) trainees was found to be
at or above the accepted level for competency (¥3) across a range of areas e.g. 4.6
[SD=0.9]. Available CTS-R reports (n=22) supported the structured supervisor reports’
findings for those particular trainees e.g. mean rating for 22 Trainees was 42 (SD=5.16).
CONCLUSIONS: This study indicates that trainees can provide meaningful clinical
interventions when delivering CBT to selected cases under supervision. The costs of
supervision need to be judged against these clinical gains.
9 The First Hit
Dr Joseph Malone, FY Doctor, MerseyCare NHS Trust
Aims and Hypothesis
I made this 15 minute film to highlight the all too common tragic back-story to
addictions, giving back a sense of identity to these individuals and bringing them out of
that space in-between.

Poster abstracts from the International Congress of the Royal College of Psychiatrists

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Poster abstracts from the International Congress of the Royal College of Psychiatrists