No abstract

In response to differential clinical presentations of survivors of multiple or chronic exposure to trauma, complex post-traumatic stress disorder (CPTSD) has been included in the 11th revision of the International Classification of Diseases (ICD-11). A growing body of research has explored the prevalence of CPTSD in a range of populations, yet its prevalence in adults diagnosed with Emotionally Unstable Personality Disorder (EUPD) has been subject to limited evaluation, including in individuals requiring specialist inpatient care. The International Trauma Questionnaire (ITQ) was administered to 42 females with primary diagnoses of EUPD admitted to a specialist DBT service. Twenty-eight (66.8%) participants met full diagnostic criteria for either PTSD (11.9%, n=5) or CPTSD (54.8%, n=23). Additionally, PTSD and CPTSD symptomatology were highly prevalent in participants who did not meet the functional impairment criteria. Significant differences in the prevalence of CPTSD were found, dependent on whether a measure of functional impairment was included. This is the first study to explore the prevalence of CPTSD in an inpatient EUPD sample, using diagnostic thresholds. The findings highlight the importance of attending to trauma as well as EUPD-related needs. Theoretical, clinical and future research implications are discussed.

AimsThe Royal College of Psychiatry introduced a new postgraduate training curriculum in August 2022. One of the main changes is the introduction of a new collaborative tool between supervisor and trainee, the placement-specific personal development plan (PSPDP). The aim of this project is to locally explore trainee's views and experiences with the PSPDP.MethodsWe explored the views and experiences of seven psychiatry trainees within the South London and Maudsley NHS Foundation Trust in a single 60-minute focus group, co-facilitated by two authors over Microsoft Teams. The participants were purposively identified to have started core and higher training under the new curricula and a snowballing approach was used to recruit them. The data were recorded, transcribed, and analysed in line with ethical guidelines. The analysis was done by using Clarke and Braun's approach to thematic analysis.ResultsThree overarching themes were identified: 1.Positives of using a collaborative tool with a psychiatric supervisor (PS),2.Challenges in implementation and3.Trainees’ perspectives on directions forward.The most notable subtheme of theme one was the improved curricular alignment between learning opportunities, curriculum content, and assessment tools. As one participant mentioned: “When we were going through [the PSPDP], it definitely guided us, what we wanted to (…) get out of this placement in particular, and also the kind of workplace-based assessments needed.”. The time-effective and structured approach to learning, regular progress follow-up, as well as improved motivation to engage with the placement were further subthemes mentioned. Examples of subthemes emerging from theme two were lack of PS knowledge about the PSPDP, as well as lack of training and information for trainees. Participants commented that “supervisors really didn't know what they were supposed to do” and that “the information [shared during induction] was outdated”. One example of subthemes from theme three was the need for additional training both for trainees and PSs. As one participant mentioned: “Training is required for supervisors (…) and for us as well to get really used to the system. Because it's a good system if we know how to use it.”ConclusionTo the best of our knowledge this is the first study exploring trainees’ views on the new PSPDP. Whilst trainees appreciated the potential benefits of working through the PSPDP together with their supervisor, significant challenges remained and may hinder its meaningful use. Our next steps are designing and running a hybrid questionnaire to gather views from a larger sample.

AimsThe Specialist Adolescent Mental Health Service at the Maudsley Hospital provides multi-disciplinary mental health care to adolescents in London. There is currently no policy by which non-medical members of the multi-disciplinary team can request a psychiatric review for their patients. Staff feedback revealed problems with the medical review referral process to be a lack of clarity on how to make referrals, and a lack of transparency (e.g. referral outcome, approximate waiting time).This projected aimed to improve the clarity of the process for requesting psychiatric reviews and to develop skills in leadership as a future child psychiatrist.MethodsWe designed and introduced a referral form and integrated waiting list. Next we developed a policy document for making referrals. Finally we modified the referral form so that when submitted, it automatically updated the integrated waiting list. At the outset and after each intervention we resurveyed the staff.ResultsAt the outset 71% of staff reported finding the process somewhat unclear, while 29% reported finding the referral process neither clear nor unclear. Following the final change 100% staff each reported finding the process very clear or somewhat clear.ConclusionThe changes we implemented resulted in a clearer and more transparent referral process for medical reviews. We anticipate that this improved staff satisfaction will equally translate into some benefits for patient care, such as more clarity around when a medical review can be expected and what it might entail.

AimsCOVID-19 can spread rapidly in psychiatric inpatient settings. Previous studies have found that patients have a higher risk of hospitalisation and death than adults in the community. The aim of this project was to improve the care of patients with COVID-19 in psychiatric inpatient settings.MethodA baseline audit was conducted of care COVID-19 patients received in wards that experienced outbreaks in January 2021 in a London Mental Health Trust. Clinical notes were reviewed for management plans, including clear documentation of risk of serious illness, frequency of vitals monitoring, and thresholds for escalation to medical teams.A new protocol was subsequently developed and implemented at one inpatient unit: “COVID-19: Early Identification of Risk and Management”. This included an adjusted 4C mortality score to determine risk of deterioration, and schedules for observation monitoring based on this outcome. Each schedule specified separate frequencies of monitoring of critical observations (oxygen saturations, respiratory rate) and routine observations, thus minimising unnecessary staff exposure. It prompted venous thromboembolism (VTE) assessment and documentation of escalation criteria.Result44 patients were identified across three working age (WAA, n = 29) and two older age (OA, n = 15) adult wards. 7.5% of WAA and 33.3% of OA patients were hospitalised. 20% of OA patients died following a positive test. 58% of patients had a documented management plan for COVID-19, but only 56% mentioned observation frequency, 19% escalation criteria, and 9% risk of serious disease. No patient received a repeat VTE assessment following diagnosis. The audit identified inconsistent approaches to COVID-19 management between wards, and found no relationship between risk of deterioration and frequency of observation monitoring. Following implementation of this protocol, 100% (n = 4) of patients had a robust plan for COVID-19 management, and 100% received a VTE assessment.ConclusionThe audit supported previous findings that psychiatric inpatients are at risk of serious COVID-19 infection. This highlights an urgent clinical and ethical need to optimise COVID-19 care in psychiatric inpatient settings. The results of this audit suggest that risk factors for severe infection and elements of routine care are not widely understood or implemented by clinical staff. Introducing evidence-based protocols to support clinicians in managing the physical healthcare of these patients may be one way of promoting best practice. The improvement in care observed in the pilot study has resulted in this protocol being rolled out across the Trust in an ongoing quality improvement project.