Aims To review compliance with current blood monitoring guidelines of Older Adult Community Mental Health (OACMHT) patients who are on clozapine within the community teams of Herefordshire and Worcestershire Health and Care NHS Trust. This is for full blood count, prolactin, glycated haemoglobin (HbA1C), liver function, renal function, lipid profile, glucose, and clozapine assay. Methods Our trust guidelines state the following blood parameters should be monitored every 6 months: 1.Full Blood Count (FBC) 2.Glucose (fasting if possible) 3.Prolactin 4.Urea & electrolytes (U&E) 5.Lipid profile (fasting if possible) 6.Liver Function Tests (LFT) 7.HbA1c (annually) 8.Clozapine plasma assay (annually) We reached out to the medical secretaries of the following OACMHTs: Wyre Forest, Malvern Evesham & Pershore, Worcester & Droitwich, Redditch & Bromsgrove to collate a list of patients on clozapine. We then retrospectively looked at blood test results in the past 1 year from 31.12.22 to 31.12.23 and assessed compliance of the 8 haematological parameters. Results In total, 7 patients were identified across the 4 OACMHTs caseloads who were on clozapine. In the past 1 year, we would expect 2 episodes of monitoring for FBC, Glucose, U&E, Prolactin, Lipid profile, and LFT, as well as 1 episode of HbA1C and clozapine drug levels. Compliance for FBC monitoring for 2 episodes was achieved for 100% (n = 7) of the patients. Compliance for 2 episodes of glucose and prolactin monitoring were 0%. Compliance for 2 episodes of renal profile monitoring was 57% (n = 4), but 86% (n = 6) of the patients had at least 1 episode of renal profile monitoring. Compliance for 2 episodes of Lipid profile monitoring was 0%, however 43% (n = 3) of the patients had at least 1 test. In terms of LFTs, 71% (n = 5) of the patients achieved the expected 2 episodes of monitoring, and 100% of them at least 1 episode of monitoring. For HbA1C monitoring, 100% of the patients had the expected 1 episode of monitoring annually. For clozapine plasma levels, 43% (n = 3) of the patients achieved their expected annual episode of monitoring. An interesting observation of note was that a number of blood parameter investigations were performed by GPs/hospitals as part of another investigation, not exclusively for the sole purpose of clozapine monitoring. For example, 50% of the U&Es, 33% of lipid profiles, 71% of LFTs, and 43% of HbA1c tests were done by the GP/hospital. Conclusion The OACMHTs within our trust achieved 100% compliance with FBC and HbA1c monitoring in the past 1 year. 71% compliance was achieved with LFT monitoring, 57% was achieved with U&E monitoring and 43% compliance was achieved with the annual clozapine monitoring. With regards to tests done by GP/hospitals, on one hand, repeated phlebotomy of patients would come with increased direct medical (equipment, facilities) and non-medical (time) cost to service and intangible costs (pain) to patients. It would also not be cost effective to repeat these tests if done recently. Hence one could use recent test results as part of their monitoring routine. However, if these patients do not happen to see their GPs or have a hospital admission for unrelated issues, would they have missed their ideal monitoring targets? This unpredictability of timely monitoring raises the question of whether there is a need for the creation/standardisation of clozapine clinics within the OACMHTs, especially if the clozapine patient caseloads continue to grow.

Aims To assess physical health in patients under the Early Intervention Service, whom are prescribed antipsychotics. To consider whether further intervention needs to be provided or promoted to improve physical health in this group. Method Assessment of carenotes database for all 63 patients on EIS caseload prescribed antipsychotics. Result Out of 47 patients studied, 20 were non-smokers at baseline. 25% of them ended up becoming smokers by the end of the study time. Out of 47 patients studied 28 were non-drinkers at baseline. 32% of them ended up engaging in alcohol by the end of the study time. Out of 47 patients studied, 38 patients had data available to record weight changes per year. Out of the 38 patients, 27 of them had positive weight change; average weight change was + 6.38 kg per year. The highest weight gain was 38.4 kg, the highest weight lost was 47.3 kg. Out of 47 patients studied, 35 patients had data available to record BMI changes. Out of the 35 patients, 27 of them had positive BMI increases, average BMI change was + 2.68. The highest BMI increase was 12.84. The highest BMI decrease was 8.24. Out of 47 patients studied, 11 patients had data available to record random glucose level changes. Out of the 11 patients, 7 of them had increased glucose levels, average glucose change were + 0.5mmol/l. The highest increase in glucose was 3.9mmol/l and the highest drop in glucose was 2.6mmol/l. Out of 47 patients studied, 19 patients had data available to record HbA1c levels. Out of the 19 patients, 10 of them had increased HbA1c levels, with the average change being + 0.31 mmol/mol. The highest increase in HbA1c levels was 5 mmol/mol and the highest drop in HbA1c levels was 3 mmol/mol. Out of 47 patients studied, 30 patients had data available to record cholesterol changes. Out of the 30 patients, 21 of them had increased cholesterol levels, with the average change being + 0.09mmol/l. The highest increase in cholesterol was 1.7mmol/l and the highest drop in cholesterol levels was 2.6. Taken together, we show that anti-psychotic use has a negative effect on physical health parameters such as weight gain, BMI increase, HbA1c levels and cholesterol levels. This increases the patient's risk of developing diabetes/metabolic syndrome in the future. Conclusion Re-audit.

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

With the recent global interest in mental health, there has been an increase in the number of people coming forward to discuss the once frowned upon illness. It is true that some progress has been made in terms of establishing an equal footing within the health and social care landscape with the help of various campaigns. However, there is still much work to be done with regards to removing the stigma of mental health within the healthcare sector itself. It is no surprise that mental illness statistics are significantly higher amongst medical practitioners due to the high-stress nature of their jobs, yet it is believed to be under reported. Interestingly, there is emerging evidence that physician burn out stems early in their careers whilst in medical school, suggesting areas that need improvement in medical education with regards to how medical students view and handle mental illness. As such, two issues have been identified and discussed here - the stigmatisation of mental illness whilst in medical school and the underemphasis of mental illness as compared to other physical health problems in medical education. It is hoped that discussing these issues can help stimulate subsequent positive changes.

Introduction: Whilst many medical students become involved in research during their medical school careers, there is often little formal guidance on how to write this research up into a paper that is suitable for publication. Abstracts are often used for screening and selection of research by journals, conferences/meetings as well as the readers. Therefore, a good, clear abstract that accurately conveys research in an engaging manner is necessary to provide a competitive advantage for publication/poster presentation. Methods: A non-systematic search of PubMed and Google was conducted to identify articles published prior to November 2018 that were relevant to writing an abstract. Results: There are three main types of abstracts: informative, critical, and descriptive. Each is used under different circumstances to summarise different types of work. In this paper, provide worked examples of each of the different types of abstract and discuss the style and formatting of an abstract. Focus is also given to how to write concisely and develop an academic writing together, with additional tips on submitting an abstract to journals or conferences. Discussion: This paper provides a comprehensive overview of the types of abstracts that medical students may need to write and how to write them. Whilst structure and content are of course important, the key to writing a good abstract is the ability to develop a concise, formal academic writing style, which takes practice. Specific journals and conferences may have their own rules on the style of abstract needed, and these should always be followed.

Anatomy is often said to be the bread and butter of doctors, but in light of the ever-increasing additions to medical curricula and difficulties in teaching the subject, Anatomy has dropped out of favour with both staff and students, making way for the teaching of other new exciting specialties. In this paper, we highlight some of the new advances Anatomy has made in the recent years, demonstrating the relevance and potential clinical implications these discoveries can have, thus supporting the notion that Anatomy as a subject is still very much alive and exciting, as it was in the early days.

BACKGROUND:Neurodegenerative diseases like Alzheimer's Disease (AD) are a global health issue primarily in the elderly. Although AD has been investigated using primary cultures, animal models and post-mortem human brain tissues, there are currently no effective treatments.SUMMARY:With the advent of induced pluripotent stem cells (iPSCs) reprogrammed from fully differentiated adult cells such as skin fibroblasts, newer opportunities have arisen to study the pathophysiology of many diseases in more depth. It is envisioned that iPSCs could be used as a powerful tool for neurodegenerative disease modelling and eventually be an unlimited source for cell replacement therapy. This paper provides an overview of; the contribution of iPSCs towards modeling and understanding AD pathogenesis, the novel human/mouse chimeric models in elucidating current AD pathogenesis hypotheses, the possible use of iPSCs in drug screening, and perspectives on possible future directions.KEY MESSAGES:Human/mouse chimeric models using iPSCs to study AD offer much promise in better replicating AD pathology and can be further exploited to elucidate disease pathogenesis with regards to the neuroinflammation hypothesis of AD.