The impact of COVID-19 on access to mental health services and the use of teletherapy as an alternative form of treatment

The aim of this research study is to determine the impact of COVID-19 on access related to mental health services and also explain the use of teletherapy as an alternative form of treatment. This research study is based on secondary research data analysis to determine the research study data collected from websites related to the ratios of COVID-19 also that mental health services. Determine the research study used E-views software, and the generated result included descriptive statistics, correlations, the dickey fuller test analysis, the histogram, and state, also that explain the variance and test of equality between them. The overall result shows COVID-19 shows a direct impact on mental health services;teletherapy directly links with mental health services. Benefits make teletherapy the best online therapy session for overcoming various types of depression and mental illness in patients. Also, teletherapy is an alternative form of mental health service that is mostly provided to people affected due to the pandemic conditions of the coronavirus.Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

Attitudes of the Parents of Children and Adolescents Aged 0-18 with Intellectual Disability to Vaccine

Objective: Studies have shown that individuals with disabilities participate in routine immunization programs less than individuals without any disabilities. This study was carried out to explore the attitudes of parents of children and adolescents aged 0-18 years with an intellectual disability towards vaccination before the COVID-19 pandemic. Material(s) and Method(s): This descriptive study was conducted with the parents of 94 children and adolescents aged 0-18 years who were educated in a special training center in Izmir. Socio-demographic Questionnaire and Attitudes towards Vaccination Scale were used as data collection tools for the study. Attitudes towards Vaccine Scale has been developed by Cvjetkovic et al. Ethics approval was obtained from the Izmir Katip Celebi University Non-Invasive Clinical Research Ethics Committee, and institutional approval was obtained from the institution administration. Result(s): The rate of parents who stated that they believed that vaccines had serious side effects was 73.4%. The rate of families who had never been vaccinated and thought that the vaccines were ineffective was 14.9%. The parents' total ATVS median score was 43 and they displayed a moderately positive attitude. Those who believed that "vaccines have serious side effects" had the lowest median ATVS score (p< 0.005). Median ATVS scores of fully vaccinated parents were higher than those of the parents who did not have any vaccinations and who had incomplete vaccination, and they displayed a more positive attitude (p< 0.005). According to the parents' sources of information, ATVS scores were compared (p< 0.005), and the median ATVS scores of those who received information from healthcare personnel were higher than those of the parents who received information from other sources (p< 0.005). Conclusion(s): In this study, while 14.9% of the parents of children and adolescents with intellectual disabilities reported that they did not get their children vaccinated, 85.1% got their children vaccinated. Children and adolescents with intellectual disabilities have higher health risks due to various reasons such as the inadequacy of health protection and improvement programs, and therefore, they should be among the priority groups in immunization.Copyright © 2023 by Pediatric Infectious Diseases and Immunization Society.

Dual challenge: A pilot study of challenges using masks in individuals with intellectual disabilities during the Covid pandemic

Introduction: Individuals with intellectual disabilities experience greater difficulties compared to the general population in using masks to protect from SARS-CoV-2 due to inability to understand the need to wear masks, hypersalivation, irritability etc. This study aims to identify the challenges faced by these individuals in using masks and their correlation with the severity of intellectual disability. Methodology: 50 individuals aged 6 to 18 years with intellectual disabilities attending NIEPID were recruited after taking informed consent from the caregivers. Socio-demographic details and difficulties faced while using masks and when their family members wear masks were collected using semi-structured proforma. Data was analyzed using MS Excel and SPSS version 25. Result(s): The mean age of participants was 11.06 years. Male: Female ratio was 1.94:1. Majority (92%) of individuals were having mild to moderate intellectual disabilities. 62% wore masks properly. Irritability (24%) and touching the masks repeatedly (54%) were the commonest mood and behavioral changes noted while wearing masks respectively. Soiling of masks as a result of hypersalivation was a concern in 18% of the cases. The strength of significant correlations between the degree of mental retardation and difficulties faced with mask usage was negligible to low. Discussion(s): 88% and 54% of individuals observed their family members while wearing masks and tried to imitate this behaviour respectively. This can be utilized in training to wear masks. Behavioural issues when family members wear masks place them at a higher risk of contracting covid. Improper fitting of masks was an issue in 30% of the study population and requires exercising caution while selecting masks. Conclusion(s): Insights gained into the challenges faced by individuals with intellectual disabilities while using masks help devise appropriate behavioral interventions to enhance compliance with using masks. Mask tolerance training is essential for preparedness for future pandemics.

Participating in the digital world: a consensus statement on digital social contact for people with disabilities living in sheltered care facility homes

Introduction: Digital social contact is increasingly being used, which accelerated during the COVID-19 pandemic. This study aimed to determine the consensus among stakeholders regarding recommendations for the use and facilitation of digital social contact for people with intellectual disabilities living in sheltered care facility homes. Method(s): This consensus statement was developed in three consecutive rounds of questionnaires (rapid online modified Delphi design). The expert-groups included people with disabilities (N = 6) and their families (N = 10), support professionals (N = 9), behavioural consultants (N = 7), managers of sheltered care facility homes (N = 10), scientists and industry experts (N = 15). Finding(s): Four main themes were identified: 1. Reasons for and types of digital social contact;2. Support and training needs;3. Materials and other requirements needed to enable digital social contact;and 4. Best practices and future developments. For each theme, several recommendations were formulated. Discussion and conclusion: This study resulted in a consensus statement aimed mainly at care professionals, families of people with intellectual disabilities and managers of sheltered care facility homes. Findings show that digital social contact can contribute to societal participation of people with disabilities. Additionally, tailored exploration of digital contact is recommended, as well as aiming for inclusive-by-design technology developments with developers and stakeholders working together.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Providing Comprehensive Services to Treat Patients and the Inpatient Psychiatric Bed Crisis

Objectives: A growing mental health crisis and a shortage of inpatient psychiatric beds have resulted in a surge of patients' boarded' in emergency departments awaiting acute inpatient psychiatric placement. This delays care and causes a further burden on already stressed emergency services. In June 2020, the Centers for Disease Control and Prevention (CDC) reported an increased incidence of anxiety and depressive disorders since March of 2020, in comparison to pre-pandemic data. This has further exacerbated the shortage of psychiatric beds nationwide. In addition, staff shortages at state psychiatric hospitals in the Commonwealth of Virginia led to temporary closures to admissions. State facilities in VA provide care for our most vulnerable population, including (involuntary) patients on a temporary detention order (TDO). Carilion Clinic implemented the Comprehensive Psychiatric Emergency Program (CPEP) in August 2020 with the goal of early identification and robust treatment of psychiatric patients while in the ED. Since implementation of the CPEP, providers have been able to redirect patients away from burdened state psychiatric facilities by rapid stabilization of patients in the ED. Patients were able to step down to a less restrictive environment, often no longer meeting criteria for TDO. This study aims to assess the rate of TDO releases pre- and postimplementation of the CPEP at Carilion Clinic. Method(s): A pilot program was launched in August 2020 at Carilion Roanoke Memorial Hospital through a collaboration of the Departments of Emergency Medicine and Psychiatry. The staff was comprised of a psychiatrist, a psychiatric nurse practitioner, and a social worker. Data was collected from May 2020 to June 2021 from the Epic electronic medical record and included all patients in the ED on a TDO, ages six and above. Patients who no longer met criteria for a TDO were released from involuntary status and either redirected as a voluntary patient to an inpatient psychiatric unit or discharged to the community. The rate of TDO releases three months prior to CPEP implementation was assessed and compared to the TDO release rate post-CPEP implementation. Result(s): Prior to CPEP implementation, the TDO release rate was 7%, amounting to four patients released from a TDO per month. After implementation of CPEP, the TDO release rate increased to 19%, equating to thirteen patients released from a TDO per month during the pilot period. This led to a decrease in the number of patients that would have previously been admitted to a state psychiatric facility. Patients who benefitted from implementation of the CPEP were those with conditions in the following categories: chronic mental illness (32%), individual/family crisis (24%), neurocognitive disorders (20%), substance use disorder (18%), autism spectrum disorders and intellectual/developmental disabilities (6%). Conclusion/Implications: Implementation of the Comprehensive Psychiatric Emergency Program (CPEP) in Carilion Clinic' Emergency Department was successful in reducing the number of state psychiatric admissions by redirecting 11% more involuntary patients to voluntary status. The results of this study highlight the benefits of having in-house psychiatry teams dedicated to early triage, rapid treatment, and comprehensive case management for psychiatric patients in the emergency department. References- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics;2020. https:// www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

Qualitative exploration of the physical activity engagement among college students with intellectual disabilities

Higher education institutions today have offered a range of postsecondary transition programs for adults with.intellectual disabilities (ID). Applying the social-ecological framework, this study was aimed to analyze qualitative data about the experiences and perceptions of physical activity (PA) among eight college students with ID at a post-secondary transition program in the United States. The phenomenological approach was utilized to describe participants' lifeworld experience of PA. Results indicated that the most PA opportunities on campus merely derived from the availability of adapted programs. Only one participant met the minimum requirement of engaging moderate-intensity exercise weekly. Based on the analysis using the social-ecological framework, the results include twelve themes at the intrapersonal level (self-efficacy, personality, emotion, past experiences, knowledge, and time), interpersonal level (family support and friend support), and institutional level (specifically, university recreation center, available adapted programs, adverse weather, and COVID effect) that influenced their PA participation. The current transition program seemed to promote sedentary behaviors during school hours. Strategies to enhance PA engagement for this population should include increasing students and parents' knowledge of PA and health, providing adequate social support from college mentors and more adapted PA opportunities and alternative options on campus. These recommendations could boost PA self-efficacy and overcome barriers at multiple levels in students with ID.Copyright © The British Society of Developmental Disabilities 2023.

A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior

Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.

Psychopathological Symptoms and Mentalizing Capabilities in Adolescents with Anorexia Nervosa before and during Covid-19 Pandemic

Introduction: The COVID 19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. Specifically, it has created a global context likely to increase eating disorders' (Eds') risk and symptoms and to decrease factors that protect against EDs. Previous studies have highlighted a link between mentalizing deficits and clinical problems. This study aims to compare Covid-Period vs. NON-Covid Period adolescent patients affected by Anorexia Nervosa (AN) considering their psychopathological symptoms and their mentalizing capabilities. Method(s): 206 female adolescents (aged between 12 and 17 years) affected by AN were recruited from the Service for Eating Disorders at S. Gerardo Hospital in Monza. Exclusion criteria were the presence of intellectual disabilities and neurological disorders. The first group of 94 subjects was recruited between September 2018 and February 2020 (NON-Covid Period), and the second group of 112 individuals was recruited between August 2020 and May 2022 (Covid Period). The following instruments were administrated: EDI-3 (Eating Disorders Inventory-3) was used to provide a standardized clinical evaluation of symptomatology associated with eating disorders;SCL-90R (Symptom Checklist 90- Revised) was used to assess psychological problems and psychopathological symptoms;Reflective Functioning Questionnaire (RFQ) was used to assess mentalizing skills, considering that Reflective functioning (RF) is the operationalization of the mental processes underlying the capacity to mentalize. Result(s): A preliminary analysis of data showed worse values in primary and composites scales of EDI-3, higher levels of general psychopathological suffering (SCL-90 composite scales) and more marked levels of hypo-mentalization (RFQ-u) in the Covid-Period subjects: the differences were statistically significant. Conclusion(s): Although these results are still preliminary, it is possible to hypothesize a correlation between marked levels of hypo-mentalization and higher rates of psychopathological suffering and a worse clinical pattern of Anorexia Nervosa. It is also possible to hypothesize that a preventive intervention to strengthen the reflexive functions may result protective factor against the onset of more severe clinical manifestations and comorbidities;mentalizing abilities could be an important target for therapeutic interventions. Further research should be conducted on larger samples and with a new assessment after treatment interventions.

Health inequalities and diabetes

Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives', to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse. In diabetes care inequalities are widespread, impacting on prevention, treatment, access to technology, screening for complications, risk of complications, morbidity and mortality. Ethnicity is a major risk factor, starkly demonstrated by the increased COVID-19 related mortality in people from minority ethnic groups with diabetes. Disadvantaged groups include, but are not limited to, those with social deprivation, intellectual and physical disabilities and severe mental illness. The decision to shelve the long-awaited white paper on tackling health inequalities, taken recently by the last Secretary of State for Health amid protests from a coalition of medical organisations, makes it unlikely that the government will take the actions proposed by Marmot. In the absence of a national strategy, responsibility to recognise and address inequalities in diabetes care falls on health care professionals, in teams and as individuals. Copyright © 2023 John Wiley & Sons.

Clusters of SARS-CoV-2 infection across six schools for children with intellectual and developmental disabilities

Background. In-person learning is important for children with intellectual and developmental disabilities (IDD) because of the additional health, vocational, and functional services for students at these schools. It may be difficult to reduce SARS-CoV-2 transmission in IDD schools because students require assistance with activities of daily living such as eating, during which social distancing and masking cannot occur. Surveillance testing and cluster tracking in schools for children with IDD, which may be considered high-risk environments for transmissions, could have benefits for mitigating transmission and keeping students in schools. The objective of this study was to identify SARS-CoV-2 clusters in IDD specific schools to compare viral transmission in delta and BA.1 variant waves. Methods. A saliva-based PCR test was offered to students and staff for weekly SARS-CoV-2 screening at six Special School District (SSD) schools dedicated to children with IDD. Clusters, which are considered 2 or more positives cases in the same classroom having an epidemiological link, were then recorded. All weekly testing took place between November 23, 2020 and May 27, 2022. Clusters were recorded from November 15, 2021 to January 28, 2022. A Fisher's exact test was used to compare categorical variables. Results. 545 (90%) and 113 (16%) students participated in weekly testing. 160 participants tested positive throughout the study, 23 (14%) during the delta variant wave and 115 (72%) during the BA.1 variant wave. There was no significant variation in age, race, ethnicity, gender, or vaccination status between positive cases recorded from alpha, delta, and BA.1 variant waves (Table 1). Notably, the vaccination rate of positive participants was lower than the vaccination rate of participants who did not test positive. 42 clusters were recorded, 3 (7%) during the delta variant wave and 39 (93%) during the BA.1 variant wave (Fig. 1). Conclusion. The highly transmissible BA.1 variant resulted in an increase in clusters observed in IDD specific schools. Mitigation strategies for less transmissible alpha and delta waves were not as effective in reducing transmission during the BA.1 wave.

COVID-19-related loneliness, social isolation and burden in informal caregivers worldwide

Background: Informal caregivers may experience high levels burden. Prior to COVID-19, loneliness and social isolation, and especially the discordance between them, were recognized for rapid aging-related cognitive decline. The COVID-19 has significantly increased social isolation and loneliness in caregivers. Thus, we aimed to explore the variables that were associated with higher care burden among all caregivers and only among caregivers for people living with dementia, and whether the increased burden could be associated with a discrepancy between loneliness and social isolation. Method(s): 'Comparing Loneliness and Isolation in COVID-19' was an online global survey of over 20,000 respondents, including 5243 caregivers across 50 countries with enduring brain or/and physical health conditions. We first used a multilevel modelling to identify risk factors associated with higher burden. Then, we defined profiles of discrepancy between loneliness and social isolation, based on the differences between standardized score on a scale of loneliness and of social connectedness and estimated the association between the discrepancy and higher burden. Result(s): In our sample, 74% of caregivers were female, 44% were caring for people with dementia, and 22% for people with multiple conditions, including dementia. The most prevalent age group was 60-69 years old. Factors significantly associated with higher care burden were being female, having poorer financial situation, worse mental health during the pandemic, caring for people with dementia or intellectual disabilities, caring in the same home, being diagnosed with COVID, and changes of care abilities. 40% of caregivers consistently reported high level of loneliness and social isolation, 38% reported consistent lower levels of both, and two groups reported discordance (low levels of loneliness and high social isolation in 13%;high levels of loneliness and mild social isolation in 12%). The latter group was at the highest risk of self-reported increased and intense care burden. Conclusion(s): This represents the largest, most widespread survey on the impact of the COVID-19 pandemic on caregivers of people with long-term conditions to date and reflects the importance of capturing the nuances in the relationship between loneliness and social isolation in caregivers. It will be an important resource for support agencies and to inform policy. Copyright © 2022 the Alzheimer's Association.

Gender differences in reaction to Covid19 in people with Autism Spectrum Disorder

Introduction: The Covid 19 pandemic has had an enormous psychological impact in which women were mentally more affected than men (Berthelot et al 2020 - Liu et al 2020). More over it exacerbated symptoms and suffering in individuals with psychiatric disorders. The question is how did it affect individuals with autism (ASD). And if so, did it affect women and girls more that men and boys or differently. Objective(s): To evaluate the impact of the covid 19 pandemic and the subsequent lockdown in patients with ASD Methods: a combination of literature review and assessement of the population of individuals with autism spectrum disorders in a large specialized unit for individuals with ASD Results: No seperate reports on individuals with ASD were found in the recent literature. Obviously the pandemic and confinement had great impact on individuals with intellectual disabilities amongst whom many individuals with comorbid developmental disorders as ADHD and/or Autism (e.g.Palacio-Ortiz et al 2020 - Guessoum et al 2020) In our population some remarkable outcomes were noted in the sense that a substantial part of the population with autism had positive experiences: e.g. clear social rules / less contact. Males enjoyed more online contact and games / experienced less loneliness - In females we found significantly more depressive symptoms, anxiety and suicidal behaviour. Conclusion(s): Covid 19 has had a great psychological impact with marked gender differences. Remarkably in ASD men enjoyed some of the benefits of the confinement. In women with ASD the emotional impact was significantly higher.

A New World - Changing the Landscape in End of Life Care, Hospice UK National Conference

The proceedings contain 245 papers. The topics discussed include: application of the lantern model to stories from the pandemic: its use in enhancing MDT working;hidden work and hidden workers in hospice care;carrying the torch for physician associates (PAS) working in UK hospices;'going against the grain of all we do': hospice staff experiences of moral distress during COVID-19;transformation of death and bereavement support processes across children and adult hospice services;development of a journal club to improve care in a hospice through evidence based practice;no barriers here! advance care planning and people with intellectual disabilities;online community of practice development - palliative care and homelessness;enhancing bereavement group support - changing from a social to a psycho-educational model;and hospice heritage stories: making every memory matter.

International Journal of Health Governance review 26.4

Using historic institutionalism to evaluate healthcare governance in Vietnam and the Philippines during COVID-19

A Weighty Matter:Quality Improvement Project in Pediatric Obesity During COVID-19 Pandemic at a Federally Qualified Health Center(FQHC)

Purpose/Objectives: Understand the rates of pediatric obesity in the Inland Empire of Southern California, in the context of COVID quarantine, to improve counseling and treatment of these patients. Design/Methods: A retrospective chart review was performed on all patients seen at a FQHC in Southern California. Patients between 5 and 18, who had a clinic visit between 6/1/2020 to 7/31/2020 for a well-child visit, with at least one other well-child visit in calendar year 2019 and 2018 were included. Patients with congenital heart disease, short gut syndrome, ADHD on stimulant medications, G tube dependence, diseases affecting growth or stature, complex syndromes (CHARGE, VACTERL, DiGeorge), syndromes affected growth, oncologic conditions, intellectual disability, transplant recipients, incomplete BMI data or malnutrition (BMI Z score <= -1) were excluded. BMI values, Z-scores, and percentiles, as well as relative changes from 2018 to 2019, and 2019 to 2020 were analyzed using one-way ANOVA and Tukey post hoc test. Results: There was a statistical difference in BMI between years as determined by a one-way ANOVA (F(2,509) = 2.811, P = 0.05). A Tukey post hoc test revealed that the BMI of students in 2020 was statistically higher (19.87.65, p = 0.05) compared to the BMI in 2018 (18.25.71). There was no statistical difference in BMI between 2020 and 2019, and 2019 and 2018 (Figure 1). When groups were stratified into morbidly obese (BMI >= 99%), obese (BMI >=95% & <99%), overweight (BMI >=85% & <95%), and healthy weight (BMI >=5% & < 85%), patients who were not at a healthy weight increased from 36.8% in 2018 to 40.4% in 2019, to 44.7% in 2020 (Figure 2). As shown in the SANKEY diagram (Figure 3), while there was an initial decline in morbidly obese patients in 2018 to 2019 (-8.3%), there was a relatively large increase from 2019 to 2020 (+45.5%). From 2018 to 2019, 75 out of 141 patients (53.2%) had a decrease in BMI, while in 2019 to 2020 there were 56 out of 141 patients (39.7%) who had a decrease in BMI. Out of the 75 patients who had a decrease in BMI from 2018 to 2019, 49 (65.3%) had a rebound increase in BMI from 2019 to 2020. Conclusion/Discussion: There was a significant increase in overall BMI from 2018 to 2020 with an overall increase in patients who fall into the obese and overweight categories in 2020. 65.3% of patients who had a decreasing BMI from 2018 to 2019 have a rebound increase in BMI in 2020. This can likely be contributed to the COVID-19 pandemic and stay-at-home orders leading to a more sedentary lifestyle. More research should be performed to elicit multifactorial (physical activity, diet, and psychosocial factors) etiology of the worsening obesity epidemic during the COVID-19 pandemic.

The relationship Between Glycemic Control and Food Insecurity in People with Diabetes Mellitus and Comorbid Psychosis

Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012). Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 12 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65;one inpatient or two outpatient diagnoses of schizophrenia (F20-29), bipolar disorder (F31), or major depressive disorder with psychotic features (F32.3;F33.3) and one inpatient or two outpatient diagnoses of DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We compared food insecure and food secure particpants with level of social support and frequency of psychiatry symptoms. •Regression analysis was applied to examine the associations between food security status, social support, and mental health symptoms. Results: 624 patients with diabetes and psychosis were identified. 156 patients responded, giving a response rate of 26%. 25% of respondents were found to be food insecure. 16% of respondents demonstrated low social support while 43% showed moderate social support and 41% showed high social support. Mean CSI was 19.36, which suggests participants experienced symptoms several times per month (versus daily or weekly). Significantly lower social support was found in participants with food insecurity compared to those without (p=0.008). This relationship was driven by lower social support from family (p<0.001) compared to friends (p=0.61) or significant others (p=0.192). Additionally, greater psychiatric symptom severity was found in people with food insecurity (p <0.001). Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms. Discussion: This study showed that food insecurity was significantly associated with both low perceived social support and more frequent psychiatric symptoms. However, no evidence of a moderating effect of social support on the relationship between food insecurity and psychiatric symptom severity was found. Rate of food insecurity was found to be lower than previous studies, which showed approximately 50% of individuals who used public mental health services faced food insecurity (Adams et al., 2021). The study sample was not limited to public mental health service users, which is the likely cause of this lower rate. Conclusion/Implications: Food insecurity is associated with poorer mental health outcomes, which have been associated with poorer health outcomes. The presence of perceived social support does not mitigate the need for addressing food insecurity. There is a need for both medical and mental health providers who care for people with co-morbid diabetes and psychosis to specifically address food insecurity. References: 1. Adams WE, Rogers ES, Edwards JP, Lord EM, McKnight L, Barbone M. Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey. Psychiatr c Services. 2021 Jun 23:appi-ps. 2. Coleman-Jensen AJ. US food insecurity status: toward a refined definition. Social Indicators Research. 2010 Jan 1;95(2):215-30. 3. Hammami N, Leatherdale ST, Elgar FJ. Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study. Nutrition journal. 2020 Dec;19(1):1-1. 4. Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20. 5. Na M, Miller M, Ballard T, Mitchell DC, Hung YW, Melgar-Quiñonez H. Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries. Public health nutrition. 2019 Apr;22(5):874-81. 6. Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81. Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8. Stubbs B, Vancampfort D, De Hert M, Mitchell AJ.Acta Psychiatr Scand. 2015 Aug;132(2):144-57. Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms.

TREATMENT SUCCESS IN A RESISTANT CASE OF INSOMNIA WITH AN IRREGULAR CIRCADIAN RHYTHM DISORDER

Introduction: A 19-year-old non-verbal male with history of CHARGE syndrome, severe autism, intellectual disability, coloboma with blindness OD and severely imparied vision OS, deafness, self-injurious and aggressive behavior, Tetralogy of Fallot status post repair, pulmonary valve replacement, hypertension, hypothyroidism, megacolon, gastrostomy tube dependence, eosinophilic esophagitis and chronic kidney disease with an irregular sleep cycle who has failed multiple medications for insomnia has shown treatment success with suvorexant. Report of Cases: This patient's sleep schedule ranges from 1.5 to 5 hour segments at various times of day or night including naps at school with occasional longer periods of sleep up to 10 hours and longer periods of wakefulness up to 22 hours who has been treated with the following medications: trazodone, clonidine, hydroxyzine, diphenhydramine, quetiapine, gabapentin, mirtazapine, eszopiclone, melatonin and ramelteon. His behavioral problems have been treated with olanzapine. He continued to be aggressive and difficult to direct. His parents reported exhaustion. Then, suvorexant 5mg was added at bedtime while the following sleep medications were continued: gabapentin total daily dose of 1500mg (300mg in morning and 3pm;900mg at bedtime, 300mg one hour later if still awake), ramelteon 8mg, mirtazapine 7.5mg and olanzapine 10mg at bedtime and bid prn aggressive behavior. He also takes the following daily medications: bisacodyl, polyethylene glycol, simethicone, hyoscyamine, cholecalciferol, aspirin, levothyroxine, hypoallergenic nutritional formula, starch and albuterol prn. With the addition of suvorexant 5mg, he had been able to get 9.5 hours of consolidated sleep at night with improvement in his behavior until he contracted Covid-19 and regressed. The suvorexant dose was increased to 10mg which again improved his insomnia and behavior. Conclusion: Various medications have either not worked at all or have worked suboptimally for insomnia in this medically complex patient who has an irregular Circadian rhythm disorder. Adding an orexin receptor antagonist as a novel mechanism to his regimen has shown promise. At this time, this patient has been stable for one month with suvorexant 10mg at bedtime after regression on the 5mg dose that coincided with a Covid-19 infection. We are proceeding with cautious optimism.