Using implementation science in youth mental health workforce development: Adapting to the COVID-19 pandemic in Australia

Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.

Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic

BackgroundThis study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.MethodsThe survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.ResultsThere were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.ConclusionsDuring the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems for vulnerable young people

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. Following the 'social cure' theory, this study aimed to investigate the association, and potential mechanisms, of group membership continuity and reducing mental ill-health amongst vulnerable young people. Method(s): Cross-sectional survey data from a sample of 105 young people aged 16-35, collected approximately 1 year after the global COVID-19 outbreak (January-July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences), and the mediation of these associations by hope and social connectedness (in-person and online). Results and Conclusion(s): Prior multiple group memberships were associated with the preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as a means to potentially help prevent exacerbated symptoms and promote recovery of mental health problems, particularly during significant life events.

Trauma-focused therapy in early intervention for psychosis settings: Results of a feasibility RCT of 'EMDR for psychosis'

Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.

Subjective experience of people with psychotic and bipolar disorders: Contributors to mental health and wellbeing during the COVID-19 pandemic and suggestions for improved care in future pandemics

Aims: People with psychotic and bipolar disorders were particularly vulnerable to poor mental health and wellbeing in the early phases of the COVID-19 pandemic. However, their subjective experience of what they were most worried about concerning the pandemic, what contributed most to how they were doing, and what they suggest the mental health services could do to improve care during a pandemic, requires investigation. Method(s): Three months after the outbreak of COVID-19, 520 people with psychotic and bipolar disorders responded to an online survey about the pandemic impact on mental health and wellbeing, including three open-ended questions. The material was analysed using thematic analysis. Result(s): The participants' main worries were: fear of the virus itself;fear of protective measures;fear of a completely changed world;fear of social consequences;and fear of poor mental health. These worries involved others as much as themselves. Participants' experience of main positive contributors were: a slower pace of life;more time to reflect;maintaining daily routine;keeping up social contact;and mental health service availability. The most prominent suggestions to improved mental health services were: stay open;be proactive;and individualize treatment. Conclusion(s): In the early stages of the pandemic people with psychotic and bipolar disorders were equally worried about the pandemic consequences for others and the world at large, not just for themselves. Positive contributors to wellbeing included increased calm and time to respite. They suggested that mental health services remain available and flexible during future pandemics.

Patient and public involvement in the development, delivery and evaluation of a novel engagement intervention in early intervention in psychosis services

Background: The Early Youth Engagement (EYE) project co-developed the first engagement-focussed intervention derived from the perspectives of young people and their families in Early Intervention in Psychosis services. Patient and Public Involvement (PPI) in the EYE-2 study aimed to ensure that the voices of people experiencing first episode psychosis, and carers, were embedded in the refinement, delivery and evaluation of the Early Youth Engagement (EYE-2) approach across the UK. Method(s): The EYE-2 project used a multi-level PPI approach: Each of five sites had a PPI lead, trained and supported by senior PPI researchers. PPI leads convened local Lived Experience Advisory Panels (LEAPs), and co-delivered staff and researcher training. Practical challenges were identified and resolved. Results and Impacts: Tangible PPI impacts included: the co-produced revised booklets and EYE-2 website https://www.likemind.nhs.uk following workshops of over 40 people;the delivery of on average 52 peer-led intervention social groups at each site, allowing people to connect with peers with lived experience and build a sense of optimism, shared identity, interpersonal skills and problem-solving in a social environment, with activities driven by service users. Written outcomes included a PPI-led booklet on running peer-led social groups, a person-centred telephone interview for the HoNOS questionnaire for use during the Covid-19 pandemic, peer reviewed papers, blogs and video logs. Conclusion(s): PPI was integral to the delivery of the EYE-2 study;the multi-level approach facilitated a diversity of voices across different aspects of the study and ensured that people with lived experience shaped the intervention, research design and implementation.

Pandemic related mental health

OnTrackNY is a nationally recognized Coordinated Specialty Care model disseminated across New York state for young people experiencing early non-affective psychosis. OnTrackNY is a network of 22 teams located in licensed outpatient clinics, serving over 2500 individuals. OnTrackNY offers medication management, case management, individual and group cognitive behaviourally oriented therapy, family support and psychoeducation, supported employment and education, and peer support services. Teams receive training for implementation through an intermediary organization called OnTrack Central. OnTrackNY was selected as a regional hub of the National Institute of Mental Health Early Psychosis Intervention Network (EPINET), a national learning healthcare system (LHS) for young adults with early psychosis. This symposium will present the different ways in which EPINET OnTrackNY implemented systematic communitybased participatory processes to ensure robust stakeholder involvement to improve the quality of OnTrackNY care. Florence will present results of an assessment of stakeholder feedback experiences used to develop strategies for assertive outreach and engagement of program participants, families and providers. Bello will present on mechanisms for integrating of co-creation principles to design, develop and execute quality improvement projects in EPINET OnTrackNY. Stefancic will present on quality improvement projects that used rapid cycle qualitative methods, tools, and strategies to build team capacity and flexibility to respond to an LHS. Montague will present adaptations to OnTrackNY services during the COVID-19 pandemic using an implementation science framework. Finally, Patel will lead a discussion on the implications of involving individuals with lived experiences in all phases of the process to maximize learning in an LHS.

Connecting a national early psychosis workforce in a COVID affected world

Orygen's role in supporting the Australian Early Psychosis Program AEPP) includes workforce development and training. Aim(s): The aim of this project was to deliver training and to develop and connect a national early psychosis network during the global pandemic which reduced face to face workforce development activity. Method(s): A blended learning approach was adopted, incorporating sharing support resources for clinicians in managing risk online, and developing online training and discussion events. Multi-site workshops and interactive events were developed and delivered providing an avenue of support to clinicians and increasing activity and engagement with the AEPP hub where a range of resources and activities were available. The online AEPP hub was used as a central point for training, online events and other workforce development activity. Conclusion(s): Clinicians from Australia's Early Psychosis program were offered a range of activities across modalities to increase their support, connection, skills and knowledge during a period of time where it became increasingly difficult to share information in face to face settings. Data alongside quantitative information and evaluation was collected to understand if the strategy was successful. A blended interactive learning strategy that incorporates multi-site interactive workshops, online events and an online HUB' has been successful in connecting an early psychosis workforce and increasing engagement with each other via interactive modalities in a world unable to connect face to face. This data collected will be presented.

The effect of Covid-19 on duration of untreated psychosis in first-episode service

Background: During the first months of the COVID-19 pandemic presentations to emergency psychiatric services sharply declined, despite no significant change in the incidence of psychosis. Aim(s): To investigate the impact of COVID-19 on the duration of untreated psychosis (DUP) in a first-episode service. Method(s): Data was collected by the specialized treatment early in psychosis (STEP) clinic to compare the DUP pre vs. early and late pandemic stages. The onset of the pandemic was defined as the 15th of March 2020, based on an analysis of case numbers and the advent of restrictions. Outcome measures were DUP total (the time elapsed between onset of psychosis and enrolment in the STEP clinic), DUP demand (the time from onset of psychosis to first antipsychotic prescription), and DUP supply (the time from first antipsychotic prescription to enrolment into STEP). Result(s): DUP total decreased significantly (p = .008) during the early pandemic compared with pre-pandemic from a median of 208 (IQR, 24-1020.0) to 55.5 days (IQR, 8.0-560.0). During the late pandemic stage, DUP total increased back to a median of 153.5 days (IQR, 1.0- 885.0). DUP demand decreased significantly (p = .001) during the early pandemic compared to pre-pandemic from a median of 117 (IQR, 17.0-714.0) to 35 days (IQR, 2.0-541.0) and then reduced further to 27.5 (IQR, 0.0-690.0) days during the late pandemic. No significant changes were found in DUP supply (p = .24) across the different stages of the pandemic. This is the first study to show a reduction in DUP associated with the pandemic.

E-research in early psychosis: Methodological recommendations for ethics and data security

Aims: The COVID-19 pandemic compelled replacement in traditional research practices (paper-pencil questionnaire) to technology-driven practices (online surveys). Such methods may be effective in reaching larger samples, geographically harder-to-reach populations, reduce recruitment costs, increase cost and time efficiency of recruitment. Despite these advantages, concerns about privacy and confidentiality, sample bias, data quality such as inaccurate responses, duplicate survey completion, and fraudster activity or bots prevail. We aim to provide researchers and reviewers with a series of recommendations for effectively executing and evaluating data collection via online platforms. Method(s): A rapid literature review was conducted and best practices and strategies to mitigate problems with e-research data collection were collated in summer 2021. Based on study needs, these strategies were applied in an on-going e-research in early psychosis intervention services with multiple stakeholder groups across Canada. Result(s): The results were categorized and prioritized based on strategy effectiveness (most, moderate, least) and at three implementation stages (before, during, and after recruitment). An 11-step data quality checklist was adapted and implemented in consultation and approval from institutional research ethics board thus ensured ethical acceptability. Key strategies include not sharing the full survey link publicly, collecting and checking paradata, attention check questions, and so forth. Conclusion(s): Given their unique strengths, the challenges of internetbased research and data collection should not deter researchers from using such approaches. Further, our study provides concrete evidence-based practices and insights for advancing ethical and highquality e-research, taking into account specific considerations associated with early psychosis settings.

Identifying the Influencing Factors of Depressive Symptoms among Nurses in China by Machine Learning: A Multicentre Cross-Sectional Study

Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.

The utility of a fidelity measure to monitor early psychosis services across Australia

Aims: This project aims to describe the development, implementation, and adaptation of a fidelity tool to measure service quality in a national network of early psychosis services across Australia-the headspace Early Psychosis program. Method(s): An 80-item Early Psychosis Prevention and Intervention Centre Model Integrity Tool (EMIT) was developed. The tool assesses adherence in six sites across Australia. Ratings were informed by interviews, routine data and site policies. The EMIT has been adapted for use virtually during Covid-19 restrictions on in-person site visits. A review is underway to enhance the tool to capture quality of services. The Revised EPPIC Model Integrity Tool (REMIT) will be utilized to assess fidelity and service quality in 2023. Result(s): All six sites participated in five fidelity assessments since 2017. In the initial visits, average scores were in the 'low' fidelity range. By the fifth fidelity visit, the network average improved to 'superior' fidelity. The EMIT was successfully adapted for use virtually during Covid-19 and sites were able to maintain scores of high to superior fidelity. The results from the use of the redeveloped tool, the REMIT will be presented. Conclusion(s): The Australian Early Psychosis model has been successfully implemented across the headspace Early Psychosis program. Ongoing fidelity assessments are an effective method to improve and maintain fidelity. The review and development of the REMIT reflects the sites state of implementation and ensures services are of high quality. The findings of the initial use of the REMIT tool in fidelity assessments in early 2023.

Association Between COVID-19 Pandemic and Serious Mental Illness: Systematic Review within Salutogenesis Model for Public Health Management

Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.

Scientific rationale of Indian AYUSH Ministry advisory for COVID-19 prevention, prophylaxis, and immunomodulation

The current outbreak of COVID-19 is caused by the SARS-CoV-2 virus that has affected > 210 countries. Various steps are taken by different countries to tackle the current war-like health situation. In India, the Ministry of AYUSH released a self-care advisory for immunomodulation measures during the COVID-19 and this review article discusses the detailed scientific rationale associated with this advisory. Authors have spotted and presented in-depth insight of advisory in terms of immunomodulatory, antiviral, antibacterial, co-morbidity associated actions, and their probable mechanism of action. Immunomodulatory actions of advised herbs with no significant adverse drug reaction/toxicity strongly support the extension of advisory for COVID-19 prevention, prophylaxis, mitigations, and rehabilitation capacities. This advisory also emphasized Dhyana (meditation) and Yogasanas as a holistic approach in enhancing immunity, mental health, and quality of life. The present review may open-up new meadows for research and can provide better conceptual leads for future researches in immunomodulation, antiviral-development, psychoneuroimmunology, especially for COVID-19.Copyright © 2021, Institute of Korean Medicine, Kyung Hee University.

Growth and characteristics of US first episode psychosis programs

Aims: In 2008, only two US states supported first-episode psychosis (FEP) programs. Today every state in the United States has a plan for supporting FEP programs, and over 350 programs currently operate across the country. In this presentation, we will describe the milestones and factors that have marked the growth of U.S. early psychosis programs and their characteristics. Method(s): Data were drawn from two national surveys fielded in 2018 and 2022. The 2018 survey data included responses from leadership at 215 early psychosis programs across the United States, and the 2022 survey data includes responses from U.S. state mental health authorities. The surveys provide information about a variety of key programmatic features of FEP clinics across the United States, including, program size, client capacity, duration of care, referral sources, services offered, funding, and outcomes measurement. Results and Discussion: Nearly 70% of the programs tie their start date to after the 2014 influx of federal funding. Services offered by the FEP programs have many similarities despite programs prescribing to specific FEP models (e.g., NAVIGATE, EASA, OnTrackNY, etc.). The surveys show program-level changes that have occurred between 2018 and 2022 and offer historical and data-driven explanations for how FEP programs have developed. The 2022 survey data also provide information regarding how States have chosen to implement the additional COVID-19 emergency funds designated for early psychosis programming.

An EPPIC tale - 30 years of EPPIC and PACE

Background: The Early Psychosis Prevention and Intervention Centre (EPPIC) and the Personal Assessment and Crisis Evaluation (PACE) were established in Melbourne in 1992. The two services focused on the early detection of emerging illnesses and the development of clinical interventions for psychosis in young people. Aim(s): To describe the development and evolution of the EPPIC and PACE teams over the past 30 years. Method(s): Initially a modest service, operating on one site with fewer than 100 new clients each year, the service has expanded to nine subteams across two regional hubs and three satellite clinics. We will describe the components of the services and the changes to service provision over a 30-year period. Result(s): Over the past 30 years, national and international early psychosis services have developed and youth services have broadened their scope. Service models are being developed that reflect a staged model of illness and clinical care to ensure interventions are responsive to young people's needs. We will outline some of the challenges for EPPIC and PACE in delivering evidence-based interventions across a large service with limited clinical resources, as well as through multiple Covid lockdowns. One of the ongoing challenges is to maintain a focus on early intervention of positive symptoms of psychosis amongst increasing diagnostic complexity and associated interventions. Conclusion(s): The EPPIC and PACE clinical model has been successfully replicated in a number of services around Australia and worldwide. Challenges and future directions will be discussed further.

RED-EMAR - A Chilean pilot initiative of early detection and intervention in clinical high-risk subjects

The COVID-19 crisis has had a significant impact on the mental health of adolescents and young adults in South America. As a result, the appearance of a higher incidence of anxiety and depressive disorders in these countries have been documented and could lead to the appearance of severe mental health disorders. In this context, the prevention and early intervention in mental health is a current challenge in Central and South America. Since the last decade, the existence of initiatives in this field has been mapped in Mexico, Brazil, Chile and Argentina, mostly in first episode psychosis programs. However, Chile is the only country in South America with a multicentre prospective initiative for early detection and intervention in clinical high-risk subjects (called RED-EMAR). The aim of RED-EMAR is disseminate the value of the at-risk mental state concept (abbreviated to EMAR in Spanish), establish agreed therapeutic strategies in this field, and establish potential new evidence-based local interventions. The successful experiences of this network include the monitoring and discussion of clinical cases in telemedicine and the development of mental health psychoeducation guidelines. However, Insufficient resources, stigma, and the lack of mental health public policies are some of the weaknesses of this initiatives in South America. The development and access to early detection and intervention services in South America could be a window of opportunity to reduce the impact of severe mental health disorders such as psychosis and related disorders and move towards an approach aimed at prevention or delaying its onset.

Psychosocial factors associated with the risk of developing psychosis in a Mexican general population sample

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals who screened positive for Clinical High-Risk for psychosis (CHRpositive group) and those who did not (Non-CHR group), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population. Findings showed that participants in the CHRpositive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. The CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences as well as higher levels of childhood maltreatment, poorer family functioning, and more COVID-related distress than the Non-CHR group. Findings of multivariate analysis showed that the variables associated with screening positive for CHR were: having an unhealthy family functioning, a higher risk associated with cannabis use, a lower level of education, having experienced a major natural disaster, violent or unexpected death of a relative or friend, higher levels of childhood maltreatment, and higher COVID-related distress. An older age was a protective factor for screening positive for CHR. Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.

Trends in Second Generation Antipsychotic Prescribing for Adolescents from 2013-2021

Objectives: To examine temporal trends of FDA-approved and off-label second-generation antipsychotic (SGA) prescribing for adolescents over time through the Covid-19 pandemic. Method(s): This is a new-user, retrospective longitudinal panel study using electronic health record data from a large, integrated health care system. Outpatient prescription orders for a new SGA (index date) for adolescents (age 10-17 years) during 2013-2021 were analyzed. Prescription orders were linked to diagnoses at time of encounter to examine prescribing behavior. A one-year lookback period was used for baseline inclusion and exclusion criteria, including one-year "washout" of SGAs and continuous insurance enrollment. FDA-approved use was determined by two outpatient diagnoses (one baseline diagnosis and the prescription order diagnosis) for autism, psychotic disorders, bipolar disorders, or Tourette's;the remaining proportion was considered potentially off-label. We report crude annual prescribing rates per 1,000 youths. Result(s): There were 8,145 unique patients with new SGA prescription orders, of which 5,828 (71.6%) had linked diagnoses available. Calendar year 2013 had the highest prescribing rate prior to Covid-19 onset (2.1 per 1,000) but then declined through 2016 (1.7 per 1,000). Prescribing rates in 2020 (2.0 per 1,000) and 2021 (2.2 per 1,000) were higher than those between 2017-2019. Across all study years, SGA prescriptions were mostly off-label and ordered for aripiprazole, quetiapine, or risperidone. The proportion of off-label indications was highest in 2013 (80.1%) and lowest (69.1%) in 2019. Off-label proportions increased again in 2020 (76.1%) and in 2021 (74.1%). At baseline, patients frequently had other psychotropic prescriptions (e.g., antidepressants 63.3%, stimulants 22.9%, and sedatives/hypnotics 20.7%). Conclusion(s): A general decline in SGA prescribing rates among adolescents was observed from 2013 to 2019, but then increased following Covid-19 onset. Despite known safety risks, off-label use of SGAs remains prominent. Future studies are needed to better understand prescribing outside of pediatric professional society guidelines.Copyright © 2023

What impact did the COVID-19 pandemic have on psychosis and the delivery of early intervention psychosis (EIP) services in Australia?

Background: The COVID-19 pandemic had a catastrophic impact worldwide, the significance of which continues to be explored. For EIP services the implications were two fold. First, that the pandemic and associated psychosocial stressors would lead to an increased incidence of psychosis and secondly, social distancing measures would negatively impact the detection and treatment of people with psychosis. 18 months on and we now have the data to explore these questions. Method(s): Participants included in this study are young people who attended one of the six headspace Early Psychosis (hEP) services across Australia and met the criteria for being at Ultra High Risk (UHR) of psychosis or experiencing a First Episode of Psychosis (FEP), were aged between 12 and 25 years, and provided informed consent for their data to be used. We will analyse the following routinely collected data from young people accessing EIP services and compared outcomes collected the year before the COVID-19 pandemic occurred (March 2019-February 2020) with data collected during the pandemic (March 2020 onwards): a. Clinical and functional outcomes of young people at UHR or with FEP, b. Duration of untreated psychosis (DUP), c. patterns of substance use, and d. source and rates of referrals. Results and Conclusion(s): I will present the differences in the above outcomes for those young people accessing treatment pre and during COVID-19 pandemic. Confounding factors such as age, gender, sexuality, ATSI status, CALD background will be controlled for. Discussion of the results ad implication for clinical practice will follow.