Visit Data and Telehealth in a Clinic for Trafficked Persons: Virtual Care and Human Trafficking During the COVID-19 Pandemic.

BACKGROUND: Human trafficking involves coerced labor or sex. THRIVE, a multidisciplinary University of Miami clinic for trafficked persons, transitioned to a hybrid telehealth model during the COVID-19 pandemic. Th is paper presents appointment data across THRIVE clinic services during this transition. METHODS: A review of appointments for THRIVE patients (n=156) was conducted to compare pre-pandemic (February 2019 to February 2020) and pandemic (March 2020 to December 2021) appointment trends. RESULTS: There were 15% more scheduled (n=51.1 versus n=44) and 8% more completed (n=30.2 versus n=27.9) appointments per month early in the pandemic period with telehealth use compared to the pre-pandemic period. Telehealth was most used within psychiatry. Rescheduled and no-show appointments per month significantly increased during the pandemic period (p=0.010 in pandemic period 1 and and p=0.028 in pandemic period 2). There were few significant differences in appointment trends according to demographic variables. CONCLUSION: Telehealth succeeded in connecting THRIVE patients during the pandemic, highlighting its potential for long-term use amongst trafficked persons.

First-Onset Psychosis Leading to Multiple Myeloma Diagnosis: A Case Report and Literature Review.

Although multiple myeloma (MM) can cause various neurological complications, direct central nervous system (CNS) involvement is exceedingly uncommon and poorly understood. There has been one other reported case in the literature of a patient presenting with psychosis prior to diagnosis of MM. We present a case of a 58-year-old female with no history of psychiatric illness who presented to a behavioral health inpatient unit with paranoid delusions, multisensory hallucinations, and disorganized behavior in the days preceding her MM diagnosis. Due to hypercalcemia and altered mental status, she was transferred to an inpatient medical unit for further medical workup. Imaging revealed a sternal mass and diffuse lytic lesions. MM was confirmed. Her psychotic symptoms improved after one cycle of chemotherapy and steroids, treatment with aripiprazole, and resolution of hypercalcemia. Unlike other case reports where mental status changes have been described as consequences of already diagnosed MM, this patient's psychotic symptoms manifested prior to her MM diagnosis. While the exact pathophysiological mechanisms remain unclear, this case highlights a potential link between the sudden onset of psychosis and underlying undiagnosed MM. Healthcare providers need to be aware of this rare clinical presentation of psychosis in conjunction with MM.

"Because the resources aren't there, then we fail. We fail as a society": A Qualitative Analysis of Human Trafficking Provider Perceptions of Child Welfare Involvement among Trafficked Mothers.

BACKGROUND: Little is understood about child welfare involvement (CWI) in cases where the birth mother has experienced human trafficking. OBJECTIVES: The aim of this study was to explore provider perceptions of the impact of CWI for the trafficked mother. METHODS: Participants were selected among providers caring for trafficked birth mothers. Semi-structured interviews were conducted with providers and qualitative content analysis was conducted. RESULTS: Interviewees reported reasons for CWI, positive and negative impacts of CWI and provided recommendations for systems improvement. CONCLUSION FOR PRACTICE: Recommendations from this exploratory study include mechanisms to support trafficked mothers, train hospital social workers, and systems change. During the prenatal period, strategies to support the trafficked mother may include addressing gaps in social determinants of health, ensuring appropriate medical and mental health care, early screening and referral to substance use treatment services, enhancing community support, and working to develop safety plans for survivors and their families. Enhanced engagement of social workers and all providers to improve understanding of the unique complexity of trafficked mothers is needed. Education should include an understanding that judgement of a caretaker's ability to parent should be current and holistic and not reflexive based on history in the electronic medical record. An exploration of the child welfare system itself should also be undertaken to identify and modify discriminatory laws and policies. Finally, efforts to address social determinants of health in the community and enhance the trauma-informed nature of child welfare referrals could improve the lives of trafficked mothers.

Personalized Medicine and Mood Disorders.

Some of the latest advances in personalized psychiatry with future research directions are discussed in this article. Many factors contribute to the phenotypic psychiatric profile in individual patients. These overlapping factors include but are not limited to genetics, epigenetics, central nervous system circuit alterations, family history, past personal history, environmental influences including early life stress, and more recent life stressors. The authors discuss the role of pharmacogenomics, particularly in the cytochrome P450 enzyme system in relation to treatment response. Despite some promising advances in personalized medicine in psychiatry, it is still in its early phases of development.