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.

What Do We Long For? Refllections on Feminist Movements for Social Justice

In this collective essay, we contemplate tipping points including the COVID-19 pandemic, climate crisis, and gendered and racialized forms of state violence through our reflections on shifting meanings of and movements for social justice, shaped by our own lived experiences. Inspired by the writings of feminist scholars and activists including Grace Lee Boggs, adrienne maree brown, Dean Spade, bell hooks, and others, we grapple with the meanings of social justice in contemporary contexts.

The Social Determinants of Loneliness During COVID-19: Personal, Community, and Societal Predictors and Implications for Treatment

Objective The COVID-19 pandemic dramatically altered social determinants of health including work, education, social connections, movement, and perceived control;and loneliness was commonly experienced. This longitudinal study examined how social determinants at the personal (micro), community (meso), and societal (macro) levels predicted loneliness during the pandemic. Methods Participants were 2056 Australian adults surveyed up to three times over 18 months in 2020 and 2021. Multi-level mixed-effect regressions were conducted predicting loneliness from social determinants at baseline and two follow-ups. Results Loneliness was associated with numerous micro determinants: male gender, lifetime diagnosis of a mental health disorder, experience of recent stressful event(s), low income, living alone or couples with children, living in housing with low natural light, noise, and major building defects. Lower resilience and perceived control over health and life were also associated with greater loneliness. At the meso level, reduced engagement with social groups, living in inner regional areas, and living in neighbourhoods with low levels of belongingness and collective resilience was associated with increased loneliness. At the macro level, increased loneliness was associated with State/Territory of residence. Conclusions Therapeutic initiatives must go beyond psychological intervention, and must recognise the social determinants of loneliness at the meso and macro levels. Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy.

Immunological response to airway Aspergillus in CF is reduced following treatment with the CFTR modulator elexacafor-tezacaftor-ivacaftor

ObjectivesAspergillus fumigatus is the most frequently cultured fungal pathogen in sputum from cystic fibrosis (CF) patients. Elexacaftor-tezacaftor-ivacaftor (ETI) is a CFTR modulator which results in significant improvements in lung function. We aimed to investigate the effect of ETI therapy on the serological response to Aspergillus in adult CF patients prescribed ETI.MethodsData from 275 patients with at least one Phe508del mutation were included. Aspergillus IgG, Aspergillus IgE, total IgE and blood eosinophil count were collected annually 3 years prior to ETI initiation, at baseline (initiation of therapy) and at 3-monthly intervals for the first 12 months of ETI treatment. FEV1 was compared at baseline and at 3 months as a marker of treatment response.ResultsThere was a significant relative increase in median FEV1 values of 22% at 3 months following ETI initiation (p<0.0001). In the year prior to ETI initiation, there was a significant decrease in total IgE (from 59.3 to 57.5, median change -1.8, p=0.007) and Asp-IgE (from 0.39 to 0.30, median change -0.09, p<0.0001) but not Asp-IgG. In the first 3 months following ETI, there was a significant reduction in all markers (median total IgE 53.6 to 32.9 p<0.001, median Asp-IgE 0.27 to 0.17, p<0.001 and Asp-IgG from 60.0 to 50.5, p<0.001). Asp-IgG continued to decline over the 12 month period post ETI. Asp-IgE however did not change from 3 to 6 months and appeared to increase between 3 and 9 months post ETI. Similarly, total IgE displayed an acute drop but appeared to plateau thereafter. Using suggested clinical ULN for CF, the proportion of patients with significant rises in Asp-IgE declined by 19.1% and Asp-IgG declined by 45%.ConclusionsETI therapy resulted in an acute, clinically relevant increase in lung function. In the same time frame, we noted an acute reduction in markers of immunological response to Aspergillus fumigatus. This may be due to reduced airway fungal burden, direct effects on immunological response or potentially reduced pathogen exposure as many patients were shielding during the COVID pandemic. Further longitudinal data is required to establish if these changes will be maintained.

CHANGES IN PATTERNS OF EMERGENCY DEPARTMENT REFERRALS TO A LIAISON MENTAL HEALTH TEAM DURING COVID-19

During the COVID-19 pandemic, research has shown a significant drop in mental health presentations, especially during the most restrictive phases, such as lockdown.1 However, as restrictions have begun to lessen, there has been a large uptick in the use of mental health services. Some researchers fear a tsunami of mental health needs which could potentially overload the healthcare system.2 The aim of this research project was to investigate mental health referrals of a pediatric cohort to the ED at CHI Temple Street from March 1 to April 29, 2021. Data was audited and standardized via paper proformas. 22 variables were ultimately used, and upon completing data collection, the variables were exported to Microsoft Excel and then SPSS for analysis. Statistical methods such as frequencies, cross-tabs, and Chi-squares were used to generate data outputs. Results showed an 102% increase in total presentations to the ED from the same time frame in 2020. There was a statistically significant relationship between suicidal ideation, certain methods of self-harm, and taking certainmedications with acute ward admission. Out of 110 patients from which data was collected, only 28% were admitted to the acute ward. The results show a significant rise in mental health presentations to the ED from the previous year. Those that were admitted to the ED tended to have more complex presentations than those who weren't. There is a potential lack of alternative mental health services in the community that may be funneling patients to the ED, which could benefit from increased funding.

ONLINE REFLECTIVE PRACTICE GROUPS FOR INTERDISCIPLINARY TRAINEES IN PAEDIATRIC HOSPITALS DURING COVID-19 PANDEMIC: WHAT'S THE EVIDENCE?

In 2017, the report on the National Wellbeing of Doctors proposed that there are ever-increasing burnout rates. [1] Reflective practice groups are used to explore a deep level of understanding of doctor-patient relationships, in order to combat burnout and increase satisfaction at work. This study aims to assess online reflective practice groups for interdisciplinary trainees in Paediatric hospitals during the Covid-19 pandemic. The Balint group methodology was adapted for an online format. Trainees from psychiatry, emergency and paediatric specialties answered two online questionnaires before and after six sessions of Balint group meetings. There were nine responses to the pre-Balint questionnaire and eight responses to the post-Balint questionnaire. The data was analysed using Microsoft Excel. 75% of participants were from Crumlin Children's Hospital. Most were women, aged 26-30 years and 3-11 years' experience. Six participants preferred online groups while four preferred face to face groups after the sessions were completed. Trainees indicated that they thought about patient cases afterward and their teams were disrupted which may cause mild burnout due to the struggles faced. There was a positive relation between burnout reduction and Balint sessions. Additionally, the sessions were positively reviewed by the trainees and there were no sessions cancelled which may indicate the trainees appreciation for the group. Reflective practice programs should be implemented for trainees in all institutions since there is a positive link between reducing the risk of burnout and reflective practice groups. It should be available for all specialties, not only psychiatry and general practice.

Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic.

Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.

Optimal Scheduling for Behind-the-Meter Batteries under Different Tariff Structures

The increasing deployment of photovoltaic systems and behind-the-meter batteries into power distribution systems has increased interest in optimal system operating conditions. Electricity tariff, as an indirect factor, plays a pivotal role in controlling the customers' behavior, especially in the presence of batteries. The residential sector, as one of the largest consumers, requires accurate analysis of the impacts of tariffs on its load profile for short-term and long-term planning. In this paper, a household equipped with a photovoltaic array and battery is modeled and the effects of flat-rate, stepped rate, time-of-use, and demand charge pricing structures on the battery charge/discharge model are analyzed. Furthermore, the effects of COVID-influenced consumption patterns and the increase in feed-in tariff for photovoltaic energy on battery scheduling are investigated. The battery scheduling problem is formulated as a non-linear optimization function, to minimize electricity costs for customers, and is solved using a Genetic algorithm. © 2021 IEEE.

Increased mental health presentations by children aged 5-15 at emergency departments during the first 12 months of covid-19

Aims To determine changes in mental health (MH) attendance at Emergency Departments (ED) by children aged five to 15 during the COVID-19 pandemic. Methods Analysis of MH presentations during the first year of the pandemic compared with prior year for three public paediatric EDs serving the greater Dublin area with a paediatric population of 430,000. Results Overall, ED attendance during the 12 months to 28th February 2021 was 34.3% below prior year, while MH presentations were 8.9% above prior year. MH attendances initially decreased by 26.8% (2020: 303;2019: 414) during the first four months of the pandemic (March to June), lower than the corresponding decrease of 47.9% for presentations for any reason (2020: 11,530;2019: 22,128). However, MH presentations increased by 52.4% in July and August (2020: 218;2019: 143), and by 45.6% in September to December (2020: 552;2019: 379), dropping 28.1% below prior year in January (2021: 87;2020: 121) before returning to prior year levels in February 2021 (2021: 107;2020: 106). Conclusion Following the initial COVID-19 lockdown, ED presentations by children for acute MH care increased significantly over prior year, with this increase sustained throughout 2020. Long-term stressors linked to the pandemic may be leading to chronic MH problems, warranting increased funding of MH services as part of the response to COVID-19.

Post pandemic physician vulnerability

Clinicians have adapted robustly since the first outbreak of COVID 19 in Ireland. This piece highlights physician vulnerability in a new era of telemedicine and explores the challenges we face in terms of stigma and burnout. It explores the consequences, both positive and negative, of living and working in a virtual world recommending strategies to optimise patient care, training and clinician wellbeing.