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.

Associations Among Resilient Coping Strategies, Frontolimbic Functional Connectivity, and Depression and Anxiety During the COVID-19 Pandemic

Background: The COVID-19 pandemic is an ongoing stressor that has resulted in millions of deaths and worsening of psychiatric health worldwide. However, we lack knowledge regarding the influence of specific behavioral and neural factors that may alleviate the impact of the pandemic on mental health. Thus, we assessed whether pre-pandemic resilient coping strategy engagement and frontolimbic circuitry influence depression and anxiety symptoms during the pandemic. Methods: In 72 young adults (72.2% female, mean age 24 years), we assessed depression and anxiety symptoms (BDI and SCARED-A), resilient coping strategies (CD-RISC), and resting-state functional connectivity (FC) of frontolimbic circuitry using fMRI. We conducted general linear models to test preregistered hypotheses that 1) less resilient coping pre-pandemic and 2) weaker frontolimbic FC pre-pandemic would predict more severe symptoms during the pandemic;and 3) coping would interact with FC to predict symptoms during the pandemic. Results: Anxiety symptoms worsened during the pandemic as compared to pre-pandemic, while depression symptoms improved (ps<0.001). Less resilient coping predicted more severe depression symptoms during the pandemic (p=0.023). Weaker frontolimbic FC pre-pandemic predicted more severe obsessive-compulsive (p=0.015) and separation anxiety symptoms (p=0.040) during the pandemic. Resilient coping interacted with frontolimbic FC to predict depression (p<0.001), obsessive-compulsive (p=0.041), panic (p=0.017), and generalized anxiety (p=0.027) symptoms during the pandemic. Conclusions: Less coping strategy engagement and weaker frontolimbic FC may represent risk factors for poor psychiatric health during the pandemic. This research may inform efforts to ameliorate the adverse psychological effects of the COVID-19 pandemic, as well as subsequent global stressful events. Supported By: This work was supported by the National Institutes of Health (NIH) Director’s Early Independence Award (DP5OD021370) to DGG;Brain and Behavior Research Foundation (National Alliance for Research on Schizophrenia and Depression;NARSAD) Young Investigator Award to DGG;and National Science Foundation Graduate Research Fellowship Program Award to BHG and JCF. Keywords: Depression, Anxiety, Brain Imaging, fMRI, Coping Strategies, COVID-19 Pandemic

Adaptation to Open-Book Online Examination During the COVID-19 Pandemic

INTRODUCTION: COVID-19 altered medical education systems worldwide as many medical schools quickly changed to online assessment systems. However, the feasibility of online assessment and how it compares to traditional examinations is unclear. METHODS: We compared 4^th year medical students' online surgery clerkship assessment scores to the traditional written examinations. The percent of correct scores using online open-book examination was compared to the results of the traditional closed-book examination in the previous three rotations. Additional correlation between grade point average(GPA) and examination performance were reviewed. RESULTS: Compared with the traditional groups, medical students who took the online, open-book examination had a significantly higher mean score in both MCQ(85.21 vs. 77.36, 72.43, 83.00, p<0.001) and essay examinations (187.36 vs. 158.77, 152.17, 152.29, p<0.001), but a significantly lower mean score in short answer examination (60.09 vs. 66.79, 67.73, 64.82, p<0.001). The online open-book examination group had a significantly lower correlation between the essay score and their GPA than the previous traditional groups (z=2.81 p=0.005, z=2.23 p=0.026, z=2.19 p=0.029). CONCLUSION: Although an online, open-book examination was feasible during the COVID-19 pandemic, this study indicates that mean scores are significantly different which has important implications regarding grading and standard setting. More research is required to assess other effects of this new assessment on long-term knowledge retention and application.