Digital interventions for substance use disorders in young people: Rapid review

This rapid review provides an overview of recent literature on the nature of digital interventions for young people in terms of technologies used, substances and populations targeted, and theoretical or therapeutic models employed. A keyword search was conducted using MEDLINE and other databases for 2015-2021. Following a title/ and full-text screening of articles and consensus decision on study inclusion, data extraction proceeded using an extraction grid. Data synthesis relied on an adapted conceptual framework (Stockings et al., 2016) that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment). The review identified 43 articles describing 39 digital interventions. Most were early interventions (n = 28), followed by prevention (n = 6) and treatment (n = 5). Of the five technologies identified, web-based interventions (n = 14) were most common. Digital interventions have mainly focused on alcohol use (n = 20), reflecting limited concern for other substance use and co-occurring use. Yet the rise in substance use and related harms during the Covid-19 pandemic highlights a critical need for more innovative substance use interventions. Technologies with more immersive and interactive features, such as VR and game-based interventions, call for further exploration. Only one intervention was culturally tailored and purposefully designed for gender minority youth, and another was geared to young men. As well, most interventions used a personalized or normative feedback approach, while a harm reduction approach guided only one intervention. The incorporation of culturally tailored interventions and harm reduction approaches may promote uptake and stronger engagement with digital interventions amongst youth.

The Earthquake Disaster in Turkiye: A Review from Child and Adolescent Psychiatry Perspective

The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences.Copyright © 2023, Duzce University Medical School. All rights reserved.

Cannabis-Induced Catatonia in a 15-Year-Old Male: A Case Report

Introduction: Catatonia is a syndrome of primarily psychomotor disturbances most common in psychiatric mood disorders but that also rarely has been described in association with cannabis use. Case Presentation: A 15-year-old White male presented with left leg weakness, altered mental status, and chest pain, which then progressed to global weakness, minimal speech, and a fixed gaze. After ruling out organic causes of his symptoms, cannabis-induced catatonia was suspected, and the patient responded immediately and completely to lorazepam administration. Discussion(s): Cannabis-induced catatonia has been described in several case reports worldwide, with a wide range and duration of symptoms reported. There is little known about the risk factors, treatment, and prognosis of cannabis-induced catatonia. Conclusion(s): This report emphasizes the importance of clinicians maintaining a high index of suspicion to accurately diagnose and treat cannabis-induced neuropsychiatric conditions, which is especially important as the use of high-potency cannabis products in young people increases.Copyright © 2023, State Medical Society of Wisconsin. All rights reserved.

Low Barrier Tele-Buprenorphine in the Time of COVID-19: A Case Report

Background: To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD). Case Presentation: Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later. Conclusion(s): COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.

Characteristics of patients treated for suicidal behavior during the pandemic in a psychiatric emergency department in a Spanish province

Introduction: Different studies have suggested that psychological, social and economic factors could contribute to an increase in the suicide. That is why the scientific community fear an epidemic of suicides secondary to this crisis. The objective is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic. Material(s) and Method(s): We compared visits to the emergency room and their characteristics of all patients with suicidal behavior before and after the pandemic in Lerida. Information on sociodemographic status, reason for consultation, diagnosis and characteristics of suicidal behavior was obtained from the electronic medical record. Result(s): No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p = 0.201). The characteristics in the multiple logistic regression associated with suicidal behavior are: being a woman (OR: 1.81 [1.27-2.56]), living with relatives (OR: 1.55 [1.05-2.32]) and have a diagnosis of non-alcohol related substance use disorder (OR: 1.94 [1.09-3.42]). As protective factors, being visited in the emergency room during the second state of alarm (OR: 0.68 [0.48-0.96]) and having depression (OR: 0.67 [0.47-0.96]). Conclusion(s): Emergency care for suicidal behavior did not increase during the pandemic and, in fact, in 2020 completed suicides decreased by almost half in the province. Risk factors for suicide attempt were female gender, living with relatives, and having a substance use disorder diagnosis. Instead, depression was a protective factor.Copyright © 2022

Addiction Treatment Facilities under Special Circumstances/Settings

Background: There has been a rampant increase in substance abuse in Kashmir valley for the last few years. Department of Psychiatry SKIMS Medical College Srinagar has extended its services to cater to the needs of the substance users in the valley even during the COVID -19 pandemic. In 2021, de-addiction services were also started among prison inmates of central jail Srinagar. This was the first of its kind of services provided in the valley. The management of substance users with Hepatitis infections had also been challenging. Purpose(s): To describe the management of substance users under special circumstances(COVID-19), special settings(Central Jail Srinagar), high-risk groups(substance users with blood-borne infections). Method(s): Semi-structured proformas were used to collect data from special groups of participants a) those who were seeking treatment during COVID-19 times from the De-addiction center, SKIMS Medical College b) Prison in-mates on treatment for substance-use disorders c) substance users who are hepatitis B and/or positive. This included Socio-demographic details, clinical profile, the pattern of substance use, coping strategies, and treatment seeking. Preliminary Findings: More than 25 percent of the prison in-mates are substance dependent and relapse rate is very high. Psychiatric comorbidity like mood disorders and or personality disorders are present among most of the prison-inmates. During COVID-19 times, 90% patients reported average to very high level of importance and value given to their own health and health of family and friends and focussed on treatment of their illness(85%). Substance users with blood-borne infections were associated with highrisk behavior in the form of needle-sharing. Conclusion(s): The findings provide a voice that there is a need for backup plans that cater to the needs of substance users during in-evitable circumstances like the COVID-19 pandemic. Policymakers should focus on prison mental health for the functioning of a better society. Substance users with blood-borne infections should be rigorously treated to prevent them from taking the shape of an epidemic.

COVID-19 pandemic and mental health service delivery in India: Lessons learned and way forward

The COVID-19 pandemic impacted almost all areas of service delivery for mental illnesses, including substance use disorders across the globe. India was one of the world's most affected countries due to the COVID-19 pandemic. One of the strictest lockdowns was imposed during this time in the country leading to disruption of mental health service delivery. Amongst the vulnerable populations, the mentally ill, especially patients with severe mental illnesses, substance use disorders, and children with mental illness, were the worst affected due to the same. Many modifications and adaptations were made in the country by various stakeholders to provide uninterrupted services to the people suffering from mental illnesses. In this symposium, we discuss the impact of the COVID-19 pandemic, lockdown, and disruption of health services for these vulnerable populations and provide insights into various steps taken for providing services to them. Presenter 1 will focus on the impact of COVID-19 on service delivery for severe mental illnesses in India. Presenter 2 will discuss issues faced by children with mental illnesses during the COVID-19 pandemic. Presenter 3 will discuss the problems faced by patients with substance use disorders. Presenter 4 will highlight modifications done by various stakeholders during the pandemic, specifically focusing on telepsychiatry services in India.

Innovative Approaches to Data Collection Needs in Clinical Trials: Considerations, Lessons Learned and Future Directions

Technological advances and unique data collection requirements across multiple data streams have led to a proliferation of options for data collection in clinical trials. This includes traditional clinical trial data collected in 21CFR Part 11-compliant electronic casereport forms, patient-reported outcomes via standardized assessments and/or computerized tasks, passive or interactive data collection from application-based systems, provider, and/or hospital/clinic-level surveys. The COVID-19 pandemic has led to additional data collection considerations and necessitated policy changes accelerating the ability to conduct health care, clinical trial study visits, and other data collection procedures remotely. Such developments will leave enduring marks on policy related to healthcare and the conduct of clinical trials. The National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) conducts multisite clinical trials on pharmacological and behavioral interventions for Substance Use Disorders (SUDs). The Data and Statistics Center at Emmes is responsible for developing data systems across many NIDA CTN trials and works with Lead Investigative teams such as the New York Node to develop novel approaches to data collection that suit the needs of individuals with SUDs and the studies designed to test and implement effective treatments. This presentation will include different perspectives from members of these teams. Challenges with technological literacy, access to smartphone devices with active data plans, and limitations to remote support from research staff can be barriers to completing assessments for SUD populations. The development of different data system approaches allowing (1) remote completion of web-based surveys and (2) encrypted, automated remote login to a 21CFR11-compliant system (no user ID and password required) will be discussed, as well as interactions between systems and considerations of approaches for different clinical research scenarios. For example, populating a survey link onto an eCRF if research staff assistance is needed for survey completion or for manual distribution of unique links embedded with participant information. Pros and cons of varied approaches to allow participants to access surveys will be discussed, including QR codes, automated vs personalized distribution via SMS and email, and mailed paper invitations with vanity URLs, which may differ by respondent population. In addition, studies targeting a specific patient population may require prescreening a large number in order to attain enrollment targets (e.g. tens of thousands of primary care patients who are sub-clinical threshold but at-risk for SUD). Approaches for conducting extensive prescreening anonymously and lessons learned (predicting prescreen targets accurately, monitoring enrollment rate, staffing and resource considerations) will be presented. Finally, an increasing number of clinical trials examine implementation of SUD interventions in specific patient populations or settings alongside traditional efficacy outcomes. Implementation assessments present unique considerations for data collection;in particular, the need to collect pre-implementation assessments of provider and site-level readiness prior to the onset of training and the new intervention;and before sites have been endorsed for trial data collection in order to avoid contamination. Another unique consideration involves qualitative data collection around the implementation process, and any adaptations made to the intervention or implementation facilitation based on a combination of qualitative and quantitative data. Balancing implementation needs with efficacy testing in clinical trials will also be discussed. Dr. Kathryn Hefner is a clinical psychologist and the Scientific Director of the National Institute on Drug Abuse Clinical Trials Network's (NIDA CTN) Data and Statistics Center (DSC). Her research interests involve substance use and effective treatments for substance use and comorbid mental health conditions. She leads the DSC's efforts in p tient-reported outcomes, including the adoption of novel data collection practices for the NIDA CTN. In addition, she serves as Co- Lead Investigator on CTN-0126, a longitudinal followup study of participants in CTN-0097 and CTN-0100. Dr. Matisyahu Shulman is a clinician-scientist at New York State Psychiatric Institute (NYSPI) and Columbia University Irving Medical Center. His research focus is on opioid use disorders clinical trials and the use of technology to enhance implementation, quality improvement, and treatment delivery. He is part of the lead team of several large multisite opioid treatment trials, including the CTN-0097 trial, a hybrid type I effectiveness-implementation trial, and CTN- 0126, a longitudinal follow-up study. Ms. Onumara Opara, MPH, is the National Project Director for CTN-0097. She has over 9 years of experience in project management for clinical and community-based research. Onumara oversees the dayto- day operations of the CTN-0097 trial, including coordination of protocol activities, implementation efforts at clinical sites, organization and supervision of study teams, training of research staff, quality assurance, and monitoring study progress. Ms. Christina Scheele,MA, is a Senior Data Manager at the CTN Data and Statistics Center at the Emmes Company. She has supported multiple CTN studies during system development and helped to troubleshoot and implement novel approaches to data collection to ease participant and staff burden. Ms. Scheele also has experience using multiple electronic database capture systems for other research studies which required unique and innovative system development for implementation. She currently serves as Data Management Lead on the CTN- 0097, CTN-0100, and CTN-0126 studies. Rebecca Price is a Senior Data Manager who has been at Emmes since 2016, currently supporting the NIDA DSC. Rebecca's main role has included leading the development, maintenance, and/or closeout activities for multiple CTN studies, and she has played a central role in adopting novel data collection practices across several NIDA CTN studies. Dr. Greiner is an addiction psychiatrist in training and a T32 postdoctoral fellow in the Division of Substance Use Disorders at Columbia University and NYSPI. Her main research interest is in implementation and dissemination of evidence-based interventions for substance use disorders in community settings. In particular, she is interested in implementation strategies, costs associated with implementing and sustaining interventions across different organizations, and developing methodology around implementation process. Dr. Greiner will discuss the hybrid effectiveness-implementation NIDA CTN (CTN-0097) trial led by principal investigators Drs. Adam Bisaga and Edward Nunes.

Preliminary Efficacy of Remote, Brief Telepsychotherapy for Covid-19 Patients and Their First-Degree Relatives

Introduction: Over the last two years, the COVID-19 pandemic has negatively impacted the mental health of both COVID-19 patients and the general population. Adults with COVID-19 risked their lives, lost their loved ones, struggled with comorbid clinical conditions to manage, and have been unable to enjoy the physical presence of their families during the infection, quarantine, and lockdown periods. During hospitalization and discharge, family members often did not receive clinical updates from providers and patients, were unable to offer in-person assistance, and to receive psychological support. Incidence and prevalence of depression and anxiety among COVID- 19 older adults and their family members skyrocketed beyond the possibilities of any mental health system to address psychological aftermath of this pandemic and intervene with in-person services. In response to the urgent need for treatments that could be remotely delivered at a large scale, we designed DigiCOVID, a digital mental health approach that offered remote brief tele-psychotherapy to COVID-19 patients and/or their first-degree relatives. The main goal of this single arm, naturalistic study was to evaluate the feasibility, acceptability and usability of DigiCOVID. Additionally, we assessed the impact of DigiCOVID on psychopathology by means of self-report questionnaires. Method(s): Participants underwent an initial phonebased screening to of inclusion and exclusion criteria. Inclusion criteria were: 18-80 years old;positive nasopharyngeal swabs or serology to COVID-19 (for the patients' subgroup);absence of visual/ motor deficits that might interfere with study participation;good level of Italian;and adequate tech literacy. Participants were excluded if they had a previous or actual DSM-5 diagnosis of bipolar disorder, psychotic disorder, or substance use disorder;if they had a diagnosis of dementia;or if they presented suicidal ideation assessed through the Columbia Suicide Severity Rating Scale. Next, they completed a neuropsychological test over video to assess IQ (if lower than 70 participants were excluded), and filled out online gold-standard selfreports for depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), post traumatic symptoms (IES-R) and general wellbeing (GHQ-12). Participants were then assigned to a psychotherapist who remotely conducted eight remote tele-psychotherapy sessions. After treatment, online questionnaires were filled out again to collect data on preliminary efficacy. Result(s): Since November 2021, 138 patients were recruited, 83 completed the intervention (57 patients, 26 fist-degree relatives), and 55 dropped out. At a group level, participants showed significant improvements on all clinical outcomes (PHQ-9: R2=0.12, p=.0019;ISI: R2=0.15, p=.0004;IES-R: R2=0.11, p=.0003;GHQ- 12: R2=0.23, p<.0001;GAD-7: R2=0.12, p=.0011). Given the high heterogeneity in illness severity and psychopathology, we conducted clustering on baseline data coming from the five online questionnaires: 55% of the whole sample had no psychopathology (Cluster 1), whereas 45% showed severe psychopathology (Cluster 2). When clustering was conducted on post-treatment data, three clusters emerged: no psychopathology, residual psychopathology and severe psychopathology. 71% of Cluster 1 participants remained asymptomatic;25% of Cluster 2 participants showed full symptom remission, while 48% and 28% of Cluster 2 participants showed partial symptom remission and no significant effect of treatment, respectively. Conclusion(s): Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology. Further research is needed to investigate distinct profiles of treatment response.

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.

Quality of life of a group of Ecuadorian health professionals in covid-19

Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

The "Janus-like" RNA-editing machinery in innate antiviral immunity

Our innate immune systems are evolved to provide the first line of immune defense against microbial infections. A key effector component is the adenosine deaminase acting on the RNA-1 (ADAR-1)/ interferon (IFN) pathway of the innate cytoplasmic immunity that mounts rapid responses to many viral pathogens. As an RNA-editing enzyme, ADAR-1 targets viral RNA intermediates in the cytoplasmic compartment to interfere with the infection. However, ADAR-1 may also edit characteristic RNA structures of certain host genes, notably, the 5-hydroxytryptamine (serotonin) receptor 2C (5HT2CR). Dysfunction of 5-HT2CR has been linked to the pathology of several human mental conditions, such as Schizophrenia, anxiety, bipolar disorder, major depression, and the mental illnesses of substance use disorders (SUD). Thus, the ADAR-1mediated RNA editing may be either beneficial or harmful;these effects need to be tightly modulated to sustain innate antiviral immunity while restricting undesired off-target self-reactivity. In this communication, we discuss ideas and tools to identify the orphan drug candidates, including small molecules and biologics that may serve as effective modulators of the ADAR-1/IFN innate immunity and are thereby promising for use in treating or preventing SUD-and/or viral infection-associated mental illnesses.Copyright © 2023, Research Trends (P) LTD.. All rights reserved.

Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review

Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication;standardized protocols for evidence-based treatments;systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings. Copyright © The Author(s), 2023. Published by Cambridge University Press.

Empowering Social Prescribing and Peer Support: A Proposed Therapeutic Alliance against Addiction and Substance Misuse within the Middle East

The authors propose that social prescribing is an empowering strategy to assist individuals to connect and thrive within their communities and supports improvements in their health and well-being. Whilst, social prescribing schemes have been developed within western healthcare systems for some decades and continue to gain popularity, there has been little evidence of its widespread use within the Middle East. This region has continued to be predominantly focused on pharmaceutical interventions for individuals experiencing addiction and substance misuse and whilst it is acknowledged that there are enclaves throughout the region, these are not common practice. A world shaped by a post-COVID-19 global economic crisis appears to have had detrimental effects on physical and mental health due to substance misuse and addictions. The use of social prescribing utilizes psychological and social factors rather than an overreliance on the bio-medical model which relies on biological interventions to treat addictions and substance use disorder. Firstly, the authors will advocate for a wider exploration of the use of social prescribing in order to create a holistic approach to combating the health and social care determinants of addictions and substance for the Middle Eastern region. The paper will demonstrate how the use of social prescribing could be used to reaffirm empowerment as a means of aiding people to become more independent of hospital institutions and current pharmaceutical interventions. Seminal work on empowerment and peer-support will be presented to create awareness on the challenges of establishing and promoting empowerment within entrenched bio-medical models of care. Secondly, the authors will remonstrate for a need to establish peer-support by empowering those with lived experiences of addictions and substance misuse issues to become members of the multi-disciplinary team to treat these conditions. Copyright © 2022 Richard Mottershead, et al.

Depression symptoms and anxiety after coronavirus infection in the elderly: a case study

Introduction & Background: Coronavirus is regarded as a new condition afflicting the globe. It normally results in anxiety-based issues in society, especially in the elderly. Furthermore, people with underlying illnesses are more involved in this condition. Consequently, the current article intends to examine the association between social support and the level of COVID-19 anxiety in the elderly in Fasa, Iran. Patients and Methods: The current examination was cross-sectional research performed on 600 elderly covered by urban and rural family physician clinics after receiving permission from the Research Deputy and the university's Ethics Committee through the Press Line program. The data was gathered through a demographic information collection form, a COVID-19 anxiety measurement questionnaire, and a multidimensional scale of perceived social support. Data obtained were examined in SPSS-23 software. Result(s): The average age of the elderly was 65.91+/-4.84 years. The majority of the respondents (60%) were female. There was a substantial negative association between anxiety and perceived social support and its components (p<0.05). The outcomes of statistical regression analysis revealed that the variables of social support, career, and marital status held a statistically significant relationship with anxiety (P<0.05), and these variables defined 42% of the variance of COVID-19 anxiety variable in the elderly (p <0.05). Conclusion(s): Based on the results, it can be stated that improving social support can greatly decrease COVID-19 anxiety in the old people. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Transgender Adolescents of Color and HIV: Unique Challenges in Preventing New Infections

Background. An estimated HIV prevalence of 9.2% for all transgender persons nationally with a significantly higher prevalence for transgender women at 14.1%. A paucity of published data exists defining the risk of HIV in transgender or nonbinary (TGNB) youth of color. The Bronx has the highest incidence of homelessness and the highest unemployment rate in the country, which peaked at 24.6% during COVID19. We assessed SDOH in TGNB youth of color and the impact on their ability to prioritize and access HIV prevention. Methods. An assessment of sexually active TGNB youth 14-27 years (N=101) in 2021-2022 was conducted to evaluate potential barriers to HIV prevention by querying the 4 U's: 1) Unemployed 2) Uninsured / Underinsured 3) Unstable housing and 4) substance Use disorder. The assessment also integrated questions about gender affirmation, HIV / STI prevention. Information obtained was used to assess knowledge gaps that affect their understanding of HIV risk. Based on the results, a research tool, ARTISTA (Assess Risk for Transmitted Infections in Sexually active Transgender Adolescents) was implemented to improve gaps in understanding HIV / STI risk in TGNB youth. Ultimately, ARTISTA can be used to influence policies for HIV Prevention in this population. Results. Patient's mean (+sd) age was 20 (+ 2.7) years, 50% were trans female, 50% trans male, 66% were youth of color. Gender affirming care was associated with increased odds of STI testing (adjusted odds ratio = 1.90 95% confidence interval = 1.33-2.73 with no relation to gender identity. Despite awareness, initiation of PrEP and adherence among trans females was disappointing. Trans females, 24%(10/41) initiated PrEP, 2 seroconverted;1 stopped and 7 are 70% adherent to daily oral PrEP. Unemployment (23%), Unstable housing (11%), Uninsured (10%) and Substance Use disorder (40%) were priorities over prevention. Conclusion. Gender affirmation is associated with an opportunity to improve awareness of HIV / STI prevention. ARTISTA assessment reveals it's not just about PrEP, but about the social / structural barriers to access and uptake. SDOH must be addressed in this population if we are serious about ending the epidemic.

Methamphetamines and Serious Injection Related Infections: Epidemiology and Outcomes of Alabama's Drug Crisis

Background. The U.S. is facing a steep increase in infectious consequences of intravenous drug use due to the ongoing opioid crisis, surging methamphetamine use, and health care disruptions caused by COVID-19. We hypothesize that the sociodemographic and clinical outcomes of persons who inject drugs (PWID) differ based on their drug of choice (opioids, methamphetamines). Further, we hypothesize that the OUD (opioid use disorder) continuum, including linkage and retention inOUD treatment, will vary depending on co-occurring methamphetamine use. By elucidating differences in these groups, we aim to identify opportunities for interventions along the care continuum. Methods. This is a retrospective study of hospitalized PWID receiving care at the University of Alabama at Birmingham Hospital for a serious injection related infection (SIRI) between 1/11/2016 and 4/24/2021. We queried the EMR for clinical data and health outcomes. We extracted data on substance use disorder(s), treatments, and linkage to care through review of primary and addiction medicine consultation notes. Using statistical measures of association, we compared demographic factors and clinical outcomes among groups;delineating between those with and without methamphetamine use, and without OUD. When appropriate, additional comparisons were made to detect statistical differences between factors and those with and without methamphetamine use. Results. Of 370 PWID, 286 had OUD, 94 had OUD and methamphetamine use, and 84 had another substance use disorder. There were significant differences according to drug use disorder with patients with OUD and meth use being mostly White (99%), 42% female, and younger relative to those who use opioids only. Patient directed discharge was most common among those with OUD plus meth use, but death was highest for those with OUD only. The OUD care continuum was similar and alarming for both groups with many gaps in care. (Table Presented) Conclusion. PWID with SIRI are a diverse group with significant differences based on substance of choice, but all experience suboptimal hospital outcomes. There are opportunities to improve linkage and retention across the care continuum, most noticeably outpatient linkage.