Mental disorders during the pandemic of a new coronavirus infection: causes and predisposing factors.

Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness. Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data. Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder - 24%, recurrent depressive disorder - 20%, schizophrenia - 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent - psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors. Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Mental disorders during the pandemic of a new coronavirus infection: causes and predisposing factors

Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness. Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data. Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder - 24%, recurrent depressive disorder - 20%, schizophrenia - 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent - psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors. Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Consensus of Chinese experts on the work and demonstration of online Balint groups working committee on doctor-patient relationship, Chinese psychiatrist association, Chinese medical doctor association.

Balint group helps health professionals to get emotional support and different perspectives of feedback, inspire reflection, and alleviate job burnout. During the outbreak of COVID-19, it was difficult for medical staff to carry out the traditional form of in person Balint group. Referring to the work of international pilot online Balint group, leaders of Balint group all over China have accumulated some experience and encountered new problems by using the internet to carry out discussion. In order to assist and standardize the work of online Balint group and enrich the ways of expanding Balint work, the Working Committee on Doctor-patient Relationship, Chinese Psychiatrist Association, Chinese Medical Doctor Association organized experts to have two rounds of discussion, and developed the consensus on: Principles and forms of online Balint group, the way of using web platforms for demonstration and learning, matters needing attention, the future development, and so on.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Mental disorders during the pandemic of a new coronavirus infection: causes and predisposing factors.

Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness. Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data. Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder - 24%, recurrent depressive disorder - 20%, schizophrenia - 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent - psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors. Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.Copyright © 2022 Ima-Press Publishing House. All rights reserved.

Influence of significant stressful events on the course of primary cephalalgia.

Objective. To analyze diagnoses, clinical characteristics, incidence and specifics of comorbid mental and other disorders in Russian patients with a main complaint of headache before and after the novel coronavirus infection (COVID-19) pandemic and special military operation. Material and methods. We have retrospectively analyzed primary medical records of all patients over 16 years old with a main complaint of headache who appealed to the University Headache Clinic between April 1, 2019 and July 1, 2019 (before the COVID-19 pandemic), in 2021 (COVID-19 pandemic) and 2022 (after onset of special military operation). Results. There were more visits of patients diagnosed with migraine in April-June 2021 compared to the same period in 2019. In April-June 2022, the number of patients with migraine and aura significantly increased from 11.7 to 18.5% (p=0.03). Other migraine characteristics remained the same throughout 3 years. Indicators of emotional status changed significantly. In 2021, the number of patients with anxiety increased from 28.0 to 44.9% (p=0.001). In 2022, anxiety continued to be high. Prevalence of depression did not change significantly in 2021 compared to 2019, but its manifestations have changed. Anhedonia and an-ergy became more common. The number of patients with depression significantly increased among people with headache from 28.7 to 43.9% in 2022 (p=0.0001). The proportion of patients with a first-time depressive episode significantly increased (from 2.7% in 2021 to 21.3% in 2022, p=0.0001). The number of patients referred to a psychiatrist was 10.2% in 2022 that is significantly higher compared to 2021. Conclusion. Significant socio-economic events can be triggers for onset or relapse of comorbid anxiety-depressive disorders in patients with primary cephalalgia.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Mental health training needs of physicians in Bangladesh: Views from stakeholders

Bangladesh is a lower-middle-income country with a high burden of mental health conditions and inadequate health systems. Prior research in similar settings has found that training physicians in mental health literacy can contribute to reducing the mental health treatment gap and strengthening the mental health care pathway. This study explores the need for mental health training for physicians by gathering stakeholders' perspectives and proposes recommendations for designing a mental training program in the context of Bangladesh. Key informant interviews were conducted among psychiatrists (n = 9), and mental health entrepreneurs (n = 7);one focus group discussion was conducted with psychologists (n = 8);and one-on-one interviews were held with physician (n = 17). Due to the COVID-19 restrictions, all interviews were conducted online, recorded and transcribed. Transcriptions were analyzed thematically, utilizing both an inductive and deductive approach. The data analysis from forty-one stakeholders generated three major themes and eight subthemes. Stakeholders perceived that the inadequate mental health system and low mental health awareness among physicians significantly contribute to the mental health treatment gaps. Stakeholders emphasized the need to include mental health training for physicians to increase skills related to identification and management of mental health conditions. Stakeholders suggested some basic components for the training content, feasible modalities to deliver the training, and implementation challenges. Recommendations included utilizing online training, ensuring interesting and practical content, and incorporating certification systems. At a systems level, stakeholders recommended including a mental health curriculum in undergraduate medical education, capacity building of other healthcare workers and increasing awareness at the policy level. There is clear agreement among stakeholders that implementing mental health training for physicians will promote universal health coverage and reduce the mental health treatment gap in Bangladesh. These findings can support creation of policies to strengthen the care pathway in countries with limited resources.Copyright © 2022 The Authors

Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services.

OBJECTIVE: This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic. CONCLUSIONS: Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.

Regulatory and Medico-legal Aspects of Technology and Psychiatry in India -3rd National Official workshop of the IPS Technology and Psychiatry Specialty Section

Globally, Technology and Psychiatry have emerged significant during the COVID-19 Pandemic. Technology is rapidly evolving and is definitely impacting the world of Psychiatry and mental health care across academics, research, training and clinical care. Technology is here to stay. It is pertinent that Psychiatrists and Allied professionals get adequate skills and training in Technology and Psychiatry for its application to clinical care and research. Many countries have relevant regulations, Guidelines, Bills, Policies, Acts, and Compliances regarding Technology and Health Care. The Telemedicine Guidelines were released during the COVID-19 Pandemic in India. Subsequently, The Telepsychiatry Guidelines were released by IPS and NIMHANS. There are certain regulations, such as EHR standards, Personal Data Protection Bill, DISHA, Information Technology Act, Drugs and Cosmetic Act, etc., for healthcare and technology in India. Aims and objectives of the workshop: * To create awareness of the regulatory and medicolegal aspects of Technology and Psychiatry in India * To improve the knowledge and skills Psychiatrists in Technology and Psychiatry Speakers and Topics: Dr Darpan Kaur : Conceptual Overview Framework of Needs and Perspectives of Regulatory and Medicolegal Aspects of Technology and Psychiatry in India, Dr Parmod Kumar: Telemedicine Guidelines and TelePsychiatry Guidelines in India Dr Shahul Ameen: Electronic Health Record (EHR) Standards and Personal Data Protection Bill Dr Vijay Chandra: Information Technology (IT) Act and Drugs and Cosmetic Act Dr Sudhir Bhave: Digital Information Security Health Care Act (DISHA).

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.

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.

The effect of the COVID-19 pandemic period on the prevalence of metabolic syndrome in patients with schizophrenia and bipolar disorder: Metabolic syndrome and COVID-19 Pandemic Period

Aim: This study aimed at investigating the impact of COVID-19 lockdown on metabolic profile in bipolar disorder and schizophrenia patients at the time of COVID-19. Material(s) and Method(s): This study was completed with 190 individuals diagnosed with schizophrenia (116) and bipolar disorder (74). Waist circumference and blood pressure measurements were taken on the same date as triglyceride, glucose and HDL data in the electronic recording system of the participants. Initial assessment data are measurements within 3 months prior to the publication of the first case in Turkey. The second evaluation data, on the other hand, is the data obtained within 3 months after the date of removal or relaxation of the restrictions, which is defined as the normalization period. Result(s): A significant increase was observed in the incidence of metabolic syndrome in the participants after the COVID-19 lockdown. In addition, a significant increase in glucose, triglyceride and diastolic blood pressure values, and a significant decrease in HDL values were detected. There was no significant change in systolic blood pressure and waist circumference values. Discussion(s): It has been shown that the COVID-19 lockdown increases the incidence of metabolic syndrome in patients with schizophrenia and bipolar disorder and causes irregularities in metabolic syndrome parameters.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Emerging challenges in child psychiatry practices in the post-pandemic era

Following the Covid pandemic, there are various changes in the presentation and management of childhood psychiatric disorders. The introduction of telepsychiatry for delivering therapies has its own merits and demerits. However, as a consequence of the lack of one-on-one therapy and regular consultation with a child psychiatrist which is essential for the management of neurodevelopmental disorders, detrimental effects in terms of an increase in symptoms and behavioral problems were observed. Increased identification of cases of neurodevelopmental disorders especially ADHD and autism has escalated the burden on caregivers and treating professionals. These all need to be addressed in the post-pandemic situation calling for novel approaches for better service delivery on part of the psychiatrist in advising home-based therapies rather than depending on therapy centers. Due to the disruption of routine schooling during Covid pandemic, children are facing problems in adjusting to regular school postpandemic, especially children belonging to younger age groups. Most of these children are presenting with multiple somatic complaints to avoid attending school leading to a decline in scholastic performance. Other factors such as changing schools and increased screen time have an additive role in school refusal. These are the major factors that affected most school-going children. This scenario has been increasing and has to be tackled by employing a multidisciplinary approach involving psychiatrists, psychologists, parents and school authorities. Several studies demonstrate that early identification of the problem of school refusal and an early reintroduction to school has a good prognosis. Electronic gadget usage is on the rising trend bringing about its own set of challenges including internet addiction and gaming disorders. Psychiatrists should address these problems delicately, understanding the child's point of view which may require out-of-the-box approaches.

NUBE Abstract

The proceedings contain 14 papers. The topics discussed include: providing comprehensive services to treat patients and the inpatient psychiatric bed crisis;impact of COVID-19 pandemic on pediatric substance abuse related presentations to emergency services between July 2019 and March 2022;patient-specific characteristics that influence a psychiatrist' perception of a patient' risk for attempting suicide in the emergency department;racial disparities in emergency restraint use for agitated patients;emergency department use of a restraint chair is associated with shorter restraint periods and less medication use than the use of 4-point restraints;the utility of the Columbia-suicide severity rating scale in determining a patient' imminent risk for suicide in the emergency department;and rare disease masked behind common presentation: toxic leukoencephalopathy up close.

Validating the Busch Francis Scale for use in Telepsychiatry

Background: The COVID-19 pandemic has dramatically accelerated the utilization and acceptance of telepsychiatry, with many departments transitioning to virtual models over the past 2 years out of necessity. While there has been some research on physician and patient satisfaction with the transition, there has been significantly less research on the quality of care provided (Mishkin). By its nature, telemedicine precludes physical examination. While many psychiatric conditions are amenable to diagnosis via patient interview alone, some such as catatonia require a physical exam for diagnosis. The Busch Francis Catatonia Rating Scale (BFCRS) is a well validated in-person exam for catatonia to both screen for and rate the severity of a catatonia diagnosis (Sienaert), but to our knowledge it has not been validated via telemedicine. Our literature review revealed a paucity of research on the contribution of each individual item to the overall sensitivity of the rating scale, thus it is impossible to predict the value of a fully virtual or hybrid exam. We plan to evaluate the inter-relater reliability between an in-person BFCRS performed by a psychiatrist and one supervised by a psychiatrist through telemedicine technology. Current practice at our institution is for the psychiatry resident performing tele-consults to Methods: We will draw participants from the pool of patients for whom psychiatric consults are ordered at two separate medical campuses. Our team will consist of C-L psychiatry fellows performing BFCRS exams patients at these campuses;we will strive to see all patients for whom a psychiatric consultation is ordered. In addition to a standard psychiatric consult (which may or may not include a BFCRS), patients will receive an in-person BFCRS screening exam performed and scored by the research team member at their site and one additional hybrid BFCRS exam scored by the research team member at the alternate site with physical exam components only performed by the onsite research team member. Data collected for each participant will include demographic information, medical and psychiatric diagnoses and BFCRS scores. We will compare the sensitivity and specificity fully virtual (which will by necessity exclude some components such as rigidity) and hybrid BFCRS exam to the full in-person scale, which we will treat as a gold standard. Discussion/Conclusion: This project is currently in early stages. We hope to gather data to inform the future practice of C-L psychiatrists performing consults through telemedicine. Mishkin AD, Cheung S, Capote J, Fan W, Muskin PR. Survey of clinician experiences of telepsychiatry and tele-consultation-liaison psychiatry. J Acad Consult Liaison Psychiatry. Published online November 15, 2021:S2667-2960(21)00184-1. Reference: Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord. 2011;135(1-3):1-9 Copyright © 2022

Improving Substance Use Treatment Capability in Collaborative Care

Background: In 2019, Beth Israel Lahey Health Behavioral Services (BILH BS) began system-wide implementation of Collaborative Care (CoCM). CoCM is an evidence based model of integrated care designed to treat persistent behavioral health conditions within primary care, including substance use disorders (SUD). The onset of the COVID-19 pandemic presented an increase in substance use at a state and national level, while a dearth of available treatment options drove increased demand for substance use treatment in primary care (NIDA 2022;Ornell 2020). An internally distributed provider survey served to determine a baseline of substance use treatment capability within BILH CoCM, as well as a gap in provider confidence and capability in meeting these treatment needs. Method(s): BILH BS CoCM partnered with an addictions psychiatrist to develop a comprehensive training module for Behavioral Health Clinicians (BHC) specific to treating substance use disorders within the CoCM model. A pre-module self-assessment was distributed to 25 participating BHC to score provider comfort and knowledge in assessing and treating substance use disorders. Providers responded according to a 5-point Likert scale. BHC are required to attend three 60-minute interactive didactics. A post-module self-assessment will be distributed to assess change in BHC comfort and knowledge of treating SUD and how new skills have been incorporated into patient care. Result(s): 25 BHCs completed the pre-module self-assessment. Results represented a diverse range of answers, with the majority of BHCs reporting moderate comfort and familiarity in assessing and treating substance use disorders. The final data collection and analysis will be completed in May 2022. Conclusion(s): At this time, BILH CoCM BHCs have completed 2/3 lectures in the training module. We anticipate that BHCs will self-assess an improvement in overall comfort and knowledge in assessing and treating substance use disorders in the context of CoCM. BHCs are expected to report a change in their patient engagement practices and treatment planning. This training module may prove essential in building provider capability in the treatment of substance use disorders within primary care. There is an opportunity to continue to assess gaps in provider knowledge, and enhance continuing education with periodic provider surveys and training expansion. References: NIDA. (2022, February 25). COVID-19 & Substance Use. Ornell, F et al. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. 2020;Psychiatry research;2020:289. Copyright © 2022

COVID-19 and CAP: What Changed in Training and Practice for Early Career Child/Adolescent Psychiatrists?

Covid-19 pandemic has affected early career psychiatrists (ECP) and psychiatric trainees significantly. Child and Adolescent Psychiatry (CAP) specialists and trainees have a particular position in the pandemic as redeployments to adult units are possibly more disorientating for these psychiatrists normally working in paediatric settings. Redeployments and abrupt but potentially permanent changes to the delivery of service and training are explored via the Covid-19 and Early Career Psychiatrists survey which was prepared and disseminated by the EPA ECP Committee and the European Federation of Psychiatric Trainees (EFPT). The CAP related data from the survey will be discussed in this presentation and the implications on the future of CAP will be considered with particular emphasis on training.

Film-based resources for grief management in medical education

Introduction: Grief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education. Objective(s): To explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue. Method(s): We reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1]. Result(s): We recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person's loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system. Conclusion(s): This film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves.

Compare in-person and online outpatient visits based on changes in patients' treatment

Introduction: The COVID epidemic has forced psychiatrists to introduce changes in outpatient clinics. A significant proportion of visits began without the patient's face-to-face contact with the doctor. Are these visits stigmatized with a worse assessment of mental state? We know that much of the information flow takes place outside of verbal contact. In telephone contact, psychiatrists are limited to listening to the patient's response and we know that non-verbal speech does not always go hand in hand with words. Objective(s): The aim of the study is to compare face-to-face visits with a psychiatrist with outpatient visits by telephone in terms of changes in the treatment applied by psychiatrists. Method(s): The frequency of introducing changes in the current pharmacological treatment of patients was compared. Face-to-face visits to the outpatient clinic and visits where psychiatrists contacted patients via telephone were analyzed. Treatment change was defined as a reduction or increase in drug dose, drug discontinuation or the initiation of a new drug by a psychiatrist. Result(s): We assumed that visits without non-verbal contact do not provide as much information as direct visits. Consequently, patients who are often negative about the need to take medications over the phone will present themselves better to psychiatrists, thus the change in treatment will be used less frequently in this group. The results will be presented at the conference. Conclusion(s): Currently, various forms of psychiatric care are evolving to adapt to new needs. We should also be aware of the consequences of these changes.