The Biopsychosocial Impact and Syndemic Effect of COVID-19 on Youth Living with HIV in Kenya.

COVID-19's rapid emergence as a biological and psychosocial threat has affected people globally. The purpose of this qualitative study, which was guided by syndemic theory and the biopsychosocial framework, was to examine the impact of COVID-19 on youth living with HIV (YLWH) in Kenya. Seven virtual focus groups and two in-depth interviews were conducted with 15 YLWH aged 18-24, 13 youth affected by HIV aged 18-24, and 12 HIV healthcare providers living in Nakuru and Eldoret, two of Kenya's largest cities. Data were analyzed using qualitative content analysis, which was guided by a descriptive phenomenological approach. Findings provided information about the problems and needs of YLWH as well as potential solutions for mitigating COVID-19's biopsychosocial impact and syndemic effect on YLWH in Kenya. A variety of individual, community, healthcare, and government issues were identified including but not limited to concerns about psychosocial functioning; economic stability; access to medical treatment and medication; the availability of goods and services; patient education; and the dissemination of accurate information. These findings have important implications for addressing the ongoing and long-term impact of the pandemic on YLWH in resource-limited settings through research, policy, and practice.

Therapeutic drug levels of second generation antipsychotics in youth: a systematic review.

OBJECTIVE: In children and adolescents, the prevalence rate of mental illness is claimed to be as high as 10-20%. Effective pharmacological treatments are available for use in children, adolescents, and adults; however, most of what is known about the effects of these treatments has been confirmed in clinical studies involving adults only. Second generation antipsychotic drugs (SGAs) are the most common class of antipsychotic medication used in pediatric populations, and these drugs are increasingly being used for disorders other than psychosis. Many SGAs are routinely used in pediatric care, and the vast majority of use in this population is off label. Children, adolescents, and adults differ in age, weight, height, and metabolism, which may lead to pharmacokinetic differences in how drugs ultimately affect target tissues. The aim of this review is to summarize and evaluate the literature that investigated blood plasma levels of SGAs in youth. METHODS: Plasma levels were assessed in relation to their administered dose, indication, and therapeutic range (if known). Studies were limited to those evaluating oral administration only. A systematic electronic database search for peer-reviewed articles published between 2000 and 2013 was conducted. Twenty-one articles were included in the review. Additional articles for discussion were also included throughout the article. RESULTS: The only SGA that may require routine therapeutic drug monitoring (TDM) in youth given the current body of research is clozapine. Highly variable results were seen in studies of aripiprazole, olanzapine, and risperidone, indicating that more research is needed on plasma levels with these drugs. Quetiapine maintained a similar profile to that found in adults, with no dosage adjustments or indications of TDM. CONCLUSION: TDM may be indicated in any circumstance in which cytochrome P450 inhibitors or inducers are coprescribed. Further research is required for establishing a sounder safety profile for SGA use in the pediatric population.

Improving metabolic and cardiovascular health at an early psychosis intervention program in vancouver, Canada.

Psychotic disorders most commonly appear during the late teenage years and early adulthood. A focused and rapid clinical response by an integrated health team can help to improve the quality of life of the patient, leading to a better long-term prognosis. The Vancouver Coastal Health early psychosis intervention program covers a catchment area of approximately 800,000 people in the cities of Vancouver and Richmond, Canada. The program provides a multidisciplinary approach to supporting patients under the age of 30 who have recently experienced first-break psychosis. The program addresses the needs of the treatment environment, medication, and psychological therapies. A critical part of this support includes a program to specifically improve patients' physical health. Physical health needs are addressed through a two-pronged, parallel approach. Patients receive routine metabolic health assessments during their first year in the program, where standard metabolic parameters are recorded. Based on the results of clinical interviews and laboratory tests, specific actionable interventions are recommended. The second key strategy is a program that promotes healthy lifestyle goal development. Patients work closely with occupational therapists to develop goals to improve cardiometabolic health. These programs are supported by an active research environment, where patients are able to engage in studies with a focus on improving their physical health. These studies include a longitudinal evaluation of the effects of integrated health coaching on maintaining cardiometabolic health in patients recently admitted to the program, as well as a clinical study that evaluates the effects of low versus higher metabolic risk antipsychotic drugs on central adiposity. An additional pharmacogenomic study is helping to identify genetic variants that may predict cardiometabolic changes following treatment with antipsychotic drugs.