Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.

To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.

We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.

Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65–0.80; Black: odds ratio 0.86, 95% CI 0.76–0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88–0.92) had a reduced odds of being exception reported, whereas patients diagnosed with ‘other psychoses’ (odds ratio 1.19, 95% CI 1.15–1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.

Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.

Inadequate recruitment and retention impede clinical trial goals. Emerging decentralized clinical trials (DCTs) leveraging digital health technologies (DHTs) for remote recruitment and data collection aim to address barriers to participation in traditional trials. The ACTIV-6 trial is a DCT using DHTs, but participants’ experiences of such trials remain largely unknown. This study explored participants’ perspectives of the ACTIV-6 DCT that tested outpatient COVID-19 therapeutics.

Participants in the ACTIV-6 study were recruited via email to share their day-to-day trial experiences during 1-hour virtual focus groups. Two human factors researchers guided group discussions through a semi-structured script that probed expectations and perceptions of study activities. Qualitative data analysis was conducted using a grounded theory approach with open coding to identify key themes.

Twenty-eight ACTIV-6 study participants aged 30+ years completed a virtual focus group including 1–4 participants each. Analysis yielded three major themes: perceptions of the DCT experience, study activity engagement, and trust. Participants perceived the use of remote DCT procedures supported by DHTs as an acceptable and efficient method of organizing and tracking study activities, communicating with study personnel, and managing study medications at home. Use of social media was effective in supporting geographically dispersed participant recruitment but also raised issues with trust and study legitimacy.

While participants in this qualitative study viewed the DCT-with-DHT approach as reasonably efficient and engaging, they also identified challenges to address. Understanding facilitators and barriers to DCT participation and DHT interaction can help improve future research design.

Understanding the factors contributing to optimal cognitive function throughout the aging process is essential to better understand successful cognitive aging. Processing speed is an age sensitive cognitive domain that usually declines early in the aging process; however, this cognitive skill is essential for other cognitive tasks and everyday functioning. Evaluating brain network interactions in cognitively healthy older adults can help us understand how brain characteristics variations affect cognitive functioning. Functional connections among groups of brain areas give insight into the brain’s organization, and the cognitive effects of aging may relate to this large-scale organization. To follow-up on our prior work, we sought to replicate our findings regarding network segregation’s relationship with processing speed. In order to address possible influences of node location or network membership we replicated the analysis across 4 different node sets.

Data were acquired as part of a multi-center study of 85+ cognitively normal individuals, the McKnight Brain Aging Registry (MBAR). For this analysis, we included 146 community-dwelling, cognitively unimpaired older adults, ages 85-99, who had undergone structural and BOLD resting state MRI scans and a battery of neuropsychological tests. Exploratory factor analysis identified the processing speed factor of interest. We preprocessed BOLD scans using fmriprep, Ciftify, and XCPEngine algorithms. We used 4 different sets of connectivity-based parcellation: 1)MBAR data used to define nodes and Power (2011) atlas used to determine node network membership, 2) Younger adults data used to define nodes (Chan 2014) and Power (2011) atlas used to determine node network membership, 3) Older adults data from a different study (Han 2018) used to define nodes and Power (2011) atlas used to determine node network membership, and 4) MBAR data used to define nodes and MBAR data based community detection used to determine node network membership.

Segregation (balance of within-network and between-network connections) was measured within the association system and three wellcharacterized networks: Default Mode Network (DMN), Cingulo-Opercular Network (CON), and Fronto-Parietal Network (FPN). Correlation between processing speed and association system and networks was performed for all 4 node sets.

We replicated prior work and found the segregation of both the cortical association system, the segregation of FPN and DMN had a consistent relationship with processing speed across all node sets (association system range of correlations: r=.294 to .342, FPN: r=.254 to .272, DMN: r=.263 to .273). Additionally, compared to parcellations created with older adults, the parcellation created based on younger individuals showed attenuated and less robust findings as those with older adults (association system r=.263, FPN r=.255, DMN r=.263).

This study shows that network segregation of the oldest-old brain is closely linked with processing speed and this relationship is replicable across different node sets created with varied datasets. This work adds to the growing body of knowledge about age-related dedifferentiation by demonstrating replicability and consistency of the finding that as essential cognitive skill, processing speed, is associated with differentiated functional networks even in very old individuals experiencing successful cognitive aging.

The prevalence of mild to moderate cognitive impairment, including episodic memory deficits, in people living with HIV (PLWH) remains high despite the life-extending success of antiretroviral pharmacotherapy. With PLWH now reaching near-normal life expectancy, questions concerning a potential synergy between age- and HIV disease-related effects, including degradation in fronto-limbic circuits, neural systems also compromised in Parkinson’s disease (PD), have emerged.

This cross-sectional study examined the similarities and differences in component processes of verbal episodic memory and their neural correlates in 42 PLWH, 41 individuals with PD, and 37 controls (CTRL) (all participants aged 45-79 years). Learning over five trials, short-delay (SD) and long-delay, (LD), free-recall (FR) and cued-recall (CR) indices were assessed using the California Verbal Learning Test-2. Retention scores for FR and CR were derived adjusting for Trial 5 performance. All memory scores were age- and education-corrected based on the control group and reported as Z-scores. Regional brain volumes were calculated using 3T MRI data and the SRI24 atlas to delineate frontal (precentral, superior, orbital, middle, inferior, supplemental motor, and medial) and limbic (hippocampus, thalamus) regions. Brain volumes were age- and head-sized corrected based on 238 controls (19-86 years old).

Compared with the CTRL group, the HIV and PD groups were impaired on learning across trials and on SD and LD free- and cued-recall, with no group difference between the HIV and PD groups on any score. All three groups benefited similarly from cues compared with free-recall. The HIV and PD groups did not differ from CTRL on retention scores. Regarding brain volumes, the HIV group had smaller middle frontal volumes than the PD or CTRL groups and smaller thalamic volumes than the PD group. Correlational analyses (Bonferroni correction for 8 comparisons, p<.01) indicated that fewer total number of words recalled on Trial 5, learning over Trials 1-5, total words recalled on SD-CR, LD-FR, and LD-CR were associated with smaller orbitofrontal volume in the HIV but not the PD group; the correlations between orbitofrontal volume and memory scores were significantly different between the HIV and PD groups. In PD, but not HIV, lower retention scores on SD-FR and LD-CR correlated to smaller hippocampal volume.

Impairment in learning and cued recall performance indicate that both encoding and retrieval processes are affected in PLWH and PD. Neural correlates of verbal memory differed between groups, with orbitofrontal volume associated with learning and recall in PLWH, whereas hippocampal volume was associated with retention scores in PD. Together, these results suggest that different nodes within the fronto-limbic mnemonic circuitry underlie the mutual verbal episodic memory deficits observed in older PLWH and PD. Support: AA023165, AA005965, AA107347, AA010723, NS07097, MH113406, and the Michael J. Fox Foundation for Parkinson’s Research

The COVID-19 pandemic has significantly impacted mental health services, with the literature reporting an increase in the incidence of psychiatric admissions.

The aim of this study was to assess the impact of the pandemic on clinical presentations, characteristics of admission and incidents occurring in three acute inpatient mental health facilities in the UK.

This was a retrospective study comparing data from the first and third UK lockdown to the five years prior to the pandemic. Data was acquired from electronic clinical records and addressed two acute psychiatric inpatient wards and one psychiatric intensive care unit. Key outcomes of comparison were clinical presentations, number of admissions, length of hospital stay, number of incidents and characteristics of incidents.

Compared to the previous 5 years, a higher number of incidents characterized by violence and aggression were reported during the first (56.8% vs 44.3%, x2=16.56, df=1, p<0.001) and third lockdown (100.0% vs 86.2%, x2=36.40, df=1, p<0.001). An increase in non-psychotic disorders was observed in the first lockdown (20.0% vs 13.1%, x2=4.76, df=1, p=0.029), whilst increased first episode psychosis (19.7% vs 11.3%, x2=8.1, df=1, p=0.004) and schizophrenia spectrum disorders (74.4% vs 57.2%, x2= 7.6, df=1, p=0.006) were diagnosed during the third lockdown. There were no significant changes in the diagnosis of mood disorders in both lockdowns compared to previously. The median length of inpatient stay significantly reduced during the first lockdown (28 days vs 36 days, x2= 7.66, df=1, p=0.006).

Increased inpatient incidents may be explained by the impact of the pandemic on staffing levels and resources, combined with increased emotional distress amongst patients in the face of uncertainty. The pandemic may have increased substance misuse potentially linked with the increased incidence of first episode psychosis.

S. Bonaccorso: None Declared, O. Ajnakina: None Declared, A. Ricciardi: None Declared, S. Ouabbou: None Declared, J. Wilson: None Declared, C. Theleritis: None Declared, M. Badhan: None Declared, A. Metastasio: None Declared, N. Stewart: None Declared, M. Barczyck: None Declared, F. Johansson: None Declared, T. Tharmaraja: None Declared, F. Schifano Speakers bureau of: Prof. Fabrizio Schifano is a member of the European Medical Agency

Major Depressive Disorder (MDD) is prevalent, often chronic, and requires ongoing monitoring of symptoms to track response to treatment and identify early indicators of relapse. Remote Measurement Technologies (RMT) provide an exciting opportunity to transform the measurement and management of MDD, via data collected from inbuilt smartphone sensors and wearable devices alongside app-based questionnaires and tasks.

To describe the amount of data collected during a multimodal longitudinal RMT study, in an MDD population.

RADAR-MDD is a multi-centre, prospective observational cohort study. People with a history of MDD were provided with a wrist-worn wearable, and several apps designed to: a) collect data from smartphone sensors; and b) deliver questionnaires, speech tasks and cognitive assessments and followed-up for a maximum of 2 years.

A total of 623 individuals with a history of MDD were enrolled in the study with 80% completion rates for primary outcome assessments across all timepoints. 79.8% of people participated for the maximum amount of time available and 20.2% withdrew prematurely. Data availability across all RMT data types varied depending on the source of data and the participant-burden for each data type. We found no evidence of an association between the severity of depression symptoms at baseline and the availability of data. 110 participants had > 50% data available across all data types, and thus able to contribute to multiparametric analyses.

RADAR-MDD is the largest multimodal RMT study in the field of mental health. Here, we have shown that collecting RMT data from a clinical population is feasible.

No significant relationships.

Cyberchondria involves excessive and uncontrollable online searching of information about a perceived illness. This behavior can cause or maintain distress.

Little is known about cyberchondria during the COVID-19 pandemic or how cyberchondria in one individual may cause distress in their significant other if they are self-isolating together; our study sought to fill these gaps.

We conducted a Qualtrics Panel survey with 760 cohabitating Canadian couples; in June 2020, participants retrospectively reported on their cyberchondria behavior, general anxiety, and COVID-19 fears during the month of April 2020, while adhering to stay-at-home advisories. Two separate actor-partner interdependence models (APIMs) used cyberchondria excessiveness and compulsion to predict generalized anxiety and COVID-19 danger/contamination fears in the actor and partner.

Both cyberchondria excessiveness and compulsion were associated with higher general anxiety and higher COVID-19 danger/contamination fears in the individual (actor effects). Partner cyberchondria compulsion was associated with higher general anxiety in the individual whereas partner cyberchondria excessiveness was associated with higher COVID-19 danger/contamination fears in the individual (partner effects).

Findings suggest that excessive and uncontrollable searching of information about COVID-19 on the internet during lockdown may contribute to distress in both the individual engaging in the cyberchondria behavior, and in their romantic partner. Moreover, different aspects of cyberchondria in the partner (compulsion vs. excessiveness) appears to contribute to general vs. COVID-19-specific anxiety/fears in the partner, respectively. Future research should examine mechanisms underlying the observed partner effects (e.g., co-rumination, social contagion) and reasons for the differential partner effects of cyberchondria components.

Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. Case series report that clozapine-treated patients with COVID-19 have no documented neutropenia.

We sought to investigate the potential adverse effect of coronavirus disease (COVID-19) in patients taking clozapine.

We retrospectively inspected data of 13 consecutive patients on clozapine, admitted to Highgate Mental Health Centre -Camden & Islington NHS Foundation Trust between March and June 2020. Selection was based on their COVID-19 symptoms presentation and/or COVID-19 positive test. We used a linear regression model with COVID status as independent variable and absolute neutrophil count (ANC) as dependent variable to inform about a correlation between COVID-19 status and neutrophil count. STATA was used for statistics.

We collected data on thirteen patients of which nine were male. The median age was of 41.97 years; six subjects were Black, three were Asian and four were White Caucasian. Ten subjects tested positive to COVID-19 and 3 were suspected cases -these latter were excluded from stastical analysis. During COVID-19 infection, neutrophils count (ANC) dropped significantly to 4.215 from a baseline value of 5.337. The beta values of 0.83 shows that ANC declined significantly during COVID-19 infection (p =<.0001, R2 = 95%). In three of thirteen patients, ANC drop was significant and changed the patients’ monitoring status from green to amber and required frequent blood tests.

Clinicians should bear in mind that a significant drop in neutrophils count may occur in COVID-19 -infected patients taking clozapine.

No significant relationships.