In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.

The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.

Functional magnetic resonance imaging (fMRI) research has generally focused on drawing conclusions from average brain activation patterns. Importantly, the brain is inherently variable; growing literature has found that within-individual blood oxygen level-dependent (BOLD) signal variability may be meaningful, and not just “noise.” For example, recent research has identified increased BOLD signal variability in healthy younger and older adults during more effortful/complex task loads of n-back paradigms, commonly used tasks that involve important elements of executive function (e.g., attention, working memory, planning, inhibition, etc.). Verbal fluency is a complex cognitive domain that also involves similar processes to generate words given certain rules. As a result, the current study builds on existing literature to investigate within-individual BOLD signal variability patterns in peak coordinates of a verbal fluency network during different loads of a letter n-back task. Due to greater executive demands, greater variability was expected during more effortful/complex n-back task loads in regions of a verbal fluency network.

Forty-eight healthy young adults (Mage(SD) = 22.41(4.47), 25 females) from the Atlanta area completed a letter n-back task in an MRI scanner. After standard processing in AFNI, images were corrected for motion and physiological artifacts, which may be confounding sources of variability. Volumes associated with each load of the letter n-back task (0-back, 1-back, 2-back, 3-back, crosshair) were identified. Task runs were normalized and respective run means were subtracted prior to concatenating all runs for each load type. Standard deviations were calculated across this mean-run corrected time series. Ten peak regions of interest (ROIs) were identified from a verbal fluency network generated from 84 peer-reviewed publications for this domain gathered on NeuroSynth. Paired samples t-tests with Benjamini-Hochberg correction for multiple comparisons were conducted to explore differences in variability during n-back task loads.

In several of the verbal fluency network ROIs, within-individual BOLD signal variability was significantly greater for 2-back versus 0-back loads with medium to large effect sizes (p’s < .001 - < .01, Cohen’s d range: .53-.93). Variability was also significantly greater for 3-back versus 0-back loads with small to medium effect sizes (p’s < .001 - < .01, Cohen’s d range: .48-.74). Specific regions that evidenced this pattern included ROIs in the left inferior frontal gyrus, left cingulate, right inferior frontal gyrus, left middle frontal gyrus, and left superior parietal lobule. Only two regions demonstrated increased variability in the 1-back load versus crosshair (left middle frontal gyrus, p < .001, d = .63; left lentiform nucleus, p < .05, d = .42). No regions demonstrated a significant difference in variability in the 0-back load versus crosshair.

This study contributes to growing literature examining within-individual BOLD signal variability in healthy individuals by exploring variability patterns in a verbal fluency network. The observed pattern of results supports the hypothesis and is in line with previous research, demonstrating that greater variability occurs with greater executive task demands. Future research can use an inscanner task of verbal fluency and can extend variability findings during this in-scanner task to out-of-scanner measures of verbal fluency.

Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions.

To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness.

Data were collected from individuals aged 18–26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown.

Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78–36.57) and 15.6% (95% CI 15.39–15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease.

Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.

External natural events, such as the COVID-19 pandemic, can contribute to increased stress, depression and anxiety in pregnant persons. Thus far, studies on the impact of maternal mental health during the pandemic on perinatal outcomes have been conflicting.

Assess the impact of prenatal mental health during the COVID-19 pandemic on preterm birth (PTB) and low birthweight (LBW).

Pregnant individuals, >18 years were recruited in Canada, their data were collected through a web-based questionnaire. Our analysis includes data on individuals recruited between 06/2020 and 08/2021, who completed questionnaires at baseline and 2-month post-partum. Data on maternal sociodemographic, comorbidities, medication, mental health measures (Edinburgh Perinatal Depression Scale, General Anxiety Disorder-7, stress), hardship (CONCEPTION study Assessment of Stress from COVID-19 –150 points), gestational age at delivery and birth weight were self-reported. PTB defined as delivery before 37 weeks of gestation. LBW defined as birth weight less than 2,500 grams.

A total of 1,265 and 1,233 participants were included in the analyses of PTB and LBW, respectively. After adjusting for potential confounders, we found no differences between prenatal mental health and PTB ([depression [adjusted RR [aRR] 1.01, CI 95% 0.91 to 1.11], anxiety [aRR 1.04, CI 95% 0.93 to 1.17], stress [aRR 0.88, CI 95% 0.71 to 1.10], hardship [aRR 1.00, CI 95% 0.96 to 1.04]). However, we found that the risk of PTB was increased with ethnicity/race (aRR 3.85, CI 95% 1.35 to 11.00), obstetrician/gynecologist follow-up (aRR 2.77, CI 95% 1.12 to 6.83). We didn’t find any significant association between prenatal mental health and LBW. However, annual household income, previous delivery were associated with a decreased risk of LBW (aRR 0.15, CI 95% 0.05 to 0.49; aRR 0.39, CI 95% 0.20 to 0.77, respectively).

Conclusion: No association was found between prenatal mental health during the COVID-19 pandemic and the risk of PTB or LBW. However, it is imperative to continue the follow-up of mothers and their offspring in order to detect early any long-term health problems.

None Declared

Psychiatry training programs vary in the degree to which they offer trainees with an opportunity to get involved in research. Exposure to research during the training period is critical, as this is usually when trainees start their own scientific research projects and gain their first experiences in academic publishing.

We present the European Journal of Psychiatric Trainees (EJPT) (ejpt.scholasticahq.com), the official journal of the European Federation of Psychiatric Trainees (EFPT), including its scope, mission and vision and practical considerations.

Reflecting on the foundation and operation of the European Journal of Psychiatric Trainees.

The European Journal of Psychiatric Trainees is an Open Access, double blind peer-reviewed journal which aims to publish original and innovative research as well as clinical, theory, perspective and policy articles, and reviews in the field of psychiatric training, psychiatry and mental health. Its mission is to encourage research on psychiatric training and inspire scientific engagement by psychiatric trainees. Work conducted by psychiatric trainees and studies of training in psychiatry are prioritized. The journal is open to submissions, and while articles from psychiatric trainees are prioritized, submissions within scope from others are also encouraged. The article processing fee is very low and waivable. It is planned to publish two issues yearly.

The first article was published in July 2022, titled “Fluoxetine misuse by snorting in a teenager: a case report” and it received 218 views as of 17 October 2022, which confirms the journal’s potential for visibility.

The European Journal of Psychiatric Trainees is a non-profit initiative designed to offer psychiatric trainees a platform to publish and gain experience in publishing. Thanks to its robust double blind peer reviewing system, it has the potential to contribute to scientific excellence.

None Declared

Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions.

Data came from n = 999 patients ages 18–75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models.

Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31–1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65–2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43–2.87) and bullying (RR = 1.44; 95% CI = 0.99–2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE.

Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.

The serotonin (5-HT) hypothesis of anorexia nervosa (AN) posits that individuals predisposed toward or recovered from AN (recAN) have a central nervous hyperserotonergic state and therefore restrict food intake as a means to reduce 5-HT availability (via diminished tryptophan-derived precursor supply) and alleviate associated negative mood states. Importantly, the 5-HT system has also been generally implicated in reward processing, which has also been shown to be altered in AN.

In this double-blind crossover study, 22 individuals recAN and 25 healthy control participants (HC) underwent functional magnetic resonance imaging (fMRI) while performing an established instrumental reward learning paradigm during acute tryptophan depletion (ATD; a dietary intervention that lowers central nervous 5-HT availability) as well as a sham depletion.

On a behavioral level, the main effects of reward and ATD were evident, but no group differences were found. fMRI analyses revealed a group × ATD × reward level interaction in the ventral anterior insula during reward anticipation as well as in the medial orbitofrontal cortex during reward consumption.

The precise pattern of results is suggestive of a ‘normalization’ of reward-related neural responses during ATD in recAN compared to HC. Our results lend further evidence to the 5-HT hypothesis of AN. Decreasing central nervous 5-HT synthesis and availability during ATD and possibly also by dieting may be a means to normalize 5-HT availability and associated brain processes.

Mobile technology offers unique opportunities for monitoring short-term suicide risk in daily life. In this study of suicidal adolescent inpatients, theoretically informed risk factors were assessed daily following discharge to predict near-term suicidal ideation and inform decision algorithms for identifying elevations in daily level risk, with implications for real-time suicide-focused interventions.

Adolescents (N = 78; 67.9% female) completed brief surveys texted daily for 4 weeks after discharge (n = 1621 observations). Using multi-level classification and regression trees (CARTSs) with repeated 5-fold cross-validation, we tested (a) a simple prediction model incorporating previous-day scores for each of 10 risk factors, and (b) a more complex model incorporating, for each of these factors, a time-varying person-specific mean over prior days together with deviation from that mean. Models also incorporated missingness and contextual (study week, day of the week) indicators. The outcome was the presence/absence of next-day suicidal ideation.

The best-performing model (cross-validated AUC = 0.86) was a complex model that included ideation duration, hopelessness, burdensomeness, and self-efficacy to refrain from suicidal action. An equivalent model that excluded ideation duration had acceptable overall performance (cross-validated AUC = 0.78). Models incorporating only previous-day scores, with and without ideation duration (cross-validated AUC of 0.82 and 0.75, respectively), showed relatively weaker performance.

Results suggest that specific combinations of dynamic risk factors assessed in adolescents' daily life have promising utility in predicting next-day suicidal thoughts. Findings represent an important step in the development of decision tools identifying short-term risk as well as guiding timely interventions sensitive to proximal elevations in suicide risk in daily life.