In the United States, African Americans (AAs) have been disproportionately affected by COVID-19 mortality. However, AAs are more likely to be hesitant in receiving COVID-19 vaccinations when compared to non-Hispanic Whites. We examined factors associated with vaccine hesitancy among a predominant AA community sample. We performed a cross-sectional analysis on data collected from a convenience sample of 257 community-dwelling participants in the Central Savannah River Area from 5 December 2020, through 17 April 2021. Vaccine hesitancy was categorized as resistant, hesitant, and acceptant. We estimated relative odds of vaccine resistance and vaccine hesitancy using polytomous logistic regression models. Nearly one-third of the participants were either hesitant (n = 40, 15.6%) or resistant (n = 42, 16.3%) to receiving a COVID-19 vaccination. Vaccine-resistant participants were more likely to be younger and were more likely to have experienced housing insecurity due to COVID-19 when compared to both acceptant and hesitant participants, respectively. Age accounted for nearly 25% of the variation in vaccine resistance, with 21-fold increased odds (OR: 21.93, 95% CI: 8.97–5.26–91.43) of vaccine resistance in participants aged 18 to 29 compared to 50 and older adults. Housing insecurity accounted for 8% of the variation in vaccine resistance and was associated with 7-fold increased odds of vaccine resistance (AOR: 7.35, 95% CI: 1.99–27.10). In this sample, AAs under the age of 30 and those experiencing housing insecurity because of the COVID-19 pandemic were more likely to be resistant to receiving a free COVID-19 vaccination.

Bipolar I disorder is characterized by the presence of at least one manic episode (DSM-5). Despite a decent percentage of individuals being diagnosed later in life, there currently exist no formal treatment guidelines for late-onset bipolar disorder (LOBD), which remains poorly understood. Typically, manic or manic-like episodes in elderly individuals can be thought of as arising from a secondary, physical cause. However, in the absence of a pre-existing neurological disorder - and when laboratory, imaging, and exam findings do not fully support a neurological picture - the determination of a structural versus primary etiology for LOBD becomes challenging. We present the case of Ms. S, a 79-year-old woman with a past psychiatry history of bipolar disorder diagnosed after 2012 and non-contributory past medical history who was admitted to a state mental hospital on a probate court order from local jail secondary to labile mood and physical aggression toward an officer. Initial labs were remarkable for slightly elevated low-density lipoprotein and a B12 at the lower limit of normal. She was started on a regiment oral B12 supplement, valproic acid 500 mg twice daily, haloperidol 5 mg nightly, and diphenhydramine 25 mg nightly. Despite her medication regimen, she continued to display marked mood lability, tangential thought processes, grandiose delusions, and paranoia. A CT head one week into admission revealed bilateral periventricular white-matter hyperintensities with decreased attenuation and chronic white-matter infarcts. She underwent five sessions of electroconvulsive therapy (ECT), with significantly improving Montreal Cognitive Assessment and Young Mania Rating Scale scores. At the time of discharge on day 32, the patient was fully oriented to self and surroundings with good hygiene, a normal rate of speech, euthymic mood, and congruent affect. The case of Ms. S underscores the importance of a thorough workup to rule out secondary causes of mania. In addition, it is a clarion call for revisiting and researching a comprehensive management approach to LOBD, for which serial cognitive assessments and ECTs may play an important role.