Changes in Adherence to Oral Medications of People With Mental Illness During the Pandemic: Neuroticism and Conscientiousness Personality Traits Moderate the Effect of Medication Beliefs (preprint)

Objectives. After the declaration of pandemic status in several countries, the continuity of face-to-face visits in psychiatric facilities has been delayed, or even interrupted to reduce viral spread. Little is known about the personality factors associated with medication beliefs and adherence amongst individuals with mental illness during COVID-19 pandemic. This longitudinal study explored whether the big-five personality traits prospectively moderate the effects of medication beliefs on changes in adherence during the pandemic for a group of outpatients with psychosis or bipolar disorder. Results. Thirteen outpatients undergoing face-to-face follow-up assessments during the pandemic were included (41 observations overall). Participants had stronger concerns about their psychiatric medications rather than beliefs about their necessity, and adherence to medications was generally low. Participants with higher necessity beliefs had a better adherence to medications than those who perceived less their benefits. People with higher conscientiousness and neuroticism traits and more concerned about the medication side effects had a poorer adherence.These preliminary data suggest the importance of a careful assessment of the adherence to medications amongst people with psychosis/bipolar disorder during the pandemic. Interventions aimed to improve adherence might focus on patients’ medication beliefs and their conscientiousness and neuroticism personality traits.

Vulnerabilities of High-Security Forensic Psychiatry Residences in Italy during the COVID-19 pandemic: a qualitative survey and a proposal for recovery and prevention (preprint)

Italy is the first European country severely hit by the COVID-19 pandemic after the outbreak in Wuhan. In our healthcare context, the closing of forensic psychiatric hospitals in 2014 completed the long transition from a containment approach for offenders with severe mental disorders to a model oriented to recovery and community reintegration. High-Security Forensic Psychiatry Residences (REMS) were implemented by regional health authorities. Within these settings, inpatients with severe psychiatric disorders who committed a criminal offense, without criminal responsibility but still considered socially dangerous, are held, and treated. The current COVID-19 emergency represents a severe stressful event which has a potentially negative impact on the recovery process of the inpatients and on the work-related health of the psychiatric professionals. The present paper consists of two sections. In the first one, we discuss the organizational and clinical issues emerged in the forensic psychiatry system in Italy. We identify vulnerable groups and processes and suggest long-term prevention strategies at both clinical and organizational levels. Within the second section, we present the findings of a qualitative exploratory survey conducted in four different REMS immediately after the stop of the lockdown. Based on a qualitative approach, this survey explored the COVID-19 effects on mental health of REMS inpatients and healthcare workers. Thematic analysis showed five key themes: “Intervention and prevention strategies during the lockdown decision making”; “Inpatients’ reactions to the pandemic”; “Psychological reactions of the healthcare staff”; “Recovery process and relations with community mental health services”; “Lessons for the future learned from the COVID-19”.

The impact of the COVID-19 pandemic on patients with OCD: Effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study.

The containment measures implemented to reduce the progression of the COVID-19 pandemic can increase the risk of serious mental disorders, including obsessive-compulsive disorder (OCD). The general fear of getting infected and the importance given to personal hygiene, may have a negative impact on this clinical population. In a group of patients with OCD who had completed an evidence-based therapeutic path for OCD before the quarantine, this study evaluated the changes on OCD symptoms during the quarantine and investigated the effects of contamination symptoms and remission state before the quarantine on OCD symptom worsening during the quarantine. The Yale-Brown Obsessive Compulsive (Y-BOCS) Severity score, administered before the quarantine, was re-administered after six weeks since the beginning of the complete lockdown. A significant increase in obsession and compulsion severity emerged. Remission status on OCD symptoms and having contamination symptoms before the quarantine were significantly associated with more elevated OCD symptom worsening during the quarantine. To our knowledge, this is the first study which assessed OCD symptoms at the COVID-19 time. Our results support the need to improve relapse prevention during the period of social restrictions and develop alternative strategies such as online consultations and digital psychiatric management.