Brief tele-psychotherapy for COVID-19 patients and their family members

Since the COVID-19 pandemic onset, researchers and clinicians have attempted to characterize a heterogeneous cluster of psychopathological symptoms that typically emerge when patients are no longer positive to SARS-CoV-2 infection, and can persist for weeks if not months. These symptoms include depression, anxiety, acute/posttraumatic stress, and sleep disturbances, and are frequently observed in COVID-19 patients as well as in their first-degree relatives. COVIDrelated symptomatology seems to map onto well-established psychopathological macro-areas: 1) trauma and post-traumatic symptoms, mainly for those who have experienced hospitalization or loss;2) adaptation and functional reorientation due to physical complications or sequelae;3) identity reorientation following the experience of illness/isolation/lockdown;and 4) exacerbation of premorbid psychopathological traits solicited by the COVID-19 experience. Notably, the severity of COVID-19 related psychopathology ranges from mild to more disabling conditions and seems to affect youth, adults, and elders irrespectively of the severity of the acute COVID-19 illness. Nonetheless, it unequivocally affects wellbeing, quality of life, and real-world functioning. In response to the urgent need for treatments that could be offered safely, without burdening an already strained mental health system, an interdisciplinary group of psychotherapists and researchers based in Milan, Italy has undertaken the first national attempt to create a research-informed infrastructure to study the feasibility and efficacy of a remote tele-psychotherapy free service for COVID-19 patients and their first-degree relatives. The process initially leveraged clinical experiences with COVID-19 patients and family members remotely referred to the Ospedale Maggiore Policlinico in Milan for psychological assistance from various intensive care units and hospital wards. Next, the research group reviewed the scientific literature on psychotherapeutic approaches designed to remotely treat psychopathology. The harmonization of techniques and strategies deriving from several psychotherapeutic orientations (psychodynamic therapy, constructivist therapy and hermeneutic-phenomenological therapy) culminated in the development of the first brief psychotherapy service for COVID-19 related psychopathology. The service, designed to easily integrate with the workflow of the national health system, consists of 8 remote, 50-minute, individual psychological sessions that are offered weekly using secure video conferencing software. The feasibility and evidence base for this treatment have been investigated thanks to a research project funded by Fondazione Cariplo and Regione Lombardia that has recruited as of June 2022 more than 140 participants, between COVID-19 patients and firstdegree relatives. Results from this study will be presented during the symposium and indicate that remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and efficacious at significantly reducing anxiety, depression, post-traumatic symptoms, and sleep disturbances. Interestingly, statistical analyses suggest distinct profiles of treatment response among participants with severe COVID-19 related psychopathology, in that 25% showed full symptom remission, 48% showed partial symptom remission, and 28% showed no significant effect of treatment. 30 months after the pandemic onset, the same interdisciplinary group of psychotherapists and researchers summarizes reflections from the weekly experiences of group supervision/intervision, and offers a retrospective on the possibilities and limits of this brief tele-psychotherapy service, with an emphasis on the conceptual properties, roles, and symbolic connotations of the remote setting, and on the relationship between patients' illness severity and intrinsic motivation. Above and beyond COVID-19-related psychopathology, the novel quantitative and qualitative data presented at this symposium will provide insightful information about the implementation potent al of remote brief tele-psychotherapy - a promising treatment model that can change clinical practice, enhance cost-effectiveness, and lead to better wellbeing and quality of life for patients.

First episode psychosis during the Covid-19 pandemic in Milan, Italy: Diagnostic outcomes at 1-year follow-up.

An influence of the Covid-19 pandemic on First Episode Psychosis (FEP) has been hypothesized. We previously reported an increase of FEP during the early stages of the pandemic in Milan, Italy. Here we report a 1-year follow-up of the same cohort and comparison with a FEP cohort from 2019. The higher proportion of non-chronic psychoses observed during the pandemic (58.62% in 2020 vs 43,75% in 2019) should be confirmed in larger cohorts over a longer follow-up period.