The impact of COVID-19 on benzodiazepine usage in psychiatric inpatient units.

OBJECTIVE: This study aims to investigate whether COVID-19 has led to increased usage of benzodiazepines in acute psychiatric settings. METHOD: We evaluated the rates of benzodiazepine usage in two acute psychiatric inpatient units over a period of two years, 2019 and 2020 (the year of the pandemic). Rates of oral atorvastatin usage over the same period were used as a comparator. RESULTS: We saw a significant increase in the usage of benzodiazepines in the period between April and December 2020 compared to the same period in 2019 despite a decline in the total number of admissions in 2020. Usage peaked further at the time of eased pandemic restrictions which coincided with higher rates of emergency department mental health (MH) presentations and acute MH hospital admissions. We also noticed higher rates of substance use disorder recorded on admission. Hospital leave restrictions due to COVID-19 also led to further restrictions on smoking. CONCLUSION: Benzodiazepine usage increased in the context of the COVID-19 pandemic. The study encourages more research to better understand the impact of the pandemic on acute psychiatric settings.

The impact of the COVID-19 pandemic on hospital-treated self-harm in Sydney (Australia).

OBJECTIVES: This study investigated trends in hospital-treated self-harm and hospital presenting suicidal ideation in the period before and after COVID-19 public health responses by key socio-demographic groups among those presenting to hospitals in the Western Sydney (Australia) population catchment. METHODS: Emergency department presentations for the period January 2016 to June 2021 were used to specify a series of interrupted time-series models to compare the observed and expected event rates of (1) hospital-treated self-harm and (2) hospital presenting suicidal ideation in the period following the onset of COVID-19 public health measures in March 2020. Rate differences between observed and expected rates in the post-implementation period were also estimated in models stratified by sex, age group, country of birth and socio-economic status. RESULTS: There was no significant increase in hospital-treated self-harm in the period post-implementation of public health orders (March 2020) compared to the previous period, although there were lower than expected rates of emergency department presentations among non-Australian-born males, males aged 0-14 years and 25-44 years, and females aged 45-64 years. In contrast, there was a significant increase in hospital presenting suicidal ideation, particularly among women (rate difference per 100,000 = 3.91, 95% confidence interval = [1.35, 6.48]) and those aged 15-24 years (both males and females, rate differences ranging from 8.91 to 19.04), and among those residing in lower socio-economic status areas (both males and females, rate differences ranging from 0.90 to 2.33). CONCLUSION: There was no increase in hospital-treated self-harm rates in the 15 months post-implementation of COVID-19 public health orders in Western Sydney; however, there was a significant increase in hospital presenting suicidal ideation. The limited change in suicidal behaviour may reflect the success of social and economic supports during this period, the benefits of which may have been different for young people, and those of lower socio-economic status.

'Things are not what they seem to be': A proposal for the spectrum approach to conspiracy beliefs.

OBJECTIVE: Conspiracy beliefs (also known as conspiracy theories) become more prominent at times of heightened uncertainty and inconsistent or conflicting explanations provided by the authorities for events like terrorist attacks or pandemics, such as COVID-19. This article aims to examine the relevance of conspiracy beliefs for psychiatry in the context of the dynamics of trust and mistrust. CONCLUSIONS: Conspiracy beliefs may be situated on a spectrum of mistrust-related phenomena, which extends from healthy scepticism to persecutory delusions. They can be conceptualised as unfounded and fixed beliefs held with strong conviction about harm inflicted by powerful groups on the community or another group of people, usually with preserved insight that these beliefs differ from those that most people have and with reasons for having such beliefs not necessarily being implausible. It is important for conspiracy beliefs to be distinguished from persecutory delusions.