A Virtual Inpatient Psychiatry Unit in a Multicampus Health Care System During the COVID-19 Pandemic.

A virtual, telehealth-based inpatient psychiatric unit was implemented in a multicampus health care system to care for patients involuntarily admitted under emergency hold laws who tested positive for COVID-19. Through a multidisciplinary approach, these patients received proper general medical and psychiatric treatments. This column describes the development and operationalization of the unit in terms of team structure, patient referral and admission, patient and staff safety, general medical and psychiatric treatments, and discharge planning. The results of this virtual approach to caring for patients with both COVID-19 and acute mental illness illustrate the potential of a multidimensional approach for improving care efficiency during public health emergencies.

Loneliness, social connectedness, and resilience during COVID pandemic among those with and without cognitive impairment

Background Loneliness in older adults is multifactorial. Social connectedness and resilience are protective against loneliness and have been adversely affected by the COVID pandemic. The objective was to measure loneliness in older adults with and without cognitive impairment and to compare the interaction of loneliness with resilience and social connectedness in these subgroups. Methods A cross-sectional study was conducted in community dwelling older adults (N=254) (November 2020-ongoing). Demographic data were collected along with variables related to social determinants of health. Loneliness was assessed with the 3-item loneliness questionnaire, resilience with the Brief Resilience Coping Scale (BRCS) and social connectedness using the 6-item Lubben social network scale. Results Mean age was 74.6 (±8.0) years, 93.7% male, 50.8% rural, 79.5% Caucasian, and 17.3% African American. Mean education was 14 years (±2.4). The majority of the participants reported loneliness (57.5%). Mean Lubben social network score was 14.7 (±7.1) and mean resilience score was 15.0 (±4.1). Loneliness was higher in those living alone compared to those living with someone (5.6 vs. 4.6, p<0.001, 95% CI: -1.6, -0.48). There were strong negative correlations between social connectedness and loneliness (p<0.001, r=-0.43) and resilience and loneliness (p=0.001, r=-0.19). Compared to those without cognitive impairment (N=151), participants with cognitive impairment (N=101) had a significantly lower mean social network score (p=0.007, 95% CI: 0.69, 4.23). Compared to those without cognitive impairment, participants with cognitive impairment had lower mean resilience score, however the difference was not statistically significant (p=0.080, 95% CI: -0.11, 1.97). T-MoCA and FAQ mean scores for the cognitively impaired older adults were 15.2 (±4.6) and 8.0 (±9.3), respectively. The strong negative correlation between resilience and loneliness scores persisted in the subgroup with cognitive impairment (p=0.028, r=-0.22). Conclusions Loneliness was commonly reported among older adults during the COVID pandemic. Loneliness was negatively correlated with social connectedness and resilience. Compared to cognitively intact counterparts, those with cognitive impairment reported significantly lower social connectedness. This finding indicates that those with cognitive impairment may need more attention during natural disasters that foster physical separation.

Loneliness and Neuropsychiatric Symptoms in Cognitively Impaired Older Adults during COVID-19 Pandemic

Background Cognitively impaired older adults living in the community have been vulnerable to the effects of COVID-19 confinement. The current study’s objectives were to examine the prevalence of loneliness in such adults along with impact of COVID-19 on neuropsychiatric symptoms and functional status. Methods A cross-sectional study was conducted in community dwelling cognitively impaired older Veterans (N=41). Demographic data such as age, gender, race, and rurality were collected. Loneliness data were collected with the 3-item Loneliness Questionnaire. Cognition was assessed with the Tele-Montreal Cognitive Assessment (T-MoCA) and functional status of instrumental activities of daily living was assessed with the Functional Activities Questionnaire (FAQ). Neuropsychiatry symptoms including severity and distress were collected using the Neuropsychiatric Inventory (NPI), and change during COVID was also recorded for each symptom. Results Demographic characteristics included: mean age of 71.9 (±8.6) years, 95.1% male, 46.3% rural, 75.6% Caucasian, and 19.5% African American. Loneliness was prevalent in most participants (62.5%). T-MoCA and FAQ mean scores were 15.1 (±4.5) and 10.0 (±8.6), respectively. Mean NPI total severity and total distress were 8.4 (±5.9) and 11.4 (±8.5), respectively. Irritability was most frequently reported symptom (65%), followed by agitation (57.5%), anxiety (55%), depression (50%), and night-time behavior (50%). A majority of the participants reported worsening of neuropsychiatric symptoms during COVID (71.1%). Among those that reported worsening neuropsychiatric symptoms, 70.4% noted an increase in ≥ two symptoms. Conclusion Older adults with pre-existent cognitive impairment may be at high risk for loneliness and worsening of neuropsychiatric symptoms during the COVID pandemic.

Surgical & medical management of ROCM (Rhino-orbito-cerebral mucormycosis) epidemic in COVID-19 era and its outcomes - a tertiary care center experience.

OBJECTIVE: To evaluate the outcome of patients with ROCM (Rhino-orbito-cerebral mucormycosis) following their medical and surgical management. MATERIALS AND METHODS: It is a prognostic study based in a tertiary care center in North-Western India. Patients who developed ROCM post COVID-19 infection from 1st September 2020 to 30th June 2021 were included in this study. Surgical debridement and administration of antifungal therapy was done for the post-COVID-19 ROCM patients. Disease progression and survival was studied up to 5 months of follow-up in the second wave. RESULTS: A total of 145 ROCM patients were included. The mean age at presentation, male: female ratio was 48.2 years and 2:1 respectively. As per our proposed new staging system and treatment strategy, the majority of patients belonged to stage II (31.72%) and stage III (31.03%). On a follow-up period of 5 months, 26 (18%) patients have lost their life and rest of the patients are on strict follow-up. CONCLUSION: ROCM is an extremely aggressive fungal infection which rapidly became an epidemic following the COVID-19 pandemic. The diverse and unique presentation led us to evolve a new strategy to classify and manage these patients.

Stress of Overseas Long-Distance Care During COVID-19: Potential "CALM"ing Strategies.

"CALM"ing strategies during COVID-19 pandemic. Created with BioRender.com.

A systematic review of loneliness and social isolation scales used in epidemics and pandemics.

The COVID-19 pandemic has heightened social isolation and loneliness. There is a lack of consensus on rating scales to measure these constructs. Our objectives were to identify commonly used loneliness and social isolation scales over the last two decades and test their user characteristics. 7928 articles were searched in PubMed/MEDLINE, CINAHL, Web of Science, and APA PsychINFO databases. 41 articles were included based on study criteria. Among fourteen scales reported, UCLA 3-item loneliness scale was found to be most commonly used. The scale is specifically developed for telephone use and is the fastest taking less than a minute for self-administration.