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.

Designing Accountable Health Care Algorithms: Lessons from Covid-19 Contact Tracing

AI THEME ISSUE: How can health care organizations ensure that there is accountability of algorithms for accuracy, bias, and the wide range of unintended consequences when deployed in real-world settings? A machine-learning system for Covid-19 contact tracing serves as a model to scope out, develop, interrogate, and assess an algorithmic solution that produces improvements in care, mitigates risk, and enables evaluation by many stakeholders.

Impact of COVID-19 on the Delivery of Telepsychiatry in Italian Mental Health Services

Background: The COVID-19 pandemic prompted a rapid re-organization of mental health services, favouring a widespread diffusion of remote consultations and a reduction of face-to-face interventions. Aims of the Study: We employed a registry-based approach to (i) compare the overall functioning of outpatient services in Lombardy in 2019 and 2020, and (ii) report the distribution of telepsychiatry interventions in these settings. Methods: We summarized descriptive information on demographic and clinical data retrieved from all regional community-based mental health centres in 2019 and 2020, grouped according to regional provinces. We then described the progression of remote vs. in-person consultations (first psychiatric visits, psychiatric control visits, team meetings, group and individual psychotherapy, family interviews, social and nursing support, psychoeducation, daily and social skills training and job placement) during the course of 2020. Results: In the first semester of 2020, the number of outpatient service contacts was consistently lower than the previous year (-10,59%), with the largest drop recorded in March and May (-21,89% and -16,86% respectively). This trend normalized during the second semester (-0,60% in 2020). Only a minority of total consultations were recorded as remote delivery (11,70% overall), with the highest percentage at the end of the year (24,10% in November). The majority of remote consultations involved patients diagnosed with psychotic, mood, personality and anxiety disorders (22,87%, 22,27%, 17,69 and 11,37% respectively). Remote consultation types were distributed as follows: 24,04% were psychiatric control visits, 19,24% individual or group psychotherapy, 14,10% nursing support, 11,57% team meetings, 9,73% interview with families, 7,86% psychoeducation activities, 7,03% daily and social skills training activities, 3,43% social support activities,0,45% job placement activities and 0,06% first psychiatric visits. Discussion: Before the current Covid-19 crisis, telepsychiatry was largely unexploited in Italy. Our data reveal the extent and characteristics of its implementation in the mental health services of the country's most populous region. Implications for Health Policies: A clarification of the magnitude of current telepsychiatry implementation will aid policymakers who face the task of shaping future mental health services.

Bowel Perforation in Covid-19 Case Series

OBJECTIVE: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019(COVID-19) who developed bowel perforation. MATERIALS AND METHODS: This case series was conducted in Emergency Department of AORN Sant'Anna and S. Sebastiano located in Caserta. All patients resulted positive to SARS-Cov-2 in nasopharyngeal swabs whith a positive laboratory test for SARS-CoV-2 from real time reverse transcription polymerase chain reaction(RT-PCR) as well as bowel perforation which was identified by abdominal CT, from September 2020 to December 2020. RESULTS: A total of five patients were identified with Bowel perforation occurred despite all patients being on anticoagulation. All patients were Italian, predominantly male(four patients) with an average age of 60 years and the most common comorbidity was hypertension, diabetes and obesity. DISCUSSION: Bowel perforation in COVID-19 is clinically significant with high morbidity and mortality. In our series 40% of patients who were diagnosed of bowel perforation died. Average time to death after bowel perforation diagnosis was 6 days. CONCLUSION: We describe a case series of COVID-19 patients who developed bowel perforation. KEY WORDS: Covid-19, Bowel perforation.

«FIELD» REFLECTIONS AT THE TIME OF COVID-19 EMERGENCY

This work recounts our Zoom meetings held during the months of Covid-19 lockdown and born in order to promote «camp» reflections on the state of emergency we were experiencing. The paragraphs describe the various themes emerging from the meetings: 1) the traumatic specificity of the Covid-19 emergency;2) remote working;3) symmetry, asymmetry, and reality;4) borders, boundaries, and new scenarios;5) the psychoanalytic institution, the emergency, and the aftermath;6) final reflections on group writing. © 2020, Raffaello Cortina Editore. All rights reserved.

Telework during COVID-19 outbreak: Impact on mental health among Italian workers

IntroductionSince February 2020, the outbreak of COVID-19 has spread to several countries worldwide, including Italy, leading to an uptake of telework.ObjectivesWe aim to evaluate the psychopathological impact of teleworking during the COVID-19 pandemic in Italy, identifying mental health determinants among home-based workers.Methods804 participants completed an online survey, including the psychometric scales “Depression, Anxiety and Stress Scale – 21 items” (DASS-21) and the “Insomnia Severity Index” (ISI). Teleworkers were also asked to provide information about their current work routine, home environment and clinical history.ResultsAt the DASS-21, 30% of the participants presented pathological levels of depression, 20.8% of anxiety and 30.7% of stress. At the ISI, 5% appeared to suffer from insomnia. Respondents with psychological and physical frailties, greater social isolation or inadequate working spaces manifested higher levels of psychiatric symptoms. Moreover, we also find a correlation of these symptoms with occupations in education. Telework was broadly appreciated and 87% of respondents expressed a willingness to maintain access to this arrangement.ConclusionsOur results document that about a third of our sample manifested psychopathological symptoms while teleworking during the COVID-19 outbreak in Italy. However, telework itself does not seem to be directly associated with increased psychiatric symptoms, which were instead exacerbated by COVID-19-related stressful circumstances, as well as by constitutional and social determinants of health. Going forward, authorities should promote adequate measures in order to guarantee a healthy approach to teleworking.DisclosureNo significant relationships.

Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy.

The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first  hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.