What can we say about the impact of teleconsultations on preventing psychiatric inpatient treatment during COVID-19 pandemic?

Introduction: Telepsychiatry was proved effective and satisfactory in settings like the emergency department and mental health services, but its use is historically restricted. Although there are several studies about telepsychiatry pros and cons, more is needed to know about its effect on patient's follow-up and its influence on inpatient treatment rates, specifically during COVID-19 pandemic. Objective(s): The aim is to look for an eventual change on psychiatric inpatient admissions, during COVID-19 pandemic, when psychiatric patients are in follow-up through teleconsultation. Method(s): We compared the number of hospitalizations for 3 different 6 months periods of time: the 2nd semester of 2019 with no teleconsultations, March-August 2020 only with teleconsultations (except some few 1st consultations) and the 1st semester of 2021 with face-to-face and teleconsultations. A one-way repeated measures ANOVA was conducted on a 1050 patients sample. Result(s): The statists showed that the type of approach in consultations didn't lead to statistically significant differences in hospitalizations (F test-statistic = 0.33086, p = 0.718345). Conclusion(s): There is a plethora of advantages about telepsychiatry and it was already shown to be as effective as in-person contact. Some articles show an association of telepsychiatry with a decrease in hospitalization rates, but mostly display similar clinical outcomes. In this study, the authors found that the results follow the latter tendency, although we must consider the COVID-19 pandemic as a possible decompensation and worsening clinical factor. More studies on this matter are important to better understand the potential benefits (and risks) of this treatment setting.

Influenza and schizophrenia: Howcan we shed a light in the new virus from an old association?

Introduction: COVID-19 raises serious concerns regarding its unknown consequences for health, including psychiatric long term outcomes. Historically, influenza virus has been responsible for pandemics associated with schizophrenia. Epidemiological studies showed increased risk for schizophrenia in children of mothers exposed to the 1957 influenza A2 pandemic. Controversy remains concerning the mechanisms of pathogenesis underlying this risk. Objective(s): We aim to review the evidence for the association between influenza infection and schizophrenia risk, the possible pathogenic mechanisms underlying and correlate these findings with the schizophrenia hypothesis of neurodevelopment. Method(s): We reviewed literature regarding evidence from epidemiological, translational animal models and serological studies using medline database. Result(s): The biological mechanisms likely to be relevant account to the effects of infection-induced maternal immune activation, microglial activation, infection-induced neuronal autoimmunity, molecular mimicry of the influenza virus, neuronal surface autoantibodies and psychosis with potential infectious antecedents. Influenza infection may fit into the theory of the neurodevelopment of schizophrenia as a factor that alters the normal maturation processes of the brain (possible second or third hit). Conclusion(s): Influenza infection has multiple pathogenic pathways in both pre and post natal processes that might increase the risk of schizophrenia or psychosis. The existing evidence regarding the relationship between influenza virus and psychosis might help us draw similar long-term concerns of COVID-19.

Judicialization of administrative measures to tackle the Covid-19 pandemic in Brazil

This article studied the judicialization lawsuits related to the pandemic of the new coronavirus, within the scope of Administrative Law. The cases that reached the Brazilian Federal Supreme Court (FSC), available at the "Painel de Acoes COVID-19", were analyzed, as well as a sample of the cases that reached the state courts, obtained through journalistic reports, consolidated on the "Consultor Juridico" website. Descriptive analysis and content analysis techniques were used, in the thematic mode, for both sources of information. The following variables were analyzed: procedural classes groups, procedural classes, main subject, notification date, time until the first decision, decisions, decisions groups, and total of cases archived remotely. Near 34% of the actions referred to the flexibilization or tightening of free movement, restrictive measures on and the opening of commerce and services, and another 34% referred to budgeting issues, mainly dealing with the suspension of state debts and untying resources to combat the pandemic. The median time until the first decision made by the FSC was less than five days for all categories. The judicialization of COVID-19 pointed out already known flaws in public health and social policies in Brazil, and it can encourage a lot of actions, both by the Legislative and the Executive, to mitigate these problems. This article demonstrates the importance of observing the responses brought by the judicialization, and of the dialogue between the three powers, to deal with the demands of the pandemic better and with several other demands of society.