Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health.

BACKGROUND: The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. METHODS: Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. RESULTS: When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. CONCLUSIONS: Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. TRIAL REGISTRATION: Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.

Toxicity of psychotropic drugs in patients with COVID-19: A systematic review.

OBJECTIVE: Due to the global spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), guidance for the use of psychotropic drugs in this context is necessary. We aimed to review clinical evidence regarding the potential toxicity of psychiatric medications in the context of SARS-CoV-2 infection. METHODS: A systematic search for all types of empirical studies and reviews in a broad set of electronic databases and trial registries was conducted up to the 15th of August 2020. RESULTS: We identified 3 case series and 4 single-case reports on the occurrence of toxicity induced by various psychotropic drugs (lithium, n = 2; clozapine, n = 5; risperidone n = 2; haloperidol n = 1; duloxetine, n = 1). In addition, we provide a new case report on the possible precipitation of valproic acid-induced hyperammonemic encephalopathy. In most cases, SARS-CoV-2 infection may have precipitated drug toxicity/side effects. The management of toxicity did not diverge from the usually applied principles in the absence of infection. CONCLUSIONS: Due to the limited available evidence and the recent genomic diversity and evolution of the SARS-CoV-2, it is currently not possible to derive evidence-based recommendations for the use of psychotropic drugs in the context of SARS-CoV-2 infection. Nevertheless, we provide some guidance based on the reviewed literature. At the current state of knowledge, there is no contraindication for any psychotropic drug. Caution is warranted regarding the dosing and, in particular, the monitoring of clozapine, lithium and valproate.

Impact of the COVID-19 Pandemic on Psychiatric Admissions to a Large Swiss Emergency Department: An Observational Study.

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency with profound mental health consequences. The psychiatric emergency department (ED) plays a key role during this mental health crisis. This study aimed to investigate differences in admissions at a Swiss psychiatric ED from 1 April to 15 May during a "pandemic-free" period in 2016 and a "during-pandemic" period in 2020. The study included 579 consultations at psychiatric ED in the "during-pandemic" period and 702 in the "pandemic-free" period. Sociodemographic and clinical characteristics were compared, and logistic regression analysis was performed to identify variables associated with psychiatric admissions during the pandemic. A reduction in total psychiatric ED admissions was documented during COVID-19. Logistic regression analysis predicted the independent variable (ED admission during the pandemic) and estimated odds ratio (OR) for being unmarried/not in a relationship, arrival in an ambulance, suicidal behavior, behavioral disorders and psychomotor agitation. Though only statistically significant in bivariate analysis, patients were also more likely to be involuntarily hospitalized. This picture appears to be reversed from a sociodemographic and clinical point of view to our observation of psychiatric ED consultation in 2016. These findings highlight that the reduction in psychiatric ED admissions during the pandemic seems to be associated with living alone and more severe psychopathologies, which must alert psychiatrists to ensure access to mental health care in times of pandemic.

COVID-19 and psychiatry : urgent opening of a cohort ward at Geneva's psychiatric hospital Covid-19 et psychiatrie : ouverture en urgence dune unite de cohortage a la Clinique psychiatrique de Geneve

Due to the rapid spread of the novel coronavirus pandemic, a reorganization of the health care sector was needed. Many questions arose concerning the specificity of psychiatric care in this unprecedented situation. In Geneva, Switzerland, the department of psychiatry decided to open a new ward for its infected patients. Beyond the challenge of setting it up quickly, we faced the challenges of taking care of a heterogeneous group of patients and of incorporating protection measures we were not accustomed to, which add a significant amount of time to the daily care of patients. The staff recruitment on a voluntary basis, close supervision, availability of the personal protective material as well as support from the infection prevention and control unit have enabled proper functioning of the ward. Devant la vitesse de propagation de la pandemie due au nouveau coronavirus, une reorganisation des systemes de sante a ete necessaire. De nombreuses questions se sont posees quant a la specificite de la psychiatrie dans cette situation exceptionnelle. A Geneve, le departement de psychiatrie a pris la decision douvrir une nouvelle unite de cohortage pour ses patients contamines. Outre le defi du delai court pour la mettre en place, nous avons ete confrontes a celui de prendre en charge une patientele heterogene et de devoir appliquer des mesures de protections avec lesquelles nous etions peu familiers, chronophages. Le recrutement de lequipe sur une base volontaire, un encadrement tres present, la disponibilite du materiel de protection et le soutien du service prevention et controle de linfection ont permis un bon fonctionnement de lunite.