The Place of Care under Constraint for Mood Disorders in the Context of the Collapse of the Supply of Psychiatric Care during the COVID-19 Crisis.

BACKGROUND: In March 2020, the Belgian population was exposed to a confinement situation that it had never experienced before associated with the collapse in access to psychiatric care. Initially, only emergencies and constrained care continued to operate. In these specific circumstances, where both the overall population and the psychiatric population, was exposed to unique stress factors, what was the role of forced psychiatric internments in the treatment of mood disorders? SUBJECTS AND METHODS: We have measured the number of detentions for observation with and without suicide attempt over the two years prior to the pandemic in order to obtain theoretical reference values. We have compared these values with the measures over the 12 months following the start of the confinement period, which constitute the Crisis values. The continuation of measures, with an equal number of observation measures, constituted the Post-Crisis values. For these same cases, we compared in suicide attempt cases, whether the criteria for Severe Major Depressive Disorder were met or not. Lastly we compared the number of observation measures that were lifted, or not, within ten days of patient care. RESULTS: There was no significant increase in Detentions for Observation following a suicide attempt during the Crisis period. However a significant increase was observed during the Post-Crisis period. As regards cases of attempted suicide during the Crisis period, the number of patients suffering from Major Depressive Disorders reduced significantly in terms of statistics. This confirms our impression of a change in population. The Post-Crisis values dropped to the Theoric values. The number of Observation measures lifted increased quite significantly during the Crisis period, while there was a return to values in terms of statistics similar to the Theoric values during the Post-Crisis period. CONCLUSIONS: Although the population, both the healthy population and those suffering from a psychiatric condition, was subject to stress that it had never before experienced coinciding with a collapse of healthcare provision, there was no increase in patients meeting the criteria to benefit from constrained care during the Crisis period. On the other hand, there was a significant change in statistical terms in the population of patients who attempted suicide. We have seen a collapse in the number of patients suffering from depressive disorders and an equivalent increase in the number of patients with personality disorders or adjustment disorders. The number of Observation measures lifted during the Crisis period also grew quite significantly. Constrained care was available to help manage reactive suicide attempts. All other things being equal, they indirectly showed a reduction in Major Depressive Disorders requiring constrained care in the population.

Increased respiratory dead space could associate with coagulation activation and poor outcomes in COVID-19 ARDS.

PURPOSE: To determine whether VDPhys/VT is associated with coagulation activation and outcomes. MATERIALS AND METHODS: We enrolled patients with COVID-19 pneumonia who were supported by invasive mechanical ventilation and were monitored using volumetric capnography. Measurements were performed during the first 24 h of mechanical ventilation. The primary endpoint was the likelihood of being discharge alive on day 28. RESULTS: Sixty patients were enrolled, of which 25 (42%) had high VDPhys/VT (>57%). Patients with high vs. low VDPhys/VT had higher APACHE II (10[8-13] vs. 8[6-9] points, p = 0.002), lower static compliance of the respiratory system (35[24-46] mL/cmH2O vs. 42[37-45] mL/cmH2O, p = 0.005), and higher D-dimer levels (1246[1050-1594] ng FEU/mL vs. 792[538-1159] ng FEU/mL, p = 0.001), without differences in P/F ratio (157[112-226] vs. 168[136-226], p = 0.719). Additionally, D-dimer levels correlated with VDPhys/VT (r = 0.530, p < 0.001), but not with the P/F ratio (r = -0.103, p = 0.433). Patients with high VDPhys/VT were less likely to be discharged alive on day 28 (32% vs. 71%, aHR = 3.393[1.161-9.915], p = 0.026). CONCLUSIONS: In critically ill COVID-19 patients, increased VDPhys/VT was associated with high D-dimer levels and a lower likelihood of being discharged alive. Dichotomic VDPhys/VT could help identify a high-risk subgroup of patients neglected by the P/F ratio.