Experience of patients and their caregivers with telepsychiatry consultations: An exploratory study.

Background: While telepsychiatry became a prominent and widely used service in the COVID-19 pandemic-related lockdown, data regarding the patient's experience of telepsychiatry consultations is lacking. Materials and Methods: In this study, we attempted to understand the experience and level of satisfaction of 129 patients receiving psychiatry consultations over video consultations from April 2021 to December 2021. We also tried to understand the factors that might be associated with the satisfaction of the patients. Results: About three-fourths (77.5%) of the respondents were very satisfied with the quality of care provided and the overall experience of the consultation. The majority (92.2%) of the respondents reported that they would "definitely" recommend the telepsychiatry service to a friend or relative in need of a psychiatric consultation. The majority of the patients expressed high levels of satisfaction with the amount of time spent, the amount of freedom in expressing themselves, the amount of freedom in choosing the treatment option, the prescription provided, and the number of medications prescribed. The clarity of voice and the quality of connectivity throughout the consultation were found to be associated with the level of satisfaction. Conclusions: The present study suggests that overall satisfaction with teleconsultations was high among patients and/or caregivers for telepsychiatry consultations.

A Rapid Systematic Review of the Prevalence of Suicide and Self-Harm Behaviors in Adolescents During the COVID-19 Pandemic.

Background: COVID-19 has caused psychological, social, and physical isolation in adolescents resulting in varying rates of suicidal behavior and self-harm. Aims: We investigated the pandemic's impact on adolescent suicidal behavior and self-harm by reviewing the existing literature. Methods: We searched PubMed using keywords: adolescent, suicide, suicidal behavior, self-harm, prevalence, and COVID-19 and included studies reporting primary data only. Results: Of the 551 studies identified, we included 39 studies in the final analysis. Two of the six high-quality population-based suicide registry studies reported increased suicide rates during the pandemic. Seven of fifteen emergency department-based studies out of which four were of high quality and three high-quality population-based health registry studies reported increased self-harm. A few school and community-based surveys and national helpline data also reported an increase in suicidal behavior or self-harm. Limitations: Methodological heterogeneity of the included studies. Conclusions: There is wide variation in study methodology, population, settings, and age groups in the included studies. Suicidal behavior and self-harm were increased in specific study settings and adolescent populations during the pandemic. More methodologically rigorous research is needed to evaluate the impact of COVID-19 on adolescent suicidal behavior and self-harm.

Correction to: Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: A Rare Entity Visited.

[This corrects the article DOI: 10.1007/s13224-022-01737-5.].

Correction to: Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: A Rare Entity Visited.

[This corrects the article DOI: 10.1007/s13224-022-01737-5.].

Misconceptions Related to Covid-19 Infection Among the Medical Students During the Early Part of the Covid-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to widespread controversies related to the transmission, treatment, prevention, and management of COVID-19 infection. Medical students have been involved in patient care across the globe and many a times the general public looks forward towards the medical professionals to get proper information about various issues related to COVID-19. We aimed to evaluate the knowledge and misconceptions held by the medical students on various aspects of COVID-19 infection. SUBJECTS AND METHODS: An online cross-sectional survey was conducted through the Survey Monkey® platform using the Whatsapp®, among the medical undergraduate students of a tertiary care Institute of Eastern India. RESULTS: 236 medical students (of different years of medical training/MBBS) participated in the survey and the response rate to the survey was 47.2%. The mean age of the participants was 20.91 (SD-1.86) years, and about three-fifths were males (58.5%). One-third students were either in their first year of MBBS (31.8%) or the final year (35.16%) of MBBS. Incorrect beliefs related to various preventive aspects, risk of increasing chance of getting infection and modes of spread of infection were present in a significant proportion of students, with a wide variation for specific issues. When the number of participants with at least one incorrect related to any of the aspects of COVID-19 infection was evaluated, it ranged from 59% to 85% in different domains. CONCLUSIONS: This survey highlights the widespread prevalence of misconceptions about various aspects of COVID-19 among medical students, which needs to be addressed by proper education and awareness.

Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: a Rare Entity Visited.

Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.

Suicidal Behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre: An exploratory Study

Background: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. Aim: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre and how patients with suicidal behaviour were handled during the initial consultation. Methods: All new adult patients (aged >18 years) registered with telepsychiatry services during 19th July to 20th of Sept 2021 were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). Results: The study included 1065 adult patients (aged≥18 years). In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% ofthe patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in thelast few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of non-suicidal self-injurious behaviour (NSSI) in the lifetime and0.5% had NSSI behaviour in the last few weeks. Based on the suicidality, 1% of thepatients were asked to report to the emergency immediately, 1.4% were given an appointment within 72 hours for follow-up and 3.6% were explained high risk management. Conclusions: Suicidal behaviour, especially active suicidal ideations and suicidal plan is not very prevalent in patients seeking telepsychiatry consultation.

EXPERIENCE AND SATISFACTION OF TELEPSYCHIATRY CONSULTATIONS AMONG PATIENTS AND CLINICIANS

Background: During the Covid-19 pandemic, telepsychiatry has become normalised in multiple institutes across India as the primary method of care delivery. However, not much evidence is available regarding the experience of a tele-psychiatry consultation for both the care-providing clinician as well as the recipient. Objective: This study aims to assess the experience and satisfaction of the clinician and the patients/their caregiver during a telepsychiatry consultation. Methods: Clinicians scored their experience of providing the consultation to patients over a call(video/audio) in a detailed Google form based questionnaire on a 6 point Likert scale, ranging from very dissatisfied to very satisfied. Patient’s sociodemographic details were collected in a standard manner. Patients were sent a modified version of the Google form questionnaire on their registered mobile number to report their degree of satisfaction, after the call ended. Results: 371 consecutive teleconsultations between April to June 2021 were assessed by 3 clinicians, of which 132 patients/caregivers responded back. The patients had a mean age of 43.5 years, were mostly male, married, educated beyond matric, employed and belonged to urban nuclear families. The average distance of their location from the hospital was 178 km and more than 80% of the patients were accompanied by their relatives in the teleconsultation. 53.6% of the consultations did not face any technological problems, while 24% had connectivity issues from the patient side. Overall, ~66.8% clinicians and 62% of the patients reported being satisfied to a large extent. 66% of the clinicians felt teleconsultation experience was same as an in-person consultation. Conclusions: Teleconsultation in psychiatric patients might not be as difficult as intuitively thought and needs to be explored further as an opportunity to reach out to a larger population, beyond the urban educated sociodemographic group who are the primary beneficiaries in the current scenario.

Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study.

BACKGROUND: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS: 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS: In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS: Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.

Perceived advantages and disadvantages of telepsychiatry - An online survey of psychiatrists in India.

Context: Telepsychiatry is being practiced in India for many years but was formalized only in 2020. It has many advantages and disadvantages. Aims: This study aimed to understand the perceived advantages and disadvantages of telepsychiatry practices in India. Settings and Design: An online survey with ethics approval by the Indian Psychiatric Society (IPS) Ethics Review Board. All psychiatrists who are members of the IPS and whose email address was available with the society were sent the survey link by email. Methodology: Information about existing telepsychiatry consultation practices in India and perception of advantages and disadvantages by the practitioners were collected between June and July 2020. Statistical Analysis: Frequency, percentages, mean, and standard deviation were calculated. Results: Responses by 340 responders were analyzed. Majority of the responders felt that telepsychiatry would provide easy accessibility to mental health services (n = 283, 83.24%) and would lead to less exposure to infections (n = 222, 65.29%). Half of the responders (n = 177, 52.06%) felt that there would be an increased doctor shopping resulting in poor care and nearly three-fourth (n = 245, 72.06%) felt that mental health professionals would fall into a problem while dealing with a suicidal or a homicidal patient. Some expressed that the inability to do physical and central nervous system examinations could lead to missing out comorbidities. About one-third (n = 117, 36.56%) felt that the patient recording the consultation would be a legal issue. Conclusions: This online survey showed that psychiatrists perceive many advantages and some disadvantages in practicing telepsychiatry.

Cognitive Deficits in Patients with COVID-19 Infection during Their Hospital Stay: An Exploratory Study.

Background The literature on presence of cognitive deficits in patients recovered from coronavirus disease 2019 (COVID-19) infection is emerging. However, the data on whether cognitive deficits have its onset during the acute phase of illness has not been evaluated extensively. Aim This article estimates the level of cognitive functioning of patients with COVID-19 while they were admitted to COVID-designated wards. Secondary objectives were to assess the influence of medical comorbidities, severity of COVID-19 infection, and depressive and anxiety symptoms on cognitive functioning in patients with COVID-19 infection. Methods Sixty-six clinically stable patients with COVID-19 infection were evaluated during their inpatient stay on Hindi Montreal Cognitive Assessment scale (H-MoCA), Hindi Mini-Mental State Examination (HMSE) scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Questionnaire -7. Results The mean age of the study participants was 39.85 (standard deviation [SD] 16.89) years and the participants were evaluated after 9.34 (SD 4.98; median 9.0) days of being diagnosed with COVID-19 infection. About one-fourth (28.8%; n = 19) of the participants had cognitive impairment on HMSE and about two-fifths ( n = 26; 39.39%) had cognitive impairment as per the cutoff used for H-MoCA. A higher level of cognitive deficits were seen among participants who were older, diagnosed with diabetes mellitus, and those who required oxygen support during their hospital stay prior to assessment. Conclusion Low cognitive score was found in one-fourth (28.8%) to two-fifths (39.9%) of the persons, depending on the assessment scale among those with acute COVID-19 infection. Low cognitive score was more prevalent among the elderly, those with diabetes mellitus, and those who required oxygen support prior to the assessment.

Profile of Patients Availing Marital and Psychosexual Clinic Services During the Pre-COVID and COVID Era: A Study From a Tertiary Care Center

Aim:To assess the profile of patients availing the marital and psychosexual clinic (MPC) services through the telemode at a tertiary care center after the imposition of lockdown and compare the same with the profile of the patients attending the outpatient services, in-person MPC services during the prelockdown period.Materials and Methods:It was a retrospective study in which comparisons were made between patients availing the MPC services from March 24, 2020 to March 23, 2021 with the profile of patients during the period of March 24, 2019 to March 23, 2020 (ie, COVID period?lockdown).Results:A total of 112 patients availed the MPC services during the COVID study period compared to 307 patients in the pre-COVID period. However, when the proportion of MPC cases among the total walk-ins was compared, during the COVID period the proportion of MPC cases increased by almost 1.75 times. During the COVID time period, there was an increase in the patients who were significantly younger (P = .002), females (P = .003), more from urban locality (P = .035), and being referred by self or caregiver (P = .001). In terms of specific diagnosis, as compared to the pre-COVID timeframe, significantly higher numbers of patients were diagnosed with premature ejaculation (PME) and PME + erectile dysfunction while the services were being provided through the telemode.Conclusion:The present study suggests an increase in the proportion of patients seeking help for marital and sexual issues while the services are being provided by telemode.

Management of a Psychiatry Inpatient Unit During the COVID-19 Pandemic: An Audit of Services.

Objective: To evaluate the demographic and clinical profiles of patients admitted to the psychiatry ward during the coronavirus disease 2019 (COVID-19) pandemic and compare with profiles of patients admitted 1 year before the onset of the pandemic (ie, before the lockdown announcement in India). An additional objective was to evaluate the incidence of COVID-19 infection in the psychiatry inpatient unit and discuss the measures taken to run the unit during the pandemic, including the measures taken if any patient or staff member was detected to have COVID-19 infection.Methods: This retrospective study was conducted in a tertiary care hospital in North India. Data of patients admitted to the inpatient unit from March 24, 2019, to March 23, 2020, were compared with data from March 24, 2020, to March 23, 2021. The data were extracted from the inpatient registry.Results: Compared to the pre-pandemic period, fewer patients were admitted during the pandemic, and the patients admitted had more severe illness. During the ongoing pandemic, the incidence of COVID-19 infection among the residents was 5%, nursing staff was 4.7%, and support staff was 6.66%. The incidence rate of COVID-19 among the patients was 3.2%. Patients were not found to be the primary source of infection; on the other hand, COVID-positive status among the health care professionals was responsible for patients becoming infected.Conclusions: During the ongoing COVID-19 pandemic, psychiatry inpatient facility can be managed with reduced capacity and by following COVD-19 protocol.

Impact of the COVID-19 Pandemic on Consultation-Liaison Psychiatry Services: An Exploratory Study From a Tertiary Care Center in North India.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of psychiatric care, including consultation-liaison psychiatry (CLP) services. The objective of this study was to assess the demographic and clinical profiles of psychiatric referrals made to CLP services during the pandemic period and compare to data during the same timeframe from the previous year at a tertiary care center in North India.Methods: Data of patients referred for CLP consultation and seen by the CLP team in the medical-surgical wards wherein COVID-negative patients were admitted during the period of March 24, 2020, to October 11, 2020 (approximately 6.5 months, 201 days) were extracted from the CLP register (routinely maintained). These data were compared with that of the same timeframe from the previous year (March 24, 2019, to October 11, 2019).Results: During 2020, a total of 562 patients were referred to CLP services, in contrast to 1,005 patients referred in 2019, suggesting a 44% reduction in the number of referrals made to CLP services. During 2020, CLP referral patients more often had metabolic/endocrine disorders, myocardial infarction, and peripheral vascular diseases and less often had chronic obstructive pulmonary disease/asthma and autoimmune disorders compared to 2019. Also, the number of referrals made to CLP services in 2020 for treatment of new disorders declined significantly (P < .001), whereas referrals for abnormal behavior/uncooperativeness (P < .001), self-harm attempts (P = .007), and other reasons (evaluation for organ transplant, sleep disturbances; P = .029) increased significantly. Further, significantly higher percentages of patients were diagnosed with delirium (P = .03) and depressive disorders (P = .04) in 2020 compared to 2019.Conclusions: There was a significant increase in the number of psychiatric referrals for depressive disorders and self-harm attempts among admitted patients from medical-surgical units during the COVID period. These findings suggest that there is a need to modify CLP services to address the needs of patients referred to CLP services, especially during the COVID-19 pandemic.

Don't forget me in amidst of COVID-19 pandemic: A case series and review of literature on steroid associated psychiatric manifestations.

There is a sudden upsurge in the use of steroids due to the ongoing COVID-19 pandemic, especially in patients with severe or critical COVID-19 infection. There are reports of excessive use of steroids, both in terms of use in patients who do not require the same and use in doses higher than the recommended. There are reports of the emergence of different adverse outcomes of excessive steroid use in the form of diabetes mellitus and a higher incidence of mucormycosis. However, little attention has been paid to the mental health impact of the use of steroids. This review attempts to evaluate the existing data in terms of incidence of psychiatric side effects of steroids, and the risk factors for steroid associated psychiatric manifestations. Additionally, an attempt is made to discuss the pathogenesis of steroid-associated psychiatric side effects and why it is likely that the incidence of psychiatric side effects may be more in patients with COVID-19 infection. There is a need to improve the awareness about the psychiatric side effects of steroids, both among the physicians and mental health professionals, as in any patient presenting with new-onset psychiatric symptoms while having COVID-19 infection or during the post-COVID-19 infection phase, a possibility of steroid associated side effect needs to be considered.

Fatigue, perceived stigma, self-reported cognitive deficits and psychological morbidity in patients recovered from COVID-19 infection.

BACKGROUND: Few studies have highlighted multiple psychosocial and physical outcomes in patients with COVID-19 infection after recovery. However, the data from developing countries is limited. AIM: To evaluate psychological morbidity, post-traumatic stress disorder (PTSD), fatigue, and perceived stigma among patients with COVID-19 after recovery from the acute phase of COVID-19 infection. METHODS: In a cross-sectional online survey, 206 adult patients (age>18 years), recovered from COVID-19 infection completed the Patient Health Questionnaire-4 (PHQ-4), the Impact of Events Scale-Revised (IES-R), Fatigue Severity Scale (FSS), 4 items self-designed questionnaire evaluating cognitive deficits and self-designed questionnaire to evaluate perceived stigma. Additionally, they completed the information about demographic and clinical information. RESULTS: The prevalence of anxiety, depressive symptoms, and PTSD in the study sample was 24.8 %, 23.8 %, and 30 % respectively. About three-fifths of the participants (61.2 %) had at least one fatigue symptom as per the FSS with the mean FSS score being 32.10 ± 15.28. About one-fourth of the participants (23.7 %) reported "feeling confused and always feeling mentally foggy", and 38 % of patients reported experiencing at least one cognitive problem. The level of felt stigma related to self was seen in 31.1 %, 20 % reported stigma related to family, and 50 % reported stigma in relation to neighbors and society. Those reporting higher PTSD scores had higher anxiety and depressive scores, reported more fatigue and stigma, and had a higher level of cognitive deficits. A higher fatigue score was also associated with higher anxiety, depression, and cognitive deficits. CONCLUSIONS: Our study reveals that a significant proportion of patients after recovery from COVID-19 experience psychological morbidities, fatigue, cognitive problems, and stigma. Efforts should be made to take care of these issues in routine post-COVID follow-up care.