User Perception of Telephone-Based Telepsychiatry Consultation: A Cross-Sectional Survey.

Objective: To assess user perception regarding different aspects of the telepsychiatry process.Methods: This cross-sectional survey study was conducted between July and September 2020 with follow-up patients attending teleconsultation at a tertiary care center (N = 108). The online survey included questions about the user's experience such as the appointment process and different aspects of teleconsultation, as well as perceived benefits, difficulties experienced, and suggestions for improvement. The sociodemographic and clinical data were retrieved from the electronic record.Results: The majority of patients expressed satisfaction with teleconsultation. The patients who were living far from the center (> 100 km) and those with psychotic illness favored telepsychiatry. Patients with nonpsychotic illnesses reported significantly less satisfaction with counseling in teleconsultation.Conclusions: The findings substantiate the acceptance of telepsychiatry services and emphasize the need for a tailor-made hybrid form of consultation as per the patient's profile.

Impact of COVID-19 lockdown on substance availability, accessibility, pricing, and quality: A multicenter study from India.

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence. Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24-April 14) and the second phase (April 15-May 3) of lockdown. Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid. Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown.

Psychological Impact of the COVID-19 Pandemic and Associated Lockdown on Outpatients With Psychiatric Illness: A Cross-Sectional Study.

Objective: To explore the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic and associated lockdown on patients with psychiatric illness.Methods: An online survey-based cross-sectional study was conducted among patients receiving follow-up treatment at a tertiary care center from January to March 2020. The data were collected using a questionnaire about the possible challenges in 3 broad areas: treatment-related challenges, psychosocial difficulties, and concerns related to COVID-19.Results: The majority of patients (72.6%) reported a positive impact due to the increased availability of family support. Patients with depression and anxiety disorders (39.0%) experienced a more negative impact compared to those with psychotic disorders. Many of the psychiatric patients (22.6%) stopped medications and had difficulties accessing health services. Patients also experienced increased interpersonal conflict, sleep difficulties, and a surge in screen time.Conclusions: The findings highlight the difficulties faced by patients with psychiatric illnesses and emphasize the importance of family cohesion during times of crisis.

Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study.

INTRODUCTION: Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic. MATERIAL AND METHODS: This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale - 21 (DASS 21) which was used to quantify emotional distress experienced by them. RESULTS: A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician. CONCLUSIONS: Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system.

A multicentric survey among patients with substance use disorders during the COVID-19 lockdown in India.

Background: The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions. Materials and Methods: We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June-September) of the pandemic. Results: An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ2 = 20.408, P = 0.000), make attempts (χ2 = 12.436, P = 0.000), seek treatment (χ 2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ2 = 35.143, P = 0.000) and experience stigma by family members (χ2 = 29.951, P = 0.000) and neighbors (χ2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others. Conclusion: COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions.

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus.

BACKGROUND AND AIMS: People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic. METHODS: We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic. RESULTS: There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic. CONCLUSIONS: People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.

Children and COVID19: Understanding impact on the growth trajectory of an evolving generation.

The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5-7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0-18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.