Effects of strict COVID-19 lockdown on patients with obsessive-compulsive disorder compared to a clinical and a nonclinical sample.

BACKGROUND: Symptoms of obsessive-compulsive disorder (OCD) have been reported to increase during the COVID-19 lockdowns because of the hygiene requirements related to the pandemic. Patients with adjustment disorder (AD) may, in turn, represent a vulnerable population for identifiable stressors. In this study, we aimed at assessing potential symptoms changes in OCD patients during the lockdown in comparison with AD patients as well as versus healthy controls (HC). METHODS: During the COVID-related lockdown, we enrolled 65 patients and 29 HC. Participants were tested with four clinical rating scales (Yale-Brown obsessive-compulsive scale and Brown Assessment of Beliefs Scale for OCD patients; Beck Depression Inventory-II and State-Trait Anxiety Inventory-Y for each group) that had been also administered just before the Italian lockdown. RESULTS: Our results showed that during the lockdown: (i) the symptoms of depression and anxiety increased in all groups, but this increase was most pronounced in HC (p < 0.001); (ii) OCD symptoms severity did not increase, but the insight worsened (p = 0.028); (iii) the proportion of OCD patients showing hygiene-related symptoms increased (p = 0.031 for obsessions of contamination), whereas that of patients with checking-related symptoms decreased. CONCLUSIONS: The lockdown-induced psychological distress apparently changed the characteristics and the pattern of OCD symptoms expression but not their overall severity. This evidence confirms the heterogeneity and changing nature of OCD symptoms, strongly depending on the environmental circumstances.

Depression and Anxiety Symptoms "Among the Waves" of the COVID-19 Pandemic in Obsessive Compulsive Disorder and Adjustment Disorder Patients.

The COVID-19 pandemic and the associated restrictions caused great psychological suffering to the general population and psychiatric patients. We aimed to explore the course of depression and anxiety symptoms in obsessive compulsive disorder (OCD) patients, adjustment disorder (AD) patients, and participants without psychiatric disorders (control group, CG) across the different phases of the pandemic: the first lockdown, a temporary interruption of restrictions, and the second lockdown. Out of the 158 patients screened, we enrolled 46 OCD and 19 AD patients as well as 29 CG participants. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to all participants at each time point. The results showed different symptom severities among the groups throughout the whole study, with OCD patients always scoring higher than AD patients and the CG, and the AD patients always scoring higher than the CG. The symptom course within each group was different. OCD patients' symptoms sharply worsened during the first lockdown and then remained stable irrespective of the subsequent pandemic phases. In the AD and CG groups, symptoms waxed and waned following the fluctuations of the restriction provisions, with a complete return to the baseline when the restrictions were stopped only in the CG. These findings suggest that the influence of the pandemic and of the associated restrictions on depression and anxiety manifestations may vary depending on the particular pre-existing mental health status.

The prevalence of adjustment disorder and predisposing factors in infertile women.

BACKGROUND: Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women. METHOD: In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022. RESULT: The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (ß = 0.27, p < 0.001), coronavirus anxiety (ß = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (ß = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women. CONCLUSIONS: The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.

Prevalence of adjustment disorder during COVID-19 in Northeast India: An observational study

Background: The 11th revision of the International Classification of Diseases (ICD-11) aims to provide a new definition of adjustment disorder (AjD), which is one of the most frequently diagnosed disorders. Coronavirus disease (COVID-19) pandemic has affected the mental health of people and the associated stressors could lead to AjD. The study aimed to investigate the AjD symptoms during COVID-19 pandemic based on the ICD-11 concept on a clinical sample. Methodology: A cross-sectional observational study was conducted between June 10, 2020, and August 9, 2020, among patients visiting the outpatient department of the authors' institute. Prevalence rates of stressors due to COVID-19 and AjD were estimated using scale of the International AjD Questionnaire (IADQ). Results: The study enrolled 723 subjects and 638 subjects endorsed at least one psychological stressor. The IADQ algorithm showed that 25.24% (161) of subjects were suffering from AjD due to the COVID-19 pandemic with a mean score of 20.29 (standard deviation = 4.26) among them. The most common stressors were related to financial problems (81.03%), work problem (63.17%), and personal health problems (27.43%). Conclusion: The high proportion of AjD during COVID-19 in this study may reflect a need for specific interventions. Provision for health-care services for such individuals is essential to avoid other mental disorders in the future.

Profile of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital

Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India. Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital Material(s) and Method(s): This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis. Result(s): We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam. Conclusion(s): We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.

Validation of the brief Adjustment Disorder New Modules with Australian oncology patients.

BACKGROUND: Evidence suggests that up to 30% of cancer patients may meet the criteria for adjustment disorder. However, no assessment instruments have been validated for use with cancer patients. The Adjustment Disorder New Module (ADNM)-8 and ADNM-4 are brief screening tools for adjustment disorder mapped directly to the new ICD-11 criteria. The aim of this study was to investigate the factor structure and validity of both instruments in an Australian sample of adult oncology patients.  METHODS: A total of 405 participants with a cancer diagnosis were recruited online from across Australia. Participants reported cancer-specific information, such as time since diagnosis, treatment stage, cancer stage, type of cancer, and the following questionnaires: 8-item Adjustment Disorder New Module (ADNM-8), the World Health Organisation Well-Being Index (WHO-5), and the short form Depression Anxiety and Stress Scale (DASS-21). The predictiveness of stressors was assessed using multiple regression analysis and the structure of the ADNM-8 and the ADNM-4 was tested using confirmatory factor analysis.  RESULTS: Six previously tested models were examined, and the results suggested a 2-factor structure reflecting the two ICD-11 diagnostic criteria clusters of preoccupation with the stressor and failure to adapt was a good fit for both scales. The ADNM-4 outperformed the longer version of the scale on numerous fit indices though the ADNM-8 and ADNM-4 were highly correlated. Correlations of both scales with the psychological distress scale, the stress subscale, and the wellbeing index indicated good construct validity. CONCLUSIONS: Our results suggest that the ADNM-8 and ADNM-4 are useful screening tools for assessing adjustment disorder symptoms in cancer patients. The prompt screening of cancer patients encourages early intervention for those at risk of adaptation difficulties and informs research and clinical decisions regarding appropriate treatments.

ICD-11 adjustment disorder following diagnostic procedures of prostate cancer: A 12-month follow-up study.

OBJECTIVE: The medical procedures in diagnosing or treating prostate cancer may impair adjustment and quality of life. The current prospective study aimed to evaluate the trajectories of symptoms of ICD-11 adjustment disorder in patients diagnosed vs. non-diagnosed with prostate cancer before (T1), after diagnostic procedures (T2), and at 12-month follow-up (3). METHODS: In total, 96 male patients were recruited before prostate cancer diagnostic procedures. The mean age of the study participants at baseline was 63.5 (SD = 8.4), ranging from 47 to 80 years; 64% were diagnosed with prostate cancer. Adjustment disorder symptoms were measured using the Brief Adjustment Disorder Measure (ADNM-8). RESULTS: The prevalence of ICD-11 adjustment disorder was 15% at T1, 13% at T2, and 3% at T3. The effect of cancer diagnosis was not significant on adjustment disorder. A medium main effect for time was detected on adjustment symptom severity, F(2, 134) = 19.26, p < .001, partial η2 = 0.223, with symptoms significantly lower at 12-month follow-up, compared to T1 and T2, p < .001. CONCLUSIONS: The study's findings reveal the increased levels of adjustment difficulties in males undergoing the diagnostic process of prostate cancer.

Psychometric and factorial validity of the International Adjustment Disorder Questionnaire (IADQ) in an Italian sample: A validation and prevalence estimate study.

INTRODUCTION: Adjustment disorder (AjD) is a is a maladaptive emotional or behavioural reaction to a stressful event or change in a person's life. Compared to other previously validated tools, the International Adjustment Disorder Questionnaire (IADQ) stands out as one of the most reliable and handy one for AjD. Since no homologous instrument exists now, in this study, we aimed to validate an Italian version of the IADQ. METHODS: Twenty-one thousand two hundred and six subjects (80.4% females) during the initial stages of the SARS-CoV-2 pandemic were recruited. We conducted a confirmatory factor analysis (CFA), testing two latent models, a monofactorial and a bifactorial one. Concurrent validity by correlating the total and the two factors' scores with measures of depression, anxiety and post-traumatic stress was then estimated. We finally estimated the rates of AjD among the population, and a binary logistic regression was conducted to analyse the predictors of such disorder. RESULTS: CFA showed a bifactorial validity, with both excellent incremental and comparative fit indices. The IADQ scores correlated strongly with symptoms of depression, anxiety and stress. In the Italian sample, the prevalence of probable AjD was 8.23%. Female gender, being engaged, widowed and having COVID-19-related stressors resulted as significant independent risk factors for AjD. CONCLUSIONS: IADQ is an easy-to-use, brief and psychometrically sound self-report measure for AjD. Thus, it may be considered a reliable tool for both research and clinical settings. To the best of our knowledge, our study reported for the first time the prevalence of AjD during COVID-19 pandemic.

Women's mental health during the COVID 19 pandemic and the problem of domestic violence in a lockdown situation

Introduction: The current situation caused by restrictive measures related to the COVID-19 pandemic provokes the high level of aggressiveness and all forms of domestic violence. These results in mental health problems. Objective(s): The purpose of this study was to find out the consequences of domestic violence against women and to identify psychological problems and mental disorders in women. Method(s): Acohort of 18 females was examined by psychiatrists and psychologists. All women turned to specialists at the Moscow Institute of Psychiatry for help. Result(s): All women were victims of violence by their husbands and partners. Lockdown situation associated with COVID 19 pandemic has exacerbated the problem of domestic violence. Clinical assessment has revealed different depressive symptoms, anxiety, fear, suicidal tendencies forming the clinical picture of adjustment disorder (2 cases), acute reaction to stress (3 cases), posttraumatic stress disorder (2 cases), depressive episode (8 cases), eating disorders behavior in the form of bulimia and anorexia (3 cases). Conclusion(s): The research has revealed that domestic abuse against women associated with lockdown situation during the COVID 19 pandemic often results in psychological and longterm mental health problems. In these cases, prevention is needed to combat violence against women with the participation of public health specialists, psychologists, psychiatrists, sociologists.

Relationship between adjustment disorder symptoms and probable diagnosis before and after second lockdown in Israel: longitudinal symptom network analysis.

BACKGROUND: There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology. AIMS: To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder. METHOD: This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ). RESULTS: Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was 'difficult to relax' in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. 'Worry a lot more' (preoccupation) and 'difficult to adapt to life' (failure to adapt) at T1 significantly predicted this diagnosis at T2. CONCLUSIONS: Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.

Efficacy, Safety, and Tolerability of PH94B in Adjustment Disorder With Anxiety: Design of an Exploratory Phase 2A Clinical Trial

BACKGROUND: Adjustment disorders are now primary diagnoses in the trauma and stressrelated disorders section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Adjustment disorder with anxiety (AjDA) is the development of emotional or behavioral symptoms considered excessive in response to stressful events, significantly impairing a person's ability to function in social, occupational, and/ or other situations. Traumatic experiences related to the COVID-19 pandemic may have increased rates of adjustment disorders, especially among those whose life routines were disrupted by pandemic-associated stress and anxiety. PH94B (3b-hydroxy-androsta-4,16-dien-ol) has shown rapid-onset efficacy in the treatment of social anxiety disorder (Liebowitz et al. Am J Psychiatry. 2014). PH94B is a neuroactive steroid administered as a nasal spray that engages olfactory chemosensory neurons, activating subsets of olfactory bulb neurons that project directly to the limbic amygdala regulating fear and anxiety circuits. OBJECTIVE: To assess the efficacy, safety, and tolerability of PH94B in adults with AjDA. METHODS: This is an exploratory, phase 2A, randomized, double-blind, 4-week, placebo-controlled, 2-arm study in adults with AjDA. The primary outcome is change from baseline to week 4 in the Hamilton Anxiety Rating Scale (HAM-A) total score after intranasal administration of PH49B 4 times daily vs placebo. Patients with a DSM-5 diagnosis of AjDA confirmed by the Mini-International Neuropsychiatric Interview (MINI) with Adjustment Disorders Module and a clinician-rated HAM-A score of ≥20 at screening (Visit 1), with ≤15% decrease at baseline (Visit 2, randomization) are eligible for inclusion. Secondary outcomes include change from baseline to week 4 in the Adjustment Disorder New Module Scale (ADNM), the International Adjustment Disorder Questionnaire (IADQ), the Clinical Global Impression of Improvement (CGI-I), and the Patient Global Impression of Change (PGI-C). Change from baseline in the Hamilton Depression Rating Scale (HAM-D) was exploratory. RESULTS: A total of 40 patients will be randomized (1:1 drug to placebo). The study design features the use of the ADNM and IADQ, newly developed according to ICD-11 criteria for evaluation of AjDA. While both are validated, neither has been tested in placebo-controlled clinical trials. Both scales begin with a list of stressors (18 for ADNM and 9 for IADQ);a yes answer to any 1 stressor triggers a series of questions about the frequency and duration of a patient's reaction to the stressor (ADNM) or quantifies symptoms in response to the stressor (IADQ). CONCLUSIONS: Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. Anxiety and impaired functioning are increasing, particularly in response to the COVID-19 pandemic, and no pharmacologic treatment is currently approved by the FDA for AjDA. PH94B, an investigational pherine nasal spray, is also being studied for treatment of other anxiety-related disorders.

Examining the Longitudinal Associations between Adjustment Disorder Symptoms and Boredom during COVID-19.

The COVID-19 pandemic has led to a myriad of stressors, underscoring the relevance of adjustment disorder during these extraordinary times. Boredom-as a feeling and as a dispositional characteristic-is an equally pertinent experience during the pandemic that has been cross-sectionally linked to various mental health difficulties. The current longitudinal study expanded on this work, examining the associations between adjustment disorder symptoms and boredom (both as a feeling and as a trait) over time during the COVID-19 pandemic. Community participants completed questionnaires three times, rating their trait boredom at Time 1 and their feelings of boredom and adjustment disorder symptoms (preoccupation with a pandemic stressor and failure to adapt) over the past week at Times 1-3. Latent growth curve analyses found that an increase in feelings of boredom was significantly associated with increased preoccupation with a pandemic stressor and increased difficulties with adapting over time. Additionally, trait boredom significantly predicted changes in preoccupation and the failure to adapt, such that participants high in trait boredom increasingly struggled with these symptoms over time. Our results suggest that increased feelings of boredom and a trait disposition towards boredom can be detrimental to people's ability to adjust over time to the stressors associated with the pandemic. Boredom, as an aversive state and as a chronic difficulty, may be important to address in treatment approaches for adjustment disorder symptoms during COVID-19.

The network structure of ICD-11 adjustment disorder: A comparison of clinical and nonclinical samples.

BACKGROUND: International Classification of Diseases, 11th revision (ICD-11) adjustment disorder (AjD) is characterized by two main symptom clusters: preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and nonclinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy. METHODS: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) using data from 330 clinical participants from the UK and a nonclinical sample of 699 participants from Switzerland. RESULTS: Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks. CONCLUSIONS: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis.

Evaluation of Psychiatric Counseling for Patients Hospitalized with COVID-19 in a University-Affiliated General Hospital in Tehran, Iran

Background: Coronavirus disease 2019 (COVID-19) is associated with a number of psychiatric problems in patients;however, mental healthcare in these patients does not appear to be adequate. Objectives: This study aimed to evaluate the extent of psychological care provided to COVID-19 patients admitted to the hospital and the most common reasons for psychiatric counseling. Methods: This study examined the electronic medical records of all COVID-19-positive patients admitted to Rasoul-e-Akram hospital in Tehran, Iran, within April 1 and September 30, 2020 (approximately 2200 cases). Results: Psychiatric consultation was requested for 5.45% of admitted patients with COVID-19 diagnosis based on a positive real-time reverse transcription-polymerase chain reaction. More than half of those who received psychiatric counseling had a previous psychiatric disorder. The most common reason for requesting psychiatric counseling in patients with a previous psychiatric disorder was the patient’s evaluation and management;the most common reason in patients without a psychiatric disorder was agitation and lack of cooperation. The most common diagnosis in patients with a positive history of psychiatric disorder was bipolar disorders (33.9%), followed by opioid use disorder (29%). Adjustment disorder (54%) and delirium (26%) were the most common diagnoses in patients without a history of psychiatric disease. Conclusions: The current study showed that psychiatric counseling in COVID-19 patients was limited to a small number, including those with a positive history of psychiatric illnesses and prominent psychiatric symptoms.

Dysgeusia and Appetite Loss: Thinking Beyond MDD and COVID-19

Background: Dysgeusia is a distortion of taste sensation. Etiologies can include medications and Covid-19, among others. Dysgeusia may lead to appetite loss which is nonspecific and can have multiple causes, including major depressive disorder (MDD) (Coulter, 1988). Although post-marketing data revealed no association between nifedipine and dysgeusia (Ackerman, 1997), case reports of dysgeusia from nifedipine exist (Ackerman, 1997). We present a case of nifedipine-induced dysgeusia mistaken for depression. Case Report: A 42-year-old man with hypertension and diabetes was admitted to the hospital following right thalamocapsular and intraventricular hemorrhages. Hypertension was managed with metoprolol, lisinopril, nifedipine, and chlorthalidone. Levetiracetam was started for seizure prophylaxis. Medications included pantoprazole, simethicone, transdermal lidocaine, insulin, metformin, docusate, senna, and subcutaneous heparin. Psychiatric consultation was requested out of concern that appetite loss indicated depression. The day before psychiatric evaluation, mirtazapine 15 mg at bedtime for mood and appetite was started. Nifedipine 90 mg daily had been started 9 days prior to his first complaint of decreased appetite. The patient reported feeling disconnected from his family and “sad" for ∼10 years, complaining that family members “talk behind his back.” He was otherwise without paranoia. He denied insomnia, anhedonia, hopelessness, poor concentration, suicidal ideation, homicidal ideation, guilt, mania, or hallucinations. He reported poor appetite due to epigastric discomfort and bad taste to foods. Covid-19 testing was not yet widely available. No other signs or symptoms suggestive of Covid-19 were present. Although alert and fully oriented, concentration was impaired with sometimes tangential thought processes. Affect was full without depression. A diagnosis of adjustment disorder was made. The psychiatry team suspected nifedipine-induced dysgeusia and advised discontinuing nifedipine. Appetite improved two days later. Discussion: This case highlights the importance of considering alternative causes of nonspecific symptoms of depression, including decreased appetite, that may have non-psychiatric causes. Dysgeusia is widely recognized as a symptom of Covid-19. Other causes, including medications may be underrecognized and amenable to intervention. Conclusion: It would be helpful to consider medication side-effects as potential causes for taste distortion alongside psychiatric diagnoses, and COVID-19. References: 1. Coulter DM: Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of post marketing surveillance BMJ 1988;296: 1086–8. 2. Ackerman BH, Kasbekar N: Disturbances of taste and smell induced by drugs. Pharmacotherapy 1997;17(3):482-96.

Two Years of COVID-19 in Austria-Exploratory Longitudinal Study of Mental Health Outcomes and Coping Behaviors in the General Population.

Since the long-term mental health impact of COVID-19 is not yet fully understood, the present study explored changes in mental health outcomes and pandemic-related coping behaviors across four pandemic stages. The main objective was to gain insights into the dynamics of mental health and coping, considering different pandemic features at different assessment waves. The final sample consisted of N = 243 adults from the Austrian general population. Data were collected at four timepoints (between June 2020 and December 2021) via LimeSurvey, an open-source online survey tool. Symptoms of posttraumatic stress disorder (PTSD), adjustment disorder (AD), anxiety, and depression were assessed using validated instruments: Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), AD-New Module 8 (ADNM-8), and Patient Health Questionnaire (PHQ4). We also administered the Pandemic Coping Scale (PCS) to address pandemic-related coping behaviors. Cochran's Q test and repeated measures ANOVAs were applied to assess changes over time. The results indicated that prevalence rates of AD (χ2(2) = 16.88, p = 0.001), depression (χ2(3) = 18.69, p < 0.001), and anxiety (χ2(3) = 19.10, p < 0.001) significantly changed across four assessment waves. Changes in mean scores of the assessed mental health outcomes were also observed. For pandemic-related coping, we found differences in the subscales: healthy lifestyle: F(3, 651) = 5.11, prevention adherence: F(2.73, 592.35) = 21.88, and joyful activities: F(3, 651) = 5.03. Taken together, our study showed a higher mental health burden in wintertime than in summertime, indicating an increased need for psychosocial support in times of stricter measures, higher incidences, and higher death rates. Furthermore, the observed decrease in adaptive coping behaviors suggests that easy-to-implement coping strategies should be actively promoted in order to maintain mental health during and in the aftermath of pandemics.

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked. METHODS: An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not. RESULTS: The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others. CONCLUSIONS: Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.

Knowledge Level of Health Care Providers about Complicated Grief during the COVID-19 Pandemic

Objective: The coronavirus 2019 (COVID -19) pandemic had great psychological impact on COVID-19 patients and their families. Relatives of the deceased COVID-19 patients are at risk for complicated grief. Healthcare providers (HCPs) should be able to identify complicated grief cases. The aim of this study was to assess HCP knowledge regarding complicated grief during the COVID-19 pandemic. Method: This cross-sectional study was conducted using an online researcher-made questionnaire. The questionnaire was designed and validated before being used in this study. The questionnaire included demographic questions as well as knowledge about complicated grief and its symptoms, risk factors and management. The link to the questionnaire website was sent to HCP governmental and private sectors. Data was analyzed using the ordinal regression model by the SPSS 16 software. Results: A total of 887 HCPs (69% female and 31% male) participated in this study. Majority of the participants (594, 70%) had fair overall knowledge about complicated grief while 206 (23.2%) participants had poor knowledge. Poor knowledge level about risk factors for complicated grief was observed in 44.3% of the participants. Fair or poor knowledge about prevention and management of complicate grief was observed in 39.2% of participants. Knowledge about complicated grief had a significant positive relationship with female gender (OR: 1.55;95% CI: 1.15-2.08) and higher education level (OR: 1.86;95% CI: 1.37-2.54). Conclusion: Knowledge of HCPs about complicated grief was low. There is need for HCP knowledge improvement regarding complicated grief by appropriate education. [ FROM AUTHOR] Copyright of Iranian Journal of Psychiatry is the property of Tehran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland.

The ICD-11 has introduced a new conceptualization of adjustment disorder (AjD) as a stress response syndrome with core symptoms of preoccupations and failure to adapt to the stressor. The current study aimed to assess the reliability and validity of the International Adjustment Disorder Questionnaire (IADQ) in two culturally distinct samples from Israel and Switzerland. Two samples were recruited in Israel (N = 1142) and Switzerland (N = 699) during the initial stages of the COVID-19 pandemic. Confirmatory factor analysis indicated that a correlated two-factor model provided an excellent fit to the Israeli and Swiss sample data. The IADQ scores correlated strongly with another measure of AjD symptoms and with symptoms of depression, anxiety, acute stress and negative emotions, whereas correlations with posttraumatic stress disorder, complex posttraumatic stress disorder and positive emotions were weaker. In the Swiss sample, 18.8% met diagnostic criteria for probable AjD and 10.2% in the Israeli sample. The current study provides the first evidence of the validity of the German and Hebrew versions of the IADQ and can be used for the screening of this debilitating condition.