Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations.

Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic.

Background: Suicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants. Results: A total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning. Conclusions: Considerable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts. Supplementary Information: The online version contains supplementary material available at 10.1186/s41983-022-00577-4.

A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations.

The role of psychodynamic theory in consultation-liaison (C-L) work, and particularly the importance of countertransference, has been well established. The psychological impact of the COVID-19 pandemic on healthcare workers is a new factor that must now be taken into account as C-L psychiatrists traverse a changed healthcare landscape. In this article, we highlight the case of a critically ill COVID-19 patient who endorsed a desire for hastened death. This request generated significant conflict between the physicians and nurses caring for him, and it became challenging for the C-L team to perform our typical liaison function. We briefly review the existing literature on the psychological impact of the pandemic on healthcare workers, and examine how psychodynamic factors within this context impacted the events that unfolded. Themes under consideration include the effect of mass trauma on clinician defense mechanisms, and specifically the impact on countertransference toward patients who express a desire for hastened death. C-L psychiatrists themselves are not immune to such reactions and must be particularly attentive to emergent conflict in such cases. Interdisciplinary meetings to discuss and process these disagreements may be effective in repairing staff ruptures.

COVID-19 Related Mental Health Issues among Patients with Cancer: A Pilot Study

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic is associated with more psychological distress than its rampant spread, mortality, and morbidity. Cancer patients are at increased risk of mortality and morbidity than the general population. Due to this, there is a possibility that cancer patients may be suffering from a higher level of COVID-19 related anxiety, fear, and obsession. Aim: To explore COVID-19 related mental health issues (anxiety, fear, and obsession) and its correlates in patients with cancer. Materials and Methods: The present study was a cross-sectional pilot study which was conducted in a tertiary care teaching hospital located in Ratnagiri, Maharashtra, India. Patients receiving treatment for cancer (n=55) consequently at tertiary care teaching hospital of India were recruited. The Corona Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), Fear of COVID-19 Scale (FCV-19S), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 Scale (GAD-7) were used to assess all eligible patients. Fisher's-exact test. spearman's rank correlation, and logistic regression were used to analyse the data. Results: Among the 55 patients (mean age was 49.64 +/- 13.08 years) with cancer, 11 (20%) had Coronavirus related anxiety and 2 (3.6%) had obsession related COVID-19, 22 (40%) had depression and 18 (32.7%) has GAD. CAS score positively correlated with FCV-19S score [rho=0.50 (p<0.001)], PHQ-9 score [rho=0.90 (p<0.001)] and GAD-7 score [rho=0.74 (p<0.001)]. Conclusion: COVID-19 related mental health issues (fear, anxiety), depression, and GAD were prevalent among patients with cancer. Further, COVID-19 specific issues may not be addressed in routine screening and evaluation in current practice. Therefore, there is an urgent need to develop systematic strategies to screen and develop specific mental health interventions for patients with cancer.

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation-liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. METHODS: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. RESULTS: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium. CONCLUSION: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.

Liaison psychiatry before and after the COVID-19 pandemic.

INTRODUCTION: the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS: a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS: patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS: the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.

A pilot national-access young person's Klinefelter Syndrome multidisciplinary team clinic: patient and clinician reported outcomes

Most children are diagnosed with Klinefelter's as part of investigating learning and behavioural difficulties or during prenatal screening. Klinefelter's is the most common chromosomal abnormality affecting men (1 in 650) and is associated with a large spectrum of clinical manifestations including learning, behavioural and developmental delays. The optimal management of this condition involves many different specialties, as seen in the development of adult Klinefelter multidisciplinary team (KSMDT) clinics. Unfortunately, young patients are often outside the remit of these adult clinics, and often experience major gaps and delays to the patient pathway, with a lack of coordination in areas such as hormone replacement therapy, psychological & educational support and fertility counselling. Based on this, a national survey was carried out to assess the needs of young (16-20) Klinefelter Syndrome patients which led to the setting up a young person's KSMDT clinic model for KS. We report on the patient and clinician reported feedback in the first 6 months of this clinic. The structure of the pilot young person's KSMDT clinic included input from endocrinologists, a fertility team of urologists & reproductive medicine doctors, a psychology team involving both clinical and educational psychology, a neurodisability team, genetics specialists as well as a specialist pharmacist and a patient liaison. Each consult was specifically structured to the patient's priorities, with both the patient and parent invited to attend and to separately indicate these priorities. Ten patients (mean age 17, range 16 – 20) were seen in the first clinic. To assess the quality of care received in the clinic, an 8 -point feedback questionnaire was given to each patient & parent attending the clinic to fill out at the end of the clinic. The form included a space for feedback for each speciality involved. The feedback forms were reviewed by 2 individual researchers and entries were assessed using an adapted Likert scale (0 – 5). Clinicians involved in the clinic were also encouraged to attend and rate the other specialties, the effectiveness of MDT clinic. All patients & parents were satisfied about the structure of clinic, the provision and management plans. 94% of patients indicated they were very satisfied (score = 5) about endocrine consultation compared to 100%, 90% and 88% in genetic, neurodisability/psychology and fertility consultations respectively. Key factors influencing these positive results included the presence of detailed fertility counseling, access to patient support groups and having a transition plan to the adult KSMDT clinic. Clinician feedback was positive with all members agreeing that the pre and post clinic MDTs allowed effective discussion of complex issues such as hormone initiation, future fertility as well as socio-educational factors affecting the well-being of the patient. The overall patient and clinician feedback for the young person's KSMDT clinic was uniformly positive, with the multispecialty approach allowing communication with and between all relevant specialities on the same day, avoiding the need to come for multiple separate appointments across different sites (especially relevant during the Covid era). A fully fledged clinic is now running based on the feedback and insight provided from the pilot process, with a seamless transition of these young patients to our adult KSMDT clinic to continue to support them. Work supported by industry: no. [ FROM AUTHOR] Copyright of Journal of Sexual Medicine is the property of Elsevier B.V. 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.)

Acute Period Psychiatric Effects of COVID-19 in Hospitalized Patients: A Retrospective Investigation.

Although it is known that COVID-19 has a serious impact on mental health, there are few studies on the acute period complications in hospitalized patients. In this study, it has been aimed to evaluate the reason for asking for consultation, prevalence of psychiatric disease and recommended psychiatric interventions, in COVID-19 infected patients who were consulted to consultation liaison psychiatry. This study has been conducted by retrospectively examining the psychiatric consultation reports of 138 patients who were hospitalized for COVID-19 in a university hospital in Turkey between March 2020 and October 2021. Patients' data were obtained from electronic medical records. According to the results of the analysis, the reasons for requesting a consultation were insomnia (26.22%), anxiety/fear of death (20.76%), agitation (17.48%), and hallucinations/fluctuation in consciousness (11.47%), respectively. The most common psychiatric diagnoses were delirium and sleep disorders (22.5%), these were followed respectively by adjustment disorder (11.6%), anxiety (10.9%) and depression (3.6%). Medical treatment was recommended for 85.5% of the patients, and haloperidol was the most frequently recommended agent. 44.1% of the patients treated in the intensive care unit were diagnosed with delirium and their age was higher. Advanced age caused an increase in delirium and death rates. These findings indicate that psychiatric morbidities and delirium are common among COVID-19 patients, and the need for consultation-liaison services may increase during the pandemic. (English) [ FROM AUTHOR] COVID-19'un ruh sağlığında ciddi etkilenme yarattığı bilinmesine rağmen, yatarak tedavi gören hastalardaki akut dönem komplikasyonlar hakkında az sayıda araştırma vardır. Bu çalışmada, konsültasyon liyezon psikiyatrisine danışılan COVID-19 enfekte hastalarda konsültasyon istenme nedeni, psikiyatrik hastalık yaygınlığı ve önerilen psikiyatrik müdahalelerin değerlendirilmesi amaçlanmıştır. Çalışma, Türkiye'de bir üniversite hastanesinde, Mart 2020-Ekim 2021 tarihleri arasında, COVID-19 nedeniyle yatarak tedavi gören 138 hastaya ait psikiyatrik konsültasyon raporlarının geriye doğru incelenmesiyle yürütülmüştür. Hastalara ait veriler elektronik tıbbi kayıtlardan elde edilmiştir. Yapılan analiz sonuçlarına göre, konsültasyon istenme nedenleri sırasıyla uykusuzluk (%26.22), kaygı/ölüm korkusu (%20.76), ajitasyon (%17.48) ve halüsinasyon/bilinçte dalgalanma (%11.47) idi. En sık konulan psikiyatrik tanılar deliryum ve uyku bozuklukları (%22.5) idi, bunları sırasıyla uyum bozukluğu (%11.6), anksiyete (%10.9) ve depresyon (%3.6) izliyordu. Hastaların % 85.5'ine medikal tedavi önerilmişti ve haloperidol en sık önerilen ajandı. Yoğun bakımda tedavi gören hastaların %44.1'i deliryum tanısı almıştı ve bunların yaşları daha yüksekti. Íleri yaş, deliryum ve ölüm oranlarında artışa neden olmuştu. Bu bulgular, COVID-19 hastaları arasında psikiyatrik morbiditelerin ve deliryumun yaygın olduğuna, pandemisi sırasında konsültasyon-liyezon hizmetlerine olan ihtiyacın artabileceğine işaret etmektedir. (Turkish) [ FROM AUTHOR] Copyright of Journal of Inonu University Health Services Vocational School is the property of Inonu Universitesi Saglik Hizmetleri Meslek Yuksekokulu 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.)

Increased prevalence and severity of psychiatric illness in hospitalized youth during COVID-19.

BACKGROUND AND OBJECTIVES: Previous studies have demonstrated an increase in mental health emergencies among youth seen in ambulatory and emergency room settings during the COVID-19 pandemic. This study investigates rates of mental health-related consultation and markers of illness severity since the start of the pandemic. METHODS: We evaluated all pediatric patients admitted to a single children's hospital from March 2019 to March 2021 who received psychiatry and/or psychology consults. We report the absolute number of these patients, as well as the proportion of all study site admissions who received such consults. Severity of psychiatric illness was described in terms of LOS, disposition, and use of restraints and psychotropic medications. RESULTS: The number and proportion of pediatric patients receiving psychiatry and/or psychology consults rose during the pandemic. Participants also became proportionally more female and older. The study population had higher odds of requiring restraints and antipsychotics during the pandemic. CONCLUSIONS: More pediatric inpatients at the study site have required psychiatric care during the pandemic. The severity of mental illness in this population appears to have worsened based on increased utilization of as-needed psychotropic medications and restraints. These findings highlight the changes experienced by patients and providers during the pandemic and merit further study.

Multisectoral actions of mental health during the COVID-19 pandemic in Mazandaran province of Iran.

AIM: A widespread outbreak of COVID-19 is followed by adverse effects on the mental health of the general population. Therefore, this study is an audit to investigate the activities of various organizations during the COVID-19 pandemic in Mazandaran Province, Iran. METHODS: The aim of the study was to collect the data, the relevant officials in various organizations and units were contacted to collect the statistics of actions taken in psychology and psychiatry wards. Moreover, databases such as Google Scholar and Iranian resources were searched. RESULTS: According to the results, different healthcare systems worked in parallel during the peak of the COVID-19 pandemic. For example, Mazandaran University of Medical Science [MAZUMS] Health Vice-Chancellor performed the following activities during this crisis: establishing a virtual crisis management working group, holding a provincial educational committee to train the crisis management teams, organizing virtual psychological intervention teams in the healthcare systems, and so forth. In addition, the mental health activities by Mazandaran Welfare Organization during the COVID-19 outbreak included providing hostelry free psychological counseling, quarantine boarding and rehabilitation centers, and providing harm prevention protocols of COVID-19, especially for marginalized regions. In the third level of medical centers, including hospitals, consultation-liaison psychiatry or psychiatrists and clinical psychologists, therapeutic interventions for comorbid psychiatric disorders with COVID-19 disease, and online workshops for mental health were conducted to reduce burnout of medical staff and nurses. CONCLUSION: This study can provide a good guideline for different service providers by using the experiences of other centers to achieve better results.

Delirium in COVID-19 and post-liver transplant patients: an observational study.

OBJECTIVE: Delirium is a major complication in hospitalised patients. This study aimed to compare the mortality trends of patients with delirium according to the underlying physical condition. METHODS: Hospitalised patients diagnosed with delirium by the Modena Consultation-Liaison Psychiatry Service (Italy) during 2020 were enrolled. Three groups were identified: COVID; after orthotopic liver transplant (OLT); other conditions. The full medical records were screened to retrieve socio-demographic and clinical data. INTERMED score and Delirium Rating Scale were used to retrospectively rate bio-social-complexity and delirium severity. Early (20 days) and end of study (31st January 2021) mortality were ascertained for each subject. RESULTS: A total of 103 patients were enrolled. Patients hospitalised for COVID showed higher INTERMED scores (two-tailed t-test, p = 0.019) and higher 20-day mortality (HR = 3.68, p = 0.014). When considering a 1-year follow-up, the main predictor of mortality was patients' age in all three subgroups (HR = 1.06; p = 0.003). CONCLUSION: Our results suggest that patients hospitalised for COVID-19 with delirium showed higher bio-psycho-social complexity and higher short-term mortality, regardless of the severity of delirium. OLT patients showed lower mortality and bio-psycho-social complexity, despite being still considered as 'complex', according to the INTERMED score. Future research should focus on understanding the underlying mechanisms in the relationship between delirium and mortality.Key pointsPatients hospitalised for COVID-19 with delirium were found at risk of higher short-term mortality and higher bio-psycho-social complexity.OLT patients showed lower overall mortality and lower bio-psycho-social complexity than the other two groups, despite being still in the 'complex' range according to the INTERMED score.Future research should assess the areas of impact of delirium in patients affected by COVID-19, considering short- and long-term outcomes.

Relapse in bipolar disorder in hospitalized patients with COVID-19: A case series and key recommendations.

COVID-19 has adversely affected the lives of people with bipolar disorder (BD). We have reported three patients with BD, who suffered from relapse after being diagnosed with COVID-19. Patient X is a 54-year-old man who developed manic episode, while Y is a 63-year-old man and Z is a 52-year-old woman who developed severe depression after being hospitalized for COVID-19. In this case series, three patients with BD who developed manic or depressive episodes during COVID-19 infection have been described. Adequate liaison between consultation-liaison psychiatrist and primary medical team was done. Rational pharmacotherapy along with psychosocial interventions led to favorable outcomes in all three cases.

Survey of Clinician Experiences of Telepsychiatry and Tele-Consultation-Liaison Psychiatry.

BACKGROUND: The COVID-19 pandemic created pressure to implement telepsychiatry across practice models. OBJECTIVE: We sought to evaluate the overall success of this change and to identify what types of practice settings, provider groups, and patient groups were best served by telepsychiatry and telepsychotherapy utilization. We were particularly interested in how providers of consultation-liaison psychiatry adapted to remote care. METHODS: An anonymous provider survey querying demographics, education, training, technological experience, practice setting, treatment modalities, patient groups, transition process, and outcomes was made openly available via social media and professional listservs. We used multivariable regression modeling to evaluate for predictors of the positive outcomes of overall satisfaction, subjective ability to diagnose and treat patients adequately using exclusively telepsychiatric platforms, and patient satisfaction by proxy. RESULTS: Three hundred thirty-three respondents, mostly young (59.4% younger than 50 years), female (69.7%), and physicians (67.9%), completed the survey. One hundred ninety-seven (59.1%) worked in consultation-liaison psychiatry. Of the total, 85.9% gave affirmative answers to overall satisfaction. Multivariable linear regression models found that satisfaction was predicted by general comfort with technology (P < 0.001), but negatively correlated with having technical issues (P < 0.001), a priori skepticism (P < 0.001), clinician being male (P = 0.004), and treating LGBTQ+ patients (P = 0.022). Completeness was associated with having training in telehealth (P = 0.039) and general comfort with technology (P < 0.001) but negatively associated with treating LGBTQ+ patients (P = 0.024) or inpatients (P = 0.002). Patient satisfaction by proxy was positively associated with general comfort with technology (P < 0.001) and the respondent being a nonphysician (P = 0.004) and negatively associated with encountering a technical issue (P = 0.013) or treating inpatients (P = 0.045). Consultation-liaison psychiatrists had similar results overall and were more likely to have other staff assist in making televisits effective (mean [standard deviation]: -1.25 [3.57] versus -2.76 [3.27], P < 0.001) especially if consultative (mean [standard deviation]: -0.87 [3.67] versus -2.39 [3.01], P = 0.010). CONCLUSIONS: This study suggests high rates of overall satisfaction in telepsychiatry adoption, even in consultation-liaison psychiatry. There is distinct benefit in bolstering training, providing technical support, and addressing skepticism. Future research should include patient surveys and control groups and should focus on vulnerable populations such as sexual and gender minorities.

Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar.

BACKGROUND: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. METHODS: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. RESULTS: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. CONCLUSION: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.

Design and Implementation of a Regional Inpatient Psychiatry Unit for Patients who are Positive for Asymptomatic SARS-CoV-2.

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.

Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital.

BACKGROUND: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. METHOD: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal-Wallis test, and fisher exact test. RESULTS: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. CONCLUSIONS: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey.

BACKGROUND: The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE: This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS: A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS: Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS: To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.

Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument.

BACKGROUND: As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. OBJECTIVE: We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. METHODS: The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. RESULTS: Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION: These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.