Fitting in an Unfit Society With Autism Spectrum Disorder: Case Report.

Evaluating behavioral mimicking is important in healthcare providers' everyday functioning with an increased presentation of Tourette syndrome-like cases during the COVID-19 pandemic, seen due to the popular video creators on social media (e.g., TikTok) exhibiting these behaviors. Individuals with autism spectrum disorder (ASD) face difficulties with connection and assimilation, and they adapt by camouflaging their behaviors to fit with those of the neurotypical majority. Our team evaluated the behaviors of one individual with ASD to establish whether camouflaging was playing a role in her psychiatric stabilization in our inpatient psychiatric unit. We present a case of a 30-year-old female with ASD, admitted to our long-term inpatient psychiatric facility for significant mood dysregulation that persisted despite numerous treatment approaches (mediations, groups, etc.). While her initial behaviors included head banging and self-induced falls, her behaviors seemed to change based on those of her peers, in an apparent attempt to camouflage into the social environment within the unit. She also appeared to learn new self-harm behaviors, such as skin picking, from peers around her. The team was able to establish a temporal link between some instances of peers exhibiting specific behaviors and our patient engaging in similar behavior. Although inpatient units effectively manage long-term stabilization in other psychiatric disorders, these environments are not designed for individuals with ASD. Treatment teams should recognize the malleability of behaviors in patients with ASD and must identify and manage behavioral mimicking early during inpatient psychiatric treatment; otherwise, it may lead to significant harm.

Psychology Internship Training Amidst COVID-19: Balancing Training Opportunities, Patient Care, and Risk of Exposure.

The emergence of the 2019 novel coronavirus (COVID-19) has dramatically altered how psychologists deliver its training. At least for the time being, virtual care has become the primary method for delivering mental health services. This has allowed patients and clinicians to continue to access and provide services in a way that would have been impossible years ago. Not only has this shift impacted patients, but it has also impacted supervision and training. The impact has been especially profound on inpatient units where the psychiatric and medical acuity is high of patients and the therapeutic milieu is an important aspect of treatment. The purpose of this paper is to review the impact of COVID-19 on pre-doctoral psychology interns during their rotation on an inpatient psychiatry unit at the start of the pandemic (January to June of 2020) and use these experiences to onboard the next class of interns in the new academic year (July 2020 to June 2021) using a hybrid model of in-person and virtual training experiences. At the end of 2020/2021 rotation, we voluntarily asked interns to complete a questionnaire that was developed based on the qualitative experiences of the previous class to assess the effectiveness of this hybrid model. We also surveyed multi-disciplinary staff members who were essential personnel and required to work in person during this time about their experiences of safety and support. With this information, we explore and offer guidance to other inpatient training sites who are likely to encounter similar challenges during this time. In particular, we discuss the integration of virtual technology into this training experience, as well as the restructuring of clinical and supervisory experiences. We highlighted several short-term strategies that we have flexibly adapted to our inpatient unit. The lessons learned herein seek to guide supervisors and trainees alike in adapting their psychology training programs to meet the evolving demands of COVID-19.

COVID-19 and the emergence of inpatient tele-ward rounds

Introduction: Telemedicine has been at the heart of healthcare system's strategic response to the COVID-19 pandemic. Within psychiatry, there has been a surge of research and guidelines into the use of video-teleconferencing to replace face to face consultations across clinical settings. Clinical ward rounds are central to inpatient psychiatric care yet little guidance is available on how best to integrate telemedicine into the multidisciplinary work of inpatient psychiatry. Objective(s): We report on the introduction of video teleconferencing for psychiatric ward rounds on our acute inner-London psychiatric unit during the outbreak of COVID-19. Method(s): In undertaking the rapid transition to tele-ward rounds, we had to reconcile the multiple functions of psychiatric ward rounds with the technological resources available to us. Result(s): Tele-ward rounds helped simplify care delivery, facilitate multidisciplinary collaboration and improve accessibility for patients and relatives in a time of crisis. The transition to teleward rounds also brought about technical, operational and communication issues that may impact on the patient experience and quality of care including governance challenges, contextual dissonance and technological limitations. Conclusion(s): The routine use of newer technology in psychiatry ward rounds is unlikely to succeed on the basis of improvisation, particularly given the stream of technical innovations in telemedicine, and the multifarious quality of social interactions in our clinical setting. Staff training and the development of an adapted etiquette and code of communication are both essential. Patient participation in future developments will also help ensure tele-ward rounds continue to meet the standards of high quality inpatient psychiatric care beyond the COVID-19 pandemic.

Inpatient Psychiatry During COVID-19: A Systems Perspective.

Numerous reports describe how individual hospitals responded to the COVID-19 pandemic, but few describe how these changes occurred across a large public health system of care. As the early epicenter of the pandemic, New York State's response, particularly the New York City metropolitan area, included a range of coordinated planning and regulatory efforts to preserve and create medical and intensive care unit capacity where needed; maintain access to acute psychiatric services; and redefine inpatient psychiatric care through strict infection control, easing of regulatory requirements, and use of telehealth. These strategies reflected similar efforts across the United States.

Shifts in inpatient psychiatry utilization patterns at a U.S. Academic Medical Center during the COVID-19 pandemic.

The COVID-19 pandemic has impacted utilization volumes and patterns for inpatient psychiatry, though reports have noted inconsistencies on small populations. We obtained demographic and diagnostic data from a retrospective cohort of admitted psychiatric patients at a single-site from March-July 2020 and the corresponding months in 2019. Despite controlling for the modest decrease in inpatient admissions, no statistically significant changes in demographics or utilization was found, except for an increase in patients with substance use disorder (p<0.001). These early findings highlight the demand and necessity for inpatient psychiatry services even during the first COVID-19 spike.

Challenges With Long-Term Care Placement in Pediatric Psychiatry During COVID-19: A Case Series From Inpatient Unit.

A large number of children and youth have been affected worldwide during the coronavirus disease 2019 (COVID-19) pandemic. Apart from the obvious medical and financial impacts of the COVID-19 pandemic, there has been an immense amount of psychosocial impact specifically on children and adolescents ranging from parents losing their jobs leading to financial hardships to school closure leading to not having significant interaction with their peers and having to spend more time at home which often leads to psychosocial conflicts. According to the literature review, in recent times, there has been worsening of mental health illnesses, increased suicide attempts, and severity of suicide attempts which has led to more visits to the hospitals and clinics with psychiatric concerns. There has been a pattern of increasing patient acuity in inpatient psychiatric units, more specifically in the pediatric units. The average length of stay for inpatient units has been increasing in the pediatric psychiatric units and an unfortunate downside of which has been noted to be increased lag time for placements in foster care systems or residential treatment centers in recent times. Here, we present cases of three teenagers who faced significant challenges in obtaining placement to foster care systems or residential treatment centers in the context of longer wait times experienced for intensive-out-of-home treatment services during the COVID-19 pandemic and discuss potential solutions to this issue.

Impact of SARS-CoV-2 infection and implementation of infection prevention and control (IPC) measures on inpatient psychiatric units.

Psychiatric inpatients are at high risk of acquiring and transmitting communicable diseases such as SARS-CoV-2 (COVID-19). Via chart review, the authors examined a cohort of COVID-positive psychiatric inpatients admitted between March and June of 2020, early in the pandemic, to Valleywise Health Medical Center (VMHC), in Arizona, USA. The goal was to assess the ways in which the virus itself as well as infection prevention and control (IPC) measures affected psychiatric inpatients. Variables examined included demographics, psychiatric diagnoses, COVID-19 symptoms, medical comorbidities, and length of stay. Behavioral health faciltiies encountered significant challenges in blalancing the need for a therapeutic milieu and compliance with IPC measures. During the study period, 39 patients and 15 staff members contracted COVID. All but one COVID-positive staff member provided direct patient care. During the study period, VMHC behavioral health facilities were largely successful in identifying and quarantining COVID-positive patients. The hospital's IPC policies/procedures were constantly updated to incorporate new guidelines and address emerging knowledge about the virus, which may have lowered transmission rates and mitigated potential complications. To preserve quallity and safety of psychiatric care, the therapeutic milieu was altered, which may have adversely affected patient care and/or lengthened hospital stay.

Maintaining a Bronx inpatient psychiatry service at full capacity during the COVID-19 pandemic.

PURPOSE: The purpose of this article is to present an overview of rapidly transformed workflows on our inpatient psychiatry service during COVID-19 pandemic outbreak in New York. CONCLUSION: Rapidly transformed workflows, staffing patterns and discharge policies, as well as programs addressing the emotional and social needs of our staff enabled us to not only run our service without interruptions and maintain full inpatient census but also prevent the spread of COVID-19. PRACTICE IMPLICATIONS: The challenges we faced and lessons we learned can be easily applied to other inpatient psychiatry services as we anticipate the second surge of COVID-19 infection.

Epidemiology, Infection Prevention, Testing Data, and Clinical Outcomes of COVID-19 on Five Inpatient Psychiatric Units in a large Academic Medical Center.

Inpatient psychiatric facilities can face significant challenges in containing infectious outbreaks during the COVID-19 pandemic. The main objective of this study was to characterize the epidemiology, testing data, and containment protocols of COVID-19 in a large academic medical center during the height of the COVID-19 outbreak. A retrospective cohort analysis was conducted on hospitalized individuals on five inpatient psychiatric units from March 1st to July 8th, 2020. Demographic data collected include age, race, gender, ethnicity, diagnosis, and admission status (one or multiple admissions). In addition, a Gantt chart was used to assess outbreak data and timelines for one unit. Testing data was collected for patients admitted to inpatient psychiatric units, emergency room visits, and employees. 964 individuals were hospitalized psychiatrically. The study population included ethnically diverse patients with various mental illnesses. We also describe infection prevention strategies, screening, and triage protocols utilized to safely continue patient flow during and beyond the study period with a low patient and employee infection rate. In summary, our study suggests that early implementation of triage, screening, extensive testing, and unit-specific interventions can help prevent and contain the spread of COVID-19 in inpatient psychiatric units and help facilitate safe delivery of care during a pandemic.

Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit.

OBJECTIVES: The first known COVID-19 outbreak in a long-term care facility in the United States was identified on February 28, 2020, in King County, Washington. That facility became the initial U.S. epicenter of the COVID-19 pandemic when they discovered 129 cases associated with the outbreak (81 residents, 34 staff members, and 14 visitors) and 23 persons died. The vulnerability of the elderly population, shared living and social spaces, suboptimal infection control practices, and prolonged contact between residents were identified as contributing factors to the rapid spread of the disease. The first known case of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a U.S. inpatient geriatric psychiatry unit was also in King County, Washington, and occurred soon afterward on March 11th, 2020. Between March 11 and March 18, nine inpatients and seven staff members were confirmed to have SARS-CoV-2 infection. This article examines how the swift identification and isolation of confirmed patients, an enhanced infection prevention protocol, and engagement of frontline psychiatric care staff prevented a catastrophic outcome in a vulnerable population. METHODS: Here we describe infection control and nursing-led interventions that were quickly enacted in response to this SARS-CoV-2 outbreak in an inpatient geriatric psychiatry unit. RESULTS: The interventions effectively contained the outbreak, with no further patients and only one staff member testing positive for SARS-CoV-2 over the subsequent 2-month time period. CONCLUSIONS: We share our learnings and preventative infection control measures that can be adapted to a variety of settings to prevent or contain future outbreaks of COVID-19.

Prolonged persistence of PCR-detectable virus during an outbreak of SARS-CoV-2 in an inpatient geriatric psychiatry unit in King County, Washington.

BACKGROUND: We describe key characteristics, interventions, and outcomes of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak within an inpatient geriatric psychiatry unit at the University of Washington Medical Center - Northwest. METHODS: After identifying 2 patients with SARS-CoV-2 infection on March 11, 2020, we conducted an outbreak investigation and employed targeted interventions including: screening of patients and staff; isolation and cohorting of confirmed cases; serial testing; and enhanced infection prevention measures. RESULTS: We identified 10 patients and 7 staff members with SARS-CoV-2 infection. Thirty percent of patients (n = 3) remained asymptomatic over the course of infection. Among SARS-CoV-2 positive patients, fever (n = 5, 50%) and cough (n = 4, 40%) were the most common symptoms. Median duration of reverse transcription polymerase chain reaction (RT-PCR) positivity was 25.5 days (interquartile range [IQR] 22.8-41.8) among symptomatic patients and 22.0 days (IQR 19.5-25.5) among asymptomatic patients. Median initial (19.0, IQR 18.7-25.7 vs 21.7, IQR 20.7-25.6) and nadir (18.9, IQR 18.2-20.3 vs 19.8, IQR 17.0-20.7) cycle threshold values were similar across symptomatic and asymptomatic patients, respectively. CONCLUSIONS: Asymptomatic infection was common in this cohort of hospitalized, elderly individuals despite similar duration of SARS-CoV-2 RT-PCR positivity and cycle threshold values among symptomatic and asymptomatic patients.

COVID-19 and acute inpatient psychiatry: the shape of things to come.

Psychiatric services that provide acute inpatient care have to respond to the challenges brought about by the COVID-19 pandemic to consistently deliver high standards of treatment to patients and ensure the safety of staff. This can only be achieved by fostering a culture that rewards initiative and empowers inpatient teams to implement and comply with changes which everyone understands and benefits from. The experience of an inner London acute psychiatric unit has shown the value of combining proactive leadership, multidisciplinary decision making and good communication in adapting services to an everchanging environment. Practical solutions have emerged that have improved service delivery and patient care, and which will likely outlast the COVID-19 pandemic. These include changes to team work and routine, streamlining patient care with a focus on goal directed admissions, developing a healthier work environment and adopting novel technology in patient care and multidisciplinary collaboration.KEY POINTSPsychiatric inpatient units have to manage the COVID-19 crisis alongside the risk of acutely disturbed behaviour, while ensuring high standards of care and patient throughput.To respond to the COVID-19 crisis, inpatient units have to foster a culture that rewards initiative and empowers teams to implement and comply with changes that everyone understands and benefits from.Adaptive strategies should include good communication, a healthy work environment, flexible rules, dynamic infection control and adopting novel technology for clinical care and multidisciplinary work.Proactive leadership, multidisciplinary teamwork, transparency and a shared ethos of responsibility are the main tools to build effective inpatient teams.