Trauma-focused therapy in early intervention for psychosis settings: Results of a feasibility RCT of 'EMDR for psychosis'

Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.

Association Between COVID-19 Pandemic and Serious Mental Illness: Systematic Review within Salutogenesis Model for Public Health Management

Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.

Inpatient forensic psychiatry in the time of COVID-19: a survey study of perceived mental health implications on people with schizophrenia spectrum disorder

Background: The aim of our study was to assess the perceived mental health impact of the COVID-19 pandemic on people with schizophrenia spectrum disorder (SSD) in an inpatient forensic psychiatric institution and to identify personal networks most crucial for the patient during the pandemic. Method(s): In this cross-sectional survey study, 44 patients with SSD took part in a COVID-19-specific interview. The data was correlated with the Positive and Negative Syndrome Scale (PANSS) to evaluate the patients' psychopathology. In addition, we investigated subgroups of vaccinated and unvaccinated patients to analyze possible differences in psychopathology. Result(s): Less contact with family members was associated with significantly higher PANSS scores (p < 0.05). Patients who reported to feel less relaxed and more stressed during the pandemic than they had been before the outbreak of the virus showed significantly higher PANSS scores (p < 0.05). Unvaccinated patients demonstrated significantly higher PANSS scores than their vaccinated controls (p < 0.05). Conclusion(s): Social support from family members played an important role for people with SSD in inpatient forensic psychiatric institutions during the pandemic. Moreover, individuals with SSD seemed to be more emotionally vulnerable during the pandemic. A more pronounced symptomatology in patients with SSD might be a potential barrier to immunization against COVID-19.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

A brief cognitive assessment of patients with schizophrenia and its correlation with disease severity

Background-Schizophrenia is a complex, heterogeneous behavioural and cognitive syndrome whose origins appear to lie in genetic and/or environmental disruption of brain development, Cognitive functions are required to perform in the spheres of personal, social, and occupational activities of everyday life. .Restoring cognitive function or bypassing cognitive impairment could significantly contribute to better outcome and recovery in schizophrenia. Aim-. To assess the cognitive functions in patients with schizophrenia and To study the relationship between cognition and disease severity Methods-Cross sectional study done on 50 patients with schizophrenia visiting SDM hospital Dharwad, disease severity measured using PANSS, and cognitive assesment using BACS Result-. The Brief Assessment of Cognition in Schizophrenia (BACS) assessed the aspects of cognition found to be most impaired and most strongly correlated with outcome in patients with schizophrenia Conclusion-Cognitive functions are responsible for better day to day functioning and are related to functioning impairment in everyday living skills;hence by improving cognition, patient's functioning in everyday living skills may improve, giving them a better chance of vocational and independent living success.

THE RISK PERCEPTION DURING COVID-19 IN A PSYCHIATRIC POPULATION: A CROSSSECTIONAL OBSERVATIONAL STUDY

SCOPO DEL LAVORO: The Coronavirus Disease 2019 (COVID-19) is a syndrome caused by a new Coronavirus strain, diagnosed for the first time in China and subsequently spread throughout the world. For this reason, on January 2020 the World Health Organization (WHO) declared a state of pandemic. In Italy, the first case of COVID-19 was reported on February 2020. Since then, the Italian Government imposed some restrictions, such as social distancing, in some cases confinement, that have contributed to generate a great psychological distress and forced people to seek new strategies to cope to the emergency. The American Psychological Association (APA) defines the perception of risk as an “individual's subjective assessment of the level of risk associated with a particular hazard”. The risk perception has a strong impact on changing people's choices in the face of events and it can be divided into a rational part and a heuristic part guided by emotions. The aim of this study was to evaluate the perception of risk in three groups of psychiatric patients (depressed, bipolar and schizophrenic) in order to address which categories of patients were most vulnerable during an emergency situation and to evaluate future choices on public health and emergency planning. MATERIALI E METODI: A cross-sectional observational study was conducted on an outpatient setting between January 2021 and February 2021, which was during of Phase 2 of the Italian COVID-19 lockdown. Patients were previously tested to check the clinical stability through Drug Attitude Inventory (DAI), Quality of Life Index (QLF), Insight Scale (IS) and Short Form-12 Health Survey (SF-12), Positive and Negative Syndrome Scale (PANSS) for schizophrenic patients, Hamilton Rating Scale for Depression (MADRS) for depressed patients and MADRS plus Young Mania Rating Scale (YMRS) for bipolar patients. In addition, we used a questionnaire proposed by Lanciano et al., (2020) composed by 10 items to assess the perception of risk, risk-related variables and emotional states during COVID-19 emergency. RISULTATI: There were no statistical differences among the three groups of patients, thus the suggesting an homogeneity of the sample. Results showed that patients were more concerned about economic, psychologic and interpersonal consequences of COVID-19 pandemic, than about their own health. Positive and anxiety related emotions were the most frequent. In the multiple regression analysis, the likelihood of COVID resolution was positively correlated with the diagnosis of schizophrenia, the increased perceived effectiveness, and the presence of positive emotions. The perception of knowledge of the COVID phenomenon positively influenced both the institutional-economy risk and the psychological risk. Finally, positive emotions and uncertainty positively influenced the interpersonal risk. CONCLUSIONI: Our study highlight the need to give more attention to support psychiatric patients during emergency situations to reduce the perceived isolation. to prevent them from engaging in risky behavior.

A Review on Schizophrenia: Outline and Treatment

Schizophrenia is a debilitating, genetic brain condition caused by anomalies that appear early in infancy and interrupt normal brain development. It has a lifetime risk of 1% and affects people of all ages, with around 10% dying by suicide. COVID-19 may raise the risk of mortality and morbidity in people with schizophrenia. Although antipsychotic medications of the first, second, and third generations are the most commonly prescribed treatments for schizophrenia, they are linked to major side effects such as tardive dyskinesia, oxidative stress, and EPS. Ayurvedic herbal medications and some dietary supplements score well in this category since they can be taken for a long time without causing major adverse effects and have antioxidant properties. Low potency first generation antipsychotics, sedating antihistamines, and benzodiazepines, as well as inhalable antipsychotics, oral and short acting injectable olanzapine, and ziprasidone, as well as low potency first generation antipsychotics, sedating antihistamines, and benzodiazepines, should be avoided or closely monitored for patients with COVID-19. Mentally ill patients with COVID-19 should be segregated if at all possible, and employees should be adequately protected.

P.0447 The psychopathological impact of the SARS-CoV-2 epidemic on subjects suffering from mental disorders: an observational retrospective study

Introduction: SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide in 2020, leading the World Health Organization (WHO) to declare a pandemic [1] and the Italian government firstly to declare a state of emergency, then to impose restrictive measures lasting about two months. COVID-19 pandemic generated fear, anxiety, depression and post-traumatic symptoms in the general population [2,3] as well as among subjects affected by mental disorders [4]. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders. Aims: To investigate potential psychopathological changes over time during the first wave of COVID-19 pandemic comparing different psychiatric disorders. Methods: Data about demographic/clinical variables and psychopathological status were retrospectively collected. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Primary outcomes: Brief Psychiatry Rating Scale (BPRS), Clinical Global Impression (CGI), Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes: Disability Scale (DISS), Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAM-D), Montgomery and Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Descriptive analyses and linear regression models were performed. Summary of results: A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2 (p<0.05). Only psychotic and OC symptoms did not significantly improve at T2. Primary outcomes: time had a significant effect on the change of BPRS (F=26.56;p<0.001), CGI-severity (F=8.29;p<0.001), CGI-improvement (F=41.88;p<0.001) and HAM-A (F=33.63;p<0.001) scores. BPRS and CGI-S scores were higher among subjects affected by personality disorders (PDs) than in the depressed (MDD) and anxiety/obsessive-compulsive (OC) groups (p<0.05). PD patients also showed higher HAM-A scores than schizophrenia (SKZ) ones (p=0.02). Secondary outcomes: Time had a significant effect on the change of DISS-stress (F=40.80;p<0.001), DISS-support (F=9.26;p<0.001), HAM-D (F=9.50;p<0.001) and MADRS (F=9.40;p<0.001) scores. The time effect was not significant for DISS-disability (F=1.23;p=0.29), PANSS (F=1.37;p=0.26), YMRS (F=2.84;p=0.06) and Y-BOCS (F=0.55;p=0.59) scores. DISS-disability scores were higher in the PD group with respect to bipolar disorder (BD) (p=0.009), MDD (p<0.001) and anxiety/OCD (p=0.03) groups;SKZ and BD patients had lower DISS-stress scores than PD ones (both p values = 0.02). Conclusions: Patients affected by PDs showed to be particularly affected by the negative effects of outbreaks on mental health and perhaps they require specific clinical attention in case of traumatic events such as pandemics. Moreover, although SKZ patients reported lower anxiety levels than PD ones, the worsening of psychotic and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples would allow an in-depth comparison of the psychopathological impact of pandemics between the different psychiatric diagnoses. The study has been registered on ClinicalTrials.gov with the following ID number: NCT04694482 No conflict of interest