Fears and anxieties of pregnant women facing the pandemic

Pregnancy and the entire mothering process is always a very big challenge, which involves physical and emotional changes in women. Currently, with the numbers of cases confirmed by COVID-19 growing every day in our city, everything is uncertain. This whole scenario brought many anxieties, concerns and ques- tions. This is no different with pregnant women, on the contrary, their fears and anxieties have multiplied during this period. The project, through a field study, aimed to assess the emotional state of the pregnant woman in relation to the pandemic COVID-19. A quantitative research was carried out, with the application of a virtual questionnaire prepared by the author herself. 39 pregnant women who are monitoring their prenatal care at a clinic in the city of Tres Coracoes - MG were interviewed. The research appli- cation was released with an opinion embodied under the number of CAAE 39410820.9.0000.5158 and authorization from the res- ponsible nurse, where the contact phones of the pregnant women were noted so that the questionnaire could be applied in a virtual way, through the Google Forms platform, after the term agree- ment. It was found that psychological disorders appeared in 51.3% of the study population and 48.7% who already had some disorder such as anxiety and depression stated that their clinical condition worsened with the pandemic. This target audience is a group considered at risk by the World Health Organization. It should be given full support and support, through guidance on preventive measures and complete assistance by a multidiscipli- nary team.

A Case Report of Psychogenic Non-epileptic Seizures in a 29-Year-Old Male With Schizophrenia.

Psychogenic non-epileptic seizures (PNES) involve episodes of movement, sensation, or behaviors that may appear clinically similar to epileptic seizures but without cortical electroencephalographic activity that defines epileptic seizures. This case report involves a 29-year-old male with a history of type I diabetes mellitus, schizophrenia, and a prior suicide attempt via insulin overdose. He was admitted to the emergency department after being found unresponsive on the floor in his bedroom. Given the nature of his prior suicide attempt, he was initially treated for hypoglycemic coma. After arrival at the emergency department, he was noted to have normal blood glucose but displayed symptoms of acute psychosis and was transferred to the behavioral health unit, where subsequent paroxysmal episodes with seizure-like features were observed. He then underwent video-electroencephalography monitoring to evaluate for epilepsy. After no epileptic activity was recorded, he was transferred back to the behavioral health unit and treated for underlying schizophrenia and suspected PNES. After showing gradual improvement on antipsychotic medication, no further seizure-like activity was observed. His stay was complicated by a SARS-CoV-2 infection, which he recovered from without complication, and he was released on day 11. Extensive education was provided for the patient and his family on recognizing the symptoms of PNES and the importance of adherence to antipsychotic medication to avoid psychiatric decompensation and PNES recurrence. This case report highlights the challenge of diagnosing and treating a patient with PNES with underlying psychiatric comorbidities and a history of insulin overdose.

Research Roundup

George Winter provides an overview of recently published articles that are of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.

Experience of psychosis during the COVID-19 pandemic among hospitalized patients

The content of auditory hallucinations (AHs) and delusions is malleable and reflects the social environment and the local culture. COVID-19 is a significant new feature of the social environment, yet research has not yet determined how the phenomenology of psychosis has changed since the COVID-19 outbreak. Adult patients (N = 17) receiving care within an acute inpatient psychiatric care setting in Boston were recruited to participate in an hour-long Zoom interview about their psychosis phenomenology and the potential impact of COVID-19. Thematic analysis of interview data found that for many, ideas about COVID-19 were present in the content of their AHs and shaped their paranoid ideation. Some felt that the frequency and loudness of the AHs had increased. However, not all participants spoke in ways that suggested the virus had affected their experience. Results demonstrate that COVID-19 influenced the content of psychosis for many, but the effect of COVID-19 on psychosis was not uniform. The increased social isolation, financial insecurity, and socio-political climate of the period also seemed to negatively impact individuals with psychosis. Understanding how COVID-19 specifically has influenced psychosis helps to illustrate how societal and external factors may shape this experience.

Factors influencing effective prevention behavior among medical care workers during epidemic

Objective: To identify the influencing factors of effective prevention behaviors among medical staff during the COVID-19 pandemic in China. Methods: A total of 863 medical care workers were recruited from hospitals of some regions in China from February to March, 2020. Depression, anxiety and stress scale (DASS), the perceived social support scale (PSSS), simplified coping style questionnaire (SCSQ) and some self-developed scales were used to collect information of the study participants. Pearson correlation analysis was used to test the correlation between variables;Mplus was used to build a structural equation model to analyze the direct and indirect factors affecting the effective prevention behavior of these medical personnel. Results: The score of effective preventive behavior of 863 medical staff was (50.18 +or- 4.99). Anxiety was weakly negatively correlated with effective prevention behavior (r = - 0.139, P < 0.05), and positive coping style, attitude, perceived severity, behavior skills and perceived social support were weakly positively correlated with effective prevention behavior (r = 0.258, 0.104, 0.131, 0.302, 0.276, P < 0.05, respectively). The fitting degree of the established structural equation model was good (X 2/df = 2.829, CFI = 0.931, TLI = 0.920, RMSEA = 0.046, SRMR = 0.045). The perceived social support had an impact on effective prevention behavior, and its total effect(beta = 0.270) and direct effect(beta = 0.134) were statistically significant (P < 0.05). Positive coping style could play a part of intermediary role between understanding social support and effective prevention behavior(beta = 0.049, P = 0.019), behavioral skills could play a partial intermediary role between understanding social support and effective prevention of behavior(beta = 0.061, P = 0.002), anxiety, attitude and behavior skills could play a chain intermediary role between understanding social support and effectively preventing behavior(beta = 0.002, P = 0.012), and anxiety, perceived severity, and behavioral skills can play a chain intermediary role between understanding social support and effectively preventing behavior(beta = - 0.001, P = 0.028), with the ratio of intermediary effect to total effect 0.181, 0.226, 0.007, - 0.004 (P < 0.05), respectively. Conclusions: By improving the understanding of social support, positive attitude and coping strategies, and improving the behavior skills can promote medical staff to take effective preventive behavior.

A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia.

The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.

Clozapine treatment and risk of COVID-19.

The antipsychotic clozapine is known to have immune-modulating effects. Clozapine treatment has been reported to be associated with increased risk of COVID-19 infection. However, it remains unclear whether this is because of increased testing of this patient group, who are closely monitored. We linked anonymised health records from mental health services in Cambridgeshire (UK), for patients taking antipsychotic medication, with data from the local COVID-19 testing hub. Patients receiving clozapine were more likely to be tested for COVID-19, but not to test positive. Increased testing in patients receiving clozapine suggests prudent judgement by clinicians, considering the overall health vulnerabilities of this group.

Relationships between COVID-19 disease and mental disorders: A view from practice inclinical psychology

(Slovak) V teto studii se autor zameruje na tri okruhy problemu, ktere pozoruje v oblasti prime ambulantni pece o dusevni zdravi v souvislosti s nemoci covid-19. Jedna se o problematiku: 1) neuropsychologickych deficitu;2) uzkostnych a afektivnich poruch;3) psychotickych poruch. K dosavadnim prehledovym studiim z posledniho roku se snazi doplnit pozorovani z vlastni klinicko- -psychologicke praxe a upozornit na nutnost pripravy a dostatecne kapacity zdravotnich sluzeb v oblasti pece o dusevni zdravi. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact of high prebiotic and probiotic dietary education in the SARS-CoV-2 era: improved cardio-metabolic profile in schizophrenia spectrum disorders.

BACKGROUND: The development of new aetiological premises, such as the microbiota-gut-brain axis theory, evidences the influence of dietary and nutritional patterns on mental health, affecting the patient's quality of life in terms of physical and cardiovascular health. The aim was to determine the impact of a nutritional programme focused on increasing the intake of prebiotic and probiotic food on cardio-metabolic status in individuals with schizophrenia spectrum disorders in the contextual setting of the SARS-CoV-2 era. METHODS: A randomised clinical trial (two-arm, double-blind, balanced-block, six-month intervention) was conducted in a group of 50 individuals diagnosed with schizophrenia spectrum disorder during the SARS-CoV-2 confinement period. The control group received conventional dietary counselling on an individual basis. In the intervention group, an individual nutritional education programme with a high content of prebiotics and probiotics (dairy and fermented foods, green leafy vegetables, high-fibre fruit, whole grains, etc.) was established. Data on cardiovascular status were collected at baseline, three and six months. In addition, anthropometric parameters were analysed monthly. RESULTS: Forty-four subjects completed follow-up and were analysed. Statistical differences (p < 0.05) were found in all anthropometric variables at baseline and six months of intervention. A 27.4% reduction in the prevalence of metabolic syndrome risk factors in all its components was evidenced, leading to a clinically significant improvement (decrease in cardiovascular risk) in the intervention group at six months. CONCLUSIONS: The development of a nutritional programme focused on increasing the dietary content of prebiotics and probiotics effectively improves the cardio-metabolic profile in schizophrenia spectrum disorders. Therefore, nursing assumes an essential role in the effectiveness of dietary interventions through nutritional education and the promotion of healthy lifestyles. Likewise, nursing acquires a relevant role in interdisciplinary coordination in confinement contexts. TRIAL REGISTRATION: The study protocol complied with the Declaration of Helsinki for medical studies; the study received ethical approval from referral Research Ethics Committee in November 2019 (reg. no. 468) and retrospectively registered in clinicaltrials.gov (NCT04366401. First Submitted: 28th April 2020; First Registration: 25th June 2020).

Comparison of Healthcare Utilization Between Telemedicine and Standard Care: A Propensity-Score Matched Cohort Study Among Individuals With Chronic Psychotic Disorders in Ontario, Canada.

Background: Telemedicine adoption has grown significantly due to the coronavirus of 2019 pandemic; however, it remains unclear what the impact of widespread telemedicine use is on healthcare utilization among individuals with psychosis. Objectives: To investigate the impact of telemedicine use on changes in healthcare utilization among patients with chronic psychotic disorders (CPDs). Study Design: We conducted a population-based, retrospective propensity-matched cohort study using healthcare administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14, 2020 and September 30, 2020 and a CPD diagnosis any time before March 14, 2020. Telemedicine users (2+ virtual visits after March 14, 2020) were propensity score-matched 1:1 with standard care users (minimum of 1 in-person or virtual ambulatory visit and maximum of 1 virtual visit after March 14, 2020) based on several baseline characteristics. Monthly use of various healthcare services was compared between the two groups from 12 months before to 3 months after their index in-person or virtual ambulatory visit after March 14, 2020 using generalized estimating equations (eg, hospitalizations, emergency department [ED] visits, and outpatient physician visits). The slope of change over the study period (ie, rate ratio) as well as a ratio of slopes, were calculated for both telemedicine and standard care groups for each outcome. Study Results: A total of 18 333 pairs of telemedicine and standard care patients were identified after matching (60.8% male, mean [SD] age 45.4 [16.3] years). There was a significantly greater decline across time in the telemedicine group compared to the standard care group for ED visits due to any psychiatric conditions (ratio of slopes for telemedicine vs standard care (95% CI), 0.98 (0.98 to 0.99)). However, declines in primary care visit rates (ratio of slopes for telemedicine vs standard care (1.01 (1.01 to 1.02)), mental health outpatient visits with primary care (1.03 (1.03 to 1.04)), and all-cause outpatient visits with primary care (1.01 (1.01 to 1.02)), were steeper among the standard care group than telemedicine group. Conclusions: Overall, patients with CPDs appeared to benefit from telemedicine as evidenced by increased outpatient healthcare utilization and reductions in ED visits due to psychiatric conditions. This suggests that telemedicine may have allowed this patient group to have better access and continuity of care during the initial waves of the pandemic.

When COVID-19 Is Not All: Femicide Conducted by a Murderer with a Narcissistic Personality "Masked" by a Brief Psychotic Disorder, with a Mini-Review.

Several cases of COVID-19-related mental disorders have emerged during the pandemic. In a case of femicide that occurred in Italy during the first phase of the pandemic, coinciding with a national lockdown, a discrepancy arose among forensic psychiatry experts, particularly toward the diagnosis of Brief Psychotic Disorder (BPD) related to COVID-19. We aimed to discuss the evaluation of the case through an integration of information and a literature review on comparable reported cases. An analysis of the diagnosis of brief acute psychosis was then performed, as well as a mini-review on cases of COVID-19-related psychosis. Results showed that psychotic symptomatology was characterized by polythematic delusions that always involved a SARS-CoV-2 infection. To a lesser extent, the delusions were accompanied by hallucinations, bizarre cognitive and associative alterations, insomnia, hyporexia, dysphoria, and suicidal behavior. No particularly violent acts with related injury or death of the victim were described. Finally, we could hypothesize that our case was better represented by a diagnosis of personality with predominantly narcissistic and partly psychopathic traits. The present case highlighted the importance, in the context of forensic psychiatry, of integrating assessments with the crime perpetrators, namely through accurate clinical interviews, neuropsychological tests, diachronic observations, and comparison with similar cases present in the literature. Such an integrated approach allows precise evaluation and reduces the odds of errors in a field, such as forensic psychiatry, where a diagnostic decision can be decisive in the judgment of criminal responsibility. Moreover, discerning forensics from health cases represents an important issue in risk management.

Mental health and its associated factors in college students during COVID-19 confinement in campus

Objective: To investigate mental health and its associated factors in college students during COVID-19 confinement in campus, and to provide a scientific basis for mental health education.

Meta-analysis of prevalence and associated factors of depressive symptoms in Chinese college students before and after the COVID-19 epidemic

Objective: To explore the prevalence and related factors of depressive symptoms in Chinese college students before and after the COVID-19 epidemic and to provide a reference for mental health education and management.

Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial.

BACKGROUND: DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. METHODS: Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial's original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. RESULTS: The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI -0.0015, 0.0079), incremental costs of €84.17 (95% CI -8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. CONCLUSION: Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

Taking care of mental wellbeing: updates from the nutraceutical market

According to a European market survey conducted by Innova Market Insights, the main area of customers' concern is related to stress management: 47% of consumers identified it with low mood, while 41% linked it with sleep interruptions. According to a different American Psychological Association poll, 78% of American adults say that the pandemic is a substantial source of stress in their lives, and 67% of those adults claim to have noticed an increase in stress during the Covid-19 outbreak. In this situation, dietary supplements might provide a sophisticated way to assist clients in enhancing their mood, sleep, and cognitive function throughout a trying time. This increased interest may also be attributed to the numerous studies conducted in recent years that link the immune system, gut, and brain, leading to the creation of several substances that have been shown to regulate stress and its associated negative effects. Prior to now, the market has focused on a wider aspect of mental wellbeing related to modern living, stress management, mental fatigue, concentration and memory performances, sleep quality, and depression. In the past, the mental health category has offered solutions to improve mental performance and relaxation. Bacteria can so easily join the market for mental health products, especially in light of recent developments in pharmaceutical formulation research that have made it possible to combine probiotics with botanicals to achieve the best of both worlds. In order to give 360 degree support for mental health, innovative ways that combine several actives were developed as a result of this insight.

Analysis of COVID-19-related psychiatric disorders - clinical manifestations and therapeutic considerations

During the COVID-19 pandemic, neuropsychiatric disorders have been diagnosed both in the acute phase, and in the aftermath of this disease. Inpatients, as well as outpatients recently diagnosed with mild, moderate or severe forms of Coronavirus infection have reported neuropsychiatric manifestations with variable duration, symptoms that could be directly or indirectly related to the viral pathogenic agent. Patients who are recovering from the acute phase of COVID- 19 also may exhibit various psychopathological manifestations, during the so-called "post-COVID-19 syndrome" or "long COVID-19 syndrome". Explanations regarding the onset of this type of clinical manifestations and the SARS-CoV-2 infection are extremely diverse, ranging from biological factors (e.g., direct central nervous system viral activity, cerebral hypooxygenation, high level of inflammatory response) to psycho-social stressors (e.g., isolation, fear of death, anxiety related to possible somatic complications or sequelae). Objectives: The primary objective of this article was to analyze psychiatric manifestations in patients with acute COVID-19 disease and in patients during post-COVID-19 phase. The secondary objective was to propose a conceptual framework for the evaluation and treatment of these patients. Methods: Patients included in this analysis were screened positive for COVID-19 infection in the last 6 months before their first psychiatric examination. These patients were further evaluated to detect any personal history of psychiatric disorders, somatic comorbidities, or significant concomitant pharmacological treatments. Specific scales for the measurement of symptoms severity and functional impairment were administered in all patients. Results: Five patients were included in this analysis, one during the acute phase of COVID-19 infection, and four patients were evaluated after the complete remission of this disease. Hyperactive delirium, mild neurocognitive disorder, major depressive episode, panic disorder with agoraphobia, or acute psychotic disorder were the main diagnoses in these patients. All patients received adequate treatment and they were monitored using psychological scales until symptoms remission or stabilisation. Conclusions: Psychosocial stressors, neurobiological changes, systemic inflammatory reaction, and individual vulnerability factors may contribute to a diathesisstress model for psychiatric disorders onset within the acute phase or after the remission of acute manifestations in COVID-19-diagnosed patients.

Correlation between stress, anxiety and depression of patients with rheumatoid arthritis during COVID-19 pandemic and their non-compliance to treatment: a cross-sectional study

Background: The prevalence of anxiety and depression is high in rheumatoid arthritis (RA) patients. As RA patients tend to be immunodeficient, they are at greater risk of coronavirus disease 2019 (COVID-19) infection due to their scheduled hospital appointments. Therefore, they have become more anxious and worried during COVID-19 pandemic, and some patients recently have canceled or postponed their treatment. Objectives: This study aimed to assess the effect of stress, anxiety, and depression due to COVID-19 outbreak on non-compliance to treatment among RA patients.

Reincorporation of recovered workers COVID-19 and long COVID in the metalworking industry in Lima Peru 2021

Persistent COVID is characterized by functional and psychological symptoms and sequelae that persist for more than 12 weeks post infection, such as: fatigue, dyspnea, anxiety, depression;generating inconveniences in the resumption of work activities of workers. A descriptive, cross-sectional epidemiological study was carried out, evaluating the reincorporation of workers operating in metalworking industries in Lima, Peru;recovered and persistent COVID, between the third quarter 2020 and the first quarter 2021. The Borg dyspnea scales and the modified dyspnea scale of the Medical Research Council (mMRC) were applied, in addition to the Goldberg anxiety and depression scale. The results were analyzed using descriptive statistics, using measures of central tendency and dispersion. It was observed that more than 80% of recovered workers are reinstated;and for persistent COVID, between 75% and 43% are reinstated for charges 8121 and 8122, respectively. Respiratory effort at rest was normal by the Borg scale for each group, while in effort a value R2 = 0.2986 was obtained, indicating no reincorporation in 74.51% and 43.33% in categories 8121 and 8122, respectively;also 45.12% and 42.68% of the recovered workers and persistent COVID showed symptoms of fatigue;36.25% and 35.26% anxiety;25.4% and 15.21% of depression, respectively;Likewise, the total of workers were overweight with an average BMI> 26 Kg/m2;being higher in women (27.4 Kg/m2). COVID-19 affects the health of workers (recovered and persistent COVID), reduces return to work and consequently the productivity of companies.