ABSTRACT
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.
ABSTRACT
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