Self-reported Medication Adherence in Schizophrenia and Bipolar Disorder Patients during COVID-19 Pandemic in a COVID Care Hospital: A Cross-sectional Study

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic has made it difficult for patients with Schizophrenia and Bipolar Affective Disorder (BPAD) to receive ongoing care, which has led to non adherence to medication and undesirable health outcomes. Lower treatment adherence in severe mental illness might lead to symptom exacerbation and relapses and might cause a strain on the health system during COVID-19 pandemic. Aim: To assess the treatment adherence in Schizophrenia and BPAD patients during prevailing COVID-19 situation in India. Materials and Methods: This cross-sectional study was conducted among 92 patients with Schizophrenia and BPAD through a questionnaire between January to September 2021 in a COVID-19 care hospital Government Medical College Palakkad/District hospital Palakkad, Kerala, India. Demographic and clinical data, adherence to treatment, along with Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D). Clinical Global impression (CGI S&I), Work and Social Adjustment Scale (WSAS), Modified COVID Threat Scale (CTS) and Medication Adherence Rating Scale (MARS) were collected. The outcomes included adherence to medication, deterioration of the psychopathology, improvement in severity, social functioning. Descriptive statistics was used to define the sample characteristics and presented as mean and standard deviation and frequency and percentages. Spearman's Correlation coefficient was used to find the correlation between MARS and other variables: CTS, BPRS, YMRS, HAM-D, CGI and WSAS. Results: A total of 92 patients were interviewed which comprised of 43 patients with Schizophrenia and 49 patients with Bipolar disorder. As assessed by MARS rating scale 19 patients (20.65%) had a MARS score less than six suggesting poor adherence and 73 (79.35%) had MARS score 6 and greater suggesting better adherence to the treatment. This was supported by negative correlation with BPRS, YMRS, HAM-D and CGI-S and CGI-I scales which implies that the COVID-19 pandemic did not hinder the patients to take the medication. The mean MARS score was 7.31±2.11. A total of 37 (40.2%) patients had acute exacerbation of the illness during the COVID-19 related lockdown and 37 (40.2%) had exacerbation during the six months prior to COVID-19 lockdown. There was negative correlation between MARS scores and the CTS but was not statistically significant. Conclusion: Despite the COVID-19 pandemic related restriction, patients with Schizophrenia and BPAD were adherent to the medication and the number of relapses during COVID-19 pandemic was similar to the period before the pandemic. COVID-19 related anxiety didn't have an impact on medication adherence and relapse in this study. [ FROM AUTHOR] Copyright of Journal of Clinical & Diagnostic Research is the property of JCDR Research & Publications Private Limited 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.)

Impact of the COVID-19 pandemic on patients with pre-existing mood disorders.

OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic on patients with established mood disorders during a period of stringent mandated social restrictions. METHODS: Semi-structured interviews were conducted with 36 individuals attending the Galway-Roscommon Mental Health Services with an International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) diagnosis of either Bipolar Affective Disorder (BPAD) (n = 20) or Emotionally Unstable Personality Disorder (EUPD) (n = 16) in this cross-sectional study. We determined the impact of the COVID-19 restrictions on anxiety and depressive symptoms, impulsivity, thoughts of self-harm, social and occupational functioning and quality of life. RESULTS: The COVID-19 pandemic deleteriously impacted mental health (56.3% v. 15.0%, χ2 = 7.42, p = 0.02), and mood (75.0% v. 20.0%, χ2 = 11.17, p = 0.002) to a greater extent in the EUPD compared to the bipolar disorder cohort, with 43.8% of individuals with EUPD reporting an increase in suicidal ideation. Psychometric rating scales [Beck Anxiety Inventory (BAI), Beck Depression Scale (BDS), Beck Hopelessness Scale (BHS), Barratt Impulsivity Scale (BIS)] and Likert scales for anxiety, mood and quality of life noted significantly higher levels of psychopathology in the EUPD cohort (p < 0.01). Qualitative analysis reflected quantitative data with themes of the employment of maladaptive coping mechanisms and reduced mental health supports notable. CONCLUSIONS: Individuals with EUPD are experiencing significant mental health difficulties related to the COVID-19 pandemic. The provision and recommencement of therapeutic interventions to this cohort, in particular, are warranted given the significant distress and symptoms being experienced.

Relationship of the fear of COVID-19 with residual symptoms and functionality in patients with bipolar affective disorder

Purpose: The aim of this study was to determine the relationship between fear of COVID-19 and residual symptoms and functionality levels in patients with bipolar affective disorder.Materials and Methods: The study included 85 consecutive patients with bipolar affective disorder who were diagnosed with bipolar affective disorder according to DSM-5, were aged between 18-65 years, were literate and applied to the outpatient clinic. The patients were grouped as those with depressive/manic symptoms and those in remission with residual symptoms.Results: There was no statistically significant difference among the participants according to having or not having manic residual symptoms in the The Fear of COVID-19 Scale. The participants which did not have any depressive residual symptoms demonstrated statistically significant lower scores than the participants who had depressive residual symptoms in The Fear of COVID-19 Scale. The Hamilton Depression Scale and Functioning Assessment Short Test scores scores were significantly positively correlated with Fear of COVID-19 Scale scores.Conclusion: Patients with depressive residual symptoms score significantly higher in the Fear of COVID-19 Scale. Studying resilience, fear of illness and residual symptoms in patients during the stress period will also be valuable in terms of determining follow-up and treatment strategies.

Stress and burden among caregivers of persons with bipolar affective disorder during the COVID-19 pandemic in India

Introduction: Bipolar affective disorder (BPAD) is a severe mental illness causing significant problems in the lives of individuals with the disorder and those who care for them as well are. Most of the time people with mental illness are taken care of by mental health professionals, while little priority is given to their caregivers. There are numerous studies in India attempting to understand the impact of illness on caregivers and the problems faced by the caregivers of persons with BPAD. Methods: The study aimed to assess the family caregivers' stress and burden among caregivers of persons with BPAD at a tertiary care center in Dharwad, India. Descriptive research design and simple random sampling was used for recruiting 50 samples. Apart from sociodemographic schedule, burden assessment scale and perceived stress scale (PSS) were used for data collection. Results: The mean age of caregivers was 44.76 years. The average duration of illness of the patients was 9.80 years and their mean annual income was 35,500 rupees reported in the study. The mean score of impact of wellbeing subscale was higher (11.34) when compared with other sub scales of the burden assessment scale, and the overall score of burden assessment scale (31.82) indicated high levels of burden. PSS mean was 21.44, indicating high stress levels. Conclusion: The study concludes that burden and perceived stress were elevated among the caregivers of people with BPAD during the COVID-19 pandemic.

Effect of COVID-19 and sociocultural milieu on the psychopathology of mental health disorders: A hospital-based study.

BACKGROUND: Coronavirus disease (COVID-19) has posed a remarkable threat to mental health all around the world. This pandemic has increased the incidence of common as well as severe mental illness (SMI) all around the world. MATERIALS AND METHODS: We report 10 cases presenting to the psychiatric outpatient department (OPD) of Institute of Medical Sciences, Banaras Hindu University, from August to October 2020. They were either referred by other departments (3 patients) or came primarily to psychiatric OPD (7). RESULTS: Five out of these 10 cases presented with predominant psychotic features; 3 cases had predominant obsessive-compulsive features; and 1 case was of dissociative trance possession. CONCLUSION: COVID-19 can affect the psychopathology of both types of patients either with preexisting mental illness as well as new-onset SMI.

Does Nicotine Prevent Cytokine Storms in COVID-19?

COVID-19 has a benign outcome in most cases, yet it can also be fatal and no specific treatment is available as of yet. Older age and several medical comorbidities are risk factors for COVID-19 complications. We report on an elderly man with a longstanding history of bipolar affective disorder associated with heavy smoking, alcohol abuse and multiple comorbidities, including severe chronic obstructive pulmonary disease and recurrent pulmonary sepsis, who contracted COVID-19 during his inpatient treatment of a manic episode, and who fully recovered from COVID-19 without any need for respiratory support. We discuss how his excessive use of nicotine replacement therapy may have contributed to his emerging unscathed from COVID-19. Nicotine, an α7-nACh receptor agonist, may boost the cholinergic anti-inflammatory pathway and hinder the uncontrolled overproduction of pro-inflammatory cytokines triggered by the SARS-CoV-2 virus, which is understood to be the main pathway to poor outcomes and death in severe COVID-19.

Clozapine: An Updated Overview of Pharmacogenetic Biomarkers, Risks, and Safety-Particularities in the Context of COVID-19.

BACKGROUND: clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia (TRS) in adults and is underused. OBJECTIVE: to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 pandemic. DATA SOURCES: a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and "schizophrenia", "side effects", "agranulocytosis", "TRS", or "bipolar affective disorder (BAF)" for the last ten years. STUDY ELIGIBILITY CRITERIA: clinical trials on adults with acute symptoms of schizophrenia or related disorders. RESULTS: we selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia, (b) CLZ in bipolar disorder, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia, and (f) CLZ therapy and COVID-19 infection. LIMITATIONS: we considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) a CLZ-associated risk of pulmonary embolism imposes prophylactic measures for venous thromboembolism; (c) convulsive episodes are not an indication for stopping treatment; the plasma concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 infection may enhance clozapine toxicity, generating an increased risk of pneumonia. Therapy must be continued with the proper monitoring of the white blood count, and the clozapine dose decreased by half until three days after the fever breaks; psychiatrists and healthcare providers must act together.