Antibody levels of COVID-19 vaccine: A comparison between healthy subjects and psychiatric patients on antidepressants

This study compares the serological antibody level post-COVID-19 vaccine among healthy subjects and psychiatric patients on antidepressant therapy. It also examines the difference in antidepressants' side effects experienced by psychiatric patients following the completion of two vaccine doses. A comparative posttest quasi-experimental study was conducted among healthy subjects and psychiatric patients on antidepressant medication in a teaching hospital in Malaysia. Elecsys Anti-SARS-CoV-2 assay was used to detect the antibody titre between weeks 4 and 12 post vaccination. The antidepressant side-effect checklist (ASEC) was used to monitor the occurrence of antidepressant-related side effects pre-and post-vaccination. 24 psychiatric patients and 26 healthy subjects were included. There was no significant difference in the antibody level between the patients (median = 1509 u/ml) and the healthy subjects (median = 995 u/ml). There was no significant worsening in the antidepressant-related side effects. The antibody level post-COVID-19 vaccine did not differ significantly between patients on antidepressant therapy and healthy subjects. Additionally, there was no change in the antidepressant side effects experienced by the patients following the completion of the vaccine.Copyright © 2022, Research Trends (P) LTD.. All rights reserved.

Functional movement disorders during the COVID-19 pandemic

Functional movement disorders (FMDs) are a heterogenous group of movement abnormalities that greatly affect the quality of life of patients. They usually manifest as a result of underlying psychological or psychiatric illnesses without any known structural or neurochemical diseases. Various neurological disorders such as encephalitis, stroke, demyelination, seizures, and neuropathy have been reported by otherwise healthy individuals during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Here, we describe the case of a 27-year-old woman who presented to our outpatient department with episodes of deviation of angle of mouth with variability and distractibility. Following thorough clinical evaluation and appropriate investigation, the underlying etiology was identified as FMD secondary to the restrictions imposed during the COVID-19 pandemic to contain the transmission of the virus. The lockdown, isolation, financial strain, and other pandemic-related issues are stressors that may contribute to psychogenic disorders in people.Copyright © 2021 Annals of Movement Disorders Published by Wolters Kluwer - Medknow.

A Multicenter Double-Blind, Placebo-Controlled Trial of Escitalopram in Children and Adolescents with Generalized Anxiety Disorder.

Objective: Generalized anxiety disorder (GAD) in children and adolescents is associated with substantial morbidity and increases the risk of future psychopathology. However, relatively few psychopharmacologic studies have examined treatments for GAD in pediatric populations, especially in prepubertal youth. Methods: Children and adolescents aged 7-17 years of age with a primary diagnosis of GAD were treated with flexibly dosed escitalopram (10-20 mg daily, n = 138) or placebo (n = 137) for 8 weeks. Efficacy measures included the Pediatric Anxiety Rating Scale (PARS) for GAD, Clinical Global Impression of Severity (CGI-S) scale, Children's Global Assessment Scale (CGAS); safety measures included the Columbia-Suicide Severity Rating Scale (C-SSRS) as well as adverse events (AEs), vital signs, and electrocardiographic and laboratory monitoring. Results: Escitalopram was superior to placebo in reducing anxiety symptoms of GAD, as seen in the difference in mean change from baseline to week 8 on the PARS severity for GAD score (least squares mean difference = -1.42; p = 0.028). Functional improvement, as reflected by CGAS score, was numerically greater in escitalopram-treated patients compared with those receiving placebo (p = 0.286), and discontinuation owing to AEs did not differ between the two groups. Vital signs, weight, laboratory, and electrocardiographic results were consistent with previous pediatric studies of escitalopram. Conclusions: Escitalopram reduced anxiety symptoms and was well tolerated in pediatric patients with GAD. These findings confirm earlier reports of escitalopram efficacy in adolescents aged 12-17 years and extend the safety and tolerability data to children with GAD aged 7-11 years. ClinicalTrials.gov Identifier: NCT03924323.

Profile of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital

Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India. Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital Material(s) and Method(s): This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis. Result(s): We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam. Conclusion(s): We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.

Prescribing medicines by a teacher: A case report of unusual presentation of OCD

Background: Obsessive Compulsive Disorder (OCD) can present with unusual symptomatology. Aim(s): To discuss a case of OCD with an atypical manifestation in an adult male teacher who has an obsession and compulsion of prescribing medications to the villagers and its management. Case Summary: A 35 years old male teacher presented with complaint of recurrent obsessional thoughts about prescribing medications to patients and compulsion for the same. He started having these thoughts after conducting duty at a community health center as a COVID-19 booth controller. He perceived these thoughts as intrusive, irrational, absurd, anxiety provoking and distressing;would trying to resist them, but won't be able to do so. He used to sit beside hospitals, squares in villages, and medical shops to find patients and prescribe medications to them to relieve his anxiety. After prescribing medications although his anxiety symptoms would decrease, but he would feel guilty about prescribing medication as he knew that is not an expert. He also faced financial issues as he used to buy medications for villagers, so that they allow him to prescribe medications. He was diagnosed as a case of OCD with good insight and was started on Tab. Escitalopram which was gradually built up to 20 mg over the 3 months along with psychoeducation and supportive sessions. Currently he is in remission and maintaining well since last 2 months. Conclusion(s): This case report illustrates that clinician should remain vigilant about the unusual presentations of OCD to avoid the misdiagnosis and timely management.

THERAPY OF POST-COVID DEPRESSION: A PROACTIVE PSYCHOSOMATIC APPROACH.

OBJECTIVE: Aim: Evaluation of the effectiveness of the early 8-week monotherapy with escitalopram as a form of proactive psychosomatic intervention for patients with post-COVID depression. PATIENTS AND METHODS: Materials and methods: 44 patients with post-COVID depression were involved in a proactive psychosomatic intervention in the form of an 8-week intake of escitalopram (Medogram, Medochemiе Ltd) for 2-8 weeks in the case of a diagnosis of severe depression. Hamilton Depression Scale (HAM-D), Somatic Symptom Scale (SSS-8), Quality of Life Scale (CQLS) were used to assess symptoms and status dynamics. RESULTS: Results: Patients with post-COVID depression after an 8-week course of escitalopram therapy showed a significant reduction in mental and somatic symptoms of depression and an improvement in quality of life. At the time of enrollment in the study, 12 (28.58%) individuals had mild depression, 15 (35.71%) had moderate depression, and 15 (35.71%) had severe depression. At the end of the 8th weeks of taking the drug in 24 (57.14%) there were no signs of depression on the HAM-D scale, in 18 people there were subclinical manifestations of depression. The effectiveness of escitalopram in reducing the symptoms of depression in this study was 66%. CONCLUSION: Conclusions: With the introduction of pharmacotherapy with escitalopram there was a significant reduction in mental and so¬matic symptoms of depression and an improvement in quality of life. Escitalopram (Medochemie Ltd) may be an effective drug for psychopharmacotherapy of depressive symptoms in patients who have had COVID-19. Further studies are promising its effective¬ness in the treatment of post-COVID depression.

Is it Time to Revisit Neuroinflammatory Depression? A Case of COVID-19 Associated Depression and the Role of ECT

Background: The neurobiology of depression can be heterogeneous with multiple hypotheses proposed, including serotonin and neuroinflammatory pathways, each falling short of explaining the complete picture. Several reports describe the increased frequency of depression in the community following the COVID-19 pandemic and reports about neuropsychiatric sequela of the virus are emerging and the possible role of neuroinflammation. We present a patient who developed severe depression with psychotic features subsequent to his COVID-19 infection and was treated successfully with ECT following several failed medication trials. Case: A 49-year-old male with a past medical history of type II diabetes, hyperlipidemia, hypertension, chronic kidney disease, and gastroesophageal reflux disease was diagnosed with COVID-19 in January 2021. Upon initial diagnosis, neither admission nor treatment with steroids was required. He presented to the emergency department four days later with sepsis, pneumonia, and AKI secondary to COVID-19 along with the new onset of suicidal ideations with plans to cut himself and significant psychomotor features despite no previous history of mental illness or treatment. His EEG showed diffuse slow waves, consistent with encephalopathy, but no delirium was noted. He exhibited irritability, anger, anhedonia, negativism, and isolated himself in his room. He demonstrated delusional fear about his apartment exploding due to electricity disconnected for not paying his bills. He misinterpreted the blood draws as someone suspecting he has HIV. Treatment started on the medical floor and he was later transferred to the psychiatric floor. Several psychotropic medications were tried separately including citalopram 20mg, escitalopram 20mg, and bupropion (titrated to 300mg) with the addition of aripiprazole 5 mg without improvement. ECT was considered and his depression and psychosis improved following 6 treatments of bilateral ECT. He was discharged following completion of 10 ECT treatments on 300 mg of bupropion daily and 5mg olanzapine at night. Discussion: Viral infections such as HIV, Hepatitis C, and Influenza are associated with neuropsychiatric sequelae, including depression. COVID-19 infection is occasionally associated with ‘cytokine storm’ which may exacerbate neuroinflammation via increases in cytokines and possible activation of mast cells and microglia.[1] The role of elevated pro-inflammatory cytokines and glucocorticoid receptor resistance is widely studied. Interleukin-6 and CRP are the most strongly linked to depression with a high correlation for anhedonia and psychomotor retardation, prominent features of depression in our case, hinting at a possible role of neuroinflammation. [2] Psychotic features and psychomotor retardation are predictors of ECT response which matched the response to ECT in this case. References: 1. Kempuraj, Duraisamy, et al. COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist 2020: 402-414. 2. Tiemeier, Henning, et al. Inflammatory proteins and depression in the elderly. Epidemiology 2003: 103-107.

Clinical efficacy of Vortioxetine and escitalopram in the treatment of depression

Objectives: This study was aimed to investigate the efficacy and safety of vortioxetine hydrobromide in the treatment of major depressive disorder (MDD). Methods: One hundred and eighty patients with the newly diagnosed depression in our hospital between August 2018 and August 2019 were selected and randomly divided into an observation group and a control group, 90 each group. The control group was treated with escitalopram, and the observation group was treated with voltaxetine. The efficacy and adverse reactions were evaluated by the Hamilton Depression scale-17 (HAMD-17), Sheehan Disability Scale (SDS), Perceived Deficits Questionnaire-Depression (PDQ-D), and treatment emergent symptom scale (TESS) before treatment and at the end of the 8th and 24th week after treatment. Results: At the end of the 8th and 24th week after treatment, the HAMD-17 scores of the two groups were lower than those before treatment (P<0.05);at the end of the 8th and 24th week after treatment, the PDQ-D and SDS scores of the two groups were lower than those before treatment (P<0.05), and the above scores of the observation group were lower than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Voltaxetine can improve cognitive function and clinical symptoms of patients with severe depression and has high safety, which is worth clinical attention.

P.0729 Highlights of psychedelic history and current research on psilocybin application for treatment of depression – a comprehensive literature review

Introduction: Psychedelics have seen various labels: mystical sacrament aids, potential interrogation tools for the Cold War, agents for social change in the Hippie counter movement, a panacea for various mental disorders, and a tool to “hack” of the psyche. This has led to their reputation as both societal threat and a psychopharmacological breakthrough. After the loss of data on over 1000 clinical papers spanning 40000 study subjects in the 60′s, a 40-year hiatus, and a few very determined researchers, new insights of increasingly quality have been emerging from research on the potential benefits of the use of psilocybin in depression. We aim to review available data on psilocybin for treating depression, providing a bird's-eye view on the literature (historical and current), while reporting potential neurobiological, psychological and cognitive mechanisms involved, safety and methodological concerns (as well as recent advancements), emerging modalities of treatment, with a commentary on social and cultural movements occurring in parallel to the scientific endeavor to create regulated and scientifically approved treatments. Methods: Eligible studies will be identified through an electronic search of Medline and clinicaltrials.gov from inception to the date of submission. The search strategy will combine relevant standardized subject terms and text words for psychedelics, psilocybin, and depression, with relevant Boolean operators implemented. Only articles written in the English language will be included. Reference lists from eligible studies will be cross-checked to identify potential additional studies. For data synthesis, results and outcomes will be explored narratively, along reporting and critical analysis of relevant statistical data. Results: Psilocybin emulates serotonin, with special affinity for the 5-HT2A receptor. Neuroimaging studies suggest an attenuation of the default mode network and an overall increase in multiple brain area connectivity [1]. Current treatment models involve previous psychological profiling and preparation, followed by one to two sessions where administration of 25 mg of psilocybin under supervision and support from the researcher, a physician, and a therapist, with post-treatment integration. Since 2011, five clinical studies, evaluated psilocybin treatment efficacy on patients suffering from clinical depression [2,3,4]. Limited by small samples, variability of setting, timeline, and methodology, they combined number of 139 patients. Despite these limitations, 60% of patients reported significant symptom reduction (58-83%) providing promising preliminary evidence for further investment. A recent trial found no significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients, further contributing to this trend of research [5]. Over 50 studies addressing effects of psilocybin in depression have been approved on clinicaltrials.gov. One of these [6] is a phase 2 multicentered clinical trial, aiming to further evaluate the safety and efficacy of psilocybin in treatment resistant depression in a variable dose range. Conclusion: Psilocybin might become a promising approach to depression. These therapies have been (re)gaining social and cultural support, with parallel “off label” use in various spiritual and psychotherapeutic settings. There is a need for the upmost rigor in designing future research. Psilocybin might emerge as an important therapeutic tool for current and upcoming global mental health challenges in a post-COVID-19 world. No conflict of interest

P.0370 Escitalopram efficacy in post-covid depression treatment: a pilot study

Background. During the COVID-19 pandemic, the level of depressive symptoms is markedly increased, more than 3-fold higher during the COVID-19 pandemic than before [1]. A significant proportion of post-COVID patients suffer from persistent fatigue, dyspnea, and neuropsychological symptoms [2]. Persistent mental problems with critical levels of anxiety, depression, and post-traumatic stress disorder are seen in survivors of COVID-19 at 1 year after discharge [3]. While studies of psychological distress currently focused on social anxiety and lockdown measures, a mental disorder due to COVID-19 may be a great deal in the future [4]. Thus, the question of the effective psychopharmacological treatment of this problem needs to be raised [5]. Objective. This study aimed to evaluate the efficacy of 10-week escitalopram monotherapy in relieving the symptoms of depression in survivors of COVID-19. Methods. The study was conducted based on Railway Clinical Hospital #1 and on the Department of Medical Psychology, Psychosomatic Medicine and Psychotherapy of National Medical University. After signing the informed consent, a total of 33 patients after COVID-19 and complaints of depressive symptoms that arose in the recovery period were assessed. The mean age was 37,54 ± 8,97 years, 25 participants (75,65%) were females and 8 participants (24,24%) were males. depression of patients was assessed by 17-item Hamilton Depression Scale. The intervention consisted of the addition of a 10 mg per day (20 in cases of severe depression) dose of escitalopram to standard therapy of post-COVID syndrome for 10 weeks. A paired t-test was used to evaluate the difference in depressive symptoms pre- and post-treatment. Data collection and data analysis were carried out with Microsoft Excel and R – programming language for data analysis and research. Results. The mean score on Hamilton Depression Scale before escitalopram prescription was 15.57 ± 4.16 points. Before treatment 10 participants (30,3%) had symptoms of mild depression, 14 participants (42,42%) – symptoms of moderate and 9 participants (27,27%) had symptoms of severe depression. No correlation between age, gender, and depressive symptoms were found. After 10-week treatment, the mean score on Hamilton Depression Scale was 5.72 ± 2.87 points. 21 participants had no symptoms of depression (63,64%), 10 participants (30,30%) had symptoms of mild depression and 1 participant (3,03%) had symptoms of moderate depression. Therefore, a decrease in the score from baseline was 9.84 ± 4.63 points (p<0,001). The effect did not depend on age or gender. Conclusions: Our study confirms the common presence of depressive symptoms in patients in the recovery period after COVID-19. Treatment with escitalopram may be quite effective in reducing the symptoms of depression in patients with the post-COVID syndrome. However, it is also interesting to study the persistence of this effect, which was not evaluated in this study. Further studies involving more patients, as well as comparison with a control group, are promising. No conflict of interest

P.0403 Disticnt effects of SSRIs therapy in patients with the first episode of major depressive disorder/generalized anxiety disorder after COVID-19 disease

Introduction: The World Health Organization postulated Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) is a pandemic situation in the whole world [1]. Although the main damaging of SARS-Cov-2 in the human organism is linked to its severe acute respiratory illness, a new coronavirus, SARS-CoV-2 implicates in the various central nervous system impairments and deteriorations [1,2]. The major clinical outcomes of COVID-19 in the brain are associated with its deleterious neurological and mental health actions [3]. Currently, we do not know exactly how actually SARS-CoV-2 might negatively alter the brain functions in humans. Today, there are limited findings concerning the studying of neuropsychiatric action for SARS-Cov-2 in humans after COVID-19 disease. The aim of the present study was to compare the efficacy of SSRIs (escitalopram, sertraline and fluoxetine) for 6 months therapy on the affective profile of man and women with the first Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) cases following COVID-19 disease without any previous psychiatric diagnosis. Methods. For the assessment of affective profile in man and women (30-55 years) with the first MDD or GAD cases after COVID-19 disease, we used the different tests: Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety scale (ShARS Scale). The hormonal and Vitamin D3 levels in the serum blood were measured by immune-enzyme analysis before and after SSRIs therapy. Results. After 6 months of SSRIs therapy, MADRS Scale showed a significant improvement of the depressive manifestations in both men and women with the first MDD case after COVID-19 (p%26lt;0,05). However, these patients of both gender demonstrated significantly high anxiety level by ShARS Scale. We found that SSRIs were able to reduce anxiety level only on 25%25 in man or on 35%25 in women with the first MDD case after COVID-19 before treatment (p%26lt;0,05). Interestingly, MADRS Scale showed a similar improvement of the depressive manifestations in both men and women with the first GAD case after COVID-19 treated with SSRIs for 6 months (p%26lt;0,05). Also, women with the first GAD case after COVID-19 treated with SSRIs had the parameters of their affective profile that were similarly to those of control group. The reduction of depressive symptoms in women with the first GAD case after COVID-19 treated with SSRIs was associated with restoration of cortisol concentrations in the serum blood compared to the initial levels. Conclusion: Thus, our pilot clinical study clearly demonstrated that SSRIs treatment have a beneficial effect on the depressive symptoms in patients of both gender with the first MDD or GAD cases after COVID-19. However, SSRIs therapy alone failed to produce the decrease of anxiety in the patients of both gender with the first MDD or GAD cases after COVID-19. In light of the demonstrated data, the importance of truly adequate treatment to the long-term neuropsychiatric outcomes of COVID-19 in patients of both gender, further randomized clinical trials involving new pharmacological therapies are needed in the future. No conflict of interest

Pharmacological Inhibition of Acid Sphingomyelinase Prevents Uptake of SARS-CoV-2 by Epithelial Cells.

The acid sphingomyelinase/ceramide system plays an important role in bacterial and viral infections. Here, we report that either pharmacological inhibition of acid sphingomyelinase with amitriptyline, imipramine, fluoxetine, sertraline, escitalopram, or maprotiline or genetic downregulation of the enzyme prevents infection of cultured cells or freshy isolated human nasal epithelial cells with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or vesicular stomatitis virus (VSV) pseudoviral particles (pp-VSV) presenting SARS-CoV-2 spike protein (pp-VSV-SARS-CoV-2 spike), a bona fide system mimicking SARS-CoV-2 infection. Infection activates acid sphingomyelinase and triggers a release of ceramide on the cell surface. Neutralization or consumption of surface ceramide reduces infection with pp-VSV-SARS-CoV-2 spike. Treating volunteers with a low dose of amitriptyline prevents infection of freshly isolated nasal epithelial cells with pp-VSV-SARS-CoV-2 spike. The data justify clinical studies investigating whether amitriptyline, a safe drug used clinically for almost 60 years, or other antidepressants that functionally block acid sphingomyelinase prevent SARS-CoV-2 infection.