Demand Analysis of a Psychiatric Emergency Room and an Adolescent Acute Inpatient Unit in the Context of the COVID-19 Pandemic in Madrid, Spain.

Introduction: COVID-19 represents a serious threat to mental health worldwide. The aim of this study is to identify changes in adolescent psychiatry treatment demand in a tertiary hospital in Madrid during the first month (March 11 to April 11) after the pandemic declaration by the World Health Organization (WHO). We hypothesized that fear of contagion within COVID-19 may deter people from asking for psychiatric care. Method: The current study is retrospective, observational, and transversal. We reviewed the clinical records of 89 adolescents who went to the Emergency Room (ER) or were hospitalized at the Acute Inpatient Unit (AIU) at the Puerta de Hierro University Hospital-Majadahonda (PHUH-M) between March 11 and April 11. Socio-demographic, clinical, and demand variables were included in the study. Chi-square or Fisher exact tests were performed to compare categorical variables. We used the U Mann-Whitney test to compare quantitative variables. The level of statistical significance was set at p< 0.05. Analyses were conducted using SPSS v11.0. Results: The number of adolescents demanding psychiatric care at the ER dropped from 64 adolescents in 2019 to 25 in 2020. Similarly, psychiatric demand collapsed from 31 to 18 patients when comparing 2019 and 2020. Furthermore, the average hospital stay in 2020 trended toward a decrease when compared to 2019 (8.94 ± 4.87 vs. 14.32 ±10.23, p = 0.08). Self-injurious thoughts and behaviors were the most predominant reasons for consultation at both ER and AIU. Conclusion: The demand for adolescent psychiatric care decreased in the first month after the declaration of the pandemic. Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive reaction described in other disasters. Further studies are needed.

COVID-19 Psychiatric Inpatient Unit- experience and challenges

Introduction: On January 2021 the Department of Psychiatry became the only unit exclusively dedicated to COVID patients with severe mental illness in acute decompensation. Only patients in risk of rapid medical deterioration were excluded and forwarded to intensive care. Objective(s): Discussion of this unprecedented experience. Method(s): Analysis of 28 patients hospitalized during 3 months with both an acute psychiatric disorder and an SARS-CoV-2 infection;description of the multidisciplinary intervention made. Result(s): Our samplewas characterized by a majority of patients with an acute psychotic episode derived from a schizophrenia spectrum disorder (42%) or a bipolar affective disorder (21%). Only 3% of the patients had a diagnosis of severe major depressive disorder. And 10% of patients developed severe respiratory symptoms requiring oxygen or urgent transfer to COVID medical wards. Most patients presented periods of psychomotor agitation, lack of impulse control and self-aggression. Psychopharmacological and psychotherapeutic interventions had to be adapted to these unusual conditions. Most of them had already gone through a period of isolation in the buffer ward created to exclude false negatives, which promoted atypical deliriums and symptoms of post-traumatic stress. The psychiatric team was faced with the emergent need to adapt an intervention model based on trust to a model that had to prioritize physical safety. Conclusion(s): The pandemic experience was transformative forall who lived through it. From the challenge perspective, it may have been enriching. But the maintained confrontation with the antithesis of therapy, defined by "caring, supporting, communicating, approaching", was devastating in ways that we consider essential to be debated.

Descriptive analysis of patients admitted to a new adolescent inpatient unit in Madrid

Introduction: Adolescent mental health problems may have increased after COVID-19 worldwide pandemic. Therefore it seems necessary to study the state of mental health inpatient adolescent units. Objective(s): Adolescent mental health problems may have increased after COVID-19 worldwide pandemic. Therefore it seems necessary to study the state of mental health inpatient adolescent units. Method(s): An observational and descriptive analysis of the sample of patients between 12 and 17 years-old, that were admitted to the inpatient mental health unit since its opening on April 2021. Result(s): A total of 205 patients were admitted from April 2021 until October 2021. We have observed sex diferences within patients admitted, as the 82.9% of them were female. The mean age was 14.7, being 14.6 for girls and 15.3 for boys. The most common reason for admission (RFA) were suicidal ideation/attempt, eating disorders, affective disorders, conduct disorders/challenging behaviors and psychosis. Suicidal ideation/attempt was the most common RFA (57.07%) in both sexes, being higher among females (60.3%) than males (42.9%). Eating disorders were the second most common RFA in girls (17.7%) while psychosis (17.1%) and mood disorders (17.1%) were the second most common RFA within boys. Conclusion(s): Findings on how COVID-19 affected adolescents mental health are controversial in the literature, our data suggest that there is a need of developing quality studies that analyse how the pandemic might be influencing adolescents suicidal ideation/ attempt and its protective and risk factors.

Perceptions, emotional reactions and needs of adolescent psychiatric inpatients during the COVID-19 pandemic: a qualitative analysis of in-depth interviews.

BACKGROUND: The new coronavirus pandemic (COVID-19) has been accompanied by severe psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness. AIMS: To explore adolescent psychiatric inpatients' perceptions, emotional reactions and needs during the first wave of the COVID-19 pandemic. METHODS: Individual in-depth interviews were conducted with nine psychiatric inpatients aged 12-17 years. Through open-ended questions, interviewers initiated five themes: (a) knowledge about coronavirus pandemic, (b) changes in everyday routine due to the pandemic, (c) adolescents' feelings about the pandemic, (d) adolescents' positive thoughts and behaviors, and (e) how the social environment can help adolescents deal with the pandemic-related situation. A thematic analysis was conducted using line-by-line open coding. RESULTS: Regarding their knowledge of the impact of the current pandemic, almost all adolescents focused on information about the nature of coronavirus and on existing crisis management practices. Almost all patients identified predominantly negative changes due to the quarantine state, including restrictions on both social life and personal freedom as well as excessive contact with family members during home isolation. As far as their emotions were concerned, adolescents did acknowledge anxiety about self-harm and harming their loved ones as well as mood swings within the family nucleus; anxiety was also manifested about the unknown and the management of the pandemic in other countries. Avoidance of thought rumination about the coronavirus and its consequences, positive thinking and looking towards the future were reported as constructive strategies for coping with challenging emotions. Additionally, a sense of belongingness seems to have been playing a pivotal role in the adolescents coping strategies. Trust in the authorities and the community was another quite noteworthy point that emerged during the interviews. Lastly, our findings indicated adolescents' benefit from receiving balanced health messaging coupled with balanced thinking within their social and family environment. CONCLUSIONS: Enhanced comprehension of possible mediating psychological pathways is needed to help clinicians, researchers, and decision-makers to avert the deterioration of mental disorders and overall functioning, as well as additional stress-related disorders.