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The aim of this research study is to determine the impact of COVID-19 on access related to mental health services and also explain the use of teletherapy as an alternative form of treatment. This research study is based on secondary research data analysis to determine the research study data collected from websites related to the ratios of COVID-19 also that mental health services. Determine the research study used E-views software, and the generated result included descriptive statistics, correlations, the dickey fuller test analysis, the histogram, and state, also that explain the variance and test of equality between them. The overall result shows COVID-19 shows a direct impact on mental health services;teletherapy directly links with mental health services. Benefits make teletherapy the best online therapy session for overcoming various types of depression and mental illness in patients. Also, teletherapy is an alternative form of mental health service that is mostly provided to people affected due to the pandemic conditions of the coronavirus.Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.
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This case study draws attention on mental health sequelae that emerged in the context of the COVID-19 outbreak after recovery from hospitalization, even in subjects without personal psychiatric history. The case involves a 65-year-old male shift nurse who took SARS-COV-2 infection through a co-worker and that had been hospitalized for interstitial pneumonia from April 6 to April 17. After recovery, he developed psychiatric symptoms overlapping between different dimensions of psychiatric disorders and started to be followed by the Occupational Health Department of a Major University Hospital in central Italy. He reported a score of 28 at the Peritraumatic Distress Inventory and of 39 at the Self-Rating Anxiety State. He was treated with a combination therapy of SSRI and NaSSA antidepressants with clinical remission. In this case study, authors discuss the possible overlapping role of post-traumatic stress and anxiety symptoms in patients discharged after COVID-19 hospitalization that may deserve appropriate classification, treatment and follow up with the future goal to refine clinical management of post and long COVID syndromes of subjects who present low abnormalities in other specialty investigations.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Objectives: the aim of the study was description of the association between the number of hours spent on the internet and symptomatology of Internet addiction, corrected by sociodemographic data, mental instability, alcohol and cannabis use, gambling, and subjective estimation of physical and mental health using responses from a representative sample of Czech respondents during COVID-19 pandemic. Sample and setting: The group consisted of 2 602 people (1 206 men, 1 396 women), average age 44,61 years, SD = 15,8223, range 15-85 years randomly selected by quota selection based on age, gender, education and region. Data were processed by hierarchical multivariate linear regression analysis (OLS). The dependent variable was data from the Excessive Internet Use test. Independent variables were age, gender, net income, marital status, education, subjective estimation of mental and physical health, data from MHI-5, CAGE, cast and PGsi tools. Result(s): the results are in line with previous research, which indicates that the development of internet addiction is mainly due to time spent on the Internet, the risk is inversely related to age and slightly higher in men. The influence of other variables measuring substance use, gambling and mental health supports hypotheses about common etiology of various types of addiction and their association with mental health. Study limitation: the study is based on self-referential data, has a heuristic, empirical character and does not rely on a pre-formulated theory.Copyright © 2022 TIGIS Spol. s.r.o.. All rights reserved.
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Case Report: Over 90% of cases of cryptococcal meningoencephalitis present in immunocompromised patients, with the majority of those being in patients with AIDS. However, this infection can also occur in patients with other immunocompromised states, such as steroid use, malignancy, rheumatologic diseases, and use of immunosuppressive medications. Delay in diagnosis can often lead to rapid neurological deterioration and mortality. Case: A young, otherwise immunocompetent patient, with a history of Chiari I malformation and recent COVID- 19 infection presented with syncope following two weeks of headaches, generalized body aches and weakness after COVID-19 diagnosis. Physical exam demonstrated an isolated CN VI palsy. Head imaging revealed new right caudate infarcts, and a cerebellar tonsillar descent compatible with history of Chiari I malformation. Initial lumbar puncture (LP) was deferred due to congenital brain herniation. Over the next few days, the patient continued to show increasing neurological deficits such as truncal ataxia and increased mood instability. The patient was transferred to the Intensive Care Unit, and LP was obtained under special neuro-critical care direction. Due to increased opening pressures and yeast on gram stain, cryptococcus was suspected and later confirmed. Although anti-fungal therapy was initiated, the patient continued to deteriorate, leading to cardiac arrest, intubation, and placement of lumbar drain. The patient unfortunately did not demonstrate neurologic recovery following arrest and progressed to brain death. Discussion(s): While cryptococcal meningoencephalitis is overwhelmingly a disease of immunocompromised patients, it can occur in immunocompetent hosts, and delay in diagnosis and treatment can lead to adverse and fatal outcomes. This patient had no known underlying conditions besides a recent mild COVID-19 infection and underlying Chiari I malformation, neither of which are known to be associated with cryptococcal meningoencephalitis. These factors may however have played a role in his disease and progression. Copyright © 2023 Southern Society for Clinical Investigation.
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Introduction: The COVID-19 pandemic has shown how quickly and drastically everyday life can change in extreme situations. Objective(s): To investigate how external factors can affect human health - mentally and physically - and what indicators herald the proximity to a critical upheaval. Method(s): Using theories from theoretical physics and psychology, researchers from Heidelberg University and Karlsruhe Institute of Technology will observe emotional reaction via an 'infinitesimal stimulus' (f) to an image that gives the 'infinitesimal displacement' (d). While both the stimulus and the reaction are chosen to be small - and hence keep a person well within their emotional stability - the ratio (d/f ) provides us a quantitative measure of the individual's susceptibility i.e. reaction sensitivity. Over a six-month phase, we hope to correlate the individual susceptibility with the person's general emotional state and to define a threshold reaction to indicate a person's proximity to an emotional instability. Semistructured interviews of extreme cases give us further insight into correlations between emotional states and susceptibility. Result(s): If an increased susceptibility in an individual actually precedes a long-term change in mood, then regular susceptibility measurements can be used, for instance, to detect depression at an early stage. We are particularly curious to observe the extent to which models from physics can be applied to society and the individual. Conclusion(s): The final output is to integrate practical implementation aspects into the medical curricula in a transdisciplinary manner. If possible, a formula for understanding health stability should be formulated that would be highly innovative for the medical field.
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A study which included 97 children who had COVID-19 during the period from September 2021 to January 2022 was conducted. This article discusses the symptoms occurring after COVID-19 infection. The analysis of the results showed that the largest proportion among sick children was in patients with reduced cognitive functions, an increased level of neuroticism, depressed state and emotional instability. The most common comorbidities were the diseases of the gastrointestinal tract, respiratory and cardiovascular systems.
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Background: SARS-CoV 2 infection (Covid-19) has a wide range of Clinical and laboratpry symptoms typical for rheumatic diseases, in particular systemic lupus erythematosus (SLE). Objectives: Analysis of the course of Covid-19 in patients with SLE and the influence of antirheumatic drugs on its outcomes. Methods: A retrospective analysis of 12 patients with SLE previously observed in the rheumatology department and had Covid-19 in 2020-2021. Average age of patients (83% women) is 41 years (24-59 years old), duration of SLE-11 years (3-25 years). 10 patients had low SLE activity, 1-moderate, 1-high. In anamnesis 8 patients had hematological disorders, 4-secondary antiphospholipid syndrome (APS) with thrombosis, 3-cerebrovasculitis, 5-lung damage, 3-lupus nephritis. All patients were treated with glucocorticosteroids (GCs) (the average dose 2 1/4 tablets per day), 10 (66,7%)-with hydroxychloroquine (HCQ), 4 (33,3%)-with immunosuppressants: 2-mycophenolate mofetil, 1-methotrexate, 1-cyclophos-phamide. 3 (25%) patients received rituximab (RTM) 2-3 months before the onset of COVID-19. 9 (75%) patients received outpatient treatment, 5 of them had a mild infection (3-without lung damage, 2-with lung damage-CT 1), 4-had a moderate course, 3 (25%)-were admitted to the hospital,1-to the intensive care unit. Results: Patients were divided into 3 groups for SLE therapy. The frst group (6 patients) was treated with GCs (average dose of 1 1/2 tab.) and HCQ (200-400 mg). All of them had mild to moderate course of infection without complications. Exacerbation of SLE was noted in 3 (50%) patients: 2 had capillarities, psycho-emotional lability, deterioration of laboratory parameters, 1 (with secondary APS) developed deep vein thrombosis of the legs and an exacerbation of lupus nephritis a month after. The second group (3 patients) received GCs (average dose 2 1/4 tab.) and immunosuppressants. In 2 patients the course of Covid-19 was mild, in 1-moderate. Exacerbation of SLE was noted in 2 patients: 1 had headaches, high titers of ANA and anti-DNA, 2nd-a severe exacerbation (hematological disorders, lupus nephritis with impaired renal function). The third group (3 patients) received GCS (average dose 5 tab.) and rituximab. 2 patients received RTM for 2 years, the last infusion was carried out for 3 months before the onset of an infection. Their course of Covid-19 was moderate with CT-2 lung damage and mild respiratory failure. There were no exacerbations of SLE after recovery. The 3rd patient initially had a high activity of SLE with nephrotic syndrome, arterial hypertension, batterfy rash, arthritis, fever, which required high doses of GCs and 2 rituximab infusions of 500 and 1000 mg. A month later, a severe COVID-19 developed with 70% lung damage, severe respiratory failure (SpO2-80%), and cytokine storm syndrome. He was treated with GCS, anticoagulants, tocilizumab, immunoglobulin, followed by recovery. Mild and moderate course of COVID-19 was observed in 92% of patients with SLE, in 8%-severe. Exacerbation of SLE after infection occurred in 41% of cases with no lethal outcomes. Conclusion: Patients with low activity SLE on small doses of GCs and HCQ tolerate COVID-19 relatively easily. The high activity of SLE and the use of ritux-imab contribute to the severe course of COVID-19 with damage to the lungs and respiratory failure, so the use of anti-B-cell therapy during a pandemic is undesirable. The effect of immunosuppressants is controversal. Exacerbation of SLE after COVID-19 in 41% of all patients requires monitoring of laboratory parameters and observation by a rheumatologist for at least six months after recovery from infection.
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STATEMENT OF PROBLEM/QUESTION: Health care for individuals experiencing homelessness is typically fragmented and passive, and illequipped to meet the complex needs of this population. DESCRIPTION OF PROGRAM/INTERVENTION: The Mobile, Medical, and Mental Health Care Team (M3 Team) is a mobile, patient-centered, integrated care model for people experiencing chronic homelessness with a chronic medical condition, serious mental illness, and substance use disorders. M3 innovates in three ways: 1) M3 is mobile and patient-centered, meeting people where they are - both geographically and in their readiness for engagement;2) M3 is integrated and holistic, integrating primary care, behavioral health care, and health-related social needs across public medical and mental health systems;3) M3 focuses on racial equity to include provider training, prioritization of Black clients, and data disaggregation by race and ethnicity. MEASURES OF SUCCESS: We conducted quarterly assessments of enrolled patients using two standardized scales: (1) self-reported functioning and mental health symptoms using the Behavior and Symptom Identification Scale (BASIS-24), and (2) substance use using the Addiction Severity Index (ASI) drug and alcohol use scales. To assess changes in the dependent variables over time, we used repeated measures ANOVA with time, gender, race, ethnicity, number of comorbidities, and an indicator of whether the measurement was taken before or after the start of the COVID-19 pandemic as independent variables. We also evaluated emergency department utilization and hospitalizations, 6 and 12 months pre- and post-enrollment on the M3 Team (unadjusted results presented here, adjusted analyses currently ongoing and will be presented if accepted). We also tracked enrollment in social programs. FINDINGS TO DATE: 54 clients were enrolled between August 2019 and December 2022. In the 6 months following the start of M3 enrollment, participants experienced decreases in mean severity of mental health symptoms related to depression and functioning (-0.205, p=0.011) and self-harm (-0.055, p=0.008), as well as alcohol use (-0.120, p=0.007) and drug use (-0.065, p=0.001). In the 18 months following M3 initiation, mean severity of symptoms related to depression and functioning (-0.372, p=0.003), self-harm (-0.073, p=0.019), emotional lability (-0.114, p=0.014), and drug use (-0.080, p=0.005) decreased while other domains were not significantly different from baseline values. On average, ED visits post enrollment were significantly lower than pre-enrollment for the 6-month and 12-month measures by 51% and 43%, respectively. Hospitalizations pre- and post-enrollment were not significantly different. Enrollment in a variety of social service programs increased over the enrollment period. KEY LESSONS FOR DISSEMINATION: Delivery models that integrate primary care, behavioral health care, and social services hold promise for improving behavioral health outcomes, reducing ER utilization, and addressing social needs of individuals with complex health needs who are experiencing homelessness.
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Introduction: During 2020, measures to contain the global health crisis caused by the coronavirus disease (COVID-19) included social confinement, with the consequent interruption of normal activities. In Argentina, particularly, the confinement was one of the longest and strictest in the world. Within this context, the current study was aimed at exploring changes in illness severity among bipolar disorder (BD) patients living under strict lockdown. Method: Ninety BD outpatients under naturalistic conditions were followed from March (when the lockdown measures were imposed in our country) to September 2020. Thirteen variables of illness severity were assessed during this period, which were compared with the results obtained during the same 28-week period of the previous year (i.e., from March to September 2019). Results: No significant differences were observed between periods in the rate of patients that remained euthymic during the entire follow-up (28.9% before the pandemic versus 41.1% during the pandemic, p = 0.09). For most variables, no significant differences were observed. A small decrease was found in depressive episode density (from 0.39 ± 0.74 to 0.22 ± 0.63, p = 0.003). Symptom and episode density during the pre-pandemic period and the number of previous depressive episodes at study entry predicted worse outcomes during the pandemic. Conclusion: Findings from a large sample of BD individuals indicate that illness severity variables have not worsened as a result of the lockdown. In addition, our findings suggest an important degree of positive coping among BD patients and emphasize the effectiveness of telepsychiatry in treating this clinical population.
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Introduction: Nelson syndrome has been reported in up to 25% of adults after bilateral adrenalectomy (BLA) for Cushing’s disease (CD). It usually manifests as an expanding pituitary mass, rising adrenocorticotropic (ACTH) hormone levels and, in many patients, the development of hyperpigmentation. We review the clinical course of a patient with rising ACTH levels after BLA for presumed CD. Although the diagnosis of Nelson syndrome was considered, he was found 9 years after BLA to have an ectopic ACTH secreting bronchial carcinoid tumor as a cause for the elevated ACTH levels. Case Description: A 35 year old male was evaluated at another institution in 2010 after he presented with weight gain, new onset hypertension, muscle weakness with multiple falls, depression, irritability and emotional lability. He was diagnosed with CD and was referred to a university center where he underwent trans-sphenoidal pituitary surgery in May 2011. An adenoma was seen on frozen section but not on the final pathology. He developed transient symptoms of adrenal insufficiency on the second post-operative day. Because of persistent hypercortisolism he underwent BLA in November 2011. We started following him in 2012 and signs of hypercortisolism gradually resolved. He appeared euadrenal on hydrocortisone 10 mg am, 5 mg 12 noon and 5 mg 6 pm and fludrocortisone 0.05 mg daily. ACTH levels increased from 54 pg/ml (6-50) in 2012 to 1024 pg/ml in 2019. He had no hyperpigmentation and MRI of the pituitary from 2014-20 did not show a pituitary mass. During an evaluation for COVID-19 infection in May 2020, a chest x ray revealed a right lower lobe lung mass measuring 3.3 x 2.0 cm. He underwent right lower lobe lung lobectomy in July 2020 and pathology revealed a carcinoid tumor-spindle cell pattern which stained strongly positive for ACTH and weakly positive for chromogranin. ACTH levels after the surgery decreased to 16.3 pg/ml. Discussion: Some authors have suggested that Nelson syndrome be considered in patients with BLA who have one of the following: an expanding pituitary mass or ACTH levels >500 p/ml at 3 different time points after surgery. This case highlights the need to consider ectopic ACTH syndrome as another cause for rising ACTH levels after BLA for CD especially in those patients who are not found to have a discreet adenoma after pituitary surgery.