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Objectives: The impact of the COVID-19 pandemic on mental health is not yet well-studied. This study's objective is to describe demographic characteristics of the population diagnosed with depression or anxiety, and to compare PHQ9 scores before and after the pandemic. Method(s): A retrospective cohort study was performed using Komodo Health's healthcare claims and EMR data, which included Patient Health Questionnaire-9 (PHQ9) survey responses. The study's baseline and follow-up periods were set as one year before and after 03/01/2020. Patients selected were >=18 years of age, had a MDD, GAD, or other psychiatric diagnosis in both periods, and had taken at least one PHQ9 survey in both periods, resulting in 10,433 patients. Demographic characteristics were described across age, gender, and race/ethnicity, and a subgroup analysis was performed on PHQ9 scores and depression categories using averages (mean, SD) and odds ratios. Result(s): Demographic analysis showed depression severity correlated with patients who were younger, female, and Black or Hispanic. Younger patients (<30) were more likely than older (>=30) to be in the moderately severe category or worse (PHQ9 score >=15) in both time periods (ORs 1.72 and 1.62, p<0.001). This was also true for female as compared to male (ORs 1.45 and 1.49, p<0.001), and Black or Hispanic as compared to White (ORs 1.87 and 1.47, p<0.001). However, mean PHQ9 scores tended to decrease in the follow-up period. The overall mean decreased slightly from 6.28 (SD 6.05) to 5.68 (SD 5.82), which was consistent in nearly all age, gender, and race/ethnicity subcategories. Conclusion(s): While the improvements in average PHQ9 scores were counterintuitive, given the harmful impacts of the pandemic, existing correlations between demographics and depression severity remained. One possible explanation is that this cohort definition selected for patients who received more consistent mental healthcare. Further study will investigate this and other possible factors.Copyright © 2023
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Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness. Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data. Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder - 24%, recurrent depressive disorder - 20%, schizophrenia - 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent - psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors. Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.Copyright © 2022 Ima-Press Publishing House. All rights reserved.
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INTRODUCTION AND OBJECTIVE: Psychotropic medications have a significant impact on sexual health. Long-term usage is strongly associated with dyspareunia, decreased libido, hypogonadism and erectile dysfunction. We hypothesized that the prescription rates for psychotropic medications increased in adolescent patients during the COVID-19 pandemic because of the unprecedented stress levels on youth in isolation. Therefore, we evaluated the prescription rates of psychotropic medications as well as concurrent use of PDE5i in adolescent patients during the COVID-19 pandemic compared to the pre-pandemic era. METHOD(S): We utilized data generated from TriNetX Research Network to conduct a retrospective matched cohort study. Adolescent patients aged 10-19 presenting for outpatient evaluation were placed into two cohorts: 1) outpatient evaluation before and 2) during the COVID-19 pandemic. Patients with prior psychiatric diagnoses and those with prior use of psychotropic medications were excluded. The outcomes of interest were new prescriptions within 90 days of outpatient evaluation. Propensity score matching was performed using logistic regression to build cohorts of equal size. RESULT(S): A total of 1,612,283 adolescents pre-COVID-19 and 1,008,161 adolescents presenting during the COVID-19 pandemic for outpatient evaluations were identified. After propensity matching, a total of 1,005,408 adolescents were included in each cohort each withan average age of 14.7 +/- 2.84 and 52% female and 48% male. Prescribing of antipsychotics and benzodiazepines were more frequent during the pandemic for adolescents (RR: 1.58, 95% CI 1.01-2.2). However, they were less likely to receive antidepressants (Risk Ratio (RR): 0.6, 95% Confidence Interval (CI) 0.57-0.63), anxiolytics (RR: 0.78, 95% CI 0.75-0.81), stimulants (RR: 0.26, 95% CI 0.25-0.27), as well as mood stabilizers (RR: 0.44, 95% CI 0.39-0.49). Erectile dysfunction requiring oral PDE5i in this cohort was more frequent during the pandemic for adolescents (RR: 1.53, 95% CI 1.05-2.01). CONCLUSION(S): The rates of antipsychotic and benzodiazepine prescriptions increased during the COVID-19 global pandemic compared to preceding years. This coincided with a statistically significant increase in the prescription of PDE5i for erectile dysfunction. Adolescents may face an increased risk of sexual dysfunction as both their illness and the medications they are prescribed both have a positive association with sexual dysfunction. Clinicians must be cognizant of the fact that adolescents may face an increased risk of medication related sexual dysfunction.
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Background: COVID-19, one of the deadliest pandemics, has taken a toll on physical and mental health alike. It has been noticed that there is a rise in psychiatric comorbidities in covid recovered cases. Various disorders like PTSD, anxiety, depression, sleep disorders have been reported in COVID-19 survivors .Current study aims to estimate the prevalence of psychiatric disorders and its associated correlation in patients with history of COVID-19. Method(s): The study population comprised the patients referred to the Psychiatry OPD from the post covid OPD over 3 months. Patients were assessed using a semi structured proforma, sociodemographic profile, treatment facility( institutional or home quarantined), duration of stay at treatment facility, medical and psychiatric diagnosis were recorded and analysed using descriptive statistics. Result(s): 160 patients were included and assessed of which 66.25% were male and 33.75% were female. Mean age was 38.8 years.The referral rate was found to be 15.9%. Most common psychiatric disorder was sleep disorder (25%), followed by stress and trauma related disorder (16.25%), depression (11.25%), anxiety disorder (10%). Conclusion(s): We would like to emphasize on vigilant approach and constant supervision of these patients so that an early diagnosis could be made and an add on burden to mental health care system could be reduced.For this to be achieved screening of such patients should be increased .
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Background: Approximately 30% to 50% of breast cancer patients experienced mental distress prior to the advent of COVID.The delayed access to cancer treatment due to the outbreak of COVID -19 pandemic posed a unique challenge to breast cancer patients and caused a significant level of mental distress among them. In the current research, we examined the psychological impacts of COVID on breast cancer patients in China using Symptom Checklist-90-R (SCL-90-R). Method(s): Participants were breast cancer patients at the outpatient clinic of Xijing hospital. The study was conducted virtually, and the questionnaires were distributed via Wenjuanxing, the Chinese alternative of Qualtrics. The researchers were healthcare workers affiliated with Xijing hospital, and the survey was sent to a breast cancer patient support group which included 1399 cancer patients and 6 healthcare workers. The initial sample consisted of 199 participants who signed an informed consent form to participate in the study. The inclusion criteria were as follows: 1) diagnosed with breast cancer, 2) aged 18 years or above, and 3) had no history of cognitive impairment or previous diagnosis of psychiatric disorders. The validated Mandarin version of the SCL-90-R (Wang, 1984) was then given to the participants to evaluate their psychological status.Categorical variables were summarized as numbers and percentages;continuous variables were described as mean (M) +/- standard deviation (SD). Data were analyzed using IBM SPSS Statistics Version 26. Result(s): Participants (N = 195) filled out the SCL-90 questionnaire in February, 2020. All participants were female breast cancer patients treated at Xijing hospital, among which 16.41%, 36.41%, 19.49%, and 28.21% had respectively received treatment for less than a year, 1-3 years, 3-5 years, and 5 years or more. 64.62% of the patients were at stage I;0.77% were at stage II and III;4.62% were at stage IV according to TNM classification. The molecular type of participants is as follows: 47.2% of ER+ HER2-, 31.8% of HER2+, and 21.0% of Triple negative.Participants whose treatments continued to be delayed, on average, reported an elevated general psychopathology score (M = 1.48, SD = 0.47) compared to participants whose treatments were resumed (M = 1.30, SD = 0.34), and the difference was statistically significant, t(193) = 2.96, p = .003, d = 0.44, 95%Cl [0.06, 0.30]. The one-way ANOVA revealed a marginally significant effect of length of treatment delay on general psychopathology score, F(4, 190) = 2.09, p = .08, eta2 = .04. Follow-up multiple comparison analysis showed that participants who had their treatment delayed for 3 weeks to 1 month (M = 1.70, SD = 0.70) reported significantly higher general psychopathology scores than participants whose delay in treatment was less than 1 week (M = 1.34, SD = 0.40), p = .05. General health status (p < .001) and current treatment status (p = .02) are the only two variables that were statistically associated with general psychopathology score.Poorer perceived health status and current delay in treatment were associated with higher general psychopathology score, Additionally, younger age was associated with higher interpersonal sensitivity (p = .01) and hostility (p = .006). Conclusion(s): We found that breast cancer patients at an advanced stage were more likely to experience psychological symptoms with longer treatment delay, and whose treatments continued to be delayed reported elevated psychological symptoms than individuals whose treatment were resumed, regardless of treatment type. Additionally, a treatment delay of more than three weeks might have exacerbated breast cancer patients' psychological symptoms, whereas a short-term delay of less than three weeks was less likely to have a significant effect on one's mental wellbeing.
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Background: The COVID-19 pandemic has dramatically accelerated the utilization and acceptance of telepsychiatry, with many departments transitioning to virtual models over the past 2 years out of necessity. While there has been some research on physician and patient satisfaction with the transition, there has been significantly less research on the quality of care provided (Mishkin). By its nature, telemedicine precludes physical examination. While many psychiatric conditions are amenable to diagnosis via patient interview alone, some such as catatonia require a physical exam for diagnosis. The Busch Francis Catatonia Rating Scale (BFCRS) is a well validated in-person exam for catatonia to both screen for and rate the severity of a catatonia diagnosis (Sienaert), but to our knowledge it has not been validated via telemedicine. Our literature review revealed a paucity of research on the contribution of each individual item to the overall sensitivity of the rating scale, thus it is impossible to predict the value of a fully virtual or hybrid exam. We plan to evaluate the inter-relater reliability between an in-person BFCRS performed by a psychiatrist and one supervised by a psychiatrist through telemedicine technology. Current practice at our institution is for the psychiatry resident performing tele-consults to Methods: We will draw participants from the pool of patients for whom psychiatric consults are ordered at two separate medical campuses. Our team will consist of C-L psychiatry fellows performing BFCRS exams patients at these campuses;we will strive to see all patients for whom a psychiatric consultation is ordered. In addition to a standard psychiatric consult (which may or may not include a BFCRS), patients will receive an in-person BFCRS screening exam performed and scored by the research team member at their site and one additional hybrid BFCRS exam scored by the research team member at the alternate site with physical exam components only performed by the onsite research team member. Data collected for each participant will include demographic information, medical and psychiatric diagnoses and BFCRS scores. We will compare the sensitivity and specificity fully virtual (which will by necessity exclude some components such as rigidity) and hybrid BFCRS exam to the full in-person scale, which we will treat as a gold standard. Discussion/Conclusion: This project is currently in early stages. We hope to gather data to inform the future practice of C-L psychiatrists performing consults through telemedicine. Mishkin AD, Cheung S, Capote J, Fan W, Muskin PR. Survey of clinician experiences of telepsychiatry and tele-consultation-liaison psychiatry. J Acad Consult Liaison Psychiatry. Published online November 15, 2021:S2667-2960(21)00184-1. Reference: Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord. 2011;135(1-3):1-9 Copyright © 2022
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The objective of this current work was to explore whether modification of the diagnostic criteria upon the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the impact of the COVID-19 pandemic had influenced the diagnostic and sociodemographic profiles of mental health admissions. For that purpose, we designed an observational, longitudinal, and retrospective study of the data recorded in the discharge reports of the Brief Hospitalization Unit at Castellon (Spain), between January 2006 and December 2021. The sample consisted of 7,037 participants, with a mean age of 42.1 years. The mean age of admissions, number of women, and presentation of affective disorders, addictions, and dementias all increased significantly during the DSM-5 period. Beyond diagnoses, the reduction in readmissions before the pandemic could be attributed to the use of long-acting injectable antipsychotics. In contrast, the pandemic did not change the percentage of readmissions or the volume of admissions. Also, during the pandemic period, the significant results obtained indicate that the average stay was reduced, affective disorders decreased, and addictions increased. Therefore, clinicians should consider these diagnostic and sociodemographic fluctuations when adapting clinical care, taking into account gender perspective, ageing of patients and increasing of dual and affective disorders.
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COVID-19 , SARS-CoV-2 , Adult , Female , Humans , COVID-19/epidemiology , Hospitalization , Pandemics , Retrospective Studies , MaleABSTRACT
Background: The COVID-19 pandemic has been linked to increased mental health issues and interpersonal violence. Both psychiatric diagnoses and young males are overrepresented in the trauma population. Our objective was to characterize injury characteristics and their relationship to psychiatric diagnoses after the COVID-19 lockdown at a trauma centre in Edmonton, Alberta. Specifically, we queried relationships between gender, age, length of stay and intentionally violent injuries, and we reviewed access to inpatient and outpatient mental health and addiction resources. Method(s): We performed a retrospective chart audit for trauma patients aged 18-64 years admitted to the University of Alberta Hospital Trauma Service from June 1 to Aug. 31, 2020. Variables included demographics, injury characteristics, psychiatric history, substance use disorder history and presence of psychiatry and addictions consultations. Treatment plans and follow-up were assessed. Frequencies and basic descriptives were calculated. Univariate analyses were performed to identify relationships between psychiatric or addiction diagnosis (or both) and injury patterns. Result(s): A total of 176 patients met the inclusion criteria. Patients were young (mean age 39.7 yr) and male (73%), and blunt injury was most common (82%). Sixty-three patients (36%) had a psychiatric (29 patients) or addiction (59 patients) history. Twenty-eight patients (15%) received consults to the psychiatry service. At discharge, follow-up included mental health team (10 patients, 36%), family physician (2 patients, 7%) or self-referral resources (8 patients, 29%). Eight patients were not provided follow-up. Fifty-nine patients (34%) had 1 or more addictions history. Nineteen patients (32%) received consultations to psychiatry (18 patients) or addictions (1 patient). Otherwise, 6 patients (10%) were provided community resources at tertiary survey, 6 patients (10%) declined offered resources and 6 patients (10%) had traumatic brain injury (addiction resources deferred). Twenty-five patients (42%) either were not offered resources or documentation was unclear. On univariate analysis of patients with psychiatry consult, age was similar, but females were more likely to be represented (42% v. 24%, p = 0.06). Average length of stay was 17 days versus 9.7 days (p = 0.05). Having a psychiatric consultation or addictions history (or both) was associated with a violent mechanism of injury (35% v. 18%, p < 0.02). Conclusion(s): Over one-third of trauma patients aged 18-64 years had a psychiatric or addiction history (or both) and were significantly more likely to have a violent injury mechanism. Psychiatric consultation was common, more so in female patients, and linked to increased length of stay. Community follow-up was suboptimal, especially for patients with addiction history. Resource access and provision must be optimized to improve care, reduce recidivism and target interpersonal violence during this time of increased individual and system stress..
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Background: In March 2020, World Health Organization declared COVID-19 outbreak a pandemic, with children forced to be away from structured school settings making them experience circumstances that could accelerate weight gain, including increased stress, irregular mealtimes, increased screen time, and lesss physical activity. Recent studies showed increased body mass index (BMI) trends in children during COVID-19 pandemic and recommended replicating this result with other population. Our study aims to measure the BMI trends before and after the COVID-19 pandemic lockdown in children 2-19 years of age presented to ambulatory clinics at a local community with the majority of black race. Method(s): A retrospective study on children aged 2-19 years who presented to ambulatory clinics affiliated with Brookdale Hospital, New York from 10/1/2018 to 10/31/2021. We included subjects with at least two BMI readings before COVID-19 lock down in March 2020, and at least one reading afterwards. Children who were underweight at baseline (BMI percentile < 5) or with medical conditions that may cause impact on weight such as endocrinological conditions (e.g. diabetes mellitus or hypothyroidism), genetic (e.g. Prader Willi syndrome), gastrointestinal diseases (e.g. inflammatory bowel disease or celiac disease), psychiatric diagnoses (e.g. eating disorders), as well as children who received systemic steroids > 2 weeks, were excluded from the study. Two baseline BMI readings were taken for all subjects during the pre-COVID period from October 2018 until March 2020 (one during the first 9 months, baseline-1;and second during the following 9 months, baseline-2). In the post-COVID period, the latest BMI measurement for the same cohort, at least 9 months from COVID-19 lockdown, was retrieved for comparison. Data was analyzed using SPSS software. The percentage of overweight and obese children was compared between different timelines using Chi-squared test. Change of BMI percentiles over time was tested for significance using the Wilcoxon Signed Ranks test. Result(s): After implementing the exclusion criteria, final number of studied patients was 3713. Children < 5 years old were 905 (24.4%), 5-12 years old were 1707 (46%), and > 12 years old were 1101 (29.7%). The median age (IQR) was 9 (5-12) years, with 1844 (49.6%) males. Black race accounted for 1777 (47.9%) while Hispanics or Latinos were 470 (12.7%), with other ethnicities being 1466 (39.4%). There was no difference in the percentage of obese children from baseline-1 (806/3713=21.7%) to baseline-2 (829/3713=22.3%), p-value=0.795, but this increased significantly in the post-COVID period (1136/3713= 30.6%), p-value <0.001 (figure 1). There was no significant change in the percentage of overweight children between the three timelines. The BMI percentile median (IQR) did not change between baseline-1 = 70 (36-93) and baseline-2 = 71 (35- 93), however, this increased significantly to 81 (36-93) in the post-COVID period, p-value<0.001 compared to both baseline-1 and baseline-2. Comparing the change in BMI percentiles from baseline 2 to post-COVID in the different age groups, it was more evident in the <5 years age group (median increment of 4.3 percentile) and 5-12 years age group (median increment of 3.9 percentile) compared to the >12 years age group (median increment of 0.7 percentile), p-value<0.001 (table 1). Conclusion(s): In our local community, COVID-19 lockdown resulted in a higher prevalence of obesity and an overall increase in BMI percentiles among children aged 2-19 years. The increase in BMI percentiles was more evident in children less than 12 years of age.
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Background: Long COVID is increasingly recognized as a post-viral syndrome;however general knowledge within the medical field is limited and many with the syndrome continue to face challenges accessing healthcare. The present study examined long COVID patients' perceptions and experiences of medical care. Methods: Participants (N=123) with protracted COVID A-136 symptoms (? 3 months) were recruited via social media and completed online measures of premorbid health, COVID-19 positivity, symptoms, recovery, and perceptions of their healthcare experience. Satisfaction with medical care was rated on a scale of 0 ?very dissatisfied? to 4 ?very satisfied.? Results: Participant satisfaction of long COVID related healthcare ranged from ?dissatisfaction? with their emergency room experience (M=1.45, SD=1.37) to ?neither satisfied nor dissatisfied? for cardiology (M=2.43, SD=1.25). Fifty-six participants (46%) received an anxiety disorder diagnosis by at least one physician despite experiencing symptoms that were not consistent with the diagnosis (e.g. protracted fever, anosmia). As a result, they felt dismissed (84%), unheard (64%), angry (54%), and delayed (29%) or discontinued medical care (25%). Common themes in the open-ended responses included perceiving providers to be dismissive of long COVID medical literature (18%), female patients' belief that clinician response and treatment would have been different if they were male (15%), and a desire for clinicians to recognize limits of their knowledge (11%). Ten percent reported positive experiences, specifically when the relationship felt collaborative and/or the clinician recognized a need to learn more about post-COVID syndromes and complications. Another 5% acknowledged and empathized with challenges faced by the medical community during the pandemic. Discussion: These findings suggest that long COVID patients are generally dissatisfied with their healthcare experiences, and that, in line with research in other populations, engaging the patient's experience, working collaboratively, and recognizing limits of knowledge contribute to a more positive experience. When a formal mental health evaluation supports a psychiatric diagnosis, clinicians can improve patient engagement and treatment compliance by acknowledging symptoms that are inconsistent with such diagnosis and referring to other specialists as appropriate.
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Background: Due to the COVID-19 pandemic children were deprived of in-person attendance at school and experienced social isolation. The impact of these social-distancing measures on pediatric mental health is only now being unraveled. We conducted a descriptive review of psychiatric diagnoses at a pediatric outpatient practice in a Southern Illinois rural community. We compared the trends of pediatric psychiatric diagnosis before and following the COVID pandemic. Methods: Pediatric Group LLC has multiple office locations in Rural Southern Illinois catering to about 10,000 pediatric patients staffed by pediatric providers and a clinical psychologist. The pediatric population has remained stable during the period. The care providers and practices have remained unchanged over the past four years. We did a retrospective review of electronic health records from January 2019 through June 2021. Using ICD10 diagnostic codes, we analyzed the top 100 diagnoses made at the pediatric practice. Diagnoses were broadly classified into psychiatric and non-psychiatric categories. Psychiatric illnesses included anxiety, attention deficit hypersensitivity disorder (ADHD), conduct disorders, mood disorders, sleep disorders, and other psychiatric illnesses such as post-traumatic stress disorder (PTSD). Descriptive comparisons were made between pre-COVID (2019) and post-COVID (2021) periods. Results: Compared to a baseline of 5044 encounters in 2019 (pre-COVID), attendance was 9% lower (4680) in 2020. Attendance dropped by 14% (2206) in the first half of 2020, increasing by 11% (2474) to reach preCOVID levels in the second half of 2020. The attendances continued to increase in the first half of 2021, reaching 43% higher (3614) numbers compared to pre-COVID levels. Compared to 2019 and 2020, an increase in all psychiatric diagnoses was seen in our offices in the year 2021. Further analysis of the year 2021 showed significant increases in Anxiety and Depressive disorders, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation disorder (DMDD), and Major Depressive disorders (MDD) that almost doubled the statistics from the pre-COVID period. Sleep disorders and Post Traumatic Distress Disorder (PTSD) visits increased by far more than 150 percent. (Table 1) Conclusion: A steady increase in pediatric psychiatric illness has been noted in the second half of 2020 and first half of 2021 following COVID pandemic. We observed an increase by over two times with almost all the psychiatric disorders in 2021. The overall increase in the incidence of various pediatric psychiatric illnesses is concerning. We believe that the absence of in-school attendance may have played a significant role.
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BACKGROUND: In studies of COVID-19 patients, delirium is associated with functional impairments, increased length of stay (LOS), and mortality, though the condition is often under-detected. To date, no research has examined the impact of COVID-19 on the likelihood of developing delirium while hospitalized. Using a validated delirium screening tool, we examined 1) the association between COVID-19 diagnosis and incidence of delirium among patients admitted to acute care units at a large, urban academic hospital, and 2) factors associated with the incidence of delirium among patients admitted with COVID-19. METHODS: The study population consists of all adult patients admitted to acute care units at Froedtert & the Medical College of Wisconsin from July 2020 to February 2021. Patients were excluded if they had delirium at admission, were admitted from an ICU, or had history of a psychiatric diagnosis. Delirium was assessed using Nursing Delirium Screening Scale (NuDESC). Screening occurred every 8 hours;patients scoring ≥ 2 were considered delirious. COVID-positivity was assessed via Polymerase Chain Reaction (PCR) test prior to admission or after admission but prior to delirium onset. A multivariate logistic regression was used to estimate the association between COVID-19 status and odds of developing deliriumduring the hospital stay, adjusting for demographics, financial vulnerability (uninsured or Medicaid enrollees), comorbidities, and time fixed effects. RESULTS: 20,509 patients were included. The mean age was 55.6 (SD=19.7), with 9,768 (47.6%) >60. 11,553 (56.3%) were female. 4,351 (21.2%) were considered financially vulnerable. 374 patients (1.8%) tested positive for COVID-19. 2,278 patients (11.1%) developed delirium. Of COVID-positive patients, the incidence rate of developing delirium rose to 18.2%.On average, COVID-positive patients had 62%higher relative risk (OR 1.62, 95% CI 1.24-2.14, p=.001) of developing delirium than COVID-negative patients. This result persisted in sensitivity analyses where we also controlled for patients' LOS. Development of delirium was associated with male sex (OR 1.30, 95%CI 1.18-1.42, p=.000), Black race (OR 1.62, 95%CI 1.18-1.42, p=.000), Hispanic ethnicity (OR 1.33, 95%CI 1.05-1.69, p=.017), financial vulnerability (OR 1.63, 95%CI 1.42-1.89, p=.000), and age >40. Among COVID-positive patients, development of delirium was associated with male sex (OR 2.39, 95%CI 1.41-4.06, p=.000), and age >60. We found no evidence that the presence of specific COVID-19 symptom(s) increased the odds of developing delirium compared to asymptomatic COVID-19-positive patients. CONCLUSIONS: Patients with COVID-19 were significantly more likely to develop delirium during their hospital stay than their COVID-19 negative counterparts, even after controlling for confounding. Among COVID-19 positive patients, patients >60 are especially vulnerable. Providers should proactively assess delirium among COVID-19 patients, with a particular focus on the elderly.
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Background: Dysgeusia is a distortion of taste sensation. Etiologies can include medications and Covid-19, among others. Dysgeusia may lead to appetite loss which is nonspecific and can have multiple causes, including major depressive disorder (MDD) (Coulter, 1988). Although post-marketing data revealed no association between nifedipine and dysgeusia (Ackerman, 1997), case reports of dysgeusia from nifedipine exist (Ackerman, 1997). We present a case of nifedipine-induced dysgeusia mistaken for depression. Case Report: A 42-year-old man with hypertension and diabetes was admitted to the hospital following right thalamocapsular and intraventricular hemorrhages. Hypertension was managed with metoprolol, lisinopril, nifedipine, and chlorthalidone. Levetiracetam was started for seizure prophylaxis. Medications included pantoprazole, simethicone, transdermal lidocaine, insulin, metformin, docusate, senna, and subcutaneous heparin. Psychiatric consultation was requested out of concern that appetite loss indicated depression. The day before psychiatric evaluation, mirtazapine 15 mg at bedtime for mood and appetite was started. Nifedipine 90 mg daily had been started 9 days prior to his first complaint of decreased appetite. The patient reported feeling disconnected from his family and “sad" for ∼10 years, complaining that family members “talk behind his back.” He was otherwise without paranoia. He denied insomnia, anhedonia, hopelessness, poor concentration, suicidal ideation, homicidal ideation, guilt, mania, or hallucinations. He reported poor appetite due to epigastric discomfort and bad taste to foods. Covid-19 testing was not yet widely available. No other signs or symptoms suggestive of Covid-19 were present. Although alert and fully oriented, concentration was impaired with sometimes tangential thought processes. Affect was full without depression. A diagnosis of adjustment disorder was made. The psychiatry team suspected nifedipine-induced dysgeusia and advised discontinuing nifedipine. Appetite improved two days later. Discussion: This case highlights the importance of considering alternative causes of nonspecific symptoms of depression, including decreased appetite, that may have non-psychiatric causes. Dysgeusia is widely recognized as a symptom of Covid-19. Other causes, including medications may be underrecognized and amenable to intervention. Conclusion: It would be helpful to consider medication side-effects as potential causes for taste distortion alongside psychiatric diagnoses, and COVID-19. References: 1. Coulter DM: Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of post marketing surveillance BMJ 1988;296: 1086–8. 2. Ackerman BH, Kasbekar N: Disturbances of taste and smell induced by drugs. Pharmacotherapy 1997;17(3):482-96.
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Background/Significance: Nationwide, the number of hospital emergency department (ED) visits has steadily increased over the past decade;since 2009, ED volumes have increased over 11%.1 The proportion of ED visits primarily involving psychiatric concerns (including substance use) has also been on the rise, from 6.6% of all visits in 2007 to 10.9% of all visits in 2016.2 A recent retrospective analysis of ED visit data from the National Emergency Department Sample examining the years 2010 through 2014 identified mental health concerns (including substance use) as the second-most frequent ED presentation, with abdominal pain ranking as the most frequent.3 Challenges to caring for patients with prominent psychiatric concerns in EDs include: prolonged lengths of stay (LOS),4 boarding and overcrowding,5 increased restraint use,6 financial sequelae,7 and safety implications for patients and staff.5 Many EDs have limited access to psychiatric expertise. Unique features of our innovative ED-based Psychiatry service line include: 1) joint administration by academic departments of Emergency Medicine and Psychiatry, and 2) concurrent, rather than consecutive, evaluations conducted by Emergency Medicine physicians and Psychiatrists for optimal efficiency and collaboration. Methods: The ED Psychiatry Program at Froedtert Hospital was implemented in 2019 to improve patient care, systems-based processes, and cross-specialty education. IRB approval was granted on 4/7/2020 to review data collected on all patients seen in the ED by the new ED Psychiatry service and compare metrics with primary psychiatric patients seen in the ED prior to program implementation. Patient care metrics from the first 12 months has been analyzed;cases in which the ED psychiatrist was involved total 382 (data from 5 patients seen during this period could not be reviewed due to erroneous recording of identifying information). 754 charts were reviewed in total—377 post-implementation (9/1/2019-8/31/2020) and 377 pre-implementation (9/1/2018-8/31/2019). The following metrics were recorded and analyzed using basic summary statistics: ED LOS, disposition, psychiatric diagnosis at discharge, medication class recommended, medication class administered, medication route recommended, and medication route administered. Statistical analysis was performed both on the 12-month groups in aggregate, as well as separately in 6-month groupings to assess for any COVID-19 related confounding effect. Results: Analysis of the first 12 months of data (n = 377 control and intervention patients) demonstrates statistically significant results across a number of domains, including disposition (decrease in hospital admissions and increases in transfers and ED discharges post-implementation), psychiatric diagnoses (increases in personality, intellectual developmental, and anxiety spectrum disorders post-implementation), and medication classes and administration routes utilized (decrease in benzodiazepine use and increases in both atypical antipsychotic use, as well as oral route of administration post-implementation). There were also notable decreases in ED LOS for patients being admitted and transferred from the ED;however, these differences were not statistically significant. Discussion: Analysis of the first year of service data suggests program efficacy and overall value to the health system, with relevant metrics including shorter ED LOS, improved diagnostic accuracy, increased provision of pharmacological treatment interventions in the ED setting and upon discharge, and more resource-appropriate dispositions for patients presenting to the ED with psychiatric concerns. Future directions for further study include: 1) review of the total data set, numbering over 1300 patients in 2 years;2) de-duplication of the data set to eliminate repeat patient encounters as a potential source of confounding;3) collaboration with a faculty biostatistician team for further statistical analysis;and 4) collection and analysis of additional relevant metrics, including restraint use (both f equency and duration), utility of 1:1 observers, patient insurance status (to aid in quantifying possible financial impact), additional patient demographic data (including age, race, gender, ethnicity), and time of patient presentation to the ED. Conclusion/Implications: Integration of psychiatric care into medical settings has been widespread in outpatient environments, but acute models are lacking. Complex psychiatric presentations impede ED workflows and often lead to inadequate care for this vulnerable population. Our jointly administered program that embeds CL Psychiatrists into our academic ED care team has improved and enhanced the care of ED patients presenting with psychiatric concerns as well as operational efficiencies within the department. References: 1. Agency for Healthcare Research and Quality. (2021, April). HCUP Fast Stats. Retrieved from Healthcare Cost and Utilization Project (HCUP): www.hcup-us.ahrq.gov/faststats/national/inpatienttrendsED.jsp 2. Theriault, K., Rosenheck, R., & Rhee, T. (2020). Increasing Emergency Department Visits for Mental Health Conditions in the United States. J Clin Psychiatry, 20m13241. 3. Hooker, E. A., Mallow, P. J., & Oglesby, M. M. (2019). Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med, 344-351. 4. Ding, R., McCarthy, M., Desmond, J., Lee, J., Aronsky, D., & Zeger, S. (2010). Characterizing waiting room time, treatment time, and boarding time in the emergency room using quantile regression. Acad Emerg Med, 813-823. 5. American College of Emergency Physicians. (2014). Polling Survey Results. 6. Zeller, S., Calma, N., & Stone, A. (2014). Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments. West J Emerg Med, 1-6. 7. Nicks, B. A., & Manthey, D. M. (2012). The impact of psychiatric patient boarding in emergency departments. Emerg Med Int.
ABSTRACT
Background Corona virus disease (COVID-19) has emerged as a public health emergency &pandemic, which has affected the world in several domains including financial &psychological. Resident doctors helping the community during this tragedy at frontline have also suffered from psychological problems during their duty. Aim To screen for anxiety &depression among resident doctors of various departments involved/not involved in COVID-19 duty at a tertiary care hospital. Methods A cross-sectional study conducted on 175 resident doctors who were screened for depression using Public Health Questionnaire-9 (PHQ-9) and for anxiety using Generalized Anxiety Disorder-7 Scale (GAD-7). The study was conducted through an online survey using Google forms. Results Out of 175 resident doctors, 15.42% screened positive for depression requiring treatment and 15.42% for having significant anxiety. Significant association was found between depression &presence of any kind of symptoms and psychiatric comorbidity;between anxiety and gender, presence of psychiatric comorbidity &any kind of symptoms. Conclusion Our study suggested elevated levels of anxiety &depression due to COVID-19 pandemic. There is a need of early diagnosis &psychiatric intervention to help them cope with the issue.
ABSTRACT
Background: Increases in the prevalence of mental health symptoms during global pandemics have been observed. We hypothesized that people with HIV (PWH) and without HIV (HIV-) would experience an increase in mental health symptoms and alcohol use after the onset of the COVID-19 pandemic and that PWH would experience a greater increase than HIV-individuals. Methods: Participants were recruited from two established cohorts of PWH and HIV-adults in Omaha, Nebraska for whom baseline data including mental health and alcohol use assessments had been collected prior to the pandemic. Participants were excluded from the original cohorts if they had any known psychiatric diagnosis or were taking antipsychotics or anticonvulsants. Participants were reassessed utilizing the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), and Pittsburgh Sleep Quality Index (PSQI) between February and April 2021. All outcomes were evaluated using generalized linear mixed models. Results: Of the 95 participants who completed all questionnaires, 50 were PWH and 45 HIV-. Groups did not statistically differ in age, sex, race or ethnicity (mean: 45.67 years;69.5% male;74% non-Hispanic white). Pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in PWH versus HIV-. After the onset of the pandemic, mean BDI-II and AUDIT scores increased significantly in both groups (see Table;P<.001 and P=0.003, respectively) and AUDIT scores were significantly higher in males than females (P=.002). Measures of binge drinking and alcohol misuse as well as mean BAI and PSQI scores increased numerically intra-pandemic. Intra-pandemic mean BDI-II and AUDIT scores increased more among HIV-than PWH, but not significantly so. The percentage of PWH and HIV-participants who moved into a more severe category of depression as measured by the BDI-II (eg, from minimal to moderate) after the onset of the pandemic was identical (18%). Conclusion: Measures of depression and alcohol use increased significantly after the onset of the COVID-19 pandemic in people with and without HIV. Although there were no significant differences in the changes between the groups, PWH had higher baseline scores so the increases in this group may have more clinical impacts. Screening for symptoms of mental health and alcohol use is critical, especially in PWH during a pandemic. Future work will explore the longer-term impact of the pandemic on mental health symptoms and alcohol use.
ABSTRACT
Objective: Immediate effects of coronavirus disease 2019 outbreak on psychiatric patients are unknown. In this study, we aimed to investigate the impact of the coronavirus disease 2019 outbreak and public health measures on the psychological well-being of patients with psychiatric disorders. Methods: This cross-sectional study assessed 436 outpatients recruited from a tertiary psychiatry clinic in Istanbul, Turkey, nearly 1 month after the government introduced strict measures of lockdown against the ongoing outbreak. Respondents completed a web-based survey on sociodemographic data, subjective sleep quality, and a range of psychiatric symptoms using the Impact of Events Scale-Revised and Hospital Anxiety and Depression Scale. Results: Respondents reported high frequencies of clinically significant post-traumatic stress disorder symptoms (32.6%, Impact of Events Scale-Revised score ≥ 33), anxiety (36.4%, Hospital Anxiety and Depression Scale anxiety score > 10), and depression symptoms (51%, Hospital Anxiety and Depression Scale score > 10). In total, 20.5% of respondents described that their psychological status worsened during the coronavirus disease 2019 outbreak, and 12.1% of respondents described poor or very poor sleep in the prior month. Positive predictors of increased post-traumatic stress disorder symptoms included chronic medical diseases, knowing someone in the social vicinity diagnosed with the coronavirus disease 2019 infection, job loss or being on temporary leave after the outbreak, and increased exposure time to television or social media. In contrast, male gender, older age, higher educational attainment, and psychiatric diagnoses of schizophrenia, and (to a lesser degree) bipolar disorder were the negative predictors. Conclusion: Our results suggest that patients with psychiatric disorders are prone to substantial psychological distress during the coronavirus disease 2019 outbreak, and various individual, behavioral, and social factors mediate this effect.
ABSTRACT
The pathophysiological underpinnings of central nervous system (CNS) involvement in SARS-CoV-2 infection, as well as the profile of adverse neuropsychiatric effects of pharmacological agents employed in the management of COVID-19, are yet to be elucidated. Here, we report a 43-year-old female patient who suffered from COVID-19 and who developed new-onset psychotic agitated behavior which may be related to either the COVID-19 infection itself or to the drugs that were used in the treatment. On her third day of treatment with oseltamivir, hydroxychloroquine, and azithromycin, the patient, who had no previous background of neurological or psychiatric diagnosis, presented with a new-onset psychomotor agitation with auditory hallucinations and insomnia. Her psychiatric symptoms have improved with oral olanzapine 5 mg/d. This report underscores the importance of neuropsychiatric monitoring in patients with COVID-19. Clinicians should be aware of the limited knowledge on the neuropsychiatric safety profile of the medication used for COVID-19 treatment, while they have focused on the neuropsychiatric outcomes of COVID-19 itself.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic forced the implementation of social distancing guidelines to minimize spread of the coronavirus. However, it is not yet understood what effects these precautions had on the rates of penetrating neurotrauma. METHODS: We retrospectively analyzed neurotrauma data from our institutional trauma registry from distinct periods defined as pre-COVID-19 (March 2019-September 2019) and COVID-19 (March 2020-September 2020). Demographics, injury characteristics, mechanisms of trauma, and past medical history (including psychiatric diagnosis) were collected. Data were analyzed for between-group differences and presented as odds ratios. RESULTS: We observed a significant rise in the number of neurotrauma cases in 2020 (558 vs. 630, OR 1.129 [1.0071, 1.2657]). There was a decrease in the proportion of male victims (71.3% vs. 68.6%, p = 0.03). There were significant differences noted in the mechanism of injury between groups. Patients in 2020 were less likely to present with falls (42.3% vs. 34.3%, OR 0.7119 [0.5627, 0.9005]) and more likely to present with GSW (4.48% vs. 7.78%, OR 1.7981 [1.0951, 2.9523]). Of the patients with penetrating cranial injuries, the most common motive was assault (56.7% vs. 60.0%), followed by self-inflicted (13.3% vs. 20.0%) and accidental (20.0% vs. 18.3%) with a significant difference between years (p = 0.0043). The presence of comorbid psychiatric illness or substance abuse did not confer an increased odds of presenting with penetrating injuries. No significant differences were noted in mean arrival or discharge GCS or injury severity as measured by ISS. However we did observe significant increases in patients presenting with bilaterally reactive pupils (48.3% vs 59.3%, p = 0.0025), patients discharged home (27.6% vs 37.3%, p = 0.0002), and survival at 6 months (41.4% vs. 54.2%, p = 0.0188). CONCLUSION: We observed a higher rate of penetrating neurotrauma while social distancing measures were in place. It is unclear if the psychosocial effects of quarantine and social distancing had a causative relationship with the increased rates of assault and self-inflicted penetrating injuries.
ABSTRACT
Introduction: There is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory biomarkers for its objectivity as diagnostic or prognostic purpose and how they are impacted in clinical course of systemic outcome in COVID-19 infection. Materials and methods: Authors screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. Authors compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome. Results: Among the clinical laboratory biomarkers only D-dimer levels were found to be significantly impacting the variability among various psychiatric diagnosis (F=2.479, p <0.033). while serum ferritin levels were just marginally close to significance (F= 2.221, p=0.053). We observed that serum CRP, vitamin D levels and serum procalcitonin levels were not significantly variable between seven domains of psychiatric disorders. These laboratory biomarkers were considered to be useful not only for early suspicion of neuropsychiatric disorders and identifying high risk cohorts but also rationalizing therapies, predicting outcome and framing ICU admissions. Conclusions: The present study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID-19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations and their prognosis.