Informed consent in psychotic decompensation

The consent of an informed patient is not merely a signature on a legally binding document, but rather a process in which the patient is empowered and becomes an active ally in a treatment. Valid informed consent includes adequate information that is given to the patient in an appropriate manner, the voluntariness of consent, and the patient's ability to make a decision regarding treatment. Meeting these conditions when treating patients with mental health disorders can be challenging. Mental disorders can compromise a person's ability to understand relevant information about the nature of their illness as well as their ability to make decisions regarding treatment. However, a psychiatric diagnosis does not imply that a person is unable to make a decision regarding their treatment, nor does it exclude them as an equal partner in the therapeutic process. By reviewing the case of a 39-year-old patient who developed an acute psychotic disorder during the treatment of COVID pneumonia, we dive into the ethical dilemmas that arise when approaching a patient who is experiencing psychotic decompensation. © 2022 University of Rijeka, Faculty of Medicine. All rights reserved.

Simultaneous Individual Complicated Grief Treatment With a Couple

Persistent complex bereavement/complicated grief occurs when, after a period of 12 months following a death, there remains an ongoing intense yearning and sorrow for the deceased, preoccupation with the death and its circumstances, difficulty accepting its reality, and disruption in personal identity. This case study illustrates the successful application of Complicated Grief Treatment (CGT), a manualized research-supported intervention, with a husband and wife each receiving individual therapy simultaneously with separate clinicians. The core of CGT involves graded completion of imaginal and situational revisiting (i.e., exposure) exercises. To target maladaptive rumination and counterfactual thinking more explicitly, strategies from a research-based treatment for trauma, Cognitive Processing Therapy, were also incorporated for one member of the couple. To our knowledge, CGT has not been examined with couples receiving individual therapy delivered simultaneously. As such, practitioners have little information about how to proceed with cases where multiple members of the same family are experiencing complicated grief. We will detail the treatment provided, outlining the course of care for each member of the couple, highlighting unique adjustments made to tailor implementation to each individual and to deliver the intervention simultaneously. Quantitative and qualitative data show the effects of treatment on symptoms of complicated grief, depression, and relationship satisfaction.Copyright © The Author(s) 2022.

Sleep Disorders and Associated Factors in Children Who Admitted to the Child and Adolescent Psychiatry Outpatient Clinics During the Pandemic.

Objective: This study determined whether children have sleep disorders during the Coronavirus disease-2019 (COVID-19) pandemic restriction process, and if they do, to determine in which areas they have problems with sleep, as well as to examine the relationship of sleep disorder with chronotype and coronavirus anxiety. Materials and Methods: In April-November 2020, 98 patients attending Kocaeli University Child Psychiatry clinics and attending primary school 1-4th grade were recruited. "Sociodemographic Form", "Child Sleep Habits Questionnaire", and "Children's Chronotype Questionnaire" were applied to the parents. The short form of the "Coronavirus Anxiety Scale" and the information form about the pandemic process were applied to the children. Results: According to the sleep habits questionnaire, 70.4% of the group had clinically significant sleep problems. The most common sleep disorders observed in our study;are bedtime resistance, delayed falling asleep, and nighttime awakenings. A significant relationship was found between physical illness in the family (p=0.019), smoking (p=0.032), sleep pattern change during the pandemic (p=0.002), sleep change of the mother (p=0.006) and/or father (p=0.035), change in appetite (p=0.010), and sleep disorder. According to the chronotype scale, 66 children were morning and children's anxiety toward coronavirus was low. Conclusion: Our study shows that sleep disturbance in children is marked during the pandemic period, but this is due to changes in sleep patterns and parents' sleep rather than problems related to anxiety or chronotype associated with the pandemic. It will be useful to question these factors and make arrangements in this direction when evaluating the sleep-related problems of patients who apply to outpatient clinics. (English) [ FROM AUTHOR] Amaç: Bu çalışmada, Koronavirüs hastalığı-2019 (COVID-19) pandemisi kısıtlama sürecinde çocukların uyku bozukluğu yaşayıp yaşamadığının, eğer yaşıyorlarsa uyku ile ilgili hangi alanlarda sorun yaşadıklarının saptanması, ayrıca uyku bozukluğunun kronotip ve Koronavirüs anksiyetesi ile ilişkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Nisan-Kasım 2020 tarihleri arasında Kocaeli Üniversitesi Çocuk ve Ergen Psikiyatri polikliniklerine başvuran;ilkokul 1-4. sınıfa giden 98 hasta çalışmaya dahil edilmiştir. Ebeveynlere "Sosyodemografik Bilgi Formu", "Çocuk Uyku Alışkanlıkları Anketi", "Çocukluk Dönemi Kronotip Anketi";çocuklara ise "Koronavirus Anksiyete Ölçeği Kısa Formu" ve pandemi süreci ile ilgili beş maddeden oluşan bilgi formu uygulanmıştır. Bulgular: Uyku alışkanlıkları anketi toplam puanına bakıldığında, grubun %70,4'ünün klinik olarak anlamlı düzeyde uyku sorunu yaşadığı saptanmıştır. Çalışmamızda gözlenen en yaygın uyku bozuklukları;yatma zamanı direnci, uykuya dalmanın gecikmesi ve gece uyanmalarıdır. Ailede fiziksel hastalık (p=0,019), sigara kullanımı (p=0,032), pandemide uyku düzen değişikliği (p=0,002), annenin uyku değişimi (p=0,006), babanın uyku değişimi (p=0,035), ve iştah değişimi (p=0,010) ile uyku bozukluğu arasında anlamlı ilişki saptanmıştır. Kronotip ölçeğine göre 66 çocuğun sabahçı, 31 çocuğun ara form, bir çocuğun ise akşamcı olduğu gözlenmiştir. Çocukların Koronavirüse yönelik anksiyetesinin düşük olduğu saptanmıştır. Sonuç: Çalışmamız, çocuklarda pandemi döneminde uyku bozukluğunun belirgin düzeyde olduğunu ancak bu durumun pandemi ile ilişkili anksiyete ya da kronotip ile ilgili sorunlardan çok, uyku düzenlerindeki değişiklik ve ebeveynlerin uykusundaki değişimlerden kaynaklandığını göstermektedir. Polikliniklere başvuran hastaların uyku ile ilgili sorunları değerlendirilirken bu faktörlerin sorgulanması ve bu yönde düzenlemeler yapılması yararlı olacaktır. (Turkish) [ FROM AUTHOR] Copyright of Journal of Turkish Sleep Medicine is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Forensic psychiatry in times of COVID-19: A qualitative study into the concerns and needs of patients

Purpose: The aim of this study is to gain a better understanding of the concerns and needs of forensic psychiatric patients regarding the impact of the COVID-19 crisis on their mental health and treatment. Design/methodology/approach: Semi-structured interviews were conducted with nine patients from various wards of the hospital. Using the consensual qualitative research method, these interviews were coded by a team of three researchers. Findings: Four domains emerged from the analysis, namely, restrictions, emotional consequences, coping and communication. One of the primary restrictions for patients was not being allowed to have physical contact with the people in their network/visitors. This prompted patients, in some cases, to decline visitors altogether. Emotional consequences of the COVID-19 measurements included anxiety, frustration and passivity. Ambiguity about the rules added to this frustration. Furthermore, a cut in autonomy was felt by patients due to them not being able to do their own grocery shopping. Despite these restrictions that were imposed on patients, the relationship between patients and staff was perceived as good and even improved according to the participants. Practical implications: A lack of autonomy emerged as a salient issue related to the restrictions within the hospital. Certain degrees of control may be inevitable, but it is nonetheless important to focus on the effect of control within forensic settings. This could be done by aiming to actively include patients in decisions that affect their living climate. Furthermore, it appeared that the "ballet dancer" approach was used by the staff of the hospital, leaving more room for individualized care. As perceived support is important to increase willingness to accept the treatment being offered, a focus on this approach in times of rapid change such as during a pandemic, would be recommended. Originality/value: Because few pandemics have occurred in the past century, little information is available about how a pandemic might affect patients residing in forensic psychiatric hospitals. To the best of the authors' knowledge this is one of the first studies to assess concerns and needs of forensic psychiatric patients regarding the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The problem of anti-vaccine attitudes in the COVID-19 era: analysis in the context of psychopathological dimensions and treatment proposals based on own experience

Anti-vaccine attitudes against COVID-19 are a common phenomenon, but rarely understood as a medical problem. In patients who are already under psychiatric treatment, it is worth paying attention to diagnosis and starting of psychotherapy of this problem. The association of the anti-vaccine issue with anxiety, obsession and paranoia is an opportunity to achieve solution and may lead to the progress of psychotherapy. The problem with the right choice of authority seems to be one of most important challenges for psychiatry these days.

IMPACT of the COVID-19 PANDEMIC on HEALTHCARE UTILIZATIONS of RMD PATIENTS in EUROPE. RESULTS from the REUMAVID STUDY (PHASE 1 and 2)

Background: The beginning of the COVID-19 pandemic led to a collapse of healthcare systems that was difficult to manage. Objectives: The aim of this study was to assess the impact of the COVID-19 pandemic on RMD patients' healthcare utilization. Methods: REUMAVID is an international cross-sectional study collecting data through an online survey on RMD in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatolo-gists, and health researchers. Data were collected in two phases, the frst (P1) between April-July 2020 and the second (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS) were collected in the survey. Healthcare utilization includes scheduled appointments and attendance at the rheumatol-ogist, consultation of possible treatment effects if COVID-19 is contracted with the rheumatologist, primary health care and psychological care. Descriptive analysis and Mann-Whitney test was used to explore association with healthcare utilization in both phases of REUMAVID. Results: There were a total of 2,002 participants across both phases with comparable demographic characteristics [mean age 52.6 (P1) vs. 55.0 years (P2);80.2% female (P1) vs 83.7% (P2);69.6% married (P1) vs 68.3% (P2), 48.6% university educated (P1) vs 47.8% (P2)]. Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%). Only 39.2% could have a scheduled appointment with their rheumatologist during P1, compared to 72.5% of patients in P2 (p<0.001). In this sense, only 41.6% of participants in the P1 attended such an appointment while in P2 this figure was 61.5% (p<0.001). The majority of patients (83%) had their scheduled face-to-face appointment changed to an online or telephone phone in the P2, although this proportion was lower in the P1 (54.4%). The most frequent reason for canceling the face-to-face appointment was the alternative of making it by phone or online (54.4% in P1 vs. 83.0% in P2, p<0.001). Although, in P1, 38.1% of participants could contact with their rheumatolo-gist by phone or online, this proportion was 64.3% in P2 (p<0.001). In P1, 64.0% of patients were able to consult with their rheumatologist about the possible effects of treatment in case of contracting COVID-19 (vs. 41.2% in P2;p<0.001). With respect to general practitioners, 57.6% of patients in P1 declared to had accessed primary care or general practitioner (vs. 77.5% in P2;p<0.001). Furthermore, in P2, a higher proportion of participants (63.2%) were able to continue their psychological or psychiatric therapy either online or by phone (vs. 48.3% in P1;p<0.001;Figure 1) Conclusion: During the frst year of COVID-19 pandemic, RMD patients had easier access to the healthcare system, specifcally to their rheumatologist. This access was improved through phone and online care. In addition, access to primary care as well as psychological care improved during the second year of pandemic.

Forensic psychiatry in times of COVID-19: a qualitative study into the concerns and needs of patients

Purpose The aim of this study is to gain a better understanding of the concerns and needs of forensic psychiatric patients regarding the impact of the COVID-19 crisis on their mental health and treatment. Design/methodology/approach Semi-structured interviews were conducted with nine patients from various wards of the hospital. Using the consensual qualitative research method, these interviews were coded by a team of three researchers. Findings Four domains emerged from the analysis, namely, restrictions, emotional consequences, coping and communication. One of the primary restrictions for patients was not being allowed to have physical contact with the people in their network/visitors. This prompted patients, in some cases, to decline visitors altogether. Emotional consequences of the COVID-19 measurements included anxiety, frustration and passivity. Ambiguity about the rules added to this frustration. Furthermore, a cut in autonomy was felt by patients due to them not being able to do their own grocery shopping. Despite these restrictions that were imposed on patients, the relationship between patients and staff was perceived as good and even improved according to the participants. Practical implications A lack of autonomy emerged as a salient issue related to the restrictions within the hospital. Certain degrees of control may be inevitable, but it is nonetheless important to focus on the effect of control within forensic settings. This could be done by aiming to actively include patients in decisions that affect their living climate. Furthermore, it appeared that the "ballet dancer" approach was used by the staff of the hospital, leaving more room for individualized care. As perceived support is important to increase willingness to accept the treatment being offered, a focus on this approach in times of rapid change such as during a pandemic, would be recommended. Originality/value Because few pandemics have occurred in the past century, little information is available about how a pandemic might affect patients residing in forensic psychiatric hospitals. To the best of the authors' knowledge this is one of the first studies to assess concerns and needs of forensic psychiatric patients regarding the COVID-19 pandemic.

Asking Questions, Finding Answers

An introduction to the journal is presented which discusses various reports within the issue on topics including emerging literature on the neuropsychiatric issues associated with Covid-19, cultural issues that may arise in patients with psychosis, and use of civil commitment.

Psychiatric Care in the US. (Cover story)

The article discusses the increase in mental disorders among many American adults and the youth by the end of 2021, but with less than half of them getting adequate treatment. Topics covered include a state by state study on provision of psychiatric help based on cost, access, and quality, the factors of cost and physician shortage in foregoing mental health care, and pieces of legislation to address the crisis.

P.0493 COVID-19 related perceived stress in patients with rheumatic diseases: an Italian cross-sectional study

Background: COVID-19 outbreak is a public emergency that forced people to a radical change in their daily life, generating great insecurities and concerns about health, work, and social relationships [1]. Quarantine measures were responsible for detrimental effects on mental health of the general population, leading to the exacerbation of stress, depression and anxiety [2]. Psychological impact might be even more severe on fragile people such as those suffering from rheumatic diseases (RDs), for whom previous evidence demonstrated a negative effect of psychological stressors on outcome disease [3]. Objective: The aim of the present study is to identify the factors associated with higher levels of perceived stress in patients affected by RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the Perceived Stress Scale (PSS). Perceived stress levels were stratified as follows: low (<14), moderate (14-26) and high (>27). Descriptive analyses were performed on the total sample;one-way analyses of variance (ANOVA) and Pearson's correlation were used to compare PSS scores between groups defined by qualitative and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with higher PSS scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard PSS scores, total sample mean (SD) was 18.1 ± 8.1. Specifically, 154 patients (30,4%) reported low, 264 (52.1%) moderate and 89 (17.6%) high levels of stress. PSS scores resulted significantly different with regard to: gender (F=18.32, P<0.01), residence in Lombardy (F=14.90, P<0.01), diagnostic group (F=6.20, P<0.01), hypertension (F=4.06, P=0.04), gastritis (F=3.83, P=0.05), bowel diseases (F=9.74, P<0.01), overweight/obesity (F=5.96, P=0.02), COVID-19 infection (F=4.32, P=0.01), depressive symptoms (F=17.18, P<0.01), anxiety symptoms (F=19.79, P<0.01), prescription of psychiatric therapy before COVID-19 (F=30.90, P<0.01), type of pre-existing psychiatric symptoms (F=12.41, P<0.01), use of psychiatric compounds before COVID-19 (F=36.39, P<0.01), type of psychiatric compounds before COVID-19 (F=13.53, P<0.01), current prescription of psychiatric compounds (F=44.68, P<0.01), type of ongoing psychiatric compounds (F=15.18, P<0.01), anxiety sources (F=30.90, P<0.01). Independent variables associated with higher PSS scores were: female gender (β=0.12, P<0.01), younger age (β=-0.23, P<0.01), residence outside Lombardy (β=-0.09, P=0.03), presence of overweight/obesity (β=0.11, P=0.01), current prescription of psychiatric compounds (β=0.26, P <0.01) and financial difficulties (β=0.19, P <0.01). Conclusion: Our findings highlight the considerable psychological impact derived from COVID-19 pandemic on people affected by RDs. In addition, different factors resulted to be predictive of significant levels of perceived stress in these patients. A multidisciplinary approach, including mental health support, should be considered in order to improve the psychological well-being of fragile patients during traumatic events such as pandemics. No conflict of interest

P.0494 Which rheumatic patients are more vulnerable to the stressful effects of COVID-19?

Background: Post-traumatic stress disorder (PTSD) is a psychiatric condition that may develop after exposure to a traumatic event [1];COVID-19 pandemic could be defined as a traumatic experience since it has resulted in either direct (e.g. the fear of contagion and the risk of death) or indirect aftermaths (e.g. psychological distress, depression and anxiety) [2]. Besides, it has been shown that PTSD, promoting inflammatory responses, might worsen the prognosis of patients affected by illnesses characterized by systemic inflammation such as rheumatic diseases (RDs) [3]. Objective: The aim of the present study is to verify the presence of PTSD symptoms and related factors in patients suffering from RDs during the COVID-19 pandemic. Methods: This cross-sectional study analyzed data from an anonymous online survey about mental health of people with RDs. Participants were enrolled through several RD patients’ associations between May and September 2020, after the first pandemic wave in Italy. They filled out a questionnaire including demographic and clinical information, mental health issues and the 22-items of the Impact of Event Scale-Revised (IES-R). The total score ranges from 0 to 88;a score ≥ 33 defines patients at risk of PTSD. Descriptive analyses were performed on the total sample: one-way analyses of variance (ANOVAs) were used to compare IES-R scores between groups defined by qualitative variables;Pearson's correlations were performed to study the relation between rating scale scores and quantitative variables. Finally, multivariate regression analyses were performed to identify independent variables associated with IES-R scores. Results: 507 patients with RDs participated in the survey: 419 females (82.6%) and 88 males (17.4%) with a mean age of 53.06 years and mean disease duration of 13.74 years. As regard IES-R scores, total sample mean (SD) was 29.7 ± 17.5;of note, 209 participants (41.2%) had scores ≥33. IES-R scores resulted to be significantly different according to: gender (F=14.75, P<0.01), residence in Lombardy (F=8.22, P<0.01), diagnostic group (F=4.17, P= 0.02), prescription of psychiatric therapy before COVID-19 (F=17.87, P<0.01), type of pre-existing psychiatric symptoms (F=7.59, P<0.01), use of psychiatric compounds before COVID-19 (F=27.17, P<0.01), type of psychiatric compounds before COVID-19 (F=14.58, P<0.01), current prescription of psychiatric compounds (F=29.30, P<0.01), type of ongoing psychiatric compounds (F=13.81, P<0.01), anxiety source (F=20.81, P<0.01), and the presence of overweight/obesity (F=7.60, P< 0.01), bowel diseases (F=8.00, P<0.01), depressive symptoms (F=5.74, P=0.02), anxiety symptoms (F=26.81, P<0.01). Independent variables associated with higher IES-R scores were: female gender (β=0.14, P <0.01), living outside Lombardy (β=-0.10, P=0.02), intestinal diseases (β=0.10, P=0.03), anxiety (β=0.19, P <0.01) and health related concerns (β=0.13, P <0.01). Conclusion: These findings point out high rate of severe self-reported distress among Italian RD patients in response to the pandemic. Given that psychological and emotional stressors strictly affect disease severity leading to poorer quality of life, our study sustains the necessity to implement support measures for fragile patients during traumatic events. No conflict of interest

Moving Beyond the Enormity Problem: Tackling the Global Refugee Crisis

The article discusses the mental health issues linked to the global refugee crisis. Also cited are the scientific and cultural advances that led to reduced cost of care for common illnesses like anxiety, depression and stigma due to mental health disorders, and other topics like ecocide, climate change, and the COVID-19 pandemic.

Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area.

BACKGROUND: This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. METHODS: Patients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OUTCOME: The most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. CONCLUSION: This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.

Higher psychogeriatric admissions in COVID-19 than in severe acute respiratory syndrome.

OBJECTIVES: To examine whether psychogeriatric admissions increased after COVID-19, independent of seasonal variation; whether the increase was comparable with that seen in severe acute respiratory syndrome (SARS); and which factors were associated with such increase. METHODS: All psychiatric admissions aged 65 or older in the 3 months before and after COVID-19 (from November 2019 to April 2020), in the previous 2 years (from November 2017 to April 2018 and from November 2018 to April 2019), and in the year of SARS (from November 2002 to April 2003) in a major gazette inpatient psychiatric unit in Hong Kong, which serves a catchment population of 1.4 million, were anonymously reviewed. The number of psychogeriatric admissions between different timeframes was compared, and factors that might explain the increase in admissions following COVID-19 were examined. RESULTS: Psychogeriatric admissions increased by 21.4% following the COVID-19 outbreak. This increase was not explained by seasonal variation and was greater and lasted longer than that in SARS. A rising trend in admissions for older adults living in residential care homes was observed. The increase in admissions was associated with fewer outpatient attendance, fewer home visits by nurses, and more older adults with dementia requiring inpatient care. CONCLUSIONS: Our findings highlight the impact of COVID-19 on older adults' mental health, greater demand for inpatient psychogeriatric services in COVID-19 than in SARS, and the importance of maintaining support for community-living older adults, in particular those with dementia, and their caregivers in reducing the needs for inpatient psychiatric treatment during the pandemic. Clinicaltrials.gov # ChiCTR2000033317.