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Background: This study aims to evaluate the mental health status of children, adolescents and their parents during the first year of COVID-19 pandemic in Belgium. Method(s): Analysis compared results before and during the second national lockdown, which started on November 2nd 2020. A cross-sectional online survey was conducted between May 2020 and April 2021. Result(s): Two hundred and eighteen adults and 273 children fully completed the survey. Almost one in five children (17.9%) presented moderate-to-severe scores of depression. Adolescents presented a higher level of depression than children (p = 0.007). The rate of moderate-to-severe depression scores (10.8% to 21%, p = 0.007) and internalized symptoms increased during the second lockdown (p < 0.001). Parents' depression (p < 0.001) and anxiety (p = 0.027) levels also increased during the second lockdown. Logistic regression showed that the use of psychotropic medication in parents and parents' depression scores were risk factors for children to have worse depression scores. Conclusion(s): The second lockdown appears to worsen the effects of the pandemic on children's and parents' mental health. There is a need to implement specific interventions targeting both children/adolescents and their parents to support them during lockdown periods and improve mental health outcomes.Copyright © 2022, The Author(s).
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Objectives: To examine temporal trends of FDA-approved and off-label second-generation antipsychotic (SGA) prescribing for adolescents over time through the Covid-19 pandemic. Method(s): This is a new-user, retrospective longitudinal panel study using electronic health record data from a large, integrated health care system. Outpatient prescription orders for a new SGA (index date) for adolescents (age 10-17 years) during 2013-2021 were analyzed. Prescription orders were linked to diagnoses at time of encounter to examine prescribing behavior. A one-year lookback period was used for baseline inclusion and exclusion criteria, including one-year "washout" of SGAs and continuous insurance enrollment. FDA-approved use was determined by two outpatient diagnoses (one baseline diagnosis and the prescription order diagnosis) for autism, psychotic disorders, bipolar disorders, or Tourette's;the remaining proportion was considered potentially off-label. We report crude annual prescribing rates per 1,000 youths. Result(s): There were 8,145 unique patients with new SGA prescription orders, of which 5,828 (71.6%) had linked diagnoses available. Calendar year 2013 had the highest prescribing rate prior to Covid-19 onset (2.1 per 1,000) but then declined through 2016 (1.7 per 1,000). Prescribing rates in 2020 (2.0 per 1,000) and 2021 (2.2 per 1,000) were higher than those between 2017-2019. Across all study years, SGA prescriptions were mostly off-label and ordered for aripiprazole, quetiapine, or risperidone. The proportion of off-label indications was highest in 2013 (80.1%) and lowest (69.1%) in 2019. Off-label proportions increased again in 2020 (76.1%) and in 2021 (74.1%). At baseline, patients frequently had other psychotropic prescriptions (e.g., antidepressants 63.3%, stimulants 22.9%, and sedatives/hypnotics 20.7%). Conclusion(s): A general decline in SGA prescribing rates among adolescents was observed from 2013 to 2019, but then increased following Covid-19 onset. Despite known safety risks, off-label use of SGAs remains prominent. Future studies are needed to better understand prescribing outside of pediatric professional society guidelines.Copyright © 2023
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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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Introduction: There was an increase in antipsychotic prescribing for people with dementia during the COVID-19 pandemic (1). To explain this increase, the current study was conducted to explore the views of staff working in care homes for the elderly during the pandemic on the use of antipsychotics for residents with Behavioural and Psychological Symptoms of Dementia (BPSD). Aim(s): The aim was to explore the use of antipsychotics for people with BPSD during the COVID-19 pandemic by interviewing staff in care homes about their experiences during that time. Method(s): Semi-structured interviews were conducted online with staff working in ten UK elderly care settings using convenience sampling. Participants mainly onsite care home staff were recruited through online networks, for example, Twitter, and support groups such as CHAIN and NIHR clinical research network. Interviews were conducted between May 2021-March 2022, were audio recorded, transcribed verbatim, and analysed inductively using thematic analysis in NVivo version 12. Result(s): Ten interviews were completed with managers (n=2), care staff (n=6) and nurses (n=2) in nursing homes (n=7) and residential homes (n=3) (all were female). The first theme 'Challenges experienced in care provision' entails challenges experienced in the care environment;residents were confined to their rooms, activities were suspended, staff were absent and stressed, and family visits were barred. The reduced human contact affected residents' sense of self, mental and physical wellbeing, and in turn, their behaviours. The second theme 'Prescribing process' refers to doctors prescribing medicines in response to staff raising concerns. The third theme 'Attitude toward antipsychotics' denotes participants' positive and negative beliefs about antipsychotics. The positive beliefs included antipsychotics being the right choice and beneficial, an increased need and continued use of antipsychotics, use of a combination of medications and weighing the risks and benefits of antipsychotics. The negative beliefs included reports of adverse effects and short-term benefits of antipsychotics, antipsychotics not always beneficial, benefits in deprescribing, dislike for antipsychotics and belief antipsychotics are the last resort. Some expressed the need for antipsychotics had not increased but been driven by health professionals involved. The fourth theme 'Other psychotropic medication' alluded to other commonly used psychotropic medications and associated risks and benefits. The fifth theme 'Measures implemented within care settings' represented strategies implemented to avert the initiation or bolster antipsychotic deprescribing such as non-pharmacological approaches, nurses' assessment of residents before requesting antipsychotics, multidisciplinary consultation, and medication review. Conclusion(s): This is the first study that reports care home staff views on antipsychotic use for residents with dementia during the pandemic. The limitations include that only views of female respondents were obtained and the limited sample size. Care homes faced enormous challenges in the provision of care services to residents with dementia during the pandemic. The multitude of difficulties experienced in care homes due to lack of preparedness may have influenced staff to have positive views of antipsychotics and their use as an option during the pandemic. It's important to acknowledge and address these difficulties for example through education and training interventions to help with future preparedness.
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Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started elexacaftor/tezacaftor/ivacaftor while COVID- 19 was unfolding. Occurring almost simultaneously, these two events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual, and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. Although many patients improved from a physical standpoint, mental health problems increased. Between 2020 and 2022, demand for mental health services increased exponentially, creating a national mental health crisis, but inequities in insurance coverage existed between physical and mental health care. Finding a mental health provider became an almost impossible task. This author sought to address insurance inequity and increased demand for mental health services by offering cognitive behavioral therapy (CBT) sessions to adults with CF to optimize their health andwellbeing. CBT is considered an evidence-based approach for most mental health problems. Method(s): Eight adults at the Stanford Adult CF Center were referred for CBT with social work from August 2021 to April 2022. Referrals were based on mental health crisis, mental health screenings, insurance barriers, and availability of mental health providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable, with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored to patients' unique needs. Referrals were accepted on a continuous basis, space available. Mental health problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria Results: All eight patients receiving CBT demonstrated significant improvement in mental health symptoms, as evidenced by a mean reduction in Patient Health Questionnaire-9 score of 3 and General Anxiety Disorder-7 score of 3.3. (Six of 8 patients were screened before and after therapy.) Other measures of improvement were patient selfreport as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction in or stoppage of psychotropic medications. Conclusion(s): Mental health is a vital component of health and should be properly addressed as part of CF care. Although mental health care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and CF. Given the current mental health crisis and shortage of therapists to meet newdemands, there are serious implications for long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing mental health problems as part of CF care rather than referring patients to community providers who often are poorly positioned to meet their needs. The Stanford CF program will continue to use social work role to provide mental health servicesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, innovative healthy weight intervention in youth with SED.Hypothesis: The active intervention is more effective than control in decreasing BMI Z-score compared at 12 m. Method(s): We conducted a two-arm randomized trial in 2 outpatient pediatric mental health settings in 112 youth, ages 8-18 yrs. The active intervention group was offered 12m of in-person and virtual individual weight management sessions led by health coaches who provided guidance on improving diet and increasing physical activity, and engaged parents. Result(s): At baseline, mean (SD) age was 13.0 (2.7) yrs with 46% ages 8-12 and 54% 13-18;55% were male, 46% Black, 39% had household income less than $50K/yr and 31% lived in a single-parent household. Primary diagnoses were ADHD (41%), major depression (23%), and anxiety (23%). Mean BMI Z-score (SD) was 2.0(0.4), BMI 30.4 (6.4) kg/m2.Mean(SD) psychotropic medications were 2.1(1.4).At 12m, 111 (99%) had a follow-up weight;42 were collected after the onset of the COVID pandemic). The intervention group compared to the control group had 0.15 decrease in BMI Z-Score (95% CI 0.26 to 0.04), p<0.007) between baseline and 12 m (Figure) and a 1.43 kg/m2 decrease in BMI (95% CI 2.43, 0.42, p<0.006). Estimated net effect on BMI Z-score for intervention vs. control was enhanced during the pandemic but not statistically different from net effects pre-pandemic (p=0.06). Conclusion(s): A weight control intervention designed for children with SED decreased BMI Z-score substantially over 12 months, including during the COVID-19 pandemic. These results provide empirical evidence in support of weight control programs in a population at high risk for early development of CVD risk factors.
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Background: The effect of psychiatric comorbidity on pregnancy outcome among SARS-CoV-2 positive women with asymptomatic and mildly symptomatic infections remains largely unknown Methods: Electronic medical records of all pregnant women who received care at Mayo Health System and tested positive for SARS-CoV-2 (RT-PCR) from March 2020 through October 2021 were reviewed Results: Among 789 patients, 34.2% (n=270) had psychiatric comorbidity. Of those, 62.2% (n=168) had depression prior to pregnancy and 5.2% (n=14) reported new onset depression during pregnancy. Anxiety diagnosis was present in 65.6% (n=177) prior to pregnancy and new onset anxiety in 4.4% (n=12). Thirteen percent of SARS-CoV-2 positive pregnant women (n=108) received a psychotropic medication during pregnancy. In addition, 6.7% (n=18) and 10.7% (n=29) of pregnant women with psychiatric comorbidity had a documented nicotine, cannabis and/ or illicit substance use during and prior to pregnancy, respectively. Asymptomatic and mildly symptomatic SARS-CoV-2 positive pregnant women with psychiatric comorbidity had significantly higher risk for cesarean delivery [35.6% vs.24.9%). Conclusion(s): In conclusion, the prevalence rates of depression, anxiety, and prescribed antidepressant medications during pregnancy among asymptomatic and mildly symptomatic SARS-CoV-2 infected women were substantially higher than average, which negatively impacted on pregnancy and neonatal outcomes. Keywords: SARS-CoV-2, Pregnancy, Depression, AnxietyCopyright © 2023
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COVID-19 pandemic deeply affected young adults' mental health, partially because of both forced social isolation measures and loneliness. An increase in anxious and depressive symptoms and psychotropic drug use was established during this period. It seems essential to evaluate the potential protective factors, such as resilience, in order to detect vulnerable individuals. This prospective longitudinal study was carried out in a two-phase survey: the first one during lockdown in spring 2020 (T1) and the second one in summer 2020 (T2), when restrictive measures were slackened. The main outcomes were the resilience scale for adults (RSA), the loneliness scale, mental health care needs (MHCN) before and after lockdown and social contacts. Participants were divided into three groups according to their MHCN. 5% of the participants experienced an increase in MHCN at T1, including the start of a psychotropic treatment. Differences in mean RSA scores (total score and Perception of self score) were statistically significant between groups at T1. The difference of loneliness scores was decreased between T1and T2, in particular in youth with MHCN. The COVID-19 pandemic and associated restrictive measures represent a negative impact on youth mental health, particularly among vulnerable individuals. Resilience and social contact with peers are protective factors that need to be taken into account.Copyright © 2021 Association des Medecins anciens etudiats de l'Universite libre de Bruxelles (A.M.U.B.). All rights reserved.
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Background/Purpose: Patients with Glioblastoma Multiforme (GBM) have complex care needs and poor prognoses, which places their caregivers at risk for existential distress and psychopathology. Many caregivers seek support in coping with this role;the COVID-19 pandemic further exacerbated caregiver distress and the demand for caregiver support services. The purpose of this study was to examine how psychosocial service use and barriers to use relate to existential distress, anxiety, and depression. Method(s): This study was part of a RCT examining Meaning-Centered Psychotherapy among 60 distressed caregivers of patients with GBM. At baseline, caregivers reported use of psychosocial services and barriers to seeking those services. Additionally, participants completed measures of meaning, existential distress, spiritual wellbeing, anxiety, depression, and caregiver burden. We descriptively analyzed use of healthcare services, prevalence and intensity of barriers to seeking support, and investigated their correlations with outcome measures. Result(s): The most common service endorsed was psychotropic medication use, with 29.3% of caregivers reporting using medications to cope, and it was the only service associated with significantly lower personal meaning and spiritual well-being, and higher anxiety. Of the barriers reported, difficulty finding support (46.4% endorsed), lack of time for support (35.1% endorsed), and caregiving responsibilities (33.9% endorsed) were the most common. Caregivers who endorsed difficulty finding support as a barrier had significantly higher levels of anxiety and depressive symptoms, lack of family support, and impact on schedule. Further, caregivers who reported higher perceived intensity of barriers had elevated levels of existential vacuum, anxiety, and depression. Conclusions and Implications: GBM caregivers often rely on psychotropic medication as a stopgap to manage distress, which may worsen existential distress and anxiety, likely because resources like talk therapy and support groups are inaccessible. These results underscore the need for expanded caregiver support services, and how barriers to these services may exacerbate existential distress and discourage caregivers.
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This article considers current contemporaneous practical issues of delirium care in nursing homes with reference to a hypothetical case study B.M. I introduce the diagnosis and management of delirium-superim-posed-on-dementia (DSD), being relatively common in patients in advanced phases of illness of many nursing home residents. General principles are discussed, although this article applies mainly to higher income countries. There is inevitably much palliative and end-of-life care in nursing homes, necessitating rigorous advance care planning. Nursing home residents are especially prone to acquiring infections. Urinary tract infections (UTIs) are traditionally the most commonly treat-ed infection among nursing home residents and, indeed, the accurate diagnosis of a UTI poses significant and distinctive challenges in the nursing home setting. There is no denying, however, that recently the global coronavirus (SARS-CoV-2) pandemic has posed an existential threat to both staff and residents of nursing homes. Resident-focused factors are striking. Psychotropic drugs are the most frequently prescribed medications in European nursing homes, but medication errors in nursing homes in general are relatively prevalent. Contributing factors to a high burden from pain for residents include residents belief set that age-related pain is inevitable, as well as un-der-recognition of pain and inappropriate pain assessment by clini-cians. Dehydration is associated with frailty, poor cognition, falls, de-lirium, disability, and mortality. Issues relating to the environment also matter. It is also impossible to ignore the organisational constraints on the provision of high quality care. Faced with widespread staffing short-ages, and many economies in financial distress, one partial solution is to retain current staff longer in nursing homes. Research on nursing home staffing has expanded beyond just staffing levels to include mul-tiple other staffing issues of concern.Copyright © by Societa Italiana di Gerontologia e Geriatria (SIGG).
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The emergence of the novel coronavirus SARS-CoV-2 has significantly impacted the world's population, disrupting healthcare systems around the globe and leading to human and material losses. While different vaccines have been approved in record time, there continues to be a high number of daily new cases, and patients face a wide range of presentations of the disease, from asymptomatic to potentially fatal. Therefore, the search for therapeutic agents that can aid in the management and control of the disease has become one of the main goals for researchers and clinicians. As an inflammatory disease, targets for the treatment of COVID-19 have largely involved the immune system. Inflammation has also been associated with mental health disorders, and studies have shown the potential involvement of inflammatory pathways in the pathophysiology of depression. As a consequence, the hypothesis of using antidepressants and other psychotropics for the treatment of COVID-19 has emerged. In this review, we aim to summarize the molecular pathways that could be involved as well as the emergent evidence that has been reported by studies performed since the appearance of SARS-CoV-2 in 2019. While it has been observed that there are potential therapeutic pathways for the use of antidepressants in the treatment of COVID-19, additional studies are needed to evaluate the feasibility, safety, and efficacy of psychotropics in this disease.Copyright © 2023 Bentham Science Publishers.
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Introduction: The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication. Objective(s): This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients. Design(s): A cross-sectional study was performed over a period of 4 months (July-October 2021) targeting 128 patients using psychotropic drugs. Result(s): The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend's advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist's recommendation were the main reported reasons for using generic drugs. Conclusion(s): During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies.Copyright © The Author(s) 2023.
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Background: Phytochemicals and their derivatives/analogues represent over 50% of the current medicines worldwide in clinical use. Despite a significant contribution to the total bioactive natural plant products, aquatic plants are underestimated, and several species are extinct and in the endangered list. Objective(s): The aim of this review article is to draw the attention of common people and scientists toward a few important contributions of the aquatic plants to natural product chemistry and drug discovery by highlighting the chemical and pharmaceutical aspects of the same. Method(s): The presented data were collected and selected from the literature obtained by an online search for the ethnomedicinal properties, biological activities and bioactive chemical constituents of aquatic plants using Google Scholar, PubMed and Scifinder chemical abstract service. Result(s): The selected literature data revealed that the extract and compounds isolated from several aquatic plants possess significant biological/pharmaceutical properties. For example, the alpha-asarone (24) and asiatic acid (33) isolated from Acorus calamus and Centella asiatica, respectively, exhibited significant neuroprotective effects in vitro and in vivo. The cripowellin A (59), cripowellin C (60), cripowellin B (61) and cripowellin D (62), isolated from Crinum erubescens, exhibited potent antiplasmodial and antiproliferative activities with half maximal inhibitory concentration (IC50) in nanomolar range (11-260 nM). Several other alkaloids from different Crinum species have also shown anticancer properties against different cancer cell lines with IC50 value <5 microM. Alkaloids and resin glycosides, isolated from different Ipomoea species, have displayed significant psychotropic, psychotomimetic, anticancer, and antibacterial activities with IC50 value <5 microM. Conclusion(s): The aquatic plants play a significant role in the discovery of bioactive natural products. Although several biological activities and bioactive compounds have been reported from these plants, further assessment and scientific validation of most of their traditional usages still need to be done. There are several other similar species that are underestimated and not much explored. Many aquatic plants, such as Ipomoea carnea Jacq., Juncus lomatophyllus Spreng., Commelina benghalensis Linn, Gunnera perpensa L., Scirpus maritimus L. and Mentha longifolia (L.) L., may be considered for further evaluation. In addition to these, one should not undermine the potential of Crinum macowanii for COVID-19 pathogenesis, as its chemical constituent lycorine has shown significant SARS-CoV-2 inhibitory potential (EC50, 0.3 muM;SI >129). Furthermore, most rural communities are still using the wetland resources for their cultural, medicinal, economic, domestic, and agricultural needs. Hence, the conservation of aquatic plants and wetlands is an issue of great concern.Copyright © 2023 Bentham Science Publishers.
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Aim: We aimed to study the demographic and clinical profile of patients who sought teleconsultation for psychiatric disorders from august 2020 to January 2021. Material(s) and Method(s): In this cross-sectional descriptive study, data was retrieved from the telepsychiatry services and was analyzed to examine the demographic and clinical parameters of patients. Result(s): A total of 3444 teleconsultations were sought with a mean age of 37.78 15.08. About 80% of the patients were in the age group of 20-60 years. Females outnumbered males with 1938 (56.3%) females and 1538 (43.7%) males. Mood disorders were the most frequent diagnosis with Major Depressive Disorder in 1572 (45.6%) and Bipolar Disorder in 636 (18.5%). Co-morbidity was present in 234 (6.8%) of the study group. The mean psychotropics prescribed were 1.95 0.84. One, two, three and four psychotropics were prescribed in 918 (26.7%), 1470 (42.7%), 900 (26.1%) and 42 (1.2%) respectively. Those aged < 20 years or >= 60 years prescribed psychotropics at lower rates in comparison to the 20-60 years age group. Female patients had a significantly higher rate of psychotropic prescription than male patients. Three or four psychotropics were prescribed to those with co-morbidity at a significantly higher rate. Conclusion(s): Demographic and clinical profile of patients seeking treatment through telepsychiatry was found to be comparable with faceto-face outpatient consultations.
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Background: To evaluate the potential of probiotics in stress management caused by the Covid-19 pandemic. Material(s) and Method(s): PubMed, Elsevier, New England journal of Medicine and Google Scholar were searched for the keywords "Probiotics and stress management during the Covid pandemic" up to 30th April 2022. Result(s): Probiotics have a great potential of managing mild stress. The pandemic has brought about physical as well psychological distress and has had a negative impact on the mental health of individuals. Stress increases the risk of cardiovascular diseases, hypertension and neuropsychiatric disorders. Probiotics can be used to alleviate mental stress. Probiotics maintain ecological balance of gut and provide immunity. They also affect mood and health of host by regulating gut-brain axis of host and may be used as Psychobiotics by altering various neurotransmitters like dopamine, serotonin, adrenocorticotrophic hormone, epinephrine, norepinephrine and GABA. The use of probiotics in mild stress will help reduce the risk of adverse effects and dependence associated with the psychotropic drugs. Conclusion(s): The ongoing studies on probiotics seems to be a good solution towards stress and related problems which is rapidly increasing due to COVID-19 pandemic. Probiotics seem to be beneficial in handling stress as they alter the release of neurotransmitters reducing stress level of an individual and have a positive effect on mood. The current pandemic is likely to continue and there is a need for greater preparedness of stress management, therefore, it is essential to explore the full potential of probiotics application in stress management.Copyright © 2022 Authors.
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Guduchi (Tinospora cordifolia) is an essential drug of the Ayurvedic medicine system used in different Ayurvedic formulations to treat a variety of ailments. Guduchi is a member of the Menispermaceae family and is widely produced in tropical and sub-tropical countries such as India, Sri Lanka, China, Myanmar, Philippines, South Africa, Thailand, Bangladesh, and several south-east Asian continents such as Indonesia, Malaysia. All parts of Guduchi have nutritional value and medicinal importance, including the roots, stem, bark, and leaves. A different class of phytochemicals like alkaloids, glycosides, aliphatic compounds, diterpenoids, sesquiterpenoids, phenolic compounds, steroid and polysaccharides, etc., are found in Guduchi. Tinosporaside, tinosporine, magnosporine, berberine, choline, Jatrorrhizine, palmatine, beberine, giloin, giloinsterol, and other beneficial biomarkers are present in this herb. Guduchi is used to treat cold, fever, headache, jaundice, digestive disorder, among other things, and it shows several proven pharmacological activities such as anti-oxidant, anti-inflammatory, antidiabetic, immunomodulatory activity, anti-toxic, hepatoprotective, anticancer, cardioprotective activity, radioprotective, antimicrobial, anti-stress, anti-HIV and many more. This review article majorly highlights the phytochemical present in Guduchi, analytical works and pharmacological activities of Guduchi. Copyright © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research.
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BACKGROUND: Self-mutilating behavior in the pediatric population is associated with psychiatric and psychosocial factors. Autosarcophagy, or self-cannibalism, is an extremely rare form of self-mutilation and is predominantly seen with psychosis or substance use.1 We report a case of oral autosarcophagy in a pediatric patient in the absence of substance use or psychosis. OBJECTIVE: To learn about autosarcophagy and its treatment in the pediatric population and to explore other neuropsychiatric disorders in which it is a predominant manifestation. METHODS: Review of a case using electronic medical records and relevant literature. Key terms: 'autosarcophagy,' 'body focused repetitive behavior,' 'oral self injury,' 'pediatric self-mutilation' using Medscape and Google Scholar. RESULTS: We present a 14-year-old female with history of seizure disorder in full remission, depression, self-cutting behavior, and suicidal ideation with 2 psychiatric hospitalizations, who presented to the pediatric emergency department with oral bleeding after eating one-third of her tongue over the course of a month. Evaluation was notable for poverty of speech and constricted affect. Patient stated she was 'trying to remove an infection' and alleviate discomfort. She denied that this behavior was an attempt to end her life but endorsed past suicidal ideations and cutting behavior. History revealed emergency room evaluation for aggressive behavior and episodes of volitional enuresis. We diagnosed major depressive disorder, recurrent episode in remission without psychosis. Drug screen, complete blood count, complete metabolic panel, COVID-19, urinalysis, thyroid-stimulating hormone, head computed tomography, and beta-human chorionic gonadotropin were negative. Patient continued home oral medications aripiprazole 10 mg daily, fluoxetine 30 mg daily, and levetiracetam 500 mg twice daily and was discharged the next day. CONCLUSIONS: Self-harm is observed in 17.2% of adolescents, 13.4% of young adults, and 5.5% of older adults.2 Cases of self-mutilation in pediatric patients typically present as cutting, burning, or head banging.3 Our differential diagnoses include borderline personality disorder due to repeated impulsivity and self-harm, and body focused repetitive behavior disorder (obsessive-compulsive disorder-related disorder), which presents with repetitive strain injuries and dental malocclusions. Treatment of self-mutilation involves treating the underlying psychiatric condition with psychotropic medications.4,5 In pediatric patients, dialectical behavioral therapy has been shown to reduce parasuicidal behaviors after 1 year of therapy.6 Our patient, under constant 24-hour observation, was cleared by medical, psychiatric, and dental teams. The patient followed up with outpatient psychotherapy and psychiatry. We are presenting this rare case for clinicians to identify and manage pediatric patients presenting with unique forms of self-harm tendencies.
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Service or Program: The number of COVID-19 infections have increased dramatically since March 2020 in Qatar. Measures have been taken to minimize the risk of exposure to COVID-19 including medication home delivery by postal service and by using telemedicine at The Mental Health Service (MHS), a tertiary care hospital in Qatar. In order to continue patients' access to care during the pandemic, the Medication Therapy Management (MTM) clinic at MHS would like to utilize clinical pharmacists to offer patient counseling, medication reviews, and develop medication action plans with the patients via telepharmacy. Justification/Documentation: Patients for whom counseling is essential to ensure positive outcomes of therapy were identified;patients on lithium or clozapine (phase 1), patient on newly prescribed psychotropics or on antipsychotic polypharmacy (phase 2), females on valproate in childbearing age (phase 3). The aim of this quality improvement (QI) project was to improve the number of patients currently receiving MTM service from baseline (90) by 20% by September 2020, 50% by December 2020 and 80% by March 2021. Outcome measure included percentage increase in patients from baseline who are receiving telepharmacy service, process measures included the percentage compliance of filling the Moresky Medication Adherence Scale-4 by the pharmacist, the percentage of referrals to other MHS services, balance measures were patient/caregivers and staff satisfaction. The improvement in outcome measure was successfully achieved in each phase;phase 1 - 28%, phase 2 - 82%, phase 3 - 127%. QI tools were used as appropriate. Adaptability: This service was intended to be provided by clinical pharmacists to adult patients registered under MHS. Similar service can easily be adapted to another setting by clinical pharmacists using comparable strategies and measures. Significance: The lessons learnt from this QI project will help in increasing patients' access to care, promote better utilization of resources, and allow better communication and management of patients.
ABSTRACT
In response to the COVID-19 pandemic, governments around the world imposed confinement and physical distancing directives for all citizens. Although essential to reduce the spread of the SARS-CoV-2 virus, these measures may have collateral consequences for older adults, such as increased psychological distress. Research suggests, as a population, older adults have been experiencing less psychological distress than younger adults during COVID-19. However, most of these studies examine mean levels of psychological distress and do not capture the heterogeneity of outcomes, like subgroups who may experience increased psychological distress. The goal of this longitudinal study was to use group-based trajectory modelling (GBTM) to identify meaningful subgroups that follow different trajectories of psychological distress among 645 older adults with a mean age of 78.69 (SD = 5.67). Participants were recruited from two research cohorts and newspaper ads. Telephone-based assessments were conducted across four time periods: T1-Spring 2020-first confinement, T2-Summer 2020-first deconfinement, T3-Fall 2020-second confinement, and T4-Winter/Spring 2021-continued confinement. Participants completed the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point and provided information on socioeconomic, medical, and psychosocial factors. Results indicated that the average psychological distress level was stable across the first three time points but slightly increased at the fourth assessment (Fig. 1). Using GBTM, three groups emerged to best characterize the different trajectories of psychological distress: resilient (50.5%), fluctuating (34.9%), and elevated (14.6%) distress groups (Fig. 1). Those in the fluctuating and elevated groups were more likely to have chronic mental health problems, mobility issues, insomnia symptoms, loneliness, COVID-19 related acute stress and general health anxiety than those in the resilient group. Those who lived in poverty, who could not use technology, and who took psychotropic medication had uniquely increased odds of being in the elevated group. These findings identify subgroups of older adults at greater risk of psychological distress with potential intervention targets to alleviate distress during and after the pandemic.
ABSTRACT
Background: Pediatric patients with increasing psychiatric needs introduce a substantial challenge for inpatient care. This study illustrates how the COVID-19 pandemic has influenced the number and acuity of psychiatry and psychology consults among pediatric inpatients at a tertiary care hospital. Methods: The study population included all pediatric patients (ages 0-25) admitted to University of Michigan's C.S. Mott Children's Hospital between March 2019 and March 2021 who received a psychology and/or psychiatry consult. Three time periods were defined: pre-pandemic, 3/1/19-3/15/20;early pandemic, 3/16/20-6/30/20;and steady-state pandemic, 7/1/20-2/28/21. The patients were described demographically and clinically. To assess differences among time periods, ANOVA testing was conducted for numeric variables and chi-square tests were used for categorical variables. The number of pediatric inpatients receiving psychiatry and/or psychology consults was reported for each month of the study period as a count and as a percent of all pediatric admissions. Psychiatric acuity was described in terms of length of stay and use of restraints and as-needed medication. Logistic regression was used to estimate the odds of requiring restraints based on time period, controlling for relevant demographic and clinical variables (age, sex, race, length of stay, and use of benzodiazepines and psychotropics). Logistic regression was also used to estimate the odds of patients requiring as-needed medications (midazolam, lorazepam, diazepam, clonazepam, alprazolam, haloperidol, chlorpromazine, quetiapine, risperidone, aripiprazole, olanzapine, and ziprasidone) based on time period, controlling for clinical and demographic variables (age, sex, race, length of stay, and restraint use). Results: Among the 1,636 patients in the study, average age was 14.0 years (IQR 8.1 to 17.2) and 57.9% were female. Overall, 68.6% were White, 13.6% were Black, and 2.4% were Asian. Among all races, 5.7% identified as Hispanic. Percent of pediatric patients receiving psychiatry and/or psychology consults was higher on average during the pandemic months (71.2% during steady-state pandemic compared to 47.9% pre-pandemic). Across all participants, 2.1% required restraints, 34.4% used psychotropics, and 42.6% used benzodiazepines. During the pandemic, admissions became proportionally more female (64.1% during steady-state pandemic vs. 55.3% pre-pandemic) and older (average age 14.8 years during steady-state pandemic vs. 13.4 years pre-pandemic). During steady-state pandemic, children admitted had 5.70 times higher odds of requiring restraints and 1.78 times higher odds of using psychotropics, compared to children admitted pre-pandemic. Length of stay decreased during the pandemic, and was associated with psychotropic use, benzodiazepine use, male sex, and younger age. Conclusion: A higher proportion of pediatric admissions during the COVID-19 pandemic required psychiatry and/or psychology consults. Additionally, these patients were of higher psychiatric acuity, based on increased use of as-needed medications and restraints. These findings highlight the dramatic changes experienced by individual patients and their healthcare teams during the pandemic.