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This case study draws attention on mental health sequelae that emerged in the context of the COVID-19 outbreak after recovery from hospitalization, even in subjects without personal psychiatric history. The case involves a 65-year-old male shift nurse who took SARS-COV-2 infection through a co-worker and that had been hospitalized for interstitial pneumonia from April 6 to April 17. After recovery, he developed psychiatric symptoms overlapping between different dimensions of psychiatric disorders and started to be followed by the Occupational Health Department of a Major University Hospital in central Italy. He reported a score of 28 at the Peritraumatic Distress Inventory and of 39 at the Self-Rating Anxiety State. He was treated with a combination therapy of SSRI and NaSSA antidepressants with clinical remission. In this case study, authors discuss the possible overlapping role of post-traumatic stress and anxiety symptoms in patients discharged after COVID-19 hospitalization that may deserve appropriate classification, treatment and follow up with the future goal to refine clinical management of post and long COVID syndromes of subjects who present low abnormalities in other specialty investigations.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Upper respiratory tract infections are responsible for millions of physician visits in the United States annually. Although viruses cause most acute upper respiratory tract infections, studies show that many infections are unnecessarily treated with antibiotics. Because inappropriate antibiotic use results in adverse events, contributes to antibiotic resistance, and adds unnecessary costs, family physicians must take an evidence-based, judicious approach to the use of antibiotics in patients with upper respiratory tract infections. Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis. Evidence supports antibiotic use in most cases of acute otitis media, group A beta-hemolytic streptococcal pharyngitis, and epiglottitis and in a limited percentage of acute rhinosinusitis cases. Several evidence-based strategies have been identified to improve the appropriateness of antibiotic prescribing for acute upper respiratory tract infections.Copyright © 2022 American Academy of Family Physicians.
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The measures taken by the governments of the sub-Saharan states, especially in Nigeria and South Africa, in a bid to curb the spread of the dreaded corona virus (COVID-19) are discussed in this article. It is submitted that measures such as social distancing and lockdown of businesses exacerbated the existing problem of unemployment in sub-Saharan countries. Accordingly, this article analyzes the adequacy of the relevant laws and policies that were adopted by the governments of selected sub-Saharan African countries, namely, Nigeria and South Africa in a bid to stimulate the economy and to reduce unemployment in the wake of the COVID-19 pandemic. Nigeria and South Africa were selected because they are amongst the largest economies in sub-Saharan Africa. The authors argue that the governments of Nigeria and South Africa should adopt and enforce pragmatic policies that are backed by appropriate legislation to combat the huge unemployment rate which was worsened by the advent of COVID-19. The article highlights that the problem of unemployment in Nigeria and South Africa must be addressed through adequate review of the employment policies, finance policies, educational curriculum and other related policies. It further recommends the review of the empowerment and socio-economic policies of these countries in order to prevent restlessness, riots and poverty-related protests that are induced by massive unemployment of the youth, women and other marginalized persons in Nigeria and South Africa.
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Introduction: In this study, we aimed to evaluate how the COVID-19 pandemic has affect sleep patterns. To do this, we used the Functional Outcomes of Sleep Questionnaire (FOSQ10) tool among the general US population. Method(s): A Qualtrics survey containing the FOSQ10 questions and additional demographics was created for Amazon MTurk, a crowdsourcing platform. Respondents aged 18 years and older completed the survey anonymously in October 2021. Two-way analysis of variance and 2-tailed t tests were used for analyses. Result(s): A total of 2474 responses were included. The 3 most prevalent sleep disorders were snoring (48% of respondents), insomnia (11% of respondents), and sleep apnea/mild/ moderate/severe (6% of respondents). The 3 most common services and/or procedures that people indicated interest in were sleep study (32% of respondents), nasal appliance (28% of respondents), or oral appliance (22% of respondents). The 3 most common social media platforms used before bed were Facebook (48% of respondents), Instagram (47% of respondents), and YouTube (39% of respondents). Individuals who had COVID-19 had a lower average FOSQ10 score than those who did not (27.0+/-6.4 [SD] vs 29.2+/-7.2), P<.0001. Individuals who snore had a lower average FOSQ10 score than those who do not (27.6+/-6.6 vs 29.4+/-7.4), P<.0001. Individuals who had a romantic partner or family member complain about their sleeping pattern (restlessness, snoring, etc) had a lower average FOSQ10 score than those who do not (27.1+/-6.5 vs 30.0+/-7.3), P<.0001. Individuals who have seen an otolaryngologist about snoring or any other sleep-related problems had a lower average FOSQ10 score than those who have not (26.7+/-6.0 vs 29.4+/-7.4), P<.0001. Conclusion(s): A higher score on the FOSQ10 was found to be associated with better sleep outcomes. It is an appropriate tool for assessing functional outcomes of sleep in the US population and can be used by otolaryngologists to better understand and treat patients with impaired sleep.
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Background: The COVID-19 pandemic may affect youth's physical and mental well-being, partially because of the countries' rules to contain the virus from spreading. However, there is still uncertainty about the impact of physical distancing on youth's mental health. We aimed to estimate the prevalence of feeling agitated, anxious, down, sad, or low mood (FNF) due to physical distance measures and verify which factors are associated with young Portuguese and Brazilian people. Methods: We used cross-sectional data from the instrument "COVID-19 Barometer: Social Opinion"in Portugal (March 2020 and September 2021) and from "COVID-19 Social Thermometer"in Brazil (August 2020 to April 2021);these surveys included data regarding the health and socioeconomic impact on the population. The health and sociodemographic variables of the two countries were summarized as absolute and relative frequencies. A multivariable logistic regression model was fit by country to estimate the relation between FNF and selected variables of interest. Results: Approximately 36% of the sample studied reported anxiety, agitation, sadness, or low mood almost every day in Portugal and 52% in Brazil due to physical distancing. In Portugal, having more than two comorbidities represented a greater chance of experiencing FNF every day or almost every day (odds ratio [OR] = 1.51 [CI: 1.22-1.87]) than those without comorbidities. In contrast, having a university education level represented a protector factor (OR = 0.76 [CI: 0.67-0.88]). In Brazil, being unemployed increased the chance of FNF compared to students (OR = 11.2). Conclusions: Physical distancing measures have impacted the mental well-being of the young population in Portugal and Brazil. The countries must make a quick effort to attend to and protect young people's well-being and mental health in the changing context of the current pandemic.
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Introduction: The hypothalamus plays a crucial role in regulating vital functions and circadian rhythms. Both the tumor involving the hypothalamic area and its treatment can lead to hypothalamic dysfunction, resulting in disturbances in sleep-wake patterns, sleep fragmentation, and increased daytime sleepiness. We describe two patients with craniopharyngioma who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes diagnosed as severe sleep disturbances. Case reports: Patient 1 is a 19-year-old male diagnosed with surgically treated craniopharyngioma. Subsequently, episodes of psychomotor slowing, afinalistic movements of the upper limbs diagnosed as seizures in another neurological center appeared;antiepileptic treatment was started without improvement. At the first examination in our center, excessive daytime sleepiness (EDS), fragmented nighttime sleep, episodes characterized by bimanual automatic gestures occurring during drowsy state, hypnagogic hallucinations, and sudden loss of muscle tone while awake were recognized. Actigraphy demonstrated irregular bedtimes, frequent nocturnal activity, and inappropriate daytime rest episodes. The Epworth Sleepiness Scale (ESS) showed subjective EDS (ESS=19). At PSG, hypersomnolence, severe sleep-related breathing disorder (SRBD), and no interictal and ictal seizure abnormalities were found. A BiPAP NIV was started, and antiepileptic therapy was discontinued. In the following months, PSG revealed marked improvement in SRBD and 1 SOREMP, and the MSLT a mean SOL of 6 min and 10 sec and 3 SOREMPs. These data allowed the diagnosis of secondary narcolepsy, and treatment with pitolisant was initiated with clinical improvement and reduced daytime sleepiness (ESS=9). Patient 2 is a 12-year-old male, surgically treated for craniopharyngioma at the age of 4 years, who developed episodes of myoclonic jerks, temporal and spatial disorientation, and psychomotor agitation during the lockdown period for COVID-19 emergency. Surmising paroxysmal epileptic episodes, the patient was hospitalized. The anamnestic data collection revealed a sleep-wake rhythm dysregulation, fragmented nighttime sleep, EDS, oneiric stupor-like episodes during which the patient performed simple automatic gestures mimicking daily-life activity, and severe impairment of alertness. The Long-term video-EEG, including polygraphic measurements, showed destruction of the wake-NREM sleep-REM sleep boundaries, episodes of undetermined state of vigilance, and concurrence of elements typical of different sleep stages. Moreover, a severe SRBD (AHI 19/h) has been observed. The MRI showed a volumetric increase in the post-surgical interpeduncular fossa and right paramedian cysts. Therefore, a multifactorial therapeutic plan including sleep hygiene and slow-release melatonin was started with improvement in nighttime sleep, but EDS persisted. Surgical treatment of cyst fenestration improved sleep-wake rhythm and behavior;BiPAP NIV was initiated with very poor adherence. Discussion: We aim to focus on sleep disorders as a possible complication of tumors involving the hypothalamic region. Our cases highlight that the clinical manifestation of these dysfunctions can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment that can harm patients' health and the quality of life of patients and their families. Conclusion: These findings support the need to incorporate comprehensive sleep assessment in survivors from childhood brain tumors involving the suprasellar/hypothalamic region.
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Since the emergence of COVID-19 in 2020, various actions have been taken by governments and agencies globally to curtail its spread and devastating effects. Risk communication is an essential component of such actions. Examination of public interest, risk perception and new cases of COVID-19 is vital to understanding the effectiveness of risk communication strategies implemented. With data paucity plaguing policymaking in Nigeria, there is a need to examine new data sources to support the enhancement of risk communication. The study explored Google Trends (GT) and Google Mobility Reports (GMR) in monitoring public restlessness and risk perception, respectively, toward COVID-19 in Nigeria. This is geared toward understanding the effectiveness of the national risk communication strategy. COVID-19 case statistics, stringency index, mobility, and search indices for selected terms were collated (February 28 to June 30, 2020). Temporal dynamics were examined while correlation analysis was carried out to examine the association. Public attention peaked just around the commencement of the nationwide lockdown and declined considerably afterwards despite increasing new cases. Mobility toward most place categories showed a sharp decline at the beginning of the pandemic, except for residential areas. This trend also reversed soon after the lockdown. COVID-19 case statistics were found to be negatively correlated with the public interest. Public interest had a weak but both negative and positive association with the stringency index, while mobility exhibited a weak negative association with the case statistics (except residential area mobility). The results indicated that the risk communication efforts were inadequate in providing a prolonged health behavior change. The initial risk communication and lockdown created a positive outcome, however, the impact soon faded out. The evidence suggests that risk perception may have been poorly targeted by risk communication interventions. It is recommended that continuous monitoring of public interest and risk perception is implemented during an emergency and risk communication adjusted accordingly. Copyright © 2022 Lawal.
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Background: Coarctation of the aorta (CoA) is a congenital heart defect. Due to the narrowing of the descending aorta, blood flow mainly reduces after the stenosis, and CoA can occur at any region in the thoracic and abdominal aorta. Cardiac surgeons and cardiologists are familiar with postoperative complications of CoA;however, there are also some other complications that have not been reported to date. Case Presentation: The present study investigated three cases of CoA undergoing reconstructive surgery. Nevertheless, a couple of days after the surgery, they manifested symptoms suspected of cerebral infarction. Ischemic infarction was observed after performing brain computed tomography. Additionally, we discuss possible pathophysiology and reasons that can lead to this problem. Conclusions: In this case report, we presented three cases of CoA patients who underwent reconstructive surgery and manifested cerebral infarction as an adverse effect of the reconstructive surgery.
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Objective: To evaluate the efficacy and mechanism of Clinically Designed Improvisatory Music (CDIM) to induce calmness and stress relief in patients admitted to the Epilepsy Monitoring Unit (EMU). Background: Epilepsy monitoring requires simulating seizure-inducing conditions which frequently causes discomfort to EMU patients. COVID-19 hospital restrictions added another layer of stress upon hospital admission. The purpose of this research was to provide evidence that CDIM brings relief to EMU patients. Design/Methods: Five individuals with epileptic seizures in the EMU during the COVID-19 lockdown participated in the study (average age+ SD=30.2 + 6). Continuous video EEG and heart tracing were obtained before, during, and after live CDIM. CDIM consisted of 40 minutes of virtual calming music played by a music practitioner on viola. Post-intervention surveys assessed patients' emotional state. Alpha/beta power spectral density ratio was calculated for each subject across the brain and was evaluated using one-way repeated analysis of variance, comparing 20 minutes before, during, and 20 minutes after CDIM. Post-hoc analysis was performed using paired t-test. Results: Patients reported enhanced emotional state (9.25/10), contentment (9.5/10), and decreased restlessness (8.75/10) on a 10-point Likert scale. Compared to baseline, all experienced decreases in heart rate during CDIM. Alpha/beta ratio increased at whole-brain and regional levels during CDIM and persisted post-intervention. There was a significant main effect of CDIM on alpha/beta ratio (p < 0.05). Conclusions: Consistent with investigations in patients with depression and anxiety, we found positive effects of music as reported by patients, a decrease in heart rate, an increased alpha/beta ratio due to calming effect in response to CDIM. These effects persisted for at least 20 minutes post-intervention. Our study provides proof of concept that live CDIM provided demonstrable comfort for patients admitted in the EMU during the COVID-19 pandemic.
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Objective: As the COVID-19 pandemic brings widespread changes in families, the sociology of sleep becomes noticeable. Yet, the socio-contextual determinants of a biopsychosocial phenomenon as sleep are poorly investigated. We examine changes concomitantly occurring in the child's sleep per familial and community stressors. Methods: During the pre-COVID-19 outbreak period, in 24 minority children (5.4 ± 1.7 years old, 54.2% girls), sleep was objectively measured 24 h for two consecutive weeks, and this was repeated three times over the study period of three months. The caregiver filled out questionnaires surveying sociodemographic, community and family aspects. Results: Children went to bed at 22:26 and woke up at 07:04, with each a variability of about 50 min. Money and time were revealed as related key stressors to sleep. Five dimensions best fitted their association. In general, concurrent changes within the individual child indicate that mean sleep variables seem to relate to predominantly features of the stressors (explained variance of 34.7 to 56.7%), while variability of sleep tends to associate to situational aspects of the stressors (explained variance of 30.4 to 61.8%). Associations were best explained in terms of the 24 h dimension, particularly exposing sleep variability. Conclusion: Individual variabilities in a child's sleep are associated with familial resources, such as caregiver's time to self, money and basic needs. Time spent in bed, a modifiable factor by society and shaper of sleep quantity and quality, plays a key role in stressor-sleep associations. Insights from biopsychosocial perspectives may be valuable for understanding COVID-19 sleep studies, and the development of (post-) COVID-19 sleep recommendations.
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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.
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Background: Since the outbreak of the COVID-19 pandemic, many scientific papers have described the medical aspects and treatment of the virus infection and its symptoms. There are also many studies on how pandemics of this magnitude affect psychological wellbeing. Despite the spread of COVID-19, it has remained a rather threat for many people in Poland. They have often expressed disbelief and negative attitudes toward social restrictions. The study aimed to investigate changes in attitudes to the COVID-19 threat in young people and the psychological repercussions of social isolation. Material/Methods: The present study examined the changes in young people's attitudes, ones not directly affected by COVID19, over a period of a month. It comprised 41 individuals aged 21 to 60. The participants were asked to fill out a specially designed Internet questionnaire. This consisted of 5 open questions concerning their attitudes, values, feelings, reactions, and vision of the future. They were also encouraged to give their own remarks. Results: At first, 46.6% of participants reported a feeling of discomfort, while 48.4% treated the situation as an opportunity to temporarily slow down the pace of life. However, negative moods and deterioration of mental state arose over time, and 58.7% of respondents reported discomfort in the second study. It shows that counter-arguing against information that causes discomfort and fear does not work for long. Moreover, the majority of them believed that the epidemic would result in the deterioration of their psychological wellbeing. Conclusions: The study revealed that psychological restlessness was almost imperceptible at first, and many participants reported a feeling of relief. Nevertheless, deterioration of mental state arose gradually, often leading to a lack of motivation, feelings of loneliness, helplessness, and, consequently, aggressive behaviors. The neuropsychological and biological aspects of long-term stress are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Delirium and psychomotor agitation are relevant clinical conditions that may develop during COVID-19 infection, especially in intensive care unit (ICU) settings. The psychopharmacological management of these conditions is receiving increasing interest in psychiatry, considering hyperkinetic delirium as one of the most common neuropsychiatries acute consequences in COVID-19 recovery patients. However, there are no actual internationally validated guidelines about this topic, due to the relatively newly introduced clinical condition; in addition, a standardized psychopharmacologic treatment of these cases is a complex goal to achieve due to the risk of both drug-drug interactions and the vulnerable conditions of those patients. The aim of this systematic review and case series is to evaluate and gather the scientific evidence on pharmacologic handling during delirium in COVID-19 patients to provide practical recommendations on the optimal management of psychotropic medication in these kinds of patients. The electronic databases PubMed, Embase and Web of Science were reviewed to identify studies, in accordance with the PRISMA guidelines. At the end of the selection process, a total of 21 studies (n = 2063) were included. We also collected a case series of acute psychomotor agitation in COVID-19 patients hospitalized in ICU. Our results showed how the symptom-based choice of the psychotropic medication is crucial, and even most of the psychotropic drug classes showed good safety, one must not underestimate the possible drug interactions and also the possible decrease in vital functions which need to be strictly monitored especially during treatment with some kinds of molecules. We believe that the evidence-based recommendations highlighted in the present research will enhance the current knowledge and could provide better management of these patients.
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COVID-19 Drug Treatment , Delirium , Delirium/drug therapy , Humans , Intensive Care Units , Psychomotor Agitation , Psychotropic Drugs/therapeutic use , SARS-CoV-2ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had an impact on people globally, including mothers living in coastal regions. Therefore, this study aims at identifying the psychological status of single mothers living in the coastal regions of Indonesia. METHODS: A descriptive quantitative cross-sectional design was used with non-probability sampling in coastal regions of West Java, Indonesia. Furthermore, the Zung Self Rating Anxiety Scale was used to assess the anxiety level of single mothers. RESULTS: The anxiety of single mothers during the COVID-19 pandemic was generally moderate (n = 45.77.59%), with 44.83% attributing it to health and the economy. Furthermore, previous results showed that this condition was observed in the elderly (n = 38.65.52%), though it lasted <5 years in the majority of cases (n = 33.56.90%). Symptoms associated with the anxiety of single mothers during the pandemic include an increase in restlessness, nervousness, and anxiety. CONCLUSION: The economy and health of single mothers were the primary sources of anxiety during the COVID-19 pandemic. A high percentage of these women suffer from mild anxiety and require immediate care to prevent the development of other health problems. Therefore, health cadres and community nurses are expected to take action to achieve optimal psychological welfare among single mothers during the pandemic. Further study can be conducted by focusing on the theme of defense mechanisms or resilience.
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The primary objective of this study was to examine, interrogate and establish the influence of COVID-19 lockdown on the well-being of women in the academy and the roles they play as university employees and family members. This study was premised within interpretivism paradigm, and life history;and diaristic approach was used to understand this phenomenon. Biographies and interviews qualitative techniques were used to collect data from six women in academia in one university in South Africa. The research findings identified the COVID-19 pandemic as a cause of anxiety and restlessness among academic women;the excessive workload and lack of time;difficulties in balancing home and work duties;a lack of access to proper resources to aid job duties and research;and a lack of online resources-data, network access and Blackboard. This study recommended adequate online facilities and the design of the virtual mental wellness programmes to help academic women.
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Background: Ornithine-transcarbamylase deficiency (OTC) is the most common type of urea cycle disorder, and it is the only one with X-linked inheritance. The clinical presentations can vary from severe symptoms caused by hyperammonemia in childhood or adolescence to milder cases with late-onset in adulthood (similar to delirium or acute psychosis) [1], in the context of precipitating factors such as pregnancy, high protein intake, acute stress, infections, certain medications (valproate, steroids, haloperidol) [2]. Method: We present a case of a 31-year-old female, with no history of mental disorders, with a personal history of Hashimoto thyroiditis and urticaria, and a family history of OTC deficiency (her two-year-old niece). She was also a heterozygous carrier for the OTC deletion, reporting periods of meat avoidance and anorexia. She was single, lived alone, and complained of work-related stress, mainly as she worked from home during the COVID-19 pandemic as an IT consultant. The patient presented at our clinic in emergency for psychomotor agitation, slurred speech, complex auditory and visual hallucinations, and mystical delusional ideas. Furthermore, one week before her presentation, she started fasting because of her Christian orthodox religious beliefs (before Easter celebration), but she also complained of insomnia, fatigue, and tachycardia. The patient reported being vaccinated with the first dose of Pfizer's SARS-CoV-2 vaccine one week before the presentation. Results: Laboratory tests showed iron-deficient anemia and ketonuria;hepatic function was normal. Thyroid function was also normal, but anti thyroperoxidase antibodies were elevated. Serum ammonia levels were normal, and urinary orotic acid levels were within normal range. The result of head CT was unremarkable. Neurological examination was normal. She was started on 10 mg i.m. Haloperidol per day, but given the possibility of inducing hyperammonemia in urea cycle disorders patients, she was switched to Risperidone 6 mg/day, which was gradually reduced to 3 mg/day. Also, she was started on a protein-restricted diet. On the second and third days of admission, she was partially disoriented and somnolent but showed no signs of metabolic encephalopathy;therefore, metabolic treatment was not initiated. On the sixth day, she was almost completely recovered, with no psychotic symptoms. After the remission of psychotic symptoms, the neuropsychological evaluation showed significant cognitive deficits: executive functions (impaired performance on Tower of London task), deficits of focused and distributed attention, and decreased immediate verbal memory, even though the patient had received higher education, being at the top of her class during her studies. Given that metabolic profiles were normal, we discuss the complex interactions between autoimmune disorders, genetic factors, precipitating factors, and psychosocial factors that could have contributed to the psychotic episode. Conclusion: Clinicians should consider various factors that can influence the psychological state of a patient, paying attention to atypical factors or symptoms. Also, regarding the treatment of psychiatric symptoms in patients with urea cycle disorders with a normal metabolic profile, psychiatrists must avoid certain medications (haloperidol, valproate) that can worsen the patient's status. No conflict of interest