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1.
Eur Arch Psychiatry Clin Neurosci ; 2022 Sep 07.
Article in English | MEDLINE | ID: covidwho-2007142

ABSTRACT

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

2.
Annales Medico-Psychologiques ; 2022.
Article in English | EMBASE | ID: covidwho-2003849

ABSTRACT

Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d'Orientation et d'Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.

3.
Journal of Cystic Fibrosis ; 21:S5, 2022.
Article in English | EMBASE | ID: covidwho-1996739

ABSTRACT

As new therapies emerge for cystic fibrosis (CF), it is important to understand their psychiatric implications. Studies have shown cystic fibrosis transmembrane conductance regulator (CFTR) modulators to be associated with worsening of depression and anxiety symptoms. Trikafta® (elexacaftor/tezacaftor/ivacaftor) is a newly-approved CFTR modulator that significantly improves lung function, decreases pulmonary exacerbations, and improves the quality of life. Further studies are needed to evaluate the effects of Trikafta® on anxiety and depression. Objectives: To evaluate the effects of Trikafta® on PHQ-9 (depression screening questionnaire) and GAD-7 (anxiety screening questionnaire), scores in adult patients with CF seen at an academic health centre in the Southeastern United States. Methods:We conducted a retrospective chart review of 127 adult patients with CF who initiated Trikafta® between (11/2019 to 08/2021). We gathered data, including demographic information (age, sex, race, CF mutation), annual PHQ-9 and GAD-7 scores, corresponding FEV1 percent predicted, BMI, mental health diagnoses, counseling/psychotherapy use, psychiatric medication use, prescriber of those medications, number of psychiatric emergency department visits and psychiatric admissions, and sleep disturbances. We then ran linear mixed models examining the effect of Trikafta® on PHQ- 9 and GAD-7 scores after controlling for timing with respect to the COVID- 19 pandemic. Results: Of the 127 adult patient charts reviewed,100were included. These patients yielded 562 PHQ-9 and 562 GAD-7 scores taken from 01/2015–01/ 2022. No change in PHQ-9 scores was found after initiating Trikafta® or after the beginning of COVID (designated as March 15, 2020). Similarly, GAD-7 scores showed no significant change after Trikafta® or COVID. Table 1. Patient demographics: N = 100 (Table Presented) Conclusion: There is no significant change in PHQ-9 and GAD-7 scores of patients with CF after initiating Trikafta®

4.
Annales Médico-psychologiques, revue psychiatrique ; 2022.
Article in French | ScienceDirect | ID: covidwho-1976990

ABSTRACT

Résumé La dépression est le trouble psychiatrique le plus fréquent dans la population générale, et les consultations aux urgences pour dépression seraient en hausse depuis plusieurs années. Le Centre Psychiatrique d’Orientation et d’Accueil est un service d’urgences psychiatriques à vocation régionale situé à Paris qui recense environ 10 000 consultations par an. Parmi ces consultations, on retrouve près de 40 % de diagnostics de troubles de l’humeur. La prise en charge du patient aux urgences repose sur une évaluation globale, qui ne doit pas se limiter à l’entretien psychiatrique. Le contexte d’arrivée, l’environnement et l’entourage du patient doivent être pris en compte afin d’aboutir à une orientation optimale. Une attention particulière doit être portée aux premiers épisodes (élimination d’un diagnostic différentiel, dépistage d’un éventuel trouble bipolaire) et à l’évaluation du risque suicidaire. L’existence d’un facteur causal externe ou d’un trouble de personnalité comorbide ne doit pas faire banaliser la consultation et mener à un sous-diagnostic de dépression caractérisée. Le traitement médicamenteux aux urgences est le plus souvent symptomatique (traitement anxiolytique par benzodiazépines ou neuroleptiques selon les situations), et l’orientation ambulatoire doit toujours être privilégiée. Des adaptations thérapeutiques peuvent alors être envisagées. La décision d’une hospitalisation doit toujours être argumentée, et le consentement aux soins rigoureusement évalué. La prise en compte et éventuellement l’accompagnement de l’entourage sont presque toujours nécessaires. Tous ces éléments doivent être argumentés dans le dossier. Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d’Orientation et d’Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.

5.
Ann Gen Psychiatry ; 21(1): 29, 2022 Jul 30.
Article in English | MEDLINE | ID: covidwho-1968586

ABSTRACT

BACKGROUND: Despite concerns on mental health problems related to lockdowns, recent reports revealed a reduction in psychiatric admissions in Emergency Departments (ED) during the lockdown period compared with the previous year in several countries. Most of the existing studies focused on the first lockdown not considering the different phases of the COVID-19 crisis. The present study aimed to analyze differences in ED admission for psychiatric consultation during three different phases of the COVID-19 health crisis in Italy. METHODS: Information on ED admission for psychiatric consultations were retrospectively collected at the ED of the Santo Spirito Hospital in Rome (Italy), and compared between the three periods: the lockdown (March-June 2020) and the post-lockdown period (June 2020-June 2021) compared to the pre-lockdown (January 2019-March 2020). Multinomial logistic regression was used to assess the risk of accessing ED for psychiatric consultation before, during, after the lockdown. RESULTS: Three thousand and eight hundred seventy-one ED psychiatric consultations were collected. A significant reduction of psychiatric consultations in ED during the lockdown period and the post-lockdown (H 762,45; p < 0.001) was documented. Multinomial logistic regression analysis showed that compared to pre-lockdown during the lockdown and post-lockdown patients were more likely to be men (RRR 1.52; 95% CI 1.10-2.12) and more often diagnosed with non-severe mental illnesses (nSMI) (relative risk ratio [RRR] 1.53, 95% CI 1.10-2.15; and 1.72, 95% CI 1.42-2.08); during the lockdown, patients were also more often diagnosed with alcohol/substance abuse (A&S) (RRR 1.70; 95% CI 1.10-2.65). CONCLUSIONS: several changes in the clinical characteristics of psychiatric consultations during and after the lockdown emerged from the present study; nSMI and A&S abuse patients were more likely to present at the ED in the lockdown and post-lockdown periods while SMI patients appeared to be less likely. These may inform clinicians and future preventive strategies among community mental health services.

6.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-1966662

ABSTRACT

Background/Significance: Nationwide, the number of hospital emergency department (ED) visits has steadily increased over the past decade;since 2009, ED volumes have increased over 11%.1 The proportion of ED visits primarily involving psychiatric concerns (including substance use) has also been on the rise, from 6.6% of all visits in 2007 to 10.9% of all visits in 2016.2 A recent retrospective analysis of ED visit data from the National Emergency Department Sample examining the years 2010 through 2014 identified mental health concerns (including substance use) as the second-most frequent ED presentation, with abdominal pain ranking as the most frequent.3 Challenges to caring for patients with prominent psychiatric concerns in EDs include: prolonged lengths of stay (LOS),4 boarding and overcrowding,5 increased restraint use,6 financial sequelae,7 and safety implications for patients and staff.5 Many EDs have limited access to psychiatric expertise. Unique features of our innovative ED-based Psychiatry service line include: 1) joint administration by academic departments of Emergency Medicine and Psychiatry, and 2) concurrent, rather than consecutive, evaluations conducted by Emergency Medicine physicians and Psychiatrists for optimal efficiency and collaboration. Methods: The ED Psychiatry Program at Froedtert Hospital was implemented in 2019 to improve patient care, systems-based processes, and cross-specialty education. IRB approval was granted on 4/7/2020 to review data collected on all patients seen in the ED by the new ED Psychiatry service and compare metrics with primary psychiatric patients seen in the ED prior to program implementation. Patient care metrics from the first 12 months has been analyzed;cases in which the ED psychiatrist was involved total 382 (data from 5 patients seen during this period could not be reviewed due to erroneous recording of identifying information). 754 charts were reviewed in total—377 post-implementation (9/1/2019-8/31/2020) and 377 pre-implementation (9/1/2018-8/31/2019). The following metrics were recorded and analyzed using basic summary statistics: ED LOS, disposition, psychiatric diagnosis at discharge, medication class recommended, medication class administered, medication route recommended, and medication route administered. Statistical analysis was performed both on the 12-month groups in aggregate, as well as separately in 6-month groupings to assess for any COVID-19 related confounding effect. Results: Analysis of the first 12 months of data (n = 377 control and intervention patients) demonstrates statistically significant results across a number of domains, including disposition (decrease in hospital admissions and increases in transfers and ED discharges post-implementation), psychiatric diagnoses (increases in personality, intellectual developmental, and anxiety spectrum disorders post-implementation), and medication classes and administration routes utilized (decrease in benzodiazepine use and increases in both atypical antipsychotic use, as well as oral route of administration post-implementation). There were also notable decreases in ED LOS for patients being admitted and transferred from the ED;however, these differences were not statistically significant. Discussion: Analysis of the first year of service data suggests program efficacy and overall value to the health system, with relevant metrics including shorter ED LOS, improved diagnostic accuracy, increased provision of pharmacological treatment interventions in the ED setting and upon discharge, and more resource-appropriate dispositions for patients presenting to the ED with psychiatric concerns. Future directions for further study include: 1) review of the total data set, numbering over 1300 patients in 2 years;2) de-duplication of the data set to eliminate repeat patient encounters as a potential source of confounding;3) collaboration with a faculty biostatistician team for further statistical analysis;and 4) collection and analysis of additional relevant metrics, including restraint use (both f equency and duration), utility of 1:1 observers, patient insurance status (to aid in quantifying possible financial impact), additional patient demographic data (including age, race, gender, ethnicity), and time of patient presentation to the ED. Conclusion/Implications: Integration of psychiatric care into medical settings has been widespread in outpatient environments, but acute models are lacking. Complex psychiatric presentations impede ED workflows and often lead to inadequate care for this vulnerable population. Our jointly administered program that embeds CL Psychiatrists into our academic ED care team has improved and enhanced the care of ED patients presenting with psychiatric concerns as well as operational efficiencies within the department. References: 1. Agency for Healthcare Research and Quality. (2021, April). HCUP Fast Stats. Retrieved from Healthcare Cost and Utilization Project (HCUP): www.hcup-us.ahrq.gov/faststats/national/inpatienttrendsED.jsp 2. Theriault, K., Rosenheck, R., & Rhee, T. (2020). Increasing Emergency Department Visits for Mental Health Conditions in the United States. J Clin Psychiatry, 20m13241. 3. Hooker, E. A., Mallow, P. J., & Oglesby, M. M. (2019). Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med, 344-351. 4. Ding, R., McCarthy, M., Desmond, J., Lee, J., Aronsky, D., & Zeger, S. (2010). Characterizing waiting room time, treatment time, and boarding time in the emergency room using quantile regression. Acad Emerg Med, 813-823. 5. American College of Emergency Physicians. (2014). Polling Survey Results. 6. Zeller, S., Calma, N., & Stone, A. (2014). Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments. West J Emerg Med, 1-6. 7. Nicks, B. A., & Manthey, D. M. (2012). The impact of psychiatric patient boarding in emergency departments. Emerg Med Int.

7.
Int J Environ Res Public Health ; 19(15)2022 07 22.
Article in English | MEDLINE | ID: covidwho-1957294

ABSTRACT

Introduction: The COVID-19 pandemic affected the wellbeing of children and adolescents. The psychiatric emergency room (ER) is the hub of psychiatric emergencies and reflects clinically significant mental problems. Previous studies compared 2019 and 2020 and observed a decline in ER referrals. The current study focused on the continuous trend of referrals from 2010 to the end of 2021. Method: In our observational retrospective study, we procured data from 9156 child and adolescent referrals to our psychiatric ER. The comparison was made based on similar months of each year. Results: There was a significant positive trend in monthly referrals between 2010 and 2021, representing a similar increase in referrals per month in comparison to that month in the preceding year (unstandardized ß = 4.21, 95% CI = 3.44 to 4.98, p < 0.0001). Between March 2020 and February 2021 (monthly visits = 72.5 + 16.6 [median = 79.5], annual referrals = 870), we observed no additive effect beyond this general trend after controlling for population growth. Conversely, between March and December 2021 (monthly referrals = 106.1 + 31.8 [median = 105.5], overall referrals = 1061) we observed a significant additive effect beyond the projected incline, as predicted by previous years (ß = 21.61, 95% CI = 12.12 to 31.06, p < 0.0001). Conclusions: The first year of the COVID-19 pandemic was no different from the continuous decade long rise of referrals to the children and adolescents' psychiatric ER. Conversely, the second year showed an additional incline beyond the general trend. The complexity in this rising need demands the awareness of clinicians and policy makers alike.


Subject(s)
COVID-19 , Mental Disorders , Adolescent , COVID-19/epidemiology , Child , Emergency Service, Hospital , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Pandemics , Referral and Consultation , Retrospective Studies
8.
Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine ; 33(7):330-337, 2022.
Article in English | Wiley | ID: covidwho-1913828

ABSTRACT

?? ????COVID?19?????????????????????????????????????????????????????2020?1???12??COVID?19????2018?1???2019?12????2???COVID?19?????????????????????????????????????????????????????????????2020??2019????????????????????????????????????????????????????20???????????????????COVID?19???????????????2020??????????20????39%???????COVID?19?????27%???????????????????2020?????????????????????COVID?19??????????????????????????????????????????????????????????????????????????????????COVID?19??????????????????????????????????????COVID?19?????????????????????????????????????????????????????

9.
Journal of Mental Health Policy and Economics ; 25(SUPPL 1):S5, 2022.
Article in English | EMBASE | ID: covidwho-1912905

ABSTRACT

Background: In the USA, the early stage of COVID-19 led to stateimposed restrictions on population movement, work activity, and social gatherings. Some research finds that emergency department (ED) visits for psychiatric care declined during these restrictions. This work, however, does not control for strong patterning over time in ED visits, does not examine subtypes of ED visits, and does not test whether these visits strongly rose above expected levels after the loosening of societal restrictions. Aims of the study: We improve upon the literature and analyze, in the largest hospital in the most populous county in the US (Los Angeles, California), two COVID-19-related aims. First, we control for strong temporal patterning and test whether psychiatric ED visits fall below expected levels during the 1st stage of strong societal restrictions-and if so, which ED subtypes account for this decline. Second, we test whether psychiatric ED visits rebounded to greater than expected levels after the loosening of societal restrictions. Method: We obtained counts of psychiatric ED visits (66,451 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County and USC (LAC+USC) hospital. We applied Box-Jenkins time series methods to identify and remove autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020) as well as the subsequent period of relaxed restrictions (i.e., May 8 to Dec 31, 2020). If results rejected the null, we explored which type of visits (i.e., depression, schizophrenia, anxiety, suicidal ideation, alcohol use, substance use) accounted for the changes. Results: Psychiatric ED visits fell by 58.47 per week during the 1st stage of societal restrictions (SD=17.59, p<.005). This coefficient sums to 526 fewer visits over the 9-week period, accounting for a 13% fall in visits. Alcohol use and anxiety disorder accounted for the largest share of the reduction. After the 1st stage of societal restrictions, however, we observe no ''rebound'' above expected values in psychiatric ED visits overall (coef= -6.89, SD=13.86, p=.60) or by diagnostic subtype. Discussion: Initial societal restrictions due to COVID-19 reduced the demand for psychiatric ED care. However, after the relaxing of societal restrictions, psychiatric ED visits did not experience a compensatory rebound. This pattern of results does not support the speculation that foregone ED care during the initial societal restrictions subsequently led to a psychiatric ''pandemic'' of urgent visits. Implications for Health Care Provision and Use: The perturbation of ED visits during COVID-19 societal restrictions does not appear to warrant an increase in psychiatric care teams to meet higher ED demand in the long-run. Implications for Health Policies: If replicated, results should encourage attempts to shift, to non-urgent settings, a portion of psychiatric visits that present in the ED. Implications for Further Research: The effectiveness of alternative treatment modalities during the COVID-19 pandemic (e.g., telemedicine) in lieu of ED care, as well as a more careful understanding of potential resilience during societal disruptions, merits further investigation.

10.
Journal of Mental Health Policy and Economics ; 25(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1912832

ABSTRACT

The proceedings contain 69 papers. The topics discussed include: valuing mental illness by using the well-being valuation method;psychotropic polypharmacy use among high need children - the role of the individual, family, and neighborhood characteristics;secure attachment and sensitive parenting: potential for longer-term cost savings;workplace disclosure of serious mental illness: theory and evidence;new set of reference unit costs (RUCs) for health economic evaluations in Europe: methods and tools for development;psychiatric emergencies in Los Angeles county during, and after, initial COVID-19 societal restrictions: an interrupted time-series analysis;changes in outpatient care for alcohol use disorders among the commercially insured in the U.S. during the COVID-19 pandemic;and mental health care integration in community health centers and hospital emergency department utilization.

11.
BJPsych Open ; 8(2): e75, 2022 Mar 24.
Article in English | MEDLINE | ID: covidwho-1759797

ABSTRACT

BACKGROUND: Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown. AIMS: To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations. METHOD: This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020. RESULTS: Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent. CONCLUSIONS: Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.

12.
European Neuropsychopharmacology ; 53:S349, 2021.
Article in English | EMBASE | ID: covidwho-1597912

ABSTRACT

Introduction During the course of coronavirus disease-2019 (COVID-19) pandemic, many neuropsychiatric manifestations of the disease have been observed while the precise pathophysiology remains unknown [1]. New variants of coronavirus such as the 501.V2 and B.1.1.7 have emerged and obscurities in pathogenesis have increased even further with these variants. Here, we describe a patient with long-term effects of COVID-19, manifesting first episode psychosis accompanied by Cotard's Syndrome (CS) after infection with the B.1.1.7 variant of SARS-CoV-2. Case A 41-year-old female with no adverse medical history was admitted to the emergency department with symptoms of loss of smell, myalgia and sore throat and COVID-19 infection was confirmed by a positive RT-PCR test result for the B.1.1.7 variant of coronavirus. Two months after the completion of treatment for COVID-19, the patient started to have thoughts of being annihilated by viral occupation of her body and of her nervous system getting decomposed. The patient's family brought her to the psychiatric emergency department. The patient was found to have strong suicidal ideations, referential thoughts, belief of being physically dead and her children being in danger of obliteration by COVID-19. Clinical evaluation of the mental state of the patient was significant for decreased speech output and speed as well as psychomotor activity. Nihilistic, persecutory and referential delusions with no insight were recorded. Upon hospitalization and treatment with olanzapine 20mg/day orally and electroconvulsive therapy, her psychiatric symptoms and suicidal ideation ameliorated. The patient was discharged from the hospital with olanzapine 20mg/day orally and she is currently being followed-up in our outpatient clinic. Discussion To the best of our knowledge, this is the first report of a patient who developed CS and psychotic symptoms associated with COVID-19 following infection with a new variant of coronavirus. CS is a rare self-perceptual anomaly with the presentation of nihilistic delusions. While the exact pathogenesis of CS remains unexplained, defective mechanisms of proprioception or interoception may lead to a self-misattribution following a perceptual dysfunction which might trigger CS [2]. Although blood tests indicated no systemic inflammation for the index patient, an indistinct neuroinflammatory process may lead to neurotoxicity that might result in perceptual disruption and CS or psychotic features, as suggested in previous reports [3]. Considering well-described anosmia and ageusia with COVÍD-19 and our case's symptoms after the infection, new variants of SARS-CoV-2 might affect the perceptual pathways. The angiotensin-converting enzyme-2 (ACE-2) receptor which might modulate smell and taste perception, has been identified as a potential viral receptor. Such interaction may disrupt chemosensory perception. Overall, COVID-19 may cause abnormal processing of perceptions. This in turn can lead to anosmia, ageusia and defective proprioception, resulting in self-misattributions as seen in the patient in the current case report who was diagnosed with CS. Clinicians should keep in mind that infections with the rapidly spreading B.1.1.7 variant of SARS-CoV-2 might result in more severe symptoms or long-term consequences of COVID-19 compared to other strains. No conflict of interest

13.
European Neuropsychopharmacology ; 53:S313-S314, 2021.
Article in English | EMBASE | ID: covidwho-1593214

ABSTRACT

Background: SARS-CoV-2 is a severe acute respiratory syndrome which generates a wide spectrum of clinical presentations. Fever, gastrointestinal and upper respiratory symptoms are among the most common initial manifestations reported [1]. However, neuropsychiatric symptoms are also frequent, and in some cases, these can remain as sole manifestation of the infection [2]. We report a case of a 53-year-old woman with delirium with psychotic component, concomitant with SARS-CoV-2 infection, with no other associated symptoms. We aim to discuss the mechanisms through which SARS-CoV-2 affects the Central Nervous System (CNS), highlighting the heightened possibility of such occurrence, even in the absence of risk factors for neurological disease. Methods: Description of a clinical case and review of the literature on the subject. Results: E., a married 53-year-old woman with no background of medical illness, was brought to the psychiatric emergency room for a case of disorganized behavior with acute onset. Mental state evaluation revealed altered level of conscienciousness, distractibility, incoherent speech, poorly structured persecutory delusional beliefs, auditory hallucinations and sleep maintenance insomnia. Clinical history and examination revealed no other neurological as well as gastrointestinal and respiratory symptoms or signs. Diagnosis of delirium was confirmed using Confusion Assessment Method (CAM) Diagnostic Algorithm. Laboratory investigation revealed leukocytosis and elevation of creatinine-kinase and lactate-dehydrogenase. Electroencephalogram exhibited an unspecific grade 1/5 encephalopathy. No significant changes were found in chest X-ray, brain CT-scan or lumbar puncture. Hospitalization was proposed, aiming diagnostic investigation and clinical stabilization. According to institutional norms at the time, prior screening for SARS-CoV-2 was performed, with the RT-PCR test result coming positive. Cerebral spine fluid was not tested for SARS-CoV-2. E. was medicated with olanzapine 5mg id and was discharged eight days later, fully recovered from her neuropsychiatric symptoms, and exhibiting no other clinical manifestations of SARS-CoV-2 in the meantime. Conclusions: We report the case of a delirium as a sole manifestation of SARS-CoV-2 infection. The presence of symptoms such as delusional beliefs and hallucinations should be interpreted as features of delirium manifestation, instead of a SARS-CoV-2-induced psychosis [3]. Direct and indirect mechanisms of SARS-CoV-2 CNS disturbance have been proposed in scientific literature, such as neuronal invasion and cytokine storm, respectively [4]. In our case, implication of SARS-CoV-2 in delirium etiology is suggested by the temporal relationship between the two and the absence of other possible causes found for this clinical presentation. E.’s absence of risk factors for delirium (such as old age or other medical conditions), as well as the absence of any other symptomatology during the course of this disease, both suggest that SARS-CoV-2 poses a particular risk of CNS damage when compared to other respiratory viruses. Thus, in current pandemic times, the sheer presence of delirium should encourage screening of a SARS-CoV-2 infection, even in the absence of other symptoms [1]. Further studies are needed to understand the mechanisms by which SARS-CoV-2 infection affects the CNS. No conflict of interest

14.
European Neuropsychopharmacology ; 53:S419, 2021.
Article in English | EMBASE | ID: covidwho-1592736

ABSTRACT

Background. Notwithstanding predictions of increase in suicide risk related to the current pandemic [1,2], as was the case in previous pandemics [3], so far there is no clear evidence of increased rates of suicide, self-harm, suicide attempts, or suicidal thoughts associated with the COVID-19 pandemic [4]. An increase in suicide deaths after the initial decline in the pandemic ourbreak has been described in Japan [5]. Objective. We assessed the impact of the COVID-19 outbreak on trends in suicide mortality and suicidal behavior (SB) in Cantabria (Spain). Methods. Data collection: suicide mortalities by the Institute of Forensic Medicine of Cantabria (IML) and SB (suicidal ideation, or suicide attempt defined as any self-injurious act with at least some intent to die) by Emergency Department (ED) visits using triage data from the electronic health care records of University Hospital Valdecilla (HUMV, reference hospital for all psychiatric emergencies in Cantabria, Spain). Collection period: January-2015 to December-2020. Data are analyzed in three different COVID-19 pandemic periods (outbreak and lockdown: March–June;return to quasi-normality and second wave: July-September;third wave: October-December) compared to those same quarters of the previous five years. Since we exclusively used available aggregate data in this study, formal ethical review was not required. Results. Since 2015, there has been an increasing trend of admissions to the ED of HUMV for SB, having almost tripled between 2015-2019 (88 vs 249). During 2020, visits for SB decreased by more than 30% in comparison with the previous year (173 vs 249). This decline started in March with the onset of the covid-19 pandemic. Previously in the first quarter of the year there were 35% more consultations for SB than 2019. On the contrary, during lockdown (second quarter) SB visits were one third of those in the same period of 2019. Although the third and fourth quarters of 2020 see a doubling of visits compared to the containment period, the number of visits in both quarters is between 60-65% of those in 2019. In 2020, suicides have dropped compared to 2019, both in absolute numbers (46 vs. 52) and rates per-100,000 inhabitants (7.89 vs. 8.95). In the first quarter of 2020 there were 19 suicides (7 more versus 2019), but during lockdown there were only 8 (12 less than in the same period 2019). Conclusions. In Cantabria (Spain), no increase in suicide or SB has been observed related to the pandemic. Conversely, in 2020 we found a decrease in both, consultations for SB and deaths by suicide, compared to 2019. The decrease in suicides and SB has been observed in all periods of Covid-19 pandemic (outbreak and lockdown;quasi-normality and second wave;third wave). Suicide data are difficult to collect in real time and the economic effects of the pandemic are still evolving. Preventive strategies will need to be developed to cope the possible increase in suicide and SB when current social protective measures are discontinued.No conflict of interest

15.
Medicina (Kaunas) ; 57(12)2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1572560

ABSTRACT

Background and Objectives: While the impact on mental health of 2019 coronavirus (COVID-19) has been extensively documented, little is known about its influence on subjective fears. Here, we investigate the COVID-19 impact and its related restrictions on fears of patients admitted to a psychiatric Emergency Department (ED) during and post-lockdown. Materials and Methods: A retrospective study on 1477 consultations at the psychiatric ED of the University Hospital of Geneva (HUG) was performed using a mixed-methods analysis. The first analysis section was qualitative, aiming to explore the type of fears, while the second section statistically compared fears (i) during lockdown (16 March 2020-10 May 2020) and (ii) post-lockdown (11 May 2020-5 July 2020). Fears were also explored among different patient-age sub-groups. Results: 334 patients expressed one/more fears. Both in lockdown and post-lockdown, fears mostly pertained to "containment measures" (isolation, loneliness). When compared lockdown vs. post-lockdown, fears about "work status" (deteriorating, losing work) prevailed in lockdown (p = 0.029) while "hopelessness" (powerless feeling, inability to find solutions) in post-lockdown (p = 0.001). "Self around COVID-19" (dying, getting sick) fear was relatively more frequent in youth (p = 0.039), while "hopelessness" in the elderly (p < 0.001). Conclusions: Collectively, these findings highlight that lockdown/post-lockdown periods generated temporally and demographically distinct COVID-19 related fears patterns, with special regard to youth and elderly, two particularly vulnerable populations when faced with sudden and unexpected dramatic events. For this reason, the particular ED "front-line service" status makes it a privileged observatory that can provide novel insights. From a mental health perspective, these latter can be translated into pragmatic, more personalized prevention strategies to reinforce specific resilience resources and mitigate the current and long-term pandemic's impact.


Subject(s)
COVID-19 , Adolescent , Aged , Communicable Disease Control , Emergency Service, Hospital , Fear , Humans , Mental Health , Retrospective Studies , SARS-CoV-2 , Switzerland
16.
BMC Public Health ; 21(1): 1840, 2021 10 12.
Article in English | MEDLINE | ID: covidwho-1463238

ABSTRACT

BACKGROUND: The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada. METHODS: We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Quasi-Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Significant changes in ED visits, mental health diagnoses, police responses, and calls to the crisis line from March 5 to September 5, 2020 were examined using changepoint analyses. RESULTS: Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. There was a significant increase in weekly mental health diagnoses starting in the week of July 12 - July 18. There was a significant increase in crisis calls starting in the week of May 31 - June 6, the same week that many guidelines, such as gathering restrictions, were eased. There was a significant increase in weekly police responses starting in the week of June 14 - June 20. CONCLUSIONS: Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Emergency Service, Hospital , Humans , Mental Health , Ontario/epidemiology , SARS-CoV-2
17.
Soc Psychiatry Psychiatr Epidemiol ; 56(12): 2299-2310, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1391825

ABSTRACT

BACKGROUND: We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS: A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS: The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION: Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.


Subject(s)
COVID-19 , Mental Health , Communicable Disease Control , Emergency Service, Hospital , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2
18.
Front Psychiatry ; 12: 603318, 2021.
Article in English | MEDLINE | ID: covidwho-1346422

ABSTRACT

Background: During the spread of coronavirus disease (COVID-19), mandatory quarantines increased social isolation and anxiety, with inevitable consequences on mental health and health seeking behavior. We wished to estimate those trends. Methods: We examined all psychiatric visits to the emergency department (ED) during March, April 2020, compared to identical months in 2018, 2019. We evaluated both number and nature of referrals. Results: Throughout the years, psychiatric referrals comprised about 5% of the total number of ED visits. In March-April 2020, 30% decreases were observed in overall ED visits and in psychiatric referrals in the ED. Compared to 2018-2019, in 2020, the proportions of these diagnoses were higher: anxiety disorders (14.5 vs. 5.4%, p < 0.001), personality disorders (6.7 vs. 3.2%, p = 0.001), psychosis (9.5 vs. 6.7%, p = 0.049), post-traumatic stress disorder (3.2 vs. 1.5%, p = 0.023). Compared to 2018-2019, in 2020, proportions were lower for adjustment disorder (5.8 vs. 8.9%, p = 0.036) and for consultation regarding observation (11.7 vs. 31.6%, p < 0.001). Differences were not observed between 2018-2019 and 2020 in the proportions of other diagnoses including suicide and self-harm disorders. Referrals concerning suicide and self-harm in a rural hospital and community clinic were 30% lower in the COVID-19 lockdown than in the same months in 2018, 2019. Conclusion: Psychiatric ED visits decreased by the same proportion as overall visits to the ED, apparently driven by fears of COVID-19. Referrals relating suicidality and self-harm shown nominal decrease, but their proportioned share remained constant. Increased anxiety and delayed care may eventually lead to increased mental health needs.

19.
Front Psychiatry ; 12: 681318, 2021.
Article in English | MEDLINE | ID: covidwho-1304620

ABSTRACT

Aims: Carers of psychiatric patients often suffered from mental and physical burden during the coronavirus disease 2019 (COVID-19) pandemic due to the lack of mental health services. This study investigated the pattern of fatigue and its association with quality of life (QOL) among the carers of patients attending psychiatric emergency services during the COVID-19 pandemic. Methods: In this cross-sectional study, carers of patients attending psychiatric emergency services during the COVID-19 pandemic were consecutively included. Fatigue, insomnia symptoms, depressive symptoms, and QOL were assessed with standardized instruments. Results: A total of 496 participants were included. The prevalence of fatigue was 44.0% (95% CI = 39.6-48.4%). Multivariate logistic regression analysis revealed that fatigue was positively associated with higher education level (OR = 1.92, P < 0.01) and more severe depressive (OR = 1.18, P < 0.01) and insomnia symptoms (OR = 1.11, P < 0.01). ANCOVA analysis revealed that the QOL was significantly lower in carers with fatigue compared with those without (P = 0.03). Conclusions: Fatigue was common among carers of patients attending psychiatric emergency services during the COVID-19 pandemic. Considering the adverse impact of fatigue on QOL and other health outcomes, routine screening and appropriate intervention for fatigue are warranted for this subpopulation.

20.
J Acad Consult Liaison Psychiatry ; 62(6): 588-594, 2021.
Article in English | MEDLINE | ID: covidwho-1246008

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, there have been an increasing number of emergency department visits for behavioral health reasons, even as overall emergency department volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high-intensity care for severely ill patients who are likely to be homeless and underserved. OBJECTIVE: We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. METHODS: Changes in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. RESULTS: The pandemic's impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. CONCLUSIONS: There has been a decrease in volume at these services after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.


Subject(s)
COVID-19 , Emergency Services, Psychiatric , Hospitalization , Hospitals , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
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