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1.
J Clin Psychol Med Settings ; 2022 Oct 22.
Article in English | MEDLINE | ID: covidwho-2085457

ABSTRACT

Nurses experience a high incidence of workplace bullying and are at a higher risk of suicide than the general population. However, there is no empirical evidence on how exposure to workplace bullying is associated with suicide ideation and attempts among nurses. Nurses were recruited from tertiary hospitals in Shandong Province, China, using stratified cluster sampling. Suicide ideation and attempts were assessed using two items, and the Workplace Psychologically Violent Behaviors Instrument was used to measure subtypes of workplace bullying. The prevalence of workplace bullying, suicide ideation, and suicide attempts was 30.6%, 16.8%, and 10.8%, respectively. After adjusting for covariates, victims of workplace bullying were at a high risk of suicide ideation and attempts. Among workplace bullying subtypes, individuals' isolation from work and direct negative behaviors were predictors of both suicide ideation and attempts; attack on personality only predicted suicide attempts. The more bullying subtypes experienced by nurses, the greater their likelihood of suicide ideation and attempts. These findings suggested that workplace bullying was associated with an increased risk of suicide ideation and attempts in nurses, with both independent and cumulative risks. Interventions should focus on prevention and managing the effects of workplace bullying among nurses.

2.
Contemp Clin Trials ; 123: 106966, 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2075975

ABSTRACT

BACKGROUND: Despite their intrinsic strengths and resilience, some American Indian and Alaska Native (AI/AN) communities experience among the highest rates of suicide of any racial and ethnic group. Caring Contacts is one of the only interventions shown to reduce suicide in clinical trials, but it has not been tested in AI/AN settings. OBJECTIVE: To compare the effectiveness of Enhanced Usual Care (control) to Enhanced Usual Care augmented with a culturally adapted version of Caring Contacts (intervention) for reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations. METHODS: We are implementing a single blind randomized controlled trial of Caring Contacts in five AI/AN communities across the country (South Dakota, Montana, Oklahoma, and Alaska). Eligible participants have to be (1) actively suicidal or have made a suicide attempt within the past year; (2) at least 18 years of age; (3) AI/AN; (4) able to speak and read English; (5) able to participate voluntarily; (6) willing to be contacted by text, email or postal mail; and (7) able to provide consent. Following consent and baseline assessment, participants are randomized to receive either Enhanced Usual Care alone, or Enhanced Usual Care with 12 months (25 messages) of culturally adapted Caring Contacts. Follow-up assessments are conducted at 12 and 18 months. CONCLUSIONS: If effective, this study of Caring Contacts will inform programs to reduce suicide in the study communities as well as inform future research on Caring Contacts in other tribal settings. Modifications to continue the trial during the COVID-19 pandemic are discussed. CLINICAL TRIALS REGISTRATION: NCT02825771.

3.
Chest ; 162(4):A1014, 2022.
Article in English | EMBASE | ID: covidwho-2060752

ABSTRACT

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: The COVID-19 pandemic raised economic strife, social isolation, fear from contagion, and anxiety to a level where 45% of surveyed U.S. adults report a detriment to their mental health. With U.S. suicide rates up from 10 to 14 cases per 100,000 over the past 20 years, the health and safety of a vulnerable mental health population becomes more of a concern. We report a case of an individual with depression who was resuscitated after severe toxicity from alcohol and beta-blocker ingestions. CASE PRESENTATION: A 58-year-old woman with prior suicide attempts was found in an obtunded state after finishing a 20-pack of beer and swallowing a propranolol 20 mg pill bottle. On admission, she presented with bradycardia, hypotension, and alteration to a Glasgow Coma Scale of 9 with emesis residue on her face. Her blood gas revealed an anion-gap metabolic acidosis with a pH of 7.26, lactate of 2.53, normal potassium and calcium, and glucose of 134 mg/dL. Toxicity labs were notable for an alcohol of 199 mg/dL. Her EKG demonstrated a junctional bradycardia with a p-wave complex after the QRS consistent with retrograde depolarization of the atrium (Image 1). She was intubated to protect her airway. She subsequently developed cardiac arrest secondary to pulseless electrical activity. She underwent CPR for 33 minutes with boluses of intravenous epinephrine, glucagon, insulin, calcium gluconate, and sodium bicarbonate prior to return of spontaneous circulation. Due to failure of transcutaneous pacing, a transvenous pacer was placed. In concert with Poison Control, she was started on an a euglycemic insulin drip and an intralipid infusion. Her hemodynamics improved, and she was weaned off pacing and ICU interventions within 24 hours. She was discharged a week after admission with no residual morbidities. DISCUSSION: Overdose from nonselective beta-blockers can result in bradycardia, hypotension, seizures, QRS widening, QTc prolongation with ventricular tachy-arrhythmias, hyperkalemia, and hypoglycemia. Understanding the pharmacodynamics of beta-blocker toxicity enables targeted interventions to improve: chronotropy with epinephrine, glucagon, and pacing;inotropy with insulin, calcium, glucagon, and phosphodiesterase inhibitors;QRS widening with sodium bicarbonate;and QTc prolongation with magnesium or lidocaine. The high lipid solubility of propanol allows for intravenous lipid infusions to aid in drug elimination for patients in refractory cardiogenic shock. CONCLUSIONS: Despite a lack of labs for monitoring beta blocker toxicity, our case demonstrates successful resuscitation in a severe overdose. Perhaps an absence of hyperkalemia, hypoglycemia, QRS and QTc changes, and tachy-arrhythmias in this incident portended to a decreased morbidity and mortality. Ultimately, we reaffirmed the role of intralipid infusions as a critical treatment adjunct for recovery from cardiogenic shock secondary to beta blockade. Reference #1: Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM. 2020;113(10):707-712. Reference #2: Kerns W 2nd. Management of beta-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin North Am. 2007;25(2):309-viii. Reference #3: Anderson AC. Management of beta-adrenergic blocker poisoning. Clin Pediatr Emerg Med. 2008;9(1):4–16. DISCLOSURES: No relevant relationships by Jackie Hayes No relevant relationships by Andrew Salomon

4.
Chest ; 162(4):A893, 2022.
Article in English | EMBASE | ID: covidwho-2060718

ABSTRACT

SESSION TITLE: Cases of Overdose, OTC, and Illegal Drug Critical Cases Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hydroxychloroquine (HCQ) is commonly prescribed for the management of connective tissue disorders such as systemic lupus erythematosus and rheumatoid arthritis. Despite its widespread use, there are limited case reports describing HCQ intoxication and management. HCQ toxicity presents predominantly with cardiovascular manifestations, including hypotension, arrhythmias, and QT interval prolongation on electrocardiogram (EKG). Other findings include visual disturbances, altered mental status, and hypokalemia. CASE PRESENTATION: We present the case of a 60-year-old female with a history of rheumatoid arthritis and depression. She presented to the emergency department (ED) after ingesting 10-15 tablets of HCQ 200 mg in a suicide attempt. In the ED, she was noted to be lethargic and tachycardic. EKG revealed sinus tachycardia with a heart rate of 127 beats per minute and prolonged QTc of 680msec. The diagnostic evaluation also revealed hypokalemia with potassium 3.7mmol/l. Initial management in the ED included administration of activated charcoal, potassium supplementation, and intravenous bicarbonate infusion. The patient was admitted to the ICU for monitoring and supportive care. Serum electrolyte panel and EKG were monitored. The patient made an uneventful recovery after 2-3 days. The QT interval normalized, and hypokalemia improved. She was subsequently discharged to an inpatient psychiatric unit. DISCUSSION: Although HQC is commonly prescribed, there is limited data describing overdose. Our case of HCQ overdose presented as changes in mental status, QT interval prolongation, and hypokalemia. Similar findings have been reported in previous case reports. Management includes early gastric decontamination with activated charcoal, potassium supplementation, and supportive care. Intravenous bicarbonate infusion has been utilized for prolonged QT intervals, and benzodiazepines have been used for agitation and sedation. CONCLUSIONS: Although rare, HCQ toxicity can be life-threatening. It is a commonly prescribed agent, and therefore the clinician should be aware of its toxicity profile and management. Reference #1: Bakhsh HT. Hydroxychloroquine Toxicity Management: A Literature Review in COVID-19 Era. J Microsc Ultrastruct. 2020;8(4):136-140. Published 2020 Dec 10. doi:10.4103/JMAU.JMAU_54_20 Reference #2: McKeever R. Chloroquine/hydroxychloroquine overdose. Vis J Emerg Med. 2020;21:100777. doi:10.1016/j.visj.2020.100777 Reference #3: Lebin JA, LeSaint KT. Brief Review of Chloroquine and Hydroxychloroquine Toxicity and Management. West J Emerg Med. 2020;21(4):760-763. Published 2020 Jun 3. doi:10.5811/westjem.2020.5.47810 DISCLOSURES: No relevant relationships by Priyaranjan Kata No relevant relationships by Wajahat Khan No relevant relationships by Pratiksha Singh

5.
Chest ; 162(4):A664, 2022.
Article in English | EMBASE | ID: covidwho-2060663

ABSTRACT

SESSION TITLE: A Look Into Poisoning and Drug Overdoses SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: We present a case of a 64-year-old woman with severe obesity (BMI 53) who presented with shock after beta-blocker (BB) and calcium channel-blocker (CCB) overdose. CASE PRESENTATION: The patient presented after an intentional suicide attempt, taking multiple antihypertensive medications, including tablets of nifedipine 90mg, carvedilol 25mg, and losartan 100mg. She had also been experiencing shortness of breath and lower extremity pain for several days. Upon arrival, she was lethargic and minimally responsive, and was found to be in shock with a heart rate 63. She was intubated for airway protection and started on multiple vasopressors including norepinephrine, phenylephrine, vasopressin, dopamine and epinephrine for circulatory support. She was also found to be positive for SARS-CoV-2. She was given activated charcoal, received gastric lavage, and whole bowel irrigation. She received a bolus of regular insulin at 1U/kg, and subsequently started on a high-dose insulin infusion titrated to 11U/kg/h along with dextrose infusion and calcium gluconate. By day four of admission, vasopressor requirements had been reduced to only norepinephrine and the insulin infusion had been successfully discontinued. However, her hospital course was further complicated MRSA and Pseudomonas pneumonia, and renal failure requiring hemodialysis. She continued to develop refractory shock, and remained over 50 liters net positive. Her condition progressively deteriorated and her gross volume overload was difficult to manage, and ultimately expired on day ten of admission. DISCUSSION: The management of CCB and BB overdose has been studied, with hyperinsulinemic euglycemic therapy (HIET)1,2 as our choice. Our patient's decline was likely secondary to the high volumes of dextrose infusion required after HIET. With underlying renal failure, insulin clearance proved to be a significant challenge. Such severe obesity with a weight-based regimen resulted in over 1500U insulin/hr at any given point with our patient. Renal clearance is governed by a proportion of t/V, where t denotes length of a dialysis session and V the volume of fluid in the patient's body.3 Patients with significant volume would require extensive dialysis sessions and fluid balances would be challenging. Continuous renal replacement therapy (CRRT) was attempted later in her hospital course. However, the patient was not able to tolerate it as she had progressed to multiorgan failure. CONCLUSIONS: HIET has shown to be a successful management strategy for CCB and BB overdose. However, weight-based dosing can prove to be a challenge in patients with severe obesity. CRRT should be considered early in severely obese patients that undergo HIET, given the rapid accumulation of fluid secondary to the large-volume insulin and dextrose infusions. Further investigations should look into identifying maximal safe dosages of HIET, especially in severely obese patients. Reference #1: Cole JB, Arens AM, Laes JR, Klein LR, Bangh SA, Olives TD. High dose insulin for beta-blocker and calcium channel-blocker poisoning. Am J Emerg Med. 2018 Oct;36(10):1817-1824. doi: 10.1016/j.ajem.2018.02.004 Reference #2: Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177 Reference #3: Turgut F, Abdel-Rahman E, M: Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review. Nephron 2017;137:172-177. doi: 10.1159/000479118 DISCLOSURES: No relevant relationships by Alejandro Garcia No relevant relationships by Vishad Sheth no disclosure on file for Andre Sotelo;

6.
Psychiatry Res ; 317: 114837, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2031635

ABSTRACT

Current suicidal ideation and suicide attempts among psychiatric patients during the COVID-19 pandemic were studied through systematic review and meta-analysis. We searched the following electronic databases using the relevant search terms: Medline, Embase, PubMed and Web of Science, with the search time as of January 31,2022. Forest plots were obtained using Stata statistical software and a random-effects model was used to conduct a meta-analysis of the prevalence of suicidal ideation. We found 21 eligible studies, 11 of which provided suitable data for meta-analysis. 10 studies explored current suicidal ideation and reported a pooled prevalence of 20.4% (95%CI 14.0-26.8). Six studies examined suicide attempts, with a pooled prevalence of 11.4% (95%CI 6.2-16.6). The prevalence of suicidal ideation and suicide attempts varied by the study method used and by the study sites. This work highlights the need for real-time monitoring of suicidal ideation and suicide in psychiatric patients during the covid-19 pandemic r to inform clinical practice and help identify research questions for future epidemiological studies.


Subject(s)
COVID-19 , Suicide, Attempted , Humans , Suicide, Attempted/psychology , Suicidal Ideation , Pandemics , Prevalence
7.
Nature ; 608(7924):S35, 2022.
Article in English | EMBASE | ID: covidwho-2031818
8.
BJPsych Open ; 8(5): e166, 2022 Sep 08.
Article in English | MEDLINE | ID: covidwho-2021389

ABSTRACT

BACKGROUND: The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions. AIMS: We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic. METHOD: We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods. RESULTS: In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients' rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11-13) v. 13 (interquartile range: 12-14), P < 0.001). CONCLUSIONS: Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.

9.
Eur Child Adolesc Psychiatry ; 2022 Aug 26.
Article in English | MEDLINE | ID: covidwho-2014171

ABSTRACT

Since the outbreak of the COVID-19 pandemic, increases in suicidal ideation and suicide attempts in adolescents have been registered. Many adolescents experiencing suicidal ideation turn to online communities for social support. In this retrospective observational study, we investigated the communication-language style, contents and user activity-in 7975 unique posts and 51,119 comments by N = 2862 active adolescent users in a large suicidal ideation support community (SISC) on the social media website reddit.com in the onset period of the COVID-19 pandemic. We found significant relative changes in language style markers for hopelessness such as negative emotion words (+ 10.00%) and positive emotion words (- 3.45%) as well as for social disengagement such as social references (- 8.63%) and 2nd person pronouns (- 33.97%) since the outbreak of the pandemic. Using topic modeling with Latent Dirichlet Allocation (LDA), we identified significant changes in content for the topics Hopelessness (+ 23.98%), Suicide Methods (+ 17.11%), Social Support (- 14.91%), and Reaching Out to users (- 28.97%). Changes in user activity point to an increased expression of mental health issues and decreased engagement with other users. The results indicate a potential shift in communication patterns with more adolescent users expressing their suicidal ideation rather than relating with or supporting other users during the COVID-19 pandemic.

10.
Psychology of Men & Masculinities ; 2022.
Article in English | Web of Science | ID: covidwho-2016591

ABSTRACT

The COVID-19 pandemic is causing extensive job loss leading to a loss of social status in many men. Endorsement of traditional masculinity ideology may render some men particularly sensitive to status loss and thereby to an increased risk for suicidality. In this anonymous online survey conducted in German-speaking European countries, 490 men completed questionnaires regarding loss of social status due to the COVID-19 pandemic, past-month and lifetime suicide attempt and suicidal ideation. Furthermore, endorsement of traditional masculinity ideology and prototypical and male-typical externalizing depression symptoms were measured. Out of a total of 490 men, 14.7% of men reported experiencing status loss due to the pandemic. These men were more than four times as likely to have attempted suicide in the past month (OR = 4.48, 95% CI [1.72, 11.67]) and more than twice as likely to report suicidal ideation during the past 2 weeks (OR = 2.47, 95% CI [1.42, 4.28]), than men not reporting status loss. Status loss, but not endorsement of traditional masculinity ideology, was associated with suicide outcomes. However, when male-typical externalizing depression symptoms and prototypical depression symptoms were included in the models, they exhibited the only direct associations with suicide outcomes (e.g., for past-month suicide attempt: male-typical externalizing depression symptoms OR = 2.18, 95% CI [1.31, 3.62], prototypical depression symptoms OR = 2.41, 95% CI [1.13, 5.12]). A significant interaction between status loss and endorsement of traditional masculinity ideology further suggests an enhancing moderating effect of traditional masculinity on the relationship between status loss and past-month suicide attempts (OR = 3.27, 95% CI [1.16, 9.27]). Status loss due to the COVID-19 pandemic emerges as risk factor for suicide in men. Men who experience status loss due to the COVID-19 pandemic while concomitantly exhibiting strong endorsement of traditional masculinity ideology have an additional increased risk of suicide. Public Significance Statement Status loss due to the COVID-19 pandemic, particularly among men with strong endorsement of traditional masculinity ideologies, may play a critical role in understanding the elevated suicide rates in the aftermath of the most acute phase of the COVID-19 pandemic. Health care policy should specifically target men with experienced status loss due to the COVID-19 pandemic in suicide prevention programs and swiftly design mental health care campaigns tailored to the group of men with strong endorsement of traditional masculinity ideology.

11.
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.

12.
Journal of General Internal Medicine ; 37:S441, 2022.
Article in English | EMBASE | ID: covidwho-1995634

ABSTRACT

CASE: A 44 year old female with history of depression and recent suicide attempt presents with one week of cognitive and functional decline. One month prior to presentation, patient attempted suicide with opioids requiring intubation for respiratory depression and stroke sequelae. She was discharged from this stay after 12 days having returned to mental and functional baseline. Two weeks later, she demonstrated decreased focus and concentration, progressing to decreased mobility and akinesis, eventually presenting to our hospital. Admission metabolic and toxic workup was negative. CT head redemonstrated findings of previously known stroke. MRI demonstrated new increased T2 Flair of the parietal lobes and the cerebral white matter. LP was without evidence of infection or inflammation. Encephalitis panel and autoimmune workup were negative. Neurology consult suggested delayed post-hypoxic leukoencephalopathy as a possible diagnosis, given clinical course of improvement and subsequent decline, along with akinetic mutism and deep cortical white matter flair abnormalities. After failed trial of lorazepam, she was started on amantadine and her cognitive and functional status improved slowly. IMPACT/DISCUSSION: Delayed post-hypoxic leukoencephalopathy (DPHL) is a rare syndrome characterized by biphasic time course with initial recovery and subsequent cognitive and functional decline. DPHL can follow any event of prolonged cerebral hypoxia most frequently CO poisoning. It can occur with more common causes of hypoxia including overdose, cardiac arrest, and seizures;recent case reports have reported DPHL following severe covid infection. The clinical course involves a hypoxic event followed by a return to functional baseline typically lasting 7-21 days, after which progressive physical and mental decline occur. Signs include neuropsychiatric symptoms like amnesia and disorientation, as well as parkinsonism or akinetic mutism (1). The mechanism of DPHL is unclear. One possible mechanisms involves diffuse demyelination. The half life of myelin basic proteins is approximately 20 days, the length of the lucid interval. Hypoxia may abruptly halt the myelination process but symptoms may not emerge until a critical threshold of loss was achieved. Evaluation of DPHL involves considering other causes of encephalopathy, such as infection, substance use, stroke, catatonia, and toxins. In the absence of other causes, diagnosis of DPHL is based on characteristic time course following hypoxic event, symptoms, and MRI findings of diffuse T2 hyperintensity of cerebral white matter are pathognomonic (1). Treatment of DPHL is generally supportive. Limited evidence suggests amantadine may be of benefit. CONCLUSION: Physicians should consider DPHL in patients who have experienced cerebral hypoxia and present with the characteristic time course and imaging findings.

13.
Eur Arch Psychiatry Clin Neurosci ; 2022 Jul 04.
Article in English | MEDLINE | ID: covidwho-1971702

ABSTRACT

The consequences of the current COVID-19 pandemic for mental health remain unclear, especially regarding the effects on suicidal behaviors. To assess changes in the pattern of suicide attempt (SA) admissions and completed suicides (CS) in association with the COVID-19 pandemic. As part of a longitudinal study, SA admissions and CS are systematically documented and analyzed in all psychiatric hospitals in Frankfurt/Main (765.000 inhabitants). Number, sociodemographic factors, diagnoses and methods of SA and CS were compared between the periods of March-December 2019 and March-December 2020. The number of CS did not change, while the number of SA significantly decreased. Age, sex, occupational status, and psychiatric diagnoses did not change in SA, whereas the percentage of patients living alone while attempting suicide increased. The rate and number of intoxications as a SA method increased and more people attempted suicide in their own home, which was not observed in CS. Such a shift from public places to home is supported by the weekday of SA, as the rate of SA on weekends was significantly lower during the pandemic, likely because of lockdown measures. Only admissions to psychiatric hospitals were recorded, but not to other institutions. As it seems unlikely that the number of SA decreased while the number of CS remained unchanged, it is conceivable that the number of unreported SA cases increased during the pandemic. Our data suggest that a higher number of SA remained unnoticed during the pandemic because of their location and the use of methods associated with lower lethality.

14.
Clin Exp Emerg Med ; 9(2): 120-127, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1939480

ABSTRACT

OBJECTIVE: To compare and analyze the differences in the sociodemographic and clinical characteristics of suicide attempters who visited an emergency department (ED) before and during the coronavirus disease (COVID-19) pandemic. METHODS: This single center, retrospective study was conducted by reviewing the medical records of patients in the "self-injury/suicide" category of the National Emergency Department Information System who visited an ED between January 2019 and December 2020. We obtained information on baseline characteristics, suicide attempt, and disposition. Data were analyzed using the chi-squared test. RESULTS: A total of 456 patients were included. The number of patients visiting the ED for suicide attempts increased by 18.2% (from 209 to 247 cases) during the COVID-19 pandemic, and the ratio of suicide attempters to the total number of ED visits increased by 48.8% (from 0.43% to 0.64%, P<0.001). There were significant differences in methods of suicide attempt, endotracheal intubation, ED disposition, and the presence of mental illness. Drug overdose (42.1% vs. 53.4%) and gas inhalation (5.7% vs. 8.5%) increased, and hanging decreased (6.0% vs. 2.0%) during the pandemic. Endotracheal intubation (13.9% vs. 5.7%) and intensive care unit admission (29.7% vs. 14.6%) decreased. More patients with the history of mental illness visited during the pandemic (54.0% vs. 70.1%). CONCLUSION: Since the COVID-19 pandemic began, suicide attempts have increased in this single ED although the lethality of those attempts is low.

15.
Brain-Broad Research in Artificial Intelligence and Neuroscience ; 13(1):113-123, 2022.
Article in English | Web of Science | ID: covidwho-1928959

ABSTRACT

Viral infections can be a cause of CNS infection, causing mental and neurological symptoms. Even under normal conditions, good mental health is of paramount importance to the functioning of society. Healthcare workers are critical to the COVID-19 pandemic and beyond, but may have to leave work if their mental health is affected. We present the favorable evolution of a patient, a 55 year-old woman, medical staff with a history of viral infection with SARS CoV-2 (August 2020). which is brought by a crew of the Ambulance service in the emergency department (ED) service (December 2020) for multi-drug ingestion for suicide. After treatment and investigations she is transferred to the "Elena Doamna" Psychiatric Hospital. After 4 days of hospitalization, he returns to the emergent' department by transfer from the Psychiatric Hospital for underlying seizures, confusion syndrome. During her admission to the neurology service of the "Sf Ap. Andrei" Emergency Clinical Hospital, the patient benefited from numerous clinical and paraclinical investigations. which prodded information abut the patient's neuropsychiatric evolution.

16.
British Journal of Psychiatry ; 220(5):307-308, 2022.
Article in English | EMBASE | ID: covidwho-1916986
17.
Basic and Clinical Pharmacology and Toxicology ; 130(SUPPL 2):27-28, 2022.
Article in English | EMBASE | ID: covidwho-1916039

ABSTRACT

Objective: COVID-19 has left no healthcare system untouched. Adjustments to accommodate COVID-19 pandemic needs resulted in widespread deferment of non-COVID19 scheduled healthcare activities, added to a general patient's reluctance to visit healthcare settings. This study is aimed to analyse retrospectively demographic and clinical characteristics of patients with acute poisoning attended at the Emergency Department (ED) in three different pandemic periods of time. Material and/or methods: We carried out an observational and retrospective study in which we included all the patients who visited the Emergency Department at Hospital Son Espases due to acute poisoning during three different periods of time from June to July in 2019 (pre pandemic), same period in 2020 (right after the strict confinement in Spain) and in 2021 (post-pandemic). This study was approved by the Research Ethics Committee of the Balearic Islands. Results: All cases of acute poisoning were included (n = 1182). Patients with acute poisoning presenting to the ED decreased significantly during the pandemic (2019: 1.9%, 2020: 1.5%;p < 0.01). The ratio male/female and the mean age of the patients increased during the pandemic (2 vs. 1.4, p = 0.02, and 31.4 vs. 41.3 years, p < 0.001, respectively). The roll of poisoning in suicide attempts increased substantially during the pandemic (2019: 8.71%, 2020: 21%;p < 0.01), mostly driven by the increase in poisoning due to commercially available drugs (2019: 14.20%;2020: 28.76%, p < 0.01), while recreational drug poisoning decreased (2019: 76.1%, 2020: 62%;p < 0.01), while in 2021, figures tended to return to prior patterns. Conclusions: This study found significant changes in some clinical patterns in patients attending the ED due to acute poisoning in the context of COVID19, in line with the already described impact of the pandemic in other areas of the healthcare system.

18.
Clinical Toxicology ; 60(SUPPL 1):97, 2022.
Article in English | EMBASE | ID: covidwho-1915448

ABSTRACT

Objective: The COVID-19 pandemic has affected daily life in unprecedented ways. Many studies have found dramatic changes in individuals' physical activity, sleep and mental health [1]. This study aimed to analyze retrospectively demographic and clinical characteristics of patients with acute poisoning presenting to the Emergency Department (ED) [2] in three different periods of time (June-July): pre-pandemic (2019), after strict confinement of the Spanish population (2020) and post-pandemic (2021) [3]. Methods: All cases of poisoning in the study periods were reviewed. Demographic variables and the type of intoxication were studied. A comparison was made between the three periods. Results: All cases of acute poisoning were included (n=1182, 528 in June-July 2019;299 in June-July 2020, 355 in June-July 2021). Patients with acute poisoning presenting to the ED decreased during the pandemic (2019: 1.9%, 2020: 1.5%;p<0.01). The ratio male/female increased during the pandemic (2 versus 1.4, p=0,02). The mean age of the patients increased during the pandemic (2019: 31.4, 2020: 41.3, p<0,001), this tendency was maintained in 2021 (38.3). Poisoning in suicide attempts increased during the pandemic (2019: 8.71%, 2020: 21%;p<0.01), as well as poisoning due to commercialized drugs (2019: 14.20%;2020: 28.76%, p<0.01), while recreational drug poisoning decreased (2019: 76.1%, 2020: 62%;p<0.01), in 2021 these increased again (69%, p 0.07). Conclusion: This study has found significant changes in some clinical patterns in patients attending the ED due to acute poisoning in the context of COVID-19, in line with the already described psychological impact of the pandemic.

19.
Clinical Toxicology ; 60(SUPPL 1):96, 2022.
Article in English | EMBASE | ID: covidwho-1915440

ABSTRACT

Objective: To investigate calls made to the Finnish Poison Information Center (FPIC) before and during the COVID-19 pandemic. We hypothesized that the number of calls concerning COVID-related drugs and disinfectants would have increased, as well as the number of calls regarding intentional poisonings, due to the social and economic stress caused by the pandemic. Methods: We analysed the FPIC call records to assess the impact of the COVID-19 pandemic on our statistics. The pandemic started in Finland in March 2020 and the highest peaks were experienced during April 2020, December 2020, March 2021 and August 2021. We compared the mean number of calls per month from the same time period (March-June) before the pandemic (years 2018-2019) and during the pandemic (years 2020-2021). Results: The FPIC receives approximately 40,000 calls yearly from healthcare professionals and the public. The total number of calls was not significantly changed by the pandemic. Compared with 2018-2019, we observed a mean 161% increase (2018, n=24;2019, n=25;2020, n=61;2021, n=67) in calls concerning hand disinfectants during the pandemic. Respectively, there was a 180% increase concerning hydrogen peroxide (2018, n=3;2019, n=2;2020 n=9;2021, n=5) and a 24% increase in calls concerning vitamin D (2018, n=38;2019, n=50;2020, n=60;2021, n=49). Hydrogen peroxide (1%) was used at the dentist as a mouth disinfectant during the pandemic, so the abundant use was seen in our call records. Most of the vitamin D and hand disinfectant exposures were accidental and concerned toddlers. There was also an increase in cases of intentional drinking of hand disinfectants due to their easy availability. Calls regarding intentional poisonings (including drug of abuse and suicide attempts) experienced a slight (13%) increase (2018, n=342;2019, n=351;2020, n=369;2021, n=413), which has also been the trend for the past few years. There was no increase in calls concerning drugs (such as antivirals) used in the treatment of COVID-19. Conclusion: The total number of calls to the FPIC was not affected by COVID-19. Some of the most prominent changes during the pandemic were the increase in calls concerning hand disinfectants and hydrogen peroxide. There was no increase in calls concerning COVID-related drugs, which has been the case in some Poison Information Centers in the United States.

20.
Clinical Toxicology ; 60(SUPPL 1):98, 2022.
Article in English | EMBASE | ID: covidwho-1915437

ABSTRACT

Objective: Paracetamol and Ibuprofen are popular over the counter analgesics and frequently involved in suicidal overdose in adolescents. The aim of the study is to determine trends of paracetamol and ibuprofen overdose in adolescents and young adults before and during the COVID-19 pandemic. Methods: A retrospective descriptive study of suicide attempts by poisoning in adolescents and young adults (10-25 years) reported to the Swiss National Poison Center before and after the beginning of the COVID-19 pandemic (1 January 2016 to 30 June 2021). Intervention date was defined as end of Q1 2020 (lockdown in Switzerland started on 16 March 2020). Preintervention period was determined as Q1 2016-Q1 2020, postintervention period as Q2 2020-Q2 2021. Data collected included age, sex, time of call (month, year), and substances. Trends for cases involving paracetamol and/or ibuprofen were analysed per quarter (Q), and by patient age. Results: Overall 7697 cases met inclusion criteria (females n=5883, males n=1808, unknown n=6). Paracetamol was involved in 1864 cases (24.2%), ibuprofen in 1021 cases (13.3%), including 394 cases combining both substances. We recognized a higher proportion of exposures in 13 to 17-year-olds (paracetamol 28.4%, ibuprofen 16.2%), with a maximum proportion in 15- year-olds (paracetamol 30.7%, ibuprofen 18.3%). Comparing the average number of cases per quarter of the preintervention period to the postintervention period revealed an increase of 1.2 with an overproportional rise in paracetamol exposures of 1.4. Suicide attempts by paracetamol were even more common in the 13 to 17-year-olds (rate 1.7) (Table 1). Due to the small numbers in 10 to 12-year-olds trends are not determined. Conclusion: Paracetamol is involved in a quarter of suicide attempts in adolescents and young adults, even up to a third in the 15-year-olds, whereas ibuprofen plays a less prominent role. The observed increase in paracetamol overdoses in the 13 to 17- year-olds during the postintervention period requires close observation.

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