Arabic translation and validation of the Clinician Administered Staden Schizophrenia Anxiety Rating Scale (S-SARS) (preprint)

Background: Literature on anxiety in patients with schizophrenia of Arab origin is surprisingly scarce, particularly given that expressions of both psychotic disorders and anxiety disorders can be largely shaped by cultural factors. The present study proposes to complement the literature by examining the psychometric properties of an Arabic translation of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) in a sample of chronic, remitted patients with schizophrenia from Lebanon. As the Arabic version of the Generalized Anxiety Disorder 7‑Item Scale (GAD‑7) has not been previously validated in an Arabic-speaking clinical population of patients with schizophrenia, this study had as a secondary objective to examine the psychometric properties of this scale before its use. Method: his cross-sectional study has been conducted during August and October 2023. A total of 117 chronic inpatients diagnosed with schizophrenia who were remitted and clinically stable filled the survey, with a mean age of 57.86 ± 10.88 years and 63.3% males. Results: Confirmatory factor analyses showed that all 10 items were condensed into a single factor and had high factor loading values between 0.53 and 0.81. The reliability of the Arabic version of the S-SARS was excellent as attested by a Cronbach’s alpha and a McDonald’s omega coefficients of 0.89 and .90, respectively. The score of Arabic S-SARS correlated positively with the GAD-7 scores (r = .55; p < .001), thus supporting good convergent validity. As for discriminant validity, findings showed positive correlations between S-SARS and depression scores as assessed using the Calgary Depressive Symptoms Scale. In addition, the Arabic S-SARS correlated negatively with general functioning, further supporting the good validity and clinical relevance of the scale. Finally, measurement invariance was established in the gender subsamples (males vs. females) at the configural, metric and scalar levels, with females showing more anxiety than males. Conclusion: Findings suggest that the Arabic S-SARS holds good psychometric properties, and is suitable for use among Arabic-speaking patients with schizophrenia in clinical practice and research. The Arabic version of S-SARS will hopefully be widely applied to provide useful and timely clinical information for monitoring and adequately treating patients with schizophrenia, in order to improve the course and prognosis of the disease.

The impact of COVID-19 pandemic and lockdown on emergency psychiatry department admissions (preprint)

Background: This study aimed to explore the impact of coronavirus disease 2019 pandemic and lockdown period (LP) measures on patients’ visits to psychiatric emergency department (PED) of Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School. Methods: We conducted a retrospective cohort study comparing the number and characteristics of patients during the initial lockdown with visits in the pre- and post-lockdown months. We also investigated the number of monthly PED visits and hospitalizations between March 11, 2020-2021 and compared it to the same period in 2019 and between March 2021-2022. Results: PED visits in the initial LP in Istanbul increased by 109% compared to the pre-lockdown months in the previous year. Anxiety and depressive disorders were responsible for most of this increase. The decline in PED visits was 3.1% and 42% during the first and second year of the pandemic, respectively; however, among the major diagnostic categories, we found that the rates of anxiety, depressive disorders, and OCD increased significantly in the first year, while psychotic disorders declined and bipolar disorders remained the same. In the second year, there was a trend toward pre-pandemic year ratios. Conclusion: The present findings highlight the immediate and long-term effects of the COVID-19 pandemic and lockdown measures on patients’ admission to the PED.

New-onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination: a rare case report.

BACKGROUND: Rare cases of COVID-19 infection- and vaccine-triggered autoimmune diseases have been separately reported in the literature. In this paper, we report the first and unique case of new onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination in a previously healthy 26-year-old Tunisian female. CASE PRESENTATION: A 26-years old female with a family history of a mother diagnosed with schizophrenia, and no personal medical or psychiatric history, was diagnosed with mild COVID-19 infection four days after receiving the second dose of Pfizer-BioNTech COVID-19 vaccine. One month after receiving the vaccine, she presented to the psychiatric emergency department with acute psychomotor agitation, incoherent speech and total insomnia evolving for five days. She was firstly diagnosed with a brief psychotic disorder according to the DSM-5, and was prescribed risperidone (2 mg/day). On the seventh day of admission, she reported the onset of severe asthenia with dysphagia. Physical examination found fever, tachycardia, and multiple mouth ulcers. Neurological evaluation revealed a dysarthria with left hemiparesis. On laboratory tests, she had severe acute kidney failure, proteinuria, high CRP values, and pancytopenia. Immune tests identified the presence of antinuclear antibodies. Brain magnetic resonance imaging (MRI) revealed hyperintense signals in the left fronto-parietal lobes and the cerebellum. The patient was diagnosed with systemic lupus erythematosus (SLE) and put on anti-SLE drugs and antipsychotics, with a favorable evolution. CONCLUSIONS: The chronological relationship between COVID-19 infection, vaccination and the first lupus cerebritis manifestations is highly suggestive, albeit with no certainty, of the potential causal link. We suggest that precautionary measures should be taken to decrease the risk of SLE onset or exacerbation after COVID-19 vaccination, including a systematic COVID-19 testing before vaccination in individuals with specific predisposition.

Can social isolation caused by physical distance in people with psychosis be overcome through a Phone Pal?

The current pandemic has forced many people into self-isolation and to practice social distancing. When people are physically isolated and distant from each other, technology may play a fundamental role by enabling social connection and reducing feelings of loneliness caused by this prolonged social isolation. In response to the COVID-19 pandemic, many mental health services worldwide have had to shift their routine face-to-face outpatient appointments to remote telepsychiatry encounters. The increased pressure on mental health services highlights the importance of community-led health-promotion interventions, which can contribute to preventing mental illness or their relapses, and to reduce the burden on health services. Patients with psychosis are particularly socially isolated, have sedentary lifestyles, and commonly face stigma and discrimination from the general population. At the same time, patients with psychosis value technology, are interested in, use and own smart-phones to digitally connect, and are satisfied with their use. Thus, among psychosocial interventions, a helpful resource may be "Phone Pal," a complex intervention which facilitates remote communication between volunteers and socially isolated patients with psychosis through different smart-phone tools. While "Phone Pal" has been originally developed for people with psychosis, it may also be useful to the wider population, helping to overcome the social isolation caused by physical distancing, particularly in these times of widespread isolation. "Phone Pal" may be a potential public health resource for society, providing important support to those that may need it the most, and possibly benefit most from it.

How does the public understand the causes of mental disorders? An analysis of Irish news media before and during the COVID-19 pandemic.

Public perceptions of the determinants of mental illness have important implications for attitudes and stigma, but minimal previous research has explored how causal attributions are spontaneously invoked in everyday public discourse. This study investigated how causal explanations for mental illness are disseminated in popular Irish news media, in the two years before and after the onset of the COVID-19 pandemic. Keyword searches of a news media database identified 1,892 articles published between March 2018 to March 2022 that mentioned one of six categories of mental disorders: anxiety disorders, mood disorders, substance-related disorders, personality disorders, eating disorders, and psychotic disorders. Overall, 25% of the identified articles contained a causal explanation for mental illness. Inductive content analysis revealed the content and prevalence of eight types of causal explanations for mental disorders. Overall, attributions to life events/experiences, the cultural/societal environment, interpersonal relations, and health and lifestyle factors occurred more frequently than attributions to biological or psychological determinants. Life events/experiences were the most common explanation for anxiety and personality disorders, cultural/societal environment for eating disorders, and health/lifestyle factors for mood and psychotic disorders. Interpersonal factors in mental illness aetiology became more salient following the COVID-19 pandemic. The findings emphasise the need for theory and research on lay explanations of mental disorders to account for diversity, both in the range of attributions invoked, and in how attributional patterns shift across time and mental disorders category.

Potential mechanisms between psychotic-like experiences and suicidal ideation in the context of COVID-19: A longitudinal study.

OBJECTIVE: Although many studies have found an association between psychotic-like experiences (PLEs) and suicidal ideation (SI), the underlying psychological mechanisms have not been well established. Therefore, we conducted a longitudinal study in technical secondary school and college students to explore the role of fear-response to the COVID-19 and depression in the association between PLEs and SI in the context of the COVID-19 pandemic. METHODS: PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Depression, fear, and SI were assessed using the Psychological Questionnaire for Public Health Emergency (PQPHE). PLEs were evaluated before the pandemic (T1), and fear, depression, and SI were measured during the pandemic (T2). RESULT: A total of 938 students completed both waves of the survey through electronic questionnaires. PLEs, fear, depression, and SI were all correlated with each other (all p < 0.01). T2 depression partly (58.2 %) mediated the relationship between T1 PLEs and T2 SI (b = 0.15, 95%CI = 0.10, 0.22). T2 Fear moderated the relationship between T1 PLEs and T2 depression (b = 0.05, 95%CI = 0.01, 0.09) and the relationship between T1 PLEs and T2 SI (b = 0.11, 95%CI = 0.06, 0.16). CONCLUSION: PLEs are both directly and indirectly related to SI. Depression can result from PLEs and lead to the subsequent SI. Additionally, high levels of fear during the COVID-19 pandemic can aggravate the adverse impact of PLEs on mental health problems. These findings provide potential targets for future suicide prevention.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study.

BACKGROUND: The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD). METHODS: Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis. CONCLUSION: Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

Internet Gaming Disorders and Early Onset Psychosis in Young People: A Case Study and Clinical Observations.

BACKGROUND: Over the last ten years, the video game industry has grown exponentially, involving about 2.5 billion young adults in the world. The estimated global prevalence of gaming addiction has been reported to be 3.5% ranging from 0.21% to 57.5% in the general population. Moreover, during the recent COVID-19 pandemic period, school closures and stay-at-home measures have also further increased the opportunities for prolonged and intensified playing of video games. Little is known about the relationship between IGD and psychosis, and the literature is still scarce. Some characteristics of patients with psychosis, particularly those with a first-episode psychosis (FEP), may suggest that these individuals would be particularly liable to develop IGD. CASE PRESENTATION: We report two cases of young patients with to Internet gaming disorder, experiencing early onset psychosis treated with antipsychotic therapy. CONCLUSION: Although it is difficult to show the specific mechanisms underlying the psychopathological alterations in IGD, it is clear that excessive exposure to video games could be a risk factor for precipitating psychosis especially in a vulnerable age group such as adolescence. Clinicians should be aware of the possibility of a higher risk of psychotic onset associated specifically with gaming disorders in very young people.

Tele-mental Health Transitions for Pennsylvania Coordinated Specialty Care Programs for Early Psychosis During the COVID-19 Pandemic.

This study examined provider and client perspectives of tele-mental health (TMH) in early psychosis care during the COVID-19 pandemic. To achieve this goal, thirty-three mental health providers and 31 clients from Pennsylvania Coordinated Specialty Care (CSC) programs completed web-based surveys assessing TMH usage, experiences, and perceptions between May and September 2020. Three additional TMH-related questions were asked two years later of PA CSC Program Directors between Feb and March 2022. Descriptive statistics characterized responses. Open-ended items were coded and grouped into themes for qualitative synthesis. As early as mid-2020, participants reported extensive use of TMH technologies, including telephone and video visits. Although most providers and clients preferred in-person care to TMH, most clients still found TMH to be comparable to or better than in-person care; 94% of clients indicated interest in future TMH services. Providers also noted more successes than challenges with TMH. Nine themes emerged regarding provider-perceived client characteristics that could benefit from TMH and were grouped into two categories: client-level (access to technology, comfort with technology, transportation, young age, symptom severity, functioning level, motivation for treatment adherence) and interpersonal-level (external support systems and engagement with program prior to the pandemic) characteristics. Two years later, program directors reported continued perceived advantages of TMH in CSCs, although some barriers persisted. Despite the unexpected shift to TMH in early psychosis programs during the COVID-19 pandemic, findings indicated a relatively positive transition to TMH and perceived promise of TMH as a sustained part of routine care.

Operationalising a Recovery-Oriented Support and Information Programme Online: The EOLAS Programme.

Evidence demonstrates that psychoeducation interventions have clinical and recovery-related benefits for people experiencing psychosis and their family members. The EOLAS programmes are one example of recovery-oriented psychoeducation programmes for psychosis. They differ from other programmes in that they are co-designed and co-facilitated (peer and clinician) group programmes. Due to the COVID-19 pandemic, EOLAS went online using a videoconferencing platform. The study examined the feasibility, acceptability and usefulness of EOLAS-Online and explored whether some of the positive recovery outcomes reported by attendees regarding the in-person programmes were replicated online. Data were collected through an online survey and semi-structured interviews. Quantitative data were analysed using descriptive statistics. Thematic analysis was used for qualitative data. Fifteen attendees (40% of attendees) completed the surveys and eight participated in interviews. A total of 80% were satisfied/very satisfied with the programme. The programme was rated highly for increased knowledge of mental health, coping strategies, and engaging with peers. The use of technology was mostly unproblematic, although some audio and video-related challenges were identified. Engaging with the online programme was experienced positively, including facilitator support to engage. The overall findings indicate that EOLAS-Online is feasible, acceptable and useful in supporting attendees' recovery journeys.

Psychotic Disorders in the Elderly: Diagnosis, Epidemiology, and Treatment.

This review covers the latest advances in our understanding of psychosis in the elderly population with respect to diagnosis, epidemiology, and treatment. Major topics of discussion include late life psychiatric disorders such as schizophrenia, schizoaffective disorder, and delusional disorder as well as dementia-related psychosis. Clinical differences between early-onset and late-onset disorders are reviewed in terms of prevalence, symptomatology, and approach to treatment. Newly revised research and clinical criteria for dementia-related psychosis are referenced. The evidence base for emerging therapies including citalopram and pimavanserin in relation to conventional therapies such as atypical antipsychotics are discussed..

Psychotic Symptoms After SARS-CoV-2 Infection.

ABSTRACT: This case series reports three middle-aged male patients with no prior history of psychiatric disorders who developed psychotic symptoms with manic characteristics after COVID-19 infection. They presented mystic and paranoid delusions associated with euphoria, logorrheic, insomnia, and bizarre behaviors. Two of them required psychiatric hospitalization and one received corticosteroids. Treatment with antipsychotic medication improved their symptoms in a few weeks. This case series reports the new-onset psychosis probably due to COVID-19 infection. Pathogenetic speculation about the probable causes of COVID-19 psychosis, such as inflammatory reaction and corticosteroid use, was done. Moreover, other probable causes of manic psychosis, such as late-onset bipolar disorder, were also considered and ruled out. There is a need for more research to determine the causality between psychotic symptoms and COVID-19 infection.