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1.
BMJ Qual Saf ; 31(5): 337-339, 2022 May.
Article in English | MEDLINE | ID: covidwho-1807442
2.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1725049

ABSTRACT

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Developing Countries , Mental Health , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Bipolar Disorder/psychology , Bipolar Disorder/therapy , Brazil , COVID-19 , Caregivers , Dementia/nursing , Family , Health Services Accessibility , Humans , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/psychology , Multimorbidity , SARS-CoV-2 , Sensation , Social Isolation
3.
Transl Psychiatry ; 12(1): 90, 2022 03 03.
Article in English | MEDLINE | ID: covidwho-1721498

ABSTRACT

The acid sphingomyelinase (ASM)/ceramide system may provide a useful framework for better understanding SARS-CoV-2 infection and the repurposing of psychotropic medications functionally inhibiting the acid sphingomyelinase/ceramide system (named FIASMA psychotropic medications) against COVID-19. We examined the potential usefulness of FIASMA psychotropic medications in patients with psychiatric disorders hospitalized for severe COVID-19, in an observational multicenter study conducted at Greater Paris University hospitals. Of 545 adult inpatients, 164 (30.1%) received a FIASMA psychotropic medication upon hospital admission for COVID-19. We compared the composite endpoint of intubation or death between patients who received a psychotropic FIASMA medication at baseline and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, psychiatric and other medical comorbidity, and other medications. FIASMA psychotropic medication use at baseline was significantly associated with reduced risk of intubation or death in both crude (HR = 0.42; 95%CI = 0.31-0.57; p < 0.01) and primary inverse probability weighting (IPW) (HR = 0.50; 95%CI = 0.37-0.67; p < 0.01) analyses. This association was not specific to one FIASMA psychotropic class or medication. Patients taking a FIASMA antidepressant at baseline had a significantly reduced risk of intubation or death compared with those taking a non-FIASMA antidepressant at baseline in both crude (HR = 0.57; 95%CI = 0.38-0.86; p < 0.01) and primary IPW (HR = 0.57; 95%CI = 0.37-0.87; p < 0.01) analyses. These associations remained significant in multiple sensitivity analyses. Our results show the potential importance of the ASM/ceramide system framework in COVID-19 and support the continuation of FIASMA psychotropic medications in these patients and the need of large- scale clinical trials evaluating FIASMA medications, and particularly FIASMA antidepressants, against COVID-19.


Subject(s)
COVID-19 , Mental Disorders , Adult , Hospitalization , Humans , Intubation, Intratracheal , Mental Disorders/drug therapy , Psychotropic Drugs/therapeutic use , SARS-CoV-2
4.
Curr Opin Psychiatry ; 34(4): 351-356, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1635161

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS: Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY: Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.


Subject(s)
COVID-19/complications , COVID-19/psychology , Mental Disorders/complications , Mental Disorders/psychology , Substance-Related Disorders/complications , Substance-Related Disorders/psychology , Drug Interactions , Humans , Mental Disorders/drug therapy , Pandemics , Risk Factors , SARS-CoV-2 , Vulnerable Populations/psychology
6.
Lancet Psychiatry ; 8(12): 1019-1021, 2021 12.
Article in English | MEDLINE | ID: covidwho-1521656
7.
J Child Adolesc Psychopharmacol ; 31(4): 243, 2021 05.
Article in English | MEDLINE | ID: covidwho-1493620
9.
PLoS One ; 16(10): e0258916, 2021.
Article in English | MEDLINE | ID: covidwho-1480461

ABSTRACT

OBJECTIVES: Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. DESIGN: Retrospective observational study. PARTICIPANTS: Outpatients at a geriatric psychiatric clinic in New York City. MEASUREMENTS: Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. RESULTS: A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher's exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4-96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. CONCLUSION: We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.


Subject(s)
Antipsychotic Agents/adverse effects , COVID-19/mortality , Mental Disorders , Outpatients , SARS-CoV-2 , Aged , Aged, 80 and over , Antipsychotic Agents/administration & dosage , Female , Geriatric Psychiatry , Humans , Male , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/mortality , New York City/epidemiology , Retrospective Studies
10.
BMJ Open ; 11(7): e049824, 2021 07 07.
Article in English | MEDLINE | ID: covidwho-1365197

ABSTRACT

OBJECTIVES: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). SETTING: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. DESIGN: Cross-sectional study. PARTICIPANTS: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months. OUTCOME MEASURES: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence. RESULTS: Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50-59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70). CONCLUSIONS: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe. TRIAL REGISTRATION NUMBER: NCT03704805.


Subject(s)
HIV Infections , Mental Disorders , Adult , Cross-Sectional Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Prevalence , Rural Population , Zimbabwe/epidemiology
13.
Health Aff (Millwood) ; 40(6): 904-909, 2021 06.
Article in English | MEDLINE | ID: covidwho-1280643

ABSTRACT

COVID-19 interrupted delivery of mental health care in the US. During the initial course of the COVID-19 pandemic new starts of antidepressants declined by 7.5 percent, anxiolytics by 5.6 percent, and antipsychotics by 2.6 percent compared with expected levels. Our findings suggest that there is large unmet need for mental health treatment in the US due to COVID-19.


Subject(s)
Antipsychotic Agents , COVID-19 , Mental Disorders , Antipsychotic Agents/therapeutic use , Humans , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Pandemics , Psychotropic Drugs/therapeutic use , SARS-CoV-2
14.
Medicine (Baltimore) ; 100(20): e25609, 2021 May 21.
Article in English | MEDLINE | ID: covidwho-1236276

ABSTRACT

INTRODUCTION: This study is the protocol for a systematic review to evaluate the efficacy of herbal medicine on COVID-19 survivors with psychological sequelae. Currently, there are many COVID-19 survivors with psychological sequelae as COVID-19 has widely spread all over the world. However, there is no critically appraised evidence of the benefit of herbal medicine for COVID-19 survivors with psychological sequelae. MATERIALS AND METHODS: We will search 11 electronic databases from inception to December, 2022: 4 English databases, MEDLINE, PubMed, Excerpta Medica database (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL); 3 Chinese databases, the Chinese National Knowledge Infrastructure, the Chinese Scientific Journal database, and the Wan Fang database; and 4 Korean databases, the Oriental Medical Advanced Searching Integrated System, the Korean Studies Information Service System, the National Digital Science Links, and the Research Information Sharing Service. We will include randomized controlled trials (RCTs), non-RCTs, and quasi-RCTs for all formations of TRADITIONAL herbal medicine versus conventional drug, placebo, and no treatment for COVID-19 survivors. We will only include the COVID-19 survivors with psychiatric symptoms lasting at least 1 month, regardless of their race, sex, and age. DISCUSSION AND CONCLUSIONS: This systematic review will be published in a peer-reviewed journal. The findings will provide evidence and treatment directions for clinicians. This protocol does not need ethical approval because it will be based on published research. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020210592.


Subject(s)
COVID-19/psychology , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional/methods , Mental Disorders/drug therapy , SARS-CoV-2 , Clinical Trials as Topic , Humans , Mental Disorders/virology , Meta-Analysis as Topic , Research Design , Systematic Reviews as Topic , Treatment Outcome
15.
Signal Transduct Target Ther ; 6(1): 183, 2021 05 17.
Article in English | MEDLINE | ID: covidwho-1230872

ABSTRACT

CK2 is a constitutively active Ser/Thr protein kinase, which phosphorylates hundreds of substrates, controls several signaling pathways, and is implicated in a plethora of human diseases. Its best documented role is in cancer, where it regulates practically all malignant hallmarks. Other well-known functions of CK2 are in human infections; in particular, several viruses exploit host cell CK2 for their life cycle. Very recently, also SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has been found to enhance CK2 activity and to induce the phosphorylation of several CK2 substrates (either viral and host proteins). CK2 is also considered an emerging target for neurological diseases, inflammation and autoimmune disorders, diverse ophthalmic pathologies, diabetes, and obesity. In addition, CK2 activity has been associated with cardiovascular diseases, as cardiac ischemia-reperfusion injury, atherosclerosis, and cardiac hypertrophy. The hypothesis of considering CK2 inhibition for cystic fibrosis therapies has been also entertained for many years. Moreover, psychiatric disorders and syndromes due to CK2 mutations have been recently identified. On these bases, CK2 is emerging as an increasingly attractive target in various fields of human medicine, with the advantage that several very specific and effective inhibitors are already available. Here, we review the literature on CK2 implication in different human pathologies and evaluate its potential as a pharmacological target in the light of the most recent findings.


Subject(s)
COVID-19 , Cardiovascular Diseases , Casein Kinase II , Cystic Fibrosis , Eye Diseases , Mental Disorders , Protein Kinase Inhibitors/therapeutic use , SARS-CoV-2 , COVID-19/drug therapy , COVID-19/enzymology , COVID-19/genetics , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/enzymology , Cardiovascular Diseases/genetics , Casein Kinase II/antagonists & inhibitors , Casein Kinase II/genetics , Casein Kinase II/metabolism , Cystic Fibrosis/drug therapy , Cystic Fibrosis/enzymology , Cystic Fibrosis/genetics , Eye Diseases/drug therapy , Eye Diseases/enzymology , Eye Diseases/genetics , Humans , Mental Disorders/drug therapy , Mental Disorders/enzymology , Mental Disorders/genetics , Mutation , Phosphorylation , Signal Transduction/drug effects , Signal Transduction/genetics
16.
Int J Psychiatry Clin Pract ; 25(2): 142-146, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1221414

ABSTRACT

OBJECTIVE: Psychiatric patients are at increased risk of contamination, morbidity, and mortality associated with COVID-19, together with potentially more pronounced adverse effects. We present and discuss the adverse effects observed in an acute psychiatric clinic that has admitted COVID-19 patients during the first three months of the pandemic in Turkey. METHODS: The COVID-19 treatment schemes were formed in accordance with the national and regional guidelines at the time of admittance, which were mainly based on the use of hydroxychloroquine and other drugs. The sample consisted exclusively of inpatients, and all patients were enrolled in the study regardless of their specific diagnosis or treatment schemes. RESULTS: 4 out of 23 patients (17.4%) had experienced adverse effects, two of which had mild hepatic enzyme elevation and one had mild sinus bradycardia. Of note is that we haven't encountered any serious complications or life-threatening events during inpatient treatment. The most emphasised adverse effect in the literature, namely QTc prolongation and ECG changes, were not observed in our sample. The adverse effects were not found to be significantly associated with patient-related factors nor dose of antipsychotic medication. CONCLUSIONS: From our point of view, non-cardiac adverse effects should not be overlooked while treating comorbid psychiatric and COVID-19 patients.KEY POINTSAcute inpatient psychiatric treatment of patients who have comorbid COVID-19 is a complex situation requiring multidisciplinary action.Adverse drug reactions, which may or not result from the interaction of psychiatric and COVID-19 treatment, should be of concern for this patient group.While there is controversy over the benefits of some of the off-label COVID-19 medications, there should also be discussion over safety and concomitant medication use.In order to be adequately prepared for future escalations of COVID-19 pandemic, psychiatric services should thoroughly evaluate their initial experience with COVID-19, including from the point of drug effectiveness and safety.


Subject(s)
Antiviral Agents/adverse effects , COVID-19/drug therapy , Drug-Related Side Effects and Adverse Reactions/etiology , Mental Disorders/drug therapy , Psychotropic Drugs/adverse effects , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , COVID-19/complications , Drug Interactions , Drug-Related Side Effects and Adverse Reactions/epidemiology , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Mental Disorders/complications , Middle Aged , Psychotropic Drugs/administration & dosage , Psychotropic Drugs/therapeutic use
17.
Hum Psychopharmacol ; 36(5): e2789, 2021 09.
Article in English | MEDLINE | ID: covidwho-1182144

ABSTRACT

INTRODUCTION: Inpatients with coronavirus disease 2019 (COVID-19) show a high rate of neuropsychiatric manifestations, possibly related to a higher risk of serious illness or death. Use of psychotropic medications (PMs) indicates the presence of neuropsychiatric symptoms in COVID-19 patients. So far, potential clinical predictors of use of PMs have not been much investigated. In order to extend research in this area, we aimed to investigate the prevalence of PM prescription among a sample of inpatients with COVID-19 and to find potential predictors of initiation of PMs in these individuals. METHODS: This is a cross-sectional single-center study, conducted during the first outbreak peak in a hospital of northern Italy. Information on socio-demographic characteristics, comorbidities, routine blood test, use of potential COVID-19 treatments, and length of stay were retrieved from medical records. RESULTS: Data were available for 151 inpatients. Forty-seven of them (31.1%) started at least one prescription of a PM. PM prescription was significantly inversely associated with lymphocyte and platelet counts. A significant association was also found for lactate dehydrogenase (LDH). CONCLUSION: Our findings suggest that the initiation of PMs could be common among COVID-19 inpatients. Lymphocyte and platelet counts as well as LDH levels may reflect neuropsychiatric complications of COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/epidemiology , Hospitalization/trends , Psychotropic Drugs/therapeutic use , Aged , Aged, 80 and over , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Italy/epidemiology , Male , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/psychology , Middle Aged
18.
Acta Psychiatr Scand ; 143(6): 526-534, 2021 06.
Article in English | MEDLINE | ID: covidwho-1180758

ABSTRACT

OBJECTIVE: To determine how mental disorders and psychopharmacological treatments before and during COVID-19 hospital admissions are related to mortality. METHODS: Subjects included in the study were all adult patients with a diagnosis of COVID-19, confirmed clinically and by PCR, who were admitted to a tertiary university hospital in Badalona (Spain) between March 1 and November 17, 2020. Data were extracted anonymously from computerized clinical records. RESULTS: 2,150 subjects were included, 57% males, mean age 61 years. History of mental disorders was registered in 957 (45%). Throughout admission, de novo diagnosis of mood or anxiety, stress, or adjustment disorder was made in 12% of patients without previous history. Delirium was diagnosed in 10% of cases. 1011 patients (47%) received a psychotropic prescription during admission (36% benzodiazepines, 22% antidepressants, and 21% antipsychotics). Mortality rate was 17%. Delirium during admission and history of mood disorder were independently associated with higher mortality risk (hazard ratios, 1.39 and 1.52 respectively), while previous year's treatments with anxiolytics/hypnotics and antidepressants were independently associated with lower mortality risk (hazard ratios, 0.47 and 0.43, respectively). CONCLUSION: Mental symptoms are very common in patients hospitalized for COVID-19 infection. Detecting, diagnosing, and treating them is key to determining the prognosis of the disease and functional recovery.


Subject(s)
COVID-19 , Inpatients , Mental Disorders , Psychotropic Drugs , COVID-19/diagnosis , COVID-19/mortality , COVID-19/psychology , COVID-19/rehabilitation , COVID-19 Nucleic Acid Testing , Female , Hospital Records/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Inpatients/psychology , Inpatients/statistics & numerical data , Male , Mental Disorders/diagnosis , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/virology , Middle Aged , Prognosis , Psychotropic Drugs/classification , Psychotropic Drugs/therapeutic use , Recovery of Function , Risk Assessment , SARS-CoV-2/isolation & purification , Spain/epidemiology
20.
Am J Health Syst Pharm ; 78(10): 862-871, 2021 05 06.
Article in English | MEDLINE | ID: covidwho-1101810

ABSTRACT

PURPOSE: This article aims to evaluate management options for antipsychotic-induced hyperprolactinemia and associated treatment considerations such as efficacy, tolerability, drug interactions, contraindications, and dosing regimens. SUMMARY: Hyperprolactinemia is a common adverse effect of antipsychotics. First-line management includes reducing the dose of the offending antipsychotic, discontinuing the antipsychotic, or switching to another antipsychotic associated with a lower risk of hyperprolactinemia. However, these options are not always practical and are associated with a risk of relapse of the psychiatric illness. Other management options include adjunctive aripiprazole, dopamine agonists (cabergoline and bromocriptine), metformin, and herbal supplements. A search of Embase, PubMed, and Google Scholar using key terms such as hyperprolactinemia, prolactin, antipsychotic, treatment guidelines, aripiprazole, dopamine agonist, cabergoline, bromocriptine, metformin, herbals, supplements, and medications was conducted for literature retrieval. Upon evaluation of the available literature we found the following: (1) aripiprazole is safe and effective in lowering prolactin levels within normal limits; (2) adjunctive cabergoline and bromocriptine decrease elevated prolactin levels, while cabergoline may be more effective in reducing prolactin but can also be associated with a more serious adverse effect of cardiac valvular abnormalities; (3) metformin causes a mild reduction of prolactin levels; and (4) there are limited data to support use of herbal medications (chamomile, Peony-Glycyrrhiza decoction, and shakuyaku-kanzo-to) in antipsychotic-induced hyperprolactinemia. CONCLUSION: There are treatments available for antipsychotic-induced hyperprolactinemia in patients who are unable to alter their current antipsychotic regimen. However, there remains a need for additional short- and long-term studies to determine the efficacy and safety of these treatment strategies, given that patients taking antipsychotics typically require chronic, life-long treatment for their illnesses.


Subject(s)
Antipsychotic Agents , Hyperprolactinemia , Mental Disorders , Antipsychotic Agents/adverse effects , Aripiprazole/adverse effects , Humans , Hyperprolactinemia/chemically induced , Hyperprolactinemia/diagnosis , Hyperprolactinemia/drug therapy , Mental Disorders/drug therapy , Prolactin/therapeutic use
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