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2.
JMIR Ment Health ; 8(3): e25542, 2021 Mar 11.
Article in English | MEDLINE | ID: covidwho-1133828

ABSTRACT

BACKGROUND: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. OBJECTIVE: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. METHODS: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. RESULTS: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI -3.6 to -6.2; Cohen d=0.77; P<.001), anxiety (95% CI -3.0 to -4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI -0.5 to -0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI -0.2 to -1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. CONCLUSIONS: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials.

3.
Drug Saf ; 43(12): 1315-1322, 2020 12.
Article in English | MEDLINE | ID: covidwho-1092872

ABSTRACT

INTRODUCTION: In the stressful context of the coronavirus disease 2019 (COVID-19) pandemic, some reports have raised concerns regarding psychiatric disorders with the use of hydroxychloroquine. In this study, we reviewed all psychiatric adverse effects with hydroxychloroquine in COVID-19 patients, as well as in other indications, reported in VigiBase, the World Health Organization's (WHO) global database of individual case safety reports. METHODS: First, we analyzed all psychiatric adverse effects, including suicide, of hydroxychloroquine in COVID-19 patients reported to 16 June 2020. We also performed disproportionality analysis to investigate the risk of reporting psychiatric disorders with hydroxychloroquine compared with remdesivir, tocilizumab, or lopinavir/ritonavir prescribed in COVID-19 patients. We used reporting odds ratios (RORs) and their 95% confidence intervals (CIs) to calculate disproportionality. Second, we sought to examine the psychiatric safety profile of hydroxychloroquine in other indications (before 2020). RESULTS: Among the 1754 reports with hydroxychloroquine in COVID-19 patients, we found 56 psychiatric adverse effects. Half of these adverse effects were serious, including four completed suicides, three cases of intentional self-injury, and 12 cases of psychotic disorders with hallucinations. Compared with remdesivir, tocilizumab, or lopinavir/ritonavir, the use of hydroxychloroquine was associated with an increased risk of reporting psychiatric disorders (ROR 6.27, 95% CI 2.74-14.35). Before 2020, suicide was the main cause of death among all adverse drug reactions reported with hydroxychloroquine, followed by cardiac adverse effects (cardiomyopathy) and respiratory failure. CONCLUSIONS: This pharmacovigilance analysis suggests that COVID-19 patients exposed to hydroxychloroquine experienced serious psychiatric disorders, and, among these patients, some committed suicide. Further real-world studies are needed to quantify the psychiatric risk associated with hydroxychloroquine during the COVID-19 pandemic.


Subject(s)
Antiviral Agents/adverse effects , COVID-19/drug therapy , Hallucinations/chemically induced , Hydroxychloroquine/adverse effects , Psychoses, Substance-Induced/etiology , Self-Injurious Behavior/chemically induced , Suicide/statistics & numerical data , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Adult , Aged , Aged, 80 and over , Alanine/adverse effects , Alanine/analogs & derivatives , Antibodies, Monoclonal, Humanized/adverse effects , Databases, Pharmaceutical , Drug Combinations , Female , Hallucinations/epidemiology , Humans , Lopinavir/adverse effects , Male , Mental Disorders/chemically induced , Mental Disorders/epidemiology , Middle Aged , Psychoses, Substance-Induced/epidemiology , Ritonavir/adverse effects , Self-Injurious Behavior/epidemiology , Suicide, Attempted/statistics & numerical data , Young Adult
4.
Health Aff (Millwood) ; 40(1): 170-173, 2021 01.
Article in English | MEDLINE | ID: covidwho-1094072

ABSTRACT

A woman with serious mental illness cycles between a state hospital, shelters, nursing homes, and psychiatric units, with no permanent place to land.


Subject(s)
Mental Disorders , Female , Humans , Mental Disorders/therapy , Nursing Homes
5.
Community Ment Health J ; 57(1): 10-17, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064541

ABSTRACT

Changes to community psychiatry during COVID-19 are unprecedented and without clear guidelines. Minimizing disruption, ensuring quality care to the already vulnerable people with serious mental illness is crucial. We describe and reflect our adaptations and innovations at one community psychiatry program, based on three key principles. In (i) Defining and maintaining essential services while limiting risk of contagion, we discuss such strategies and ways to assess risks, implement infection control, and other creative solutions. In (ii) Promoting health and mitigating physical and mental health impacts, we reflect on prioritizing vulnerable patients, dealing with loss of community resources, adapting group programs, and providing psychoeducation, among others. In (iii) Promoting staff resilience and wellness, we describe building on strength of the staff early, addressing staff morale and avoiding moral injury, and valuing responsive leadership. We also identify limitations and potential further improvements, mindful that COVID-19 and similar crises are likely recurring realities.


Subject(s)
COVID-19 , Community Mental Health Centers/organization & administration , Community Mental Health Services/organization & administration , Continuity of Patient Care/organization & administration , Mental Disorders/psychology , Mental Disorders/therapy , Disaster Planning , Humans , Mental Health , Pandemics , SARS-CoV-2
6.
Int J Psychiatry Med ; 56(4): 255-265, 2021 07.
Article in English | MEDLINE | ID: covidwho-1058157

ABSTRACT

BACKGROUND: There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. OBJECTIVE: We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. METHODS: We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. RESULTS: We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. CONCLUSIONS: Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.


Subject(s)
Bipolar Disorder/complications , COVID-19/complications , COVID-19/psychology , Delirium/complications , Psychotic Disorders/complications , Schizophrenia/complications , Bipolar Disorder/drug therapy , COVID-19/drug therapy , Delirium/drug therapy , Drug Interactions , Female , Humans , Male , Middle Aged , Pandemics , Polypharmacy , Psychotic Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Retrospective Studies , SARS-CoV-2 , Schizophrenia/drug therapy
7.
Mil Med ; 186(9-10): e956-e961, 2021 08 28.
Article in English | MEDLINE | ID: covidwho-998429

ABSTRACT

INTRODUCTION: There is emerging evidence to support that the COVID-19 pandemic and related public health measures may be associated with negative mental health sequelae. Rural populations in particular may fair worse because they share many unique characteristics that may put them at higher risk for adverse outcomes with the pandemic. Yet, rural populations may also be more resilient due to increased sense of community. Little is known about the impact of the pandemic on the mental health and well-being of a rural population pre- and post-pandemic, especially those with serious mental illness. MATERIAL AND METHODS: We conducted a longitudinal, mixed-methods study with assessments preceding the pandemic (between October 2019 and March 2020) and during the stay-at-home orders (between April 23, 2020, and May 4, 2020). Changes in hopelessness, suicidal ideation, connectedness, and treatment engagement were assessed using a repeated-measures ANOVA or Friedman test. RESULTS: Among 17 eligible participants, 11 people were interviewed. Overall, there were no notable changes in any symptom scale in the first 3-5 months before the pandemic or during the stay-at-home orders. The few patients who reported worse symptoms were significantly older (mean age: 71.7 years, SD: 4.0). Most patients denied disruptions to treatment, and some perceived telepsychiatry as beneficial. CONCLUSIONS: Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Longer-term outcomes are needed in rural patients with serious mental illness to better understand the impact of the pandemic on this population.


Subject(s)
COVID-19 , Mental Disorders , Psychiatry , Telemedicine , Aged , Humans , Mental Disorders/epidemiology , Mental Health , Pandemics , Public Health , Rural Population , SARS-CoV-2
9.
S Afr Fam Pract (2004) ; 62(1): e1-e4, 2020 08 03.
Article in English | MEDLINE | ID: covidwho-713651

ABSTRACT

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.


Subject(s)
Decision Making , Mental Competency/psychology , Neoplasms/psychology , Schizophrenic Psychology , Terminal Care/psychology , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/psychology , Female , Humans , Informed Consent/psychology , Pandemics , Pneumonia, Viral/psychology , SARS-CoV-2 , Schizophrenia
10.
J Med Ethics ; 46(9): 579-580, 2020 09.
Article in English | MEDLINE | ID: covidwho-640567

ABSTRACT

The COVID-19 pandemic has introduced new ethical challenges in the care of patients with serious psychiatric illness who require inpatient treatment and who may have beeen exposed to COVID-19 or have mild to moderate COVID-19 but refuse testing and adherence to infection prevention protocols. Such situations increase the risk of infection to other patients and staff on psychiatric inpatient units. We discuss medical and ethical considerations for navigating this dilemma and offer a set of policy recommendations.


Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/prevention & control , Ethics, Medical , Hospitalization , Mental Disorders/complications , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Quarantine , Refusal to Participate , Betacoronavirus , COVID-19 , COVID-19 Testing , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Humans , Infection Control/methods , Mental Disorders/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Policy , Psychiatry , SARS-CoV-2 , Social Isolation , Treatment Refusal
12.
Dtsch Med Wochenschr ; 145(10): 675-681, 2020 05.
Article in German | MEDLINE | ID: covidwho-47406

ABSTRACT

We have recently observed several clusters of psychiatric symptoms in the context of COVID-19: (1) increased anxiety in psychiatric in- and outpatients with different diagnoses; (2) more cases of domestic violence often associated with increased drug- or alcohol-consumption in offenders and victims; (3) a nihilistic "apocalyptic" syndrome of elderly patients cut-off from their families; (4) visual and acoustic hallucinoses due to pneumonia and sepsis-related confusional states. Cases of chloroquine-related toxicity have been reported elsewhere, but have not been observed in our hospital so far. Mental issues related to COVID-19 reported from China and practical recommendations are briefly summarized. Many patients with serious mental disorders will suffer world-wide due to a reallocation of medical, social and financial ressources.


Subject(s)
Coronavirus Infections/psychology , Mental Health , Pneumonia, Viral/psychology , Anxiety/epidemiology , Betacoronavirus , COVID-19 , Domestic Violence , Humans , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology
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