PRESTOapp for health workers with mental health symptoms related to the COVID-19 pandemic

Introduction: The COVID-19 pandemic has caused a significant impact on the mental health of health workers that has brought many hospitals to launch immediate preventive mental health programs. Objective(s): (1) To adapt and enhance a smartphone app (PRESTOapp) for health workers with mental health symptoms related to the COVID-19, and (2) to demonstrate its potential effectiveness in significantly reducing anxiety-depressive and PTSD symptoms in this population. We aim to incorporate Natural Language Processing (NLP)-based techniques in a chatbot userinterface that will enable a more personalized and accurate monitoring and intervention. Method(s): An 18-months study with a 6-months preliminary phase to adapt PRESTOapp to health workers, enhance it with NLP-based techniques and chatbot user-interface, and evaluate its feasibility, and effectiveness in 12-months. Result(s): PRESTOapp has the potential to provide a prompt, personalized and integral response to the mental health demand due to the COVID-19. It will help by providing an innovative digital platform, that will allow remote monitoring of the symptoms course, provide brief psychotherapeutic interventions, and detect urgent situations. If the preliminary results of this study point to a potential effectiveness of the intervention, PRESTOapp may be easily adapted to the general population. Conclusion(s): PRESTOapp may be one of the key digital platforms that may help preventing and treating potentially severe mental health consequences. Considering the unresolved problem of burnout in health workers even before the COVID-19, this project will develop the necessary technology for implementing cost-effective mental health solutions, not only during the pandemic.

Psychiatric clinical profiles and pharmacological interactions in COVID-19 inpatients referred to a consultation liaison psychiatry unit

IntroductionThe Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19.ObjectivesThe aim of the study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit.MethodsThis is a cross-sectional retrospective study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI).ResultsOf 71 patients included (median [ICR] age 64 [54-73] years;70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%).ConclusionsPatients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection.DisclosureNo significant relationships.

COVID-19 inpatients with psychiatric disorders: Real-world clinical recommendations from an expert team in consultation-liaison psychiatry.

BACKGROUND: The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. METHODS: We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. CASE-CENTERED RECOMMENDATIONS: Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. LIMITATIONS: Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. CONCLUSIONS: Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.

Unravelling potential severe psychiatric repercussions on healthcare professionals during the COVID-19 crisis

The coronavirus disease 2019 (COVID-19) outbreak is putting healthcare professionals, especially those in the frontline, under extreme pressures, with a high risk of experiencing physical exhaustion, psychological disturbance, stigmatization, insomnia, depression and anxiety. We report the case of a general practitioner, without relevant medical or psychiatric history that experienced a “brief reactive psychosis (298.8)” under stressful circumstances derived from COVID-19. She presented with delusional ideas of catastrophe regarding the current pandemic situation, delusions of self-reference, surveillance and persecution, with high affective and behavioural involvement. Physical examination and all further additional investigations did not reveal any secondary causes. She was administered olanzapine 10 mg with a significant psychopathological improvements being discharged with indications to maintain the treatment. To our knowledge this is the first case of severe mental illness in a healthcare professional without previous psychiatric history due to COVID-19 outbreak. Around 85% of patients presenting a brief psychotic disorder will develop a potentially disabling serious psychotic illness in the long-term. This case represents the potentially serious mental health consequences on healthcare professionals throughout the COVID-19 crisis and emphasizes the need to implement urgent measures to maintain staff mental health during the current pandemic.