[COVID-19 Pandemic-Related Effects on Psychiatric and Psychosocial Care in Urban and Rural Areas - Two Studies Implementing the Questionnaire PandA-Psy]. / Corona-Pandemie-bedingte Auswirkungen auf die psychiatrische und psychosoziale Versorgung im städtischen und ländlichen Raum ­ Zwei Untersuchungen mit dem Fragebogen PandA-Psy.

OBJECTIVE: To assess COVID-19 pandemic-related changes in psychiatric and psychosocial services and their impact on the care of people with severe mental illness in two contrasting regions. METHODS: Development and use of an online questionnaire (PandA-Psy) in Leipzig (N=50) and Mecklenburg-Western Pomerania (N=126). RESULTS: In community psychiatric care, mostly comparable changes caused by the COVID-19 pandemic were observed in the two selected regions. These mainly concern the decrease in face-to-face contacts and group services, the increase in digital and telephone services, as well as the increasing constraints of staff. Differences between the regions are discussed. CONCLUSION: PandA-Psy was successfully used to map changes caused by the COVID-19 pandemic in psychiatric and psychosocial services in two areas. In addition to the predominantly negative consequences of the pandemic situation, we also found opportunities arising from the crisis.

Overpolicing people with serious mental health conditions: Considering racialized trauma for trauma-informed psychiatric rehabilitation services.

OBJECTIVE: We call for the psychiatric rehabilitation field to assess overpolicing as racialized trauma via a targeted universal trauma screening to provide trauma-informed rehabilitation services. METHODS: We examine the overpolicing of low-level, nonviolent activities and offenses through frequent stops, tickets, and arrests of disproportionately those who have mental health conditions and are Black, Indigenous, and people of color. These police interactions can produce traumatic responses and exacerbate symptoms. Assessing and responding to overpolicing is vital for psychiatric rehabilitation to provide trauma-informed services. RESULTS: We present preliminary practice data using an expanded trauma exposure form with racialized trauma, such as police harassment and brutality, that is absent from validated screenings. From this expanded screening, the majority of participants reported undisclosed racialized trauma. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: We recommend the field devote practice and research to racialized trauma and policing and the lasting effects to support trauma-informed services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The perception of the RTS team of workers about the home and the production of care in the context of the Covid-19 pandemic / A percepção da equipe de trabalhadoras do SRT acerca do domicílio e da produção do cuidado no contexto da pandemia de Covid-19

Resumo Introdução: Os Serviços Residenciais Terapêuticos (SRT) são pontos da Rede de Atenção Psicossocial alinhados com a lógica da desinstitucionalização. O objetivo deste estudo foi analisar a percepção de 'casa' pela equipe de cuidadoras de SRT e suas implicações para a produção do cuidado durante a pandemia de Covid-19. Métodos: Estudo qualitativo de abordagem cartográfica que teve como cenário de estudo 4 SRT do município do Rio de Janeiro. Para a coleta dos dados, foram realizadas entrevistas com 9 trabalhadoras e observação participante de reuniões. Resultados e discussão: Os analisadores Lugar de Casa e Efeitos da Pandemia emergiram do processamento. O primeiro mostra a percepção das trabalhadoras acerca do ambiente da casa, enquanto o segundo traz a influência da pandemia na produção do cuidado nas SRT. O ambiente das residências é múltiplo, diverso e, por vezes, contraditório, permeado por diferentes modos de vida e influenciado por aspectos culturais, percepções e experiências vividas.

Abstract Introduction: The Residential Therapeutic Services (RTS) are places of the Psychosocial Care Network aligned with the logic of deinstitutionalization. This study aimed to analyze the perception of 'home' by the SRT team of caregivers and its implications for the production of care in the Covid-19 pandemic situation. Methods: Qualitative study of cartographic approach, which had 4 SRT in the city of Rio de Janeiro as scenario. Data collection involved interviews with 9 workers and participant observation of the SRTs' meetings. Results and Discussion: The analyzers Home and Pandemic Effects emerged from analysis. The first analyzer shows the workers' perception of the home environment, while the second analyzes the production of care and the influence of the Covid-19 pandemic on the SRT. The residence environment is multiple, diverse, sometimes contradictory, composed of different lifestyles and influenced by cultural aspects, perceptions and life experiences.

[Psychiatric Rehabilitation in Austria - A Comparison of Symptoms at Admission Before and During COVID-19 Pandemic, as well as Rehabilitation Success]. / Medizinisch-psychiatrische Rehabilitation in Österreich ­ Ein Vergleich der Symptombelastung bei Reha-Beginn vor und während der COVID-19-Pandemie, sowie des Rehabilitationserfolgs.

OBJECTIVE: International literature reports an increase of the incidence of psychological disorders because of the COVID-19 pandemic. Especially young people and people with pre-existing psychological disorders are troubled by the pandemic. Objective of this study is the extent of psychological symptoms, the functioning and the treatment success of rehabilitation inpatients who participated in a medical and psychiatric rehabilitation in the year before the COVID-19 pandemic and those who participated during the COVID-19 phase. METHODS: The data of N=1,715 rehabilitation inpatients who completed the rehabilitation before the lockdown in 2019 and N=707 rehabilitation inpatients who began in 2020 after the lockdown of the clinic due to the pandemic (during the COVID-19 phase) from March to Mai 2020 are compared in reference to their sample characteristics and their results in patient reported outcomes. RESULTS: There are no significant differences between the two observed time periods in reference to the sociodemographic characteristics of the rehabilitation inpatients. At the beginning of the rehabilitation there was no significant difference in the scale somatization. There was a significantly higher score in the scales' anxiety and depression during the COVID-19 phase, but only to the extent of a small effect. The results of the scales of activity and participation (ICF 3 F AT) as well as functionality (WHODAS 2.0) do not differ in the time periods at the beginning of the rehabilitation. However, rehabilitation inpatients with low socioeconomic status (rehabilitation allowance or disability pension) have critical scores in some scales. The rehabilitation success is comparable to the one before the COVID-19 pandemic and falls within the range of medium to high effect sizes. CONCLUSION: The study shows - with respect to its limitations - low or no significant differences in reference to the sociodemographic data and the symptomatic load at the beginning of the rehabilitation. The effect sizes are comparable with the time frame bevor the COVID-19 pandemic. The results of international studies, which reported a considerable increase in psychological stress of the population cannot directly be transferred to the Austrian rehabilitation clientele.

Hope in Psychiatric Patients: An Observational Study in a Psychiatric Rehabilitation Centre.

INTRODUCTION: The COVID-19 pandemic has led to the re-evaluation of some fundamental aspects for the management of emotions and psychological dynamics. Hope and its lack are important factors that have been especially evaluated in caregivers and HCWs. Instead, our study aimed to explore hopelessness among psychiatric rehabilitation center residents with Primary Psychosis. METHODS: We recruited 116 inpatients affected by Primary Psychosis (schizophrenia, bipolar disorder, major depression disorder and personality disorder). Hopelessness was sought through the BHS, during the covid-19 pandemic period. They were compared with data from previous studies on HCWs (HealthCare Workers), in the same period, and in the same centre. RESULTS: The results obtained in this group of patients showed high total scores on the BHS scale (mean total score: 7.28±SD 3.73). These data are significantly higher than those found in HWs in the same pandemic period (mean total score: 3.74±SD 3.62). Among the different disorders the borderline personality disorder patients have presented the highest score (mean total score: 8.00±SD 3.50). CONCLUSION: Understanding resident - and HCWs- level variations in hopelessness may be important for targeting interventions to improve the outcome of residential psychiatric patients.

Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program.

Culinary medicine is an evidence-based approach that blends the art of cooking with the science of medicine to inculcate a healthy dietary pattern. Food prescription programs are gaining popularity in the Unites States, as a means to improve access to healthy foods among patient populations. The purpose of this paper is to describe the implementation and preliminary impact of A Prescription for Healthy Living (APHL) culinary medicine curriculum on biometric and diet-related behavioral and psychosocial outcomes among patients with diabetes participating in a clinic-led food prescription (food Rx) program. We used a quasi-experimental design to assess APHL program impact on patient biometric outcome data obtained from electronic health records, including glycosylated hemoglobin (HbA1c), body mass index (BMI), and blood pressure (n = 33 patients in the APHL group, n = 75 patients in the food Rx-only group). Pre-post surveys were administered among those in the APHL group to monitor program impact on psychosocial and behavioral outcomes. Results of the outcome analysis showed significant pre-to-post reduction in HbA1c levels among participants within the APHL group (estimated mean difference = -0.96% (-1.82, -0.10), p = 0.028). Between-group changes showed a greater decrease in HbA1c among those participating in APHL as compared to food Rx-only, albeit these differences were not statistically significant. Participation in APHL demonstrated significant increases in the consumption of fruits and vegetables, fewer participants reported that cooking healthy food is difficult, increased frequency of cooking from scratch, and increased self-efficacy in meal planning and cooking (p < 0.01). In conclusion, the results of our pilot study suggest the potential positive impact of a virtually-implemented culinary medicine approach in improving health outcomes among low-income patients with type 2 diabetes, albeit studies with a larger sample size and a rigorous study design are needed.

Introduction to the special section: A call to action to address psychiatric rehabilitation workers' well-being.

The well-being of the psychiatric rehabilitation workforce is a growing concern, particularly as a result of the stresses of the COVID-19 pandemic on demand for mental health services. Research focusing on this aspect of psychiatric rehabilitation services remains limited but is important in supporting a resilient mental health workforce. This special section presents four papers that focus on aspects of worker well-being and burnout, including drivers of well-being and other outcomes, as well as exploring potential action steps and contexts that organizations could consider in their efforts to bolster well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychosocial care experiences of patients with COVID-19 at home in Iran: A qualitative study.

Due to the onset peak of COVID-19, as well as a shortage of human resources, physical environment, protective and medical equipment in hospitals, many patients with mild to moderate symptoms of COVID-19 are pushed to home care. This condition not only raises public health concerns but also causes a number of psychosocial problems. Therefore, this study intends to examine the psychosocial experiences of patients with COVID-19 after passing the crisis stage. A qualitative study with a conventional content analysis method was used. Thirty participants were selected using purposeful sampling from Khoy Educational and Medical Centers from 20 March to 20 June 2020. In-depth semi-structured interviews were used to collect data. Data were analysed by continuous comparative analysis using MAXQDA 10 software. The concepts extracted from data analysis identified eight subthemes and three main themes. Social rejection theme includes three subthemes: 'Insularity of the patient', 'Concealment' and 'patient as the life-threatening center'. Lack of support theme consists of three subthemes including: 'financial concerns', 'non-response of the treatment team after discharge' and 'concerns about the persistent condition of the disease'. Efforts to gain mental peace theme has two subthemes: 'recourse to spirituality' and 'strengthening hope'. According to the results of the present study, it is necessary to examine the psychological and social needs of patients. Also, by identifying high-risk groups, supportive psychological networks such as telephone, internet and on-site medical services to help patients, medical worker and others affected in overcoming psychological problems should be increased. Providing free service packages such as the Internet, free financial aid to damaged jobs and creating the necessary platforms for online shopping and payment services, as well as training on how to plan and practice rehabilitation at home for patients and family caregivers can be helpful.

Treatment of opioid use disorder in primary care.

Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.

The times they are a-changin: implementing new psychiatric rehabilitation models within a community care in the post COVID-19 era.

During the COVID-19 pandemic, community healthcare treatments have played a crucial role in early detection and intervention against the epidemic spreading (as most of the infected individuals were at home). For the national policy on mental health services in Italy, "the person as a community resource within a caring community" is still a crucial idea that the COVID-19 era helped to revive, together with the supremacy of the public healthcare pathway over the private one. In this article, new mental health rehabilitation models (such as the Personal Health Budget and the Individual Placement and Support) are suggested as useful intervention approaches on which to base psychiatric care within a community care in the post COVID-19 era.

Clubhouses Response to COVID-19: Member Challenges and Clubhouse Adaptations.

Clubhouses have been found to improve a variety of psychosocial outcomes for individuals with mental health concerns. Due to the barriers encountered during COVID-19, Clubhouses adapted their programming to meet member's needs. The purpose of the present study was to document and synthesize Clubhouse member's needs and Clubhouse adaptations during COVID-19. Clubhouse members, staff, and directors (n = 29) from five accredited Clubhouses across Canada participated in interviews about their experiences within Clubhouses during the pandemic. Interview notes were analyzed using thematic analysis through an iterative process until consensus occurred. The results indicated a number of challenges that Clubhouse members experienced including increased mental health symptoms, isolation and loneliness, and difficulty accessing services. Clubhouse adaptations included increased communication, expansion of the meal program, and sustained program delivery through technology. The results suggest that COVID-19 has provided an opportunity for Clubhouses and other community-based organizations to innovate to meet their member's needs.

COVID-19 Transmission in a Psychiatric Long-Term Care Rehabilitation Facility: An Observational Study.

OBJECTIVE: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. METHODS: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. RESULTS: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. CONCLUSION: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.

Possible affective cognitive cerebellar syndrome in a young patient with COVID-19 CNS vasculopathy and stroke.

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.

[Psychosocial support during the COVID-19 pandemic: interdisciplinary concept of care at a university hospital]. / Psychosoziale Unterstützung während der COVID-19-Pandemie: interdisziplinäres Versorgungskonzept an einem Universitätsklinikum.

BACKGROUND: Since the beginning of the outbreak, the COVID-19 pandemic has caused an increased demand for psychosocial support for patients, their family members, and healthcare workers. Concurrently, possibilities to provide this support have been hindered. Quarantine, social isolation, and SARS-CoV­2 infections represent new and severe stressors that have to be addressed with innovative psychosocial care. OBJECTIVE AND METHOD: This article describes the COVID-19 psychosocial first aid concept at the University Hospital Munich (LMU Klinikum) developed by an interdisciplinary team of psychiatric, psychological, spiritual care, psycho-oncological, and palliative care specialists. RESULTS: A new psychosocial first aid model has been implemented for COVID-19 inpatients, family members, and hospital staff consisting of five elements. CONCLUSION: The concept integrates innovative and sustainable ideas, e.g. telemedicine-based approaches and highlights the importance of multidisciplinary collaboration to cope with challenges in the healthcare system.