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Psychosomatics ; 61(6): 585-596, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-726823


BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Encefalopatías/fisiopatología , Infecciones por Coronavirus/fisiopatología , Delirio/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Neumonía Viral/fisiopatología , Betacoronavirus , Encefalopatías/psicología , Depresores del Sistema Nervioso Central/uso terapéutico , Infecciones por Coronavirus/psicología , Delirio/fisiopatología , Delirio/psicología , Moduladores del GABA/uso terapéutico , Humanos , Lorazepam/uso terapéutico , Melatonina/uso terapéutico , Pandemias , Neumonía Viral/psicología , Guías de Práctica Clínica como Asunto
Palliat Med ; 34(9): 1249-1255, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-690192


BACKGROUND: The literature contains limited information on the problems faced by dying patients with COVID-19 and the effectiveness of interventions to manage these. AIM: The aim of this audit was to assess the utility of our end-of-life care plan, and specifically the effectiveness of our standardised end-of-life care treatment algorithms, in dying patients with COVID-19. DESIGN: The audit primarily involved data extraction from the end-of-life care plan, which includes four hourly nursing (ward nurses) assessments of specific problems: patients with problems were managed according to standardised treatment algorithms, and the intervention was deemed to be effective if the problem was not present at subsequent assessments. SETTING/PARTICIPANTS: This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died). RESULTS: Sixty-one patients met the audit criteria: the commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10-20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. CONCLUSION: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems.

Infecciones por Coronavirus/mortalidad , Delirio/tratamiento farmacológico , Quimioterapia/normas , Disnea/tratamiento farmacológico , Cuidados Paliativos al Final de la Vida/normas , Cuidados Paliativos/normas , Neumonía Viral/mortalidad , Cuidado Terminal/normas , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/enfermería , Quimioterapia/estadística & datos numéricos , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Cuidados Paliativos/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/enfermería , Guías de Práctica Clínica como Asunto , Cuidado Terminal/estadística & datos numéricos , Reino Unido/epidemiología
Psychosomatics ; 61(5): 544-550, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-616923

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/terapia , Delirio/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Neumonía Viral/terapia , Agitación Psicomotora/tratamiento farmacológico , Fármacos Inductores del Sueño/uso terapéutico , Anciano , Analgésicos Opioides/efectos adversos , Azepinas/uso terapéutico , Betacoronavirus , Depresores del Sistema Nervioso Central/uso terapéutico , Clordiazepóxido/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Delirio/etiología , Delirio/fisiopatología , Delirio/psicología , Dexmedetomidina/efectos adversos , Femenino , Guanfacina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Hidromorfona/efectos adversos , Unidades de Cuidados Intensivos , Ketamina/efectos adversos , Melatonina/uso terapéutico , Midazolam/efectos adversos , Oxicodona/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Propofol/efectos adversos , Agitación Psicomotora/etiología , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/psicología , Respiración Artificial , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/etiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Traqueostomía , Triazoles/uso terapéutico , Ácido Valproico/uso terapéutico
Palliat Med ; 34(9): 1235-1240, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-616769


BACKGROUND: Hospital clinicians have had to rapidly develop expertise in managing the clinical manifestations of COVID-19 including symptoms common at the end of life, such as breathlessness and agitation. There is limited evidence exploring whether end-of-life symptom control in this group requires new or adapted guidance. AIM: To review whether prescribing for symptom control in patients dying with COVID-19 adhered to existing local guidance or whether there was deviation which may represent a need for revised guidance or specialist support in particular patient groups. DESIGN/SETTING: A retrospective review of the electronic patient record of 61 hospital inpatients referred to the specialist palliative care team with swab-confirmed COVID-19 who subsequently died over a 1-month period. Intubated patients were excluded. RESULTS: In all, 83% (40/48) of patients were prescribed opioids at a starting dose consistent with existing local guidelines. In seven of eight patients where higher doses were prescribed, this was on specialist palliative care team advice. Mean total opioid dose required in the last 24 h of life was 14 mg morphine subcutaneous equivalent, and mean total midazolam dose was 9.5 mg. For three patients in whom non-invasive ventilation was in place higher doses were used. CONCLUSION: Prescription of end-of-life symptom control drugs for COVID-19 fell within the existing guidance when supported by specialist palliative care advice. While some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond existing local guidance was not observed.

Biofarmacia/estadística & datos numéricos , Infecciones por Coronavirus/tratamiento farmacológico , Delirio/tratamiento farmacológico , Disnea/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Cuidado Terminal/métodos , Cuidado Terminal/normas , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Betacoronavirus , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Midazolam/uso terapéutico , Persona de Mediana Edad , Morfina/uso terapéutico , Pandemias , Estudios Retrospectivos