Follow-up of telemedicine mental health interventions amid COVID-19 pandemic.

The initiation of the program Mental Health Support Program for Coronavirus Infection addressed the increased demand for mental health services in the province of Salamanca, resulting from the COVID-19 pandemic. The psychiatry service provided care for COVID-19 patients, their families, and healthcare workers who treated them, as these groups were identified as being at risk. This study aims to describe the assistance provided, including personnel and resources utilized, types of interventions carried out, and to assess the demand for mental health care and predominant symptoms and emotions experienced by patients. Billboards and the complex's intranet publicized the program. Specific clinical approach using telemedicine were provide from March 2020 to December 2021 to COVID-19 patients, their relatives, and healthcare workers. 216 patients were included with a mean age of 53.2 years, with women comprising 77.3% of this group. All the groups received treatment in similar proportions. Over a period of 730 h, a total of 1376 interventions were performed, with an average duration of 31.8 min per intervention. The program could treat 79.6% of these patients without requiring referrals to other services. When the program concluded, only 21 participants (9.7%) were discharged to the local mental health network to continue their mental health treatment. The program effectively reduced the burden on regular mental health services due to its ability to treat most patients without requiring referrals. The program was able to attend to most mental health requests with minimal involvement of the regular mental health service.

Post-Pandemic Evolution of Suicide Risk in Children and Adolescents Attending a General Hospital Accident and Emergency Department.

BACKGROUND: Lockdowns and other health protective measures, such as social distancing, imposed during the COVID-19 pandemic nurtured unprecedented levels of stress and social isolation around the world. This scenario triggered an increase in suicide thoughts and self-harm behaviours among children and young people. However, the longer-term impact of the pandemic on children's and adolescents' mental health, especially with regard to self-harm, is still to be fully discovered. METHODS: We carried out a retrospective study where we collected data related to suicide ideation and self-harm behaviours in all patients aged under 18 that required on-call psychiatric services at the General Hospital Accident and Emergency (A&E) department in Salamanca, Spain, during 2019 (pre-pandemic) and in both 2021 and 2022 to capture possible variation at different time points during the post-pandemic period. RESULTS: A total of 316 patients aged under 18 were seen by on-call psychiatric services at the A&E department during the three time periods: 78 in 2019, 98 in 2021 and 140 in 2022. The mean age was 15.12 (SD 2.25) and females represented more than twice the number of males each year. More than half of all patients assessed during 2022 disclosed suicide thoughts, whilst in 2019, it was near 25%. This increase in suicide ideation rates was more marked among females (X2 = 15.127; p = 0.001), those aged over 15 (X2 = 16.437; p < 0.001) and/or those with a previous history of mental health problems (X2 = 17.823; p < 0.001). We identified an increase in the proportion of males with suicide ideas, especially between 2021 and 2022 (X2 = 8.396; p = 0.015). CONCLUSIONS: Our study suggests that children's and adolescents' demand for urgent mental healthcare and their clinical presentations in A&E departments with suicide thoughts and/or self-injuries do not seem to be declining after the pandemic but increasing over time. More research is warranted to understand possible factors involved in this sustained upward trend.

Prevalence of hepatitis C virus infection in patients with chronic mental disorders: The relevance of dual disorders / Prevalencia de la infección por el virus de la hepatitis C en pacientes con trastornos mentales crónicos: la relevancia de la patología dual

Objective: The prevalence of hepatitis C virus (HCV) infection is higher in people with psychiatric disorders compared to the general population. In addition, patients with severe mental illness are frequently affected by substance abuse, which increases the risk of blood-borne viral infections. Epidemiological studies in samples of hospitalised individuals with chronic mental disorders and dual diagnosis (DD) are lacking. The objective of this study was to investigate the prevalence of HCV infection in a sample of in-patients with severe mental illness. Patients and methods: This was a retrospective observational study. All patients meeting selection criteria admitted to the Medium-Term Psychiatric Unit of the University of Salamanca Health Care Complex between 2007 and 2018 were included. The primary endpoint was the prevalence of HCV infection. The secondary endpoint comprised the characteristics influencing the occurrence of HCV infection in these patients. Results: A total of 497 admissions were included and patients’ last admission data were considered for analyses (n=345). The overall prevalence of HCV infection was 3.8% and reached 14.3% among DD patients, who showed a higher prevalence than those without this condition (14.3% versus 3.1%, p=0.009). HCV RNA was detected in 6 individuals at diagnosis who received DAA treatment reaching sustained virological response. Conclusions:The prevalence of HCV infection in our sample was higher than in the general population, especially among DD patients. Despite the multiple barriers to access healthcare by patients with chronic mental illness, efforts to include this population in screening and treatment are mandatory.(AU)

Objetivo: La prevalencia de la infección por el virus de la hepatitis C (VHC) es mayor en las personas con trastornos psiquiátricos que en la población general. Además, los pacientes con enfermedades mentales graves padecen con frecuencia abuso de sustancias, que aumenta el riesgo de infecciones virales transmitidas por la sangre. El objetivo de este estudio fue investigar la prevalencia de la infección por el VHC en una muestra de pacientes hospitalizados con trastornos psiquiátricos graves. Pacientes y métodos: Se trata de un estudio observacional retrospectivo. Se incluyeron todos los pacientes que cumplían los criterios de selección ingresados en la Unidad de Convalecencia del Servicio de Psiquiatría del Complejo Asistencial Universitario de Salamanca entre 2007 y 2018. El criterio de evaluación principal fue la prevalencia de la infección por VHC. El criterio de evaluación secundario abarcó las características que contribuyen a dicha infección en estos pacientes. Resultados: Se consideraron los datos del último ingreso de los pacientes incluidos (n=345). La prevalencia global de la infección por VHC fue del 3,8% y alcanzó el 14,3% entre los pacientes con patología dual, que mostraron una prevalencia mayor que aquellos sin esta condición (14,3 versus 3,1%, p=0,009). Se detectó ARN de VHC en 6 individuos en el momento del diagnóstico, que recibieron tratamiento DAA y alcanzaron una respuesta virológica sostenida. Conclusiones: La prevalencia de infección por VHC en nuestra muestra fue mayor que en la población general, especialmente entre los pacientes con patología dual. A pesar de las barreras que dificultan el acceso a la atención sanitaria de los pacientes con enfermedades mentales crónicas, es imprescindible incluirlos en el cribado y el tratamiento.(AU)

Prevalence of hepatitis C virus infection in patients with chronic mental disorders: The relevance of dual disorders.

OBJECTIVE: The prevalence of hepatitis C virus (HCV) infection is higher in people with psychiatric disorders compared to the general population. In addition, patients with severe mental illness are frequently affected by substance abuse, which increases the risk of blood-borne viral infections. Epidemiological studies in samples of hospitalised individuals with chronic mental disorders and dual diagnosis (DD) are lacking. The objective of this study was to investigate the prevalence of HCV infection in a sample of in-patients with severe mental illness. PATIENTS AND METHODS: This was a retrospective observational study. All patients meeting selection criteria admitted to the Medium-Term Psychiatric Unit of the University of Salamanca Health Care Complex between 2007 and 2018 were included. The primary endpoint was the prevalence of HCV infection. The secondary endpoint comprised the characteristics influencing the occurrence of HCV infection in these patients. RESULTS: A total of 497 admissions were included and patients' last admission data were considered for analyses (n=345). The overall prevalence of HCV infection was 3.8% and reached 14.3% among DD patients, who showed a higher prevalence than those without this condition (14.3% versus 3.1%, p=0.009). HCV RNA was detected in 6 individuals at diagnosis who received DAA treatment reaching sustained virological response. CONCLUSIONS: The prevalence of HCV infection in our sample was higher than in the general population, especially among DD patients. Despite the multiple barriers to access healthcare by patients with chronic mental illness, efforts to include this population in screening and treatment are mandatory.

Increased incidence of high-lethality suicide attempts after the declaration of the state of alarm due to the COVID-19 pandemic in Salamanca: A real-world observational study.

The coronavirus pandemic has led to people getting involved in harmful behaviors. In our observational study, we assessed 241 patients with suicidal thoughts or behaviors in the emergency room before, during, and after the lockdown, from January to July 2020. After the lockdown, retired patients made higher-lethality attempts, and consultations related to suicide were less frequent, but active suicidal behaviors were more frequent. Men tended to use more lethal methods, and women made more suicidal gestures and had more suicide-related consultations. We observed an increase in the lethality of the attempts after the declaration of the state of alarm.

Effectiveness and types of interventions to reduce mental illness-related stigma among Medical university students: A literature review (1997-2020).

There is a high prevalence of stigma among medical students towards mental illness, which can have far reaching negative consequences. It is essential to intervene and modify their preconceptions in order to fight against stigma.

Eficacia y tipos de intervencionespara reducir el estigma hacia laenfermedad mental en estudiantesuniversitarios de Medicina: Unarevisión de la literatura (1997-2020) / Effectiveness and types of interventions to reduce mental illness-related stigma among medical university students: A literature review (1997-2020)

Entre los estudiantes de MEDICINA existe una alta prevalencia de estigma hacia la enfermedad mental, lo que puedeprovocar consecuencias negativas de gran alcance. Es de suma importancia intervenir y modificar las cogniciones en los futuros médicos para luchar contra el estigma. El objetivo de este trabajo es describir los tipos y la efectividad de las intervenciones para la reducción del estigma hacia las enfermedades mentales entre los estudiantes de MEDICINA a través de una revisión de la literatura existente de 1997 a 2020. Se realizó una búsqueda sistemática en las bases de datos PubMed, Web of Science (WOS) y Cochrane Library según la metodología PRISMA. Se localizaron un total de 87 manuscritos, tras la lectura de sus resúmenes se procedió a la exclusión de 49 por no adaptarse a los parámetros de estudio. Se seleccionaron 38 documentos que cumplían con los criterios de inclusión y 6 añadidos de búsquedas relacionales. Se evaluaron 44 estudios con una participación de global de 20.196 estudiantes de MEDICINA. En el 97 % de los casos las metodologías de intervención de reducción de estigma fueron eficaces. Se hallaron 16 tipos de intervenciones diferentes que presentan alta heterogeneidad metodológica. Las intervenciones aplicadas para la reducción del estigma hacia las enfermedades mentales (EM) entre los estudiantes de MEDICINA demuestran efectividad prácticamente en su mayoría. Las prácticas educativas son las más eficaces a largo plazo y junto con la comprensión médica positiva, la búsqueda de ayuda y el contacto experiencial en vivo, se presentan como fuertes estrategias de combate hacia las actitudes estigmatizantes.(AU)

objective of this study is to describe the types and effectiveness of interventions to reduce mental illness-related stigmaamong medical university students through a review of theliterature published from 1997 to 2020. A systematic searchwas carried out in the following databases: PubMed, Web ofScience (WOS) and Cochrane Library, following the PRISMAmethodology. After the search, 87 manuscripts were found.49 documents met the selection criteria, and 6 additional texts were included after a search for related studies. 44studies were assessed, with a global participation of 20.196Medicine students. In 97% of the cases, the methods of intervention for the reduction of stigma towards mental disorders (TM)were effective. 16 different types of interventions were found, with a limited number of methodologies.Teaching practices are the most effective in the long-term,together with a positive medical understanding, the searchfor help and the in vivo experiential contact, which are presented as strong strategies to combat stigmatizing attitudes.(AU)

A real-world ten-week follow-up of the COVID outbreak in an outpatient drug clinic in Salamanca (Spain).

OBJECTIVE: To compare over ten weeks the number of relapses, hospital admissions, calls made, admissions to therapeutic communities, face-to-face visits, treatment adjustment, number of injectables administered, and number of emergencies attended due to emotional and behavioral alterations and/or substance use disorder, and to describe and quantify social emergencies in an outpatient drug clinic (ODC) in Salamanca (Spain) from March 16, 2020, to May 22, 2020. METHODS: This is an ecological study of the COVID pandemic over ten weeks. The study examines the set of alcohol or other drug-dependent or dual disorder patients in the population of Salamanca, Spain. The measurements were: professionals; calls made; percentage of successful calls; face-to-face visits; first visits made; reviews made; techniques; injectable treatments; other treatments; evolution; relapses. The ODC includes about 375 new patients each year and another 650 other patients annually. RESULTS: The study found the number of relapses to be greater in the last five weeks of the 10-week study period. Patients' psychopathological instability also increased, and face-to-face visits were necessary. The most frequent psychopathology that required face-to-face intervention was depressive disorder. The number of interventions with patients increased. In parallel, social workers' efforts were greater after the seventh week. There was a decrease in response to calls. Throughout this time, the ODC attended to patients who needed to be treated for the first time. CONCLUSIONS: Confinement due to the coronavirus pandemic generated maladaptive emotional responses and other behaviors, such as excessive alcohol consumption. The number of face-to-face consultations, admissions, and referrals to therapeutic communities increased. Patients under stress and in social isolation resorted more often to substance use. The ODC had to adopt a flexible approach to evaluate patients with more serious problems, by using face-to-face assessments.

The Relevance of Dual Diagnoses among Drug-Dependent Patients with Sleep Disorders.

BACKGROUND: Sleep disorders are often associated with drug use. Nearly 70% of patients admitted for detoxification report sleep problems. Dual disorder (DD) is the comorbidity between mental disorders in general and disorders related to psychoactive substance use. The association between substance use and sleep disorders (SD) appears to be bidirectional. Our objective is to analyze the association between sleep disturbance history and drug use pattern (alcohol, cannabis, opioids, and cocaine). METHODS: Analysis of data in the first interview at the Addictions Unit of the Department of Psychiatry at the University of Salamanca Health Care Complex between October 2017 and January 2020. The sample consists of 398 patients. We studied the association between different variables: origin of patients (Inpatient Dual Diagnosis Detoxification Unit (IDDDU) vs. Outpatient Drug Clinic (ODC), presence of affective disorder, psychotic disorder, type of drug used, and treatment. RESULTS: Of patients with DD, 62% had more delayed sleep induction, sleep fragmentation, early awakening, and nightmares. Outpatients had more difficulty falling asleep because, in many cases, they had not previously sought any medical assistance. On the other hand, 67% of the patients with insomnia presented depression. CONCLUSIONS: There is evidence of a harmful association between DD and SD.

The response of the mental health network of the Salamanca area to the COVID-19 pandemic: The role of the telemedicine.

The COVID-19 pandemic reached world-wide causing a great impact on healthcare services. The aim of this work is to describe the response of the Mental Health Network of the Salamanca´ Area (Spain) to this crisis and the reorganization of its resources within the first 8 weeks after the state of alarm was declared. The Psychiatry Service applied a contingency plan which included the reorganization of the human resources, the closure of some of the units and the implementation of telemedicine programs along with two specific programs, namely a mental health assistance program in the context of the infection by coronavirus, and another program for homeless people. 9.038 phone interviews were carried out in the outpatients and community mental health programs. The activity in subacute and acute wards, as well as that of the day hospital programs was decreased to 50%. Based on that this real-world response provided we concluded that the usage of telemedicine is promising in patients with any kind of disorder. Its implementation in daily practice will be considered in the future. Research must continue on COVID-19's impact on patients with mental disorders and Psychiatry's necessary adaptations and new approaches to them.