Can we predict a "tsunami"? Symptomatic and syndromal density, mood instability and treatment intensity in people with bipolar disorders under a strict and long lockdown.

BACKGROUND: Converging evidence supports the involvement of circadian rhythm disturbances in the course and morbidity of bipolar disorders (BD). During 2020, lockdown measures were introduced worldwide to contain the health crisis caused by the COVID-19 pandemic. As a result, chronobiological rhythms were critically disrupted and illness outcomes were expected to worsen. The current study aimed to explore changes in morbidity among BD patients living under lockdown. METHODS: Ninety BD outpatients under naturalistic treatment conditions were followed from March to September 2020 using a mood chart technique. Different treatment and illness variables, including mood instability, were assessed and compared with the outcomes obtained during the same 28-week period in 2019. RESULTS: For most clinical variables, no significant differences were observed between time periods. A slight decrease was found in symptom intensity (from 15.19 ± 20.62 to 10.34 ± 15.79, FDR-adjusted p = 0.04) and in the number of depressive episodes (from 0.39 ± 0.74 to 0.22 ± 0.63, FDR-adjusted p = 0.03), whereas the intensity of pharmacological treatment remained unchanged. Previous illness course predicted mood outcomes during the confinement. LIMITATIONS: Follow-up periods were relatively short. Further, actigraphy or other methods capable of ensuring significant changes in physical activity were not used. CONCLUSIONS: In line with other studies, our findings show no worsening in the clinical morbidity of BD patients during lockdown. This conspicuous contrast between our initial predictions and the observed findings highlights the fact that we are still far from being able to provide accurate predictive models for BD.

Are all antidepressants the same? The consumer has a point.

BACKGROUND: Although a large variety of antidepressants agents (AD) with different mechanisms of action are available, no significant differences in efficacy and safety have been shown. However, there have been few attempts to incorporate data on subjective experiences under different AD. METHOD: We conducted a qualitative and quantitative analysis of the posts from the website www.askapatient.com from different AD. We reviewed a random sample of 1000 posts. RESULT: After applying the inclusion and exclusion criteria, we included a final sample of 450 posts, 50 on each of the most used AD: sertraline, citalopram, paroxetine, escitalopram, fluoxetine, venlafaxine, duloxetine, mirtazapine, and bupropion. Bupropion, citalopram, and venlafaxine had the higher overall satisfaction ratings. Sertraline, paroxetine, and fluoxetine had high reports of emotional blunting, while bupropion very few. Overall satisfaction with AD treatment was inversely associated with the presence of the following side-effects: suicidality, irritability, emotional blunting, cognitive disturbances, and withdrawal symptoms. After adjusting for confounders, only emotional blunting was shown to be more frequently reported by users of serotonergic agents, as compared to non-serotoninergic agents. CONCLUSION: This research points out that the subjective experience of patients under treatment should be taken into consideration when selecting an AD as differences between agents were evident. In contrast to the more frequent treatment decisions, users might prefer receiving a non-serotoninergic agent over a serotonergic one due to their lower propensity to produce emotional blunting.

[Adaptation of psychiatric practice in public and private mental health institutions of the City of Buenos Aires during the COVID-19 pandemic]. / Adaptación de la práctica psiquiátrica en instituciones de salud mental públicas y privadas de la Ciudad de Buenos Aires durante la pandemia de COVID-19.

BACKGROUND: One of the most significant indirect impacts of the COVID-19 pandemic will be seen on the mental health of the population. On this study, we will take into account the adapting capacity that the most representative mental health services (MHS) of Buenos Aires (BA) City have had as to this new situation. METHODS: We designed an online survey including 10 self-administered closed questions, strictly anonymous. It has been sent to targeted professionals who work in public and private MHS of BA after 2 months of the beginning of the lockdown. RESULTS: We got 38 answers. 2 professionals rejected to answer. 34% belonged to private institutions and 66% to public ones. 81% of the total were able to implement online assistance but only 24% had been trained on how to treat patients in this context. 69% of the private and 12% of the public sector professionals informed to have been trained on telemedicine tools. 69% of the private and 36% of the public sector professionals informed to have prepared materials for the users on telemedicine resources. 68% mentioned that their service was properly organized. 40% of the public sector professionals may have been reassigned to work on tasks related to the pandemic. 40% of the total informed a reduced capacity of assistance. CONCLUSIONS: The MHS of BA may have been able to migrate their assistance to telemedicine, however we have noticed differences in the training levels. A better capacity of training on this modality might be needed.