Consensus of the Liaison-Psychiatry Committee of the Colombian Psychiatric Association on the diagnosis and treatment of delirium in the context of the COVID-19 pandemic.

The pandemic caused by the new coronavirus named SARS-CoV-2 poses unprecedented challenges in the health care. Among them is the increase in cases of delirium. The severe SARS-CoV-2 disease, COVID-19, has common vulnerabilities with delirium and produces alterations in organs such as the lungs or the brain, among others, which have the potential to trigger the mental disorder. In fact, delirium may be the first manifestation of the infection, before fever, general malaise, cough or respiratory disturbances. It is widely supported that delirium increases the morbidity and mortality in those who suffer from it during hospitalization, so it should be actively sought to carry out the relevant interventions. In the absence of evidence on the approach to delirium in the context of COVID-19, this consensus was developed on three fundamental aspects: diagnosis, non-pharmacological treatment and pharmacological treatment, in patients admitted to the general hospital. The document contains recommendations on the systematic use of diagnostic tools, when to hospitalize the patient with delirium, the application of non-pharmacological actions within the restrictions imposed by COVID-19, and the use of antipsychotics, taking into account the most relevant side effects and pharmacological interactions.

[Listening and support groups in a teaching hospital as a model of intervention for healthcare workers during the COVID-19 pandemic]. / Grupos de escucha y apoyo en un hospital universitario como modelo de intervención para profesionales de la salud durante la pandemia de COVID-19.

BACKGROUND: Healthcare workers facing the COVID-19 pandemic have experienced unexpectedly traumatic situations associated with concerns about the possibility of acquiring the infection, excessive workloads, and the increased inpatient mortality rates. The objective was to make changes in hospital practices that facilitate spaces for the well-being of healthcare worker teams. METHODS: We conducted an ongoing intervention during the first year of this outbreak. We established peer support groups by videoconference and individual virtual interventions for specialist physicians, resident physicians, nurses, and support personnel, focusing on problems and emotions related to the psychological impact of being on the clinical front line working with patients with pneumonia due to SARS-CoV-2 (COVID-19). RESULTS: The group work helped the expression of feelings, peer support, and validation of personal emotional experience. The participants expressed the need for physical and psychological security in the battle against COVID-19 and the need for interpersonal ties and giving meaning to their experiences. CONCLUSIONS: Based on our findings, we consider it necessary to investigate the potentially traumatic experiences of healthcare workers and provide evidence-based knowledge that can generate novel approaches in psychosocial support work structures for this group.

Dystonic storm in consultation-liaison psychiatry.

Dystonia is a movement disorder characterised by sustained muscle contractions that produce repetitive twisting movements or abnormal postures. It can be classified according to the aetiology as primary (idiopathic and genetic forms), or secondary. The presentation associated with generalised, intense episodes and with exacerbation of severe muscle contractures and usually refractory to traditional pharmacotherapy is known as dystonic status or dystonic storm. In the present article, a case is presented of a 33-year-old patient with a history of congenital deafness, stimulant use disorder and on psychopharmacological treatment with antipsychotics, who presented with a severe dystonic reaction that evolved to a status dystonicus.

[Report of a case of penile self-amputation]. / A propósito de un caso de autoamputación peneana.

INTRODUCTION: Motivated by a clinic case, this report introduces some issues related with genital self-amputation in terms of descriptions, epidemiological and clinical issues. METHODOLOGY: Case report describing a clinic case of genital self-amputation. The description is followed by a discussion based on the information available in the scientific literature. A man, 32 years old, with no history of mental disorder, who amputates his penis with a cutting object after quarreling with his mate for infidelity reasons. RESULTS: Several characteristics imply risk factors for genital self-mutilation, such as gender identity disorders, rejection to male genitals, guilt feelings related to sexual activity and a history of previous self-injuries. More common diagnoses include schizophrenia and affective disorders followed by disorders induced by psychoactive substances. CONCLUSION: Genital self-amputation is not a frequent situation and has been under-recorded; however, bearing in mind the high association with psychopathology and recurrence reported in worldwide literature, it is necessary to carry out a proper study and following up of patients exhibiting this conduct.