Influence of social isolation caused by coronavirus disease 2019 (COVID-19) on the psychological characteristics of hospitalized schizophrenia patients: a case-control study

Social isolation and cognitive function in patients with schizophrenia: A two years follow-up study

Cognitive impairment is a core characteristic of schizophrenia. Social isolation has been linked to impaired cognitive function among the general population. In this longitudinal study, we examined the association between social isolation and cognitive function among inpatients with schizophrenia. Two waves of data (2019 and 2021) were collected from chronic psychiatric wards. A total of 166 inpatients completed all measurements at baseline and follow-up. Social isolation was measured by incorporating the frequency of social contact and participation, while cognitive functions were assessed by the Taiwan version of the Montreal Cognitive Assessment (MoCA-T). We used multiple linear regression to evaluate the link between baseline social isolation and cognitive function. For the total sample, social isolation was significantly related to poor language abilities (β = -0.17, p = 0.013) and delayed recall (β = -0.15, p = 0.023). Sex-stratified analysis showed that social isolation was significantly related to poor global cognitive function (β = -0.14, p = 0.021) and domain-specific cognitive functions including language abilities (β = -0.26, p = 0.003) and delayed recall (β = -0.19, p = 0.045) in male inpatients. No significant association was found between social isolation and global cognitive function or any cognitive domain (all ps > 0.05) for females. All associations were independent of loneliness and other covariates. These findings suggested that social isolation could predict poor subsequent cognitive function in inpatients with schizophrenia, especially in males. Interventions aimed at enhancing social connections could potentially improve cognitive function in this population.

Causal relationship between schizophrenia and sex hormone binding globulin: A Mendelian randomization study

OBJECTIVE

The underlying etiology of schizophrenia is still not fully understood, and recent studies have pointed to a potential link between hormonal factors and the risk of developing this condition. Sex Hormone-Binding Globulin (SHBG) is a protein that regulates the bioavailability of sex hormones. However, the causal relationship between SHBG levels and schizophrenia remains unclear, this study aimed to investigate the causal relationship based on two-sample Mendelian randomization (MR) analysis.

METHODS

This study was based on the summary data of genome-wide association studies (GWAS) of schizophrenia and SHBG in European populations. Two-sample MR was applied, and genetic factors were used as instrumental variables, and the causal relationship between schizophrenia and SHBG was assessed.

RESULTS

We selected 79 single nucleotide polymorphisms with genome-wide significance from the schizophrenia GWAS as instrumental variables. The inverse variance weighting (IVW) method results showed that there is a causal relationship and a positive correlation between schizophrenia and female SHBG, with an odds ratio (OR) of 1.024 (95%CI: 1.007-1.042, P = 0.005), and this result was further confirmed by the Weighted median odds ratio (OR) of 1.032 (95%CI: 1.016-1.048, P = 5.58E-05) and the Weighted mode of 1.035 (95%CI: 1.004-1.067, P = 0.028). Schizophrenia and male SHBG also have a causal relationship and a positive correlation, with an odds ratio (OR) of 1.027 (95%CI: 1.007-1.047, P = 0.008).

CONCLUSION

This study found a positive correlation between schizophrenia and SHBG in both men and women through MR analysis, indicating that the level of SHBG may be elevated in patients with schizophrenia, regardless of gender.

Prevalence of poor sleep quality in COVID-19 patients: a systematic review and meta-analysis

Objective

The coronavirus disease (COVID-19) and the public health responses were associated with a huge health burden, which could influence sleep quality. This meta-analysis and systematic review examined the prevalence of poor sleep quality in COVID-19 patients.

Methods

PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 27, 2022. Prevalence rates of poor sleep were analyzed using a random effects model.

Results

Totally, 24 epidemiological and 12 comparative studies with 8,146 COVID-19 patients and 5,787 healthy controls were included. The pooled prevalence of poor sleep quality based on the included studies was 65.0% (95%CI: 59.56-70.44%, I2 = 97.6%). COVID-19 patients had a higher risk of poor sleep quality compared to healthy controls (OR = 1.73, 95% CI: 1.30-2.30, p < 0.01, I2 = 78.1%) based on the 12 comparative studies. Subgroup analysis revealed that COVID-19 patients in low-income countries (p = 0.011) and in studies using a lower Pittsburgh Sleep Quality Index score cut-off (p < 0.001) were more likely to have poor sleep quality. Meta-regression analyses revealed that being female (p = 0.044), older (p < 0.001) and married (p = 0.009) were significantly correlated with a higher risk of poor sleep quality while quality score (p = 0.014) were negatively correlated with the prevalence of poor sleep quality in COVID-19 patients.

Conclusion

Poor sleep quality was found to be very common in COVID-19 patients. Considering the negative effects of poor sleep quality on daily life, sleep quality should be routinely assessed and appropriately addressed in COVID-19 patients.

The Impact of Stress from Social Isolation during the COVID-19 Pandemic on Psychiatric Disorders: An Analysis from the Scientific Literature

The COVID-19 pandemic generated, in addition to severe symptoms, hospitalizations and deaths worldwide, as well as stress from the fear of the disease and social uncertainties, from restriction measures and social isolation. Stress from social isolation impacts mental health, aggravating existing conditions and triggering neuropsychiatric symptoms in individuals with biopsychosocial vulnerability. During and immediately after the period of social restriction imposed by the pandemic, the scientific community carried out several research protocols. These revealed results that relevantly demonstrate the harmful effect of the stress induced by the pandemic situation. This narrative review reports and discusses research results demonstrating impairments in psychiatric disorders such as autism spectrum disorder, dementia, eating disorders, schizophrenia, anxiety, and depression. In this sense, the community has identified a significant negative influence of social isolation on the mental health of individuals through the modification of individual routines and the absence of social interactions. Moreover, the community identified perceived differences related to the impacts on men and women. In addition to studies showing the effect of social isolation on disorders, an evaluation of protocols with some possible therapeutic intervention strategies during times of social restriction was developed.

Childhood trauma and suicide risk in hospitalized patients with schizophrenia: the sequential mediating roles of pandemic related post-traumatic stress symptoms, sleep quality, and psychological distress

Introduction

Stressful global situation due to the COVID-19 pandemic caused a tremendous impact on mental health in hospitalized patients with schizophrenia. The mediating roles of psychological impact related to COVID-19, sleep quality, and psychological distress were investigated in the association between childhood trauma and suicidal risk in hospitalized patients with schizophrenia.

Methods

We analyzed cross-sectional data of 147 patients with schizophrenia and 189 healthy controls (HCs).

Results

Histories of childhood trauma and schizophrenia were good predictors of COVID-19-related psychological impact, global sleep quality, and psychological distress. Moreover, the series mediation model showed that the effect of childhood trauma on suicidal risk in hospitalized patients with schizophrenia was totally sequential mediated by the psychological impact of COVID-19, sleep quality, and psychological distress.

Conclusion

Clinicians need to recognize the increased suicidal risk associated with COVID-19-related psychological distress in schizophrenia patients with a history of childhood trauma.

The risk of hospitalization for psychotic disorders following hospitalization for COVID-19: a French nationwide longitudinal study

COVID-19, like other infectious diseases, may be a risk factor for psychotic disorders. We aimed to compare the proportions of hospitalizations for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or for another reason in the adult general population in France during the first wave of the pandemic. We conducted a retrospective longitudinal nationwide study using the national French administrative healthcare database. Psychotic disorders were first studied as a whole, and then chronic and acute disorders separately. The role of several adjustment factors, including sociodemographics, a history of psychotic disorder, the duration of the initial hospitalization, and the level of care received during that hospitalization, were also analyzed. Between 1 January 2020 and 30 June 2020, a total of 14,622 patients were hospitalized for psychotic disorders in the 12 months following discharge from hospital for either COVID-19 or another reason. Initial hospitalization for COVID-19 (vs. another reason) was associated with a lower rate of subsequent hospitalization for psychotic disorders (0.31% vs. 0.51%, odds ratio (OR) = 0.60, 95% confidence interval (CI) [0.53-0.67]). This was true for both chronic and acute disorders, even after adjusting for the various study variables. Importantly, a history of psychotic disorder was a major determinant of hospitalization for psychotic disorders (adjusted OR = 126.56, 95% CI [121.85-131.46]). Our results suggest that, in comparison to individuals initially hospitalized for another reason, individuals initially hospitalized for COVID-19 present a lower risk of hospitalization for first episodes of psychotic symptoms/disorders or for psychotic relapse in the 12 months following discharge. This finding contradicts the hypothesis that there is a higher risk of psychotic disorders after a severe COVID-19.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study

BACKGROUND

The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD).

METHODS

Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis.

CONCLUSION

Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

The Effects of COVID-19 Lockdown on Social Connectedness and Psychological Distress in U.S. Adults with Chronic Diseases

Lockdown measures enacted in 2020 to control the spread of COVID-19 led to increases in the prevalence of mental health problems. Due to their high-risk status, individuals with chronic diseases may be at increased risk and disproportionately adversely affected by the COVID-19 pandemic. The investigators examined associations between having a high-risk chronic condition, social connectedness, and general distress and COVID-19-specific distress among U.S. adults during the COVID-19 lockdown. Baseline measures of a longitudinal survey collected at the beginning of the pandemic (April to June 2020) were analyzed to identify factors associated with loss of social connectedness from pre- to post-lockdown. The associations between social connectedness and both general and COVID-19-specific psychological distress were adjusted for certain high-risk chronic illnesses and interaction effects. The sample available for analysis included 1354 subjects (262 high-risk chronic diseases and 1092 without chronic illness). Those reporting the loss of social connectedness were younger (median = 39 vs. 42) and more likely to be unemployed because of the pandemic (19.4% vs. 11.0%). Adjustment for interaction demonstrated a stronger negative association between social connectedness change and the psychosocial impact of COVID-19 for those with high-risk illness(es) (change in connectedness*chronic illness OR = 0.88, 95%CI: 0.79-0.98, p = 0.020). These findings inform our understanding of the distribution and intersection of responses to public health lockdown orders in the U.S. and build further evidence of the importance of social connectedness on psychological distress.

COVID-19 and Psychiatric Admissions: A Comparative Study of Pre-pandemic and Post-pandemic Psychosis Admissions in a South Florida Emergency Department

We noticed a subjective increase in psychosis admissions within our emergency department (ED) with the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify trends concerning admissions due to psychosis in the ED before and after the beginning of the COVID-19 pandemic. We analyzed 508 psychiatric admissions through the ED from October 2019 to October 2020, of which 367 cases of psychosis were identified. Statistical analysis was performed using T-tests and Pearson's correlation coefficient. T-testing showed mean psychosis admissions during the pandemic (March 2020 to July 2020) to be greater than admissions occurring during the pre-pandemic period (October 2019 to February 2020) (p = 0.04). Pearson's correlation coefficient identified the relationships between COVID-19 admissions and psychosis admissions during this time as positive (r = 0.5) but did not reach statistical significance (p = 0.06). Therefore, within our time frame, we did see a noted increase in psychosis by 22.9% during the pandemic compared to pre-pandemic times. Current research remains conflicted concerning psychiatric ED admissions during COVID-19, with some stating an increase and others finding a decrease. Our data showed a significant statistical increase in the mean number of psychosis cases when comparing pre-pandemic and pandemic admissions. These findings help add pertinent data to understand how psychosis admissions trended before and during the beginning of the COVID-19 pandemic, specifically in South Miami, Florida. It also provides a foundation for future studies by providing data points concerning mental illness within the vulnerable population of patients served in our community.

How did the Covid-19 pandemic affect individuals with schizophrenia from Turkey?

BACKGROUND

Serious mental illness, including schizophrenia, have been shown to be associated with psychosocial vulnerabilities in the face of adverse events. While individuals with schizophrenia might undergo many psychosocial difficulties during the COVID-19 pandemic, they might also not be affected, or report increased subjective well-being. This suggests that it is important to understand diverse impacts and further understand the unique experiences.

METHODS

To capture how the pandemic affected them and how they handled the challenges if there were any in the initial and more recent phases of the pandemic, 18 individuals with schizophrenia living in Turkey were interviewed.

RESULTS

Thematic analysis of interviews resulted in four superordinate themes for both time points. Three themes related to the impact of the pandemic (i.e. burdens of COVID-19, positive impacts of COVID-19, no impact of COVID-19) indicated that they shared a number of challenges with the general population. Themes about the positive impacts and no impact also replicated the previous findings in this clinical population. One last theme named as facilitators of coping implied that the participants tried to deal with the burdens by using available resources, adapt to the changes in their daily living, and benefit from social interaction and support.

CONCLUSIONS

To conclude, people with schizophrenia seem to be coping with challenges posed by the pandemic with diverse strategies and they seem to even experience psychological growth alongside with negative impacts. The individualized needs and potential for growth have pivotal implications for the management of the illness during the pandemic.

Factors Influencing the Level of Depression and Anxiety of Community-Dwelling Patients with Schizophrenia in China during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) poses a huge challenge to global public health. People with schizophrenia living in communities urgently need effective interventions to help them adjust to life and work, but they have not received enough attention. This study aims to assess the prevalence of anxiety and depression symptoms in community-dwelling patients with schizophrenia in China during the epidemic and to explore the possible influencing factors.

METHODS

Using a cross-sectional survey, we collected 15,165 questionnaires. Assessments included demographic information, concern about COVID-19-related information, sleep status, anxiety and depressive symptoms, and accompanying illnesses. The 7-item Generalized Anxiety Disorder (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate depression and anxiety levels. Group comparison was conducted by t-test, ANOVA, or chi-square test wherever suitable, with Bonferroni pairwise correction. Multivariate logistic regression was performed to identify predictors for anxiety and depression.

RESULTS

16.9% of patients had at least moderate anxiety, and 34.9% had at least moderate depression. T-test showed that females scored higher on GAD-7 and PHQ-9 than males, and patients without accompanying long-standing diseases, who were not concerned about COVID-19, had lower GAD-7 and PHQ-9 scores. ANOVA showed that participants aged from 30 to 39, with higher education scored higher on GAD-7, and patients with better sleep, and having less concern about COVID-19, had lower GAD-7 and PHQ-9 scores. Regression analysis indicated that participant ages of 30-39 and 40-49 positively predicted anxiety, whereas patient ages of 30-39 years positively predicted depression. Patients with poor sleep, accompanying diseases, and concern about the COVID-19 pandemic were more likely to experience anxiety and depression.

CONCLUSION

During the pandemic, Chinese community-dwelling patients with schizophrenia had high rates of anxiety and depression. These patients deserve clinical attention and psychological intervention, especially those with risk factors.

Effect of Animal-Assisted Therapy (AAT) on Social Interaction and Quality of Life in Patients with Schizophrenia during the COVID-19 Pandemic: An Experimental Study

PURPOSE

Most patients with schizophrenia exhibit low willingness to return to society because of negative social experiences. The COVID-19 pandemic led to severe social isolation for schizophrenia patients. However, animal-assisted therapy (AAT) can improve individuals' empathy, social functions, and quality of life. The study aimed to evaluate the effectiveness of AAT in improving social interactions and quality of life in patients with chronic schizophrenia during the COVID-19 pandemic.

METHODS

An experimental study was conducted, with six institutions for psychiatric rehabilitation in Taiwan as the case institutions. Patients in these institutions were randomly allocated to the experimental group, which received 60 minutes of AAT once a week for 12 weeks, or the control group, which engaged in routine discussion groups and watched short films about animals. Comparisons between the two groups were made before and after the intervention on social function, social adaptive function, and quality of life. Data were collected before the intervention (T1), immediately after the intervention (T2), and 3 months after the intervention (T3).

RESULTS

Comparison between groups showed that social functioning was significantly higher in the experimental group than in the control group at T2. However, there was no sign of improvement in social adaptive functions of the experimental group. The experimental group exhibited significantly higher quality of life than the control group at T2 and T3.

CONCLUSIONS

There was an impact of COVID-19 on the studied effects. AAT improved social functioning and quality of life in patients with chronic schizophrenia. The effect on quality of life lasted only up to 3 months after the intervention. AAT should be promoted for use as a community-based rehabilitation tool in patients with chronic schizophrenia.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2200061715. https://www.chictr.org.cn.

Mental Health Impact of Early Stages of the COVID-19 Pandemic on Individuals with Pre-Existing Mental Disorders: A Systematic Review of Longitudinal Research

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.

Have the COVID-19 outbreak and related restrictions affected the right to mental health of people with severe mental health conditions?

The Coronavirus disease (COVID-19) outbreak, and the restrictions implemented by governments to limit its public health impact, may have determined a reduction of the right to mental health of people with severe mental health conditions, that is a limitation to adequate, human, and value-based mental healthcare, with rising inequalities in comparison with the general population. This systematic review was, therefore, conducted to collate evidence on the impact of the pandemic period on the mental health of individuals with pre-existing severe mental health conditions. Of 3,774 retrieved citations, we selected 21 studies meeting the inclusion criteria. The majority of the included studies assessed trends in psychological symptoms over the pandemic period, then arguing that symptoms worsened for a number of reasons, including the risk of contracting the virus, the disruption of mental health services, and the feelings of loneliness and isolation associated with the restriction measures. Even though studies provided somewhat contradictory results, the majority of evidence indicates that people with pre-existing mental health conditions were more likely to report greater self-isolation distress, anxiety, depression, COVID-19-related perceived stress, and were more likely to voluntarily self-isolate than those without a mental health condition. These findings appeared to suggest that a combination of factors related to the pandemic itself and to the prevention and mitigation strategies were responsible for a reduction of the right to mental health of people with mental health conditions, with increased inequalities in comparison with the general population.

Psychological impact of COVID-19 lockdown on a population with serious mental illness. A prospective cohort study

Introduction

COVID-19 has spread worldwide since its appearance at the end of 2019. In Spain, 99-day long home confinement was set from March 15th 2020. Previous studies about events requiring situations of isolation suggested that mental health problems may occur among the general population and, more specifically, vulnerable groups such as individuals with serious mental illness (SMI). This study aims to assess the psychological effect of confinement in patients with mental illness admitted to an inpatient psychiatric unit.

Method

In this longitudinal study, IDER (State-Trait Depression Inventory) and STAI (State-Trait Anxiety Inventory) questionnaires were used at two different times (at the beginning and after the lockdown) of the pandemic to evaluate the depression and anxiety symptoms, respectively, in a population of patients who had been previously admitted to the Psychiatry Unit of the Basurto University Hospital.

Results

95 participants completed the IDER questionnaire in the first measurement, with a mean score of 24.56 (SD = 8.18) for state and 23.57 (SD = 8.14) for trait. In the case of STAI, the mean score was 27.86 (SD = 15.19) for the state and 30.49 (SD = 14.71) for the trait. No differences between the first and the second time were found in anxiety and depression levels. People with personality disorders presented high levels of anxiety.

Conclusions

Individuals with a personality disorder showed the highest scores in anxiety and depression. Nevertheless, strict confinement did not affect this population, despite the literature that evidences that the pandemic has worsened people's mental health with SMI.

Pregnant Women’s Anxiety and Depression Symptoms and Influence Factors in the COVID-19 Pandemic in Changzhou, China

Background

With the coronavirus disease 2019 (COVID-19) pandemic, pregnant women’s psychological conditions have become a global challenge. The aim of the study was to identify the prevalence of anxiety and depression symptoms and analyze their influence factors among pregnant women in Changzhou, China during the COVID-19 pandemic and provide them with appropriate healthcare strategies.

Methods

Participants were 681 pregnant women who visited various obstetrics and gynecology clinics in Changzhou, China between 25 February 2020 and 7 March 2020. They were asked to complete an online survey. The Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to detect anxious and depressive symptoms. The chi-squared test and multivariate logistic regression analysis were carried out to examine the associated factors in these groups.

Results

Overall, the prevalence rates of anxiety and depression symptoms among pregnant women were 31.72 and 36.12%, respectively, but most of them were mild. Having an irregular diet with poor subjective sleep quality, perceiving little family support, spending too much time on news related to the coronavirus, and having severe subjective life impact by the coronavirus were related to anxiety and depression symptoms. In addition, lack of physical exercise and exposure to electronic screens over 5 h per day were associated with depression symptoms.

Conclusion

Pregnant women with an irregular diet, poor sleep quality, little family support, excessive attention to COVID-19 news, and lives impacted by the coronavirus severely are at high risk for anxiety and depression symptoms during the COVID-19 pandemic. This indicates that targeted measures to address mental health in pregnant women during the pandemic period are needed.

The Acute Impact of the Early Stages of COVID-19 Pandemic in People with Pre-Existing Psychiatric Disorders: A Systematic Review

People with pre-pandemic health conditions are more vulnerable and more likely to suffer greater psychosocial impact due to the current COVID-19 pandemic and the lockdown measures. Thus, the objective of this work was to systematically review the impact of the early stages COVID-19 pandemic on people with pre-existing psychiatric disorders. The search was performed between 23 January and 2 September 2021 in PubMed, PsycINFO, and EMBASE. A total of 4167 published results were identified; however, only 49 were included in this review. Results show that there was considerable heterogeneity among studies, which resulted in a low consensus. However, it seems that the impact of the first stage of the COVID-19 pandemic on psychiatric disorders was two-fold: (1) an overall effect, in which people suffering from psychiatric disorders in general experienced more psychological distress and anxiety when compared to people who had no psychiatric diagnosis, and (2) a condition-specific effect, namely in people suffering from eating disorders and obsessive compulsive disorders. Moreover, the current work highlights that there were also some external factors that were related to worsening symptoms. For instance, unemployment or experiencing work and financial difficulties can be a trigger for greater distress during the pandemic for people with mood disorders, and being alone and in social isolation during the COVID-19 pandemic may actually increase substance use and relapse rates. Further studies are needed to prospectively investigate the long-term effects of the current COVID-19 pandemic on people with (pre)-existing psychiatric conditions and on the onset or deterioration of psychiatric-related symptoms in a larger number of participants, as well as exploring the long-term effects of the current pandemic on mental health.

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.

Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is having a great impact on individuals from all over the world, particularly on individuals with mental disorders. Several studies found more pronounced psychiatric symptoms, notably symptoms of depression and anxiety.

AIM

To assess the situation of patients with serious mental illness (SMI: Affective disorders and schizophrenia) regarding their mental health outcome during the pandemic.

METHODS

A systematic search using the databases PubMed and MEDLINE was conducted, employing the key words “COVID-19”, “SARS-CoV-2”, “psychiatric/mental disorder/illness”, “affective/mood disorder”, “bipolar disorder”, “(major) depression”, “schizoaffective disorder”, and “schizophrenia”. Studies that had been published up until January 9, 2021 were included. Information of studies in languages other than English and German was mostly taken from their English abstracts.

RESULTS

The literature search concluded in the finding of 36 studies containing relevant clinical data. A general impairment of the mental health of individuals with SMI could be detected, particularly in individuals with affective disorders, as compared to those with schizophrenia. Compared to healthy controls, symptoms of anxiety, depression, and stress were more pronounced in individuals with SMI. Relevant factors found that impacted their mental health were age, resilience, and socioeconomic environment, especially the shortage of mental health services, lack of social support, and inadequate information about COVID-19.

CONCLUSION

In light of these results, mental health services should be reinforced, notably the use of telemental health services. Furthermore, supplying individuals with SMI with adequate information about the COVID-19 pandemic and increasing their resilience is important. When researching the impact of the COVID-19 pandemic on individuals with SMI, standardization as well as follow-up studies are needed to enable better comparability and understanding.

Description and Functional Outcomes of a Novel Interdisciplinary Rehabilitation Program for Hospitalized Patients With COVID-19

OBJECTIVES

The aims of the study were to describe an interdisciplinary inpatient rehabilitation program for patients recovering from COVID-19 and to evaluate functional outcomes.

DESIGN

This is an analysis of retrospective data captured from the electronic health record of COVID-19 patients admitted to the rehabilitation unit (N = 106). Rehabilitation approaches are described narratively. Functional gain was evaluated using the Activity Measure for Postacute Care 6 Clicks, basic mobility and daily activities.

RESULTS

Interdisciplinary approaches were implemented to address the medical, physical, communication, cognitive, and psychosocial needs of COVID-19 patients. COVID-19 patients exhibited significant improvements in basic mobility (Activity Measure for Postacute Care for basic mobility, P < 0.001, Cohen d = 1.35) and daily activities (Activity Measure for Postacute Care for daily activities, P < 0.001, Cohen d = 1.06) from admission to discharge. There was an increase in ambulatory distance as well as the percentage of the patients who were able to breathe on room air. At discharge, fewer patients required supplemental oxygen on exertion. Eighty percent of the patients were discharged home after an average length of stay of 17 days. Greater functional improvement was associated with younger age, longer intubation duration, and participation in psychotherapy, but not a history of delirium during hospitalization.

CONCLUSIONS

Early rehabilitation is associated with improved mobility and independence in activities of daily living after COVID-19.

The COVID-19 Pandemic Introduces Diagnostic and Treatment Planning Complexity for Individuals at Clinical High Risk for Psychosis

COVID-19 has led to a great deal of general suffering and an increased prevalence of psychiatric illness worldwide. Within the area of psychosis-risk syndromes, a highly heterogeneous clinical population, the picture is quite nuanced as the social restrictions resulting from the pandemic have reduced stress for some and increased it for others. Further, a number of pandemic-related societal and cultural changes have obfuscated the diagnostic and treatment landscape in this area as well. In this opinion article, we describe several prototypical cases, representative of presentations seen in our clinical high-risk (CHR) research programs. The cases highlight considerable clinical variability and, in addition, speak to the current complexities faced by diagnosticians and treatment providers. In addition to discussing these issues, this piece introduces potential solutions highlighting the promise of incorporating data-driven strategies to identify more homogenous CHR subtypes and employ precision medicine.

The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review

CONTEXT

Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.

OBJECTIVES

To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.

METHODS

A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions.

RESULTS

COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection.

IMPLICATIONS

The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources. ACCESSIBLE SUMMARY.

Could technology enable individuals with schizophrenia to access health care? The case of Ecuador

Purpose

The purpose of this paper is to fill in the gaps in the literature regarding health-care access for individuals with schizophrenia, with a focus on Ecuador, and how technology can enable health-care access during the pandemic.

Design/methodology/approach

To achieve this aim, the author reviewed peer-reviewed articles in English and Spanish (using, among other sources, Medline and ProQuest), the Ecuadorian Constitution, law projects on mental health and suicide and government reports.

Findings

The consensus seems to be that the Ecuadorian health-care system has failed in its constitutional mandate to provide essential care for mentally ill patients, such as those suffering from schizophrenia. The data supporting the use of the internet and smartphone technology for delivering health services during the pandemic are extremely clear, but substantive governmental responses have been lacking.

Research limitations/implications

The major limitation of this study is the lack of data on schizophrenia in Ecuador and the use of technology.

Originality/value

This evaluation of the current literature on the effect of the pandemic on access to health care for patients suffering from mental illness is much-needed and should provide a welcome data source for research, practice and policymaking.

COVID-19 in People With Schizophrenia: Potential Mechanisms Linking Schizophrenia to Poor Prognosis

As the global burden of mortality from COVID-19 continues to rise, an understanding of who is most at risk of adverse outcomes is of paramount importance. Pre-existing cardiometabolic, renal and respiratory diseases as well as old age are well-established risk factors associated with disease severity and mortality among patients with COVID-19. However, mounting evidence also indicates an increased susceptibility to, and risk of adverse outcomes from COVID-19 in people with schizophrenia, independent of age and comorbidity. Therefore, elucidating the underlying pathophysiological mechanisms which may increase the risk of poor outcomes in people with schizophrenia is of crucial importance. Here, we provide a narrative on the current understanding of COVID-19 in patients with schizophrenia and propose potential mechanisms which may link schizophrenia with an increased susceptibility to, and greater risk of adverse outcomes from COVID-19. Given the existing knowledge gaps, robust clinical and biological studies are required to further our understanding of some of these underlying mechanisms, so that effective prevention and treatment strategies for COVID-19 in patients with schizophrenia can be developed.

Cuarentena y COVID-19, una percepción más allá de la infección

El síndrome respiratorio agudo severo (SARS), cuyo agente causal es el Coronavirus SARS-CoV, surgió en 2003, sin embargo, a finales del 2019, se observó que un nuevo Coronavirus (SARS-CoV-2) causaba una enfermedad similar a la influenza, denominada COVID-19 (acrónimo del inglés coronavirus disease 2019), la cual, presentaba desde síntomas respiratorios leves hasta lesiones pulmonares graves, y en algunos casos, cursando con insuficiencia multiorgánica y muerte 1,2,3.

Schizophrenia during the COVID-19 pandemic

PURPOSE OF REVIEW

The coronavirus disease 19 (COVID-19) pandemic is having a critical impact on healthcare systems across the world, as well as on mental health in the general population; however, evidence regarding the impact of the COVID-19 pandemic on people living with schizophrenia and on the onset of psychotic symptoms is currently emerging.

RECENT FINDINGS

People living with schizophrenia are at an increased risk of COVID-19 and present worse COVID-19-related outcomes, including mortality. They show low levels of information and of concern regarding the possibility of contagion and infection but presented substantially stable levels of psychotic symptoms and even increased subjective well being during the pandemic. SARS-CoV-2, as well as the prolonged social isolation and the spread of misinformation, appear to be responsible in some cases for the onset of psychotic symptoms.

SUMMARY

Clinicians should inform and educate their patients on the risks related to SARS-CoV-2 infection and COVID-19 and on the precautions that they should adopt to avoid contagion. Particular attention should be devoted to maintaining the continuity of care, especially in frail patients. Telemedicine might represent a valid support, but face-to-face visits in some cases remain essential. The hypothesis of a direct role of viral infection on the onset of psychotic disorders is currently debated, as viral involvement of central nervous system appears to be rather infrequent in COVID-19.

Fears Related to COVID-19 among Rural Older People in Japan

Coronavirus disease 2019 (COVID-19) has affected people’s social lives by inhibiting their movement; this seriously impacts the lives of older people in particular. Rural older people may have been particularly affected because they live dispersedly and in isolation. This study explored rural older people’s perceptions of how COVID-19 has impacted their social lives. This qualitative study assessed participants who were 65 years and older and residing in rural Japanese communities. Five focus group discussions were conducted with 53 participants to explore their perceptions and challenges during COVID-19. Data were analyzed using thematic analysis, and four themes were developed: the beginning of suffering, social cognitive suppression, reflection on rural contexts, and critical approaches to the pandemic based on rural standards. The daily activities of rural older people were suppressed due to social norms and pandemic-related standard precautionary measures based on urban areas. Specific infection control standards for rural areas and the provision of direct information to individuals in the community to sustain social support are needed. To effectively maintain rural social support, as well as the trust and accountability of rural citizens, constant dialog among local governments and rural citizens is required.

Psychopathological Impact and Resilient Scenarios in Inpatient with Schizophrenia Spectrum Disorders Related to Covid Physical Distancing Policies: A Systematic Review

The COVID-19 epidemic posed great challenges to the healthcare community. To contain the epidemiological emergency, confinement measures were instituted, affecting the entire population. The lack of social contact, as well as the disruption of daily life, caused the exacerbation of anxiety and depressive symptoms. The present review of the literature aims to investigate what the effects of the pandemic have been on patients with schizophrenia, hypothesizing, an exacerbation of psychotic symptomatology (positive, negative, disorganized symptoms). Between November 2020 and January 2021, 5353 articles were collected and analyzed from the databases of the ResearchGate, Pubmed, and Psycnet websites, subjected to PRISMA methodology. Of these, 11 were evaluated for eligibility, but only three were included in the study because they met all inclusion criteria. The research did not confirm the expected results, showing that any kind of worsening of schizophrenic symptomatology involved the study samples. However, interesting outcomes were highlighted, such as a significant increase in general well-being during the early period of the pandemic, especially by women, or an increase in CPR (C-reactive Protein) levels in the blood, signaling an inflammatory state. Although the systematic review refuted the initial hypothesis, this must be a starting point: the topic is recent and these findings leave ample room for further investigation, particularly in long-term longitudinal research. It is possible that the true response to this disruption of daily life that occurred only during the past year may manifest itself later in time. On the other hand, interesting outcomes have been brought to light that may provide further interesting research insights.

[Consequences of the COVID-19 pandemic for people with schizophrenia, dementia and substance use disorders]

Die COVID-19(„coronavirus disease 2019“)-Pandemie stellt die Sozial- und Gesundheitssysteme weltweit vor unerwartete Herausforderungen. Die direkten und indirekten medizinischen Folgen einer Infektion mit dem neuartigen Coronavirus bringen die Versorgungssysteme vielerorts an die Grenze ihrer Leistungsfähigkeit. Die neurotropen Effekte von COVID-19 können nicht nur neurologische, sondern auch psychische Akut- und Langzeitfolgen nach sich ziehen. Im psychiatrischen Kontext sind zusätzlich die psychischen und psychosozialen Folgen von Kontaktbeschränkungen und Lockdowns sowie die Auswirkungen täglicher medialer Berichterstattung auf Menschen mit psychischen Störungen zu berücksichtigen. In diesem Beitrag werden die Konsequenzen der COVID-19-Pandemie für Menschen mit psychischen Erkrankungen, insbesondere mit Schizophrenie, Demenz und Abhängigkeitserkrankungen, erörtert.

Effect of Coronavirus Disease 2019 on the Psychology and Behavior of Patients on Methadone Maintenance Treatment in Wuhan, China: A Clinical Observational Study

Methadone maintenance treatment (MMT) is a national strategy adopted for the treatment of heroin dependency in China. The sudden outbreak of coronavirus disease 2019 (COVID-19) and the resultant social isolation in Wuhan have also had a significant negative impact on local patients undertaking MMT. In this study, 76 patients on MMT from the Wuhan First Health Clinic were selected as the research objects to investigate the effect of COVID-19 on the levels of stress, anxiety, and depression, as well as the withdrawal symptoms and craving and substance use. Our results revealed that, during the outbreak, the Perceived Stress Scale (PSS) score, HAMA score, HAMD score, and craving in the included patients was significantly higher than that at the baseline and post-epidemic (p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively); the positive rate of morphine and methamphetamine urine test was significantly lower than that the post-epidemic (p = 0.01, p < 0.01, respectively); the amount of tobacco used during the outbreak and the post-epidemic period was significantly higher than that at the baseline (p < 0.01, p < 0.01, respectively), while the amount of alcohol consumed at the outbreak was significantly higher than at the baseline and the post-epidemic (p < 0.01, p < 0.01, respectively). The negative emotions aroused by the COVID-19 outbreak and the accompanying social isolation to patients on MMT are an important factor of negative reinforcement that adversely affected the patients' craving for drugs and the consumption of legal substances. This finding suggests the need to strengthen the psychological counseling for patients on MMT during severe epidemic, actively alleviating the negative emotions, reducing the risk of substance abuse, and strengthening drug management after the epidemic to prevent the rise of substance (legal or illegal) abuse.