Tele-Psychiatry Assessment of Post-traumatic Stress Symptoms in 100 Patients With Bipolar Disorder During the COVID-19 Pandemic Social-Distancing Measures in Italy

Longitudinal trajectories of anxiety and depression in subjects with different mental disorders after one year in the COVID-19 pandemic

The aim of this study was to prospectively assess the development and trajectories of anxiety and depressive symptoms among subjects with different mental disorders, during the 3rd wave of the COVID-19 pandemic (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A sample of 527 subjects, with different DSM-5 diagnoses, was enrolled at nine Italian psychiatric outpatient services. Assessments at T0 and T1 included the Generalized Anxiety Disorder 7-Item (GAD-7) for anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Differences in anxiety and depressive symptoms rates emerged across different mental disorders and a general improvement at T1 was detected for all of them in both the GAD-7 and PHQ-9 scores, except for Psychosis and Obsessive-Compulsive Disorder (OCD). Patients with Feeding and Eating Disorders (FED) reported statistically significantly higher: GAD-7 scores than those with Bipolar Disorder (BD), at both times, and Anxiety Disorders at baseline; PHQ-9 scores than all other diagnostic categories, at both times. Unemployment, no COVID-19 infection, OCD were predictive variables related to GAD-7 scores at T1, while being unmarried, BD or FED related to PHQ-9 scores at T1. Subjects with mental disorders reported anxiety and depressive symptoms during the third pandemic wave and most of patients showed an improvement over a 3-month follow-up, despite differences emerged among diagnostic categories and for the variables involved. Further studies are needed to deepen knowledge on pandemic impact on patients with mental disorders.

Tele-mental health during the COVID-19 pandemic: A systematic review of the literature focused on technical aspects and challenges

Introduction

Mental disorders are the leading cause of disability and the second leading cause of death worldwide, which leads to the death of more than 9 million people annually. The global impact of the Coronavirus epidemic on mental health includes insomnia, anxiety, and depression. Therefore, given the current situation, innovations such as telemedicine to provide prevention and treatment services for people with mental disorders seem necessary.

Methods

A literature review was performed according to the preferred items to report in systematic reviews and meta-analyses (PRISMA). Covering a period from January 2020 to July 2023, we conducted a systematic literature search on five electronic databases (PubMed-Mesh, Scopus, Web of Science, Science direct, and PsycInfo). The search strategy included three categories of keywords: Mental health, Tele, COVID-19.

Results

A total of 112 articles were identified by searching the databases of published articles, 13 articles met our inclusion criteria. A total of 76.2% of them were related to patients with stress, anxiety, and depression issues. We found that the real-time method has been the most common method used to communicate between the physician and the patient (92.3%). The communication technologies used also included telephone, video call, video conference, and E-mail. During these communications, data was exchanged in text, voice, and video formats. In three studies (27%), interoperability with other systems was mentioned. In addition, 69.2% of the studies reported challenges, the most important of which were access to electronic and communication devices, network connection problems, audio and video problems, and privacy issues.

Conclusions

Considering the many advantages of telemedicine technology in the field of mental health, the need to use this technology in developing countries, including our country, is obvious. But the application of these technologies requires the investigation of technical aspects and challenges related to them as much as possible, which have been seen in few studies.

PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: a naturalistic, longitudinal, multicenter study

The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.

Pandemic experiences and psychopathological aspects in individuals with mood disorders and other mental disorders

Individuals with different personality traits, temperaments, and psychological symptoms have different attitudes toward the pandemic experiences and restrictive measures. The aim of the present study was to evaluate the associations between the psychological factors and the attitudes toward COVID-19, experienced during the third pandemic wave in Italy, in a sample of individuals with psychiatric disorders. Between March and September 2021, 53 patients with mood disorders and other mental disorders completed a survey composed of self-report questionnaires that assessed sleep quality, depressive and hypomanic symptoms, and temperament and personality traits. Positive and negative attitudes toward the pandemic experience were assessed using an ad hoc questionnaire. The results showed that individuals with more severe depressive symptoms were less prone to adhere to government guidelines, and were more convinced that the pandemic was not a real problem. Reduced sleep quality was associated with increased skepticism toward official explanations concerning the causes of COVID-19. Lastly, negative affect and cyclothymic temperament predicted the disposition toward COVID-19 vaccines. In conclusion, these findings highlighted that some psychological aspects and psychiatric symptoms could influence the beliefs about COVID-19 and compliance with government recommendations. Further research is needed to provide indications on how to improve the current healthcare policies.

Symptom severity and well-being of patients with mental illness during the COVID-19 pandemic: a two-wave survey

PURPOSE OF THE ARTICLE

To examine changes in symptom severity and well-being during the coronavirus disease 2019 (COVID-19) pandemic among individuals with pre-existing mental illness.

MATERIALS AND METHODS

In February 2021, we conducted a follow-up questionnaire-based survey among adults with mental illness, who responded to a similar survey on mental health in June 2020. The participants completed the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in mental health using the pre-pandemic period as reference. The survey data were merged with sociodemographic and clinical data from the medical records of all invitees to the first survey, enabling analysis of attrition and weighting of the results.

RESULTS

A total of 613 of 992 (62%) invitees participated in the follow-up wave of the survey. The weighted mean WHO-5 and BSI-18 scores were 38 and 27, respectively, and did not differ statistically significantly from the first wave. Multivariate logistic regression showed that having a vocational education (skilled worker/craftsman) was positively associated with reporting deterioration in psychological well-being (OR: 2.95, 95%CI: 1.14-7.81), while being unemployed was negatively associated with reporting deterioration in psychological well-being (OR: 0.20, 95%CI: 0.07-0.56) from the first to the second survey wave. The most common reason for self-reported deterioration in mental health was loneliness (70%).

CONCLUSIONS

Approximately one year into the COVID-19 pandemic, the level of symptoms remained high, whereas the level of psychological well-being remained low among patients with mental illness.

Intimate Relationships during COVID-19 across the Genders: An Examination of the Interactions of Digital Dating, Sexual Behavior, and Mental Health

The COVID-19 pandemic has resulted in economic hardship, psychological stress, anxiety, and depression in a significant proportion of the global population. However, the bidirectional effects of social isolation and pre-existing or developed psychological stress could inform sexual behaviors and affect digital dating outcomes. Additionally, it is unknown whether intimate behaviors and relationships have been equally affected across the genders during the COVID-19 pandemic. The purpose of this study is to contrast the course of intimate relationships pre-and post-COVID-19, with a focus on diverse genders, digital dating, mental health, and behavior. A review of the dating landscape during COVID-19 is developed in this study, encompassing themes including diverse genders, sexual orientation, demographic characteristics, sexual behavior, the state of psychological wellbeing, and interactions with digital dating apps. The authors reviewed the trends and challenges of digital romance. Dating before and during the pandemic is explored, discussing how COVID-19 experiences may inform future romantic partnerships. Mobile dating applications saw a surge in downloads and usage across popular platforms, including Tinder (3 billion swipes in March 2020) and Ok Cupid (700% increase in dates), with the top 20 dating apps gaining 1.5 million daily users. Cross-sectionally, being younger, single, and having higher levels of stress was a predictor of higher dating-app usage during the COVID-19 lockdowns. Risky sexual behavior and having multiple sexual partners were reduced during social distancing as there was an increased worry of contracting the virus. Heightened incidents of domestic/intimate partner abuse have caught the headlines in several countries. COVID-19 during lockdown has also posed barriers to accessing support and help from sexual and mental health services.

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.

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.

Pharmacological Treatment of Acute Psychiatric Symptoms in COVID-19 Patients: A Systematic Review and a Case Series

Delirium and psychomotor agitation are relevant clinical conditions that may develop during COVID-19 infection, especially in intensive care unit (ICU) settings. The psychopharmacological management of these conditions is receiving increasing interest in psychiatry, considering hyperkinetic delirium as one of the most common neuropsychiatries acute consequences in COVID-19 recovery patients. However, there are no actual internationally validated guidelines about this topic, due to the relatively newly introduced clinical condition; in addition, a standardized psychopharmacologic treatment of these cases is a complex goal to achieve due to the risk of both drug-drug interactions and the vulnerable conditions of those patients. The aim of this systematic review and case series is to evaluate and gather the scientific evidence on pharmacologic handling during delirium in COVID-19 patients to provide practical recommendations on the optimal management of psychotropic medication in these kinds of patients. The electronic databases PubMed, Embase and Web of Science were reviewed to identify studies, in accordance with the PRISMA guidelines. At the end of the selection process, a total of 21 studies (n = 2063) were included. We also collected a case series of acute psychomotor agitation in COVID-19 patients hospitalized in ICU. Our results showed how the symptom-based choice of the psychotropic medication is crucial, and even most of the psychotropic drug classes showed good safety, one must not underestimate the possible drug interactions and also the possible decrease in vital functions which need to be strictly monitored especially during treatment with some kinds of molecules. We believe that the evidence-based recommendations highlighted in the present research will enhance the current knowledge and could provide better management of these patients.

The interplay between acute post-traumatic stress, depressive and anxiety symptoms on healthcare workers functioning during the COVID-19 emergency: A multicenter study comparing regions with increasing pandemic incidence

BACKGROUND

Healthcare workers (HCWs) deployed to the frontline during the COVID-19 pandemic are at risk for developing mental disorders, with a possible impact on their wellbeing and functioning. The present study aimed at investigating post-traumatic stress symptoms (PTSS), anxiety and depressive symptoms and their relationships with impairment in the functioning impairment among frontline HCWs from three Italian regions differently exposed to the first wave of the COVID-19 emergency: Tuscany (low), Emilia-Romagna (medium) and Lombardy (high).

METHODS

514 frontline HCWs were consecutively enrolled in hospital units devoted to the treatment of COVID-19 patients. They completed the IES-R, PHQ-9 and GAD-7 to assess PTSS, depressive and anxiety symptoms respectively, and the WSAS to investigate functioning impairment.

RESULTS

A total of 23.5% of HCWs reported severe PTSS, 22.4% moderate-severe anxiety symptoms, 19.3% moderate-severe depressive symptoms and 22.8% impairment in global functioning. HCWs from the higher-exposure regions reported significantly higher scores in all instruments than those from lower-exposure regions. In a multiple linear regression model, PTSS, depressive and anxiety symptoms presented a significant positive association with the functioning impairment. Both PTSS and depression resulted to be independently related to functioning impairment.

LIMITATIONS

The cross-sectional design and the use of self-report instruments.

CONCLUSIONS

Depressive and PTSS appear to be the greatest contributors to functioning impairment in HCWs exposed to a massive stressful sanitary event as the COVID-19 pandemic. A more accurate assessment of work-related mental health outcomes in such population could help planning effective prevention strategies and therapeutic interventions.

A longitudinal study of post-traumatic stress, depressive and anxiety symptoms trajectories in subjects with Bipolar Disorder during the COVID-19 pandemic

Background

Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset.

Methods

A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points.

Results

We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one.

Conclusions

Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample

BACKGROUND

Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II.

OBJECTIVE

(1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse.

METHODS

This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (https://clinicaltrials.gov; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes.

RESULTS

The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity.

CONCLUSION

Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients.

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.

Gender and occupational role differences in work-related post-traumatic stress symptoms, burnout and global functioning in emergency healthcare workers

OBJECTIVES

To explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers.

DESIGN

A cross-sectional study.

PARTICIPANTS/SETTING

126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited.

MAIN OUTCOME MEASURES

Participants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning.

RESULTS

The present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015).

CONCLUSION

Our results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.

Implications of the COVID-19 pandemic for people with bipolar disorders: A scoping review

INTRODUCTION

The COVID-19 (coronavirus disease 2019)-related pandemic represents a global source of societal and health burden. Yet, the impact of the pandemic on people with severe mental illness, including bipolar disorder (BD), remains unclear, warranting scoping review on the matter.

METHODS

The MEDLINE and EMBASE databases were systematically searched from inception up to April 24, 2021, adopting broad inclusion criteria to assess a variety of clinical and public health themes related to people with a primary diagnosis of BD during the COVID-19 pandemics. The present work complying with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) registered in the Open Science Framework (OSF) repository (https://osf.io/7evpx/).

RESULTS

Fourteen papers informed the present scoping review. Four major themes were identified: (i) impact of COVID-19-related stressors on BD; (ii) impact of COVID-19 on mental health service utilization among people with BD; (iii) impact of BD on the risk of acquiring SARS-CoV-2 infection; (iv) engagement in preventative behaviors among people with BD. Additional themes warranting further research were nonetheless detected.

LIMITATIONS

Further original studies are needed.

CONCLUSION

The present study confirmed the high-vulnerability hypothesis concerning people with BD versus the general population, reinforcing the need for further research related to the COVID-19 pandemic. Additional information is warranted to compare the impact of the pandemic period among BD people against pre-pandemic records, the general population, and other severe mental illnesses, namely people with schizophrenia or major depressive disorder, to inform the public health and the delivery of patient-tailored interventions.

An Italy-China Collaboration for Promoting Public Mental Health Recommendations During the COVID-19 Pandemic

The rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergency involved Italy as the first European country. Meanwhile, China was the only other country to experience the emergency scenario, implementing public health recommendations and raising concerns about the mental health of the population. The Italian National Institute of Health [Istituto Superiore di Sanità (ISS)] reviewed relevant scientific literature in mental health to evaluate the best clinical practices and established the collaboration with the WHO, World Psychiatry Association, and China to support the public health system in a phase of acute emergency. This process permitted the definition of organizational and practical-operational Italian guidelines for the protection of the well-being of healthcare workers. These guidelines have been extensively disseminated within the Italian territory for maximum stakeholder utilization.

Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation

BACKGROUND

The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group.

METHODS

An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2).

RESULTS

At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients.

CONCLUSIONS

There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.

A mediating role for mental health in associations between COVID-19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19

INTRODUCTION

Patients with COVID-19 often suffer from psychological problems such as post-traumatic stress disorder (PTSD) and self-stigmatization that may negatively impact their quality of life and sleep. This study examined mental health as a potential mediating factor linking self-stigmatization and PTSD to quality of life and sleep.

METHODS

Using a cross-sectional design, 844 people who had recovered from COVID-19 were called and interviewed. Data were collected using structured scales. Structural equation modeling was applied to assess fitness of a mediation model including self-stigma and PTSD as independent factors and quality of life and insomnia as dependent variables.

RESULTS

Mental health, COVID-19-related self-stigma, and mental quality of life were associated. Insomnia, PTSD, and COVID-19-related self-stigma displayed significant direct associations (r = .334 to 0.454; p < .01). A mediation model indicated satisfactory goodness of fit (CFI = 0.968, TLI = 0.950, SRMR = 0.071, RMSEA = 0.068). Mental health as a mediator had negative relationships with COVID-19-related self-stigma, PTSD, and insomnia and positive associations with quality of life.

CONCLUSION

Mental health may mediate effects of COVID-19-related self-stigma and PTSD on quality of life and insomnia. Designing programs to improve mental health among patients with COVID-19 may include efforts to reduce negative effects of PTSD and COVID-19-related self-stigma on quality of life and insomnia.

Increases in distress during stay-at-home mandates During the COVID-19 pandemic: A longitudinal study

The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 500,000 deaths, and hospitalization of thousands of individuals worldwide. Cross-sectional data indicate that anxiety and depression levels are greater during the pandemic, yet no known prospective studies have tested this assertion. Further, individuals with elevated trait anxiety prior to a global pandemic may theoretically be more apt to experience greater pandemic-related anxiety and/or impairment. The current study tested whether anxiety and depression increased from the month before the state's Stay-At-Home order to the period of the Stay-At-Home order among 120 young adults in Louisiana, a state with especially high rates of COVID-19 related infections and deaths. We also tested whether pre-pandemic social anxiety was related to greater pandemic related anxiety, depression, and COVID-related worry and impairment. Depression but not anxiety increased during the Stay-At-Home order. Further, pre-pandemic trait anxiety, social anxiety, and depression were statistically significant predictors of anxiety and depression during the Stay-At-Home order, although only social anxiety was robustly related to COVID-related worry and impairment. Emotional distress increased during the COVID-19 pandemic Stay-At-Home order and this is especially the case among individuals with pre-pandemic elevations in trait anxiety (especially social anxiety) and depression.

Negative Appraisals of the COVID-19 Social Impact Associated With the Improvement of Depression and Anxiety in Patients After COVID-19 Recovery

Objective: Little is known about the factors affecting the recovery of mental health in COVID-19 patients. The purpose of this study is to look into the change of psychological distress and to explore the role of negative appraisals in the improvement of psychological distress in COVID-19 patients after they recovered from the infection. Methods: We conducted a longitudinal survey on patients with COVID-19 infection in Changsha. The 9-item Patient Health scale, the 7-item Generalized Anxiety Disorder scale, and a newly developed measure, the COVID-19 Impact Scale (CIS) were applied to assess patients' depression, anxiety, and negative appraisal toward COVID-19 infection during their hospitalization and 1 month post-discharge. Results: Seventy-two patients were included in the analysis. A significant decrease in anxiety and depression levels was observed after patients were discharged from hospital. Two meaningful factors of the CIS were extracted based on factor analysis, namely "health impact," and "social impact." The change of social impact explained the 12.7 and 10.5% variance in the depression and anxiety symptom improvement, respectively. Conclusions: Change in negative appraisals, especially the appraisals related to COVID-19 social impact may play a vital role in the relief of psychological distress of infected patients. Therefore, a cognitive and social care perspective might be considered when promoting the mental health recovery and readjustment to society among COVID-19 patients.

Mental Symptoms and Stress of Hospitalized Schizophrenia Patients With 2019 Novel Coronavirus Disease: An Observation Study

Background: The 2019 novel coronavirus disease (COVID-19) is an extremely rapidly spreading respiratory infection caused by SARS-CoV-2. Many schizophrenic patients were infected with COVID-19 in Wuhan City, Hubei Province. This study took hospitalized schizophrenia patients with COVID-19 as the research subjects and observed the changes in psychopathology and stress of patients with COVID-19 and the accompanying social isolation. Methods: To sort and isolate potential COVID-19-infected patients, an isolated ward was set up from January 30, 2020, to March 30, 2020. Schizophrenia patients with COVID-19 were referred to this ward, and long-term hospitalized cases were included in this study. The Positive and Negative Syndrome Scale and Perceived Stress Scale were used to evaluate the severity of mental symptoms and psychological stress in the early stage of the outbreak of COVID-19, after the diagnosis of COVID-19 and after recovery. At the time of diagnosis, we also extracted the patient's routine blood, biochemical and other indicators and asked the patient's perception of COVID-19. Results: 21 hospitalized schizophrenia patients with COVID-19 were recruited in this study. The changes in PANSS scores were not significant (p = 0.225 baseline vs. diagnosed, p = 0.399 cured vs. diagnosed). The CPSS scores increased significantly after diagnosis and transfer to the isolation ward (p < 0.001 baseline vs. diagnosed, p < 0.001 cured vs. diagnosed). The course of schizophrenia was a protective factor of stress levels to cases (t = -3.25, p = 0.006), and patients' perception of COVID-19 was a risk factor (t = 2.48, p = 0.038). The final multiple linear regression model was statistically significant (F = 8.16, p < 0.001). Conclusion: Hospitalized schizophrenia patients with COVID-19 had increased stress levels and negative symptoms but alleviated positive symptoms after medical isolated treatment. This reminds us that in the face of major epidemics, we must specifically alleviate the psychological burden at the peak of the epidemic and improve the prognosis of patients after the epidemic.

Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study

BACKGROUND

The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population.

AIM

To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.

METHODS

This monocentric observational study preliminarily collected variables of the urgent psychiatric consultations (UPCs) carried out in emergency room (ER) from 1-3-2020 to 31-8-2020 and the socio-demographic and clinical characteristics of patients who required UPCs in the 6-month period, comparing these data with those collected from 1-3-2019 to 31-8-2019. The data, collected in alpha-numeric code, were statistically analyzed through STATA 12-2011.

RESULTS

This research reported a reduction of both UPCs and hospital psychiatric admissions. Concomitantly, we observed an increase of UPCs required by people already being treated by psychiatric and other health services, residents in psychiatric facilities and non-Italians. In 2020, differently from 2019, the most frequent reasons for urgent psychiatric consultations were aggressive behavior and adjustment disorders with anxiety and depressive mood.

CONCLUSION

This preliminary study suggests that, during the COVID-19 epidemic, urgent psychiatric consultations in ER were reduced, except for the most vulnerable people due to their clinical and/or social conditions.