Consultation-Liaison Psychiatry During COVID-19 Lockdown: A Retrospective Chart Review

The impact of the second wave of COVID-19 on liaison psychiatry: a comparative retrospective study with the homologous non-pandemic period

OBJECTIVE

To determine the impact of COVID-19 pandemic (COVID-19-P) on clinical and health organisational variables of patients evaluated by Liaison Psychiatry (LP).

METHODS

Revision of all collaboration requests (CR) to LP for patients hospitalised in a Portuguese General Hospital during the second wave of COVID-19-P, from 1 October to 31 December of 2020. Medical charts were analysed and selected variables were compared with those of the homologous non-pandemic period. Data were statistically analysed.

RESULTS

There was a 22.3% decrease in the number of CR in 2020. The most frequently given reasons for CR were depressive symptoms, psychomotor agitation, and difficulties in adapting to the disease in both years. However, 5.9% more patients reported suicidal ideation in 2020. The hospitalisation length before CR was smaller in 2020 than in 2019 (9 vs 11). There was a higher proportion of patients followed in a psychiatric consultation and previously taking psychotropic medication before hospitalisation in 2020 than in 2019. After the assessment, the trend was that both groups did not meet diagnostic criteria for any disorder and no pharmacological adjustment was needed.

CONCLUSION

This study highlights the need to better characterise the indirect repercussion of COVID-19-P, and focus on the prevention and treatment of mental illness particularly in adverse contexts.Key PointsFewer collaboration requests to liaison psychiatry during the second wave of COVID-19;Collaboration requests were made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and psychotropic medication;Most because of depressive symptoms and more with suicidal ideation;Fewer collaboration requests to liaison psychiatry during COVID-19;Made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and medication;Most because of depressive symptoms and more with suicidal ideation.

Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review

There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.

Suicidal Behavior in the First Wave of the COVID-19 Pandemic

PURPOSE OF REVIEW

Since the declaration of the COVID-19 pandemic, there have been numerous social changes to try to ​​contain the spread of the disease. These sudden changes in daily life have also changed the way we relate to others, in addition to creating a climate of uncertainty and fear. Therefore, the objective of this review is to compile published data of the consequences of suicidal behavior in the first months from the onset of the pandemic.

RECENT FINDINGS

The analysis reflects a concern about issues related to suicide since the beginning of the pandemic. A large number of online surveys have been released and have provided data on relatively large populations. The percentage of the population with suicidal ideation in that period seems to be approximately 5-15%. Many studies associate suicidal ideation with being young, female, and presence of sleep problems. Surveys of healthcare workers do not seem to indicate a higher prevalence of suicidal ideation compared to the general population. The incidence of suicide attempts seen in emergency departments did not seem to change, while the number of visits for other issues, unrelated to suicide, did decrease. The few studies on completed suicide do not indicate an increase in incidence in these first 6 months since March 2020, when the WHO declared the start of the pandemic. It does not seem that there have been major changes in the figures related to suicidal behavior in the studies from the first wave of the COVID-19 pandemic, although it is still too early to know the consequences it will have long term. The social and economic damages resulting from the pandemic will certainly take a long time to recover.

Emerging Psychiatric Themes in Post-COVID-19 Patients on a Psychiatry Consultation-liaison Service

The need for consultation-liaison psychiatry on COVID-19 wards has substantially increased since the start of the pandemic. In this cross-sectional study, we aimed to summarize the characteristics of patients admitted to the post-COVID-19 ward of the American University of Beirut Medical Center who received a psychiatric consultation. We collected relevant sociodemographic and medical data, information about past psychiatric history, psychiatry consultation details, hospital course, and disposition outcome. We also conducted chi-square and binary logistic regression analyses to assess the association between the different variables and disposition outcome. A total of 52 patients (mean age 57.33 years; equal gender distribution) were seen by the psychiatry consult-liaison team. Most had medical comorbidities and 21.2% required intubation. The most prevalent psychiatric diagnoses were delirium (30.8%), major depressive episode (15.4%), and other anxiety disorder (15.4%). Pharmacological management was implemented in 90.4% of cases and mainly included second-generation antipsychotics (36.5%). Non-pharmacological interventions consisted of those related to delirium and therapy for anxiety. Only intubation was significantly associated with disposition outcome (p = 0.004). This study highlights the various psychiatric themes emerging during the acute and post-acute periods of hospitalization for COVID-19. Hospitalized individuals recovering from the infection should be diligently screened and referred to the psychiatry consultation-liaison team to ensure the implementation of appropriate interventions.