Impact of the COVID-19 pandemic on patients with mental health problems and the differences among diagnostic categories

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a total upending of our daily lives. While anxiety and depression were frequently reported among the general population, the pandemic's impact on patients with mental health problems remains unknown.

METHODS

A cross-sectional questionnaire survey involving 1,166 patients was conducted at one psychiatric hospital and one mental health clinic.

RESULTS

Symptom deterioration was reported in 23% to 34% of the patients and 9% to 20% reported increase in drug dosage. No significant differences were reported in these items among diagnostic categories. Patients with F3 (mood disorders) reported more psychological stress during the pandemic's beginning and during the emergency. Patients with F2 (schizophrenia, schizotypal, and delusional disorders) did online shopping and meetings less frequently, and reported poorer adherence of 3C's, while mask management was stricter in patients with F4 (neurotic, stress-related, and somatoform disorders). Symptom deterioration was significantly associated with increase in drug dosage, new physical symptoms, anxiety unrelated to COVID-19, stress at the beginning of pandemic, stress during the 'state of emergency', poor adaptability to environmental change, daily life changes, decrease in sleeping time, and decrease in time spent outside.

CONCLUSION

One third of patients reported symptom deterioration during the pandemic, which was associated with stress and daily life changes. Patients with good adaptability to environmental changes might resilient against symptom deterioration. Providing continuous support to help patients manage their daily life in this COVID-19 era may minimize the risk of symptom deterioration.

Is an isolation room harmful to patients with schizophrenia?: A biochemical study of salivary amylase

Introduction

Some patients with acute phase schizophrenia are too agitated to receive treatment in a normal hospital room. They must be isolated for the treatment. Although the stay in an isolation room seems harmful to patients, no study detailing the stress response to isolation with objective measures has been conducted.

Method

Nine patients with schizophrenia or schizoaffective disorder were recruited (mean age = 52 years, male = 3, schizophrenic = 7). At the time of evaluation, they were staying in an isolation room. To evaluate stress response to the environment, the level of salivary amylase was tested when the patients were either in the isolation room (T1) or out of the isolation room (T2). T2 was defined as one hour after the room's door was opened. The data were analyzed by the Wilcoxon rank-sum test.

Result

There is a significant difference between the median (range) levels of salivary amylase at T1 and T2 (19 [2–146] vs 44 [9–178], respectively, P = 0.021).

Discussion

The data demonstrate that the stress response at T2 was stronger than that at T1, which suggests that the isolation room environment is less stressful to the patient compared to being outside the room. An environment that has many potential stimuli, such as the presence of other patients and a television in the lobby, may be harmful to patients with acute phase schizophrenia. Therefore, although the isolation room is apparently harmful, it could, in fact, have a positive effect on patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

EMP2 regulates angiogenesis in endometrial cancer cells through induction of VEGF

Understanding tumor-induced angiogenesis is a challenging problem with important consequences for the diagnosis and treatment of cancer. In this study, we define a novel function for epithelial membrane protein-2 (EMP2) in the control of angiogenesis. EMP2 functions as an oncogene in endometrial cancer, and its expression has been linked to decreased survival. Using endometrial cancer xenografts, modulation of EMP2 expression resulted in profound changes to the tumor microvasculature. Under hypoxic conditions, upregulation of EMP2 promoted vascular endothelial growth factors (VEGF) expression through a HIF-1α-dependent pathway and resulted in successful capillary-like tube formation. In contrast, reduction of EMP2 correlated with reduced HIF-1α and VEGF expression with the net consequence of poorly vascularized tumors in vivo. We have previously shown that targeting of EMP2 using diabodies in endometrial cancer resulted in a reduction of tumor load, and since then we have constructed a fully human EMP2 IgG1. Treatment of endometrial cancer cells with EMP2-IgG1 reduced tumor load with a significant improvement in survival. These results support the role of EMP2 in the control of the tumor microenvironment and confirm the cytotoxic effects observed by EMP2 treatment in vivo.