Management of psychiatric conditions and delirium during the COVID-19 pandemic across continents: lessons learned and recommendations (original) (raw)
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The International Journal of Psychiatry in Medicine
Background There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. Objective We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. Methods We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. Results We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. Conclusions Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reducti...
Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19
2021
The outbreak of coronavirus disease (COVID-19) in December 2019 has led to massive lifestyle, economic, and health changes. The COVID-19 pandemic has had broad impacts on psychiatric patients, exacerbating symptoms such as psychosis, depression, and suicidal ideation. Therefore, we aimed to review the psychological impacts of COVID-19 on psychiatric patients and mental healthcare staff and provide practical guidance for medical staff and authorities. The main findings of this review included the impacts of COVID-19 on psychiatric patients and mental health professionals as well as the transformation of mental health care. Greater consideration should be given to the care of patients with psychosis and depression because of their lack of self-care ability, neurocognitive impairment, and impaired immune function. Depressive symptoms can be exacerbated due to several factors, such as economic crises, social isolation, and limited physical activity. Unemployment and financial problems c...
The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients
Pakistan Journal of Medical Sciences
COVID-19 is a viral infection that has multisystemic physical and psychological complications. The following paper looks at the various challenges seen while treating psychiatric patients during the COVID pandemic. There is a need for physician to be aware of the drug interactions between psychiatric medications and the medications used routinely in the management of COVID. There is also the concern of psychiatric side effects of medications used to manage COVID and medical complications caused by some side effects of psychiatric drugs. The telepsychiatry and telemedicine paradigm has made it mandatory for physicians to be vigilant of the same. doi: https://doi.org/10.12669/pjms.36.5.3073 How to cite this:Javed A, Mohandas E, De-Sousa A. The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.3073 This is an Open Access article distributed under the terms of the Creative...
Journal of Affective Disorders, 2020
Background: : The management of coronavirus disease 2019 (COVID-19) in patients with comorbid psychiatric disorders poses several challenges, especially regarding drug interactions. Methods: : We report three representative case-scenarios on patients with psychiatric disorders and COVID-19 to provide a practical approach based on the existing literature and the clinical experience of an expert team in consultation-liaison psychiatry. Case-centered recommendations: : Psychopharmacological ongoing treatments should be prioritized and most doses should be reduced 25-50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion, and methadone. If the psychopharmacological usual doses are in the low-to-median range levels, a dose change during COVID-19 drugs co-administration is not recommended, but only ECG and clinical monitoring of adverse effects and drug levels if required. Furthermore, when introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present. (A) In agitated delirium, olanzapine is recommended as first-line antipsychotic and quetiapine should be avoided. (B) In severe mental illness (SMI), essential treatments should be maintained. (C) In non-SMI with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated. Limitations: : Most recommendations on pharmacological interactions provide only a limited qualitative approach and quantitative recommendations are lacking. Conclusions: : Patients with psychiatric disorders and COVID-19 should be managed on a personalized basis considering several clinical criteria and, should not be excluded from receiving COVID-19 treatments. Risks of pharmacological interaction are not absolute and should be contextualized, and most psychopharmacological treatments should include an ECG with special attention to QTc interval.
Psychiatric Manifestations in COVID-19 Patients Presenting to a Tertiary Care Center: A Case Series
Indian Journal of Private Psychiatry
Coronavirus disease-2019 (COVID-19) pandemic has emerged as a public health emergency and has led to economic, occupational, and social disruption. Along with physical illness, it is also associated with disruption of mental health. In this case series, we have presented six different case reports of persons with COVID-19 illness, who presented to or were referred to the psychiatric assessment. These include panic disorder, mania, depressive episode, acute psychosis, delirium, and organic catatonia.
Psychiatric Quarterly, 2021
The Coronavirus Disease 2019 (COVID-19) can affect mental health in different ways. There is little research about psychiatric complications in hospitalized patients with COVID-19. The aim of the study was to describe the psychiatric clinical profile and pharmacological interactions in COVID-19 inpatients referred to a Consultation-Liaison Psychiatry (CLP) unit. This is a cross-sectional study, carried out at a tertiary hospital in Spain, in inpatients admitted because of COVID-19 and referred to our CLP Unit from March 17,2020 to April 28,2020. Clinical data were extracted from electronic medical records. The patients were divided in three groups depending on psychiatric diagnosis: delirium, severe mental illness (SMI) and non-severe mental illness (NSMI). Of 71 patients included (median [ICR] age 64 [54-73] years; 70.4% male), 35.2% had a delirium, 18.3% had a SMI, and 46.5% had a NSMI. Compared to patients with delirium and NSMI, patients with SMI were younger, more likely to be institutionalized and were administered less anti-COVID19 drugs. Mortality was higher among patients with delirium (21.7%) than those with SMI (0%) or NSMI (9.45%). The rate of side effects due to interactions between anti-COVID19 and psychiatric drugs was low, mainly drowsiness (4.3%) and borderline QTc prolongation (1.5%). Patients affected by SMI were more often undertreated for COVID-19. However, the rate of interactions was very low, and avoidable with a proper evaluation and drug-dose adjustment. Half of the patients with SMI were institutionalized, suggesting that living conditions in residential facilities could make them more vulnerable to infection.
Revista Colombiana de PsiquiatrÃa (English ed.)
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. r e v c o l o m b p s i q u i a t. 2 0 2 2;5 1(3):245-255
Psychiatric comorbidity in clinically stable COVID-19 patients
Indian Journal of Psychiatry, 2022
reported its first case in Kerala and thereafter, the reported cases have increased steadily to reach around 800000 cases, across the country as of July 11, 2020. This infection has spread now in almost every part of India. [2] The COVID 19 pandemic worldwide represents a dangerous and potentially traumatic event and it can be regarded as a mental health catastrophe. [3] Corona virus infection can affect the brain resulting in some neurological and psychiatric symptoms including a headache, dizziness, psychotic symptoms, PTSD, anosmia, altered sensorium, impaired consciousness, confusion and/or delirium. With the increasing number of cases, COVID-19 patients are facing several challenges including the stigma and discrimination. Furthermore, in the current situation, it seems that in COVID-19 sufferers, Departments of Psychiatry,