Spanish flu and mental disorders in the Margraviate of Istria at the end of WWI

This paper seeks to provide a brief overview of epidemics and pandemics in Irish history and to identify any lessons that might be useful in relation to psychiatry in the context of COVID-19. A review of selected key reports, papers and publications related to epidemics and pandemics in Irish history was conducted. Viruses, epidemics and pandemics are recurring features of human history. Early Irish sources record a broad array of plagues, pandemics and epidemics including bubonic plague, typhus, cholera, dysentery and smallpox, as well as an alleged epidemic of insanity in the 19th century (that never truly occurred). Like the Spanish flu pandemic (1918-20), COVID-19 (a new coronavirus) presents both the challenge of the illness itself and the problems caused by the anxiety that the virus triggers. Managing this anxiety has always been a challenge, especially with the Spanish flu. People with mental illness had particularly poor outcomes with the Spanish flu, often related to the large, unhygienic mental hospitals in which so many were housed. Even today, a full century after the Spanish flu pandemic, people with mental illness remain at increased risk of poor physical health, so it is imperative that multi-disciplinary care continues during the current outbreak of COVID-19, despite the manifest difficulties involved. The histories of previous epidemics and pandemics clearly demonstrate that good communication and solidarity matter, now more than ever, especially for people with mental illness.

Pandemics have occurred throughout the decades. The last pandemic was the Spanish flu pandemic in 1918, which infected 500 million people and caused death to as many as 100 million people worldwide. At present, a similar situation is occurring as coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, has infected a few million people worldwide and has been declared a pandemic by the World Health Organization in March 2020. There are various mental health responses in pandemic outbreaks. People’s thought process, behavior, and emotional response to an outbreak vary greatly according to their own backgrounds and the community that they live in. For some people, the misinformation, uncertainty, and fear of contagion may increase stress and anxiety, which can induce mass panic. Mental health education and psychological support from all stakeholders, such as the government, health professionals, and the community, may be valuable during a pandemic.

This Article seeks to give an overview of how the pandemic has affected society throughout this period, which can be a source of many mental health problems. As in the Spanish influenza pandemic, the COVID-19 pandemic and the imposition of measures of social separation, isolation and limitation of contact with other people were, and are still, a major stress factor. The stress associated with this period disrupted the functioning of people both individually and socially, being the main factor of the phenomenon called compensation. Under the current circumstances, people have a predisposition for emotional disorders such as: Anxiety, depression, stress, insomnia, anger, Emotional depletion and including post-traumatic symptoms of disorder, according to recent studies by the Lancet analyzing the psychological effects of quarantine. The COVID-19 crisis has a wide range of effects on our mental and emotional health: From negative emotions with greater intensity and duration, such as anxiety and depression, to unfinished emotional mourning, linked both to the loss of loved ones and even to emotional and relational disconnection. Also, all that has happened in recent times makes us live in “collective pain” , we have lost our right to travel without restrictions or the freedom to participate in sad events or family and community joy, we have lost family or friends. In many cases of these losses, the strands of the dollar are also being cut, which is why people need additional support. We need to find solutions to this, because we have to deal with the natural grief caused by human disappearance, as we know it, but also an isolation characteristic of the suffering process that now overlaps the physical isolation imposed by the epidemic. Another important aspect is to prevent instability in the psycho-social element of the human Community. It is clear that there is a need to impose safety measures both jointly and individually. Psychological aspects should be addressed early, so that measures can be taken to reduce the psychological costs of pandemic, perceived isolation and to address uncertainties that can give rise to anxiety and depression. Addressing psychological issues has effects not only in the short term, motivating adherence to pandemic measures, but also in the long term, through lower incidence of post-traumatic stress, anxiety, depression, substance abuse, etc. The fastest change expected after this crisis will be the individual one, each crisis is a chance for every person to look further.

Notes on Contributors

The first cases of a new coronavirus (SARS-CoV-2) were identified toward the end of 2019 in Wuhan, China. Over the following months, this virus spread to everywhere in the world. By now no country has been spared the devastation from the loss of lives from the disease (Covid-19) and the economic and social impacts of responses to mitigate the impact of the virus. Our lives in South Africa have been turned upside down as we try to make the best of this bad situation. The 2020 school year was disrupted with closure and then reopening in a phased approach, as stipulated by the Department of Education. This booklet is a collective effort by academics who are Members of the Academy of Science of South Africa (ASSAf) and other invited scholars to help you appreciate some of the basic scientific facts that you need to know in order to understand the present crisis and the various options available to respond to it. We emphasise that the threat of infectious diseases is not an entirely new phenomenon that has sprung onto the stage out of nowhere. Infectious diseases and pandemics have been with us for centuries, in fact much longer. Scientists have warned us for years of the need to prepare for the next pandemic. Progress in medicine in the course of the 20th century has been formidable. Childhood mortality has greatly decreased almost everywhere in the world, thanks mainly, but not only, to the many vaccines that have been developed. Effective drugs now exist for many deadly diseases for which there were once no cures. For many of us, this progress has generated a false sense of security. It has caused us to believe that the likes of the 1918 ‘Spanish flu’ pandemic, which caused some 50 million deaths around the world within a span of a few months, could not be repeated in some form in today’s modern world. The Covid-19 pandemic reminds us that as new cures for old diseases are discovered, new diseases come along for which we are unprepared. And every hundred or so years one of these diseases wreaks havoc on the world and interferes severely with our usual ways of going about our lives. Today’s world has become increasingly interconnected and interdependent, through trade, migrations, and rapid air travel. This globalisation makes it easier for epidemics to spread, somewhat offsetting the power of modern medicine. In this booklet we have endeavoured to provide an historical perspective, and to enrich your knowledge with some of the basics of medicine, viruses, and epidemiology. Beyond the immediate Covid-19 crisis, South Africa faces a number of other major health challenges: highly unequal access to quality healthcare, widespread tuberculosis, HIV infection causing AIDS, a high prevalence of mental illness, and a low life expectancy, compared to what is possible with today’s medicine. It is essential that you, as young people, also learn about the nature of these new challenges, so that you may contribute to finding future solutions.

COVID-19 Catatonia—Would We Even Know?

COVID-19 is a new infectious disease and as such we are faced with uncertainties in its course and treatment. Modern methods of containing pandemics are more behavioral and educational – psychological factors play a role in their success. Previous pandemics such as the Spanish flu, the swine flu and SARS have had effects on mental stress and disorders. Personality characteristics give a clearer look at vulnerability to stressors – people with high scores of negative emotionality (neuroticism) will face serious difficulties during pandemics. The different personality traits are relevant to our understanding of pandemic-related anxieties and sufferings, and the psychological effect of pandemics may be more pronounced, more widespread, and more lasting than the pure somatic effect of the infection.

Early-life factors may be important for later dementia risk. The association between a more advantaged early-life environment, as reflected through an individual's height and socioeconomic status indicators, and decreases in dementia incidence by birth cohort is unknown. To examine the association of birth cohort and early-life environment with dementia incidence among participants in the Adult Changes in Thought study from 1994 to 2015. This prospective cohort study included 4277 participants from the Adult Changes in Thought study, an ongoing longitudinal population-based study of incident dementia in a random sample of adults 65 years and older who were born between 1893 and 1949 and are members of Kaiser Permanente Washington in the Seattle region. Participants in the present analysis were followed up from 1994 to 2015. At enrollment, all participants were dementia-free and completed a baseline evaluation. Subsequent study visits were held every 2 years until a diagnosis of dementia, death, or withdrawal from the study. Participants were categorized by birth period (defined by historically meaningful events) into 5 cohorts: pre-World War I (1893-1913), World War I and Spanish influenza (1914-1920), pre-Great Depression (1921-1928), Great Depression (1929-1939), and World War II and postwar (1940-1949). Participants' height, educational level, childhood financial stability, and childhood household density were examined as indicators of early-life environment, and later-life vascular risk factors for dementia were assessed. Cox proportional hazards regression models, adjusted for competing survival risk, were used to analyze data. Data were analyzed from June 1, 2018, to April 29, 2020. Participants completed the Cognitive Abilities Screening Instrument every 2 years to assess global cognition. Those with scores indicative of cognitive impairment completed an evaluation for dementia, with dementia diagnoses determined during consensus conferences using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Among 4277 participants, the mean (SD) age was 74.5 (6.4) years, and 2519 participants (58.9%) were women. The median follow-up was 8 years (interquartile range, 4-12 years), with 730 participants developing dementia over 24 378 person-years. The age-specific dementia incidence was lower for those born in 1929 and later compared with those born earlier. Compared with participants born in the pre-Great Depression years (1921-1928), the age- and sex-adjusted hazard ratio was 0.67 (95% CI, 0.53-0.85) for those born in the Great Depression period (1929-1939) and 0.62 (95% CI, 0.29-1.31) for those born in the World War II and postwar period (1940-1949). Although indicators of a more advantaged early-life environment and higher educational level (college or higher) were associated with a lower incidence of dementia, these variables did not explain the association between birth cohort and dementia incidence, which remained when vascular risk factors were included and were similar by sex. Age-specific dementia incidence was lower in participants born after the mid-1920s compared with those born earlier. In this population, the decrease in dementia incidence may reflect societal-level changes or individual differences over the life course rather than early-life environment, as reflected through recalled childhood socioeconomic status and measured height, educational level, and later-life vascular risk.

Encephalitis lethargica (EL) was a mysterious epidemic. temporally associated with the 1918 Spanish influenza pandemic. Numerous symptoms characterized this disease, including headache, diplopia, fever, fatal coma, delirium, oculogyric crisis, lethargy, catatonia, and psychiatric symptoms. Many patients who initially recovered subsequently developed profound, chronic parkinsonism. The etiologic association of influenza with EL is controversial. Five acute EL autopsies and more than 70 postencephalitic parkinsonian autopsies were available in the Armed Forces Institute of Pathology (AFIP) tissue repository. Two of these 5 acute EL cases had histopathologic changes consistent with that diagnosis. The remaining 3 cases were classified as possible acute EL cases as the autopsy material was insufficient for detailed histopathologic examination. RNA lysates were prepared from 29 CNS autopsy tissue blocks from the 5 acute cases and 9 lysates from blocks containing substantia nigra from 2 postencephalitic cases. RNA recovery was assessed by amplification of beta-2-microglobulin mRNA and 65% of the tissue blocks contained amplifiable RNA. Reverse transcription-polymerase chain reaction (RT-PCR) for influenza matrix and nucleoprotein genes was negative in all cases. Thus, it is unlikely that the 1918 influenza virus was neurotropic and directly responsible for the outbreak of EL.

Back to table of contents Previous article Next article Clinical & ResearchFull AccessSpecial Report: Hispanic Community and COVID-19—Addressing Health Inequalities Can No Longer Be DelayedHector Colon-Rivera, M.D.Hector Colon-Rivera, M.D.Published Online:23 Jun 2020https://doi.org/10.1176/appi.pn.2020.7a28AbstractThe Hispanic community in this country, which has long been underserved with regard to health and mental health care, is experiencing additional barriers to maintaining their health and mental health and getting the care they need during the pandemic.The values of a community are reflected in individuals' willingness to secure well-being and vitality for all. I envision a day when preventable death, disabilities, and health disparities are eliminated. This transformation will occur only by examining the causes of health inequities and social determinants of health and directing more interventions to collaborate in health promotion and disease prevention.The socioeconomic status of Hispanics in the United States is considerably lower than that of non-Hispanic whites due to several specific characteristics of the Hispanic population, including their lower family income, more limited educational attainment, and lower-paying occupations.Hispanics are more likely to work in agriculture, construction, domestic and food services, and other low-wage occupations with inadequate health insurance coverage. Limited formal education may impair people's ability to navigate the complex health care delivery system. Additionally, Hispanics are more likely to live in impoverished communities, in close living conditions, and cities with less-developed trash and sewer infrastructures. Most foreign-born Hispanics and Puerto Ricans primarily speak Spanish, and most of the health-related instructions and materials are in English, so non-English speakers don't have access to them.Despite the disparities in employment, education, and income, Hispanics have lower age-adjusted mortality rates than African Americans and, in many cases, lower rates than non-Hispanic whites. One possible explanation is the social support and traditional values of the families and community as they tend to stay together.This action makes it hard for communities with extended families who highly value family contact to get through difficult situations when asked to stay away from each other because of the pandemic. A loss of cultural values in family members who are U.S. born or assimilated to the culture can lead to intergenerational stress that undermines family relationships and lowers expectations about academic performance, mental health, and well-being.These socioeconomic differences of Hispanic communities continue to be valid during the COVID-19 pandemic. Of course, all human beings have a right to know when and how to seek care. But data continue to show that African Americans and Hispanic people are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population.iStock/rightdxThis situation is similar to the Spanish flu in 1918, cholera pandemic of 1961 to 1975, and the H1N1 swine flu outbreak in 2009. People with limited ability to communicate because of language differences and limited social and economic options do not receive adequate health information and services, which ultimately exacerbates health disparities. We must learn from our past mistakes.Closing places of trust for our communities like churches, barbershops, and community parks has left a gap in communication channels in minority neighborhoods across the country. Without culturally relevant communication strategies, many cities were lost.The Centers for Medicare and Medicaid Services and other federal and state regulatory bodies waived specific requirements for telecommunications, which has allowed many Americans to continue to get health care services. While based on my colleagues' and my experiences during the pandemic, telehealth is not the optimal solution for every patient, these changes are important to not only ensure but also increase access to care. In addition to physicians and nurses, other health care professionals, including psychologists and social workers, can provide telehealth services. I have been practicing telemedicine for more than four years, and this is the first time I have seen such policy changes. Telehealth has been promoted as an innovative approach to bridging the health care delivery gap by increasing access to services for medically underserved communities for decades.Unfortunately, it was not until the pandemic affected both white and non-white communities that we saw a loosening of the rules. That loosening increased access to resources that could have been the salvation, for so long, of socioeconomic revitalization, connectivity, and technology infrastructure development to address health equity for underserved communities. The same effect was seen when the life expectancy of the U.S. white population declined mainly due to the opioid epidemic. Specific treatment options were marketed primarily to suburban communities, whose residents can pay for treatment.The spread of telehealth services during the pandemic and increased medication access for assisted treatment during the opioid epidemic have a lot in common. They illustrate how racially different health policies and health care practices make those vulnerable even more vulnerable in the face of inadequate attention to public health.Case Examples of Impact of Pandemic on Hispanic CommunityLet's take the experiences of some of my patients. I am using pseudonyms for both of the cases discussed to protect the patients' identities.Gilberto was doing well; his diabetes and opioid use disorder were well controlled. He was working and taking care of his family. After the pandemic hit, the restaurant where he was working was forced to close. He did not have health benefits or accumulated days off, so his boss let him go. He started eating junk food, which affected his sugar control. Poor glycemic control is a risk factor for severe infections, and adverse outcomes of infection with COVID-19 and other diseases, including bacterial pneumonia, are more likely without reasonable glycemic control.Gilberto was admitted to the hospital for glycemic control and discharged home to quarantine after testing positive for COVID-19 because he was asymptomatic. His wife called my office after he relapsed on heroin after three years of sobriety on buprenorphine. Gilberto then told me that he was ashamed of calling me as he had "failed."Stigma and shame associated with mental illness and lack of information reduce the utilization of services. But we know that a fact in recovery culture is that a substance use disorder is a disease of isolation, and, in every possible way, what we are asking people to do during the pandemic is to isolate.For people struggling with a substance use disorder and chronic illness, virtually all of the services and treatments available to them have been disrupted by the COVID-19 epidemic. People are told to stay home, which directly contradicts the need to go to clinics to obtain services. Without in-person meetings, remaining sober is difficult for some individuals, and it is difficult for our communities to call for help.Unfortunately, there are countless stories of patients struggling with similar situations. Having clinics provide their services over the phone presupposes that there are physicians who are healthy and certified to prescribe every medication and that the pharmacies and doctors' offices are functioning. Additionally, rehabilitation facilities have limited new admissions, canceled programs, or even shuttered their doors for fear of spreading the virus.Another patient was Marla, an undocumented Guatemalan woman who worked in a pizzeria "under the table." She never stopped reporting to her job, even after she began coughing and feeling ill. Her condition quickly deteriorated. She was admitted for treatment and discharged two weeks later. However, her mother became sick while Marla was in the hospital. After her mother began gasping for air, Marla's husband rushed her to the hospital. Marla and her mother could not see each other due to COVID restrictions, and her mother died from COVID-19. Marla feels guilty about what happened, saying that finding support and accepting loss of her mother have been hard without seeing her psychotherapist and me, her psychiatrist, in person.We need to make extra efforts to maintain social bonds during this time of enormous stress and social isolation. Healthy social conditions can ensure that the most vulnerable members of society benefit from the same fundamental rights and opportunities as more affluent citizens. We need to ensure that all residents have equal access to quality health care and essential community services that preserve and protect health.How to Strive to Understand the Social Determinants of HealthFor providers, the complexity of social health determinants paired with the medical field's challenges and organizational priorities make it hard to know where to start focusing, but determining the "who," how," "where," and "what" of the underlying factors impacting minority communities is critical. Food security, jobs, education, and quality of housing are four determinants of a secure link to health and are common areas of focus for health care organizations.Understanding market-specific population issues should lead our health systems and private practices to focus on increased access to behavioral health services and virtual telehealth offerings as part of overall growth strategies. Shifting individuals' and organizations' mindset around can better inform the way we create services aligned to health equity and the communities' preferences and needs.Social Determinants of Health Go Beyond Racism and ColorismThe coronavirus is not a racist disease. It has no eyes, and its only goal in life is to replicate inside the living cells of an organism. There are no biological reasons why Black and Hispanic people should be getting sick with and dying of coronavirus more than white people. Skin color continues to serve as the most apparent criterion in determining how a person will be assessed and treated in our country. The racial categories in the United States for our phenotypically ambiguous population are limited. According to the U.S. Census, you are white, Black, American Indian/Alaska Native, Asian, Native Hawaiian/other Pacific islander, or multiracial. The privileging of light skin over dark affects where you live, what you eat, where you work, and other environmental factors.What Can We Do?Improve education and leadership programs in the workforce: Without a doubt, the future workforce will have an increasingly Hispanic identity. We need to improve the access of Hispanics to education and eradicate the root causes for the shortage of Hispanics' advancement into leadership. Less than 5% of corporate leaders and physicians are Hispanics. For one, there is still outright prejudice and bias in the workplace. A fair and equitable work environment creates a competitive system. Those who do well get promoted, and issues of race, ethnicity, and gender do not matter because merit is all about performance. For the most part, Hispanic individuals have been closed out of the health professions, and supporting them would create a pool of potential health care workers in the United States.Create flexible and culturally competent policies and payments: Culturally specific guidelines for mental and substance use disorder treatment programs must be created so that Black and Hispanic people can access treatment and get high-quality care.Tailor communication channels: Public health information changes rapidly, and timely guidance to minority communities is critical. Public health concepts are not readily understandable across cultures. Concepts such as social distancing, flattening the curve, self-quarantining, wearing face masks, and washing hands should be explained in a culturally appropriate manner. The dissemination of news and information through mainstream and social media should also be done in a culturally appropriate manner.Partner with communities, nonprofits, and community leaders: Community leaders are trusted messengers and influencers to their communities. They know their community's needs. They often have diverse partnerships and collaborations with schools, local businesses, law enforcement, and medical personnel. Mental health professionals are critical for outreach, engagement, and linking Blacks and Latinos with mental and substance use disorders to treatment. As medical professionals, we should promote and educate patients about lifestyle factors associated with disparities, including preventive care; dietary behavior; physical activity; use of tobacco, alcohol, and other substances; and sexual practices. Screening and treatment are particularly crucial for the control and prevention of many conditions. Knowing where to find treatment facilities with cultural competence and resources for Hispanics is essential to obtain preventive care and treatment and avoid the progression of disease and worse outcomes, including death.Collect and release data to improve resources to improve health disparities: All states and municipalities need to collect and release the demographic data on who is being affected with coronavirus in both the Hispanic and Black communities. The more we understand about the virus, the better equipped we will be to determine the resources and funding needed in these communities. The COVID-19 pandemic has common ground with the Black Lives Matter movement. These bring opportunities for our country to make investments that will help revive our national potential for productivity by promoting the health of minority communities and targeting disparities in population health. An increased focus on chronic disease prevention and control programs that engage Latino communities in addressing environmental, policy, and behavioral changes is needed.Supporting our international medical graduates (IMGs) colleagues: Join advocacy efforts and groups supporting non-U.S. citizen international medical graduates (IMGs) who are practicing or otherwise lawfully present in the country. Given workforce demands during and probably after the pandemic, there is an urgent need to take these opportunities for fast-tracking immigrant and bilingual people into the health care force, especially in areas of the country with higher rates of poverty and chronic disease such as minority communities.The trends in health disparities are demographic and based on socioeconomic inequalities that create high-risk conditions for Hispanic communities. We can reduce health disparities by addressing inequalities, but we need to deliberately change our focus from thinking only of white-type patterns of health care needs and use. Such thinking ignores other groups who may have different needs. The change is possible only if the efforts of federal, private, and state health agencies are coordinated and include benchmarks to hold them accountable and ensure that Hispanic individuals are getting the care they need. If we do fail to achieve equality in the health care system and law enforcement, we will continue to leave Hispanic communities and others vulnerable in the face of harmful social determinants of health. ■ResourcesAPA offers a number of resources on working with Latino/a and Hispanic patients on its website:"Guide on Best Practice Highlights Latino/as and Hispanics.""Working with Latino/a and Hispanic Patients" with Lisa Fortuna, M.D."Mental Health Facts for Hispanics and Latinos/as"."Stress & Trauma Toolkit for Treating Hispanics in a Changing Political and Social Environment"."Engagement Interview Protocol" that helps psychiatrists work with patients from different cultural backgrounds and understand the meaning of symptoms based on patients' cultures and traditions."Psychosis Literacy Among Latinos With First-Episode Psychosis and Their Caregivers".APA members interested in joining the Caucus of Hispanic Psychiatrists should go here and click on "Join" on the right side of the webpage.Hector Colon-Rivera, M.D., is medical director for APM Inc., a nonprofit that serves the communities of North Philadelphia with behavioral health, housing, foster home, and education services. He is also a faculty member at the University of Pittsburgh Medical Center and the Einstein Medical Center, the president of APA's Caucus of Hispanic Psychiatrists, and the Area 3 representative to the APA Assembly. ISSUES NewArchived

Any conflict, extreme stress, emergency situation, natural disaster multiplies mental health hazard. History of Spanish flu outbreak witnesses the damage of pregnant women i.e. as short-term impact inflate the rate of preterm deliveries and the baby’s who were in womb persist the risk of developing medical and psychiatric disorders like diabetes, coronary artery disease, cancer and schizophrenia in future. Pregnant women are considered more vulnerable for COVID-19 as pregnancy makes women prone to respiratory pathogen, which leads to severe pneumonia. Women are three times more prone to anxiety than man. Continuous strict restriction on consultancy visit and gathering, rumors and contradictory information, uncertainty about delivery plan & health of mother and baby indirectly affected women’s emotional and psychological health of perinatal period. Fear and stigma grasps them when anticipating social discrimination and segregation from baby if they become positive. Growing evidence shows psychological impacts i.e. high levels of anxiety, depression and stress are prevalent among pregnant women irrespective of geographical and cultural boundaries across countries like India, China, Canada, UK, Australia and Israel. WHO recommended for adopting holistic approach of care, consideration of major two aspects (i.e. clinical and psychological experiences) in pandemic situations for helping in better positive coping of mother, baby and family members. This present review aimed to find out triggering factors, challenges, major types of psychological issues, consequences of psychological impact among perinatal women due to COVID-19 and want to prescribe evidence-based resolution and preparedness for combating such pandemic situation.

Neuropsychiatric sequalae to coronavirus disease 2019 (COVID-19) infection are beginning to emerge, like previous Spanish influenza and severe acute respiratory syndrome episodes. Streptococcal infection in paediatric patients causing obsessive compulsive disorder (PANDAS) is another recent example of an infection-based psychiatric disorder. Inflammation associated with neuropsychiatric disorders has been previously reported but there is no standard clinical management approach established. Part of the reason is that it is unclear what factors determine the specific neuronal vulnerability and the efficacy of anti-inflammatory treatment in neuroinflammation. The emerging COVID-19 data suggested that in the acute stage, widespread neuronal damage appears to be the result of abnormal and overactive immune responses and cytokine storm is associated with poor prognosis. It is still too early to know if there are long-term-specific neuronal or brain regional damages associated with COVID-19, resulting in distinct neuropsychiatric disorders. In several major psychiatric disorders where neuroinflammation is present, patients with abnormal inflammatory markers may also experience less than favourable response or treatment resistance when standard treatment is used alone. Evidence regarding the benefits of co-administered anti-inflammatory agents such as COX-2 inhibitor is encouraging in selected patients though may not benefit others. Disease-modifying therapies are increasingly being applied to neuropsychiatric diseases characterised by abnormal or hyperreactive immune responses. Adjunct anti-inflammatory treatment may benefit selected patients and is definitely an important component of clinical management in the presence of neuroinflammation.

NMDAR antibodies in patients with psychosis

The Exacerbation of Burnout During COVID-19: A Major Concern for Nurse Safety

There are certain similarities in the perception of mental illness and infectious diseases, such as “fear of contagion,” resulting in the public stigma that has shrouded both throughout centuries, to the point that, possibly, unconscious bias may have resulted in the lack of interest in pandemic outbreaks on the part of psychiatry. This chapter briefly examines both the near-universal fear of becoming infected and losing one’s “self” in the process and our fascination with the topic, as exemplified in our enthrallment with zombies and the “undead,” helping us better understand unconscious bias at the individual and collective levels. This chapter also briefly reviews a historic “point of intersection” when the last global pandemic (Spanish flu of 1918) significantly affected the personal life of probably the best-known psychiatrist in history and the father of psychoanalysis (Sigmund Freud), possibly affecting his scientific reasoning and resulting theories, without receiving critical scrutiny at the time.