Mental Health Care Units Research Articles

2.F. Scientific session: Challenges in healthcare architectures

Abstract The Workshop titled “Challenges in healthcare architectures” - proposed and developed by the three EUPHA Section: Urban Public Health (URB), Public Mental Health (MEN) and Environmental Health (ENV) - is aimed to foster the dialogue between designers (architects and urban planners), Public Health experts (operators, professionals and epidemiologists), general/sanitary Directors of healthcare facilities and medical staff, to establish a multidisciplinary approach for understanding together how to create and manage the healthcare facilities of the future. According to the main Conference topic “Sailing the waves of European public health: exploring a sea of innovation”, the workshop mainly addresses both the “Health care services and systems” and the “Health workforce, practice and training” EPH24 conference topics. The Workshops purpose is to explore the concept for the hospital of the future, that should be resilient to changes and capable of protecting different users’ health and tackle the transforming social, economic, environmental and epidemiological needs of the context in which they are located. As in many other spheres and economic activities, the pandemic accelerated the processes of innovation and digitization that had somehow already been activated. The healthcare issue, the use of smart devices for a dialogue between the healthcare professionals and the pervasive use of apps to monitor certain health parameters, are just some of the megatrends that were being observed and which have now necessarily entered into everyday life. In the same way, the hospital, which in the face of this gradual process of dematerialization and relocation of ‘softer’ clinical-diagnostic activities, reaffirms itself as a center of the highest specialty for the treatment and care of acute patients, for high-level clinical and experimental re-search, for diagnostics and more complex operations. At the same time, and finally, the hospital is inserted in a territorial healthcare facilities network, that should be planned, designed, and managed. The workshop program includes inputs which they argue current experiences, emerging practices and scientific outcomes related to the hospital design, planning and management sphere, coming from four different European countries. From designing to managing practices, in “Hospital Design and planning in the line of Foresight of Health Needs” and in “Sustainability in the Next Generation Hospital”. From digitalization in national resilience experiences, in “Digital Health Spaces in the City of Lisbon. The Role of Digitalization in linking Boundaryless Hospitals and Smart Health Cities” to novel approaches for specific disease, in “Building bridges: mobile mental health care units in four European countries”. Key messages • Explore the “hospital of the future” concept, resilient to changes, capable of protecting users’ health, and to tackle the transforming social, economic, environmental and epidemiological needs. • Establish a multidisciplinary and territorial approach, for understanding together how to create and manage the healthcare network of the future.

Building bridges: mobile mental health care units in four European countries

Abstract Background Individuals living in rural and remote areas may have limited access to mental healthcare due to lack of facilities, socioeconomic reasons, stigma and lack of mental health literacy. To meet the needs and provide needs-based care care mobile mental health care clinics were established in some countries in Europe, including in Belgium, Germany, Greece and in Moldowa. A mobile clinic is a customized motor vehicle that travels to communities to provide mental health care. The mobile clinics are an integral part of the health care system and help ensure access to mental care. Aims To describe mobile care clinics in two countries in Europe using a case study design. Results Mobile clinics deliver a wide variety of mental health services, are heterogeneous and consist of multidisciplinary teams, including physicians, social workers, and other health professionals. The organization and financing of the Mobile mental health clinics is different in the four countries (e.g. part of the mental health care system in Belgium, and Moldova, part of initiatives in Germany and Greece). Due to data protection no detailed data on patients can be provided at the moment. The structures on mental health care mobile clinics in the four countries will be described in detail in the talk. Discussion Mobile clinics often serve as a bridge between communities and the mental health care system. Another important issue in rural areas is the ongoing aging of the population. The number of Elderly patients is expected to rise in the future. The care of those patients is challenging for the mental health and the primary care system. There is a necessity for establishing bridges between mobile clinics and hospital care.

The Practical and Social Functioning (PSF) scale: development and measurement properties of an instrument for assessing activity and social participation among people with serious mental illness

BackgroundParticipation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the “International Classification of Functioning, Disability and Health (ICF)” framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings.MethodsThe PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures.ResultsThe final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect.ConclusionThe development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning.Trial registrationThe study Implementation of Guidelines for the Treatment of Psychoses was registered retrospectively on 31 August 2017 at ClinicalTrials.gov (NCT03271242).

Killing Two Birds with One Stone: Mandatory Therapy and the Prevention of Sex Crime in France.

This paper considers the development of new clinical and medical practices in the early 2000s in France, after the adoption of legal reforms aiming at the prevention of sexual infractions and the protection of minors. The paper explains how the reform led to the creation of a new form of punishment for sexual offenders, l'obligation de soin (therapeutic obligation), which can be described as long-term mandatory therapeutic monitoring. This paper offers an analysis of the implementation of this measure from the standpoint of the specialized mental health care unit which were entrusted the mission of caring for the new group of convicted patients, i.e., patients sentenced to undergo mandatory therapy, after this legal reform. In the new regime these mandatory therapies created, clinicians are tasked to combine their conventional mission of care for the patient in the present, with the judicial mandate of detecting and preventing the patient's relapse qua recidivism in the future. Mobilizing ethnographic examples that evidence the way clinical care comes to encompass a penal mandate of long-term surveillance of convicted patients, I argue that the dual injunction of procuring care while preventing relapse-recidivism constrains the psychodynamic forms of clinical intervention deployed by French clinicians, realigns both psychiatric and clinical interventions along penal lines, and revives interest in some of the diagnostic categories and aims of criminal psychiatry which were important for the development of psychiatry in France.

'We are working in specialty units'-An exploratory qualitative study.

To explore related support needs of general nurses in specialty mental health units and provide references for formulating a model to support this population working in mental health care units. An exploratory qualitative design. In-depth individual unstructured interviews were performed with 15 general nurses who worked in mental health care units and were selected through purposive sampling. Data were collected through in-depth, individual, unstructured interviews. Data were analysed thematically using Tech's eight-step analysis method. Two themes with their subthemes were extracted. The two themes included (a) Needs for professional growth and (b) the Need for emotional support. Influenced by many factors, general nurses could not perform some nursing activities in mental health care units. Health managers should plan the training program to empower and provide emotional support to the general nurses in mental health care units. Further research is required to develop a model to facilitate the support of general nurses allocated to these units. This study follows the consolidated criteria for reporting qualitative research. A total of 15 general nurses participated in the study. We utilized their lunch time to conduct the interviews, significantly contributing to the article's content.

Delphi method applicability in drug foresight

BackgroundThe aim of the current study was to assess the accuracy of expert predictions, which were derived using a Delphi panel foresight study between 2009 and 2011, on a variety of drug-related topics in Finland in 2020.MethodsThe material used to evaluate the accuracy of the predictions consists of published reports on statistics, survey results, official register data, wastewater analyses and official documents. Whenever possible, we used multiple information sources to ascertain possible changes related to the predictions.ResultsBetween 2009 and 2011, the majority – but not all – of the experts accurately predicted an increase in drug use. Indeed, more people experimented with or used drugs, and more drug residues were found in wastewater monitoring. The experts also correctly predicted an increase in population-level approval of drug use, but this development has been rather slow. Contrary to predictions, there was no marked increase in the use of new synthetic drugs. However, the misuse of buprenorphine increased during the 2010s. In the drug market, unit prices were surprisingly stable over the ten-year period. There were no changes in legislation related to the legal status of drugs, as was foreseen by the experts. However, enforcement moved in the direction foreseen by the experts: more lenient measures have been taken against users. Drug care system reforms favored a combination of mental health and addiction care units between 2009 and 2011, and 2020, as foreseen by the experts.ConclusionsIt seems to have been easier for the experts to foresee the continuation of existing trends, e.g., increasing use of drugs or widening approval of drugs, than to predict possible changes in the popularity of distinct groups of drugs such as new psychoactive substances (NPS). Even armed with the prediction that drug imports and wholesale would increasingly fall into the domain of organized crime, this undesirable development could not be stopped. Expert disagreement can also be seen as a valuable indication of uncertainty regarding the future. Foresight related to drug-related issues can produce relatively accurate and realistic views of the future at least up to ten years ahead.

How group climate in forensic and secured mental health is related to patients’ treatment motivation

ABSTRACT Motivation is an important factor for successful treatment. Unvoluntary treatment conditions forced by law influence motivation negatively. To optimise motivation in these settings, this study aimed to examine whether group climate (GC) is related to motivation and whether the fulfilment of the basic psychological needs (BPN) as described in the Self Determination Theory (SDT) might explain this relationship. Participants (n = 60) were inpatients from two forensic and one secured mental health-care unit. Participants completed questionnaires including GC, BPN, and motivation scales. Demographic information was collected in their personal files. Correlation analyses showed that there was more treatment motivation when participants perceived a chance to learn (GC ‘growth’(r = .27, p < .05)) and perceived flexibility and fairness (GC ‘repression’ (r = .30, p < .05)). The results showed insufficient support for BPN as mediators. However, autonomy did correlate significantly with both growth (r = .50, p < .01) and repression (r = .27, p < .05), as well as motivation (r = .47, p < .01). These results imply that creating prospect, hope for the future, using fair rules and be autonomy-supportive are important factors to pay attention to in reaching optimal motivation in these difficult treatment settings.

Implementing bedside handovers in mental health care: Insights from an experience-based co-design

ObjectivesBedside handovers have the potential to provide opportunities to increase patient involvement in mental health care. However, limited research has been conducted on this subject. MethodsIn this study, we investigate the suitability of experience-based co-design as a method for designing bedside handover in mental health care. ResultsThe article discusses the goals of bedside handover, the preferred structure and content of the handover, its location and frequency, and the familiarization involved in it. ConclusionsEBCD proved to be a suitable method of making recommendations for involving patients in nursing handover in a mental healthcare unit of a general hospital.Practice implications: Nurses and mental health care patients agreed on the ISBARRT model to structure bedside handovers.

Urban distance to mental healthcare units and public transport increases duration of untreated psychosis in first-episode patients.

There is a growing interest in environmental and social determinants of mental health. However, how distance to healthcare and public transportation affect illness is neglected in schizophrenia research. Here, we are interested in how the availability of mental healthcare and the ways to reach it may be associated with psychosis. We aim to investigate the association between distances to healthcare units and subway stations and duration of untreated psychosis (DUP) and greater initial severity in an antipsychotic-naïve first episode of psychosis (FEP) sample. Using 212 untreated FEP patients' data, we calculated the distances from their residences to the places of interest. Diagnoses comprehended schizophrenia spectrum disorders, depressive and bipolar affective disorders, and substance-induced disorders. Linear regressions were performed with distances as independent variables, DUP and Positive and Negative Syndrome Scale (PANSS) scores as dependent variables. Longer distance to emergency mental healthcare was related to longer DUP (95% CI: p = .034, B = 0.152) and higher total PANSS (95% CI: p = .007, B = 0.0189); longer distance to community mental healthcare units was related to longer DUP (95% CI: p = .004, B = 0.0204) and higher total PANSS (95% CI: p = .030, B = 0.152). Moreover, a longer distance to the closest subway station predicted longer DUP (95% CI: p = .019, B = 0.170). Our results indicate that poor healthcare access is related to longer DUP and higher initial PANSS scores. Future research should investigate how investments in mental health access and actions to improve public transport access could impact DUP and treatment outcomes in psychosis patients.

‘Main the gap!’ The view of healthcare professionals on gains and pitfalls of traditional and innovative models for providing mental health care to imprisoned persons with a severe mental illness in Spain

IntroductionDifferent mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models.ObjectivesTo explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain.Methods21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis.ResultsHealthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome.ConclusionsInnovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges.Disclosure of InterestNone Declared

Pulmonary embolism masked by symptoms of mental disorders.

The objective of this article is to draw attention to an unusual clinical manifestation of pulmonary embolism (PE) as symptoms suggesting an underlying mental disorder. This seems all the more important since PE is one of the most common causes of potentially preventable hospital deaths and delayed diagnosis of PE in patients consulted at emergency departments has been shown to be most common in elderly patients and the ones presenting with significantly altered mental status. PE is a life-threatening condition that requires prompt diagnosis and appropriate management. There is no symptom that can be found characteristic for PE. Clinical picture of this condition is varied and may resemble many other disorders. The article emphasises that PE may also manifest with psychopathological symptoms that mimic psychiatric emergencies. Three most common groups of psychopathological symptoms that can mask a developing PE, such as panic attacks, symptoms of psychosis, and catatonia, are discussed here based on the literature review. Particular care must be exercised while evaluating such a patient because initial misdiagnosis results in the patient being referred to a mental health care unit instead of a unit treating somatic disorders. There are no diagnostic or treatment facilities in large psychiatric hospitals to assist such a patient. This, in turn, leads to a significant delay in management and, consequently, to major complications or death.

Nurse-led brief psycho-education on self-stigma among clients with schizophrenia and affective disorders: - Solomon four-group design

BackgroundThe negative impact of self-stigma among clients with mental illness is well documented. Psychoeducation was found to be an effective measure for managing the treatment gap by reducing the stigma associated with the illness. PurposeThe present study investigated the effectiveness of a nurse-led brief psycho-education in reducing self-stigma among clients in the remittent stage of schizophrenia and affective disorders. MethodsThis study used Solomon- four-group design and was carried out at the Institute of mental health, Rohtak, India. A total of 80 participants were consecutively recruited using the block randomization method and as per the sampling criteria. A trained nurse delivered a 30-min individual-based brief psycho-education to the intervention group as per the standard module. The outcome measure was the reduction in the stigma based on a standardized stigma scale during a 1-month follow-up period. ResultsThe mean age of the participants was 40.48 years (SD = 3.55). Overall, the study observed a significant reduction of stigma scores in the intervention group in the alienation, stereotype endorsement, social withdrawal domain of ISMI during 1-month follow-up (p < 0.001). No interaction effect was found between intervention and pre-test except the social withdrawal domain (p = 0.034). ConclusionsThe nurse-led brief psycho-education has the potential to reduce stigma among clients with mental illness. Our findings open an area of discussion for placing greater attention on nurse-led brief psycho-education in this setting. The study provides pioneer research evidence regarding the involvement of nurses as brief psycho-education therapists among clients attending the tertiary mental health care unit of a lower-middle-income country. Considering the short-term effect of this study, more studies should be conducted in similar settings for an evidence base to advocate supportive nursing care practices in the routine mental health setting.

Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation

ObjectivesTo examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units.DesignVHA inpatient mental health units were...

Challenges in Adopting Recovery-oriented Practices in Specialized Mental Health Care: “How Far Should Self-Determination Go; Should One be Allowed to Perish?”

Mental health services need to transform from a primary focus on symptom reduction to a recovery-oriented delivery. Research on recovery-oriented practices is mainly based in community mental health settings, while research on specialized mental health care remains scarce. In this article, we aim to identify and explore the experiences faced by professionals working in specialized mental health care units that aim to be recovery-oriented. Data were collected during seven focus group interviews with 45 professionals from four psychiatric hospitals and district psychiatric centers in Norway. We used reflexive thematic analysis to interpret the data. Three main themes emerged from the analysis: (a) disease-oriented structures, (b) negotiating roles and (c) risk management. This study identified the many tensions professionals face as they try to shift specialized mental health care toward a recovery-oriented paradigm. Specifically, professionals must balance managing risks and promoting self-determination. To succeed, it is not sufficient to implement practices that are characterized as recovery-oriented without also changing existing systems, structures, and frameworks. We suggest approaching recovery orientation through shared decision-making. This could contribute to the promotion of self-determination and increased inpatient safety in specialized mental health care.

Violence Prevention Climate Scale: Translation, Adaptation, and Psychometric Assessment of the French Canadian Version

Introduction: Violence in psychiatric settings has negative consequences on patients, staff, and the institution alike. Efforts to prevent violence cannot currently be assessed due to a lack of suitable indicators. The Violence Prevention Climate Scale (VPC-14) is a validated tool that can be filled out by both staff and patients to assess the violence prevention climate in mental health care units. Objective: This study aimed to conduct the translation and adaptation of the VPC-14 to a French Canadian context, and to assess its psychometric properties in general and forensic psychiatric settings. Methods: This study followed a transcultural approach for validating measuring instruments. Psychometric properties were assessed in 308 patients and staff from 4 mental health and forensic hospitals in Quebec (Canada). Content validity was assessed using a bilingual participant approach. Internal validity was examined through exploratory factor analysis and internal consistency for each care setting using Cronbach’s alpha coefficient analysis. Results: The Échelle modifiée du climat de prévention de la violence [Modified Violence Prevention Climate Scale] (VPC-M-FR) consists of 23 items with a 3-factor structure: 1) staff action, 2) patient action, and 3) the therapeutic environment. Cronbach’s alphas ranging from 0.69 to 0.89 were obtained for the internal consistency of the scale. Discussion and conclusion: The VPC-M-FR has satisfactory psychometric properties for measuring the violence prevention climate in mental health and forensic settings. By measuring the violence prevention climate from the standpoint of patients and staff, targeted preventive measures can be implemented to improve safety for all.

Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa.

BackgroundLiving with or managing an adolescent suffering from depression predisposes the adolescent and parents to various experiences, considering the multifactorial nature of depression and associated symptoms.ObjectiveThis study explored and described the experiences of adolescents and their parents on the mental health management of depression in the North West province (NWP), South Africa.MethodA qualitative, exploratory, descriptive, contextual research design was adopted. Data was collect from two mental health care institutions and two mental health care units attached to two general hospitals in the NWP, SA. Thirty-two participants (18 adolescents and 14 parents) were purposefully selected for the study. Data were collected through individual interviews and analysed using Tesch’s open-coding method to generate themes and categories which were presented with the concurrent support of participants direct quotations.ResultsThe study revealed that the experiences of adolescents with depression and their parents taking care of them at homes include the following: emotional distress, poor coping mechanisms, financial burden, repeated suicidal attempts, negative attitudes from support systems and withdrawal behaviours. Appropriate therapeutic environments, ongoing monitoring by mental healthcare practitioners and adequate support systems were suggested by participants as management approaches that could enhance the recovery of adolescents from depression.ConclusionThe findings revealed the devastating experiences of adolescents with depression and their parents taking care of them in their various homes which confirms the dire need for attention on the plights of these groups in order to facilitate adolescents’ recovery and strengthen the adolescents’ and parents’ coping mechanisms for a healthier family.

Stress and Burnout Among Mental Health Staff During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has deeply altered social and working environments among health care workers. These health care workers are therefore at risk of additional psychosocial strain and ensuing metal health symptoms, which indirectly affects patient care. In this study, we aimed to assess the psychosocial and psychopathological impact of COVID-19 among acute care mental health and addictions staff. This study is a cross-sectional survey and contains a sample size of 60 mental health and addiction acute care workers recruited from within Nova Scotia Health Authority. The survey was constructed using the online survey system, Opinio, and consisted of three sections: demographic variables (gender, age group and profession); the DASS-21 Questionnaire (which provides dimensional measures of stress, anxiety and depression); and the MBI-HSS (MP) Questionnaire (which measures three dimensions of burnout-emotional exhaustion, depersonalization and personal achievement). The majority of participants had at least one pathologic score on the DASS-21 and MBI-HSS (MP) sections (75.5% and 93.5%, respectively). The median severity on the DASS-21 and MBI-HSS (MP) were both moderate, with the younger age group (20-35 years) having more significant burnout scores (p = 0.0494). Simple logistic regression showed a significant relationship between burnout severity and pathologic distress, and simple linear regression showed significant correlation between DASS-21 and MBI-HSS (MP) scores, with a R2 value of 0.4633. More planning, programs, resources and further research are needed to support wellness and recovery of all health care professionals who work at the mental health and addictions acute care unit.

Prevalence and predictors of relapse among adolescent patients with mental illness in Butembo city (Eastern Part of the Democratic Republic of Congo)

This study aimed to determine the prevalence and predictors of relapse in adolescents with mental illness. To carry this cross-sectional study, we recruited participants from the patients who attended healthcare services at five mental healthcare units located in the eastern Democratic Republic of Congo. We enrolled patients aged between 10 and 17 years old, with a history of being readmitted at least once to a mental facility. Nearly one in 10 patients with mental illness is an adolescent, and seven in 10 adolescents with mental illness are readmissions. The majority of participants were males, aged 17 years old; lived in rural settings, were illiterate, and were single mothers/fathers. The predictors of relapse are low educational level, being a female or a single mother/father, having the age of 17 years, low self-esteem, perceived poor social support, living in rural areas, and the highly expression emotions. Being treated for bipolar and substance use disorder increases the risk of relapse in adolescents. Our results highlight the burden of mental illness in adolescents.

Clinical Features of First-episode Psychoses During the COVID-19 Pandemic.

The pandemic of the new coronavirus infection has become one of the most significant global social shocks in the past decade. It influenced the lifestyle of many people, including those with mental disorders. To compare the psychopathological structure of psychotic states in young patients (up to 40 years old) with first-episode psychosis before the COVID-19 pandemic and during the COVID-19 pandemic. The research was conducted at the First psychotic episode clinic of the Mental-health clinic No. 1 n.a. N.A. Alexeev, Moscow, Russia. In total, 66 patients were enrolled, who met the inclusion criteria: first-in-life admission to a mental healthcare unit that occurred during the spring of 2019 (control group) or spring 2020 (experimental group), diagnosis on admission that belonged to the group "Acute and transient psychotic disorders" (F23.XX) of ICD-10. Patients with a disability or concurrent somatic or neurologic conditions were excluded from the study. Assessment of clinical and psychopathological characteristics with the allocation of the leading syndrome within the psychotic state, psychometric assessment according to the PANSS scale was carried out, the above indicators were compared between the experimental and control group. We observed statistically insignificant increase in the rates of affective and catatonic subtypes of psychoses, a decrease in the rate of the delusional subtype of paranoid syndrome. PANSS scores differed significantly for different clinical subtypes of psychoses, although the differences between the experimental and control groups showed no statistical significance. Additionally, in spring 2020, a considerable decrease in the total number of hospitalizations was revealed. The differences in the clinical and psychopathological structure of psychotic states revealed during the COVID-19 pandemic were statistically insignificant. Additional results of the study may indicate a decrease in the availability of mental healthcare for patients with psychoses, which requires further investigation.

Changes in clinical features of first-episode psychoses during the COVID-19 pandemic

Introduction: The COVID-19 pandemic affected everybody on Earth. Aside from biological effects on human body, harmful psychosocial events, such as mass quarantine measures, were involved. The situation of pandemic was shown to alter the clinical presentation of psychotic disorders, as well. Purpose of the study: To assess possible changes of clinical presentation in young patients with first-episode psychosis during the COVID-19 pandemic. Materials and methods: The research was conducted at Early psychosis unit of Mental health clinic No.1 named after N.A. Alekseev, Moscow, Russia. In total, 66 patients were enrolled, who met the inclusion criteria: first in life admission to a mental health care unit occurred during the spring of 2019 (comparison group) or spring 2020 (main group), diagnosis on admission belonged to the group “Acute and transient psychotic disorders” (F23.XX). Patients with disability or clinically significant somatic or neurologic condition were excluded from the study. Assessment of patient’s condition upon admission included psychiatric status, distinctive clinical features, psychometric scaling using PANSS. Obtained data were compared between main group and comparison group. Results: We observed an increase in rates of affective and catatonic subtypes of psychoses, with corresponding decrease in rate of delusional subtype. PANSS scores differed significantly for different clinical subtypes of psychoses, albeit differences between main and comparison group showed no statistical significance. In 2020, considerable decrease in total number of hospitalizations was revealed, possibly representing poor accessibility of psychiatric care during the COVID-19 pandemic. Conclusion: Obtained results contribute to understanding the influence of large-scale social calamities, COVID-19 pandemic in particular, on the clinical features of psychotic disorders. Information regarding the effects of named calamities on mental health may help deliver better mental healthcare to patients with first-episode psychoses in the event of global social disasters.