Pre-existing Psychiatric Conditions Research Articles

The Influence of Successful Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse on Depression, Anxiety, and Insomnia-A Prospective Intervention Impact Assessment Study.

Introduction: The association between pelvic floor disorders (PFDs) and psychiatric conditions is an area of emerging interest. The causal direction of this relationship, however, remains ambiguous; it is unclear whether PFDs directly contribute to the deterioration of mental health or if pre-existing psychiatric conditions such as depression exacerbate the symptoms of PFDs. This study aimed to evaluate the effects of successful surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) on symptoms of depression, anxiety, and insomnia. Materials and Methods: This investigation focused on patients who underwent successful surgical interventions for SUI and POP. Both subjective and objective symptoms of PFDs, along with psychiatric status, were assessed before and after the surgical procedures. Results: This study found that successful surgical treatment of SUI and POP led to a significant reduction in anxiety scores. Additionally, in patients with SUI, successful treatment was objectively associated with a decrease in the severity of insomnia. Alleviation of symptoms associated with the lower urinary tract, prolapse, and colorectal-anal region following POP surgery was correlated with improvements in depression and anxiety but not insomnia. Subjectively assessed improvements in SUI subjective symptoms were linked to reductions in the severity of depression, anxiety, and insomnia in patients who underwent anti-incontinence surgery. Conclusions: These findings suggest a potential cause-and-effect relationship between PFDs and certain psychiatric disorders, highlighting the importance of successful treatment of PFDs in mitigating symptoms of depression, anxiety, and insomnia.

Understanding Burn Injuries: From Epidemiology to Rehabilitation and Psychometric Evaluation

Burn injuries have long been recognized as one of the most severe traumas, posing significant challenges to both physical and psychological well-being. This comprehensive review explores various aspects of burn injury, including epidemiology, mechanisms of injury, advancements in contemporary treatment, rehabilitation, health status assessment methods, the impact of preexisting psychiatric conditions, personality assessment, and coping strategies. Globally, burn injuries rank among the leading causes of trauma-related deaths, with factors such as burn depth, extent of injury, age, and associated conditions influencing outcomes. Advancements in treatment, including surgical techniques and skin substitutes, have significantly improved survival rates. Rehabilitation plays a crucial role in maximizing patients' ability to adapt to life after burn injury, addressing both physical and psychological aspects. Health status assessment methods encompass a range of measures, from general health indices to disease-specific scales. Preexisting psychiatric conditions, personality traits, and coping strategies also play significant roles in post-burn adaptation and recovery. Developing burn-specific coping scales could enhance our understanding of the unique stressors faced by burn patients and improve patient outcomes. This review highlights the interdisciplinary nature of burn care and the importance of addressing physical, psychological, and social aspects in the treatment and rehabilitation of burn survivors.

Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer

(1) Background: A pre-existing psychiatric condition may impact decision making by patients and/or physicians following a thyroid cancer diagnosis, such as potentially electing surgery over active surveillance, thus shortening the time to cancer removal. This is the first study to investigate the association between pre-existing anxiety and/or depression and time to receive surgical treatment for thyroid cancer. (2) Methods: Retrospective data were collected from 652 surgical thyroid cancer patients at our institution from 2018 to 2020. We investigated the time between thyroid cancer diagnosis and surgery, comparing patients with pre-existing anxiety and/or depression to those without. (3) Results: Patients with anxiety, depression, and both anxiety and depression had a significantly shorter time between diagnosis and surgery (51.6, 57, and 57.4 days, respectively) compared to patients without (111.9 days) (p = 0.002, p = 0.004, p = 0.003, respectively). (4) Conclusions: Although little is known about the impact of pre-existing psychiatric conditions in the decision-making process for thyroid cancer surgery, this present study showed that anxiety and/or depression may lead to more immediate surgical interventions. Thus, psychiatric history may be an important factor for physicians to consider when counseling patients with thyroid cancer.

Preexisting Psychiatric Conditions as Risk Factors for Diagnosed Long COVID-19 Syndrome Within Aggregated Electronic Health Record Data.

This study aimed to investigate the frequency of long COVID diagnosis among patients infected with severe acute respiratory syndrome coronavirus 2 with preexisting psychiatric conditions versus those without preexisting psychiatric conditions. The TriNetX Analytics platform, an aggregated electronic health record research network containing the deidentified electronic health record data of more than 90 million patients, was queried for patients who were diagnosed with COVID-19 infection based on International Classifications of Disease, Tenth Revision codes. Patients were stratified based on their preexisting psychiatric conditions, and new diagnoses of long COVID were recorded and reported as the primary outcome. Among 1,180,948 patients previously diagnosed with COVID-19, 17,990 patients (1.52%) were diagnosed with long COVID based on the newly implemented International Classifications of Disease, Tenth Revision code "U09: post-COVID-19 condition." After propensity score matching, patients with any preexisting psychiatric diagnosis had a 1.52 (95% confidence interval [CI] = 1.47-1.58) times greater prevalence of diagnosed long COVID within 180 days of infection than patients without preexisting psychiatric diagnoses. Patients with diagnosed anxiety disorders (relative risk [RR] = 1.64; 95% CI = 1.57-1.71), mood disorders (RR = 1.65; 95% CI = 1.57-1.72), bipolar disorder (RR = 1.37; 95% CI = 1.21-1.54), major depressive disorder (RR = 1.69; 95% CI = 1.56-1.83), psychotic disorders (RR = 1.23; 95% CI = 1.06-1.44), and substance use disorders (RR = 1.28; 95% CI = 1.22-1.36) had higher risks for long COVID diagnoses when compared with patients without preexisting psychiatric illness at the time of diagnosis. Multiple preexisting psychiatric diagnoses are associated with an increased risk of being diagnosed with long COVID after COVID-19 infection.

Impact of Preexisting Depression and Anxiety on Hospital Readmission and Long-Term Survival After Cardiac Arrest.

While sudden cardiac arrest (CA) survivors are at risk for developing psychiatric disorders, little is known about the impact of preexisting mental health conditions on long-term survival or postacute healthcare utilization. We examined the prevalence of preexisting psychiatric conditions in CA patients who survived hospital discharge, characterized incidence and reason for inpatient psychiatry consultation during these patients' acute hospitalizations, and determined the association of pre-CA depression and anxiety with hospital readmission rates and long-term survival. We hypothesized that prior depression or anxiety would be associated with higher hospital readmission rates and lower long-term survival. We conducted a retrospective cohort study including patients resuscitated from in- and out-of-hospital CA who survived both admission and discharge from a single hospital between January 1, 2010, and December 31, 2017. We identified patients from our prospective registry, then performed a structured chart review to abstract past psychiatric history, prescription medications for psychiatric conditions, and identify inpatient psychiatric consultations. We used administrative data to identify readmissions within 1 year and vital status through December 31, 2020. We used multivariable Cox regressions controlling for patient demographics, medical comorbidities, discharge Cerebral Performance Category and disposition, depression, and anxiety history to predict long-term survival and hospital readmission. We included 684 subjects. Past depression or anxiety was noted in 24% (n = 162) and 19% (n = 129) of subjects. A minority of subjects (n = 139, 20%) received a psychiatry consultation during the index hospitalization. Overall, 262 (39%) subjects had at least 1 readmission within 1 year. Past depression was associated with an increased hazard of hospital readmission (hazard ratio 1.50, 95% CI 1.11-2.04), while past anxiety was not associated with readmission. Neither depression nor anxiety were independently associated with long-term survival. Depression is an independent risk factor for hospital readmission in CA survivors.

Racial discrimination in healthcare settings and mental health among a population-based sample of racial and ethnic minoritized adults with COVID-19 in Michigan

The COVID-19 pandemic has worsened existing racial health disparities and racial discrimination in healthcare; however, little is known about how racial discrimination in healthcare settings is related to mental health during the pandemic. Using a population-based probability sample of racial and ethnic minoritized adults with a polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection in Michigan, we examined how measures of perceived racial discrimination in (1) seeking healthcare for COVID-19 (n = 1,210) and (2) receiving testing/treatment for COVID-19 (n = 1,364) were associated with binary variables of depressive and anxiety symptoms. We conducted a modified Poisson regression analysis with robust standard errors to estimate associations between each measure of racial discrimination and each mental health outcome separately, adjusting for demographic and socio-economic variables, health insurance, and pre-existing physical and psychiatric conditions. 7.3 % and 8.7 % of adults reported racial discrimination in seeking healthcare for COVID-19 and in getting testing/treatment for COVID–19, respectively. Although the overall prevalence of racial discrimination in healthcare settings was low, experiences of racial discrimination were associated with depressive symptoms. Adults who experienced racial discrimination in seeking healthcare had 1.74 times higher prevalence of reporting depressive symptoms (95 % CI:1.21–2.52) than those who did not. Moreover, adults who experienced racial discrimination in getting testing/treatment had 1.86 times higher prevalence of reporting depressive symptoms (95 % CI:1.36–2.53) than those who did not. Neither measure of racial discrimination was associated with anxiety symptoms in the adjusted models. There is a need for promoting anti-racial discrimination policies, educational programs, and awareness efforts in healthcare settings.

Evaluating Patient-Reported Outcomes and Wearable Data Among Individuals with Relapsed/Refractory Multiple Myeloma

Background: Digital life coaching (DLC) pairs patients with a certified health coach to identify and achieve wellness-related goals through phone calls and text messages. DLC has been shown to improve physical quality of life in a recent randomized trial of patients with multiple myeloma (MM) undergoing upfront transplantation (Banerjee, BMT 2023). However, transplantation is an acute life disruption that may not necessarily reflect long-term wellness; this is particularly true for patients living with relapsed/refractory (R/R )MM, for which symptom burden and uncertainty may be chronically higher. As such, a new study (clinicaltrials.gov ID: NCT05956457) is under way to explore the feasibility and outcomes of DLC with integrated symptom monitoring (via a wearable activity tracker) to inform a more complete understanding of the patient experience with R/R MM. Endpoints from this study will include symptom burden, health self-efficacy, and financial, physiologic, and psychosocial well-being, and if and how DLC may be used to support this population. Study Design and Methods: For this prospective, non-randomized, quasi-experimental study at the University of Washington, up to 100 individuals will be enrolled. Individuals must meet the following Inclusion criteria: English speaking; aged 18 years and older, R/R MM diagnosis; initiated at least the second line of therapy for MM at time of study enrollment and must have been exposed to at least one proteasome inhibitor (PI) and/or one immunomodulatory drug (IMiD). Individuals will be excluded from participation if they meet any of following criteria: anticipated to have 6 months or less to live, have a serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with participant safety, provision of informed consent, or compliance with study procedures; and those who do not own or have access to a personal smartphone or device allowing for access to text or email Consented individuals will be enrolled in a 3-month DLC coaching program, consisting of weekly calls and up to 4 digital nudges, delivery of content via text or email, each week. The evidence-based coaching curriculum focuses on supporting patient self-management of symptoms; physical, mental, financial, social and sexual health; and nutrition, exercise, and sleep. Patient-reported outcomes (PROs) will be collected at baseline and monthly for 3 months to track progress during both coaching and treatment, and to provide insights into the experience and well-being of participants. PROs include quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 & Quality of Life Questionnaire Multiple Myeloma-20); health self-efficacy (measured with the Cancer Behavior Inventory- Brief); anxiety and depression (Patient Health Questionnaire-4); financial toxicity (Comprehensive Score for Financial Toxicity); and medication adherence (CASE Medication Adherence Index). Physical activity will be captured via wrist-worn activity tracker provided to participants. Descriptive analysis will be conducted for this study. Feasibility for this study is defined as a retention rate greater than or equal to 70%. Retention is defined as individuals who agree to participate in the DLC program and complete the 3 months of engagement post-enrollment. Engagement is defined as the completion of 1 nudge (call, text, or email) per module out of 5 nudge opportunities. Summary statistics, such as frequencies, percentages, means, standard deviations, and ranges, will be used to describe patient demographic and clinical characteristics of the study population. Summary statistics will also be used to describe PRO by assessment time. We will also assess the additional PRO trends over time using linear mixed models (LMMs). Additional models will be created to assess intervention effect while controlling for possible confounding covariates, and the relationship between self-efficacy and other PROs. Implications: Results of this study are anticipated to elucidate (1) if and how DLC may be used to support individuals with R/R MM and (2) clinical and PRO outcomes, including both survey and wearable data, for individuals with R/R MM in a DLC program.

Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study.

Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature. This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses. We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05. The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02). This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.

Autistic characteristics and mental health symptoms in autistic youth during the first COVID-19 wave in Canada.

Autistic youth are at heightened risk for mental health issues, and pandemic-related stressors may exacerbate this risk. This study (1) described caregiver-reported youth mental health prior to and during the pandemic; and (2) explored individual, caregiver, and environmental factors associated with changes in autistic characteristics, social-emotional symptoms, and overall mental health. 582 caregivers of autistic children (2-18 years old) completed an online survey between June and July 2020 in which they provided demographic information, their child's pre-COVID and current mental health, autistic characteristics, and social-emotional symptoms. Caregivers also rated their own perceived stress, and COVID-related household and service disruption. According to caregivers, youth experienced more autistic characteristics and social-emotional concerns during the pandemic. Autistic youth were also reported to experience poorer overall mental health during the pandemic than before the pandemic. Older youth whose caregiver's indicatedhigher perceived stress and greater household disruption were reported to experience more autistic traits during pandemic. Caregiver-reported increases in youth social-emotional symptoms (i.e., behavior problems, anxiety, and low mood) was associated with being older, the presence of a pre-existing mental health condition, higher caregiver stress, and greater household and service disruption. Finally, experiencing less household financial hardship prior to COVID-19, absence of a pre-existing psychiatric condition, less caregiver stress, and less service disruption were associated with better youth pandemic mental health. Strategies to support the autistic community during and following the pandemic need to be developed. The developmental-ecological factors identified in this study could help target support strategies to those autistic youth who are most vulnerable to mental health problems.

The Effects of the First Phase of the Covid-19 Pandemic on the Mental Health of Children and Adolescents With preexisting Psychiatric Conditions.

Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times.

Psychological Impacts of COVID-19 Pandemic

Thousands of millions of people faced devastating impacts around the world during COVID-19 pandemic. Not only anxiety or fear of COVID-19 dominated the negative psychological impacts, mental disorders such as depression, posttraumatic stress disorder, and sleep disturbance increasingly appeared during or after the pandemic. Apart from the confirmed patients, survivors of the viral infection, close family members, elders, children and adolescents, people quarantined, people with preexisting psychiatric conditions, frontline police, emergency medical services, and health-care workers, mental distress specific to the vulnerable groups should be recognized. Preventive strategies including self-regulations, leadership, and teamwork were highlighted. Specific evaluations for at-risk population and efficacious treatment such as cognitive behavioral treatment could be considered. This article delineated directions for mental health workers during pandemic.

Evaluating resilience in response to COVID-19 pandemic stressors among veteran mental health outpatients.

There is a public health need to understand mental health vulnerabilities to COVID-19 pandemic-related stressors and promote resilience among high-risk populations with preexisting psychiatric conditions. Recent cross-sectional studies suggest increases in mental health distress (e.g., depression and anxiety) during the pandemic. The present study expands upon these emerging findings using longitudinal latent modeling and hierarchical linear regressions. Consistent with the developmental psychopathology literature on resilience, we distinguished between promotive or risk (i.e., main effect), and protective or vulnerability (i.e., moderation) effects on mental health during the pandemic. At a large medical center, 398 veterans receiving outpatient mental health care provided prepandemic (Time 1) and during pandemic (Time 2) assessments of mental and physical health-related distress. Additional Time 2 questionnaires assessed pandemic-related stressors and positive behavioral adaptations in the summer of 2020. As expected, total stressor scores predicted longitudinal worsening of self-reported mental (β = -.205) and physical health (β = -.217). Positive behavioral adaptations enacted during the pandemic moderated and protected against stressor effects on mental health (β = .160). In addition, the presence of substance use disorders moderated and conferred vulnerability to stressor effects on physical health (β = -.158). Thus, higher COVID-19 pandemic stressor exposure may have exacerbated mental and physical health distress among veterans with common forms of psychopathology. Nevertheless, behavioral activation, purposeful maintenance of social connections, and focused treatment for substance misuse may be important intervention targets for reducing the longitudinal impact of pandemic stressors and enhancing resilience among people with mental illness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association Between Societal Isolation and the Subject of Mental Health

Being social creatures, humans need a safe and secure social environment to exist. For one's physical and emotional well-being, it is imperative to have satisfying social connections. Loneliness may result from a lack of social connections. Intimacy and a sense of belonging are fundamental human desires. Interpersonal connections have several advantages. Loneliness has been perceived as a universal human experience since the dawn. Social connection is essential for everyone's survival. People are innately social beings that rely on one another for assistance. Even though mental health issues and social isolation often coexist in young children, early isolation does not indicate worse mental health issues in the future. However, children with such issues and behaviors could find it difficult to handle the social difficulties they face as they advance through the early years of school. Humans are social animals, and when they don't feel connected, they tend to get sadder, sicker, and more susceptible to developing depression and other mental health problems. Isolation is a frequent occurrence that become more prevalent during the COVID-19 global pandemic, having an adverse effect on people's physical and mental health everywhere. Furthermore, according to the most recent data, there may be an increase in the prevalence of mental health problems among at-risk groups and persons who are vulnerable to them after the pandemic's height. 6 Children and adolescents, the elderly, people who are unemployed or homeless, COVID-19 survivors, people with pre-existing psychiatric conditions, community workers, pregnant women, people who are physically or mentally disabled, migrants, refugees, and members of the LGBT community, as well as people who belong to racial or ethnic minorities, are among the vulnerable populations. Loneliness in the elderly beings and social isolation pose a substantial threat to public health because they increase the risk of dementia and other serious disorders in a huge number of people.

Mental health consequences of COVID-19 suppression strategies in Victoria, Australia: a narrative review.

The COVID-19 pandemic has imposed significant mental health burdens upon the general population worldwide, either directly owing to the disease or indirectly through aggressive public health measures to control spread of the virus that causes COVID-19. In this narrative review, we used a systematic approach to summarize the impact of restrictive lockdown measures on the general mental health of people living in Victoria, Australia during 2020 and to identify the groups with an increased risk of adverse mental health outcomes. A systematic database search (Ovid Medline, PsycINFO, Embase) for articles examining the mental health of Victorians in the context of the COVID-19 pandemic during 2020 yielded 88 articles, of which 15 articles were finally included in this review. We found that the general mental health of Victorians was negatively affected by COVID-19 restrictions during 2020. Although studies reported heterogeneous mental health outcomes, we found that the general population consistently used coping strategies and demonstrated mental health help-seeking behaviors in response to the restrictions. Women, children, young people, carers, people who became unemployed owing to the pandemic, and those with pre-existing psychiatric conditions had a higher risk of adverse mental health consequences during the COVID-19 pandemic in 2020.

ANXIETY LEVEL OF MIDWIFERY CLINICAL STUDENTS DURING COVID-19 PANDEMIC

Introduction: Clinical midwifery students experience higher anxiety than the general population during COVID-19 pandemic. The higher level of anxiety is due to pressure in their clinical learning environment. This study will explore the effect of the clinical learning environment on the increased anxiety in midwifery students during the COVID-19 pandemic. Method: This prospective cross-sectional study was conducted on 82 clinical midwifery students at Airlangga University using an online survey. We excluded students who had not started clinical studies and students with pre-existing medical or comorbid psychiatric conditions that could explain the pain. Information from participants included  socio-demographic, clinical learning environment questionnaire, and Hamilton Rating Scale for Anxiety (HRS-A). Results: The study showed that most of the respondents aged 20-27 years (73.2%), in the second semester (76.8%), living in boarding houses/contracts (74.4%), unmarried status (75.6%), the level of family income is very high (68.3%), and the perception of a poor clinical learning environment (51.2%). Participants experienced no anxiety the most (52.4%) and significantly correlated with the age p=0.047, domicile status p=0.076, and clinical learning environment p=0.008. But not their semester p=0.991, marital status p = 0.406, and family income p=0.872. Conclusion: These data indicate that age, domicile status, and clinical learning environment contribute to the incidence of anxiety in midwifery clinic students during the COVID-19 pandemic. 

Psychiatric morbidity is common in orthognathic surgery patients—a retrospective study

The study aimed to clarify psychiatric morbidity in patients who underwent orthognathic surgery (OS) pre- and postoperatively. Patients ≥18 years undergoing OS were included in this retrospective study. The outcome variable was the incidence of new mild, moderate, or severe psychiatric morbidity or exacerbation of preexisting psychiatric morbidity postoperatively. Surgery and patient-related background variables for outcome were analyzed (SPSS for Macintosh, version 27; IBM SPSS, Inc., Armonk, NY, USA). Of 182 patients, 44 (24%) had preceding psychiatric morbidity. It was associated significantly with history of alcohol abuse (P < .001) and smoking (P=.046) and was more common in older patients (P = .042). During the postoperative phase, new psychiatric morbidity or exacerbation of a preexisting psychiatric condition was found in 12 patients (7%). Preceding psychiatric history (OR 8.88, P=.004) and high-dose perioperative dexamethasone (OR 9.81, P=.036) were independent predictors for postoperative psychiatric morbidity. No other evaluated variables were associated with outcome. Psychiatric conditions are common among OS patients. Treatment planning should consider the patient's mental health to minimize the risk of exacerbating psychiatric conditions, and collaboration with psychiatric professionals is recommended. Perioperative high-dose dexamethasone should be used with caution considering possible adverse psychiatric effects.

Post COVID-19 Cognitive Impairment in a Patient with Bipolar Disorder

COVID-19 has caused widespread health conditions, psychological and social distress among people and there is evidence that shows profound neuropsychiatric complications during acute and post-recovery phases of the infection. Cognitive impairment occurring after COVID-19 infection can be explained by various mechanisms, including persistent systemic inflammation, direct viral invasion, alteration in the blood-brain barrier, and cerebrovascular endothelial injury.There are few studies that have explored the impact of COVID-19 on pre-existing psychiatric conditions. This case report highlights the temporal association of cognitive impairment with COVID-19 and the need for cognitive assessment and management in post-COVID-19 patients with pre-existing psychiatric conditions.

Analysis of Anxiety and Depression in the Context of Commercially-Available Energy Beverage Consumption

Energy drinks are common in the diets of teenagers. Despite the increase in consumption in American teenagers, little has been done to study its effects on the anxiety and depressive behaviors of teenagers. 25 participants were selected including a majority of Asians and Caucasians between the ages of 12 to 22. The participants filled out a survey that recorded a baseline for a week, and then drank increasing dosages of energy drinks the following week while continuing to fill out a survey. They filled out a survey that was designed with SIG E CAPS indicators on each day, and the results were compared using a student’s t-test. The results were not statistically significant, but this supports that the caffeine limit set by the Food and Drug Administration does indeed prevent negative effects of caffeine on adolescents. One participant, with a pre-existing psychiatric condition, withdrew from the study after his markers of anxiety were significantly higher in the week that he took the energy drinks. While the study was limited in both scale and dosage, it did fall in alignment with the body of literature that preceded it. To formulate a statistically significant study with results that have a higher confidence level, the dosage of caffeine and the number of participants who consume it would need to be increased. The study, while not being statistically significant, reinforced the pediatric limit of caffeine and opened the door to further studies that involve a higher dosage or more participants. 

Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study.

Background: Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. Methods: Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. Results: All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. Conclusion: ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.

Wellness for the Wounded: Mental Health Care in the Diabetic Limb Salvage Team.

Managing patients with diabetic foot ulcers mandates coordinated input from multiple disciplines. Our practice has published previously on the value of a multidisciplinary team, incorporating skills from plastic surgery, vascular surgery, podiatry, rheumatology, and hyperbaric oxygen therapy in a single location.1 A relatively underdiscussed and poorly recognized component of the multidisciplinary team is mental health care through psychiatrists and psychosocial support. The effects of acute and chronic wound formation on a patient’s quality of life are well documented. Much of the literature comes from studies on trauma and burn survivors. In these fields, preexisting mental health conditions have been linked to higher rates of reoperation, longer hospital stays, and longer times to return to preinjury activity.2 More recently, validated surveys that assess emotional quality of life, such as the 36-Item Short-Form Health Survey, have been applied to the chronic wound populations.3 Patients with chronic leg ulcers have the highest rates of depression among patients with skin diseases and consistently report lower quality of life, worse physical functioning, and higher levels of pain.4 However, few studies comment on the critical role of psychiatrists, psychologists, and social support in the chronic wound population. In the chronic wound population, the interplay of mental health and wound-related outcomes is critical. Chronic diseases, such as diabetes, require lifelong maintenance therapy and diligent monitoring for acute emergencies. Patients who have difficulty adapting to their intensive medically necessary care face higher disease burden and are at risk for experiencing the extremes of disease progression, such as limb loss. Research shows that patients with high mental illness burden often have difficulty adhering to medication schedules. Patients who are prescribed psychiatric medication take, on average, 58 to 65 percent of all prescribed medications.5 Patients with chronic wounds and diabetic foot ulcers are seen bimonthly to weekly by a team of specialized wound care physicians who are not trained to recognize or manage psychiatric disease. Adding psychiatry or behavioral psychology to the wound team provides critical services that allow for prompt identification of disease. Incorporating providers who are equipped to manage physical and mental aspects of care is essential to improve health outcomes and reduce health care costs. To accomplish this goal, all centers that provide care for patients with diabetic wounds can (1) incorporate a dedicated expert in mental health on their team, (2) consistently refer all diabetic wound patients who are exhibiting signs of mental health distress to a behavioral health specialist, (3) educate existing staff members on the role of mental health in wound healing, and (4) screen patients for depression and anxiety during all stages of care. There is abundant need for research into the relationship between successful chronic wound management and mental health support. More longitudinal analyses of the development of new or progression of preexisting psychiatric conditions as a consequence of chronic wound formation will help guide treatment of coexisting conditions. Quality trials also need to assess which behavioral or pharmacologic treatments yield the greatest benefit to wound healing and functional outcomes. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.