Pre-existing Psychiatric Diagnosis Research Articles

Biomedical Applications of Cold Plasma

Coronavirus pandemic created havoc on our planet, affecting all aspects of human life. It has resulted in human mortality and morbidity worldwide. It did not spare social and economic fabric of societies. It has resulted in huge psychosocial impact on human race. Various disease containment measures such as quarantine, physical distancing, complete lockdowns imposed by governments across the globe has severely affected mental health of children and adolescents. This paper is aimed at reviewing various articles published regarding the Coronavirus Disease 2019 (COVID-19) pandemic impact on mental health of children with or without previous mental health problems. Different electronic databases, such as Science Direct, PubMed and Google Scholar were searched for articles describing impact on mental health of children and adolescents with/without previous mental health problems due to COVID-19. Search strategies included terms such as: “COVID-19”, “SARS-CoV-2”, “mental health”, “children”, “adolescent”, “behavioural impact”, “depression” and “anxiety.” The majority of children and adolescents experienced deterioration in their mental health as emergency measures were implemented throughout the world. Children diagnosed with preexisting mental health problems or Autism Spectrum Disorder (ASD) experienced more negative changes compared with children/ adolescents without pre-existing psychiatric diagnoses. There is increased anxiety, depression, irritability, sleep disorders, lethargy, dissatisfaction and fear of death. There is need to plan and implement strategies to provide easy and early access to mental health services for which various stakeholders should come together.

Delirium and other neuropsychiatric manifestations of COVID-19 infection in people with preexisting psychiatric disorders: a systematic review

BackgroundPsychiatric disorders increase risk of neuropsychiatric disease and poor outcomes, yet little is known about the neuropsychiatric manifestations of COVID-19 in the psychiatric population. The primary objective is to synthesize neuropsychiatric outcomes of COVID-19 in people with preexisting psychiatric disorders.MethodsData were collected during an ongoing review of the impact of pandemics on people with existing psychiatric disorders. All study designs and gray literature were included. Medline, PsychInfo, CINAHL, EMBASE, and MedRx were searched from inception to September 1 2020. Risk of bias was assessed using a published tool that can accommodate all study types. Two independent authors screened the studies and extracted data. Data were narratively synthesized, as there were insufficient data to meta-analyze. Evidence was appraised according to GRADE.ResultsFour case reports were included, comprising 13 participants from three countries. Many large-sample, relevant papers were omitted for not reporting psychiatric history, despite reporting other comorbidities. Included participants (n = 13) were hospitalized with COVID-19 and appeared to meet criteria for delirium. Myoclonus, rigidity, and alogia were also reported. The most commonly reported preexisting psychiatric diagnoses were mood disorders, schizophrenia, and alcohol use disorder.ConclusionsPeople with preexisting psychiatric disorders may experience delirium, rigidity, myoclonus, and alogia during COVID-19 infection; although higher quality and longitudinal data are needed to better understand these phenomena. Relevant COVID-19 literature does not always report psychiatric history, despite heightened neuropsychiatric vulnerability within this population.Trial Registration: PROSPERO (CRD42020179611).

Prevalence of Psychiatric Illnesses in Patients Undergoing Oral and Maxillofacial Surgery Procedures in an Outpatient Setting

Mental illness is highly prevalent among adults in the United States, with almost 1 in 5 adults living with some degree of mental illness. Given most of oral and maxillofacial surgery (OMS) procedures are inherently anxiety-generating, the authors sought to determine the burden of psychiatric illness in the population seeking care at an outpatient OMS unit of the University of Cincinnati. The authors hypothesized that psychiatric diagnoses would be common in this population.This is an ongoing retrospective cohort study. Study subjects were identified by searching CPT codes through electronic health records to identify all patients older than 15 years of age who underwent any oral and maxillofacial surgery outpatient procedure in 2018 (January 1 to December 21). Data on demographics, ASA status, presence of psychiatric diagnosis according to DSM-5, type of procedure, and complications were collected by performing a retrospective chart review. A total of 4616 patients were identified for the chosen timeframe. All the duplicates (387 patients) were removed; 252 patients were further removed as they did not meet the inclusion criteria (no procedure performed, < 15 years old). That left a dataset of 3977 patients. So far, complete data extraction has been conducted for 1300 patients who were chosen randomly. Data extraction was conducted by 5 students who were all trained on the procedures for data extraction.Descriptive analysis was conducted and prevalence rates were calculated. Out of total of 1300 patients who were reviewed, 60.9% (792) were females and 39.1% (508) were males. Age range was from 15 to 98 years with a mean age of 34.2 years; 45.2% (588) were Caucasian, 39% (507) were African-American, 0.7% (9) were Asian, 3.1% (40) were Hispanic, 3.3% (43) were other races, and 8.7% (113) were of unknown race; 32.1% (418) of patients were classified as ASA I, 55.6% (723) were ASA II, 11.2% (145) were ASA 3, and 1.1% (14) were ASA IV. Among the total reviewed population through OMS vision, 305 patients were found to have reported psychiatric diagnosis. Further review of medical history of the remaining patients was performed through Epic, and 26 more patients were found to have reported psychiatric diagnosis. A total of 25.5% (331) of patients were found to have a pre-existing psychiatric diagnosis. Out of these patients, 62 had neurogenic disorders, 29 had schizophrenia spectrum disorders, 56 had bipolar disorders, 218 had anxiety and depressive disorders, 82 had substance use and addictive disorders, 5 had personality disorders, and 7 had other disorders. A total of 102 patients had multiple psychiatric diagnosis. Among the 1300 procedures completed, 11.8% (153) of patients experienced postoperative complications and, among these, 24.9% (38) had psychiatric diagnoses.The review shows that psychiatric illnesses are common among the oral and maxillofacial surgery population. This population is also likely to have more complications. The ongoing record review would shed more light in this arena when complete. Prognostic implications of preoperative psychiatric disorders on surgical outcome should be demonstrated prospectively in intervention studies.

Improving Surgical Quality for Patients With Mental Illnesses: A Narrative Review.

The aim of this study was to identify disparities in care for surgical patients with preexisting mental health diagnoses. Mental illness affects approximately 6.7 million Canadians. For them, stigma, comorbid disorders, and sequelae of psychiatric diagnoses can be barriers to equitable health care. The goal of this review is to define inequities in surgical care for patients with preexisting mental illness. We searched OVID Medline, Pubmed, EMBASE, and the Cochrane review files using a combination of search terms using a PICO (population, intervention, comparison, outcome) model focusing on surgical care for patients with mental illness. The literature on mental illness in surgical patients focused primarily on preoperative and postoperative disparities in surgical care between patients with and without a diagnosis of mental illness. Preoperatively, patients were 7.5% to 40% less likely to be deemed surgical candidates, were less likely to receive testing, and were more likely to present at later stages of their disease or have delayed surgical care. Similar themes arose in the postoperative period: patients with mental illness were more likely to require ICU admission, were up to 3 times more likely to have a prolonged length of hospital stay, had a 14% to 270% increased likelihood of having postoperative complications, and had significantly higher health care costs. Surgical patients with preexisting psychiatric diagnoses have a propensity for worse perioperative outcomes compared to patients without reported mental illness. Taking a thorough psychiatric history can potentially help surgical teams address disparities in access to care as well as anticipate and prevent adverse outcomes.

Effectiveness of the Weighted Blanket With Psychiatric Patients in the Emergency Department: A Pilot Study.

Restraint and seclusion continue to be used with patients demonstrating aggressive and violent behaviors while in the emergency department and as inpatients in behavioral health (BH) units. The use of sensory interventions such as the weighted blanket (WB) is garnering interest as alternatives to aid in managing anxiety, anger, and aggressive behaviors. Reports of the effectiveness of the WB have primarily been anecdotal, and results of research with children have been mixed. Only one study has been conducted with the WB with adults on an inpatient psychiatric unit. The aim of this pilot study was to assess the effectiveness of the WB by determining whether it decreases anxiety and/or anger in adult emergency department patients with preexisting psychiatric diagnoses. The study used a quasi-experimental, nonequivalent control group design with pre- and posttests for anxiety and anger. The intervention was a 15-pound WB. Participants (N = 15) were in one of three groups, which included no weighted blanket (NWB), WB for 15 minutes, or WB for 30 minutes. All three groups showed a decrease in anxiety and anger scores. However, participants in the WB groups had a greater decrease in anxiety and anger posttest scores. The small sample size in this study did not allow for the determination of any differences between groups on anxiety or anger scores that could be viewed as a significant finding.

Mechanisms of parental distress during and after the first COVID-19 lockdown phase: A two-wave longitudinal study.

BackgroundIn these unpredictable times of the global coronavirus disease 2019 (COVID-19) pandemic, parents worldwide are affected by the stress and strain caused by the physical distancing protocols that have been put in place.ObjectiveIn a two‐wave longitudinal survey, we investigated the levels of parental stress and symptoms of anxiety and depression in a sample of parents at two time points; during the implementation of the strictest physical distancing protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three months after the discontinuation of the protocols (T2, N = 1,489). Further, we investigated the relationships between parental stress and anxiety and depression relative to relationship quality and anger toward their children at the two aforementioned time points, including subgroups based on age, parental role, cultural background, relationship status, education level, number of children, employment status and pre-existing psychiatric diagnosis.Methods and findingsParents were asked to fill out a set of validated questionnaires on the two measurement points. Parental stress significantly decreased from T1 to T2, indicating that the cumulative stress that parents experienced during the implementation of the distancing protocols declined when the protocols were phased out. The decrease of perceived parental stress was accompanied by a significant decrease in the symptoms of both depression and anxiety among the participating parents. Symptoms meeting the clinical cut-offs for depression (23.0%) and generalized anxiety disorder (23.3%) were reported among participating parents at T1, compared to 16.8% and 13.8% at T2, respectively. The reduction in depression and anger toward their child(ren) from T1 to T2 was associated with a reduction of parental stress. Relationship quality and anger toward their child(ren) at T1 further predicted a change in the level of parental stress from T1 to T2.ConclusionsThe study underlines the negative psychological impacts of the implementation of the distancing protocols on parents’ health and well-being. Uncovering the nature of how these constructs are associated with parents and families facing a social crisis such as the ongoing pandemic may contribute to the design of relevant interventions to reduce parental distress and strengthen parental coping and resilience.

Learning from previous lockdown measures and minimising harmful biopsychosocial consequences as they end: A systematic review.

BackgroundInfectious outbreaks, most recently coronavirus disease 2019 (COVID-19), have required pervasive public health strategies, termed lockdown measures, including quarantine, social distancing, and closure of workplaces and educational establishments. Although evidence analysing immediate effects is expanding, repercussions following lockdown measures remain poorly understood. This systematic review aims to analyse biopsychosocial consequences after lockdown measures end according to short, medium, and long-term impacts.MethodsPubMed, Ovid MEDLINE, Embase, PsycInfo, Web of Science, and Scopus databases were searched from inception to January 12, 2021. Reference lists were manually reviewed. Eligible studies analysed biopsychosocial functioning after lockdown measures secondary to recent infectious outbreaks ended. Lockdown measures were defined as quarantine, isolation, workplace or educational closures, social or physical distancing, and national or local closure of public institutions deemed non-essential. Studies exclusively researching outcomes during lockdown measures, examined infectious participants, or analysed lockdown measures not pertaining to an infectious outbreak were excluded. Two independent reviewers extracted data and assessed bias with a third resolving discrepancies. Data was extracted from published reports with further information requested from authors where necessary. The mixed methods appraisal tool assessed study quality, languages were restricted to English, German, Italian, and French and narrative synthesis was applied.ResultsOf 5149 identified studies, 40 were eligible for inclusion. Psychological distress, economic repercussions, social, biological, and behavioural ramifications were observed. Short to medium-term effects comprised reactions relating to early trauma processing whereas medium to long-term repercussions manifested in maladaptive behaviours and mental health deterioration. Increased alcohol intake, stigmatisation, and economic effects were also identified consequences. High-risk groups included health care workers, children, elderly, inpatients, those with pre-existing psychiatric diagnoses, and socially isolated individuals.ConclusionsSupporting vulnerable groups and offering education, workplace modifications, financial, and social assistance may mitigate negative repercussions. Establishing a rapid and comprehensive evidence base appraising the efficacy of such interventions and identifying areas for development is essential. This review was limited by study heterogeneity and lack of randomisation in available literature. Given the unprecedented nature and progression of COVID-19, the relevance of previous outcomes remains uncertain.Protocol registrationPROSPERO registration CRD42020181134

Coping With COVID-19: Mindfulness-Based Approaches for Mitigating Mental Health Crisis

The novel coronavirus disease COVID-19 that first emerged in Wuhan, China, in Nov-Dec 2019 has already impacted a significant proportion of the world population. Governments of many countries imposed quarantines and social distancing measures in 2020, many of which remain in place, to mitigate the spread of the SARS-Cov-2 virus causing the COVID-19 disease. The direct impact of COVID-19 on people infected with the virus, their families and the health care workers, as well as the impact of the mitigation measures such as quarantine, social distancing, and self-isolation on the rest of the population have contributed to a global mental health pandemic, including anxiety, depression, panic attacks, posttraumatic stress symptoms, psychosis, addiction, obsessive-compulsive disorder, and suicidality. These effects are present acutely (for example, due to fear of contamination or losing loved ones, effects of quarantine/isolation, withdrawal of community and social services, etc.) and may continue long after the pandemic is over (for example, due to bereavement, unemployment, financial losses, etc). The COVID-19 pandemic has triggered mental health problems in people without previous history of mental illness, as well as worsened the symptoms in those with pre-existing psychiatric diagnosis. Therefore, the global effort is called for to deal with this mental health pandemic secondary to COVID-19 itself to address the emergence of new as well as the exacerbation of the existing mental health issues. Conversely, this global context provides an extraordinary opportunity for studying individual differences in response to and resilience in the face of physical and psychological threat, challenge to “normal” way of life, and long-term uncertainty. In this viewpoint article we outline the particular suitability of mindfulness, its skills and mechanisms, as an approach to the prevention and management of mental health issues, as well as to the promotion of well-being and building the foundations of adaptability and flexibility in dealing with the long-term uncertainty and profound changes to the social, economic, and possibly political systems as this pandemic continues to unfold.

Changes in Diagnostic and Demographic Characteristics of Patients Seeking Mental Health Care During the Early COVID-19 Pandemic in a Large, Community-Based Health Care System.

The early COVID-19 pandemic resulted in great psychosocial disruption and stress, raising speculation that psychiatric disorders may worsen. This study aimed to identify patients vulnerable to worsening mental health during the COVID-19 pandemic. This retrospective observational study used electronic health records from March 9 to May 31 in 2019 (n = 94,720) and 2020 (n = 94,589) in a large, community-based health care system. Percent change analysis compared variables standardized to the average patient population for the respective time periods. Compared to 2019, psychiatric visits increased significantly (P < .0001) in 2020, with the majority being telephone/video-based (+264%). Psychiatric care volume increased overall (7%), with the greatest increases in addiction (+42%), behavioral health in primary care (+17%), and adult psychiatry (+5%) clinics. While patients seeking care with preexisting psychiatric diagnoses were mainly stable (−2%), new patients declined (−42%). Visits for substance use (+51%), adjustment (+15%), anxiety (+12%), bipolar (+9%), and psychotic (+6%) disorder diagnoses, and for patients aged 18–25 years (+4%) and 26–39 years (+4%), increased. Child/adolescent and older adult patient visits decreased (−22.7% and −5.5%, respectively), and fewer patients identifying as White (−3.8%) or male (−5.0) or with depression (−3%) or disorders of childhood (−2%) sought care. The early COVID-19 pandemic was associated with dramatic changes in psychiatric care facilitated by a rapid telehealth care transition. Patient volume, demographic, and diagnostic changes may reflect comfort with telehealth or navigating the psychiatric care system. These data can inform health system resource management and guide future work examining how care delivery changes impact psychiatric care quality and access.

Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents.

This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6–18 (N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10–18 (N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2–5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67–70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19–31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37–56%, anxiety 31–50%, irritability 40–66%, attention 40–56%, hyperactivity 23–56%, obsessions/compulsions 13–30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12–55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96–2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13–3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97–5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-021-01744-3.

The effects of the COVID-19 outbreak and measures in patients with a pre-existing psychiatric diagnosis: A cross-sectional study.

Background COVID-19 has seriously affected physical and mental health world-wide,both due to spreading of the virus and due to the socially restrictive measures most governments have enforced. Increased anxiety, stress and depressive symptoms have been widely reported in the general population. The current study investigated the effects of COVID and the restrictive measures in the Netherlands on stress, anxiety and loneliness in patients with a pre-existing psychiatric disorder. Methods 189 patients with a pre-existing psychiatric disorder treated at the University Medical Center Utrecht (UMCU) provided consent to participate in an electronically provided survey. Questionnaires on anxiety, depressive symptoms, worry, stress and general health were completed by 148 participants. Results All patients reported heightened distress as well as the presence of depressive symptoms and loneliness during the initial phase of the restrictive measures. Patients could be divided into two major subgroups with either psychotic disorder (n = 71) and affective disorder (n = 86). Patients with affective disorders were more affected by the outbreak and accompanying socially restrictive measures than patients with psychotic disorders. Conclusions Our findings indicate negative mental health effects of the global COVID-19 pandemic and the restrictive measures in a particularly vulnerable population, with differential effects on diagnostic groups.

The Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare Workers with Pre-Existing Psychiatric Conditions.

Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to have elevated prevalence of psychiatric symptoms, but little is known about HCWs with psychiatric diagnoses. To examine their response to the pandemic, we analyzed their perspective, and association with psychiatric symptoms and stress among HCW with psychiatric diagnosis. Using an online survey of HCW, we analyzed demographics, work information, health factors, open-ended question, sources of stress and standardized mental health scales (Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Stress Disorder Checklist (PCL)). Sixteen out of 129 HCWs reported a pre-existing psychiatric diagnosis (median age 32 years, 8 were females, 8 work in the emergency department). Their perception of the impact severity on symptoms was significantly correlated with all the mental health scales and with stress from avoiding physical contact. In multivariate analysis, PSS score and PCL score were associated with self-rated impact of the COVID-19 pandemic on symptoms (standardized beta = .51 for PCL and standardized beta = .55 for PSS). GAD-7 score was significantly related to both impact (standardized beta = .44) and stress from avoiding physical contact (standardized beta = .53). HCWs with psychiatric diagnoses reported a range of perception of the impact of the pandemic on their symptoms with increased severity associated with worse psychiatric outcomes and more stress from avoiding physical contact with others. There is a growing importance to protect HCWs mental health, including those with pre-existing psychiatric diagnosis, and proactively counter psychosocial consequences of healthcare crises.

Nursing Home Transfers for Behavioral Concerns: Findings from the OPTIMISTIC Demonstration Project.

To characterize pretransfer on-site nursing home (NH) management, transfer disposition, and hospital discharge diagnoses of long-stay residents transferred for behavioral concerns. This was a secondary data analysis of the Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care project, in which clinical staff employed in the NH setting conducted medical, transitional, and palliative care quality improvement initiatives and gathered data related to resident transfers to the emergency department/hospital setting. R software and Microsoft Excel were used to characterize a subset of transfers prompted by behavioral concerns. NHs in central Indiana were utilized (N = 19). This study included long-stay NH residents with behavioral concerns prompting transfer for acute emergency department/hospital evaluation (N = 355 transfers). The measures used in this study were symptoms prompting transfer, resident demographics and baseline characteristics (Minimum Data Set 3.0 variables including scores for the Cognitive Function Scale, ADL Functional Status, behavioral symptoms directed toward others, and preexisting psychiatric diagnoses), on-site management (e.g., medical evaluation in person or by phone, testing, and interventions), avoidability rating, transfer disposition (inpatient vs emergency department only), and hospital discharge diagnoses. Over half of the transfers, 56%, had a medical evaluation before transfer, and diagnostic testing was conducted before 31% of transfers. After transfer, 80% were admitted. The most common hospital discharge diagnoses were dementia-related behaviors (27%) and altered mental status (27%), followed by a number of medical diagnoses. Most transfers for behavioral concerns merited hospital admission, and medical discharge diagnoses were common. There remain significant opportunities to improve pretransfer management of NH transfers for behavioral concerns.

Heightened Levels of Maladaptive Daydreaming Are Associated With COVID-19 Lockdown, Pre-existing Psychiatric Diagnoses, and Intensified Psychological Dysfunctions: A Multi-country Study.

The COVID-19 pandemic has been spreading globally since December 2019, bringing with it anxieties, mortal risk, and agonizing psychological suffering. This study aimed to explore the relationship between maladaptive daydreaming (MD)—an addictive mental behavior to vivid fantasy associated with distress and functional impairment—and forced COVID-19 pandemic-related self-isolation and quarantine. Previous literature indicated that individuals employ MD for the regulation of distress and boredom, wish fulfillment, and entertainment experiences. The literature on the impact of the COVID-19 pandemic on mental health identifies a flareup in psychological difficulties in the general population. In this study we explored the associations between the pandemic threat and mental health indices among individuals with MD. We surveyed 1,565 adults from over 70 countries who responded to calls for participants posted in online MD communities and other general social media sites. Probable MD was determined based on an empirically derived cut-off score on a pertinent measure. After controlling for sociodemographic variables, a series of MANCOVAs, followed by post-hoc ANCOVAs, revealed that individuals with probable MD who were observing lockdown restrictions reported having spent more time in fantasy, experienced more intense and vivid daydreaming, and had a stronger urge to daydream than other participants. Similar statistical procedures indicated that, individuals with probable MD who reported pre-existing anxiety and depression disorders described a greater urge to daydream due to the pandemic and greater difficulty to control this addictive behavior. Compared to individuals with likely normal daydreaming, individuals with suspected MD reported more pandemic-attributed deterioration on a wide array of psychological distress indices. Our data show that the current worldwide pandemic threat is connected with an elevated intensity of this addictive form of mental activity, and that MD is associated with the exacerbation of psychological distress and dysfunction rather than with beneficial regulation of the experienced stressor.

Minimising Negative Biopsychosocial Impacts as Lockdown Measures End: A Systematic Review

Background: Infectious outbreaks, most recently Coronavirus disease 2019 (COVID-19), have required public health strategies, termed lockdown measures, including quarantine and closure of public institutions. Although evidence analysing immediate effects is expanding, repercussions following lockdown measures remain poorly understood. This review aims to analyse the biopsychosocial consequences after lockdown measures end according to short, medium, and long-term impacts. Methods: Eligible studies analysed biopsychosocial functioning following lockdown measures secondary to infectious outbreaks. Studies exclusively researching outcomes during lockdown, review articles, or those analysing lockdown measures not pertaining to an infectious outbreak were excluded. Data was extracted from published reports with further information requested where necessary. The mixed methods appraisal tool assessed study quality, a protocol was registered with PROSPERO (CRD42020181134), and narrative synthesis was applied. Findings: Of 3495 identified studies, 27 were eligible. Psychological distress, economic repercussions, social, and behavioural ramifications were observed. Short to medium-term effects comprised reactions relating to early trauma processing whereas medium to long-term repercussions manifested in maladaptive behaviours and mental health deterioration. High-risk groups included healthcare workers, children, elderly, inpatients, those with pre-existing psychiatric diagnoses, and socially isolated individuals. Interpretation: Supporting vulnerable groups and offering education, workplace modifications, financial, and social assistance may mitigate negative repercussions. Establishing a rapid and comprehensive evidence base appraising the efficacy of such interventions and identifying areas for development is essential. This review was limited by heterogeneity and lack of randomisation in available literature. Given the unprecedented nature and progression of COVID-19, the relevance of previous outcomes remains uncertain. Funding: None.Declaration of Interests: The authors declare no competing interests.

573 Frequency of Burn Injuries in Children with Autism Spectrum Disorders and Attention Deficit/hyperactivity Disorder and Implications on Treatment Compliance

Abstract Introduction Children with autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) are at a higher risk of burn injuries, compared to children with neurotypical development, but little is known about the epidemiology of burn injuries in children diagnosed with ASD and ADHD. Research within the pediatric burn population using the Burn Outcomes Questionnaire (BOQ) has been successful in capturing levels of risk on burn-recovery specific domains such as compliance to treatment, pain, and parental concerns. Methods The current study retrospectively assessed a subsample of BOQ data in children with burn injuries who also had a diagnosis of ASD or ADHD. This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board. Results Of the 593 patients who completed a BOQ, 186 patients were identified with a diagnosis of ASD or ADHD. 127 patients had multiple parent-reported symptoms which align with diagnoses of ASD and ADHD, including 116 (63.4%) with attention or behavioral problems, 42 (23.3%) with a developmental delay, 7 (3.9%) with an intellectual disability and 90 (49.7%) had learning problems. 66 (37.3%) patients had pre-existing comorbid psychiatric diagnoses of depression. Conclusions Results indicated that a large portion of patients have a diagnosis of ASD/ADHD with significantly higher levels of parental concern regarding compliance compared to youth without an ASD/ADHD diagnosis. Results suggest that modified curriculum may be necessary to assure effective prevention education for children with ASD and ADHD. Applicability of Research to Practice While it is important to educate all children in burn prevention efforts, special attention may be necessary to assure training with children at greater risk for burn injury. Specific parent training would be imperative to understand the critical burn care needs of children with developmental disabilities.

Implications of Perioperative Polypharmacy in Adolescents Undergoing Bariatric Surgery: a Single-Center Experience.

Adolescents seeking bariatric surgery may present with pre-existing psychiatric diagnoses for which they use chronic medications. To heighten awareness concerning perioperative polypharmacy in adolescents with extreme obesity, we conducted a retrospective review of patients undergoing laparoscopic sleeve gastrectomy between February 2010 and May 2017 at Children's National Health System (CNHS). A total of 167 adolescent patients had pre-existing psychiatric diagnoses which included depression (50%), anxiety (23%), ADHD (23%), and binge eating disorder (11%). Medications prescribed to treat these diagnoses included selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Additionally, all patients were given fentanyl, ondansetron, morphine, and acetaminophen perioperatively. Although no life threatening symptoms of drug-drug interactions (DDIs) were appreciated, the combined use of many different potent drugs in these patients warrants attention.

Mental health perspectives of COVID-19 and the emerging role of digital mental health and telepsychiatry

The 2019 coronavirus pandemic started in December and has now spread worldwide. This pandemic has huge mental health implications with immense psychological morbidity among the common man, patients with preexisting psychiatric diagnoses causing many relapses and exacerbations after it has ensued. Many guidelines have been put forward by various agencies to address the issue of combating mental health challenges that have arisen as a result of this pandemic. This review paper looks at the role of psychiatry and psychiatrists and the mental health challenges faced by us during this pandemic. The role of mental health interventions, the issues faced and the emerging role of telepsychiatry with its ethical and clinical dilemmas are discussed.

The prevalence and impact of psychiatric symptoms in an undiagnosed diseases clinical program

In 2008, the NIH launched an undiagnosed diseases program to investigate difficult to diagnose, and typically, multi-system diseases. The objective of this study was to evaluate the presence of psychiatric symptoms or psychiatric diagnoses in a cohort of patients seeking care at the Emory Special Diagnostic Service clinic. We hypothesized that psychiatric symptoms would be prevalent and associated with trauma exposure, and a decreased quality of life and functioning. This is a cross-sectional, retrospective analysis of 247 patients seen between February 7, 2014 and May 31, 2017. The sources for data included the Emory Health History Questionnaire (HHQ) that had the work and social adjustment and quality of life enjoyment and satisfaction questionnaire–short form (QLSQ) embedded in it; medical records, and the comprehensive standardized special diagnostic clinic forms. Primary outcomes were presence of any psychiatric symptom, based on report of the symptom on the HHQ or medical record, or presence of a confirmed preexisting psychiatric disorder. Seventy-two percent of patients had at least one psychiatric symptom while 24.3% of patients had a pre-existing psychiatric diagnosis. Patients with any psychiatric symptom had significantly diminished Q-LES-Q scores (45.27 ± 18.63) versus patients with no psychiatric symptoms (62.01 ± 21.57, t = 5.60, df = 225, p<0.0001) and they had significantly greater functional disability. Patients with a psychiatric disorder also had significantly diminished Q-LES-Q scores (45.16 ± 17.28) versus those without a psychiatric diagnosis (51.85 ± 21.54, t = 2.11, df = 225, p = 0.036) but did not have significantly increased functional impairment. Both patients with psychiatric symptoms and ones with psychiatric disorders had an increased prevalence of trauma. Psychiatric symptoms are prevalent in patients evaluated for undiagnosed disorders. The presence of any psychiatric symptom, with or without a formal psychiatric diagnosis, significantly decreases quality of life and functioning. This suggests that assessment for psychiatric symptoms should be part of the evaluation of individuals with undiagnosed disorders and may have important diagnostic and treatment implications.

Factors Associated With Nonadherence to Pelvic Floor Physical Therapy Referral for the Treatment of Pelvic Pain in Women.

Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment. The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence. This was a retrospective cohort study. ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. "Primary outcomes" was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders. Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval=0.62-0.90) and 0.44 (95% confidence interval=0.21-0.90), respectively. Patients who attended ≥ 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean=16 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean=6.9 vs 3.1). Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010-2012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence. Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.