Pre-existing Psychiatric Illness Research Articles

Increased self-immolation frequency and severity during the COVID-19 pandemic

ObjectiveTo determine whether the increased restrictions, isolation and stressors associated with COVID-19 led to an increase in rates or severity of self-immolation burn injuries. DesignRetrospective review of a prospectively-collected database of New South Wales burn patients, comparing 2020 data with the preceding 5 years. SettingBoth adult units in the New South Wales Statewide Burn Injury Service (Concord Repatriation General Hospital and Royal North Shore Hospital). ParticipantsAll adult patients in New South Wales with self-inflicted burn injuries between 1st January 2015 and 31st December 2020. Outcome measuresDemographic information, precipitating factors, burn severity, morbidity and mortality outcomes. ResultsWe found18 episodes of self-immolation in 2020, compared to an average of 10 per year previously. Burn size significantly increased (43% total body surface area vs 28%) as did revised Baux score (92 vs 77). Most patients had a pre-existing psychiatric illness. Family conflict and acute psychiatric illness were the most common precipitating factors. Conclusion2020 saw an increase in both the frequency and severity of self-inflicted burn injuries in New South Wales, with psychiatric illness a major factor.

Free Papers Compiled

Free Papers Compiled

Clinical considerations with use of psychotropic medications in COVID-19 patients

Clinical considerations with use of psychotropic medications in COVID-19 patients

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

Free Papers Compiled

Background:COVID-19 pandemic has plagued the world for the past two years. Inflammatory response to SARS CoV 2 virus, social isolation due to quarantine and lock down, loss of loved ones to COVID-19, financial constraints, fear associated with morbidity and mortality of COVID-19 infection are risk factors for developing neuropsychiatric symptoms in patients who have recovered from COVID-19 infection.Aim & Objective:To assess the socio-demographic profile neuropsychiatric manifestations in Post-COVID patients.Materials and methods:Cross-sectional study conducted in Ramaiah Hospital from June 2020 to June 2021. All Patients who have tested negative after infection by COVID 19 and referred by the treating physician from Post-COVID clinic were recruited. Data pertaining to socio-demographic details, family history of COVID infection and death due to same was recorded. Psychiatric diagnosis was made using International Classification of Disease – 10 (ICD-10).Results:Forty patients were recruited for the study. Most of them were male (N=23, 57.5%), age between 30-45 years (N=14, 35.0%), married (N=31, 77.5%), employed (N=25, 62.5%), and urban population (N=39, 97.5%). Most of the participants had family history of COVID-19 (N=23, 57.5%), did not have death in family due to COVID-19 (N=33, 82.5%) and did not suffer from pre-existing psychiatric illness (N=33, 82.5%). The most common psychiatric diagnosis was Panic Disorder (N=13, 32.5%) followed by Depression (N=12, 30.0%).Conclusion:Mental health professionals should prepare to manage the mental health pandemic that is co-occurring with COVID-19 pandemic and is likely to continue beyond the COVID-19 infection pandemic.

Free Papers Compiled

Background:Victoria hospital a specialized COVID center in Bangalore saw more than 10,000 patients with COVID-19 infection who have been admitted. Most of them were moderate to severely or critically ill patients who are at risk of developing acute brain dysfunction (delirium). Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. Hence to find the prevalence, risk factors for developing delirium in patients admitted with COVID-19 infection, was the objective of this research work.Methodology:The study includes 10,200 covid infected patient who were admitted to Victoria hospital, from June 2020 to June 2021. Among them 550 cases were found to have neuropsychiatric symptoms. Patients who were on life support, prisoners, patients were with pre-existing Psychiatric illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug dependence (Except ADS and NDS), suicide attempt were excluded. Patients who were blind or deaf were also excluded. Patient demographics, delirium assessments, and management strategies were noted and entered in Microsoft Excel sheets. The outcome was to determine the prevalence of delirium and to find any associated risk factors for delirium the next day.Results:Delirium was diagnosed in 106 patients.The mean age of patients was 60 years.68 % were males & 32 % were females. 80 % of them had medical history, 10 % had past history of Alcohol dependence. 40 % of cases were treated in ICU& 32 % of them were treated on Invasive mechanical ventilation (Ventilators). On investigations, inflammatory markers raised in almost all (C- reactive protein 100 %, D-dimmer 64% and Serum ferritin 69 %). Treatment given was Steroids (Dexamethasone IV) in 100%, Remdesivir in 85 %, Iv antibiotics (Cephalosporin) in 100 %. For Symptomatic delirium treatment Injection Haloperidol IV 1.5 mg to 5mg thrice per day to once daily in 98% cases, some received Quetiapine 12.5 mg to 100mg /day in 5% or Tab Olanzapine 2.5 mg to 10 mg per day in 9% cases. Delirium Mortality rate was 45 % and recovery rate was 55 %.Conclusions:Severe SARS-CoV2 infection may be associated with COVID-19 delirium. High mortality, (more than 50 %) is found in covid delirium patients. Hypoxia could be the main reason for delirium in Covid 19. Elevated inflammatory markers is associated with Delirium in covid 19 patients.

P027 Brain Fog in Patients With Inflammatory Bowel Disease, and Association With Use of Probiotics.

Brain fog has been minimally studied in patients with inflammatory bowel disease (IBD). IBD patients frequently consume probiotics, whether sanctioned by a physician or not. However, probiotic consumption in itself has been shown to increase the incidence of brain fog. We aimed to study the association between brain fog in IBD patients with or without probiotic use. We conducted a cross-sectional study among patients visiting a busy IBD clinic. Patients aged >18 with a biopsy-proven diagnosis of inflammatory bowel disease, without pre-existing psychiatric illness or current use of opioid medications were included. They were divided into 2 groups: those using probiotics and those who did not. Patients were given a questionnaire that included details about symptoms of brain fog. Groups were analyzed by chi-square test for differences in baseline demographics, and Mann Whitney U test to compare outcomes between groups. A p-value < 0.05 was considered statistically significant. Of the 66 patients included (mean age 44±2 years), 35 (53%) were female and 59 (89.4%) were Caucasian. Among these patients, 31.8% (n = 21) took probiotics as dietary supplements with the majority (67%, n = 14) taking probiotics for over a year. Overall, there was a trend for an association between probiotic use and brain fog in all patients (p = 0.080) but no statistical significance was attained. However, brain fog was significantly associated with probiotic use among Caucasian patients (p = 0.044). Furthermore, there was a statistically significant association between brain fog and male patients using probiotics (p = 0.004). Duration of probiotic use was also associated with brain fog (p = 0.038). Consumption of probiotics was independently associated with brain fog in men, as well as Caucasian patients with IBD respectively. Given the high prevalence of probiotic use in IBD patients, prospective studies are warranted to examine the causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD.

Personality and Psychiatric Disorders among Employees of New York City Workplaces Affected by the 9/11 Attacks on the World Trade Center

Objective Personality is associated with psychopathology after disasters, but its association with the portion of postdisaster psychopathology that is incident remains unclear. It is also unclear whether any particular attributes of personality are associated with resistance to the persistence or recurrence of preexisting psychopathology after disasters. This exploratory study of employees of workplaces affected by the September 11, 2001, attacks on the World Trade Center in New York City examined the specific relationships of personality variables (specifically, novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, and self-transcendence) to incident postdisaster psychiatric disorders and resistance to the persistence/recurrence of preexisting psychiatric disorders after the disaster. Methods Approximately 3 years after the 9/11 attacks, 379 employees were recruited from 8 selected affected workplaces (3 in the World Trade Center towers, 5 at varied distances in the geographic area). Lifetime predisaster and postdisaster psychiatric disorders were assessed retrospectively with the Diagnostic Interview Schedule for DSM-IV, disaster experience details were collected with the Disaster Supplement, and personality was assessed with the Temperament and Character Inventory. Results Underdeveloped executive functioning (low self-directedness and/or low cooperativeness) was associated with incident postdisaster psychopathology, and components of resilience (low harm avoidance, high self-directedness, and high persistence) were associated with postdisaster resistance to persistence/recurrence of preexisting psychiatric illness. Conclusions Personality is related to both incident and persistent/recurrent portions of postdisaster psychopathology, not clearly distinguished in previous research. Personality variables related to executive functioning and resilience may aid in assessing risk and developing treatments to prevent disaster-related psychopathology.

Anti-NMDA receptor encephalitis and overlapping demyelinating disorder in a 20-year old female with borderline personality disorder: proposal of a diagnostic and therapeutic algorithm for autoimmune encephalitis in psychiatric patients \u201ccase report\u201d

BackgroundAnti-NMDA receptor encephalitis (NMDAR-E) is an autoimmune encephalitis (AE) mainly affecting young females. It typically presents with isolated psychiatric symptoms (e.g. depressed mood) at first and neurological abnormalities (e.g. seizures, movement disorders) only develop later. Thus, there is a high risk of overlooking NMDAR-E in patients with preexisting psychiatric illness due to symptom overlap in the prodromal period of the disease when treatment is most effective. Although rare, concomitant or sequential development of a demyelinating disorder is increasingly recognized as an associated disease entity (overlap syndrome), with immediate diagnostic and therapeutic implications.Case presentationWe report a patient with a borderline personality disorder (BPD), which developed NMDAR-E and an overlapping demyelinating disorder with anti-Myelin oligodendrocyte glycoprotein (MOG) -IgG positivity. The initial clinical presentation with predominantly affective symptoms (e.g. mood lability, anxiety, depressed mood) lead us to suspect an exacerbation of the BPD at first. However, acute changes in premorbid behavior, newly developed psychotic symptoms and memory deficits lead us to the correct diagnosis of an AE, which was further complicated by the development of a demyelinating disorder. As a result of impaired illness awareness and psychosis, diagnostic and treatment was difficult to carry out. The symptoms completely remitted after treatment with methylprednisolone 1 g daily for 5 days and 5 cycles of plasma exchange.ConclusionsContinuous awareness for neuropsychiatric clinical warning signs in patients with a pre-diagnosed psychiatric disorder is important for a timely diagnosis. Therefore, we believe that the diagnostic and therapeutic algorithm provided here, for the first time specifically addressing patients with preexisting psychiatric illness and integrating overlap syndromes, can be a useful tool. Moreover, in order to timely perform diagnostics and treatment, judicial approval should be obtained rapidly.

Analysis of psycho-sociodemographic features in referred male psychiatric patients with suicidal ideation

Abstract Suicide is defined by the World Health Organization as an act in which an individual ends his or her own life. Suicidal behavior is a major public health problem worldwide. According to the World Health Organization, the global suicide rate is 10,5/100.000 – 13,5/100.000 in case of men and 7,7/100 000 in case of women and is the 2nd most common cause of violent death. Suicide is a multifactorial phenomenon that can be approached from different perspectives. In Romania, this rate is similar to the global rate: in 2016, the estimated suicide rate was 10.4/100,000, well below the European average. Suicide rates vary by region, age group, gender, ethnicity, and registration of mortality statistics. The aim of the present study is to investigate the psycho-socio-demographic indicators of a cohort of patients with suicidal thoughts emergency referred to a particular psychiatric ward in one year. In our research, we performed a case-control, analytical, randomized, observational study at the Clinical Hospital of Neurology and Psychiatry Brasov among adult psychiatric patients admitted during 2014. The following data on patients were processed: demographic data (age, gender, place of residence), psychosocial data (social background, marital status, education), chronic somatic comorbidities, family history of psychiatric illness, pre-existing psychiatric illnesses, previous suicide attempts and their characteristics. The risk of suicide was assessed by the Modified Scale for Suicide Ideation - Miller et al. Questionnaire and distinguished 3 categories. In our sample of 77 cases we identified 14 patients with low suicide risk, 17 with moderate risk and 46 with high suicide risk. The focus of our study was on suicidal behavior. Suicide attempt, as a complex clinical problem with a waste complexity of ethiology, has high demands on psychiatric care. Being familiar with the different psycho-socio-demographic profiles by gender is proved to be a useful tool in both “screening” and in subsequent case management. These principles can facilitate decision-making, can increase adherence to treatment, and reduce the risk of repetitive attempts.

Impact of COVID-19 outbreak on posttraumatic stress in patients with psychiatric illness

The present study aimed to examine the prevalence of posttraumatic stress response in reaction to the COVID-19, including posttraumatic-stress-disorder-like symptoms (PTSD-like symptoms) and depressive symptoms, among patients with pre-existing psychiatric illness. The socio-demographic and psychological correlates of PTSD-like symptoms were also examined. A total of 193 participants were recruited. More than 45% of the respondents reported significant PTSD-like symptoms related to the COVID-19; this group of patients also had a high level of pandemic-related depressive symptoms. High level of PTSD-like symptoms were predicted by rumination on concerns about the outbreak of COVID-19 and feeling of social isolation. They were also associated with hypervigilance to cues related to the pandemic. Our results suggested that the pandemic had taken a psychological toll on people living with psychiatric illness. Further research is needed to understand the development and mechanism of traumatic stress reaction in response to a prolonged infectious disease outbreak among this vulnerable population. Clinical attention is also called to mitigate the psychiatric sequalae of the pandemic in this vulnerable group of people.

Dual-action ADHD drug provides both early- and late-onset symptom relief

Dual-action ADHD drug provides both early- and late-onset symptom relief

Mitigating the impacts of COVID-19: where are the mental health trials?

Mitigating the impacts of COVID-19: where are the mental health trials?

Pre-Existing Psychiatric Illness Is Associated With an Increased Risk of Delirium in Patients With Acute Respiratory Distress Syndrome.

Patients with acute respiratory distress syndrome (ARDS) are highly susceptible to developing delirium for a multitude of reasons. Previous studies have linked pre-existing depression with an increased risk of postoperative delirium in patients undergoing cardiac and non-cardiac surgery. However, the evidence regarding the association between pre-existing psychiatric illnesses and delirium in ARDS patients is unknown. In this study, we aim to determine the relationship between pre-existing psychiatric illness and the risk of development of delirium amongst ARDS patients. We performed a retrospective study of a mixed group of patients admitted to the intensive care unit (ICU) between January 2016 and December 2019 with a diagnosis of ARDS per the Berlin definition. The study group was divided into 2 cohorts: subjects with delirium and subjects without delirium. Comparison between the 2 groups was conducted to examine the impact of pre-existing psychiatric illnesses including major depressive disorder (MDD), generalized anxiety disorder (GAD), bipolar disorder, schizophrenia, or post-traumatic stress disorder. Multivariable logistic regression analysis was performed adjusting for benzodiazepine use, sedatives, analgesics, sequential organ failure assessment score, and corticosteroid use to determine the association between pre-existing psychiatric disorders and delirium. 286 patients with ARDS were identified; 124 (43%) of whom were diagnosed with ICU delirium. In patients diagnosed with ICU delirium, 49.2% were found to have preexisting psychiatric illnesses, compared to 34.0% without any preexisting psychiatric illness (OR = 1.94, P = 0.01). In a subgroup analysis of individual psychiatric illnesses, GAD and MDD were associated with the development of delirium (OR = 1.88, P = 0.04 and OR = 1.76, P = 0.05 respectively). ARDS patients with preexisting psychiatric illnesses, particularly GAD and MDD are associated with an increased risk of developing ICU delirium. Clinicians should be aware of the effect of psychiatric co-morbidities on developing delirium in critically ill patients.

Suicide and self-harm in adult survivors of critical illness: population based cohort study

ObjectiveTo analyse the association between survival from critical illness and suicide or self-harm after hospital discharge.DesignPopulation based cohort study using linked and validated provincial databases.SettingOntario, Canada between January 2009 and...

Delirium, Depression and Long-Term cognitive Impairment

<h3>Introduction</h3> Over the last decade, we are seeing increased survival rates from critical care stays. However, critical care survivors are at increased risk for long-term physical, psychological, and cognitive impairments. While there is substantial work examining how premorbid medical and demographic factors influence adverse long-term outcomes, less is known about how pre-existing psychiatric illnesses such as depression may influence ICU course and post-ICU outcomes. Delirium is a key negative prognostic indicator of poor post-ICU course. and a risk factor for cognitive impairment. Along with changes in cognitive performance, the most frequent psychological sequela found in intensive care unit (ICU) survivors is depression. Depression affects approximately one third of adults in the ICU and increases the risk of mortality in the 2 years after discharge. It is unclear how depression and cognitive performance deficits may interact. In adult and geriatric populations depression is itself a risk factor for cognitive impairment. Cognitive deficits in attention, memory and executive function are seen in depressed patients and ICU survivors who suffered delirium. The purpose of the study is to examine whether premorbid history of depression influences acute and long-term critical care outcomes. We hypothesized that a premorbid history of depression would be associated with a more complicated ICU course, quantified as days of delirium. We also hypothesized that a premorbid depression would be associated with greater levels of cognitive impairment and greater depression severity in the year following ICU stay. <h3>Methods</h3> Patients admitted to the medical/surgical ICU services were eligible for enrollment in the Brain ICU longitudinal cohort study. We determined a pre-admission history of depression from the health proxy. Patients were assessed for delirium using the Confusion Assessment Method for the ICU (CAM-ICU) and level of consciousness using the Richmond Agitation-Sedation Scale (RASS). Patients were assessed after hospital discharge at 3 and 12 months (+/- 1 month) for depression using the Beck Depression Inventory-II (BDI-II). In all long-term models, we included patients who had any assessment data available at a given time point to have the same number of patients in cognitive outcomes and depressive symptom severity models at a given time point. Missing outcome and covariate data was handled using five imputations (with three burn-in imputations) and predictive mean matching. All continuous covariates were allowed to have a nonlinear relationship with DCFDs using restricted cubic splines with three knots, except for IQCODE which has too little variability to allow splines. Primary models examined the effect of pre-admission history of depression on: a) ICU course, measured as delirium/coma free days; b) post-discharge cognitive performance, measured by the RBANS total score; and c) post-discharge depression symptom severity, measured by the BDI. To examine the effect of depression history on delirium/coma free days we used a proportional odds logistic regression model adjusting for age, gender, Charlson Score, Framingham Stroke Risk Profile, IQCODE, years of education, AHRQ socioeconomic status index, CSHA frailty and APACHE APS at enrollment. To examine the association of a reported pre-admission history of depression with long-term cognition and depression, we used multivariable regression with history of depression as our primary exposure of interest and either RBANS global cognition scores or Beck Depression Inventory II (BDI-II) depression scores as outcomes. We created separate models to examine these outcome measures at 3 and 12 months after hospital discharge. <h3>Results</h3> A total of 821 were included in the analysis. The median age at enrollment was 61 years and 261 (33%) had a history of depression prior to their critical illness. After adjusting for demographic and other relevant covariates, a pre-admission history of depression, was not associated with days of delirium or coma in the ICU (OR 0.78, 95% CI, 0.59 - 1.03 p=0.077). We did not observe an effect of pre-admission history of depression on RBANS scores at either 3 months or 12 months compared to those with no prior history of depression (3 months -0.04, 95% CI, -2.70 - 2.62 p=0.97; 12 months 1.5, 95% CI, -1.26 – 4.26 p=0.28). Patients with a prior history of depression were more likely to have higher BDI scores at 3 months and 12 months (3 months OR 2.15, 95% CI, 1.42 – 3.24 p=0.001; 12 months OR 1.89, 95% CI, 1.24- 2.87 p=0.003). <h3>Conclusions</h3> Patients with a history of depression prior to ICU stay exhibit a greater severity of depressive symptoms in the following year.

Heart and brain interactions : Pathophysiology and management of cardio-psycho-neurological disorders.

Cardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.

The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients.

Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Patient data were obtained from the Healthcare Cost and Utilization Project's State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients' psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

The Impact of Isolation on Mental Health during the COVID-19 Pandemic

The unintended consequences of appropriate public health interventions during an infectious disease outbreak such as isolation and quarantine of exposed individual include depression, anxiety, exacerbation of pre-existing mental illness, cardiovascular illness, and dementia. Populations that may be especially at risk for mental health consequences of isolation include children and adolescents, the elderly, people with cognitive disorders such as dementia, and those with preexisting psychiatric illness. Awareness of these dangers of necessary public health responses and allocation of resources for interventions when populations are under a lockdown should be a mandatory part of emergency planning.

Aphasia: Conversion/dissociation or organic etiology?

Aphasia: Conversion/dissociation or organic etiology?