Pre-existing Illness Research Articles

A study of factors affecting the health seeking behaviour of people with pre-existing mental illness during the COVID-10 pandemic

Health or care seeking behavior has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy. A little understanding exists concerning socio-ecological barriers experience when seeking mental health care. we aimed at determining the factors that affect health seeking behavior of people with preexisting mental illness during COVID19 pandemic. METHODOLOGY: A Cross sectional study done for three months duration at Department of psychiatry, Chengalpattu Medical College and Hospital with sample size of 105. Ethical committee clearance was obtained.105 patients (age >18 years) consecutive patients having an International Classification of Disease 10 (ICD-10) psychiatric diagnosis, were included. Informed consent was obtained. Data regarding Socio demographic and clinical profile was obtained. RESULTS: In our study,39% of the patients belonged to 30-45 and 46-60 years of age, 6.7% of patients were between the age of above 60. 60% of study participants were male and the rest were female.69.5 % of patients had financial crisis ,70.5% of patients had decrease in the monthly income of the family by 30%or more.60% of patients had difficulty in travel to the hospital due to lack of transport facility during COVID pandemic. DISCUSSION AND CONCLUSION; Factors determining health-seeking behavior can help address problems and delay in early identification and optimal management of mental disorders during pandemic. Implementing community-based strategies to support resilience and psychologically vulnerable individuals during the COVID-19 crisis is fundamental for any community.

Effect of COVID-19 and sociocultural milieu on the psychopathology of mental health disorders: A hospital-based study.

Background:Coronavirus disease (COVID-19) has posed a remarkable threat to mental health all around the world. This pandemic has increased the incidence of common as well as severe mental illness (SMI) all around the world.Materials and Methods:We report 10 cases presenting to the psychiatric outpatient department (OPD) of Institute of Medical Sciences, Banaras Hindu University, from August to October 2020. They were either referred by other departments (3 patients) or came primarily to psychiatric OPD (7).Results:Five out of these 10 cases presented with predominant psychotic features; 3 cases had predominant obsessive–compulsive features; and 1 case was of dissociative trance possession.Conclusion:COVID-19 can affect the psychopathology of both types of patients either with preexisting mental illness as well as new-onset SMI.

COVID‐19 and the two‐way relationship with neuropsychiatric disorders

<scp>COVID</scp>‐19 and the two‐way relationship with neuropsychiatric disorders

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.

A study of adverse effects of prophylactic hydroxychloroquine used for coronavirus disease 2019

Background: Emergence and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in the coronavirus disease 2019 (COVID-19) has posed a significant threat to public health and safety. Indian Council of Medical Research (ICMR) recommended use of antimalarial agent, hydroxychloroquine (HCQ) for the prophylaxis of COVID-19 for high-risk population. This was a cross-sectional study carried out at a tertiary care hospital with a dedicated COVID-19 hospital. Aims and Objectives: The objective of this study was to evaluate adverse drug reactions (ADRs) attributed to prophylactic doses of HCQ among health care workers (HCWs). Materials and Methods: This cross-sectional study conducted at tertiary care hospital which included HCWs involved in COVID-19-related services and has taken at least one dose of HCQ. A pre-validated web-based questionnaire was administered to the study participants. Data regarding demographic parameters, pre-existing illness, reason for prophylactic HCQ use, pre-existing comorbidities, concomitant medications, start date of HCQ intake, and adverse effects experienced were collected. Results: Two hundred and ninety-two participants have taken HCQ prophylactically and were used for final analysis. Overall, 52 adverse events were documented in 11 participants (3.77 %). The most frequently reported symptoms were nausea and headache, followed by diarrhea, vomiting, abdominal pain, mood disturbances such as feeling irritated, gastritis, decrease/loss of appetite, and skin rash. Three participants required medication (tablet Pan D, Rantac 150 mg, ORS, and syrup Mucaine) for the treatment of adverse effects. Three participants discontinued HCQ due to headache, mood disturbances such as feeling irritated, decrease/loss of appetite, nausea, and vomiting. Conclusion: In the present study, no serious ADRs were reported. However, larger studies are warranted to generate more comprehensive safety data for HCQ use in COVID-19.

PH Roundtable: Pulmonary Hypertension and Telehealth in the Time of Coronavirus Disease 2019

PH Roundtable: Pulmonary Hypertension and Telehealth in the Time of Coronavirus Disease 2019

Comparison of PHQ-9 and PHQ-2 as Screening Tools for Depression and School Related Stress in Inner City Adolescents.

BackgroundMajor depressive disorder is associated with significant morbidity and mortality in adolescents. Suicide is one of the leading causes of mortality between 15 and 19 years. Both AAP and USPSTF recommend routine depression screening of adolescents. Patient Health Questionnaire-2 (PHQ-2) and Patient Health Questionnaire-9 (PHQ-9) are widely used in primary care practice, however, PHQ-2 does not screen for suicidality. School-related factors are known to affect adolescent mental health.PurposeTo compare PHQ-2 and PHQ-9 for depression screening in adolescents, with respect to age, gender, chronic illness over the course of 9 months.MethodsAs a QI initiative, we compared screening results in our inner-city pediatric practice using PHQ-2 and PHQ-9 from Jun’18 to Feb’19. EMR of 2364 patients 12 to 21 years were reviewed. We considered the PHQ-2 score of ≥2 and PHQ-9 of ≥10 as positive. Pre-existing chronic medical and mental illnesses were noted.ResultsOf these 61.5% of patients were females, 95% were Black/Hispanic, and 96% were insured by Medicaid. About 10.6% of PHQ-9 tests were positive whereas 7.4% PHQ2 were positive. Logistic regression was performed to ascertain the effects of age, gender, and chronic illness. Females were more likely to have a positive screen, as were patients with chronic illness. Age had no effect on the outcome. The screening yield for both tests was comparable in the summer months. PHQ9 yield increased while schools were in session while PHQ 2 remained stable.ConclusionPHQ9 is superior as a screening test compared to PHQ2. Repeat screening should be targeted toward patients with chronic medical conditions and/or mental health diagnoses. PHQ9 may be better at screening for school-related stress.

An evaluation of symptom domains in the 2 years before pregnancy as predictors of relapse in the perinatal period in women with severe mental illness.

Symptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period. Data were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with SMI (positive, negative, disorganization, mania, depression, and catatonia) recorded in clinical notes 2years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalization during pregnancy and 3months postpartum. Seventy-six women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganization symptoms showed a positive association at borderline significance with relapse during pregnancy (adjusted odds ratio [aOR]=1.36; 95% confidence interval [CI]=0.99-1.87 per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62-0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganization (1.84; 1.22-2.76), positive (1.50; 1.07-2.11), and manic (1.48; 1.03-2.11) symptoms were associated with relapse during pregnancy, and disorganization (1.54; 1.08-2.20) symptom domains were associated with relapse postpartum. Positive, disorganization, and manic symptoms recorded in the 2years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterization of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.

Aphasia: Conversion/dissociation or organic etiology?

Aphasia: Conversion/dissociation or organic etiology?

Coronavirus disease-2019 infection among people living with noncommunicable diseases: Improving the prognosis

The ongoing Corona Virus Disease-2019 (COVID-19) infection tends to affect all age-groups, while the development of the serious complications, including mortality has been reported among elderly people and those with pre-existing chronic illnesses. The available evidence suggests that any age group person living with any of the non-communicable diseases (NCDs) can get infected by COVID-19. Keeping the prognosis of the patients with pre-existing NCDs, it is important that the practice of smoking should be discouraged by them. In conclusion, the people living with non-communicable diseases tends to develop serious pulmonary complications secondary to the acquisition of COVID-19 infection. Thus, it is the responsibility of these people to strictly adhere to the prevention measures, while the health professionals should understand their vulnerability and provide additional care while managing them to save their lives.

Paradoxes of suicide and psychological crisis-An Uttarakhand phenomenon during COVID-19 lockdown

Indian government had mandated nationwide lockdown with stringent guidelines from March 24th to May 4th 2020. Lockdown created huge impact on everything. It has exacerbated pre-existing mental illness in many, thereby leading to “Quarantine Blues.” This retrospective study had been conducted in Department of Forensic Medicine and Toxicology at a tertiary health care centre, Haldwani th th in Nainital district; Uttarakhand to focus on how the lockdown effect correlated to suicide from March 24th to May 4th 2020 with the same time period of preceding years (2016–2019). There was a decline in the trend of suicides during lockdown (n=1) when compared with concurrent time interval over the previous years. Domestic violence spikes are supposed to bloom the number of suicides, but Uttarakhand phenomenon is a paradox which needs to be further evaluated.

Coronavirus Disease 2019 Pandemic: Meeting the Needs of Vulnerable Population Groups

The ongoing Corona Virus Disease-2019 (COVID-19) outbreak has already been given a Pandemic status and also continues to be a public health emergency of international concern. The epidemiological analysis and the trends of mortality clearly suggests that even though, the disease is quite common in all age-groups, the disease has manifested in severe forms among elderly and those people who are having pre-existing medical illnesses. It is the need of the hour to ensure that both these high-risk groups are offered additional attention, without subjecting them to isolation or stigmatization, which decreases their overall probability of access to health care services. Further, it is extremely important to strengthen the risk communication mechanism and take appropriate steps for the relay of timely and trustworthy measures to the entire community, with special attention to the two high-risk groups. In conclusion, as the COVID-19 continues to increase in magnitude and geographical distribution, it is our responsibility to take appropriate steps to improve the wellbeing of community, with an additional support to the high-risk population groups.

Association of Pre-existing Mental Illness with All-cause and Cancer-specific Mortality in Medicare Beneficiaries with Pancreatic Cancer

Association of Pre-existing Mental Illness with All-cause and Cancer-specific Mortality in Medicare Beneficiaries with Pancreatic Cancer

The psychological impact of the COVID-19 pandemic and associated risk factors during the initial stage among the general population in India.

In the absence of treatment and unclear prognosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself, and public health measures like lockdown enforced by the government to limit the spread of the virus poses a threat to the psychological health of the general population. To assess the psychological status of the Indian population during the initial phase of lockdown. It was a cross-sectional online survey where the questionnaire was disbursed by snowballing. The link to the survey was shared in different social networking platforms between 6th and 22nd of April 2020. The questionnaire collected responses related to the sociodemographic variables, exposure history, precautionary measures used, and the Depression, Anxiety, and Stress Scale (DASS-21) score. A total of 541 participants responded to the questionnaire. Only 422 respondents' responses from 23 states of India who completed the questionnaire were included for assessment. The mean age of the participants was 30.5 (SD=10.9) years. Female constituted 60.4% (n=255) of the respondents. The pre-existing medical illness that the respondents had were diabetes mellitus, four per cent (n=17), hypertension, five per cent (n=21), thyroid dysfunction, nine per cent (n=38), and mental illness, five per cent (n=21). The median (IQR) of the DASS-21 item scale was found to be 16 (4-32). The percentage of the respondents who reported stress was 35.5% (n=149), anxiety, 32% (n=135), and depression, 34.7% (n=146). Respondents with sociodemographic variables like being single, student status, competed education till graduation, homemakers, working in public sector, and history of mental illness were more likely to experience stress, anxiety, and depression. A majority of the respondents were practicing hand hygiene and social distancing. Respondents who were unaware of their exposure status were more likely to have depression. The Indian population is experiencing the psychological impact of the coronavirus disease 2019 (COVID-19), which may increase with the spread of the infection. India needs to gear up to face mental health consequences. People with a pre-existing physical and psychological illness needs extra care and precaution to prevent any relapse or development of complications.

Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer.

We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65yearsat diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders. Preexisting SMI was associated with greater all-cause (HR=1.36; 95%CI 1.18, 1.57) and cancer-specific (HR=1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR=1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR=2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR=1.49; 95%CI 1.25, 1.78), obese (HR=1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR=1.42; 95%CI 1.13, 1.78). Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.

“Continuing the Connection” or “Carrying On”? A Qualitative Evidence Synthesis of How Widows Explain the Physical Health Outcomes After Spousal Loss

The experience of losing a loved one can have profound effects on physical and psychological well-being, and previous research has reported an increased risk of mortality after spousal loss. This qualitative evidence synthesis reviewed 16 studies on the perspectives of widows who experienced adverse physical health outcomes after spousal loss. This review examines how widows described or explained the physical health outcomes after losing their spouse. We found that widows implicitly associated the physical health outcomes they experienced with losing their spouse. They described that losing their spouse exacerbated preexisting illness and led to new disease conditions such as heart failure, rheumatoid arthritis, infections, acute urinary retention, shingles, and impaired mobility. While these physical health outcomes limited widows’ ability to come to terms with their loss, widows in multiple studies prioritized the emotional and mental consequences associated with grief over any physical health outcomes they experienced. Furthermore, since the deceased spouse performed caregiving responsibilities, the surviving spouse experienced a shift from caregiving to self-management of their preexisting medical condition. In situations where widows were unable to meet their own health needs, they experienced an intensification of their own illness. Given these findings, we consider the relationship between widows’ meaning-making and physical and clinical outcomes. We discuss how meaning-making can contribute to severe emotional, mental, and physical health outcomes after a traumatic event such as spousal loss.

Pre-Existing Mental Disorder, Clinical Profile, Inpatient Services, And Costs in People Hospitalised Following Traumatic Spinal Injury: A Population Record-Linkage Study

IntroductionRisk of traumatic injury is increased in individuals with mental illness, substance use disorder and dual diagnosis (mental disorders); these conditions will pre-exist among individuals hospitalised with acute traumatic spinal injury (TSI). Although early intervention can improve outcomes for people who experience mental disorders or TSI, the incidence, management, and cost of this often complex comorbid health profile is not sufficiently understood.&#x0D; Objectives and ApproachIn a whole-population cohort of patients hospitalised with acute TSI, we aimed to describe the prevalence of pre-existing mental disorders, and compare differences in injury epidemiology, costs and inpatient allied health service access.&#x0D; Record-linkage study of all hospitalised cases of TSI between June 2013 and June 2016 in New South Wales, Australia. TSI was defined by specific ICD-10-AM codes. Mental disorder status was considered as pre-existing where specific ICD-10-AM codes were recorded in incident admissions.&#x0D; Results13,489 individuals sustained acute TSI during this study. 13.11%, 6.06%, and 1.82% had pre-existing mental illness, substance use disorder, and dual diagnosis, respectively. Individuals with mental disorder were older (p&lt;0.001), more likely to have had a fall or self-harmed (p&lt;0.001), experienced almost twice the length of stay and inpatient complications, and increased injury severity compared to individuals without mental disorder (p&lt;0.001).&#x0D; Conclusion / ImplicationsIndividuals hospitalised for TSI with pre-existing mental disorder have greater likelihood of increased injury severity and more complex, costly acute care admissions compared to individuals without mental disorder. Care pathway optimisation including prevention of hospital acquired complications for people with pre-existing mental disorders hospitalised for TSI is warranted.

Preparing for the Behavioral Health Impact of COVID-19 in Michigan.

Purpose of ReviewAs a global pandemic, COVID-19 has profoundly disrupted the lives of individuals, families, communities, and nations. This report summarizes the expected impact of COVID-19 on behavioral health, as well as strategies to address mental health needs during the COVID-19 pandemic and its aftermath. The state of Michigan in the USA is used to illustrate the complexity of the mental health issues and the critical gaps in the behavioral health infrastructure as they pertain to COVID-19. Scoping review was conducted to identify potential mental health needs and issues during the COVID-19 pandemic and its aftermath.Recent FindingsThe ramifications of COVID-19 on mental health are extensive, with the potential to negatively impact diverse populations including healthcare providers, children and adolescents, older adults, the LGBTQ community, and individuals with pre-existing mental illness. Suicide rates, alone, are expected to rise for Michiganders due to the economic downturn, isolation and quarantine, increased substance use, insomnia, and increased access to guns associated with the COVID-19 pandemic.SummaryThis report promotes awareness of a behavioral health crisis due to COVID-19. Increasing access to behavioral health care should minimize COVID-19’s negative influence on mental health in Michigan. We propose a three-prong approach to access: awareness, affordability, and technology. Addressing workforce development and fixing gaps in critical behavioral health infrastructure will also be essential. These actions need to be implemented immediately to prepare for the expected “surge” of behavioral health needs in the ensuing months.

C-Reactive Protein (CRP) levels in influenza and other respiratory viral infections

Background: Viruses are major causes of upper respiratory tract infections (URTIs). Yet, antibiotics are commonly prescribed for URTIs. Point-of-care C-reactive protein (CRP) tests can be used to guide antibiotic prescribing for URTI. We sought to assess for the associations between CRP levels and influenza and other respiratory viral infections. Methods and materials: From June 2016 through November 2018, we screened 715 adults presenting with uncomplicated URTI (ICD10-AM J00-J06) at the emergency department of a 1600-bed acute hospital in Singapore for 15 major respiratory viruses using a multiplex PCR respiratory virus pathogen panel (Seeplex RV15 ACE Detection), via throat and nasal swabs, and CRP levels using a finger-prick point-of-care test (QuikRead go). We compared CRP levels between influenza and other viruses, and assessed for independent associations between CRP levels and influenza and other viral infections using multivariable multinomial logistic regression models. Results: Participants were young (median age 36 [IQR 28–51] years) and predominantly healthy (67.8% had no pre-existing illness). Almost half (48%) of them had a respiratory virus detected, with influenza (20.6%) and rhinovirus (14.4%) being the two most commonly detected viruses. CRP levels were significantly different between patients with influenza, other respiratory viruses, and no virus detected, with 32%, 46%, and 53% respectively having CRP ≤ 5 mg/L (P < 0.001). A CRP level of 6–20 mg/L was 1.7 times as likely to be associated with other respiratory viral infections (AOR 1.73, 95% CI 1.13–2.65) and 3.4 times as likely with an influenza infection (AOR 3.40, 95% CI 2.09–5.52) as a non-viral URTI, after adjusting for age, comorbidity, travel in the past 7 days, prior influenza vaccination within 6 months, month and year of illness episode. A CRP level of 21–40 mg/L was also twice as likely to be associated with an influenza infection (AOR 2.38, 95% CI 1.26–4.47) as a non-viral URTI. Conclusion: A mildly raised CRP level of 6–20 mg/L was more likely to be associated with a viral than non-viral URTI, although a higher CRP level of 21–40 mg/L was more suggestive of an influenza infection. Point-of-care CRP tests could provide clinical decision support for antibiotic use in uncomplicated URTIs.

&lt;p&gt;Analysis of Symptoms of COVID-19 Positive Patients and Potential Effects on Initial Assessment&lt;/p&gt;

BackgroundSARS-CoV-2 is a highly contagious virus, significantly impacting Germany among other countries since its emergence. Because of heterogeneous symptoms and a subset of patients even being asymptomatic at presentation, fast identification of infected patients remains challenging.ObjectiveThe goal of this study is the evaluation of different patient groups with a focus on symptoms and pre-existing illness at admission, as this is important for initial assessment and adequate emergency care.MethodsCOVID-19 positive patients at the University Hospital Heidelberg were retrospectively analyzed for disease history and symptoms at the initial presentation as well as mortality. The authors obtained institutional review board (IRB) approval by the Ethics Committee (Medical Faculty of Heidelberg University) prior to commencing the study.ResultsDyspnea was more common in patients admitted to intermediate care/intensive care units (48 vs 13%, P<0.001) and showed a significantly higher percentage in the deceased (91 vs 48%, P=0.004). The symptoms of all presenting patients were highly variable, and many manifestations commonly associated with COVID-19 like cough, fever, and sore throat were only detected in a subset of patients, 60%, 43%, and 33%, respectively.ConclusionDyspnea was present significantly more often in patients dying of COVID-19 compared to all patients admitted to the IMC/ICU, necessitating adequate observation and monitoring. In all presenting patients, initial symptoms showed large variation; therefore, COVID should be considered as a main differential diagnosis at every patient presentation, and patients with high pre-test probability should, if possible, be isolated until testing results are known.