Pre-existing Psychiatric Disorders Research Articles

Clinical effectiveness of nirmatrelvir plus ritonavir for patients with COVID-19 and preexisting psychiatric disorders

ABSTRACT Objectives This study assessed the clinical effectiveness of the combination of nirmatrelvir and ritonavir (NMV-r) in treating nonhospitalized patients with COVID-19 who have preexisting psychiatric disorders. Methods Patients diagnosed with COVID-19 and psychiatric disorders between 1 March 2020, and 1 December 2022, were included using the TriNetX network. The primary outcome was the composite outcome of all-cause emergency department (ED) visits, hospitalization, or death within 30 days. Results Propensity score matching yielded two cohorts of 20,633 patients each. The composite outcome of all-cause ED visits, hospitalization, or death within 30 days was 3.57% (737 patients) in the NMV-r cohort and 5.69% (1176) in the control cohort, resulting in a reduced risk in the NMV-r cohort (HR: 0.657; 95% confidence interval (CI): 0.599–0.720). The NMV-r cohort exhibited a lower risk of all-cause hospitalization (HR: 0.385; 95% CI: 0.328–0.451) and all-cause death (HR: 0.110; 95% CI: 0.053–0.228) compared with the control group. Conclusion NMV-r could mitigate the risk of adverse outcomes in nonhospitalized patients with COVID-19 and preexisting psychiatric disorders. However, only a limited number of patients in this population received adequate treatment, thus emphasizing the importance of promoting its appropriate use.

A systematic review of suicide risk management strategies in primary care settings.

Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts. A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized. Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance. Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.

Preferential and sustained platelet activation in COVID-19 survivors with mental disorders

Pre-existing mental disorders are considered a risk factor for severe COVID-19 outcomes, possibly because of higher vascular burden. Moreover, an unconventional platelet activation characterizes COVID-19 and contributes to inflammatory and thrombotic manifestations. In the light of the inflammation theory of mental disorders, we hypothesized that patients with mental disorders could be sensitive to the SARS-CoV-2 elicited platelet activation. We investigated platelet activation in 141 COVID-19 survivors at one month after clearance of the virus, comparing subjects with or without an established pre-existing diagnosis of mental disorder according to the DSM-5. We found that platelets from patients with a positive history of psychiatric disorder underwent unconventional activation more frequently than conventional activation or no activation at all. Such preferential activation was not detected when platelets from patients without a previous psychiatric diagnosis were studied. When testing the effects of age, sex, and psychiatric history on the platelet activation, GLZM multivariate analysis confirmed the significant effect of diagnosis only. These findings suggest a preferential platelet activation during acute COVID-19 in patients with a pre-existing psychiatric disorder, mediated by mechanisms associated with thromboinflammation. This event could have contributed to the higher risk of severe outcome in the psychiatric population.

Pattern of Medical Comorbidities among Patients of Postpartum Psychosis at a Tertiary Care Center of Central India

Abstract Background and Aim: The reproductive age group is vulnerable to various preexisting psychiatric disorders as well as newly diagnosed illnesses. The stress associated during pregnancy increases the likelihood of developing psychiatric comorbidities even more. Of importance are postpartum blues, depression, and psychosis. The presence of various medical comorbidities may be a contributing factor for the development of psychiatric illnesses. This study was done to find the pattern of medical comorbidities among patients of postpartum psychosis. Materials and Methods: The study was carried out at the Department of Psychiatry and Department of Obstetrics and Gynecology, Shyam Shah Medical College, Rewa (Madhya Pradesh). Total duration of the study was 1 year, all patients diagnosed with postpartum psychosis (n = 88) were segregated using simple random sampling and every 2nd patient was included in the study (n = 44). Further, necessary assessments were carried out and patients were discharged postrecovery. Results: In the present study, 59.09% of patients (26) belonged to the age group 25–35 years, 81.81% of patients (36) were from lower socioeconomic status, housewives 79.54% (35), and 36.36% (16) were middle school educated. About 63.63% of patients (28) females were nulliparous. About 59.09% of patients (26) were delivered through cesarean section. The most prevalent medical comorbidity was postpartum infection which was present in 50% of the patients (22), followed by hypothyroidism in 43.18% of patients (19). Conclusion: Various medical comorbidities may precipitate, maintain, or aggravate underlying postpartum psychosis which may alter their course progression and outcome.

Universal screening of postpartum depression with Edinburgh Postpartum Depression Scale: A prospective observational study.

To assess the feasibility of universal screening of postpartum depression (PPD), using the Edinburgh Postpartum Depression Scale (EPDS) in the general population. To investigate the proportion of women identified as being at risk of PPD and with confirmed PPD or other mental disorders after a psychiatric consultation. A multicenter prospective cohort study in four French maternities conducted between 2020 and 2023. All women aged over 18 years, who delivered following a singleton pregnancy after 37 weeks of gestation were eligible for inclusion. The exclusion criteria were pre-existing psychiatric disorders such as depressive syndrome. The EPDS was completed at 8 weeks postpartum via an online self-administered questionnaire. If the response to the questionnaire suggested a mental disorder, a psychiatric consultation was proposed to the women concerned. The endpoints were the proportion of women completing the EPDS, the EPDS score, the proportion of women at risk of PPD, the proportion of psychiatric consultation, and the subsequent diagnosis. The study included 923 women, of whom 55.0% (508/923) completed the EPDS. Among them, 28.1% (143/508) had an EPDS score of 10 or more, and 11.2% (57/508) received a psychiatric consultation. PPD was confirmed in 8.8% (5/57) of women. Other disorders detected were mood disorders, disorders specifically associated with stress, and anxiety/fear-related disorders, in 33.3%, 28.1%, and 14.0% of the women, respectively. Screening with self-administered EPDS is feasible, with a good response rate, making it possible to suspect mental disorders, including PPD, and to offer psychological support when needed.

Association of pre-existing depression and anxiety with Omicron variant infection.

Pre-existing psychiatric disorders were linked to an increased susceptibility to COVID-19 during the initial outbreak of the pandemic, while evidence during Omicron prevalence is lacking. Leveraging data from two prospective cohorts in China, we identified incident Omicron infections between January 2023 and April 2023. Participants with a self-reported history or self-rated symptoms of depression or anxiety before the Omicron pandemic were considered the exposed group, whereas the others were considered unexposed. We employed multivariate logistic regression models to examine the association of pre-existing depression or anxiety with the risk of any or severe Omicron infection indexed by medical interventions or severe symptoms. Further, we stratified the analyses by polygenic risk scores (PRSs) for COVID-19 and repeated the analyses using the UK Biobank data. We included 10,802 individuals from the Chinese cohorts (mean age = 51.1 years, 45.6% male), among whom 7841 (72.6%) were identified as cases of Omicron infection. No association was found between any pre-existing depression or anxiety and the overall risk of Omicron infection (odds ratio [OR] =1.04, 95% confidence interval [CI] 0.95-1.14). However, positive associations were noted for severe Omicron infection, either as infections requiring medical interventions (1.26, 1.02-1.54) or with severe symptoms (≥3: 1.73, 1.51-1.97). We obtained comparable estimates when stratified by COVID-19 PRS level. Additionally, using clustering method, we identified eight distinct symptom patterns and found associations between pre-existing depression or anxiety and the patterns characterized by multiple or complex severe symptoms including cough and taste and smell decline (ORs = 1.42-2.35). The results of the UK Biobank analyses corroborated findings of the Chinese cohorts. In conclusion, pre-existing depression and anxiety was not associated with the risk of Omicron infection overall but an elevated risk of severe Omicron infection, supporting the continued efforts on monitoring and possible early intervention in this high-risk population during Omicron prevalence.

Neurological, psychiatric, and sleep investigations after treatment of anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis in Spain: a prospective cohort study

Anti-leucine-rich glioma-inactivated protein 1 (LGI1) encephalitis is an autoimmune disorder that can be treated with immunotherapy, but the symptoms that remain after treatment have not been well described. We aimed to characterise the clinical features of patients with anti-LGI1 encephalitis for 1 year starting within the first year after initial immunotherapy. For this prospective cohort study, we recruited patients with anti-LGI1 encephalitis as soon as possible after they had received conventional immunotherapy for initial symptoms; patients were recruited from 21 hospitals in Spain. Patients were excluded if they had an interval of more than 1 year since initial immunotherapy, had pre-existing neurodegenerative or psychiatric disorders, or were unable to travel to Hospital Clínic de Barcelona (Barcelona, Spain). Patients visited Hospital Clínic de Barcelona on three occasions-the first at study entry (visit 1), the second 6 months later (visit 2), and the third 12 months after the initial visit (visit 3). They underwent neuropsychiatric and videopolysomnography assessments at each visit. Healthy participants who were matched for age and sex and recruited from Hospital Clínic de Barcelona underwent the same investigations at study entry and at 12 months. Cross-sectional comparisons of clinical features between groups were done with conditional logistic regression, and binary logistic regression was used to assess associations between cognitive outcomes at 12 months and clinical features before initial immunotherapy and at study entry. Between May 1, 2019, and Sept 30, 2022, 42 participants agreed to be included in this study. 24 (57%) participants had anti-LGI1 encephalitis (mean age 63 years [SD 12]; 13 [54%] were female and 11 [46%] were male) and 18 (43%) were healthy individuals (mean age 62 years [10]; 11 [61%] were female and seven [39%] were male). At visit 1 (median 88 days [IQR 67-155] from initiation of immunotherapy), all 24 patients had one or more symptoms; 20 (83%) patients had cognitive deficits, 20 (83%) had psychiatric symptoms, 14 (58%) had insomnia, 12 (50%) had rapid eye movement (REM)-sleep behaviour disorder, nine (38%) had faciobrachial dystonic seizures, and seven (29%) had focal onset seizures. Faciobrachial dystonic seizures were unnoticed in four (17%) of 24 patients and focal onset seizures were unnoticed in five (21%) patients. At visit 1, videopolysomnography showed that 19 (79%) patients, but no healthy participants, had disrupted sleep structure (p=0·013); 15 (63%) patients and four (22%) healthy participants had excessive fragmentary myoclonus (p=0·039), and nine (38%) patients, but no healthy participants, had myokymic discharges (p=0·0051). These clinical and videopolysomnographic features led to additional immunotherapy in 15 (63%) of 24 patients, which resulted in improvement of these features in all 15 individuals. However, at visit 3, 13 (65%) of 20 patients continued to have cognitive deficits. Persistent cognitive deficits at visit 3 were associated with no use of rituximab before visit 1 (odds ratio [OR] 4·0, 95% CI 1·5-10·7; p=0·0015), REM sleep without atonia at visit 1 (2·2, 1·2-4·2; p=0·043), and presence of LGI1 antibodies in serum at visit 1 (11·0, 1·1-106·4; p=0·038). Unsuspected but ongoing clinical and videopolysomnography alterations are common in patients with anti-LGI1 encephalitis during the first year or more after initial immunotherapy. Recognising these alterations is important as they are treatable, can be used as outcome measures in clinical trials, and might influence cognitive outcome. Fundació La Caixa.

Effect of vicarious discrimination on race-based stress symptoms among Asian American young adults during the COVID-19 pandemic.

The COVID-19 pandemic has led to a rise in anti-Asian hate crimes in the United States. Previous work has established that experiencing racism increases one's dysfunctional anxiety and avoidance actions-key symptoms of race-based stress symptoms. However, the psychological impact of vicarious, or secondhand, discrimination (witnessing racism targeting one's own race group) remains less understood. We tested the hypothesis that higher reported vicarious discrimination would be associated with higher levels of race-based stress symptoms reported by Asian American young adults (n = 135) during the pandemic using a cross-sectional analysis of the COVID-19 Adult Resilience Experiences Study (CARES). Starting in April 2020, CARES assessed sociodemographic characteristics and key psychometric scales in young adults through three waves of online surveys. Our multiple regression analysis showed vicarious discrimination significantly predicted race-based stress symptoms, even after controlling for direct discrimination (p < .01). This association remained significant after controlling for age, gender, subjective childhood family social status, and preexisting psychiatric disorders (p < .01). Our results demonstrate that regardless of the effect that direct discrimination might have on race-based stress symptoms, witnessing discrimination against members of one's own racial group is significantly associated with increased race-based stress symptoms (b = 2.68, p < .01). Social media was the most common source of vicarious discrimination, with one out of three participants in our sample reporting nearly daily exposure. Providers should intentionally create a space within the therapeutic setting to discuss the effects of vicarious discrimination. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of pre-existing psychiatric illness on traumatic brain injury outcomes: A propensity-matched cohort study

Introduction There are limited data on how patients with pre-existing psychiatric disorders fare after sustaining a traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of pre-existing psychiatric illness on clinical outcomes after TBI. Methods A retrospective review was conducted at a regional level 1 trauma center of patients who suffered a TBI between 2012 and 2020. Propensity scores were used to match patients with psychiatric disorder 1:1 to controls. The matched population was used in analyses. Results Totally, 5343 patients sustained TBI in the study period of which, 977 (18%) had a pre-existing psychiatric disorder. These patients had 1.6 times longer hospital length of stay (LOS) and 1.2 times longer ICU LOS, though days on a ventilator were not longer. TBI readmission, unrelated to the initial head injury, which was more frequent for patients with psychiatric disorder (OR = 2.6 [1.5, 4.6]). Conclusion In patients sustaining a TBI, having a pre-existing psychiatric disorder is an independent risk factor for increased LOS, and TBI readmission. Identifying psychiatric patients as being of higher risk may allow for targeted modifications toward head injury prevention.

The effects of pre-existing psychiatric disorders on gastric cancer survival.

293 Background: Despite advances in available treatment, gastric cancer (GC) survival remains low (34.5% overall 5-year survival). In patients diagnosed with cancer, having a prior psychiatric disorder (PD) has been associated with worse survival outcomes compared with no prior PD. Therefore, we examined the relationship between a prior PD diagnosis and GC survival. Methods: We queried the Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2000 to 2017 for patients who were 66 years of age or older with histologically confirmed GC. Patients with prior cancer history, who were diagnosed by autopsy or death certificate, or were not continuously enrolled in Medicare for at least one year prior to their GC diagnosis were excluded. Patients diagnosed with a PD at least one year prior to GC diagnosis and patients without a prior PD were defined as the exposed and unexposed groups, respectively. PDs were categorized as either mild (depression and anxiety) or severe (bipolar or psychotic disorders and schizophrenia). We performed adjusted multivariable Cox proportional hazards regression modeling to evaluate the relationship between prior PD and 5-year overall and cancer-specific survival. Cancer stage, histologic grade, age at diagnosis, sex, race and ethnicity, rural/urban, comorbidity, socioeconomic status, and marital status were examined as potential confounders. Results: Out of 10,464 identified GC patients, 1,651 had a prior PD (46.3% male, mean age 77.5 years) and 8,813 did not have a prior PD (61.5% male, mean age 77.4 years). Our PD patient cohort included 1,355 mild and 296 severe PD patients. When we examined overall survival, patients with a prior PD had a greater hazard of death compared to patients without a prior PD (adjusted hazard ratio: 1.12; 95% CI: [1.05, 1.19]). However, we found no association between having a prior PD compared with not having a prior PD on GC-specific survival (adjusted hazard ratio: 1.07; 95% CI: [0.99, 1.15]). In GC patients with a prior PD, we examined the effects of severe PD versus mild PD on survival. For overall survival, severe PD patients had a greater hazard of death compared with mild PD patients (adjusted hazard ratio: 1.43; 95% CI: [1.23, 1.65]). Similarly, for GC-specific survival, severe PD patients had a greater hazard of death compared to mild PD patients (adjusted hazard ratio: 1.26; 95% CI: [1.06, 1.50]). Conclusions: Our study found that GC patients with a prior PD had a 12% greater likelihood of overall mortality compared with GC patients without a prior PD. Our analysis also showed that GC patients with a prior severe PD had a 43% higher likelihood of overall mortality and a 26% higher likelihood of GC-specific mortality compared with GC patients with a prior mild PD. Future work to identify the mechanism between PDs and cancer survival is critical to develop effective targeted interventions to improve survival of this highly fatal cancer.

Perinatal depression and risk of mortality: nationwide, register based study in Sweden

ObjectiveTo determine whether women with perinatal depression are at an increased risk of death compared with women who did not develop the disorder, and compared with full sisters.DesignNationwide, register based...

Effectiveness of molnupiravir for treating COVID-19 in patients with psychiatric disorders.

This study investigated the clinical effectiveness of molnupiravir for treating non-hospitalized COVID-19 patients with pre-existing psychiatric disorder. This retrospective cohort study used the TriNetX research network to identify patients with psychiatric disorder who experienced non-hospitalized COVID-19 between 1 January 2022, and 1 May 2023. The propensity score matching (PSM) method was used to match patients receiving molnupiravir (treated group) with those who did not (untreated group). The outcome included short-term outcomes - the composite of all-cause hospitalization or death within 30days and the risk of post-COVID-19 conditions up to a year after COVID-19 diagnosis. Two groups of 9,421 patients, each with balanced baseline characteristics, were identified using the PSM method. During the 30-day follow-up, treated group was associated with a reduced risk of hospitalization or mortality compared to untreated group (HR, 0.760; 95% CI, 0.665-0.869). Compared to untreated group, treated group also exhibited a decreased risk of experiencing post-COVID-19 conditions, including chest/throat pain (HR, 0.615; 95% CI, 0.543-0.696), abnormal breathing (HR, 0.761; 95% CI, 0.687-0.884), abdominal symptoms (HR, 0.748; 95% CI, 0.674-0.831), fatigue (HR, 0.718; 95% CI, 0.638-0.808), headache (HR, 0.753; 95% CI, 0.665-0.852), cognitive symptoms (HR, 0.769; 95% CI, 0.630-0.940), myalgia (HR, 0.647; 95% CI, 0.530-0.789), cough (HR, 0.867; 95% CI, 0.770-0.978), and palpitation (HR, 0.641; 95% CI, 0.534-0.770) during the 1-year follow-up. Molnupiravir could be associated with lower rates of all-cause hospitalization or death and also lower risk of post-COVID-19 condition among non-hospitalized COVID-19 patients with pre-existing psychiatric disorder.

Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients’ experiences in Denmark

Objective Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Design Cross-sectional study using questionnaire and register data. Setting General practice in Denmark. Subjects Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients’ experiences. Main outcome measures Patients’ experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation. Box 1. Included survey items on the patients’ experiences Results A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP’s abilities, and the patients’ knowledge of the process following the GP referral. Conclusion The patients’ experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.

Explainable AI-Based Identification of Contributing Factors to the Mood State Change in Children and Adolescents with Pre-Existing Psychiatric Disorders in the Context of COVID-19-Related Lockdowns in Greece

The COVID-19 pandemic and its accompanying restrictions have significantly impacted people’s lives globally. There is an increasing interest in examining the influence of this unprecedented situation on our mental well-being, with less attention towards the impact of the elongation of COVID-19-related measures on youth with a pre-existing psychiatric/developmental disorder. The majority of studies focus on individuals, such as students, adults, and youths, among others, with little attention being given to the elongation of COVID-19-related measures and their impact on a special group of individuals, such as children and adolescents with diagnosed developmental and psychiatric disorders. In addition, most of these studies adopt statistical methodologies to identify pair-wise relationships among factors, an approach that limits the ability to understand and interpret the impact of various factors. In response, this study aims to adopt an explainable machine learning approach to identify factors that explain the deterioration or amelioration of mood state in a youth clinical sample. The purpose of this study is to identify and interpret the impact of the greatest contributing features of mood state changes on the prediction output via an explainable machine learning pipeline. Among all the machine learning classifiers, the Random Forest model achieved the highest effectiveness, with 76% best AUC-ROC Score and 13 features. The explainability analysis showed that stress or positive changes derived from the imposing restrictions and COVID-19 pandemic are the top two factors that could affect mood state.

30 A Study to Assess Functional and Psychological Outcome After 6 Months of Moderate and Severe Traumatic Brain Injury (TBI)

Objective:Assessment of clinical, functional and psychological outcome after 6 months of moderate and severe TBIParticipants and Methods:Sixty consecutive participants aged 18 and above with moderate to severe TBI (GCS score of 3-12 at admission) attending the Outpatient Department of Neurosurgery Specialty, Post Graduate Institute of Medical Education and Research, Chandigarh, India were recruited. The exclusion criteria were any pre-existing major psychiatric disorders, intellectual disability, current or past history of substance abuse, degenerative and/or progressive condition, terminal illness and past history of TBI. Ethical clearance was obtained from Institute Ethics Committee. Written informed consent was obtained from all participants prior to inclusion in the study. Socio-demographic details (age, sex, marital status, family type, place of residence, education and occupation) and clinical details (mode of injury, injury severity, treatment, status on discharge, any previous co morbidities) were obtained from participant and hospital records. Functional outcome was assessed by Glasgow Outcome Scale and Barthel’s Index of Activities of Daily Living. Mini Mental State Examination (MMSE) was used to assess cognitive status. Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression.Results:Out of 60 patients, 40 had moderate head injury and 20 patients had suffered from severe head injury. There were 53 male (88.3%) and 7 (11.7%) female and the mean age was 34 years (SD=14.5). The mean duration of TBI was 11 months (SD=6.5). Fifty percent participants were married and majority was living in joint/extended families. Majorities were residing in rural localities 36 (60%). With regard to education level 11.7% were illiterate, 33% were educated up to 10th standard and 21.7% up to 12th standard. With regard to occupation, 11.7% were unemployed, 6.7% were housewives, 11.7% were students, 8.3% were retired and rest (61.6%) was engaged in varied occupations.The most common mode of injury was road traffic accident (90%). Contusion was the most common CT abnormality noted (37 patients, 61.7%). Regarding treatment, 36 patients (60%) underwent surgical intervention and 24 (40%) were managed conservatively. With regard to surgical intervention, 28 (77.8 %) patients underwent decompressive hemicraniectomy and subsequent cranioplasty and rest 8 (22.2 %) underwent craniotomy and hematoma evacuation. As per Glasgow Outcome Scale, 50 (83%) had low disability and 10 (17%) had moderate to severe disability. The mean Barthel’s Index score was 19.6+1.07 (Range 15-20) which indicated that most of the patients had resumed independence in activities of daily living. Only 25% participants were observed to have cognitive impairment (MMSE). With regard to anxiety and depression 16.7% showed symptoms of anxiety whereas 30% showed symptoms of depression (HADS score &gt;8).Conclusions:After 6 months of TBI, most participants had resumed independence in activities of daily living but cognitive impairment is persistent in 25% and symptoms of depression in 30% participants.

Self-inflicted Burns: The Experience of a UK Regional Burns Center.

Self-inflicted burns (SIBs) are preventable injuries that often occur due to suicidal intent or deliberate self-harm. The incidence of SIB and demographics vary across different countries. This study highlights our regional experience of SIB over almost 2 decades, assessing characteristics and outcomes. A retrospective chart review of all patients assessed at a UK regional burns center, presenting with SIB, from 2003 to 2021, was performed. Subgroup analyses based on gender, the presence or absence of pre-existing psychiatric disorders, and in-hospital patient mortality were undertaken. The relationship between annual mental health funding and the incidence of SIB was assessed. Over the study period, a total of 285 SIB cases, with a median age of 42.84 years, were presented to our center. The majority of patients were male (63.2%) and had a pre-existing psychiatric disorder (74.7%). Flame burns were the most frequent type of injury (82.1%) and the median total BSA (TBSA) was 10.25%. The average length of hospital stay was 10 days and the inpatient mortality rate was 20.7%, significantly greater than the mortality of the rest of the cohort (3.7%, P < .01). SIB survivors were younger and had less severe burns, relative to non-survivors. There was no statistically significant correlation between the incidence of SIBs and mental health funding. SIBs account for a minority of referrals to our regional burns center. Adequately funded regional and national measures should be implemented to reduce the incidence and impact of these injuries, alongside appropriate mental health support.

Risk factors for poor COVID-19 outcomes in patients with psychiatric disorders

BackgroundCoronavirus disease 2019 (COVID-19) has been found to have a greater impact on individuals with pre-existing psychiatric disorders. However, the underlying reasons for this increased risk have yet to be determined. This study aims to investigate the potential factors contributing poor outcomes among COVID-19 patients with psychiatric disorders, including delayed diagnosis of infection, vaccination rates, immune response, and the use of psychotropic medications. MethodsThis retrospective cohort study analyzed medical records of 15,783 adult patients who were diagnosed with COVID-19 infection by positive PCR tests between January and September 2022 at a single medical center. We identified psychiatric diagnoses using ICD-9 diagnostic codes from the preceding 3 years before COVID infection. Primary outcome was in-hospital mortality and secondary outcomes were severe illness requiring intensive care or mechanical ventilation, and hospitalization within 45 days after a positive COVID-19 test. We compared the rates of outcomes, viral load, vaccination status at the time of positive test, psychotropic medications prescription within 90 days prior, antiviral medication use, and blood inflammation markers between patients with and without psychiatric disorders. The Cox proportional hazard model was used to examine the association of psychiatric diagnoses, vaccination status, and psychotropic medication prescription with poor outcomes. ResultsPatients with psychiatric disorders demonstrated higher rates of severe illness (10.4% v.s. 7.1%) and hospitalization (16.4% vs. 11.3%), as well as a shorter duration to in-hospital mortality (6 vs. 12.5 days) compared to non-psychiatric patients. Psychiatric patients had higher vaccination rates and lower levels of inflammatory markers than non-psychiatric patients. Antipsychotic medication use was associated with in-hospital mortality (hazard ratio [HR] = 4.79, 95% confidence interval [CI] = 1.23–18.7), while being unvaccinated was associated with hospitalization (HR = 1.81, 95% CI = 1.29 to 2.54) and severe illness (HR = 3.23, 95% CI = 1.95 to 5.34) among patients with psychiatric disorders. Sedatives prescription was associated with all poor outcomes in general patients. ConclusionConsidering the narrow time window between a positive COVID-19 test and poor outcomes, healthcare providers should undertake close monitoring of patients with preexisting psychiatric disorders during the initial days after a positive PCR test. Furthermore, caution should be taken when prescribing psychotropic medications, with special attention to antipsychotics.

Stressors and coping mechanisms among pregnant women with psychiatric disorders during the COVID-19 pandemic.

Women with psychiatric disorders are vulnerable to relapse in pregnancy, and the COVID-19 pandemic has presented an additional stressor. Data came from a supplemental study offered to women enrolled in the Massachusetts General Hospital Center for Women's Mental Health National Pregnancy Registry for Psychiatric Medications. Registry participants were also invited to complete an email questionnaire relating to their experiences of pregnancy during the pandemic. Prepartum experiences of 230 respondents were analyzed. The most common diagnoses in this group were depression (30%), anxiety disorders (29%), and bipolar affective disorder (17%). Common stressors included changes in employment, greater childcare and/or schooling responsibilities, more conflict in the household, and increased isolation. Participants reported negative impacts and/or coping mechanisms associated with the pandemic, such as sleep problems, reduced physical activity, changes in eating, and greater amounts of screen time. Positive impacts and/or coping mechanisms were also reported, including more quality time with family, more time in nature, and being more appreciative of aspects of life previously taken for granted. Our findings suggest that the COVID-19 pandemic has had an overall negative psychosocial impact on many pregnant women with preexisting psychiatric disorders. We also observed positive coping mechanisms, which could be drawn on as sources of resilience.

Identifying High-Risk Individuals for Suicide During Covid-19 Pandemic: Prevention and Intervention

Background. The mental health outcomes of the coronavirus pandemic (COVID-19) might be hazardous and may evoke a tsunami of mental illness. Multiple lines of evidence indicate that the COVID-19 pandemic has profound psychological and social effects. It has been expected that the mental illnesses and suicide rates may rise not only due to the suffering of the pandemic itself but also to prolonged combat strategies, including lockdown and quarantine over a longer period. It is henceforth important to identify potential risk factors for developing risk prevention strategies with urgent consideration.Materials and Methods. A systematic review approach was employed to collect information regarding the high-risk individuals for suicide during a pandemic and subsequently present the prevention and intervention-focused strategies for managing the condition. The article published just after the pandemic outbreak including the time period: 2019 to 2020 available at PubMed, PsycINFO, and LISTA, was considered for the present study.Results. The findings suggest that the COVID-19 pandemic is associated with solitude, agony, anxiety, fear of infection, depression, insomnia, and economic complications. These conditions may subsequently lead to complex psychiatric complaints in vulnerable populations, including individuals with pre-existing psychiatric disorders, those having a history of suicide attempts, and those taking treatment for suicide risk.Conclusion. To decrease the risk of suicides during COVID-19, reducing people's stress, anxiety, and loneliness is important. Specialized training in the workforce on crisis management would have additional benefits. Governments shall devote adequate funding and resources to control the mental health consequences of the pandemic.

Risk and contextual factors associated with legal intervention injury and hospital outcomes among trauma patients in Pennsylvania

ABSTRACT Police violence has been described as an ongoing public health issue with profound impacts on individuals and communities. We leveraged a state-wide trauma registry to identify patients injured through legal intervention between 1989 and 2019 to examine individual characteristics associated with injuries, contextual factors during legal intervention, and clinical outcomes of injury to capture the nature of legal intervention injury. A total of 1098 patients injured through legal intervention were identified and 1095 patients from the PTOS dataset were matched for comparison with respect to injury and demographic factors. Patients injured through legal intervention were more likely to be male, identify as Black, had pre-existing psychiatric and substance use disorders (PECs), be intoxicated at admission, and have lower socioeconomic status. For White patients, PECs, intoxication, and lower SES were risk factors for worse clinical outcomes. Time of day and location of event also played a role in understanding this type of injury. Police violence disproportionately impacts racial minority groups as well as other disadvantaged and marginalized communities. An intersectional approach may help to understand contextual risk factors that can in turn aid in efforts to reduce law enforcement-related deaths and injuries.