Psychiatric hospitalization during the two SARS-CoV-2 pandemic waves:New warnings for acute psychotic episodes and suicidal behaviors

BACKGROUND The subsequent waves of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic have represented a dramatic health emergency characterized by significant consequences on mental health.Diachronic variations in the incidence rates of acute relapse of psychiatric disorders may represent significant"sentinel events"for assessing the mental health response to an unprecedented stressful event.AIM To investigate the variation in psychiatric hospitalization rates and differences in sociodemographic and clinical-psychopathological peculiarities at Bologna"Maggiore"General Hospital Psychiatric Ward(GHPW)between the first two waves SARS-CoV-2 pandemic and the same periods of the previous 3 years.The secondary purpose of the study was to suggest a diachronic response pathway to stress by reporting additional literature data on coping strategies.METHODS This observational and retrospective study collected information on admission to the GHPW at the"Maggiore"Hospital in Bologna in the index periods defined as follows:the first period between February 24,2020 and April 30,2020(first epidemic wave)and the second period between October 8,2020,and January 7,2021(second pandemic wave).Absolute numbers and proportion of admitted patients,their sociodemographic and clinical-psychopathological characteristics were compared with the same parameters recorded in the two same periods of the previous 3 years.No strict inclusion or exclusion criteria were provided in the data collection to collect information on all patients requiring acute psychiatric hospitalization.RESULTS During the first wave,there was a significant reduction in hospitalization rates,although there was a simultaneous increase in compulsory hospitalizations and the acute relapse of schizophrenia spectrum and other psychotic disorders.During the second wave,hospitalization rates reached those recorded during the same period of the previous 3 years,mainly due to the rise of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressor-related disorders and suicidal behaviors.CONCLUSION The coping strategies adopted during the first wave of the SARS-CoV-2 pandemic protected the vulnerable population from the general risk of clinical-psychopathological acute relapse,even if they increased the susceptibility to run into schizophrenia spectrum and other psychotic disorder relapses.In the medium-long term(as in the second pandemic wave),the same strategies do not play protective roles against the stress associated with the pandemic and social restriction measures.Indeed,during the second wave of the SARS-CoV-2 pandemic,an increase in total hospitalization rate,suicidal behaviors and the incidence rate of bipolar and related disorders,depressive disorders,anxiety disorders,trauma-and stressorrelated disorders was observed.

Investigation of attitudes toward mental illness among nursing students in Indonesia

Objective:People with mental illness(PMI)are often stigmatized or experience negative attitudes from society.In particular,nursing students'attitudes toward PMI will influence the quality of care these patients receive.Some factors influencing attitudes toward PMI among nursing students have been identified.The present study aimed to examine factors influencing attitudes toward mental illness among nursing students in Indonesia.Methods:Nursing students(n-317)were assessed for attitudes toward mental illness using the Community Attitude toward the Mentally Ill questionnaire.Details regarding sociodemographic variables(age,gender,ethnicity,year of study,monthly family income,personal experience with mental illness,family history of mental illness,and knowing or having direct contact with PMI)and knowledge about mental illness by using Mental Health Knowledge Schedule questionnaire were also obtained.Results:The mean Community Attitude toward the Mentally Ill questionnaire score was 103.75±9.15,with the highest mean of the four subscales being that of authoritarianism 27.97±2.87 followed by social restrictiveness,community mental health ideology,and benevolence 27.52±3.68,24.38±3.80,and 23.89±3.27,respectively.The factors significantly associated with nursing students'attitudes toward mental illness were age(r=-0.18,P=0.001),year of study(H=16.65,P<0.001),knowing or having direct contact with PMI(Z=-2.35,P=0.019),and knowledge of mental illness(r=-0.22,P<0.001).Conclusions:Several demographic variables,direct contact with PMI,and level of knowledge about mental illness can contribute to variations in attitudes toward PMI among nursing students in Indonesia.Education and direct contact with PMI serve as intervention strategies to reduce negative attitudes and stigma associated with mental illness among nursing students.

Where to seek help? Barriers to beginning treatment during the first-episode psychosis

Objective:As decreasing the duration of untreated psychosis has been highlighted as key indicator in relation to improved prognosis,this study aims to identify the access barriers to beginning early treatment of young people in first-episode psychosis(FEP),based on family reports on the experience of perceiving illness and help-seeking.Method:A qualitative research was carried out with 12 relatives of 12 young people passing through their first psychiatric hospital admission as a result of their FEP.Depth interviews were used for data collection and thematic content method for data analysis.Results:Barriers to beginning treatment were lack of knowledge and difficulty in recognizing mental illness,lack of knowledge on where to seek specialized treatment,and stigma and resistance to psychiatric treatment.Conclusion:It was demonstrated that the family members are protagonists in the search for treatment of young people in their FPE,given that the initiative for seeking treatment came from them.

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

BACKGROUND In children and adolescents compared to adults,clinical high-risk of psychosis(CHR)criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant.Based on high rates of non-converters to psychosis,especially in children and adolescents,it was suggested that CHR criteria were:(1)Pluripotential;(2)A transdiagnostic risk factor;and(3)Simply a severity marker of mental disorders rather than specifically psychosis-predictive.If any of these three alternative explanatory models were true,their prevalence should differ between persons with and without mental disorders,and their severity should be associated with functional impairment as a measure of severity.AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.METHODS In the mainly cross-sectional examinations,8–17-year-old community subjects(n=233)randomly chosen from the population register of the Swiss Canton Bern,and inpatients(n=306)with primary diagnosis of attention-deficit/hyperactivity disorder(n=86),eating disorder(n=97),anxiety including obsessive–compulsive disorder(n=94),or autism spectrum disorder(n=29),not clinically suspected to develop psychosis,were examined for CHR symptoms/criteria.Positive items of the Structured Interview for Psychosis-Risk Syndromes(SIPS)were used to assess the symptomatic ultra-high-risk criteria,and the Schizophrenia Proneness Instrument,Child and Youth version(SPI-CY)was used to assess the 14 basic symptoms relevant to basic symptom criteria.We examined group differences in frequency and severity of CHR symptoms/criteria usingχ^(2) tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes,and their association with functioning using correlation analyses.RESULTS The 7.3%prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%rate in inpatients.Frequency and severity of CHR criteria never differed between the community and the four inpatient groups,while the frequency and severity of CHR symptoms differed only minimally.Group differences were found in only four CHR symptoms:suspiciousness/persecutory ideas of the SIPS[χ2(4)=9.425;P=0.051,Cramer’s V=0.132;and Z=-4.281,P<0.001;Rosenthal’s r=0.184],and thought pressure[χ^(2)(4)=11.019;P=0.026,Cramer’s V=0.143;and Z=-2.639,P=0.008;Rosenthal’s r=0.114],derealization[χ2(4)=32.380;P<0.001,Cramer’s V=0.245;and Z=-3.924,P<0.001;Rosenthal’s r=0.169]and visual perception disturbances[χ^(2)(4)=10.652;P=0.031,Cramer’s V=0.141;and Z=-2.822,P=0.005;Rosenthal’s r=0.122]of the SPI-CY.These were consistent with a transdiagnostic risk factor or dimension,i.e.,displayed higher frequency and severity in inpatients,in particular in those with eating,anxiety/obsessive–compulsive and autism spectrum disorders.Low functioning,however,was at most weakly related to the severity of CHR criteria/symptoms,with the highest correlation yielded for suspiciousness/persecutory ideas(Kendall’s tau=-0.172,P<0.001).CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes,or merely markers of symptom severity.

Selective serotonin reuptake inhibitors and risk reduction for cardiovascular disease in patients with schizophrenia: A controversial but promising approach

Patients with schizophrenia(SCZ)are at high risk of cardiovascular disease(CVD)due to an inherited predisposition,a sedentary life style and the use of antipsychotic medications.Several approaches have been taken to minimize this risk but results continue to be unsatisfactory.A potential alternative is prescribing selective serotonin reuptake inhibitors(SSRIs).SSRIs decrease platelet aggregation and reduce the risk of coronary heart disease in patients with depression.We therefore aim to investigate whether there is evidence that supports the use of SSRIs to reduce the risk for CVD in SCZ.A review of the literature revealed five published reports relating to the impact of SSRIs on CV risk in SCZ.Three trials assessed the influence on metabolic parameters of fluvoxamine when combined with clozapine.Two of those studies found improvements with fluvoxamine.Of the other two reports,one indicates SSRIs as a group caused minimal but statistically significant increments in total cholesterol,low-density lipoprotein and triglyceride.The second report suggests that when SSRIs are combined with antipsychotics,the metabolic impact depends on the antipsychotic prescribed.While there are promising results,no conclusions can be made currently on whether SSRIs increase or decrease CV risk in SCZ.Further studies are needed to resolve this matter.

Pimavanserin for the treatment of psychosis in Alzheimer’s disease: A literature review

BACKGROUND Alzheimer’s disease(AD)is among the most prevalent forms of dementia in the world and neuropathological studies suggest similar high prevalence of mixed(AD+vascular)dementias.Approximately 25%-50%of individuals with AD develop psychosis sometime during their illness.The presence of psychosis in AD worsens outcomes.Currently there are no United States Food and Drug Administration(FDA)approved medications for the treatment of psychosis in AD.Pimavanserin,a novel atypical antipsychotic medication,was approved by the FDA for the treatment of hallucinations and delusions associated with Parkinson disease psychosis and is currently in clinical trials for the treatment of psychosis in AD.AIM To evaluate the existing literature regarding the use of pimavanserin for treating psychosis among individuals with AD.METHODS A literature review of clinical studies of pimavanserin treatment for psychosis in individuals with AD was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.Trials were identified by systematically searching PubMed,MEDLINE,EMBASE,Cochrane Central Register of Controlled Trials,Web of Science,and Scopus through October 2019.The 5-point Jadad scoring system was used to assess the methodologic quality of the randomized placebo-controlled trials.RESULTS A total of 499 citations were retrieved and pooled in EndNote and de-duplicated to 258 citations.This set was uploaded to Covidence for screening.Two separate screeners(Srinivasan S and Tampi RR)evaluated the titles,abstracts,and full text of eligible articles.Of the identified 258 abstracts,98 articles underwent full text review and 2 publications from 1 randomized controlled trial(RCT)were included in the final analysis.The quality of evidence was assessed to be of good methodologic quality,scoring 4 out of 5 using the 5-point Jadad questionnaire with the Jadad Scoring calculation.This systematic review found only one RCT that evaluated the use of pimavanserin for the treatment of psychosis among individuals with AD.This phase 2 trial resulted in two publications,the second of which was a subgroup analysis from the original study.The evidence from these two publications showed that pimavanserin improves psychotic symptoms among individuals with AD when compared to placebo at week 6.CONCLUSION Pimavanserin may be a pharmacologic consideration for the treatment for psychosis in AD.Additional RCTs are needed to assess the evidence of effectiveness before pimavanserin is considered a standard treatment.

Violent offences of methamphetamine users and dilemmas of forensic psychiatric assessment

Methamphetamine(MA),an extremely addictive synthetic stimulant,has quickly spread to become the most frequently used illicit drug in China.People with a history of chronic and heavy MA use have a high possibility of exhibiting schizophrenia-like psychotic symptoms,mainly delusions of reference,auditory hallucinations and cognitive deficits.These emerging findings suggest MA use increases aggression and violence and that there is a correlation between MA use and violence.However,it is unclear how to assess the capacity of criminal responsibility in“MA-induced”psychosis and how to set clear boundaries between schizophrenia and MA-induced psychosis when only limited and inconsistent evidence is available.Furthermore,a final persuasive differential diagnostic method based on improved understanding of schizophrenia and MA-induced psychotic disorders has yet to be developed.This paper will evaluate the epidemiology,social harm,and forensic psychiatric assessment of MA users,propose a future direction for the differential diagnosis between MA-induced psychotic disorders and schizophrenia,and put forward some practical solutions to assess the capacity of criminal responsibility of defendants with drug-induced psychotic disorder.