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.

Microstructural brain abnormalities,affective temperaments,and suicidal behavior in patients with major depression

According to magnetic resonance imaging(MRI)studies,brain white matter(WM)abnormalities have been suggested to play a critical role in the pathogenesis of major depressive disorder(MDD)and related suicidal behavior.However,MRI findings may be limited by low spatial resolution;therefore,an important contribution to the understanding of the role and significance of WM alterations derived by the development of the most recent magnetic resonance techniques,such as diffusion tensor imaging(DTI).Several DTI studies reported an association between altered WM integrity and MDD/suicidal behavior.Microstructural WM abnormalities may be located in neural circuits critically implicated in emotional processes and mood regulation resulting in enhanced vulnerability to psychiatric morbidity.WM abnormalities detected using DTI may contribute to functional deficits and help to clarify the pathophysiological mechanisms underlying MDD as well as suicidal behavior.By a clinical point of view,research also suggested that affective temperaments may play a relevant role in the psychopathological characteristics of mood disorders,clinical trajectory of episodes and polarity,long‑term outcome and suicidality.Unfortunately,only few studies investigated the association between affective temperaments and WM abnormalities and discussed their possible implications in patients with MDD and suicidal behavior.Using a comprehensive search of Medline database,the aim of the present study was to critically review the current literature on the association between WM alterations as assessed by MRI and DTI techniques,affective temperaments,MDD and suicidal behavior.

BDNF methylation and mRNA expression in brain and blood of completed suicides in Slovenia

BACKGROUND Suicide is a major public health problem.Worldwide,around 800000 people die by suicide every year.Suicide is a multifactorial disorder,with numerous environmental and genetic risk factors involved.Among the candidate genes,changes in the BDNF locus at the gene,epigenetic,mRNA,and protein expression levels have been implicated in psychiatric disorders,including suicidal behavior and completed suicides.AIM To investigate changes in BDNF methylation and expression of four alternative BDNF transcripts for association with completed suicide.METHODS This case-control study included 42 unrelated male Caucasian subjects,where 20 were control subjects who died following acute cardiac arrest,and 22 were suicide victims who died by hanging.DNA and RNA were extracted from brain tissue(Brodmann area 9 and hippocampus)and from blood.DNA methylation and mRNA expression levels were determined by targeted bisulfite next-generation sequencing and reverse-transcription quantitative PCR.Statistical analysis was done by use of two-tailed Student’s t tests for two independent samples,and the Benjamini-Hochberg procedure was implemented for correction for multiple comparisons.RESULTS In DNA from brain tissue,there were no significant differences in BDNF methylation between the study groups.However,data showed significantly reduced DNA methylation of the BDNF region upstream of exon I in blood samples of suicide victims compared to the controls(5.67±0.57 vs 6.83±0.64,P_(corr)=0.01).In Brodmann area 9 of the brain of the suicide victims but not in their hippocampus,there was higher expression of BDNF transcript I-IX(NM_170731.4)compared to the controls(0.077±0.024 vs 0.05±0.013,P=0.042).In blood,expression analysis for the BDNF transcripts was not feasible due to extensive RNA degradation.CONCLUSION Despite the limitations of the study,the obtained data further support a role for BDNF in suicidality.However,it should be noted that suicidal behavior is a multifactorial disorder with numerous environmental and genetic risk factors involved.