COVID AND PSYCHIATRY Flashcards
neuropsychiatric/psychiatric signs and symptoms seen in/after COVID
insomnia/sleep disorder anxiety impaired concentration/attention/memory depressed mood confusion emotional lability altered consciousness pressured speech euphoria irritability auditory/visual hallucinations persecutory ideas suicidality and self harm fatigue frequent recall of traumatic memories psychotic symptoms
factors associated w/ psychiatric/neuropsychiatric outcome in COVID
female
age
health-care worker
married
previous chronic physical illness
presence of AVN
functional impairment
average pain
distressing pain after SARS
SARS related worry
chance locus of control
frequent recall of SARS memories
social network size
death of relative due to SARS
medicolegal involvement
neuropsychiatric effects of COVID
delirium can be presenting feature - most common neuropsychiatric feature
- associated w/ poorer outcomes esp in ITU (up to 1/3 can have cognitive and behavioural symptoms)
fatigue in 1/5 post resolution
psychosis, mood disorder, catatonia, encephalitis, encephalopathy and other neurological disorder (stroke can be a presenting feature)
high rates of anxiety, depression and PTSD in those discharged from hospital
long COVID
psychosis and COVID
1/3 had a psychiatric or neurological diagnosis at 6mths follow up
- pts in ICU - 46% had a psychiatric or neurological diagnosis at 6mths
6mths after COVID diagnosis, 17% diagnosed w/ anxiety disorder, 1% psychotic disorder
- ICU - 19% anxiety, 2% psychosis
likely immune modulated - both infection and treatment play a part
mental illness and risk of getting +ve COVID test/SARS-CoV-2 infection
higher risk associated w/ Sz related disorders
SARS-CoV-2 infection higher among pts w/ severe mental illness and substance use disorder
mortality risk among confirmed COVID pts was significantly higher in pts w/ than those w/o mental disorders
COVID death was high among pts w/ severe mental illness
learning disability and COVID
death rate for people w/ LD was 2.3x the rate in the general pop
- after adjusting for under-reporting, rate was 3.6x general pop
fewer care homes for LD have had outbreaks than other care homes
LD and COVID - US data
higher rather of COVID incidence than those w/o LD
more likely to be admitted to hospital if diagnosed
higher rates of ICU stay
more likely to die following COVID diagnosis
changes in psychiatric services due to COVID
change from face to face to remote consultations
- challenging populations
- not all are easy to reach
- telephone vs internet based
- privacy and governance issues
effect of COVID on suicide
difficulties in collecting real time suicide data - investigation into death
SARS pandemic - increase in suicide
national inquiry into suicide and homicide - real time surveillance found no change in pre vs post lockdown suicide rates
BMJ editorial - no evidence of an increase in suicide at present
- might be early evidence, change in demographic who have died by suicide might have changed
suicidal ideation and COVID
systematic review suggests there may be an increase
- more research needed
COVID and self-harm
study found recorded incidence of self harm was 38% lower in April 2020 than the rate expected on the basis of previous years
decrease was particularly marked in women, people <45 and those from the most deprived quintile of practices
