COVID in Psychiatry

Question 1

What are possible neuropsychiatric effects of COVID-19?

Answer 1

• Delirium can be presenting feature – most common neuropsychiatric feature
• Fatigue in up to 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

Question 2

What is delirium associated with?

Answer 2

•Delirium is associated with poorer outcomes esp in ITU cases where up to 1/3 can have cognitive and behavioural symptoms

Question 3

Does having a mental disorder increase the risk of getting the virus?

Answer 3

• No

* However, a positive COVID test a higher risk was associated with schizophrenia-related disorders

Question 4

How do learning disabilities affect COVID outcomes?

Answer 4

•Death rate for people with learning disabilities was 240 deaths per 100,000. 2.3 times the rate in the general population for the same period.

•After adjusting for under-reporting the estimated rate was 369 per 100,000 adults, which is 3.6 times the rate in the general population.
Fewer care homes for LD have had outbreaks (according to PHE) than other care homes

Question 5

What are the changes that have been made to psychiatric services?

Answer 5

•NHS went into emergency operations on 16th March 2020
•Some reopening has occurred.
•Change from face to face to remote consultations using technology
-Challenging populations
-Not all are easy to reach
-Telephone vs internet based such as Attend Anywhere
-Privacy and Governance issues
•There were modifications made to the Mental Health •Legislation in England and in Scotland HOWEVER these have never been enacted

Question 6

What has been the effect of COVID-19 on suicide?

Answer 6

•NO EVIDENCE OF INCREASED SUICIDE AT PRESENT

• Difficulties in collecting real time data on suicide as there needs to be investigation into death
• In the SARS pandemic there was an increase in suicide
• National Confidential Inquiry into Suicide and Homicide based at the University of Manchester – Real time surveillance found no change in pre vs post lockdown suicide rates

Question 7

What has been the effect of COVID-19 on self-harm?

Answer 7

• A study of 1500 general practices in the UK using the Clinical Practice Research Datalink found that the recorded incidence of self-harm was 38% lower in April, 2020, than the rate expected on the basis of previous years.
• This decrease was particularly marked in women, people younger than 45 years, and those from the most deprived quintile of practices.