Impact of lockdown due to COVID-19 pandemic on psychiatric patients

Background: There was sudden reorganization of services during lockdown due to COVID-19. Care of psychiatric patients was in threat due to closure of inpatient department and conversion of hospitals into COVID treatment centres.Methods: List of follow-up patients not attending our outpatient department during lockdown was obtained. They were contacted through telephone. Evaluation was done with Brief psychiatry rating scales (BPRS) and WHODAS2 scales. Statistical analysis of obtained data was done.Results: Comparison of BPRS total score, WHODAS domain scores and total score between outpatients and inpatients was done using independent samples ‘t’ test. It was found to be statistically significant (p<0.05). Anxiety and distractibility are the more prominent symptoms in majority of psychiatry patients.Conclusions: Psychiatric patients needs safe place, with people to talk and to take care of daily activities. It is highly recommended urgent need of creating awareness program on COVID-19 pandemic which targets this vulnerable population. It is essential to provide continued psychiatric intervention using tele-psychiatric platform and ensure their social support using community mental health services during the pandemic. A standard protocol on the management of patients with serious mental illness during an infectious disaster should be developed.

Clinical psychology in palliative care

Clinical psychologists with specialist knowledge and skills in palliative care can be described as palliative psychologists. Whether as core members of a palliative care team or as consultants, palliative psychologists can become involved soon after a diagnosis of serious illness and continue to provide care during treatment, transitions of care, during the dying process, and in bereavement. The distress patients and family caregivers may experience is on a continuum and may involve both psychological and spiritual factors. When the patient and family coping strategies become depleted or are inadequate to face the challenges imposed by illness, suffering can ensue. The palliative psychologist may offer assessment and management of anxiety, depression, and other types of psychological distress. Grief reactions should always receive special and ongoing attention to determine whether the distress is manageable or whether psychological or psychiatric intervention is warranted. Because of the ongoing interplay of psychological and spiritual concerns, palliative psychologists can effectively use spiritual screening and the spiritual history to understand spiritual and existential needs, and help integrate spiritual care into the psychotherapy session. This offers the opportunity to collaborate with spiritual care providers in the psychospiritual care of the patient and the family. Maintaining professional self-care is also a mandate for palliative psychologists and includes the timely recognition of risk factors for professional distress, protective factors, and meaningful interventions.

STEPPS for Borderline Personality Disorder: A Pragmatic Trial and Naturalistic Comparison With Noncompleters

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group psychotherapy approach that is effective for patients with borderline personality disorder (BPD) in a public health care setting. The sample in this study comprised 118 outpatients with BPD who were asked to participate in a Spanish-adapted version of STEPPS for 18 months, a psychotherapy program that could be added to their usual psychiatric intervention. They were divided into an experimental group who participated in STEPPS, and a control group, who received treatment as usual. Several variables were collected and the Borderline Evaluation of Severity Over Time (BEST) scale was administered at pretest, Months 3 and 6, posttest (Month 18), and 2-year follow-up (Month 42), after which a post hoc data analysis was carried out. The STEPPS program improved the as-usual treatment provided previously, and the results were cost-effective. A higher educational level and good patient collaboration predicted better outcome.

The Unseen Reality

It is not uncommon to encounter a patient who is convinced of a somatic cause for their pain. However, in the case of delusional parasitosis, the patient demonstrates an unshakable conviction of some type of infestation. This can lead various form self-mutilation intended to extract the parasite. They will search for evidence in the excrement. They can seem quite convincing. In some instance, this belief can result in very obsessive cleaning rituals, which may include children. Patients are unconvinced by other explanations and resist psychiatric intervention. However, this, oftentimes, is the only hope for effective management. It is important to not discount the patient; the problem is real to them. Attempts should be made, without reinforcing their delusion, to gain their trust so they will agree to appropriate consultations.

Use of telepsychiatry for the management of mental health problems in migrants

An estimated 3.3% of the global population lives outside their place of birth. This heterogenous group includes not only high-skilled labour and expats, but also refugees and asylum seekers. Research has shown that the prevalence of certain mental illnesses, such as post-traumatic stress disorder and depression, may be higher in migrants than in the general population. However, some migrants might not be able to receive the relevant mental health treatment owing to various social, cultural, and physical barriers. One possible solution is the use of telepsychiatry, defined as the delivery of psychiatric intervention from a distance. This includes real-time videoconferencing, pre-recorded videos, or even decision support systems. This technology has the ability to connect migrants with a clinician who understands their language and culture, thereby improving the patient satisfaction and outcome. The benefits of telepsychiatry, along with the challenges in its implementation, will be discussed in this chapter, as will potential problems related to ethics, regulation, and confidentiality.

Psychiatric Intervention and Psychiatrist's Role in the COVID-19 Epicenter-Wuhan: Personal Experience and Perspective

This invited commentary is the personal experience of a psychiatrist who assisted in Wuhan, China during the pandemic. From the personal perspective, it explains why psychiatrists need to go to Wuhan, discusses the psychological problems faced by the front-line medical staff and confirmed COVID-19 patients and the corresponding psychological interventions provided to them, describes the particularity and coping methods of psychological issues related to COVID-19 epidemic.