Are patients with mental disorders more vulnerable to loneliness and social isolation during the COVID-19 pandemic? - Findings from the Japan COVID-19 and Society Internet Survey.

BACKGROUND: Loneliness and social isolation are well-known factors that worsen the symptoms among patients with mental disorders. Few previous studies have explored loneliness and social isolation among populations with mental disorders during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, our study examined the mental health impact of the pandemic on these population groups in terms of loneliness and social isolation. METHODS: We used data from the Japan COVID-19 and Society Internet Surveys, a large-scale online survey. Using multivariable logistic regression analysis, we calculated the odds ratios and 95 % confidence intervals (CIs) of moderate-to-severe loneliness and high social isolation for major chronic diseases, including mental disorders, after adjusting for potential confounders. Calculations were performed for each type of mental disorder. Finally, calculations were performed to explore the association between moderate-to-severe loneliness or high social isolation and psychiatric symptoms among patients with mental disorders. RESULTS: Of the 28,175 participants, 2021 (7.2 %) had a mental disorder. Mental disorders, especially depression and anxiety disorders, were found to be associated with a higher risk of moderate-to-severe loneliness and high social isolation. Patients with mental disorders who experienced moderate-to-severe loneliness and high social isolation were found to have exacerbated psychiatric symptoms. LIMITATION: Our findings were obtained from a cross-sectional study design. CONCLUSIONS: Patients with mental disorders were more vulnerable to moderate-to-severe loneliness and high social isolation during the pandemic, which contributed to the exacerbation of their symptoms. Depression and anxiety, in particular, were most likely to occur and required special attention.

Multiple distant metastases arising from a single, low-grade rectal neuroendocrine tumor: an autopsy case report.

BACKGROUND: Rectal neuroendocrine neoplasms are rare epithelial neoplasms of the rectum. The incidence of these tumors has increased over the past decades. However, many questions remain unanswered regarding their clinicopathology, including the possible mechanisms in which these tumors may grow and metastasize. CASE PRESENTATION: In this case report, we report the findings of an autopsy of a 65-year-old Japanese woman diagnosed with multiple liver metastases from a single, low-grade rectal neuroendocrine tumor. The diagnosis was made in late 2018 to early 2019, and subsequently the patient underwent several rounds of standard chemotherapy. However, due to unfavorable side effects, she opted for palliative care at our hospital instead from December 2020. The patient's condition was generally stable for the next 17 months, but in May 2022, she was hospitalized for increased abdominal pain. Despite enhanced pain control therapy, she eventually passed away. An autopsy was conducted to determine the exact cause of death. The primary rectal tumor was found to be small, but showed strong histological evidence of venous invasion. Metastases in the liver, pancreas, thyroid gland, adrenal glands, and vertebrae were also present. On the basis of the histological evidence obtained, we deduced that the tumor cells may have mutated and gained multiclonality as they spread vascularly to the liver, contributing to the distant metastases. CONCLUSIONS: The results from this autopsy may provide an explanation for the possible mechanism by which small, low-grade rectal neuroendocrine tumors metastasize.