Defining the concept of mental dysregulation in patients requiring ambulance and/or emergency department care: protocol for a Delphi consensus study.

INTRODUCTION: From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. METHODS AND ANALYSIS: A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). ETHICS AND DISSEMINATION: This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.

Interventions to reduce interpersonal stigma towards patients with a mental dysregulation for ambulance and emergency department healthcare professionals: review protocol for an integrative review.

INTRODUCTION: Worldwide, there is an increase in the extent and severity of mental illness. Exacerbation of somatic complaints in this group of people can result in recurring ambulance and emergency department care. The care of patients with a mental dysregulation (ie, experiencing a mental health problem and disproportionate feelings like fear, anger, sadness or confusion, possibly with associated behaviours) can be complex and challenging in the emergency care context, possibly evoking a wide variety of feelings, ranging from worry or pity to annoyance and frustration in emergency care staff members. This in return may lead to stigma towards patients with a mental dysregulation seeking emergency care. Interventions have been developed impacting attitude and behaviour and minimising stigma held by healthcare professionals. However, these interventions are not explicitly aimed at the emergency care context nor do these represent perspectives of healthcare professionals working within this context. Therefore, the aim of the proposed review is to gain insight into interventions targeting healthcare professionals, which minimise stigma including beliefs, attitudes and behaviour towards patients with a mental dysregulation within the emergency care context. METHODS AND ANALYSIS: The protocol for a systematic integrative review is presented, using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A systematic search was performed on 13 July 2023. Study selection and data extraction will be performed by two independent reviewers. In each step, an expert with lived experience will comment on process and results. Software applications RefWorks-ProQuest, Rayyan and ATLAS.ti will be used to enhance the quality of the review and transparency of process and results. ETHICS AND DISSEMINATION: No ethical approval or safety considerations are required for this review. The proposed review will be submitted to a relevant international journal. Results will be presented at relevant medical scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42023390664 (https://www.crd.york.ac.uk/prospero/).

The effects of the COVID-19 outbreak and measures in patients with a pre-existing psychiatric diagnosis: A cross-sectional study.

Background COVID-19 has seriously affected physical and mental health world-wide,both due to spreading of the virus and due to the socially restrictive measures most governments have enforced. Increased anxiety, stress and depressive symptoms have been widely reported in the general population. The current study investigated the effects of COVID and the restrictive measures in the Netherlands on stress, anxiety and loneliness in patients with a pre-existing psychiatric disorder. Methods 189 patients with a pre-existing psychiatric disorder treated at the University Medical Center Utrecht (UMCU) provided consent to participate in an electronically provided survey. Questionnaires on anxiety, depressive symptoms, worry, stress and general health were completed by 148 participants. Results All patients reported heightened distress as well as the presence of depressive symptoms and loneliness during the initial phase of the restrictive measures. Patients could be divided into two major subgroups with either psychotic disorder (n = 71) and affective disorder (n = 86). Patients with affective disorders were more affected by the outbreak and accompanying socially restrictive measures than patients with psychotic disorders. Conclusions Our findings indicate negative mental health effects of the global COVID-19 pandemic and the restrictive measures in a particularly vulnerable population, with differential effects on diagnostic groups.