Impact of the COVID-19 pandemic on patients with mental health problems and the differences among diagnostic categories.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a total upending of our daily lives. While anxiety and depression were frequently reported among the general population, the pandemic's impact on patients with mental health problems remains unknown. METHODS: A cross-sectional questionnaire survey involving 1,166 patients was conducted at one psychiatric hospital and one mental health clinic. RESULTS: Symptom deterioration was reported in 23% to 34% of the patients and 9% to 20% reported increase in drug dosage. No significant differences were reported in these items among diagnostic categories. Patients with F3 (mood disorders) reported more psychological stress during the pandemic's beginning and during the emergency. Patients with F2 (schizophrenia, schizotypal, and delusional disorders) did online shopping and meetings less frequently, and reported poorer adherence of 3C's, while mask management was stricter in patients with F4 (neurotic, stress-related, and somatoform disorders). Symptom deterioration was significantly associated with increase in drug dosage, new physical symptoms, anxiety unrelated to COVID-19, stress at the beginning of pandemic, stress during the 'state of emergency', poor adaptability to environmental change, daily life changes, decrease in sleeping time, and decrease in time spent outside. CONCLUSION: One third of patients reported symptom deterioration during the pandemic, which was associated with stress and daily life changes. Patients with good adaptability to environmental changes might resilient against symptom deterioration. Providing continuous support to help patients manage their daily life in this COVID-19 era may minimize the risk of symptom deterioration.

Effect of Downsized Screw Selection on Bone Healing and Postoperative Complications in Volar Plating of Distal Radius Fractures.

When performing volar plating of distal radius fractures, selecting downsized subchondral screws may prevent dorsal screw penetration (DSP), which is a risk factor for extensor tendon rupture. However, downsizing may cause loss of reduction or poor bone healing. This prospective study investigated the effect of downsized screw selection on bone healing and postoperative complications. A total of 115 patients with postoperative follow-up longer than 6 months comprised the study population. Using a depth gauge, screws that were 2-mm shorter than the measured value were selected. The DSP then was checked using dorsal tangential view (DTV) radiographs during surgery and at final follow-up. Baseline data included bone healing, loss of reduction of radiological parameters, DSP location, and postoperative complications. To assess DSP on DTV radiographs, the dorsal surface of the radius was divided into the radial and ulnar sides at the Lister tubercle, and each was further divided into 2 equal regions. These 4 regions were defined as zones 1 to 4 from the radial side. A total of 114 patients (99%) showed bone healing. Mean loss of reduction was approximately 1° and within 1 mm in radiological parameters. Eleven patients (9.6%) showed DSP during surgery or at final follow-up despite using 2-mm downsized screws. The most common site of DSP was zone 3. Extensor pollicis longus rupture occurred in 2 patients (1.7%) despite no DSP. Downsized screw selection provided a high rate of bone healing with minimum loss of reduction and a low complication rate. The extensor tendon can be torn regardless of DSP. [Orthopedics. 2021;44(2):e259-e265.].