Mental Health of Patients Hospitalized Due to Covid-19.

Objective: The COVID-19 pandemic has imposed numerous challenges on the mental health of the population of each affected country. The mental health of patients hospitalized due to COVID-19 was particularly at risk. The goal of this research was to examine the occurrence of mental disorders in such patients and what were the risk factors for poorer mental health during hospital treatment for COVID-19. Method: We included 135 subjects treated for COVID-19 who were discharged during January 2022. We collected their sociodemographic data as well as data on somatic comorbidities and treatment during hospitalization. We monitored how many patients were hospitalized with a psychiatric diagnosis and therapy, and how many of them started using psychotropic drugs during hospitalization. Those data were recorded both at the time of discharge and again one year later. Results: Statistical analysis showed that the number of patients using psychotropic drugs increased 4x (n=11 (8.1%) at admission vs. n=44 (32.6%) in hospital) during hospital treatment due to COVID-19. There was an increase in the use of all psychotropic drugs except for antidepressants; specifically, there was a 3.3x increase in treatment with anxiolytics (5.2% at admission vs. 17.0% in hospital), a 3.4x increase in treatment with antipsychotics (5.2% vs. 17.8%), and an 8x increase in treatment with hypnotics (0.7% vs. 5.9%). Their use decreased close to baseline after discharge. Conclusions: Our research showed that hospitalization due to COVID-19 leads to deterioration of mental health. We assume that there is a fear of death in the background, which can be well explained by the "landscape of fear" theory.

Rehospitalization Rates Among Patients with Psychotic Disorders During Covid-19 Pandemic: Oral Versus Long-Acting Injectable Antipsychotics.

Objective: The superiority of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics is often emphasized, even in terms of adherence and rehospitaliza-tion rates. As such, LAIs are particularly recommended during the COVID-19 pandemic. The goal of our research was to determine whether there are differences in the number of rehospitalizations in patients treated for schizophrenia, schizophrenia-like disorders, and delusional states (psychotic disorders) with LAI antispychotics versus oral antispychotics. Method: Subjects with schizophrenia, schizophrenia-like disorders and delusional states participated in our retrospective study. 124 subjects were treated with oral anti-psychotics, while 72 received LAIs along with oral antipsychotics. We collected their sociodemographic data and psychiatric history data. Our main outcome measure was the number of rehospitalizations. Results: Statistical analysis showed that the studied groups did not differ according to sociodemographic parameters, except that in the group of patients with LAIs there was a significantly higher percentage of men (65 (52.4) vs 50 (69.4), p=0.029)). Also, the groups do not differ according to the psychiatric history data. There is no difference in the duration of the current hospitalization nor in the composition of the patients, considering the order of the current hospitalization. The difference in the number of rehospitalizations is not significant neither in the first year of follow-up (p=0.144), nor in the second (p=0.142), nor after two years of follow-up (p=0.083). Conclusions: Our research has shown that there is no difference in the number of rehospitalizations in patients with schizophrenia, schizophrenia-like disorders and delusional states, considering whether they take oral antipsychotics or they also take LAIs along with them. We can therefore conclude that it is particularly important to work on improving patient adherence. We must make psychiatrists aware that the pandemic, like other threats, can be our ally in improving adherence ("perceived threat as a health belief").

Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression.

BACKGROUND: Postpartum depression is a psychiatric disorder that starts from the second to the sixth week after birth. Breastfeeding is considered a protective factor for postpartum mood swings. This paper aims to examine the effect of breastfeeding on postpartum depression and anxiety, and how it affects child development. METHODS: The study included 209 pregnant women, 197 puerperea, and 160 women at the end of the third month after delivery, followed through three time-points. The instruments used in the study were the Edinburgh Postpartum Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI). RESULTS: Postpartum mothers with low risk of PPD breastfed their children more often than mothers with a mild or severe risk of perinatal depression. Mean values on the BDI scale three months after giving birth were higher in mothers who did not breastfeed their child (M = 3.53) than those who did breastfeed their child (M = 2.28). Postpartum anxiety measured by BAI was statistically negatively correlated (rs-, 430) with the duration of breastfeeding. CONCLUSION: Nonbreastfeeding mothers are more depressed and anxious compared to breastfeeding mothers.

Patterns of chronic physical multimorbidity in psychiatric and general population.

OBJECTIVE: A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations. METHODS: We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population. RESULTS: Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: "Relatively healthy", "Musculoskeletal", "Hypertension and obesity", and "Complex multimorbidity" with no significant differences in the nature of multimorbidity latent classes patterns. The class "Relatively healthy" was significantly less (ARI = -25% (CI95% -30% -21%), and the class "Hypertension and obesity" was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI95% 17% - 23%). CONCLUSIONS: These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.

Once-monthly paliperidone palmitate in early stage schizophrenia - a retrospective, non-interventional 1-year study of patients with newly diagnosed schizophrenia.

BACKGROUND: Long-acting antipsychotic therapy may be best suited for patients in the early stage of schizophrenia, when the most can be done before disease progression associated with poor adherence occurs. We explored the patterns of use of once-monthly paliperidone palmitate (PP1M), concomitant medication use, hospitalization, and clinical outcomes of adult, newly diagnosed patients with schizophrenia receiving continuous treatment with PP1M for at least 12 months. METHODS: This was an international, multicenter, exploratory, retrospective chart review of medical records of adult patients who were newly diagnosed (not more than 1 year before initiation of PP1M treatment) with schizophrenia and who had received continuous treatment with PP1M for ≥12 months in naturalistic clinical settings. RESULTS: A total of 84 (93.3%) patients were included in the analysis. All but one patient (98.8%, n=83) had received oral antipsychotic medication at least during the last month before the first PP1M administration. Three patients (3.6%) were newly hospitalized during the 12-month documentation period. The reason for hospitalization for all three was management of episode/relapse. A total of 79.2% of patients had a ≥20% improvement and 47.2% had a ≥50% improvement in Positive and Negative Syndrome Scale total score from baseline to endpoint. Half of patients (53.3%) showed a significant improvement, as reflected by an increase in Personal and Social Performance (PSP) total score of at least 7 points from baseline to endpoint (mean [SD] 11.9 [15.0] points; P<0.001). One quarter of patients (24.4%, n=11) moved from a PSP score of 31-70 (ie, moderate to marked functional impairment) at baseline to a PSP score of mild to no functional impairment (PSP score ≥71) at endpoint. Most adverse drug reactions were mild or moderate in severity. CONCLUSION: Continuous treatment with PP1M over 12 months was associated with statistically significant and clinically meaningful improvements in psychotic symptoms, disease severity, and functional outcomes in patients with schizophrenia.

Depression and serum interleukin-6 levels in patients on dialysis.

BACKGROUND: Depression is a common psychiatric problem in patients undergoing dialysis. Several studies have been performed to validate the association between depression and inflammation in haemodialysis patients. The levels of proinflammatory cytokines are increased in chronic renal failure patients, as in depression. The objective of this study was to compare the incidence of depression in the patients on dialysis (on hemodialysis /HD/ and on continuous ambulatory peritoneal dialysis /CAPD/), and a relationship between depression and the presence of inflammation. SUBJECTS AND METHODS: 88 patients (52 on HD and 36 on CAPD) were enrolled in this study. Depressive symptoms were measured with the Beck Depression Inventory (BDI). The BDI is a 21-item self-report instrument, and the elevated symptoms of depression were defined as a BDI score ≥16. HD patients were treated with high-flux polysulphone biocompatible dialyzers and CAPD patients were treated with usual dwell time (4-6 hours during the day and 8-10 hours at night). The presence of an inflammatory state was assesded by determinations of plasma interleukin-6 (IL-6) levels. RESULTS: Depression (BDI ≥16) was present in 28.4% of dialysis patients, 35% of patients on hemodialysis (HD) and 18.1% of patients on continous ambulatory peritoneal dialysis (CAPD). The BDI score was significantly lower in CAPD patients comparing to HD patients, as well as the levels of albumin, C-reactive protein (CRP) and interleukin-6 (IL-6). IL-6 serum levels were similar in patients with depression and patients without depression in the whole group, as in HD patients. In CAPD patients without depression IL-6 levels were significantly lower. CONCLUSIONS: The prevalence of depression was higher in HD comparing to CAPD patients. Although IL-6 level was higher in HD compared to CAPD patients, the relationship between depression and presence of inflammation parametars were observed in CAPD, but not in HD patients.

Metabolic syndrome and inflammation markers in patients with schizophrenia and recurrent depressive disorder.

BACKGROUND: The high prevalence of metabolic syndrome in patients with psychiatric disorders, almost double the prevalence reported for the general population, is worrying. The aim of this study is to investigate the presence of metabolic syndrome and inflammatory marker levels in patients with schizophrenia and recurrent depressive disorder in a Croatian psychiatric sample. SUBJECTS AND METHODS: This study included 62 inpatients with schizophrenia and 62 with recurrent depressive disorder treated at the Department of Psychiatry, University Hospital Centre Split, enrolled from November 2011 until May 2012. The cases were compared to 124 healthy subjects from the general population. RESULTS: The presence of metabolic syndrome was found in 56.5% of the patients with schizophrenia and 53.2% of the patients with depression, which was significantly more prevalent than in the control group (32.3%). The levels of inflammation markers (i.e., C-reactive protein and PAI-1) were significantly higher among patients with metabolic syndrome. CONCLUSIONS: Patients with schizophrenia and recurrent depressive disorder demonstrate a high prevalence of metabolic syndrome that is also related to inflammation processes. In the context of integrative medicine, clinicians and researchers should consider psychiatric patients within a holistic approach.

Prevalence of depressive symptoms among college students and the influence of sport activity.

The present study asses the prevalence of depressive symptoms among college students in Split, Croatia, and positive influence of sport activity on decreasing the depression symptoms. Authors screened all 664 college students of the first year of study. All of them were over the 18 years and the mean age was 19.4 +/- 1.2 years. There were 466 females (70.2%) and 178 (26.8%) males. They answered The Beck Depression Inventory (BDI) and questionnaire about their sport activity (no sport activity, recreational and active in sports). For the purpose of the analysis depressive symptoms were defined as a score of > 11. Chi-square and Mann-Whitney test were used for data analysis. 9.4% of the students had significant depression symptoms (score > 11). No one student had score > 26 (symptoms of major depression). Statistically significant lower score on BDI have students who are active in sports (score median = 3) compared to group of recreational (score median = 4) and in correlation to group who are not active in sports (score median = 5) (Kruskal-Wallis: p < 0.001). In the group of active in sports (N = 254) there are only 5.5% with depressions symptoms, while in the group of non active in sports (N = 60) are 18 depressive (chi2-test: p = 0,005). Females are statistically more depressed than males (chi2-test: p = 0.01). In the female group 49 (10.5%) are depressed, and in the male group are 9 (5%). Compared to gender in separate analysis we did not find correlation of decreasing depression symptoms and sport activity among males (chi2-test: p = 0.47), while in females we find that sport activity has significant effect (chi2-test: p = 0.026). Our results shoved moderate values of depression symptoms among college population in Split, Croatia. More females than males experienced depressive symptoms. While sport activity did not have significant influence on the depression in male population, it has significant influence in reducing the depression symptoms among females.

False-positive methadone urine drug screen in a patient treated with quetiapine.

We present a case of T.M. admitted to University Department of Psychiatry, Split University Hospital Center, in Croatia, because of the acute psychotic reaction (F23.9). The patient's urine tested positive for methadone without a history of methadone ingestion. Urine drug screen was performed with the COBAS Integra Methadone II test kit (kinetic interaction of microparticles in solution /KIMS/ methodology) by Roche. Drugs that have been shown to cross-react with methadone feature a tricyclic structure with a sulfur and nitrogen atom in the middle ring, which is common for both quetiapine and methadone. Therefore, it is plausible that this structural similarity between quetiapine and methadone could underlie the cross-reactivity on methadone drug screen. Besides quetiapine, a number of routinely prescribed medications have been associated with triggering false-positive urine drug screen results. Verification of the test results with a different screening test or additional analytical tests should be performed to avoid adverse consequences for the patients.

Exanthema medicamentosum as a side effect of promazine.

Dermatological side effects of psychopharmacological drugs are fortunately not so often. They are mostly presented in the group of mood stabilizers and antiepileptic drugs, particularly the carbamazepine and lamotrigine, and can be manifested through the Stevens Johnson syndrome, Toxic Epidermal Necrolysis (TEN)/Lyell's syndrome with about 30% lethality. According to the literature the group of phenothiazines is the category of drugs with rare appearances of skin reactions. Promazine, aliphatic phenothiazines antipsychotic, including less frequent side effects in the leaflet states increased skin sensitivity to sun, skin rash-associated with contact dermatitis, allergic reactions, cholestatic icterus. The only reported dermatological side effect of promazine is its metabolites deposition in the cornea. Analyzing the e-data basis we have not found references connecting the Exanthema medicamentosum as a side effect of promazine. A forty-two years old female patient was admitted to the Dermatological Clinic because of suspected exanthema, undoubtedly caused by promazine as a medication for Sy. Borderline.

Blood lactate levels in patients receiving first- or second- generation antipsychotics.

AIM: To compare the blood lactate levels between patients with psychotic disorder receiving first- and those receiving second-generation antipsychotics. METHODS: The study was conducted at the psychiatric inpatient and outpatient clinics of the Split Clinical Hospital from June 6, 2008 to October 10, 2009. Sixty patients with psychotic disorder who were assigned to 6-month treatment were divided in two groups: 30 received haloperidol (first generation antipsychotic) and 30 received olanzapine (second generation antipsychotic). Blood lactate levels, other metabolic parameters, and scores on the extrapyramidal symptom rating scale were assessed. RESULTS: Patients receiving haloperidol had significantly higher blood lactate levels than patients receiving olanzapine (P < 0.001). They also more frequently had parkinsonism, which was significantly correlated with both haloperidol treatment at 1 month (P < 0.001) and 6 months (P = 0.016) and olanzapine treatment at baseline (P = 0.016), 3 months (P = 0.019), and 6 months (P = 0.021). Also, patients receiving haloperidol had significant correlation between blood lactate and dystonia at 1 month (P < 0.001) and 6 months (P = 0.012) and tardive dyskinesia at 1 month (P = 0.032). There was a significant difference between the treatment groups in lactate levels at all points from baseline to month 6 (P < 0.001). CONCLUSION: It is important to be aware of the potential effect of haloperidol treatment on increase in blood lactate levels and occurrence of extrapyramidal side effects. Therefore, alternative antipsychotics should be prescribed with lower risk of adverse side effects.