THE EFFECT OF THE SARS-COV-2 PANDEMIC ON THE INCIDENCE OF PSYCHIATRIC DISORDERS: AN OVERVIEW.

The SARS-CoV-2 pandemic exerted an unprecedented threat to the population worldwide. This led to a sharp increase in symptoms of depression, anxiety, and PTSD, especially in the early phase of the pandemic. As far as data allowed a comparison with the pre-pandemic era, an increase by odds ratios of up to 3,5 was found. People affected by the virus showed an even greater amount of symptomatology as compared to the general population. Next to psychological stress, direct and indirect effects of the virus on the brain in these persons could be observed. Only on very few occasions, a direct invasion of the virus in the brain could be observed. Yet far more important seems to be the induction of a low-grade inflammation in the brain ("neuroinflammation"). This kind of processes have been observed earlier accompanying many psychiatric and neurologic diseases. In this way, especially cognitive symptoms might persist long after the acute infection has abated.

First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports.

OBJECTIVE: Since the onset of COVID-19 pandemic, many case reports and case series dealt with new-onset psychotic disorders in patients either infected with SARS-CoV-2 or thematically linked to the pandemic, but without an infection. Our aim was to provide a comprehensive collection of these reports to illustrate the nature of these psychoses. METHODS: We conducted a literature search in MEDLINE, Embase, PsycINFO, using search terms regarding first-episode psychotic disorders in the context of corona. RESULTS: 96 case reports or case series covering 146 patients (62 without and 84 with SARS-CoV-2 infection) were found. Compared to patients without infection, patients with infection showed significantly more often visual hallucinations (28.6% vs 8.1%), confusion (36.9% vs 11.3%), an acute onset of illness (88.5% vs 59.6%) and less often depression (13.1% vs 35.5%) and a delusional content related to the pandemic (29.5% vs 78.3%). Both groups had an equally favourable outcome with a duration of psychosis ≤2 weeks in half and full remission in two-thirds of patients. In patients with infection, signs of inflammation were reported in 78.3% and increased CRP in 58.6%. While reports on patients with infection are continuously published, no report about patients without infection was found after July 2020. CONCLUSION: Cases without infection were considered reactive and originated all from the first wave of the corona pandemic. In cases with infection, inflammation was considered as the main pathogenetic factor but was not found in all patients. Diagnosis was impeded by the overlap of psychosis with delirium.

[Neuropsychiatric Aspects of COVID-19 - A Narrative Overview]. / Neuropsychiatrische Aspekte von COVID-19 ­ Eine narrative Übersicht.

The SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus Type 2) and COVID-19 (Coronavirus Disease 2019) can affect numerous organ systems. In the present paper we offer an overview of the current state of knowledge about the psychiatric aspects of SARS-CoV-2 infection.Medline, Embase und LIVIVO were searched for relevant literature, the last query dating from March 2nd, 2021. Different stress factors in the context of the pandemic can lead to manifest mental illnesses. In addition, there is a risk of neuropsychological changes due to the biological effects of the virus itself.Our work describes the psychological symptoms of COVID-19 sufferers themselves and the psychological effects of the epidemic and the associated socio-economic and psychosocial stress factors on those who are not sick.The most common psychiatric complication among people with COVID-19 is delirium, while hospitalized patients seem to have an increased incidence of symptoms of anxiety, depression and PTSD. There are many case reports on psychotic disorders. In general, an existing psychiatric illness (especially dementia and psychotic disorders) also increases the risk of infection and of a more severe course of the disease. After recovery from COVID-19 infection, there is also a higher incidence of mental illnesses, in particular "Chronic Post-SARS Syndrome" with its manifestations such as fatigue, anxiety, depression and PTSD. In addition, the course of dementia seems to be negatively influenced by an infection with SARS-CoV-2.The second part deals with the effects of the epidemic as a stressor and the established socio-political measures on the mental health of people with and without previous mental illnesses. The literature currently available shows high symptom values for anxiety and depressive disorders as well as post-traumatic stress disorders, stress, suicidality, sleep disorders etc. Risk factors seem to include female gender, younger age and fewer resources, as well as previous psychiatric or physical illnesses. Extrinsic factors such as high infection rates, large numbers of deaths, long curfews/lockdowns, low trust in the government and ineffective measures against economic and social consequences increase the burden.

Risk of PTSD Due to the COVID-19 Pandemic Among Patients in Opioid Substitution Treatment.

Background: The impact of the COVID-19 pandemic on the mental health of patients suffering from addictive disorders is of major concern. This study aimed to explore the presence and potential increase in post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety since the beginning of the pandemic for patients in opioid substitution therapy (OST). Methods: This cross-sectional survey study evaluated a clinical sample of patients in OST (N = 123). Symptoms of post-traumatic stress disorder (PTSD) due to the COVID-19 pandemic were assessed by an adapted version of the impact of event scale (IES-R), resulting in two subgroups of low and high risk for PTSD. The depression, anxiety, and stress scale (DASS-21) was applied to collect data on the respective symptoms, and changes since the onset of the pandemic were reported on separate scales. Sociodemographic and COVID-19 related factors, as well as data on craving, consumption patterns, concomitant use, and the drug market were further assessed. Results: A binary logistic regression analysis confirmed the impact of self-perceived higher burden by psychological and economic factors on the elevated risk for PTSD due to the pandemic. The high-risk PTSD group also showed higher levels of depression, anxiety and stress, as well as a more pronounced deterioration in these symptoms since the pandemic. While reported levels of craving did not differ between the two groups, the high-risk PTSD group indicated a significantly higher increase in craving since the crisis, when compared to the low-risk group. Discussion: Our findings demonstrate elevated levels of clinical symptoms among patients in OST, with more than a quarter of patients found at risk for PTSD due to the COVID-19 pandemic. Furthermore, about 30-50% of our patients reported concerning levels of depression, anxiety, or stress. Special attention should be drawn to these findings, and potential deterioration of the situation should be addressed by health care facilities. Particularly, psychological, and financial burden due to the crisis were identified as factors increasing the risk for PTSD. These factors can easily be evaluated during routine anamneses, and might be a valuable source of information, when special attention is needed.

Self-Reported and Parental Assessments of Internet Gaming Disorder, and Their Accordance with DSM-5 Criteria in a Clinical Relevant Population.

Internet gaming disorder (IGD) is of growing importance as a research field and in clinical settings, as documented by the inclusion of the diagnosis in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the preliminary International Classification of Diseases. Studies using screening tools to assess IGD and comparison with expert evaluations in clinical relevant populations are rare. Furthermore, concerned parents are often the first source of information in clinical practice, and their assessment of addictive behavior often differs widely from their child's self-evaluation. In two studies (N = 95) we investigated the usefulness of the Internet Addiction Test (IAT) and the Compulsive Internet Use Scale (CIUS) with adolescents at risk of IGD, either in parental company (Study 1) or alone (Study 2). Self-reported assessments on the scales were compared with parental ratings (only Study 1) and an expert face-to-face evaluation according to DSM-5 (both studies). We found higher correlations between expert evaluations of IGD criteria and screening scores for self-reported compared with parental ratings. Quality of categorization into persons with and without IGD confirmed that parental assessments were not conclusive in this setting. In this context, different cutoff values, sensitivity, and specificity for the screening instruments are discussed. We conclude that IAT and CIUS provide tentative usefulness for self-evaluation of adolescents at risk of IGD, and suggestions for using different cutoff scores for varying purposes are provided. In our study, parental assessments on the screening tools lead to an overestimation of IGD and are, therefore, not recommended as a sole source of information in clinical settings.

Developments in Drug Addiction During COVID-19-An Austrian Perspective Based on a Clinical Sample.

Concerns about the negative consequences of the COVID-19 pandemic on people with substance use disorder (SUD) were raised by experts in the field around the world. Here we provide an Austrian perspective, discussing the impact of the pandemic on help-seeking patient with drug use disorder during the initial stage of the pandemic. Our perspectives are based on the situation as perceived at our clinical facility, and supported by original data collected from a small clinical sample of patients with drug use disorder (N = 32). The viewpoints and related descriptive data include the perceived individual impact of COVID-19, as well as various aspects of drug use behavior and the Austrian drug market before and after the onset of the pandemic. The consequences for a subgroup of patients in opioid substitution treatment (N = 24) are discussed. Surprisingly and in contrast to anticipated developments, we had the impression of a rather stable situation in Austria, at least at this early stage of the pandemic. The immediate impact of COVID-19 on these help-seeking patients with high levels of drug dependency seemed less severe than anticipated so far. Importantly, this observation might be a short-term effect for this already fragile group and careful monitoring of further developments as well as preparation of long-term strategies are advised. In general, problematic drug use is associated with many health risk factors and finding appropriate long-term health care strategies has to remain a top priority facing the pandemic. Our perspectives are restricted to observations from help-seeking patients at our clinic, and no conclusions for the general population can be directly drawn.

Nalmefene in the Treatment of Internet Pornography Addiction - A Case Report and Review of Literature.

: The mu-opioid antagonist nalmefene (18 mg per day) was administered in the treatment of a heterosexual male with internet pornography addiction. The patient had no other co-addictions or psychiatric comorbidities, allowing a direct measurement for the effectiveness of nalmefene on internet pornography addiction. Over a period of 72 weeks and an assessment frequency between 1 and 18 weeks, self-monitoring assessments of craving and pornography consumption were collected on different craving and obsessive-compulsive scales. Results indicate that nalmefene impressively decreased addictive symptoms. Importantly, the patient-induced discontinuation of nalmefene led to an immediate increase of craving scores and addictive behavior, which dropped again after restarting the medication. The patient has been in complete remission of symptoms for over a year under our supervision, and for further 2 years after that according to his account. Therefore, nalmefene seems to be a useful adjunction for patients with internet pornography addiction.

Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse.

Background: The impact of the ongoing COVID-19 pandemic on vulnerable groups like patients suffering from substance use disorders is expected to be tremendous, and corresponding concerns were raised early on by many experts around the world. Psychosocial distress, financial insecurities and physiological problems associated with the COVID-19 crisis could be especially challenging for this group of patients. Methods: In the current study data was collected from a clinical sample of patients with alcohol use disorder (AUD; N = 127) during the initial stage of the pandemic. The impact of various COVID-19 related factors (physiological, psychosocial, economic and others) on patients' personal life was evaluated. Alcohol consumption, craving, and potential posttraumatic stress disorder (PTSD) symptoms were assessed using different scales and their associations were analyzed. Furthermore, differences regarding these variables between comparably sized groups of patients who remained abstinent (N = 37), relapsed (N = 41), or reported unaltered drinking behavior (consuming subgroup, N = 49) were investigated. The impact of sociodemographic and COVID-19 factors on relapse (in comparison to abstinence) was evaluated using binary logistic regression analysis. Results: Our results confirmed the expected positive associations between alcohol consumption, craving, and PTSD symptoms, respectively, among patients with AUD. Furthermore, group differences indicate significantly lower levels on all three scales for abstinent patients. Although generally low PTSD scores were observed, 8% of our participants were found to be at risk of PTSD. Results of a binary logistic regression analysis indicated the presence of psychosocial COVID-19 factors (e.g., isolation, anxiety, and depression) as well as living alone as two major risk factors for relapse. Discussion: Our findings based on actual patient data support the anticipated negative consequences of the pandemic on persons with AUD. Crucially, our results regarding relapse emphasized psychosocial COVID-19 factors and isolation as especially challenging circumstances for persons with AUD, whereas economic and physiological health aspects seemed of minor impact on relapse. Our results reflect the initial stage of the pandemic, whereas long-term developments should be closely monitored.

Neurobiological processes during the Cambridge gambling task.

Although vast research has been conducted concerning gambling behavior this is the first study combining behavioral and functional magnetic resonance imaging (fMRI) data while using the Cambridge Gambling Task (CGT). We tested 20 healthy right-handed men and chose an event-related design to allow for precise temporal separation of gambling stages. In the color decision stage participants had to guess whether a yellow token was hidden behind red or blue boxes presented in varying color ratios, then stake wagers during the bet decision stage. In the final stage the outcome (won or lost) was presented. Analyzing the blood-oxygenation level-dependent (BOLD) contrasts in the decision stages we found increases of activation in brain areas involved in decision making, working memory and learning, when participants bet on the majority choice. During the outcome stage increased brain activation was found in parts of the reward system and areas involved in decision making and impulse control, when winning. When losing, activation increased in areas involved in risk aversion and management of uncertainties. When participants lost unexpectedly (i.e. lost although they bet on the majority), increased activation was found in the insula, compared to winning expectedly. The more unexpectedly participants won the higher the increase of brain activation in parts of the reward system and areas involved in executive functions. Our study gives an extensive overview of brain areas involved in different stages of gambling and during various outcomes, with corresponding behavioral data (e.g. speed and quality of decision making) illustrating underlying tendencies.

Addictive Potential of Online-Gambling. A Prevalence Study from Austria.

There are hints, that online-gambling has a higher addictive potential than offline-gambling. In this study prevalence and sociodemographic distribution of online- vs. offline-gambling in Austria are gathered and possible relations discussed. Problematic gambling-behavior was assessed via Lie-and-Bet questionnaire from Johnson. The results indicate a tendency of younger gamblers and particularly problematic gamblers towards online-gambling. Considering the substantial addictive potential of online-gambling and hints of a future trend away from offline- towards online-gambling, preventive measures like public restrictions for online providers and awareness campaigns for consumers about the dangers of online-gambling offers are reasonable.

pro mente Oberösterreich - inclusion instead of exclusion.

pro mente OÖ is one of the biggest organisations offering psycho-social care and treatment. It is a crucial part of the differentiated system of social psychiatric services in Austria. First, the article describes the organization pro mente OÖ, its history and services. Then, a selection of framework conditions of social psychiatric supply is presented. In this respect some existing strengths and weaknesses of the Austrian psycho-social supply system are discussed.

Treatment Duration With Long-Acting Injectable Antipsychotics After In-hospital Initiation: A Retrospective Cohort Study.

PURPOSE: Long-acting injectable (LAI) antipsychotics are recommended especially for patients with multiple admissions and poor adherence. The empirical basis of this strategy is a matter of debate. METHODS: In a retrospective cohort study extending over 6 years, all patients admitted for inpatient treatment with a diagnosis of psychotic disorders according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision (F2) were screened for treatment episodes with a new start of an LAI. Indication for LAI treatment was based primarily on previous medication default. All-cause discontinuation was used as a measure of treatment efficiency. Patients with early dropout (termination of LAI treatment within 6 months) were compared with patients with longer treatment (treatment >6 months) for sociodemographic and treatment variables using bivariate and multivariate analyses. RESULTS: A total of 194 treatment episodes with new start of LAIs were identified. Almost one half dropped out within 6 months (early dropout: n = 95 [49%]; mean duration, 2.2 months). Termination of treatment was mainly due to patients' refusal to continue. However, almost a third of patients (61; 31.4%) had a treatment duration of more than 2 years. In a multivariate Cox regression model, longer treatment duration was associated with older age (P = 0.05), not being single (P = 0.04), fewer admissions during the year preceding the index episode (P = 0.02), and better ratings for adherence at the index episode (P = 0.03). CONCLUSIONS: There are both more patients than expected leaving the treatment early and more patients than expected staying for long periods, even among patients with a history of poor adherence.

[Online-gambling - new hazard potential?]. / Glucksspiele Im Internet - Neues Gefahrenpotential?

Since the new American psychiatric classification, DSM V, was released, bringing together substance-related disorders and gambling disorder into one chapter, the addictive potential of gambling and sports wagering is beyond all question. Even the neurobiological processes of the brain show similarities in all addictive disorders. Gambling is more and more shifted into the cyberspace owing to the global expansion of the internet. The addictive potential of online-gambling seems to be higher than offline, though, which is also reflected by the patient population of the outpatient clinic for gambling addiction in Linz. This fact poses a challenge for the persons affected, therapists, gambling providers, legislator the society as a whole.

[Incidence and risk factors for mental abnormalities in children of psychiatric inpatients]. / Häufigkeit und Risikofaktoren für psychische Auffälligkeiten bei Kindern psychiatrischer Patienten.

Children of mentally ill parents are exposed to a variety of stress- and harmful life events. To which extent the mental illness of one or both parents affects their children's mental development is barely studied. Therefore, over a period of 6 months 142 patients with children below the age of 18 (n=237 children), who were admitted to the Dept. for Psychiatry and Psychotherapy 1 of the Paracelsus Medical University Salzburg, were questioned for abnormalities in their children's mental development. Additionally all these patients were assessed for their family situation, demographic data and psychiatric disorder. 38.4% (n=91) of the children showed mental abnormalities. The most common one were emotional (n=41), social (n=41) and learning (n=34) disabilities. Parental duration of the illness (p=0.001), age of the children (p=0.044), illness of both parents (p=0.008), longlasting family conflicts (p=0.003) and living with only one parent (p=0.012) were correlated significantly with mental abnormalities in children. The results confirm an increase risk for mental abnormalities in children of psychiatric patients. This risk varies with existing risk and protective factors, which can be partially influenced. Therefore children of mentally ill parents with problems in their mental development should be detected early. Even if genetic risk factors cannot be changed reducing known psychosocial risk factors and promotion protective factors can significantly influence a healthy development of these vulnerable children.

A closer look at self-reported suicide attempts: false positives and false negatives.

The validity of self-reported suicide attempt information is undermined by false positives (e.g., incidences without intent to die), or by unreported suicide attempts, referred to as false negatives. In a sample of 1,385 Austrian adults, we explored the occurrence of false positives and false negatives with detailed, probing questions. Removing false positives decreased the rate of suicide attempters from 4.3% to 2.7%. Probing questions also revealed 0.8% false negatives. We recommend using probing questions with both those who report a suicide attempt and those who do not report a suicide attempt to increase the validity of self-reported suicide-related information.