Emergency psychiatric services needed to address mental health fallout of COVID-19 era

Emergency psychiatric services and clinical and diagnostic COVID-19 screening of psychiatric emergency patients are needed during the ongoing pandemic, according to study results published in Journal of Psychiatric Research.

“Much has been discussed about the profound stress and the potential for mental health disorders generated by COVID-19 illness and its societal and economic consequences,” Stephen J. Ferrando, MD, of the department of psychiatry at Westchester Medical Center Health System in New York, and colleagues wrote. “Surprisingly little clinical data are available.”

In the current study, the researchers aimed to characterize patients who presented for psychiatric emergencies during the COVID-19 pandemic, as well as to describe stressors related to COVID-19. They compared sociodemographic characteristics, psychiatric diagnoses, symptoms and disposition of patients evaluated for psychiatric emergency during the height of the COVID-19 pandemic, between March 1 and April 30, with those seen immediately prior to this period, between January 1 and February 28. Further, they compared the same outcomes of patients who tested positive for COVID-19 with those who tested negative. They rated prevalence and nature of stressors related to COVID-19 that affected the emergency presentation.

Results showed depression and suicidal ideation were the most common psychiatric diagnoses and presenting symptoms during both periods. The researchers noted a significant decline in emergency psychiatric volume among children and adolescents, but not adults, when comparing the two periods. Children and adolescents during the COVID-19 period had more new onset disorders and were at increased risk for admission to inpatient care; however, they were less likely to have presentations for suicide attempts, impulse control disorders and agitation/aggression. Moreover, adults were more likely to have no outpatient care access, present with anxiety disorders and were at increased risk for admission to inpatient care. A total of 25% of patients had a psychiatric emergency directly affected by COVID-19. The more severe stressors were linked to fear of COVID infections and actual COVID infection in self or family members. Patients with COVID-19 infection were more likely to have psychosis, including new-onset; however, they were less likely to be depressed or suicidal vs. their counterparts who did not have COVID-19.

“Enhanced mental health services will be critically important to address the mental health consequences of this ongoing pandemic and prevent an upsurge in psychiatric emergencies,” Ferrando and colleagues wrote. “Specific psychotherapeutic interventions, including online therapies, should be developed to target pandemic-related stresses, such as the acute and chronic consequences of COVID-19 infection itself, fear of infection, isolation and grief. Finally, rapid COVID-19 testing should be available to all patients presenting to psychiatric emergencies and specialized inpatient protocols and programs must be established to safely care for psychiatric patients with COVID-19 infection.”