Analysis of the psychiatric consultations requested for hospitalized COVID-19 patients: One year results from a major pandemic hospital

Öz

Background/Aim: Coronavirus 2019 (COVID-19) has brought unprecedented challenges to the practice of consultation-liaison psychiatry. Moreover, it is probable that the characteristics of psychiatric consultations and administered treatments have varied and will continue to vary significantly over time. Given the relative lack of prior research concerning this issue, this study aimed to provide a multi-dimensional analysis of the psychiatric consultations requested for inpatients diagnosed with COVID-19 and to examine the temporal course of the selected variables throughout the pandemic. Methods: In this retrospective cohort study, the medical records of 232 patients who underwent psychiatric consultation between May 1, 2020 and April 30, 2021 were reviewed in detail. Data were obtained for a series of variables, including reasons for consultation, diagnoses after assessment, medical comorbidities, past psychiatric history, treatment arrangements, and clinical outcomes, after which the data were systematically classified to be included in the multi-dimensional analysis. Results: The mean age of the patients was 66.79 (17.18) years (61.21% were males). The most common reasons for consultation were psychomotor agitation, anxiety, and treatment non-compliance, while adjustment disorder and delirium were the most common diagnoses after psychiatric evaluation. Among the reasons for consultation, the shortest durations from admission to consultation were associated with psychomotor agitation, assessment for drug interaction, and treatment non-compliance while among the diagnoses, the duration was shortest for dementia, mental retardation, bipolar disorder, and psychosis. The most frequently prescribed medications were antipsychotics, antidepressants, and benzodiazepines. The number of consultations and rates of delirium and death showed a significant increase over the course of the study. Delirium and medical comorbidities were found to be the strongest predictors of death as a clinical outcome. Conclusion: Knowledge and experience in the field of consultation-liaison psychiatry might contribute to the accurate diagnosis of COVID-19-related neuropsychiatric syndromes in addition to implementation of appropriate treatment interventions.

Anahtar Kelimeler

• COVID-19
• Consultation-liaison psychiatry
• Neuropsychiatry
• Psychopharmacology
• Delirium
• Adjustment disorder

Kaynakça

1. 1. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020 Mar 31;368:m1295.
2. 2. Spuntarelli V, Luciani M, Bentivegna E, Marini V, Falangone F, Conforti G, et al. COVID-19: is it just a lung disease? A case-based review. SN Compr Clin Med. 2020;2(9):1401-6.
3. 3. Beach SR, Praschan NC, Hogan C, Dotson S, Merideth F, Kontos N, et al. Delirium in COVID-19: a case series and exploration of potential mechanisms for central nervous system involvement. Gen Hosp Psychiatry. 2020;65:47-53.
4. 4. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep;19(9):767-83.
5. 5. Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry. 2020 Apr 1;63(1):e32.
6. 6. Arbelo N, López-Pelayo H, Sagué M, Madero S, Pinzón-Espinosa J, Gomes-da-Costa S, et al. Psychiatric Clinical Profiles and Pharmacological Interactions in COVID-19 Inpatients Referred to a Consultation Liaison Psychiatry Unit: a Cross-Sectional Study. Psychiatr Q. 2021 Sep;92(3):1021-33.
7. 7. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020 Jul;87:34-9.
8. 8. Jasti M, Nalleballe K, Dandu V, Onteddu S. A review of pathophysiology and neuropsychiatric manifestations of COVID-19. J Neurol. 2021 Jun;268(6):2007-2012.

9. 9. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066.
10. 10. Turan Ş, Poyraz BÇ, Poyraz CA, Demirel ÖF, Aydın ET, Bostan BU, et al. Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations. Asian J Psychiatr. 2021;57:102563.
11. 11. Jin J-M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health. 2020 Apr 29;8:152.
12. 12. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11:1-13.
13. 13. Hamer M, Kivimäki M, Gale CR, Batty GD. Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK. Brain Behav Immun. 2020;87:184-7.
14. 14. Simonetti A, Pais C, Jones M, Cipriani MC, Janiri D, Monti L, et al. Neuropsychiatric symptoms in elderly with dementia during COVID-19 pandemic: definition, treatment, and future directions. Front Psychiatry. 2020 Sep 29;11:579842.
15. 15. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical presentation of COVID19 in dementia patients. J Nutr Health Aging. 2020;24:560-2.
16. 16. Iqbal Y, Al Abdulla MA, Albrahim S, Latoo J, Kumar R, Haddad PM. Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team. BJPsych open. 2020;6(5).
17. 17. Hao F, Tan W, Jiang L, Zhang L, Zhao X, Zou Y, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun. 2020;87:100-6.
18. 18. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry. 2021;8(2):130-40.
19. 19. Horn M, Granon B, Vaiva G, Fovet T, Amad A. Role and importance of consultation-liaison psychiatry during the Covid-19 epidemic. J Psychosom Res. 2020;137:110214.
20. 20. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611-27.
21. 21. Parker C, Shalev D, Hsu I, Shenoy A, Cheung S, Nash S, et al. Depression, Anxiety, and Acute Stress Disorder among Patients Hospitalized with COVID-19: A Prospective Cohort Study. J Acad Consult Liaison Psychiatry. 2021 Mar-Apr;62(2):211-9.
22. 22. Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003;54(3):216-26.
23. 23. Chapman DP, Perry GS, Strine TW. Peer reviewed: the vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2005;2(1).
24. 24. Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, Sánchez-Larsen Á, Layos-Romero A, García-García J, et al. Neurologic manifestations in hospitalized patients with COVID-19: the ALBACOVID registry. Neurology. 2020;95(8):e1060-e70.
25. 25. Wang Y, Zhu L-Y, Ma Y-F, Bo H-X, Deng H-B, Cao J, et al. Association of insomnia disorder with sociodemographic factors and poor mental health in COVID-19 inpatients in China. Sleep Med. 2020;75:282-6.
26. 26. Morin CM, Carrier J. The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Med. 2021 Jan;77:346-7.
27. 27. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020;89:594-600.
28. 28. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis. Ann N Y Acad Sci. 2021 Feb;1486(1):90-111.
29. 29. Varatharaj A, Thomas N, Ellul MA, Davies NW, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry. 2020;7(10):875-82.
30. 30. Parra A, Juanes A, Losada C, Álvarez-Sesmero S, Santana V, Martí I, et al. Psychotic symptoms in COVID-19 patients. A retrospective descriptive study. Psychiatry Res. 2020;291:113254.
31. 31. Noone R, Cabassa JA, Gardner L, Schwartz B, Alpert JE, Gabbay V. Letter to the Editor: New onset psychosis and mania following COVID-19 infection. J Psychiatr Res. 2020;130:177.
32. 32. Brown E, Gray R, Monaco SL, O'Donoghue B, Nelson B, Thompson A, et al. The potential impact of COVID-19 on psychosis: a rapid review of contemporary epidemic and pandemic research. Schizophr Res. 2020 Aug;222:79-87.
33. 33. Courtenay K, Perera B. COVID-19 and people with intellectual disability: impacts of a pandemic. Ir J Psychol Med. 2020;37(3):231-6.
34. 34. Grier E, Lunsky Y, Sullivan WF, Casson I. Health care of adults with intellectual and developmental disabilities in a time of COVID-19. Can Fam Physician. 2021.
35. 35. Vieta E, Pérez V, Arango C. Psychiatry in the aftermath of COVID-19. Revista de psiquiatria y salud mental. 2020;13(2):105.
36. 36. Bishara D, Kalafatis C, Taylor D. Emerging and experimental treatments for COVID-19 and drug interactions with psychotropic agents. Ther Adv Psychopharmacol. 2020 Jun 22;10:2045125320935306.
37. 37. Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med. 2001;161(8):1099-105.
38. 38. Rivière J, van der Mast RC, Vandenberghe J, Van Den Eede F. Efficacy and tolerability of atypical antipsychotics in the treatment of delirium: a systematic review of the literature. Psychosomatics. 2019;60(1):18-26.
39. 39. Baller EB, Hogan CS, Fusunyan MA, Ivkovic A, Luccarelli JW, Madva E, et al. Neurocovid: Pharmacological recommendations for delirium associated with COVID-19. Psychosomatics. 2020;61(6):585-96.
40. 40. Anmella G, Arbelo N, Fico G, Murru A, Llach C, Madero S, et al. COVID-19 inpatients with psychiatric disorders: real-world clinical recommendations from an expert team in consultation-liaison psychiatry. J Affect Disord. 2020;274:1062-7.
41. 41. Luykx JJ, Vinkers CH, Tijdink JK. Psychiatry in times of the coronavirus disease 2019 (COVID-19) pandemic: an imperative for psychiatrists to act now. JAMA psychiatry. 2020;77(11):1097-8.
42. 42. Russ MJ, Sisti D, Wilner PJ. When patients refuse COVID-19 testing, quarantine, and social distancing in inpatient psychiatry: clinical and ethical challenges. J Med Ethics. 2020;46(9):579-80.
43. 43. Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. MedRxiv. 2020.
44. 44. Mukaetova-Ladinska E, Kronenberg G. Psychological and neuropsychiatric implications of COVID-19. Eur Arch Psychiatry Clin Neurosci. 2021 Mar;271(2):235-248.
45. 45. Garcez FB, Aliberti MJ, Poco PC, Hiratsuka M, Takahashi SdF, Coelho VA, et al. Delirium and adverse outcomes in hospitalized patients with COVID‐19. J Am Geriatr Soc. 2020;68(11):2440-6.
46. 46. Diez‐Quevedo C, Iglesias‐González M, Giralt‐López M, Rangil T, Sanagustin D, Moreira M, et al. Mental disorders, psychopharmacological treatments, and mortality in 2150 COVID‐19 Spanish inpatients. Acta Psychiatr Scand. 2021 Jun;143(6):526-34.