COVID-19 Salgını Öncesi ve Sonrasında Bir Psikiyatri Kliniğinde Yatırılarak Tedavi Edilen Hastaların Tanı ve Tedavi Süreçlerinin Değerlendirilmesi

Öz

Bu çalışmada pandemi öncesi ve pandemi döneminde bir üniversite hastanesinin psikiyatri servisinde yatarak tedavi gören hastaların yatış özellikleri, tanısal dağılımları ve tedavi uygulamalarındaki değişimlerin karşılaştırılması amaçlanmıştır. Retrospektif ve karşılaştırmalı olarak planlanan çalışmada, 11 Mart 2018–10 Mart 2020 tarihleri pandemi öncesi, 11 Mart 2020–2 Mart 2022 tarihleri pandemi dönemi olarak tanımlanmıştır. Bu dönemlerde psikiyatri servisinde yatarak tedavi gören hastalara ait epikriz kayıtları incelenmiş ve toplam 891 yatış değerlendirilmiştir. Bunların 547’si pandemi öncesi, 344’ü pandemi dönemine aittir. Sosyodemografik özellikler, tanı grupları, yatış özellikleri ve tedavi uygulamaları iki dönem arasında karşılaştırılmıştır. Pandemi döneminde toplam yatış sayısı azalmıştır. Sosyodemografik özellikler ve tanı dağılımları açısından iki dönem arasında anlamlı fark saptanmamıştır. Her iki dönemde en sık yatış nedenleri majör depresyon ve bipolar bozukluk olmuştur. Pandemi döneminde acil servis üzerinden yatış oranı, yatış sırasında bildirilen intihar düşüncesi ve ek medikasyon gereksinimi artmıştır. Buna karşın ortalama yatış süresi ve elektrokonvülzif tedavi seans sayısı azalırken depo antipsikotik kullanım oranı artmıştır. Bulgular, pandemi döneminde klinik uygulamalar ve bazı yatış özelliklerinin değiştiğini göstermektedir.

Anahtar Kelimeler

• COVID-19
• elektrokonvülzif tedavi
• psikiyatrik tedavi süreci
• ruhsal hastalıklar
• yataklı tedavi

Destekleyen Kurum

Bu çalışma için finansal destek alınmamıştır.

Etik Beyan

Etik Kurul Onayı: Çalışma için Eskişehir Osmangazi Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan 20.12.2022 tarih ve 38 sayılı karar ile onay alınmıştır. Onam: Çalışma retrospektif dosya taramasına dayandığından bireysel bilgilendirilmiş onam alınmamıştır. Telif Hakkı Devir Formu: Tüm yazarlar tarafından Telif Hakkı Devir Formu imzalanmıştır. Yazar Katkıları: Konsept: F.D., F.K. Tasarım: F.D., F.K. Veri Toplama veya İşleme: F.D. Analiz veya Yorum: F.D., F.K. Literatür Taraması: F.D., F.K. Yazma: F.D., F.K. Çıkar Çatışması Bildirimi: Yazarlar arasında çıkar çatışması yoktur. Finansal Destek: Bu çalışma için finansal destek alınmamıştır. Araştırma ve Yayın Etiği Beyanı: Bu çalışmada araştırma ve yayın etiği ilkelerine uyulmuştur.

Evaluation of Diagnostic and Treatment Processes of Patients Hospitalized in a Psychiatry Clinic Before and After the COVID-19 Outbreak

Öz

This study aimed to compare hospitalization characteristics, diagnostic distributions, and treatment practices among patients hospitalized in a university psychiatry inpatient unit before and during the pandemic. In this retrospective comparative study, March 11, 2018–March 10, 2020 was defined as the pre-pandemic period and March 11, 2020–March 2, 2022 as the pandemic period. Medical records of hospitalized patients were reviewed, and 891 hospitalizations were evaluated, including 547 in the pre-pandemic period and 344 during the pandemic. Sociodemographic characteristics, diagnostic groups, hospitalization features, and treatment practices were compared between the two periods. The total number of hospitalizations decreased during the pandemic. No significant differences were found in sociodemographic characteristics or diagnostic distributions. Major depressive disorder and bipolar disorder were the most common reasons for hospitalization in both periods. During the pandemic, admissions through the emergency department, suicidal ideation at admission, and the need for additional medication increased. In contrast, the mean length of hospitalization and the number of electroconvulsive therapy sessions decreased, while the use of long-acting injectable antipsychotics increased. These findings suggest that clinical practices and some hospitalization characteristics changed during the pandemic.

Anahtar Kelimeler

• COVID-19
• electroconvulsive therapy
• hospitalization
• mental disorders
• psychiatric therapeutic process

Destekleyen Kurum

Financial Support: No financial support was received for this study.

Etik Beyan

Ethics Committee Approval: The study was approved by the Eskişehir Osmangazi University Non-Interventional Clinical Research Ethics Committee (Decision No: 38, Date: 20.12.2022). Informed Consent: As the study was based on a retrospective review of medical records, individual informed consent was not obtained. Copyright Transfer Form: A Copyright Transfer Form was signed by all authors. Author Contributions: Concept: F.D., F.K. Design: F.D., F.K. Data Collection and/or Processing: F.D. Analysis and/or Interpretation: F.D., F.K. Literature Review: F.D., F.K. Writing: F.D., F.K. Conflict of Interest: The authors declare that there is no conflict of interest. Financial Support: No financial support was received for this study. Statement of Research and Publication Ethics: The authors declare that the principles of research and publication ethics were followed in this study.

Kaynakça

1. 1. Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, Ballard C, Christensen H, Cohen Silver R, Everall I, Ford T, John A, Kabir T, King K, Madan I, Michie S, Przybylski AK, Shafran R, Sweeney A, Worthman CM, Yardley L, Cowan K, Cope C, Hotopf M, Bullmore E. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547-60.
2. 2. Murphy L, Markey K, O’Donnell C, Moloney M, Doody O. The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: a scoping review. Arch Psychiatr Nurs 2021;35:375-94.
3. 3. Wu T, Jia X, Shi H, Niu J, Yin X, Xie J, Wang X. Prevalence of mental health problems during the COVID-19 pandemic: a systematic review and meta-analysis. J Affect Disord 2021;281:91-8.
4. 4. Sánchez-Guarnido AJ, Huertas P, Garcia-Solier R, Solano M, Díez B, León M, Herruzo-Cabrera J. Risk factors for relapse in people with severe mental disorders during the COVID-19 pandemic: a multicenter retrospective study. Healthcare (Basel) 2022;10:64.
5. 5. Çelik İnce S. Covid-19 Pandemisi ve Kronik Ruhsal Hastalığı Olan Bireylere Yansımaları. Cumhuriyet Üniv Sağlık Bilim Enst Derg 2020; 5(3): 235-244.
6. 6. Usta Sağlam NG, Beştepe EE, İzci F, Sarıkaya İ, Usta H, Baz F. COVID-19 pandemic and individuals with severe mental illness: a comparative study of community mental health centers’ early experiences in COVID-19 pandemic. Klinik Psikiyatri Dergisi 2022;25:49-56.
7. 7. Ćosić K, Popović S, Šarlija M, Kesedžić I. Impact of human disasters and the COVID-19 pandemic on mental health: potential of digital psychiatry. Psychiatr Danub 2020;32:25-31.
8. 8. Thome J, Coogan AN, Fischer M, Tucha O, Faltraco F. Challenges for mental health services during the 2020 COVID-19 outbreak in Germany. Psychiatry Clin Neurosci 2020;74:407.

9. 9. Correa H, Malloy-Diniz LF, da Silva AG. Why psychiatric treatment must not be neglected during the COVID-19 pandemic. Braz J Psychiatry 2020;42:449.
10. 10. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry 2020;7:e21.
11. 11. Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, Khan M, O’Connor RC, Pirkis J; COVID-19 Suicide Prevention Research Collaboration. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry 2020;7:468-71.
12. 12. Gobbi S, Płomecka MB, Ashraf Z, Radziński P, Neckels R, Lazzeri S, Dedić A, Bakalović A, Hrustić L, Skórko B, Es haghi S, Almazidou K, Rodríguez-Pino L, Alp AB, Jabeen H, Waller V, Shibli D, Behnam MA, Arshad AH, Barańczuk-Turska Z, Haq Z, Qureshi SU, Jawaid A. Worsening of preexisting psychiatric conditions during the COVID-19 pandemic. Front Psychiatry 2020;11:581426.
13. 13. Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr Bull 2020;46:752-7.
14. 14. Li YC, Bai W, Cai H, Wu Y, Zhang L, Ding YH, Yang JJ, Du X, Zeng ZT, Lu CM, Feng KX, Mi WF, Zhang L, Liu HZ, Balbuena L, Cheung T, Su Z, An FR, Xiang YT. Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 2022;12:303.
15. 15. Li H, Chen X, Pan J, Li M, Wang M, Wang W, Wang Y. Impact of the COVID-19 pandemic on utilization of inpatient mental health services in Shanghai, China. Healthcare (Basel) 2022;10:1402.
16. 16. Oflezer C, Atay O, Ipekcioglu D, Kasdogan ZE, Gurbuz ZD, Bahadir H, Oflezer O, Eskil Cicek O. A retrospective study of electroconvulsive therapy during COVID-19. Dusunen Adam J Psychiatr Neurol Sci 2023;36:238-248.
17. 17. Aditya AMA, Waikar S, Rodrigues MAGCS. Impact of COVID-19 on electroconvulsive therapy at a tertiary care hospital in Goa, India: a retrospective study. J Contemp Clin Pract 2025;11:199-206.
18. 18. Glock M, Erdekian A, Rueb M, Uhl F, Husemann R, Stoffers-Winterling J, Lindner S, Tüscher O, Hölzel LP, Lieb K, Adorjan K, Wiegand HF. Utilization of mental health services during the first year of the COVID-19 pandemic: a systematic review and meta-analysis. Eur Psychiatry 2026;69:e10.
19. 19. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, Cannon M, Correll CU, Byrne L, Carr S, Chen EYH, Gorwood P, Johnson S, Kärkkäinen H, Krystal JH, Lee J, Lieberman J, López-Jaramillo C, Männikkö M, Phillips MR, Uchida H, Vieta E, Vita A, Arango C. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020;7:813-24.
20. 20. Percudani M, Corradin M, Moreno M, Indelicato A, Vita A. Mental health services in Lombardy during COVID-19 outbreak. Psychiatry Res 2020;288:112980.
21. 21. Arango C. Lessons learned from the coronavirus health crisis in Madrid, Spain: how COVID-19 has changed our lives in the last 2 weeks. Biol Psychiatry 2020;88:e33-e34.
22. 22. Pinals DA, Hepburn B, Parks J, Stephenson AH. The behavioral health system and its response to COVID-19: a snapshot perspective. Psychiatr Serv 2020;71:1070-4.
23. 23. Goldman ML, Druss BG, Horvitz-Lennon M, Norquist GS, Kroeger Ptakowski K, Brinkley A, Greiner M, Hayes H, Hepburn B, Jorgensen S, Swartz MS, Dixon LB. Mental health policy in the era of COVID-19. Psychiatr Serv 2020;71:1158-62.
24. 24. Vrinssen J, Zielasek J, Gouzoulis-Mayfrank E. Utilization of inpatient mental health care in the Rhineland during the COVID-19 pandemic. Front Public Health 2021;9:593307.
25. 25. White S, Demler TL, Trigoboff E, Keers L, Matecki C. Impact of COVID-19 on the mental health of psychiatric inpatients. Innov Clin Neurosci 2023;20:18-22.
26. 26. Miron AA, Ifteni PI, Teodorescu A, Petric PS. Long-acting injectable antipsychotics (LAIs) prescribing trends during the COVID-19 pandemic in Romania. Healthcare (Basel) 2022;10:1265.
27. 27. Haider B, O'Sullivan AK, Bessonova L, Keane E, Achtyes E, Harvey PD, Kane JM, Saklad SR, Trotter JP, Claxton A, Polak T, McGrory J, Noori W, Sikora Kessler A, Yarlas A, Velligan D. Changes in clinical management of patients with schizophrenia treated with long-acting injectable antipsychotics (LAIs), including telepsychiatry use, during the COVID-19 pandemic. Neuropsychiatr Dis Treat 2023;19:623-634.
28. 28. Kazgan A, Yildiz S, Kurt O, Aslan EA, Batmaz S. Medication and symptom severity in schizophrenia patients in COVID-19 pandemic: A cross-sectional study. Med Science 2021;10:860–868.
29. 29. Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 2020;177:868-872.
30. 30. Tiihonen J, Mittendorfer-Rutz E, Majak M, Mehtälä J, Hoti F, Jedenius E, Enkusson D, Leval A, Sermon J, Tanskanen A, Taipale H. Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry 2017;74:686-93.
31. 31. Gannon JM, Conlogue J, Sherwood R, Nichols J, Ballough JR, Fredrick NM, Chengappa KNR. Long acting injectable antipsychotic medications: Ensuring care continuity during the COVID-19 pandemic restrictions. Schizophr Res 2020;222:532-533.
32. 32. Martinez-Roig M, Arilla-Aguilella JA, Bono-Ariño MC, Rolando-Urbizu R, Arriola-Segura A. ECT: A decision to decrease risks during COVID-19 pandemic. Rev Psiquiatr Salud Ment (Engl Ed) 2022;15:137-9.
33. 33. Surve RM, Sinha P, Baliga SP, M Radhakrishnan , Karan N, Jl A, Arumugham S, Thirthalli J. Electroconvulsive therapy services during COVID-19 pandemic. Asian J Psychiatr 2021;59:102653.
34. 34. Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry Res 2020;289:113096.
35. 35. Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, Law GR. Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug Alcohol Depend 2021;229:109150.
36. 36. Capuzzi E, Di Brita C, Caldiroli A, Colmegna F, Nava R, Buoli M, Clerici M. Psychiatric emergency care during Coronavirus 2019 (COVID-19) pandemic lockdown: results from a Department of Mental Health and Addiction of northern Italy. Psychiatry Res 2020;293:113463.
37. 37. Montalbani B, Bargagna P, Mastrangelo M, Sarubbi S, Imbastaro B, De Luca GP, Anibaldi G, Erbuto D, Pompili M, Comparelli A. The COVID-19 outbreak and subjects with mental disorders who presented to an Italian psychiatric emergency department. J Nerv Ment Dis 2021;209:246-50.
38. 38. Pignon B, Gourevitch R, Tebeka S, Dubertret C, Cardot H, Dauriac-Le Masson V, Trebalag AK, Barruel D, Yon L, Hemery F, Loric M, Rabu C, Pelissolo A, Leboyer M, Schürhoff F, Pham-Scottez A. Dramatic reduction of psychiatric emergency consultations during lockdown linked to COVID-19 in Paris and suburbs. Psychiatry Clin Neurosci 2020;74:557-9.
39. 39. Ambrosetti J, Macheret L, Folliet A, Wullschleger A, Amerio A, Aguglia A, Serafini G, Prada P, Kaiser S, Bondolfi G, Sarasin F, Costanza A. Impact of the COVID-19 pandemic on psychiatric admissions to a large Swiss emergency department: an observational study. Int J Environ Res Public Health 2021;18:1174.
40. 40. Çelikbaş Z, Batmaz S, Akpınar Aslan E, Eser B, Güneysu İ, Savaş AE, Aydın S. How did the COVID-19 pandemic affect outpatient presentations and consultation requests at a university hospital psychiatry clinic in Turkey. J Psychiatr Nurs 2021;12:324-32.
41. 41. Killgore WDS, Cloonan SA, Taylor EC, Fernandez F, Grandner MA, Dailey NS. Suicidal ideation during the COVID-19 pandemic: the role of insomnia. Psychiatry Res 2020;290:113134.
42. 42. Iob E, Steptoe A, Fancourt D. Abuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic. Br J Psychiatry 2020;217:543-6.
43. 43. Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA, Howard ME, Rajaratnam SMW. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049-1057.
44. 44. Kelly BD. Coronavirus disease: challenges for psychiatry. Br J Psychiatry 2020;217:352-353.
45. 45. Courtet P, Olié E, Debien C, Vaiva G. Keep socially (but not physically) connected and carry on: preventing suicide in the age of COVID-19. J Clin Psychiatry 2020;81:20com13370.
46. 46. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912-20.
47. 47. Volavka J, Citrome L. Pathways to aggression in schizophrenia affect results of treatment. Schizophr Bull 2011;37:921-9.
48. 48. Montross LP, Zisook S, Kasckow J. Suicide among patients with schizophrenia: a consideration of risk and protective factors. Ann Clin Psychiatry 2005;17:173-82.
49. 49. Wong AH, Roppolo LP, Chang BP, Yonkers KA, Wilson MP, Powsner S, Rozel JS. Management of agitation during the COVID-19 pandemic. West J Emerg Med 2020;21:795-800.
50. 50. Yun K, Lurie N, Hyde PS. Moving mental health into the disaster-preparedness spotlight. N Engl J Med 2010;363:1193-5. doi:10.1056/NEJMp1008304.
51. 51. Garriga M, Agasi I, Fedida E, Pinzón-Espinosa J, Vazquez M, Pacchiarotti I, Vieta E. The role of mental health home hospitalization care during the COVID-19 pandemic. Acta Psychiatr Scand 2020;141:479-480.