The psychopathological impact of the SARS-CoV-2 epidemic on subjects suffering from different mental disorders: An observational retrospective study

Alice Caldiroli, Enrico Capuzzi, Agnese Tringali, Ilaria Tagliabue, Marco Turco, Andrea Fortunato, Matteo Sibilla, Caterina Montana, Laura Maggioni, Cristian Pellicioli, Matteo Marcatili, Roberto Nava, Giovanna Crespi, Fabrizia Colmegna, Massimiliano Buoli, Massimo Clerici, Alice Caldiroli, Enrico Capuzzi, Agnese Tringali, Ilaria Tagliabue, Marco Turco, Andrea Fortunato, Matteo Sibilla, Caterina Montana, Laura Maggioni, Cristian Pellicioli, Matteo Marcatili, Roberto Nava, Giovanna Crespi, Fabrizia Colmegna, Massimiliano Buoli, Massimo Clerici

Abstract

SARS-CoV-2 infection causes a pulmonary disease (COVID-19) which spread worldwide generating fear, anxiety, depression in the general population as well as among subjects affected by mental disorders. Little is known about which different psychopathological changes the pandemic caused among individuals affected by different psychiatric disorders, which represents the aim of the present study. Specific psychometric scales were administered at three time points: T0 as outbreak of pandemic, T1 as lockdown period, T2 as reopening. Descriptive analyses and linear regression models were performed. A total of 166 outpatients were included. Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2. Only psychopathology in schizophrenia (SKZ) patients and obsessive-compulsive (OC) symptoms did not significantly improve at T2. Subjects affected by personality disorders (PDs) resulted to be more compromised in terms of general psychopathology than depressed and anxiety/OC ones, and showed more severe anxiety symptoms than SKZ patients. In conclusion, subjects affected by PDs require specific clinical attention during COVID-19 pandemic. Moreover, the worsening of SKZ and OC symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures. Further studies on larger samples are needed to confirm our results. ClinicalTrials.gov Identifier: NCT04694482.

Keywords: COVID-19; Obsessive-compulsive symptoms; Outpatients; Pandemic; Personality disorders; Psychotic symptoms.

Conflict of interest statement

None.

Copyright © 2021 Elsevier B.V. All rights reserved.

Figures

Fig. 2
Fig. 2
Changes in CGI severity and improvement scores between groups over time Legend: BD = Bipolar Disorder; CGI = Clinical Global Impression; MDD = Major Depressive Disorder; OCD = Obsessive-Compulsive Disorder; PD = Personality Disorder; SKZ = Schizophrenia. T0: outbreak of pandemic (January-February 2020) T1: lockdown period (March-April 2020) T2: reopening (May-June 2020) * = statistically significant differences.
Fig. 3
Fig. 3
Changes in HAM-A scores between groups over time Legend: BD = Bipolar Disorder; HAM-A = Hamilton Rating Scale for Anxiety; MDD = Major Depressive Disorder; OCD = Obsessive-Compulsive Disorder; PD = Personality Disorder; SKZ = Schizophrenia. T0: outbreak of pandemic (January-February 2020) T1: lockdown period (March-April 2020) T2: reopening (May-June 2020) * and ** = statistically significant differences.
Fig. 1
Fig. 1
Statistically significant changes in BPRS scores between groups over time Legend: BD = Bipolar Disorder; BPRS = Brief Psychiatric Rating Scale; MDD = Major Depressive Disorder; OCD = Obsessive-Compulsive Disorder; PD = Personality Disorder; SKZ = Schizophrenia. T0: outbreak of pandemic (January-February 2020) T1: lockdown period (March-April 2020) T2: reopening (May-June 2020) * and ** = statistically significant differences.

References

    1. American Psychiatric Association . American Psychiatric Publishing; Washington, DC: 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5®.
    1. Barlati S., Nibbio G., Vita A. Schizophrenia during the COVID-19 pandemic. Curr. Opin. Psychiatry. 2021;34:203–210. doi: 10.1097/YCO.0000000000000702.
    1. Benatti B., Albert U., Maina G., Fiorillo A., Celebre L., Girone N., Fineberg N., Bramante S., Rigardetto S., Dell'Osso B. What happened to patients with obsessive compulsive disorder during the COVID-19 pandemic? A multicentre report from tertiary clinics in northern Italy. Front. Psychiatry. 2020;11:720. doi: 10.3389/fpsyt.2020.00720.
    1. Bozzatello P., Bellino S., Bosia M., Rocca P. Early detection and outcome in borderline personality disorder. Front. Psychiatry. 2019;10:710. doi: 10.3389/fpsyt.2019.00710.
    1. Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–920. doi: 10.1016/S0140-6736(20)30460-8.
    1. Buoli M., Cesana B.M., Fagiolini A., Albert U., Maina G., de Bartolomeis A., et al. Which factors delay treatment in bipolar disorder? A nationwide study focused on duration of untreated illness. Early Interv. Psychiatry. 2021;15:1136–1145. doi: 10.1111/eip.13051.
    1. Caldiroli A., Capuzzi E., Riva I., Russo S., Clerici M., Roustayan C., Abbass A., Buoli M. Efficacy of intensive short-term dynamic psychotherapy in mood disorders: a critical review. J. Affect. Disord. 2020;273:375–379. doi: 10.1016/j.jad.2020.04.002.
    1. Caldiroli A., Serati M., Orsenigo G., Caletti E., Buoli M. Age at onset and social cognitive impairment in clinically stabilized patients with schizophrenia: an ecological cross-sectional study. Iran. J. Psychiatry. 2018;13:84–93.
    1. 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 doi: 10.1016/j.psychres.2020.113463.
    1. Centorrino F., Cincotta S.L., Talamo A., Fogarty K.V., Guzzetta F., Saadeh M.G., Salvatore P., Baldessarini R.J. Hospital use of antipsychotic drugs: polytherapy. Compr. Psychiatry. 2008;49:65–69. doi: 10.1016/j.comppsych.2007.08.002.
    1. Clerici M., Durbano F., Spinogatti F., Vita A., de Girolamo G., Micciolo R. Psychiatric hospitalization rates in Italy before and during COVID-19: did they change? An analysis of register data. Ir. J. Psychol. Med. 2020;37:283–290. doi: 10.1017/ipm.2020.29.
    1. Consiglio dei Ministri, 2020. Delibera del consiglio dei ministri 31 gennaio 2020. Dichiarazione dello stato di emergenza in conseguenza del rischio sanitario connesso all'insorgenza di patologie derivanti da agenti virali trasmissibili. (20A00737) (GU Serie Generale n.26 del 01-02-2020). .
    1. Daly M., Robinson E. Anxiety reported by US adults in 2019 and during the 2020 COVID-19 pandemic: population-based evidence from two nationally representative samples. J. Affect. Disord. 2021;286:296–300. doi: 10.1016/j.jad.2021.02.054.
    1. de Girolamo G., Cerveri G., Clerici M., Monzani E., Spinogatti F., Starace F., Tura G., Vita A. Mental health in the coronavirus disease 2019 emergency-the Italian response. JAMA Psychiatry. 2020;77:974–976. doi: 10.1001/jamapsychiatry.2020.1276.
    1. Forte G., Favieri F., Tambelli R., Casagrande M. COVID-19 pandemic in the italian population: validation of a post-traumatic stress disorder questionnaire and prevalence of PTSD symptomatology. Int. J. Environ. Res. Public Health. 2020;17:4151. doi: 10.3390/ijerph17114151.
    1. Gentile A., Torales J., O'Higgins M., Figueredo P., Castaldelli-Maia J.M., De Berardis D., Petito A., Bellomo A., Ventriglio A. Phone-based outpatients' follow-up in mental health centers during the COVID-19 quarantine. Int. J. Soc. Psychiatry. 2020 doi: 10.1177/0020764020979732.
    1. Goodman W., Price L., Rasmussen S.A., Mazure C., Fleischmann R.L., Hill C.L., Heninger G.R., Charneyet D.S. The yale-brown obsessive compulsive scale (Y-BOCS): part I. Development, use and reliability. Arch. Gen. Psychiatry. 1989;46:1006–1011. doi: 10.1001/archpsyc.1989.01810110048007.
    1. Goodman W., Price L., Rasmussen S.A., Mazure C., Delgado P., Heninger G.R., Charney D.S. The yale-brown obsessive compulsive scale (Y-BOCS): part II. Validity Arch. Gen. Psychiatry. 1989;46:1012–1016. doi: 10.1001/archpsyc.1989.01810110054008.
    1. Green M.F., Harvey P.D. Cognition in schizophrenia: past, present, and future. Schizophr. Res. Cognit. 2014;1:e1–e9. doi: 10.1016/j.scog.2014.02.001.
    1. Gualano M.R., Lo Moro G., Voglino G., Bert F., Siliquini R. Effects of Covid-19 lockdown on mental health and sleep disturbances in Italy. Int. J. Environ. Res. Public Health. 2020;17:4779. doi: 10.3390/ijerph17134779.
    1. Gueorguieva R., Krystal J.H. Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry. Arch. Gen. Psychiatry. 2004;61:310–317. doi: 10.1001/archpsyc.61.3.310.
    1. Guy W. National Institute of Mental Health; Rockville, MD: 1976. Early Clinical Drug Evaluation Unit (ECDEU) Assessment Manual For Psychopharmacology. Revised, 1976. DHEW Publication No. (ADM) 76-338.
    1. Hamada K., Fan X. The impact of COVID-19 on individuals living with serious mental illness. Schizophr. Res. 2020;222:3–5.
    1. Hamilton M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry. 1960;23:56–62. doi: 10.1136/jnnp.23.1.56.
    1. Hamilton M. The assessment of anxiety states by rating. Br. J. Med. Psychol. 1959;32:50–55. doi: 10.1111/j.2044-8341.1959.tb00467.x.
    1. Hao F., Tan W., Jiang L., Zhang L., Zhao X., Zou Y., Hu Y., Luo X., Jiang X., McIntyre R.S., Tran B., Sun J., Zhang Z., Ho R., Ho C., Tam W. 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;87:100–106. doi: 10.1016/j.bbi.2020.04.069.
    1. Kay S.R., Fiszbein A., Opler L.A. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 1987;13:261–276. doi: 10.1093/schbul/13.2.261.
    1. Kozloff N., Mulsant B.H., Stergiopoulos V., Voineskos A.N. The COVID-19 global pandemic: implications for people with schizophrenia and related disorders. Schizophr. Bull. 2020;46:752–757.
    1. Littman R., Naftalovich H., Huppert J.D., Kalanthroff E. Impact of COVID-19 on obsessive-compulsive disorder patients. Psychiatry Clin. Neurosci. 2020;74:660–661. doi: 10.1111/pcn.13152.
    1. Montgomery S.A., Asberg M. A new depression scale designed to be sensitive to change. Br. J. Psychiatry. 1979;134:382–389. doi: 10.1192/bjp.134.4.382.
    1. Moreno C., Wykes T., Galderisi S., Nordentoft M., Crossley N., Jones N., Cannon M., Correll C.U., Byrne L., Carr S., Chen E.Y.H., Gorwood P., Johnson S., Kärkkäinen H., Krystal J.H., Lee J., Lieberman J., López-Jaramillo C., Männikkö M., Phillips M.R., 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;7:813–824. doi: 10.1016/S2215-0366(20)30307-2.
    1. Overall J.E., Gorham D.R. The brief psychiatric rating scale. Psycol. Rep. 1962;10:799–812. doi: 10.2466/pr0.1962.10.3.799.
    1. Pinkham A.E., Ackerman R.A., Depp C.A., Harvey P.D., Moore R.C. A longitudinal investigation of the effects of the COVID-19 pandemic on the mental health of individuals with pre-existing severe mental illnesses. Psychiatry Res. 2020;294 doi: 10.1016/j.psychres.2020.113493.
    1. Prestia D., Pozza A., Olcese M., Escelsior A., Dettore D., Amore M. The impact of the COVID-19 pandemic on patients with OCD: effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study. Psychiatry Res. 2020;291 doi: 10.1016/j.psychres.2020.113213.
    1. Preti E., Di Pierro R., Fanti E., Madeddu F., Calati R. Personality disorders in time of pandemic. Curr. Psychiatry Rep. 2020;22:80. doi: 10.1007/s11920-020-01204-w.
    1. Quittkat H.L., Düsing R., Holtmann F.J., Buhlmann U., Svaldi J., Vocks S. Perceived impact of Covid-19 across different mental disorders: a study on disorder-specific symptoms, psychosocial stress and behavior. Front. Psychol. 2020;11 doi: 10.3389/fpsyg.2020.586246.
    1. Sheehan D.V., Harnett-Sheehan K., Raj B.A. The measurement of disability. Int. Clin. Psychopharm. 1996;11:89–95. doi: 10.1097/00004850-199606003-00015.
    1. Shepherd A., Sanders C., Doyle M., Shaw J. Personal recovery in personality disorder: systematic review and meta-synthesis of qualitative methods studies. Int. J. Soc. Psychiatry. 2016;62:41–50. doi: 10.1177/0020764015589133.
    1. Torales J., O'Higgins M., Castaldelli-Maia J.M., Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int. J. Soc. Psychiatry. 2020;66:317–320. doi: 10.1177/0020764020915212.
    1. World Health Organization, 2020. WHO director-general's opening remarks at the media briefing on COVID-19, 11 March 2020. (Accessed 03 December 2020).
    1. Young R.C., Biggs J.T., Ziegler V.E., Meyer D.A. A rating scale for mania: reliability, validity and sensitivity. Br. J. Psychiatry. 1978;133:429–435. doi: 10.1192/bjp.133.5.429.
    1. Zhand N., Joober R. Implications of the COVID-19 pandemic for patients with schizophrenia spectrum disorders: narrative review. BJPsych Open. 2021;7:e35. doi: 10.1192/bjo.2020.157.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren