Liaison Psychiatry During the Peak of the Coronavirus Pandemic: A Description of Referrals and Interventions

Introduction: The novel coronavirus SARS-CoV-2 belongs to the coronavirus family, a group of viruses that can cause upper respiratory infections in humans. Among other symptoms, it can present as an asymptomatic infection or as a more severe disease requiring hospitalization. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term repercussions. We describe the characteristics and interventions in those COVID-19 patients referred to our liaison psychiatry service. Materials and Methods: This is a cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of Cruces University Hospital (Basque Country, Spain). Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained for 1 month from March 17 to April 17, 2020. We recruited data regarding clinical and referral characteristics and psychiatric interventions. Results: Of a total of 721 SARS-CoV-2 hospitalizations, 43 (5.6%) patients were referred to our psychiatry liaison service. The median age was 61 years old, and 62.8% were women. The infectious disease department was the most frequent petitioner (37.2%), and the most common reason for referral was patient anxiety (25.6%). A total of 67.4% of patients received psychological counseling and 55.8% received some pharmacological approach, with a median of 3.7 visits/calls per patient. In addition, 20.3% needed a medication switch due to potential interactions between psychotropics and drugs used to treat SARS-CoV-2. Discussion: In our study, up to 5.6% of SARS-CoV-2 hospitalized patients needed a psychiatric evaluation, especially for anxiety and mood symptoms. Psychosocial factors associated with the pandemic, drugs used to treat the infection, or a direct causative effect of the virus may explain our findings.

Gender differences among psychiatric patients attended in a emergency department

Introduction

Mental health disorders are considered a priority in health policies around the world. It is estimated that more than 900 million people worldwide have a mental disorder, in which stress-related disorders account for a high number of emergency department visits. The scientific literature has pointed out the importance of considering how gender and sex differences influence the clinical outcomes of people with mental illness, playing an important role in the clinical management of these patients.

Objectives

The aim of this report is to investigate the presence of gender differences in the care of psychiatric patients attending the emergency department (ED), taking into account the clinical characteristics, reasons for consultation and practices.

Methods

The study considered all episodes of patients who visited the ED during 2017 and who were assessed by the psychiatric department. Statistical analyses were performed using IBM SPSS Statistic software.

Results

During the 12 months period, a total of 3180 episodes were evaluated by the psychiatric department in the ED. Of them, 1723 were female (54,2%) and 1457 male. Regarding clinical data, there were found statistically significant differences with respect to the pharmacological prescription in the ED, specifically in the prescription of benzodiazepines, psychiatric diagnoses after discharge and the indication of hospital admission between women and men.

Conclusions

This study emphasizes the importance of considering the existence of gender differences in both the clinical presentation as well as in the care of psychiatric patients attending the ED. The analysis of these variables would help to improve the health care of psychiatric patients.

Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study

Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m²). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.