Consequences of the COVID-19 Pandemic on the Mental Health of Patients in Opioid Substitution Treatment

Introduction

The many negative consequences of the COVID-19 pandemic especially on vulnerable groups like patients suffering from drug addiction have been anticipated by experts early on. While drug consumption patterns of patients in opioid substitution treatment (OST, N=24) seemed hardly influenced at the early stage of the pandemic in Austria, the impact on the mental health of this population remained unclear.

Objectives

The main goal was to investigate long-term consequences of the pandemic in terms of PTSD and clinical symptoms of depression, anxiety and stress among patients in OST between December 2020 and February 2021.

Methods

In a cross-sectional survey study (N=123) an adapted version of the impact of event scale (IES-R) was applied to evaluate PTSD symptoms due to the COVID-19 pandemic. Clinical symptoms were assessed by the depression, anxiety and stress scale (DASS-21), and respective changes due to the pandemic were documented. Sociodemographic and COVID-19 related factors, as well as data on drug consumption patterns were collected.

Results

A binary logistic regression analysis confirmed the negative long-term consequences of psychological and economic COVID-19 related factors on a higher risk for PTSD due to the pandemic. The high-risk PTSD group also demonstrated higher levels and a deterioration of depression, anxiety and stress symptoms since the pandemic.

Conclusions

Among our sample of patients in OST, 27% were at risk of PTSD due to the pandemic, and 30 to 50% reported concerning levels of depression, anxiety and stress. Health care facilities might use these findings as a valuable source of information, when special attention is needed.

Disclosure

No significant relationships.

Long-term Psychological Effects of the COVID-19 Pandemic on Patients with Alcohol Use Disorder

Introduction

Vulnerable groups like patients suffering from alcohol use disorders (AUD) are expected to be particularly affected by the negative consequences of the COVID-19 pandemic. In a prior study (N=127), we found that psychosocial COVID-19 factors and living alone elevated the probability for relapse during the initial stage of the pandemic, whereas long-term effects on mental health have yet to be investigated.

Objectives

Here we aimed to investigate the risk of PTSD, as well as levels and developments in depression, anxiety and stress symptomatology as a consequence of the COVID-19 pandemic among patients with AUD.

Methods

Data was collected from a clinical sample of patients with AUD (N=136) in late 2020 and early 2021. PTSD symptoms due to the pandemic were assessed using an adapted version of the impact of event scale (IES-R). Levels in clinical symptoms were collected on the depression, anxiety and stress scale (DASS-21), and changes since the onset of the pandemic were assessed additionally.

Results

The high-risk PTSD-group showed higher levels of depression, anxiety and stress, and reported more severe deteriorations in these symptoms, when compared to the low-risk group. A binary logistic regression model revealed psychological and social aspects of the pandemic to increase the probability for PTSD, whereas sociodemographic and other COVID-19 related factors showed no significant effects.

Conclusions

About 30% of patients with AUD indicated an elevated risk of PTSD due to the pandemic, as well as deteriorations in levels of depression, anxiety and stress. These concerning findings should be especially considered in current and future treatment settings.

Disclosure

No significant relationships.

Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis

BACKGROUND

Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated colitis in which Clostridium difficile is absent. Although the cause is not known, previous reports have suggested a role of Klebsiella oxytoca.

METHODS

We studied 22 consecutive patients who had suspected antibiotic-associated colitis and who were negative for C. difficile. Patients underwent diagnostic colonoscopy, and among those who received a diagnosis of antibiotic-associated hemorrhagic colitis, stool samples were cultured for K. oxytoca. We isolated K. oxytoca strains and tested them for cytotoxin production using a tissue-culture assay. In addition, we also cultured stool samples obtained from 385 healthy subjects for K. oxytoca. An in vivo animal model for antibiotic-associated hemorrhagic colitis was established with the use of Sprague-Dawley rats.

RESULTS

Of the 22 patients, 6 had findings on colonoscopy that were consistent with the diagnosis of antibiotic-associated hemorrhagic colitis, and 5 of these 6 patients had positive cultures for K. oxytoca. No other common enteric pathogens were found in the five patients. Before the onset of colitis, all five were receiving penicillins, and two were also taking nonsteroidal antiinflammatory drugs (NSAIDs). All isolated K. oxytoca strains produced cytotoxin. K. oxytoca was found in 1.6% of the healthy subjects. In the animal model, K. oxytoca was found only in the colon of rats that received amoxicillin-clavulanate in addition to being inoculated with K. oxytoca. In these rats, infection with K. oxytoca induced a right-sided hemorrhagic colitis that was not observed in uninfected animals that received amoxicillin-clavulanate, indomethacin (an NSAID), or both.

CONCLUSIONS

Our fulfillment of Koch's postulates for cytotoxin-producing K. oxytoca suggests that it is the causative organism in at least some cases of antibiotic-associated hemorrhagic colitis. Infection with K. oxytoca should be considered in patients with antibiotic-associated colitis who are negative for C. difficile.