Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review

Background Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions. Methods Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed. Results We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, − 9.1%, p = 0.064 and (363 vs. 437, − 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by − 32.8% (p <  0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001). Conclusions A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions

Die Anwendung der Virtuellen Realität in der Behandlung psychischer Störungen

Background: Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. Methods Selective literature search in PubMed and Google Scholar. Results An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. Conclusions VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.Hintergrund: Die Virtuelle Realität (VR) ermöglicht das Eintauchen in eine interaktive, digitale Welt mit realitätsnahen Erfahrungen, die im Rahmen therapeutischer Intervention kontrolliert und personalisiert eingesetzt werden können. In dieser Übersichtsarbeit werden die aktuellen Forschungsergebnisse zur VR in der Behandlung psychischer Störungen zusammengefasst. Methode: Selektive Literaturrecherche in PubMed und über Google Scholar. Ergebnisse: Eine zunehmende Anzahl von Publikationen beschreibt unterschiedliche Einsatzformen der VR in der Behandlung psychischer Störungen. Die Mehrheit der VR-Anwendungen basiert auf Adaptionen bereits etablierter psychotherapeutischer Methoden, insbesondere der Expositionstherapie. Die Virtuelle Expositionstherapie (VRET) in der Behandlung der spezifischen Phobie und der Agoraphobie mit Panikstörung ist laut metaanalytischen Daten gleich wirksam wie die traditionelle Expositionstherapie in vivo. VRET für die soziale Phobie ist signifikant wirksamer als Warte- oder Placebo-Kontrollgruppen, aber im Vergleich zur Expositionstherapie in vivo sind die metaanalytischen Befunde derzeit inkonsistent. VRET bei der posttraumatischen Belastungsstörung (PTBS) ist laut Metaanalysen gleich wirksam wie eine aktive Psychotherapie. Für die VR-basierte Behandlung der psychotischen Störungen gibt es positive Befunde bezogen auf Reduktion des Stimmenhörens. Bei Patienten mit einer Abhängigkeitserkrankung kann mittels VR „craving“ induziert werden mit noch unzureichend belegter diagnostischer und therapeutischer Relevanz. Schlussfolgerung: Die VRET kann als Erweiterung der psychotherapeutischen Behandlung der Angststörungen angeboten werden. Vielversprechende Befunde der VR-basierten Therapien der PTBS und der psychotischen Störungen implizieren den Bedarf weiterer Forschung zur Klärung ihrer Effektivität und Sicherheit. Im Bereich der Abhängigkeitserkrankungen ist die Evaluation klinisch orientierter VR-Anwendungen erforderlich

Genome-wide association analyses of symptom severity among clozapine-treated patients with schizophrenia spectrum disorders

Clozapine is the most effective antipsychotic for patients with treatment-resistant schizophrenia. However, response is highly variable and possible genetic underpinnings of this variability remain unknown. Here, we performed polygenic risk score (PRS) analyses to estimate the amount of variance in symptom severity among clozapine-treated patients explained by PRSs (R2) and examined the association between symptom severity and genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activity. Genome-wide association (GWA) analyses were performed to explore loci associated with symptom severity. A multicenter cohort of 804 patients (after quality control N = 684) with schizophrenia spectrum disorder treated with clozapine were cross-sectionally assessed using the Positive and Negative Syndrome Scale and/or the Clinical Global Impression-Severity (CGI-S) scale. GWA and PRS regression analyses were conducted. Genotype-predicted CYP1A2, CYP2D6, and CYP2C19 enzyme activities were calculated. Schizophrenia-PRS was most significantly and positively associated with low symptom severity (p = 1.03 × 10−3; R2 = 1.85). Cross-disorder-PRS was also positively associated with lower CGI-S score (p = 0.01; R2 = 0.81). Compared to the lowest tertile, patients in the highest schizophrenia-PRS tertile had 1.94 times (p = 6.84×10−4) increased probability of low symptom severity. Higher genotype-predicted CYP2C19 enzyme activity was independently associated with lower symptom severity (p = 8.44×10−3). While no locus surpassed the genome-wide significance threshold, rs1923778 within NFIB showed a suggestive association (p = 3.78×10−7) with symptom severity. We show that high schizophrenia-PRS and genotype-predicted CYP2C19 enzyme activity are independently associated with lower symptom severity among individuals treated with clozapine. Our findings open avenues for future pharmacogenomic projects investigating the potential of PRS and genotype-predicted CYP-activity in schizophrenia

Comprehensive dissection of prevalence rates, sex differences, and blood level-dependencies of clozapine-associated adverse drug reactions

Clozapine is often underused due to concerns about adverse drug reactions (ADRs) but studies into their prevalences are inconclusive. We therefore comprehensively examined prevalences of clozapine-associated ADRs in individuals with schizophrenia and demographic and clinical factors associated with their occurrence. Data from a multi-center study (n = 698 participants) were collected. The mean number of ADRs during clozapine treatment was 4.8, with 2.4 % of participants reporting no ADRs. The most common ADRs were hypersalivation (74.6 %), weight gain (69.3 %), and increased sleep necessity (65.9 %), all of which were more common in younger participants. Participants with lower BMI prior to treatment were more likely to experience significant weight gain (&gt;10 %). Constipation occurred more frequently with higher clozapine blood levels and doses. There were no differences in ADR prevalence rates between participants receiving clozapine monotherapy and polytherapy. These findings emphasize the high prevalence of clozapine-associated ADRs and highlight several demographic and clinical factors contributing to their occurrence. By understanding these factors, clinicians can better anticipate and manage clozapine-associated ADRs, leading to improved treatment outcomes and patient well-being

Determinants of patient satisfaction in clozapine users: results from the Clozapine International Consortium (CLOZIN)

Clozapine is highly effective for treatment-resistant schizophrenia but is underutilized due to patient and clinician-related concerns. Little is known about the general level of patient satisfaction with clozapine and determinants thereof. We therefore explored determinants of patient satisfaction with clozapine in individuals diagnosed with schizophrenia spectrum disorders (SSDs). Cross-sectional data from 480 clozapine users were used to examine demographic and clinical factors, including symptom severity, treatment response, and adverse drug reactions (ADRs). Patient satisfaction was self-rated on a scale of 1 to 10. Results showed a mean satisfaction score of 7.4 (SD = 1.9), with significant associations between satisfaction and treatment response (B = 0.42, R2 = 0.19, p = 3.9 × 10−18), symptom severity (B = 0.10, R2 = 0.05, p = 2.06 × 10-9), occurrence of ADRs (B = −0.16, R2 = 0.06, p = 3.2 × 10-5), and recreational drug use (B = −1.32, R2 = 0.05, p = 2.09 × 10-4). Hypersalivation and prolonged sleep duration were the only ADRs linked to lower satisfaction (B = −0.72, R2 = 0.06, p = 3.5 × 10-5 and B = −0.57, R2 = 0.04, p = 1.4 × 10-3, respectively). Despite concerns about ADRs, treatment effectiveness showed a stronger association with patient satisfaction among clozapine users than the occurrence of ADRs. In conclusion, our findings suggest that strategies aimed at bolstering clozapine’s effectiveness may help counter worldwide underprescription rates of clozapine in patients with SSDs