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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 20-24

Impact of the second wave of COVID-19 on psychiatric patients at a tertiary psychiatric hospital in Telangana state of South India


Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana, India

Date of Submission31-Jan-2022
Date of Decision11-Mar-2022
Date of Acceptance21-Mar-2022
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Haripriya Chintala
Institute of Mental Health, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_6_22

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  Abstract 


Background: COVID-19, caused by the coronavirus, was declared a global pandemic by the WHO on March 11, 2020. The COVID-19 pandemic hit India, similar to the world, reporting its first case in March 2020. After the first wave, the second wave in India started on March 2021. The impact of the second wave was huge on all tertiary care centers, especially psychiatric care centers, compared to the first wave of COVID-19.
Aim: The aim of this study is to study the impact of COVID-19 on psychiatric patients at a tertiary psychiatric hospital in Telangana state of South India.
Methodology: A retrospective chart review of all patients who got infected with COVID-19 during the second wave was done. We screened all the inpatient cases who were under admission during the second wave. For the study, a semi-structured intake pro forma was used. Sociodemographic variables, clinical variables, treatment variables, and outcomes of COVID-19-infected psychiatric patients were studied.
Results: The current article compiles the management of the COVID-19 outbreak in the Institute of Mental Health in inpatient care and the challenges and experiences during the management of psychiatric inpatients with COVID-19 in a tertiary care center in Telangana.

Keywords: COVID-19, inpatients, mortality, psychiatric care center, psychiatric patients, psychotropics


How to cite this article:
Chintala H, Rayirala A, Molanguri U. Impact of the second wave of COVID-19 on psychiatric patients at a tertiary psychiatric hospital in Telangana state of South India. Telangana J Psychiatry 2022;8:20-4

How to cite this URL:
Chintala H, Rayirala A, Molanguri U. Impact of the second wave of COVID-19 on psychiatric patients at a tertiary psychiatric hospital in Telangana state of South India. Telangana J Psychiatry [serial online] 2022 [cited 2022 Nov 28];8:20-4. Available from: https://tjpipstsb.org/text.asp?2022/8/1/20/346241




  Introduction Top


The first case of the novel coronavirus in India was reported in March 2020.[1],[2] At the time of writing, this article India faced two waves, with a maximum number of cases reported in the second wave. During the second wave of the pandemic, 3 crore population in India and 6 lakh population in Telangana were affected.[3],[4] In Telangana state, 2nd lockdown was announced in May 2021 to dampen the exponential increase in the number of cases during the 2nd wave.[5] Ministry of social and family welfare, central, and all the state governments recognized the role of psychiatry during the pandemic. COVID-19 has affected psychiatric care in all settings worldwide. There is an increased load on psychiatric setups worldwide.[6],[7],[8],[9],[10] Psychiatric patients with severe mental illness usually do not have insight into their illness. Lack of insight into the illness of both psychiatric and physical in COVID-19-infected psychiatric patients, difficulty in understanding the symptoms, and following COVID appropriate behaviors cause a significant impact on the identification and management of both illnesses.[11] Due to limited research in the context of challenges in the treatment of COVID-infected psychiatric patients, we considered explaining the impact of psychiatric care on COVID-infected psychiatric inpatients and the challenges faced in managing the patients for both psychiatry-related issues and COVID-19 in this article. Here, we present the compendium of psychiatric care at the Institute of Mental Health (IMH), Hyderabad.

Aim and objectives

The aim of this study is to study the impact of COVID-19 on psychiatric patients at a tertiary psychiatric hospital in Telangana state of south India. The aim of this study is to study the sociodemographic profile of COVID-19-infected patients, the psychiatric clinical profile of COVID-19-infected patients, the various psychiatric drugs prescribed and drug-drug interactions, the outcome of the treatment, and the challenges we faced during the management.


  Materials and Methods Top


It is a retrospective chart review done on 85 inpatients who turned positive during inpatient stay for COVID-19 on screening, at IMH, Hyderabad, Telangana, during October, November, and December 2021.

Study design

The study design involves retrospective chart review.

  1. Study duration: 3 months – October, November, and December 2021
  2. The study was done at the IMH, Hyderabad, Telangana.


Study subjects

Inpatients admitted at the psychiatric hospital who turned positive for COVID-19 on screening were either symptomatic or asymptomatic.

Inclusion criteria

  1. Only patients who are positive for COVID-19 are included in the study
  2. Patients above 18 years
  3. Patients with any medical comorbidities.


Exclusion criteria

The patients with inadequate records were excluded from the study.

We conducted this study in the IMH, Erragadda, Hyderabad, a tertiary care referral center in Telangana. IMH is a psychiatric center with 600-bedded inpatient setup. We conducted this study after the permission of the institutional ethics committee. A retrospective chart review of all patients who got infected with COVID-19 during the second wave was done. We screened all the inpatient cases and the cases in the outpatient department that were planned for admission. For the study, a semi-structured intake pro forma was used. Sociodemographic variables, clinical variables, treatment variables, and outcomes of COVID-19-infected psychiatric patients are studied, and we described the respective statistics in the results.


  Results Top


A total of 596 mentally ill patients who were staying as inpatients in the hospital were screened for COVID-19 infection, irrespective of whether they were symptomatic or asymptomatic during the second wave. Of these, 96 patients were tested positive for COVID-19 and these were isolated and kept separately in isolation wards. Out of which, 85 patients' files were reviewed and the remaining 11 patients were excluded as the records did not have adequate details. These patients were monitored regularly for psychiatricand medical symptoms, and their vitals were also monitored frequently. They were kept in isolation for 2 weeks and they were shifted to normal wards after the rapid antigen test became negative.

About 90% of patients had no symptoms during screening. Most of the patients were between the age groups of 30–45 years (54%), followed by the age group of 18–30 years (23%) and the age group of >45 years (22%). In the sample, more patients were male (64%). About 94% belonged to low-socioeconomic status [Table 1].
Table 1: Sociodemographic variables of COVID-19-infected patients in Institute of Mental Health

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Around 62% of the samples had a primary diagnosis of schizophrenia and schizoaffective disorder, 20% of the samples had a diagnosis of bipolar affective disorder. Nine percent had substance use disorder, 4% had mental retardation, and 2% had depression as the primary diagnosis. About 25% of the total samples had comorbid medical diagnoses such as hypertension, diabetes, seizure disorder, anemia, hypothyroidism, and head injury [Table 2].
Table 2: Clinical variables of COVID-19-infected patients in Institute of Mental Health

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The patients were on antipsychotics olanzapine (41%), risperidone (22%), trifluoperazine (12%), amisulpride (9%), haloperidol (9%), clozapine (4%), and quetiapine (3%), respectively. The most common mood stabilizer was sodium valproate (45%), followed by lithium carbonate (4%), and carbamazepine (1%). Fluoxetine was the antidepressant in 12% of patients [Table 3].
Table 3: Treatment variables of COVID-19-infected patients in Institute of Mental Health

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Out of 85 patients, only nine patients had symptoms during the initial screening. Most of the patients were asymptomatic during the initial screening. The most common symptoms were cold and fever. Twelve patients developed symptoms during the period of isolation. All patients who were positive during the screening test were isolated for 14 days in COVID wards separately for males and females. Regular monitoring of vitals, monitoring of COVID-related symptoms, and psychiatric symptoms were done for these patients. A pulmonologist from a government hospital reviewed the patients every day.

Doxycycline 100 mg bd for 5 days, ivermectin 12 mg OD for 3 days, and multivitamins were started for all the patients for COVID-related symptoms by the pulmonologist from government tuberculosis and chest hospital. Psychiatric medication was continued; however, benzodiazepines were tapered and stopped in all the patients as advised by the pulmonologist. Five patients had symptoms of fall in Spo2 during the isolation period. After reviewing with the pulmonologist, steroids and anticoagulants were started for these patients. Oxygen inhalation was required for three patients. Two patients were referred to general hospital because of hemoptysis and low saturations.


  Discussion Top


One study has shown that the mortality in COVID-infected psychiatric patients with the diagnosis of schizophrenia was 26.7%, mood disorders were 18.4%, and anxiety disorders were 10.8%.[12] One more study on mortality has shown that patients with a psychiatric diagnosis had higher mortality compared to patients with no psychiatric diagnosis is 35.7% of 2-week mortality, 40.9% of 3-week mortality, and 44.7% of 4-week mortality.[13] Some studies have shown that the mortality and outcome in COVID-infected psychiatric patients were higher with the severe outcome.[14],[15] Contrary to the above studies, in our study, there was one casualty reported in 85 patients, which is <1% and there was no difference noted concerning the psychiatric diagnosis.

Challenges faced during the second wave

There were multiple challenges faced during the management of COVID-infected psychiatric patients.

Only 10% of patients had symptoms such as running nose, fever, and cough; however, most of the patients were diagnosed only by screening.[16] Swab testing in severe psychotic patients was difficult. Challenges in taking precautions of COVID-19 such as physical distancing, sanitization, compulsory usage of mask in psychiatric patients with poor insight, and aggressive patients was difficult.[17],[18] Most of the patients were on antipsychotics which cause sedation. Currently, available evidence reports no contraindications of psychotropics in COVID-19 infections.[19] However, it is important to consider drug–drug interactions during the treatment. However, the dose of benzodiazepines was lowered by the pulmonologist given the risk of respiratory depression. Treating patients with acute symptoms, aggression, and suicidal thoughts were challenging. Patients were referred to a general hospital set up in case of complications. However, there were difficulties to maintain aggressive patients in the general hospital setup. Even other departments were not willing to admit mentally ill patients in a general hospital setup.[20]

Suggestions

All necessary safety precautions and specific guidelines to be prepared in all psychiatric setups for screening of patients and patient attendants, and admission procedures. Training of all health care workers regarding the COVID-19 aspects such as hand hygiene, sanitization, and physical distancing should be made mandatory.

All the staff and patients should be properly sanitized. Setting up of an intensive care unit (ICU) and emergency ICU beds with a physician made available on regular basis in all psychiatric hospitals. In a general hospital setting, a psychiatrist should be made available to address the referral cases in an emergency.

It was noted that psychotropics have drug–drug interactions with azithromycin (risk of QTc prolongation with antipsychotics, risk of hepatotoxicity with some mood stabilizers); however, no side effects were noted in patients during the treatment.[21],[22],[23] Most antipsychotics, antidepressants, and mood stabilizers did not have any significant drug–drug interactions with medications used for the management of COVID-19.

Strength of the study

There was a paucity of literature on the impact of COVID-19 on mentally ill patients, and this study attempted to throw some light on the effect of the pandemic on this special group and some challenges we faced during the management of these patients.

Limitations

  1. Smaller sample size
  2. As it was a retrospective chart review, some of the data were inadequate.



  Conclusion Top


As per the study the morbidity and mortality in COVID-19 infected psychiatric patients was very less. All cases have recovered except for one case. The medications prescribed for COVID-19 didn't have any drug-drug interactions in the current Sample. However there is scope for further research regarding the same. Early screening of cases and isolation, following standard COVID -19 protocol, Regular, monitoring of Vitals, Identification of Comorbidities and complications, effective multidisciplinary approach of psychiatric and medical management are key for the management of COVID-19 infected psychiatric patients.

Acknowledgment

We would like to thank Dr. Rajshekhar, professor of Psychiatry at the Institute of mental health for his guidance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mahase E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction. BMJ 2020;368:m1036.  Back to cited text no. 1
    
2.
Sidana A, Goel V, Kaur S. Impact of the COVID-19 pandemic on psychiatric hospitalization in a tertiary care hospital of Northern India. Prim Care Companion CNS Disord 2021;23:PAGE 1.  Back to cited text no. 2
    
3.
Coronavirus Outbreak in Telangana – COVID19india.org. (n.d.). Available from: https://www.COVID19india.org/state/TG. [Last retrieved on 2022 Feb 25].  Back to cited text no. 3
    
4.
Coronavirus Outbreak in India – COVID19india.org. (n.d.). Available from: https://www.COVID19india.org/state/TT. [Last retrieved on 2022 Feb 25].  Back to cited text no. 4
    
5.
Government of Telangana G.O Regarding Lockdown, Pub. L. No. G.O.Ms.No. 119, G.O.Ms.No. 119 Dated: 08.06.2021 1; 2021. Available from: https://telangana.gov.in/PDFDocuments/G-O-119-Extension-of-Lockdown-in-Telangana-from-10-06-2021-to-19-06-2021.pdf. [last accessed on 2021 Jun 08].  Back to cited text no. 5
    
6.
Levitt G. COVID-19 infection in an inpatient psychiatric hospital setting: Demographics, outcomes, and impact on well-being. Prim Care Companion CNS Disord 2021;23:3 page.  Back to cited text no. 6
    
7.
Kim HK, Carvalho AF, Gratzer D, Wong AH, Gutzin S, Husain MI, et al. The impact of COVID-19 on psychiatric emergency and inpatient services in the first month of the pandemic in a large urban mental health hospital in Ontario, Canada. Front Psychiatry 2021;12:563906.  Back to cited text no. 7
    
8.
Xiang YT, Zhao YJ, Liu ZH, Li XH, Zhao N, Cheung T, et al. The COVID-19 outbreak and psychiatric hospitals in China: Managing challenges through mental health service reform. Int J Biol Sci 2020;16:1741-4.  Back to cited text no. 8
    
9.
Puangsri P, Jinanarong V, Wattanapisit A. Impacts on and care of psychiatric patients during the outbreak of COVID-19. Clin Pract Epidemiol Ment Health 2021;17:52-60.  Back to cited text no. 9
    
10.
COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey. (n.d.). Available from: https://www.who.int/news/item/05-10-2020-COVID-19-disrupting-mental-health-services-in-most-countries-who-survey. [Last retrieved on 2022 Feb 25].  Back to cited text no. 10
    
11.
Druss BG. Addressing the COVID-19 pandemic in populations with serious mental illness. JAMA Psychiatry 2020;77:891-2.  Back to cited text no. 11
    
12.
Nemani K, Li C, Olfson M, Blessing EM, Razavian N, Chen J, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry 2021;78:380-6.  Back to cited text no. 12
    
13.
Li L, Li F, Fortunati F, Krystal JH. Association of a prior psychiatric diagnosis with mortality among hospitalized patients with coronavirus disease 2019 (COVID-19) infection. JAMA Netw Open 2020;3:e2023282.  Back to cited text no. 13
    
14.
Toubasi AA, AbuAnzeh RB, Tawileh HB, Aldebei RH, Alryalat SA. A meta-analysis: The mortality and severity of COVID-19 among patients with mental disorders. Psychiatry Res 2021;299:113856.  Back to cited text no. 14
    
15.
Barcella CA, Polcwiartek C, Mohr GH, Hodges G, Søndergaard K, Niels Bang C, et al. Severe mental illness is associated with increased mortality and severe course of COVID-19. Acta Psychiatr Scand 2021;144:82-91.  Back to cited text no. 15
    
16.
Murugesan, Manisha & Patley, Rahul & Chander, Kalaivanan & Basavaraju, Vinay & Manjunatha, Narayana & Kumar, Naveen & Bada Math, Suresh & Murthy, Pratima & Gangadhar, Bn. (2020). Guidelines on managing mental illness in hospital settings during COVID 19. page 8.  Back to cited text no. 16
    
17.
Li L. Challenges and priorities in responding to COVID-19 in inpatient psychiatry. Psychiatr Serv 2020;71:624-6.  Back to cited text no. 17
    
18.
Kavoor AR. COVID-19 in people with mental illness: Challenges and vulnerabilities. Asian J Psychiatr 2020;51:102051.  Back to cited text no. 18
    
19.
Yalçın N, Ak S, Demirkan K. Do psychotropic drugs used during COVID-19 therapy have an effect on the treatment process? Eur J Hosp Pharm 2021;28:e2.  Back to cited text no. 19
    
20.
Bojdani E, Rajagopalan A, Chen A, Gearin P, Olcott W, Shankar V, et al. COVID-19 pandemic: Impact on psychiatric care in the United States. Psychiatry Res 2020;289:113069.  Back to cited text no. 20
    
21.
Nemani K, Conderino S, Marx J, Thorpe LE, Goff DC. Association between antipsychotic use and COVID-19 mortality among people with serious mental illness. JAMA Psychiatry 2021;78:1391-3.  Back to cited text no. 21
    
22.
Ostuzzi G, Papola D, Gastaldon C, Schoretsanitis G, Bertolini F, Amaddeo F, et al. Safety of psychotropic medications in people with COVID-19: Evidence review and practical recommendations. BMC Med 2020;18:3. [Doi: 10.1186/s12916-020-01685-9].  Back to cited text no. 22
    
23.
Hirschtritt ME, Slama N, Sterling SA, Olfson M, Iturralde E. Psychotropic medication prescribing during the COVID-19 pandemic. Medicine (Baltimore) 2021;100:e27664.  Back to cited text no. 23
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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