The impact of the COVID-19 pandemic has propelled changes in healthcare delivery, incorporating new technologies and resulting in interruptions of care and access to treatment.

To understand the ways that the COVID-19 pandemic has affected mental health, particularly in those with psychotic disorders. The unique nature and scale of the COVID-19 pandemic today presents an opportunity to learn more about the challenges faced by our patients and improvements that can be made in the delivery of mental healthcare.

We report five cases of patients with preexisting psychotic disorders seen on an inpatient psychiatry unit who decompensated for reasons relating to the COVID-19 pandemic. We conducted a review of the literature by searching the PubMed database for the keywords “mental health,” “psychosis,” “COVID-19,” “epidemic,” “pandemic,” and “coronavirus.

The prevalence of psychotic disorders in the US is estimated to be between 0.25% and 0.64%. In the context of an epidemic or pandemic, the incidence of psychotic symptoms in those infected with a virus is estimated to be between 0.9% and 4%, demonstrating increased risk to this group. The effects of the COVID-19 pandemic have contributed to psychiatric decompensation.

The COVID-19 pandemic is an opportunity to identify ways in which our patients are at risk and how we can attempt to alleviate those risks to provide improved care going forward. By appreciating the multifaceted ways in which the current situation has affected our patient population, we can extrapolate lessons that will allow us to better serve our patients even when this pandemic passes.

No significant relationships.

The prevalence of depressive disorders in patients with schizophrenia is estimated at 25%. Nevertheless, depressive symptoms occurring during the acute decompensation of schizophrenia have rarely been studied.

The aim of our study was to assess depressive symptoms in hospitalized patients suffering from schizophrenia.

We conducted a cross-sectional, descriptive and analytical study, including 30 schizophrenic patients, hospitalized in the psychiatry B “department of the Hedi Chaker university hospital in Sfax. The assessment of clinical severity of schizophrenia was performed by the Positive and Negative Syndrome Scale (PANSS), that of depressive symptoms by the “Calgary Depression Scale for Schizophrenia” (CDSS).

The mean age of patients was 41.2. Most of patients were male (86.7%) and unemployed (83.3%). Only 13.3% of them were married. Patients were hospitalized 8.83 times in average. A personal history of suicide attempts was found in 16.70% of cases. The mean score in the CDSS scale was 5.12. According to the CDSS score, a depressive state was diagnosed in 36.7% % of patients. Depression was associated with significantly more frequent history of suicide attempts (p=0.028), as well as significantly higher scores in the positive dimension of the PANSS (p=0.03).

Our results show that depressive symptoms are common during the acute decompensation phase of schizophrenia. They are associated with impaired functioning of patients, as well as a higher risk of suicide. Screening for depressive symptoms in patients hospitalized for schizophrenia is therefore essential in order to ensure better management.

No significant relationships.

Emergency services personnel are highly vulnerable to acute and cumulative critical incident stress (CIS) that can manifest as anger, guilt, depression, and impaired decision-making, and, in certain instances, job loss. Interventions designed to identify such distress and restore psychological functioning becomes imperative.

A statewide debriefing team was formed in 1988 through a collaborative effort between an academic department of emergency medicine and a social work department of a teaching hospital, and a metropolitan area fire department and ambulance service. Using an existing CIS debriefing model, 84 pre-screened, mental health professionals and emergency services personnel were provided with 16 hours of training and were grouped into regional teams.

Debriefing requests are received through a central number answered by a communicator in a 24-hour communications center located within the emergency department. Debriefings are conducted 48–72 hours after the event for specific types of incidents. Follow-up telephone calls are made by the debriefing team leader two to three weeks following a debriefing. The teams rely on donations to pay for travel and meals.

One hundred sixty-eight debriefings were conducted during the first four years. Rural agencies accounted for 116 (69%) requests. During this period, 1,514 individuals were debriefed: 744 (49%) firefighters, 460 (30%) EMTs, and 310 (21%) police officers, dispatchers, and other responders. Deaths of children, extraordinary events, and incidents involving victims known to the responders (35%, 14%, and 14% respectively) were the most common reasons for requesting debriefings. Feedback was received from 48 (28%) of the agencies that requested the debriefing. All of those who responded felt that the debriefing had a beneficial effect on its personnel. Specific individuals identified by agency representatives as having the greatest difficulty were observed to be returned to their pre-incident state.

CIS debriefings are judged as beneficial. A statewide response team is an effective way to provide these services at no cost to agencies.