ArticlePDF Available
COVID-19: The Hidden Impact on
Mental Health and Drug Addiction
Stefania Chiappini
1
*, Amira Guirguis
1,2
*, Ann John
2
, John Martin Corkery
1
and Fabrizio Schifano
1
1
Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences,
University of Hertfordshire, Hateld, United Kingdom,
2
Swansea University Medical School, Swansea University, Swansea,
United Kingdom
Keywords: COVID-19, addiction, mental health, drug abuse, prescription drug misuse
INTRODUCTION
There is concern the Coronavirus Disease (COVID)-19 pandemic is having a negative impact on the
mental health of the general population through a range of suggested mechanisms: fear, uncertainty,
and anxiety; social distancing/isolation; loneliness; and economic repercussions (13). Previous
disasters such as the Severe Acute Respiratory Syndrome (SARS) in 2003 (46) contributed to
increased anxiety, mood, and thought disorders, adjustment disorders, and post-traumatic stress
disorders (PTSD) (1,715), resulting, in extreme cases, in suicidal behaviours (e.g., suicidal ideation,
suicide attempts, and actual suicide) (10,16), especially in cases of concomitant Substance Use
Disorder (SUD) (17,18). According to a recent study from the Well Being Trust (18) the high levels
of stress, isolation and unemployment due to the COVID-19 pandemic could cause up to 75,000
deaths of despairrelated to deaths to drug, alcohol, and suicide (18). High risk of mental illness
was previously identied in individuals with existing or history of mental illnesses (1,9,12,14,19),
but also vulnerable categories might be considered the elderly (>80 years old), children/adolescents,
individuals from deprived areas, peri-natal women and BAME (Black, Asian and minority
ethnicities) (1,12,14,19). Finally, healthcare workers have been experiencing emotional
overload due to several reasons, including both organizational issues relating to the shortage of
suitable personal protective equipment, reduction in human resources and relentless work shifts
(2023), but also the burden developed by the fear of becoming infected and infecting relatives, high
mortality rates, grieving the loss of patients and colleagues, separation from families (2224).
Specically, according to Huang et al. (25), among the rst-line medical staff of a Tertiary Infectious
Disease Hospital for COVID-19 in China, the incidence of anxiety and post traumatic symptoms in
female medical staff was higher than that in male, and in nurses more represented than that in
doctors (25).
DISCUSSION
Often overlooked in this scenario are those with SUD (26,27), who may experience: (a) changes in
levels of drug usean increase is often seen as a reactive behaviour to negative impact of disasters;
(b) a shift to other substances if access to those previously used become limited; (c) a relapse, if they
had already recovered from alcohol/drug addiction. Risks of severe COVID and intensied mental
Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7671
Edited by:
Fernando Barbosa,
University of Porto, Portugal
Reviewed by:
Domenico De Berardis,
Azienda Usl Teramo, Italy
Mercedes Lovrecic,
National Institute for Public Health,
Slovenia
*Correspondence:
Stefania Chiappini
stefaniachiappini9@gmail.com
Amira Guirguis
amira.guirguis@swansea.ac.uk
Specialty section:
This article was submitted to
Addictive Disorders,
a section of the journal
Frontiers in Psychiatry
Received: 13 June 2020
Accepted: 20 July 2020
Published: 29 July 2020
Citation:
Chiappini S, Guirguis A, John A,
Corkery JM and Schifano F (2020)
COVID-19: The Hidden Impact on
Mental Health and Drug Addiction.
Front. Psychiatry 11:767.
doi: 10.3389/fpsyt.2020.00767
OPINION
published: 29 July 2020
doi: 10.3389/fpsyt.2020.00767
health issues in people who use drugs (PWUD) include: physical
comorbidity, e.g., lung or cardiovascular disease, HIV, viral
hepatitis infections; psychological comorbidity, e.g., general
distress, sleep disorders, anxiety/mood disorders, psychotic
symptoms; and homelessness, incarceration, economic
difculties, and socioeconomic issues deriving from drug
addiction (8,11,27,28). Overdose risk for addicted people
who are home-isolating, and hence with typically no one to
inject them with naloxone, should be considered in a time of
overloaded emergency services and healthcare systems in general
(27,29). The COVID-19 pandemic is already impacting drug
markets, including shortages of numerous types of drugs at the
street level, price increases for consumers on the black market
and reductions in purity. Synthetic drugsavailability, such as
methamphetamine, is drastically reduced due to air travel
restrictions and ight cancellations, while cocaine, mostly
trafcked by sea, continues to be detected in European ports
during the pandemic (30). Heroin and opioids seem to be
pushed toward being trafcked along maritime routes. Finally,
cannabis appears to be less available, due to restrictions on
movement across regions and borders under coronavirus
lockdown. These disruptions are likely to grow and further
increase risks for people who use drugs, for example by
increasing variability in drug purity, the likelihood of
adulteration, and contamination of heroin supply with
synthetic opioids, such as fentanyl. These issues can also
encourage shifts to more at-risk drug using behaviours such as
use of drugs such as street benzodiazepines, and synthetic
cannabinoids (31). Additionally, the COVID-19 crisis is likely
to increase the need to access drug treatment and services, e.g.,
extra demand for opioid substitution therapy and other
medication. Access to drug services is being disrupted by self-
quarantine, social distancing and other public health measures
adopted for dealing with COVID-19 (27,29,31). Similarly,
community pharmacies are challenged by staff shortages,
service disorganisation, and self-isolation (27,29,32).
In response to the long-lasting and wide-ranging challenging
effects of the pandemic (5,12,19,27,29), some harm-avoiding
interventions have been adopted, including: more exible take-
home-medication treatment programmes for opioid addicted
patients (33,34); guidance for facilitating controlled substance
prescribing (26,29,35); tele-health for monitoring drug-
dependent patients; and access to virtual support groups
through online meetings (15,26,32). Conversely, both peer-
support groups and rehabilitation facilities have suspended
programmes and limited new admissions (27,32). Hollander &
Carr (36) compared and contrasted the acceptability and impact
of telemedicine versus in-person consultations. During the
COVID pandemic, telehealth has demonstrated to enable
continuity of services, while protecting service providers from
infection. However, in-person consultations are still needed for
certain groups of patients where maintenance in treatment is
at risk.
In this context, due to the disruption of drug markets,
reduced supply and access to illicit drugs, internet drug-
seeking activities may be on the increase. In line with this,
rogue/illicit pharmaceutical products, such as benzodiazepines,
has also reportedly doubled their prices in some areas (24).
Alternative drugs or medications might be considered by users
including quetiapine, gabapentinoids, Z-drugs (e.g., zolpidem)
(3739) and some Over-The-Counter (OTC) medications (37,
38), such as codeine; ephedrine and pseudoephedrine; and the
antidiarrhoeal loperamide (poor mans methadone).
IMPLICATIONS IN PRACTICE
Interventions addressing the health, psychological, and social
effects of the pandemic are required. Healthcare professionals
have an important role in educating patients about the common
psychological effects of a pandemic. COVID-19, together with
general environmental factors, such as stress or trauma, may
contribute to both a mental illness and a SUD developing. A
proactive approach to upscale our mental health care, emergency
preparedness and response for people with SUDs is urgently
needed; mental health services should develop and evaluate: clear
remote assessment; care pathways for people at risk; psycho-
education strategies, regarding self-harm/suicide, overdoses, and
domestic violence; and staff training to support new ways of
working (1,7,12). Healthcare providers, including pharmacists,
and public health policies are challenged to: develop strategies to
implement prevention measures against transmission of COVID-19
in drug users settings, such as preventing overcrowding or sharing
drug-using equipment; and ensure continuity of care for drug-users
and people with SUDs. Specically, access to community
maintenance, e.g., expand methadone delivery via mobile teams
for quarantined patients should be facilitated (40,41). Monitoring
psychosocial needs and delivering psychosocial support to
vulnerable patients as well as healthcare workers should be
provided (2,3,8,42,43). It is crucial to strengthen telemedicine
and support it with appropriate governance and funding in order to
be able to monitor the mental health situation post-pandemic.
Supporting healthcare workers with appropriate equipment,
training on telehealth and caring for their safety with respect to
protection against infection and spread of infection, preventing
violence and burglary in drug treatment services, pharmacies would
enable robust support against a possible mental health wave post-
pandemic. Prescribers and pharmacists should be warned about:
possible requests to prescribe more drugs than needed to take home;
excessive sales of prescription/OTC products which might be
diverted and abused; and aggression toward staff. Developing
multidisciplinary support platforms could be helpful in reducing
the mental distress due to misinformation and teaching problem-
solving strategies to cope with the pandemic (13).
AUTHOR CONTRIBUTIONS
The opinion was developed by all authors. SC drafted the rst
version of the manuscript with input from all authors. All authors
contributed to the article and approved the submitted version.
Chiappini et al. COVID-19: Impact on Mental Health and Drug
Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7672
REFERENCES
1. Gunnell D, Appleby L, Arensman E, Hawton K, John A, Kapur N, et al.
Suicide risk and prevention during the COVID-19 pandemic. Lancet
Psychiatry (2020) 7(6):46871. doi: 10.1016/S2215-0366(20)30171-1
2. Holmes EA, OConnor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al.
Multidisciplinary research priorities for the COVID-19 pandemic: a call for
action for mental health science. Lancet Psychiatry (2020) 7(6):54760.
doi: 10.1016/S2215-0366(20)30168-1
3. Smith K, Ostinelli E, Cipriani A. Covid-19 and mental health: a
transformational opportunity to apply an evidence-based approach to
clinical practice and research. Evid Based Ment Health (2020) 23(2):456.
doi: 10.1136/ebmental-2020-300155
4. Chan SM, Chiu FK, Lam CW, Leung PY, Conwell Y. Elderly suicide and the
2003 SARS epidemic in Hong Kong. Int J Geriatr Psychiatry (2006) 21
(2):1138. doi: 10.1002/gps.1432
5. Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, et al.
Ensuring mental health care during the SARS-CoV-2 epidemic in France: A
narrative review. Encephale (2020) 46(3S):S3S13. doi: 10.1016/
j.encep.2020.04.005
6. Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA Disaster Technical Assistance Center. Supplemental Research
Bulletin. Issue 5: Traumatic Stress and Suicide After Disasters (2015).
https://www.samhsa.gov/sites/default/les/dtac/srb_sept2015.pdf (Accessed
May19, 2020).
7. Courtet P, OliéE, Debien C, Vaiva G. Keep socially (but not physically)
connected and carry on: preventing suicide in the age of COVID-19. J Clin
Psychiatry (2020) 81(3):20com13370. doi: 10.4088/JCP.20com13370
8. GOV.UK. COVID-19 mental health campaign launches (2020). https://www.
gov.uk/government/news/covid-19-mental-health-campaign-launches
(Accessed May 19, 2020).
9. Hao F, Tan W, Jiang L, Zhang L, Zhao X, Zou Y, et al. Do psychiatric patients
experience more psychiatric symptoms during COVID-19 pandemic and
lockdown? A case-control study with service and research implications for
immunopsychiatry. Brain Behav Immun (2020) 87:1006. doi: 10.1016/
j.bbi.2020.04.069
10. Mamun MA, Grifths MD. First COVID-19 suicide case in Bangladesh due to
fear of COVID-19 and xenophobia: Possible suicide prevention strategies.
Asian J Psychiatr (2020) 51:102073. doi: 10.1016/j.ajp.2020.102073
11. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Eng J
Med (2020). doi: 10.1056/NEJMp2008017
12. Reger MA, Stanley IH, Joiner TE. Suicide Mortality and Coronavirus Disease
2019A Perfect Storm? JAMA Psychiatry (2020). doi: 10.1001/
jamapsychiatry.2020.1060
13. Rajkumar RP. COVID-19 and mental health: A review of the existing
literature. Asian J Psychiatr (2020) 52:102066. doi: 10.1016/j.ajp.2020.102066
14. Thakur V, Jain A. COVID 2019-Suicides: A global psychological pandemic.
Brain Behav Immun (2020) 08891591(20):306437. doi: 10.1016/
j.bbi.2020.04.062
15. WHO. Mental health and psychosocial considerations during COVID-19
outbreak (2020). https://www.who.int/docs/default-source/coronaviruse/
mental-health-considerations.pdf (Accessed May 24, 2020).
16. Grifths MD, Mamun MA. COVID-19 suicidal behavior among couples and
suicide pacts: Case study evidence from press reports. Psychiatry Res (2020)
289:113105. doi: 10.1016/j.psychres.2020.113105
17. Dsouza DD, Quadros S, Hyderabadwala ZJ, Mamun MA. Aggregated
COVID-19 suicide incidences in India: Fear of COVID-19 infection is the
prominent causative factor. Psychiatry Res (2020) 28:113145. doi: 10.1016/
j.psychres.2020.113145
18. Petterson S, Westfall J, Miller BF. Projected Deaths of Despair During the
Coronavirus Recession. Well Being Trust (2020) 8:2020. WellBeingTrust.org.
19. Wand APF, Zhong B-L, Chiu HFK, Draper B, De Leo D. Covid-19: The
implications for suicide in older adults. Int Psychogeriatr (2020), 16.
doi: 10.1017/S1041610220000770
20. CDC, 2020; Centers for Disease Control and Prevention (CDC). Healthcare
Personnel and First Responders: How to Cope with Stress and Build Resilience
During the COVID-19 Pandemic (2020). https://www.cdc.gov/coronavirus/
2019-ncov/hcp/mental-health-healthcare.html (Accessed July 7, 2020).
21. Epidemiology for public health. Istituto Superiore di Sanità. COVID-19: stress
management among healthcare workers (2020). https://www.epicentro.iss.it/
en/coronavirus/sars-cov-2-stress-management-healthcare-workers (Accessed
July 7, 2020).
22. Walton M, Murray E, Christian MD. Mental health care for medical staff and
afliated healthcare workers during the COVID-19 pandemic. Eur Heart J
Acute Cardiovasc Care (2020) 9(3):2417. doi: 10.1177/2048872620922795
23. Wu K, Wei X. Analysis of Psychological and Sleep Status and Exercise
Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19
in China. Med Sci Monit Basic Res (2020) 26:e924085. doi: 10.12659/
MSMBR.924085
24. Zhuo K, Gao C, Wang X, Zhang C, Wang Z. Stress and sleep: a survey based
on wearable sleep trackers among medical and nursing staff in Wuhan during
the COVID-19 pandemic. Gen Psychiatr (2020) 33(3):e100260. doi: 10.1136/
gpsych-2020-100260
25. Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of
medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua
Lao Dong Wei Sheng Zhi Ye Bing Za Zhi (2020) 38(3):1925. doi: 10.3760/
cma.j.cn121094-20200219-00063
26. Drug Enforcement Administration (DEA). COVID-19 information page
(2020). www.deadiversion.usdoj.gov/coronavirus.html. (Accessed May 21,
2020)
27. European Monitoring Centre for Drug and Drug Addiction (EMCDDA). The
implications of COVID-19 for people who use drugs (PWUD) and drug service
providers (March 2020). http://www.emcdda.europa.eu/publications/topic-
overviews/covid-19-and-people-who-use-drugs_en (Accessed May 19, 2020).
28. Zhu S, Wu Y, Zhu CY, Hong WC, Yu ZX, Chen ZK, et al. The immediate
mental health impacts of the COVID-19 pandemic among people with or
without quarantine managements. Brain Behav Immun (2020) 87:568.
doi: 10.1016/j.bbi.2020.04.045
29. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann
Intern Med (2020a) 173(1):612. doi: 10.7326/M20-1212
30. United Nations (UN). COVID-19 causes some illegal drug prices to surge, as
supplies are disrupted worldwide (2020). https://news.un.org/en/story/2020/
05/1063512 (Accessed May 25, 2020).
31. Volkow ND. Coping with the Collision of Public Health Crises: COVID-19 and
Substance Use Disorders (2020b). NIH Directors Blog with Dr. Volkow.
https://directorsblog.nih.gov/2020/04/21/coping-with-the-collision-of-
public-health-crises-covid-19-and-substance-use-disorders/ (Accessed May
19, 2020).
32. Green TC, Bratberg J, Finnell DS. Opioid use disorder and the COVID 19
pandemic: A call to sustain regulatory easements and further expand access to
treatment. Subst Abus (2020) 41(2):1479. doi: 10.1080/08897077.2020.1752351
33. Advisory Council on the Misuse of Drugs (ACMD). COVID-19: ACMD advice
on proposed legislative changes to enable supply of controlled drugs during a
pandemic (April 2020). https://www.gov.uk/government/publications/acmd-
advice-on-covid-19-emergency-legislation-to-enable-supply-of-controlled-
drugs (Accessed May 21, 2020).
34. Substance Abuse and Mental Health Services Administration (SAMHSA).
FAQs: Provision of methadone and buprenorphine for the treatment of opioid
use disorder in the COVID-19 emergency (2020). https://www.samhsa.gov/
sites/default/les/faqs-for-oud-prescribing-and-dispensing.pdf (Accessed
May19, 2020).
35. Levander XA, Wakeman SE. Covid-19 will worsen the opioid overdose crisis is
we don"t prepare now (2020). STAT. https://www.statnews.com/2020/03/17/
covid-19-will-worsen-the-opioid-overdose-crisis-if-we-dont-prepare-now/
(Accessed May 25, 2020).
36. Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. New
Engl J Med (2020) 382(18):167981. doi: 10.1056/NEJMp2003539
37. Levine DA. Pharming: the abuse of prescription and over-the-counter drugs
in teens. Curr Opin Pediatr (2007) 19(3):2704. doi: 10.1097/
MOP.0b013e32814b09cf
38. Reeves RR, Ladner ME, Perry CL, Burke RS, Laizer JT. Abuse of medications
that theoretically are without abuse potential. South Med J (2015) 108(3):151
7. doi: 10.14423/smj.0000000000000256
39. Schifano F. Recent Changes in Drug Abuse Scenarios: The New/Novel
Psychoactive Substances (NPS) Phenomenon. Brain Sci (2018) 8(12):221.
doi: 10.3390/brainsci8120221
Chiappini et al. COVID-19: Impact on Mental Health and Drug
Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7673
40. Becker WC, Fiellin DA. When Epidemics Collide: Coronavirus Disease 2019
(COVID-19) and the Opioid Crisis. Ann Intern Med (2020) 173(1):5960.
doi: 10.7326/M20-1210
41. Simeone R. Doctor Shopping Behavior and the Diversion of Prescription
Opioids. Subst Abuse (2017) 11:1178221817696077. doi: 10.1177/
1178221817696077
42. Kawohl W, Nordt C. COVID-19, unemployment, and suicide. Lancet
Psychiatry (2020) 7(5):38990. doi: 10.1016/S2215-0366(20)30141-3
43. Klomek AB. Suicide prevention during the COVID-19 outbreak. Lancet
Psychiatry (2020) 7(5):390. doi: 10.1016/S2215-0366(20)30142-5
Conict of Interest: The authors declare that the research was conducted in the
absence of any commercial or nancial relationships that could be construed as a
potential conict of interest.
Copyright © 2020 Chiappini, Guirguis, John, Corkery and Schifano. This is an open-
access article distributed under the termsof the Creative Commons Attribution License
(CC BY). The use, di stribution or reproduction in other forums is permitt ed, provided
the original author(s) and the copyright owner(s) are credited and that the original
publication in this journal is cited, in accordance with accepted academic practice. No
use, distribution or reproduction is permitted which does not comply with these terms.
Chiappini et al. COVID-19: Impact on Mental Health and Drug
Frontiers in Psychiatry | www.frontiersin.org July 2020 | Volume 11 | Article 7674
... factors, such as a lack of appropriate personal protective equipment, a reduction in human resources, and relentless work shifts, fear of becoming infected and infecting family members, high mortality rates, grief over the loss of patients and colleagues, and separation from families. [3] Women in the first-line medical staff at a Tertiary Infectious Disease Hospital for COVID-19 were more likely than men to suffer from anxiety and post-traumatic symptoms, according to a Chinese study, and nurses were more prevalent than doctors [4] In COVID-19 patients, PTSD was observed in 28% of recovered patients, as well as depression, anxiety, sleeplessness, and OC symptoms in 40% of those who were still awake after treatment in an Italian study. Over half (56%) of participants had results that fell outside of the usual range in some way. ...
... Some people took their own lives as a result of these mental health issues (e.g., suicide attempts, actual suicide and suicidal ideation). [3] High levels of stress, loneliness, and unemployment due to the COVID-19 pandemic could lead to up to 75,000 "fatalities of despair," including drug, alcohol, and suicide deaths, according to a new report by the Well Being Trust. [6] It's vital to examine the psychopathology of COVID-19 survivors, frontline workers, and the general population, especially those with pre-existing mental health concerns, after the pandemic spreads. ...
... There are a number of strategies needed to combat the addiction issue during the COVID-19 Pandemic, including easy access to de-addiction centres, telemedicine, social support, and virtual peer groups. [3,8,9] ...
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Background Fatal drug overdoses in the USA hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. Methods Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. Results Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. Conclusions Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.
... Most prior studies targeting the effects of infectious outbreaks on mental health have centered on fear, isolation, and addictions (Chiappini et al., 2020), which are considered more typical outcomes of life-changing events. The COVID-19 pandemic, however, seemed to carry an added stigma and burden for many Asians. ...
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The United States (U.S.) has a long history of racism and xenophobia, especially around infectious outbreaks. Recently, the associations of COVID-19 to China and Chinese people have been reflected in a surge of anti-Asian sentiment and hate crimes. Therefore, the present study examines the perceived change in everyday racism among Asians in the U.S. during the COVID-19 outbreak. This study used self-report surveys to assess the perceptions of everyday racism before and during the pandemic among Asians, Latinxs, and Whites residing in the U.S. We tested a 3 (race [Asians vs. Latinxs vs. Whites]) × 2 (perceptions [before vs. during pandemic]) analysis of covariance with repeated measures for perceptions to determine whether there were differences between racial groups for everyday racism before and during the COVID-19 pandemic. Findings strongly indicate that Asians in the U.S. perceived a change in everyday racism during the COVID-19 pandemic compared to Latinxs and Whites. Exploratory findings show that East and Southeast Asians, in particular, experienced the steepest perceived increase in everyday racism. Anti-Asian sentiment seems to have intensified in the U.S. during the COVID-19 pandemic, as evident in the rise of everyday racism against Asians. These experiences may serve as additional stressors for Asians in the U.S. during these already distressing times and disproportionately impact East and Southeast Asians. Implications for theory, research, and practice are discussed.
... Compared to the presence of mental illness and SUD alone, DD is associated with delayed diagnosis, worsening prognosis, and higher complications, including greater exacerbation of psychiatric symptoms, medication nonadherence, and increased aggressive and violent behaviour [1,4,5]. Moreover, patients with DD have fared poorly upon recent Coronavirus Disease (CoViD)-19 restrictions and increased gaps in medical management [6][7][8]. The interaction between substance abuse and mental symptoms is complex and depends on the type of mental health problem and the type and amount of substance used. ...
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Background Concurrent disorder or dual diagnosis refers to a combination of substance use disorders and mental disorders that occur in the same patient simultaneously. These conditions pose significant clinical and healthcare impacts and are often underdiagnosed, undertreated, and complex to manage. Objective We assessed the quality of current pharmacological recommendations for the management of dual diagnosis, particularly by evaluating the use of second-generation antipsychotics (SGA). Method A literature search was performed using the PubMed and Scopus databases for publications up to September 21, 2021, without any time restrictions. The following search strings were used: (aripiprazole OR brexpiprazole OR cariprazine OR paliperidone OR risperidone OR quetiapine OR clozapine OR olanzapine) AND (psychosis OR schizophrenia OR schizoaffective) AND (“substance use disorder” OR cocaine OR alcohol OR cannabis OR heroin OR “double diagnosis” OR “dual diagnosis”)) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). Results The search produced a final set of 41 articles. Most patients were males and were affected by schizophrenia, with cannabis the most abused substance, followed by alcohol. Aripiprazole was the most used drug, either orally or by long-acting formulations, followed by risperidone with oral and long-acting formulations, clozapine, olanzapine, and quetiapine. Conclusion The findings highlight the use of SGA for the treatment of psychotic symptoms in comorbidity with substance use. Future studies on people with dual diagnosis and focused on long-term evaluations are warranted and need to investigate the efficacy of newly introduced molecules, such as partial D2 agonists and long-acting injectable antipsychotics.
... When the COVID-19 pandemic spread to the United States in early 2020 (Centers for Disease Control and Prevention [CDC], 2020), not only did it cause record high levels of unemployment (Falk et al., 2021) in addition to a significant increase in mental health problems (Chiappini et al., 2020), but also, schools and universities were faced with the daunting task of abruptly transitioning from in-person to virtual learning. For graduate students training in clinical psychology, the sudden transition to a virtual setting meant a decrease in hours spent training at their clinical practica, with some practicum sites losing training positions completely due to the financial and occupational impact of the pandemic (Ramos, 2021). ...
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İşletmelerin adil satış fiyatlarıyla satışlarını artırarak karlılığa ulaşması istenen ve beklenen bir durumdur. Aksi durumda haksız ve yanıltıcı birtakım yöntemlerle etik dışı fiyat uygulamaları tüketicilere zarar vermektedir. Birçok ülkede bu tür durumların tespit edilmesi halinde satıcılara yönelik hukuki yaptırımlar bulunmaktadır. Bu çalışmanın amacı, tüketicilere uygulanan etik dışı fiyat uygulama yöntemleri ve bu konuda Türkiye’de mevcut olan hukuki düzenlemeler hakkında okuyucuların dikkatini çekmek ve farkındalık düzeylerini arttırmaktır. Bu çalışmada etik dışı fiyat uygulamaları kapsamında sıklıkla karşılaşılan raf ve kasa fiyatı uyumsuzluğu, yalancı indirimler, aşırı fiyatlamalar, küsuratlı fiyatlamalar, fiyat farklılaştırması, birim fiyatlandırma, gramaj hileleri, karaborsacılık hakkında ikincil kaynaklar Belge Tarama yöntemi ile toplanarak doküman ve söylem analizine tabi tutulmuştur. Bu çalışma tüketicilerin alışveriş esnasında fiyat, kalite, gramaj, etiket, indirim vb. hususlarda dikkatli olmaları gerektiğine işaret etmektedir. Tüketicilerin iddia edilenlerin ne kadar doğru ve güvenilir olduğuna ikna olmaları gerektiği ilgili literatürden anlaşılmaktadır. Bu çalışmada, tüketicilerin satın aldıkları ürünler konusundaki bilinçlerinin yüksek olmasının ne kadar önemli olduğu bir kez daha ortaya çıkmıştır. Bu yönüyle araştırmanın alışveriş yapan tüketicilere yararlı olacağı beklenmektedir. Tüketicilerin ürünlerin fiyatları konusunda dikkatli davranmaları, aceleci olmamaları şüphelendikleri durumlarda kendi denetimlerini kendilerinin yapması gerektiğine işaret edilmiştir.
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Background: Health care provision during the COVID-19 pandemic and confinement has led to significant changes in the activity of addiction centers. These changes in healthcare activity may have had a greater impact on patients with dual pathology. The aim of this study is to compare the treatment indicators of patients with dual pathology in addiction centers during the pre-confinement, confinement, and post-confinement periods. Methods: A retrospective observational study was conducted for the period between 1 February 2019 and 30 June 2021. A total of 2785 patients treated in specialized addiction services were divided into three periods according to their time of admission: pre-confinement, confinement, and post-confinement. Results: During the pre-pandemic period, the addiction centers attended to an average of 121.3 (SD = 23.58) patients, decreasing to 53 patients during confinement (SD = 19.47), and 80.69 during the post-confinement period (SD = 15.33). The number of appointments scheduled monthly for each patient decreased during the confinement period, although this number increased after confinement. There was a reduction in the number of toxicological tests carried out both during and after confinement (except for alcohol). Conclusions: The results show a reduction in the number of patients seen and the care activity delivered to dual diagnosis patients. These results, which were caused by the COVID-preventive measures, may affect the progress and recovery of dual patients. A greater investment is needed to bring the care activity up to the standards of the years prior to confinement.
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Backgroud COVID-19 pandemic has significantly affected the sleep health of local medical and nursing staff. Aim We used wearable pulse oximeters to monitor and screen the medical and nursing staff working in hospitals designated for COVID-19 in the Wuhan area. This study aimed to establish a reliable basis to provide sleep intervention for the medical and nursing staff. Methods Thirty medical and nursing staff members with symptoms of insomnia were instructed to wear medical ring-shaped pulse oximeters to monitor their sleep overnight. We also used the Insomnia Severity Index (ISI) and the Chinese version of the Self-Reporting Questionnaire (SRQ-20) to evaluate the severity of insomnia and mental health status, respectively, for each participant. Results Among the 30 participants, only 26 completed the screening. Ten cases (38.5%) demonstrated moderate to severe sleep apnoea–hypopnea syndrome (SAHS) when using an oxygen desaturation index ≥15 times/hour as the cut-off value. Participants with comorbid moderate to severe SAHS had significantly higher ISI and SRQ scores (p values 0.034 and 0.016, respectively) than those in the insomnia group. Correlation analysis revealed that ISI was positively correlated with total sleep time (TST) (r=0.435, p=0.026), and negatively correlated with deep sleep (r=−0.495, p=0.010); furthermore, patient SRQ scores were positively correlated with TST, sleep efficiency (SE) and REM (rapid eyes movement) sleep % (r=0.454 and 0.389, 0.512; p=0.020, 0.050 and 0.008, respectively). Stepwise logistic regression indicated that SRQ-20 and sex were risk factors for insomnia with comorbid SAHS, and their OR values were 1.516 and 11.56 (95% CI 1.053 to 2.180 and 1.037 to 128.9), respectively. Conclusion Medical and nursing staff with insomnia showed clear signs of comorbid sleep apnoea attributable to stress. The wearable pulse oximeters accurately monitored the participants’ breathing when asleep.
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BACKGROUND The aim of this study was to understand the changes in psychological factors and sleep status of front-line medical staff in the fight against COVID-19 and provide evidence of exercise interventions to relieve psychological stress and improve sleep status for medical staff. MATERIAL AND METHODS A survey study was conducted among 120 front-line medical staff in the fight against COVID-19, of which 60 medical staff worked at the designated hospital (experimental group) and 60 medical staff worked at the non-designated hospital (control group). The Symptom Checklist 90 (SCL-90), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and PTSD Checklist-Civilian Version (PCL-C) were used to assess mental status. Sleep status was assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS SCL-90 scores of somatization, depression, anxiety, and terror were higher than normal in front-line medical staff at the designated hospital. The SAS (45.89±1.117), SDS (50.13±1.813), and PCL-C (50.13±1.813) scores in the experimental group were higher than the normal control group, and were significantly different from those in the control group on SDS and PCL-C scales (P<0.05). The total average PSQI of the experimental group was 16.07±3.761, indicating that the sleep quality was poor. Among them, participants with moderate insomnia reached 61.67%, and participants with severe insomnia reached 26.67%. CONCLUSIONS There are psychological symptoms and sleep symptoms in front-line medical staff who participate in the fight against COVID-19, and they affect each other. Hospitals should improve emergency management measures, strengthen psychological counseling for clinical front-line medical staff, strengthen exercise intervention, and improve their sleep quality and mental health.
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Covid-19: The implications for suicide in older adults - Anne Pamela Frances Wand, Bao-Liang Zhong, Helen Fung Kum Chiu, Brian Draper, Diego De Leo
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The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource.
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Many Indian COVID-19 suicide cases are turning the press-media attentions and flooding social media platforms although, no particular studies assessed the COVID-19 suicide causative factors to a large extent. Therefore, the present study presents 72 COVID-19 suicide cases (aged 19 to 65 years; 55 cases were males). The suicide causalities are included as follows – fear of infection (16-cases), quarantine related issues (whereas no specific reasons were reported in 9 cases and rest causalities were heterogenous), COVID-19 related stress (n=9), tested positive for COVID-19 (n=7), isolation related issues (n=5) and migrant unable to return home (n=3) etc. Considering the extreme psychological impacts related to COVID-19, there emerges a need for countrywide extensive tele-mental health care services.
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There are many reasons for COVID-19-related suicides including the fear of getting the disease, the fear of passing the disease onto others, mental instability (e.g., depression, anxiety and/or stress) as a consequence quarantine, isolation, economic hardship, and the unavailability of food and alcohol based on published reports (Dsouza et al., 2020; Goyal et al., 2020; Mamun & Griffiths, 2020a; Mamun & Ullah, 2020; Thakur & Jain, 2020). However, another worrying type of suicide cases concerns couples dying together that are related to COVID-19, the majority of which concern suicide pacts by couples. Here, we present six cases in chronological order of couple suicides and attempted suicides relating to COVID-19 comprising 12 individuals from four countries (i.e., Bangladesh, India, Malaysia, and the US).
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This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale- Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p<0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p<0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p<0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.