Journal of psychiatric practice
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This case report describes a unique presentation of Cotard syndrome in an 18-year-old female patient experiencing first-episode psychosis. Cotard syndrome was first described in 1880 by Jules Cotard as a novel subtype of anxious depression and is presently understood as a rare cluster of mood and psychotic symptoms centered on nihilistic delusions including the absence of organs and a perception of being dead. Although rare, Cotard syndrome has been described in a variety of neurological and psychiatric illnesses, but it is most commonly seen in middle-aged adults with a history of chronic mood disorders. ⋯ The patient displayed limited improvement over the first week of treatment with quetiapine but improved rapidly during the second week of hospitalization after a medication change to risperidone. The patient's rapid response to risperidone is unique, as most existing evidence suggests that electroconvulsive therapy is the most effective treatment for Cotard syndrome. This response indicates an opportunity for the implementation of a second-generation antipsychotic medication in patients with Cotard syndrome in areas where electroconvulsive therapy is not available.
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The COVID-19 pandemic and its need for social distancing as a response have the potential to increase the experience of loneliness in the population, with an associated increase in symptoms of mental disorders. As the world has largely adapted to remote platforms for employment, socializing, and health service delivery, the degree to which virtual opportunities for social engagement may offset the impact of limited in-person interactions on mental health functioning is unknown. This column offers preliminary data from an ongoing experience sampling study of the prevalence, course, and impact of loneliness on mental health in a community adult sample living under social distancing requirements during the COVID-19 pandemic. ⋯ In addition, respondents reported frequent instances of negative effects on physical and mental health, including disruptions in sleep and recurring suicidal ideation. While further analyses are needed, these findings are consistent with similar emerging reports showing increased rates of mental health concerns during periods of social distancing. Possible avenues for addressing these concerns using remote interventions are explored.
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This article explains how the mortality rate of an illness such as Coronavirus Disease 2019 (COVID-19) is calculated as well as how the definition of what is a "case" has changed from the earliest days of the pandemic to now. Many factors were not known about The Sudden Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) which causes COVID-19 at the beginning of the pandemic because it is a novel human pathogen. One key factor that was not known in the earliest days of the pandemic was that many patients are either asymptomatic or have symptoms so mild that they may not seek medical attention and hence these patients would not be identified as a "case" if that term is defined as being sufficiently symptomatic to be seeking medical attention. ⋯ The mortality rate of this virus dropped as a function of this change. On the basis of the results of an unintended, naturalistic experiment on an expeditionary cruise in March of 2020, there was more than a 5-fold drop in the calculated mortality rate due to this definitional change in what constituted a case. This column explains this issue and discusses its implications for effectively dealing with the SARS-CoV-2 (or COVID-19) pandemic.
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The goal of this column is to help mental health care professionals understand coronavirus disease 2019 (COVID-19) so that they can better explain the complexities of the current crisis to their patients. The bottom-line of this column is that, while COVID-19 can infect virtually everyone in the human population, only about 5% are susceptible to severe infection requiring admission to an intensive care unit and/or causing a fatal outcome and this population can be identified on the basis of comorbid medical illness and/or age. These numbers are based on experience in China, the United States, and Europe. ⋯ Taking the data on high-risk individuals into account would allow for a gradual lifting of restrictions on the majority of the population while maintaining more stringent safeguards to protect the vulnerable portion of the population. Nevertheless, the entire population would need to continue to practice good hygiene and social distancing while simultaneously-and perhaps even more vigorously-focusing on sheltering the vulnerable population until adequate community immunity has been achieved to prevent the spread of the virus, whether that is accomplished through natural exposure alone or with the addition of safe and effective vaccine(s) which may not be available for a year. Continued widespread testing for antibodies will help determine how far or close this country is-and other countries are-from developing effective community immunity.
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The United States is currently experiencing an opioid epidemic, as drug overdose deaths have become a leading cause of death. According to the Centers for Disease Control, in 2017, opioids were responsible for 47,000 deaths, which involved both illicit and prescription opioids. ⋯ The purpose of this program was to train patients and their families on how to respond to an opioid overdose and administer naloxone spray. The paper describes the implementation of this program.