On March 11th, 2020, the outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic. Governments took drastic measures in an effort to reduce transmission rates and virus-associated morbidity. This study aims to present the immediate effects of the pandemic on patients presenting in the psychiatric emergency department (PED) of Hannover Medical School. Patients presenting during the same timeframe in 2019 served as a control group. A decrease in PED visits was observed during the COVID-19 pandemic with an increase in repeat visits within 1 month (30.2 vs. 20.4%, pBA = 0.001). Fewer patients with affective disorders utilized the PED (15.2 vs. 22.2%, pBA = 0.010). Suicidal ideation was stated more frequently among patients suffering from substance use disorders (47.4 vs. 26.8%, pBA = 0.004), while patients with schizophrenia more commonly had persecutory delusions (68.7 vs. 43.5%, pBA = 0.023) and visual hallucinations (18.6 vs. 3.3%, pBA = 0.011). Presentation rate of patients with neurotic, stress-related, and somatoform disorders increased. These patients were more likely to be male (48.6 vs. 28.9%, pBA = 0.060) and without previous psychiatric treatment (55.7 vs. 36.8%, pBA = 0.089). Patients with personality/behavioral disorders were more often inhabitants of psychiatric residencies (43.5 vs. 10.8%, pBA = 0.008). 20.1% of patients stated an association between psychological well-being and COVID-19. Most often patients suffered from the consequences pertaining to social measures or changes within the medical care system. By understanding how patients react to such a crisis situation, we can consider how to improve care for patients in the future and which measures need to be taken to protect these particularly vulnerable patients.

Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.

Objectives: Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60 years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Methods: Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. Results: 230 patients (63.0% female, mean age 73.7 � 8.4 years, median length of stay 18 days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180).The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R 2 = 0.747). Conclusion:An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy.The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.

ZUSAMMENFASSUNG Hintergrund Im Zuge der zunehmenden Bürokratisierung des Arztberufs drohen Kernaufgaben der klinischen ärztlichen Tätigkeit in den Hintergrund zu geraten. Bürokratische Aufgaben können zu einer vermehrten Arbeitsbelastung des ärztlichen Personals und zu einer Gefährdung der Patientensicherheit führen. Dennoch liegen kaum Daten zur ärztlichen Arbeitsbelastung durch bürokratische Tätigkeiten vor. Das vorliegende Pilotprojekt soll einen Beitrag zur Schließung dieser Datenlücke leisten. Methodik Am Beispiel medizinischer Begründungen (MBEG) in der klinischen Psychiatrie wurde über einen 6-Monats-Zeitraum untersucht, wie viel Arbeitszeit im Klinikalltag für bürokratische Tätigkeiten aufzuwenden ist. Insgesamt wurden 66 MBEG für 42 Patienten erstellt und ausgewertet. Ergebnisse Pro Kalenderwoche wurden 2,6 ± 2,2 MBEG (Mittelwert ± Standardabweichung) erstellt, bei einer geschätzten durchschnittlichen Bearbeitungszeit von 22 Minuten pro MBEG. Für knapp 30 % der MBEG war mindestens eine halbe Stunde Arbeitszeit bis zur Fertigstellung erforderlich. Ungefähr ein Viertel aller MBEG-Anfragen war fehlerhaft zugeordnet oder es handelte sich um bereits beantwortete Anfragen. Schlussfolgerung Die aus einem Übermaß an Bürokratie resultierende Mehrarbeit kann ein Risiko für die Gesundheit des ärztlichen Personals darstellen und die Patientensicherheit kompromittieren. Maßnahmen zum Bürokratieabbau, z. B. mithilfe technischer Lösungen, sollten umgesetzt werden.