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Background This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. Methods Patients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. Outcome The most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. Conclusion This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.

Background This study describes neuropsychological, medical, psychiatric and functional correlates of cognitive complaints experienced after recovery from acute COVID-19 infection. Methods Sixty participants underwent neuropsychological (NP), psychiatric, medical, functional, and quality of life assessments 6-8 months after acute COVID-19. Those seeking care cognitive complaints in a post-COVID-19 clinical program for Post-Acute Symptoms of COVID-19 (PASC) (Clinical Group, N=32) were compared to those recruited from the community who were not seeking care (Non-Clinical, N=28). A subset of participants underwent serological testing for pro-inflammatory cytokines C-Reactive Protein, Interleukin-6, and Tumor Necrosis Factor-α in order to explore correlations with neuropsychological, psychiatric and medical variables. Outcome For the entire sample, 16 (27%) had extremely low test scores (< 2 nd %ile on at least 1 NP test). The Clinical Group with cognitive complaints scored lower than age-adjusted population norms in tests of attention, processing speed, memory, and executive function, and significantly more scored in the extremely low range than the Non-Clinical Group (38% vs. 14%, p<0.04). The Clinical Group also reported higher levels of depression, anxiety, fatigue, PTSD and functional difficulties and lower quality of life. In logistic regression analysis, scoring in the extremely low range was predicted by acute COVID-19 symptoms, current depression score, number of medical comorbidities and subjective cognitive complaints in the areas of memory, language, and executive functions. IL-6 correlated with acute COVID symptoms, number of medical comorbidities, fatigue, and measures of executive function. CRP correlated with current COVID symptoms, depression score and, inversely, with quality of life. Conclusion Results suggest the existence of extremely low neuropsychological test performance experienced by some individuals months after acute COVID-19 infection, affecting multiple neurocognitive domains. This extremely low neuropsychological test performance is associated with worse acute COVID-19 symptoms, depression, medical comorbidities, functional complaints, and subjective cognitive complaints. Exploratory correlations with pro-inflammatory cytokines support further research into inflammatory mechanisms and viable treatments.

This report describes the development, implementation and outcomes of a "COVID-19 Anxiety Hotline," designed to address the community's mental health crisis provoked by the coronavirus pandemic. The service was specifically designed using survey data regarding the effects of the COVID-19 pandemic on its staff and community members. Callers had aroundthe-clock direct access to mental healthcare providers at no cost. Quantitative analysis showed that nearly three out of four callers experienced new onset anxiety and insomnia driven by fear of exposure, and had difficulty accessing mental health care. In addition to immediate support, referral to tele-mental health care was provided to 86% of callers. Qualitative analysis indicates the effectiveness of immediate support and appropriate referrals using a tele-health platform. Our report indicates that the service was utilized by the general population, by health care workers, and rapidly provided referrals to individuals with limited access to mental health care during the pandemic.

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