Managing COVID + ve patients on inpatient adolescent psychiatry unit- A unique challenge

Abstract

The Corona virus disease 2019 (COVID-19) has had a profound impact on the physical as well as mental well-being of people around the globe. The response to and resulting consequences of the COVID-19 pandemic poses significant challenges for patients suffering from mental health disorders as demonstrated by a recent study by Xie et al. examining adult COVID-19 patients admitted for inpatient psychiatric treatment for first-episode mental health issues [1]. Children, too, have the potential to experience adverse mental health outcomes due to distress resulting from the pandemic: a study by Jolly et al. examined recently surfacing reports on varied presentations of pediatric patients undergoing hospitalization in psychiatry hospitals in context of COVID-19. One major source of stress is the institution of widespread social distancing practices as schools have transitioned to partial or full-time virtual learning [2]. In addition, extracurricular activities have undergone restrictions or been canceled entirely and in-person contact with peers and other important social supports has been limited. These changes place strain on children which can lead to distress and worsening mental health outcomes [2]. The pandemic has also caused significant economic stress for many families. Increased unemployment, forced changes in interpersonal interactions, the wide-ranging effects caused by the safety measures being taken in response to COVID-19, and even concern over COVID-19-related illness or death itself may directly impact the mental health of children as well as indirectly impacting their mental health due to increased stress experienced by parents and the family as a whole [2]. Moreover, children who become COVID-positive and are subject to specific safety protocols in their care are under additional pressure that can further exacerbate mental health problems related and unrelated to the COVID-19 pandemic. There have been limited studies evaluating the treatment of COVID-19 pediatric patients admitted for the treatment of mental health disorders [3,4]. Here we present two cases of COVID-positive pediatric patients in an inpatient psychiatric facility and how the milieu was changed around them.

Masked Tardive Dyskinesia in the Coronavirus Disease 2019 Era

“…The universal donning of masks led to a decreased ability to read people's facial expressions [1]. In this context, it is prudent to think about how diagnoses can be missed or worsened by the practice of mandatory masking [2]. Since the pandemic, children have experienced increased depression, anxiety, and stress that may lead to increased suicidal behavior.…”

“…In childhood, it is associated with several symptoms such as inattention, hyperactivity, and impulsivity. Symptoms may change or evolve as a person gets older with an increased risk of developing psychiatric comorbidities such as depression, anxiety, and substance addiction [2]. Pharmacotherapy is the most common intervention for ADHD.…”