key: cord-0733155-gy90nvir authors: Rohde, C.; Hougaard Jefsen, O.; Noerremark, B.; Aalkjaer Danielsen, A.; Dinesen Ostergaard, S. title: Psychiatric Symptoms Related to the COVID-19 Pandemic date: 2020-04-23 journal: nan DOI: 10.1101/2020.04.16.20067744 sha: 4575bdc896422190e0a6a203bc306c39a2e895f4 doc_id: 733155 cord_uid: gy90nvir The COVID-19 pandemic and the consequential societal changes are likely to have major health consequences way beyond those caused by the virus infection. One of the medical fields that may experience significant consequences of the pandemic is that of psychiatry. Importantly, individuals who already live with mental disorders may be particularly vulnerable to the psychological stress associated with the pandemic. However, data on how the COVID-19 pandemic affects this group of people is largely absent from the literature. Here, we report data from a quality development project conducted at the psychiatric services of the Central Denmark Region (CDR), which has a catchment area of approximately 1.3 million people covered by five psychiatric hospitals providing inpatient and outpatient treatment of all types of mental disorders. Based on a manual screening of all clinical notes from the period from February 1st to March 23rd 2020 that contained at least one of the following words: corona, COVID, virus, epidemic, pandemic, and contaminate/contamination (including compound words), we found 1357 notes from 918 adult patients that described pandemic-related psychopathology (symptoms that appeared to be caused/deteriorated by the pandemic and/or its societal consequences). To our knowledge, this is the first investigation of COVID-19 pandemic-related psychopathology from a large psychiatric treatment setting. The results clearly suggest that this phenomenon exists among individuals with mental illness. However, as the data from this investigation stems from standard clinical practice where the patients were not systematically assessed for pandemic-related psychopathology, we cannot speak to its overall prevalence. Nevertheless, we believe that our findings underline the necessity of taking urgent action to mitigate the negative effects of the COVID-19 pandemic on patients with mental disorders. A low-cost intervention would be to simply discuss the ongoing pandemic and its societal consequences with patients seeking care in psychiatric settings - as this may lead to relief of pandemic-related symptoms via general comforting, and clarification of misunderstandings/false beliefs regarding the pandemic. The COVID-19 pandemic and the consequential societal changes are likely to have major health consequences way beyond those caused by the virus infection. 1 One of the medical fields that may experience significant consequences of the pandemic is that of psychiatry. [2] [3] [4] Importantly, individuals who already live with mental disorders may be particularly vulnerable to the psychological stress associated with the pandemic. 4 However, data on how the COVID-19 pandemic affects this group of people is largely absent from the literature. Here, we report data from an investigation conducted at the psychiatric services of the Central Denmark Region (CDR), which has a catchment area of approximately 1.3 million people covered by five psychiatric hospitals providing inpatient and outpatient treatment of all types of mental disorders. Based on clinical observation and evidence of the psychological effects of both the current 5 and past 2 pandemics, we hypothesized that we would find examples of "pandemic-related" symptoms (deterioration) of anxiety, obsessive-compulsive disorder, depression and psychotic disorders (e.g. schizophrenia). We extracted all clinical notes from the period from February 1 st to March 23 rd 2020 (first verified case of COVID-19 in Denmark was reported on February 26 th 2020) 6 from the electronic medical record system used by the psychiatric services of the CDR for individuals (patients) aged 18 or above. Subsequently, we conducted an electronic search for clinical notes containing at least one of the following words: "corona", "COVID", "virus", "epidemic", "pandemic", and "contaminate/contamination" (including compound words). Then, all clinical notes containing these words were screened manually to determine whether they described symptoms that seemed plausibly related to the COVID-19 pandemic. Finally, the clinical notes describing pandemic-related psychiatric symptoms were labeled according to the most dominant psychopathology. For a more detailed description of the methods, see the Supplementary Material. In the period from February 1 st to March 23 rd there were 412,804 clinical notes reporting on a total of 14,561 adult patients in the psychiatric services of the CDR. In this dataset, the electronic search resulted in 11,072 notes from 5796 patients that contained at least one of the six COVID-19 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 23, 2020. . https://doi.org/10.1101/2020.04.16.20067744 doi: medRxiv preprint pandemic-related words mentioned above. The subsequent manual screening showed that while the majority of these notes described logistics (e.g. "The appointment was rescheduled to a phone consultation due to the risk of COVID-19"), 1357 of the notes from 918 patients (621 females with a mean age of 36.3 years (SD=14.3) and 297 males with a mean age of 40.9 years (SD=13.8)) described pandemic-related symptoms. The main diagnoses of these patients and the type of pandemic-related psychopathology described in the notes are reported in Figure 1 , which also shows the cumulative incidence of i) patients with pandemic-related psychopathology, ii) clinical notes describing pandemic-related psychopathology, and iii) confirmed cases of COVID-19 in To our knowledge, this is the first investigation of COVID-19 pandemic-related psychopathology from a large psychiatric treatment setting. The results clearly suggest that this phenomenon exists among individuals with mental illness. However, as the data from this investigation stems from standard clinical practice where the patients were not systematically assessed for pandemic-related psychopathology, we cannot speak to its overall prevalence. Nevertheless, we believe that our findings underline the necessity of taking urgent action to mitigate the negative effects of the COVID-19 pandemic on patients with mental disorders. A low-cost intervention would be to simply discuss the ongoing pandemic and its societal consequences with patients seeking care in psychiatric settings -as this may lead to relief of pandemic-related symptoms via general comforting, and clarification of misunderstandings/false beliefs regarding the pandemic. This project is supported by an unconditional grant from the Novo Nordisk Foundation (Grant number: NNF20SA0062874). None. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 23, 2020. . The nationwide lockdown announced on March 11th 2020 involved closure of kindergartens, schools, teaching institutions, restaurants, bars and many other small businesses. On March 23 rd 2020, the lockdown was extended to April 14 th 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 23, 2020. . https://doi.org/10.1101/2020.04.16.20067744 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 23, 2020. . https://doi.org/10.1101/2020.04.16.20067744 doi: medRxiv preprint World Health Organization webpage on the novel coronavirus The psychological impact of quarantine and how to reduce it: rapid review of the evidence Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness Suicide Mortality and Coronavirus Disease 2019-A Perfect Storm? JAMA Psychiatry Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China Danish State Serum Institute webpage containing COVID-19 data from Denmark