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in category psychiatry and clinical psychology

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1: No safe level of alcohol consumption for brain health: observational cohort study of 25,378 UK Biobank participants
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Posted 12 May 2021

No safe level of alcohol consumption for brain health: observational cohort study of 25,378 UK Biobank participants
99,820 downloads medRxiv psychiatry and clinical psychology

Anya Topiwala, Klaus P. Ebmeier, Thomas Maullin-Sapey, Thomas E Nichols

Objectives To estimate the relationship between moderate alcohol consumption and brain health, determining the threshold intake for harm and identifying whether population subgroups are at differential risk. Design Observational cohort study. Alcohol consumption was determined at baseline assessment visit using touchscreen questionnaire (2016-10). Multi-modal MRI brain and cognitive testing were performed subsequently (2014-20). Clinical data was extracted from linked Hospital Episode Statistics. Setting UK Biobank study. Brain imaging was performed on identical scanners with identical protocols at three UK centres (2014-20). Participants 25,378 participants (mean age 54.9, s.d.=7.4 years). Main outcome measures Brain health as defined by structural and functional MRI brain measures. Results Alcohol consumption was negatively linearly associated with global brain grey matter volume (beta= -0.1, 95%CI= -0.11 to -0.09, p<2x10-16). The association with alcohol was stronger than other modifiable factor tested and robust to unobserved confounding. Widespread negative associations were observed with white matter microstructure (beta= -0.08, 95%CI= -0.09 to -0.06, p<2x10-16) and positive correlations with functional connectivity. Higher blood pressure and body mass index increased risk of alcohol-related harm (SBP*alcohol: beta= -0.01, 95%CI = -0.02 to -0.004, p=0.005; BMI*alcohol: beta= -0.01, 95%CI = -0.02 to -0.002, p=0.02). Binging on alcohol had additive negative effects on brain structure on top of the absolute volume consumed (daily compared to never binging: beta= -0.19, 95%CI= -0.30 to -0.08, p<0.01). No evidence was found for differential effects of drinking wine, beer or spirits. Conclusions No safe dose of alcohol for the brain was found. Moderate consumption is associated with more widespread adverse effects on the brain than previously recognised. Individuals who binge drink or with high blood pressure and BMI may be more susceptible. Detrimental effects of drinking appear to be greater than other modifiable factors. Current low risk drinking guidelines should be revisited to take account of brain effects.

2: Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study
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Posted 21 Oct 2020

Cognitive deficits in people who have recovered from COVID-19 relative to controls: An N=84,285 online study
57,198 downloads medRxiv psychiatry and clinical psychology

Adam Hampshire, William Trender, Samuel R Chamberlain, Amy Jolly, Jon E. Grant, Fiona Patrick, Ndaba Mazibuko, Steve CR Williams, Joseph M Barnby, Peter J. Hellyer, Mitul A Mehta

Case studies have revealed neurological problems in severely affected COVID-19 patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of severity. We analysed cognitive test data from 84,285 Great British Intelligence Test participants who completed a questionnaire regarding suspected and biologically confirmed COVID-19 infection. People who had recovered, including those no longer reporting symptoms, exhibited significant cognitive deficits when controlling for age, gender, education level, income, racial-ethnic group and pre-existing medical disorders. They were of substantial effect size for people who had been hospitalised, but also for mild but biologically confirmed cases who reported no breathing difficulty. Finer grained analyses of performance support the hypothesis that COVID-19 has a multi-system impact on human cognition. Significance statementThere is evidence that COVID-19 may cause long term health changes past acute symptoms, termed long COVID. Our analyses of detailed cognitive assessment and questionnaire data from tens thousands of datasets, collected in collaboration with BBC2 Horizon, align with the view that there are chronic cognitive consequences of having COVID-19. Individuals who recovered from suspected or confirmed COVID-19 perform worse on cognitive tests in multiple domains than would be expected given their detailed age and demographic profiles. This deficit scales with symptom severity and is evident amongst those without hospital treatment. These results should act as a clarion call for more detailed research investigating the basis of cognitive deficits in people who have survived SARS-COV-2 infection.

3: Increased rate of joint hypermobility in autism and related neurodevelopmental conditions is linked to dysautonomia and pain
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Posted 15 Sep 2020

Increased rate of joint hypermobility in autism and related neurodevelopmental conditions is linked to dysautonomia and pain
12,902 downloads medRxiv psychiatry and clinical psychology

Jenny L L Csecs, Valeria Iodice, Charlotte L Rae, Alice Brooke, Rebecca Simmons, Nick G Dowell, Fenella Prowse, Kristy Themelis, Hugo Critchley, Jessica A Eccles

Objective: Autism, attention deficit hyperactivity disorder (ADHD), and tic disorder (Tourette syndrome; TS) are neurodevelopmental conditions that frequently co-occur and impact psychological, social and emotional functioning. Vulnerability to chronic physical symptoms, including fatigue and pain, are also recognised. The expression of joint hypermobility, reflecting a constitutional variant in connective tissue, predicts vulnerability to psychological symptoms alongside recognised physical symptoms. Here, we tested for increased rates of joint hypermobility, autonomic dysfunction and pain in 109 adults with neurodevelopmental diagnoses. Method: Rates of generalized joint laxity in those individuals with neurodevelopmental conditions were compared to those in the general population in UK. Levels of orthostatic intolerance and musculoskeletal symptoms were compared to a neurotypical control group. Results: Adults with neurodevelopmental diagnoses manifest elevated rates of joint hypermobility (50%) compared to the general population rate of 20% and a matched control population of 10%. Odds ratio for hypermobility in individuals with neurodevelopmental diagnoses, compared to the general population was 4.51 (95%CI 2.17-9.37), with greater odds in females rather than males. Neurodevelopmental patients reported significantly more symptoms of orthostatic intolerance and musculoskeletal skeletal pain than controls Conclusions: In adults with neurodevelopmental conditions, there is a strong link between the expression of joint hypermobility, autonomic dysfunction and pain, more so than in healthy controls. Increased awareness and understanding of this association may enhance the management of core symptoms and allied difficulties including comorbid stress-sensitive physical symptoms.

4: Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review
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Posted 06 Apr 2020

Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review
12,164 downloads medRxiv psychiatry and clinical psychology

Ignacio Ricci-Cabello, Jose F. Meneses-Echavez, Maria Jesús Serrano-Ripoll, D Fraile-Navarro, Maria Antònia Fiol de Roque, Guadalupe Pastor Moreno, Adoración Castro, Isabel Ruiz-Pérez, Rocío Zamanillo Campos, Daniela Gonçalves-Bradley

ObjectivesTo examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers'(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact. DesignSystematic rapid review and meta-analysis. Data sourcesMEDLINE, Embase, and PsycINFO, searched up to 23 March 2020. MethodWe selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems. ResultsWe included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%; 6 studies, 3,373 participants), followed by depression (38%, 95% CI 15 to 60%; 7 studies, 3,636 participants), acute stress disorder (31%, 95% CI 0 to 82%, 3 studies, 2,587 participants), burnout (29%, 95% CI 25 to 32%; 3 studies; 1,168 participants), and post-traumatic stress disorder (19%, 95% CI 11 to 26%, 10 studies, 3,121 participants). Based on 37 studies, we identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, social rejection or isolation, stigmatization), and occupational (working in a high risk environment (frontline staff), specific occupational roles (e.g., nurse), and lower levels of specialised training, preparedness and job experience) factors. Five studies reported interventions for frontline HCW, two of which were educational and aimed to prevent mental health problems by increasing HCWs' resilience. These interventions increased confidence in support and training, pandemic self-efficacy, and interpersonal problems solving (very low certainty). One multifaceted intervention implemented training and organisational changes) targeted at hospital nurses during the SARS epidemic, reporting improvements in anxiety, depression, and sleep quality (very low certainty). The two remaining interventions, which were multifaceted and based on psychotherapy provision, did not assess their impact. ConclusionThe prevalence of anxiety, depression, acute and post-traumatic stress disorder, and burnout, was high both during and after the outbreaks. These problems not only have a long-lasting effect on the mental health of HCWs, but also hinder the urgent response to the current COVID-19 pandemic, by jeopardising attention and decision-making. Governments and healthcare authorities should take urgent actions to protect the mental health of HCWs. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study, more so when they are modifiable, represent important targets for future interventions. SUMARY BOX1: What is already known on this topic?O_LIPrevious studies showed that healthcare workers involved providing frontline care during viral epidemic outbreaks are at high risk of developing mental health problems. C_LIO_LIGiven the current COVID-19 pandemic, there is an urgent need to synthesize the evidence regarding the impact of viral epidemic outbreaks on mental health of healthcare workers. C_LI 2: What does this study add?O_LIThis timely systematic rapid review offers for the first time pooled estimations of the prevalence of the most common mental health problems experienced by HCWs during and after viral epidemic outbreaks, namely anxiety (45%), depression (38%), and acute stress disorder (31%), among others. C_LIO_LIOur study also identifies a broad number of factors associated with these conditions, including sociodemographic factors such as younger age and female gender, social factors such as lack of social support, social rejection or isolation, stigmatization, and occupational factors such as working in a high risk environment, specific occupational roles, and having lower levels of specialised training, preparedness and job experience. C_LIO_LIOur study shows that, although educational and multifaceted interventions might mitigate the development of mental health problems, the certainty on the evidence is very low - therefore indicating that further high quality research is urgently needed to inform evidence-based policies for viral pandemics. C_LI

5: Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020. Preliminary results.
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Posted 06 Apr 2020

Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020. Preliminary results.
11,711 downloads medRxiv psychiatry and clinical psychology

Rosario Sinta Gamonal Limcaoco, Enrique Montero Mateos, Juan Matías Fernández, Carlos Roncero

IntroductionSince the beginning of the outbreak in China, ending 2019, the Novel Coronavirus (COVID-19) has spread subsequently to the rest of the world causing an on-going pandemic. The World Health Organisation (WHO) declared COVID-19 "a public health emergency of international concern." Taking into consideration the lockdown and quarantine situation, a research team of doctors from the Hospital of Salamanca, decided to do an evaluation of the current emotional state on the general population with a web-based survey in English and in Spanish, which was considered a useful and fast method that could help us determine how people perceived stress and worry due to the COVID-19. MethodsThe survey included a 22 items, gathering information in 3 sections: Sociodemographic data, the Perceived Stress Scale (PSS-10) by Cohen and additional queries that assessed the current worry and change of behaviours due to this pandemic. ResultsThe survey received 1091 respondents from 41 countries, from March 17 to the 1st of April, 2020. The mean age of the respondents was 43.1 (14.2) years old, and more than two thirds were women. 21.1% were health personnel. The mean of the PSS-10 score was 17.4 (6.4). Significantly higher scores were observed among women, youth, students, and among those who expressed concern and those who perceived increased susceptibility to the COVID-19. In contrast, no significant differences were observed between the health professionals and the general population. A weak correlation was observed between mean relative volume RSV of the last 28 days and the number of cases reported (rho = 0.31, p <0.001) and deaths (rho = 0.28, p <0.001). DiscussionWith these results the researchers describe an increase of affective symptoms due to the COVID-19. This pandemic is raising the anxiety levels. The findings of the study show the affective and cognitive alterations people are going through. This survey is the first attempt to measure the psychological consequences this pandemic is having, in order to be able to provide the support to confront this global issue, addressing the mental health care that will be needed.

6: COVID-19 in Wuhan: Immediate Psychological Impact on 5062 Health Workers
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Posted 23 Feb 2020

COVID-19 in Wuhan: Immediate Psychological Impact on 5062 Health Workers
10,881 downloads medRxiv psychiatry and clinical psychology

Zhou Zhu, Shabei Xu, Hui Wang, Zheng Liu, Jianhong Wu, Guo Li, Jinfeng Miao, Chenyan Zhang, Yuan Yang, Wenzhe Sun, Suiqiang Zhu, Yebin Fan, Junbo Hu, Jihong Liu, Wei Wang

BACKGROUNDThe outbreak of COVID-19 has laid unprecedented psychological stress on health workers (HWs). We aimed to assess the immediate psychological impact on HWs at Tongji Hospital in Wuhan, China. METHODSWe conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7), respectively. We also designed a questionnaire to assess the effect of psychological protective measures taken by Tongji Hospital. Multivariate logistic regression was used to identify predictors of acute stress, depression, and anxiety. RESULTSWe received 5062 completed questionnaires (response rate, 77.1 percent). 1509 (29.8 percent), 681 (13.5 percent) and 1218 (24.1 percent) HWs reported stress, depression and anxiety symptoms. Women (hazard ratio[HR], 1.31; P=0.032), years of working> 10 years (HR, 2.02; P<0.001), concomitant chronic diseases (HR, 1.51; P<0.001), history of mental disorders (HR, 3.27; P<0.001), and family members or relatives confirmed or suspected (HR, 1.23; P=0.030) were risk factors for stress, whereas care provided by hospital and department administrators(odds ratio [OR], 0.76; P=0.024) and full coverage of all departments with protective measures (OR, 0.69; P=0.004) were protective factors. CONCLUSIONSWomen and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the COVID-19 pandemic. Psychological protective measures implemented by the hospital could be helpful.

7: COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey.
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Posted 14 Apr 2020

COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey.
8,035 downloads medRxiv psychiatry and clinical psychology

Rodolfo Rossi, Valentina Socci, Dalila Talevi, Sonia Mensi, Cinzia Niolu, Francesca Pacitti, Antinisca Di Marco, Alessandro Rossi, Alberto Siracusano, Giorgio Di Lorenzo

Background The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to four weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. Methods A web-based survey spread throughout the internet between March 27th and April 6th 2020. 18147 individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. Results Respondents endorsing PTSS, depression, anxiety, insomnia, high perceived stress and adjustment disorder were 6604 (37%), 3084 (17.3%), 3700 (20.8%), 1301 (7.3%), 3895 (21.8%) and 4092 (22.9%), respectively. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress and insomnia. Conclusion We found high rates of negative mental health outcomes in the Italian general population three weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population s mental health.

8: Prevalence and Risk Factors for Acute Posttraumatic Stress Disorder during the COVID-19 Outbreak
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Posted 10 Mar 2020

Prevalence and Risk Factors for Acute Posttraumatic Stress Disorder during the COVID-19 Outbreak
7,011 downloads medRxiv psychiatry and clinical psychology

Luna Sun, Zhuoer Sun, Lili Wu, Zhenwen Zhu, Fan Zhang, Zhilei Shang, Yanpu Jia, Jingwen Gu, Yaoguang Zhou, Yan Wang, Nianqi Liu, Weizhi Liu

Background To exam the prevalence of and risk factors for acute posttraumatic stress disorder (PTSD) in Chinese people shortly after the COVID-19 outbreak. Methods An online questionnaire survey was conducted between 30 January and 3 February, 2020. The survey included two self-administered questionnaires: one was designed to require personal information (gender, age, education background), current location, recent epidemic area contact history, the classification of population, and subjective sleep quality; the other was the PTSD Checklist for DSM-5 (PCL-5). Results A total of 2091 Chinese participated in this study. The prevalence of PTSD among the Chinese public one month after the COVID-19 outbreak was 4.6%. Multiple linear regression analysis revealed that gender (p < 0.001), epidemic area contact history (p = 0.047), classification of population (p < 0.001), and subjective sleep quality (p < 0.001) could be regarded as predictor factors for PTSD. Limitations First, the majority of participants in this study were the general public, and confirmed or suspected patients being a small part. Second, the measurement of PTSD might be vulnerable to selection bias because of an online self-report study, such as participants recruitment. Third, the prevalence of PTSD in this study was estimated by an online questionnaire rather than a clinical interview. Conclusions The results revealed that some Chinese showed acute PTSD during the COVID-19 outbreak. Therefore, comprehensive psychological intervention needs further implementation. Furthermore, females, people who having recent epidemic area contact history, those at high risk of infection or with poor sleep quality deserve special attention.

9: Social Media Reveals Psychosocial Effects of the COVID-19 Pandemic
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Posted 11 Aug 2020

Social Media Reveals Psychosocial Effects of the COVID-19 Pandemic
6,118 downloads medRxiv psychiatry and clinical psychology

Koustuv Saha, John Torous, Eric D. Caine, Munmun De Choudhury

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic has caused several disruptions in personal and collective lives worldwide. The uncertainties surrounding the pandemic have also led to multi-faceted mental health concerns, which can be exacerbated with precautionary measures such as social distancing and self-quarantining, as well as societal impacts such as economic downturn and job loss. Despite noting this as a "mental health tsunami," the psychological effects of the COVID-19 crisis remains unexplored at scale. Consequently, public health stakeholders are currently limited in identifying ways to provide timely and tailored support during these circumstances. ObjectiveOur work aims to provide insights regarding peoples psychosocial concerns during the COVID-19 pandemic by leveraging social media data. We aim to study the temporal and linguistic changes in symptomatic mental health and support expressions in the pandemic context. MethodsWe obtain [~]60M Twitter streaming posts originating from the U.S. from 24 March-24 May 2020, and compare these with [~]40M posts from a comparable period in 2019 to attribute the effect of COVID-19 on peoples social media self-disclosure. Using these datasets, we study peoples self-disclosure on social media in terms of symptomatic mental health concerns and expressions of support. We employ transfer learning classifiers that identify the social media language indicative of mental health outcomes (anxiety, depression, stress, and suicidal ideation) and support (emotional and informational support). We then examine the changes in psychosocial expressions over time and language, comparing the 2020 and 2019 datasets. ResultsWe find that all of the examined psychosocial expressions have significantly increased during the COVID-19 crisis - mental health symptomatic expressions have increased by [~]14%, and support expressions have increased by [~]5%, both thematically related to COVID-19. We also observe a steady decline and eventual plateauing in these expressions during the COVID-19 pandemic, which may have been due to habituation or due to supportive policy measures enacted during this period. Our language analyses highlight that people express concerns that are very specific to and contextually related to the COVID-19 crisis. ConclusionsWe studied the psychosocial effects of the COVID-19 crisis by using social media data from 2020, finding that peoples mental health symptomatic and support expressions significantly increased during the COVID-19 period as compared to similar data from 2019. However, this effect gradually lessened over time, suggesting that people adapted to the circumstances and their "new normal". Our linguistic analyses revealed that people expressed mental health concerns regarding personal and professional challenges, healthcare and precautionary measures, and pandemic-related awareness. This work shows the potential to provide insights to mental healthcare and stakeholders and policymakers in planning and implementing measures to mitigate mental health risks amidst the health crisis.

10: Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19
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Posted 30 Mar 2020

Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19
5,234 downloads medRxiv psychiatry and clinical psychology

Xiangyu Kong, Kailian Zheng, Min Tang, Fanyang Kong, Jiahuan Zhou, Le Diao, Shouxin Wu, Piqi Jiao, Tong Su, Yuchao Dong

ObjectiveThe 2019 coronavirus disease (COVID-19) epidemic has raised international concern. Mental health is becoming an issue that cannot be ignored in our fight against it. This study aimed to explore the prevalence and factors linked to anxiety and depression in hospitalized patients with COVID-19. MethodsA total of 144 patients diagnosed with COVID-19 were included in this study. We assessed depression and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS), and social support using the Perceived Social Support Scale (PSSS) among patients at admission. Multivariate linear regression analyses were performed to identify factors associated with symptoms of anxiety and depression. ResultsOf the 144 participants, 34.72% and 28.47% patients with COVID-19 had symptoms of anxiety or depression, respectively. The bivariate correlations showed that less social support was correlated with more anxious (r=-0.196, p<0.05) and depressive (r=-0.360, p<0.05) symptoms among patients with COVID-19. The multiple linear regression analysis showed that gender ({beta}=1.446, p=0.034), age ({beta}=0.074, p=0.003), oxygen saturation ({beta} =-2.140, p=0.049), and social support ({beta} =-1.545, p=0.017) were associated with anxiety for COVID-19 patients. Moreover, age ({beta}=0.084, p=0.001), family infection with SARS-CoV-2 ({beta} =1.515, p=0.027) and social support ({beta} =-2.236, p<0.001) were the factors associated with depression. ConclusionHospitalized patients with COVID-19 presented features of anxiety and depression. Mental concern and appropriate intervention are essential parts of clinical care for those who are at risk.

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Posted 06 May 2020

4,148 downloads medRxiv psychiatry and clinical psychology

Absar Ahmad, Ishrat Rahman, Maitri Agarwal

Purpose: Research on the impact of social distancing on mental health during epidemics is limited, especially in India. The purpose of this study is to scale the association between anxiety and socio-demographic factors during Covid19 lockdown among the general Indian population. Design/methodology/approach: A descriptive cross-sectional nationwide study was designed to enrol the general population. The inclusion criteria for this study were Indian citizens aged 15 years and above. The study was conducted from 29th March to 12th April 2020, using an online google questionnaire. The anxiety among respondents was detected and measured using a Generalised Anxiety Disorder Scale which consists of 7 questions (in English), i.e. GAD-7. Findings: Respondees were 398, and from these participants, the prevalence of anxiety was 25.4 per cent. Based on the bivariate logistic regression analysis, the predictors of anxiety were gender, religion, occupation as business/self- employed, marital status, family size, health status and sleep deprivation. Conclusion: This study reports the prevalence of anxiety among Indian population who were grounded at their homes during lockdown due to coronavirus pandemic in the country. Limitations: (1) The selection of participants through non-random sampling. (2) Because of the cross-sectional character of the study, causal conclusions cannot be drawn. Originality/Value: This paper fulfils an identified need to study the mental health status of the population under situations like lockdown, thereby helping fill a persistent gap in Indian research on this issue. Keywords: Anxiety, GAD-7, Lockdown, Coronavirus, Isolation, India

12: Single-cell dissection of schizophrenia reveals neurodevelopmental-synaptic axis and transcriptional resilience
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Posted 09 Nov 2020

Single-cell dissection of schizophrenia reveals neurodevelopmental-synaptic axis and transcriptional resilience
4,134 downloads medRxiv psychiatry and clinical psychology

W. Brad Ruzicka, Shahin Mohammadi, Jose Davila-Velderrain, Sivan Subburaju, Daniel Reed Tso, Makayla Hourihan, Manolis Kellis

Schizophrenia is a devastating mental disorder with a high societal burden, complex pathophysiology, and diverse genetic and environmental risk factors. Its complexity, polygenicity, and small-effect-size and cell-type-specific contributors have hindered mechanistic elucidation and the search for new therapeutics. Here, we present the first single-cell dissection of schizophrenia, across 500,000+ cells from 48 postmortem human prefrontal cortex samples, including 24 schizophrenia cases and 24 controls. We annotate 20 cell types/states, providing a high-resolution atlas of schizophrenia-altered genes and pathways in each. We find neurons are the most affected cell type, with deep-layer cortico-cortical projection neurons and parvalbumin-expressing inhibitory neurons showing significant transcriptional changes converging on genetically-implicated regions. We discover a novel excitatory-neuron cell-state indicative of transcriptional resilience and enriched in schizophrenia subjects with less-perturbed transcriptional signatures. We identify key trans-acting factors as candidate drivers of observed transcriptional perturbations, including MEF2C, TCF4, SOX5, and SATB2, and map their binding patterns in postmortem human neurons. These factors regulate distinct gene sets underlying fetal neurodevelopment and adult synaptic function, bridging two leading models of schizophrenia pathogenesis. Our results provide the most detailed map to date for mechanistic understanding and therapeutic development in neuropsychiatric disorders.

13: Mapping Psilocybin-Assisted Therapies: A Scoping Review
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Posted 12 Dec 2019

Mapping Psilocybin-Assisted Therapies: A Scoping Review
4,022 downloads medRxiv psychiatry and clinical psychology

Ron Joseph Shore, Paul Ioudovski, Sandra McKeown, Eric Dumont, Craig Goldie

We conducted a scoping review on psilocybin-assisted therapy for addiction, depression, anxiety and post-traumatic stress disorder. Psilocybin is a naturally-occurring tryptophan derivative found in species of mushroom with psycho-active properties. From 2022 records identified by database searching, 40 publications were included in the qualitative synthesis from which we identified 9 clinical trials with a total of 169 participants. Trials used a peak-psychedelic model of therapy, emphasizing inward journey through the use of eyeshades, set musical scores and with medium to high doses of psilocybin. No serious adverse effects were reported; mild adverse effects included transient anxiety, nausea and post-treatment headaches. Overall, the 9 trials all demonstrated safety, tolerability and preliminary efficacy in the treatments of obsessive-compulsive disorder, substance use disorder, treatment-resistant unipolar depression, anxiety or depression in patients with life-threatening cancer and demoralization among long-term AIDS survivors.The literature was found to be early and exploratory, with several limitations: only 5 were randomized controlled trials, small and homogenous patient sample size, difficulties in blinding, and the confounding influence of psychological supports provided. Further research is indicated to establish effectiveness for these and other indications, with a more diverse range of patients, and with differing program and dosing modalities.

14: Analysis of psychological state and clinical psychological intervention model of patients with COVID-19
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Posted 24 Mar 2020

Analysis of psychological state and clinical psychological intervention model of patients with COVID-19
3,861 downloads medRxiv psychiatry and clinical psychology

Lu Yang, Danjuan Wu, Yanbin Hou, Xunqiang Wang, Ni Dai, Guanjun Wang, Qing Yang, Wenhui Zhao, Zhongze Lou, Yunxin Ji, Liemin Ruan

BackgroundPatients with the 2019 coronavirus disease (COVID-19) have different degrees of psychological pain, such as anxiety and depression, which may related to their prognosis. Psychological intervention can be conducted in different ways to improve psychological pain and improve the treatment effect. ObjectiveThe present study aimed to investigate and analyze the psychological status of patients with COVID-19 during the course of illness, and to evaluate the effect and influencing factors of psychological crisis intervention, so as to explore the effective mode of clinical psychological intervention in acute patients under isolation environment. MethodsA total of 143 persons participated in the study, including 26 patients diagnosed with COVID-19 in the isolation ward (COVID-19 group), 87 patients with general pneumonia in the observation ward (General Pneumonia group) and 30 healthy volunteers (Normal group). All the patients in the ward received comprehensive psychological intervention, including telephone psychological counseling (active and passive), self-adjustment of written materials and one-to-one psychological crisis intervention. Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were used to evaluate the mental health status of all patients on the day of admission and 1 week after treatment. ResultsThe scores of HAMA and HAMD of all patients (including isolation ward and observation ward) were significantly higher than the healthy volunteers at the time of admission. The total score of HAMA and HAMD in CVOID-19 group were both higher than that General Pneumonia group. After 1 weeks hospitalization with comprehensive psychological intervention, the scores of HAMA and HAMD in CVOID-19 group were significantly decreased. ConclusionPatients those who diagnosed with COVID-19 in the isolation ward and/or general pneumonia in observation ward have different degrees of anxiety, depression and sleep problems. While receiving antiviral treatment, patients also need psychological intervention. Comprehensive psychological intervention model has been proved to be effective.

15: Mental health status and coping strategy of medical workers in China during The COVID-19 outbreak
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Posted 25 Feb 2020

Mental health status and coping strategy of medical workers in China during The COVID-19 outbreak
3,709 downloads medRxiv psychiatry and clinical psychology

Siyu Chen, Min Xia, Weiping Wen, Liqian Cui, Weiqiang Yang, Shaokun Liu, Jiahua Fan, Huijun Yue, Shangqing Tang, Bingjie Tang, Li Xiaoling, Lin Chen, Zili Qin, Kexing Lv, Xueqin Guo, Yu Lin, Yihui Wen, Wenxiang Gao, Ying Zheng, Wei Xu, Yun Li, Yang Xu, Li Ling, Wenbin Lei

The authors have withdrawn their manuscript whilst they perform additional experiments to test some of their conclusions further. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

16: Years of life lost due to the psychosocial consequences of COVID19 mitigation strategies based on Swiss data
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Posted 22 Apr 2020

Years of life lost due to the psychosocial consequences of COVID19 mitigation strategies based on Swiss data
3,621 downloads medRxiv psychiatry and clinical psychology

Dominik Andreas Moser, Jennifer Glaus, Sophia Frangou, Daniel Scott Schechter

Background: The pandemic caused by COVID-19 has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies however carry a significant risk for mental health which can lead to increased short-term and long-term mortality and is currently not included in modelling the impact of the pandemic. Methods: We used years of life lost (YLL) as the main outcome measure as applied to Switzerland as an exemplar. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status and social isolation as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. Results: The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average 9.79 YLL. Conclusions: The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.

17: Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts
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Posted 18 Jun 2020

Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts
3,372 downloads medRxiv psychiatry and clinical psychology

Alex Siu Fung Kwong, Rebecca M Pearson, Mark J Adams, Kate Northstone, Kate Tilling, Daniel Smith, Chloe Fawns-Ritchie, Helen Bould, Naomi Warne, Stan Zammit, David J Gunnell, Paul Moran, Nadia Micali, Abraham Reichenberg, Matthew Hickman, Dheeraj Rai, Simon Haworth, Archie Campbell, Drew Altschul, Robin Flaig, Andrew M. McIntosh, Deborah A. Lawlor, David J Porteous, Nicholas J Timpson

Background: The impact of COVID-19 on mental health is unclear. Evidence from longitudinal studies with pre pandemic data are needed to address (1) how mental health has changed from pre-pandemic levels to during the COVID-19 pandemic and (2), whether there are groups at greater risk of poorer mental health during the pandemic? Methods: We used data from COVID-19 surveys (completed through April/May 2020), nested within two large longitudinal population cohorts with harmonised measures of mental health: two generations of the Avon Longitudinal Study of Parents and Children (ALPSAC): the index generation ALSPAC-G1 (n= 2850, mean age 28) and the parents generation ALSPAC-G0 (n= 3720, mean age = 59) and Generation Scotland: Scottish Family Health Study (GS, (n= 4233, mean age = 59), both with validated pre-pandemic measures of mental health and baseline factors. To answer question 1, we used ALSPAC-G1, which has identical mental health measures before and during the pandemic. Question 2 was addressed using both studies, using pre-pandemic and COVID-19 specific factors to explore associations with depression and anxiety in COVID-19. Findings: In ALSPAC-G1 there was evidence that anxiety and lower wellbeing, but not depression, had increased in COVID-19 from pre-pandemic assessments. The percentage of individuals with probable anxiety disorder was almost double during COVID-19: 24% (95% CI 23%, 26%) compared to pre-pandemic levels (13%, 95% CI 12%, 14%), with clinically relevant effect sizes. In both ALSPAC and GS, depression and anxiety were greater in younger populations, women, those with pre-existing mental and physical health conditions, those living alone and in socio-economic adversity. We did not detect evidence for elevated risk in key workers or health care workers. Interpretation: These results suggest increases in anxiety and lower wellbeing that may be related to the COVID-19 pandemic and/or its management, particularly in young people. This research highlights that specific groups may be disproportionally at risk of elevated levels of depression and anxiety during COVID-19 and supports recent calls for increasing funds for mental health services. Funding: The UK Medical Research Council (MRC), the Wellcome Trust and University of Bristol.

18: Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands
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Posted 29 May 2020

Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands
3,318 downloads medRxiv psychiatry and clinical psychology

Jet D. Termorshuizen, Hunna J. Watson, Laura M. Thornton, Stina Borg, Rachael E. Flatt, Casey M. MacDermod, Lauren E. Harper, Eric F. van Furth, Christine M. Peat, Cynthia Bulik

We received rapid ethical permission to evaluate the early impact of COVID-19 on people with eating disorders. Participants in the United States (US, N=511) and the Netherlands (NL, N=510), recruited through ongoing studies and social media, completed an online baseline survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being. Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with diagnoses. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increases in their binge-eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID-19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID-19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self-care, and motivation to recover.

19: Genome-wide association study of over 40,000 bipolar disorder cases provides new insights into the underlying biology
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Posted 18 Sep 2020

Genome-wide association study of over 40,000 bipolar disorder cases provides new insights into the underlying biology
3,205 downloads medRxiv psychiatry and clinical psychology

Niamh Mullins, Andreas J. Forstner, Kevin S O'Connell, Brandon Coombes, Jonathan R I Coleman, Zhen Qiao, Thomas Damm Als, Tim Bigdeli, Sigrid Børte, Julien Bryois, Alexander W Charney, Ole Kristian Drange, Michael J. Gandal, Saskia P Hagenaars, Masashi Ikeda, Nolan Kamitaki, Minsoo Kim, Kristi Krebs, Georgia Maria Panagiotaropoulou, Brian M. Schilder, Laura G Sloofman, Stacy Steinberg, Vassily Trubetskoy, Bendik S Winsvold, Hong-Hee Won, Liliya Abramova, Kristina Adorjan, Esben Agerbo, Mariam Al Eissa, Diego Albani, Ney Alliey-Rodriguez, Adebayo Anjorin, Verneri Antilla, Anastasia Antoniou, Swapnil Awasthi, Ji Hyun Baek, Marie Bækvad-Hansen, Nicholas Bass, Michael Bauer, Eva C Beins, Sarah E Bergen, Armin Birner, Carsten Bøcker Pedersen, Erlend Bøen, Marco P Boks, Rosa Bosch, Murielle Brum, Ben M. Brumpton, Nathalie Brunkhorst-Kanaan, Monika Budde, Jonas Bybjerg-Grauholm, William Byerley, Murray Cairns, Miquel Casas, Pablo Cervantes, Toni-Kim Clarke, Cristiana Cruceanu, Alfredo Cuellar-Barboza, Julie Cunningham, David Curtis, Piotr M. Czerski, Anders M. Dale, Nina Dalkner, Friederike S. David, Franziska Degenhardt, Srdjan Djurovic, Amanda L Dobbyn, Athanassios Douzenis, Torbjørn Elvsåshagen, Valentina Escott-Price, I Nicol Ferrier, Alessia Fiorentino, Tatiana M Foroud, Liz Forty, Josef Frank, Oleksandr Frei, Nelson B. Freimer, Louise Frisén, Katrin Gade, Julie Garnham, Joel Gelernter, Marianne Marianne Giørtz Pedersen, Ian R Gizer, Scott D Gordon, Katherine Gordon-Smith, Tiffany A Greenwood, Jakob Grove, Jose Guzman-Parra, Kyooseob Ha, Magnus Haraldsson, Martin Hautzinger, Urs Heilbronner, Dennis Hellgren, Stefan Herms, Per Hoffmann, Peter A. Holmans, Laura Huckins, Stephane JAMAIN, Jessica S Johnson, Janos L. Kalman, Yoichiro Kamatani, James Kennedy, Sarah Kittel-Schneider, James A Knowles, Manolis Kogevinas, Maria Koromina, Thorsten M Kranz, Henry R Kranzler, Michiaki Kubo, Ralph Kupka, Steven A Kushner, Catharina Lavebratt, Jacob Lawrence, Markus Leber, Heon-Jeong Lee, Phil H Lee, Shawn E. Levy, Catrin Lewis, Cal Liao, Susanne Lucae, Martin Lundberg, Donald J MacIntyre, Wolfgang Maier, Adam Maihofer, Dolores Malaspina, Eirini Maratou, Lina Martinsson, Manuel Mattheisen, Nathaniel W McGregor, Peter McGuffin, James D McKay, Helena Medeiros, Sarah. Medland, Vincent Millischer, Grant W Montgomery, Jennifer L. Moran, Derek W Morris, Thomas W. Mühleisen, Niamh O'Brien, Claire O'Donovan, Loes Olde Loohuis, Lilijana Oruc, Sergi Papiol, Antonio F. Pardiñas, Amy Perry, Andrea Pfennig, Evgenia Porichi, James B. Potash, Digby Quested, Towfique Raj, Mark H Rapaport, J. Raymond DePaulo, Eline J Regeer, John P. Rice, Fabio Rivas, Margarita Rivera, Julian Roth, Panos Roussos, Douglas Ruderfer, Cristina Sánchez-Mora, Eva C Schulte, Fanny Senner, Sally Sharp, Paul D Shilling, Engilbert Sigurdsson, Lea Sirignano, Claire Slaney, Olav B. Smeland, Janet L Sobell, Christine Søholm Hansen, Maria Soler Artigas, Anne T Spijker, Dan J. Stein, John S Strauss, Beata Beata Świątkowska, Chikashi Terao, Thorgeir E. Thorgeirsson, Claudio Toma, Paul Tooney, Evangelia-Eirini Tsermpini, Marquis P Vawter, Helmut Vedder, James T R Walters, Stephanie H Witt, Simon Xi, Wei Xu, Hannah Young, Allan H Young, Peter P Zandi, Hang Zhou, Lea Zillich, HUNT All-In Psychiatry, Rolf Adolfsson, Ingrid Agartz, Martin Alda, Lars Alfredsson, Gulja Babadjanova, Lena Backlund, Bernhard T Baune, Frank BELLIVIER, Susanne Bengesser, Wade H Berrettini, Douglas H R Blackwood, Michael Boehnke, Anders Børglum, Gerome Breen, Vaughan J Carr, Stanley Catts, Aiden Corvin, Nicholas Craddock, Udo Dannlowski, Dimitris Dikeos, Tõnu Esko, Bruno ETAIN, Panagiotis Ferentinos, Mark A. Frye, Janice M. Fullerton, Micha Gawlik, Elliot Gershon, Fernando Goes, Melissa J Green, Maria Grigoroiu-Serbanescu, Joanna Twarowska-Hauser, Frans Henskens, Jan Hillert, Kyung Sue Hong, David M Hougaard, Christina Hultman, Kristian Hveem, Nakao Iwata, Assen V Jablensky, Ian R Jones, Lisa A Jones, René S. Kahn, John R Kelsoe, Kirov George, Mikael Mikael Landén, Marion Leboyer, Cathryn Lewis, Qingqin S Li, Jolanta Lissowska, Christine Lochner, Carmel Loughland, Nicholas G Martin, Carol A Mathews, Fermin Mayoral, Susan L McElroy, Andrew M McIntosh, Francis J. McMahon, Ingrid Melle, Patricia Michie, Lili Milani, Philip B. Mitchell, Gunnar Morken, Ole Mors, Preben Bo Mortensen, Bryan Mowry, Bertram Mueller-Myhsok, Richard M. Myers, Benjamin M Neale, Caroline M. Nievergelt, Merete Nordentoft, Markus M Nöthen, Michael C O'Donovan, Ketil J Oedegaard, Tomas Olsson, Michael J Owen, Sara A Paciga, Chris Pantelis, Carlos Pato, Michele Pato, George P. Patrinos, Roy H Perlis, Danielle Posthuma, Josep Antoni Ramos-Quiroga, Andreas Reif, Eva Z Reininghaus, Marta Ribasés, Marcella Rietschel, Stephan Ripke, Guy A. Rouleau, Takeo Saito, Ulrich Schall, Martin Schalling, Peter Schofield, Thomas G Schulze, Rodney J Scott, Laura J Scott, Alessandro Serretti, Cynthia Shannon Weickert, Jordan W. Smoller, Hreinn Stefansson, Kari Stefansson, Eystein Stordal, Fabian Streit, Patrick F. Sullivan, Gustavo Turecki, Arne E Vaaler, Eduard Vieta, John B Vincent, Irwin D Waldman, Thomas W Weickert, Thomas Werge, Naomi R. Wray, John-Anker Zwart, Joanna M. Biernacka, John I. Nurnberger, Sven Cichon, Howard Edenberg, Eli A Stahl, Andrew McQuillin, Arianna Di Florio, Roel A Ophoff, Ole A. Andreassen

Bipolar disorder (BD) is a heritable mental illness with complex etiology. We performed a genome-wide association study (GWAS) of 41,917 BD cases and 371,549 controls of European ancestry, which identified 64 associated genomic loci. BD risk alleles were enriched in genes in synaptic signaling pathways and brain-expressed genes, particularly those with high specificity of expression in neurons of the prefrontal cortex and hippocampus. Significant signal enrichment was found in genes encoding targets of antipsychotics, calcium channel blockers, antiepileptics and anesthetics. Integrating eQTL data implicated 15 genes robustly linked to BD via gene expression, encoding druggable targets such as HTR6, MCHR1, DCLK3 and FURIN. Analyses of BD subtypes indicated high but imperfect genetic correlation between BD type I and II and identified additional associated loci. Together, these results advance our understanding of the biological etiology of BD, identify novel therapeutic leads and prioritize genes for functional follow-up studies.

20: Psychiatric side effects induced by chloroquine and hydroxychloroquine: a systematic review of case reports and population studies
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Posted 07 Oct 2020

Psychiatric side effects induced by chloroquine and hydroxychloroquine: a systematic review of case reports and population studies
3,199 downloads medRxiv psychiatry and clinical psychology

Fernanda Talarico, Sucheta Chakravarty, Yang S. Liu, Andrew Greenshaw, Ives Cavalcante Passos, Bo Cao

Chloroquine and hydroxychloroquine are commonly used drugs in the treatment of malaria as well as chronic diseases, such as rheumatoid arthritis, and systemic lupus erythematosus. Although various reports on possible psychiatric side effects of these drugs exist, the nature and extent of these effects remain poorly understood. Moreover, the relevance of these drugs in the treatment of early stages of COVID-19 necessitates a careful estimation of their side effects. Here, we provide a systematic review of the psychiatric side effects associated with chloroquine and hydroxychloroquine. We used PubMed, Scopus, and Web of Science platforms to identify relevant literature published between 1962 and 2020. Search terms included chloroquine, hydroxychloroquine, psychiatry, psychosis, depression, anxiety, bipolar disorder, delirium, and psychotic disorders. Only case reports and clinical trials were included. All studies included records of psychiatric side effects induced by either chloroquine or hydroxychloroquine or both. Both retrospective and prospective, randomized as well as non-randomized population studies were included. Overall, the psychiatric side effects are dose- and sex-independent. The most common psychiatric side effects reported are increased speech output/ excessive talking, increased psychomotor activity, irritable mood, auditory hallucinations, delusion of grandiosity, and suicide attempts, likely due to brain intoxicationbe of chloroquine or hydroxychloroquine. The symptoms can develop in a few hours to 11 weeks after drug intake and are normally reversed within a week after the drug withdrawal. We conclude that CQ and HCQ have the potential to induce psychiatric side effects. This study calls for further investigation of psychiatric symptoms induced by these drugs in the short and long term.

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