新型冠状病毒肺炎疫情下癫痫病房管理策略

正2019年12月爆发的新型冠状病毒肺炎(以下简称"新冠肺炎"),是世界第六起、中国第一起"国际关注的突发公共卫生事件"~([1]),迄今已影响全球数百万人~([2]),造成10万余人死亡。新冠肺炎可累及神经系统,出现类似癫痫发作样的临床症状~([3, 4]),此类患者作为疫情的隐形传播者,存在极大隐患。与慢性病管理一样,癫痫治疗需要定期随访和持续     

支持性心理治疗在新冠肺炎患者中的应用

目的探讨支持性心理治疗对改善新冠肺炎患者精神心理问题的作用,为新冠肺炎此类突发疫情的早期心理干预提供参考。方法选取2020年2月1日-3月1日在武汉大学人民医院重症监护病房住院治疗的35例新冠肺炎重症患者为研究对象,进行为期2周的支持性心理干预。于干预前和干预2周后,采用匹兹堡睡眠质量指数量表(PSQI)、患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)和社会支持评定量表(SSRS)对患者的睡眠质量、抑郁、焦虑情绪和社会支持水平进行评定。结果检出32例(91.43%)患者存在失眠,31例(88.57%)存在焦虑症状,32例(91.43%)存在抑郁症状,29例(82.86%)表示感受到社会支持不足。干预2周后,患者PSQI、GAD-7和PHQ-9评分均低于干预前(t=5.272、5.475、4.621,P均0.01),SSRS评分较干预前高(t=-4.639,P0.01)。干预后,存在失眠、焦虑、抑郁、感受到社会支持不足的患者比例均低于干预前(χ~2=18.714、16.232、16.970、4.480,P均0.01)。结论支持性心理治疗可能有助于改善新冠肺炎患者的焦虑、抑郁情绪和睡眠质量。     

精神障碍合并新冠肺炎患者院前急诊转运体会

目的探讨严重精神障碍患者合并新冠肺炎如何安全规范的进行院前急诊转运。方法收集2020-02-05-02-25院前急诊转运的60例严重精神障碍合并新冠肺炎患者,并进行分析。结果60例患者全部为专科医院确诊病例,需转运至定点医院救治。除1例因高龄、多基础疾病的患者在转运途中死亡外,其余59例患者均安全转运至定点医院。结论精神障碍合并新冠肺炎患者属特殊群体,急诊转运途中采用规范的转运方案和特殊护理方式,提高患者依从性,可起到安全高效的转运效果,值得临床借鉴。     

新冠肺炎救治医务人员抑郁症状与急性应激反应及心理韧性的关系

目的:探讨新冠肺炎救治医务人员抑郁症状与急性应激反应、心理韧性的关系。方法:采用方便取样法选取参加武汉新冠肺炎救治45 d的167名医务人员进行9项患者健康问卷(PHQ-9)、斯坦福急性应激反应问卷(SASRQ)和Connor-Davidson心理韧性量表(CD-RISC)自评;以PHQ-9≥10分为抑郁症状阳性分界值,分析新冠肺炎救治医务人员抑郁症状与急性应激反应、心理韧性的关系。结果:131名医务人员(78.44%)为抑郁组,包括中度77人,中重度35人,重度19人。抑郁组PHQ-9总分与SASRQ各因子分呈正相关,与CD-RISC总分及各因子分呈负相关(P均0.01)。抑郁组SASRQ的唤醒、再体验因子和CD-RISC的主体性、稳定性因子对PHQ-9总分有显著预测作用(P0.05或P0.01),分别可解释PHQ-9方差变异的62.9%、30.9%。心理韧性在抑郁组急性应激反应与抑郁之间起部分中介作用,中介效应占总效应的59.02%。结论:急性应激反应、心理韧性对新冠肺炎救治医务人员抑郁症状有显著预测作用;心理韧性在其急性应激反应与抑郁之间起部分中介作用。     

严重精神障碍合并新冠病毒感染患者闭环管理策略探讨

在新冠肺炎疫情波动的环境下,严重精神障碍患者在疫情传播链条节点上的预防措施及应对策略,目前的研究结果尚不明确。从既往的防控经验来看,精神卫生专科医疗机构建立行之有效的新发传染病防控体系以及设立过渡病区等手段,有助于降低疫情传播的风险。然而,对于针对严重精神障碍合并新冠病毒感染的患者,其在诊疗过程中精神症状复发或加重,在方舱医院或传染病房无法配合诊疗的状况,目前的管理策略尚未清晰。本文基于抗疫一线实地调研,围绕严重精神障碍合并新冠病毒感染患者的管理现实困难、紧急状态处理策略、一线精神科医护人员的防护条件以及紧急状态下医护人员处理此类患者的法律依据等方面,对严重精神障碍患者在感染新冠病毒状态下的管理策略进行探讨。     

接纳承诺疗法对1例双相情感障碍患者在新冠肺炎疫情中的情绪调节

报道1例双相情感障碍患者在新冠肺炎疫情中使用接纳承诺疗法进行心理治疗的过程,患者经6次ACT治疗后,能够更多地关注当下的生活,对未来生活充满动力和希望,疗效显著且短期内未出现反复。     

防控新冠肺炎疫情境外输入风险一线医护人员抑郁情绪调查

目的对参加北京市新冠肺炎疫情境外输入风险防控的一线医护人员的抑郁情绪状况进行调查,并分析相关影响因素,为改善一线医护人员心理健康状况提供参考。方法通过问卷星发放电子问卷,使用患者健康问卷抑郁量表(PHQ-9)对支援北京小汤山定点医院参加入境人员新冠肺炎筛查和救治工作的984名一线医护人员进行调查。结果共回收问卷770份,回收率为78.3%,检出344人(44.7%)存在抑郁症状。Logistic回归分析显示,工作内容变化大(OR=2.206,P<0.01)、睡眠减少(OR=2.359,P<0.01)、睡眠不足6小时(OR=2.032,P<0.05)、每天关注疫情信息>1小时(OR=1.095,P<0.05)是抑郁的风险因素,规律的运动习惯(OR=0.473,P<0.01)是减少抑郁的保护因素。结论防控新冠肺炎疫情境外输入风险的一线医护人员抑郁症状检出率较高,采取科学的工作轮换机制、保持足够的睡眠、减少关注疫情的时间以及规律运动可能是维护其身心健康的有效措施。     

新冠肺炎疫情影响下长期居家人员的情绪及睡眠质量的调查及危险因素分析

目的:探讨新冠肺炎疫情影响下长期居家人员的情绪及睡眠质量,并分析其影响因素。方法:采取便利抽样的方式,通过网络问卷的形式对国内受新冠肺炎疫情影响的长期居家人员进行心理健康及睡眠质量的调查,分为长期居家组(居家≥4周)与非长期居家组(居家4周),评估长期居家人员的焦虑、抑郁、躯体化症状及睡眠质量,并对危险因素进行分析。结果:长期居家组(n=77)和非长期居家组(n=161)在年龄、性别、婚姻、慢性病等方面差异无统计学意义;在地区、受教育程度、工作状态、职业、躯体疼痛等方面比较差异有统计学意义(P0.05或P0.01);长期居家组人员的广泛性焦虑量表(GAD-7)、患者健康问卷抑郁症状量表(PHQ-9)、患者健康问卷(PHQ-15)、失眠严重指数量(ISI)评分均显著高于非长期居家组人员(P0.05或P0.01);受教育程度高是焦虑的保护因素,躯体疼痛是焦虑、躯体化症状及睡眠质量的危险因素,有慢性病史是抑郁、躯体化症状及睡眠质量的危险因素,已婚是躯体症状的保护因素,处于工作状态是睡眠质量的保护因素(P0.05或P0.01)。结论:疫情影响下,长期居家人员容易出现焦虑抑郁情绪及躯体不适感,睡眠质量较差;在有慢性病史、伴有躯体疼痛的人员中更明显;而在受教育程度高、处于工作状态中及有配偶的人员中相对较轻。     

新冠肺炎疫情期间封闭管理精神科医护人员焦虑抑郁症状及相关因素调查

目的探讨新冠肺炎疫情期间封闭管理精神科医护人员焦虑抑郁状况及相关因素,为改善其心理健康状况提供参考。方法采用随机数字表法抽取临沂市精神卫生中心接受封闭管理的精神科医护人员124名,应用一般情况调查表、广泛性焦虑量表(GAD-7)、患者健康问卷抑郁量表(PHQ-9)进行测查。结果封闭管理精神科医护人员轻度、中度、重度焦虑症状检出率分别为49.59%、4.96%、4.13%;轻度、中度、中重度、重度抑郁症状检出率分别为30.58%、7.44%、2.48%、2.48%。不同年龄的精神科医护人员GAD-7评分差异有统计学意义(F=3.207,P=0.044),有无子女及不同行为类型的精神科医护人员PHQ-9评分差异有统计学意义(F=3.993,P=0.048;F=6.523,P=0.002)。逐步回归分析显示,影响封闭管理精神科医护人员焦虑的因素为:年龄和存在A型行为(β=0.225、0.183,P均<0.05);影响其抑郁的因素为:A型行为和年龄(β=0.258、0.187,P<0.05或0.01)。结论新冠肺炎疫情期间,封闭管理精神科医护人员普遍出现不同程度的焦虑、抑郁症状,年龄大和存在A型行为类型者是出现焦虑、抑郁症状的高危人群。     

新型冠状病毒肺炎患者急性应激障碍精神科药物干预2例报告

目的总结新型冠状病毒肺炎患者伴发急性应激障碍(acute stress disorder,ASD)的病例特征及精神科干预策略,以提高对新型冠状病毒肺炎患者ASD的识别和诊疗认识。方法报告2例在隔离状态下确诊新型冠状病毒肺炎患者出现ASD的病例,结合文献分析其临床特征及精神科干预过程。结果2例患者在隔离状态下确诊为新型冠状病毒肺炎后,出现ASD,2例患者均无自知力,不配合治疗,同时有情绪激动、冲动或纠缠行为,严重影响隔离病房诊疗秩序,并增加工作人员感染风险。其中1例因有明显焦虑、悲观、绝望表现,短期使用小剂量奥氮平合并氟哌噻吨美利曲辛片治疗后,焦虑、抑郁情绪很快缓解;另1例老年患者除情绪症状外,有被害妄想症状,在持续小剂量奥氮平治疗约5 d后,情绪症状改善,妄想症状消失。结论新型冠状病毒肺炎患者ASD不仅有焦虑、抑郁、睡眠障碍症状,还会出现冲动、消极行为,临床上应高度警惕,需要精神科干预时,应灵活应用指南,在保证安全的基础上,选择快速、有效的治疗方案。     

Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic

ObjectiveTo assess the prevalence and sociodemographic correlates of insomnia symptoms among Chinese adolescents and young adults affected by the outbreak of coronavirus disease-2019 (COVID-19).MethodsThis cross-sectional study included Chinese adolescents and young adults 12–29 years of age during part of the COVID-19 epidemic period. An online survey was used to collect demographic data, and to assess recognition of COVID-19, insomnia, depression, and anxiety symptoms using the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) questionnaires, respectively. The Social Support Rate Scale was used to assess social support.ResultsAmong 11,835 adolescents and young adults included in the study, the prevalence of insomnia symptoms during part of the COVID-19 epidemic period was 23.2%. Binomial logistic regression analysis revealed that female sex and residing in the city were greater risk factors for insomnia symptoms. Depression or anxiety were risk factors for insomnia symptoms; however, social support, both subjective and objective, was protective factors against insomnia symptoms. Furthermore, anxiety and depression symptoms were mediators of social support and insomnia symptoms.ConclusionsResults of this study revealed a high prevalence of sleep problems among adolescents and young adults during the COVID-19 epidemic, especially senior high school and college students, which were negatively associated with students’ projections of trends in COVID-19. The adverse impact of COVID-19 was a risk factor for insomnia symptoms; as such, the government must devote more attention to sleep disorders in this patient population while combating COVID-19.     

2019冠状病毒病(COVID-19)临床防治神经科专家共识

目前2019冠状病毒病(coronavirus disease 2019,COVID-19)疫情严重,该病毒除主要累及肺外,还可累及神经系统等,尤其早期以神经系统症状为首发症状时,往往容易误诊,延误治疗,这类患者还是隐形的传播者。为了让神经科医师了解这一疾病的发生发展和转归,熟悉相关的防治流程,我们将目前有关COVID-19的临床诊治以及相关研究的进展做一总结,以指导神经科医师对COVID-19的临床防治。     

The Associated Factors of Anxiety and Depressive Symptoms in COVID-19 Patients Hospitalized in Wuhan,China

This study was aimed to investigate the prevalence and factors associated with anxiety and depressive symptoms among hospitalized patients with COVID-19 during the epidemic outbreak in Wuhan, China. A total of 99 COVID-19 patients were recruited and completed the Hospital Anxiety and Depression Scale (HADS) and the modified Medical Research Council (mMRC) Scale. Results showed there was no significant difference in anxiety or depressive symptoms between male and female. Patients aged 46–60 years old had a higher ratio of both anxiety and depressive symptoms. Besides, patients whose hospital stays was longer than 14 days had a higher risk of depressive symptoms than those stays was less than 7 days. There was no significant difference in the correlation between level of dyspnea and the levels of anxiety or depressive symptoms. In conclusion, COVID-19 patients might have anxiety and depressive symptoms during hospitalization. Clinicians should pay attention to the middle age group and patients with longer hospital stays.

     

Guillain Barre syndrome associated with COVID-19 infection: A case report

Novel outbreak with coronavirus 2019 began since 31 December 2019. Coronaviruses can cause multiple systemic infections that respiratory complications are the most obvious symptoms. In this report, we describe the symptoms of Guillain Barre syndrome (GBS) in one infected patient with COVID-19, for the first time. We reported a 65-years- old male patient with complaints of acute progressive symmetric ascending quadriparesis. Two weeks prior to hospitalization, the patient suffered from cough, fever, and RT-PCR was reported positive for COVID-19 infection. The electrodiagnostic test showed that the patient is an AMSAN variant of GBS. COVID-19 stimulates inflammatory cells and produces various inflammatory cytokines and as a result, it creates immune-mediated processes. GBS is an immune-mediated disorder and molecular mimicry as a mechanism of autoimmune disorder plays an important role in creating it. It is unclear whether COVID-19 induces the production of antibodies against specific gangliosides. Further investigations should be conducted about the mechanism of GBS in patients with COVID-19, in the future.     

新型冠状病毒性肺炎疫情下神经外科急诊诊疗行为的建议及策略

目的 探讨新型冠状病毒肺炎（COVID-19）疫情期间神经外科急诊诊疗行为的建议及策略。方法 回顾性分析2020年1月20日到2020年3月20日武汉大学人民医院神经外科一病区收治的67例急诊病人的临床资料。分析67例病人及与这些病人有接触的41位医护人员感染COVID-19的情况，总结防控经验。结果 67例病人中，4例确诊COVID-19，3例疑似COVID-19。所有医护人员中，2名医师确诊感染COVID-19，其中1人为无症状感染，1人为轻症感染；1名护士确诊COVID-19，为轻症感染；医师及护士均未见疑似感染者。医护人员确诊感染COVID-19均发生在标准化防控措施开始执行之前，且不能排除社区感染的可能性。结论 通过科学的防控措施可将COVID-19的院内感染发生率控制在低水平，在疫情期间为神经外科急诊病人持续提供优质，安全的医疗服务     

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

ObjectiveThe Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.Methods831 teenagers (aged 14–19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.ResultsThe adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.ConclusionThese findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.     

New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study

Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID-19). This multicenter retrospective study enrolled people with COVID-19 from January 18 to February 18, 2020 at 42 government-designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID-19.     

Unilateral common carotid artery dissection in a patient with recent COVID-19: An association or a coincidence?

The “Corona Virus Disease 2019 (COVID-19)”, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), progressed rapidly since its first outbreak, and quickly developed into a pandemic. Although COVID-19 mostly presents with respiratory symptoms, researchers have started reporting neurologic manifestations such as cerebrovascular diseases in patients, with COVID-19 as the pandemic has progressed. Herein, we report a case of 38-year-old female patient identified with a left common carotid artery dissection, with COVID-19. Clinicians must keep in mind that COVID-19 can cause vascular complications such as carotid artery dissections in the ensuing period, even after the acute phase, although there is currently a lack of sufficient evidence to identify any causal association between COVID-19 and arterial dissections.     

COVID-19 pandemic and mental health consequences: Systematic review of the current evidence

BackgroundDuring the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002–2003) was associated with psychiatric complications.MethodsWe systematically searched the database Pubmed including studies measuring psychiatric symptoms or morbidities associated with COVID-19 among infected patients and among none infected groups the latter divided in psychiatric patients, health care workers and non-health care workers.ResultsA total of 43 studies were included. Out of these, only two studies evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the indirect effect of the pandemic (2 on patients with preexisting psychiatric disorders, 20 on medical health care workers, and 19 on the general public). 18 of the studies were case-control studies/compared to norm, while 25 of the studies had no control groups. The two studies investigating COVID-19 patients found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and significantly higher level of depressive symptoms (p = 0.016). Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. Studies investigating health care workers found increased depression/depressive symptoms, anxiety, psychological distress and poor sleep quality. Studies of the general public revealed lower psychological well-being and higher scores of anxiety and depression compared to before COVID-19, while no difference when comparing these symptoms in the initial phase of the outbreak to four weeks later. A variety of factors were associated with higher risk of psychiatric symptoms and/or low psychological well-being including female gender, poor-self-related health and relatives with COVID-19.ConclusionResearch evaluating the direct neuropsychiatric consequences and the indirect effects on mental health is highly needed to improve treatment, mental health care planning and for preventive measures during potential subsequent pandemics.     

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.