End-of-Life Care and Bereavement Issues in Human Immunodeficiency Virus–AIDS

This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process

Improvement of Superimposed Pseudo Seizures in a Patient With Anxiety Disorder

Introduction: Pseudoseizures or psychogenic non epileptic seizures (PNES) are associated to mental health disorders and stress.2 PNES can often present superimposed with seizure disorder and abnormal EEG, making it harder to be recognized and treated. We present a complex case of seizure disorder status post CVA with superimposed PNES in the context of Bipolar disorder, Somatization and Anxiety disorder. Case Description: LA is a 39 yo female with PMHx of CVA with left sided residual weakness, thyroid disease, seizure disorder who presents with active jerking movements in left lower extremity that started during her neurology outpatient visit. Patient was AAO. Neurological examination was only significant for residual severe spasticity of left upper extremity and active shaking and spasm of both legs, first on left leg thereafter switching to right leg and back to left leg for over an hour, including during EEG. Emergency EEG was performed with patient having active shaking and tremor-like symptoms, being normal. Symptoms resolved after patient learned that EEG did not show active ictal activity. Upon psychiatric evaluation, patient endorsed anxiety, insomnia, mood swings, and somatic symptoms: pain, headaches. MSE was negative for active SI/HI, paranoia or psychosis. Testing for HAM-A was 27 and Somatic symptom scale-8 was 18. Patient was started on Lamotrigine, Sertraline and Clonazepam, with improvement of her symptoms. Discussion: This case highlights the importance to be vigilant for pseudoseizures1 since misdiagnosis can often lead to inappropriate treatment, increase in readmission rates and comorbidities2

Neuropsychiatric Consequences of COVID-19: A Literature Review

Objective: This review presents recent studies illustrating neurological and psychiatric effects seen in COVID-19 patients. Introduction: COVID-19 has been associated with diverse acute neurological manifestations in patients1. However, longer-term mental health and psychiatric sequelae are less clear. Monitoring the neuropsychiatric consequences of COVID-19, along with their risk factors and mechanisms, can provide valuable information to prepare patients and health providers for inevitable long-term sequelae of COVID-19. Methods: A PubMed search was completed with the following criteria present in the title and/or abstract: ((COVID-19 AND patients) AND (psychiatric)) OR ((COVID-19 AND patients) AND (neuropsychiatric)). This yielded 118 results in English for which the full-text was available. Studies presented in this review were chosen with the following inclusion criteria: observational studies of neuropsychiatric effects in COVID-19 patients published from January 2020 to August 20, 2020. 10 studies investigating clinical signs of neuropsychiatric sequelae in COVID-19 patients and meeting inclusion criteria were identified. Results: This review identified 10 studies, meeting inclusion criteria, that investigated neuropsychiatric manifestations of COVID-19. The diverse symptoms found in these studies fell into various overlapping categories with implications for longer-term neuropsychiatric follow-up: neurological, involving the CNS, PNS, and musculoskeletal system; psychiatric, including post-traumatic stress, depression, anxiety, and psychosis; and increased inflammatory markers. Conclusion: Neuropsychiatric effects associated with COVID-19 are common and potentially severe. Additional studies are necessary to further characterize the role of SARS-CoV-2 in potential long-term neuropsychiatric sequelae. Understanding the risk factors and mechanisms behind these manifestations can help identify targets for early intervention and ensure that patients receive optimal care. References: 1. Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P., Fusar-Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020). Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet. Psychiatry, 7(7), 611–627

A Review on COVID-19 and SES in the United States. Does Low SES Increase Risk of Psychiatric Complications From COVID-19?

A review on COVID-19 and SES in the United States. Does low SES increase risk of psychiatric complications from COVID-19? Sara Khan, MS-II, College of Allopathic Medicine Shivani Kaushal, MS-II, College of Allopathic Medicine Ron Israel, MD, Psychiatry, Aventura Hospital and Medical Center Sindhura Kompella, MD, Psychiatry, Aventura Hospital and Medical Center Clara Alvarez Villalba, MD, Program Director, Psychiatry, Aventura Hospital and Medical Center Objective. We will examine the relationship between coronavirus disease-19 (COVID-19) and socioeconomic status (SES) and elucidate which populations are most vulnerable to severe outcomes. Background. This review was completed in preparation for a retrospective study on whether low SES COVID-19 patients have an increased rate of psychiatric admissions compared to higher SES counterparts. We will summarize current research on COVID-19 and SES and explore whether low SES COVID-19 patients face an increased risk of psychiatric complications. Methods. We searched the PubMed database using terms “COVID-19 and SES” and “COVID-19 and socioeconomic status”. Selected studies evaluated SES in relation to confirmed or probable COVID-19 cases in the U.S. Results. Studies indicate that areas with higher rates of poverty, lower levels of education, and higher proportions of racial/ethnic minorities have an increased rate of COVID-19 cases, admissions, and fatality. However, these studies do not evaluate whether low SES patients face an increased rate of psychiatric complications. Conclusion. Research indicates COVID-19 disproportionately plagues populations with low SES. However, there is a lack of data on whether they are at heightened risk for psychiatric sequelae. Despite the growing evidence of neuropsychiatric symptoms in COVID-19 patients, studies do not evaluate sociodemographic factors in relation to psychiatric complications. Given that low SES is a risk factor for mental illness and COVID-19 may result in psychiatric symptoms, perhaps low SES patients are more likely to experience psychiatric sequelae. To bridge gaps in the literature, future studies should assess sociodemographic factors in COVID-19 patients with psychiatric complications