Role of psychiatric hospitals during a pandemic: introducing the Munich Psychiatric COVID-19 Pandemic Contingency Plan

BACKGROUND Psychiatry is facing major challenges during the current coronavirus disease 2019 (COVID)-19 pandemic. These challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to people with mental illness while at the same time providing relief to overstretched general medicine services. Although psychiatric disorders comprise the leading cause of the global burden of disease, mental healthcare has been deemphasised in the wake of the onslaught of the pandemic: to make room for emergency care, psychiatric wards have been downsized, clinics closed, psychiatric support systems discontinued and so on. To deal with this pressing issue, we developed a pandemic contingency plan with the aim to contain, decelerate and, preferably, avoid transmission of COVID-19 and to enable and maintain medical healthcare for patients with mental disorders. AIMS To describe our plan as an example of how a psychiatric hospital can share in providing acute care in a healthcare system facing an acute and highly infectious pandemic like COVID-19 and at the same time provide support for people with mental illness, with or without a COVID-19 infection. METHOD This was a descriptive study. RESULTS The plan was based on the German national pandemic strategy and several legal recommendations and was implemented step by step on the basis of the local COVID-19 situation. In addition, mid- and long-term plans were developed for coping with the aftermath of the pandemic. CONCLUSIONS The plan enabled the University Hospital to maintain medical healthcare for patients with mental disorders. It has offered the necessary flexibility to adapt its implementation to the first and second waves of the COVID-19 pandemic in Germany. The plan is designed to serve as an easily adaptable blueprint for psychiatric hospitals around the world

The multimodal Munich Clinical Deep Phenotyping study to bridge the translational gap in severe mental illness treatment research

Introduction: Treatment of severe mental illness (SMI) symptoms, especially negative symptoms and cognitive dysfunction in schizophrenia, remains a major unmet need. There is good evidence that SMIs have a strong genetic background and are characterized by multiple biological alterations, including disturbed brain circuits and connectivity, dysregulated neuronal excitation-inhibition, disturbed dopaminergic and glutamatergic pathways, and partially dysregulated inflammatory processes. The ways in which the dysregulated signaling pathways are interconnected remains largely unknown, in part because well-characterized clinical studies on comprehensive biomaterial are lacking. Furthermore, the development of drugs to treat SMIs such as schizophrenia is limited by the use of operationalized symptom-based clusters for diagnosis. Methods: In line with the Research Domain Criteria initiative, the Clinical Deep Phenotyping (CDP) study is using a multimodal approach to reveal the neurobiological underpinnings of clinically relevant schizophrenia subgroups by performing broad transdiagnostic clinical characterization with standardized neurocognitive assessments, multimodal neuroimaging, electrophysiological assessments, retinal investigations, and omics-based analyzes of blood and cerebrospinal fluid. Moreover, to bridge the translational gap in biological psychiatry the study includes in vitro investigations on human-induced pluripotent stem cells, which are available from a subset of participants. Results: Here, we report on the feasibility of this multimodal approach, which has been successfully initiated in the first participants in the CDP cohort; to date, the cohort comprises over 194 individuals with SMI and 187 age and gender matched healthy controls. In addition, we describe the applied research modalities and study objectives. Discussion: The identification of cross-diagnostic and diagnosis-specific biotype-informed subgroups of patients and the translational dissection of those subgroups may help to pave the way toward precision medicine with artificial intelligence-supported tailored interventions and treatment. This aim is particularly important in psychiatry, a field where innovation is urgently needed because specific symptom domains, such as negative symptoms and cognitive dysfunction, and treatment-resistant symptoms in general are still difficult to treat

Efficient three-dimensional reconstruction of aquatic vegetation geometry: Estimating morphological parameters influencing hydrodynamic drag

Aquatic vegetation can shelter coastlines from energetic waves and tidal currents, sometimes enabling accretion of fine sediments. Simulation of flow and sediment transport within submerged canopies requires quantification of vegetation geometry. However, field surveys used to determine vegetation geometry can be limited by the time required to obtain conventional caliper and ruler measurements. Building on recent progress in photogrammetry and computer vision, we present a method for reconstructing three-dimensional canopy geometry. The method was used to survey a dense canopy of aerial mangrove roots, called pneumatophores, in Vietnam’s Mekong River Delta. Photogrammetric estimation of geometry required 1) taking numerous photographs at low tide from multiple viewpoints around 1 m2 quadrats, 2) computing relative camera locations and orientations by triangulation of key features present in multiple images and reconstructing a dense 3D point cloud, and 3) extracting pneumatophore locations and diameters from the point cloud data. Step 3) was accomplished by a new ‘sector-slice’ algorithm, yielding geometric parameters every 5 mm along a vertical profile. Photogrammetric analysis was compared with manual caliper measurements. In all 5 quadrats considered, agreement was found between manual and photogrammetric estimates of stem number, and of number × mean diameter, which is a key parameter appearing in hydrodynamic models. In two quadrats, pneumatophores were encrusted with numerous barnacles, generating a complex geometry not resolved by hand measurements. In remaining cases, moderate agreement between manual and photogrammetric estimates of stem diameter and solid volume fraction was found. By substantially reducing measurement time in the field while capturing in greater detail the 3D structure, photogrammetry has potential to improve input to hydrodynamic models, particularly for simulations of flow through large-scale, heterogenous canopies

Structural investigations of (La,Pu)PO4_{4} monazite solid solutions: XRD and XAFS study

A solid state method was used to synthesize La1-xPuxPO4 (x = 0.01, 0.05, 0.10, 0.15, (0.5)) solid solutions with monazite structure. XRD measurements of the compounds with x = 0.50 revealed the formation of two phases: (La,Pu)PO4-monazite and a cubic phase (PuO2). Pure-phase La1-xPuxPO4-monazite solid solutions were obtained for materials with x = 0.00–0.15 and confirmed by a linear dependence of the lattice parameters on composition according to Vegard's law. X-ray absorption spectroscopy (XAS) analysis at the Pu-LIII and La-LIII edges confirmed the +III valence state of plutonium in the monazite solid solutions. The local environment of Pu is PuPO4-like along the solid solution series, except for the longest fitted cation-cation distance, which may be an indication of cluster formation consisting of a few Pu-atoms in the La-Pu-monazite lattice

Effects of prenatal Poly I:C exposure on global histone deacetylase (HDAC) and DNA methyltransferase (DNMT) activity in the mouse brain

The aim of our study was to investigate the brain-specific epigenetic effects on global enzymatic histone deacetylase (HDAC) and DNA methyltransferase (DNMT) activity after prenatal exposure to maternal immune challenge by polyinosinic:polycytidylic acid (Poly I:C) at gestational day (GD) 17 in C57BL/6JRccHsd mouse offspring. Pregnant mice were randomly divided into 2 groups, receiving either 5 mg/kg Poly I:C or phosphate buffered saline (PBS) intravenously at GD 17. Subsequently, the effects on whole brain enzymatic HDAC and DNMT activity and the protein levels of various HDAC isoforms were assessed in the offspring. Overall, a significant sex × treatment interaction effect was observed after prenatal exposure to maternal immune challenge by Poly I:C, indicative of increased global HDAC activity particularly in female offspring from mothers injected with Poly I:C when compared to controls. Results on the levels of specific HDAC isoforms suggested that neither differences in the levels of HDAC1, HDAC2, HDAC3, HDAC4 or HDAC6 could explain the increased global HDAC activity observed in female Poly I:C offspring. In conclusion, we show that Poly I:C administration to pregnant mice alters global brain HDAC, but not DNMT activity in adult offspring, whereas it is still unclear which specific HDAC(s) mediate(s) this effect. These results indicate the necessity for further research on the epigenetic effects of Poly I:C