Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey

IntroductionThe impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma.MethodsUsing data from an online UK-wide survey of 4500 people with asthma (median age 50–59 years, 81% female), conducted in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting having had COVID-19.ResultsThe COVID-19 group (n=471, 10.5%) reported increased inhaler use and worse asthma management, compared with those not reporting COVID-19, but did not differ by gender, ethnicity or household income. Among the COVID-19 group, 56.1% reported having long COVID, 20.2% were ‘unsure’. Those with long COVID were more likely than those without long COVID to describe: their breathing as worse or much worse after their initial illness (73.7% vs 34.8%, p<0.001), increased inhaler use (67.8% vs 34.8%, p<0.001) and worse or much worse asthma management (59.6% vs 25.6%, p<0.001). Having long COVID was not associated with age, gender, ethnicity, UK nation or household income.Analysis of free text survey responses identified three key themes: (1) variable COVID-19 severity, duration and recovery; (2) symptom overlap and interaction between COVID-19 and asthma; (3) barriers to accessing healthcare.ConclusionsPersisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma.

Implications of the Symptom-Level Overlap Among DSM Diagnoses for Dimensions of Psychopathology

Research on the patterns of covariation among mental disorders has proliferated, as summarized in the Hierarchical Taxonomy of Psychopathology (HiTOP). This brief letter sought to examine whether symptom overlap represents an important source of bias in the statistical structure of psychopathology. I found that 358 pairs of the DSM-5 diagnoses covered by the HiTOP framework had one or more overlapping, and that a third (n = 130; 34%) of the unique constituent symptoms do reinforce the higher-order structure of HiTOP through repetition within dimensions and/or between dimensions in the same superspectrum. By contrast, 86% of the possible pairs of diagnoses did not have any shared symptoms, and the majority of the unique constituent symptoms (n = 222; 58%) do not influence the structure through repetition; a fifth (n = 71; 19%) work against the HiTOP structure at the subfactor, spectrum, and superspectrum level. I conclude that symptom-level homogeneity likely inflates the similarity and consequent covariation of some DSM diagnoses—e.g., in the Antisocial Behavior dimension—and research on the statistical structure of psychopathology should account for this potential source of bias. However, the patterns of symptom overlap in the DSM are not strong enough to make the HiTOP structure a foregone conclusion.

Bypassing the Adrenals: A Rare Case of Adrenal Insufficiency Following Bariatric Surgery

Background: Adrenal insufficiency (AI) is a life-threatening disorder that is generally caused by primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Patients often present with fatigue, hypotension, anorexia, and weight loss. There are few reported cases of AI following bariatric surgery; a type of procedure designed to cause weight loss and anorexia - two of the cardinal symptoms of AI. Establishing a diagnosis of AI in patients who have undergone bariatric surgery can be challenging due to symptom overlap, but it is of critical importance given that an acute stressor has the potential to precipitate adrenal crisis with risk of death. Clinical Case: A 42-year-old woman presented 15-months after sleeve gastrectomy with biliopancreatic diversion and duodenal switch with nausea, vomiting, decreased oral intake, weight loss, weakness and fatigue. Her symptoms were severe, requiring admission to the hospital and were initially thought to be a result of her bariatric surgery. Initial intake exam and labs were notable for mild hypotension, persistent hypoglycemia with hemoglobin A1c &lt;3.4%. Further evaluation revealed a low AM cortisol (5.5 μg/dL) and diagnosis of AI was confirmed by a failed cosyntropin stimulation test with cortisol levels of 7.0 μg/dL and 10.6 μg/dL 30- and 60-minutes after cosyntropin administration, respectively. Her diagnosis remained confounded by the presence of concomitant micronutrient deficiencies including copper, zinc, vitamin D and vitamin B6. Furthermore, she was found to have low insulin and c-peptide levels of 1 μU/mL and 0.4 ng/ml, respectively, despite persistent hypoglycemia. The patient was treated with enteral nutrition via nasojejunal feeds and glucocorticoid replacement therapy with daily oral hydrocortisone and fludrocortisone. Each of her symptoms improved after initiation of steroid replacement therapy and she was discharged home. Conclusion: Clinicians should keep a high degree of suspicion for adrenal insufficiency in patients who have undergone bariatric surgery due to the degree of symptom overlap in this population.

Neuroleptic malignant syndrome: a guide for psychiatrists

SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

The epidemiology of apathy in neurological disorders

Apathy is defined as an independent psychiatric syndrome characterized by deficits in goal-directed behaviour, goal-directed cognitions, and the emotional concomitants of goal-directed behaviour. Apathy is present in both neurodegenerative disorders such as dementia, and in acute neurological disorders such as stroke. This chapter will review the frequency and correlates of apathy in Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and stroke. In all these disorders, diagnosis of apathy is complicated by the symptom overlap with depression and cognitive impairment. Nevertheless, structured diagnostic interviews, ratings scales, and standardized diagnostic criteria for apathy have been recently developed. Apathy is one of the most frequent behavioural complications of neurological disorders; it is associated with poor quality of life and increased caregiver burden. Treatment of apathy is limited to small case series, and its specific management in the different neurological condition remains unclear.

Prevalence and severity of posttraumatic stress symptoms in psychosis: associations with affective and patient-centered variables in those referred for psychological services

Individuals with psychosis and comorbid posttraumatic stress disorder typically present with more severe forms of illness. Subthreshold posttraumatic stress symptoms (PTSS) are also likely to cause significant distress. The spontaneous disclosure of abuse history is unlikely, which is problematic given that PTSS often go unnoticed due to psychotic symptom overlap, yet when asked, most individuals desire treatment even for subthreshold PTSS. if associations are found between PTSS severity, clinical symptomology, and patient-centered variables, it will further justify the need to enhance PTSS screening during routine care to encourage appropriate referral to specialized services. One hundred and two individuals with psychosis participated in an intake evaluation following referral for psychological services at a clinic specializing in psychological interventions for psychosis, which included the PTSD Checklist for DSM-5. Prevalence of trauma exposure was explored in conjunction with PTSS severity and referral-type. Clinical variables were entered in a multivariate analysis of variance with low, moderate, and high PTSS severity. Of the 102 participants, 21.6% did not report trauma and 14.7% reported events not meeting DSM-5 PTSD criterion A. Data from 65 participants were included; 6.2% of which were referred for trauma. Main effects emerged for all variables except wellbeing and delusional severity. Depression, anxiety, and stress were all significantly higher in the severe compared to low PTSS categories. Quality of life was significantly lower in the severe versus low PTSS category. Severe PTSS were associated with depression, anxiety, and stress, and lower QoL. A severe PTSS category captures a broader range of people likely requiring services and speaks to an important need to improve referral rate for trauma intervention.