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Physicians and psychiatrists need to be aware of the co-occurrence of mental and physical health problems and the challenges posed for both general and mental health services. There is a need to screen appropriately in both settings to ensure timely diagnosis and treatment. Liaison psychiatry provides psychological assessment and treatment for people with physical illness, but there is a gap in the provision of physical healthcare for people with severe mental illness. There is a need for public policy to drive this forward to overcome the institutional barriers to equitable access to healthcare and for educators to reverse the tendency to teach mind and body as separate systems.

Objectives This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm. Methods All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the three months from 1st March to 31st May 2020. These data were compared with presentations in the same months in the three years preceding (2017-2019). Data were obtained from the anonymised service database. Results This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a four-year period were examined, there was a significantly higher lethality of attempt (p<0.001), and significant differences in diagnosis (p=0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p=0.036). There were also significant differences in the underlying psychiatric diagnoses(p=0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period. Conclusions COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of the restrictions and changes due to Covid-19, especially with respect to self-harm.

The potent vasoconstrictor endothelin (ET) is implicated in several human disease states including hypertension, congestive heart failure, renal failure, pulmonary hypertension, ischemia, and cerebral vasospasm.1-9Two subtypes of ET receptors known as ETa and ETb have been cloned and characterized in animal and mammalian systems.10-13 A third endothelin receptor subtype has been cloned from Xenopus dermal melanophores and heart,14•15 although this subtype has not yet been described in mammalian tissues.Both ETa and ETb receptors are widely distributed in animal and human tissues.16-26 In a wide variety of animal tissues, vasoconstriction occurs via activation of ETa and/or ETb receptors depending upon the species and vascular bed under study.17-26 However, there is some controversy as to whether ETb receptors play an important role in mediating vasoconstrictor responses in mammalian tissues.20-23 Davenport et al. have reported that ETA-mediated vasoconstriction plays a major role in some human vessels, such as coronary artery, but have been unable to demonstrate ETb receptor-mediated contractions in human tissues using ETB-selective agonists such as [Ala 1,3,11,15]ET-1 and BQ 3020.20 However, Luscher et al. have reported that ETb receptor mRNA was detected by Northern blot analysis in human internal mammary artery and aortic smooth muscle cells.23 Several groups have shown that the ETb receptor agonist SRTX-6c can elicit vasoconstriction in human vessels although the magnitude of the response has been found to be considerably less than that observed for ET-1 itself.24-26 It is possible that downregulation of ETb receptors in isolated tissues is responsible for these observations.A number of peptide ET antagonists have been reported including BQ-12327•28 and FR 139317,29 which are potent ETA-selective antagonists; balanced ETa/ETb antagonists including PD 14289330 and PD 14506531 and the recently reported ETB-selective antagonist, BQ-788.32 A number of non-peptide endothelin antagonists have also been reported. These include the Shionogi steroid analog 97-13933 and several balanced ETa/ETb non-peptide antagonists, including Ro 46-2005,9 Ro 47t Department of Therapeutics.