Purpose The aim of our study is to evaluate the number and the features of admissions to the emergency room (ER) requiring psychiatric consultation, in the period between May 4th and August 31st 2020. Methods We carried out a retrospective longitudinal observational study examining the 4 months following the initial lockdown imposed during the COVID-19 outbreak (May 4th and August 31st 2020). More specifically, the ER admissions leading to psychiatric referral were reviewed at all seven public hospitals of AUSL Romagna (Emilia Romagna region, Italy). Socio-demographic variables, history of medical comorbidities or psychiatric disorders, reason for ER admission, psychiatric diagnosis at discharge, and actions taken by the psychiatrist were collected. Results An 11.3% ( p = 0.007) increase in psychiatric assessments was observed when compared with the same period of the previous year (2019). A positive personal history of psychiatric disorders (OR:0.68, CI: 0.53–0.87) and assessments leading to no indication for follow-up (OR: 0.22, CI: 0.13–0.39) were significantly less frequent, while there was a significant increase of cases featuring organic comorbidities (OR: 1.24, CI: 1.00–1.52) and suicidal ideation/self-harm/suicide attempt (OR: 1,71, CI: 1.19–2.45) or psychomotor agitation (OR: 1.46, CI: 1.02–2.07) as reason for admission. Conclusions Our results showed an increase in ER psychiatric consultations compared to the previous year, underlying the increased psychological distress caused by the lockdown.

The aim was to study the number of accesses to the Emergency Room (ER) requiring psychiatric evaluation in the four months following the lockdown period for the COVID-19 outbreak (May 4th, 2020-August 31th, 2020). The study is a retrospective longitudinal observational study of the ER admissions of the Hospitals of Cesena and Forlì (Emilia Romagna region) leading to psychiatric assessment. Sociodemographic variables, history for medical comorbidities or psychiatric disorders, reason for ER admission, psychiatric diagnosis at discharge and measures taken by the psychiatrist were collected. An increase of 9.4% of psychiatric assessments was observed. The difference was more pronounced in the first two months after lockdown, with a 21.7% increase of number of ER accesses, while after two months numbers were the same as those of the year before. Admission with anxiety symptoms and history of psychiatric disorder decreased significantly. Moreover, there is an age trend with an increasing age of admission.

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Background Obsessions, compulsions, and stereotypes are common psychopathological manifestations of obsessive-compulsive, psychotic, and autism spectrum disorders (ASDs). These nosological entities may be present in comorbidity, with relevant clinical difficulties in the differential diagnosis process. Moreover, ASDs are a complex group of disorders, with a childhood onset, which also persist into adulthood and present heterogeneous symptom patterns that could be confused with psychotic disorders. Methods and Results We report a case of a 21-year-old man characterized by sexual and doubt obsessions; disorganized, bizarre, and stereotyped behaviors and compulsions; and social withdrawal, inadequate social skills, visual dispersions, and hypersensitivity to light stimuli. Obsessive and compulsive features were initially included within the differential diagnosis of psychotic and obsessive-compulsive spectrum disorders. However, aforementioned psychopathological elements did not improve when multiple antipsychotic drugs (olanzapine, haloperidol, and lurasidone) were administered in the hypothesis of schizophrenia and even worsened with clozapine therapy at a dose of 100 mg/d. Obsessions and compulsions progressively reduced during the fluvoxamine 14-week treatment paradigm at a dose of 200 mg/d. Considering the persistent deficits in social communication and interactions as well as the restricted interests pattern, a differential diagnostic hypothesis of ASD was formulated, and it was then confirmed at the final evaluation at a third-level health care center. Conclusions We discuss similarities and differences in the psychopathology of obsessions, compulsions, and stereotypes in the previously mentioned disorders, to underline factors that can help in the differential diagnosis of similar cases, and consequently in the appropriateness of treatment choice.

B ipolar disorder (BPD) is a lifelong, episodic illness 1 that affects nearly 50 million persons globally. 2 Depressive episodes are responsible for the major amount of disability, 2 especially in terms of anhedonia and circadian rhythm disturbance. 3 Nevertheless, there is only a limited number of approved drugs for bipolar depression: quetiapine, fluoxetine/ olanzapine combination, cariprazine, and lurasidone are the only medications currently approved by the US Food and Drug Administration (FDA). 4 Antidepressants have limited evidence of efficacy. 5 Brexpiprazole is a dopamine 2 (D 2 ) and serotonin 5HT 1A receptor partial agonist antipsychotic 6 ; it is approved for schizophrenia (FDA, 2015; EMA, 2018), as adjunctive treatment to antidepressants in major depressive disorder (FDA, 2015), and recently, it was investigated as monotherapy in acute mania of BPD I. 7 To the best of our knowledge, 2 single-arm studies have evaluated the efficacy of brexpiprazole in bipolar depression (ClinicalTrials.gov Identifier: NCT03427892 and NCT04569448), the former was completed with positive results on depressive symptoms, the latter is still recruiting. However, possible benefits on anhedonia, anxiety, irritability, and insomnia were not assessed, and follow-up was limited to 8 weeks, in the open label trial with published results. 8 In addition, this study did not include patients with treatment-resistant depression.In this regard, we present the case of a woman with treatment-resistant bipolar II depression who showed rapid and sustained amelioration not only in overall depressive symptoms, but in the hedonic drive, after brexpiprazole augmentation therapy, during a 16-week period of observation. Written informed consent was obtained from the patient for publication of the case report.