Throughout this period we were confronted with news and information about the Corona virus and its consequences. Which led to the development of a huge sense of fear among people. Although fear has helped to maintain restrictions, it has also had a significant impact on mental health, especially among patients with a psychiatric history.

In this paper I will highlight the consequences of the nocebo effect of the pandemic among people with a psychiatric history.

To complete this work I used medical articles, studies, and specialized information on the subject.

The pandemic’s restrictions have made it difficult for psychiatric patients to be compliant treatment by avoiding regular psychiatric exams.Isolation and fear of infection has led to new decompensations in existing psychiatric pathologies.

The exacerbations of psychiatric pathology increased both in number and in their intensity, ultimately determined by the increase in the number of hospitalizations in psychiatric emergencies.

No significant relationships.

Looking at the vast majority of mental disorders in the last year, we noticed that most of them were closely related to this feeling of fear but also to the restrictive measures that appeared with the pandemic. Exposure for a period of more than a year to this mental stress has led to the appearance of a large number of psychiatric patients, especially those who have undergone SARS-CoV-2 infection or who have had close people infected, some of whom have even died.

In this paper I will highlight the post traumatic consequences in patients who have gone through the disease.

To complete this work I used medical articles, studies, and specialized information on the subject.

Patients who have gone through the disease developed sleeping problems, phobias, various anxiety and delusional disorders.

These conditions create the need for a multidisciplinary approach among this particular category of patients.

No significant relationships.

Excessive alcohol consumption is an ever-topical issue regardless of social or medical problems (pandemic). In these conditions (global medical crisis),to the problem of alcohol consumption has been added a new dimension.

The main purpose of this study is to analyze the impact of the COVID-19 pandemic on hospitalizations diagnosed with acute intoxication in the hospital. In Romania, the measures due to the pandemic were instituted starting with March 15 2020.

The study was performed retrospectively between 01.01.2020 - 30.09.2020 in the Psychiatric Hospital ‘Elisabeta Doamna’ Galati. ICD-10 criteria were used to establish the diagnosis of the disorder.

In total, 458 cases were admitted during the period mentioned, of which 401 were male (87.56%), female 57 cases (12.44%). The average age of patients was 45.67 years ± 0.695, with minimum age of 19 years and maximum age of 93 years. The month with the most admissions was January with 80 (17.46%) March by 79 (17.25 %). The months with the fewest hospitalizations were April with 27 cases (5.89%) and July with 35 cases (7.64%).

The analysis of the data shows that as measures specific to the epidemic crisis were instituted, the number of hospitalizations decreased significantly by about 3 times.

To evaluate the efficacy of three different strategies in the management of self-aggressive behavior (defined as repeated overdoses, explicit suicidal attempts or self-mutilation) observed in heroin dependent patients.

A group of 16 patients, mean age 26.2, diagnosed with heroin dependence, were treated as outpatients, with (1) oxcarbazepine (mean daily dose 900 mg), (2) cognitive behavioral therapy focused on coping strategies and cognitive restructuring (2 sessions per week) or (3) the combination of the previous two methods. All the included patients were monitored for 6 months using Inventory of Drug Taking Situations (IDTS), Clinical Global Impression-Improvement (CGI-I), Suicide Attempt-Self Injury Interview-Short Version (SAS II-B) and Global Assessment of Function (GAF). The randomization of the patients in the three groups was single blinded.

Oxcarbazepine was well tolerated and no drop out related to adverse events was registered. Patients that received combined therapy registered an improvement (p< 0.01) in all self-aggressive behaviors (33% to baseline), global functioning (25%) and clinical impression (24%). There was a significant difference between this group and the psychotherapy only treated group (p< 0.01 on SAS II-B, GAF, CGI), but not significant when it was compared to oxcarbazepine group (p=0.06). Regarding the impact of treatment strategies over the severity of addiction, only the combined therapy had some success, by decreasing with 11% the IDTS score.

The combined therapy, using CBT and oxcarbazepine, reduced the risk for self-aggressive behaviors on medium term in heroin dependent patients and mildly decreased the severity of the dependence.

To establish the frequency of self-image distorsions in alcohol dependent patients and if addressing them through a targeted psychotherapeutic approach would be beneficial.

A group of 45 patients, 32 male and 13 female, mean age 39.6, diagnosed with alcohol dependence (DSM IV TR), were evaluated for establishing the severity of self-image distorsions, using-baseline and endpoint- Rotter Incomplete Sentence Test (RIST) and Thematic Apperception Test (TAT); for the monitoring of the dependence severity and its associated impairments we used Inventory of Drug Taking Situations (IDTS)-alcohol focused version and Global Assessment of Function (GAF) every 4 weeks for 6 months. From the initial group, 38 (84.4%) patients have been found with moderate and severe self-image distorsions (feeling of insecurity and inferiority, external locus of control, frequent use of denial, regression and projection). They received cognitive-behavior therapy (CBT) focused on restructuring cognitive dysfunctional beliefs about self and experimenting new ways to relate to self and significant others.

The psychotherapeutic approach decreased the overall severity of alcohol dependence (-35.7 on IDTS, p< 0.01) and consequently improved the global functioning (+18.2 on GAF, p< 0.01) after 6 months. These results correlated with the improvement of self-image, reflected on the severity of P-Ego scale from RIST (-23.2%, p< 0.01) and on the improvement of defense system (more frequent use of anticipation, suppression and rationalization and less of denial and projection).

Patients with alcohol dependence have very often self-image distorsions and could, therefore, benefit from a psychotherapy that addresses specifically this phenomenon.

Alzheimer Dementia (AD) is known as the most common cause of degenerative dementias that decrease patient life expectancy, quality of life and increase caregivers burden. Objective: To determine the evolution of cognitive and non-cognitive symptoms under donepezil treatment and to evaluate the impact of these symptoms evolution over the caregivers.

This prospective, open-label, trial included a group of 56 patients, 34 male and 22 female, mean age 72.4, diagnosed with AD according to DSM-IV-TR criteria. Patients received either donepezil (n= 30) or 1400 UI/day mean dose of vitamin E (n=26). We evaluated these patients monthly during 1 year using Mini-Mental State Examination (MMSE), AD Assessment Scale (ADAS), Hamilton Depression Rating Scale (HAMD)-17 items, Brief Psychiatric Rating Scale (BPRS)- 18 items, Global Assessment of Functioning Scale (GAF), Burden Interview (BI).

Patients presented significant better evolution under donepezil on cognitive symptoms as scores evolution on ADAS-Cognitive behavior subscale (+1.5+/-0.2 vs. +10.4+/-0.8, p<0.0001) and MMSE (-0.8+/-0.2 vs. –7.7+/-0.4, p<0.0001) reflected. The non-cognitive symptoms evolution was also better under donepezil treatment, as the ADAS-Noncognitive behavior subscale (+2.6+/-0.4 vs. +8.2+/-0.7, p<0.0001), HAMD (increases of 4.5 vs. 8.2, p<0.001) and BPRS (increases of 6.7 vs.14.2, p<0.0001) reflected. The evolution of GAF was better in the donepezil group (-10.5 vs. –27.5, p<0.0001) and the burden of caregivers was significant less in the same group (+10.2 vs. +30.8 on BI, p<0.0001).

Donepezil is efficient in controlling both cognitive and non-cognitive symptoms in mild to moderate AD and therefore it decreases also the caregivers burden.

Patients with schizophrenia that are treated with first generation, but also with several second generation antipsychotics, frequently describe negative changes in self-perception and daily activities due to weight gain. A systematic analysis of the weight gain influence over the body image is necessary because it could offer a perspective over the patient's discomfort, improving his/her chances to therapeutic compliance and a better life quality. Psychotherapy, change of antipsychotics, nutritional counselling, ocupational therapy or physical exercises scheduling could be solutions to these cases.

A group of 34 patients, 18 female and 16 male, diagnosed with chronic schizophrenia (DSM IV TR), mean age 45.3, treated with antipsychotic agents for at least 2 years (haloperidol 15 cases, olanzapine 10 cases, amisulpride 5 cases, risperidone 4 cases) were evaluated in order to configure a body image profile, using self-reports, investigator-based reports and Draw-a-Person-Test (DAP). Patients included in this evaluation presented a mean weight gain of 10%, reported to their premorbid value.

The body image was negative in 82.3% with marked dysfunctional believes about self in 64.7%, while the rest of 17.6% had mild to moderate levels of self-blame or hopelessness automatic thoughts associated to weight gain. Only 17.7% patients had a neutral or positive body image, also their mean weight gain was equally to the negative body image group.

Negative body image is usually associated to weight gain as a side event to antipsychotic drugs, therefore is important to ventilate the patient's dysphoric feelings and to choose the optimal therapy.

One of the main goals of psychotherapy should be increasing the patient's quality of life. This purpose is of extreme importance in patients diagnosed with cancer that have to fight with anxiety, depression, social and occupational adjustment difficulties.

We included in a 3 months weekly sessions program of cognitive psychotherapy a number of 12 patients, 8 female and 4 male, mean age 52.4, diagnosed with malignant tumors (lung cancer 2 cases, ovarian cancer 2 cases and stomach cancer one case). The assessment included Cancer Coping Questionnaire (CCQ)- 21 items version, Hamilton Rating Scale for Anxiety (HAM-A), Beck Depression Inventory-21 items (BDI), Global Assessment of Functioning (GAF) and the dysfunctional beliefs monitoring throughout all the 3 months of this trial. Therapy focused on working with “realistic” negative automatic thoughts, attention switch on resources instead of loses, stimulating emotional expression of frustration, anger or blaming, involving in planning activities and isolation prevention. Inclusion criteria: CCQ baseline value under 42, either anxiety or depressive symptoms, or both, that interfere with daily functioning (HAM-A score over 20, BDI over 15, GAF under 75).

All patients that reach the endpoint (two drop-outs recorded) improved their cognitive approach to cancer because their coping methods improved and dysfunctional beliefs decreased in frequency and strength. CCQ score improved with 34.5%, HAM-A decreased with 15+/-2.5%, BDI decreased with 18+/-1.5% and GAF increased with 10+/-1.1% at endpoint.

Cognitive therapy is an usefull approach in oncologic patients, helping them to focus on resources, activity and relational support.

Poor sleep quality causes frequently and seriously impairments in older people daily functioning. More than that, inadequate treatment of insomnia side effects further decrease patients quality of life.

We examined whether between nonbenzodiazepine and benzodiazepine hypnotic treatment are significant differences regarding sleep quality, total sleep time, sleep onset latency, number of awakenings during the night, global functioning and side effects.

A group of 40 outpatients, 16 male and 24 female, mean age 67.9, diagnosed with insomnia, was divided in two equally groups, each of them receiving for at least 7 days either zolpidem 5 mg/day or diazepam 10 mg/day, overnight. Inclusion criteria: age over 65. Exclusion criteria: physical illness and psychiatric disorders that disrupt sleep, simultaneous administration of other sedative drugs. An assessment using Clinical Global Impressions (CGI), Global Assessment of Functioning (GAF) and self reports for depth, total perceived time, onset latency of sleep, number of awakenings during night and side effects were realised every day for a week.

The intent-to-treat (ITT) and last-observation-carried-forward (LOCF) analysis reflected statisticaly significant differences from the day 2 in four variables- depth of sleep (+3/+1.2, p<0.01), number of awakenings(+3.2/+4.9, p<0.01), GAF (+7.8/+5.5, p<0.01) and CGI (-1.9/-0.7, p<0.01) in favor of zolpidem treated patients. Also, side effects were significantly more frequent reported in benzodiazepine group (15/10, dropouts 3/1, p<0.01).

Zolpidem is a first choice treatment in older people because it is well tolerated and have a good efficacy profile compared to diazepam.

Selective serotonin reuptake inhibitors (SSRIs) are frequently used for irritable bowel syndrome, while duloxetine was evaluated in other similar psycho-somatic syndromes.

This prospective, single-blind trial intends to compare the efficacy of SSRIs and duloxetine in the treatment of irritable bowel syndrome.

A group of 22 patients, 15 female and 7 male, mean age 50.2, diagnosed with irritable bowel syndrome according to the Rome II Diagnostic Criteria (1992) were treated with either an SSRI (escitalopram 20 mg/day, n = 6 or fluoxetine 40 mg/day, n = 6) or duloxetine (90 mg/day, n = 10). Patients were evaluated initially and every 4 weeks, for 6 months, using Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale 17 items version (HAMD), Clinical Global Impressions -Severity/Improvement (CGI-I/S) and a 7-points Likert scale (LS) for self-evaluated severity.

Duloxetine improved anxiety and depressive symptoms, as reflected by the significant decrease of HAMA (−17.6 points, p < 0.05) and HAMD scores (−18.2 points, p < 0.05) at week 12. SSRIs also reduced the affective symptoms, significantly to baseline (p < 0.05), but less than duloxetine (−14.3, −15.2) at week 12, with no significant difference at week 24 (p = 0.120). The CGI-I results paralleled the decrease of HAMD and HAMA, while the LS evaluation of gastrointestinal symptoms improved similarly in both groups, with no significant difference (p = 0.09).

Duloxetine is an efficient agent in the treatment of irritable bowel syndrome, because it decreases the mood symptoms more rapidly than SSRIs. The overall efficacy of SSRIs and duloxetine at 6 months is nevertheless similar.

Perceptual and thought distorsions that are observed in the acute episodes of schizophrenia make the adaptation to reality very difficult, but there are residual symptoms that interfere with coping in the interepisodic phases, also. There are specific coping strategies found by such patients in order to face the difficult challenges of hallucinations, delusions, attentional and memory deficits, but also the social stigma and negative symptoms, like isolation.

We assessed 51 patients, 40 male and 11 female, mean age 39.8, diagnosed with chronic schizophrenia- paranoid (n=22), residual (n=14), catatonic (n=10) and disorganised (n=5) type, according to DSM -IV- TR criteria, in order to establish a correlation between main categories of coping mechanisms and the specific type of schizophrenia. Inclusion criteria: patients included in a cognitive- behavioural therapy and antipsychotic maintenance treatment for at least 4 weeks. Exclusion criteria: axis II comorbidity or severe somatic pathology that could modify patients coping strategies.

Patients with paranoid schizophrenia associated maladaptive coping strategies like alcoholism (36.3%) and aggression (27.2%), those with residual type presented more social withdrawal (71.4%) and self- harming (35.7%), while catatonic and disorganised schizophrenia cases had a high incidence of thought blocking (60% and 40%, respectively) and social isolation (60% in both groups).

There are more frequent types of coping mechanisms in each form of schizophrenia. This is an important fact for focusing the psychotherapy approach on conversion to adaptative coping strategies, using techniques like verbal challenge and reality testing, reatributtion- enhancing methods, activities daily programming.

Cognitive- behavioural therapy (CBT) is an augmentation strategy used in bipolar depression because it improves compliance to treatment, patient's insight into specific areas of daily behavior, allows patient to recognize early signs of disease and to cope with stressfull events.

To analyse the efficacy and action onset of augmentation cognitive- behavioural specific techniques in patients diagnosed with bipolar depression that receive an antidepressant and anticonvulsant combination therapy.

A group of 18 patients, 6 male and 12 female, mean age 32.9, admitted in our clinic with bipolar disorder type I, major depressive episode (DSM-IV-TR) were distributed in two equally groups, one of them received only antidepressant drug plus anticonvulsant, the other combined psychopharmacological treatment with CBT. All patients received carbamazepine (flexible dose 400-600 mg/day) and selective serotonin reuptake inhibitor (SSRI): 7 patients fluoxetine 20-40 mg/day, 6 patients paroxetine 20-40 mg/day and 5 sertraline 150-200 mg/day. Inclusion criteria: Hamilton Depression Rating Scale 17 items (HAMD-17) over 17, Young Mania Rating Scale (YMRS) under 10. Exclusion criteria: axis I or II comorbidity. We used weekly for 4 weeks and monthly for 5 months HAMD, YMRS, Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI).

There was a significant better improvement in patients receiving CBT treatment (-12%HAMD, -14%GAF, -16%CGI). YMRS was stable in both groups. The onset of antidepressant action was observed earlier in CBT group (10.5 days compared to 17.5).

CBT stands as an efficacious augmentation strategy for patients who are treated with antidepressant and anticonvulsant therapy.

Although the mechanisms explaining metabolic impairments observed during antipsychotic treatment are not well known, there are important differences between drugs regarding the possibility of inducing lipidic and glucose impairments.

To assess the effects of atypical and typical antipsychotics -olanzapine, aripiprazole, risperidone and haloperidol over the weight, glucose and HDL-cholesterol levels, during 24 weeks of treatment.

A 43 patients group, 30 male and 13 female, mean age 42.1, admitted during an acute phase of chronic schizophrenia (DSM-IV-TR), were distributed on flexible dose of olanzapine (N=12) 10-20 mg/day, aripiprazole (N=11) 15-30 mg/day, risperidone (N=10) 4-8 mg/day or haloperidol (N=10) 10-20 mg/day. Weight, fasting glucose and HDL-cholesterol were weekly monitored during the first month and monthly after that. Inclusion criteria: baseline glucose and HDL-cholesterol levels within normal range. Exclusion criteria: familial history of diabetus mellitus or obesity.

Regarding the weight gain, the safest antipsychotic is aripiprazole (+0.4+/-0.2 kg at endpoint), followed by haloperidol (+1.9+/-0.2 kg), while olanzapine (+5.6+/-1.1 kg) and risperidone (+3.4+/-0.5 kg) are less tolerated. The glucose level >125 mg/dl was observed at endpoint in 3 patients with risperidone, 6 with olanzapine, 2 with haloperidol. The HDL-cholesterol over 40 mg/dl (men) and over 50 mg/dl (female) appeared in 4 cases of olanzapine and 3 cases of risperidone treated patients.

There are quantitative differences in the level of weight gain, HDL-cholesterol and glucose level induced by antipsychotics. The safest antipsychotic agent is aripiprazole because it doesn't induce significant weight gain or other metabolic complications.