LAUSR

An outbreak, such as the coronavirus disease 2019 (COVID19), may facilitate relapse of psychotic disorders through outcome, such as social distancing, lockdown or change in the priority of health services [1]. Besides the effects of the outbreak, lack of insight, non-adherence to treatment, poor social and cognitive functioning observed in psychotic disorders may make it difficult to maintain treatment [2]. Non-adherence to treatment is a major risk factor for relapse in individuals with schizophrenia or bipolar disorder [3, 4]. Using long-acting injectable antipsychotics (LAIs) may be a solution against the risk of relapse under outbreak conditions. Community mental health centers (CMHCs) may be protective against the risk of relapse, but their delivery of care is also affected by the outbreak. They might have to develop and implement new interventions as the outbreak commands [5], but few evidence exists to design a relevant plan for relapse prevention [6] and to apply a sustainable clinical practice [7]. In this background, we aimed to detect the relapse rate of patients registered at Etimesgut CMHC, Ankara, to investigate the basic characteristics of patients who experienced relapse during the first trimester (from 10th of March to 10th of June) of the COVID-19 outbreak in Turkey, and to compare main findings with the same period in 2019 as being suggested by Moreno et al. [7]. Our CMHC had been closed between 23 March and 13 April 2020 because the team was initially assigned to Etimesgut State Hospital for the outbreak until mid-April. Once reopened, telepsychiatry monitoring at CMHC was initiated once/twice a week or biweekly according to the patient’s clinical status. From a number of total 188 patients, 155 could be contacted. The medical charts of these 155 patients (schizophrenia/schizoaffective disorder n = 131 [84%], bipolar disorder n = 24 [16%]) were investigated retrospectively. The demographic, clinical characteristics and medication adherence of the patients were recorded. Relapse criteria were defined as: (1) psychiatric hospitalization, (2) admission to emergency department (ER) for psychiatric reasons, (3) discontinuing antipsychotics (defined as not using oral formulations for a week or delaying the next LAI injection for two weeks), (4) new onset of suicidal thoughts or suicide attempt, and (5) non-suicidal self-harm or violent behavior. The mean age of the sample was 46.6 ± 12.5, with a mean duration of education 9 ± 3.6 years. Most of the patients were male (68%), single/separated (59%), unemployed (56%) and living with their families (90%). The mean duration of illness was 20 ± 10.6, and follow-up duration at the CMHC was 2.9 ± 1.5 years. The median number of previous hospitalization was 2 (min–max: 0–10, IQR:2), and the median duration after the last hospitalization was 6 years (min–max: 0–30, IQR: 4). The relapse rate of the patients in the first trimester of COVID-19 outbreak was 11% (bipolar disorder n = 2, schizophrenia n = 15). Most of the patients who experienced relapse reported discontinuation of antipsychotics (59%). In addition, 2 patients were hospitalized, 4 were admitted to the ER, 2 had new onset of suicidal thoughts/suicide attempt, and 3 showed self-harm or violent behavior. The relapse and the non-relapse groups were similar regarding age, gender, duration of education, employment and marital status, diagnosis, duration of illness and followup and the number of previous hospitalizations (p > 0.05). The relapse group had been hospitalized more recently * Emre Mutlu [email protected]