The impact of the COVID-19 pandemic on patients with personality disorders.

Q3 Medicine
Ioannis A Malogiannis
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Recent meta-analyses with 50,000-70000 participants noted the increase in anxiety, depression and feelings of loneliness in the general population.1 Patients with pre-existing mental disorders were a vulnerable group at high risk of deterioration.1,2 As part of the measures to combat the pandemic, the operation of mental health services was reduced, the access to them became more difficult and the provision of supportive and psychotherapeutic interventions continued through telepsychiatry.2 Of particular interest is the study of the impact of the pandemic on patients with personality disorders (PD).3 These patients experience severe difficulties related to interpersonal relationships and identity, which lie at the basis of intense affective and behavioral manifestations.4,5 Most studies on the impact of the pandemic on patients with personality pathology have focused on borderline personality disorder (BPD).6 Social distancing measures during the pandemic and increased sense of loneliness are serious aggravating factors for patients with BPD and may cause anxieties of abandonment and rejection, social withdrawal, and feelings of emptiness. Consequently, the patients' susceptibility to risky behaviors and substance use increases.3,7 The anxieties caused by the condition, as well as the feeling of not being in control of the situation by the subject, may mobilize paranoid ideation in patients with BPD, which further exacerbates the difficulties in their interpersonal relationships.7 In a Nordic multicenter study of 1120 outpatients with PD during the first wave of the pandemic, results showed an increase in anxiety, depression, aggression, substance use, social isolation and a decrease in work activity, while the rates of suicidal behaviors remained the same.8 On the other hand, for some patients the restricted exposure to interpersonal triggers could lead to amelioration of symptoms.7 Several papers have studied the number of visits of patients with PD or patients with self-harm to hospital emergency departments during the pandemic.6,9 In the studies that examined self-injury, the psychiatric diagnosis was not recorded, but they are mentioned here because the presence of self-harm is closely associated with PD.10 The number of emergency department visits of patients with PD or self-harm was found to be increased in some papers, decreased in others, and stable in others, compared to the previous year.6,9 During the same period, however, both the distress of patients with PD and rates of self-harm thoughts in the general population increased.3,6-8 The decreased number of emergency department visits could be the result of reduced access to services or amelioration of symptomatology due to decreased social contact or sufficient remote therapy through telepsychiatry. A critical issue that mental health services providing therapy to patients with PD had to encounter was the need to discontinue in person psychotherapy and continue by telephone or online. Patients with PD are particularly sensitive to therapeutic setting modifications and this was an aggravating factor.7 In several studies, discontinuation of in person psychotherapy for BPD patients was accompanied by worsening symptomatology, feelings of anxiety, sadness, and feelings of helplessness.6,11 When it was not possible to continue sessions by telephone or online, there was an increase in the number of emergency department visits.6,11 In contrast, continuation of sessions via tele-psychiatry was considered satisfactory by patients and in some cases their clinical picture, after the initial nuance, returned and maintained at previous level.6,11 In the above studies, the discontinuation of sessions involved a period of 2-3 months. In a study conducted at the PD services of the First Psychiatric Department of the National and Kapodistrian University of Athens, at Eginition Hospital, at the start of the restriction measures, 51 BPD patients were attending group psychoanalytic psychotherapy sessions. The face-to-face sessions were discontinued and continued online for 4 months. During this time, no self-harm incidents, suicide attempts or hospitalizations occurred; 2 patients discontinued treatment. In crises, patients used telephone communication with therapists and no emergency department visits were recorded.12 In conclusion, the pandemic had a significant psychological impact on patients with PD. 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引用次数: 2

Abstract

Three years after the outbreak of COVID-19 pandemic, numerous epidemiological studies confirm its significant psychological impact. Recent meta-analyses with 50,000-70000 participants noted the increase in anxiety, depression and feelings of loneliness in the general population.1 Patients with pre-existing mental disorders were a vulnerable group at high risk of deterioration.1,2 As part of the measures to combat the pandemic, the operation of mental health services was reduced, the access to them became more difficult and the provision of supportive and psychotherapeutic interventions continued through telepsychiatry.2 Of particular interest is the study of the impact of the pandemic on patients with personality disorders (PD).3 These patients experience severe difficulties related to interpersonal relationships and identity, which lie at the basis of intense affective and behavioral manifestations.4,5 Most studies on the impact of the pandemic on patients with personality pathology have focused on borderline personality disorder (BPD).6 Social distancing measures during the pandemic and increased sense of loneliness are serious aggravating factors for patients with BPD and may cause anxieties of abandonment and rejection, social withdrawal, and feelings of emptiness. Consequently, the patients' susceptibility to risky behaviors and substance use increases.3,7 The anxieties caused by the condition, as well as the feeling of not being in control of the situation by the subject, may mobilize paranoid ideation in patients with BPD, which further exacerbates the difficulties in their interpersonal relationships.7 In a Nordic multicenter study of 1120 outpatients with PD during the first wave of the pandemic, results showed an increase in anxiety, depression, aggression, substance use, social isolation and a decrease in work activity, while the rates of suicidal behaviors remained the same.8 On the other hand, for some patients the restricted exposure to interpersonal triggers could lead to amelioration of symptoms.7 Several papers have studied the number of visits of patients with PD or patients with self-harm to hospital emergency departments during the pandemic.6,9 In the studies that examined self-injury, the psychiatric diagnosis was not recorded, but they are mentioned here because the presence of self-harm is closely associated with PD.10 The number of emergency department visits of patients with PD or self-harm was found to be increased in some papers, decreased in others, and stable in others, compared to the previous year.6,9 During the same period, however, both the distress of patients with PD and rates of self-harm thoughts in the general population increased.3,6-8 The decreased number of emergency department visits could be the result of reduced access to services or amelioration of symptomatology due to decreased social contact or sufficient remote therapy through telepsychiatry. A critical issue that mental health services providing therapy to patients with PD had to encounter was the need to discontinue in person psychotherapy and continue by telephone or online. Patients with PD are particularly sensitive to therapeutic setting modifications and this was an aggravating factor.7 In several studies, discontinuation of in person psychotherapy for BPD patients was accompanied by worsening symptomatology, feelings of anxiety, sadness, and feelings of helplessness.6,11 When it was not possible to continue sessions by telephone or online, there was an increase in the number of emergency department visits.6,11 In contrast, continuation of sessions via tele-psychiatry was considered satisfactory by patients and in some cases their clinical picture, after the initial nuance, returned and maintained at previous level.6,11 In the above studies, the discontinuation of sessions involved a period of 2-3 months. In a study conducted at the PD services of the First Psychiatric Department of the National and Kapodistrian University of Athens, at Eginition Hospital, at the start of the restriction measures, 51 BPD patients were attending group psychoanalytic psychotherapy sessions. The face-to-face sessions were discontinued and continued online for 4 months. During this time, no self-harm incidents, suicide attempts or hospitalizations occurred; 2 patients discontinued treatment. In crises, patients used telephone communication with therapists and no emergency department visits were recorded.12 In conclusion, the pandemic had a significant psychological impact on patients with PD. However, it should be emphasized that in cases where the therapeutic setting remained alive and the continuity of therapeutic collaboration was maintained, patients with PD, despite the severity of their pathology, showed good adaptation and were able to withstand the tensions caused by the pandemic.

新冠肺炎疫情对人格障碍患者的影响
在2019冠状病毒病大流行爆发三年后,大量流行病学研究证实了其重大的心理影响。最近对5万至7万名参与者进行的荟萃分析指出,普通人群的焦虑、抑郁和孤独感有所增加先前存在精神障碍的患者是病情恶化风险较高的弱势群体。1,2作为防治这一流行病措施的一部分,减少了心理健康服务的运作,获得这些服务变得更加困难,并继续通过远程精神病学提供支持性和心理治疗干预特别令人感兴趣的是研究大流行对人格障碍(PD)患者的影响这些患者经历与人际关系和身份相关的严重困难,这是基于强烈的情感和行为表现。大多数关于大流行对人格病理患者影响的研究都集中在边缘型人格障碍(BPD)上大流行期间的社交隔离措施和孤独感的增加是BPD患者严重加重的因素,可能导致被抛弃和被拒绝的焦虑、社交退缩和空虚感。因此,患者对危险行为和药物使用的易感性增加。由这种情况引起的焦虑,以及被主体无法控制局面的感觉,可能会调动BPD患者的偏执观念,从而进一步加剧他们人际关系中的困难在北欧的一项多中心研究中,在第一波大流行期间对1120名门诊PD患者进行了研究,结果显示焦虑、抑郁、攻击性、药物使用、社会孤立和工作活动减少增加,而自杀行为的比例保持不变另一方面,对一些病人来说,有限的人际接触可能会导致症状的改善有几篇论文研究了大流行期间PD患者或自残患者到医院急诊室就诊的数量。6,9在检查自我伤害的研究中,没有记录精神病学诊断,但这里提到了这些诊断,因为自我伤害的存在与PD密切相关。10与前一年相比,PD或自残患者的急诊就诊次数在一些论文中有所增加,在另一些论文中有所减少,在另一些论文中则保持稳定。然而,在同一时期,PD患者的痛苦和一般人群中自残想法的比例都增加了。3,6-8急诊科就诊次数的减少可能是由于获得服务的机会减少,或由于社会接触减少或通过远程精神病学进行充分的远程治疗,症状得到改善。为PD患者提供治疗的心理健康服务必须遇到的一个关键问题是需要停止面对面的心理治疗,并继续通过电话或在线进行治疗。PD患者对治疗环境的改变特别敏感,这是一个加重因素在一些研究中,BPD患者停止面对面的心理治疗会伴随着症状的恶化,焦虑、悲伤和无助的感觉。6,11当无法通过电话或在线继续会诊时,急诊科就诊的次数有所增加。6,11相反,患者认为通过远程精神病学继续治疗是令人满意的,在某些情况下,他们的临床症状在最初的细微差别之后恢复并保持在以前的水平。6,11在上述研究中,疗程的中断时间为2-3个月。在雅典国立大学和Kapodistrian大学第一精神科的PD服务部门进行的一项研究中,在限制措施开始时,51名BPD患者正在参加团体精神分析心理治疗会议。面对面的会议被中断,并继续在网上进行了4个月。在此期间,没有发生自残事件、自杀企图或住院治疗;2例患者停止治疗。在危机中,患者使用电话与治疗师沟通,没有急诊室就诊记录总之,大流行对PD患者有显著的心理影响。然而,应该强调的是,在治疗环境仍然存在并保持治疗合作连续性的情况下,PD患者尽管其病理严重,但表现出良好的适应能力,并能够承受大流行造成的紧张局势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Psychiatrike = Psychiatriki
Psychiatrike = Psychiatriki Medicine-Medicine (all)
CiteScore
2.60
自引率
0.00%
发文量
37
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