Psychiatric Consultations at an Academic Medical Center in the Initial Weeks of the COVID-19 Pandemic: A Clinical and Sociodemographic Comparison of COVID-Positive and COVID-Negative Consultations

Background During the initial weeks of the COVID-19 pandemic, the overall number of psychiatric consultations decreased; however, the consultations that were placed appeared to be heavily related to either COVID-19 infection or a stressor secondary to the pandemic. New onset neuropsychiatric symptoms have been seen and described in prior reports among patients with acute COVID-19 infection. This study aimed to examine the sociodemographic and clinical characteristics of psychiatric consultations in the early portion of the pandemic, and compare patients who were COVID-19-positive with those who were negative. Methods This IRB-approved retrospective chart review involved all psychiatric consultations for COVID-19-positive patients admitted to a medical floor at an academic medical center from March 1 2020 until May 31 2020. Sociodemographic, medical (including diagnoses and laboratory values), and psychiatric information was collected from all consultations, and patients who were COVID-19 positive were matched with a COVID-negative comparison group by age (+/- 3 years) and gender. Statistical analyses to compare these groups were performed. Results There were 80 consultations for COVID-positive patients identified in the given time period. These were matched with a comparison group of 80 patients who had been listed as COVID-negative; however on review of medical records only 64 were truly negative, so 16 were excluded. Significant differences existed between groups in terms of reason for psychiatric consultation (p=0.04) and billing diagnosis (p<0.01), with COVID-positive patients appearing to have a greater likelihood of presenting with psychosis or delirium, and less likelihood for mood, anxiety, or substance use. D-dimer levels were higher in COVID-positive patients, and patients with COVID had a higher mortality rate. COVID-positive patients were more likely to receive a “second-generation antipsychotic”. Differences between groups in terms of specific psychiatric symptoms were explored. No other sociodemographic or medical differences were found between groups. Discussion/Conclusion: Patients with COVID-19 infection may be at an increased rate for delirium and for symptoms of psychosis. Multiple studies have speculated on mechanisms for such symptoms, though findings are inconclusive. This study suggests that simply increased stress during the pandemic is not the driving factor for these symptoms. Patients admitted to medical floors with COVID-19 infection should be screened for delirium and for new-onset neuropsychiatric symptoms. Funding No Funding