Anxiety and Suicidality in a Hospitalized Patient with COVID
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The COVID-19 pandemic requires social distancing, quarantine and isolation, which may precipitate new psychiatric symptoms in people without mental illness or aggravate existing conditions. Mental health service providers, including psychiatrists, clinical psychologists and social workers, should be available in every facility taking care of COVID-19 patients.
Health workers treating patients during the COVID-19 pandemic should be aware of symptoms of depression, anxiety, insomnia and/or distress developing in their patients and colleagues.

A 34-year-old man with a medical history of diabetes mellitus and smoking, presented to the emergency room with a 4-day history of weakness, fever and cough. On admission, his temperature was 37.5°C, pulse was 102 bpm, blood pressure was 133/85 mmHg, and oxygen saturation was 96% while breathing ambient air. Breath sounds were diminished with crackles over the left lower lung field. Chest radiographs showed interstitial opacities in the left lower lobe. Laboratory tests were unremarkable except for mild lymphopenia and thrombocytopenia. Nasopharyngeal and oropharyngeal swabs for COVID-19 were obtained due to a history of exposure to COVID-19 patients.

After a positive result was reported, the patient was admitted to an isolation ward. Treatment with antibiotics and hydroxychloroquine was initiated. Direct contact between the staff and the patient was purposely minimal; interaction was primarily via an electronic audio-video link. Visitors were prohibited. During his hospitalization, the patient had no fever or respiratory distress. However, he developed symptoms consistent with anxiety and insomnia. A supportive intervention was initiated by a team of social workers and treatment with brotizolam was commenced.

On hospital day 7, the patient attempted suicide by jumping from the third-floor ward. Droplet and contact precautions were initiated, and he was transferred to the trauma bay. All staff caring for the patient wore personal protective equipment. The patient was intubated and transferred under strict infection control measures for computed tomography which revealed subdural and subarachnoid haemorrhages, bladder laceration and pelvic fracture with active bleeding.

Due to haemodynamic instability, the patient was urgently transferred to the operating room for pelvic stabilization. The procedure was performed in a distal operating room and all possible precautions were taken to prevent infection spread and protect the staff, including shutting down air-conditioning and postponing other surgeries in the compound. After pelvic fixation, the patient was transferred to a level 1 trauma centre for neurosurgical intervention. Full sanitization of the operating room, trauma bay and radiology unit was carried out.

Based on this unfortunate experience, we encourage clinicians to pay special attention to the mental health aspects of the COVID-19 pandemic.

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