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Should Mental Health Professionals Watch Out for “COVID” Encephalitis?

Mental-health conditions, from substance misuse to depression, have increased during the COVID-19 pandemic. But are there mental health risks to contracting the virus itself?

Research is still ongoing, but there is evidence that COVID-19 infections could be linked to some mental health symptoms. For example, a 2020 study from Wuhan, China, found that about one-third of 214 patients with COVID-19 infection had “neurologic manifestations.” These included symptoms like dizziness and impaired consciousness, or the loss of taste and smell that is now commonly associated with the virus.

Preliminary results of a more recent study, published February 2021, show that COVID-19 survivors may be at higher risk of psychiatric concerns. These included anxiety disorders, insomnia, and dementia. However, further research is needed to confirm these findings.

Even more recently, some clinicians have been warning of another condition associated with COVID-19 and mental health symptoms: encephalitis.

What is encephalitis?

Encephalitis occurs when part of the brain swells or becomes inflamed. Symptoms can vary, depending on what part of the brain is affected. They can include:

Neck stiffness
Sensitivity to light or sound
Mental confusion or memory loss
Vision changes
Movement disorders
Loss of consciousness
Mood-related symptoms, such as anxiety or irritability
Excessive sleepiness

To diagnose encephalitis, healthcare providers may conduct scans of the brain, such as an MRI or CT scan. Electroencephalogram (EEG) can reveal the brain’s electrical activity. Patients may also be tested for infection.

Encephalitis is a serious condition that requires fast treatment of the underlying cause, which often includes antivirals or antibiotics. Mild cases often experience a full recovery. More serious cases may require months or even years of treatment and rehabilitation.

How is encephalitis linked to COVID-19?

Encephalitis is usually triggered by an autoimmune response or an infection, such as a virus. Therefore, the COVID-19 virus may cause encephalitis in rare cases.

A recent review of 23 studies looked at the outcomes of patients who developed encephalitis as a complication of COVID-19. Among hospitalized patients, the incidence of encephalitis was only 0.215 percent, and more likely in severely ill patients. For those few patients, the mortality rate was a significant 13.4 percent.

Paula Carvalho, MD, of the University of Idaho, has reported on a specific case of encephalitis in a 36-year-old man who was previously healthy, with no history of a psychiatric condition or drug use. He contracted a mild case of COVID-19. Two days after his symptoms resolved, however, he became physically and verbally aggressive.

When his family brought him to the ER, his vital signs were normal, and he showed no signs of infection, except testing positive for COVID-19. Brain MRI results indicated encephalitis. After treatment, the patient improved, and his mental status gradually returned to normal until he was discharged to home in 18 days.

The bottom line: Clinicians should be aware of this risk, and suggest the possibility of COVID-19 encephalitis for clients who exhibit abnormal behavior, acute psychosis, a confused state, or drowsiness.

Providing the best care for your behavioral health clients takes a lot of information: intake assessments, medication management, appointments, symptoms, and outcomes. Properly storing and analyzing this data not only helps you serve your clients, but keeps your practice efficient, profitable, and compliant.

BestNotes’ OutcomeTools feature takes the work out of outcome studies, leaving you free to do what you do best—treat your clients. Contact us to find out more or schedule a free demo.

date:  Oct 18, 2021
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Is COVID-19 Linked to Later Mental Health Issues?

By now you have seen that behavioral health needs have skyrocketed during the COVID-19 pandemic. We’ve already talked about how substance use and mental health issues like anxiety and depression are on the rise.

These issues occur whether or not individuals were exposed to the novel coronavirus or developed COVID-19. Newer research, however, suggests a possible link between COVID-19 and later development of mental health symptoms.

A New York Times article has described cases of individuals who developed psychiatric symptoms for the first time after being diagnosed with COVID-19. One patient developed paranoia that her children would be kidnapped. Another began to experience visual hallucinations.

There are a relatively few number of these cases, but they highlight the complicated connection between COVID-19 and behavioral health. Here are some recent findings by researchers around the world.

The Lancet Examines Links Between COVID and Mental Healthcare

An editorial in an upcoming issue of The Lancet notes the ongoing need for high-quality information about the effects of both the virus and the measures used to fight it.

This article points out that one study of U.S. electronic health records found an increased incidence of a first-time psychiatric diagnosis within 90 days of a COVID-19 diagnosis. However, the cause-and-effect connection was uncertain.

Another study, however, found that being recently diagnosed with a mental disorder was associated with an increased risk for COVID-19 infection. This association was exacerbated among African Americans and women. There was also a higher frequency of some adverse infection outcomes.

Possible Causes of Mental Health Issues After COVID-19

A group of authors from Spain have described in Psychiatry Research their observations of psychotic symptoms in COVID-19 patients. They noted that:

Psychotic symptoms in patients diagnosed with COVID-19 were more frequent in patients who had been admitted to intensive-care units.
Some psychiatric symptoms may be linked to the medications used to treat COVID-19.
Many psychotic episodes were resolved with low doses of antipsychotics.

Brain Inflammation in COVID

Inflammation in the central nervous system has been proposed as one cause of psychiatric symptoms in COVID-19 patients. However, one study in Germany indicates that this has little effect.

This study looked at neuropathological features in the brains of 43 COVID-19 patients who died between March 13 and April 24, 2020, in Hamburg, Germany. The researchers found generally mild neuropathological changes in patients with COVID-19. The most common finding was pronounced neuroinflammatory changes in the brainstem. However, the presence of the novel coronavirus in the central nervous system was not associated with the severity of neuropathological changes.

As additional research and other information emerges, we can hope to learn more about the mental-health effects of COVID-19. In the meantime, behavioral health providers should be aware of this risk among the people they serve.

As many populations and individuals struggle with mental health concerns during the COVID-19 pandemic, behavioral health services remain critical. If you’re a behavioral health provider who has not yet launched telehealth services, or you are struggling with your current telehealth system, it’s not too late. BestNotes EHR solutions offer secure, HIPAA-compliant, integrated tools to make your telehealth program a success. Contact us today to schedule a demo and learn more!

date:  Feb 08, 2021
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How Behavioral Health Providers Can Support Families’ Emotional Health During COVID-19

Between social isolation, financial difficulties, anxieties about the virus, and overall disruptions to normal life, the varying responses to the COVID-19 public health emergency have taken a significant toll on families. Behavioral health providers are uniquely positioned to help individuals and families recover from the mental health impact.

Here’s how behavioral health providers can support families and children during a difficult time


1. Look for evidence-based guidance.

When it comes to supporting families during difficult times, guidance from trusted sources can help point behavioral health providers in the right direction. Look for behavioral health-related trade and advocacy associations in your state and communities, such as the National Council for Behavioral Health, and any best practices or guidance they have issued.

You can also consider guidance for other specialties. For example, the American Academy of Pediatrics (AAP) earlier this year issued guidance for evaluating and supporting children, adolescents, and families struggling with behavioral health during COVID-19. This includes watching for reactions to stress, such as sleep and feeding disruptions, withdrawing, or expressions of fearfulness. Providers should also be aware of social health factors, such as food or housing insecurity.

2. Provide education to parents

Behavioral health providers also can support families by providing information and education, which may or may not be based on the previously mentioned guidance. Behavioral health providers can help parents and guardians identify signs of anxiety, depression, and other mental health concerns in their children of all ages. They can also advise families on appropriate stress management and self-care.

3. Connect behavioral health clients to community resources

Besides providing care and education, behavioral health providers can help direct clients and their families to additional, appropriate resources. This may include connecting clients to services that provide financial, housing, or food assistance, or physical healthcare. Get familiar with state and local resources that can provide additional support to your clients and their children and families.

4. Expand your treatment options, clinical knowledge, and services

As a behavioral health provider, you may want to consider expanding your training and education to be able to offer additional types of therapy to clients and families in need. For example, functional family therapy (FFT) is a type of short-term intervention that uses the whole family to help address adolescent behavior problems. Other options include virtual continuing education opportunities and online training sessions that may be available to you.

Even if you do not necessarily expand your current services, you may want to look at new ways to deliver them. For example, telehealth can help you provide more flexible hours, allowing you and your clients to attend therapy sessions from anywhere within your state. This can also help reduce no-shows and limit your and your clients’ potential exposure to illness. Providing online assessments can also help clients and their families get the type of therapy they need in a way that may feel less intimidating.

Challenges from the COVID-19 pandemic and the resulting increased demand for services have created many opportunities for behavioral health and addiction treatment providers. The right clinical tools are critical for helping you and your staff continue to serve clients and their families during a difficult time. BestNotes EHR solutions offer easy implementation and thorough technical support, with features such as telehealth and online assessments so you can continue to work at your best. Contact us to learn more.

date:  Dec 24, 2020
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Have Mental Illness and Addiction Rates Increased Amid the COVID-19 Pandemic?

Amid the COVID-19 public health emergency, health experts and law enforcement leaders have seen a rise in mental illness, drug overdoses, and addiction-related behaviors.

Several factors have contributed to a rise in drug and alcohol misuse this year:

Some people have used drugs and alcohol as coping methods to deal with fears and stress surrounding the virus.
Increased social isolation from stay-at-home orders can worsen feelings of anxiety and depression, prompting increased substance misuse and suicidal ideation.
Financial disruptions from business shutdowns and job loss can cause anxiety, leading to excessive drug and alcohol use.
Individuals struggling with addiction may have reduced access to providers or treatment centers due to state and local restrictions on healthcare.

Here are some of the more specific findings so far.

Significant Mental Health Impact

In a review published in the December issue of Journal of Affective Disorders, researchers looked at mental health data from eight countries, including the United States. Results showed “relatively high rates of anxiety, depression, post-traumatic stress disorder, psychological distress, and stress.”

Common risk factors for mental distress during the COVID-19 pandemic include:

Female gender
Aged 40 and younger
Preexisting chronic or psychiatric illnesses
Current students
Frequent exposure to social media or news regarding COVID-19

A report by Mental Health America found that the prevalence of mental illness among U.S. adults was already on the rise before the COVID-19 pandemic.

In 2017-2018, 19 percent of adults experienced a mental illness, up 1.5 million people from the previous year.
Suicidal ideation also rose among adults by 0.15 percent from 2016-2017 to 2017-2018.
In September 2020, 8 in 10 people who took an anxiety screen showed moderate-to-severe symptoms. The number of people screening with moderate-to-severe depression and anxiety symptoms is currently higher than before COVID-19.

These findings are supported by findings from the Centers for Disease Control and Prevention (available via PDF) on suicidal ideation.

Evidence of Increasing Alcohol Consumption

Researchers from the RAND Corporation in California and the Indiana University School of Public Health have found changes in alcohol use during the COVID-19 public health emergency. In a research letter published in September in JAMA Network Open, the authors compared survey data collected from April 29 to June 9, 2019, and from May 28 to June 16, 2020.

The frequency of alcohol consumption increased 19 percent for adults aged 30 to 59 years.
Women in particular reported a 41-percent increase in heavy drinking between the two time periods.

Drug Use and Opioid Overdoses Persist

Many areas are reporting increases in drug use and overdoses, including opioids.

In West Virginia, the number of overdose-related emergency room visits was higher for July and August 2020 than the same months the year before.
In Maryland, 657 overdoses were recorded in Anne Arundel County since January, up 15 percent compared to last year. Of those overdoses, 113 people died, an 8 percent increase in fatalities compared to 2019.
A report by the American Medical Association (PDF) found that more than 40 states have seen a rise in opioid-related mortality.

Behavioral health and addiction treatment providers are seeing increased demand for their services, at the same time they may be facing practice limitations during the COVID-19 public health emergency. BestNotes’ EHR solutions are designed to help your behavioral health practice reduce frustration and stay compliant and profitable. Contact us today to schedule a free demo.

date:  Nov 24, 2020
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How Behavioral Health Practices Can Prepare for Increased Demand

Demand for behavioral health services has skyrocketed during the COVID-19 pandemic. Besides fears of the virus itself, job losses and financial difficulties are increasing anxiety while social isolation from quarantine and stay-at-home orders are leading to a rise in depression symptoms. These difficulties are also leading to an increase in suicidal behaviors and substance misuse.

Additionally, behavioral health demand was already on the rise before COVID-19. PwC reported in February 2020 that a Health Care Cost Institute report on U.S. healthcare spending trends found that spending on psychiatry grew 43 percent between 2014 and 2018. Use of psychiatric services rose 32 percent between 2014 and 2018.

If you are an independent behavioral health provider, how can you prepare for and respond to this increased demand for your services? Here are a few things to consider.

Take a closer look at your practice’s infrastructure.

Are you practically able to add more clients to your practice? Not only should you consider your own limits of time and energy, but you also have the practice itself to consider. Make sure your practice’s infrastructure, such as your waiting room, office space, and any administrative staff, can handle more clients.

Will additional clients create more expenses or administrative burdens? Are your current solutions, such as billing, scheduling, and electronic health record (EHR) software, enough to help you manage these new clients? Make sure you understand how an increased client load will affect your practice.

Partner with other organizations.

For one reason or another, you may not have the availability to serve additional clients in your own practice. However, you may still be able to make a difference and help mitigate behavioral health demand through partnerships with other organizations in your community.

Reach out to other providers in both physical and behavioral health, as well as local health and social services agencies and community groups. Connecting with other professionals and related organizations can help you raise awareness of behavioral health issues, refer individuals in need to appropriate providers, and build your own professional network and knowledge.

If you don’t use telehealth, now is the time to start.

If you have not already added telehealth capabilities to your behavioral health practice, it is not too late. In fact, teletherapy use may be even higher now than in the early stages of the pandemic. Remote behavioral health options could allow you to see more clients in less time, whether you are conducting initial assessments or talk therapy appointments.

Although requirements have relaxed during COVID-19, it is still important to follow best telehealth practices. Make sure you take the appropriate steps to make sure you get reimbursed for telehealth, as well.

Consider adding a partner to your practice.

When you are the only behavioral health provider at your independent practice, there are greater limits to the services you provide and the number of clients you have. Hiring another therapist at your practice, or even bringing on a business partner, is one way to expand your capacity.

When you’re stressed and overworked, the right clinical tools are critical for helping you and your staff continue to serve clients and stay on top of your workload. BestNotes EHR solutions offer easy implementation, reduced clicks, and thorough technical support, as well as telehealth capabilities. Our software was created with clinicians in mind, helping you do what you do best. Contact us to learn more.

date:  Nov 24, 2020
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