| Summary: | Background: COVID-19 has impacted healthcare delivery across every setting and patient population since it began ravaging our communities in the early part of 2020. The impact of the pandemic has propelled changes in healthcare delivery incorporating new technologies and resulting at times to interruptions in care and impacting access to treatment. The aim of this study is to understand the various ways in which the COVID-19 pandemic has affected mental health overall and particularly in those with psychotic disorders who are particularly vulnerable to disruptions in their access to care and to their usual routines. There is evidence that mental health is negatively affected during epidemics and public health crises. The unique nature and scale of the COVID-19 pandemic in modern times presents an opportunity to learn more about the challenges faced by our patients and improvements that can be made in the delivery of mental health care. Methods: We report five cases of patients with preexisting psychotic disorders seen on the inpatient psychiatry unit of an inner city community hospital who decompensated for various reasons relating to the COVID-19 pandemic. In addition, we conducted a review of the existing literature on the effects of epidemics and pandemics on mental health by searching the PubMed database for the keywords “mental health,” “psychosis,” “COVID-19,” “epidemic,” “pandemic,” and “coronavirus.” Results: The ramifications of public health crises on mental health are broad and well documented. The prevalence of psychotic disorders in the US is estimated to be between 0.25% and 0.64%. In the context of an epidemic or pandemic, the incidence of psychotic symptoms in those infected with a virus is estimated to be between 0.9% and 4%. While the effects of the COVID-19 pandemic have led to psychiatric decompensation in predictable ways, such as making it difficult for patients to have access to medication, there have also been less predictable outcomes. For example, a change from in person visits with a psychiatrist to telehealth visits conducted solely on the phone was seen to cause an acute decompensation in one patient. In another case, a patient’s paranoia was exacerbated due to worries about traveling for work during the height of the pandemic, ultimately leading to decompensation. Conclusions: The COVID-19 pandemic presents us with an opportunity to identify ways in which our patients are at risk and how we can attempt to better serve them going forward. Many patients with psychotic disorders are at risk for disruptions in their access to regular care even outside the context of a pandemic. For example, while the relative risks and benefits of telehealth must be weighed on a case by case basis, it is often not a perfect replacement for regular in person care. By appreciating the multifaceted ways in which the current situation has affected our patient population, we can extrapolate lessons that will allow us to better serve our patients even when this pandemic passes.
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