Medical personnel is constantly exposed to a variety of stressful events, starting from work overloading, to threats to one's own health or personal integrity, disruptions in personal relationships due to high stress in the professional environment, continuous need to keep in touch with the advances of medical science and therapeutic guidelines etc. Structured evaluation of work-related stress disorders (WRSD) is important both for screening purposes in a vulnerable population like the medical personnel, and for the monitoring of the overall status evolution during individual or organizational interventions. Beside burnout syndrome, major depressive episodes, anxiety disorders, acute stress reactions, posttraumatic stress reactions, substance use disorders, adjustment disorders are also included in the category of WRSD. A specific instrument has been designed for the purpose of screening for WRSD in this specific population, i.e. the Work-related Stress Inventory for Medical Personnel, structured as a 20 items, self-administered instrument (WRSIMP-20). This inventory evaluates three main dimensions- (1) mood symptoms and somatic equivalents, (2) work and professional environment- related discomfort, and (3) interpersonal relationship-associated distress. The results of online administration of WRSIMP- 20 in 81 health care workers and 52 individuals not related in any way to health care professions (control group) were consistent with the premises, as this inventory has been proven valid for the targeted population. Larger trials and test-retest evaluation are needed in order to complete the psychometric properties of WRSIMP-20, but this instrument seems promising in the detection of individuals vulnerable to WRSD.
During the COVID-19 pandemic, neuropsychiatric disorders have been diagnosed both in the acute phase, and in the aftermath of this disease. Inpatients, as well as outpatients recently diagnosed with mild, moderate or severe forms of Coronavirus infection have reported neuropsychiatric manifestations with variable duration, symptoms that could be directly or indirectly related to the viral pathogenic agent. Patients who are recovering from the acute phase of COVID-19 also may exhibit various psychopathological manifestations, during the so-called “post-COVID-19 syndrome” or “long COVID-19 syndrome”. Explanations regarding the onset of this type of clinical manifestations and the SARS-CoV-2 infection are extremely diverse, ranging from biological factors (e.g., direct central nervous system viral activity, cerebral hypo- oxygenation, high level of inflammatory response) to psycho-social stressors (e.g., isolation, fear of death, anxiety related to possible somatic complications or sequelae). Objectives: The primary objective of this article was to analyze psychiatric manifestations in patients with acute COVID-19 disease and in patients during post-COVID-19 phase. The secondary objective was to propose a conceptual framework for the evaluation and treatment of these patients. Methods: Patients included in this analysis were screened positive for COVID-19 infection in the last 6 months before their first psychiatric examination. These patients were further evaluated to detect any personal history of psychiatric disorders, somatic comorbidities, or significant concomitant pharmacological treatments. Specific scales for the measurement of symptoms severity and functional impairment were administered in all patients. Results: Five patients were included in this analysis, one during the acute phase of COVID-19 infection, and four patients were evaluated after the complete remission of this disease. Hyperactive delirium, mild neurocognitive disorder, major depressive episode, panic disorder with agoraphobia, or acute psychotic disorder were the main diagnoses in these patients. All patients received adequate treatment and they were monitored using psychological scales until symptoms remission or stabilisation. Conclusions: Psychosocial stressors, neurobiological changes, systemic inflammatory reaction, and individual vulnerability factors may contribute to a diathesis- stress model for psychiatric disorders onset within the acute phase or after the remission of acute manifestations in COVID- 19-diagnosed patients.
