We report a case series of all consecutive patients admitted to the 2 psychiatric inpatient units of the San Paolo University Hospital who were discharged with a diagnosis of BPD during the COVID-19 pandemic lockdown in Milan, Italy (March 9 to May 18). This general hospital covers a catchment area of approximately 350 000 citizens in the south of the city, with a maximal capacity of 29 beds across its 2 general psychiatry wards for acute mental health conditions. Clinical diagnoses made by treating physicians (A.D'A., M.L.C., and C.R.) were confirmed with DSM-5 criteria for BPD upon follow-up. ICD-11 criteria for ATPD were also examined. All patients underwent routine blood tests, CT or MR brain imaging, and toxicological urine screening for psychoactive substances. In line with the pandemic emergency hospital procedure, all patients were also tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before being admitted to the ward.
In order to standardize the evaluation criteria, the following set of instruments was employed: the Brief Psychiatric Rating Scale (BPRS) was performed as a global measure of psychopathology upon admission and at discharge; the presence of stressful life events in the 12 months before the lockdown was assessed using Paykel's interview for recent life events; the Structured Clinical Interview for DSM (SCID-II) was performed to evaluate the presence of a personality disorder; and the Temperament and Character Inventory-240 items (TCI-240) was administered to investigate personality dimensions. Personality assessment was made in the context of a follow-up visit in the 2 weeks following discharge.
Retrospective Chart Review
In order to contextualize our observation and to screen for missed cases, at the end of the lockdown, we conducted a retrospective electronic chart review of patients admitted with a first-episode psychosis (FEP) in the same time period. All patients with a discharge diagnosis of any psychotic episode on the hospital electronic record were considered for review. Only information on patients who had never presented psychotic symptoms before the current episode were retained. All diagnoses formulated by the treating physicians were confirmed by a panel of junior (S.D'A., A.C.C., and B.G.) and senior (A.D'A. and O.G) clinicians on the basis of DSM-5 criteria, taking all available information into account.
The case series was revised to comply with recommendations of the CAse REport (CARE) guidelines, and informed consent to publication was obtained from the patients.
Schizophr Bull. 2021;47(1):15-22. © 2021 Oxford University Press