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Several studies report incidence of psychiatric symptoms and disorders among patients who recovered from COVID-19; however, little is known about the emotional impact of acute COVID-19 illness and recovery on these survivors. Qualitative methods are ideal for understanding the psychological impact of a novel illness.To describe the emotional experience of acute COVID-19 illness and recovery in patients who contracted the virus during the early months of the pandemic.Semi-structured interviews conducted by consultation-liaison (C-L) psychiatrists were used to elicit participant responses about the emotional impact of the acute and recovery phases of COVID-19 illness. Participants recruited from the Maryland, District of Columbia, and Virginia area were interviewed and audio recorded between June 2020 and December 2020. The research team extracted qualitative themes from the recordings using the principles of thematic analysis.One hundred and one COVID-19 survivors (54 women; mean [SD] age, 50 [14.7] years) were interviewed a mean of 5.16 months after their acute illness, and their responses were audio recorded. Most participants were White (77%), non-Hispanic/Latino (86.1%), and not hospitalized for COVID-19 (87.1%). Coders identified 26 themes from participant responses. The most frequently coded themes included Anxiety/Worry (49), Uncertainty (37), Supportfrom Others (35), Alone/Isolation (32), Positive Reframe/Positive Emotions (32).Survivors who contracted SARS-CoV-2 during the early months of the pandemic described both negative and positive valence emotions. They experienced emotional distress and psychosocial stressors associated with acute illness and recovery but also drew upon personal resiliency to cope. This report highlights the utility of qualitative research methods in identifying emotional responses to a novel illness that may otherwise go unnoted. C-L psychiatrists may be uniquely positioned to work in collaboration with medical colleagues in developing a multidimensional approach to evaluating an emerging illness.

Introduction Autoimmune encephalitis (AE) is an inflammatory condition which may present with encephalopathy, including psychiatric symptoms of psychosis and catatonia. When catatonia becomes life-threatening or refractory to medication, electroconvulsive therapy (ECT) should be considered. This case series represents a compilation of patient care experiences in which ECT served as a highly effective augmentation strategy for catatonia associated with autoimmune encephalitis other than NMDA AE. Methods We performed a retrospective case-study analysis of four patients with autoimmune encephalitis and catatonia who had disease onset prior to the age of 18. Cases were selected from the patients evaluated by the child psychiatry consultation and liaison inpatient service (n=460) in which care overlapped with both the autoimmune brain disease program (n=35) and the ECT program (n=4). Retrospective chart review focused on Bush Francis Catatonia Rating Scores, medication treatments targeting catatonia, ECT protocols, and special ethical considerations in patient care. Results Significant improvement in features of catatonia as evaluated by the Bush Francis Catatonia Rating Score (BFCRS) were seen in each patient treated with ECT. Across these four cases we encountered special considerations related to ECT that were specific to pediatric auto-immune catatonia. Conclusions We recommend ECT as a part of the treatment plan for patients who present with refractory features of catatonia (i.e. non-medication responsive). We advocate for following established practice parameters for the use of ECT in adolescents, with proposed modifications for patients with catatonia from this cause who often present with an increased level of medical complexity.

International audience; Children with a diagnosis of Autoimmune Encephalitis (AE) frequently require multi-disciplinary care in order to mobilize the assessment and treatment necessary for recovery. Institutional and provider practice differences often influence the diagnostic workup and treatment pathways made available to patients. There are a variety of provider coalitions in pediatric rheumatology, internal medicine, and neurology that have been making meaningful progress toward the development of consensus in assessment and treatment approaches to patient care. However, child psychiatry is currently underrepresented in this work in spite of the high psychiatric symptom burden seen in some young patients. The need for consensus is often made visible only with inter-institutional dialogue regarding patient care trajectories. We aim to review key updates in the assessment and treatment of children and adolescents with autoimmune encephalitis during the acute phase, with or without catatonia, and to outline provider perspectives by comparing current treatment models in the United States, Canada, and Europe.

Medical conditions that present with psychiatric symptoms are becoming increasingly well-recognized in response to the emergence of the field of neuroimmunology. As the availability of testing for novel antineuronal antibodies has increased, so too has the clinical awareness of this diagnostic spectrum. Psychiatrists may have little exposure to this area of expertise, yet may be called on to assist in the diagnosis and treatment of patients with complex neuropsychiatric syndromes secondary to autoimmune encephalitis. This article summarizes the evaluation and management of patients with autoimmune encephalitis and describes emerging patterns in phenotype recognition.