新冠肺炎之精神醫學觀

The Psychiatric Aspect of COVID-19

10.6320/FJM.202111_25(6).0013

黃薇嘉(Wei-Chia Huang)；陳宜明(I-Ming Chen)；陳錫中(Hsi-Chung Chen)；廖士程(Shih-Cheng Liao)

新冠肺炎（COVID-19） ； 精神症狀 ； 藥物治療 ； 精神科照會聯商 ； COVID-19 ； psychiatric symptoms ； medical treatment ； consultation-liaison psychiatry

台灣醫學

25卷6期（2021 / 11 / 25）

815 - 823

繁體中文

由於新冠肺炎（COVID-19）的流行，以及相應防疫舉措的實施，個體無論確診與否，皆會在疫情期間受到相當的心理衝擊。對於確診個案而言，精神症狀的正確歸因－疾病表徵、藥物治療副作用、或壓力引起之調適障礙－有助於照護團隊給予有效治療。對於多數個案而言，疫情相關壓力可因一般醫療人員給予的支持而緩解；而對於無法受益於支持性技巧之個案，適當轉銜配合後續藥物治療及心理社會介入，有其必要性。醫療人員在疫情期間長期處於高壓情境，需要特別關注此族群之心理健康。本篇文章旨在整理疫情期間精神症狀之歸因，並提供急性期精神症狀評估處置之臨床建議。整體而言，跨領域團隊之整合及建立暢通之轉介管道，有助於疫情期間群體心理衛生之維護，以及急性期後精神症狀之處遇。

With the spread of COVID-19 and the related quarantine, people may suffer considerable impact no matter they are diagnosed or not. For confirmed cases, mental symptoms may be part of the manifestations of COVID-19 or the side effects of drug treatment. In most cases, the physical and mental stress caused by the epidemic can be relieved with the supportive skills that ordinary medical staff have in providing daily care. However, the effect of the above-mentioned supportive techniques may be limited for patients with severe neuropsychiatric symptoms, where pharmacological and psychological intervention will improve clinical outcomes. For medical staff who work long hours in a high-pressure work environment, it is also necessary to strengthen peer support, provide stress relief methods, and actively maintain a positive attitude and sense of connectedness among peers. Implementing institutional policies that facilitate inter-disciplinary collaboration, and provide cost-effective biopsychosocial services, will promote both the health of the patients and medical staff.

1. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020;7:611-27.
   連結：
2. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Commun 2020;2:fcaa205.
   連結：
3. How COVID-19 affects the brain. JAMA Psychiatry 2021;78:682-3.
   連結：
4. The neuropsychiatric manifestations of COVID-19: Interactions with psychiatric illness and pharmacological treatment. Biomed Pharmacother 2021;135:111200.
   連結：
5. Remdesivir for the treatment of Covid-19 - final report. N Engl J Med 2020;383:1813-26.
   連結：
6. Psychopharmacology of COVID-19. Psychosomatics 2020;61:411-27.
   連結：
7. Covid-19 treatment-induced neuropsychiatric adverse effects. Gen Hosp Psychiatry 2020;67: 163-4.
   連結：
8. Mental health and the Covid-19 pandemic. N Engl J Med 2020;383:510-2.
   連結：
9. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912-20.
   連結：
10. A pandemic within a pandemic - Intimate partner violence during Covid-19. N Engl J Med 2020;383:2302-4.
    連結：
11. COVID-19 exacerbates violence against health workers. Lancet 2020;396:658.
    連結：
12. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62354 COVID-19 cases in the USA. Lancet Psychiatry 2021;8:130-40.
    連結：
13. COVID-19 inpatients with psychiatric disorders: Real-world clinical recommendations from an expert team in consultation-liaison psychiatry. J Affect Disord 2020;274:1062-7.
    連結：
14. Neurocovid: Pharmacological recommendations for delirium associated with COVID-19. Psychosomatics 2020;61:585-96.
    連結：
15. Analgesia and sedation in patients with ARDS. Intensive Care Med 2020;46:2342-56.
    連結：
16. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who. int/ Accessed August 2, 2021.
17. COVID-19 Treatment Guidelines, National Institutes of Health, 2021.