Psychiatric Emergencies During the Height of the COVID-19 Pandemic in the Suburban New York City Area

Background: This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. Methods: Medical records of 556 patients that received emergency psychiatric evaluation January 1-April 30, 2020 were reviewed. Patient seen during COVID-19 (N=201) were compared with those prior (N=355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. Outcome: A significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/ suicidal compared to their COVID-negative counterparts. Interpretation: This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic. New and severe pathology underscore the need for enhanced outpatient access and inpatient services with capacity to care for COVID-19 patients. Funding Statement: No external funding. Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: This study was approved by the institutional review board of New York Medical College and Westchester Medical Center Health System, Valhalla, New York.