The present case is a particularly striking example of what can happen with postponement in care and is used to emphasize the reciprocal role of physical and mental health. The diagnosis of patient’s withdrawal and apathy illustrates the complex interplay of medical and primary psychiatric factors, major depressive disorder exacerbated by severe hypothyroidism and associated encephalopathy. Furthermore, additional contributors, e.g., scurvy, beriberi related to chronic alcohol use, paraneoplastic process given her history of breast malignancy, odontogenic infection progressing to the central nervous system, and COVID-19 encephalopathy, needed to be considered and excluded given profoundly impaired self-care and nutritional status. Earlier detection of this patient’s symptoms through collaboration between the primary care provider and outpatient psychiatrist may have prevented or at least attenuated the severe manifestations of her illnesses.
Conclusions: Individuals with mental illness and co-morbid medical conditions are especially vulnerable to the COVID-19 pandemic, both by direct pathophysiologic effects of infection and downstream consequences at the psychosocial and systems levels. Close coordination between outpatient psychiatrists and primary care providers can help mitigate the long-term repercussions of the pandemic on individuals with psychiatric illness. Consultation-liaison psychiatrists are aptly poised to embrace their role as physicians first and focus on the basics of infection control, relapse prevention, and psychosocial support (Freudenreich, 2020). We can accept the challenge and develop thoughtful interventions to help mitigate the long-term repercussions of the pandemic on individuals with psychiatric illness like promoting accessibility to resources and supporting insurance coverage for telehealth services.
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