Clinical characteristics and outcomes of psychiatric in-patients during the COVID-19 pandemic at a Specialised Psychiatric Hospital in South Africa

Background & Objective: Worldwide, there is scant data on the management of psychiatric patients with COVID-19 infection. During the COVID-19 pandemic, a psychiatric COVID-19 unit was established at a specialised psychiatric hospital in Johannesburg, South Africa, with integrated care to meet the needs of a vulnerable psychiatric in-patient population. We describe the clinical characteristics and outcomes of these patients. Methods: This study is a single-centre, retrospective, descriptive analysis of COVID-19-positive patients admitted to the COVID-19 ward between June 2020 and February 2022 with a known mental illness, and predominantly mild to moderate COVID-19 illness, as assessed by the COVID-19 severity index using the NEWS2 score as a screening tool. Outcomes were recorded as discharged from the COVID-19 ward, transferred to a medical facility for higher care or death. Results: Fifty-one patients were treated during the period. The majority (39/51, 76.5%) were female. Common comorbidities were HIV, hypertension, and diabetes. Common psychiatric diagnoses were schizoaffective disorder, bipolar disorder, and schizophrenia. The most common COVID-19 symptoms were sore throat, cough, and fever. The most common psychiatric symptoms were psychosis, mania, and aggressive behaviour. Patient outcomes were very good, with no deaths. Only a small number (4/51; 7.8%) needed transfer to a medical ward for more specialised care. Conclusion: This retrospective review describes the clinical management of COVID-19 in psychiatric patients with severe behavioural disturbances and associated medical comorbidities. Integrated medical treatment was administered by mental health care nurses and doctors, with good outcomes. Our findings align with internationally reported figures and add to the evidence base for managing psychiatric patients during future pandemics.