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The relationship between mental health and human rights is complex and bidirectional. Global mental health movements have been emphasizing the promotion of human rights in mental health care in accordance with the UN Convention on the Rights of Persons with Disabilities and the WHO QualityRights Initiative. The main objective of this review is to have an overview of the current global situation of human rights in mental health services by performing a review of scientific literature. The literature search and elimination process yielded a total of 26 articles focussing on human rights-related reports and tools. Further assessment of these articles clearly shows that despite significant improvements in mental health service delivery in the past decade, there is still substantial reporting of the continuing prominence of stigmatizing attitudes, and human rights violations and abuses in mental health settings. The human rights perspective requires society, particularly policymakers, to actively promote necessary conditions for all individuals to fully realize their rights. We suggest developing a more comprehensive model in mental health that integrates human rights into existing services and approaches. A model that recognizes that all people with mental health conditions and psychosocial disabilities are rights holders.

Introduction:Social-distancing due to COVID-19 has led to social isolation, stress, and mental health issues in older adults, while overwhelming healthcare systems worldwide. Telehealth involving phone calls by trained volunteers is understudied and may be a low-cost, scalable, and valuable preventive tool for mental health. In this context, from patient participatory volunteer initiatives, we have adapted and developed an innovative volunteer-based telehealth intervention program for older adults (TIP-OA).Methods and analysis:To evaluate TIP-OA, we are conducting a mixed-methods longitudinal observational study.Participants:TIP-OA clients are older adults (age ≥ 60) recruited in Montreal, Quebec.Intervention:TIP-OA volunteers make weekly friendly phone calls to seniors to check in, form connections, provide information about COVID-19, and connect clients to community resources as needed.Measurements:Perceived stress, fear surrounding COVID-19, depression, and anxiety will be assessed at baseline, and at 4- and 8-weeks. Semi-structured interviews and focus groups will be conducted to assess the experiences of clients, volunteers, and stakeholders.Results:As of October 15th, 2020, 150 volunteers have been trained to provide TIP-OA to 305 older clients. We will consecutively select 200 clients receiving TIP-OA for quantitative data collection, plus 16 volunteers and 8 clinicians for focus groups, and 15 volunteers, 10 stakeholders, and 25 clients for semi-structured interviews.Discussion:During COVID-19, healthcare professionals' decreased availability and increased needs related to geriatric mental health are expected. If successful and scalable, volunteer-based TIP-OA may help prevent and improve mental health concerns, improve community participation, and decrease healthcare utilization.Clinical Trial Registration:ClinicalTrials.govNCT04523610;https://clinicaltrials.gov/ct2/show/NCT04523610?term=NCT04523610&draw=2&rank=1

Objective In an era of rising geriatric mental health care needs worldwide, technological advances can help address care needs in a cost-effective fashion. Our objective in this review was to assess whether mobile health technology, such as tablets and smartphones, are feasible to use in patients with late-life mental and cognitive disorders, as well as whether they were generally reliable modes of mental health/cognitive assessment. Methods We performed a focused literature review of MEDLINE, PsychInfo, and Embase databases, including papers specifically assessing the implementation of mobile health technologies: electronic tablets (e.g., iPad), smartphones, and other mobile computerized equipment in older adults (age ≥65 years) diagnosed with or at risk of a mental and/or cognitive disorder. Results A total of 2,079 records were assessed, of which 7 papers were of direct relevance. Studies investigated a broad variety of mobile health technologies. Almost all examined samples with dementia/cognitive dysfunction or at risk for those disorders. All studies exclusively examined the use of mobile health technologies for the assessment of cognitive and or mental illness symptoms or disorders. None of the studies reported participants having any difficulties using the mobile health technology assessments and overall reliability was similar to paper-and-pencil modes of assessment. Conclusion Overall, mobile health technologies were found to be feasible by patients and had promising reliability for the assessment of cognitive and mental illness domains in older adults. Future clinical trials will be necessary to assess whether portable communication interventions (e.g., symptom tracking) can improve geriatric mental health outcomes.

As members of the Global Mental Health and Psychiatry Caucus of the American Psychiatric Association (APA), we would like to express our grave concerns about the ongoing policies and treatment of asylum seekers, refugees, and immigrants coming to the United States, and the adverse mental health sequelae that such policies will have on these individuals and populations.

Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopram/escitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting.We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopram/escitalopram prescribing patterns.We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopram/escitalopram (44.1% vs. 22.3%, χ(2) = 14.835, p0.001), even after controlling for confounders. However, the percentage of patients using a citalopram/escitalopram dose exceeding those recommended by the Health Canada warning was similar in both groups (8.9% vs. 12.1%, χ(2) = 0.233, p = 0.63).Overall, C-L psychiatrists were less likely to prescribe citalopram/escitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopram/escitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages.

Serotonin selective reuptake inhibitors (SSRIs) have widely replaced older tricyclic antidepressants (TCAs) in the treatment of depression and anxiety over the years, given their safer cardiac profile [Glassman, 1998]. Even at therapeutic doses, TCAs commonly cause a slowing of intraventricular conduction through their sodium-channel blocking properties, leading to prolonged PR, QRS and QT intervals [Pacher and Kecskemeti, 2004]. Similarly, in vitro and animal studies have shown that citalopram and escitalopram, through their cardiotoxic metabolite, didesmethylcitalopram, can delay ventricular repolarization, prolong QT, and increase the risk of torsade de pointes by directly blocking potassium-hERG channels in cardiomyocytes [Overa, 1989; Witchel et al. 2002]. In 2011–2012, the US Food and Drug Administration (FDA) released a safety communication regarding citalopram and escitalopram and their increased risk for QTc prolongation and cardiac outcomes, especially in elderly and patients with comorbid medical illnesses [FDA, 2012]. The new FDA recommendations state that citalopram should not be used at doses greater than 40 mg per day in healthy adults, and not exceed 20 mg per day in the elderly, patients with hepatic impairment, or patients taking a CYP2C19 inhibitor. Health Canada released a similar warning for escitalopram in 2012, stating that doses greater than 10 mg should be avoided in these latter high-risk populations [Health Canada, 2012]. A retrospective cross-sectional study in elderly surgical patients published in 2014 showed no association between citalopram and escitalopram and cardiac outcomes in this vulnerable population [van Haelst et al. 2014]. However, this association has never been assessed in a sample of acutely medically ill inpatients, another highly vulnerable population.

Background and objectivesThere exists a high prevalence of psychiatric disorders in dermatological patients. However, investigators have so far evaluated psychiatric aspects of the patients suffering from several specific skin diseases, there are a few studies concerning mental health in pemphigus patients. Our objective was to evaluate mental health status, quality of life and psychological well-being of newly diagnosed pemphigus patients.MethodsBetween April 2007 and February 2008, all newly-diagnosed pemphigus patients attending the pemphigus outpatient clinic of a dermatological hospital were given a questionnaire comprising the GHQ-28 and DLQI to fill out.ResultsOut of 283 patients, 212 complete forms were returned and analyzed. The bimodal score of GHQ ranged from 0 to 26 (Mean = 9.4) and the Likert score of GHQ ranged from 6 to 68 (Mean = 31.9). The DLQI score ranged between 0 and 30 (Mean of 13.8). A total of 157 patients (73.7%) were yielded to be possible cases of mental disorder considering GHQ-28 bimodal scores. Significant correlation between the DLQI score and bimodal and Likert scoring of GHQ-28 was detected.ConclusionOur study has depicted the prevalence of psychiatric morbidity in pemphigus patients. It underlines the fact that physicians, who are in charge of care for these patients, are in an exceptional position to distinguish the psychiatric morbidity and to take appropriate measures.