Evidence-based guidance
Last updated January 2022
COVID-19 has spread rapidly around the world, with new variants constantly emerging. Mental health patients and their clinicians need rapid access to evidence-based information to help to guide their shared decision-making.
Here, we summarise the best available clinical guidelines about key COVID-19 questions that frontline mental health professionals are facing every day. This is not a legal or NHS approved document, but we have followed a rigorous methodological approach to search and select the information needed to answer these specific questions.
This webpage is a guidance for busy clinicians, organised around specific clinical questions and derived from existing guidelines in the English language (covering the UK, USA, Canada, Australia, New Zealand and Singapore) [footnote 1].
For more information you can also watch our Q&A video which answers some of the most common questions about it.
Although the document answers individual questions, we strongly encourage readers to go through the whole document as all the answers are related. A link to the evidence source is provided for each question and the full reference list is available in the appendices.
We hope that you will find this guidance useful and easily accessible. Please consider the guidance within the context of the implications of the pandemic. As always with clinical decisions, use your clinical knowledge, experience and expertise to balance the risks and benefits, taking into account the individual patient’s health, context, and preferences, and the least restrictive option, as the context for implementing the best available evidence. The application of this guidance is limited to the COVID-19 pandemic and should always be applied in compliance with national and local policies. Translations and adaptations of this guidance are available in foreign languages (see box below for details).
Translations and adaptations of the guidance are also available in the following countries:
🇧🇬 Bulgaria – Silviya Ralovska (College Private Psychiatry)
🇨🇳 China – Peng Xie (Chongqing Medical University)
🇫🇷 France – Astrid Chevance (University of Paris)
🇮🇹 Italy – Armando D’Agostino (University of Milan)
🇯🇵 Japan – Hiroyuki Fukushima (Daigo Hospital)
🇹🇷 Turkey – Ayse Kurtulmus (Istanbul Medeniyet University Goztepe Training and Research Hospital)
This webpage and the individual tables first went live on April 1st 2020, and we are updating them as new guidelines are released. The situation continues to evolve very quickly. We would therefore encourage readers to check the date of last update referenced for each table, and where there is any uncertainty to check original sources. We welcome collaboration, and so please do feed back to us any comments on the content and usefulness of this guidance.
Katharine Smith
Edoardo Ostinelli
Orla Macdonald
Caroline Zangani
James Hong
Rania Elgarf
Andrea Cipriani
Contact info: Twitter @OxfordPPL
Contents
LIST OF AVAILABLE CONTENT:
Benzodiazepines and Z-drugs (zopiclone and zolpidem)
Including:
· general advice
· acute agitation/rapid tranquillisation
· anxiety
· insomnia
· withdrawal
Clozapine treatment
Including:
· additional risks
· blood testing
· starting phase of a new treatment
· interpreting white cell count results
Digital technologies and telepsychiatry
Including:
· practical guidance and a clinician’s checklist
· guidance on effectiveness and evidence
· government and speciality guidelines
· information governance issues
· considerations before, during and after the consultation
· special considerations for older adults, children and adolescents
· cultural issues
· safeguarding and emergency issues
· training and service considerations
Domestic violence and abuse
Including:
· definitions, risk factors and signs
· general advice
· guidance for those working with children and families
· guidance for those working with those who harm
· guidance for employers
· resources for GPs, nurses, health visitors and mental health professionals
· digital safeguarding
End of life care
Including:
· management of the different aspects of the end of life care
· considerations at the time of death
· considerations after death
Inpatient wards
Including:
· management of suspected/confirmed cases
· routine care
· acutely disturbed patients
· ethical and legal aspects
· organisational considerations
· older adult inpatient wards
· vitamin D supplementation
· venous thromboembolism (VTE) prophylaxis
Lithium treatment
Including:
· blood testing
· different formulations
· interpreting lithium levels
· starting phase of a new treatment
Long-acting injectable (LAI) antipsychotics
Including:
· management of ongoing treatment
· starting phase of a new treatment
· additional risks
Pregnancy and the perinatal period
· general advice
· antenatal and perinatal mental health services
· Mother and Baby Units
· assessment of risk
· physical effects of COVID-19 on pregnant women and their babies
· management of healthcare contact in pregnancy and in the peripartum
Suicide and self-harm
Including:
· management of people at risk
· assessment
· interventions and service models
· impact on front line workers
Vaccine prioritisation and mental health
Including:
· prioritisation strategy in the UK
· guidance from other countries
Vaccine uptake and vaccine hesitancy
Including:
· definition of vaccine hesitancy
· how to monitor vaccine coverage
· what level of uptake is needed
· strategies to address inequalities in vaccine uptake
Footnote [1]
As clinicians, we know how much time matters during this COVID-19 pandemic. For this reason, we decided to develop this guidance and to summarise the already available information from existing guidelines in a regularly updated webpage. We used an evidence-based approach, but also where needed our clinical experience and the advice of international experts on providing a comprehensive but balanced synthesis.
We are aware of the exponential growth in articles in medical journals about COVID-19. We also want to capture this information, which is complementary to this guidance, using a methodologically sound approach. We have designed a systematic review of scientific literature about the impact of COVID-19 on mental health patients, on clinical mental health staff and delivery of care (the protocol is registered with PROSPERO: CRD42020178819). Our aim is to carry out a rigorous systematic review conducted rapidly rather than a rapid review conducted less rigorously. Readers may also wish to consult other systematic reviews registered in PROSPERO or other sources of living evidence, which are updated in real time and relevant to COVID-19: https://covid-nma.com/ or https://zika.ispm.unibe.ch/assets/data/pub/search_module/.
BRC Researchers from the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT) have created resources for treating patients experiencing Post-Traumatic Stress Disorder (PTSD) following admission to an Intensive Care Unit (ICU) during the COVID-19 pandemic. Read more about the work here and find the resources here.
