A novel corona virus (SARS-CoV-2) has been identified as the cause of an outbreak of
respiratory illness (corona virus disease COVID-19) all over the world. The COVID-19 pandemic
is a public health emergency of international concern and poses a challenge to psychological
resilience.

Studies reviewed the psychological impact of quarantine and reported negative psychological
effects including post-traumatic stress symptoms, confusion, and anger, infection fears,
frustration, boredom, inadequate supplies, inadequate information, financial loss, and
stigma. A loss of daily structure and reduced social contacts were associated with
frustration, boredom, reduced psychological-well being and psychological distress.

A recently conducted online questionnaire survey, investigating emotional responses and
coping strategies of nurses, found sex differences in anxiety and fear referred to COVID-19
(women showed more severe anxiety and fear than men) and differences between participants
from cities showing more anxiety and fear compared with participants from rural showing more
sadness. The closer COVID-19 was to the participants, the stronger the anxiety and anger.

All these investigated psychological variables (i.e. anxiety, depression, boredom, loss of
daily structure) have been found to impact the course and outcome of psychiatric disorders.
Nowadays, COVID-19 is a pressure source with great influence, both for individuals and for
the social public groups. Different individuals and groups may experience different levels of
psychological crisis and patients with psychiatric disorders may experience more or less
psychological symptoms than healthy control persons. According to a recent study, lithium,
widely used to treat bipolar disorder, has been shown to exhibit antiviral activity and
appears as a possible candidate for therapy of COVID-19. However, more research data are
needed to develop evidence-driven strategies to reduce adverse psychological impacts and
psychiatric symptoms during the pandemic.

Scientific questions

1. How do psychiatric patients experience the COVID-19 outbreak including quarantine and
are there associations with affective symptoms and psychological distress? Is there a
change in symptomatology during time? Are there differences to healthy controls, and
between individuals with different diagnosis?

2. Is there a difference between psychiatric patients and healthy controls in regard to
emotional response, cognition and behaviour during the COVID-19 pandemic and quarantine?
Is there a difference between different psychiatric diagnosis groups?

3. Is there an association between consequences of social distance on lifestyle factors
(nutrition, sleep quality, physical activity, substance abuse) and are there
associations with psychological well-being/psychological symptoms in individuals with
psychiatric disorder and controls? Is there a difference between different psychiatric
diagnosis groups and healthy controls?

4. What do individuals with psychiatric disorders think about the COVID-19 related measures
und quarantine regulations and how is the adherence to the measures? Are there
associations between adherence and attitude towards COVID-19 measures? Is there a
difference between patients and healthy controls? Is there a difference between
different psychiatric diagnosis groups?

5. Are there sex and age differences in the investigated variables? (emotional response to
COVID-19 outbreak, attitude towards measures, adherence)?

6. Is there a relationship between an infection with SARS-CoV-2 and disease course in
psychiatric disorder? Is there a difference between different psychiatric diagnosis
groups and healthy controls? Which role plays lithium treatment (prescribed beyond the
study) in this context? The investigators hypothesize, loss of daily structure, reduced
social contacts, loneliness, reduced psychiatric care, and other possible lifestyle
changes due to the quarantine and social distancing measures, have a negative effect on
psychological symptoms (depression, anxiety, somatisation, sleep quality) in individuals
with psychiatric disorder compared to healthy controls. In contrast, resilience and
positive cognition processes might be positively correlated to psychological well-being.