conditions from lowand middle-income countries, who might need modifications to their care. Here we present data on the feasibility of implementing intensive telehealth case management to fight the COVID-19 pandemic in a Community Psychosocial Center in Brazil. Mitigating the risks of human physical contact is a difficult task in mental health community centers because minimizing physical contact implies reducing face-to-face patient interactions, a key component of mental health treatment. Although too many visits might unnecessarily increase the risk of COVID-19 exposure, too few visits might also increase the risk of destabilization, particularly for severe cases, resulting in crowded emergency services. To achieve that optimal balance, we tested the feasibility of implementing a telehealth intensive care management system. The service currently delivers health services to 154 patients who attend the service on a regular basis, 61% male, with an average age of 38.8 (standard deviation = 13.6). Most patients have used the service for less than a year (66%), 22% between 2-5 years and 12% more than 5-years. The most frequent diagnoses include: psychosis (54%), intellectual disability (20%), bipolar (16%), and other mental health conditions (11%). Before launching the telehealth program, 48% attended the community center daily or at least 3 times a week, while the remaining 52% used the service biweekly/weekly/monthly. A total of 21% used depot formulations. At the beginning of the telehealth program (March 23rd, 2020), patient care was divided among seven case managers. Phone contact was possible for 61% of patients, with 29% being advised face-to-face through regular service attendance. We were unable to contact around 7% of service users despite significant effort. Currently, all patients are telemonitored weekly or biweekly to investigate signs of psychiatric instability. We are also monitoring respiratory symptoms and fever, reinforcing the importance of hand washing and restricting physical contact. Case managers classify patients as ‘‘stable’’ or ‘‘unstable’’ based on current changes in behavior. All stable cases are being asked to stay home. Unstable cases are being asked to visit the service for face-to-face consultations in addition to frequent systematic telemonitoring. Patients in the COVID-19 risk group (over 60 and with any chronic condition; 24%) who use depot medications are being visited at home for treatment. Increased food insecurity was detected, and all patients with basic food needs (50%) received donations, which were organized by the service. All group activities have been canceled. All actions and information about dynamic changes in patient status are coordinated with an online spreadsheet (https://figshare.com/s/ 826f200d872e35ea67f1). This spreadsheet is kept on a local server and information is kept private and secured by password. Intensive case management via telehealth is a feasible strategy that can be used in mental health community centers in lowand middle-income countries and could mitigate the exacerbated risks of psychiatric instability from stress related to COVID-19 in this vulnerable population. Giovanni A. Salum,0000-0000-0000-0000 Jaqueline F. Rehmenklau, Michele C. Csordas, Flavia P. Pereira, Juliana U. Castan, Anderson B. Ferreira, Vera B. Delgado, Liana de M. Bolzan, Miguel A. de Lima, Juarez H. Blauth, José R. dos Reis, Paula B. Rocha, Tadeu A. Guerra, Izabela M. Saraiva, Bruna de C. Gramz, Bruna R. Ronchi, Bruna L. Ribeiro, Dienifer F. Konig, Eugênio H. Grevet, Leandro B. de Pinho, Jacó F. Schneider, Paula R. Eustáquio, Márcia Z. Ramos, Myriam F. Marques, Luiza K. Axelrud,0000-0000-0000-0000 Fernanda L. Baeza, Sara E. Lacko Unidade Centro de Atenção Psicossocial, Hospital de Clı́nicas de Porto Alegre, Porto Alegre, RS, Brazil. London School of Economics and Political Science, Care Policy and Evaluation Centre, London, United Kingdom.

中文翻译：

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褪黑激素和可卡因：线粒体、免疫和肠道微生物组的作用

低收入和中等收入国家的情况，他们可能需要调整他们的护理。在这里，我们提供了有关在巴西社区心理社会中心实施密集远程医疗案例管理以对抗 COVID-19 大流行的可行性的数据。在心理健康社区中心，降低人与人身体接触的风险是一项艰巨的任务，因为尽量减少身体接触意味着减少面对面的患者互动，这是心理健康治疗的一个关键组成部分。尽管就诊次数过多可能会不必要地增加接触 COVID-19 的风险，但就诊次数过少也可能会增加不稳定的风险，特别是对于严重病例，导致紧急服务人员拥挤。为了实现最佳平衡，我们测试了实施远程医疗重症监护管理系统的可行性。该服务目前为 154 名定期参加该服务的患者提供健康服务，其中 61% 为男性，平均年龄为 38.8 岁（标准差 = 13.6）。大多数患者使用该服务的时间不到一年 (66%)，22% 的患者使用了 2-5 年，12% 的患者使用了 5 年以上。最常见的诊断包括：精神病 (54%)、智力障碍 (20%)、躁郁症 (16%) 和其他心理健康状况 (11%)。在启动远程医疗计划之前，48% 的人每天或每周至少去社区中心 3 次，而其余 52% 的人每两周/每周/每月使用一次服务。总共有 21% 使用了储存配方。在远程医疗计划开始时（2020 年 3 月 23 日），患者护理由七名病例经理分配。61% 的患者可以通过电话联系，29% 的人通过定期服务出勤得到了面对面的建议。尽管付出了巨大的努力，我们还是无法联系到大约 7% 的服务用户。目前，所有患者每周或每两周接受一次远程监测，以调查精神不稳定的迹象。我们还在监测呼吸道症状和发烧情况，强调洗手和限制身体接触的重要性。个案经理根据当前行为的变化将患者分类为“稳定”或“不稳定”。所有稳定的病例都被要求待在家里。除了频繁的系统远程监控外，还要求不稳定的病例访问该服务进行面对面的咨询。COVID-19 风险组（60 岁以上且患有任何慢性病；24%）使用长效药物的患者正在家中接受治疗。检测到粮食不安全加剧，所有有基本食物需求的患者 (50%) 都收到了由该服务组织的捐赠。所有团体活动均已取消。有关患者状态动态变化的所有操作和信息都通过在线电子表格 (https://figshare.com/s/826f200d872e35ea67f1) 进行协调。该电子表格保存在本地服务器上，信息保密并通过密码进行保护。通过远程医疗进行强化病例管理是一种可行的策略，可用于中低收入国家的心理健康社区中心，并可以减轻该弱势群体因 COVID-19 相关压力而加剧的精神不稳定风险。Giovanni A. Salum,0000-0000-0000-0000 Jaqueline F. Rehmenklau、Michele C. Csordas、Flavia P. Pereira、Juliana U. Castan、Anderson B. Ferreira、Vera B. Delgado、Liana de M. Bolzan、Miguel A. de Lima、Juarez H. Blauth、José R. dos Reis、Paula B. Rocha、Tadeu A. Guerra、Izabela M. Saraiva、Bruna de C. Gramz , Bruna R. Ronchi, Bruna L. Ribeiro, Dienifer F. Konig, Eugênio H. Grevet, Leandro B. de Pinho, Jacó F. Schneider, Paula R. Eustáquio, Márcia Z. Ramos, Myriam F. Marques, Luiza K. Axelrud,0000-0000-0000-0000 Fernanda L. Baeza, Sara E. Lacko Unidade Centro de Atenção Psicossocial, Hospital de Clı́nicas de Porto Alegre, Porto Alegre, RS, 巴西。伦敦政治经济学院，护理政策和评估中心，英国伦敦。Eugênio H. Grevet, Leandro B. de Pinho, Jacó F. Schneider, Paula R. Eustáquio, Márcia Z. Ramos, Myriam F. Marques, Luiza K. Axelrud,0000-0000-0000-0000 Fernanda L. Baeza, Sara . 巴西阿雷格里港，阿雷格里港，Atenção Psicossocial 中心，医院 de Clı́nicas de Alegre，RS，巴西。伦敦政治经济学院，护理政策和评估中心，英国伦敦。Eugênio H. Grevet, Leandro B. de Pinho, Jacó F. Schneider, Paula R. Eustáquio, Márcia Z. Ramos, Myriam F. Marques, Luiza K. Axelrud,0000-0000-0000-0000 Fernanda L. Baeza, Sara . 巴西阿雷格里港，阿雷格里港，Atenção Psicossocial 中心，医院 de Clı́nicas de Alegre，RS，巴西。伦敦政治经济学院，护理政策和评估中心，英国伦敦。