Physical and Psychological Characteristics of Nitrous Oxide Abusers During the COVID-19 Pandemic: An Observational Study.

Abstract Background The coronavirus disease 2019 (COVID-19) was classified as a global pandemic by the World Health Organization. In addition to health effects, it has also brought about psychological problems due to its economic and social impact. Psychological effects have led to drug and alcohol abuse. To inform physician decisions, there is a need to characterize the physical and psychological characteristics of nitrous oxide abusers during the COVID-19 Pandemic. Methods: We enrolled six nitrous oxide abusers who sought treatment at Taizhou Hospital of Zhejiang province between May 2020 and June 2020. Clinical data including socio-demographic, physical examination, laboratory examination, electromyography, neuroimaging, and psychological assessment were collected. Results: The enrolled patients had a mean age of 22±4.3. Clinical presentations included varying degrees of limb numbness and an ataxic gait. Under laboratory examination, it was revealed that all the patients did not have pernicious anemia, 4 patients had decreased vitamin B12 while 3 patients exhibited elevated homocysteine levels. MR of the spinal cord revealed that 4 patients had abnormal signals in the cervical spinal cord. These signals were of high symmetry with splayed or inverted V sign after T2WI. Peripheral nerve damage was observed in 5 patients who were subjected to an electromyogram (EMG) test. The Symptom Checklist 90 (SCL-90) psychological evaluation indicated that all patients had severe anxiety, depression and psychosis. The psychological status of nitrous oxide abusers was significantly different from that of health controls. After treatment by vitamin B12, the patients’ physical symptoms improved, and they were discharged from the hospital. For the evaluation of mental and psychological outcomes post-discharge, patients were asked to go to the psychological department for check-up and follow-up.Conclusion: The enrolled 6 patients caused by abuse of nitrous oxide presented with symptoms of subacute combined with spinal degeneration. They had more serious psychological problems related to the COVID-19 pandemic. These problems require immediate attention and interventional approaches. The national government and other departments should take active measures to control abuse of nitrous oxide. Trial registration: Not applicable.