Psychiatric Aspect of COVID -19

Introduction

World Health Organisation declared COVID-19 as a pandemic dated 11-02-2020. This persistent pandemic affects the mental health of people's current situation and the coming time.

The SRS-Co-V-2 (Severe acute respiratory syndrome coronavirus 2) is the virus that causes COVID-19 (coronavirus disease 2019) and might have the ability to infect the brain or alter immune response resulting into a challenge to the mental health of individual with COVID-19.

Aggressive COVID-19 control measures include social and physical distancing, social isolation, and quarantine steps with high morbidity and high fatal outcome. Thus the uncertain fear of being contaminated by human spread and the risk of spread to loved ones have a widespread concern. 

The psychological manifestation observed is increased anxiety, depression, stress, guilt, negative feelings, stigma, and the tendency for harmful behavior as suicide and self-harm. Removal of loneliness and promoting belongingness will have protection against suicide and emotional harm.

Digital psychological intervention and the effect of social relations during the stress of COVID-19 appears to be an effective intervention. Telephone consultation, messaging and digital intervention for anxiety, stress, depression, suicide is an ongoing means of psychiatric care.

Working from home, loss of employment and social and physical distancing disturbed the mental health of individuals, the online life-like engagement with gaming and platform will help to improve mental health.

The populations affected by the virus have different experiences. 

The children, teens, and families are influenced by alcohol and smoking, gambling, domestic anger, child maltreatment, parental job loss, cessation of social networking. 

The older adults, experience isolation, loneliness, grief. Those with mental issues tend to relapse, worsening of symptoms due to pandemic information. The health care workers in the direct care of infected patients have fears of contamination, moral harm, work stress, retention warning, unavailable supporting system. People with low incomes face immediate job loss and financial stress, non-available housing, eatable. Socially excluded persons at prison, homeless, and migrants need specific interventions.

The repeated media circulation of COVID-19 news has a psychological impact as amplifying the stress response and worry with impairment of daily functioning. In response, the anxiety developed promotes the media-fuelled distress behavior that affects health services. Thus positive print, TV media, and social media can influence a positive response in the population.

Health professional’s mental health 

The health professional involved directly in the care of COVID-19 positive and quarantined suspected patient has a risk of mental health problems like fear, panic, anxiety, stress, depression. These have a continuous threat of being exposed to the virulent virus and get contaminated. Also worries of infecting the family members, relatives, and colleagues after exposure.

The news of contamination of health professionals (nurses, doctors, workers, and other related) further brings the stress to their minds, and the long working hours, multiple clinical duties, depleting PPE availability leads to tremendous stress resulting in mental fatigue. 

The stress of being contracting the disease and spreading to others results in psychological problems and mental health disorders.

The ICU team faces the extreme of stress as observing the increasing number of deaths and the first one to report the news to relatives.

Thus the health care personnel need to have the availability of psychotropic drugs prescribed by a psychiatrist, regular updates to address the changing need for those engaged directly inpatient care by electronic media (WhatsApp, etc.), provision of stress management steps, psychotherapy techniques.

Dealing with stress, anxiety, sadness, grief

 After lockdown, the citizens of India are homebound to maintain the physical distance thus preventing them from being exposed to human transmission of the virus. This distancing influences mental health significantly. This brings anxiety, fear, uncertainty, sadness, the grief of losing the ability to move out freely, and contamination spread to society, a falling economy, worries of poor’s survival, relatives' health. The stress is further reinforced by exposure to news and circulating lots of rumors about the disease spread. These changes need to be addressed and modified with self changes.

Avoiding the news, distancing from social media, switching off the TV news are helpful steps to prevent the information stress. Regular exercise, rest, timely meals, and avoiding alcohol use and smoking helps to relieve the stress. Communicating with relatives is a must done by digital applications, texting messages, video chat, telephone calls, and emails use on a regular basis.

The virus epidemic is a stressful situation, the fear and anxiety can be overburdened leading to negative emotional changes in children and adults. The key is to cope with stress.

The stress observed as fear and worry of own health and family disturbed sleep initiation and appetite changes, concentration problem, deterioration of chronic illness, relapse of mental health problem, Alcohol and tobacco, sedative use.

Those who respond differently to stress during the crises in the community are more in need of stress management. They are old persons, children, teens, health professionals, persons with mental health diseases like substance use.

Children’s and teens

Parents are supposed to observe their kids and provide care calmly and confidently for them by reassurance. This parent needs to be prepared with knowledge of the behavioral change in children seen as crying excessively, irritableness, bedwetting, worried or sad child, less eating or sleeping, poor school performance, attention, and concentration problems, avoiding plays, having headache or pain in the body.  

People in quarantine

Stress comes when being separated from the loved ones during quarantine despite not being sick. Everyone responds differently in quarantine. Emotional changes observed are fear and worry about self-health and family, the stress of being monitored for signs of COVID -19. It feels anger, frustration, sadness, and withdrawal because of others' unknown fears of contracting disease despite having negative test results. Having guilt about “inability to do normal work”, being away from parenting responsibility during the quarantine.

Secondary traumatic stress occurs to them who observe the stress reactions of others being exposed to the virus. This is found among family members who need to be recognized and reduced. 

Stigma reduction

COVID-19 outbreak causes stressful situations among people resulting in fear and anxiety of disease which can lead to social stigma for people, places, or things. The unfair belief that a group of people is associated with the disease occurrence means Stigma. The stigma occurs after the person is released from quarantine, with the health care professional involved in patient care, travel history or belongs to a minority group. Such stigmatized groups tend to face social avoidance, refusal of healthcare, housing, employment, physical violence. The stigma affects the mental health of a stigmatized person. The public health officials can help counter it by maintaining the confidentiality of patients, raise awareness about the disease with spreading fear, accurate information of infection, Speak out the negative statements of media, caution about the images shared on social media.

Lockdown and alcoholism

The availability of essential goods and services during the lockdown period stopped the sale of alcohol. This results in alcohol dependence patients to develop withdrawal symptoms which can be mild to moderate withdrawal symptoms like loss of sleep headache anxiety increase in craving tremors. Such patient recovers in a few days without any serious problem. Those with severe alcohol withdrawal symptoms may lead to delirium tremens or Wernicke's Korskoff syndrome which are life-threatening situations and require hospitalization. Mental health services need to be prepared for such cases.

Telepsychiatry

It is the mode of providing mental health care services using communication and information technology which include psychiatry interviews, treatment, psychoeducation, and drug therapy.

Psychiatry consultation by audio calls, exploring the presenting problem with the patient, and providing the treatment can vary from reassurance to prescription or visit to medical emergency nearby with proper documentation provided by the GOI guidelines.

Tips to follow during COVID-19

a. Avoid mixing COVID -19 with ethnicity

b. Avoid calling bye name as “COVID -19 cases” and “COVID -19 families”

c. Avoid TV and social media which make you feel anxious sad and fearful

d. Sleep disturbance, sadness, anxiety appear very commonly thus seek mental health professional advice

e. Help others in times of need

f. Respect the caretakers and healthcare workers engaged in the care of positive cases

g. Say no to tobacco alcohol and addictive drugs

h. Maintain digital communication with your loved ones

i. Take social support from a trusted person

j. Listen to children and encourage them to express their fear and anxiety

k. Enjoy yourself in a creative activity like exercise, yoga