|
 
 |
| COMMENTARY |
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| Year : 2020 | Volume
: 4
| Issue : 2 | Page : 223-225 |
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Psychiatric morbidities in COVID-19 pandemic - An overview
Arun Selvaraj1, V Krishna Dass2
1 Department of Psychiatry, Sri Mankula Vinayagar Medical College, Puducherry, India
2 Department of Psychiatry, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| Date of Submission | 13-Jul-2020 |
| Date of Decision | 28-Aug-2020 |
| Date of Acceptance | 15-Sep-2020 |
| Date of Web Publication | 25-Nov-2020 |
Correspondence Address:
Dr. Arun Selvaraj
Department of Psychiatry, Sri Mankula Vinayagar Medical College, Puducherry
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/aip.aip_68_20
How to cite this article:
Selvaraj A, Dass V K. Psychiatric morbidities in COVID-19 pandemic - An overview. Ann Indian Psychiatry 2020;4:223-5 |
| Introduction | |  |
In the current prevailing state of pandemic, people are vulnerable to develop mental health problems. The pandemic has created a state of feeling on edge and an apprehension about future in the people's mind. Systematic review of pandemic effects on mental health consequences revealed lower psychological well-being and higher scores of anxiety and depression in the general population when compared to pre-COVID-19 state. Patients with pre-existing psychiatric disorders had worsening of psychiatric symptoms. Studies investigating mental health status of health-care workers have found increased depression/depressive symptoms, anxiety, psychological distress, and poor sleep quality.[1]
Various reasons are cited for an individual to get predisposed for developing mental turmoil during this crisis period. The safety factors of the pandemic like strict adherence with lockdown, social distancing, quarantine, excessive cleanliness, and its secondary effects have caused major impact on mental health.[2] These factors have increased the fear of COVID-19 and decreased the physical and environmental well-being. But a positive correlation was noted between fear of COVID-19 and health-compliant behaviors.[3] On the other hand, immune response triggered by the viral illness itself had impact on causing psychiatric morbidity.[4]
This article discusses the psychiatric morbidities related to COVID-19 being encountered in the current scenario based on the article published recently.
| Illness Anxiety/panic Attacks | | |
Anxiety is a recurring theme in the psychological impact of coronavirus. The prominent symptom which has affected many is fear of contracting the illness “coronaphobia.”[5] The increasing incidence and rising mortality all over the world is raising the alarm and panic among the general population. In vulnerable individuals, it has caused heightened anxiety and frequent monitoring of bodily changes. Sudden panic attacks with intense fear of going crazy or dying at regular interval have lead to impairment in routine activities and demand for frequent medical consultations and interventions. Even the medical professionals those who are constantly in close contact with COVID-19 positive and/or quarantined patients while treating them are under psychological trauma. The predictors are constant fear of getting infection, unbearable stress, helplessness, and distress watching infected patients die alone.[6]
| Depression | | |
One of the common psychological disturbances reported was depression and the severity was found to be at moderate to severe level in 16.5% of the general population even at the initial stage of COVID-19.[7] Due to deprivation in basic needs, financial crisis, uncertainty of the current situation, away from home, lack of emotional support, aging have put many individual at risk of developing the core depressive cognitions of hopelessness and helplessness. Psychologically vulnerable individuals with either past or family history of mental illness and those with anxious personality are getting easily affected and suffering to overcome the current situations.[8]
Also overt anxiety and frustration on challenges being faced is creating interpersonal issues and conflicts within the family and leading to a surge in domestic violence which in turn worsening the mental state. Emotional exhaustion, low mood, fatigue, worries about future and family, palpitations, restlessness, startle reaction, loss of interest, irritability, and disturbed sleep are common symptoms being reported which on continuation for a prolonged period has lead to suicidality.[9]
| Agoraphobia | | |
Agoraphobia, a type of anxiety disorder with point prevalence of 1.3% (NIMH) has been increasing due to pandemic threat. Intense fears of open places, crowd, or any gatherings have developed due to fear of contagion. According to the Anxiety and Depression Association of America, agoraphobia is triggered due to panic features of choking sensation, breathing difficulty similar to COVID-19 symptoms, and frequent hearing words such as “quarantine” and “physical distancing” may trigger fears of being alone and cutoff from help. During the course, due to severity, some have become complete housebound and reported that physical distancing provides relief, as it discourages situations that may trigger fear.
| Obsession and Compulsion | | |
As frequent handwashing and cleanliness is advised as an important measure to prevent coronavirus, there is a raising concern that it may worsen and cause a new surge in the prevalence of obsessive compulsive disorders. Though it's a healthy measure, it's getting generalized and imposes undue pressure to follow excessive cleanliness in all activities such as brushing, bathing, cleaning, etc., particularly in anxious people. It is further observed that many get obsessed about contamination and compelled to do cleaning for multiple times and spending hours of a day in such activities, causing significant distress. Though immediate impact may not be noticeable, aftermath of COVID will see an increase in intensity and onset of OCD. It was well documented during previous outbreaks (SARS and MERS), especially within 6 months.[10] Another interesting aspect is the hoarding tendency of people to overcome the crisis during lockdown. Hoarding disorder, a part of OCD spectrum in DSM 5, seems to be reported more frequently than the existing prevalence of 2%–5%.[11] Fortunately, symptoms of OCD which were expected to worsen in already affected individuals aren't found to be increased. According to Christopher Pittenger, Director Yale OCD research clinic “Overall a pattern that OCD specialist clinicians are noting is that our patients do quite well when there is a real, unambiguous crisis.”
| Hypochondriasis | | |
One of the conditions growing rapidly with COVID-19 is fear of having acquired already or will develop the illness, leads to experience of intense fear associated with constantly searching for symptoms of illness, repeated doctor's visits, and insist for corona testing to rule out the illness. Their fear is reinforced as there are a lot of asymptomatic patients with positive report. They were found to be preoccupied with recurrent episodes of panic attacks associated with fear of dying and significant impairment in socio-occupational functioning. They are also found to be taking medications of complementary and alternative medicine whichever are claimed to be treating or preventing the coronavirus.
It is revealed that there is a significant difference on symptoms of hypochondriasis for respondents with direct contact with COVID-19 patients, followed by exposure within the community and lastly, without exposure. It can be inferred that symptoms of hypochondriasis rise as people become in closer proximity with COVID-19 patients.[12]
| Psychosis | | |
Psychosis was found to be linked to viral exposure, treatments used to manage the infection, and psychosocial stress. Prevalence of psychosis has shown marginal increase. In a review of 14 studies, it was found that the incidence cases of psychosis in people infected with a virus was between 0.9 and 4.0%. Psychosis if affect, patients with coronavirus may create a major challenge in managing and treating the infection to clinical teams. There is moderate (if low quality) evidence to suggest a small but important number of patients will develop coronavirus related psychosis.[13]
| Social Anxiety | | |
Because of insistence on social distancing as a prevention measure, people are getting anxious to interact with others. About 25% reported having inappropriate social behavior owing to the fear of contracting the virus[14]. The attitude toward patients with any respiratory symptoms has changed and to the extent of severity, touching and even standing nearby also are considered infectious. A study of people quarantined because of potential SARS contact noted that 54% of people who had been quarantined avoided people who were coughing or sneezing, 26% avoided crowded enclosed places, and 21% avoided all public spaces in the weeks following the quarantine period.[15] Approximately 60% of people believed that patients recovered from COVID-19 infection, should not be allowed to stay within the community at this time.[14] Interestingly, the physical distancing during the COVID-19 pandemic has paved way for people with social anxiety to get short-term relief. However, avoiding social interaction will maintain social anxiety.
| Preexisting Mental Illness | | |
Patients with known psychiatric illness are experiencing exacerbation of their symptoms. Female gender, feeling no control of the situation and reporting dissatisfaction with the response of the state during the COVID-19 pandemic, and reduced interaction with family and friends increased the worsening of pre-existing psychiatric conditions.[16] One of the most important factors identified was nonavailability of medication and inability to go for a regular follow-up due to quarantine. It is reported that the important reason for relapses in patients with bipolar disorder and schizophrenia is due to difficulty in both the availability of regular medications and medication compliance. The overwhelming anxiety due to quarantine can precipitate paranoia and nihilistic ideation in already affected individual.[17] The impact of pandemic has increased the suicidal tendency particularly in patients with mood disorder and substance use disorder.[18]
| Conclusion | | |
Mental health issue is raising and alarmingly affecting increasing number of people. Three factors that are considered to be disrupting the mental health well-being are fear of contracting the illness, quarantine, and declining economic status. Anxiety disorders were found to be the most common disorder, followed by depression. Mania and psychosis were reported in less number and affecting the treatment process. Though the OCD worsening in affected individuals didn't see any upsurge in the clinics, a new peak in OCD prevalence may be seen in the post pandemic period. It may be undermined as normal behavior in the current scenario. It was also found that the worsening of symptoms in known psychiatric patients due to ongoing stress has become increasing and put them at risk of developing suicidal behavior. It was noted the poor compliance due to financial crisis and inaccessibility to drugs been cited as one of the important reasons for worsening of the existing condition. Unfortunately, psychiatric morbidities and its consequences in pandemic are expected to continue and reach a peak in after pandemic state.
Mental health care is need of the hour to be addressed to overcome the psychiatric morbidity. Tele-consultation and 24 × 7 helpline numbers are helping the needy to an extent. Community psychiatry activities have to be expanded through mental health programs to improvise the mental health facilities. UN urged that “Unless we act now to address the mental health needs associated with the pandemic, there will be enormous long-term consequences for families, communities and societies.”
| References | | |
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