|Year : 2021 | Volume
| Issue : 6 | Page : 257-258
Post-COVID Psychiatry practice
Institute of Psychiatry and Behavioral Sciences, Sir Ganga Ram Hospital, New Delhi, India
|Date of Submission||01-Nov-2021|
|Date of Decision||14-Nov-2021|
|Date of Acceptance||03-Dec-2021|
|Date of Web Publication||31-Dec-2021|
Dr. Anita Mahajan
Institute of Psychiatry and Behavioral Sciences, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi - 110 060
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mahajan A. Post-COVID Psychiatry practice. Curr Med Res Pract 2021;11:257-8
The COVID-19 catastrophe is over but not the struggle. Now, the COVID-19 patients are not flooding the healthcare system, healthcare professionals are back to their routine work, but survivors are trickling in with a disparate set of symptoms delaying their return to normal life. This post-COVID syndrome comprising physical, neurological and psychiatric symptoms, sometimes hard to define is testing the physical and mental endurance of the survivors of COVID-19.
People are grappling with multiple factors stretching their biopsychosocial limits. In India, during pandemic, there was a 20% rise in prevalence of mental disorders. Increase in domestic abuse, suicidality and emotional distress, especially in adolescents, is an issue of concern. Psychological afflictions tend to linger over time. Experts have predicted a rising wave of mental health issues in the post-pandemic period.
Notably, the patient profile of clients attending mental health clinics has changed after the recent crisis. There is already a surge in patients with anxiety disorders, depression and post-traumatic symptoms. According to a retrospective cohort study of more than 2 lakh COVID survivors, every third person had one of the 14 neurological and psychiatric conditions assessed, for example, anxiety disorders, depressive disorders, substance use disorders, psychosis, dementia and insomnia.
Patients who have suffered from COVID-19 disease, whether hospitalised or not, have a series of distinct as well as not so distinct problems such as insomnia, fatigue, weakness, headache, palpitations, inability to concentrate and related cognitive symptoms. Nightmares, traumatic memories and associated disturbing features are more common. People known for their brilliance and presence of mind are complaining of mental clouding. A math wizard expressed doubt about return of his ability and another patient was deeply disturbed by the appearance of suicidal ideas and images. Many individuals are feeling lonely and not as fit in mind and body as before. They are shuffling between medicine and psychiatry for succour.
An issue of concern is that numerous lives have been altered forever after loss of parents or offspring. Old losses have been reactivated. Bereavement, a radical emotional crisis which sets in motion sweeping changes in life of particularly children and other dependents, is known to increase the probability of death by heart disease or suicide. Grief, overt or covert, is a persistent feature in patients visiting psychiatric outpatient clinics and is eroding their coping abilities, exacerbating or precipitating their illnesses and affecting their day-to-day functioning. Unemployment and financial losses have compounded the hardship unleashed by the pandemic.
In addition, individuals who experienced the ordeal of running around for medical help, hospitalisation, oxygen and medicines feel abandoned and cynical. Vicarious trauma from multitudinous routes including information onslaught has scarred many with horrifying visuals and words leading to erosion of optimism and faith in general goodness of life. The soothing social balm at this trying time is unavailable due to persistent preventive measures for COVID-19 disease such as use of mask, social distancing, work from home and online schooling. In short, there is a crying need for psychological and psychiatric care of a large segment of population.
Various factors especially lack of awareness and stigma about mental illnesses, poor healthcare infrastructure, deficient mental healthcare personnel and a general stepmotherly treatment to mental health make it a daunting task. Chronically neglected mental health services with almost non-existent funds cannot be expected to meet this challenge. A WHO survey of 120 countries has shown that mental healthcare system in both developed and developing countries is breaking down and needs urgent attention to manage the psychiatric and psychological impact of the pandemic that is slowly building up.
It is remarkable that COVID-19 has done what the sweating hard work of psychiatrists, psychologists, patients, their families and non-government organisations could not do, that is, to bring the mental health in the forefront of health care. The mental reshuffle initiated by the isolation, ennui and introspection during lockdown period made people acutely aware of the importance of mental health as well as interdependence of people, living beings and multifarious systems of this universe. Mental health professionals, many lay people and organisations from around the world started commendable online initiatives in mental health care. These measures continue to guide and help those in need but are a drop in the ocean.
Difficult socioeconomic conditions are without a doubt responsible for an increase in psychological and psychiatric problems during COVID-19 pandemic. However, psychiatric research is consistently pointing towards a biological underpinning in aetiology of psychiatric disorders. It is known that SARS-CoV-2 virus attacks the body globally through cells carrying angiotensin-converting enzyme 2 receptors. Recent brain research implicates pro-inflammatory factors, neuroglial failure and demyelination in depression as well as some other neuropsychiatric and neurocognitive symptoms of COVID disease. The dual damage to the body and mind demands a concerted liaison approach to deal with the COVID-19 disease as a whole for best results. This calls for continuing clinical research on post-COVID needs such as patterns of recovery, nature of delayed phenomena, markers of risk for post-COVID syndrome and early interventions.
A heart-warming aspect of the COVID-19 pandemic was how it unified the whole world in fighting the disease and helping one another across the globe at various levels. Development of the vaccine in highly adverse conditions in record time and containment of the infection despite serial re-emergence of new mutations calls for celebration of the brilliance of the human mind and spirit. The medical challenges spanning mind and body consequent to the COVID-19 virus-ravaged body should not be difficult to negotiate by a collaborative multispecialty liaison in treatment, training, research and planning. In short, uniting back the separate pieces of the medical speciality and superspeciality jigsaw to understand the soma and psyche of the human being as a whole is the answer.