TAKING CARE OF PATIENTS DURING COVID-19 PANDEMIC: A GUIDE FOR PSYCHIATRISTS

   

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

The novel COVID-19 is quite contagious with a potential to flood the healthcare systems within a short span of time. No specific treatment or vaccine is available. Prevention is the best way to protect oneself which requires a lot of changes in one’s lifestyle such as social distancing, frequent hand washing and curtailment of social contacts or visits to potentially crowded places.

This scenario often leads to emotional distress, even among those who have not been directly exposed to the disease.

Psychiatrists are likely to encounter patients who have increased emotional distress resulting from the pandemic’s impact on themselves, their families and communities.

Common psychological and behavioural responses include

  Increased anxiety or fears related to health of self or loved ones

  Low or irritable mood

  Anger, increased conflicts with family

  Increased use of alcohol and tobacco

  Inability to sleep

  Concentration difficulties or impairments in daily performance

  A proportion of individuals will go on to develop syndromal disorders, such as depression,
anxiety, or trauma-related disorders, that require formal treatment.
In working with these patients, the psychiatrists should follow these principles:
 Acknowledge their concerns and uncertainties about the pandemic,
 Share medical knowledge that is accurate and objective,
 Encourage steps to reduce distress and encourage healthy lifestyle and behaviours.
Psychiatrists can play important roles in supporting physicians and healthcare personnel, as well as extend help to the community based interventions that encourage healthy behaviours during the pandemic.
Following strategies can help psychiatrists support their patients during COVID- 19 pandemic:

  Stay updated with latest information
Obtain the latest, credible information from authentic public health resources, such as the Ministry of Health & Family Welfare, Government of India, World Health Organization or Centers for Disease Control and Prevention (CDC), in order to provide accurate, factual information to your patients.

  Correct misconceptions.
In this digitally connected era with a variety of social media platforms, misinformation and rumours can spread quickly, causing unnecessary panic. If patients share any inaccurate information related to the pandemic, correct their myths or misconceptions and advise them to visit reliable public health resources to gather information.

  Limit excessive exposure to media platforms.
Try to have a limited time set aside to check for news or updates pertaining to the pandemic. Constant inflowing stream of information every few seconds or minutes is likely to result in emotional distress and undue anxieties. Use only certain trusted media sources to update yourself twice a day. Counsel your patients to avoid excessive exposure to news channels and social media updates.

 

 

  Impart education
Common psychological and behavioural responses to infectious pandemics along with interventions to manage the emotional distress and risky health behaviours must be shared. Education about basic hygiene such as hand-washing, cough etiquette, social distancing and staying at home must be reinforced. Having proper education empowers the patients to make right decisions.

  Help them by acknowledging and identifying their stress reactions

o Teach patients to recognize any alarming signs or indicators of emotional distress,

such as insomnia, concentration problems, bodily symptoms, increased use of alcohol

or tobacco etc. This will help them to monitor themselves and their family members. o It is also beneficial to acknowledge that certain emotional and behavioural responses

are part of an adaptive response to extraordinary stress
o Psychotherapy techniques such as those based on the stress-adaptation model might

be helpful.

Discuss strategies for stress management
o Plan and prepare ahead (e.g. ensuring medicine supplies for chronic health condition etc.) o Embrace preventive measures (e.g. social distancing, hand hygiene) as part of new lifestyle o Maintain sleep-wake schedule, with regular nutritious meals
o Engage in daily physical exercise, depending on one’s fitness level and stamina
o Limit the use of alcohol or tobacco as a means to cope with stress.
o Share the worries and concerns with family and relatives
o Practice deep breathing, muscle relaxation or meditation
o Develop your hobbies and activities to structure the daily routine

Identify and support high-risk patients
o Patients with pre-existing conditions e.g. those with severe anxiety, obsessive-compulsive

behaviours, or those previously exposed to severe trauma or those with severe depression

or psychosis may be particularly vulnerable during the pandemic.
o Ensure patients have prescription with an adequate supply of their maintenance

medications
o Clinical contact using telepsychiatry services can help to address any emerging concerns,

which may help to avoid exacerbations of symptoms.
o Patients who show alarming symptoms such as suicidality or aggression must be advised to

visit emergency services and must be taken up for emergency evaluation

Take care of yourself and your family
Psychiatrists themselves are vulnerable to emotional distress and they must take the necessary measures to ensure their own mental health and wellbeing (e.g. eating or sleeping adequately, taking necessary preventive measures etc.). Psychiatrists must plan ahead for the possibility of being quarantined away from one’s family after a possible exposure to a confirmed patient.

References:

  Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/

  Center for the Study of Traumatic Stress. https://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-
disease-outbreaks-response

  American Psychiatric Association Coronavirus resources. https://www.psychiatry.org/psychiatrists/covid-19-coronavirus

  Xiang YT, Yang Y, Li W, et al.Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228-229.

 

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