The psyche and the pandemic

Dr. C. J. John

Consultant Psychiatrist, Medical Trust Hospital, Kochi

Covid-19 pandemic has dealt a ‘body and mind blow’ to entire humanity in one fell swoop and many parts of the world are yet to recover from it. Being a psychosomatic disease, its ramifications are unprecedented and from pre-covid to covid to post-covid, it has shaken several frames and many victims are not with us now. In the psychological and psychiatric realms, the three phases of pre-covid, covid and post-covid have been extremely traumatic for several people. The Medical Tourism Magazine has caught up with one of the most eminent psychiatrists of our times Dr C J John, Consultant Psychiatrist with Medical Trust Hospital, Kochi, to identify the various psychological as well as psychiatric dimensions of Covid-19 and how to overcome the same in the days to come.

The very common issues in all the three phases of Covid start with anxiety, stress, fear, low mood, sleep and appetite disturbance, headache, fatigue and general weakness. They can worsen to psychiatric disorders, anxiety disorders, depressive disorders, stress-related disorders, suicidal thoughts, and even psychosis. Delirium is also common during the acute stage of Covid-19 while brain haemorrhage cases have gone up during the pandemic.

“In some persons, many of the above initial symptoms resolve on their own with adequate coping. But with certain others, when such symptoms persist for longer, and significantly disrupt his or her day-to-day functioning, it becomes clinically relevant and must be taken care of by a medical expert,” says Dr. C J John.

The fundamental approach, in most cases, is to help people understand it is normal to feel overwhelmed during such phases. “But don’t ignore such stress, but acknowledge and validate all your concerns. Connect with your existing support network, including your family members and friends, and convey to them your emotions and thoughts. Maintaining a daily diary and learning relaxation techniques like deep breathing and diaphragmatic breathing and indulging in positive self-talk, engaging in self-soothing activities like reading, cooking, singing, and gardening, helps one overcome grief and stress. Don’t remain bitter about any loss. All these are important in the three phases of Covid-19, including the ongoing post-Covid-19 phase,” adds Dr. C. J. John.

Quarantine and social distancing, too, make their own impacts. People experience emotional disturbance, irritability, insomnia, depression and post-traumatic stress symptoms immediately after the quarantine period too. The psychological effects in such cases can last for up to three years. Social distancing can lead to increased loneliness, anxiety, depression, domestic violence, child abuse, and substance abuse. Prolonged social isolation can lead to social withdrawal.

Bereavement crisis

“One of the major issues during Covid-19 is bereavement over the loss of a relative or friend. In several cases, it’s a Covid-19 affected person witnessing the death of another Covid affected relative. It could be his/her mother, daughter, brother, or father. This is extremely painful, especially when two Covid affected-kin are admitted to hospitals or their ICUs. The shock that it makes to the survivor is beyond description. Its impact is immeasurable and systematically dealing with it is a priority,” points out Dr. John.

Dr. John says that healthcare providers, while dealing with post-Covid issues, should actively and empathetically listen to the bereaving family members. “Allow them to ventilate their emotions. Help them understand that grieving is a process that is very subjective to each person. There is no right and wrong way of grieving. Grief takes time for its processing and people should allow themselves this time to process grief,” he says.

“Help people identify what gives them hope and courage, encourage them to involve in activities that help them gain strength, help them reconnect with their lives in meaningful ways again, let them know it is okay if they are not being able to handle the grief now, encourage them to try. However, do spread awareness that sometimes a psychotherapist can help them in the process. Provide a few local services available and encourage them to seek help when required,” says Dr John.

Lancet Covid-19 study

A Lancet study post Covid-19 outbreak released last year revealed that people who had to be hospitalised, especially in ICUs, suffered in terms of psychiatric and neurological issues. Increased risk for strokes in Covid-19 patients was reported. The study reported preliminary evidence for an association between Covid-19 and dementia. In the Lancet study among 2,36,379 patients diagnosed with Covid-19, the estimated incidence of a neurological or psychiatric diagnosis in the following six months was 33·62%, with 12·84% receiving their first such diagnosis. For patients who had been admitted to an ICU, the estimated incidence of a diagnosis of the same was 46·42%.

The socio-economic crisis

Unemployment, insecure job situation, and very low or nil incomes as a result of the economic recession arising from Covid-induced lockdowns and collapse of business activities have also led to psychological distress, anxiety, depression, substance abuse disorders, and suicide and suicidal behavior. In the initial stages, stigma attached to Covid-19 had resulted in emotional disturbance and other issues in the victims.

Brain fog caused by Covid-19

What helps in such crises?

Dr. John says that while one manages negative emotions, one should also strive to achieve resilience and well-being. Resilience is defined as the ability of people to bounce back after adversities. “Cultivate emotions of gratitude and forgiveness for the past, practice mindfulness by slowing down, connecting with your immediate surroundings, refocusing, and engaging with the present. Use your five senses to experience the moment that you are in now. Listen to the sounds of nature, observe your surroundings, and feel the touch. It can be practiced anywhere and anytime, build hope and optimism for the future,” Dr. John says.

Getting in touch with people you have not seen in a while and choosing the appropriate activity for you, based on your health and preference, helps.

Taking care of the ‘fence’

Dr. John says that healthcare providers who helped us fight the battle against Covid-19 with their back to the wall are a key concern. Psychological symptoms including anxiety, depression, insomnia have been prevalent in up to 60% of physicians, nurses and medical residents concerned during the Covid-19 pandemic. “Their mental and physical health too is a concern during the pandemic and post-pandemic period. Healthcare providers should practice Yoga, aerobics, muscle-building exercises and play a sport or game to keep them in fine fettle. They should compensate for sleep loss and have an eye on balanced nutrition,” says Dr. John.

Dr. John points out that some people who’ve had Covid-19 have reported brain fog that lasts weeks or even months after their other symptoms — like cough, fatigue, or fever — have faded. Brain fog is a term used to describe the feeling of being mentally slow, fuzzy, or spaced out. It leads to memory problems, lack of mental clarity, poor concentration, feeling ‘out of it', headaches and confusion. Both physiological and psychological factors play a role in this. Inflammation in and around your brain may contribute to brain fog. Poor sleep quality, the feeling of loneliness, depression, increased stress or anxiety, dietary changes, decreased physical activity, and side effects of certain medications during Covid-19 contraction can lead to brain fog. People with severe Covid-19 will be at a higher risk for brain fog.

As of now, the best treatment for brain fog caused by Covid-19 is to adopt healthy habits.

• Get plenty of sleep: Getting good quality sleep can help your body repair and recover.

• Get regular exercise: Physical activity isn’t only beneficial to your heart and lungs, it’s also a great way to boost your brain function.

• Eat well: Try to eat a well-balanced, healthy diet to give your body the nourishment it needs to return to good health.

• Avoid tobacco and alcohol: Staying away from tobacco products and alcohol can help minimize inflammation in your brain.

Long-term solutions needed

“The mental health impact of Covid-19 can last for several years to come. Increases in the prevalence of common psychiatric disorders and suicide are expected during the post-pandemic period. Enhancing access to mental health services, including tele psychiatry, early assessment, treatment and psycho-social support, screening and support for specific groups is needed to tide over the crisis. Long-term measures to mitigate the impact of economic recession on mental health is another priority area,” says Dr. C. J. John.