PTSD Among Covid Patients
The war against the COVID pandemic has been going on for over a year. India’s latest tally has been 11.6 million cases with 160 thousand deaths. These are uncertain times, and the human race is highly vulnerable. It is natural for most of us to feel insecure and worried about the future. Covid patients are especially vulnerable, and many have post-traumatic stress disorder.
What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder (PTSD) is a psychiatric disorder wherein the sufferer has experienced or witnessed an event that has been traumatic, scary or violent like war, terrorism, serious accident, sexual violence, physical abuse and even natural disasters like hurricane, fire, earthquake, etc.
PTSD has probably existed as long as mankind has. The first case could probably have been an early caveman surviving an attack by predatory animals while hunting. This disorder had many names in the past, like shell shock, battle fatigue and soldier’s heart. It was eventually recognised as a diagnosable condition in 1980 when the American Psychological Association encompassed its Diagnostic and Statistical Manual for mental health practitioners.
PTSD can be linked to the complex changes in the autonomic nervous system, specifically an increase in activity of the sympathetic nervous system (the adrenaline system underlying the “fight, flight, or freeze” reactions) and a deficit in the parasympathetic nervous system (the “rest and digest” system).
Simply put, the brain networks associated with processing threat-detection and negative emotional responses are on overdrive, and brain networks involved in executive control, problem-solving, and emotional regulation are hindered and subdued.
Post-Covid Stress Disorder – An Emerging Global Mental Health Disorder
The Covid pandemic has not just led to deaths but has also triggered many physical, mental and economic problems worldwide. There have been pandemics in the past, but they have been so far apart that it is likely that the majority of the population is inexperienced and unprepared for it.
There is constant exposure to COVID-19 related news through every form of media. The news channels constantly cover the deaths of patients, hardships faced by caregivers, discrimination against COVID patients and caregivers, economic effects of the lockdown, loss of jobs, migration of labourers and the ever-changing rules and regulations of lockdown and safety measures. All this has led to Post Covid Stress Disorder not just among patients but also in the general population. We can break the stressors of Post Covid Stress Disorder into two categories: General Stressors and Traumatic Stressors.
What Are The General Stressors Of Post Covid Stress Disorder?
The pandemic has led to many forms of stress. For the general population, the government-mandated lockdown, which took place overnight and without much prior warning, led to many stressful situations. Countless people working or travelling away from home got stuck in an unfamiliar place with no idea when they would be allowed to go home. The strict lockdown also trapped people in their own homes, causing social isolation, especially among people living alone.
People exposed to COVID-19 and who went through the mandatory quarantine faced social stigma and were treated as outcasts even after they recovered. Caregivers like doctors, nurses, hospital staff faced threats of eviction from their homes. They also received threats of violence from relatives of deceased COVID-19 patients. The lack of adequate PPE and other medical gears led to fear of contracting the infection.
With the lockdown, people couldn’t travel to work. Factories, restaurants, shops, malls shut down overnight. Countless people lost their jobs and their source of income. Those who could work from home found themselves in a difficult position to do all the housework without any help. The situation was made even more difficult in homes with children as it also involved helping them with their online school. With no work-home life balance, many were left emotionally and physically exhausted.
What Are The Traumatic Stressors Of Post Covid Stress Disorder?
Among many patients at the acute stage of the illness due to coronavirus infection, delirium is the most common stress response. Patients in quarantine (especially hospital quarantine) feel isolated, angry and depressed. Even post-hospitalization and quarantine, many experience difficulties in concentration, headaches, anxiety, panic attacks and sleep disorders. Patients also fear that the infection has changed them in some way or the other permanently because it is entirely new and unknown in the past. The uncertainty of the cure is what leads to further trauma.
Since the COVID 19 pandemic is just 15 months old, we cannot yet identify the long-term psychological problems among COVID 19 patients. However, let’s compare it to the previous coronavirus epidemics like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). One can observe that many patients who were severely ill displayed increased anxiety, depression, and PTSD. The survivors of SARS and MERS showed constant anxiety, depression and PTSD even one year after successful recovery and discharge.
Traumatic stress is also experienced by people who have witnessed the death of their loved ones. The nature of the illness and due to covid19 being highly contactable, people were not allowed to be with their dying loved ones in their last moments and thus weren’t able to say their final goodbyes. Many could not perform the last rites of their loved ones as they could not get permission to be exempted from the lockdown or were stuck in another country.
Even healthcare workers who are used to disease, illness and deaths felt overwhelmed by the sheer volume of the death counts. The rigours of wearing PPE suits for 12-14 hours every day and exposure to the virus on a daily basis caused further emotional and physical exhaustion.
Symptoms, Diagnosis And Treatment Of PTSD During COVID 19
Usually, the first symptoms of PTSD may be identified within the first three months of the traumatic event, contracting the coronavirus, severe illness, hospitalisation, recovery, and quarantine.
Recovered COVID 19 patients may present various intrusive symptoms like:
· Nightmares where they experience flashbacks of being in the hospital
· Experiencing recurrent and traumatic memories of the illness
· Avoiding any topic related to the pandemic, both good and bad
· Avoiding doctors, healthcare workers, hospitals and clinics
· Avoiding people and becoming more socially isolated
· Being hypervigilant about contracting the infection again
· Loss of concentration and interest in earlier enjoyable activities
· Feelings of anger, guilt, loss of power and shame
· Trouble in falling sleeping or disturbed sleep
PTSD is a severe mental disorder that cannot be wished away by simple willpower or discipline. It needs medical and psychological intervention, and the sooner the treatment starts, the faster is the chance for recovery. Through timely intervention, patients can stop a complete dissolution of their social, personal and work relationships.
If you or someone in your family or friend, or work circle is affected by PTSD, it is pertinent to know that there are effective treatments. Psychiatric medications like serotonergic antidepressants (SSRIs) help reduce the physical symptoms associated with PTSD. Mood stabilisers and antipsychotics are also potentially valuable medications for managing the symptoms of PTSD but only to be administered and consumed responsibly under the guidance of a medical health practitioner.
Therapists play an important role as first responders in the treatment of PTSD. Treatment usually varies from person to person, and therapists can help find the right coping strategy.
Cognitive-behavioural psychotherapy involving “emotional processing” of the trauma is one of the most effective psychological treatments for PTSD. The treatment also includes prolonged exposure therapy, eye-movement desensitisation and reprogramming (EMDR), and trauma-focused CBT. Other forms of psychotherapy which do not involve direct trauma processing may be helpful too. They include cognitive processing therapy (CPT-C), interpersonal therapy (IPT), present-centred therapy (PCT), and mindfulness-based therapies.
There are many treatment centres where you can receive the best care if you or your loved one has PTSD. You can find more about psychotherapy treatment centres through sites like Google and RehabPath.
Web-Based Survey On The Prevalence Of PTSD During The Lockdown
The Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital conducted a pan-India web-based dip-test through Google form during the last week of April 2020. The nation had by then completed four weeks of complete lockdown.
The survey asked the participants to specify the degree of their distress for each of 22 symptoms according to a five-point scale —
. 0 indicates that the symptom occurs “not at all.”
. 1 indicates that the symptom occurs “a little bit.”
. 2 indicates that the symptom occurs “moderately.”
. 3 indicates that the symptom occurs “quite a bit.”
. 4 indicates that the symptom occurs “extremely.”
The survey found the frequency of PTSD at 28.2%. The PTSD of 13.7% of participants was a clinical concern, while for 8.1%, PTSD was a probable diagnosis. A majority (55.6%) of participants reported that they had trouble staying asleep; 7.3% reported it ‘extremely’. About 41.5% of participants said other things kept them thinking about the lockdown.
The actual prevalence of PTSD will be much higher as the number of participants compared to the population of India was relatively small. This is a cause for concern as there may be many Indians who may not be aware that they may have PTSD. Hence, it’s important for health care workers and general practitioners to keep an eye out for these symptoms among their patients. Also, there needs to be more awareness about it, just like there is an awareness about the importance of wearing a mask and disinfecting your hands.
How To Keep Your Mental Health In Check During COVID 19?
Months of lockdown has shown us that many of us have been suffering from some form of anxiety, stress, boredom, and burnout. While COVID 19 patients need to be more mindful about any psychological changes they may experience, it may be prudent for the rest of the population to take some basic steps to keep their mental health checked.
If you are under quarantine, then make sure to stay connected to your friends and family. Make phone calls, send emails, chat on social media, do whatever it takes to feel less isolated. Knowing that your friends and family are there for you makes up for their physical absence.
Try to avoid stressful situations like watching the news for long hours and researching the number of cases and other grim information. Physical activities like exercise, yoga or spot running will help. Today, several Mobile Apps allow you to meditate and clear your head from stressful thoughts.
Focus on things you can control. E.g., you may not be able to go out to get groceries, but you can certainly order them home. Things can get more manageable when you focus on the ‘can’ and not the ‘cannot’.
During the lockdown, it would also be great to set boundaries between your work and home life. Inform your superiors that you won’t be available post sundown and before dawn.
If you have young children living with you, it would be wise to give them a set of chores and fun activities to do over the week so that they don’t feel bored and you don’t feel guilty. Understand that children and teenagers are especially vulnerable during these times. They cannot meet their friends, schools and colleges are shut, and they have to deal with new forms of online learning. Some youngsters may feel that the best years of their lives have been spent under lockdown. Especially those who may have had to celebrate milestones like turning into an adult (21st birthday) and graduating at home.
If you do contract the coronavirus, follow all the medical protocols and make sure to be tuned to your mental health. If you feel anxious, nervous or scared, reach out to a friend or a loved one and seek counselling. You can access many trustworthy treatment centres and reputed counsellors through sites like Rehabpath.
In the end, not everyone who falls ill from the coronavirus will face PTSD. However, be proactive about your mental health and seek guidance at the first sign of trouble. After all, prevention is better than cure.
Sources:
https://www.medicalnewstoday.com/articles/ptsd-and-covid-19#tips
https://www.medicinenet.com/posttraumatic_stress_disorder/article.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507979/
https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd