Reflections About COVID-19 and Psychiatry

Psychiatry is the branch of medicine specializing in the care of individuals exhibiting behaviors that result from dysfunction in cognitive, emotional, and motivational systems in the brain. We are currently in the midst of a pandemic that is having a profound influence on all three brain systems.

SARS-CoV-2 is the virus that causes coronavirus disease-2019 (COVID-19). This virus can directly influence brain function via several mechanisms, including infecting the brain directly, stimulating immune responses that can damage the brain, and attacking blood vessels that can lead to strokes. Psychiatrists are interested in understanding how these direct effects of the virus lead to specific psychiatric symptoms. Such understanding requires a firm foundation in neurosciences.

The fact that SARS-CoV-2 is highly contagious has resulted in a global pandemic. This pandemic has resulted in marked psychological stress, including fear of infection and death of both self and loved ones, loneliness and isolation, job loss, and financial hardship. Severe stress can dysregulate brain systems and cause symptoms of depression and anxiety. These symptoms can become disabling. How each of us reacts to stressors is partially determined by the type and severity of the stressors as well as our individual personalities. Some people are more resilient to stress while others are highly sensitive. For psychiatrists to understand how individuals respond to stress, they must have a firm understanding of the effects that both genes and environment have on behavior as well as the relationship between personality and resilience.

Individuals with psychiatric symptoms resulting either directly from COVID-19 or indirectly from stressors related to the pandemic may benefit from various interventions. Many will find support by increasing their social contacts via telephone, internet-based communication, or small group gatherings that incorporate safe COVID-19 hygiene practices, including wearing masks, social distancing, and frequent hand-washing. Some may benefit from initiating an exercise routine. Some may find individual or group counseling helpful. Others may need more intensive treatment that combines the above practices with formal talk therapies and/or medications. Except in cases involving more intensive treatments, many of these approaches do not require psychiatrists or other mental health professionals.

Certain populations are at increased risks for both the direct and indirect effects of COVID-19. Examples include health care providers who are treating COVID-19 patients and witnessing deaths of these patients. Persons with pre-existing psychiatric illnesses are also at increased risk. Some of these individuals have difficulty fully understanding the nature of the pandemic and may not understand why social distancing, masks, and hand hygiene are important. Many may be unable to see their physicians. Some may discontinue their medications and experience relapse.

Another high-risk group is the elderly. Older individuals often have medical comorbidities and are highly susceptible to both the medical consequences of the virus and psychological morbidities from fear, loneliness, and isolation. Another high-risk group includes individuals that are deemed essential workers, for example, grocery store clerks, sanitation workers, custodial workers, bus drivers, and workers in nursing homes and meatpacking plants. Psychiatrists must understand the specific challenges faced by these high-risk groups and incorporate that knowledge into treatment plans.

The pandemic is causing all fields of medicine to develop new approaches to deliver care. Some changes, including increased use of virtual visits, are likely to become permanent. The pandemic is also leading to increased awareness of health care disparities, particularly in our Black communities. Public health medicine, including public health psychiatry, will receive increased clinical and research attention.

We are living through historic times and the challenges we now face will likely be with us for years to come. In addition to changing all of our lives in various ways, these events will influence how all of medicine, including psychiatry, is practiced in the future. Some of these changes will be for the better in terms of safety and access to care.

This column was written by Eugene Rubin MD, Ph.D., and Charles Zorumski, MD.