Facing This Major Upheaval Together

Heidi Anne Duerr, MPH (HAD): Are there any neuropsychiatric symptoms associated with the COVID-19 virus?

John J. Miller, MD (JJM): It is early to speak with confidence about any real chronic aspects or consequences of the virus. There was a small study recently looking at the people in China where the virus began, and they found the primary psychiatric symptoms were post dramatic posttraumatic stress symptoms in people who were around virus.^1,2 That doesn't mean posttraumatic stress disorder (PTSD), because PTSD symptoms have to last for 30 days or longer. However, it is significant in a related fashion.

Not surprisingly, when you look at the SARS outbreak which was seemed to be a lot more dangerous and aggressive than the current COVID-19 virus, PTSD was the number one psychiatric complication both in health care providers and people who were affected by the virus. It seems like in some ways, not surprisingly, that this is a major life upheaval, and people are hypervigilant and that creates an experience of a traumatic intrusion. So, as of now, it seems like posttraumatic stress-like symptoms are the primary psychiatric comorbidity so to speak.

HAD: How do you think this pandemic will impact psychiatry as a field?

JJM: What it is doing in our own clinic here in a matter of one week is where testing out the utility of having a virtual treatment model where basically we are able to interface with a lot of people without person-to-person contact, although telepsychiatry has been growing (in our clinic it hasn't been a big piece of what we do), in some ways this is going to be a real test of what is the utility what is the effectiveness of this of telepsychiatry and how does it make sense to fit in.

I do believe that although telepsychiatry is really important and helpful during this during this period of time, there are a lot of patients that I would still want to see in person and especially doing things like monitoring their metabolics in their blood pressure and pulse and doing an abnormal involuntary movement scale exams, and I personally find a lot of important information being with the person sitting across from me and seeing the body language and getting the big picture. My hope is it doesn't move us too far in the direction of telepsychiatry but that we find the useful niches for telepsychiatry and this is certainly going to put that to the test

Transcription edited for clarity. -Ed

Have more COVID concerns and clinical tips? Email us at PTEditor@mmhgroup.com. We may share your stories, queries, or thoughts in a future editorial or even as a standalone piece. Check out our COVID-19 Resource Page for Psychiatrists.

References:

1. Sun L, Sun Z, Wu L, et al. Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China. March 10, 2020. medRxiv. doi:org/10.1101/2020.03.06.20032425.

2. Das DK. In China, COVID-19 Outbreak Leads to Posttraumatic Stress Symptoms. Psychiatry Advisor. March 17, 2020. https://www.psychiatryadvisor.com/home/topics/anxiety/ptsd-trauma-and-stressor-related/in-china-covid-19-outbreak-leads-to-posttraumatic-stress-symptoms. Accessed March 25, 2020.