covid-19 and mental health - rutgers university
TRANSCRIPT
Petros Levounis, MD, MAProfessor and Chair, Department of Psychiatry
Rutgers New Jersey Medical School
Project ECHORutgers New Jersey Medical School
Newark, New JerseyFriday, April 17, 2020
COVID-19 andMental Health
1. Working with Existing Psychiatric Disorders
2. Working with Emerging Psychiatric Disorders
3. Addressing the Mental Health Needs of the General Public
4. New Directions
Outline
2
Psychotic Disorders
ØCognitive deficitsØInjectable medicationsØStigma
oDrowsinesso Involuntary movementsoSialorrhea (drooling)
ØParanoia and the Evil WorldØSocial isolation
4Geller, Psychiatric News, April 7, 2020.
Depression and Suicide
ØEconomic difficultiesØSocial isolationØAccess to MH treatmentsØGuiltØLate spring/Early summerØThe “Pulling Together” effect
5Reger MA, JAMA Psychiatry, 2020.
PTSD "plus"
PTSD only
Non-PTSDdisorder
Subdiagnostic distress
PTSD
Oth
er d
iagn
osis
?
SCREENTraumaticevent
noPTSD
Diagnose PTSD
Assessment Road Map
0
5
10
15
20
25
% o
f pop
ulat
ion
Druguse
disorder
SUBSTANCE USE DISORDERS
Alcoholuse
disorder
MOOD DISORDERS
Bipolardisorder
Majordepression
♀ 10%♂ 5%
ANXIETY DISORDERS
GAD Panicdisorder
PTSD
8%
Lifetime Prevalence
4%
Natural disaster
49%
Rape
32%
Beating
15%
Shooting orstabbing
54%
Kidnapping,torture,captivity
Perc
enta
ge
0
10
60
20
30
40
50
Risk of PTSD in the US
Breslau et al, Archives of General Psychiatry, 1998.
Post-Traumatic Stress Disorder
A. Exposure to actual or threatened death, serious injury, or sexual violence
B. Intrusion
C. Avoidance
D. Negative Thoughts and Feelings
E. Arousal and Reactivity
11
PTSD "plus"PTSD only
Other diagnosis
No diagnosis
STEP 3
SELECT TREATMENT BASED ON
DIAGNOSES
Education/reassurance
MedicationsPsychotherapy
SCREEN for C & D
symptoms
DSM-5 diagnosis
PTSDNo PTSD
ASSESS for PTSD
STEP 1
DSM-5 diagnosis
STEP 2
ASSESS OTHER DIAGNOSES
Intervention Road Map
Disaster Psychiatry
14Adapted from Zunin and Myers (as cited in DeWolfe DJ), Training Manual for Mental Health and Human Service Workers in Major Disasters, 2nd Edition, 2000.
Mental Health Consequences
ØAnxietyØDepressionØSubstance useØLonelinessØDomestic violence/child abuse
15Galea S, JAMA Internal Medicine, 2020.
Mental Health Solutions
üDigital technologiesüSocial mediaüRoutinesüNontraditional groups for
psychological first aidüSocial distancing v. safe places
16Galea S, JAMA Internal Medicine, 2020.
Quarantine Stressors
ØLonger quarantine durationØInadequate informationØInadequate suppliesØFear, frustration, and boredom
ØFinancial lossØStigma
17Brooks SK, The Lancet, 2020.
Quarantine Solutions
üKeep it as short as possible.üGive as much information as
possible.üProvide adequate supplies.üReduce the boredom.üAltruism is better than
compulsion.18
Brooks SK, The Lancet, 2020.
Resilience Resources
üIndividualWhat do I do when things get hard?
üCommunityWho helps me when things get hard?
üExistentialWho do I want to be when this is over?
20Rosenberg AR, JAMA Pediatrics, 2020.
Psychological First Aid
FIVEMAJOR PRINCIPLES
23Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.
Psychological First Aid
Establish safety.ü Identify safe areas and behaviors.ü Provide accurate and updated information.
24Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.
Psychological First Aid
Teach calming skills.ü Acknowledge/normalize distress reactions.ü Safeguard and develop routines; restore a
sense of normalcy.ü Teach diaphragmatic breathing and muscle
relaxation techniques.ü Limit exposure to traditional and social
media as increased use enhances distress.
25Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.
Psychological First Aid
Teach maintenance of natural body rhythms.ü Nutritionü Sleep and restü Sexü Exercise
26Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.
Psychological First Aid
Maximize connectedness to social supports to the extent possible.ü This may require electronic rather than
physical presence.
27Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.
Psychological First Aid
Foster hope and optimism while not denying risk.
28Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.