COVID-19 patients are displaying sleeplessness, fear and anxiety after discharge. Psychiatrists have been seeing a steady inflow of such people, including healthcare providers, and are finding that there is a sense of fear and panic among them.

Elderly persons turning anxious on hearing the siren of an ambulance or healthcare providers worrying about re-infection — psychiatrists are increasingly receiving more such patients. Psychological support has become a must for many during and post-COVID-19 treatment, with standalone follow-up clinics in government hospitals offering psychiatric services as well.

P. Poorna Chandrika, director of the Institute of Mental Health, said that doctors at the follow-up clinic at the Rajiv Gandhi Government General Hospital were seeing persons, including healthcare providers, coming in with sleeplessness, anxiety and fear of re-infection.

Sudden isolation

“There is low mood that could be related to fatigue, and could be part of depression. This happens because people go into isolation suddenly and the restrictions cause a strain on them. Those with good family support are better off, but there are instances where testing positive for COVID-19 has caused anxiety among family members, straining relationships,” she said.

She added that they were also looking at the probability of patients going through Post-Traumatic Stress Disorder (PTSD) or having flashback memories of the event.

Lakshmi Vijayakumar, psychiatrist, said there were two types of people who were most affected — those who have lost someone to COVID-19 and those testing positive for the infection and have been under hospital isolation. The latter particularly comprised the elderly.

“Many are fine during the first week of discharge. They start experiencing depression and anxiety during the second week. People have been affected by isolation/quarantine and bereavement. This includes healthcare providers as well. They are experiencing difficulty in thinking and come after a great deal of reluctance,” she said.

Insomnia is one of the commonest symptoms, she said, adding: “We are also seeing persons with symptoms of PTSD and suicidal tendencies. We are seeing only the tip of the iceberg of mental health consequences of COVID-19.”

A challenge

In fact, Dr. Vijayakumar noted that a small percentage of persons also presented with neuro-psychological symptoms of confusion, worry and sleeplessness and then tested positive.

COVID-19 is a challenging situation for everyone — patients, healthcare providers such as doctors and staff nurses, and hospital workers, observed Karthik Deivanayagam, district mental health programme officer, Pudukottai. “There is fear and illness anxiety. The stigma associated with COVID-19 is more challenging, and mental health professionals play an important role in tackling it,” he said. He, along with his team of psychiatrists, call up persons who test positive for COVID-19, and if need be, their family members, and even frontline workers, to provide video counselling. Till now, they have made 17,000 calls in Pudukottai.

“Basic symptoms include sleeplessness, fear and anxiety. We educate them with appropriate information on COVID-19 and if necessary, provide drug therapy,” he added. An LEED strategy — listen, elicit, educate and de-escalate — has been put in placewhen providing psychological support to patients.

What can people do? Dr. Vijayakumar said, “There is no point in panicking, but precautions should be taken. We can control our sleep, appetite and exercise. So, have a routine to stay stable,” she said. While she suggested that people should avoid an overdose of television news, Dr. Chandrika said that people should filter unnecessary information on social media.