Covid-19: Nearly 20% of patients receive psychiatric diagnosis within three months of covid, study finds
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4386 (Published 11 November 2020) Cite this as: BMJ 2020;371:m4386Read our latest coverage of the coronavirus outbreak
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Dear Editor,
I read with interest the recent article published in the BMJ in November 2020 suggesting that there was an increased rate of anxiety disorder diagnosis after suffering COVID-19 infection (1). It was particularly interesting that 1 in 4 of those diagnosed had no prior psychiatric disorder. I understand your role is to summarise and you were not involved in the production of the results.
As you’ll be aware, psychiatric diagnostic criteria are widely based upon the DSM-5 which until recently, did not include panic disorder. I note that you acknowledged the lack of data which classifies the severity of the viral infection, adding uncertainty to the outcome of this article.
However, there is evidence to suggest that 1 in 5 patients in the US will be diagnosed with anxiety at some point in their midlife (2). It is interesting the particular timeframe described in this study. I wonder if you noticed whether there is a particular treatment which is most effective at dealing with this particular outcome of infection in your research?
I also wonder whether a majority of these cases could be an emotional response to the trauma of suffering from the virus. Studies previously have suggested those placed in Intensive Care have significantly increased chance of being diagnosed with a psychiatric condition, so named ‘Post Intensive Care Syndrome’ (PICS). This syndrome is formed from a myriad of psychiatric disorders, including anxiety (3). Do you think there may be a manner in which those with PICS could be separated from those suffering with purely an anxiety disorder, i.e. remove the setting of care as potentially a confounding factor? This could be particularly important due to the treatment differences (i.e. SSRI vs psychological intervention).
1. Mahase E. Covid-19: Nearly 20% of patients receive psychiatric diagnosis within three months of covid, study finds. BMJ. 2020 Nov 11;
2. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience. 2015 Sep;17(3).
3. Colbenson GA, Johnson A, Wilson ME. Post-intensive care syndrome: impact, prevention, and management. Breathe. 2019 Jun 1;15(2).
Competing interests: No competing interests
Impact of covid-19 on mental health of people with intellectual disabilities
Dear Editor
As a CT2 working in intellectual disabilities we have seen significant impacts of covid 19 on our patients’ mental health. For people for whom regular activities such as attending day centres and volunteering opportunities form a key part of their mental wellbeing, lockdown was extremely detrimental. Many of our patients have comorbid autism spectrum disorder, who rely on a set structure and set staff team, which were disrupted during the pandemic both due to closures with lockdown, and staff sickness. ADHD is another common comorbidity in our patients with intellectual disability, and being confined to their house without being able to get regular exercise has led to deteriorating mental health in this group. In addition, some patients were shielding due to their disability and/or physical health comorbidities and were therefore unable to see family and friends during this difficult time. The pandemic and the resultant requirements such as lockdown, social distancing, wearing masks etc were difficult for all of us to grasp at times, but for those whose understanding is limited by intellectual disability it became a very frightening experience. This was heightened by the fact many of our patients use sign language and facial expressions to communicate, which were hampered by mask wearing.
As a result of the pandemic we have seen more patients presenting with challenging behaviours which can be formulated in the context of boredom, lack of understanding of the situation, and difficulties adapting to change. In the majority of my clinic reviews the impact of the pandemic on the patient’s mental health is highlighted. Patients with intellectual disability are often prescribed psychotropics such as antipsychotics for acutely challenging behaviour, but now that lockdown has eased and centres are re-opening, the focus should be on re-engaging patients in meaningful activities. STOMP (1) is an NHS England backed agenda encouraging all patients with intellectual disabilities to have structured medication reviews with the goal of reducing psychotropic prescribing for challenging behaviour, and all those working with patients with intellectual disability should be implementing this.
For those working with or supporting people with an intellectual disability, “Books Beyond Words” have created fantastic resources on “Coping with Coronavirus” to support understanding aspects of the Covid pandemic. These free to download resources can be accessed on the following website https://booksbeyondwords.co.uk/coping-with-coronavirus
References
1. National Health Service, (2017). Stopping Over-Medication of People with a Learning Disability, Autism or Both. Available at: https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/
Competing interests: No competing interests