The most frequent psychological repercussions of the coronavirus pandemic are stress and anxiety, derived mainly from a concern for family health and future economic survival. This affects the general population, but tens of thousands of people face the sudden loss of family members amid a casuistry of complicated situations as wide as the variety of psychological responses, which can go through depression and post-traumatic stress.
From 5 to 10 per cent of the population has a specific phobia, a minor disorder that people do not usually consult if it is not associated with anxiety. For example, Menchón has not had patients with phobic confinement-related disorders during the confinement stage. “I think they could be associated with the fear of going outside and getting infected, but not so much with claustrophobia (the fear of being locked up in a small place) that does not occur at home because there is a sense of security,” Menchón emphasises that in order not to confuse a certain overwhelm or intolerance to confinement with a phobia, it is necessary to check if the person presents disproportionate anxiety that they recognise as irrational.
Another disorder, agoraphobia or fear of open spaces, could even improve during the state of alarm due to Covid-19. “We see patients who now feel relieved by not having to go out on the street due to family or social pressures, although when the de-escalation process ends, it will be difficult for them to return to the rhythm they had before the pandemic,” he predicts, adding that phobias they are mild disorders if they do not involve panic attacks.
Sometimes the person avoids doing something important because they forgot the previous ritual and feel insecure, or the hygiene and clothing ritual is so long that he is late for the appointment”.
People with OCD can receive cognitive-behavioural psychological therapy and pharmacological treatment.
One of the most serious mental health consequences of the Covid-19 pandemic is post-traumatic stress disorder (PTSD), which we can associate with real shocking events of the loss of loved ones or dramatic experiences during hospital collapse.
According to Menchón, the mark that PTSD leaves on an individual can occur at three levels of closeness to the traumatic event: when it is suffered in the first person when it is witnessed, and, in a lesser way, when the story is known first hand.
“PTD brings together a conglomerate of symptoms beyond a usual grief reaction with a feeling of loss, sadness or depression since it makes one feel a threat against one’s life or physical integrity .” This can happen in situations of war, serious accidents, rape, kidnapping, and robbery.
The main characteristic of this disorder is that the person experiences recurrent experiences in the form of dreams or flashbacks or a feeling of unreality (“I saw it right at the hospital door, I can believe it””) that lasts over time. After a dramatic situation, it is normal for memories to remain vivid to react to acute stress, but they do not usually last more than a month. “The person with post-traumatic stress does not limit himself to remembering. Instead, he relives those traumatic experiences with realism and a significant load of anxiety, even years later, feeling his physical integrity threatened”, emphasises the professor.
A candidate pattern for PET that could be outlined during Covid-19 is that of a person in perfect health; in a few hours, he had a fever and some discomfort; he went to the hospital and never returned home because he died within days. This unpredictable drama can be associated with post-traumatic stress in some families who do not finish accepting the outcome, but also in some health professionals who for days faced an unknown coronavirus “without weapons”, watching helplessly how many of their patients died.
“PTSD treatment can be carried out using psychological techniques, medication or a combination of both. Psychological techniques are aimed at managing the stress that triggered the trauma with different exposure strategies. An eye movement desensitisation and reprocessing technique can also be applied. However, the results of the studies have not been as conclusive as the techniques focused on exposure to trauma”, details Menchón.
This psychiatrist emphasises that psychological techniques are often combined with specific antidepressant drugs, extending the treatment if necessary to other problems that may appear, such as depression or alcohol abuse.
Globally, approximately 30 per cent of PTSD recover completely, 40 per cent have mild symptoms, and 20 per cent have moderate symptoms.