What is the impact of rising neuropsychiatric disorders – and what can we do?

Back in mid-April of this year, we first wrote about the concern that we may be dealing with a virtual tsunami of neuropsychiatric disorders in a post-COVID 19 world. Unfortunately we didn’t have to wait for the aftermath of this pandemic to see evidence that these conditions have risen dramatically in the last few months. In fact one in three Americans is dealing with symptoms of stress or anxiety, according to data from the U.S. Census Bureau and the National Center for Health Statistics.1

Most concerning is the rise even among our nation’s youth of suicide and suicide ideation. The
Centers for Disease Control and Prevention (CDC) reports that, “during June 24–30, 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.”2 There is no doubt that these problems existed before March, but in the wake of so many other issues they’ve only intensified and are affecting the youngest members of our population too.

Every day we see another tragic example of how this pandemic has impacted lives on multiple levels, from economic devastation and job uncertainty to the loss of family members and friends to the disease itself. The social isolation and distance we’ve practiced to potentially curtail the spread of illness has also served to separate us from one another and in vulnerable individuals has had the most serious consequences. Our children have had to cope with so much that has changed in their daily lives, like not seeing friends and remote school instruction, and may also be dealing with family pressures that exacerbate their own fears and anxiety.

While the available data regarding the incidence of psychiatric disease post-COVID is limited, scientists in the U.K. have already noted “a profound effect on all aspects of society” and the need to prioritize development of a program to respond to an anticipated increase in related conditions.3 Analyses of prior related viral infections identified numerous issues including cognitive alteration and neurological complications. A study of patients hospitalized with acute respiratory distress syndrome due to COVID-19 found multiple neurologic and psychiatric features and neuropsychological impairment. In the absence of detectable infections upon analysis of cerebrospinal fluids, researchers concluded that “neuropsychiatric features may have resulted from encephalopathy secondary to the massive inflammatory response and associated physiologic derangements of critical illness, cytokines, or medications, rather than the direct effect of viral infection.”4 Other studies reveal too that the neurological impact of COVID has been observed not just in patients, but in frontline healthcare workers, quarantined college-age students, children, individuals with compromised immune systems and several other subsets of the population.5 Cleary, there is and will be a need to continue investigating the widespread effects in order to address and provide appropriate intervention.

The issue of trauma and its effects on the brain is one that we will be taking up more in our discussions here as well as in our practice and our programs, some of which will be facilitated in conjunction with other specialty practitioners. We want to provide not just a rehashing of events, but offer solutions for patients who were already dealing with neurological disorders and for those who are seeking guidance in these troubling times.

There is no “magic pill” or one single solution that can address all the issues that have affected people in so many diverse ways – even if you or  your spouse have retained your job and are financially secure, the simple fact that the world around you has shifted so dramatically may be enough to upset the balance of your wellbeing. Your children may be picking up on your own fears or frustrations or those of their friends who are experiencing significant hardships.

So our best advice now and going forward is to communicate and connect - talk to your family, friends, talk to your pediatrician and your own physicians. Don’t try to “fix” things on your own as there are resources available to help in every community. If emotional wellness is compromised, it’s almost impossible to deal with anything else. And if you already suffer from a chronic illness of any kind, the unrelenting stress on your immune system and the resulting inflammation can potentially effect disease progression.

Staying healthy in mind and body is paramount now so we can come out on the other side of this crisis and find a way forward together. We are here to help if you need us or if you need any information. And we encourage you to visit our Helpful Links section of our website for support groups, disease-specific organizations and resources to assist you and your family.

In hope and healing,
Dr. Suzanne Gazda
 
References and resources:

1 Zarefsky, M. “Why depression, anxiety are prevalent during COVID-19.” (August 18, 2020)
American Medical Association (AMA), ama-assn.org
https://www.ama-assn.org/delivering-care/public-health/why-depression-anxiety-are-prevalent-during-covid-19

2 Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. Centers for Disease Control and Prevention Weekly. (August 14, 2020). https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

3 Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, Ballard C, Christensen H, Cohen Silver R, Everall I, Ford T, John A, Kabir T, King K, Madan I, Michie S, Przybylski AK, Shafran R, Sweeney A, Worthman CM, Yardley L, Cowan K, Cope C, Hotopf M, Bullmore E
Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547. Epub 2020 Apr 15.

4 Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. Neurologic Features in Severe SARS-CoV-2 Infection.
N Engl J Med. 2020;382(23):2268. Epub 2020 Apr 15.

5 Stein, M.B. MD, MPH. Coronavirus disease 2019 (COVID-19): Psychiatric illness. (July 2020)
https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-psychiatric-illness

For general information on mental health and to locate treatment services in your area, call the SAMHSA* Treatment Referral Helpline at 1-800-662-HELP (4357).
Visit: https://www.samhsa.gov/find-help/national-helpline
(*Substance Abuse and Mental Health Services Administration)

National Institutes of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

Taking Care of Your Emotional Health, cdc.gov:
https://emergency.cdc.gov/coping/selfcare.asp