Is it crucial for primary care physicians to understand the nuances of mental health issues, especially in a post-COVID era? “It is the need of the hour,” states eminent psychiatrist Dr Anurag Varma (MD, DPM, FIPS), in the recent edition of Practo Connect Webinar.
On September 14, 2022, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus made quite a positive statement about the COVID-19 pandemic, when he said– “We are not there yet. But the end is in sight.”
While this statement is optimistic and reassuring, it only highlights one side of the battle- the physiological one. The fact is, in the last couple of years grappling with COVID-19 has ensued yet another healthcare crisis pertaining to mental health.
Albeit a silent one, experts in 2020 predicted a ‘tsunami of psychiatric illness’ in the aftermath of the pandemic. Two years since, we have clear evidence indicating that mental health has become an emergent crisis of COVID-19. Some studies even reported that 30-40% of COVID-19 survivors including healthcare workers presented anxiety, fatigue, psychological distress, depression, sleep abnormalities, and PTSD during and after the pandemic.
This shows that the effects of COVID-19 are deeper than they seem and that the battle against it is yet to be fully won. This is why it’s crucial for primary care physicians, as the first point of contact and support for patients, to have a holistic understanding of the common mental health conditions and the best ways to address them.
Hence, this time on Practo Connect Webinar we had the pleasure of having eminent psychiatrist Dr Anurag Varma (MD, DPM, FIPS) speak about the common psychiatric illnesses detected post-pandemic, and share insightful steps for physicians to provide the best possible care for their patients. In this webinar session, he also focused on the impact the pandemic had on healthcare workers and stressed on the need for self-care.
Biological pathways of COVID-19 led to severe psychological impact
Dr Varma highlights the biopsychosocial aspect of mental health conditions in the post-COVID era whereby various physiological changes manifested and impacted patients psychologically. He explains how COVID led to the increase in the release of cytokines overwhelming and disrupting the blood-brain barrier. This further led to a peripheral immune cell invasion in the central nervous system which affected the normal metabolism of a person, impacting serotonin levels. Known as the happy hormone, impact on serotonin levels has not only shown to increase depression in many patients, but also cause relapse for patients who were previously suffering from depression.
“Patients who are diabetic, hypertensive or suffering from vascular brain disease or coagulopathy are at a risk for neuropsychiatric complications post COVID. Additionally, patients who previously had psychiatric illnesses like depression, schizophrenia, OCD, etc, had more medical comorbidities. This is because, as mentioned before, biological causes such as these highly impact mental health,” says Dr Varma.
Screening of mental health warning signs in patients & guidelines for self care for physicians
Advising physicians who are the first-point of contact for most patients, Dr Varma adds, “You don’t have to be a psychiatrist to ask the right questions and look out for the symptoms. If you feel that your patient is stressed or having a bit of anxiety, you can proactively share a questionnaire available on the internet with them or simply ask them during the session. Simple questions like–Do you feel depressed? Do you feel lack of energy? Do you feel like staying in bed most of the time? This will help you understand and become more cognisant of psychiatric illnesses and help your patients better. Once they see that the doctor has time and is listening, their initial reluctance fades and they open up their mental health conditions, that can even range from self-harm and suicidal ideation, in some cases.”