COVID-19 and Patients With Preexisting Psychiatric Disorders

Source: Engin Akyurt on Unsplash

In my last four blogs, I examined the research on COVID-19-related psychiatric problems in four different populations – adults in the general population, children in the general population, healthcare workers, and those infected with the virus and physically ill. In each case, journalists and researchers made frequent and extraordinary predictions that we were in the midst of a psychological pandemic – a psychological tsunami is what some writers called it. These claims began as early as March 2020, amazingly, when we had no longitudinal experience and no good research yet, and they continue unchanged through today. Just four days ago, the President of the Royal College of Psychiatrists in the UK predicted, “It is probably the biggest hit to mental health since the second world war” (Sample, 2020). The claims have been based on anecdotes and poor-quality research, and the actual evidence for a psychological pandemic has been anything but extraordinary.

Patients with preexisting psychiatric disorders

The last population I want to examine is individuals with preexisting psychiatric disorders. Researchers have conducted relatively few studies on the mental health impact of COVID-19 with samples of psychiatric patients. This contrasts with the more than 100 studies on other populations. This is likely because it is more difficult to rapidly obtain large samples of individuals with confirmed psychiatric disorders. The investigators of non-psychiatric patients were able to obtain large samples through social media apps or large registries of COVID patients and healthcare workers.

The few studies that have been published are not terribly informative. For example, in a chart review of all 14,561 adult psychiatry patients from a region in Denmark, researchers scanned the notes in electronic medical records for any evidence that patients experienced significant distress from COVID situations. Only 6% of patients had notes indicating COVID-related distress (Rohde et al., 2020). Using similar methodology for the 4,879 child psychiatry patients in the same region, they found only 2% of patients had notes indicating COVID-related distress (Jefsen et al., 2020). Just because they reported some stress, however, did not mean their clinical conditions worsened.

Contrast that to a small study of 30 adult patients in Ireland with preexisting anxiety disorders. Researchers interviewed them to ask if COVID restrictions worsened their anxiety. These researchers found that 40% claimed that COVID restrictions worsened their anxiety. They found a higher percentage than the Denmark studies perhaps because they used targeted interviews instead of reviewing charts (Plunkett et al., 2020). Still, the impact was not indicative of a crisis. The researchers concluded, “Participants reported a deleterious impact of COVID-19 on anxiety symptoms. However, this impact was not marked, with objective ratings by clinicians noting no deterioration for most participants.”

These studies suggested that even when researchers were looking for a major impact from COVID, they had trouble finding it. There are no known data yet that provide clear and convincing evidence that the added distress significantly worsened psychiatric patients or required heightened interventions.

In other words, as I have pointed out in the preceding blogs, many are stressed, but few are clinically disordered.

Many patients with social anxiety are doing better

No known studies have asked the opposite question. Are some psychiatric patients doing better during the pandemic? You might think that is a crazy question to even consider. But it is not. Many patients with social anxiety disorders, which are one of the most common problems in psychiatric clinics, are actually doing better. Why? Because they can be socially isolated. Children with social anxiety do not have to attend school in person. Adults with social anxiety do not have attend work in person.

We are seeing these patients in our clinics. They are taking breaks from psychotherapy, more satisfied with the doses of their medication, and are generally more content.

What we have seen in my clinics is that nearly all patients talk during psychotherapy sessions about the stressors of COVID on their lives. How could they not? But therapy has not re-focused from old problems to COVID problems for the vast majority of them. COVID is just another stressor like the other stressors – work, relationships, and adjusting to life changes. We have a few patients who have decompensated due to lockdown stressors, mostly from social isolation, but not many.

Still no evidence of a psychological tsunami

Despite the absence of evidence of a true psychological crisis, many writers and doctors have made extraordinary claims that a psychological pandemic exists. For example, many have claimed there is a new psychological disorder called COVID stress syndrome. There is no such thing as COVID stress syndrome. You cannot just make up disorders out of thin air for new events based on a few anecdotes and “I saw a case once.” Many have made claims that clinic volumes have swelled, but unsubstantiated claims do not constitute a crisis.

Clinical settings do not show a crisis. Good research has not shown a crisis. And that makes sense; humans are resilient to stress. Whether it is due to work stress, relationship stress, or COVID stress, humans are not fragile constructions of neurotransmitters that easily implode.

It seems clear that we are witnessing a phenomena of human nature, which is that many writers and doctors feel compelled to fabricate crises. But when they do that, even with their good intentions, they damage the integrity of science. Most of the writers seem to want a tsunami. Why is that? I’ll try to answer that in a forthcoming blog.

Psychiatry Essential Reads

Public Health and Psychiatry: Two Ways to Treat Mental Illness

It’s Time for Social Psychiatry’s Comeback

It may seem boring to write a blog to say that there is little evidence of a psychological pandemic, but as we have seen in this age of disinformation on steroids, boring news can be useful news.