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Covid-19 Pandemic and Mental Disorders
Aliyev NA1* and Aliyev ZN2
1Department of Psychiatry and Drug Addiction, Azerbaijan State Advanced Training Institute, Baku, Azerbaijan
2Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
*Corresponding author: Nadir A. Aliyev, Department of Psychiatry and Drug Addiction, Azerbaijan State Advanced Training Institute, Baku,
Azerbaijan.
Received date: July 15, 2020; Accepted date: August 28, 2020; published date: September 14, 2020
Citation: Aliyev NA and Aliyev ZN. COVID-19 pandemic and mental disorders. J Clinical Research and Reports, 5(4); DOI:10.31579/2690-
1919/110
Copyright: © 2020 Nadir A. Aliyev. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective
:
The literature on psychiatric disorders associated with the coronavirus pandemic is scarce. In
publications, indicate increased anxiety, depression, and aggression of other mental disorders. However, there
are practically isolated cases of mental disorders associated with a pandemic of coronavirus disease.
Materials and Methods:
Eligible 50 participants to meeting the DSM-5 criteria for
nosophobia, anxiety, and
exacerbation of the main diseases of patients with mental.
Results:
All examined individuals showed various mental disorders.
Conclusion:
despite the fact that the patients examined by us did not suffer from the disease, COVID-19, but
they had mental disorders of varying degrees: from neurotic to psychotic disorders.
Keywords: Covid-19 Pandemic; mental disorders
Introduction
Messages for the general population
1. The first problem. COVID-19 affects and can affect people from many
countries in many geographical areas. When treating people with
COVID-19, do not link the disease to any ethnic or nationality. Be
merciful to all who are affected, to any country and those who come from
it. People affected by COVID-19 have made no mistakes and deserve our
support, compassion and mercy. disease caused by the virus itself, which
is generally self-limiting, but can be fatal, especially in susceptible,
elderly people.
2. The second problem. These are "People who have been treated for
COVID-19", "People who have been treated for COVID-19" or "People
who have been cured of COVID-19", and their families and loved ones
will continue to work after they get rid of COVID-19. To reduce stigma,
it is important to distinguish a person from having a personality as defined
by COVID-19. Almost everyone who hears about the virus causes
anxiety, worry, worry, and suffering.
3. The third problem. Minimize watching, reading or listening to
disturbing news about COVID-19; seek information only from reliable
sources, and you can basically take practical steps to prepare your plans
and protect yourself and your loved ones. Look for information updates
once or twice a day. The sudden and continuous spread of news about the
accident can cause concern to everyone. Learn the facts; not gossip and
misinformation. Regularly gather information from the WHO website and
local health authorities' platforms to help you separate the facts from the
rumors. Facts can help minimize fears. This problem applies not only to
psychiatrists and other psychiatrists who are fully trained for
professionals, but also to cadets and students who need to develop their
education as well as possible in the current, radically changing
environment. They also need our help. [1].
Materials and methods
All patients was examined
This was a double-blind, placebo-controlled trial for patients
diagnosed with DSM-5 for rapid cycle bipolar disorder. The
patients gave their informed, written consent to participate.
The conditions of the conducted researches corresponded to the
generally accepted norms of morality, the requirements of ethical
and legal norms, as well as the rights, interests and personal dignity
of the participants of the studies were observed.
a)
Conducted research is adequate to the topic of research
work.
b)
There is no risk for the subject of research.
c)
Participants in the study were informed about the goals,
methods, expected benefits of the study and associated
with risk and inconvenience in the study.
d)
The subject’s informed consent about participation in the
research was received.
The decision of the Ethical Committee at the Azerbaijan Psychiatric
Association on the article of NA. Aliev, Z.N. Aliev “Mental disorders
caused by the COVID-19 pandemic” submitted for publication in
psychiatric journals: in connection with compliance with its legislative
Open Access
Research Article
Journal of Clinical Research and Reports
Saeed Shoja Shafti
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requirements and regulatory documents is to approve the article by N.A.
Aliyev, Z.N. Aliev “Mental disorders caused by the COVID-19
pandemic”. Patients were observed at the Mental Health Center of the
Ministry of Health of the Republic of Azerbaijan. The study was
conducted from January 01, 2020 to 01 of the June 2020 years.
Also we excluded sexually active subjects with active or unstable
epilepsy, other genetic syndromes or congenital infections
associated with autistic-like syndromes, prematurity; subjects who
have been treated within the previous 30 days by any medication
known to have a clearly defined potential for toxicity or with any
psychotropic drugs;
subjects with clinically significant
abnormalities in laboratory tests or physical examination; subjects
with a history of hypersensitivity or serious side effects associated
with the use any drugs A detailed clinical interview with parents
by a clinical expert, accompanied by physical examination and
blood analysis, was used to ensure that subjects did not meet any
exclusion criteria.
A structured clinical interview, for DSM-5 Axis
I Disorder, Patient Edition, was used to diagnose
anxiety disorders,
depressions, nosophobia
to DSM-5 [2].
Hundred patients (40 men
and 60 women) whom we studied were under observation in Mental
Clinic for Outpatients of Baku City of Azerbaijan Republic. The
length of the washout was 2 weeks. Patients were washout from the
all medications. Eligible participants were required to be between 18
and 65 years of age. We excluded serious medical conditions
including with other psychiatric disorders (e.g. bipolar disorder II
tipi, schizophrenia, patients judged to be at serious suicidal or
homicidal risk, dependence of psychoactive drugs, somatic,
neurological illness etc). Also we excluded unstable epilepsy, other
genetic syndromes or congenital infections associated with autistic-
like syndromes, prematurity; subjects who have been treated within
the previous 30 days by any medication known to have a clearly
defined potential for toxicity or with any psychotropic drugs; subjects
with clinically significant abnormalities in laboratory tests or
physical examination; subjects with a history of hypersensitivity or
serious side effects associated with the drug use, and subjects who,
during the previous 3 months, started new non- pharmacological
procedures, such as diet, vitamins and psychosocial therapy. A
detailed clinical interview with parents by a clinical expert,
accompanied by physical examination and blood analysis, was used
to ensure that subjects did not meet any exclusion criteria.
Patients clinically significant of abnormal laboratory or EEG
findings were ineligible. Patients before the study had not used
antidepressants, antipsychotics, anxiolytics, benzodiazepines, SSRI
and venlafaxine. Washout of all medicines was two weeks.
Our Follow-up observation (catamnesus) was conducted from
January 01, 2020 to June 01, 2020. The results of follow-up
observations showed that patients receiving carbamazepine in
combination with lithium are in a state in full remission during for 2.5
years.
Choosing of the antidepressants, anxiolytics, antipsychotics hypnotics
and benzodiazepines conducted according to the Textbook of
psychopharmacology fifth edition [3].
According to the experience of our Azerbaijan State Advanced Training
Institute for Doctors named by A. Aliyev, department of psychiatry and
drug addiction, mental disorders caused by the COVID-19 pandemic can
be divided into several groups:
1. Nozophobia - Fear get infected of COVID-19 (n=30)
2. Anxiety disorders caused by the COVID-19 epidemic. (n=30)
3. Depressions caused by the COVID-19 epidemic. (n=35)
4. Exacerbation of the main diseases of patients with mental disorders as
a result of the COVID-19 epidemic (n=3)
5. Therapy of mental disorders that may occur after quarantine.
6. Other mental disorders caused by the COVID-19 pandemic (n=2)
The following treatment methods are recommended for the treatment of
mental disorders caused by the COVID-19 pandemic.
I. Pharmacological groups and approximate doses of drugs
Antidepressants
Amiltriptyline. The starting dose - 20-40 mg / day intramuscular or
intravenous . When well tolerated, the daily dose can be increased by 20-
40 mg to 100-150 mg. After 7-10 days, when the desired effect is
achieved, it is taken orally, in the form of 20 mg injection; the drug is
replaced by a per-oral dose of 50 mg.
Venlafaxine. Intravenous starting dose - 75 mg once daily. If necessary,
the dose is gradually increased over 3-4 days. The daily dose is 150-200
mg.
Imipiramine. Intravenously, the starting dose is 25-50 mg / day; the
average daily dose is 150-250 mg (in the hospital - up to 300 mg / day).
The dose can be increased up to. It is taken orally after the effect is
achieved.
Clomipramine. Orally, 25-50 mg 3 times a day. Parenteral 25-50 mg /
day can be increased to 100-150 mg / day.
Paroxetine. Intravenously, the initial dose is 10 mg / day, in the absence
of the desired effect is increased by 10 mg / day to 40 mg / day; maximum
dose— 50 mg / day.
Sertraline. Internal, starting dose— 25 mg / day; After 1 week, the dose
is increased to 50 mg / day, if necessary, the dose is gradually increased
to a maximum over several days (50 mg / day) - 200 mg / day.
Trazadon. Internally, 75-150 mg / day, 3 times, up to 300-500 mg / day,
maximum - 600 mg / day.
Fluxetine. Internally, the starting dose is 20 mg in the morning; if there
is no effect, the dose can be increased for several weeks. Overdose of 20
mg / day is taken twice (morning and evening). The maximum daily dose
is 80 mg.
Fluvoxamine. Internally, the average dose is 100-200 mg / day, the
maximum is 400 mg / day.
Citaloparor. Intravenous, starting dose— 20 mg / day once, maximum—
60 mg / day.
Exitaloprom. Intravenously, the starting dose is a single dose of 10 mg /
day, the average daily dose is 20 mg.
II. Anxisolytics
Alprozalam. Internal, single dose - 0.25-0.5 mg, average daily - 1-2 mg,
maximum - 4-6 mg / day.
Buspiron. Internally, the starting dose is 15 mg / day, 3 times, if
necessary, the dose can be increased by 5 mg every 2-3 days. The average
daily dose is 20-30 mg, the maximum single dose is 30 mg, the daily dose
is 60 mg.
Tofiozepam. Internally, the starting dose is 50 mg, the average daily dose
is 100 mg (50 mg in the morning and 50 mg in the afternoon).
Clonozepam. Internally, in small doses - 0.5-2 mg, medium - 4-8 mg,
high - 8-16 mg; maximum daily dose— 20 mg
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Bromdihydrochlorphenylbenzodiazepine (Phenazepam). Internal,
single dose - 0.5-1.0 mg, average daily dose - 2-3 mg, maximum - 6-8 mg
/ day.
Chlordiazepoxide. Internal, single dose— 5-10 mg, average daily dose—
30-50 mg 2-3 times.
IV Neuroleptics
Alimemazine. Internally, the daily dose is 5-10 mg to 60-80 mg (3-4
times), if necessary, the dose can be increased to 200-400 mg / day. The
average daily parenteral dose is 40-50 mg (v / d drops), the starting dose
is 25 mg / day and can be gradually increased to 75-100 mg / day.
Holoperidol. Internally, 1.5-3 mg / day, 2-3 times a day, the dose can be
gradually increased to 10-15 mg / day, if necessary, 10-15 mg / day;
supportive dose— 0.5-5 mg / day. A / d 5-10 mg 2-3 times a day for
several days, maximum— 40 mg / day.
Levopromazine. Intravenously, 12.5-50 mg / day to 50-100 mg / day, if
necessary 300-400 mg / day parenterally, 25-75 mg / day, then the dose is
100-300 mg / day, 3 times a day , v / d 75-100 mg / day.
Persianazin. Internal, starting dose— 10 mg / day, average daily dose—
30-40 mg, 2-4 times, maximum— 50-100 mg / day.
Sulprid. Internal, oral, intravenous, single dose - 50-100 mg / day,
average daily dose - 100-600 mg, maximum dose - 1200 mg / day.
Tioridazine. Internally, the starting dose is 75-200, the average daily dose
is 600 mg / day (several receptions), the maximum daily dose in an
inpatient setting is 800 mg.
Chlorpromazine. Internally, the starting dose - 25-75 mg / day,
gradually increasing the dose to the average daily - 300-600 mg, 3-4
intravenously.
V. Normothymics
Valproate sodium. Internally, starting at 150-300 mg / day, gradually
increasing to 600-1200 mg / day.
Lithium carbonate. Orally, the average dose is 300-900 mg / day 3 times
a day (prolong foramen 1 g once a day)
Duration of treatment
The duration of outpatient, including supportive care, ranges from 1 to 2
months. The duration of inpatient treatment is 30-40. Then semi-inpatient
and supportive care is provided.
VI. Different types of psychotherapy are applied.
Psychotherapeutic methods used in depression:
• Cognitive therapy (CT; Beck, 1963, 1964, 1976; Beck, Rusk, Shaw &
Emery, 1979);
• Interpersonal psychotherapy (IPP; Clerman, Weissman, Rounsaville &
Chevron, 1984),
• Cognitive-behavioral analytical systemic psychotherapy (KDSP,
McCullough et al., 1996)
• Cognitive analytical psychotherapy (QAP, Ryle, 1997).
VII. Non-drug treatment methods
• Plants with antidepressant properties
• Ginseng tincture.
• Aralia tincture. (Shrub plant with broom-like flowers and large leaves.
• Novopassit consists of plant components (coconut, pistachio, hops,
hawthorn, cucumber (honey mint, lemon)), hibiscus (tropical plant with
large red flowers), black peony.
• Persen is made from herbs with antidepressant properties (cucumber,
peppermint, chicory).
• Tincture of cinnamon lemon.
Treatment of borderline mental disorders with electrotherapy, hydro- and
phototherapy, hyperbaric oxygenation, acupuncture-reflexology,
vibromassage, relaxation, massage, gymnastics, deprivation of sleep
deprivation.
Electrotherapy: galvanotherapy, electro-sleep, electropuncture
• Hydrotherapy
• Shower - dusty, rainy, needle, circular, shield shower - intermediate
area, Charcoal fountain shower, Scottish shower (hot 38-420 C and cold
13-220 C, question shower massage,
• Baths - local, whirlpool, contrast, oxygen, turpentine
• Russian bath - filled with water vapor, the air temperature should be 40-
50 ° С.
• Roman bath - dry hot air is supplied either on the floor or in the holes in
the wall.
• Turkish bath - the air temperature should be 40-50 ° С. Humidity is
regulated by heating water in the boiler.
• Finnish bath (sauna) - the air temperature is 70-100 ° С, the temperature
difference between the floor and the ceiling is 60 ° С, the relative humidity
is 10-15%.
• Phototherapy - laser, infrared, ultraviolet radiation treatment and
prevention. The mechanism of action of phototherapy is based on the
reactions of photo physical and photochemical effects by the tissues of
the body.
Hyperbaric oxygenation - increases the passive pressure of oxygen in the
tissues under an elevated atmosphere.
Rubdown
Massage is the oldest physical means of affecting the body. Represents a
generalized reflex reaction of the organism to some extent in the tissues
under the influence of local mechanics. Stimulates the adaptive-trophic
functions of the autonomic nervous system due to some biologically
active substances (histamine, acetylcholine, etc.) in the humoral
environment in the tissues. As a result of the massage, blood and lymph
circulation improves. Muscle tone and elasticity, contraction functions
increase, resulting in improved muscle function. Massage is applied by
hand and apparatus. There are two types of massage: classic and
segmental - reflector. Classical therapeutic massage is usually applied
every day. The main methods of classical therapeutic massage: rubbing
(rubbing), rubbing, rubbing and vibrating. Usually 10-12 courses are
conducted, repeated after two months.
Discussion
We are all responsible for reducing our own risk of
infection, and if we become infected, for reducing the risk
of infection for others. Each of us can do something to
protect vulnerable people in our communities. That is why
we continue to talk about solidarity. This is not just a threat
to individuals or countries. We are all together, and we can
save lives only together [4]
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ISSN: 2690-1919 Page 4 of 4
For psychiatrists, this means solidarity with our patients,
solidarity with their families, solidarity with our multidisciplinary
colleagues and, most of all, solidarity with each other. We need each
other now.
COVID-19 is the most serious public health problem that most
of us have ever encountered, and hopefully this will be the worst we
will ever face in the future. How psychiatry reacts to this situation
will play a large role in determining the nature and role of psychiatry
in the coming years. The message from the history of psychiatry is
clear: we can accept this challenge.
Royal College of Psychiatrists core values are courage,
innovation, respect, collaboration, training and excellence. The
COVID-19 pandemic requires that we urgently translate all these
values into action. COVID-19 requires no less. Our patients need us
now, more than ever [5].
The COVID-19 pandemic is a serious health crisis affecting several
countries: to date, more than 720,000 cases and 33,000 confirmed deaths
have been reported. Such widespread outbreaks are associated with
adverse mental health effects. With this in mind, the existing literature on
COVID-19 related to mental health was found by searching the literature
in the PubMed database. Published articles have been classified according
to their general topics and summarized. Preliminary evidence suggests
that symptoms of anxiety and depression (16–28%) and stress self-esteem
(8%) are common psychological responses to the COVID-19 pandemic
and may be associated with sleep disturbance. A number of individual and
structural variables mitigate this risk. When planning services for such
population groups, the needs of the relevant people and the necessary
preventive instructions should be taken into account. Available literature
came from only a few affected countries and may not reflect the
experience of people living in other parts of the world. In conclusion, sub-
syndromic mental health problems are a common reaction to the COVID-
19 pandemic. More representative studies are needed in other affected
countries, especially in vulnerable populations [6].
The coronavirus disease 2019 (COVID-19) pandemic is having a
profound effect on all aspects of society, including mental health and
physical health. We explore the psychological, social, and neuroscientific
effects of COVID-19 and set out the immediate priorities and longer-term
strategies for mental health science research. These priorities were
informed by surveys of the public and an expert panel convened by the
UK Academy of Medical Sciences and the mental health research charity,
MQ: Transforming Mental Health, in the first weeks of the pandemic in
the UK in March, 2020. We urge UK research funding agencies to work
with researchers, people with lived experience, and others to establish a
high level coordination group to ensure that these research priorities are
addressed, and to allow new ones to be identified over time. The need to
maintain high-quality research standards is imperative. International
collaboration and a global perspective will be beneficial. An immediate
priority is collecting high-quality data on the mental health effects of the
COVID-19 pandemic across the whole population and vulnerable groups,
and on brain function, cognition, and mental health of patients with
COVID-19. There is an urgent need for research to address how mental
health consequences for vulnerable groups can be mitigated under
pandemic conditions, and on the impact of repeated media consumption
and health messaging around COVID-19. Discovery, evaluation, and
refinement of mechanistically driven interventions to address the
psychological, social, and neuroscientific aspects of the pandemic are
required [Emily A Holmes, Rory C O’Connor, V Hugh Perry et al.
Multidisciplinary research priorities for the COVID-19 pandemic: a call
for action for mental health science [7].
To analyze mental health interventions / actions targeted at healthcare
providers who assist patients with suspected or diagnosed COVID-19.
The COVID-19 pandemic forces healthcare providers to manage their
mental health and the mental health of patients. It is important to know
and reflect on country initiatives to support the mental health of healthcare
providers during a pandemic, and to help rethink the planning,
implementation, and evaluation of strategies to be used in Brazil. Mental
health activities that supported the care of health workers who are at the
forefront of care, especially those based on identifying the disease, proper
use of personal protective equipment, and mapping of these emotionally
weakened specialists, could be listed. and / or mental distress before the
pandemic, in addition to the emotional support offered through digital
platforms [8].
History and Discovery, structure-activity relationships,
pharmacological profiles, mechanisms of action, pharmacokinetics
and disposition, indications and efficacy response, side effects and
toxicology, drug-drug interactions
antidepressants, anxiolytics,
antipsychotics hypnotics and benzodiazepines
are described in detail in
the literature [3]. Therefore, we will not dwell on them.
Conclusion
Psychopharmacological Treatment of Depression, Anxiety and Related
Disorders, Insomnia in Mental disorders caused by the COVID-19
pandemic is necessary. Treatment should be 1-2 months, with low doses
of the above drugs.
Our Follow-up observation (catamnesus) was
showed that patients receiving are in a state in full remission.
Treatment tactics of mental disorders caused by the COVID-19 pandemic
should target the underlying psychopathological syndrome.
Acknowledgment
The authors would like to thank staff of the Mental Health Center of
the Ministry of Health of the Republic of Azerbaijan
References
1. Advice and guidance from WHO on COVID-19
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American Psychiatric Association.Diagnostic and
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psychopharmacology fifth edition. Edited by Alan F.
Schatzberg, M.D. Charles B. Nemeroff, M.D., Ph.D. 2017
American Psychiatric Association Publishing. 2879 pp.
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World Health Organization (WHO). WHO Director-
General’s Opening Remarks at the Media Briefing on
COVID-19 - 5 March 2020. WHO, 2020.
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Brendan D. Kelly. Coronavirus disease: challenges for
psychiatry. The British Journal of Psychiatry (2020) 217,
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6. Ravi Philip Rajkumar. COVID-19 and Mental Health: A
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Multidisciplinary research priorities for the COVID-19 pandemic:
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