Examining psychiatric consequences of COVID-19
COVID-19 may complicate mental illness and substance abuse, while the related social isolation can trigger adverse psychiatric effects associated with loneliness.
The psychiatric complications of COVID-19 and of related social isolation are of great public health concern, but scientific studies are still at an early stage. Recognizing the great urgency of this problem, the American College of Neuropsychopharmacology held three work groups to examine psychiatric aspects of COVID-19.
In a workshop chaired by Dr. Mark Weiser, Chief Psychiatrist at the Sheba Medical Center and Professor of Psychiatry at the Sackler School of Medicine at Tel Aviv University, an international panel of experts described efforts to improve psychiatric outcomes related to COVID-19. Experts from New York addressed racial disparities in outcomes among people with serious psychiatric illness and presented innovative approaches to identify and treat psychiatric complications in patients admitted to general medical services with COVID-19 infection. Strategies developed by experts in Israel and Spain to safely treat hospitalized patients with both psychiatric illness and COVID-19 infection and to identify and treat psychological distress in caregivers of these patients were described. Early studies of psychiatric complications of COVID-19 conducted in China were also reviewed.
Dr. Weiser stated: "The COVID19 pandemic has posed major difficulties in the treatment of severely ill psychiatric patients, some of whom present with challenging combinations of behavioral and respiratory symptoms, with difficulties keeping social distancing, hygiene and wearing masks. In non-psychiatric patients we are beginning to learn about the long-term psychiatric sequelae of COVID-19 infection"
Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), led a work group to discuss the special vulnerabilities of individuals with substance abuse who contract COVID-19. COVID-19 may interact with substance abuse to worsen the severity of illness; in addition, the negative effects of COVID-19 on service delivery systems and on social networks is contributing to a rise in overdose fatalities. Experts in the group also discussed the potential adverse effect of COVID-19 infection during pregnancy on infant brain development and discussed a wide range of novel treatment approaches to improve the engagement in treatment of individuals with substance use disorders during the COVID-19 pandemic. As Dr. Volkow wrote in her June 2020 blog post : "The U.S. is now facing two intersecting health crises, the ongoing opioid overdose epidemic and the COVID-19 pandemic. Regrettably, each has
the potential to exacerbate the effects of the other," said Dr. Volkow. "NIDA has swiftly responded to the COVID-19 crisis by supporting research in areas of basic science, prevention, treatment, epidemiology, and implementation, particularly at the intersection with SUD. I am hopeful that [this] will contribute to lessening the impact of the collision between the opioid and COVID-19 crises."
Dilip Jeste, MD, Senior Associate Dean for Healthy Ageing and Senior Care at the University of California at San Diego, chaired a work group that discussed the potential impact of COVID-19-related social isolation on individuals with psychiatric illness and on the population as a whole. Loneliness adversely affects physical health with an effect similar to smoking and obesity, and loneliness is associated with increased risk for depression, substance abuse, suicide and dementia. The neurobiology underlying the relationship between loneliness and psychiatric illness is a rapidly emerging field of study which was discussed in the work group, in addition to intervention strategies to combat the effects of social isolation.
Dr. Jeste noted that "The COVID-19 pandemic has moved the already important need for research into neurobiology and interventions for loneliness and social isolation to the front burner."