What trends in psychiatric symptom increases have been observed by frontline clinicians working with individuals who have SMI during the COVID-19 crisis, and how are they being addressed?

Given the absence of published data, clinicians at one California university medical center were informally polled about their experience working with individuals with SMI during COVID-19. They reported a variety of reactions ranging from stress reduction to moderate symptom exacerbation. Some individuals who were lacking in social connectedness pre-pandemic reported an overall reduction in stress, taking comfort in social distancing as the new norm. Others put COVID-19 in perspective as a distraction from the larger issue of their illness. Also noted was a lack of concern about getting ill, which might be associated with denial or naivety. Most commonly reported were mild to moderate increases in anxiety and depression, such as concerns about getting infected, that are normative reactions to a pandemic. For some individuals who are living with relatives, worry about parents getting infected increased their sense of vulnerability. The financial impact was noted by employed individuals, and those who had just returned to work, who are worried they will lose those gains. One clinician noted a mild to moderate increase in negative symptoms such as lower levels of motivation, being less talkative, and lower levels of emotional affect which might represent using withdrawal as a way to cope. Disorganization, when present, was noted to have been associated with “stay at home” orders which disrupted routines and interfered with privacy. Reports of more severe new psychotic symptoms such as delusions have been uncommon. When present, their occurrence seemed to be associated with somatic delusions that existed pre-pandemic as is the case for one person who believes he will be infected and die. Overall, these clinicians have reported that the initial response in SMI individuals has been more manageable than initially anticipated.

For additional perspectives and tips on how to manage SMI individuals during COVID-19 see these articles:

These clinicians report that tele-psychiatry approaches for addressing these symptoms vary as well, but have been tailored to the individual’s symptoms and living circumstances. For anxiety and depression, commonly used approaches include CBT, providing support, as well as solution-focused interventions. The most salient intervention has been creating structure and a routine, which tend to help greatly. Structure and routine have also helped reduce disorganization. Case managers have reported checking in with SMI individuals more frequently than usual to implement these interventions. Also, providing factual information, that is now widely disseminated to the public about how to stay safe, has helped. In some cases, clinicians have needed to work with parents to help reinforce the “stay safe” and “social distancing” message. Reassuring the few individuals who come to clinic for long-acting therapy that the staff is well and is using CDC recommended safety procedures as well as modeling those procedures have been helpful.

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