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Journal ArticleDOI

The forgotten plague: Psychiatric manifestations of ebola, zika, and emerging infectious diseases

TL;DR: Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Virus disease (EVD) and Zika Virus, are discussed in this commentary to illustrate the continued need of care after the resolution of the actual illness.
Abstract: The media and public health generally focus on the biological and physical ramifications of epidemics. Mental health issues that coincide with emerging diseases and epidemics are rarely examined and sometimes, even eschewed due to cultural considerations. Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Virus disease (EVD) and Zika Virus, are discussed in this commentary to illustrate the continued need of care after the resolution of the actual illness. Various infectious diseases have associations with mental illness, such as an increased risk of obsessive-compulsive disorders and Tourette syndrome in children with Group B streptococcal infection. Current EVD literature does not demonstrate a strong association of mental illness symptoms or diseases but there is a necessity of care that extends beyond the illness. Patients and their families experience depression, anxiety, trauma, suicidal ideation, panic and other manifestations. Zika virus has been associated neuronal injury, genetic alteration that affects fetal development and detrimental maternal mental health symptoms are being documented. While funding calls from the international community are present, there are no specific epidemiological data or fiscal estimates solely for mental health during or after infectious diseases epidemics or disasters that support health care providers and strengthen policies and procedures for responding to such situations. Therefore, those on the frontlines of epidemics including emergency physicians, primary care providers and infectious disease specialists should serve communicate this need and advocate for sustained and increased funding for mental health programs to heighten public awareness regarding acute psychiatric events during infectious diseases outbreaks and offer treatment and support when necessary.
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Journal Article
TL;DR: This paper presents Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic, which aims to provide a strategy to address the psychological impact of CO VID-19.
Abstract: 1Department of Psychological Medicine, National University Health System, Singapore 2Department of Psychological Medicine, National University of Singapore, Singapore 3Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore Address for Correspondence: Dr Cyrus Ho Su Hui, Department of Psychological Medicine, National University Health System, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228. Email: su_hui_ho@nuhs.edu.sg Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic

1,013 citations

Journal ArticleDOI
TL;DR: High rates of negative mental health outcomes in the Italian general population 3 weeks into the CO VID-19 lockdown measures and different COVID-19 related risk factors are found.
Abstract: Background The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. Methods A web-based survey spread throughout the internet between March 27th and April 6th 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. Results Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia. Conclusion We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population's mental health.

897 citations

Journal ArticleDOI
TL;DR: ‘‘Pandemic fear’’ and COVID-19: mental health burden and strategies

889 citations

Journal ArticleDOI
TL;DR: The level of anxiety was significantly higher among people who had at least one family member, relative, or friend who contracted COVID-19 disease and the health care system should adopt a package of psychosocial interventions to reduce the anxiety of high risk groups.

497 citations


Cites background from "The forgotten plague: Psychiatric m..."

  • ...The focus of the media and the health system in general is on the ramification of epidemics, and mental health problems that co-occur with diseases are largely ignored (Tucci et al., 2017)....

    [...]

References
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Journal ArticleDOI
TL;DR: The inevitable, but unpredictable, appearance of new infectious diseases has been recognized for millennia, well before the discovery of causative infectious agents; however, the ease of world travel and increased global interdependence have added layers of complexity to containing these infectious diseases.
Abstract: The inevitable, but unpredictable, appearance of new infectious diseases has been recognized for millennia, well before the discovery of causative infectious agents. Today, however, despite extraordinary advances in development of countermeasures (diagnostics, therapeutics, and vaccines), the ease of world travel and increased global interdependence have added layers of complexity to containing these infectious diseases that affect not only the health but the economic stability of societies. HIV/AIDS, severe acute respiratory syndrome (SARS), and the most recent 2009 pandemic H1N1 influenza are only a few of many examples of emerging infectious diseases in the modern world [1]; each of these diseases has caused global societal and economic impact related to unexpected illnesses and deaths, as well as interference with travel, business, and many normal life activities. Other emerging infections are less catastrophic than these examples; however, they nonetheless may take a significant human toll as well as cause public fear, economic loss, and other adverse outcomes.

438 citations

Journal ArticleDOI
TL;DR: There may be a subgroup of D8/17-positive children who present with clinical symptoms of obsessive-compulsive disorder and Tourette's syndrome, rather than Sydenham's chorea, but who have similar poststreptococcal autoimmunity.
Abstract: Objective: The authors’ goal was to determine whether a trait marker of rheumatic fever susceptibility (labeled D8/17) could identify children with pediatric autoimmune neuropsychiatric disorders (obsessive-compulsive disorder and tic disorders) associated with streptococcal infections (PANDAS). Method: Blood samples obtained from 27 children with PANDAS, nine children with Sydenham’s chorea, and 24 healthy children were evaluated for D8/17 reactivity. Individuals were defined as D8/17 positive if they had 12% or more D8/17+ cells. Results: The frequency of D8/17-positive individuals was significantly higher in both patient groups than it was among the healthy volunteers: 85% of the children with PANDAS and 89% of the children with Sydenham’s chorea, compared with 17% of the healthy children, were D8/17 positive. Further, the mean number of D8/17+ cells was similar in the two patient groups and was significantly higher in these groups than in the group of healthy children. Conclusions: These results suggest that there may be a subgroup of D8/17-positive children who present with clinical symptoms of obsessive-compulsive disorder and Tourette’s syndrome, rather than Sydenham’s chorea, but who have similar poststreptococcal autoimmunity. (Am J Psychiatry 1997; 154:110‐112)

357 citations

Journal ArticleDOI
TL;DR: Level of symptoms and psychological distress were high over the adult lifespan, but older adults less often met criteria for any psychiatric diagnosis and, specifically, social phobia than younger adults, suggesting psychiatric problems are also less prevalent in older aged individuals with ASD.
Abstract: Although psychiatric problems are less prevalent in old age within the general population, it is largely unknown whether this extends to individuals with autism spectrum disorders (ASD). We examined psychiatric symptoms and disorders in young, middle-aged, and older adults with and without ASD (Nmax = 344, age 19–79 years, IQ > 80). Albeit comparable to other psychiatric patients, levels of symptoms and psychological distress were high over the adult lifespan; 79 % met criteria for a psychiatric disorder at least once in their lives. Depression and anxiety were most common. However, older adults less often met criteria for any psychiatric diagnosis and, specifically, social phobia than younger adults. Hence, despite marked psychological distress, psychiatric problems are also less prevalent in older aged individuals with ASD.

315 citations

Journal ArticleDOI
10 Feb 2015-JAMA
TL;DR: The Roadmap includes few recommendations toalleviate fear behaviors and address mental health needs inEbola-affectedcommunities.
Abstract: citingsymptomaticpatientsescap-ing from treatment units, families concealing sick rela-tives at home, preferential use of traditional healers,andphysicalcontactwithinfectiouscorpses.Neverthe-less, the Roadmap includes few recommendations toalleviate fear behaviors and address mental healthneedsinEbola-affectedcommunities.InWestAfrica,Ebolavirusdiseasearousesfearbe-haviors, in part because many have witnessed thegraphic hemorrhagic manifestations of those infectedandthebodiesofthosewhohavedied.Thecorpsesandbeddingofpatientswhohavediedposeinfectionhaz-ardstohealthcareworkersandfamilymembers.AsofDecember14,2014,649front-linehealthcareworkershavebecomeilland365havedied.

270 citations

Journal ArticleDOI
TL;DR: In this paper, a broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder.
Abstract: OBJECTIVE Lyme disease is a multisystemic illness that can affect the central nervous system (CNS), causing neurologic and psychiatric symptoms. The goal of this article is to familiarize psychiatrists with this spirochetal illness. METHOD Relevant books, articles, and abstracts from academic conferences were perused, and additional articles were located through computerized searches and reference sections from published articles. RESULTS Up to 40% of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system. Dissemination to the CNS can occur within the first few weeks after skin infection. Like syphilis, Lyme disease may have a latency period of months to years before symptoms of late infection emerge. Early signs include meningitis, encephalitis, cranial neuritis, and radiculoneuropathies. Later, encephalomyelitis and encephalopathy may occur. A broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder. Depressive states among patients with late Lyme disease are fairly common, ranging across studies from 26% to 66%. The microbiology of Borrelia burgdorferi sheds light on why Lyme disease can be relapsing and remitting and why it can be refractory to normal immune surveillance and standard antibiotic regimens. CONCLUSIONS Psychiatrists who work in endemic areas need to include Lyme disease in the differential diagnosis of any atypical psychiatric disorder. Further research is needed to identify better laboratory tests and to determine the appropriate manner (intravenous or oral) and length (weeks or months) of treatment among patients with neuropsychiatric involvement.

188 citations