- Many people will experience psychological and physical symptoms of stress in response to the current pandemic. This is part of a normal
- Patients can be reassured that this is a normal and healthy stress response to an abnormal event. They can also be reassured that it isn’t harmful and that symptoms will generally decrease over time without the need for psychological or medical intervention.
- Medication is not appropriate in this initial period, with the exception of a short term (up to 7 days) course of benzodiazepines to normalise sleep patterns if indicated. Use with caution in people with history of substance abuse.
- Normalising supportive approaches are most helpful in the first instance.
- Refer those with persistent or severe symptoms despite initial management to the mental health team.
Stress Symptoms after Traumatic Events
Many people will experience symptoms of psychological distress as part of the current pandemic. This is part of a normal and healthy stress response to an abnormal and unexpected event. It does not mean the person has a disorder or is developing PTSD. Most people recover from stress symptoms after a disaster without the need for formal psychological or medical intervention.
- Normal responses include bad dreams and frightening thoughts; avoidant symptoms such as staying away from reminders; feelings such as emotional numbing and dissociation, losing interest in activities and feeling worried and guilty; anxiety and hyper-arousal symptoms – being easily startled, feeling on edge, sleeping problems, irritability, anticipatory anxiety.
- Physical symptoms include headaches, stomach aches or upset, sore muscles and poor appetite, palpitations/awareness heartbeat, feeling constantly tired.
- People might also notice they are reacting in ways that are “out of character” for them.
- In very young children symptoms can include secondary enuresis – bedwetting when they’ve already learnt how to use the toilet; regression in developing speech; acting out the scary event during playtime; and being unusually clingy with a parent or other adult.
- Older children and teens usually show symptoms similar to those seen in adults. They may also display disruptive, disrespectful, or destructive behaviors.
Resilience factors that may reduce the risk of ongoing symptoms include seeking out support from other people such as friends and family; feeling good about one’s own actions in the face of the pandemic; and being able to act and respond effectively despite feeling fear.
- Patients can be reassured that these symptoms are normal, they will generally decrease over time, and that most people don’t experience an ongoing stress disorder.
- Medication is not appropriate in this initial period, with the exception of a short term (up to 7 days) course of benzodiazepines to normalise sleep patterns, if indicated. Use with caution in people with a history of substance abuse.
- Unsurpisingly, there is little evidence from randomised controlled trials for intervention in initial stress symptoms. Psychological ‘debriefing’ (i.e. making people go over the events in graphic detail and drawing emotional response from this) was once a widely used and popular form of intervention. Psychological debriefing is now cautioned against as it is ineffective and revisiting may compound the trauma [Cochrane review]. There is some evidence for trauma focused Cognitive Behaviour Therapy (CBT) for more severe acute reactions, if this service is available [Cochrane review].
Pragmatic Approaches to Initial Management
- Encourage people to seek support from friends, family and local community
- Two patient handouts provide explanations of symptoms, stress busting techniques. These are located on the clinic websites so patients can see and download. (Others on more formal techniques will follow shortly)
Discuss these with the patient.
- Reinforce positive aspects of the patient’s behaviour in the pandemic – people will often feel guilty that they don’t react as well as they would like to.
- Facilitate, where possible, assistance relating to loss of employment and insurance claims – longer time to resolution of these issues is related to ongoing symptoms
- Provide usual sleep hygiene information
- Avoid catastrophizing language and encourage patients to do the same
Those vulnerable to more severe symptoms include those:
- With a history of mental illness
- Who have experienced previous trauma
- Who have had loved ones die or experience serious illness
- Having little or no social support
- Who have other stressors such as work, housing or financial pressures
- High performing individuals who are used to environments in which they have a high degree of control
Post Traumatic Stress Disorders (PTSD)
PTSD SHOULD NOT be diagnosed less than one month after a traumatic event. PTSD may be diagnosed only when symptoms last longer than one month and cause clinically significant distress and impairments in social, occupational, or other important areas of functioning.
Within the next few weeks further resources will be provided.