Petros Levounis, MD, MAProfessor and Chair, Department of Psychiatry

Rutgers New Jersey Medical School

Project ECHORutgers New Jersey Medical School

Newark, New JerseyFriday, April 17, 2020

COVID-19 andMental Health

1. Working with Existing Psychiatric Disorders

2. Working with Emerging Psychiatric Disorders

3. Addressing the Mental Health Needs of the General Public

4. New Directions

Outline

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1Working with

Existing Psychiatric Disorders

3

Psychotic Disorders

ØCognitive deficitsØInjectable medicationsØStigma

oDrowsinesso Involuntary movementsoSialorrhea (drooling)

ØParanoia and the Evil WorldØSocial isolation

4Geller, Psychiatric News, April 7, 2020.

Depression and Suicide

ØEconomic difficultiesØSocial isolationØAccess to MH treatmentsØGuiltØLate spring/Early summerØThe “Pulling Together” effect

5Reger MA, JAMA Psychiatry, 2020.

2Working with

Emerging Psychiatric Disorders

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PTSD "plus"

PTSD only

Non-PTSDdisorder

Subdiagnostic distress

PTSD

Oth

er d

iagn

osis

?

SCREENTraumaticevent

noPTSD

Diagnose PTSD

Assessment Road Map

0

5

10

15

20

25

% o

f pop

ulat

ion

Druguse

disorder

SUBSTANCE USE DISORDERS

Alcoholuse

disorder

MOOD DISORDERS

Bipolardisorder

Majordepression

♀ 10%♂ 5%

ANXIETY DISORDERS

GAD Panicdisorder

PTSD

8%

Lifetime Prevalence

4%

Natural disaster

49%

Rape

32%

Beating

15%

Shooting orstabbing

54%

Kidnapping,torture,captivity

Perc

enta

ge

0

10

60

20

30

40

50

Risk of PTSD in the US

Breslau et al, Archives of General Psychiatry, 1998.

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Post-Traumatic Stress Disorder

A. Exposure to actual or threatened death, serious injury, or sexual violence

B. Intrusion

C. Avoidance

D. Negative Thoughts and Feelings

E. Arousal and Reactivity

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PTSD "plus"PTSD only

Other diagnosis

No diagnosis

STEP 3

SELECT TREATMENT BASED ON

DIAGNOSES

Education/reassurance

MedicationsPsychotherapy

SCREEN for C & D

symptoms

DSM-5 diagnosis

PTSDNo PTSD

ASSESS for PTSD

STEP 1

DSM-5 diagnosis

STEP 2

ASSESS OTHER DIAGNOSES

Intervention Road Map

3Addressing the

Mental Health Needs of the General Public

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Disaster Psychiatry

14Adapted from Zunin and Myers (as cited in DeWolfe DJ), Training Manual for Mental Health and Human Service Workers in Major Disasters, 2nd Edition, 2000.

Mental Health Consequences

ØAnxietyØDepressionØSubstance useØLonelinessØDomestic violence/child abuse

15Galea S, JAMA Internal Medicine, 2020.

Mental Health Solutions

üDigital technologiesüSocial mediaüRoutinesüNontraditional groups for

psychological first aidüSocial distancing v. safe places

16Galea S, JAMA Internal Medicine, 2020.

Quarantine Stressors

ØLonger quarantine durationØInadequate informationØInadequate suppliesØFear, frustration, and boredom

ØFinancial lossØStigma

17Brooks SK, The Lancet, 2020.

Quarantine Solutions

üKeep it as short as possible.üGive as much information as

possible.üProvide adequate supplies.üReduce the boredom.üAltruism is better than

compulsion.18

Brooks SK, The Lancet, 2020.

4New Directions

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Resilience Resources

üIndividualWhat do I do when things get hard?

üCommunityWho helps me when things get hard?

üExistentialWho do I want to be when this is over?

20Rosenberg AR, JAMA Pediatrics, 2020.

Thank you

NJMS.Rutgers.edu/Psychiatry

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APPENDIX

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Psychological First Aid

FIVEMAJOR PRINCIPLES

23Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Establish safety.ü Identify safe areas and behaviors.ü Provide accurate and updated information.

24Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Teach calming skills.ü Acknowledge/normalize distress reactions.ü Safeguard and develop routines; restore a

sense of normalcy.ü Teach diaphragmatic breathing and muscle

relaxation techniques.ü Limit exposure to traditional and social

media as increased use enhances distress.

25Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Teach maintenance of natural body rhythms.ü Nutritionü Sleep and restü Sexü Exercise

26Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Maximize connectedness to social supports to the extent possible.ü This may require electronic rather than

physical presence.

27Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Foster hope and optimism while not denying risk.

28Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

1. Psychiatry.org

2. CSTSonline.org

Resources

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