The Ebola outbreak has given reason for concern across the globe and most recently in the US. Recent media attention and ongoing coverage of the Ebola outbreaks in West Africa, as well as recent cases in the US, contribute to confusion among many. All this attention has also created fear and distress for our patients and their families and for health care workers. Individuals with preexisting psychiatric conditions may be particularly vulnerable to anxiety and mood symptoms as well as to the use of maladaptive coping, including substance use.
When widespread fear and anxiety about the spread of an infectious disease stress our society, psychiatrists can play a variety of important roles in population health management (Table). They can work directly with patients to encourage frank discussion of worries and distress, and they can identify symptoms such as sleep disturbances and exacerbation of underlying mental illness. Psychiatrists can also support primary care physicians and encourage them to address patients’ concerns.
In the community, psychiatrists can educate leaders about risk communication to decrease fear and anxiety. For psychiatrists who work in hospitals that may receive Ebola patients, additional consultation and work with the infectious disease teams and families of the patients (or those in quarantine) are needed. Ensuring optimal care for patients requires that psychiatrists understand the clinical aspects of Ebola and the principles of risk communication.
The Ebola virus
Ebola virus disease (EVD) is rare but potentially fatal; it is caused by infection with one of the Ebola virus strains. There are 5 identified Ebola virus species: 4 cause disease in humans; 1 causes disease only in non-human primates. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo; it has now spread to several other African countries. Since its discovery, outbreaks of Ebola have appeared sporadically in Africa. The natural reservoir host of Ebola virus remains unknown, but researchers believe the most likely reservoir is bats.
The onset of symptoms is usually abrupt, generally starting 8 to 10 days after exposure. However, the incubation period can range from 2 to 21 days. People become contagious once they begin to show symptoms. Fever, anorexia, and weakness are common, along with chills, myalgia, and malaise. The nonspecific nature of these symptoms can be confused with other, more common diseases, such as influenza and meningococcemia, so a high degree of suspicion is needed.
Additional symptoms that may present around day 5 of the disease course include an erythematous maculopapular rash that can desquamate and a range of GI problems (eg, abdominal pain, profuse diarrhea, nausea, vomiting). Patients may also experience chest pain, shortness of breath, headache, confusion, conjunctival injection, hiccups, seizures, and frank bleeding. When early symptoms are severe, mortality is increased and generally results from multiorgan failure and septic shock. Mortality rates range from 55% to 75%; patients who receive early aggressive treatment fare better.
Transmission, detection, and treatment
Despite ongoing media coverage of the issue of Ebola being aerosolized, epidemiological evidence suggests this is not a mode of transmission. Ebola virus is spread by direct contact with blood and other body fluids, such as vomitus, urine, fecal matter, or breast milk, of an infected person or someone who has recently died of Ebola. Infection can also be transmitted by surfaces or objects contaminated by body fluids of an infected person. Persons who handle dirty linen, clean examination rooms, or perform other support tasks in hospitals are at increased risk and need to be educated about safety procedures.
The issues of sexual transmission can create family burdens and distress after a patient has survived an initial infection with Ebola. Ebola virus has been detected in semen up to 3 months following recovery from infection, and media reports suggest that women who have recovered from EVD may be capable of transmitting the disease through vaginal fluids. Thus, experts recommend abstaining from sex (including oral sex) for 3 months after recovery.
Dr Morganstein is a Commander in the United States Public Health Service; Assistant Professor and Assistant Chair, department of psychiatry, and Scientist, Center for the Study of Traumatic Stress at the Uniformed Services University School of Medicine in Bethesda, Md. Dr Ursano is Professor and Chair, department of psychiatry, and Director, Center for the Study of Traumatic Stress at the Uniformed Services University School of Medicine. They report no conflicts of interest concerning the subject matter of this article.
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