A constellation of factors contributes to heightened anxiety symptoms associated with the pandemic. The author offers simple steps to help patients alleviate stress.
A constellation of factors contributes to heightened anxiety symptoms associated with COVID-19. These include concerns for self or family contracting the virus, a decrease in income or actual loss of employment, disruption of work routine, physical isolation from friends and family, restriction of leisure activities, and closing of school and daycare, are causing significant stress on patients and clinicians. Here are simple steps to help patients alleviate stress and give them pleasure. Watch the video related to this slideshow: Working With Patients With Heightened Anxiety During COVID-19.
The COVID-19 pandemic is a new and unexpected stressor that has impacted everyone in society. This is one of the few times similar to a natural disaster, where we as physicians, along with our patients, are also experiencing its impact.
Assess and inquire about your patient’s response to COVID-19 pandemic. One of the main fears that patients have is fear of contracting the virus. Based on what they tell you, you may need to educate patients about how COVID-19 is transmitted and dispel any myths they may have about the illness. I have patients who are so fearful of getting infected that they don’t step out of their house, go to the grocery store, or conduct any essential activities. When a patient knows how to protect themselves from infection, they will not be as anxious. Educate patients that they are not going to get infected just by being in the same room or building with another person, as long as they follow the rules to keep themselves safe. That is, stay 6 feet apart, wear a face covering, keep hands clean at all times, and do not touch hands to face. If they follow these rules, they will feel less stress going outside.
I have advised my highly anxious patients to limit the viewing of news and social media about COVID-19. The media is inundated with information that can increase a patient’s anxiety about the illness. Patients should focus the extra time on self-care activities, like taking breaks from work, doing physical exercises, meditation, yoga, spending time with their loved ones, listening to music, watching a good show, or reading a novel. Basically, engage in any activities that they can do at home that helps alleviate stress and gives them pleasure.
Educate patients about normal responses to stress and trauma. Normal responses can include anxiety, apprehension, disbelief, anger, insomnia, concentration problems, fatigue, irritability. In some patients, increase in pain and other physical symptoms are common. These reactions to stress are usually transient and will likely resolve with time once patients adapt to the changes brought on by COVID-19 pandemic. If a patient reports having these stress response symptoms that are not going away after a few weeks, or that are severe enough to cause significant distress or interfere with daily functioning, then you may need to assess them for the development of adjustment disorder with anxiety, acute stress reaction or new onset generalized anxiety disorder.
Patients with underlying anxiety disorders, especially generalized anxiety disorder, may experience exacerbation of their anxiety. They may need adjustment to medication if their symptoms were previously controlled by medication.
We don’t want reactively to give anxious patients PRN alprazolam or lorazepam without a thorough assessment. Patients often ask for PRN benzos because they want immediate relief of their anxiety. I can’t tell you how many times I had patients who were referred to me by their PCP for persistent anxiety, and I had to take them off PRN benzos. Even if a patient is having recurrent panic attacks, the panic attacks are usually due to an underlying anxiety disorder or depression. Just treating the intermittent panic attacks is not going to treat their underlying condition. Also, a panic attack comes on within 10 minutes. PRN benzos may take 30 minutes to an hour to take effect, so PRN dosing is not effective in preventing a panic attack. It is preferable to start patients on a SSRI first and then explore other options if needed.
Dr Choy is past president of the Orange County Psychiatric Society and a distinguished fellow of the American Psychiatric Association. Website: https://www.121psychiatry.com.