Human beings usually trivialize our mental and emotional health from our body. As a joke, we make comments like “I'm already going crazy” or “I have a memory of fish”; Perhaps it is a defense mechanism against the concern of a real background, a way to escape from any cognitive deterioration that we are going through, or simply ignorance. Any of the three situations is valid, since all people act, process, interpret and feel uniquely. However, let's talk about the effect COVID-19 on people's mental health and how this disease could potentially cause a deterioration in the cognitive functions of patients who survive it. That damage could be irreversible if we don't address it correctly.
Let's position ourselves in a country like Nicaragua, where I am from, where there is no action plan in favor of mental health, what's more, there is not even a specific legislation for the care of it, being a country whose history has been written between socio-political conflicts and natural disasters. As a medical student, I was able to see and live from the inside that my country's health system is one with many deficiencies, the state is negligent and does not invest enough in something extremely important, such as health. Therefore, the outlook for Nicaraguan society is very complicated when we speak of a comprehensive recovery for people who have survived COVID-19.
After talking to someone who suffered traumatic experiences related to shortness of breath and having read an article in “The Atlantic” about delirium disorder and its relationship with the coronavirus, I came to the conclusion that it is necessary to talk about mental health and how mental disorders could be exacerbated in survivors of COVID-19.
Delusion or confusional syndrome
We cannot speak of COVID-19 without taking into account Acute respiratory distress syndrome (ARDS), which consists of a severe injury to the lungs and a high degree of decrease in the partial pressure of oxygen in the arteries (hypoxemia); This syndrome commonly requires aggressive support such as mechanical ventilation and therefore intensive therapy in order to stabilize patients. According to researchers, hypoxemia, which characterizes ARDS, can cause delirium, better called “confusional syndrome”, in patients in the intensive care unit (ICU).
In this state, patients can undergo an alteration of consciousness and a change in cognitions that develop over a short period of time, according to the psychiatric manual of researchers Juan Lopez-Ibor Aliño and Manuel Valdés Miyar.
If we read the article in The Atlantic, we find stories of survivors of COVID-19 that narrate horror situations, such as having your arms and legs amputated, or being at your own funeral. For many years, expert scientists have studied about the direct relationship of ARDS with the generation of a state of delirium in people who are in the ICU, but another situation that they have demonstrated is more shocking: over time, the survivors of this episode develop cognitive decline in functions that often go unnoticed, such as memory, attention, concentration, processing speed or executive function of our brain, as demonstrated Hopkins and collaborators.
Anxiety and depression
Now let's talk about two diseases that many people suffer and of which very few are aware, anxiety and depression. According to Nicaraguan psychologist Junieth Cruz, it is very likely that the majority of people, at least once in our lives, have gone through an episode of anxiety, what happens is that we do not have enough health education to identify these symptoms.
According to studies related to ICU survival, it has been shown that many people, after discharge, develop psychological problems such as nightmares, panic attacks, agoraphobia, anxiety and depression. In addition, the presence of the characterization of something known as post-traumatic stress (EPT), experiencing situations such as hypervigilance, traumatic trauma and evasion.
At discharge, symptoms of depression appear to improve over the first year, anxiety persists beyond one year, but EPT persists over time according to a study by Myhren et al. On the other hand, Rothenhäusler H. and collaborators They showed that cognitive impairment and impairments could be observed even 6 years after medical discharge, and that only 46% of people could return to their previous activities.
If we refer to the public health crisis caused by COVID-19, realistically, how many survivors will be treated in the field of mental health? Will the Ministry of Health do something to alleviate the mental health crisis that is affecting it? Does the pandemic continue? Those are just 2 of the many questions that could make us reflect, not only in Nicaragua but in many other countries around the world.
In conclusion, we usually make the mistake of conceiving health as the absence of physical discomfort, without realizing that to be well one must consider the balance between mental and physical health. The demonization of self-care or the taboo around expressing psychological distress is something that we should fight to avoid a collapse of psychological and psychiatric patients, taking into account the psychological impact that the COVID-19 pandemic will generate in the medium and long term, and we should consider shifting the ego around mental health and start accepting the need for help.
Now more than ever, we must bring up this type of discussion around the conception of the integral well-being of each one and break the archaic or outdated approaches that “I do not go to the psychologist because I am not crazy”.