COVID 19 RELATED ANXIETY DISORDER

Corona (Covid 19) Related Anxiety Disorder

Corona virus infection, better known as Covid 19 infection, which started in China about three months ago, has rapidly spread to about 150 countries. So far, about 1,50,000 people have been infected with Covid 19, out of whom about 5,500 people have died.

Various forms of media (including TV, newspaper) and social media (facebook, whatsapp, etc) are full of news and information about Covid 19 infection. Various government agencies too have started awareness campaigns about Covid 19 infections and methods to limit its spread. Countries across the world have initiated partial to total shutdown. WHO has declared Covid 19 infection as a pandemic.

A problem of this magnitude, affecting the entire world is rare and many people have not faced a similar situation in their lifetime. This has resulted in anxiety and fear of varying magnitude. Recently, pulmonologist Dr Chandrakant Tarke encountered two patients with extreme anxiety.

Both patients were women, aged 23 and 30 years respectively, from Hyderabad, India. They presented with mild cold and no other significant symptoms. They had no risk factors to develop Covid 19 infection (no history of travel to Covid 19 affected countries or exposure to a Covid 19 infected patient). They had extreme fear that they were suffering from corona virus infection. They had developed obsessive trait of washing their hands multiple times with sanitizers despite staying at home and no exposure to outside. Clinical examination was normal except for hyperventilation. The fear had started after the news about Covid 19 infection in India started flashing on Indian TV channels. The fear became extreme on listening to Covid 19 awareness caller tune initiated by Government of India (which started with coughing sounds, followed by steps to prevent Covid 19 spread).
A diagnosis of anxiety disorder induced by fear of having contracted Covid 19 infection was made. Women were counselled and referred to psychiatrist for further management.

With increase in the number of Covid 19 cases across the world and the disruption resulting due to it, we are likely to come across many more people suffering from Covid 19 related anxiety disorder. As a health care professional we need to be aware of it, promptly diagnose it (clinical diagnosis suffices) and advise appropriate treatment (counselling, referral to psychiatrist/psychologist).

Steps to prevent Covid 19 related anxiety

1 .Avoid seeking constant updates about Covid 19 from TV channels or social media (updating twice a day- morning and evening- should be sufficient),

2. Do not constantly discuss about Covid 19 with your family, friends and colleagues,

3. Focus on the positive aspects of Covid 19- more than 80% have mild infections and more than 90% survive this infection,

4. Take steps to prevent Covid 19 (as already outlined across various media platforms)

5. Go for walks, exercise and engage in leisure activities (music, gardening, etc)

6. Consult a healthcare professional if you develop anxiety or fear related to Covid 19

Dr Sudhir Kumar MD DM (Neurologist), Apollo Hospitals, Jubilee Hills, Hyderabad
Dr Chandrakant Tarke MD DM (Pulmonologist), Apollo Hospitals, Jubilee Hills, Hyderabad

PSYCHOSIS (HALLUCINATIONS AND DELUSIONS) IN PARKINSON'S DISEASE

HALLUCINATIONS IN PARKINSON’S DISEASE

Main symptoms of Parkinson’s disease

Parkinson’s disease (PD) is a slowly progressive degenerative disease of brain. The major symptoms are tremors (shivering), slowness of movements, stiffness and postural imbalance.  These symptoms lead to motor disability and interfere with walking, as well as with other activities of daily living.

Memory impairment in Parkinson’s disease

The mental functions are usually normal in patients with PD, however, 10% of patients can develop dementia (memory impairment along with other cognitive dysfunction), especially in later stages of illness.

What are hallucinations?

Other significant problem in people with PD in later stages is hallucination. Hallucination is often visual. In this condition, patient sees something, which is not there. For example, they may see snakes or lizards in their room (which are not there), and get disturbed with them. They may also see strangers in their house, which are supposedly there to spy on them or harm them. These hallucinations are very upsetting for the patient, making them anxious and depressed. Some patients also have sleep disturbance due to hallucinations.

What are the causes of hallucinations in patients with PD?

1.     Adverse effects of anti-parkinsonian medicines.

2.     Infections such as urinary tract infection or pneumonia,

3.     Side effects of other medications such as pain killers and sleeping pills,

4.     Parkinson’s disease mimic such as Diffuse Lewy body disease (DLBD). In DLBD, patients may have slowness and rigidity (just like PD). However, they have prominent hallucinations and dementia (unlike PD). Moreover, DLBD patients do not respond to levodopa treatment.

Other symptoms of psychosis in patients with PD

1.     Illusions,

2.     Delusions especially paranoid

3.     Confusion,

4.     Sleep disturbance

Delusion refers to a condition where a patient believes in something, even when there is an evidence of the contrary.

How common is psychosis in PD?

About one third of patients with PD suffer from psychosis. So, it is quite common.

How do we manage psychosis in patients with PD?

Management of psychosis can be done in a stepwise fashion as outlined below:

1.     Underlying alternate causes should be looked for and managed. This would include looking for infection and offending drugs.

2.     Comorbid psychiatric conditions, such as anxiety and depression, if present, should be treated.

3.     Minor symptoms such as vivid dreams or minor hallucinations (which are non-disturbing in nature) do not require any treatment.

4.     Anti-parkinsonian drugs should be reduced or stopped. First to eliminate are trihexiphenydyl, amantadine and selegeline/rasagiline. If psychotic symptoms persist, then, the next drugs to be reduced are dopamine agonists (ropinirole and pramipexole), entacapone and levodopa.

5.     In people with cognitive impairment, cholinesterase inhibitors such as rivastigmine or donepezil can be used.

6.     Anti-psychotic medication- quetiapine is the most commonly used.

7.     The first and only FDA approved drug for treating PD psychosis (hallucinations and delusions) is PIMAVANSERIN (Nuplazid). The dose is 34 mg capsules once daily.

DR SUDHIR KUMAR MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777

drsudhirkumar@yahoo.com

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