For months now, the world has been living in the ominous shadow of COVID-19. Yes, the quarantine has been lifted, but doctors warn that the peak of the infection is yet to come. How has the COVID-19 pandemic affected the mental he alth of Bulgarians? How do frontline medics cope with stress and strain? Why did cases of domestic violence increase? These questions are answered by the head of the Clinic of Psychiatry at Aleksandrovsk Hospital, Prof. Vihra Milanova.
Prof. Dr. Vihra Milanova, MD, leads the Clinic of Psychiatry at "Alexandrovska" University Hospital and is Bulgaria's national consultant in psychiatry. She graduated in medicine in Sofia.
Prof. Milanova has over 40 years of experience as a psychiatrist. She specializes in Great Britain, Ireland and Greece. Prof. Milanova has over 220 publications in renowned peer-reviewed publications, and her scientific works have over 6,000 citations in Bulgarian and foreign journals.
Prof. Milanova, what impact did COVID-19 leave on the mental he alth of Bulgarians?
- What is actually important to know is that this so-called crisis is not over yet. We do not fully understand the problem. We do not know it because there is simply not enough time to study not only its direct but also its indirect impact.
The recommendation for the so-called three "D" - Discipline, Distance, Disinfection. At the beginning it was quite difficult to comply with them, but somehow with time we adapted and I think that for a much longer time we will have to comply with at least these three "D's". Learning to live despite the presence of COVID.
My question was during this period, and after the quarantine was lifted, did people with mental disorders increase?
- Regarding the major diseases that are very often discussed, such as schizophrenia, psychoses, affective disorders, their number remains constant. A lot of these people who are sick before this pandemic comes along, they kind of get left out. Their disease develops regardless of the epidemiological situation. So major diseases have not increased. Rather, there is a trend towards other mental disorders such as anxiety, fears, depressive states, especially among those who suffered financial hardships.
In general, we can group people according to the extent to which they have been affected by this situation as follows - medical workers infected with the virus and their relatives, general population. One particularly at-risk group is the medical workers who were on the front line. They have been isolated for a long time not only socially, but also from their relatives.
Prof. Vihra Milanova
The stress with them is perhaps the strongest. And I must tell you that a large number of them withstood the strain, but we are yet to see the consequences of that. In previous similar outbreaks, one-third of the medical personnel involved were found to show some form of psychiatric symptoms. Most often they are expressed in depression, anxiety, sleep disorder for a long period of time.
Can we talk about burnout syndrome in this case?
- Burnout is different. The syndrome of professional burnout is triggered by a combination of factors related to the structure of the personality and the working environment, by the dissatisfaction with what the profession and the conditions provide you. In this case, we are rather talking about post-traumatic stress disorder, in which one stress is experienced and after a few months this already has a more pronounced effect. Symptoms appear approximately by about 6 months.
They are also expressed in anxiety, reluctance to communicate, to exercise the profession, fatigue, exhaustion. Very often, with post-traumatic stress, people look for "salvation" in alcohol or psychoactive substances, which only complicates their condition.
And when we talk about the consequences on the psyche of front-line medical workers, what did the research you did at the Clinic of Psychiatry at the Alexander Hospital show?
- Yes, indeed, during the quarantine we did a study on the mental he alth of the front-line medical workers in the wards at Aleksandrovsk Hospital and at Tsaritsa Joanna-ISUL, and I can tell you that about 1/3 of the staff had mental symptoms - anxiety, attention disorder, concentration disorder and sleep disorder, but the real price they will pay for their dedication, as I said before, is yet to be seen.
That is why our recommendation to them is to seek specialized help - both psychiatric and psychological. But what I want to say to all other people is that we have to adapt to these conditions and accept what is happening. We should not worry about things beyond our control. Of course, it's easy to say, but not easy to do, and yet our behavior needs to be automated.
I.e. to observe the necessary distance, the discipline in public places and at home, to wash our hands regularly. All these things should become a part of our lifestyle and everyday life. This will reduce our anxiety. Here is the time to recall a wisdom that is engraved on the Ring of Solomon: "And this shall pass."
We all hope so. However, there is another group of people - those who have recovered or are currently suffering from COVID-19. How does the disease affect their psyche?
- There have already been quite a few reports and reports that COVID-19 itself is damaging human organs, including the brain. In 40% of these patients, psychiatric symptoms such as impaired concentration, insomnia, anxiety, and memory impairment are also observed. This is due to the direct toxic effect of the virus on the body, which we are yet to study.
In our practice - here at Aleksandrovsk Hospital, there were relatively few patients with COVID-19 who needed specialized psychiatric care.
The data on increasing aggression between people, on domestic violence, are disturbing. Did the Bulgarian "break out" during these months, Prof. Milanova?
- I absolutely agree that this pandemic has some mental consequences, and on a global scale. We also observe this in contact not only with patients, but also with their relatives - people are extremely aggressive.
Yes, many of them have problems - both material and emotional, but there is a lack of basic tolerance in human relations and we see it everywhere. However, I think it is very important to learn to control our emotional state, and not to look for blame for everything in external factors and circumstances. Of course, when this fails, psychologists and psychiatrists come to the rescue so that we can manage both our fears and our emotions.
Against this background, are suicides becoming more frequent?
- So far I cannot tell you, I personally have neither data nor evidence that suicides have become more frequent
But in previous such epidemics, the data says that yes, there is an increase in suicidal behavior. Especially in some of the risk groups. These are people over the age of 70 with chronic somatic diseases, who previously had problems, including financial ones, and are lonely. These are risk factors that can complicate the condition and lead to suicidal thoughts.
Summer is in full swing and I can't help but ask you if there is a correlation between high temperatures and a person's mental he alth?
- All sudden changes, including climatic ones - from warm to cold and vice versa, cannot but affect a person's psyche. This was especially evident in previous years when summers were longer and very hot. Back then, many people had a hard time adapting to the high temperatures. Usually, prolonged hot weather causes sleep problems, nervous tension, irritability. These effects of the heat can intensify in people who, by coincidence, are in a life crisis - unemployment, change of family situation, loss of loved ones.
And how do the heats of people with mental illnesses work?
- When there is a prolonged period of hot days, usually these diseases are aggravated. Therefore, our advice is that during high temperature hours they should not go outside. On these days, they should have less workload, not set themselves overwhelming tasks.
