The lock down of social interaction in many countries due to the SARS-Cov-2 epidemic has several psychological and psychiatric implications. E.g. anxiety of becoming ill, social isolation and depression, exaggerated anxiety in patients with severe agoraphobia and fear of being left alone, and not the least delay in seeking professional help for mental disorders. Some of those consequences can be dealt with by telemedicine. However, patients with chronic mental disorders, e.g. schizophrenia, severe OCD, bipolar disorders, and anorexia nervosa, require face-to-face contact and knowledge about somatic and treatment implications of stress on the mental disorder. After all, there is no evidence that internet-based therapies will help the most severely ill.
Furthermore, if CoV-19 (infection) occurs, the mental health care system must cope with several other implications. Patients with severe mental disorders have an increased risk of dying if they suffer from CoV-19. There is an increased risk of cardiac arrhythmia in patients with CoV-19. This may imply reduction in dosage of antipsychotics known to increase the risk of arrythmia in high dosages, such as amisulpiride, sertindole, ziprasidone, risperidone, olanzapine, and quetiapine. Drugs used off-label to treat CoV-19, such as chloroquine and hydroxycholorquine, may provoke severe mental disorders like psychosis and suicidality. Hypoxia and acute respiratory distress may sometimes require additional psychiatric interventions.
Adding to potential challenges, are colleagues developing insomnia and anxiety which in some cases have progressed to panic or resignation, demoralization, and depression as reported by Italian psychiatrists.
All the challenges and clinical issues listed above, require good knowledge of both psychiatry and somatic medicine, reemphasizing a pivotal role of psychiatry in pandemics. □