Containment at the source of a second wave, but psychiatric?

Le confinement à la source d’une deuxième vague, mais psychiatrique?

The effects of confinement on mental health are becoming more feel, and some psychiatric hospitals in Quebec are overwhelmed.

If the visits to the psychiatric emergency had largely decreased during the first months of the pandemic, patients wishing to limit the congestion of hospitals and reduce their risk of contracting the virus, they have found a steady pace, and this in a context far from the normality.

“Currently, we have too many beds for people with the COVID and not enough beds for people who do not have the COVID, but have the effects of the confinement,” says Dr. Karine Igartua, president of the Association des médecins psychiatres du Québec (AMPQ).

In the hospitals, Albert-Prévost and Jean-Talon Montreal, for example, the rate of bed occupancy stood at about 70 % at the beginning of April, a significant drop considering that they work most of the time at full efficiency. In the last days, this rate amounted to 113 %, leading the staff to use creativity to find spaces.

The major symptom of loneliness

The doctor attributed this increase was primarily mental health problems to the stress of confinement, and especially to the loneliness that it creates, leading people to “décompenser” according to their weaknesses. “In the er, someone jumped through the window of the second floor because he wanted to go take a walk”, she said, adding that he was not a suicide attempt, but a need to get away. The life of this individual is not in danger.

Another of his patients, who could usually count on his family to accompany him in his bipolar illness, is disorganized without the presence of his relatives, to the point where his mania became psychotic and the police had to intervene at her home, because she hit in its walls repeatedly.

The virus as a source of delusion

The nursing staff also see a few cases of patients that incorporate the COVID-19 to their delirium. “I just finished an interview with a patient […] who believes to be at the heart of a grand conspiracy including this virus, and that would be the person responsible for this infection. It was a person who was very well, and who had no history of psychiatric illness,” says Yvan Pelletier, a doctor at the Hospital in mental health Albert-Prévost.

This type of profile is far from being exclusive to Montreal or Quebec. Agence France-Presse reported a month ago in a situation very similar to the side of the Seine-Saint-Denis, a paris suburb, where young people without a history are arrived at by claiming that they were, themselves, the COVID-19.

Forecast worrying

With peak levels of psychological distress recorded in Europe, the AMPQ would not be surprised to see the crisis intensify, also in Quebec in the coming weeks. Studies conducted after other epidemics, such as SARS in 2003, portends the worst. “Of course, they [outbreaks] were not the extent of it, but actually, we had seen more depression, no more stress to post-traumatic stress and disorders substance abuse (alcohol, drugs)”, in the months and years that followed, argues Dr. Igartua.

The preliminary results of a canadian survey on the psychosocial impacts related to the pandemic undertaken by a team from the University of Sherbrooke, released at the end of April, are also of concern. One in four canadians will suffer from a disorder of post-traumatic stress disorder related to the pandemic, and the one-quarter of Canadians will suffer as a generalized anxiety disorder, according to the study.

With the introduction of accelerated telemedicine in Quebec, which has been used by many psychiatrists for follow-ups and assessments in time of crisis, the president of the AMPQ hope that the system will remain encouraged in the long term. It wants to and finally that the government is tackling the problem of shortage of manpower in mental health in the public sector where working conditions are often much lower than those in the private sector.

Elderly people, yet the most affected

As for the disease itself, psychiatrists to evaluate a very high number of elderly patients since the beginning of the crisis. According to Dr. Pelletier, the elders were so afraid of the coronavirus in force to remind the risks, that some of them have developed a disorganization with anxiety, psychotic symptoms and suicidal behaviour.

“I have a lady who has done this for the first time in 75 years a suicidal gesture, precisely because she finds it impossible to live in this confinement,” says-t it. In addition, in may, a person was also thrown from her balcony at the Chateau Beaurivage, in Montreal-North.

Going to lend a hand in a seniors ‘ residence, Dr. Karine Igartua has also been noticed that elderly people, usually very functional, have developed a form of dementia related to the fact of being locked up in their room. “They began to say “Why am I in prison? I have been accused of what? How do I have they found guilty?” They had delusions of guilt, as if they had been found guilty of something and what it is that they had been imprisoned.”

with the collaboration ofAlexis Magnival

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