Dear Editor,
The new coronavirus, as an acute and severe respiratory syndrome, was first identified in December 2019 in Wuhan, China, and rapidly spread to other parts of China and also other countries (1, 2). It commonly has the following symptoms: fatigue, fever, cough, shortness of breath, and headache (1) that normally appear after an incubation period of 4 - 6 days (3). COVID-19 has higher transmissibility than MERS and SARS, and each patient can infect about 5.7 individuals (4). The World Health Organization (WHO) has made several recommendations to prevent the spread of COVID-19, including an emphasis on frequent cleaning of hands using soap and water that can effectively remove pathogens from the surface of the skin (4, 5). This recommendation and what is referred to as a preventative measure against COVID-19 in vulnerable persons, including people with predisposing conditions like anxiety disorders, can have serious consequences such as obsessive-compulsive disorder (6, 7).
Obsessive-Compulsive Disorder (OCD) is a chronic, costly, and debilitating mental disorder characterized by time-consuming, stressful, and overwhelming obsessions and compulsions. Compulsions are repetitive mental acts or behaviors that aim at preventing or alleviating anxiety or preventing scary events from occurring (8). As known, OCD is associated with genetic factors and a variety of environmental factors such as fear of pollution, the feeling of being contaminated, and excessive washing (7, 9). What is important is that a stressful event can trigger a chronic pattern of OCD (10). Today, contracting COVID-19 is a scary event, and the emphasis on recommended health advice for infection prevention can cause or exacerbate OCD in people who are susceptible to it, especially Iranian women in whom OCD is relatively common (11). Therefore, nurses have a special role, including:
Educational activities: for people who are at risk of developing OCD, nurses should give health advice, such as the importance of promoting social distancing and avoid of contact with individuals who are suspected of having COVID-19 to reduce intrusive thoughts. Besides, nurses can reassure people that hand washing is not necessary when they are in sterile environments or home quarantine. Moreover, given that the COVID-19 pandemic has lasted for a long period, healthcare providers need to pay special attention to psychological complications, including obsessions and compulsions in people at risk.
Following up pharmacological treatments: for those patients who are taking medications, e.g., SSRI (10), nurses should emphasize the importance of regular consumption of medications to prevent the exacerbation of OCD.
Following up non-pharmacological treatments: Emotion-focused therapy and behavioral approaches such as “excessive-response prevention in exposed patients” can be effective and must continue.
Acknowledgements
References
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Kumar A, Somani A. Dealing with Corona virus anxiety and OCD. Asian J Psychiatr. 2020;51:102053. [PubMed ID: 32302962]. [PubMed Central ID: PMC7151537]. https://doi.org/10.1016/j.ajp.2020.102053.
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Ahmari SE, Dougherty DD. Dissecting Ocd Circuits: From Animal Models to Targeted Treatments. Depress Anxiety. 2015;32(8):550-62. [PubMed ID: 25952989]. [PubMed Central ID: PMC4515165]. https://doi.org/10.1002/da.22367.
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Amani M, Abolghasemi A, Ahadi B, Narimani M. The prevalence of obsessive-compulsive disorder among the women 20 to 40 years old of Ardabil city, Western part of Iran. Journal of Fundamentals of Mental Health. 2013;15(59):233-42.