Dear Editor,
The new pandemic coronavirus disease 2019 (COVID-19) that is caused by a new strain of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become an issue for governments and health care providers such as specialists including psychiatrists worldwide (1). Treatment strategies and vaccination for this disease are yet to be explored. Therefore, at this time, the best-proposed health measure to break the chain of transmission is social distancing or, in some instances, quarantine. In a recent systematic review published in Lancet, Brooks et al. (2) evaluated the psychological impacts of quarantine during the 2003 SARS outbreak and the 2014 Ebola outbreak. Accordingly, most of the reviewed studies reported adverse psychological effects, including post-traumatic stress symptoms, confusion, and anger (2). Delays in psychological interventions in such situations can lead to psychological damage to individuals who are involved (3). However, people with a pre-existing mental health problem such as anxiety or depressive disorder would be more vulnerable to experience adverse psychological effects of quarantine and social distancing.
While the global prevalence rates of anxiety and major depressive disorders in 2017 were estimated to be 3.86% and 2.21%, respectively, patients with multiple sclerosis (MS) seem to be more severely affected. According to a systematic review published in 2015 (4), the prevalence rates of anxiety and depression were 21.9% and 23.7%, respectively, among MS patients. The spread of COVID-19 and its related mortality can lead to severe anxiety in these patients. Moreover, quarantine and social distancing measures can cause limitations in seeking proper psychiatric and psychological treatments in previously affected patients. Furthermore, these patients have apprehensions concerning their disease-modifying treatment (DMT) and whether their immunity is competent to overcome the viral infection. The resultant anxiety and depression could lead to increased activity of the disease (5). Therefore, it is essential to decrease anxiety in the present circumstances.
Some measures can help in alleviating some of the concerns during a pandemic. Patients with MS should be reassured that the majority of them have competent immune systems, and their risk of being infected is similar to that of the general population. They should be advised to follow the governments’ protocols on quarantine and social distancing following the recommended hygiene practices. The patients should be appropriately informed of their DMT. Previously started DMT should continue during the outbreak, and any change in the treatment plan should be under the supervision of neurologists. However, if the patient is on treatment with immunosuppressive medications, the treatment plan should be cautiously evaluated based on rounds of treatment, disease activity, and the patient’s preference (6). Therefore, the patients need to have virtual access to their physicians to diminish anxiety related to their disease and treatment. Patients can have the medical and mental care that they need during the outbreak using telemedicine through virtual clinics and online advice with neurologists, psychiatrists, and psychologists. They should be advised to keep their daily routines and regular exercises, stay connected with their family and friends via social networks, follow a balanced healthy diet, and have an adequate sleep. It is advised to seek practical, credible information at specific times of the day, as the constant following of the stream of news on the outbreak may cause anxiety among them. Meditation and yoga are useful for reducing stress and easing the mind and body. Finally, there are online mental health support services that can provide counseling to overwhelmed anxious patients (7).
