During her work in the red zone of Lenexpo, clinical psychologist Yulia Mokhova provided assistance to 1,384 patients, 320 of them in the fourth wave. Yulia Mokhova notices the changes taking place with people against the backdrop of a pandemic not only in the buildings of the temporary hospital, but also on the street. Why group therapy is not suitable for patients with coronavirus, and making remarks to maskless people is harmful to others, Yulia Mokhova told in an interview with Fontanka.
– How do the psychological consequences of covid and the pandemic differ from psychiatric ones? At what point do you need to contact a specialist?
– Symptoms that should be alarming are sleep disorders or shallow sleep with frequent awakenings, fatigue, irritability, negativism. You cannot self-medicate, you should consult a specialist. It should be understood that a psychiatrist is always a basic doctor, a specialist who graduated from a medical school and received the specialty of a psychiatrist in addition to his basic education. The psychiatrist works with such productive symptoms as voices in the head or off-scale aggressiveness that goes beyond the norm. A psychologist, in turn, is a specialist with a higher education in the humanities. The clinical psychologist additionally receives a refresher course in the amount of 1118 hours. This is necessary so that a psychologist can work in medical institutions, including in the red zones of covid hospitals. The psychologist does not prescribe pills and does not have the right to make psychiatric diagnoses, but can make a preliminary diagnosis. For example, one of the patients began hallucinations. This and other signs gave rise to a prediagnosis – an acute psychopathic condition is questionable. The patient was recommended to consult a psychiatrist.
When a person observes any behavioral or cognitive impairment, do not immediately run to a psychiatrist. First you need to go to your clinic and make an appointment with a neurologist. If the neurologist does not find any abnormalities in his profile, but there are asthenia and other symptoms, he will refer the patient to another specialist, in particular to a psychotherapist – a general practitioner who specializes in psychotherapy.
– How to distinguish a problem with which you need to go to a specialist from a far-fetched one?
– Do not go to the other extreme and ignore the changes taking place with you. Often a disservice can be rendered by relatives or friends who will try to “calm down” you with the words: “What kind of depression is this? Go to sleep and everything will pass. ” Meanwhile, depression is a psychiatric disorder that is included in the international classifier of diseases and should be treated by a doctor – psychiatrist or psychotherapist.
Patients with covid during the first day very often complain of manifestations of cognitive impairment. Such as memory loss, both short-term and long-term, a high level of anxiety, a negative attitude towards everything. These are not psychiatric disorders, but they must be taken seriously.
– What are the official terms for the psychological and cognitive impairment caused by Covid?
– In the international classifier ICD-10 in 2021, the term “postcoid syndrome” was added. It can include a post-cobalt depressive state, loss or partial loss of cognitive functions, including memory, general asthenization, when it is difficult for a person even to move and walk. This is not depression yet, but increased fatigue. This also includes sleep disorders.
– How does postcoid depression differ from normal depression?
– Now no one can answer this question, there are still few observations and no one has carried out differentiation. Symptoms in general completely coincide with the usual depression, which since the time of Hippocrates is known as “melancholy”.
– Is it possible, based on the psychological state of a person, to assume that he was asymptomatic with covid? Is depression a symptom of a previous infection?
– No. In addition, today “depression” began to call any state associated with a breakdown and loss of motivation. But, if a person has lost a loved one in covid and is going through a period of acute mourning, this does not mean that he or she is depressed. If a person has lost a job that is meaningful to him, his child is seriously ill – this is also not depression, but the experience of a difficult life situation.
For example, an eighteen-year-old patient from Lenexpo says to me: “Today I will be discharged because I recovered. But it would be better not to get better. ” But this is not a manifestation of depression. It turned out that both of the girl’s parents left the covid in another city where she was from; she has no one in St. Petersburg. In addition, she missed many classes at the university due to illness and does not know where to start life after treatment. This is not depression either.
– Is there an unambiguous, non-subjective way to diagnose depression?
– A clinical psychologist’s tool is not biochemical analyzes, but certified and reliable questionnaire tests. They have nothing to do with tests from glossy magazines.
– Can you cheat such a test?
– Hardly ever. And why? If a person says that he has lost the meaning of life and cannot sleep normally, I can make a pre-diagnosis based on what he tells me. But the diagnosis of “depression” is not made immediately, but only as a result of several tests and sessions-conversations with a person. If you have a depressive state, I recommend consulting a psychotherapist at your place of residence.
– Is there any statistics in St. Petersburg on psychological and mental disorders against the backdrop of a pandemic?
– No. But for two years of work in the red zone, I have accumulated a lot of my own material. Unfortunately, these statistics cannot be considered relevant for the entire city. But, according to my observations, covid affects the psychological state of people very strongly.
The first difficulty that I faced in the first wave was the need to wear a mask and protective suit. The psychologist works not only with a word, but also with a face and posture, demonstrating to a person that he listens to him and supports him. Patients, of course, see my eyes when my face is covered by a medical mask, but often this is not enough to establish therapeutic contact. We compensate through touching and hugging. Another important point is that in the case of patients with coronavirus, group therapy does not work, although it is actively used, for example, for patients with oncology. Coronavirus patients experience their illness more intimately, without the resource to support others; they only open up through individual work.
During the third wave, I noticed an increase in newly diagnosed panic attacks in our patients. Our contingent is getting younger. If at the beginning of the pandemic, mainly older people suffered from covid, now it is from 32 to 40 years old. And every second person demonstrates panic attacks against the background of covid, which he has never experienced before. That is, a person does not even understand what exactly is happening to him. This fact surprised me. Young people, quite athletic, occupying positions that require a fairly stable psyche.
– How does a panic attack happen?
– The person has a growing feeling of poorly controlled anxiety, critical thinking is turned off. A person, for example, is sure that he is about to suffocate, and begs the doctors to do something about it immediately.
– How often do you have to observe the “covid fog” and what is it in general?
– This is also common in patients. It is difficult for a person to concentrate attention. Plus – short-term memory decreases, and sometimes long-term memory also fails. The person does not remember what he ate for breakfast or how yesterday evening went. In my practice at Lenexpo, there was a case when a rather young man literally forgot how to dial a phone number on a smartphone. Together we opened his contact list and found the contact “Mom”. Then it turned out that the patient did not remember the name and patronymic of his own mother. When a person finds himself in such a state, it scares both himself and his loved ones.
Patients who experience particularly severe memory lapses with covid often have had memory problems in the past. If a person is characterized by absent-mindedness, emotionality, pessimism, the coronavirus can multiply these conditions. But everything recovers over time.
Several times I had the opportunity to observe my patients in a rehabilitation center a few months after the end of treatment. Recovery occurs, but depends on many factors, including comorbidities and age.
– The younger, the easier it is to recover?
– The younger the patient, the faster his cognitive functions are restored. And the worse his psyche is restored. The explanation is simple. Older people have worse gadgets, preferring to watch TV. And they receive less negative information. And young people from the Internet receive huge volumes of highly disturbing news, often from unverified sources. “The vaccine is a shmurdyak”, “vaccination does not save from the disease” and so on.
– How to deal with this?
“Alas, no matter what I say, people will not listen. Recommendations are the most common: reasonable sports loads, regular walks in nature, adherence to sleep and nutrition. Humanity all this took place a hundred years ago during the Spanish flu pandemic. She was treated with quinine and antimalarial drugs. Millions died, and it is not known what would have happened if the activity of the pathogen of the “Spanish flu” had not suddenly disappeared without obvious reasons.
So the main advice is not to get carried away with reading news on the Internet. Try to consume the required minimum of information from trusted sources.
– How to support a relative or friend who contracted the coronavirus? Is there a stop list of phrases that shouldn’t be said for sure?
– I try to warn each of my patients about what kind of cognitive and emotional problems he may face in the process of illness. That there may be memory problems, but then it will definitely recover. Apathy and sleep disturbances will also go away. Forewarned is forearmed. Don’t say, “Don’t worry.” On the contrary, such phrases irritate a sick person. The easiest way is to say: “I am there, if you need any help, just tell me.” And, of course, one must be ready to provide this assistance.
– What is happening now with people who have not been ill with covid? Some are ready to go hand-to-hand because of a request to put on a medical mask, and scandals in public transport in Kazan after the introduction of QR codes have become the talk of the town.
– Postcoid syndrome can develop only in a person who has had covid disease. But the pandemic also affects those who do not get sick. A person is balanced and calm when he can more or less confidently foresee what lies ahead of him, somehow plan his future. The coronavirus pandemic has deprived us of this opportunity. Even a vacation trip has become very difficult to plan, the rules of the game change almost every day. It is not known for sure what will happen to loved ones, whether the children will be transferred to a distant student, whether there will be work tomorrow. The human brain is forced to be in a state of severe stress. People begin to experience constant background fear. And this makes them aggressive. Someone, experiencing fear, freezes and falls into apathy, someone, on the contrary, begins to attack. In a sense, this is a manifestation of weakness and insecurity. Strong people are always calm, because they feel that they are right and know that they should not prove anything to anyone.
– What to do if someone scandals on the bus or in a store because of a mask or a QR code, comes into conflict with a conductor or a seller?
– If the situation is not critical – roughly speaking, no one is beaten – there is definitely no need to be included in this story on either side. Because any remark of a third person will provoke the effect of infection, others will join the conflict. A note to the same maskless person on the bus should be made by the conductor.
– What other changes in people, besides aggression, does a pandemic cause?
– Suspiciousness and superstition appear. One patient, for example, stated that the coronavirus is her punishment, which she must suffer for the way she lived before the illness. As a result, we agreed that the “punishment” should be carried out competently, under the supervision of doctors.
Another patient, right in the seventh building of Lenexpo, began to lay out Tarot cards. Well, she would only wonder to herself. But she took to guessing the entire sector, asking the cards for advice on treatment regimens, for example. And people reached out to her. I had to impose restrictions on fortune-telling: for yourself – please, others – don’t. In a stressful situation, critical thinking is turned off, people are ready to believe anything. For the same reason, people take on faith fake information that they accidentally read somewhere on the Internet. After the tragedy in Beslan, those who lost their loved ones believed Grigory Grabovoi, who promised to resurrect the dead, for the same reason.
But at the same time, people show a willingness to help. Two fifty-year-old women entered the seventh pavilion almost simultaneously. And during treatment, one of them learned that her student daughter had died of covid in Moscow. The woman was in acute grief. And the second patient began to support her. When they were discharged, I met them at the rehab center. They became friends and became practically family members for each other.
Photo: Yulia Mokhova, medical psychologist at the hospital for war veterans / courtesy of the press service of the hospital for war veterans
