A team of researchers from the HSE Centre for Cognition and Decision Making and the Central State Medical Academy conducted a study on sleep disorders, mood and fatigue after COVID-19. These factors are interrelated and the researchers recommend a comprehensive approach to treat the problem effectively. The work was published in the journal Neuroscience and Behavioral Psychology.
Several factors complicate efforts of studying mental health during an epidemic. First, the use of different questionnaires can distort the results and, second, the results can be interpreted in different ways. Additional difficulties in examining patients and conducting the research during the epidemic can also arise. Doctors and researchers have difficulty conducting their study if the patient is in quarantine and cannot receive assistance due to stress from prolonged isolation and a weakened state caused by the virus itself. Therefore, doctors and researchers use telemedicine technologies more often to communicate remotely with patients. Coupled with the appropriate hospital equipment, it becomes possible to conduct psychiatric and psychological examinations that do not require a physical presence. Such measures create conditions under which the doctor can provide assistance without entering the ‘red zone,’ in a manner that is comfortable for both the physician and the patient.
The study involved 119 hospitalized patients with confirmed COVID-19 diagnoses who completed four questionnaires for depression, anxiety, fatigue and sleep disorders. Patients with higher than average scores in the results of questionnaires also underwent psychiatric interviews.
The survey found high levels of mood disturbances and sleep disorders among study participants. In all, 28% of respondents reported a decline in mood, 27% experienced a disruption in the quality of their sleep, and 73% suffered from fatigue. Higher levels of fatigue increased the risk of anxiety and depression. Likewise, increased anxiety and a decline in mood also affected overall vitality.
Such results indicate that depression can make people who have recovered from COVID-19 feel less vigorous in their daily lives. Doctors often attribute patients’ rapid loss of energy to the organic consequences of the infection, losing sight of the anxiety and mood disorders that can be masked by the infectious disease. Such an approach can result in a protracted course of asthenia during recovery from the illness, despite favorable physiological parameters. The results also showed that increased anxiety and depression have an effect on the quality of sleep.
Ainur Ragimova, Research Fellow at the HSE Institute for Cognitive Neuroscience, says that “although the relationship between mood and sleep disorders is intuitive, it is important to examine them carefully and separately especially in patients after COVID infection. Oddly enough, this aspect is often overlooked in the clinical examination of patients with COVID-19. Their sleep problems are more often attributed to physiological disturbances such as the consequences of a stay in intensive care and the effects of a prolonged lack of movement, but not to mood disorders. Our data once again underscores that when patients complain of sleep problems, it is necessary to screen their mental state both during their illness and after their quarantine has ended.”
Foreign studies have looked at the high prevalence of mood and sleep disorders in coronavirus patients during the current and past epidemics. For example, according to Italian studies, anxiety levels have increased from 5% to 36% and sleep disorders from 27.6% to 51.2% during the current epidemic.
The data obtained support theories about the relationship between sleep disorders, mood and fatigue. One of these aspects is often missed during patient exams. For example, when a patient complains of mood disorders, the doctor might fail to ask if the patient also experiences sleep disorders, and vice versa.
It is no easy task to treat mood disturbances, increased anxiety and impaired sleep quality in COVID-19 patients during their illness and recovery. First of all, the authors note, the drugs prescribed should be compatible with physiological indicators and test results (functions of the lungs, liver, kidneys and cardiovascular system) and should be checked for cross-interactions with the main drug treatment. The authors recommend prescribing low doses of non-benzodiazepine anxiolytics (benzodiazepine tranquilizers can adversely affect weakened respiratory systems) and selective serotonin reuptake inhibitors. The prescribed treatment must be monitored by a doctor and the prescribed doses should be carefully tested and titrated.
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