COVID-19: what can happen to patients with severe symptoms?

How to provide assistance to patients with psychotic personality organization in a security context for healthcare professionals and patients themselves?

People with psychotic personality organization have a tangentially disconnected, unreal and detached way of thinking and live in a world in which they often try to reduce relations with each other as much as possible. What effect will the isolation condition for Covid-19 have had on these patients?

In this article there is the intention to pay attention to a particular slice of patients who have a specific psychopathological picture: we refer to people with psychotic organization of the personality and who, therefore, at least once have presented a profound alteration of the personality and a detachment from reality. Their way of thinking tends to be disconnected, unreal and detached: these people live in a "own" world, built to measure for themselves, in which they often try to reduce relations with the Other as much as possible.

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It is therefore possible, for some, to deduce that a situation such as that which the health requirement forces us to live, that is, of almost total isolation, can only partially invalidate these people; however, even if the quarantine imposed by the Government to limit the contagion from COVID-19 reduces social relations, the current condition can easily stimulate experiences of omnipotence or persecution, just think of the conspiracy theories hypothesized by a considerable amount of people, without any psychiatric diagnosis. In particular, however, people with psychotic personality organization are more likely to experience such experiences, often being these ideas at the basis of their personality structure.

Basics of psychotic personality organization

The psychopathological framework previously described has both biological and environmental causes, that is, it depends on a disturbance of brain functioning that makes it more sensitive to stressful situations , which in turn influence the same functioning, thus triggering a vicious cycle.

More precisely, in the brain there are particular chemicals, called neurotransmitters, which - in people with psychotic organization of personalities - seem to work in an altered way and cause hallucinations , delusions and thought disorders, which seem to worsen in stressful conditions.

Furthermore, scientific evidence shows that the presence of a symptomatic picture persisting over time and relapses worsens the prognosis of the diagnosis and, in the long term, the patient's quality of life.

But what happens to these patients with government restrictions and indications?

As is known, it has been asked to reduce interpersonal contacts to health professionals and therefore, advised to reduce, where possible, also psychological and psychiatric visits. But how is the urgency for these patients assessed? What is the condition that these patients may not see their appointments canceled or significantly reduced?

The intrapsychic pain of these people is not constant but is subject to fluctuation and the more it becomes unbearable the more a symptomatic picture is presented (hallucinations, delusions, and thought disorders): often the severity, and consequently the urgency, is assessed based on the presence or absence of such symptoms.

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It is certain that the presence of the symptoms described above requires immediate intervention, but how much - in this specific case - intervening on urgency acts as a protective measure for COVID contagion - 19 for health workers and for the patients themselves? Often, when these people experience a sense of anguish and annihilation such as to present an aggravation of symptoms, it is impossible to respect the distance meter and the correct use of PPE, Personal Protective Equipment, precisely because of the extreme condition experienced by patients.

Furthermore, given the very nature of this organization of personality, which is constitutionally more vulnerable to stress, it is conceivable that, in this alarm period, instead of reducing psychological and psychiatric visits, these should be maintained if not increased before a worsening, being able - in less compromised situations - to respect the safety distance and protective measures.

In some cases, professionals were advised to change the setting by promoting psychological interviews and telemetric psychiatrists ; however, it is possible that the Mental Health Centers, where many patients with psychotic personality organization belong, for organizational reasons, are unable to provide the aforementioned health services immediately. Furthermore, these patients are not used to having a high level of awareness of their own discomfort and, for this reason, they tend to be little compliant with the care given to them, and probably - in some cases - also with the change in the therapeutic setting.

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Finally, a final aspect that deserves attention is the total suspension, promoted by the Healthcare Companies, of the services performed by psychotherapists and psychologists, in the role of volunteers or trainees, which has resulted in a sudden interruption of the ongoing treatments and, probably, updated a trauma in patients.