CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Taking Care of Patients During
the Coronavirus Outbreak:A Guide for Psychiatrists
The potential for the rapid spreadelements including police,
In the early stages of an infectious diseaseof infectious diseases is a growing
firefighters, schools, and families.
threat. In the early stages of anThe following can help healthoutbreak such as the novel Coronavirus
infectious disease outbreak such ascare professionals support patients(COVID-19), there is frequent uncertainty
the novel Coronavirus (COVID-19),
during COVID-19 and other
there is frequent uncertainty about
infectious disease outbreaks:
about the nature of the disease, its
the nature of the disease, its spread,
Stay informed. Obtain the latest
spread, scope, and impact.
scope, and impact. This often leads
information about the outbreak fromto emotional distress, even among
credible public health resources,
those who have not been directly exposed to the disease.
such as the Centers for Disease Control and Prevention
Common psychological and behavioral responses(CDC), in order to provide accurate information to yourinclude distress reactions (insomnia, anxiety, decreased
patients.
perception of safety, anger, scapegoating, and increased
Correct misinformation. Misinformation can spreadpresentation to healthcare due to fears of illness), healthquickly and easily, causing unnecessary alarm. If patientsrisk behaviors (increased use of alcohol and tobacco, altered present you with inaccurate information related to thework/life balance, social isolation, increased family conflict, outbreak, correct their misconceptions and direct them toand violence). Children and adolescents may also becomevetted public health resources.
distressed, which can manifest in “misbehaviors”, social
Limit media exposure. Encourage patients to limit
isolation, or diminished academic performance. A minority media exposure. Today’s 24-hour news cycle can make itof individuals will develop disorders, such as depression,difficult to turn away media, but research has shown thatanxiety, or posttraumatic stress, that require formal
excessive media exposure to coverage of stressful eventstreatment.
increases negative mental health outcomes. Recommend
During the COVID-19 outbreak, most patientspatients (and providers) use trusted media sources to gather
with preexisting mental health conditions will manage
needed information, then turn them off.
adequately and some may improve their functioning inEducate. Psychiatrists are in an important position to
the face of the challenges and needs of others. However,influence patient behaviors for protecting individual, family,
psychiatrists are likely to encounter some patients who have and public health by educating patients, collaborating withincreased emotional distress resulting from the outbreak’s
primary and emergency care providers, and providing
impact on them, their families, and their communities.
consultation to healthcare and community leadership.
In working with their patients, psychiatrists should: 1)
Useful information includes common psychological andacknowledge concerns and uncertainty about emerging
behavioral responses to infectious outbreaks, interventions
diseases, 2) share medical knowledge that is accurate andto manage distress and risky health behaviors, and thetimely, and 3) identify steps the patient can take to reduce
importance of skilled risk communication in managing
distress and sustain normal health behaviors, particularly
population mental health (See resources below forsleep.
additional information on these topics).
Psychiatrists can also play important roles in supporting
Inform about stress reactions. Distress is common in
healthcare providers, as well as consulting to community
the context of the fear and uncertainty caused by outbreaks.
leaders on interventions that encourage healthy population
Help non-mental health medical colleagues anticipate andbehaviors and support the needs of critical community
respond by:Continued

a. Acknowledging and normalizing distress reactions (“Isee that you’re distressed, and that’s understandable.
Many people are feeling this way right now.”)b. Teaching patients to recognize their own distress
reactions and health risk behaviors, and encouraging
them to self-monitor and/or check-in with family
members or friends. Managing these responses early
can help so that they do not become impairing.
c. Discussing strategies to reduce distress, including:i. Staying prepared (e.g., developing a personal/family preparedness plan for the outbreak).
ii. Taking everyday preventive measures (e.g.,frequent handwashing, cough etiquette).
iii. Maintaining restful sleep, eating regular meals, andexercising.
iv. Limiting use of alcohol, tobacco, and other drugs.
v. Talking to loved ones about worries and concerns.
vi. Practicing calming strategies including
diaphragmatic breathing and muscle relaxation.
vii. Engaging in enjoyable hobbies and activities.
d. Refer to specialized mental health care or emergency
evaluation when a patient experiences severe emotional
distress, develops a recurrence or worsening of mentalillness, regularly uses substances to manage negative
emotions, or has thoughts of harming themselves orothers.
Identify and support high-risk patients. Patientswith delusions, obsessive-compulsive thoughts andbehaviors, a predominance of somatic symptoms, otheractive and uncontrolled symptoms, or those previously
exposed to severe trauma may be particularly vulnerable.
More frequent clinical contact can help address emerging
concerns, which may help avoid severe exacerbations orhospitalizations. Ensure patients have adequate suppliesof medications to avoid interruption in dosing duringpotential disruptions of pharmacy supply chains.
Take care of yourself and your loved ones.
Psychiatrists are not invulnerable to experiencing
emotional distress during outbreaks, and this distress canbe compounded by caring for distressed or ill patients.
Make sure to care for your needs: hydrating, eating, andsleeping; taking breaks; checking in with loved ones;
practicing strategies to reduce distress; and monitoring
yourself for stress reactions. Ensure that your office ororganization has a plan to monitor the course of theoutbreak and adjust your response to ensure adherence tothe most current guidance.
Resources:
Centers for Disease Control and Prevention COVID-19
Info Page.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/
index.html
Psychological Effects of Quarantine and Mitigation
Strategies.
https://www.thelancet.com/journals/lancet/article/
PIIS0140-6736(20)30460-8/fulltext
Taking Care of Your Family During Coronavirus
https://www.nctsn.org/resources/parent-caregiverguide-to-helping-families-cope-with-the-coronavirusdisease-2019
Healthcare Provider Self-Care During Outbreaks.
https://www.cstsonline.org/assets/media/documents/
CSTS_FS_Sustaining_Well_Being_Healthcare_
Personnel_during.pdf
Educating Leaders about Helpful Communication
Interventions During Outbreaks.
https://www.cstsonline.org/assets/media/documents/
CSTS_FS_Coronavirus_Leaders_Guide_to_Risk_
Communication_in_the%20Face_of_Emerging_Threats_Outbreaks.pdf

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org