Psychological Effects of the COVID 19 Pandemic in Individuals & Families

Substance Abuse & Addiction During the Covid Pandemic

Kemah Palms is an adult residential substance abuse program located in Kemah, Texas, so for those of you that maybe aren’t in the Houston area, we are South Houston towards the coastline about 45 minutes south of Houston. If you are in the area and you know where the boardwalk is, we’re about a mile from the boardwalk. So that’s kind of our general area. We have 10 detox beds and 24 residential beds. So in the we have two homes that sit in a residential neighborhood right next to each other. So we have the detox home where we have twenty four hour nursing. We’ve got our our doctors that are that are in that out of that building primarily. Well, there’s 10 beds there, so we’re able to handle a full medical detox, we’re also able to work with people with a little bit higher medical acuity. So if you have someone that you’re not sure that this person would be a good fit for this place or that place, definitely give us a call because many times we are able to work with those with those clients and the residential home, it’s a twenty four bed home. Again, we’re able to work with higher medical acuity. So if they’ve got some physical handicaps and things like that, we’re able to accommodate those we do specialize in in chronic pain, so we treat substance abuse as a whole. But one of the specialties that Kemah Palms does is specializes in chronic pain.

So we do have a lot of people that come in that are needing some, some physical, what’s the word I’m looking for? Well, my brain quit. That’s OK. So things like walkers and things like that, we’re able to accommodate that. So I always let people know that with the chronic pain program, we do have chiropractor, we’ve got acupuncture, massage therapy. So it really is a true pain program that’s catered towards these people with with chronic pain. If you want more information, I am going to put my my information in the chat bar. So you guys make sure and save that in case there’s any issue with eval or you don’t get your eval, things like that for CEUs or if you have any questions regarding referrals. We do EMDR. So most of our clinicians are master level clinicians, and several of them are EMDR certified. We don’t do EMDR with every client, so I do want to be very clear on that. My counselors are always telling me, Make sure you’re tell them Krystle, tell them correctly. So we don’t want to crack somebody open and then send them home. So Kemah Palms will do 30, 60 and 90 day treatment. So if there’s someone that can do the longer term treatment with us, then we’re absolutely happy to work. EMDR work some of that trauma, but we may just work on, you know, doing a seeking safety curriculum for the for the present focus trauma unless they’re there for that longer term.

We are dual diagnosis clinic. Dr. Shoaib is our psychiatrist, so we’re grateful for that. Lots of people need that service as well. And then we are a network with most major medical insurance. So if you ever have a client that’s wanting to utilize insurance, ninety nine percent of the time, we’re able to take that. So you’re definitely welcome to give us a call. Again, I’m going to put my information in the chat bar. So if you ever have a referral or questions about a referral or Kemah in general, or if you want to be a part of our webinar series, please don’t hesitate to reach out to me and I will get you whatever information is needed. So really quick, I’m going to talk about the emails and then I’m going to pass it off to Dr. Shoaib. So CEU how I know that you guys participated today is that that I’m able to pull a report after and Zoom tells me that you were in the webinar. So just make sure that you’re not watching with another. I noticed a couple of someone had said they were watching with someone else. You do have to be signed in under your own registration for me to to see for our records in case we ever anybody wants to see those. So what will happen is after the meeting closes this afternoon, I’ll be sending out EVALs to everybody that’ll get that’ll go out in the email that you registered for the event in.

So watch your emails. Once you get that email, fill it out and send it back to me and then I will. I will email you your CEU certification. So if you have questions, let me know I’ll be kind of keeping an eye on the chat bar. I am going to run the PowerPoint for Dr. Shoaib, so I’m going to pass it over. This is Dr. Shoaib. He is our medical director of psychiatry here at Kemah Palms. So we’re super grateful to have you. Well, thank you very much, Krystle. Thank you for such a nice intro. I can tell people that Kemah Palms is the best program for detox and rehab in South Houston. You know, the services that that you said we provide. I think we provide those and then a whole lot more in compassion and care. And that’s why people, whenever they have to go back to treatment, they choose to come back here. So it’s a pleasure and an honor to be working with an organization such as Kemah Palms. And you know, the staff is just wonderful as a whole. All right, so let’s get started since we are a little tight on time. So the reason I can put this together was that as a physician, you know, when all this started and information started coming out, it was confusing for me as a doctor. So I was like, OK, well, if it’s confusing for me, I’m pretty sure it’s confusing for other people as well.

The Phycological Effects of World Disasters

So I sat down, put some stuff together to kind of make sense out of it. And then, you know, I decided, OK, you know what? I think this is something I should share with other people so that at least you can give them an idea of what this whole thing is about and what they’re feeling if their feelings are kind of justified and normal. And also to see, how do you deal with this situation? So we’ll kind of go with different groups that I have identified and separated, you know, and then we’ll talk about them and how they are affected by this whole thing and how we’re going to go about helping them out. All right. So let’s move on to our next slide. So when we look at this whole situation right, it is it is a disaster slide. So do we call it a disaster, right? So it is an infection, right? A pandemic is not a war. In most of the time that people think about disaster, they’re thinking about wars. They are thinking about, you know, hurricanes. They’re trying to think about tornadoes that destroy things. Well, you know, we have not seen any destruction of anything except for it has all the makings of a disaster. Right. It has created uncertainty, which is very typical of disasters, you know, and people’s lives, their day to day functioning. They are experiencing things that they had never expected.

You know this, this is unusual. This is unchartered territory, so it is difficult for them to deal with it. Right. So, OK. So now what happens is so we are talking about the information overload. Let’s talk about information. What? What does that mean? You know, there’s too much information out there and this information is inconsistent coming from the highest levels of government. You know, these are people we are looking at, you know, our government, W.H.O., CDC, and when we have mixed messages coming from there, it becomes very difficult. Well, let me go over a few examples. So anyway, when it came out, somebody said it’s just like a flu. It will blow or in a few days or weeks. Right? Subsequently, lockdown was enforced, meaning it was not going to win a few days, a few weeks. Then came the information. Ok, well, you don’t need to worry about wearing masks. There’s no human to human transfer, you know, then later on. Ok, yeah. Maybe we should wear a mask, but you can wear a bandana, you know, if you need to. Then it kind of changed again and it can be like, OK, everybody should be wearing a mask. Right. So we have gone from one extreme to the other. No need to do anything to wearing a mask all the time in public places. Then there’s no need to wear gloves because, you know you won’t have any kind of transfer from person to person on surfaces.

Then the information came out where, oh, it can be transferred from surfaces and it can be transferred from people to people like when you shake hands so you know you have to do this distancing thing. So now, you know, the information says that the gloves will actually prevent infection. Right? That’s pretty confusing right there. So what happens when these kind of things happen? Then we talk about uncertainty, right? Going back to that. So all this kind of mixed information, what it does is it gives us kind of an uncertain, uneasy feeling, right? Like I said, transmission person to person. Is it airborne? Does it get transferred from clothes? Yes, it does. No, it doesn’t. Ok, then we don’t know what the mechanism of infection is, right? Where does the infection start? Some people say upper respiratory tract. Some people say die. You know, we look at the symptoms. Initially, there were there were few symptoms. Not that basically every symptom that you can have in flu or cold is part of the symptomatology of of COVID 19 infection. Ok, then the information about who is at risk, right? Initially, they said very young and elderly people, so they left people like the teenagers and young, healthy adults, you know, out. So they thought that, hey, we are immune so they can go out, they can party. There’s no problem with them. But guess what? We have seen teenagers as well as healthy young adults succumb to this disease.

They get infected and some of them die. Ok, then this question about OK, how many strains are out there, right? There’s one, two, three different strains, OK, the virus is evolving. Or are there separate strains that are already there in the community? Then the question came, Are you immune? Once you have recovered from the infection, can you get infected by another strain of the same strain if you get exposed again? No clear good answers. What does that lead to? Leads to uncertainty, which leads to anxiety. All right, let’s move on to a nice right. Then there was information about treatment, right? So can it be treated with chloroquine? If you all remember, you know, suddenly that chloroquine was the malaria drug was the treatment of choice. Well, later on it was said that no, it is not. It causes cardiac problems. It is ineffective. Then, you know, OK, our antiviral is going to help. So there are a lot of, you know, I mean, this is an evolving situation. Many medications are being tried. Vitamins,  zinc, you know, you name it, people are trying it, get even the nutrition, you know, but we don’t have that answer. Ok. And then, you know, the question arose about the ventilators. Everybody probably remembers that we didn’t have enough ventilators. So there are companies who are making ventilators. Well, guess what? Then we found out that ventilators don’t necessarily save lives.

Some people said the ventilators actually kill people. You know, again, like, not that everybody needs to be on ventilator, but some people do. Some people don’t. But again, the information that is coming out is very confusing. You know, leads to uncertainty leads to anxiety. All right. So now, so looking at all the information, we realized that, you know, yes, this is a disaster. Ok? And when you look at disaster, you know, there are a lot of studies that have been done on disasters and how people respond to it. So any disaster, especially in this case, you know, it can lead to despair because there’s so much anxiety, so much uncertainty. You’re anxious. You’re worried. You know, the mind switches from living to survival mode. Ok, what does that mean? You’re living mode is day to day functioning. You get up in the morning, you shower, you have your breakfast, get on with your life, go to work, come back home, sit with family, have dinner or whatever, and then you go to bed. And then the life starts again. But it’s survival mode that is not the case. Now, suddenly you feel that you have to protect yourself and your family. People become very selfish. People become very aggressive. Hence, you have seen that when you go to a grocery store, especially initially when it all started. All the shelves were empty. Things that nobody would need for a disaster. They were gone. You know, you talk about toilet paper.

You talk about hand sanitizers. You talk about bread. You talk about anything. I mean, people were getting stuff more than than they would need for a whole year. Ok, why? Because of the uncertainty, they were not sure how long this is going to last and how bad is going to get. They were not sure if you’re going to get supplies back. I mean, we are hearing constantly from the state officials, government officials. Don’t worry about it. We are working on it. We’ll make sure that everything is supplied to the stores. People are still not believing. I mean, I had experience where I was at the store trying to get something and this my, you know, little old lady. She had her cart and she was just banging through the carts, you know, and through this stuff and pass everybody not caring about anybody. I mean, that is the kind of behavior that’s not usual. You know, normally what I have experienced is like, you know, if I go to get something and there are two items left and there’s somebody in front of me, they will take one and leave one for me. Now what’s going on is if you have five items on the shelf, they will just take all of it and dump it in their cart, not worrying about if there’s anybody else who needs the same item. So that is going to survival mode. You know, people become very aggressive, very selfish, you know, and self-centered thinking that they have to protect themselves and their families.

General Adaptation Syndrome During a Pandemic

So that’s why the behavior shifts. All right. So, in response to the disaster, there’s a syndrome that has been identified. It was identified by a Canadian scientist, Hans Selye, and he called it general adaptation syndrome. In short, GAS. So he identified three different stages. You know, our psychological response to body of the body to this stress. So first stages along stage or what we are used to fight or flight stage, right? So body starts to produce stress hormones such as cortisol adrenaline, which lead to increased heart rate, increase energy increase blood supply to basically your muscles and actually your whole body if you think about it. So if you get, like, really, really scared or really, really startled, you notice these changes within your body, right? So that’s usually just kind of acute state that just happens, and it tends to kind of calm down because during this time, you are preparing to protect yourself or your loved ones or your property or whatever it is. That is important to you. So second stage is called resistance stage, right, so the next slides are resistance stages like body tries to get back to normal. You know, our bodies are made such that they have a tendency to actually go back to what we call factory setting. Right. So body wants to go back to normal to to, you know, go down, ask for the hormone levels concern because too much, too much of stress is going to create too much production of the hormones, which are not good for out, right? It is acute stage that we need them for.

So but if the stage becomes chronic because the disaster is ongoing, right, it didn’t just happen and get over it, it actually is still ongoing, right? In case of that, you know, there’s a continued stress. Then what happens is the body gets exhausted, you know, so exhaustion. Ok. So the exhaustion stage, what you what you see is this unrelenting chronic stage, you know, that triggers anxiety and depression. This leads to anxiety and depression lead to actually lowering of the immunity. Stress also causes other health problems due to the effects on insulin and other hormones that will touch on that a little bit a little bit later. All right. Moving on next slide, talking about the response to disaster. So the disaster in itself triggers health anxiety. You know, you worry about the possibility of contracting the illness yourself and dying from it, or the possibility of your loved ones getting infected or infected and dying. You know, so it’s not just your health, but you’re also worried about health of your loved ones. And then of course, there is decreased job security. I mean, we know that a lot of people have lost their jobs, you know, their source of income. Some of them were the only ones in a family that were the providers.

Right. So that, of course, leads to concerns about financial security, which leads to more stress. And all of this is real. All right. So let’s talk about so when this disaster is ongoing now, suddenly, you know, officials decide that, OK, they are going to put us into quarantine. All right. So what does quarantine do normally if you are a person that doesn’t leave the house ever and you’re perfectly fine with that as soon as you’re told that you are in quarantine, guess what? You suddenly want to go out. You want to go to a restaurant, you want to go watch a movie, do something different. You know you want to get out because, you know, now you can’t. Right? So what that does is social withdrawal and isolation happens because the quarantine, which triggers feelings of hopelessness and helplessness. Now we have to remember that hope is the the best weapon we can have, you know, against any kind of disaster, any kind of problem. As long as you hope you’re ready to fight and, you know, do whatever you need to get better. If you lose hope, then everything is lost. You know that people just kind of give up on everything they don’t even try. So, OK, so it becomes difficult to distract from the crisis at hand because you’re constantly bombarded by the information. Now, people who have poor coping skills tend to turn to unhealthy ways of coping with stress, right? So let’s look at some of those in the next slide.

The Rise of Substance Abuse During Pandemics

So what are some unhealthy habits that become prevalent during this time? People start drinking, so people who are not drinking, those are drinking or the ones who are already drinking increase their alcohol consumption. And we have seen this actually in our patient population. We have had several admits, you know who the other people who are doing pretty well. But then there’s COVID struck and they were stuck at home and guess what went back to their drugs alcohol? And the problem with alcohol is that it is easily and abundantly available. I mean, if if a grocery store is open, they have alcohol. Guess what? They can get it from there. They don’t even have to go to a liquor store. Drug use tends to go up, especially marijuana, because a lot of times people believe that marijuana is OK because it’s legal in most, many states. Well, part of the problem is that not everybody can stand all the drugs. You know, I’ve seen marijuana causing psychosis in people. I’ve seen marijuana causing anxiety in people. I’ve see marijuana causing other problems in people. So again, it’s a bad idea from, you know, to do rely on those things, but it does go up. Cigarette smoking, you know, people who smoke a lot of time. When I talk to people, they’ll tell me, Hey, I smoke cigarettes. I’m not doing drugs. Guess what? It is probably as bad as any drug.

It is a slow poison, so it’s killing you. And unfortunately, during this time, time of stress. Cigarette smoking goes up because nicotine. Is a stimulant, so it helps them kind of deal with the situation, think better, think faster. But unfortunately, it doesn’t go anywhere. Then people start to stress, eat, you know, eating unhealthy things such as carbohydrates, fried foods, drinking sodas, you know, full of sugar, caffeinated sugary drinks, of course, which leads to weight gain and other health problems, especially in people who already have health issues. All right, so let’s talk about the health effects now. So what does stress do? You know, stress causes worsening of the medical conditions in patients with hypertension, for instance. You know, they start having spikes in the blood pressure despite taking their medication regularly. You know, I’ve seen patients with diabetes who have been stable on insulin or other medications. Suddenly, you know, they have spikes in their blood sugar. You know, it becomes unstable. They need more insulin or they need to change their medication. Patients with heart conditions, they start having problems as well. Patients with immune disorders, they start seeing seeing a spike in their symptoms. So I mean, in general, stress affects every part of our body. People don’t realize it. But you know, our medical conditions are directly related to our psychological condition. All right. So. And now what let’s talk about, you know, different groups. Ok, let’s talk about the single individuals right now.

The Effects of Pandemic Isolation on Substance Use and Addiction

Single individuals in general who are living by themselves in quarantine, stuck by themselves. They are more prone to becoming depressed and anxious. You know, OK, well, why do I say that? If you think about it, you know, in our legal system, solitary confinement is the harshest punishment, right? If somebody is bad, somebody is acting up, what do they do? Put him in the solitary so that they don’t have any interaction with others. They can talk to people. They can’t do anything. Guess what? Humans are social animals, right? We have heard this since we were kids, and that is true. We need to have an interaction of the people in a verbal interaction, physical interaction. We need to be able to talk to people. We need to be able to see people. But unfortunately, in this situation, a lot of these people are stuck in their apartments and their houses by themselves. So what happens? This leads to anxiety, which also can lead to depression and in severe cases in people who are prone to it, it can also lead to psychosis. Paranoia may develop outright, you know, psychotic other psychotic disorders, such as hallucinations, may happen. Then unhealthy activities such as online gambling goes up. Watching porn goes up. Of course, all these things affect their body and soul. I mean, a lot of these people feel very guilty for doing these things. They are not only burning money, but, you know, having other problems and then having to deal with guilt again, more depression.

They may start using drugs that they were not before. Like I mentioned earlier, marijuana may may be the drug of choice as he’s easily available, and they feel that it is OK to take because legal in certain states, they may start abusing other drugs or alcohol. May in extreme situations, they may start developing suicidal ideation risk, especially higher in individuals who are elderly and who are lonely. All right, so next, next move on. Let’s move on to the next group now. Let’s talk about the elderly, right? So many of the elderly couple couples live by themselves, right? Many feel lonely because their children are too busy to come visit. Or they may be avoiding them because they don’t want to expose them to the virus. You know, remember, it affects the elderly more, and we have seen people in nursing homes getting sick, getting severely sick. You know, so yeah, they may be avoiding going to see their parents, but then that causes more anxiety and depression in these people. You know, they start to worry, they start to worry about their own safety and that of their children. A lot of times these elderly people are on fixed incomes, you know, so they become financially stressed because of situations and disaster situations like this and the uncertainty related to that. All right. Now another problem that happens with these people, since a lot of them are not driving, they are dependent on others to take them to their doctor’s appointments right now because of the disaster.

A lot of the doctors, including myself, have switched to telemedicine. Now, a lot of these people are not tech savvy. It is very difficult for difficult for them to log on to a computer and then you get on a link and start seeing a doctor. And a lot of these people don’t feel comfortable doing that because they are, you know, from a different era. They are from from a time when you see your doctor, you hug your doctor, you talk to your doctor. So it’s different for them to get on on line and see their doctor. But a lot of them are not even able to do that because they don’t have the means to do that right. So not being able to see their doctor, a lot of them are not able to fill their medications, right? They may start feeling hopeless, they they start feeling helpless, you know, because all these things are going on that are out of their control. Ok, depression may set in, early and easily. Many of them, you know, already are depressed. They are already dealing with physical illnesses, mental illnesses, and this kind of enhances the whole experience. All right, the couples may start fighting and arguing, right, spousal abuse may happen this real, especially in disaster, when people are frustrated, they don’t know what to do with the situation, they will take it out on the other person.

Increase of Suicide Risk During the Pandemic

The suicide risk is high in this population, especially when they start feeling hopeless, helpless and feel like nobody cares for them. All right, so let’s move on to the next group, which is the families. Right? So now when you look at the family, it’s more complicated than individual right because there are a lot of people involved, a lot of dynamics involved. So, you know, because of the disaster, the loss of employment for either one or both parents. So you look at it like, OK, here’s a family where there are two parent income and things are pretty good, easy going. And then suddenly one or both lose their job. So suddenly the income has gone down to half or none. Right. So financial stress sets in, especially if they don’t have any savings to rely on. Right. So taking care of the family may seem like a burden to these people, the caregivers. They may not be able to engage in leisurely activities. You know, going to movies, going to restaurants, going to outings, you know, taking kids or even the couples themselves, being able to go out and have fun. They can, partly because of finances. Other part is because of the COVID infection and then the risk of getting sick. The children in the House may get bored because, you know, they have been out of school and they are missing their friends, so they may start argue and they may start fight with each other, putting the parents in the middle, you know, trying to kind of deal with their problems.

Youth Suicide During the Pandemic

Now, a lot of the schools have switched to online schooling, right? The schools were not prepared for that. Neither were the families. So the parents are required to help the kids with their schoolwork. Guess what? A lot of these parents are not familiar with the school stuff that the kids have. Right. So they can’t help their kids and when they can’t help their kids, it stresses the parents out and it stresses the kid because they look up to their parents and expect that they will take care of them and they will help them in any way. Unfortunately, when they can’t, then the frustration rises on both sides. Excuse me. So and then what? What else can happen? You know, children may demand for things right that the parents can’t fulfill increasing their frustration on both sides and the parents side because they feel guilty for not being able to provide for the kids what the children want. And for children who are who may be used to saying something, parents are doing it for them now. Suddenly, that’s not happening, right? Parents don’t have any downtime. Kids are at home. I mean, a lot of the families, when I talk to parents, they are. They are appreciating how much the teachers do for their children because now they have to be with their children. Twenty four seven in the house every day for several months now.

Increase of Child Abuse During the Pandemic

You know, they actually don’t have their downtime. A lot of these parents, moms, dads, when the kids are in school, actually, they do their own things. They have time to take care of themselves or their own needs. Now they don’t, you know, they don’t have any privacy. And because of that, the frustration may arise. The anger may rise. Child child abuse and spousal abuse, which is the reality. You know, I’ve seen some cases of that as well. And extreme situations, actually, it can lead to divorce because a lot of these people are not used to being with each other every day, all the time in each other’s face, you know, so the frustration rises. Suicide in this group also becomes a risk factor, especially for the primary wage earner. Why? Because they feel like they have left. They have let their families down. They feel guilty. They feel depressed. They feel the pressure to be able to provide, you know, for the family. And when they don’t have good coping skills, guess what? They start feeling dejected. They start feeling like their failure. And that can actually lead to suicide, which is, of course, an extreme situation, unfortunately. Ok, now let’s talk about children, right? That’s the next group. Children basically watch and hear everything that happens around them, so we have to keep that in mind. A lot of times parents are bickering or talking or arguing, not realizing that children are watching everything and hearing everything OK.

It affects them. Whatever happens, if they see the parents fighting is going to affect them negatively. If they see the parents loving and caring for each other is going to have a positive feeling. So not knowing enough about a pandemic, they may start developing their own ideas. Ok, and of course, their ideas are very black and white. They’re thinking very black, black and white. So there may be unrealistic, such as their parents or other loved ones dying and leaving them to take care of themselves, you know, which increases anxiety. Right. So that’s not the reality, but to the child, whatever they feel, that whatever they see is what they believe. Right? Children may start having sleep problems. They may start having nightmares, especially the situation in the household is unstable. You know, for instance, like parents bickering and fighting or somebody in the household being sick or finding out that, you know, one of their relatives is sick. All right. So let’s move on to the next slide so your children may, may start. Younger children, especially may start bedwetting again. You know when they have been dry for a while. Right? Which, of course, leads to an anger response from the parents because they get upset. It’s like, OK, you are fine. And now your bedwetting. So that’s more work for me, and I got to wash more clothes, your whole bedding and everything else. Increase the stress on the parents and then inability to see their friends and family also creates anxiety.

A lot of these kids are missing school. The ones that didn’t want to go to school are missing school, not because they miss their teachers. They miss their that interaction with their friends, with their buddies. Ok. And missing that can also lead to anxiety and depression. All right. Then they may become cranky, very cranky, clingy, needy, demanding attention from their parents because I mean, look, that is the only thing they have available, you know, especially if it’s a single parent is even more stressful for them. Parents are already stressed out, OK? These kids, because they’re not feeling good, because they’re feeling anxious, because they’re feeling depressed, you know, they’ll start fighting and arguing with each other, creating more stress for the for the parents. And some children will develop anxiety, generalized anxiety, depression, and I’ve seen a few that actually have had their first panic attack now. So I mean, we have to keep that in mind that children are not immune to psychiatric disorders, especially under chronic, unrelenting, ongoing stress. All right, now, let’s move on to teenagers, right? So this is the group that has answers to everything, right? So these guys have a sense of entitlement. They think they’re better than adults. A lot of these kids, you know, being stuck in the house, not being able to do, I mean, to them, if you think about it, you know, their friends are, are their life, you know, they are moving away from their parents and now they’re trying to establish their own identity.

So they are missing that, you know, that group and hanging out with them. So a lot of these kids, when parents, you know, put pressure on them, them that they can’t leave them and become actually truant, they may develop to behavior. They may start to rebel. They may argue with their parents. They usually are you anyways. They may start fighting with their parents, you know, asking for for for more freedom, more control. In some cases, you know, older siblings, they start bullying their young younger siblings because they’re stressed. They are frustrated. So it’s just easier to take it out on someone else and who better than the younger sibling. In certain cases, like I mentioned earlier, you know, when the information came out that, you know, it was not affecting the teenagers and young adults as bad. You know, a lot of these people, these kids thought they’re they’re fine, they can leave the house and they would, you know, skip the house in the middle of night, sneak out, hang out with friends, use drugs, alcohol. You know, a lot of them, actually, because of their lack of freedom, may start feeling that, you know, anxiety. A lot of them may start feeling depressed, which of course, increases the likelihood of them using drugs and alcohol in an attempt to self.

How the Pandemic Effects Those With Existing Mental Illness

All right, so let’s move on to the next group, which is the people with known mental illness or chronic severe medical conditions, right? This is a group that is already vulnerable, right? Most vulnerable population.

They have a lack of good support system. And you know, the whole stress of this situation can make them decompensate, you know, 50 to 60 percent of the patients with depression, OCD, anxiety. I mean, they will decompensate during this time if the stress continues right. They may stop taking their medication, either they ran out because they ran out of the medication, or they may stop taking it because there is no supervision. A lot of these people were dependent on a caregiver to come and fill their medication, you know, boxes or give them medication. And when that doesn’t happen, they don’t take their medicine and they don’t take their medicine. Of course they can decompensate, you know? And then, of course, ongoing stress and uncertainty, despite taking their medication can make things worse. Right. So this is a group that should be helped in getting to their doctor’s appointments, to their therapy appointments, getting their medications, you know, and these medications should be supervised. And a lot of these people are not, you know, who are very old or very sick. They are at very high risk of accidental overdose. They may not. Some of these people don’t remember they took their medicine or not or know how many pills they took. It’s very easy for that to happen.

They should be attended to and should be taken care of as they are at very high risk for suicide. Because once hopelessness, helplessness and depression develops, the likelihood of that happening goes substantially higher. All right, let’s move on to the group, the group that we call our heroes. These are the frontline workers. Ok. These are the people who are are fighting the fight for us, right? The doctors, the nurses, the. Firefighters, the EMT personnel, other health care workers at the hospital that that are working in the shadows, in the background, who are making the hospital work right. Things don’t get cleared up by themselves. The floors don’t get cleaned and disinfected by themselves. Somebody is doing all this work and it’s like clockwork, right? If any anybody stops. Guess what? The machine stops. So these people are at actually risk. You know, they are treating very, very sick people. They watch people die. They take care of people that they know are going to die. And sometimes their colleagues are dying. I mean, I personally know of doctors who have died because of this COVID infection who are actually very healthy. Ok, so why does that happen? You know, working long hours with very little rest leads to exhaustion. I mean, these people are not actually able to take care of themselves. They’re not able to to eat, drink, hydrate themselves, take care of themselves properly. And then a lot of these people are not even going home.

They are not able to be close to their loved ones. A lot of them alone are doctors and nurses who are staying in hotels in order to avoid exposing their families to the virus. They don’t want to bring the illness to the house, right? And when this happens for a long time, that’s what. Certainly now this person is lonely by themselves. They come to work, work like, you know, crazy hours, very stressed out, stressful situation. And then they go in the hotel room or motel room by themselves with no interaction with their loved ones, so they worry about their families. All right. So then, you know, a lot of the doctors unfortunately don’t have safety equipment, you know, proper safety equipment. I know there are a lot of people are actually using reusing the equipment or they are expected to reuse the equipment that used to be used just one time. But now they are disinfecting and using again, OK, not getting time for proper meals or hydration, worrying about getting infected themselves and infecting their family members. You know, these people may develop grief, anxiety, depression and PTSD. You know, and there have been cases where these people have developed suicidal ideation. You know, there are certain thing, something called survivor’s guilt. You know, they’re actually couples who have been in medical profession, who have been taking care of these patients. And one died the other, the other one survived.

And there have been cases where both died, leaving the family by themselves. So I mean, this is a real danger. You know, they may develop suicidal ideation. And, you know, like I mentioned earlier, that they may indulge in unhealthy and dangerous activities for two reasons. One, they feel like nothing to lose, you know, because in their mind, they have thought or decided that, you know, at some point in time, I’ll develop the infection and I’ll die. Or they may think, OK, well, you know, I will not develop the depression. It’s almost like a teenager, in which case, unfortunately, they don’t take proper, you know, precautions. All right. So after painting this picture of doom and gloom, let’s talk about how to deal with this stress, right? What I talked about was Israel. This is what we are experiencing. This is what we are seeing right in the real world out there. Ok, so how do how do we deal with stress, this stress or any of the stress that is ongoing? Ok, so first, first and foremost is hope. That’s the most important factor in dealing with any uncertain situation. It is very important to have that life OK. Keeping the hope alive is very important. All right. So how do we keep the hope alive? So let’s look at the reality. Ok, let’s look at what what actually happens compared to what we have been observing or thinking is happening. So, so first and foremost, the survival rate from this infection is ninety eight percent, meaning ninety eight percent of the people will survive the infection.

And many people will develop infection and recover on their own, not even having to go to see a doctor or do anything. So that means, God forbid, if you get infected does not mean that that’s a death sentence. Ok. We need to separate truth from fiction. All right. Don’t believe everything that you read on social media. Avoid getting into conspiracy theories. There are a bunch of those, especially when you have inconsistent information, then it’s very easy to get into that because those conspiracy theories, if you start believing in them, can lead to danger. Behavior, dangerous decision, for example, somebody says, Oh, well, this is something that is just being created. You know, the situation of fear because people want to sell vaccines, so some people may think that it is not real. The infection is not real. Guess what? They may leave house without taking precautions. They may go to places where getting infected becomes easier, right? And not taking care of themselves. So guess what? That is going to be a problem because like I said earlier, it’s a real disease affecting people and people are dying from that. All right. So what happens if you find yourself to be, you know, in distress in this mind frame where your thoughts are just kind of racing, going in circles, constantly thinking about that right? First thing that you can do and we use it in our office.

A lot of the psychologists I know, therapists who actually trained their patients in doing this is breathing exercises. Very simple exercise. You don’t spend anything except for some time. You know, stop the sense. Like, you know, this whole stress that causes anxiety and leads to a panic attack. You can act to stop it right there in its tracks, right something and stop doing what you’re doing, OK? Close your eyes and start taking deep breaths. Take a deep breath. Hold for a sec. Let it out slowly. Ok? Do this 10 times. And why are you doing it? Focus on your breathing itself. Stop thinking about anything else. Just focus on the breathing. How are you breathing in and out? Ok? You’ll be surprised how quickly it actually starts this circular thinking that people develop. This whole catastrophizing things, the situation it actually stops, which the stress you’ll notice actually goes down. A lot of times you have patients that come into the doctor’s office and you know, when you check their blood pressure, it’s really, really high because they’re in their mind thinking something bad is about to happen. Doctors are going to tell me I have some bad illness. That’s not the reality. And once they realize once they’re able to breathe through, they are able to actually think properly, normally without, you know, stressing out about that. All right. So next we’ll talk about optimism, right? Staying optimistic is very, very important because, you know, again, hope and optimism kind of go hand in hand.

You lose one, you lose other make realistic plans. You know, if you are stuck at home because the pandemic, have you lost your job? You know, you can. You’re stuck in the house. There’s nothing you can do about that part, but you can actually start preparing for the future. Ok, if you were in school, you can start saying, OK, well, let me calm down. Let me sit down, let me make plans as to what I’m going to do once the pandemic is over or even with the pandemic, how I’m going to deal with it. If somebody lose their job, they can start working on their resume, they can start networking. You can still call people just to talk to people, identify people who can actually help you find a job or things like that. Take time to ponder what is important in life. You know, a lot of times we don’t. We get up in the morning, get ready for work, get to work, come back, do whatever. Go to sleep next morning the same thing. Never stop and realize what is it that’s actually keeping us going. A lot of times we don’t realize it’s our family and friends and friends and loved ones. Ok? You’re working hard to take care of them, but we never have time to sit and talk to them and appreciate that. Right. So it is very important to stop and, you know, recognize what’s important.

Turn to your faith. You know, I mean, there are different groups when you turn to your faith, you can. That actually provides a social networking possibility. You can actually talk to these people. I love these faith groups have come together and help people who are in need with food, with finances, a lot of things. So this is probably a good time to actually go back to your faith. Ok. Now have been hearing this social distancing, social distancing, social distancing, this is a new thing that they have coined. I believe it’s more like physical distancing, but social closeness, OK, socially you don’t have to be distant. Physically, yes, it’s OK, but not socially OK. It’s a misnomer. All right. Start thinking about other people, your friends, your family, your loved ones. As I mentioned earlier, get in touch with the people that you have not been in touch with. Look, you’re not busy. You don’t have to worry about going to work or taking calls and things like that or going to school. You have time, you use the time smartly, you know, start reaching out to people and there may be elderly people in your family or friends who are in need of help. So reaching out to them offer them assistance. Hey, can I bring your groceries or can I get your medications for you? Right? Sometimes your grandparents are elderly, your parent, you can call them.

Make it, make it a point to call them for, even if it’s for five minutes, calling them every day. Just making them feel important, making them realize that somebody they’re out there thinking about them, caring for them. All right. Volunteer helping other people makes you feel better. You feel useful. You know, keeping up with the work. So those people who are working from home, I mean, again, like this, something I’ve heard complaints about from a lot of my patients where they are not able to kind of take their work because they’re working from home or they’re working longer hours. Well, you know what? You have to keep a schedule, get in the habit of having a schedule, get up in the morning, take a shower just like you were going to work, get dressed just like you were going to work because what you see in the mirror, you know, affects your psyche. It gives you a sense of purpose and normalcy. And then you have a specific area identified in your in your house that is going to be work area, OK, and try and finish your work by the same time as it did at work so that you have free time to spend with your family and, you know, hang out with them. All right, let’s move on to the next. Let’s focus on what is important, right? I touched on this before. Focus on your relationships. Your relationships with your spouse, with the children, with your friends.

You know, communicating with your families. Very important thing that a lot of us tend to not focus on or pay attention to is talking to the children. Remember, I said they watch everything. They hear everything. Talk to your children. Listen to them attentively. Let them say what they need to say. Hear them out. And then answer their questions and concerns concerns patiently. You have to be very patient, very kind. Because remember, they are black and white in their thought process. Ok. Once you are able to talk to them, that will actually reduce their anxiety. Children want to know that they are OK. You know, they’re worried about their grandparents, other people. Once you reassure them and you tell them they’re OK, let them talk to them or something like that. So they will know that actually things are not as bad as they sound like or look on TV, which I recommend not watching all the 24 seven fine leave your activities or hobbies. You know, some people like gardening or other things I can do. You can do have the whole family get involved in that. Finding time to play board games with the family, with the children, you know, or other things like cooking, baking, you know, making cakes. You know, the most of what’s going to happen. They’re going to dirty up the place. Guess what? You can teach them how to clean up the things, right? So they can actually learn something in this whole process.

Learn to love to clean. Learn to work as a team member. So I mean, there are a lot of positive things that can be done right. Have fun with the family. Like I said, you know, make chores and do fun games, for instance, like go get a less race to fold the laundry. Who does it first or who cleans their room first? You know, you’ve got to reward them with a dollar or two. At least that’s going to keep them busy and things will be taken care of around the house. It’s not going to be pressure on one or two people to keep the house straight. Right? Exercise, it’s very, very important. That doesn’t mean that you have to hit the gym because of the gyms are closed right now. But you know, things like stretching, doing yoga, going walking, jogging, you know, swimming, whatever you can do. But you should not kind of stay cooped up in the house, getting outside, getting some sun and fresh air. It actually invigorate your mind, body and soul. So it’s very, very important to go outside, you know, get some fresh air, get physically active. You know, you want the endorphins to start running so that you can actually feel better. That reduces your stress. Now let’s talk about eating and drinking habits, right? What should you drink, right? Drink non carbonated drinks. Water is the best drink ever, you know, then fresh juices, not the ones we’re from, concentrate full of sugar.

You know things that have more vitamin C because that helps boost your immune system. Cut down on the caffeinated drinks as they increase anxiety or too much caffeine can actually affect your sleep. So if you’re not able to sleep, if you are feeling anxious, lose your stress. Stress leads to lowering of immunity. So guess what? If you can stay away from those things, you are better off. You know, keep the carbohydrate consumption to as low as possible. Eat more fruits. More vegetables. Ok. Because they will help boost your immunity and fight the infection. Any infection, actually. All right, so let’s talk about. Focus. We need to kind of stop take this time and focus on life. Stop taking life for granted. We all take life for granted. We take our loved ones, our spouses, you know, everybody for granted. We need to stop it. Like I said, we need to appreciate it and then ask what what you’re grateful for, you know, and focus on those things when nothing else is going on. You know who’s around you, who’s there for you? Who can you rely on? Who can you be a source of happiness for? Right. So role of spirituality is very important. It is not necessarily a religiosity, but it is the self-awareness like in the words of Dr. Deepak Chopra, you know, self-awareness, awareness of mind awareness, your own body, awareness of your relationship, awareness of your surroundings.

I mean, if you think about it, we don’t even focus on a lot of those things. I see a lot of people live in very nice neighborhoods, beautiful neighborhoods, but they never leave their house to enjoy their neighborhood, to even see it. See it. They get up in the morning, go to work and they think they come back home and go to sleep. You know, so yeah, they live in a nice house, nice neighborhood, but they can’t even enjoy it. So take time to enjoy that. All right. So find new ways to find happiness. Ok. What does that mean? Your attitude towards life? You know, when you look at this whole situation, is it a crisis or is it an opportunity? For some people? It’s an opportunity. Some people who are unhappy with their jobs or their life situation, they decide, OK, I’m going to change my life, I’m going to change my job. This is the perfect time to go and look into something else or going to school, you know, make other people happy, try and find ways of helping other people take time to rethink your relationships, like I said earlier, or you and your lifestyle make it simpler. You know, don’t go. Go back down from a very complicated, difficult lifestyle for yourself to maintain. Just go down to your normal lifestyle. If you’re financially stressed, ask for help. There is help available. You know you can always pay back once you get back on your feet and if you’re financially stable.

Reach out to help others because helping others is going to give you a lot of satisfaction. So now, for people who are by themselves, you know, who find themselves like depressed or anxious and stressed out, you know, they can actually find psychiatric help. It’s not true for their mental health association, the different cities that they can call and find a psychiatrist, you know, or Houston psychiatric society. Or you can even call the board, you know, and find a psychiatrist to find a therapist, for instance. Again, like a lot of the doctors and therapists are doing tele therapy, actually, there’s a website again. You can actually link on open the link and you can actually find a therapist. So, I mean, there are ways where you can actually help yourself. It is very important not to get stuck in your own head. You know, reach out to people if you feel like you’re stressed out and you have to stress. Reach out to people. It’s important to be socially active. It’s important to make sure that you make the best out of this difficult situation. All right, thank you very much for listening. I hope that this was helpful. Thank you, Dr. Shoaib. I know you have to jump, so we appreciate it. I’m trying to see if I wanted to say anything real quick. Let me, guys. I did I was able to jump on.

You don’t like that you’re there on and off there. Ok, well, thanks God for everyone joining us. Wonderful. Thank you, Dr. Shoaib. I appreciate so much your expertise and you’re helping our clients every day. But sharing your knowledge with each person that took the time out to join us today. Just thank you guys for being here, and we’re going to keep trying to bring these things to you and bring great information to when we all learn we can all get better and help more people. So thanks, guys. I really appreciate it. Yeah. Thank you, Dr. Shoaib. If anybody, I will post my information right now in the chat. If you have any comments or questions or need any oops information, please don’t hesitate to email me. Most of you probably got an email from me. I’ll also post my cell phone number. If you have any questions about the referral process or anything like that, please don’t hesitate to reach out. So we’re here to help in any way that we can. If you need connections with therapists or psychiatrists or anything like that, we’re happy to do that as well. So thank you so much, everybody. Keep an eye out in your emails for your vows. Once you get that email, get it back to me and I will get your certificates over for your CEUs.