Navigating Post-COVID-19 PTSD: 2 Case Studies on Loss and Resilience respectively

The COVID-19 pandemic has left an indelible mark on the world, with its impact extending beyond the physical health domain. The psychological aftermath of the pandemic is a burgeoning area of concern, with Post-Traumatic Stress Disorder (PTSD) emerging as a significant issue.

PTSD is a mental health condition triggered by experiencing or witnessing a terrifying event. Clinically significant PTSD symptoms post-COVID-19 infection were reported in approximately 30% of patients with COVID-19 requiring hospitalization, and may present early during acute infection or months later as reflected in a 2021 research review. A 2022 review mentioned prevalence rates of 10-57% for PTSD and mentions that female sex is associated with higher levels of anxiety, depressive and post-traumatic stress symptoms.

This article explores first a case of post-COVID-19 PTSD in a patient who tragically lost their partner to the virus. Our patient, whom we’ll refer to as Jane, is a 45-year-old woman who lost her partner to COVID-19. Jane’s partner was hospitalized and, due to strict infection control measures, she was unable to be by his side during his final days. This sudden and traumatic loss, coupled with the isolation and fear associated with the pandemic, led to Jane developing symptoms indicative of PTSD: remembering circumstances from the hospital environment, flashbacks of her partner’s health deteriorating and their last discussions which appear intrusively during the day, frequent nighttime awakenings in a panic state and yearning for his return home. She avoids discussions w/ others about the event and her sense of loneliness as she has become more irritable and does not want to push family and friends away. She feels that her wellbeing is not the same as she has been living on state of high alert on most days. Although she continued her full-time work, her productivity has decreased.

Symptoms of PTSD may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. In Jane’s case, she experienced recurrent, distressing memories of her partner’s illness, intense emotional distress, and a persistent feeling of being disconnected from others. Jane’s case is not unique. The COVID-19 pandemic has created a ‘perfect storm’ for the development of PTSD. The pervasive fear of infection, the profound impact of social isolation, and the experience of severe illness or death of loved ones are all potential trauma triggers. The bereavement process is further complicated by social distancing measures, which can prevent traditional mourning practices and limit social support. As clinicians, our role in managing post-COVID-19 PTSD involves early identification, comprehensive assessment, and a patient-centered approach to treatment. Jane was initially reluctant to seek help, a common issue among PTSD sufferers. However, through compassionate communication and reassurance, we were able to engage her in treatment. Treatment for PTSD typically involves a combination of psychotherapy and medication. Cognitive-behavioral therapy (CBT) is often the first-line treatment, helping patients understand and change thought patterns that lead to harmful behaviors or emotions. In Jane’s case, CBT helped her process her grief, manage her PTSD symptoms, and develop coping strategies. Pharmacotherapy can also play a crucial role in managing PTSD. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used due to their efficacy in reducing PTSD symptoms. Jane was started on an SSRI, which, in conjunction with her psychotherapy, led to a significant reduction in her symptoms over time. Jane’s journey is a testament to resilience in the face of profound loss and trauma. Her story underscores the importance of recognizing and addressing the psychological impact of the COVID-19 pandemic.

Another case is that of Linda, a 38-year-old woman working as registered nurse who contracted COVID as infection in the early wave of the COVID-19 pandemic. Her respiratory distress accelerated at fast pace and eventually she became an ICU patient herself. She had sent messages to her parents, close friends and even to our Office before being offered artificial ventilation to avoid respiratory collapse. She instead opted for an interleukin blocking agent, about which little was known at that time. Linda emerged as one of the few survivors of the respective units and was able to leave the hospital on her feet 1 week later and return to her work after more than a month. Her respiratory complications needed additional treatment for several more weeks after discharge. But the prominence of the critical acute condition remained deeply embedded in her mind. More than 6 months after the event she continued to present memory difficulties, a certain degree of brain fogginess and incapacity to concentrate for long term and gets easily startled by similar situations besides a persistent alert mental state. Her symptoms point to PTSD developed in consequence of being directly affected by the COVID—19 infection, which is a different situation that that of the previously described case of Jane. There are more cognitive impairment symptoms that Linda presents with and her case needed a more complex psychiatric management besides the medical treatment. She, however, accepted an early aggressive medical and mental health treatment which imply a better prognosis for the long term. After almost 4 years, her PTSD symptoms have vastly attenuated, with some mild cognitive impairment sequalae that require ongoing treatment.

Biological pre-existing conditions and psychological factors (notably early-stage resilience) play an important role in the persistence of manifestations of COVID-19 as reflected in a 2021 study. Linda has overcome much of the PTSD symptoms by returning to work and studying for professional development. Jane, although not affected directly by the virus, continues to have difficulties coping with the loss of her partner and has initiated EMDR (Eye Movement Desensitization and Reprocessing). This is a psychotherapy treatment designed to alleviate the distress associated with traumatic memories and is considered effective for PTSD. A pilot study published on May 4, 2022, suggests potential benefits for long COVID patients experiencing PTSD symptoms.

Clinicians must remain vigilant for signs of PTSD in our patients as we navigate the aftermath of this unprecedented global crisis.

In conclusion, the COVID-19 pandemic has brought to the fore the critical need for mental health services. Post-COVID-19 PTSD is a significant concern that requires our attention and care. Through early identification, comprehensive treatment, and a patient-centered approach, we can help our patients navigate their journey towards healing and recovery.

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