2. Prof. Hani Hamed Dessoki, M.D.Psychiatry
Acting Dean, Faculty of Nursing
Prof. Psychiatry
Founder of Psychiatry Depart., Beni Suef University
Supervisor of Psychiatry Depart., El-Fayoum University
Treasurer of Egyptian Psychiatric Association
2020
Coping with Covid 19 Anxiety

6. INTRODUCTION
• COVID-19 pandemic is turning out to be a major stressor for
most of humanity.
• The initial focus is necessarily on the physical consequences
of the infection.
• However, there is recognition that the significant
psychological consequences emerging out of this catastrophe
need to be addressed.

7. Introduction
• The World Health Organization (WHO) has warned
that long after the pandemic COVID-19 has been
brought under control, healthcare providers will have
to deal with the diverse mental health issues afflicting
populations in different countries.
• The mental health issues began emerging almost
immediately after the WHO declared COVID-19 a
Public Health Emergency of International Concern
in January 2020.

8. PHASES OF MENTAL HEALTH
ISSUES
• Mental health issues noted in (biological) disaster
zones including COVID-19 can be classified into
an Acute phase -during the outbreak
(approximately 2-6 months)
• Long-term phase -after the control of the outbreak
(>6 months).

9. Acute Phase
a) Acute Phase (during the outbreak) –Issues to be
dealt with include immediate mental health impacts
such as fear, denial, anxiety, insomnia, dissociative
symptoms, depressive symptoms, suicidal
ideas/attempts, substance withdrawal and relapse of
pre-existing mental health problems.

10. Long-term phase
b) Long-term phase (after the control of the
outbreak) –Issues commonly presenting include
grief, survivors guilt, depression, substance use,
relapses of pre-existing mental illness, PTSD and
somatization disorders.

11. VULNERABLE POPULATION
• Children
• Senior citizens
• Pregnant women, Persons with disability
• Homeless individuals, Poor social support & lower economic
status
• Life-threatening chronic medical conditions like cancer,
chronic renal failure, liver diseases,
• Asthma/COPD, immunocompromised patients
• History of severe mental illness and wandering mentally ill

12. UNIQUE FEATURES OF INDIVIDUALS
AFFECTED WITH PSYCHOLIGICAL
STRESS
• The overlapping of psychological problems is very
common.
• For example, anxious people may also have depression
and drink alcohol to reduce anxiety and depression.
• Most people presenting with psychological disturbances
are 'normal people' who have been overwhelmed by an
extraordinary stressor.
• A vast majority of people presenting with disaster-related
psychological disturbances.

13. COMMON STRESSORS
• The rising death toll in various parts of the world is
creating a sense of panic
• Survival guilt among those who suffered from the
illness, and might have infected others
• The prospect of losing employment and sources of
income facing losses and fear of closing down your
business.

14. • Infodemic: The overabundance of misinformation
about the corona virus, especially on social media
• Social Distancing Has Become a Major Stressor for
the Youngsters
• Mental Health Issues Surrounding Food -inability to
buy groceries, vegetables, fish, meat, eggs, and dairy
products

15. ICU
• Critical illness and resultant intensive care unit stays
commonly expose patients to extreme physiological
and psychological stressors that are life-threatening
and traumatic, and frequently precipitate persistent
psychiatric illness

16. • In addition, psychiatric illnesses that occur during the
pandemic may stem from psychosocial factors such as :
• ●Frequency and extent of exposure to individuals infected
with the virus
• ●Fear of infecting family members
• ●Lack of access to testing and medical care for COVID-19
• ●Physical distancing, home confinement, quarantining, and
loneliness

17. ● Inconsistent messages and directives regarding public health
measures such as wearing face masks
● Increased workloads
● Economic hardships and insecurity
● Shortages of available resources (eg, foods, paper products,
and personal protective equipment)
● Diminished personal freedoms
● Continuous media reporting about the pandemic and the
uncertainty surrounding its eventual outcome

18. COMMON PSYCHOLOGICAL
DISTURBANCES
• Emotional disturbances that arise due to the
significant life change or a stressful life.
• Symptoms :
• Sadness of mood, anxiety or worry, fear of contracting an
infection (or a combination of all these).
• Persistent preoccupation with illness worry.
• Inability to cope (giving up) and some degree of
dysfunction.

19. • Sleep and Appetite disturbances.
• In adolescents, these symptoms might be associated
with oppositional behavior or truancy.
• In most, symptoms remit after the stressor is
removed.
• Some of these individuals with on-going issues
might progress to a depressive episode or an
anxiety disorder.

20. Economic downturns, job and livelihood
losses which can lead to significant mental
health problems.
• Symptoms :
• Low mood
• Decreased or loss of capacity to enjoy things
• Decreased energy
• Marked tiredness after even minimum effort (not due to any
medical cause including COVID-19)
• Reduction in activity or feeling restless
• Lowered attention/ concentration-complaints of poor
memory
• Loss of self-esteem and self-confidence

21. • Ideas that one is worthless, or has done something
wrong
• Feeling of helplessness
• and that there is no hope for the future.
• Death wishes, suicidal thoughts or attempts
• Sleep and appetite disturbances
• When subjects have most symptoms and are severely
dysfunctional or have persistent thoughts of death,
self-harm, and suicide, immediate referral to a
mental health specialist has to be initiated.

22. • An increase in the use of substances :-
• Individuals may use substances to overcome social isolation, as a
way of pleasure-seeking or to reduce anxiety and depression.
• Harmful use may also occur which means there is damage to health
due to alcohol or tobacco.
• In this case, harmful effects could be physical (e.g: liver/lung
related issues) or mental (e.g: worsening of mental health issues
like anxiety or depression).

23. • Continued use can lead to dependence or
addiction, which is characterized by a strong desire
to drink/smoke, difficulties in controlling the use,
persistence of drinking despite harmful
consequences.

24. OTHER MENTAL HEALTH
PROBLEMS
• Anxiety disorders: Many forms of anxiety
disorders are expected in the aftermath of
COVID-19.
• The emergence of these symptoms can occur even
during lockdown periods due to fear/ anticipation
of an infection.

25. • Generalized anxiety disorder:
• It is characterized by excessive worrying and persistent
free-floating anxiety
• Panic disorder
• It is characterized by recurrent unexpected attacks of
severe anxiety (panic attacks) that reach a peak within a
few minutes and last for a few more minutes.
• There is associated fear of having more attacks
(anticipatory anxiety) or avoidance of triggers of panic
attacks

26. • Phobias
• Most commonly certain people can excessively develop
fear of crowds in the wake of COVID-19 (due to fear of
infection). In certain cases, if there is excessive
avoidance of crowds to the point of being house-bound
it is called agoraphobia.
• In all these phobic states, anxiety symptoms are
triggered only in particular situations, and are
accompanied by strong avoidance of the situations that
trigger fears.

27. • Obsessive-compulsive disorder (OCD)
• OCD is also expected to increase in the aftermath of
COVID-19. To ensure that subjects reduce transmission
of infection, they have been bombarded with public
health messages to wash repeatedly to reduce
contamination.
• Subjects with OCD also experience repetitive thoughts
that they are contaminated (contamination obsessions)
and wash repeatedly to reduce anxiety (compulsions).

28. Severe mental illness:
In individuals already suffering from such conditions, there could be a
relapse or worsening.
Common symptoms
· Unexplained irritability/aggressive behavior
· Talking or smiling to self
· Suspiciousness
· Hearing voices when nobody is around (hallucination)
· False beliefs (delusions)
· Poor self-care

30. STAY POSITIVE
• Not following the daily news too closely.
• Getting away from social media periodically is a
good way to prevent getting depressed.
• Catch up on domestic work which often remains
pending as it is low priority
• Take up a new hobby, or just follow the old one

31. • Listen to your favorite music
• Communicate freely within the family about
dreams, aspirations, and other topics.
• Pray together, laugh together, work together, and
eat together to bring your family closer together.
• Share and amplify positive stories.

33. COPING STRATEGIES
• Try up skilling whether you are a techie, or in any other profession.
• Practice yoga at home to calm your mind and keep your body fit.
• Do deep breathing exercises to cleanse your respiratory and
circulatory systems.
• Learn how to cook interesting, nutritious meals using the simplest,
and most basic ingredients.
• Meditate to clear your mind.
• Do a spot of gardening, if possible.
• Take to writing.

34. • If there are elderly people in your locality, try to help them
by running errands or reading to them without
jeopardizing your own health.
• Watch all the movies you missed.
• Watch comedy shows. Give your imagination a free run,
and visualize delightful scenes or places.
• Indulge in a bit of nostalgia to recall happy times with
family and friends.
• Be supportive of others struggling with mental health
issues.

35. ‫وحالة‬ ‫واالكتئاب‬ ‫القلق‬ ‫اعراض‬ ‫مع‬ ‫التاقلم‬ ‫يمكن‬ ‫كيف‬‫عدم‬
‫المستجد‬ ‫كورونا‬ ‫فيروس‬ ‫مع‬ ‫المرتبط‬ ‫اليقين‬
•ً‫عادة‬‫ما‬‫تتمثل‬‫الخطوة‬‫األولى‬‫في‬‫إدراك‬‫أن‬‫القلق‬‫وعدم‬‫اليقين‬‫خالل‬‫هذه‬‫المرح‬‫لة‬‫أمر‬
‫طبيعي‬،‫وشائع‬‫فالقلق‬‫ردة‬‫فعل‬‫بشرية‬‫طبيعية‬‫تجاه‬‫الشعور‬،‫بالخطر‬‫و‬‫يمكن‬‫أن‬‫تؤثر‬
‫على‬‫أفكارنا‬،‫ومشاعرنا‬‫فأفكارنا‬‫مترابطة‬‫مع‬‫حالتنا‬‫العاطفية‬‫والبدنية‬.‫و‬‫القلق‬‫اء‬ّ‫ن‬‫الب‬
‫مفيد‬‫إلى‬ً‫حد‬،‫ما‬‫إذ‬‫يساعد‬‫الشخص‬‫على‬‫ظ‬ّ‫ق‬‫التي‬‫واتخاذ‬‫اإلجراءات‬‫الضروري‬‫ة‬.
•‫القلق‬‫حالة‬،‫طبيعية‬‫ما‬‫دامت‬‫األعراض‬‫غير‬‫خطيرة‬‫وال‬‫تسبب‬‫اإلحباط‬‫أو‬‫تؤث‬‫ر‬‫على‬
‫النشاطات‬‫اليومية‬.
•‫يمكن‬‫للتعامل‬‫مع‬‫ردود‬‫الفعل‬‫الناتجة‬‫عن‬‫التوتر‬‫والقلق‬‫واالكتئاب‬‫باألس‬‫اليب‬‫الصحيحة‬
‫أن‬‫يؤدي‬‫إلى‬‫تحسين‬‫الصحة‬‫والرفاهية‬‫واالرتقاء‬‫بنوعية‬‫الحياة‬.

36. ‫واالكتئاب؟‬ ‫القلق‬ ‫مع‬ ‫التعامل‬ ‫يتم‬ ‫كيف‬
• ‫االعتراف‬:ً،‫علىًالمرءًأنًيعترفًبمشاعرهًوقلقهًأوًتدنيًحالتهًالمزاجية‬
ً‫ا‬‫اًممكن‬‫وأنًيعيًأنًتحقيقًدرجةًكبيرةًمنًاليقينًفيًهذهًالظروفًليسًأمر‬
‫ًذلك‬ّ‫د‬‫اًلنو‬‫رغمًأنناًكناًجميع‬.‫وصىًبالعملًعلىًإدارةًاألفكارًالمتعل‬ُ‫ي‬ً‫كما‬ً‫قة‬
‫بعدمًاليقينًمنًخاللًمحاولةًالفصلًبينًاألمورًالتيًيمكنًالتحكمًبهاًوتلك‬
‫الخارجةًعنًالسيطرة،ًواالعتناءًبالجوانبًالتيًيمكنًالسيطرةًعليها‬.

37. •‫السلبية‬ ‫األفكار‬ ‫مع‬ ‫التعامل‬:‫قلقةًوالسل‬ُ‫م‬‫ينبغيًتحديدًاألفكارًال‬ً‫بيةًالتيًتدور‬
‫اًفيًزيادةًالقل‬‫اًمحوري‬‫زًوالتعاملًمعها،ًفهيًتلعبًدور‬ْ‫ج‬َ‫ع‬‫حولًال‬ً‫ق‬
‫واالكتئاب‬.‫نصحًبتحليلًاألدلةًالتيًتدحضًاألفكارًالسلبيةًو‬ُ‫ي‬ً‫أخذهاًبعين‬
‫االعتبار،ًواالنتقالًمنًالتصريحاتًالذاتيةًالسلبيةًإلىًتلكًاإلي‬ً‫جابيةًالتي‬
‫ًطبيعي‬‫تسمحًبتخفيفًالتوترًومزاولةًاألعمالًبشكل‬.‫علىًسبي‬ً،‫لًالمثال‬
ً‫اًعنًقول‬‫عوض‬"‫الظروفًالراهنةًسيئة‬"ً‫،ًيمكنًللمرءًأنًيقول‬"‫أناًواث‬ً‫ق‬
‫أننيًسأتجاوزًهذهًالظروف‬."‫وهذاًيتكفلًبتحويلًالعواطفًإلىًمشاعر‬
‫وتصرفاتًإيجابية‬.

38. •‫باألمان‬ ‫اإلحساس‬ ‫تعزيز‬:‫يمكنًتعزيزًاإلحساسًباألمانًعنًطريقًتث‬ً‫قيف‬
‫الذاتًفيماًيتعلقًبالصحةًالنفسيةًوفيروسًكوروناًالمستجدًباال‬ً‫عتمادًعلى‬
‫مصادرًموثوقة‬.‫تًأهميةًالدورًالذيًتلعبهًعاداتًالنظافةًال‬َ‫ت‬ُ‫ب‬‫وقدًث‬ً‫شخصية‬
‫اًلماًتنشرهًا‬‫الصحية،ًوالتدابيرًالتيًتقللًمنًخطرًاإلصابةًوفق‬ً‫لجهاتًالمعنية‬
‫بمكافحةًالعدوى،ًفيًتعزيزًاإلحساسًباألمان‬.

39. •‫التواصل‬:‫ينصحًبإيجادًطرقًجديدةًللتواصلًمعًاآلخرينًفيًحالًعد‬ً‫م‬
‫نًمنًالخروجًمنًالمنزل،ًمثلًاالتصاالتًالهاتفيةًوالمحادثاتًا‬ّ‫ك‬‫التم‬ً‫لنصية‬
‫ومكالماتًالفيديوًوالتراسلًمعًاألصدقاءًواألقارب،ًفمنًالمفيدًالتو‬ً‫اصلًمع‬
‫اآلخرينًبشكلًيوميًومناقشةًمشاعرناًوأفكارناًمعهم‬.
•‫صحي‬ ‫يومي‬ ‫روتين‬ ‫على‬ ‫الحفاظ‬:‫وصىًبالحفاظًعلىًروتينًيومي‬ُ‫ي‬ً‫صحي‬
‫وعمليًفيًنفسًالوقت،ًكالحصولًعلىًساعاتًنومًكافيةًوممارسةًالن‬ً‫شاط‬
‫البدنيًعندًاإلمكان‬.‫كماًأنًتنويعًالمهامًاليوميةًوتخصيصًالوقتًلل‬ً‫نشاطات‬
‫ًمساعدةًلتجنبًالرتابة‬َ‫ل‬‫ًعوام‬ّ‫د‬‫التيًنستمتعًبالقيامًبها،ًتع‬.

40. •‫العملية‬ ‫اإلجراءات‬:‫نصحًبتجنبًاإلفراطًفيًتفقدًوسائلًالتواص‬ُ‫ي‬ً‫لًاالجتماعي‬
‫ضًالقلقًو‬ّ‫وإيقافًاإلشعاراتًالتيًتصلًمنًمواقعًغيرًموثوقةًتحر‬‫التوتر‬.
‫دناًبخطواتًونصائحًع‬ ّ‫إذًينبغيًالتركيزًعلىًالمعلوماتًالتيًتزو‬ً‫مليةًلك‬
‫وألحبائكًفيًهذهًالفترة‬.‫ومنًالمفيدًتسليطًالضوءًعلىًاألخبارًاإل‬ً‫يجابيةًالتي‬
‫تبعثًعلىًاألمل،ًمثلًقصصًالمتعافينًمنًالمرض،ًواستخدامًالتكن‬ً‫ولوجيا‬
‫بشكلًإيجابيًلتعزيزًاألمانًالمجتمعيًوحسًالسيطرةًوامتالكًزمامًاأل‬‫مور‬.
•‫الموثوقة‬ ‫المعلومات‬ ‫مصادر‬:‫يجبًتحديدًالمصادرًالموثوقةًوتفقدهاًب‬ً‫شكل‬
‫معتدلًخاللًاليوم،ًمثلًمنظمةًالصحةًالعالميةًوالمراكزًالوطنيةًلمكاف‬ً‫حة‬
‫األمراضًووزارةًالصحةًالمحليةًأوًالخدماتًالصحيةًالوطنية‬.

41. •‫الهدوء‬ ‫على‬ ‫الحفاظ‬:‫يمكنًاالستعانةًبأساليبًاالسترخاءًوالسيطرةًعلىًال‬ً‫غضب‬
‫للمحافظةًعلىًالهدوء،ًكالتنفسًبشكلًثابتًمعًاسترخاءًالعضالتًفيًال‬‫وقتًنفسه‬.
ً‫اًعنًذلكًإلىًاليوغاًأوًالموسيقىًأوًممارسةًالرياضة‬‫أوًيمكنًاللجوءًعوض‬
‫اًعلىًاالسترخاء‬‫والهوايات،ًأوًأيًطريقةًتساعدكمًشخصي‬.
•‫اآلخرين‬ ‫مع‬ ‫باإليجابية‬ ‫ي‬ّ‫التحل‬:‫اًبالغًاألهميةًفي‬‫ًّالوعيًالذاتيًأمر‬‫د‬‫يع‬ً‫تجنبًإلحاق‬
‫ًماًأوًإصابتهًبالحمىًالًي‬‫ًُشخص‬‫ل‬‫الوصماتًباآلخرينًفيًالمجتمع،ًفسعا‬ً‫عني‬
‫ًعنًأنًاحتمالًالتع‬‫بالضرورةًإصابتهًبفيروسًكوروناًالمستجد،ًفضال‬ً‫افيًمن‬
‫مرضًكوفيد‬-19‫ًعام‬‫كبيرًبشكل‬.‫ل‬ُ‫م‬‫ويجبًإدراكًأنًاألشخاصًالمصابينًوال‬ً‫زمين‬
‫ًخطأ،ًوأنهمًيستحقونًمساندتناًوتعاطفن‬ّ‫ي‬‫بالحجرًالصحيًلمًيقترفواًأ‬ً،‫اًورأفتنا‬
‫ًإلىًتجنبًربطًالفيروسًبعرقًأوًجنسيةًمعينة‬‫إضافة‬.

42. •‫التفكير‬ ‫وقت‬:‫اًللتف‬‫نصحًبمحاولةًتخصيصًوقتًمعينًيومي‬ُ‫ي‬ً‫كيرًبالوضع‬
ً‫الراهنًوتسميته‬"‫وقتًالتفكير‬"‫اًعنًالقلقًطيلةًالوقت،ًشر‬‫عوض‬ً‫طًأالًيكون‬
‫اًمنًموعدًالنوم‬‫هذاًالوقتًقريب‬.

43. ‫السن‬ ‫بكبار‬ ‫خاصة‬ ‫معايير‬
•‫نًواألشخاصًالذين‬ّ‫س‬‫ّةًلدىًكبارًال‬‫ي‬‫يمكنًأنًتكونًاألعراضًالنفس‬ً‫يعانونًمن‬
‫اءًاآلخرين،ًخاص‬ّ‫ح‬‫ًباألشخاصًاألص‬‫ّةًمزمنةًأسوأًمقارنة‬‫ي‬‫حاالتًصح‬ً‫ًإذا‬‫ة‬
‫ًلإل‬ّ‫ل‬‫ل،ًبحدًذاته،ًعاملًخطرًمستق‬ّ‫مث‬ُ‫ي‬ً‫لزمينًبالعزلًالذي‬ُ‫م‬ً‫كانوا‬ً‫صابة‬
‫ن‬ّ‫س‬‫باالكتئابًلدىًكبارًال‬.ًَ‫اًمنًالخر‬‫نًأيض‬ّ‫س‬‫قدًيعانيًكبارًال‬ً‫اليًيمكن‬ّ‫ت‬‫فًوبال‬
‫اًعندًسماعًاألخبار،ًلذ‬‫اًخصوص‬‫اًوإحباط‬‫أنًيصبحواًأكثرًارتباك‬ً‫اًينبغيًعلى‬
‫ًلهم‬ّ‫ي‬‫ًوالعاطف‬ّ‫ي‬‫عمًالعمل‬ّ‫د‬‫عائالتهمًتقديمًال‬.‫عتبرًتقديمًمع‬ُ‫ي‬‫و‬ً‫لوماتًبسيطة‬
‫ّة‬‫ي‬‫اًبالغًاألهم‬‫ينًأمر‬ّ‫ن‬‫ًللمس‬‫صادقةًوغيرًمحبطة‬.‫ويجبًتكرارًالم‬ً‫علومات‬
‫هايمرًأوًأ‬ّ‫عانيًمنًمرضًالز‬ُ‫ي‬ًّ‫سن‬ُ‫م‬‫ًإذاًكانًال‬‫ن،ًخاصة‬ّ‫س‬‫لكبارًال‬ً‫ًمرض‬ّ‫ي‬
‫ّبًللخرف‬‫ب‬‫س‬ُ‫م‬ً‫آخر‬.

44. ‫باالطفال‬ ‫خاصة‬ ‫معايير‬
•‫فاتًال‬ّ‫ونهًويالحظونهًمنًتصر‬َ‫يتفاعلًاألطفالًوالمراهقونًمعًماًير‬ً‫بالغين‬
‫منًحولهم‬.‫وتنعكسًاستجابةًاألهلًالهادئةًوالواثقةًلتداعياتًمرضًكوف‬‫يد‬-
19‫ًعلىًاألطفال،ًوتسهمًفيًتقديمًالدعمًالمناسبًل‬ّ‫ي‬‫ًإيجاب‬‫بشكل‬‫هم‬.
•‫ًبالخوفًمنًاألمورًغيرًالمفهومةًبالنسبةًلهم،ًوهن‬‫يشعرًاألطفالًعادة‬ً‫اًيأتي‬
‫دورًاألهلًلطمأنتهمًعلىًالنحوًالمالئم‬.ًّ‫ن‬‫كماًيمكنًأنًيعتقدًاألطفالًأ‬ً‫هم‬
‫ف‬ّ‫مسؤولونًعنًوقوعًاألحداثًالمحيطةًبهمًبسببًإساءتهمًللتصر‬.