Psychiatrist Mendelevich: 'There is a concept of long COVID, and its consequences can be irreversible'
How Covid-19 affects the mental state, what long-covid is and whether physical education will help to cope with neuro-covid
One of the Tatarstan Telegram channels has published information about the suicide of a 60-year-old resident of Kazan, allegedly because of the coronavirus she suffered. As the head of the republican headquarters for the fight against COVID-19, Leyla Fazleeva, said during a live broadcast on Instagram, the patient “was treated in one of the hospitals, lung damage was 1-2 percent, she was discharged with positive dynamics, but despite this, the woman decided to leave her life”. What the impact of the coronavirus on the mental health of people who have had it is — this question became the topic of another live broadcast, held on the Instagram account of the operational headquarters. Vladimir Mendelevich, a well-known Russian psychiatrist, answered the questions of users of the social network and Leyla Fazleeva.
Be a rational and sane person
Leyla Fazleeva: Mr Mendelevich, coronavirus and the suicide, how would you comment on this complex message?
Vladimir Mendelevich: Any passing is a tragedy, and we express our condolences to the family of the deceased woman. If we look at it from a scientific point of view and from a practical — psychological and psychiatric — point of view, then this is quite a common phenomenon. If you compare Covid-19 as a severe disorder, subjectively severe — objectively you had other experts, they described what happened to the body, what the consequences were. Subjectively, a person has very difficult experiences in connection with pain — we do not know how this woman endured Covid-19, we do not know what the consequences were after it, because there are a lot of physical complications, weakness, lethargy, we do not know how Covid-19 affected her social status, what happened in the family, around — we are guessing with you.
We know that, for example, in severe cancer, especially in patients with chronic pain, suicide is quite common. Therefore, a person passes through the disease, feels everything, he can be emotionally anxious, and he can choose such an end, an inadequate way out of the situation. This situation still needs to be sorted out, but I am very sorry that this happened.
Leyla Fazleeva: What should each of us do? There are those who are afraid of getting infected — they have not suffered and have not yet been vaccinated. There are those who have been vaccinated and live their own story. But if you have suffered from Covid-19, what actions do you advise us to take in order not to come to such a serious and terrible decision?
Vladimir Mendelevich: In psychology, psychiatry, and other sciences related to human studies, we have a concept of harmonious response and disharmonious response. How to react correctly? First, to be a rational and sane person: you need to study, for any reason, not only the coronavirus, to know the probability of infection in different forms of behaviour, the probability of a severe course — these figures we can give, that is, doctors can give data on how many of those who fell ill, suffered severe Covid-19 or the disease was of moderate severity. And common sense will show us that in reality — this is a very dangerous disease, because this disease is not comparable to influenza. Influenza is a viral disease that affects the lung system to a greater extent. But the coronavirus affects, as a rule, not only the respiratory system, it is a systemic disease, it affects everything.
If there is a possibility of infection, and no one is immune from this, there are no such people, even if they follow all possible ways to protect themselves from Covid-19. So, I am preparing: I hope for the best, but I am preparing for the worst, I am preparing and I know what I will do if this disease suddenly appears. Vaccination is in this list. What I will do to avoid getting sick — for example, vaccination.
I try to be a sane rational person, I try not to be subjective and superstitious. So many different different facts affect the adequacy — the inadequacy of the response to Covid-19. If I were an artist who has not left his studio for decades, I would choose one tactic based on experience. I am quite an active person and had up to 150 flights a year, and the risk increased significantly. Therefore, in order to take a step towards returning to normal life, I chose one of the ways — this is vaccination, while it did not cancel my wearing a FFP2 respirator. I fly, I don't take it off and I don't eat on the plane. Vaccination is not a 100% guarantee, complete protection of a person. There are no such opportunities. The population will develop immunity, and then we will expand our areas.
I was waiting for scientific research, and the words spoken by anyone, even high people, are not a fact for me. For me, a true fact is a publication in serious scientific journals. I chose from two domestic vaccines, because the foreign ones are not imported to Russia. I am honest with you and honest with the audience — you need to make decisions sensibly — this is my life, the life of my loved ones.
Number of people with anxiety disorders has not increased in a year
Leyla Fazleeva: How does the coronavirus affect human psyche, what conclusions can be drawn in the year since the pandemic began?
Vladimir Mendelevich: A lot of research on this subject has been conducted in the world. I follow Chinese and American studies, it is important for me to understand whether their mental disorder is really caused by Covid-19. There can be no direct connection, and the virus itself cannot cause the thought of not living. This is a whole chain, after which a person can come to such a tragic end.
The scientific evidence is very different. My clinical experience shows that the number of people with anxiety disorders has not increased in a year, but I see a large number of people. My practical position is confirmed by several large-scale studies in Russia, which show that the level of anxiety and depression in the country has remained at the same level this year. But we have become more worried about the possibility of getting sick, but this does not mean that this excitement has passed into a pathological stage. This is even great — an increased, not pathological level of anxiety — it mobilises a person to make decisions sensibly. There are world studies that show that there are more anxiety, depressive and other mental disorders. Whom should we trust? Time will tell you exactly what the data is.
I would like to be happy for that in one of the very well-known medical journals, my colleague and I published an article, in which we described a unique case of a mental disorder with Covid-19 not with a minus sign — anxiety, depression, paranoia, but with a plus sign. One of my patients had euphoria, a manic state with excessive activity, but she behaved completely inadequately. We treated her, everything quickly went away. This is a unique case for world literature.
What is the most dangerous from the point of view of the psyche? There is a concept of long COVID, when Covid-19 in some cases does not end with recovery. Its consequences may be, although not everything is known to us today, but its consequences can sometimes be irreversible in the neuropsychiatric field. There is evidence that after discharge from the hospital after the coronavirus, a person complains: “I do not think, I have a bad memory, I find it difficult to choose words, in general it is not me, I do not understand where to click in the smartphone to be correct” and other reactions.
This neuro-covid is a cognitive impairment. Today, doctors, specialists, and scientists are following this process very closely. It is possible that neuro-covid can lead to Alzheimer's disease and other dementias.
Leyla Fazleeva: Yes, many people say that the mental state changes after Covid-19. But how can a person understand for himself or in close people that the condition after the coronavirus is already pathological? What to do next?
Vladimir Mendelevich: If a person subjectively feels that this interferes with him. For example, he can not cope with the previous work, with the previous intellectual activity — this is a reason to contact a specialist, because if it becomes a pathology — it will be too late. Looking from the outside, if we see how a person slows down, does not think, do not wait until this condition acquires a clinical disease. You don't need a psychiatrist here, you need a neurologist, they have drug methods, other ways to reduce cognitive impairment — attention, memory, intelligence — that's what Covid-19 affects. Look how far we have come from viral respiratory infections, we were not aware of such consequences a year ago.
A year ago, we thought, well, we would wait out a month and a half, everything would end, but it turned out to be not so. We have encountered — and this is a completely new disease for medicine, society and humanity, this has never happened before.
I would not recommend turning to folk remedies that are recommended by opponents of the scientific approach.
Leyla Fazleeva: There are, as you've said, ways to find peace of mind, to try to work with yourself, that if you feel a change. How can one restore the mental balance if they should not need to consult a specialist?
Vladimir Mendelevich: I believe that being absolutely calm and joyful when people around are dying from the coronavirus is inadequate. It's okay to be alert. So let's move the issue of peace of mind to the future, when we defeat this disease. For example, the Spanish flu lasted a year and a half, I mentioned it in an interview last March, and it seemed to me that with the current level of medicine we could can cope with Covid-19 in a month and a half. Now a year has passed, soon it will be one and a half. Reassurance can play a cruel joke, we do not need to calm down, we need to be alert.
We are living in a time of crisis of trust, no one believes anyone
Leyla Fazleeva: Is it possible to identify the category of people who are most prone to that depression will appear, anxiety will increase and it will be inadequate?
Vladimir Mendelevich: I would even distinguish two groups. The first group of people is, in principle, suspicious and anxious in nature. There are a lot of them around us, who are not only because of the coronavirus, they can panic on any occasion, they are afraid of any infection, they are sensitive to any medical information, and it is very difficult to influence them. Because this is a character, and it is very difficult to change a suspicious character with anything, so they are brought up, such is their temperament.
But the second group is a group of people who, to be honest, I can't even understand. These are people who don't want to believe any scientific information. They are all over the world, but they are also many in our country. So these people create panic. Let these people talk, but they should discuss with experts who can resist them. These are not mentally ill people, but their behaviour is very similar to the state of a mentally ill person — denial of real facts, inability to see what is really there and perseverance in their position.
Leyla Fazleeva: If we talk about people who generally deny the effectiveness of the vaccine, how, in your opinion, to separate the wheat from the chaff, whom should we trust, we are all in the information flow of an incredible level today and there is a lot of fake news, so it is quite difficult to understand everything.
Vladimir Mendelevich: I don't have an easy answer to your question. For a person to become rational in the field of coronavirus, he must become rational in general, he must be able to separate the wheat from the chaff in general in many areas of life. . Who exactly? Scientists who do not conduct popular science lectures as actively as in the Soviet era. On TV, meanwhile, priority is given to irrational programmes like The Battle of the Psychics, some secrets, conspiracies, and so on, in general, some mysticism and mythology. Where are the programmes that could give a person at least a crumb of knowledge?
Opponents today argue that the vaccine is more dangerous than the disease itself. So let's bring them into “the red zone”, show data on mortality — people, of course, do not really believe in state statistics. The vaccine does not describe any serious, massive consequences. I am not an enemy to myself, for the sake of propaganda, I would not get vaccinated — this is complete stupidity, I would not sacrifice my family to be engaged in conducting a vaccination line.
We're told that we don't know the long-term consequences. So no one knows, but when you are in danger of death, then, probably, you can focus on the data that has been obtained in recent months. I don't want to comment on the silly and naive talk about the introduction of the human genome — it's nonsense. People also believe in GMOs that it changes human DNA — this is not true, and a large number of these misconceptions.
It is impossible to compare a priori three vaccines — Sputnik V, Pfizer and Moderna, because no comparative study has been conducted. This is science. The question is — why compare, what is the value, if one is better, the other is worse. But to track the consequences, as Europe did in relation to AstraZeneca, to conduct independent research, whether there are consequences. They haven't found any connections yet, or they have found something that limits the indications for its use for some people. We don't give Sputnik V to everyone either. A person must decide for himself whom to believe.
We are living in a time of crisis of trust, no one believes anyone. How to make people believe? Probably, by telling them the truth.
Leyla Fazleeva: The question is asked by our viewer. “I got over the coronavirus and periodically note depression. Everything seems to be fine, work, family, children, but sometimes it just hits me. I didn't think that men could have such problems before. Is it temporarily?"
Vladimir Mendelevich: As a doctor, I can't talk about the prognosis without seeing the patient. According to statistics, those who moved after Covid-19 to cognitive disorders, Alzheimer's disease and other pathologies — their number is not very large. Most of the patients fully recover from this condition. The speed of recovery depends on the state of the body, the activity of the brain and other factors. That is, these phenomena are temporary and we will tell our subscriber that there is a high probability that all this will pass.
Leyla Fazleeva: If we talk about physical education and sports, healthy lifestyle, walking on the street — is it an option to restore the state of mental health, yes or no?
Vladimir Mendelevich: There is a study that suggests that Alzheimer's disease can be slowed down with increased physical activity. They are very closely related to the functional activity of the brain. I walk 5 km every day since last March. Then there was the idea to prepare the lungs and also to occupy yourself somehow in self-isolation. I recommend an active lifestyle both as a scientist and as an ordinary person.