Psychiatric Treatment of a Health Care Worker After Infection With Ebola Virus in Lagos, Nigeria

Abstract

A young single male health worker was admitted to the isolation ward of the infectious disease hospital in Lagos with Ebola virus disease, which he had contracted in the course of rendering services to the index case in Nigeria. Three weeks after the admission, he appeared confused and was sleeping poorly, talking tangentially, and exhibiting unruly, disruptive behavior toward those caring for him. His behavioral symptoms were worse during relatives' visits. The clinical management team considered a diagnosis of permanent brain injury secondary to the Ebola virus infection but could not conduct the relevant investigations because of the contagious nature of the illness. The patient was referred to the psychosocial team.On evaluation, the psychosocial team found the patient to be apprehensive and fearful about the outcome of his illness. He lamented having contracted the virus, despite having taken what he considered adequate precautions while attending to an infected patient. He had feelings of sadness and self-pity, saying that God had forsaken him and at other times saying that God did not exist. He often paced up and down the corridor. His poor sleep seemed to contribute to his daytime anxiety. He was angry with his clinical colleagues, who were now his clinical management team, and his relatives for "ostracizing" him in the isolation ward. He felt very sad about both groups seeing him in "this helpless situation." He had no past history of mental disorder.Mental state examination revealed a restless and agitated young man. He described his mood as not happy. His thinking was slowed but goal directed. He worried that some patients admitted after him had already been discharged after achieving remission and believed that his condition was probably not responding to treatment. He had no delusions, obsessions, or hallucinations. He was oriented in time, place, and person, but his attention and concentration were impaired. He could recall only one of five objects in 5 minutes. He lacked insight into his mental problem. Further cognitive and neurological evaluation was not attempted because of the patient's contagious status. He had been physically stable for several days prior to consultation, although his blood test was still positive for Ebola virus. A diagnosis of adjustment disorder with mixed disturbances of emotion and conduct was made. The psychosocial team commenced supportive psychotherapy and problem solving therapy. The patient was encouraged to cooperate with the management team and caregivers for the desired therapeutic outcome. Because of his poor sleep and anxiety, we prescribed 25 mg of amitriptyline at night, and increased the dose to 37.5 mg 48 hours later. The primary management team was educated on the nature of his psychological disorder, which could mimic cognitive impairment secondary to Ebola virus disease-induced brain encephalopathy. They were informed that his behavior could be ascribed to the psychological stress of having a life-threatening disorder. The patient's relatives were also g...

Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital

“…The outbreak itself and the control measures may lead to widespread fear and panic, especially stigmatization and social exclusion of confirmed patients, survivors and relations, which may escalate into further negative psychological reactions including adjustment disorder and depression. [3][4][5] Sudden outbreaks of public health events always pose huge challenges to the mental health service system. Examples include the HIV/AIDS epidemic that captivated world attention in the 1980s and 1990s, the severe acute respiratory syndrome (SARS) in 2002 and 2003, the H1N1 influenza pandemic of 2009, the Ebola virus outbreak in 2013, and the Zika virus outbreak in 2016.…”

Neuropsychological Manifestation in Ebola: A Concern

“…Mohammed et al recently reported an interesting case study of a post-ebola mental disorder (8). The indexed case presents with confusion and disruptive behavior (8). Psychotherapy and anxiolytic drugs were used in this case (8).…”

“…The indexed case presents with confusion and disruptive behavior (8). Psychotherapy and anxiolytic drugs were used in this case (8). Mohammed et al mentioned that brain sequela is the cause of the mental illness (8).…”

“…Psychotherapy and anxiolytic drugs were used in this case (8). Mohammed et al mentioned that brain sequela is the cause of the mental illness (8). The brain pathology and clinical correlation in ebola is an area for further research in neuropsychiatry (3,9).…”

“…Mohammed et al studied survivors of ebola and reported that an inability to concentrate and a loss of sleep were common problems (6). Mohammed et al recently reported an interesting case study of a post-ebola mental disorder (8). The indexed case presents with confusion and disruptive behavior (8).…”