Academic journal article The Israel Journal of Psychiatry and Related Sciences

Psychiatric Inpatients' Reactions to the SARS Epidemic: An Israeli Survey

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Psychiatric Inpatients' Reactions to the SARS Epidemic: An Israeli Survey

Article excerpt

Abstract: Background: The threat of the potential spreading of the SARS epidemic caused significant stress to many individuals from non-affected countries. In this study, we investigated whether the SARS threat affected the subjective mood and behavior of Israeli patients with schizophrenia and compared their reactions with those noted in their clinical staff. Methods: Subjects were evaluated with a specially designed questionnaire and a modified form of the Spielberger Scale for State Anxiety. Results: As compared to staff, patients had higher scores on the Modified Spielberger State Anxiety Scale. However, many responses (e.g., dysphoria) to the SARS threat did not differ from staff. Patients felt more protected by the authorities and some perceived the epidemic in a psychotic manner. Conclusions: It seems that patients attempt to reduce the effect of external stressors by living in an "autistic bubble" (in which outside threats cannot enter) or by denying the significance of these stressors and over-emphasizing the power of medical authorities to protect them. On the other hand, some patients also psychotically interpreted these stressors.

Introduction

The reaction of psychiatric inpatients to various threats has been the subject of several articles (1-3). These patients have reduced coping abilities and are negatively affected by many stressors. Moreover, due to their psychotic condition, they interpret various neutral conditions or minimal/distant dangers in a catastrophical manner (4).

Surprisingly, there exists another notion in the literature that maintains that during periods of war or fire conflagration, patients with schizophrenia do not panic and "attempt positively to survive and help their comrades"(5, 6).

The "Severe Acute Respiratory Syndrome (SARS) epidemic" has been one of the first 21st century epidemics and has resulted in extraordinary public health and infection control measures (7,8). It began in November 2002, when 305 cases of atypical pneumonia appeared in southern China. In February 2003, cases were reported in Hong Kong and from there the disease spread to many other countries, mainly China, Hong Kong, Singapore, Vietnam, and to Toronto, Canada. Approximately 900 persons died of the disease (9). The illness fairly rapidly spread from family members of patients who developed the illness and their medical staff. The mortality rate was reported to be around 6-7% and no specific treatment has yet been found (10). The SARS epidemic has lead to various "hysterical" reactions on the side of governments, stock exchanges, banks, flight agencies, hospitals and, last but not least, among individuals who were forced to suffer curfews, seclusion, wearing masks, remaining at the hospital (staffer patients suspected of suffering from SARS) or receiving a compulsory check-up at the airport (11).

The psychological reactions of patients and staff towards the SARS threat have surprisingly been the focus of very few articles in medical and psychiatric journals, and this was despite the clear effect of the SARS threat on the mental well-being of many individuals. Thus, for example, Maunder et al. (12) from Ontario, Canada, described the immediate psychological and occupational impact of the SARS outbreak in their hospital. Patients and staff experienced insomnia, anxiety, fear of infecting/contagion. Uncertainty and stigmatization were prominent themes for both staff and patients (12).

In Israel, a Middle Eastern country, the panic was gradual with several persons admitted to hospital after returning from the Far East. Nevertheless, the topic was very much debated in the media and much fear was expressed (13). As no SARS patients were identified in Israel, our study deals with the perceptions and fears of possible contagion of inpatients and staff in the case of a rather distant threat.

In this study, we intended to investigate whether this threat had any effect on the clinical state of psychiatric inpatients with schizophrenia at a large psychiatric hospital. …

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