Chinese 'psychological' therapy for coronavirus and lessons for the world

With panic attacks, resentment, delirium being observed, psychotropic drugs and psychological techniques were used to treat patients

This report is part of a special series on how the Chinese tackled the coronavirus crisis and the lessons India can learn to limit the damage.

Most European governments, as well as the Indian government, have mostly focused their energies on dealing with the psychological, economic and social impact of a lockdown on their citizens. But few measures, if at all, have been put in place to alleviate the mental trauma of those suffering or have emerged alive after being infected with the deadly coronavirus. The Chinese, who have ‘been there and done that’, on the other hand, have recorded behavioural patterns of patients and devised psychological ways to deal with their symptoms.

Business Standard had earlier reported how the Chinese tackled the first wave of the pandemic in the country through hospital isolation techniques, patient management and through use of western and traditional Chinese medicines. A report prepared by the Jack Ma Foundation based on notes prepared by frontline Chinese medical personnel also throws light on the acute psychological symptoms of victims observed by doctors during treatment and after their discharge. The report also details certain techniques deployed by them to deal with the consequences.

After treating thousands of patients, the Chinese observed that 48 per cent of coronavirus patients admitted for treatment displayed signs of psychological stress attributable to their emotional response to the infection. Patients displayed signs of “regret and resentment, loneliness and helplessness, depression, anxiety and phobia, irritation, sleep deprivation and panic attacks”. It was found that critically ill patients displayed signs of delirium. In addition, those who had developed inflammation of the brain (or encephalitis) due to the coronavirus infection, fell unconscious and displayed irritability when awake.

Patients were screened every week in hospital on their mental states, including a check of their vital wellness parameters, such as sleep quality, blood pressure, mood and other signs of psychological stress. Patients were also mandated to complete six psychological and psychometric tests – a few of which involved face-to-face interviews with doctors.

Among the self-rating tools that patients were encouraged to fill up using their cellphones while admitted in hospitals included a Self-Reporting Questionnaire 20 (SRS 20). Devised by the World Health Organization (WHO), this test involves the patient answering a set of 20 questions. Based on their answers, Chinese doctors could identify if a patient displayed signs of mental disorder. Among other questions, patients were asked to answer the following with a yes or no: Do your hands shake? Do you have frequent headaches? Do you cry more than usual? Have you thought of ending your life? Do you feel you are a worthless person?

There also was the Patient Health Questionnaire 9 (PHQ 9) used to measure the severity of depression in patients. This test involved patients choosing from among four options to measure the severity of certain symptoms encountered. Coronavirus patients could choose among these symptoms varying for several days over the previous two weeks, more than half the days, nearly every day and not at all during the period. Among other parameters, these symptoms or problems included: poor appetite or overeating, trouble reading the newspaper or watching TV, feelings that one had let oneself and their family down and feeling depressed and hopeless. In the end the patient was to indicate whether these problems had made their work, family and work interactions somewhat difficult, very difficult, extremely difficult or not difficult at all. 

Chinese doctors also used of the Generalised Anxiety Disorder 7 (GAD 7) test, with seven questions to determine whether a patient displayed psychological symptoms of excessive, uncontrollable and irrational anxiety about events around them. It used the same time scales and testing parameters as the PHQ 9 test with higher scores indicating the prevalence of anxiety disorders in the coronavirus patient. Among other problems, the test included asking the patient to measure the following: not being able to sit still, becoming easily annoyed, not being able to control worrying and feeling afraid as if something awful was about to happen.

The Chinese also used three other tests to be filled by doctors and psychologists after analysing the patient and rating them for their disorders on various scales. These included the Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). In HAM-D, doctors rated patients on 17 symptoms, ranging from insomnia, suicidal tendencies, agitation, anxiety, libido, depression and other physiological symptoms of mental disorder.

In HAM-A, Chinese doctors paid more attention to visible physical symptoms, including the patient’s behaviour during the interview for the test. If the coronavirus patient looked fidgety or restless, displayed signs of hand tremors, furrowed brows, pale or strained face and rapid respiration, these were taken as clear signs of high anxiety levels.

Finally, the Positive and Negative Syndrome Scale (PANSS), an interview conducted by a doctor with the patient to measure the severity of schizophrenic tendencies, was deployed. The PANSS is considered one of the most accurate psychological tools for evaluating mental disorders. Chinese doctors tried to ascertain the severity of symptoms in coronavirus patients by testing whether mental disorders were enhancing or reducing their normal functions. It was checked whether a patient displayed enhanced signs of delusion, grandiosity, hallucinatory behaviour and suspiciousness, among other symptoms. In the interview, doctors also determined whether the patient displayed reduced signs of stereotyped thinking, social and emotional withdrawal and poor rapport.

For those who displayed mild to moderate symptoms, psychotherapy, mindfulness exercises and certain medications were recommended to improve mood and sleep quality. Those displaying signs of illusion and delusion were to be administered antipsychotics such as olanzapine and quetiapine. For those with severe psychological symptoms, especially the middle aged and elderly with other existing diseases such as diabetes and hypertension, Chinese doctors recommended psychotropic drugs like citalopram, alprax and various other sleeping pills and sedatives to reduce anxiety and depression.

Series concluded. This was the last of a three-part series on the Chinese strategy to fight coronavirus based on excerpts of notes from frontline Chinese medical personnel. You can read the other two parts here:

Part 1: Revealed: China's solution to fight the first wave of coronavirus pandemic

Part 2: Coronavirus: Traditional Chinese medicines and the Ayurveda connection