Psychiatric and neuropsychiatric syndromes and COVID-19.

During the COVID-19 pandemic when uncertainty is on the rise, preliminary evidence suggests that people with obsessive-compulsive disorder might be showing relapse and worsening of symptoms. Given that increasing severity of obsessive-compulsive disorder symptoms can cause an increase in suicidal ideation, intervention becomes imperative. Although guidelines for clinicians have been outlined, they might be of little help because of the inadequate number of therapists, high cost, and scarcity of resources, such as time, energy and stable internet connection in case of teleclinics, available to most populations.

Shafran and colleagues addressed these issues and asserted that “recommendations advocated by Centres for Disease Control and Prevention throughout the world are sufficient”. Although this might be generally true, it is important to remember that most of these recommendations have been written for healthy individuals. For someone with obsessive-compulsive disorder, following these recommendations might prove challenging given the ambiguity in the terms used. For instance, the US Centre for Disease Control and Prevention recommends washing hands for at least 20 seconds and disinfecting surfaces daily, whereas WHO suggests cleaning hands regularly and thoroughly. As people living with obsessive-compulsive disorder, we can safely say these words have no limits in our minds.

To address this, we propose two interventions dealing with the two parts of obsessive-compulsive disorder: obsessions and compulsions. For obsessions, we recommend a chatbot to handle common intrusive thoughts, such as I did not wash my hands that one time; therefore, I am responsible for bringing harm upon my family. For each worry, there must be a reply pre-set by a mental health professional involving a rational counterargument with statistical data from reliable resources. For compulsions, an interactive website could be developed based on an adapted version of standard guidelines with defined limits, like the one provided by the International OCD Foundation. This site would allow people to log their daily precautionary measures and frequency and if they cross the database's pre-set limits, would provide a notification stating which measures the user is overdoing so they can be mindful of their actions. The site would exist in the English language as default, but users could switch to other preferred languages. Furthermore, a text message service could be developed for those without access to the internet. However, those without mobile phones will be more difficult to contact.

These measures can be made globally available for free. The one-time cost of developing them can be provided by public funding and local language translations could be added by volunteers from all over the world.