Dr Osonwa Ikechukwu (MBBS)
Nervous breakdown often used interchangeably as mental breakdown, though not considered a medical term, is used to describe a condition in which people are temporarily unable to function normally in day-to-day life. It is largely understood to occur when life’s demands become physically and emotionally overwhelming as can be seen during the present COVID19 pandemic. It is an unhealthy response to stress and strain.
In times like this when the world is looking for what to hinge on to as a succour in trying to circumvent further damage or cut short the global upheaval brought about by a novel virus tagged COVID19, it is imperative that we take into account one of the important factors in maintaining our absolute balance in life – Mental Health. Following the global health crisis resulting from COVID19 pandemic, maintaining optimal mental health is paramount to aiding survival. This is even as the restrictive measures such as closure of many businesses, work places, schools, and imposition of lockdown in major cities, physical and social distancing and others, are beginning to impact on people’s life. To many people, this is compounded by loss or a possible loss of source of income due to consequent economic crisis from the lockdown. 
Talking about mental health, it refers to how the brain affects people’s ability to think, feel and act. Anything that involves the status of the social, psychological or emotional well-being of an individual is considered part of mental health. A lot of factors can influence mental health, including traumatic experiences, ill health, loss of loved one, family breakups, loss of livelihood – loss of job, source of income, abuse, e.t.c
The above mentioned are things that this present COVID19 pandemic are associated with. Hence, it is not uncommon that many people have started feeling anxious, fearful, more lonely and stressed especially in areas of most affectation
1. Healthcare workers – by means of the nature of their work, even without a pandemic as this, healthcare workers are generally under pressure to perform their duties. This pressure results from increase in demand for caring for the sick, prolonged working hours with relatively limited time with family and loved one and in many nations, especially the developing countries, the remunerations from these works are nothing to write home about and as such do not compensate for the stress involved. This stress is  produced through the interactions between the demanding nature of their works and their often obsessive, conscientious and committed personalities especially but not limited to the doctors, nurses, laboratory scientists and pharmacists. The work place pressure and stress for the healthcare workers therefore would reach a crescendo as the world look unto them for respite and possible cure for the COVID19.
Also, healthcare workers are at a higher risk of being infected with this rapidly spreading virus – COVID19. As WHO rightly puts it, “health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that puts them at risk of infection. Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence”. This explicitly explains the dangers of being a healthcare worker with its attendant risk of mental breakdown especially at this time.
2. Persons with chronic illness – The American Centre For Disease Control suggest that people of all ages with underlying medical conditions, particularly if not well controlled are higher risk of severe illness from COVID19. The implication of this is that those within this group might begin to feel anxious, fearful and would react overtly with possible consequent mental breakdown. The worrying that comes from knowing you are vulnerable to a more severe complication of COVID19, can precipitate mental breakdown in this group of people. The chronic medical conditions include; People with chronic lung disease or moderate to severe asthma, those who have serious heart conditions, the immunocompromised, those with severe obesity (body mass index [BMI] of 40 or higher), the diabetics, hypertensives especially with poor control, people with chronic kidney disease undergoing dialysis, those with liver disease e.t.c
3. Infected Persons – People who are already infected with COVID19  are more likely to experience nervous (mental) breakdown. This could result from stigmatization, coping with the concept of being isolated, fear of possible complications and even death especially those with severe symptoms, who would have to be admitted into ICU and might need intubation. Even after surviving the infection, some might develop post traumatic stress disorder(PTSD) and other mental health disorder. 
4. The grieving – Those who have lost loved ones from COVID19 might suffer emotional setback, and might grief longer than required with consequent mental breakdown. Grief refers to the natural response (multifaceted response) to loss of someone or something to which a bond was formed. It is the emotional suffering one feels when something or someone that one loves is taken away and this is exactly what COVID19 pandemic has caused a lot of people. 
5. Children – The closure of schools and the sit at home(lockdown) might not be clearly understood by children. They might no longer have the sense of structure and stimulation which the school environment provides and as such would be in confusion as to what’s happening. For those of them without an understanding parents who would put up aberrant behaviors especially in homes where there’s disunity, coping might be difficult. 
6. The impoverished – In many regions of the world, particularly in developing countries such as Nigeria, Niger Republic, Somalia, and the likes, many of the people are so poor that they struggle to eat twice a day. A lot of the populace live and “feed from hand to mouth”. They live by daily scrapping and scavenging. Where they live, the kind of work they do, their high dependence on public services and their relativity to no savings, have already subjected them to high risk group for mental breakdown. This is then compounded by the harsh realities of the present economy aggravated by the lockdown due to COVID19 pandemic. 
People who are experiencing nervous breakdown may have physical, psychological, and behavioral symptoms. These may vary according to the degree of affectation. Symptoms include;
– Depressive symptoms, such as loss of hope and thoughts of suicide or self-harm
– Anxiety with its associated trembling and shakiness
– Poor eating habits
– Sleep disturbances
– Poor hygiene
– Hallucinations
– Extreme mood swings or unexplained outbursts
– Panic attacks, which include chest pain, detachment from reality and self, extreme fear, and difficulty breathing
– Paranoia, such as believing someone is watching you or stalking you
– Flashbacks of a traumatic event
– May withdraw from family, friends, and colleagues
  • Supporting one another is very important to circumventing the challenges brought about by the pandemic.
  • Proper orientation on the disease, cause, means of spread, preventive measures should be carried out by the government even up to rural areas and in local dialects. Information is key to safety
  • For all at home, video chatting with loved ones who are not within reach can be very helpful
  • Keeping in touch via social media is an important way to stay strong in this period
  • Humor is essential in helping our mind stay positive, it is a form of “distracter” from negative thinking and hence help us cope with negative experiences.
  • Indulge in creative activities as this elevates the mood and ensures mental health is preserved
  • Following the lockdown and the overwhelming burden on our healthcare system, online consultations, telemedicine and the likes can be a good way to help attend to people’s health challenges while they remain at home.
  • Having a routine will help promote mental health. This include; eating meals at regular time, sleeping, waking, exercising and maintaining social distance while at it. Keeping routine help to reduce decision fatigue. Unstructured time creates boredom, increase anxiety and allow depression to set in.
  • Families can create a schedule that everyone will get on board with, it should be fun and creative. Parent should avoid abusing themselves or using violence especially with the children around. Rather encourage continual learning.
  • For those with chronic diseases, adhering to preventive measures is very important. Stringent measure should be encouraged so as to avoid exposure to COVID19. Where possible, telemedicine can be used to get across to healthcare provider unless physical presence is required to take care of health need in the hospital
  • Reaching out to those who have lost loved ones to COVID19 would be of utmost help. Giving moral support and other material support where necessary would go along way to help
  • For infected persons, adequate and optimal care should be rendered and after recovery, should be well integrated back into society without stigmatization.
  • For healthcare workers, adequate remunerations, provision of standard personal protective equipment, good working environment, suitable insurance, and well optimized work shift to reduce burnout and other support would go a long way in encouraging them to work effectively and efficiently. Also psychosocial support is needful
  • For the impoverished, the importance of food aid, monetary assistance and provision of basic amenities cannot be overemphasized. Government, organizations and well meaning individuals must all at time during this pandemic provide necessary support needed by this group of people.
  • Very importantly, read books, it’s a good way to redirect your mind to something meaningful
The key to surviving tragic, stressful and strenuous situations such as portend by the COVID19 pandemic, is the development and maintenance of “TRAGIC OPTIMISM”
Tragic optimism refers to the ability to maintain hope and find meaning in life despite its inescapable pain, loss and suffering. It’s a term that was coined by Viktor Frankl, the Holocaust survivor and psychiatrist from Vienna, Austria.
Adopting the concept of tragic optimism enables people to grow through adversity and it help people acquire a new sense of purpose, develop deeper relationship and have a better appreciation of life.
This is exactly what we need at this trying time
# factsnotfear 
# precautionsnotpanic
# realitynotrumours
# proactivenotjustreactive
# positiveactionnotanxiety
Spread the RIGHT MESSAGE not the VIRUS
Dr Osonwa Ikechukwu (MBBS) is a practicing medical doctor, a writer who has authored many books such as Positive Thinkers Ability, Reasons To Smile Again, Building Formidable Youths, Sensual Bleed, Spoilers Within, Man and His Embattled Secrets, 365 Positive Reasons For a Glorious Year, and many more. He is the brain behind POA’S TRIANGLE ( a health oriented website. Others include;  Redefining Reality, and health_infotainment on Instagram. 
Follow @OsonwaIkechukwu on twitter. 
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