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Table of Contents
PERSPECTIVE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 74-78

Neuropsychiatric aspect of social isolation following a lockdown: A perspective


Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India

Date of Submission30-Dec-2020
Date of Acceptance08-Nov-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Bhupinder Singh Kalra
Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcfm.ijcfm_148_20

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  Abstract 

Coronavirus disease 2019 pandemic spreads through inhalation of aerosols or droplets. Therefore, the use of face masks, alcohol-based sanitizers, and most importantly practicing quarantine/ isolation and social distancing are the main modalities for its prevention and control. Although isolation is essential, various psychological effects have been implicated with its practice in most of the age groups. Longstanding isolation and negligible interpersonal interactions can have changes in psychological processes and neurological and morphological changes in the brain. Morphological changes as seen through the neuroimaging studies include reduced volume of the structures involved in the synthesis of various nerve growth factors leading to impaired neurogenesis and subsequently psychological changes which can manifest as mood alterations such as anxiety, depression, feeling demoralized, obsessive thinking, and altered sleep–wake cycles besides others especially, in the vulnerable age groups such as children and the elderly. Although quarantine remains the cornerstone to contain the spread of the pandemic, its psychological impact run simultaneously, which should be, understood, and addressed to ameliorate its long-term impact.

Keywords: At-risk population, coronavirus disease 2019, psychological impact, social isolation


How to cite this article:
Khanna S, Jain A, Kalra BS. Neuropsychiatric aspect of social isolation following a lockdown: A perspective. Indian J Community Fam Med 2021;7:74-8

How to cite this URL:
Khanna S, Jain A, Kalra BS. Neuropsychiatric aspect of social isolation following a lockdown: A perspective. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jul 4];7:74-8. Available from: https://www.ijcfm.org/text.asp?2021/7/2/74/333660




  Introduction Top


Coronavirus disease 2019 (COVID-19) pandemic continuing till date, affecting more than 240 million people globally with a confirmed casualty of more than 5 million.[1]

The novel coronavirus is thought to spread through interpersonal contact primarily by inhalation of droplets through the nose and mouth into the lungs of the patient. A person while manifesting symptoms is thought to be most infective. The virus seems to be spreading easily and sustainably in the community (community spread) in most geographic regions of the world.[2]

Many drugs/vaccines are being tested for the purpose of treatment and prophylaxis of the disease; until then, the mainstay preventive modalities include regular hand washing, avoiding contact of the face with bare hands, and most importantly social distancing/quarantine /isolation of the population.[2] Social distancing/quarantine involves being contained for a duration of days to weeks together as an attempt to avoid community spread of the infection.[3]

Regardless of the significance of social isolation as a parameter in limiting the outbreak of the infection, the widespread lockdown unavoidably has a psychological impact of its own on the people. Feelings of altered mood, anxiety, sadness, uncertainty, impending doom, and being in solitary confinement are usually observed as a sequel to mass quarantine, and the mainstream media reports of increasing number of casualties add to the already-existing fear and anxiety in the population.[4]

Psychological impact of quarantine in humans

Human beings are social animals, and our social, biological, and psychological systems are evolved to function and prosper along with other beings. Studies have suggested that the negative impact of long duration of social isolation on the physical and mental health of a person is almost similar to the risk factors such as high blood pressure, obesity, and smoking.[5]

It has been observed in various studies that long periods of social isolation can increase the risk of a variety of health problems including psychological disorders such as anxiety, depression, posttraumatic stress disorder, low self-esteem, and in worst cases death. A meta-analysis has found that chronic social isolation increases the risk of mortality by up to 29%.[5]

In a recent article published on COVID-19 outbreak, individuals who were isolated and had negligible social interaction experienced a sense of “cabin fever,” often involving feeling of restlessness, dissatisfaction, irritability, and being stuck in the surroundings.[6]

There are reports highlighting social isolation as a precipitating factor to stress, confusion, and agitation especially, among the individuals who were isolated for a relatively longer time.[6]

Age-related factors associated with psychological impact of quarantine/isolation

Although people of all the age groups are susceptible to the psychological impact of social isolation, people with disabilities, children and elderly people are at a relatively higher risk. Decline in the overall health; coexisting illnesses; and physical absence of the immediate family, relatives, peers, and friends are some of the factors that can add to the impact of social isolation.[3]

A recent report from the National Academy of Sciences has also highlighted similar factors including the distance from family, decreased enthusiasm to socialize, chronic illnesses, and visual/auditory decline, which make the elderly population more vulnerable.[7]

Similarly, adolescent age is also a vulnerable time where the people require social interactions for their holistic development and are very sensitive to social challenges. Being isolated for long periods may hamper the overall development of self-esteem and communication skills later on in life. A sense of belonging at the school, to be among the peer group, is important for the adolescents, and a longer duration of detachment from their school during this age may have an everlasting impact. This can alter their perceptions about social conduct which can lead to social anxiety and subsequently social withdrawal later in life.[8]

The impact of a healthy social structure has been highlighted in various studies, indicating that people with social anxiety, fewer numbers of friends, and personal relationships were at a higher risk of detachment later in life. Previous researches have highlighted the importance of meaningful friendships, which act as a protective barrier against the feelings of perceived social isolation in this vulnerable age of adolescence.[9] Some studies highlighting the psychological impact of social isolation have been described in [Table 1].
Table 1: Some studies highlighting the psychological impact of social isolation

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Neurobiological changes associated with social isolation

The brain is the central structure to understand the social connections and the impact of social isolation. There is substantial literature available that the perception of social isolation affects the brain structure, functioning, and subsequently the behavior and hence, is an important risk factor for a psychological impact. The available evidence on social isolation has also hypothesized that perceived social isolation leads to a significant decrease in the rate of cell proliferation in the brain.[15]

Animal studies also have long provided a strong basis of neurological effects due to social isolation in species living in a social surrounding.[16] In line with this, studies have indicated that enriched social interactions tend to enhanced neurogenesis and programming in the brain, particularly at the centers essential for social perceptions, communication, and memory consolidation.[17]

Various functional neurological cellular changes observed with social isolation include:

  1. Dysregulated development of the hippocampus due to modifications in microtubular instability and decreased microtubule-associated protein-2 expression leading to dysregulated remodeling of axons and dendrites[18]
  2. Diminished expression of synaptophysin and dendritic cell length and density of pyramidal cells[19]
  3. Increased in Tac2 gene (Tachykinin gene) expression and the production of NkB throughout the brain associated with impaired cognition, increased response to fearful stimuli, and difficulty in memory consolidation[16]
  4. Diminished synthesis of newer neurons formation, brain-derived neurotropic factor, and nerve growth factor in hippocampal region[20]
  5. Abnormal expression of cAMP response element-binding protein in the regions such as the ventral striatum and the amygdala, which has been associated with depression, anxiety, and psychosis-like behaviors.[20]


Several whole-brain exploratory studies in socially isolated individuals have highlighted various changes in brain:

  1. Large differences in the gray matter volume neuronal clusters in the anterior hippocampus, amygdala, and entorhinal/para-hippocampal regions in isolated individuals in the voxel-based morphometry studies[21]
  2. Decreased gray matter volume in the left posterior superior temporal sulcus, middle temporal gyrus, and entorhinal cortex regions that are usually associated with associative memory, motion perception, and social awareness[21]
  3. Decreased resting-state functional connectivity between several nodes of the anterior insula/operculum, dorsal anterior cingulate cortex, and the superior frontal gyrus associated with diminished alertness, mood, and executive control on functional magnetic resonance imaging studies[22]
  4. Weak activation of the mesolimbic dopamine system in isolated individuals suggesting decreased reward to social stimuli. In contrast, people that have a better social relationship tend to have a greater activation of the temporoparietal junction, dorsomedial prefrontal cortex, a region involved in cognition, information processing, and comprehension of language.[20]


Methods to reduce the impact of social isolation

A period of quarantine/isolation has a negative psychological impact, which can be detected months or years later. Hence, it is important to inquire about the history of any psychiatric or mental illnesses. For the population working in the health sector, support from the government authorities becomes imperative in ensuring the welfare, the basic necessities, and appropriate supplies for a proper functioning of the health-care system.

Some of the methods that maybe helpful in reducing the psychological impact include.

Communication

Studies have suggested that keeping in touch with health-care professionals during the periods of isolation could provide a sense of security during the isolation period. Communicating with one's family and friends also becomes paramount especially during emotionally demanding times like that of quarantine/isolation. In these present times, various social media platforms have become universal and could play a vital role in facilitating overall communication in various aspects of individual relationships.[2]

Yoga

Yoga is derived from Sanskrit yuj meaning “to attach, join, harness, yoke” and is a practice of spiritual, mental, and physical wellness and has been one of the classical schools of philosophical traditions that is thought to have originated in the prevedic civilizations.[23] In the context of a lockdown, yoga has garnered significant attention as a mainstream practice in many parts of the world as a complementary therapy to many psychological problems.[24] In a recent study involving depressed and anxious individuals, it was seen that the ones who practiced yoga once a week for at least 6 weeks besides the usual therapy had statistically significant reduction in the levels of anxiety and depression scores compared to the control group.[25]

Exercise

Regular aerobic exercise has been found to have significant mood-alleviating capacity. Simple exercises including a brisk walk, skipping ropes, or stretch-up exercises can be helpful in alleviating the stress effects due to social isolation. Mechanisms of effectiveness of the physical activity have been linked to elevated plasma levels of endogenously produced opioids including β-endorphins and β-lipotrophin as a result of aerobic exercise.[26]An increase in the endogenous opioid concentrations after exercise has an association with the psychological changes including mood fluctuations, “exercise-induced euphoria,” altered pain perception, and decreased stress response.[27]

Music therapy

Listening to music can produce a calming environment, acts as an anti-anxiety mechanism, and helps alleviate the emotional distress during long periods of social isolation.[28] In a study, participants experienced significant reduction in depression, anxiety, anger, and stress after 12 music sessions twice a week.[29]

Omega-3 fatty acids

Regular consumption of omega-3 fatty acids has been shown to play an important role in maintaining the pyschological well-being. In a study, lower plasma concentrations of docosahexaenoic acid and Eicosapentaenoic acid were found in the patients of depression.[30]


  Conclusion Top


Major infectious disease outbreaks, like COVID-19, mandates quarantine/social isolation as an important preventive strategy to curb the spread of the infection. However, the available data suggest the downside to social isolation i.e. undesirable psychological impact which can be detected even weeks or months post quarantine. In this regard, multiple micro and macro cellular changes have been observed in animal and human brain studies pertaining to social isolation. Thus, it can reasonably be said that, although quarantine is the need of the hour for the current pandemic, there also lies a psychological issue which needs to be considered. Hence, in this regard, determining any prior history of psychiatric illness or any mental health issue is important. Certain aspects should be considered that may be helpful in reducing the psychological impact in individuals before implementation of the quarantine/isolation. Meticulous planning in restricting the duration to a minimum and paying special attention to the needs of certain high-risk groups (e.g., health-care providers, patients with psychiatric illnesses) is warranted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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