CHEARS

The global COVID-19 pandemic and its associated lockdown restrictions had initially resulted in many sports competitions around the world are put on hold. High-level athletes (professional, Olympic/Paralympic, or collegiate) suffer from numerous symptoms and health disorders at similar, if not higher, rates to those of non-athletes. However, the impact that the pandemic has on mental health symptoms and disorders for athletes has not received much scientific attention. Overall management for athletes emphasized cardiac complications, screening for asymptomatic disease, and back to sports, incorporating hygiene measures. There is a delineation of management considerations for mental health symptoms and disorders in elite sportsmen. Following are some of the recommendations for mental health management of athletes during COVID-19:

 

• Psychotherapy

The term "psychotherapy" refers to the treatment of mental illnesses, symptoms of illness, diseases, or life issues by way of psychological approaches, which are frequently founded on therapeutic concepts, structure, and tactics. For elite athletes, having mild to moderate signs of mental illness and disorders, this is the therapy of choice. This seems to happen during the COVID-19 pandemic when athletes are traditionally particularly well equipped.to cognitive-behavioral treatment due to their familiarity with the organization, direction, practice, goal setting, and self-reliance. In contrast to more traditional psychotherapy, the primary goals of crisis counseling are to ensure safety, promote the return to function, and provide immediate resources. Because athletes have lost much of their customary team structure, group psychotherapy to reproduce some team dynamics within therapy groups may be good for them during the pandemic. Depending on the specific mental health problem, virtual psychotherapy may include elements that the psychotherapist does not ordinarily have access to. However, there are other impediments to psychotherapy, such as denial of psychiatric disorders and stigma associated with getting therapies. When athletes have been acclimated to social withdrawal or have less contact with members, who might otherwise be the first to recognize mental health concerns and propose referral for treatment, overcoming these hurdles may be more difficult than usual. Therefore, intervention is required at the team, league, and university sports department levels. To maximize the possibility of athletes being connected with the psychological resources from which they may benefit.

• Stimulants

Medications to treat mental health symptoms and disorders continue to be an important management strategy, particularly for patients with moderate to severe symptoms. Changes in pharmacotherapeutic management paradigms for professional athletes prescription stimulants, for example, for attention-deficit/hyperactivity disorder (ADHD), are particularly noticeable in several nations. Some jurisdictions have modified the rules for prescription stimulants, allowing them to be prescribed without a face-to-face consultation if certain protections are met. Prescribers in the United States can now prescribe stimulants if the following conditions are met: The prescription is issued by a practitioner working in the normal course of their professional activity for a genuine medical purpose. Telemedicine communication is carried out via an audio-visual, real-time, two-way interactive communication technology, and the practitioner is functioning legally. However, there are some things that prescribers who work with professional athletes should keep in mind. Before administering stimulants in this population, it is common practice to evaluate vital signs (e.g., pulse, blood pressure) and potentially laboratory tests (e.g., drug toxicity screen).

 

• Medications for psychotic and bipolar disorders

Another major area of pharmacological concern for athletes during the pandemic is medications routinely used for bipolar and psychotic disorders. Laboratory examinations are typically performed regularly for patients receiving mood-stabilizing medicines (e.g., lithium, valproic acid)22 and atypical antipsychotics (e.g., Aripiprazole, quetiapine, clozapine). While some prescribers may be prepared to postpone routine laboratory monitoring for non-athletes throughout the pandemic,28 such a postponement may be unwise for athletes. This may be especially true in areas where the pandemic coincides with warmer seasons when perspiration and dehydration are more probable in athletes.

• Antidepressants

There does not appear to be any new or distinctive advice to provide athletes during the epidemic for many antidepressants. Cardiac monitoring is recommended. Cardiovascular complications have been reported in 21% of COVID-19 hospitalized patients, prompting recommendations for advanced cardiac testing in athletes who test positive for COVID-19 via screening tests, whether symptomatic or asymptomatic.

• Medications for disorders due to substance use

Athletes with drug abuse and substance use disorders may be at increased risk of substance withdrawal (e.g., during quarantine or isolation) or, conversely, increased use of substances, including recreational and ergogenic substances, during the pandemic. Less sport-related drug testing, social isolation, less immediate need to keep fit and accomplish workout goals, lack of structure and self-treatment of elevated stress levels, and increased mental health symptoms are all likely contributors. Athletes may have more difficulty receiving therapy, including pharmaceuticals, for the management of acute and post-acute substance withdrawal and relapse prevention during this period of possibly increased substance use risks.

 

 

The current epidemic provides an excellent chance for study into new techniques of providing mental healthcare for sportsmen, and it should be considered whether these new methods should be extended beyond the pandemic. Given that this is a group that may be widely recognized in the public domain, security and confidentiality should be important considerations while engaging in telehealth with professional athletes. Furthermore, for many athletes to participate in telehealth services in the future, licensure restrictions and insurance/payer coverage would need to alter permanently. Regardless of the care modalities provided during the post-pandemic period, continued close screening for and management of mental health symptoms and disorders in elite athletes will be required for the foreseeable future, as the impact on this population is likely to persist even after return to sport.