Challenges and management of neurological and psychiatric manifestations in SARS-CoV-2 (COVID-19) patients

Abstract

COVID-19 is a pandemic caused by human coronavirus (HCoV) SARS-CoV-2, which originated in Wuhan, China, at the end of 2019 and spread globally during 2020. Due to the difficulty of clinical decision-making during this period, our study group reviewed current literature focusing on the neurological and psychiatric aspects of COVID-19. Despite the knowledge on this newly discovered virus which is constantly evolving, different pieces of evidence reported an association between COVID-19 and neurological symptoms like headache, dizziness, taste and smell disorders and complications involving the nervous system eventually triggered by the pathologic processes elicited by SARS-CoV-2. It seems that younger patients are less prone to develop severe forms of COVID-19. However, neurological signs have been reported in paediatric patients as well, and in some cases, the infection presented neurological sequelae. Furthermore, children with particular neurological diseases or treated with specific drugs (e.g. immune-suppressant therapies) must be carefully monitored during this pandemic. Neurologists should be aware of the main drug-drug interactions and the neurological side effects of COVID-19 treatments. Notably, adverse mental health impact has been reported in patients with SARS-CoV-2, which could be related either to the social strain or to the eventual neurotropic effects of the virus, which in other infections have been proven to promote the onset of psychiatric symptoms. Further, psychiatric population may be more vulnerable to the infection and at higher risk for adverse outcomes.

Post-traumatic stress, anxiety, and depressive symptoms in caregivers of children tested for COVID-19 in the acute phase of the Italian outbreak

“…In particular, the latter highlight the associations between socio-economic status and mental health outcomes, with significantly higher depressive symptoms rates reported by parents who suffered financial loss due to COVID-19 emergency as compared with those who had not and, among these, by those who had been quarantined. These findings corroborate recent evidence on the psychological impact of quarantine ( Ben-Ezra et al, 2020 ; Fiorillo et al, 2020 , Orsini et al, 2020 ). A literature review highlighted how confinement, loss of daily routine, financial loss and social stigma were significant predictors of PTSS and other mental disorders ( Sprang and Silman 2013 ; Boyraz and Legros 2020 ) .…”

Assessment of mental health, knowledge, and attitude of patients with multiple sclerosis and neuromyelitis optica spectrum disorder in response to 2019 novel coronavirus

“…It is consists of age, gender (male/female), education attainment, and marital status (single/married). In our country, education level is classified to a 4-point scale consisting elementary school (7-12 years), middle school (12)(13)(14), high school (15)(16)(17)(18), and university (19 years or more). We dichotomize the education level into "higher than diploma" and "diploma or lower than."…”

“…They indicated a robust association between mental health problems and reduced quality of life and severe disability [10][11][12][13]. A series of recent studies have indicated that COVID-19 has an association with mental health problems such as depression, anxiety, and stress in the general population and patients with chronic disorders [14][15][16][17][18]. However, few studies have investigated the mental health of MS and MS patients within COVID-19 pandemic [19].…”

COVID-19 y salud mental

“…Diferentes estudios han probado que el confinamiento ha podido ser un mecanismo eficaz para evitar la propagación de la COVID-19 18 . Sin embargo, un confinamiento estricto y prolongado, con medidas severas puede tener un impacto negativo sobre la salud mental de los individuos 19 . El estado de cuarentena impuesto a nivel nacional puede producir diferentes reacciones negativas, ya que suele ser una experiencia desagradable para quienes están expuestos a ella.…”