Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

Abstract

It has become evident that coronavirus disease 2019 (COVID-19) has a multi-organ pathology that includes the brain and nervous system. Several studies have also reported acute psychiatric symptoms in COVID-19 patients. An increasing number of studies are suggesting that psychiatric deficits may persist after recovery from the primary infection. In the current systematic review, we provide an overview of the available evidence and supply information on potential risk factors and underlying biological mechanisms behind such psychiatric sequelae. We performed a systematic search for psychiatric sequelae in COVID-19 patients using the databases PubMed and Embase. Included primary studies all contained information on the follow-up period and provided quantitative measures of mental health. The search was performed on June 4th 2021. 1725 unique studies were identified. Of these, 66 met the inclusion criteria and were included. Time to follow-up ranged from immediately after hospital discharge up to 7 months after discharge, and the number of participants spanned 3 to 266,586 participants. Forty studies reported anxiety and/or depression, 20 studies reported symptoms- or diagnoses of post-traumatic stress disorder (PTSD), 27 studies reported cognitive deficits, 32 articles found fatigue at follow-up, and sleep disturbances were found in 23 studies. Highlighted risk factors were disease severity, duration of symptoms, and female sex. One study showed brain abnormalities correlating with cognitive deficits, and several studies reported inflammatory markers to correlate with symptoms. Overall, the results from this review suggest that survivors of COVID-19 are at risk of psychiatric sequelae but that symptoms generally improve over time.

Overview of Covid-19 Infection Manifestation in Neuropsychiatry Aspect

“…6 Studies conducted on patients infected with COVID-19 more than one third showed neurologic symptoms in the acute phase of the disease and about 34% showed brain abnormalities such as white matter hyperintensity and hypodensity as well as microbleeding, hemorrhage and infarction. 7 Further evidence of SARS-CoV-2 neuroinfection, edema and neuronal degeneration were reported in post-mortem brain samples, while in the case of encephalitis genome sequencing confirmed the presence of the virus in the cerebrospinal fluid. However, histopathological findings from autopsies of 18 consecutive patients with SARS infection -CoV-2 who died in a teaching hospital between April 14 and April 29, 2020 showed hypoxic changes and did not exhibit encephalitis or other virus-specific brain changes.…”

“…The occurrence of an exaggerated immune response known as a cytokine storm. 7 When a cytokine storm occurs, there will be excessive production of cytokines causing acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) which lead to a number of diseases. other complications, especially from the CNS.…”

“…9 The effects of elevated cytokine levels affect not only inflammation and lung infection but also on the development of mental illness. 7 The renin…”

“…Several studies reported a high incidence of acute psychiatric symptoms in Covid 19 patients, there were about 35% of patients showing symptoms of anxiety and depression. 7 Studies conducted on patients with SARS-CoV-2 showed higher manifestations of symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) when compared to non-COVID controls. 11 A number of admitted patients exhibited symptoms of confusion and agitation without any respiratory symptoms or other signs of infection.…”

“…Symptoms of depression and anxiety normalized at one month of follow-up, but were predictors of PTSD lasting longer, persistent depressive symptoms at 3 months of follow-up. 7 Post-traumatic stress disorder (PTSD) can occur in approximately 6.5% to 42.8%. Men are considered more at risk of developing PTSD.…”