Psychopharmacology of COVID-19

Abstract

Background: With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administrationapproved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine. Objective: To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments. Methods: In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included. Results: COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics. Conclusions: Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.

The psychiatric and neuropsychiatric repercussions associated with severe infections of COVID-19 and other coronaviruses

“…Other comorbidities were also found in these individuals, often with older age (on average 77.4 years), being more frequent among women (60%): hypertension (60%), dyslipidemia (52.5%) and diabetes (30%). It is also seen that the involvement of SARS-CoV-2 with neurological aspects can affect different levels of the Central and Peripheral Nervous System, in addition to causing skeletal-muscular injury, representing 36.4% of the cases considered, including impairment of consciousness, ataxia, acute cerebrovascular disease, seizure and neuropathic pain, for example ( Bilbul et al, 2020 ). In an epidemiologically deeper approach, Dinakaran et al (2020) reinforces a percentage value close to the one reported by Bilbul et al (2020) regarding the neurological complaints of COVID-19 patients: 36%.…”

“…Associated with multiple impairments on the individual's mental and physical health, both in their psychiatric and neurological consequences, the action of SARS-CoV-2 and the immune response of the human Central Nervous System have been the focus of pathophysiological investigation ( Troyer et al, 2020 ). In this light, the neuroinvasive character of the virus in question and the manifestations at central and peripheral levels suffered by the referred system are raised: headache, dizziness - most common-, reduced level of consciousness, ataxia, impaired perception of taste and smell and neuropathic pain, possibly including also injury of skeletal muscle tissue ( Bilbul et al, 2020 ; Zhou et al, 2020 ). According to research by Beach et al (2020) the emergence of this panorama, including acute encephalopathy, can reach more than a third of patients with COVID-19, in addition to delirium as a common phenomenon of the most serious infections.…”

“…In this sense, in view of the use of drugs with effects that are still little known, a rigorous assessment of the possible interactions between these drugs in vivo is necessary. Thus, the physician must be aware of the possibility of making adjustments to the medication arrangements, including avoiding the use of certain agents that can raise safety concerns ( Bilbul et al, 2020 ).…”

Overview of the possible role of vitamin C in management of COVID-19

“…Since the start of coronavirus disease 2019 “COVID-19” pandemic, multiple treatment regimens have been tried under the compassionate use indications. So far, no specific antiviral drug has been proven to be effective, apart from remdesivir which showed promising results and has gained an emergency approval by Food and Drug Administration (FDA) to be used in the treatment of COVID-19 [ 1 , 2 ]. That is why supportive treatment, including supplementation of micronutrients such as vitamin C, has become a crucial part in management of COVID-19.…”

Evaluation of Health Status of Children with Autoinflammatory Diseases During COVID-19 Pandemic

“…Regarding COVID-19, based on molecular studies, it has been suggested that enhanced innate immune activation may promote a worse disease outcome [5]. However, most of our patients with AIDs are on colchicine treatment, and colchicine is one of the off-label medications used in the treatment of COVID-19, currently [18]. Gandol ni et al [19] have noted clinical improvement in their COVID-19 patient by using colchicine.…”