Amal Mumtaz, M.D., Steven Lippmann, M.D.

Though improving slightly, we are still deep in the coronavirus pandemic. Beyond just being infected and getting sick or dying, there is considerable concern about short- and long-term sequela. Many of these involve neuropsychiatric manifestations. What are they?

To start with, there is much general anxiety and uncertainty about the future, especially about the severity and continuance of this disease. Distress in our society is heightened by segments of the population refusing masks and/or vaccinations and about unapproved treatment interventions. Otherwise, the number of people with immunity from natural disease and/or vaccination are escalating in numbers. Also, several antiviral drugs and monoclonal antibody therapies are becoming available; these new pharmacotherapies are showing safety and efficacy.

In addition to our personal concerns, SARS-Co-V-2 induces nervous system pathology with complications possible. Sequelae are most significant usually in people with more severe disease. What are these concerns?

Many patients with serious COVID-19 contagion subsequently evidence diminished cognition, affective and/or anxiety related disorders. Complications are more disabling in those with other comorbidities. What about the timeline of the neuropsychiatric issues?

Most prominent among the early concerns are the psychiatric instances of depression, anxiety, psychoses, and/or insomnia. Drug dependence has escalated. Neurologically, there is evidence for stroke, dementia, myoneural junction or muscle pathology, encephalitis, parkinsonism, and/or Guillain-Barré syndrome. Sometimes, dysfunction at smell, taste, or appetite are presenting symptoms. The degree of emotional and neurological issues is usually related to the severity of the coronavirus infection. It is often worse in more significant disease; however, they also sometimes manifest in persons less seriously ill.

Following recovery, some people experience more persistent dysfunction, nowadays called long-COVID, post-COVID, “long-haul” COVID, long-haulers, and/or other names. Most prominent are the cognitive presentations of inattention, complaints of poor memory, chronic pain, and/or a diminished perception at smell, taste, or vision. Depression and anxiety sometimes persist as well, along with posttraumatic stress disorders and/or fatigue. Less common are dizziness, headaches, ataxia, seizures, or a variety of other neurological manifestations.

Time will tell the ultimate prognoses. Unknown is how long these (or other) neuropsychiatric sequelae will last and to what degree. Patients with post-COVID should be medically followed to offer symptomatic relief, interventions at rehabilitation, and to provide detection and treatment of any further neuropsychiatric or other pathologies.