Shivam Gulati, M.D., Steven Lippmann, M.D.
Post-COVID-19 syndrome includes illness presentations during or following an infection that persist longer than 12 weeks and not otherwise diagnosed (1). Manifestation of this so-called “long-covid” can exist throughout the body, including the nervous system. Psychological aspects are often the first symptoms, sometimes even before recognizing COVID-19 disease. Fear of potential infection, mental trauma during illness, and sustained turmoil after recovery are observed in some people. Longer-term effects vary and might include tiredness, flashbacks about time spend isolated, stress by dyspnea or being ventilated, and/or the results of social, occupational, educational, and/or financial problems.
The psychiatric pathophysiology remains unclear. Particles are detected in the brain of patients with other coronavirus infections (2). Despite no proof that SARS-CoV-2 also invades neurons, this virus might induce alterations in the central nervous system parenchyma and arteries (2). Such effects on the blood–brain and blood–cerebrospinal fluid barriers may cause neuronal inflammation (3,4). Immune activation is linked to cognitive and behavioral abnormalities (5). Prolonged brain inflammation decreases the capacity to react to new antigens, and an accumulation of memory T cells might result in long-term COVID-19 clinical sequelae (6). Physiological deconditioning might occur after a period of inactivity, bedrest, or a sedentary lifestyle, and posttraumatic stress disorder could result in post-COVID-19 “brain fog” (7). This form of cognitive dysfunction sometimes follows even moderate illness severity; it indicates that dysautonomia may be part of the pathophysiology (8,9). Prolonged cognitive dysfunction reportedly arises in 20-40% of patients discharged from intensive care units (10).
COVID-19 survivors sometimes complain about recurrent malaise, diffuse myalgia, depressive symptoms, and non-restorative sleep as a post-viral syndrome (11,12). Migraine-like headaches can occur and are resistant to conventional analgesics (13-15). Late-onset cephalgias also can arise. Brain fog, with attention, memory, receptive language, and/or executive dysfunctions is documented, with or without clinical fluctuations (16-18). Such symptoms may last for months to years after an infection (19).
One month after hospitalization, 56% of Italian COVID-19 survivors evidenced either posttraumatic stress disorder (PTSD), depression, anxiety, insomnia, and/or obsessive-compulsive symptomatology (20). Following severe cases of COVID-19 infection, up to 40% of patients experienced depression and/or anxiety (21-24).
In post-acute COVID-19 Chinese subjects, about 25% had anxiety, depression, and/or sleep problems at half year follow-up assessments. PTSD was identified in 30% of affected individuals who required hospitalization, with an early onset or months later (24).
Research about the psychological impact of COVID-19 is on-going. New post-disease manifestations continue to be observed in post-COVID-19 clinics. The implications of new variant coronavirus forms are yet to be understood.
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- Postolache, T. T., Benros, M. E., Brenner, L. A., et al. ”Targetable biological mechanisms implicated in emergent psychiatric conditions associated With SARS-CoV-2 infection.” JAMA Psychiatry 2021; 78(4):353
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