Neuropsychiatric Implications of COVID19
Sequelae of COVID19: Neuropsychiatric and inflammatory conditions
Posted May 31, 2020
As COVID19 continues to impact individuals and communities globally, new evidence demonstrates an “emerging wave of neuropsychiatric sequelae of COVID19 with a potential immunologic mechanism.” (Troyer et al., 2020)
In other words, some people sickened by COVID19 display symptoms after they are apparently on the road to recovery that are similar to some neuropsychiatric symptoms and these seem to be related to the body’s immune system.
Troyer, Kohn, and Hong (2020) from the University of California San Diego published a study in recent weeks about immunologic aspects of the infection that impact the central nervous system and manifest in neuropsychiatric outcomes. The present post highlights the mental health aspects of their study.
The authors point out that historical reports are on record of neuropsychiatric symptoms arising following an acute viral infection. For example, after influenza pandemics in the 18th and 19th centuries, symptoms of insomnia, anxiety, depression, psychosis, and suicidality were reported.
There are already reports surfacing, they observe, of acute neuropsychiatric symptoms associated with COVID19. One report from Wuhan, China, examined symptoms of 217 hospitalized patients. Nearly half of those with severe infection (40 of 88 in the study) described neurologic manifestations.
Another report from Wuhan described encephalopathy, or persistent alterations in consciousness, in about one-fifth of individuals following infection.
Studies of healthcare workers during past SARS and MERS outbreaks, as well as in the current pandemic, suggest that proximity to virus-infected patients may have an important impact on the frequency and severity of psychiatric symptoms reported later.
While there is limited data available on COVID-19-related psychiatric symptoms, past studies of survivors of the SARS outbreak in the period 31-50 months after infection indicate that 54.5% were diagnosed with PTSD, 39% with depression, 36.4% with panic disorder, and 15.6% OCD. (Troyer et al,. 2020)
It is known, in general, that viral infection can create inflammation in the body as the immune system responds to the invasion. For some people, this results in the development of autoimmune conditions. So in the case of neuropsychiatric symptoms appearing in individuals after COVID19 infection, inflammation related to autoimmune responses of the body is one plausible explanation.
Immunotherapies that have been used or proposed for treating immune system overreactions of COVID19 patients include intravenous immunoglobulin (IVIG), cytokine blocking medications, and Janus kinase (JAK) inhibitors. The neuropsychiatric implications of these treatments are not clear at this time.
Although much remains unknown about COVID19, it is likely that the neuropsychiatric impact of this scourge will be significant. Troyer et al,. (2020) urge the biomedical community to direct their attention to the need for longitudinal monitoring of neuropsychiatric symptoms and neuroimmune status in individuals exposed to COVID19. They suggest that the scope of investigation begin in-utero and extend through childhood and adulthood.
Lastly, the authors emphasize the importance of a psychoneuroimmunology perspective on COVID19. Such a perspective, they suggest, will aid in promoting public mental health in the aftermath of the pandemic.
Troyer, E. A., Kohn, J. N., & Hong, S. (2020). Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, behavior, and immunity.