A new study showed neurological and neuropsychiatric complications of COVID-19. Via surveillance, researchers found these complications in more than 100 patients.
The psychiatric complications of COVID-19 were unveiled by an international team of neuroscientists and psychiatrists. Their findings revealed that patients who suffered specific physical complications of COVID-19 could also experience psychiatric issues. Psychosis was an apparent symptom of the complications. They urged clinical characterizations of related symptoms to prevent or reduce COVID-19 related psychiatric complications. They published the results in the journal The Lancet Psychiatry.
Psychosis: A Symptom of an Underlying Psychiatric Problem
The COVID-19 pandemic has caused more than a medical crisis. It subdued the global economy that triggered the suspension of businesses, dismissal of workers, and loss of income. These economic consequences induced mental stress in millions of people worldwide. As such, many are experiencing anxiety, depression, and negative thoughts and emotions due to an uncertain future. While several vaccines are showing promise, it may take months before everyone can receive at least one dose.
In the clinical setting, COVID-19 can result in different complications. Some are correlated to lung function outcomes, while others are associated with neurological functions. And if the illness damaged the brain, the patient may experience psychiatric symptoms like psychosis. According to the National Alliance on Mental Illness, a US-based advocacy group, psychosis is a symptom and not an illness. It indicates an underlying neurological or psychiatric problem that must be addressed immediately.
In the US alone, about 100,000 young individuals experience psychosis annually. And out of 100 people, three will have at least one episode at some point in their lives. Psychosis refers to the disruptions of a person's perceptions and thoughts. The symptom makes it difficult for them to distinguish false reality from true reality. This can be confusing and frightening to the sufferer.
Although the exact cause is unknown, there are several factors recognized as contributors to psychosis. These include genetics, traumatic events, substance use and abuse, mental health conditions, and physical injury or illness. The latter covers any injury or illness to the nervous system, such as brain tumors, strokes, and neurological diseases like Alzheimer's and Parkinson's.
The diagnosis of the underlying cause of psychosis is critical to the patient's outcome. If detected early, a psychiatrist will have a wide range of potential treatments. If caught late, it limits the specialist's ability to treat and may lower the response rate of the patient to available treatments.
New-onset Psychosis in COVID-19 Cases
A new paper submitted in The Lancet highlighted the growing prevalence of neurological and neuropsychiatric complications of COVID-19. In UK-wide surveillance, a total of 153 patients were determined with those complications. This led researchers to urge a comprehensive assessment of patients to enable quick and effective interventions. These steps could prevent poor quality of life for survivors.
"The goal of this study was to rapidly gather information about the types of brain-related complications occurring in patients hospitalized with COVID-19. Given the study design, the percentages of patients with various syndromes should be considered rough estimates," wrote Dr. Eugene Rubin in the US magazine Psychology Today, who is the Vice Chair for Education at Washington University in St. Louis School of Medicine, and did not partake in the study.
In the study, researchers developed an online network of case reporting in the UK. The network connected major neuroscience institutions, including the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych). The institutions represented clinical syndromes linked to COVID-19 categorized as cerebrovascular events, altered mental status, peripheral neurology, and other related presentations.
The ABN network portal was launched on April 2, 2020, while the BASP portal was launched on April 3, 2020, and the RCPsych portal on April 21, 2020. The study covered data on and before April 26, 2020, the indicated lock date. A total of 153 unique cases were confirmed with neurological or neuropsychiatric complications in the UK. The average age of the patients was 71 years and 125 or 82% of patients had complete clinical records.
Researchers identified 77 or 65% of patients presented a cerebrovascular event. Out of 77 patients, 57 or 74% had an ischemic stroke, nine or 12% had an intracerebral hemorrhage, and one or 1% had vasculitis of the central nervous system. Out of 125 patients, 39 or 31% showed signs of altered mental status, nine or 23% had an unspecified encephalopathy, and seven or 18% had encephalitis or brain inflammation. Out of 39 patients with altered mental status, 23 or 59% met the criteria for psychiatric diagnoses, and 21 or 92% of these diagnoses were new. Out of 23 patients with neuropsychiatric disorders, 10 or 43% had new-onset psychosis, six or 26% had a dementia-like syndrome, and four or 17% had an affective disorder.
For the age of patients per clinical presentation, data established that 18 or 49% of 37 patients with altered mental status were younger than 60 years, and 19 or 51% were older than 60 years. While 13 or 81% of 74 patients with cerebrovascular events were younger than 60 years, and 61 or 82% were older than 60 years.
Dr. Rubin suggested that SARS-CoV-2 could spark neuropsychiatric symptoms to some patients. But what could be most surprising was these symptoms were more common than strokes in younger COVID-19 patients. This could be a starting area for biomedical scientists to investigate how the novel coronavirus trigger those symptoms. The same starting area could also unravel if the risk of neuropsychiatric symptoms of COVID-19 was influenced by existing factors. Whether influenced or not, there would be inquiries on what treatments could alleviate psychotic signs among COVID-19 patients, and what syndromes could the disease enable in the future.
Even though the coverage of the study is only in the UK, those symptoms may be happening in other countries. And if the coronavirus is here to stay, the healthcare community needs to integrate mental health assessment and intervention in handling COVID-19 cases.