1. To understand the acute neuropsychiatric manifestations of COVID-19;
2. To understand the post-acute neuropsychiatric manifestations of COVID-19; and
3. To appreciate the varied and important roles that psychiatrists can play in recognising and treating neuropsychiatric complications of COVID-19.
The 1918 Influenza Pandemic has been (rather controversially) linked to encephalitis lethargica, which was characterised by parkinsonism, sleep disorders, mood changes and catatonia. Regardless of whether the link to influenza was genuine, the existence of encephalitis lethargica has prompted concerns about the potential for the COVID-19 pandemic to cause similar severe neuropsychiatric sequelae.
Coronaviruses have long been associated with disease in humans, but they have generally caused a mild respiratory illness. This changed with the advent of the severe acute respiratory syndrome (SARS) in 2002 and the Middle East respiratory syndrome (MERS) in 2012. These disorders were associated with a substantial neuropsychiatric burden in terms of delirium and subsequent depression, anxiety and fatigue, which had wide-ranging functional ramifications.
We now have extensive evidence on the acute effects of COVID-19, although it is hard to separate its direct biological effects from the results of its wider psychosocial context. Acute distressis often present, sometimes to a severe extent. Delirium is frequent and may be a first or only manifestation. The evidence supporting dexamethasone use also raises the prospect of steroid-induced psychosis.
In the post-acute phase of COVID-19, the literature is in a much earlier phase. However, there is already evidence for higher rates of stroke, dementia, sleep disorders, mood disorders, anxiety and psychosis in the months following disease, even compared to other similar infections.
Psychiatrists have an essential role to play in managing delirium and psychosis acutely as well as supporting follow-up services for those with persistent physical and psychological symptoms.
1. Kennedy, M. et al. (2020) ‘Delirium in Older Patients With COVID-19 Presenting to the Emergency Department’, JAMA Network Open. American Medical Association, 3(11), p. e2029540. doi: 10.1001/jamanetworkopen.2020.29540.
2. Rogers, J. P. et al. (2020) ‘Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic.’, The Lancet Psychiatry. Elsevier, 7(7), pp. 611–627. doi: 10.1016/S2215-0366(20)30203-0.
3. Taquet, M. et al. (2021) ‘Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19’, medRxiv. Cold Spring Harbor Laboratory Press, p. 2021.01.16.21249950. doi: 10.1101/2021.01.16.21249950.