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Neuropsychiatric Effects Could Go on for Years for Recovered Covid-19 Patients

When the novel coronavirus pandemic finally ends, that doesn’t mean the health effects of widespread infection will disappear overnight, according to a new article. The authors warn of long-lasting neuropsychiatric conditions, which have plagued survivors of past infectious disease outbreaks for centuries. Here is more information.

SAN DIEGO – Even after the end of the novel coronavirus pandemic – whether because of a vaccine, effective therapy or something else -- the strain on the healthcare system will continue, a new article suggests. This time, however, the threat likely will be neuropsychiatric and not infectious.

The report in Brain, Behavior, and Immunity suggests those recovering from COVID-19 infections will face those issues, which will go far beyond the effects of stress on the broader world population.

"Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction or demyelinating processes, may accompany acute viral infection, or may follow infection by weeks, months, or longer in recovered patients," warn the authors from the University of California San Diego School of Medicine.

"Our article seeks to bring the medical community's attention to the need for monitoring and investigations to mitigate such outcomes, not to cause panic among individuals whose lives are already greatly affected by this pandemic."

While there is little question the pandemic is causing stress worldwide, the authors suggest that the novel coronavirus and host immunologic response might also directly affect brain and behavior, pointing out that acute and delayed neuropsychiatric sequelae have been associated with past viral pandemics.

The article notes that “in addition to pandemic-associated psychological distress, the direct effects of the virus itself (several acute respiratory syndrome coronavirus; SARS-CoV-2), and the subsequent host immunologic response, on the human central nervous system (CNS) and related outcomes are unknown.”

The authors review currently available evidence of COVID-19- related neuropsychiatric sequelae, comparing them to past viral pandemic-related outcomes. “Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction, or demyelinating processes, may accompany acute viral infection, or may follow infection by weeks, months, or longer in recovered patients,” they write.

Studies of past respiratory viral pandemics have detailed diverse types of neuropsychiatric symptoms; increased incidence of insomnia, anxiety, depression, mania, suicidality, and delirium followed influenza pandemics in the 18th and 19th centuries, the authors point out, adding, "Encephalitis lethargica is an inflammatory disorder of the CNS marked by hypersomnolence (abnormal sleepiness), psychosis, catatonia, and Parkinsonism. Incidence increased around the time of the 1918 pandemic.”.

Even in more modern times, during recent viral outbreaks, such as SARS-CoV-1 in 2003, H1N1 in 2009, and MERS-CoV in 2012 higher rates of narcolepsy, seizures, encephalitis, Guillain-Barre syndrome and other neuromuscular and demyelinating conditions were reported, according to the review.

"Reports are already surfacing of acute CNS-associated symptoms in individuals affected by COVID-19," said senior author Suzi Hong, PhD, associate professor in the departments of Psychiatry and Family Medicine and Public Health at UC San Diego School of Medicine. Those include greater stroke incidence in severely infected patients in Wuhan, China, along with delirium and loss of smell and taste senses.

The authors urge that the biomedical community should begin monitoring for symptoms of neuropsychiatric conditions and the neuroimmune status of persons exposed to SARS-CoV-2, the virus that causes COVID-19.

"We will need to do this at different points in their lives, for years to come, to fully appreciate this pandemic's effects on neuropsychiatric outcomes for differing age groups, and how to better prepare for pandemics to come," Hong said. 

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