In this systematic review and meta-analysis, the authors analysed studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). Outcomes were psychiatric signs or symptoms; symptom severity; diagnoses based on diagnostic criteria such as ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition) or psychometric scales; quality of life; and employment. Both the systematic review and the meta-analysis stratified outcomes across illness stages (acute vs post-illness) for SARS and MERS. 1963 studies and 87 preprints were identified by the systematic search, of which 65 peer-reviewed studies and seven preprints met inclusion criteria. The systematic review revealed that during the acute illness, common symptoms among patients admitted to hospital for SARS or MERS included confusion, depressed mood, anxiety, impaired memory, and insomnia. In the post-illness stage, depressed mood, insomnia, anxiety, irritability, memory impairment, and fatigue were frequently reported. When data for patients with COVID-19 were examined (including preprint data), there was evidence for delirium (confusion in 26 [65%] of 40 intensive care unit patients and agitation in 40 [69%] of 58 intensive care unit patients in one study, and altered consciousness in 17 [21%] of 82 patients who subsequently died in another study). At discharge, 15 (33%) of 45 patients with COVID-19 who were assessed had a dysexecutive syndrome in one study. 68 (94%) of the 72 studies were of either low or medium quality. The authors concluded that, if infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients during the acute stage. Moreover, they underline that clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.
by Marialuisa Zedde and Francesco Cavallieri