By Dr Antonella Macerollo
For August 2020, we have selected Rogers J.P. et al. “Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic” Lancet Psychiatry 2020; 7:611-627.
Our paper of the month deals with the ongoing debate regarding the potential psychiatric and neuropsychiatric presentations of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19.
The first two coronaviruses caused two significant outbreaks in 2002 and 2012, respectively. The authors performed a systematic review and metanalysis on this topic analysing 65 peer-reviewed studies and seven preprints, which met the inclusion criteria.
The inclusion criteria were English language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of cases with suspected or laboratory-confirmed coronavirus infection.
The exclusion criteria were studies on neurological complications without neuropsychiatric presentations and those investigating the indirect effects of coronavirus infections on the mental health of not infected people.
The total number of coronavirus cases was 3,559. The follow-up time for the post-acute infection varied between 60 days and 12 years.
Regarding SARS or MERS infection, the authors found that the acute illness was characterized by confusion [27.9%], depression [32.6%], anxiety [35.7%], impaired memory [34.1%] and insomnia [41·9%].
Interesting, steroid-induced mania and psychosis were reported in 0.7% of the acute SARS cases.
The post-acute phase was marked with depression [10.5%], insomnia [12.1%], anxiety [12.3%], irritability [12.8%], memory impairment [18.9%], fatigue [19.3%], traumatic memories [30.4%] and sleep disorder [100%]. Notably, the point prevalence of post-traumatic stress disorder was 32.2%, of depression was 14.9% and of anxiety disorders was 14.8%
COVID-19 cases showed mainly delirium (confusion [65%] and agitation [69%]) and altered consciousness [21%]. One study highlighted that 33% of COVID-19 patients had a dysexecutive syndrome. There were two reports of hypoxic encephalopathy and one report of encephalitis.
There are not enough data on post-acute Covid-19 cases, yet. However, if this infection follows a similar course to that with SARS or MERS, the greater percentage of patients should recover without experiencing mental illness. However, it is important to consider neuropsychiatric syndromes might occur in rare cases in the longer term. Further studies of post-Covid-19 illness are needed to have a better knowledge of the long-term sequelae of this infection and, consequentially, the best management of these patients.