Mood, Anxiety and Olfactory Dysfunction in COVID-19: Evidence of Central Nervous System Involvement?

Affective temperament modulates the relationship between physical and psychiatric symptoms during long-COVID: results from the Gemelli against COVID-19 post-acute care service

BACKGROUND

Affective temperaments represent the substrate of personality that can influence the expression of chronic infectious diseases, including COVID-19 and its sequelae. However, research conducted so far on this topic focused on narrow aspects of psychopathology.

AIM

To investigate the effect of affective temperaments on the relationship between physical and psychiatric symptoms in patients with long-COVID.

METHODS

The sample consisted of 1513 patients who have been hospitalized for COVID-19 and developed long-COVID. Participants performed a multidisciplinary assessment including psychiatric evaluation through the administration of rating scales. The psychiatric dimensions assessed included severity of depressive, anxiety, manic symptoms, anhedonia, hopelessness, suicidal risk, psychological distress, levels of well-being, resilience, emotion regulation, and levels of post-traumatic stress disorder (PTSD). Affective temperament was assessed through the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A). We used TEMPS-A subscales as moderators and sociodemographic and COVID-19/long-COVID-related clinical characteristics as predictors. Psychiatric rating scales total scores were outcome variables.

RESULTS

Cyclothymic, irritable, and depressive temperaments strengthened the relationship between number of long-COVID symptoms, levels of anhedonia and poor psychological well-being. Cyclothymic and irritable temperaments weakened the relationship between number of long-COVID symptoms and history of intensive care unit admission and PTSD severity. Depressive temperament strengthened the latter relationship.

LIMITATION

The clinical variables included in the analyses do not represent the entire range of psychopathology.

CONCLUSIONS

Depressive temperament enhanced the relationship between physical and psychiatric symptoms in patients with long-COVID, whereas the effects of cyclothymic and irritable temperaments may depend on the psychiatric dimension assessed.

Depression, Anxiety, and Neuropsychiatric Symptom Burden in a Longitudinal Cohort with Persistent Psychophysical Post-COVID Olfactory Dysfunction

BACKGROUND/OBJECTIVES

Olfactory dysfunction (OD) is associated with a variety of neurologic deficits and impacts socialization decisions, mood, and overall quality of life. As a common symptom comprising the long COVID condition, persistent COVID-19-associated olfactory dysfunction (C19OD) may further impact the presentations of neuropsychiatric sequelae. Our study aims to characterize the longitudinal burden of depression, anxiety, and neuropsychiatric symptoms in a population with C19OD.

METHODS

Individuals with perceived C19OD completed a psychophysical screening evaluation of their sense of smell using the comprehensive Sniffin' Sticks olfactory assessment. Only those with validated psychophysical OD were included in this prospective longitudinal study for baseline and one-year follow-up. Participants also completed PHQ-9, Beck Anxiety Inventory (BAI), and neuropsychiatric symptom questionnaires at each time point. Anxiety, depression, and neuropsychiatric symptom prevalence was calculated and compared between time points with Pearson's chi-squared, Fisher's exact, and Wilcoxon rank sum tests.

RESULTS

Each neuropsychiatric symptom evaluated in this study was reported by 13-49% of longitudinal cohort participants at both baseline and follow-up, except for seizure (0% at baseline and follow-up) and word-finding difficulty (61-68% at baseline and follow-up). Word-finding and focus difficulties were the most commonly reported symptoms. In total, 41% of participants reported some level of depression at baseline and 38% of participants reported depression at one-year follow-up, while 29% and 27% of participants reported some level of anxiety at respective time points.

CONCLUSIONS

Individuals with C19OD are at risk for developing persistent neuropsychiatric conditions. These neurologic and psychiatric sequelae are persistent with repeated longitudinal assessment, even at nearly 2.5 years following initial COVID-19 diagnosis.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BACKGROUND

The impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months.

METHODS

A retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann-Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables.

RESULTS

201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection.

CONCLUSIONS

This is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

Factors associated with loss and recovery of smell and taste after COVID-19 infection

Objective

To identify predictors associated with loss and recovery of smell and taste after COVID-19 infection.

Methods

The Integrated Public Use Microdata Series (IPUMS) 2021 National Health Interview Series (NHIS) database was used to analyze factors associated with loss and recovery of smell and taste in respondents who had a previous COVID-19 infection. Significant variables from univariate analysis were included in a stepwise backward regression model to identify independent predictors.

Results

Of the 3844 individuals who answered yes to having contracted COVID-19, 51.1% and 48.9% reported losing smell and taste, respectively. 95.7% recovered smell and 97% recovered taste. Predictors associated with higher odds of reporting a loss of smell included younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.98-0.99), female sex (OR 1.38; CI 1.17-1.63), use of e-cigarettes (OR 1.59; CI 1.25-2.02), and Mexican ethnicity (OR 1.61; CI 1.22-2.11). Predictors of taste loss were younger age (OR 0.98; CI 0.98-0.99), female sex (OR 1.31; CI 1.08-1.58), and higher BMI (OR 1.02; CI 1.00-1.04). Female sex was associated with decreased odds of reporting a recovery of smell (OR 0.74; CI 0.59-0.92) and taste (OR 0.54; CI 0.42-0.69). Black/African American race (OR 1.44; CI 1.03-2.03) and non-Mexican Hispanic ethnicities (OR 1.55; CI 1.02-2.34) were associated with an increased likelihood of reporting the recovery of smell.

Conclusion

Various factors may be associated with the loss and recovery of smell and taste after COVID-19 infections. Clinicians may use this information to better counsel patients with these symptoms.

Level of evidence

4.

COVID-19-related chemosensory changes: Findings from a prospective national database

Objective

The aim of this study was to review findings from a large prospective national database of chemosensory disturbances associated with coronavirus disease 2019 (COVID-19) infection.

Data Sources

The Virginia Commonwealth University Smell and Taste Center national database of COVID-19 chemosensory disturbances.

Methods

A series of online surveys, first opened on April 10, 2020, was made accessible nationwide to any adult with sudden chemosensory dysfunction since January 2020. Participants received subsequent follow-up surveys 14 days, 1 month, 3 months, and 6 months after enrollment. An additional survey was sent to all participants on May 28, 2022 to assess long-term outcomes. Information pertaining to demographics, symptoms, comorbidities, treatments, and life impact was collected.

Results

Of 363 participants who reported complete smell recovery, 51.2% recovered within 1 month, 70% within 3 months, and 79% within 6 months, while 8.8% took over 1 year to completely recover. Among all participants, 7.5% had no smell recovery. Positive predictors of recovery included age <40, male gender, and the presence of nasal congestion. Negative predictors included difficulty breathing and prior head injury. Many participants reported a decrease in quality of life and the presence of potential safety hazards associated with decreased smell loss.

Conclusions

Most subjects with COVID-19-related chemosensory dysfunction recover, with the majority noting complete recovery within weeks of infection. Those aged over 40 years and female gender were associated with lower rates of recovery. A considerable number of participants reported significant impact on quality of life and safety.

Are we romanticizing traditional knowledge? A plea for more experimental studies in ethnobiology

In answer to the debate question "Is ethnobiology romanticizing traditional practices, posing an urgent need for more experimental studies evaluating local knowledge systems?" I suggest to follow-up on field study results adopting an inclusive research agenda, and challenge descriptive data, theories, and hypotheses by means of experiments. Traditional and local knowledge are generally associated with positive societal values by ethnobiologists and, increasingly also by stakeholders. They are seen as a way for improving local livelihoods, biocultural diversity conservation and for promoting sustainable development. Therefore, it is argued that such knowledge needs to be documented, protected, conserved in situ, and investigated by hypothesis testing. Here I argue that a critical mindset is needed when assessing any kind of knowledge, whether it is modern, local, indigenous, or traditional.

COVID-19 and anosmia: The story so far

OBJECTIVES

The pandemic has affected over 182 million coronavirus disease 2019 (COVID-19) cases worldwide. Accumulated evidence indicates that anosmia is one of the significant characteristics of COVID-19 with a high prevalence. However, many aspects of COVID-19-induced anosmia are still far from being fully understood. The purpose of this review is to summarize recent developments in COVID-19-induced anosmia to increase awareness of the condition.

METHODS

A literature search was carried out using the PubMed, Embase, Web of Science, and Scopus. We reviewed the latest literature on COVID-19-induced anosmia, including mechanisms of pathogenesis, olfactory testing, anosmia as predictive tool, pathological examinations, imaging findings, affected factors, co-existing diseases, treatments, prognosis, hypothesis theories, and future directions.

RESULTS

The possible pathogenesis of COVID-19-induced anosmia may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The D614G spike variant may also play a role in the increased number of anosmia patients. Anosmia may also be an essential indicator of COVID-19 spread and an early indicator of the effectiveness of political decisions. The occurrence and development of COVID-19-induced anosmia may be influenced by smoking behaviors and underlying diseases such as type 2 diabetes, gastroesophageal disorders, and rhinitis. Most patients with COVID-19-induced anosmia can fully or partially recover their olfactory function for varying durations. COVID-19-induced anosmia can be treated with various approaches such as glucocorticoids and olfactory training.

CONCLUSION

Anosmia is one of the main features of COVID-19 and the underlying disease of the patient may also influence its occurrence and development. The possible pathogenesis of COVID-19-induced anosmia is very complicated, which may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system.

Polarization to M1-type microglia in the hippocampus is involved in depression-like behavior in a mouse model of olfactory dysfunction

Impaired olfactory function may be associated with the development of psychiatric disorders such as depression and anxiety; however, knowledge on the mechanisms underlying psychiatric disorders is incomplete. A reversible model of olfactory dysfunction, zinc sulfate (ZnSO4) nasal-treated mice, exhibit depression-like behavior accompanying olfactory dysfunction. Therefore, we investigated olfactory function and depression-like behaviors in ZnSO4-treated mice using the buried food finding test and tail suspension test, respectively; investigated the changes in the hippocampal microglial activity and neurogenesis in the dentate gyrus by immunohistochemistry; and evaluated the inflammation and microglial polarity related-proteins in the hippocampus using western blot study. On day 14 after treatment, ZnSO4-treated mice showed depression-like behavior in the tail suspension test and recovery of the olfactory function in the buried food finding test. In the hippocampus of ZnSO4-treated mice, expression levels of ionized calcium-binding adapter molecule 1 (Iba1), cluster of differentiation 40, inducible nitric oxide synthase, interleukin (IL)-1β, IL-6, tumor necrosis factor-α, cleaved caspase-3, as well as the number of Iba1-positive cells and cell body size increased, and arginase-1 expression and neurogenesis decreased. Except for the increased IL-6, these changes were prevented by a microglia activation inhibitor, minocycline. The findings suggest that neuroinflammation due to polarization of M1-type hippocampal microglia is involved in depression accompanied with olfactory dysfunction.

The molecular fingerprint of neuroinflammation in COVID-19: A comprehensive discussion on molecular mechanisms of neuroinflammation due to SARS-COV2 antigens

BACKGROUND AND OBJECTIVE

Severe acute respiratory syndrome coronavirus 2 attacks the neural system directly and indirectly via various systems, such as the nasal cavity, olfactory system, and facial nerves. Considering the high energy requirement, lack of antioxidant defenses, and high amounts of metal ions in the brain, oxidative damage is very harmful to the brain. Various neuropathic pain conditions, neurological disorders, and neuropsychiatric complications were reported in Coronavirus disease 2019, prolonged Coronavirus disease 2019, and after Coronavirus disease 2019 immunization. This manuscript offers a distinctive outlook on the interconnectedness between neurology and neuropsychiatry through its meticulous analysis of complications.

DISCUSSION

After recovering from Coronavirus disease 2019, approximately half of the patients reported developing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Long Coronavirus disease 2019 imaging reports illustrated the hypometabolism in various parts of the brain, such as olfactory bulbs, limbic/paralimbic domains, the brainstem, and the cerebellum. Ninety imaging and neuropathological studies of Coronavirus disease 2019 have shown evidence of white matter, brainstem, frontotemporal, and oculofrontal lesions. Emotional functions, such as pleasant, long/short-term memory, movement, cognition and cognition in decision-making are controlled by these regions. The neuroinflammation and the mechanisms of defense are well presented in the discussion. The role of microglia activation, Inducible NO synthase, Cyclooxygenases ½, Reactive oxygen species, neurotoxic toxins and pro-inflammatory cytokines, such as Interleukin-1 beta, Interleukin-6 and Tumor Necrosis Factor-alpha are highlighted in neuronal dysfunction and death. Nuclear factor kappa-light-chain-enhancer of activated B cells, Mitogen-activated protein kinase, Activator Protein 1, and Interferon regulatory factors are the main pathways involved in microglia activation in Coronavirus disease 2019 neuroinflammation.

CONCLUSION

The neurological aspect of Coronavirus disease 2019 should be highlighted. Neurological, psychological, and behavioral aspects of Coronavirus disease 2019, prolonged Coronavirus disease 2019, and Coronavirus disease 2019 vaccines can be the upcoming issues. We need a global awareness where this aspect of the disease should be more considered in health research.

[Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]

An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.

Olfactory Epithelium Infection by SARS-CoV-2: Possible Neuroinflammatory Consequences of COVID-19

BACKGROUND

The loss of smell is a typical diagnostic symptom of coronavirus disease 2019 (COVID-19). This sensorial deprivation may be expressed as quantitative (anosmia or hyposmia) or qualitative (dysosmia) alterations as a consequence of anatomical disturbances of the nasal epithelium structure. The olfactory system sends direct neuronal connections to brain structures that are involved in emotional processing, including deep temporal nuclei. This anatomical and functional feature may be related to the occurrence of emotional disorders among COVID-19 patients.

SUMMARY

We identify a possible sequence of events, from typical olfactory dysfunction that is associated with COVID-19 and caused by olfactory epithelium damage to disturbances in the quality of life and emotional state of infected patients that is attributable to possible neuroinflammatory processes. Sensorial deprivation causes deleterious actions on mood, negatively affecting quality of life. Olfactory dysfunction that is associated with COVID-19 occurs concurrently with psychological distress, symptoms of anxiety, and depressive disorders and impinges on self-perceived quality of life.

KEY MESSAGES

Changes in mood are certainly associated with multiple factors, including the environment and isolation, but the observation that the virus may penetrate the central nervous system through the olfactory bulb and the connection between the olfactory system and prefrontal and orbitofrontal cortices and the amygdala-hippocampus do not allow one to discard neural factors that are involved in the pathophysiology of emotional symptoms in post-COVID-19 patients. Behavioral symptoms of COVID-19 involve local olfactory actions and the participation of central neuronal systems.

Microglial Inflammatory Responses to SARS-CoV-2 Infection: A Comprehensive Review

Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease causing a worldwide pandemic in the year of 2019. SARS-CoV-2 is an enveloped, positive-stranded RNA virus that could invade the host through spike protein and exhibits multi-organ effects. The Brain was considered to be a potential target for SARS-CoV-2 infection. Although neuropsychiatric symptoms and cognitive impairments were observed in COVID-19 patients even after recovery the mechanism of action is not well documented. In this review, the contribution of microglia in response to SARS-CoV-2 infection was discussed aiming to design a therapeutic regimen for the management of neuroinflammation and psycho-behavioral alterations. Priming of microglia facilitates the hyper-activation state when it interacts with SARS-CoV-2 known as the 'second hit'. Moreover, the microgliosis produces reactive free radicals and pro-inflammatory cytokines like IL-1β, IFN-γ, and IL-6 which ultimately contribute to a 'cytokine storm', thereby increasing the occurrence of cognitive and neurological dysfunction. It was reported that elevated CCL11 may be responsible for psychiatric disorders and ROS/RNS-induced oxidative stress could promote major depressive disorder (MDD) and phenotypic switching. Additionally, during SARS-CoV-2 infection microglia-CD8+ T cell interaction may have a significant role in neuronal cell death. This cytokine-mediated cellular cross-talking plays a crucial role in pro-inflammatory and anti-inflammatory balance within the COVID-19 patient's brain. Therefore, all these aspects will be taken into consideration for developing novel therapeutic strategies to combat SARS-CoV-2-induced neuroinflammation.

Olfactory and gustatory dysfunction, evaluation and the impact on quality of life among COVID-19 patients: a multi-centre study

Background

Olfactory and gustatory dysfunctions are frequently reported symptoms among COVID-19 patients. However, several reports suggested that there might be significant variation in the prevalence and clinical picture of chemosensory dysfunction in COVID-19 patients among different population.

Objective

To study the prevalence of chemosensory dysfunction, recovery time and its impact on quality of life (QoL) among COVID-19 patients in Saudi population.

Methods

This multi-centre observational study was conducted at three COVID-19 centres in Saudi Arabia. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. Olfactory and gustatory dysfunctions were assessed via valid taste and smell questionnaire, electronically collected via online survey. Short version of questionnaire of Olfactory disorders-negative statements (sQOD-NS) was used to assess the impact on QoL.

Result

Total 1734 patients [926 males and 808 females, the mean age of patients was 37.7±11.6 years] with laboratory confirmed COVID-19 were recruited for this study. Chemosensory dysfunction was reported in 56.5% cases. olfactory and gustatory dysfunctions were significantly high in females (66.2%) and age group younger than or equal to 40 years (62.2%). Among patients with olfactory dysfunction and gustatory dysfunction, recovery rate was 757 (77.2%) and 702 (71.6%). Furthermore, the recovery time was within 8 days of onset of symptoms in 53.6% and 61.3% of olfactory dysfunction and gustatory dysfunction cases, respectively. Overall mean QoL score indicated Olfactory and gustatory dysfunction has significant impact on QoL [11.3±6.2 (P value<0.001)]. female as compared to males (12.8±7). Females had significant impact on QoL (11.4±6.6) as compared to males [12.8±7 (P value<0.001)].

Conclusion

Chemosensory dysfunction among Saudi population was comparable to the European data and significantly higher than Asian supporting the fact that these symptoms vary as per ethnicity. Olfactory and gustatory dysfunction significantly impaired QoL and could present as an early symptom of COVID-19. Recovery rate of these symptoms can serve as a good prognostic data for patient's counselling. Further long-term follow-up studies would lead to better understanding of prognosis and clinical outcomes.

Burnout and Professional Engagement during the COVID-19 Pandemic among Nursing Students without Clinical Experience: A Cross-Sectional Study

Burnout affects many healthcare professionals, especially nurses, causing serious health problems and disrupting the work environment. Academic burnout may also be experienced, leading students to feel unable to cope with their education. As a result, they may lose interest and even consider abandoning their studies. Hence, burnout syndrome can affect both the mental health and the professional future of those affected. To evaluate academic burnout in nursing students who had no clinical experience before starting their practical training, a cross-sectional study involving 212 third-year nursing students at the University of Granada was conducted. Data were collected using the Granada Burnout Questionnaire, the Utrecht Work Engagement Scale, the NEO Five-Factor Inventory, the Hospital Anxiety and Depression Scale, and the Fear of CoronaVirus-19 Scale. High levels of burnout were present in 37.8% of the students. Moreover, 21.5% and 8.7% had borderline cases of anxiety or depression, respectively. Another 30.8% and 9.2%, respectively, were considered likely to present these conditions. According to the predictive models of burnout dimensions obtained, neuroticism is a predictor of all three burnout dimensions. Furthermore, anxiety, depression, extraversion, responsibility and engagement are predictors of some dimensions of the syndrome. Many nursing students present high levels of burnout, which is related to certain personality variables and to the presence of anxiety and/or depression. The level of professional engagement is inversely associated with the impact of burnout. The participants in this study have normalised their return to the pre-pandemic study routine (in-person classes), and fear of COVID-19 was not a significant predictor of any dimension of burnout.

Neuropsychological deficits in patients with persistent COVID-19 symptoms: a systematic review and meta-analysis

Long-term persistent symptoms of COVID-19 affect 30-80% of patients who have recovered from the disease and may continue for a long time after the disease has been overcome. The duration of these symptoms over time might have consequences that affect different aspects of health, such as cognitive abilities. The main objective of this systematic review and meta-analysis was to objectify the persistent COVID-19 cognitive deficits after acute phase of infection and to summarize the existing evidence. Additionally, we aimed to provide a comprehensive overview to further understand and address the consequences of this disease. Our protocol was registered in PROSPERO (CRD42021260286). Systematic research was conducted in the Web of Science, MEDLINE, PubMed, PsycINFO, Scopus, and Google Scholar databases from January 2020 to September 2021. Twenty-five studies were included, six of which were analyzed for the meta-analysis, and consisted of 175 patients who had recovered from COVID-19 and 275 healthy individuals. Analyses of cognitive performance of post-COVID-19 patients and healthy volunteers were compared using a random-effects model. The results showed an overall medium-high effect size (g = -.68, p = .02) with a 95% CI (-1.05 to -.31), with a significantly moderate level of heterogeneity among studies (Z = 3.58, p < .001; I2 = 63%). The results showed that individuals who had recovered from COVID-19 showed significant cognitive deficits compared to controls. Future studies should carefully assess the long-term progression of cognitive impairments in patients with persistent COVID-19 symptoms, as well as the effectiveness of rehabilitation interventions. Nevertheless, there is an urgent need to know the profile to speed up development of prevention plans as well as specific interventions. Since more information is being obtained and more studies are being conducted on the subject, the need to examine this symptomatology multidisciplinary to achieve greater scientific evidence of its incidence and prevalence has become increasingly clear.

PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein-Barr Virus Reactivation as Trigger Agents?

COVID-19 impacted the entire world's population, frequently resulting in long-lasting neuropsychiatric complications. Furthermore, social distancing, lockdowns and fear for one's personal health worsen individual psychological wellbeing, especially in children and adolescents. Herein, we discuss the results of studies that specifically reported data about the impact of the COVID-19 pandemic or infection on children with Pediatric Acute-Onset Neuropsychiatric Disorders (PANS). Furthermore, we present the cases of five adolescents with PANS whose symptomatology increased following SARS-CoV-2 infection. What emerged from this study was that COVID-19 resulted in the exacerbation of obsessions, tics, anxiety and mood symptoms and decreased wellbeing. Moreover, new symptoms, as well as new PANS cases, are reported to have arisen after COVID-19 infection. Here, we hypothesize that the pathogenic mechanisms of silent viruses, such as the Epstein-Barr virus, are related to neuroinflammation, immune responses and reactivation, with additional roles played by social-isolation-related inflammatory processes. The discussion of PANS, which represents a model of immune-mediated neuropsychiatric manifestations, is particularly relevant, with the aim of uncovering the mechanisms that lead to neuropsychiatric Post-Acute COVID-19 Syndrome (PACS). Prospects for future studies and treatment implications are discussed.

Olfactory-related quality of life impacts psychological distress in people with COVID-19: The affective implications of olfactory dysfunctions

BACKGROUND

Coronavirus disease 2019 (COVID-19) often causes chemosensory impairment, and olfactory dysfunctions may have negative consequences on psychological distress. This study aimed at assessing which dimension of perceived olfactory disfunctions (i.e., subjective olfactory capability, smell-related problems, or olfactory-related quality of life [QoL]) was most associated with psychological distress in people diagnosed with COVID-19.

METHODS

364 participants (65 men and 299 women) diagnosed with COVID-19 on average 7 months prior to the beginning of the study were recruited between June 5 and 21, 2021, to take part in an online cross-sectional survey. Participants answered questions on demographics, clinical factors, perceived olfactory functioning, and psychological distress. Hierarchical multiple linear regression analysis was conducted, assessing the role of demographics, clinical factors, and perceived olfactory functioning dimensions on psychological distress.

RESULTS

More than half of the participants met the cut-off for all perceived olfactory dysfunctions scales and psychological distress. Being women, smoker, with comorbidities, and greater severity of COVID-19 symptoms were associated with higher scores on psychological distress. Among perceived olfactory functioning scales, only impairment in olfaction QoL was associated with psychological distress.

LIMITATIONS

Limitations concerned the cross-sectional nature of the study and the unbalanced sample in terms of gender.

CONCLUSIONS

The study confirmed the core intertwining between mood, perceived QoL, and olfactory functioning, showing how impairments in olfactory processing are strongly correlated with psychological distress through the impact they have on the perceived QoL.

'Should I stay or should I go?': A mixed methods study on nurse retention during challenging times

BACKGROUND

The World Health Organization estimates that between 80,000 and 180,000 medical personnel perished as a result of COVID-19. Although studies about nurses' organizational commitment during the COVID-19 pandemic have been conducted, the sources of motivations and resilience strategies of nurses in providing a quality healthcare service amidst the COVID-19 pandemic have yet to be explored.

OBJECTIVE

This study aimed to investigate how motivation and resilience influence nurses to serve and cater to patients during the COVID-19 pandemic.

METHODS

A sequential exploratory mixed approach was used in this study between July and August 2022. The Connor-Davidson Resilience Scale (CD-RISC-10), Work Extrinsic and Intrinsic Motivations scale (WEIMS), and Garbee and Killacky's Intent to Stay Scale (GKISS) were used to measure resilience, motivation, and intention to stay, among 50 nurses within Metro Manila. Quantitative data were analyzed using quantile regression, while qualitative data from eight participants were analyzed using thematic analysis.

RESULTS

The majority of the nurses were working 12 hours and above (52%) and earning a bi-weekly income of PHP 15,001 to 20,000 (96%). The GKISS scores of most respondents indicated their likelihood of remaining in their current profession was moderately low (Mdn = 12.5; IQR = 12-14). It was also found that there was no sufficient statistical evidence to conclude that intention to stay was associated with resilience (p = 0.914) and work motivation (p = 0.560). The qualitative strand of this study explored the significant influences of motivation, resilience strategies, and sources of intention to stay among Filipino nurses while facing the COVID-19 pandemic. The primary motivations of nurses lie in family, passion for work, and career development, while the resilience strategies include adaptiveness, time management skills, and self-fulfillments. On the other hand, the intent to stay greatly lies in serving the people and the country.

CONCLUSION

This study concludes that positive and negative resilience and motivations from different facets of the social life of Filipino nurses, including passion, familial ties, patient care, and faith are the antecedents influencing the intention to serve in the healthcare service. In terms of staying for an extended period in a nursing career, the study found that institutionalized interventions, adequate compensation and benefits, and a good workplace are determinants of staying longer in the Philippines as Filipino nurses.

Using knowledge of, attitude toward, and daily preventive practices for COVID-19 to predict the level of post-traumatic stress and vaccine acceptance among adults in Hong Kong

Introduction

COVID-19 has been perceived as an event triggering a new type of post-traumatic stress (PTSD) that can live during and after the pandemic itself. However, it remains unclear whether such PTSD is partly related to people's knowledge of, attitude toward and daily behavioral practices (KAP) for COVID-19.

Methods

Through a telephone survey, we collected responses from 3,011 adult Hong Kong residents. Then using the Catboost machine learning method, we examined whether KAP predicted the participant's PTSD level, vaccine acceptance and participation in voluntary testing.

Results

Results suggested that having good preventative practices for, poor knowledge of, and negative attitude toward COVID-19 were associated with greater susceptibility to PTSD. Having a positive attitude and good compliance with preventative practices significantly predicted willingness to get vaccinated and participate in voluntary testing. Good knowledge of COVID-19 predicted engagement in testing but showed little association with vaccine acceptance.

Discussion

To maintain good mental health and ongoing vaccine acceptance, it is important to foster people's sense of trust and belief in health professionals' and government's ability to control COVID-19, in addition to strengthening people's knowledge of and compliance with preventative measures.

Post-Viral Olfactory Loss: What We Learned from the SARS-CoV-2 Pandemic

Viral infections have always been one of the most frequent causes of persistent olfactory dysfunctions accounting for 18% to 45% of all cases [...].

Two-Year Follow-Up on Chemosensory Dysfunction and Adaptive Immune Response after Infection with SARS-CoV-2 in a Cohort of 44 Healthcare Workers

Persistent chemosensory dysfunction (PCD) is a common symptom of long-COVID. Chemosensory dysfunction (CD) as well as SARS-CoV-2-specific antibody levels and CD8+ T-cell immunity were investigated in a cohort of 44 healthcare workers up to a median of 721 days after a positive PCR test. CD was assessed using questionnaires and psychophysical screening tests. After 721 days, 11 of 44 (25%) participants reported PCD, with five describing an impaired quality of life. One participant reported hyperosmia (increased sense of smell). The risk of PCD at 721 days was higher for participants reporting qualitative changes (parosmia (altered smell), dysgeusia (altered taste), or phantosmia (hallucination of smell)) during initial infection than in those with isolated quantitative losses during the first COVID-19 infection (62.5% vs. 7.1%). The main recovery rate occurred within the first 100 days and did not continue until follow-up at 2 years. No correlation was found between antibody levels and CD, but we observed a trend of a higher percentage of T-cell responders in participants with CD. In conclusion, a significant proportion of patients suffer from PCD and impaired quality of life 2 years after initial infection. Qualitative changes in smell or taste during COVID-19 pose a higher risk for PCD.

Pathological Features and Neuroinflammatory Mechanisms of SARS-CoV-2 in the Brain and Potential Therapeutic Approaches

The number of deaths has been increased due to COVID-19 infections and uncertain neurological complications associated with the central nervous system. Post-infections and neurological manifestations in neuronal tissues caused by COVID-19 are still unknown and there is a need to explore how brainstorming promoted congenital impairment, dementia, and Alzheimer's disease. SARS-CoV-2 neuro-invasion studies in vivo are still rare, despite the fact that other beta-coronaviruses have shown similar properties. Neural (olfactory or vagal) and hematogenous (crossing the blood-brain barrier) pathways have been hypothesized in light of new evidence showing the existence of SARS-CoV-2 host cell entry receptors into the specific components of human nerve and vascular tissue. Spike proteins are the primary key and structural component of the COVID-19 that promotes the infection into brain cells. Neurological manifestations and serious neurodegeneration occur through the binding of spike proteins to ACE2 receptor. The emerging evidence reported that, due to the high rate in the immediate wake of viral infection, the olfactory bulb, thalamus, and brain stem are intensely infected through a trans-synaptic transfer of the virus. It also instructs the release of chemokines, cytokines, and inflammatory signals immensely to the blood-brain barrier and infects the astrocytes, which causes neuroinflammation and neuron death; and this induction of excessive inflammation and immune response developed in more neurodegeneration complications. The present review revealed the pathophysiological effects, molecular, and cellular mechanisms of possible entry routes into the brain, pathogenicity of autoantibodies and emerging immunotherapies against COVID-19.

Association between chemosensory impairment with neuropsychiatric morbidity in post-acute COVID-19 syndrome: results from a multidisciplinary cohort study

Preliminary methodologically limited studies suggested that taste and smell known as chemosensory impairments and neuropsychiatric symptoms are associated in post-COVID-19. The objective of this study is to evaluate whether chemosensory dysfunction and neuropsychiatric impairments in a well-characterized post-COVID-19 sample. This is a cohort study assessing adult patients hospitalized due to moderate or severe forms of COVID-19 between March and August 2020. Baseline information includes several clinical and hospitalization data. Further evaluations were made using several different reliable instruments designed to assess taste and smell functions, parosmia, and neuropsychiatric disorders (using standardized psychiatric and cognitive measures). Out of 1800 eligible individuals, 701 volunteers were assessed on this study. After multivariate analysis, patients reporting parosmia had a worse perception of memory performance (p < 0.001). Moderate/severe hypogeusia was significantly associated with a worse performance on the word list memory task (p = 0.012); Concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 was also significantly associated with episodic memory impairment (p = 0.006). We found a positive association between reported chemosensory (taste and olfaction) abnormalities and cognition dysfunction in post-COVID-19 patients. These findings may help us identify potential mechanisms linking these two neurobiological functions, and also support the speculation on a possible route through which SARS-CoV-2 may reach the central nervous system.

Factors associated with progression of depression, anxiety, and stress-related symptoms in outpatients and inpatients with COVID-19: A longitudinal study

It is known that there is an increase in the frequency of psychiatric disturbances in the acute and post‐illness phase of coronavirus disease (COVID‐19). Comorbid psychiatric symptoms complicate the management of patients and negatively affect the prognosis, but there is no clear evidence of their progress. We aimed to determine psychiatric comorbidity in inpatients and outpatients with COVID‐19 and recognize the factors that predict psychiatric comorbidity. For this purpose, we evaluated patients on the first admission and after 4 weeks. We investigated psychiatric symptoms in outpatients (n = 106) and inpatients (n = 128) diagnosed with COVID‐19. In the first 7 days after diagnosis (first phase), sociodemographic and clinic data were collected, a symptom checklist was constructed, and the Hospital Anxiety and Depression Scale (HADS) and the Severity of Acute Stress Symptoms Scale (SASSS) were applied. After 30–35 days following the diagnosis, the SASSS and the HADS were repeated. In the first phase, the frequency of depression and anxiety were 55% and 20% in inpatients, and 39% and 18% in outpatients, respectively. In the second phase, depression scores are significantly decreased in both groups whereas anxiety scores were decreased only in inpatients. The frequencies of patients reporting sleep and attention problems, irritability, and suicide ideas decreased after 1 month. Patients with loss of smell and taste exhibit higher anxiety and depression scores in both stages. Our results revealed that the rate of psychiatric symptoms in COVID‐19 patients improves within 1 month. Inpatients have a more significant decrease in both depression and anxiety frequency than do outpatients. The main factor affecting anxiety and depression was the treatment modality. Considering that all patients who were hospitalized were discharged at the end of the first month, this difference may be due to the elimination of the stress caused by hospitalization.

The Impact of Post-traumatic Stress of SARS-CoV-2 Affliction on Psychological and Mental Health of Student Survivors: Cross Sectional Study

Background

COVID-19 survivor's population is often associated with a long term impact on mental and psychological health. Recent included studies have also stated affliction of mental health due to fear of virus and preventive policies among the college students.

Objectives

The research was conducted to find the psychological and mental impacts of SARS-CoV-2 affliction among the students' survivors in the university.

Methods

The study design of the experiment was cross-sectional, sampling technique was non probability and sampling method being applied was convenience sampling. IBM Statistical Package for the Social Sciences version 20 was used for analyses. Descriptive data was examined and results were showed as mean and standard deviations, percentages, frequencies for continuous variables of IES-R scale (Intrusion, Avoidance, and Hyperarousal) using the total sample of n = 34.

Results

Out of 34 only 24 student survivors responded to the online survey post COVID-19 recovery, with an overall participation level of 71%. Grading was given for the total IES-R score which was subdivided into a predefined range. Out of 24 participants, 9 (38%) participants showed the symptoms of mild (n = 2)-severe (n = 7) psychological impacts. On correlation of factors total IES-R score and taste and sense of smell were moderately correlated. The ordinal regression for complete loss of sense of taste and smell was also significant.

Conclusion

The results from IES-R evaluation clearly outlines the presence of psychological sequels post recovery of COVID-19 episodes among the young college survivors. Complete loss of sense of smell and taste may be an indicator of psychological sequelae as compared to reduce sense of smell.

Post-viral mental health sequelae in infected persons associated with COVID-19 and previous epidemics and pandemics: Systematic review and meta-analysis of prevalence estimates

AIMS

Post-viral mental health problems (MHP) in COVID-19 patients and survivors were anticipated already during early stages of this pandemic. We aimed to synthesize the prevalence of the anxiety, depression, post-traumatic and general distress domain associated with virus epidemics since 2002.

METHODS

In this systematic review and meta-analysis, we searched PubMed, PsycINFO, and Embase from 2002 to April 14, 2021 for peer-reviewed studies reporting prevalence of MHP in adults with laboratory-confirmed or suspected SARS-CoV-1, H1N1, MERS-CoV, H7N9, Ebolavirus, or SARS-CoV-2 infection. We included studies that assessed post-viral MHP with validated and frequently used scales. A three-level random-effects meta-analysis for dependent effect sizes was conducted to account for multiple outcome reporting. We pooled MHP across all domains and separately by severity (above mild or moderate-to-severe) and by acute (one month), ongoing (one to three months), and post-illness stages (longer than three months). A meta-regression was conducted to test for moderating effects, particularly for exploring estimate differences between SARS-Cov-2 and previous pandemics and epidemics. PROSPERO registration: CRD42020194535.

RESULTS

We identified 59 studies including between 14 and 1002 participants and providing 187 prevalence estimates. MHP, in general, decreased from acute to post-illness from 46.3% to 38.8% and for mild and moderate-to-severe from 22.3% to 18.8%, respectively. We found no evidence of moderating effects except for non-random sampling and H1N1 showing higher prevalence. There was a non-significant trend towards lower MHP for SARS-CoV-2 compared to previous epidemics.

CONCLUSIONS

MHP prevalence estimates decreased over time but were still on a substantial level at post-illness. Post-viral mental health problems caused by SARS-CoV-2 could have been expected much earlier, given the previous post-viral sequelae.

Impact of the loss of smell on the sleep quality and fatigue level in COVID‑19 survivors

Purpose

Patients with Coronavirus disease 2019 (COVID-19) are reported to have symptoms such as shortness of breath, dry cough, headache, fatigue, and diarrhea. Loss of smell is a symptom that some patients have suffered from due to inflammation of olfactory epithelium and neuroinvasion of COVID-19 resulting in damage to the olfactory nerves and olfactory bulb. Losing an important sense such as smell might have unfavorable consequences on the lives of COVID-19 survivors; however, these unfavorable consequences have not been sufficiently investigated.

Methods

This was a cross-sectional descriptive study, 81 COVID-19 survivors (51.85% male) answered the Pittsburgh Sleep Quality Index, Fatigue Severity Scale, and Patient Health Questionnaire.

Results

COVID-19 survivors who lost their smell were more likely to have poor sleep quality, high fatigue severity, and depression symptoms compared to others who did not lose their smell. Most COVID-19 survivors who lost their smell were women and had breathing difficulties.

Conclusion

Our knowledge of this relationship will assist in establishing more efficient treatment regimens that consider both psychological and physiological factors. Future research is needed to investigate the causality relationship between poor sleep quality, increased fatigue, and depression symptoms in COVID-19 survivors who experienced loss of the sense of smell.

SARS-CoV-2 entry sites are present in all structural elements of the human glossopharyngeal and vagal nerves: Clinical implications

Background

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections result in the temporary loss of smell and taste in about one third of confirmed cases.

Methods

We used immunohistochemistry to confirm the presence of ACE2, NRP1 and TMPRSS2 in two cranial nerves (IX and X) that mediate taste where they leave/join the medulla. Samples from three (two paraffin embedded and one frozen) postmortem samples were studied (facial (VII) nerve was not available). We also performed immunohistochemistry using the same antibodies in two human cell lines (oligodendrocytes and fibroblasts), and we isolated RNA from one nerve and performed PCR to confirm the presence of the mRNAs that encode the proteins visualized.

Findings

All three of the proteins (ACE-2, NRP1 and TMPRSS2) required for SARS-CoV-2 infections appear to be present in all cellular components (Schwann cells, axons, vascular endothelium, and connective tissue) of the human IXth and Xth nerves near the medulla. We also found their mRNAs in the nerve and in human oligodendrocytes and fibroblasts which were stained by antibodies directed at the three proteins examined.

Interpretation

Infection of the IXth and Xth nerves by the SARS-CoV-2 virus is likely to cause the loss of taste experienced by many Covid patients. Migration of the virus from the oral cavity through these nerves to brainstem respiratory centers might contribute to the problems that patients experience.

Funding

This study was supported by the Intramural Research Program of the National Institute of Dental and Craniofacial Research (NIDCR), NIH (intramural project no. ZDE000755-01), and the Human Brain Tissue Bank, Semmelweis University, Budapest, Hungary from the Hungarian Brain Research Program (2017-1.2.1-NKP-2017-00002).

Exploring Factors and Associate Responses for Anxiety in the Coronavirus Disease 2019 Pandemic: A Web-Based Survey in Japan

Background and Objectives

Anxiety plays an important role in psychology. An exploration of anxiety and its associated reactions may provide insight into measures for addressing mental health problems caused by the coronavirus disease 2019 (COVID-19) pandemic. Data from this study provide potential correlational responses to anxiety.

Methods

A cross-sectional study using data collected via an online self-reported questionnaire was conducted in Japan during the COVID-19 pandemic. Using the State-Trait Anxiety Inventory (STAI-6), we assessed anxiety levels and explored the relationship between anxiety STAI-6 score, sources of COVID-19 information, the influences of COVID-19, social anxiety symptoms, discrimination, and evaluation of the government.

Results

A total of 4,127 participants were included in the analysis. The level of anxiety was not equally distributed across the general population with respect to age, gender, educational level, occupation, income, presence of underlying disease, and location (p < 0.05). The number of sources of information on COVID-19 had a positive correlation with the STAI-6 score (Spearman’s rho = 0.176, p < 0.001). The influence of the pandemic was correlated with moderate–severe anxiety. A high level of anxiety added to social anxiety (Spearman’s rho = 0.04, p < 0.05) and discriminatory behavior (Spearman’s rho = 0.11, p < 0.01). Being female (Estimate = 0.926) and from a non-emergency area (Estimate = −0.308) was related to higher STAI scores, and higher education (Estimate = −0.305), and income (Estimate = −0.168) decreased the STAI score. The respondents who had a lower evaluative score of the preventive activities undertaken by the national and local governments had higher STAI-6 scores.

Conclusion

Our findings provide statistical evidence for the associated reaction of anxiety and that anxiety reactions may vary in predictable ways. Further studies should focus on the strategic interventions that may decrease the associated responses to anxiety, to address mental health issues due to the pandemic.

COVID-19, Oxidative Stress, and Neuroinflammation in the Depression Route

COVID-19 is associated with oxidative stress, peripheral hyper inflammation, and neuroinflammation, especially in individuals with a more severe form of the disease. Some studies provide evidence on the onset or exacerbation of major depressive disorder (MDD), among other psychiatric disorders due to COVID-19. Oxidative stress and neuroinflammation are associated conditions, especially in the more severe form of MDD and in refractoriness to available therapeutic strategies. Inflammatory cytokines in the COVID-19 hyper inflammation process can activate the hypothalamic–pituitary–adrenal (HPA) axis and the indoleamine-2,3-dioxygenase (IDO) enzyme. IDO activation can reduce tryptophan and increase toxic metabolites of the kynurenine pathway, which increases glial activation, neuroinflammation, toxicity, and neuronal death. This review surveyed a number of studies and analyzed the mechanisms of oxidative stress, inflammation, and neuroinflammation involved in COVID-19 and depression. Finally, the importance of more protocols that can help elucidate the interaction between these mechanisms underlying COVID-19 and MDD and the possible therapeutic strategies involved in the interaction of these mechanisms are highlighted.

Self-Reported Tinnitus Severity Prior to and During the COVID-19 Lockdown in the United Kingdom

BACKGROUND AND PURPOSE

 The aim of this study was to assess whether the severity of tinnitus, as measured using ratings of tinnitus loudness, annoyance, and effect on life, was influenced by the lockdown related to the coronavirus disease 2019 (COVID-19) pandemic.

RESEARCH DESIGN

 This was a retrospective study.

STUDY SAMPLE

 The data for 105 consecutive patients who were seen at a tinnitus clinic in an audiology department in the United Kingdom during the COVID-19 lockdown between April and June 2020 and 123 patients seen in the same period of the previous year, prior to the COVID-19 pandemic were included.

DATA COLLECTION

 Demographic data for the patients, results of their pure-tone audiometry, and their score on visual analog scale (VAS) of tinnitus loudness, annoyance, and effect on life were imported from their records held at the audiology department. This was a retrospective survey comparing ratings on the VAS of tinnitus loudness, annoyance, and effect on life for consecutive patients seen during the COVID-19 lockdown and consecutive patients seen in the same period of the previous year, prior to the COVID-19 pandemic. Patients seen prior to lockdown used a pen and paper version of the VAS, while the patients who were assessed during the COVID-19 lockdown used an adapted version of the VAS, via telephone. All patients were seeking help for their tinnitus for the first time.

RESULTS

 The mean scores for tinnitus loudness, annoyance, and effect on life did not differ significantly for the groups seen prior to and during lockdown.

CONCLUSION

 Any changes in psychological well-being or stress produced by the lockdown did not significantly affect ratings of the severity of tinnitus.

The experience of people with idiopathic pulmonary fibrosis living through the COVID-19 pandemic

AIM

To explore the experience of people with idiopathic pulmonary fibrosis living through the COVID-19 pandemic.

DESIGN

A qualitative descriptive design using semi-structured interviews.

METHOD

Purposive sampling was employed to recruit 13 participants with idiopathic pulmonary fibrosis attending the respiratory department of a large urban teaching hospital in Limerick, Ireland. Data were collected between January 2021 and February 2021 through semi-structured interviews, using an online platform. Reflective thematic analysis was used for data analysis.

RESULTS

Four key themes were identified from participant's experience of living through the COVID-19 pandemic: (1) fear of contracting COVID-19 disease, (2) living with reduced social interaction, (3) the adjustment in the relationship with healthcare professionals (HCP) and (4) navigating an altered landscape.

CONCLUSION

Healthcare professionals have a key role in protecting the physical and psychological health of the person with idiopathic pulmonary fibrosis during this time and into the future. Through being cognisant of the additional supportive care needs of people with idiopathic pulmonary fibrosis, HCP can focus on developing targeted interventions aimed to enhance care provision.

IMPACT

This study considers people with idiopathic pulmonary fibrosis as a particularly vulnerable group whose experiences of living through the COVID-19 pandemic warrant specific attention. Participants felt compelled to self-isolate due to fear and anxiety of contracting COVID-19 disease. Participants reported increased social isolation with some experiencing anger and resentment at loss of precious time with loved ones. Participants felt an increased responsibility for self-monitoring their condition and had concerns about differentiating symptoms of COVID-19 disease from an exacerbation. A variety of strategies that helped them cope through the pandemic were identified and also the important role these played. The results from this study can be used to inform HCP' understanding of challenges experienced by people with idiopathic pulmonary fibrosis during enforced restrictions related to the COVID-19 pandemic.

The Effects of Persistent Olfactory and Gustatory Dysfunctions on Quality of Life in Long-COVID-19 Patients

(1) Background: Persistent olfactory (POD) and gustatory (PGD) dysfunctions are one of the most frequent symptoms of long-Coronavirus Disease 2019 but their effect on the quality of life (QoL) of patients is still largely unexplored. (2) Methods: An online survey was administered to individuals who reported to have had SARS-CoV-2 infection at least 6 months prior with persisting COVID-19 symptoms (using the COVID symptom index), including ratings of POD and PGD, and their physical (PCS) and mental (MCS) components of quality of life were assessed using the standardized short form 12 questionnaire (SF-12). (3) Results: Responses from 431 unique individuals were included in the analyses. The most frequent persistent symptoms were: fatigue (185 cases, 42.9%), olfactory dysfunction (127 cases, 29.5%), gustatory dysfunction (96 cases, 22.3%) and muscle pain (83 cases, 19.3%). Respondents who reported persisting muscle pain, joint pain, fatigue, headache, gastrointestinal disturbances, and dyspnea had significantly worse PCS. Those experiencing persistent fatigue and dyspnea also showed significantly lower MCS. Respondents reporting POD or PGD showed significantly worse QoL, but only pertaining to the MCS. Multiple regressions predicted MCS based on olfactory and marginally on gustatory ratings, but not PCS. Age significantly affected the prediction of PCS but not MCS, and gender and temporal distance from the COVID-19 diagnosis had no effect. (4) Conclusions: POD and PGD are frequent symptoms of the long-COVID-19 syndrome and significantly reduce QoL, specifically in the mental health component. This evidence should stimulate the establishment of appropriate infrastructure to support individuals with persistent CD, while research on effective therapies scales up.

Olfactory Dysfunction in Patients With Coronavirus Disease 2019: A Review

The coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on public-health and economic systems worldwide. Among the several neurological symptoms of patients with COVID-19 reported in clinical practice, olfactory dysfunction (OD) is the most common. OD occurs as the earliest or the only clinical manifestation in some patients. Increasing research attention has focused on OD, which is listed as one of the main diagnostic symptoms of severe acute respiratory syndrome-coronavirus-2 infection. Multiple clinical and basic-science studies on COVID-19-induced OD are underway to clarify the underlying mechanism of action. In this review, we summarize the clinical characteristics, mechanisms, evaluation methods, prognosis, and treatment options of COVID-19-induced OD. In this way, we hope to improve the understanding of COVID-19-induced OD to aid early identification and precise intervention.

Psychological Symptoms in COVID-19 Patients: Insights into Pathophysiology and Risk Factors of Long COVID-19

There is growing evidence of studies associating COVID-19 survivors with increased mental health consequences. Mental health implications related to a COVID-19 infection include both acute and long-term consequences. Here we discuss COVID-19-associated psychiatric sequelae, particularly anxiety, depression, and post-traumatic stress disorder (PTSD), drawing parallels to past coronavirus outbreaks. A literature search was completed across three databases, using keywords to search for relevant articles. The cause may directly correlate to the infection through both direct and indirect mechanisms, but the underlying etiology appears more complex and multifactorial, involving environmental, psychological, and biological factors. Although most risk factors and prevalence rates vary across various studies, being of the female gender and having a history of psychiatric disorders seem consistent. Several studies will be presented, demonstrating COVID-19 survivors presenting higher rates of mental health consequences than the general population. The possible mechanisms by which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the brain, affecting the central nervous system (CNS) and causing these psychiatric sequelae, will be discussed, particularly concerning the SARS-CoV-2 entry via the angiotensin-converting enzyme 2 (ACE-2) receptors and the implications of the immune inflammatory signaling on neuropsychiatric disorders. Some possible therapeutic options will also be considered.

Psychological pathways between type D personality and COVID-19

BACKGROUND

Patients with a type D personality have worse social functioning and mental health and more affective constraints than non-type D personalities. They have a negative outlook on life and health-related issues. The aim of this study was to examine the mediating role of stress and anxiety in the relationship between type D personality and COVID-19 by adjustment of the effect of demographic characteristics and perceived symptoms as confounder variables.

PARTICIPANTS AND PROCEDURE

A total of 196 patients out of those suspected of having COVID-19 and visiting the reference hospitals were selected. They had completed the type D personality and the anxiety and stress scales along with their hospital admission form before undergoing COVID-19 testing. After their COVID-19 test, the participants were divided into two groups based on their disease, an infected group (n = 90) and a non-infected group (n = 106).

RESULTS

Type D personality has no significant direct effect on infection with the disease, but taking into account the mediating variable of stress, the odds of an event in those with type D personality is 2.21 times higher than those without this personality (p = .027) and, taking into account the mediating variable of anxiety, having a type D personality increases the odds of an event by 2.62 times (p = .011), holding demographic characteristics and perceived symptoms constant.

CONCLUSIONS

Given the indirect relationship between COVID-19 and type D personality, the mediating variables of stress and anxiety can be considered full mediating variables.

Clinical Phenotype and Contagiousness of Early Breakthrough SARS-CoV-2 Infections after BNT162b2 COVID-19 mRNA Vaccine: A Parallel Cohort Study in Healthcare Workers

We evaluated the clinical protection of BNT162b2 mRNA vaccine in healthcare workers (HCWs) and how COVID-19 manifestations and contagiousness change as the time since first dose increases. A matched (1:2 ratio) parallel cohort study was performed. During the first three months of vaccination campaign, HCWs of the entire health district ASL Città di Torino (Turin, Italy) were classified according to SARS-CoV-2-positivity in respect of the vaccination schedule: post-first-dose (fHCWs, <12 days), partially (PHCWs, ≥12 from first dose to ≤7 days after the second), and totally vaccinated (THCWs, ≥8 days after the second dose). Age-/sex-matched unvaccinated controls were randomly selected from all the SARS-CoV-2-positivity detected in the same district and period. Previous infections were excluded. Clinical and virologic data (ORF1ab gene cycle threshold values, Ct) were recorded. In total, 6800 HCWs received at least one dose, and 55 tested positive subsequently: 20 fHCWs, 25 PHCWs, 10 THCWs. Furthermore, 21.8% of breakthrough infections were in male, with a median age of 49 years (32–56), and 51.4% occurred while SARS-CoV-2 B.1.1.7 variant was predominant. The incident relative risk was 0.13 (0.12–0.15) for PHCWs and 0.06 (0.05–0.07) for THCWs. Compared to controls (n = 110), no difference was observed in fHCWs, while PHCWs and THCWs showed higher prevalence of asymptomatic infections, fewer signs/symptoms with a milder systemic involvement, and significantly higher Ct values (PHCWs 30.3 (24.1–35.5) vs. 22.3 (19.6–30.6), p = 0.023; THCWs 35.0 (31.3–35.9) vs. 22.5 (18.2–30.6), p = 0.024). Duration of symptoms was also shorter in THCWs (5 days (3–6) vs. 9 (7–14), p = 0.028). A linear increase of 3.81 points in Ct values was observed across the groups by vaccination status (p = 0.001) after adjusting for age, sex, comorbidities, and time between COVID-19 onset and swab collection. BNT162b2 decreased the risk of PCR-confirmed infections and severe disease, and was associated with a virologic picture of lesser epidemiologic concern as soon as 12 days after the first vaccine dose.

The effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with COVID-19: A randomized controlled study

PURPOSE

This study aimed to determine the effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This is an experimental study. Its data were collected in the infectious diseases clinic of a research hospital from May to August, 2020. This study was carried out with 67 COVID-19 patients (33 in the experimental group and 34 in the control group). The data were collected using a personal information form, the state-trait anxiety inventory, and the Richards-Campbell Sleep Questionnaire. The progressive muscle relaxation exercises were performed twice a day for 5 days with the researcher's supervision. The data were analyzed using means, numbers, percentage distributions, the χ ² test, the dependent t test, and the independent t test.

RESULTS

Statistically significant differences were found between the experimental and control groups' mean posttest scores on the State-Trait Anxiety Inventory and the Richards-Campbell Sleep Questionnaire (p < 0.05). The in-group comparison of the experimental group found a statistically significant difference between their mean pretest and posttest scores on the State Anxiety Scale (p < 0.05). The in-group comparison of the control group found no statistically significant changes in their mean pretest and posttest scores on the State Anxiety Scale (p > 0.05).

CONCLUSION

The progressive muscle relaxation exercises effectively reduced the anxiety and improved the sleep quality of patients with COVID-19.

A living systematic review of the psychological problems in people suffering from COVID-19

OBJECTIVES

We aimed to investigate the psychological problems on people infected with SARS-CoV-2 during the pandemic.

METHODS

In this living systematic review and meta-analyses, we searched seven electronic databases for cross-sectional studies and longitudinal studies on psychological problems on COVID-19 patients from Jan 1, 2020 to Oct 7, 2020. The primary outcome was prevalence of various psychological problems such as anxiety, depression, stress, insomnia, somatization, and fear. We pooled data for prevalence with their 95% confidence interval (CI) using random effect models and assessed the study quality based on the 11-item checklist recommended by the Agency for Healthcare Research and Quality.

RESULTS

Fourty-four studies, including studies from China(35), Italy(2), Iran(2), India(1), Korea(1), Ecuador(1), Switzerland(1), Germany(1), were identified by comprising a total of 8587 completed questionnaires and 38 studies for meta-analyses. The prevalence of anxiety, depression, post-traumatic stress disorder(PTSD), insomnia, somatization, and fear in patients with COVID-19 was 16.6% (10.1%-23.1%), 37.7% (29.3%-46.2%), 41.5% (9.3%-73.7%), 68.3% (48.6%-88.0%), 36.5% (20.2%-52.8%), 47.6% (9.4%-85.7%), respectively. The prevalence of anxiety, depression, and insomnia in severe COVID-19 patients (intensive care unit inpatients) was higher than mild or clinically stable COVID-19 patients.

LIMITATIONS

A significant degree of heterogeneity in terms of populations, sampling methods, scales was noted across studies.

CONCLUSIONS

There existed high proportions of COVID-19 patients with psychological problem. The prevalence of psychological problems was closely related to the patients themselves, their surroundings and social support. It is imperative to provide ontime psychological care service for COVID-19 patients and to follow-up them for a longer period.

COVID-19 and Parkinson's disease: Defects in neurogenesis as the potential cause of olfactory system impairments and anosmia

Anosmia, a neuropathogenic condition of loss of smell, has been recognized as a key pathogenic hallmark of the current pandemic SARS-CoV-2 infection responsible for COVID-19. While the anosmia resulting from olfactory bulb (OB) pathology is the prominent clinical characteristic of Parkinson's disease (PD), SARS-CoV-2 infection has been predicted as a potential risk factor for developing Parkinsonism-related symptoms in a significant portion of COVID-19 patients and survivors. SARS-CoV-2 infection appears to alter the dopamine system and induce the loss of dopaminergic neurons that have been known to be the cause of PD. However, the underlying biological basis of anosmia and the potential link between COVID-19 and PD remains obscure. Ample experimental studies in rodents suggest that the occurrence of neural stem cell (NSC) mediated neurogenesis in the olfactory epithelium (OE) and OB is important for olfaction. Though the occurrence of neurogenesis in the human forebrain has been a subject of debate, considerable experimental evidence strongly supports the incidence of neurogenesis in the human OB in adulthood. To note, various viral infections and neuropathogenic conditions including PD with olfactory dysfunctions have been characterized by impaired neurogenesis in OB and OE. Therefore, this article describes and examines the recent reports on SARS-CoV-2 mediated OB dysfunctions and defects in the dopaminergic system responsible for PD. Further, the article emphasizes that COVID-19 and PD associated anosmia could result from the regenerative failure in the replenishment of the dopaminergic neurons in OB and olfactory sensory neurons in OE.

Parosmia, Dysgeusia, and Tongue Features Changes in a Patient with Post-Acute COVID-19 Syndrome

Coronavirus disease 2019 (COVID-19) is the pandemic of major global concern that has been causing several tragic events ever since December 2019. Infection with COVID-19 varies from being asymptomatic or mild with general unwellness to severe with difficulty in breathing and even mortality. Recently, several reports signified the persistence of symptoms or the development of new ones for weeks or months after the virus has gone, the so-called "post-acute COVID-19 syndrome." This article presents a 31-year-old female with post-acute COVID-19 syndrome showing parosmia, dysgeusia, and tongue feature changes as simultaneous newly developed manifestations after the viral clearance. Follow-up revealed complete remission of manifestations after one month. Post-acute COVID-19 syndrome can show oral manifestations. Despite the lack of evidence regarding the etiology, risk factors, and consequences of post-COVID-19 syndrome, it is important to monitor COVID-19 survivors to avoid complications during their recovery period.

Post-viral effects of COVID-19 in the olfactory system and their implications

BACKGROUND

The mechanisms by which any upper respiratory virus, including SARS-CoV-2, impairs chemosensory function are not known. COVID-19 is frequently associated with olfactory dysfunction after viral infection, which provides a research opportunity to evaluate the natural course of this neurological finding. Clinical trials and prospective and histological studies of new-onset post-viral olfactory dysfunction have been limited by small sample sizes and a paucity of advanced neuroimaging data and neuropathological samples. Although data from neuropathological specimens are now available, neuroimaging of the olfactory system during the acute phase of infection is still rare due to infection control concerns and critical illness and represents a substantial gap in knowledge.

RECENT DEVELOPMENTS

The active replication of SARS-CoV-2 within the brain parenchyma (ie, in neurons and glia) has not been proven. Nevertheless, post-viral olfactory dysfunction can be viewed as a focal neurological deficit in patients with COVID-19. Evidence is also sparse for a direct causal relation between SARS-CoV-2 infection and abnormal brain findings at autopsy, and for trans-synaptic spread of the virus from the olfactory epithelium to the olfactory bulb. Taken together, clinical, radiological, histological, ultrastructural, and molecular data implicate inflammation, with or without infection, in either the olfactory epithelium, the olfactory bulb, or both. This inflammation leads to persistent olfactory deficits in a subset of people who have recovered from COVID-19. Neuroimaging has revealed localised inflammation in intracranial olfactory structures. To date, histopathological, ultrastructural, and molecular evidence does not suggest that SARS-CoV-2 is an obligate neuropathogen. WHERE NEXT?: The prevalence of CNS and olfactory bulb pathosis in patients with COVID-19 is not known. We postulate that, in people who have recovered from COVID-19, a chronic, recrudescent, or permanent olfactory deficit could be prognostic for an increased likelihood of neurological sequelae or neurodegenerative disorders in the long term. An inflammatory stimulus from the nasal olfactory epithelium to the olfactory bulbs and connected brain regions might accelerate pathological processes and symptomatic progression of neurodegenerative disease. Persistent olfactory impairment with or without perceptual distortions (ie, parosmias or phantosmias) after SARS-CoV-2 infection could, therefore, serve as a marker to identify people with an increased long-term risk of neurological disease.

Quality of life and safety impact of COVID-19 associated smell and taste disturbances

OBJECTIVE

The association between COVID-19 and chemosensory loss has garnered substantial attention, however to date little is known about the real-life consequences of impairment in this unique patient population. The aim of this study is to evaluate the quality of life (QOL) and personal safety deficits experienced by patients with COVID-19 infection.

STUDY DESIGN

Prospective, longitudinal questionnaires.

SETTING

National survey.

METHODS

A longitudinal web-based nationwide survey of adults with COVID-19 and/or a sudden change in smell and taste was launched April 10, 2020. Previously published questions on chemosensory-related QOL and safety events were asked at the 6-month follow-up survey.

RESULTS

As of February 10, 2021, 480 eligible respondents took the 6-month questionnaire, of whom 322 were COVID-19 positive. Impact on QOL was substantial with 96% of subjects reporting at least one of the defined deficits, and over 75% reporting at least 3 of these. "Reduced enjoyment of food" was the most common complaint (87%), while 43% of subjects self-reported depression. The prevalence of safety-related issues was common in this population, with over 57% reporting at least one, and 36% reporting 2 or more events. Of the events asked, the inability to smell smoke that others could perceive was the most common at 45%.

CONCLUSIONS

COVID-19 associated chemosensory losses have a real and substantial impact on both quality of life and safety, beyond mere inconvenience. The high prevalence of these issues despite a relatively short period of olfactory deficit should alert clinicians to the serious risks to an already vulnerable patient population.

Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries

BACKGROUND

The COVID-19 pandemic represents a public health, economic and mental health crisis. We hypothesized that timely government implementation of stringent measures to reduce viral transmission would benefit mental health, as evidenced by reduced rates of depressive symptoms (i.e., Patient Health Questionnaire [PHQ]-9≥10, PHQ-2≥3).

METHODS

The systematic review herein (PROSPERO CRD42020200647) evaluated to what extent differences in government-imposed stringency and timeliness of response to COVID-19 moderate the prevalence of depressive symptoms across 33 countries (k=114, N=640,037). We included data from six lower-middle-income countries, nine upper-middle-income countries, and 18 higher-income countries. Government-imposed stringency and timeliness in response were operationalized using the Oxford COVID-19 Government Response ("Stringency") Index.

RESULTS

The overall proportion of study participants with clinically significant depressive symptoms was 21.39% (95% CI 19.37-23.47). The prevalence of clinically significant depressive symptoms was significantly lower in countries wherein governments implemented stringent policies promptly. The moderating effect of government response remained significant after including the national frequency of COVID cases at the time of study commencement, Healthcare Access and Quality index, and the inclusion of COVID patients in the study.

LIMITATIONS

Factors that may have confounded our results include, for example, differences in lockdown duration, lack of study participant and outcome assessor blinding, and retrospective assessment of depressive symptom severity.

CONCLUSIONS

Governments that enacted stringent measures to contain the spread of COVID-19 benefited not only the physical, but also the mental health of their population.

A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment

PURPOSE OF REVIEW

COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection.

RECENT FINDINGS

Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history.

SUMMARY

The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.