Psychiatric and neuropsychiatric sequelae of COVID-19 - A systematic review

Psychological Distress and Negative Emotions in Post-COVID Infection: A Comparative Study of the COVID and NO-COVID Young Patients

According to the literature, mental health assumed urgent relevance, and several scholars are debating on the enduring of the neurological and psychiatric symptoms in post COVID patients. Our study aimed to investigate the emotional dimensions in young population to the COVID exposition: primary endpoint was to detect the psychological distress up to 3 months in post-COVID-19. A comparative study was conducted among young adults in Italy. We also assessed dysphoria, depression, anxiety, stress symptoms, pessimism, and positive personality traits. The participants were 140 Italian young aged 18-30 years (mean = 22.1, SD ± 2.65; 65.0% female). The sample was distinguished in two groups: COVID and NO-COVID groups. The results revealed that young who have been exposed to COVID-19 infection evidenced emotional vulnerability by higher psychological distress (depression, anxiety, stress), dysphoria signs (irritability, discontent, interpersonal resentment, and feelings of renunciation/surrender) then No COVID-19 infection young. Furthermore, COVID patients showed higher negative emotions about the expected life, uncertain for future, and loss of motivation (characterized no desires) than NO-COVID infection. In conclusion, the vulnerability of young exposed to COVID infection even in mild severity should be considered as emerging unmet need of mental health recovering: urgent health policy actions to boost the psychological, biological and social strategic pillar for young generation.

Post-COVID-Syndrome Patients Might Overestimate Own Cognitive Impairment

BACKGROUND

After a COVID-19 infection, some patients experience long-term consequences known as Post-Covid Syndrome, which often includes cognitive impairment. We investigated the congruence between subjectively experienced and objectively measured cognitive deficits after a COVID-19 infection in an unselected, successively admitted cohort of 46 patients reporting subjective cognitive complaints (SCC).

METHODS

We employed a comprehensive neuropsychological test battery to assess objective cognitive impairment across various cognitive domains. Three different cut-off criteria were applied, commonly used in the literature to define objective neurocognitive disorder (NCD).

RESULTS

We observed a notably low congruence between SCC and NCD in Post-Covid Syndrome, regardless of the cut-off criterion. Depending on the cognitive domain, only 4% to maximally 40% of the SCC could be objectified.

CONCLUSIONS

One possible explanation for this discrepancy could be the high rate of depressive symptoms observed in the group of patients studied, which may negatively influence the perception of one's cognitive abilities. These findings emphasize the need for careful evaluation of SCC in Post-Covid Syndrome and suggest that treating depressive symptoms may also alleviate some of the perceived cognitive deficits.

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.

COVID-19 and cognitive impairment: a review of the emerging evidence

The recent surge of COVID-19 cases has raised concerns about its potential long-term effects on cognitive function. This review explores the growing body of research investigating the link between COVID-19 infection and cognitive impairment. Studies employing observational, longitudinal, and case-control designs reveal a concerning prevalence of cognitive impairment in survivors, affecting domains like attention, memory, executive function, and processing speed. The persistence of these deficits for months after the initial infection highlights the potential for long-term consequences. While the precise mechanisms remain under investigation, potential contributing factors include neuroinflammation, hypoxia, and psychological effects. Limitations within the current research landscape necessitate further investigation into the long-term trajectory of cognitive decline, the potential for intervention and recovery, and the role of vaccination in mitigating these effects. Understanding the multifaceted nature of this issue is crucial for developing effective strategies to ensure optimal cognitive health outcomes for COVID-19 survivors.

Lingering symptoms in non-hospitalized patients with COVID-19 - a prospective survey study of symptom expression and effects on mental health in Germany

BACKGROUND

The infection rates with SARS-CoV 2 virus, known since 2019, are currently significantly weakened in their dynamics. Nevertheless, COVID 19 is still a common disease, which in most cases is overcome quite well and can be treated by the general practitioner. Despite an initially uncomplicated disease progression, the long-term consequences can be considerable. Symptoms persisting over a period of more than 12 weeks after infection are summarized as Post-COVID (PC) syndrome. The aim of this study is to document the symptom expression in PC patients in the outpatient setting, with a major focus on limitations in daily life and consequences for mental health.

METHODS

This survey is part of a prospective European collaborative study with the German cohort having been slightly extended and evaluated separately. Data collection was performed by telephone interviews of adult SARS CoV 2 positive patients using standardized questionnaires (38 open and 6 closed questions). After an inclusion interview, follow-up interviews were conducted every 4 weeks over a period of 6 months. Participants were recruited in collaboration with the local health department (Wuerzburg, Germany).

RESULTS

Sixty participants were recruited in April and May 2021. After 12 weeks (PC cutoff), 48.3% still reported symptoms related to SARS-CoV-2 infection. The most commonly reported symptoms were fatigue/tiredness (33.3%), reduced concentration (26.7%), and shortness of breath (23.3%). One-quarter of respondents reported impaired functioning, with the most common daily limitations being sports (28.3%), work (25.0%), and social life (15.0%). At 6 months, 21.6% of respondents experienced anxiety and 11.6% reported depressive symptoms. Overall, 40.0% of respondents were concerned that their health would deteriorate again or not fully normalize because of COVID-19. Over two-thirds (70.0%) visited a physician during the course of the study because of COVID-19, 73.8% of whom visited their general practitioner.

CONCLUSION

PC in outpatient care appears to be a complex and multifaceted condition that not only presents with physical symptoms, but also has a significant impact on mental health and daily life. Although the complexity of the condition is not yet fully understood, our findings suggest that it presents long-term challenges, particularly in outpatient care. Further research, particularly in larger and more diverse cohorts, is needed to confirm these observations. Routine screening for psychosocial comorbidities could be a valuable approach to identify supportive interventions that may help to reduce the risk of chronification and/or somatization.

Brain health Begins Before Birth (B4): A "learning" pregnancy and birth cohort study

Mental health disorders affect over 1 billion people worldwide, profoundly impacting individuals, families, and the global economy. Risk for psychopathology begins early in life, with the perinatal period representing a critical window of vulnerability. The Brain health Begins Before Birth (B4) Study at Massachusetts General Hospital (MGH) is a prospective birth cohort designed to identify modifiable risk and resilience factors influencing early brain development and child- and adult-onset psychopathology. This study aims to deeply phenotype prenatal exposures through maternal surveys administered at multiple time points during and after pregnancy; assess early neurodevelopmental outcomes through the first two years of life; and triangulate exposure and outcome data with underlying biological mechanisms. The B4 Study consists of structured, remote surveys covering psychosocial, environmental, and health-related factors throughout pregnancy and the first two years of life, supplemented by medical record review. By integrating risk and resilience factors into a dynamic learning cohort model, the B4 Study aims to advance the field of preventive psychiatry by identifying actionable pathways for early intervention, testing strategies in real-time, and ultimately shaping policies that promote lifelong mental health and wellbeing from the earliest stages of development.

Psychiatric and neuropsychiatric sequelae of COVID-19 within 2 years: a multinational cohort study

BACKGROUND

The long-term psychiatric and neuropsychiatric sequelae of COVID-19 across diverse populations remain not fully understood. This cohort study aims to investigate the short-, medium-, and long-term risks of psychiatric and neuropsychiatric disorders following COVID-19 infection in five countries.

METHODS

This population-based multinational network study used electronic medical records from France, Italy, Germany, and the UK and claims data from the USA. The initial target and comparator cohorts were identified using an exact matching approach based on age and sex. Individuals diagnosed with COVID-19 or those with a positive SARS-CoV-2 screening test between December 1, 2019, and December 1, 2020, were included as targets. Up to ten comparators without COVID-19 for each target were selected using the propensity score matching approach. All individuals were followed from the index date until the end of continuous enrolment or the last healthcare encounter. Cox proportional hazard regression models were fitted to estimate the risk of incident diagnosis of depression, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, psychoses, personality disorders, self-harm and suicide, sleep disorders, dementia, and neurodevelopmental disorders within the first 6 months (short-term), 6 months to 1 year (medium-term), and 1 to 2 years (long-term) post-infection.

RESULTS

A total of 303,251 individuals with COVID-19 and 22,108,925 individuals without COVID-19 from five countries were originally included. Within the first 6 months, individuals with COVID-19 had a significantly higher risk of any studied disorders in all databases, with Hazard Ratios (HRs) ranging from 1.14 (95% CI, 1.07-1.22) in Germany to 1.89 (1.64-2.17) in Italy. Increased risks were consistently observed for depression, anxiety disorders, and sleep disorders across almost all countries. During the medium- and long-term periods, higher risks were observed only for depression (medium-term: 1.29, 1.18-1.41; long-term: 1.36, 1.25-1.47), anxiety disorders (medium-term: 1.29, 1.20-1.38; long-term: 1.37, 1.29-1.47), and sleep disorders (medium-term: 1.10, 1.01-1.21; long-term: 1.14, 1.05-1.24) in France, and dementia (medium-term: 1.65, 1.28-2.10) in the UK.

CONCLUSIONS

Our study suggests that increased risks of psychiatric and neuropsychiatric outcomes were consistently observed only within, and not after, the 6-month observation period across all databases, except for certain conditions in specific countries.

Natural disasters and SARS-CoV-2: potential risk factors for exacerbating mental health conditions among veterans

BACKGROUND

Puerto Rico and U.S. Virgin Islands Veterans (PRVs) have faced recurring challenges from hurricanes, earthquakes, and the COVID-19 pandemic. These events combined with prior traumas and social determinants of health (SDoH), may contribute to neuropsychiatric mental health conditions (MHCs) like post-traumatic stress disorder (PTSD) and substance use disorder (SUD) in PRVs affected by SARS-CoV-2.

METHODS

To clinically characterize the risk factors for MHCs among SARS-CoV-2 infected PRVs, we examined 839 records (2016-2020) to study SARS-CoV-2 infections and MHCs. Records were assessed for (i) PTSD and SUD using health data at diagnosis; (ii) clinical details pre-hurricanes (control; group 1), during hurricanes (group 2), and pandemic (group 3). Groups 1 and 2 were reviewed in 2020 to gauge exacerbation. Patient Health Questionnaire (PHQ-2/PHQ-9), PTSD checklist (PCL-5), Alcohol Use Disorders Identification Test (AUDIT), SDoH, and other tools were used for clinical evaluation, with the data analyzed using logistic regression.

RESULTS

Health data indicated SARS-CoV-2 infection in 21 PRVs. Earthquakes did not affect the infected PRVs nor did SDoH have any significant impact. Clinical analysis revealed that SUD worsened during hurricanes and exacerbation of all MHCs occurred during the pandemic among SARS-CoV-2 infected PRVs.

CONCLUSIONS

These results underscore the fact that the combination of natural disasters like hurricanes and SARS-CoV-2 had synergistically contributed to the deterioration of neuropsychiatric MHCs, therefore warranting equitable MH support.

Neurological long COVID in the outpatient clinic: Is it so long?

BACKGROUND AND PURPOSE

Neurological involvement in long COVID (coronavirus disease 2019) is well known. In a previous study we identified two subtypes of neurological long COVID, one characterized by memory disturbances, psychological impairment, headache, anosmia and ageusia, and the other characterized by peripheral nervous system involvement, each of which present a different risk factor profile. In this study, we aimed to clarify the persistence of neurological long COVID symptoms with a significantly longer term follow-up.

METHODS

We prospectively collected data from patients with prior COVID-19 infection who showed symptoms of neurological long COVID. We conducted a descriptive analysis to investigate the progression of neurological symptoms over time at 3-, 6-, 12-, and 18-month follow-ups. We performed a k-means clustering analysis on the temporal evolution of the symptoms at 6, 12, and 18 months. Finally, we assessed the difference between the recovery course of vaccinated and non-vaccinated patients by computing the cumulative recovery rate of symptoms in the two groups.

RESULTS

The study confirmed the presence of two subtypes of neurological long COVID. Further, 50% of patients presented a complete resolution of symptoms at 18 months of follow-up, regardless of which subtype of neurological long COVID they had. Vaccination against SARS-Cov-2 appeared to imply a higher overall recovery rate for all neurological symptoms, although the statistical reliability of this finding is hampered by the limited sample size of the unvaccinated patients included in this study.

CONCLUSIONS

Neurological long COVID can undergo complete resolution after 18 months of follow-up in 50% of patients and vaccination can accelerate the recovery.

Viruses and psychiatric disorders: We have not crossed the borderline from hypothesis to proof yet (Review)

Most psychiatric disorders are heterogeneous and are attributed to the synergistic action of a multitude of factors. It is generally accepted that psychiatric disorders are the outcome of interactions between genetic predisposition and environmental perturbations, which involve psychosocial stress, or alterations in the physiological state of the organism. A number of hypotheses have been presented on such environmental influences that may include direct insults such as injury, malnutrition and hostile living conditions, or indirect sequelae following infection from viruses such as influenza, arboviruses, enteroviruses and several herpesviruses, or the differential expression of human endogenous retroviruses. It is known that the concept of viruses is far more extensive than their perception as mere agents of acute infections, or chronic debilitating diseases, such as AIDS or some forms of cancer. Notably, an apparent causal connection between viruses and the pathophysiology of diseases has been suggested; however, it remains unclear as to how to establish this causal connection. There are inherent difficulties in answering this question with certainty, which may be due to the multitude of genetic and environmental influences that can lead to psychopathology; the latent state of chronic infection exhibited by a number of neurotropic viruses; the late onset of psychiatric disorders with respect to the acute phase of viral infection at which detection tests would be successful; the complexity of the virome; and the existence of thousands of viral species. The present review aims to provide an outline of the conclusions that have thus far been reached regarding a possible association between viral infection and psychiatric disease, and the obstacles confronted during the quest for the truth behind the role of viruses.

Objectifying persistent subjective cognitive impairment following COVID-19 infection: cross-sectional data from an outpatient memory-clinic in Germany

OBJECTIVE

Subjective cognitive impairment is frequently reported by patients experiencing Post-COVID symptoms. This study aims to assess objective impairment in attention, memory, and executive functions among these patients. Further, we investigated potential determinants of objective cognitive impairment.

METHODS

In this cross-sectional study, standardized neuropsychological testing (Vienna Testing System), assessment of cognitive symptom aggravation, psychiatric anamnesis, and psychometrics (BDI-II, Fatigue Severity Scale) were conducted in 229 patients who voluntarily presented to our outpatient memory-clinic due to subjective cognitive impairment following COVID-19. Blood-samples were collected to assess peripheral immune markers (IL-6, CRP) and APOE-ε4 genotype.

RESULTS

Objective cognitive impairment in at least one domain was present in 39% of the patients and 47% showed symptoms of moderate or severe depression. The APOE-ε4 allele was present in 32% of the patients. Higher rates of depressive symptoms (OR = 1.41, 95%-CI = 1.02-1.95) and higher burden of the APOE-ε4 allele (OR = 3.29, 95%-CI = 1.51-7.40) predicted objective cognitive impairment, regardless of age, sex, years of formal education, time since infection, and medication for diabetes or hypertension. Fatigue severity, acute COVID-19 severity or inflammation markers had no impact.

CONCLUSIONS

In our study, subjective cognitive impairment following COVID-19 was more likely associated with high rates of depression rather than relatively low rates of objective cognitive performance. Thus, the study emphasizes the necessity for extensive neuropsychological testing and evaluation of depression when examining Post-COVID patients in clinical practice. Further, the link between objective cognitive impairment, depression and APOE-ε4 does not appear to be specific to Post-COVID symptoms. Therefore, depression- and APOE-ε4-mediated neurodegenerative pathomechanisms might be a promising therapeutical target.

Innate immune sensors and regulators at the blood brain barrier: focus on toll-like receptors and inflammasomes as mediators of neuro-immune crosstalk and inflammation

Cerebral endothelial cells (CEC) that form the brain capillaries are the principal constituents of the blood brain barrier (BBB), the main active interface between the blood and the brain which plays a protective role by restricting the infiltration of pathogens, harmful substances and immune cells into the brain while allowing the entry of essential nutrients. Aberrant CEC function often leads to increased permeability of the BBB altering the bidirectional communication between the brain and the bloodstream and facilitating the extravasation of immune cells into the brain. In addition to their role as essential gatekeepers of the BBB, CEC exhibit immune cell properties as they can receive and transmit signals between the blood and the brain partly via release of inflammatory effectors in pathological conditions. Cerebral endothelial cells express innate immune receptors, including toll like receptors (TLRs) and inflammasomes which are the first sensors of exogenous or endogenous dangers and initiators of immune and inflammatory responses which drive neural dysfunction and degeneration. Accumulating evidence indicates that activation of TLRs and inflammasomes in CEC compromises BBB integrity, promotes aberrant neuroimmune interactions and modulates both systemic and neuroinflammation, common pathological features of neurodegenerative and psychiatric diseases and central nervous system (CNS) infections and injuries. The goal of the present review is to provide an overview of the pivotal roles played by TLRs and inflammasomes in CEC function and discuss the molecular and cellular mechanisms by which they contribute to BBB disruption and neuroinflammation especially in the context of traumatic and ischemic brain injuries and brain infections. We will especially focus on the most recent advances and literature reports in the field to highlight the knowledge gaps. We will discuss future research directions that can advance our understanding of the central contribution of innate immune receptors to CEC and BBB dysfunction and the potential of innate immune receptors at the BBB as promising therapeutic targets in a wide variety of pathological conditions of the brain.

Effects of Long COVID in Patients with Severe Coronavirus Disease 2019 on Long-Term Functional Impairments: A Post Hoc Analysis Focusing on Patients Admitted to the ICU in the COVID-19 Recovery Study II

Background/Objectives: This study investigated the prevalence of functional impairments and the effects of long COVID on long-term functional impairments in patients with severe COVID-19. Methods: We conducted a nationwide multicenter cohort study in collaboration with nine hospitals, collecting data using self-administered questionnaires from participants aged 20 years or older who were diagnosed with COVID-19, admitted to the intensive care unit (ICU) between April 2021 and September 2021, and discharged alive. Questionnaires regarding daily life, sequela, and functional impairments were mailed to patients in August 2022. The effects of long COVID on functional impairments were examined using a multivariate logistic regression analysis. Results: The survey was completed by 220 patients, with a mean of 416 days after discharge. Among respondents, 20.5% had physical impairments (n = 45), 35.0% had mental disorders (n = 77), and 42.7% had either (n = 94). Furthermore, 77.7% had long COVID (171/220), and the most common symptom was dyspnea (40.0%). The multivariate analysis showed that fatigue/malaise, upper respiratory tract symptoms, myalgia, muscle weakness, decreased concentration, sleep disorder, brain fog, and dizziness were risk factors for functional impairments at one year. Conclusions: Many patients with severe COVID-19 admitted to the ICU still suffered from post-intensive care syndrome even after one year, which manifested in combination with direct symptoms of the original disease, such as long COVID.

Comprehensive neuropsychological assessment and predictors of cognitive functioning at six months after COVID-19 in patients treated in the ICU, regular hospital ward, or isolated at home

Cognitive impairment in patients with COVID-19 has been reported, but findings are inconsistent. This study assessed cognitive functioning 6 months post-infection across three COVID-19 severity groups compared to non-COVID controls. Seventy-two ICU-treated, 49 ward-treated, and 44 home-isolated patients with COVID-19, along with 48 controls, underwent neuropsychological evaluation and assessment of subjective cognitive symptoms, depressive symptoms, and fatigue. Cognitive test scores were compared using ANCOVA. Associations between cognitive functioning and variables including demographics, illness severity, comorbidities, depressive symptoms, fatigue, and ICU-related factors were examined with hierarchical linear regression models. Results showed no significant differences in cognitive test performance of impairment frequencies between COVID-19 groups and controls. However, patients with COVID-19 reported higher levels of subjective cognitive symptoms, depressive symptoms, and fatigue compared to controls. Predictors of cognitive functioning included age, education, and, to a lesser extent, comorbidities. COVID-19 severity, depression, fatigue, or ICU-related variables did not significantly impact performance. These findings suggest that while individual cognitive impairments may exist, overall cognitive functioning in patients with COVID-19 was comparable to controls.

Mental health and psychological resilience amid the spread of the Omicron variant: a comparison between China and Korea

Objectives

Besides physical health risks, large public health events also exert negative impacts on people's mental health. We aimed to explore the prevalence and correlates of mental distress and its association with psychological resilience among countries amid the Omicron wave.

Methods

We conducted cross-sectional surveys simultaneously in China and South Korea from March 15 to 30, 2023. Brief Resilience Scale (BRS), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale were used to measured psychological resilience and mental distress.

Results

Self-reported rates of anxiety and depressive symptoms in 3,000 Chinese participants were 24.5% and 30.5%, while the above-mentioned rates were 17.2%and 34.4% in 1,000 Korean participants. Chinese participants had a marginally higher BRS score. Psychological resilience was inversely associated with the prevalence of anxiety symptoms and depressive symptoms. Similar results can be observed in Korea. Results remained robust in all models.

Conclusion

Chinese and Korean populations reported a high prevalence of mental distress with variations in different characteristics, indicating practical implications for developing tailored mental health policies and services in the context of large public health events.

Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

Main Predictors of Decreasing in Quality of Life in Patients With Post-COVID-19: A Cross-Sectional Study

OBJECTIVE

We aimed to assess physical and psychosomatic manifestations of patients with long COVID and their association with a decreased patient's quality of life (QOL) or different times elapsed since the COVID-19 diagnosis.

METHODS

This is a cross-sectional study. We retrospectively collected the clinical characteristics of adult patients who had tested positive for SARS-CoV-2 and had symptoms at least as early as 4 weeks after COVID-19 in México City between April 2020 and February 2021. A total of 179 were included. They answered questions to define chronic symptoms. The Sniffin' Sticks Screening 12 test olfactory evaluation was performed. The diminish of QOL was defined by ≥10 points in the EuroQol visual analog scale between pre- and post-COVID-19, and each dimension of EQ-5D-5L test was evaluated. Chi-square test, Fisher's exact test, Student t test, Wilcoxon rank-sum, and signed-rank test were used as required. A backward stepwise logistic regression analysis determined the factors associated with a decrease in QOL. All analyses were performed using R software version 3.6.3 (R Foundation).

RESULTS

In the multivariable analysis, post-COVID-19 pain/discomfort (adjusted odds ratio [aOR] 2.5 [1.66-9.68]; P = .01), anxiety/depression (aOR 13 [1.44-17.23]; P = .03), and persistence of ≥3 symptoms (aOR 2.6 [0.96-7.47]; P = .05) remained statistically significant associated with decreased QOL.

CONCLUSIONS

Patients with long COVID-19 have decreased QOL mainly associated with pain/discomfort, anxiety/depression, and ≥3 persistent symptoms. Our findings enhanced the notion of a strong psychosomatic factors involved with long COVID-19. Therefore, these patients might benefit from neuropsychological rehabilitation, although the effect of such interventions should be evaluated.

Acute and long-term effects of COVID-19 on brain and mental health: A narrative review

BACKGROUND

COVID infection has been associated with long term sequalae (Long COVID) which include neurological and behavioral effects in thousands of patients, but the etiology and scope of symptoms is not well understood. This paper reviews long term sequelae of COVID on brain and mental health in patients with the Long COVID syndrome.

METHODS

This was a literature review which queried databases for Pubmed, Psychinfo, and Medline for the following topics for January 1, 2020-July 15, 2023: Long COVID, PASC, brain, brain imaging, neurological, neurobiology, mental health, anxiety, depression.

RESULTS

Tens of thousands of patients have developed Long COVID, with the most common neurobehavioral symptoms anosmia (loss of smell) and fatigue. Anxiety and mood disorders are elevated and seen in about 25% of Long COVID patients. Neuropsychological testing studies show a correlation between symptom severity and cognitive dysfunction, while brain imaging studies show global decreases in gray matter and alterations in olfactory and other brain areas.

CONCLUSIONS

Studies to date show an increase in neurobehavioral disturbances in patients with Long COVID. Future research is needed to determine mechanisms.

Neuropsychiatric Manifestations of COVID-19 Disease and Post COVID Syndrome: The Role of N-acetylcysteine and Acetyl-L-carnitine

COVID-19 is associated with neuropsychiatric symptoms, such as anosmia, anxiety, depression, stress-related reactions, and psychoses. The illness can cause persistent cognitive impairment and "brain fog", suggesting chronic brain involvement. Clinical entities of ongoing symptomatic COVID-19 and Post COVID Syndrome (PCS) mainly present neuropsychiatric symptoms such as dysgeusia, headache, fatigue, anxiety, depression, sleep disturbances, and post-traumatic stress disorder. The pathophysiology of COVID-19-related brain damage is unclear, but it is linked to various mechanisms such as inflammation, oxidative stress, immune dysregulation, impaired glutamate homeostasis, glial and glymphatic damage, and hippocampal degeneration. Noteworthy is that the metabotropic receptor mGluR2 was discovered as a mechanism of internalisation of SARS-CoV-2 in Central Nervous System (CNS) cells. N-acetylcysteine (NAC) and acetyl-L-carnitine (ALC) are two supplements that have already been found effective in treating psychiatric conditions. Furthermore, NAC showed evidence in relieving cognitive symptomatology in PCS, and ALC was found effective in treating depressive symptomatology of PCS. The overlapping effects on the glutamatergic system of ALC and NAC could help treat COVID-19 psychiatric symptoms and PCS, acting through different mechanisms on the xc-mGluR2 network, with potentially synergistic effects on chronic pain and neuro-astrocyte protection. This paper aims to summarise the current evidence on the potential therapeutic role of NAC and ALC, providing an overview of the underlying molecular mechanisms and pathophysiology. It proposes a pathophysiological model explaining the effectiveness of NAC and ALC in treating COVID-19-related neuropsychiatric symptoms.

The Effects of COVID-19 on Anxiety and Depressive Symptoms Among Chinese College Students: Chain Mediation of Three Long COVID-19 Symptoms

Long COVID has become a public health issue, and anxiety and depressive symptoms have been on the rise among young people since the COVID-19 pandemic. The primary purpose of this study was to survey the status of COVID-19 infection, long COVID, and mental health among Chinese college students after China lifted the dynamic zero-COVID policy on December 7, 2022. The secondary purpose was to explore the mediation effect of long COVID on the relationship between COVID-19 and anxiety and depressive symptoms. A total of 958 Chinese college students (Mage = 18.68, ages 16-22, 78.2% were female) completed measures of the severity of COVID-19, long COVID somatic symptom, insomnia, fatigue, anxiety, and depressive symptoms. Four potential chain mediation models was used to examine the role of long COVID somatic symptoms, insomnia, and fatigue as mediators between COVID-19 and anxiety and depressive symptoms. The results showed that ∼80% of Chinese college students suffered COVID-19 in late 2022 and early 2023, and 47.8, 35.4, 43.8, 37, and 54.3% of the participants had at least one somatic symptom, insomnia, fatigue, anxiety, and depressive symptoms, respectively, about 2-3 months after onset. This study revealed that the influence of COVID-19 on anxiety and depressive symptoms is not determined by the severity of COVID-19 in acute phase but by long COVID. Long COVID somatic symptoms, insomnia, and fatigue played mediation effects in different degree between COVID-19 and anxiety and depressive symptoms. Interventions that target long COVID may improve anxiety and depressive symptoms of Chinese college students who have had COVID-19.

Outpatient group therapy for post-COVID patients - a naturalistic feasibility study of a face-to-face and online group concept

Background

A significant number of individuals diagnosed with SARS-CoV-2 continue to suffer from persistent symptoms, a condition commonly referred to as Post-COVID syndrome (PCS). The most common manifestations are fatigue, post-exertional malaise, respiratory problems and cognitive deficits due to the lack of a causal treatment, therapeutic options remain symptom oriented. The aim of this study was to develop a low-threshold group therapy concept for patients with PCS and to test its feasibility in face-to-face and online format.

Method

An interprofessionally oriented group therapy concept for patients with PCS was developed and a treatment manual was established. The concept comprises eight weekly sessions of 90 minutes each, during which the management of fatigue, stress intolerance and other symptoms are addressed and coping strategies are discussed and developed. The group therapy was conducted alternating in face-to-face and online format and evaluated via questionnaires.

Results

A total of 57 patients, most of them with severe limitations due to PCS, took part in the groups (n=36 online; n=21 face-to-face). The group offer was requested and accepted in both the face-to-face and online formats, and was predominantly evaluated as beneficial. Of particularly value was the opportunity to engage with peers who share similar experiences.

Conclusion

The interprofessional, integrative psychotherapeutic/psychoeducational group therapy is safe, accepted and is predominantly rated as helpful by participants. It should be carried out in online formats for patients with PCS who are limited in mobility. Controlled studies are necessary to further evaluate the proposed concept and its integration into the care landscape.

Macro- and Microstructural White Matter Differences in Neurologic Postacute Sequelae of SARS-CoV-2 Infection

BACKGROUND AND PURPOSE

Neuropsychiatric complications of SARS-CoV-2 infection, also known as neurologic postacute sequelae of SARS-CoV-2 infection (NeuroPASC), affect 10%-60% of infected individuals. There is growing evidence that NeuroPASC is a multi system immune dysregulation disease affecting the brain. The behavioral manifestations of NeuroPASC, such as impaired processing speed, executive function, memory retrieval, and sustained attention, suggest widespread WM involvement. Although previous work has documented WM damage following acute SARS-CoV-2 infection, its involvement in NeuroPASC is less clear. We hypothesized that macrostructural and microstructural WM differences in NeuroPASC participants would accompany cognitive and immune system differences.

MATERIALS AND METHODS

In a cross-sectional study, we screened a total of 159 potential participants and enrolled 72 participants, with 41 asymptomatic controls (NoCOVID) and 31 NeuroPASC participants matched for age, sex, and education. Exclusion criteria included neurologic disorders unrelated to SARS-CoV-2 infection. Assessments included clinical symptom questionnaires, psychometric tests, brain MRI measures, and peripheral cytokine levels. Statistical modeling included separate multivariable regression analyses of GM/WM/CSF volume, WM microstructure, cognitive, and cytokine concentration between-group differences.

RESULTS

NeuroPASC participants had larger cerebral WM volume than NoCOVID controls (β = 0.229; 95% CI: 0.017-0.441; t = 2.16; P = .035). The most pronounced effects were in the prefrontal and anterior temporal WM. NeuroPASC participants also exhibited higher WM mean kurtosis, consistent with ongoing neuroinflammation. NeuroPASC participants had more self-reported symptoms, including headache, and lower performance on measures of attention, concentration, verbal learning, and processing speed. A multivariate profile analysis of the cytokine panel showed different group cytokine profiles (Wald-type-statistic = 44.6, P = .046), with interferon (IFN)-λ1 and IFN-λ2/3 levels higher in the NeuroPASC group.

CONCLUSIONS

NeuroPASC participants reported symptoms of lower concentration, higher fatigue, and impaired cognition compatible with WM syndrome. Psychometric testing confirmed these findings. NeuroPASC participants exhibited larger cerebral WM volume and higher WM mean kurtosis than NoCOVID controls. These findings suggest that immune dysregulation could influence WM properties to produce WM volume increases and consequent cognitive effects and headaches. Further work will be needed to establish mechanistic links among these variables.

Risk of admission to hospital for self-harm after admission to hospital for COVID-19: French nationwide longitudinal study

BACKGROUND

Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic.

AIMS

This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons.

METHOD

Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay.

RESULTS

Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59-0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58-0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63-0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions.

CONCLUSIONS

Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.

Six-month follow-up of multidomain cognitive impairment in non-hospitalized individuals with post-COVID-19 syndrome

Some people infected with SARS-CoV-2 report persisting symptoms following acute infection. If these persist for over three months, they are classified as post-COVID-19 syndrome (PCS). Although PCS is frequently reported, detailed longitudinal neuropsychological characterization remains scarce. We aimed to describe the trajectory of cognitive and neuropsychiatric PCS symptoms. 42 individuals with persisting cognitive deficits after asymptomatic to mild/moderate acute COVID-19 at study inclusion received neuropsychological assessment at baseline (BL) and follow-up (FU; six months after BL). Assessments included comprehensive testing of five neurocognitive domains, two cognitive screening tests, and questionnaires on depression, anxiety, sleep, fatigue, and health-related quality of life. Results showed high rates of subjective cognitive complaints at BL and FU (95.2% versus 88.1%) without significant change over time. However, objectively measured neurocognitive disorder (NCD) decreased (61.9% versus 42.9%). All cognitive domains were affected, yet most deficits were found in learning and memory, followed by executive functions, complex attention, language, and perceptual motor functions. In individuals with NCD, the first three domains mentioned improved significantly over time, while the last two domains remained unchanged. Cognitive screening tests did not prove valuable in detecting impairment. Neuropsychiatric symptoms remained constant except for quality of life, which improved. This study emphasizes the importance of comprehensive neuropsychological assessment in longitudinal research and provides valuable insights into the trajectory of long-term neuropsychological impairments in PCS. While cognitive performance significantly improved in many domains, neuropsychiatric symptoms remained unchanged.

Outpatient mental health care during high incidence phases of the COVID-19 pandemic in Germany - changes in utilization, challenges and post-COVID care

BACKGROUND

As only a few studies have examined the impact of the COVID-19 pandemic on the mental health outpatient system so far, the aim of the COVID Ψ Outpatient Survey was to gain insight from outpatient providers in Germany regarding changes in utilization; associated problems and challenges; telemedicine services; interactions with inpatient and nursing home services; and experiences with post-COVID syndromes.

METHODS

Between July and September 2021, we invited 351 randomly selected outpatient mental health specialists to take part in the online survey via e-mail. Additionally, we extended an invitation to professional associations to encourage their members to participate. N = 105 physicians of most regions of Germany took part in the survey.

RESULTS

Survey participants reported changes in utilization during the high incidence phases (HIP) of the pandemic using pre-formulated categories: For the first HIP in spring 2020, 31% of the survey participants reported a decrease > 20% and 5% an increase > 20% of patient contacts. For the third HIP in spring 2021, 4% reported a decrease > 20% of contacts, while 30% an increase > 20%. Participants chose "patient's fears of infection" and "providers protection measures" as reasons for decreases, and "pandemic related anxieties", "economic stressors", and "capacity reductions of the inpatient system" as reasons for increases of patient contact. Many providers introduced telemedicine services. A majority reported consultations for post-COVID syndromes already in spring 2021.

CONCLUSIONS

The survey hinted at changes in utilization, multiple problems but as well good-practice-solutions in the mental health outpatient system during the COVID-19 pandemic.

Post traumatic stress and sleep disorders in long COVID: Patient management and treatment

Post traumatic stress disorder (PTSD) and sleep disorders are prevalent among patients with long COVID. The intersection of PTSD and/or sleep disorders with long COVID is complex. Thus, use of a biopsychosocial lens for assessment and treatment along with a trauma-informed approach to clinical care is recommended. This review provides an overview of the literature on PTSD and sleep disorders among patients with long COVID, including prevalence rates, risk factors, and potential pathophysiology. Pharmacological and non-pharmacological treatment options are reviewed. Also, we provide actionable steps clinicians can integrate into their practice to help effectively assess and treat PTSD and sleep disorders, including validated symptom assessments, recommended referrals, and specific components of non-pharmacological interventions.

Post-COVID condition: a focus on psychiatric symptoms and diagnoses in patients with cognitive complaints

OBJECTIVE

Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19.

METHODS

We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self-reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale-Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in ≥1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF).

RESULTS

Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis.

CONCLUSION

Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment.

Is There such a Thing as Post-Viral Depression?: Implications for Precision Medicine

Viral infections are increasingly recognized as triggers for depressive disorders, particularly following the SARS-CoV-2 pandemic and the rise of long COVID. Viruses such as Herpes Simplex Virus (HSV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Human Immunodeficiency Virus (HIV) are linked to depression through complex neurobiological mechanisms. These include immune system dysregulation, chronic inflammation, and neurotransmitter imbalances that affect brain function and mood regulation. Viral activation of the immune system leads to the release of pro-inflammatory cytokines, resulting in neuroinflammation and associated depressive symptoms. Furthermore, specific viruses can disrupt neurotransmitter systems, including serotonin, dopamine, and glutamate, all of which are essential for mood stabilization. The unique interactions of different viruses with these systems underscore the need for virus-specific therapeutic approaches. Current broad-spectrum treatments often overlook the precise neurobiological pathways involved in post-viral depression, reducing their efficacy. This review emphasizes the need to understand these virus-specific interactions to create tailored interventions that directly address the neurobiological effects induced by each type of virus. These interventions may include immunomodulatory treatments that target persistent inflammation, antiviral therapies to reduce the viral load, or neuroprotective strategies that restore neurotransmitter balance. Precision medicine offers promising avenues for the effective management of virus-induced depression, providing patient-specific approaches that address the specific biological mechanisms involved. By focusing on the development of these targeted treatments, this review aims to pave the way for a new era in psychiatric care that fully addresses the root causes of depression induced by viral infections.

Onset of bipolar disorder by COVID-19: The roles of endogenous ouabain and the Na,K-ATPase

Bipolar Disorder (BD) is a psychiatric disorder marked by mood swings between manic and depressive episodes. The reduction in the Na,K-ATPase (NKA) enzyme activity and the inability of individuals with BD to produce endogenous ouabain (EO) at sufficient levels to stimulate this enzyme during stressful events are factors proposed for BD etiology. According to these hypotheses, reduction in NKA activity would result in altered neuronal resting potential, leading to BD symptoms. Recently, damage to the adrenals (EO synthesis site) in coronavirus disease (COVID-19) patients has been reported, however studies pointing to the pathophysiological mechanisms shared by these two diseases are scarce. Through a literature review, this study aims to correlate COVID-19 and BD, focusing on the role of NKA and EO to identify possible mechanisms for the worsening of BD due to COVID-19. The search in the PubMed database for the descriptors ("bipolar disorder" AND "Na,K-ATPase"), ("bipolar disorder" AND "endogenous ouabain"), ("covid-19" AND "bipolar disorder") and ("covid-19" AND "adrenal gland") resulted in 390 articles. The studies identified the adrenals as a vulnerable organ to SARS-CoV-2 infection. Cases of adrenal damage in patients with COVID-19 showing lower levels of adrenal hormones were reported. Cases of COVID-19 patients with symptoms of mania were reported worldwide. Given these results, we propose that adrenal cortical cell damage could lead to EO deficiency following neuronal NKA activity impairment, with small reductions in activity leading to mania and greater reductions leading to depression.

SARS-CoV-2 spike S1 protein induces microglial NLRP3-dependent neuroinflammation and cognitive impairment in mice

Cognitive impairment is often found at the acute stages and sequelae of coronavirus disease 2019 (COVID-19), and the underlying mechanisms remain unclear. The S1 protein from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be a cause of cognitive impairment associated with COVID-19. The nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome and neuroinflammation play important roles in Alzheimer's disease (AD) with cognitive impairment. However, their roles remain unknown in COVID-19 with cognitive impairment. We stimulated BV2 cells with S1 protein in vitro and injected the hippocampi of wild-type (WT) mice, NLRP3 knockout (KO), and microglia NLRP3 KO mice in vivo with S1 protein to induce cognitive impairment. We assessed exploratory behavior as associative memory using novel object recognition and Morris water maze tests. Neuroinflammation was analyzed using immunofluorescence and western blotting to detect inflammatory markers. Co-localized NLRP3 and S1 proteins were investigated using confocal microscopy. We found that S1 protein injection led to cognitive impairment, neuronal loss, and neuroinflammation by activating NLRP3 inflammation, and this was reduced by global NLRP3 KO and microglia NLRP3 KO. Furthermore, TAK 242, a specific inhibitor of Toll-like receptor-4, resulted in a significant reduction in NLRP3 and pro-IL-1β in BV2 cells with S1 protein stimulation. These results reveal a distinct mechanism through which the SARS-CoV-2 spike S1 protein promotes NLRP3 inflammasome activation and induces excessive inflammatory responses.

Acute onset psychiatric diseases after SARS-CoV-2 virus infection among pediatric patients

Background

Psychiatric symptoms directly associated with SARS-CoV-2 virus infection have been reported sporadically in children. More cases of new-onset psychosis without severe cardinal symptoms, altered consciousness level, and psychogenic drug usage would offer compelling grounds for the association between the virus infection and psychosis.

Methods

We collected the clinical data of pediatric patients with new onset psychiatric symptoms after the SARS-CoV-2 virus infection from December 2022 to Feb 2023 and followed up with them for 1 year. These children did not have severe respiratory, cardiovascular, or systemic symptoms. They were not given psychogenic drugs. We also searched Pubmed to identify previously reported acute onset psychiatric cases related to SARS-CoV-2 virus infection in children. We summarized these patients' clinical symptoms, laboratory examination, treatment, and prognosis.

Results

We reported 11 new cases of psychiatric disease directly related to SARS-CoV-2 virus infection and reviewed 12 previously reported cases among children and adolescents. They had various psychiatric symptoms within 3 weeks after the virus infection. Brain MRI and EEG recording did not reveal remarkable abnormalities. The cerebrospinal fluid analysis (CSF) could find increased protein, immunoglobulin, and IL-8 levels, disrupted blood-brain barrier, and positive oligoclonal band in a minority of the patients. Most of the patients had good outcomes.

Conclusion

New-onset psychiatric symptoms directly related to SARS-CoV-2 virus infection are not rare phenomena among pediatric patients. CSF tests support the presence of central immune responses in some patients. Although these patients received different treatments, most of them had good prognoses.

Slow-Paced Breathing Intervention in Healthcare Workers Affected by Long COVID: Effects on Systemic and Dysfunctional Breathing Symptoms, Manual Dexterity and HRV

BACKGROUND

Many COVID-19 survivors still experience long-term effects of an acute infection, most often characterised by neurological, cognitive and psychiatric sequelae. The treatment of this condition is challenging, and many hypotheses have been proposed. Non-invasive vagus nerve stimulation using slow-paced breathing (SPB) could stimulate both central nervous system areas and parasympathetic autonomic pathways, leading to neuromodulation and a reduction in inflammation. The aim of the present study was to evaluate physical, cognitive, emotional symptoms, executive functions and autonomic cardiac modulation after one month of at-home slow breathing intervention.

METHODS

6655 healthcare workers (HCWs) were contacted via a company email in November 2022, of which N = 58 HCWs were enrolled as long COVID (cases) and N = 53 HCWs as controls. A baseline comparison of the two groups was performed. Subsequently each case was instructed on how to perform a resonant SPB using visual heart rate variability (HRV) biofeedback. They were then given a mobile video tutorial breathing protocol and asked to perform it three times a day (morning, early afternoon and before sleep). N = 33 cases completed the FU. At T0 and T1, each subject underwent COVID-related, psychosomatic and dysfunctional breathing questionnaires coupled with heart rate variability and manual dexterity assessments.

RESULTS

After one month of home intervention, an overall improvement in long-COVID symptoms was observed: confusion/cognitive impairment, chest pain, asthenia, headache and dizziness decreased significantly, while only a small increase in manual dexterity was found, and no relevant changes in cardiac parasympathetic modulation were observed.

SARS-CoV-2 S1 subunit produces a protracted priming of the neuroinflammatory, physiological, and behavioral responses to a remote immune challenge: A role for corticosteroids

Long COVID is a major public health consequence of COVID-19 and is characterized by multiple neurological and neuropsychatric symptoms. SARS-CoV-2 antigens (e.g., spike S1 subunit) are found in the circulation of Long COVID patients, have been detected in post-mortem brain of COVID patients, and exhibit neuroinflammatory properties. Considering recent observations of chronic neuroinflammation in Long COVID patients, the present study explores the idea that antigens derived from SARS-CoV-2 might produce a long-term priming or sensitization of neuroinflammatory processes, thereby potentiating the magnitude and/or duration of the neuroinflammatory response to future inflammatory insults. Rats were administered S1 or vehicle intra-cisterna magna and 7d later challenged with vehicle or LPS. The neuroinflammatory, physiological, and behavioral responses to LPS were measured at various time points post-LPS. We found that prior S1 treatment potentiated many of these responses to LPS suggesting that S1 produces a protracted priming of these processes. Further, S1 produced a protracted reduction in basal brain corticosteroids. Considering the anti-inflammatory properties of corticosteroids, these findings suggest that S1 might disinhibit innate immune processes in brain by reducing anti-inflammatory drive, thereby priming neuroinflammatory processes. Given that hypocortisolism is observed in Long COVID, we propose that similar S1-induced innate immune priming processes might play role in the pathophysiology of Long COVID.

Depression and inflammation in COVID-19 patients during and after hospitalisation – a systematic review and meta-analysis

Introduction: The severity of depression symptoms in COVID-19 patients differs among populations investigated and changes over time. Increasing evidence supports the hypothesis about the involvement of inflammation in the development of depression. Methods: A systematic review and a meta-analysis of the cross-sectional and cohort studies published between 2019 and 2023 were conducted according to the PRISMA criteria. The outcomes of interest were the proportions of mild, moderate, and severe depression symptoms during and after hospitalisation, and associations between depression and inflammation in COVID-19 patients. Results: Thirty articles were included in the systematic review. In the quantitative meta-analysis, the overall proportions of moderate-to-severe and mild-to-severe depression were estimated at 0.21 (95% CI: 0.13–0.31) and 0.35 (95% CI: 0.23–0.48), respectively. The fixed effects model of the meta-analysis of inflammatory markers showed a difference between COVID-19 patients with and without depression, with higher concentrations of both C-reactive protein and neutrophil-lymphocyte ratio detected among people suffering mood disturbances. However, in random effects models, findings for C-reactive protein lost significance, and for neutrophil-lymphocyte ratio were on the boundary of significance (p = 0.053). Conclusions: According to the study results, the proportion of depression decreases over time after a COVID-19 diagnosis. The relationship between depression and inflammation is still uncertain and requires further research.

A prospective non-randomized controlled trial testing the effectiveness of psychotherapeutic inpatient treatment of Post-COVID-19 syndrome - study protocol

INTRODUCTION

In addition to physical symptoms such as dyspnea, fatigue, post-exertional malaise, and pain, a subgroup of patients with Post-COVID-19 syndrome (Post-Acute Sequelae of COVID-19, PASC) suffers from mental illnesses such as anxiety, depression, and neurocognitive impairments. To date, there are no causal treatments available for PASC. While initial studies show that psychotherapy improves psychological symptoms, PASC-related fatigue, and psychosocial functioning, further research is needed to evaluate the effectiveness of psychotherapeutic treatment for PASC.

METHODS AND ANALYSIS

This study presents a non-randomized controlled trial aimed at evaluating the effectiveness of a five-week multimodal inpatient psychosomatic treatment program for individuals experiencing PASC symptoms and comorbid mental illness. A total of 118 patients presented at the Post-COVID Center at the Universitätsklinikum Erlangen will be assigned to the intervention group receiving inpatient psychosomatic treatment or the control group receiving treatment as usual. The inclusion criteria for the intervention group are a diagnosis of PASC and at least one condition of mental distress and problems with coping with illness. The primary objective of the intervention is to reduce mental ailments, including depression and anxiety, as well as neurocognitive deficits, and to address PASC symptoms such as fatigue and pain. The core elements of the treatment are psychotherapy in individual and group settings, medical treatment, neurocognitive training, and physical therapy, adapted to the individual's capacity and oriented towards the concept of pacing. After enrollment, participants will undergo a 6-month follow-up to assess long-term results and the sustainability of the intervention effects.

DISCUSSION

This study examines the effectiveness of inpatient psychotherapeutic treatment in PASC patients with comorbid mental illness in comparison with a control group based on treatment as usual. The results of the study can contribute to the development of evidence-based interventions to address the complex needs of patients with PASC and comorbid mental illness.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS), retrospectively registered 15.02.2024 DRKSID DRKS00033562.

Causal effect of COVID-19 on longitudinal volumetric changes in subcortical structures: A mendelian randomization study

A few observational neuroimaging investigations have reported subcortical structural changes in the individuals who recovered from the coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the causal relationships between COVID-19 and longitudinal changes of subcortical structures remain unclear. We performed two-sample Mendelian randomization (MR) analyses to estimate putative causal relationships between three COVID-19 phenotypes (susceptibility, hospitalization, and severity) and longitudinal volumetric changes of seven subcortical structures derived from MRI. Our findings demonstrated that genetic liability to SARS-CoV-2 infection had a great long-term impact on the volumetric reduction of subcortical structures, especially caudate. Our investigation may contribute in part to the understanding of the neural mechanisms underlying COVID-19-related neurological and neuropsychiatric sequelae.

Tracking cognitive trajectories in older survivors of COVID-19 up to 2.5 years post-infection

Emerging evidence suggests that neurological and other post-acute sequelae of COVID-19 can persist beyond or develop following SARS-CoV-2 infection. However, the long-term trajectories of cognitive change after a COVID-19 infection remain unclear. Here we investigated cognitive changes over a period of 2.5 years among 1,245 individuals aged 60 years or older who survived infection with the original SARS-CoV-2 strain in Wuhan, China, and 358 uninfected spouses. We show that the overall incidence of cognitive impairment among older COVID-19 survivors was 19.1% at 2.5 years after infection and hospitalization, evaluated using the Telephone Interview for Cognitive Status-40. Cognitive decline primarily manifested in individuals with severe COVID-19 during the initial year of infection, after which the rate of decline decelerated. Severe COVID-19, cognitive impairment at 6 months and hypertension were associated with long-term cognitive decline. These findings reveal the long-term cognitive trajectory of the disease and underscore the importance of post-infection cognitive care for COVID-19 survivors.

Physiological presentation and risk factors of long COVID in the UK using smartphones and wearable devices: a longitudinal, citizen science, case-control study

BACKGROUND

The emergence of long COVID as a COVID-19 sequela was largely syndromic in characterisation. Digital health technologies such as wearable devices open the possibility to study this condition with passive, objective data in addition to self-reported symptoms. We aimed to quantify the prevalence and severity of symptoms across collected mobile health metrics over 12 weeks following COVID-19 diagnosis and to identify risk factors for the development of post-COVID-19 condition (also known as long COVID).

METHODS

The Covid Collab study was a longitudinal, self-enrolled, community, case-control study. We recruited participants from the UK through a smartphone app, media publications, and promotion within the Fitbit app between Aug 28, 2020, and May 31, 2021. Adults (aged ≥18 years) who reported a COVID-19 diagnosis with a positive antigen or PCR test before Feb 1, 2022, were eligible for inclusion. We compared a cohort of 1200 patients who tested positive for COVID-19 with a cohort of 3600 sex-matched and age-matched controls without a COVID-19 diagnosis. Participants could provide information on COVID-19 symptoms and mental health through self-reported questionnaires (active data) and commercial wearable fitness devices (passive data). Data were compared between cohorts at three periods following diagnosis: acute COVID-19 (0-4 weeks), ongoing COVID-19 (4-12 weeks), and post-COVID-19 (12-16 weeks). We assessed sociodemographic and mobile health risk factors for the development of long COVID (defined as either a persistent change in a physiological signal or self-reported symptoms for ≥12 weeks after COVID-19 diagnosis).

FINDINGS

By Aug 1, 2022, 17 667 participants had enrolled into the study, of whom 1200 (6·8%) cases and 3600 (20·4%) controls were included in the analyses. Compared with baseline (65 beats per min), resting heart rate increased significantly during the acute (0·47 beats per min; odds ratio [OR] 1·06 [95% CI 1·03-1·09]; p<0·0001), ongoing (0·99 beats per min; 1·11 [1·08-1·14]; p<0·0001), and post-COVID-19 (0·52 beats per min; 1·04 [1·02-1·07]; p=0·0017) phases. An increased level of historical activity in the period from 24 months to 6 months preceding COVID-19 diagnosis was protective against long COVID (coefficient -0·017 [95% CI -0·030 to -0·003]; p=0·015). Depressive symptoms were persistently elevated following COVID-19 (OR 1·03 [95% CI 1·01-1·06]; p=0·0033) and were a potential risk factor for developing long COVID (1·14 [1·07-1·22]; p<0·0001).

INTERPRETATION

Mobile health technologies and commercial wearable devices might prove to be a useful resource for tracking recovery from COVID-19 and the prevalence of its long-term sequelae, as well as representing an abundant source of historical data. Mental wellbeing can be impacted negatively for an extended period following COVID-19.

FUNDING

National Institute for Health and Care Research (NIHR), NIHR Maudsley Biomedical Research Centre, UK Research and Innovation, and Medical Research Council.

Characterization of postintensive care syndrome in a prospective cohort of survivors of COVID-19 critical illness: a 12-month follow-up study

PURPOSE

Studies integrating an exhaustive longitudinal long-term follow-up of postintensive care syndrome (PICS) in critically ill COVID-19 survivors are scarce. We aimed to 1) describe PICS-related sequelae over a 12-month period after intensive care unit (ICU) discharge, 2) identify relevant demographic and clinical factors related to PICS, and 3) explore how PICS-related sequelae may influence health-related quality of life (HRQoL) in critically ill COVID-19 survivors.

METHODS

We conducted a prospective cohort study in adult critically ill survivors of SARS-CoV-2 infection that did or did not need invasive mechanical ventilation (IMV) during the COVID-19 pandemic in Spain (March 2020 to January 2021). We performed a telemedicine follow-up of PICS-related sequelae (physical/functional, cognitive, and mental health) and HRQoL with five data collection points. We retrospectively collected demographic and clinical data. We used multivariable mixed-effects models for data analysis.

RESULTS

We included 142 study participants in the final analysis, with a median [interquartile range] age of 61 [53-68] yr; 35% were female and 59% needed IMV. Fatigue/dyspnea, pain, impaired muscle function, psychiatric symptomatology and reduced physical HRQoL were prominent sequelae early after ICU discharge. Over the 12-month follow-up, functionality and fatigue/dyspnea improved progressively, while pain remained stable. We observed slight fluctuations in anxiety symptoms and perception of cognitive deficit, whereas posttraumatic stress disorder (PTSD) and depressive symptoms improved, with a mild rebound at the end of the follow-up. Female sex, younger age, and the need for IMV were risk factors for PICS, while having higher cognitive reserve was a potential protective factor. Physical HRQoL scores showed a general improvement over time, whereas mental HRQoL remained stable. Shorter ICU stay, better functionality, and lower scores for fatigue/dyspnea and pain were associated with better physical HRQoL, while lower scores for anxiety, depression, and PTSD were associated with better mental HRQoL.

CONCLUSIONS

Postintensive care syndrome was common in COVID-19 critical illness survivors and persisted in a significant proportion of patients one year after ICU discharge, impacting HRQoL. The presence of risk factors for PICS may identify patients who are more likely to develop the condition and who would benefit from more specific and closer follow-up after ICU admission.

STUDY REGISTRATION

ClinicalTrials.gov ( NCT04422444 ); first submitted 9 June 2020.

Systemic inflammation following traumatic injury and its impact on neuroinflammatory gene expression in the rodent brain

BACKGROUND

Trauma can result in systemic inflammation that leads to organ dysfunction, but the impact on the brain, particularly following extracranial insults, has been largely overlooked.

METHODS

Building upon our prior findings, we aimed to understand the impact of systemic inflammation on neuroinflammatory gene transcripts in eight brain regions in rats exposed to (1) blast overpressure exposure [BOP], (2) cutaneous thermal injury [BU], (3) complex extremity injury, 3 hours (h) of tourniquet-induced ischemia, and hind limb amputation [CEI+tI+HLA], (4) BOP+BU or (5) BOP+CEI and delayed HLA [BOP+CEI+dHLA] at 6, 24, and 168 h post-injury (hpi).

RESULTS

Globally, the number and magnitude of differentially expressed genes (DEGs) correlated with injury severity, systemic inflammation markers, and end-organ damage, driven by several chemokines/cytokines (Csf3, Cxcr2, Il16, and Tgfb2), neurosteroids/prostaglandins (Cyp19a1, Ptger2, and Ptger3), and markers of neurodegeneration (Gfap, Grin2b, and Homer1). Regional neuroinflammatory activity was least impacted following BOP. Non-blast trauma (in the BU and CEI+tI+HLA groups) contributed to an earlier, robust and diverse neuroinflammatory response across brain regions (up to 2-50-fold greater than that in the BOP group), while combined trauma (in the BOP+CEI+dHLA group) significantly advanced neuroinflammation in all regions except for the cerebellum. In contrast, BOP+BU resulted in differential activity of several critical neuroinflammatory-neurodegenerative markers compared to BU. t-SNE plots of DEGs demonstrated that the onset, extent, and duration of the inflammatory response are brain region dependent. Regardless of injury type, the thalamus and hypothalamus, which are critical for maintaining homeostasis, had the most DEGs. Our results indicate that neuroinflammation in all groups progressively increased or remained at peak levels over the study duration, while markers of end-organ dysfunction decreased or otherwise resolved.

CONCLUSIONS

Collectively, these findings emphasize the brain's sensitivity to mediators of systemic inflammation and provide an example of immune-brain crosstalk. Follow-on molecular and behavioral investigations are warranted to understand the short- to long-term pathophysiological consequences on the brain, particularly the mechanism of blood-brain barrier breakdown, immune cell penetration-activation, and microglial activation.

Three-Month Follow-Up of the Post-COVID Syndrome after Admission to a Specialised Post-COVID Centre-A Prospective Study Focusing on Mental Health with Patient Reported Outcome Measures (PROMs)

BACKGROUND AND OBJECTIVE

The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course.

METHODS

The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment.

RESULTS

In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre.

CONCLUSIONS

Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.

Integrative personalized medicine care for adjustment disorder of a post-COVID-19 patient: A CARE-compliant case report

RATIONALE

Depression is a common symptom in post-coronavirus disease 2019 (COVID-19) patients, which can be diagnosed with post-COVID-19 depression or adjustment disorder (AD) of post-COVID-19 syndrome. Recently, there have been reports of treating post-COVID-19 syndrome with herbal interventions. However, there are no studies of AD of post-COVID-19 syndrome treated with an integrative approach. This is a CARE-compliant case report of a patient diagnosed with AD of post-COVID-19 syndrome and improved with integrative personalized medicine care (IPMC).

PATIENT CONCERNS

An 84-year-old female patient presented symptoms of depression, insomnia, palpitations, and dyspepsia after COVID-19 diagnosis.

DIAGNOSES

The patient was diagnosed with AD due to COVID-19 according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

INTERVENTIONS

The patient was treated with the IPMC approach: conventional Western drugs for symptom improvements with herbal medicine, acupuncture, and moxibustion therapies of traditional Korean medicine to enhance her general conditions.

OUTCOMES

Depression, insomnia, palpitations, dyspepsia, and overall quality of life were assessed through various questionnaires before and after treatment. Scores notably decreased across depression scales, and insomnia severity improved significantly. After treatment, gastrointestinal symptoms vanished, and autonomic nervous system balance improved. Quality of life metrics also showed remarkable enhancement.

LESSONS

This study is the first case report to demonstrate improvement in AD of post-COVID-19 symptoms using IPMC. It is noteworthy that the patient in this study tapered off their antidepressant medication after the treatment with the IPMC approach. Further studies are needed to establish more qualified evidence to show the effectiveness and safety of IPMC for AD of post-COVID-19 syndrome.

Pragmatic approach to mobilizing individuals with critical illness due to COVID-19: clinical perspective

PURPOSE

To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19.

METHODS

Clinical perspective developed through reflective clinical practice and narrative review of best available evidence.

RESULTS

Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines.

CONCLUSIONS

Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions.

Novel Insights into Changes in Gene Expression within the Hypothalamus in Two Asthma Mouse Models: A Transcriptomic Lung-Brain Axis Study

Patients with asthma experience elevated rates of mental illness. However, the molecular links underlying such lung-brain crosstalk remain ambiguous. Hypothalamic dysfunction is observed in many psychiatric disorders, particularly those with an inflammatory component due to many hypothalamic regions being unprotected by the blood-brain barrier. To gain a better insight into such neuropsychiatric sequelae, this study investigated gene expression differences in the hypothalamus following lung inflammation (asthma) induction in mice, using RNA transcriptome profiling. BALB/c mice were challenged with either bacterial lipopolysaccharide (LPS, E. coli) or ovalbumin (OVA) allergens or saline control (n = 7 per group), and lung inflammation was confirmed via histological examination of postmortem lung tissue. The majority of the hypothalamus was micro-dissected, and total RNA was extracted for sequencing. Differential expression analysis identified 31 statistically significant single genes (false discovery rate FDR5%) altered in expression following LPS exposure compared to controls; however, none were significantly changed following OVA treatment, suggesting a milder hypothalamic response. When gene sets were examined, 48 were upregulated and 8 were downregulated in both asthma groups relative to controls. REACTOME enrichment analysis suggests these gene sets are involved in signal transduction metabolism, immune response and neuroplasticity. Interestingly, we identified five altered gene sets directly associated with neurotransmitter signaling. Intriguingly, many of these altered gene sets can influence mental health and or/neuroinflammation in humans. These findings help characterize the links between asthma-induced lung inflammation and the brain and may assist in identifying relevant pathways and therapeutic targets for future intervention.

Potential value and research frontiers of virus in neuroinflammation: a bibliometric and visualized analysis

Background

Neuroinflammation represents the immune response of the central nervous system to nerve injury, infection, toxin stimulation, or autoimmunity and is implicated in a wide range of neurological disorders. Viruses play a pivotal role as extrinsic biological drivers in neuroinflammation; however, numerous aspects remain unexplored. In this study, we employed bibliometric analysis to assess the current status of viral research in neuroinflammation and anticipate future research directions and emerging trends.

Methods

Conduct a comprehensive search for scholarly publications within the Web of Science Core Collection database, with search terms on neuroinflammation and virus. Apply Microsoft Excel Office, Hiplot, R (version 4.3.1), VOSviewer (version 1.6.20) and CiteSpace (6.2.R6, advanced) software for the bibliometric analysis and visualization.

Results

A total of 4230 articles and reviews on virus and neuroinflammation were identified, demonstrating a consistent upward trend over time. The United States was the country that contributed the most publications. Approximately 22274 authors from 4474 institutions contributed to the research. Johns Hopkins University leads with the highest number of publications and citations. The top three authors with the most published articles on this field are Power, C., Lane, T. E., and Buch, S. The Journal of Neuroinflammation is the most authoritative choice for researchers. The main research focuses in this field include multiple sclerosis, Parkinson's disease, blood-brain barrier, COVID-19, Alzheimer's disease, gene therapy. In recent years, stress have emerged as hot keywords, particularly depression, human immunodeficiency virus-associated neurocognitive disorders, blood-brain barrier, gut microbiota related directions, indicating a potential shift in research focus.

Conclusion

Research on the virus and neuroinflammation has attracted increasing attention in the past decade. European and American countries have been pivotal in conducting research on virus and neuroinflammation, while China has produced a significant number of publications, its impact is still limited. Stress is likely to emerge as the next area of focus in this field. The association and regulation between viral infection and psychiatric disorders are not fully understood, and further research is needed to explore the role of neuroinflammation caused by different types of viral infection and psychiatric disorders.

Association between COVID-19 and increased incidence of overactive bladder symptoms in female patients: A retrospective analysis

INTRODUCTION AND OBJECTIVES

To investigate female patients' post-COVID-19 voiding symptoms and to research how they relate to overactive bladder (OAB).

PATIENTS

One hundred and forty patients aged 20-50 years who were hospitalised and discharged due to COVID-19 at Kartal Dr. Lütfi Kırdar City Hospital between 2021 and 2022 and 50 patients with a history of COVID-19 among two hundred female patients who presented to the urology outpatient clinic with symptoms related to OAB were retrospectively analysed. Bladder diary, overactive bladder symptom score (OABSS), uroflowmetry values and time of onset of symptoms of symptomatic patients were recorded for all patients. Disease-free individuals for control purposes were not included in the study.

RESULTS

It was observed that 38% of 140 hospitalized patients had a symptomatic change related to OAB, and there was a significant difference in voiding diary, OABSS, and uroflowmetry Qmax values between symptomatic and non-symptomatic patients after COVID-19. (p:0.001) There was a significant difference between the pre-COVID-19 (estimated) and post-COVID-19 (current) voiding diary and OABSS values of all symptomatic patients (with and without a history of hospitalization). (p:0.001) When these two groups were compared with each other, there was a significant difference between the post-COVID-19 voiding diary, OABSS values, and the meantime to the onset of symptoms in inpatients and outpatients (p:0.001) CONCLUSION: COVID-19 may be associated with urgency/urge incontinence and overactive bladder in female patients.

Association between fatigue and depressive symptoms in persons with post-COVID-19 condition: a post hoc analysis

OBJECTIVE

Post-COVID-19 Condition (PCC) is a prevalent, persistent and debilitating phenomenon occurring three or more months after resolution of acute COVID-19 infection. Fatigue and depressive symptoms are commonly reported in PCC. We aimed to further characterize PCC by assessing the relationship between fatigue and depressive symptom severity in adults with PCC.

METHODS

A post hoc analysis was conducted on data retrieved from a randomized, double-blinded, placebo-controlled study evaluating vortioxetine for cognitive deficits in persons with PCC. We sought to determine the relationship between baseline fatigue [i.e. Fatigue Severity Scale (FSS) total score] and baseline depressive symptom severity [i.e. 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR-16) total score] in adults with PCC.

RESULTS

The statistical analysis included baseline data from 142 participants. After adjusting for age, sex, education, employment status, history of major depressive disorder (MDD) diagnosis, self-reported physical activity, history of documented acute SARS-CoV-2 infection and body mass index (BMI), baseline FSS was significantly correlated with baseline QIDS-SR-16 (β = 0.825, p = .001).

CONCLUSION

In our sample, baseline measures of fatigue and depressive symptoms are correlated in persons living with PCC. Individuals presenting with PCC and fatigue should be screened for the presence and severity of depressive symptoms. Guideline-concordant care should be prescribed for individuals experiencing clinically significant depressive symptoms. Fatigue and depressive symptom severity scores were not pre-specified as primary objectives of the study. Multiple confounding factors (i.e. disturbance in sleep, anthropometrics and cognitive impairment) were not collected nor adjusted for in the analysis herein.

TRIAL REGISTRATION

Unrestricted Research Grant from H. Lundbeck A/S, Copenhagen, Denmark. ClinicalTrials.gov Identifier: NCT05047952.

Objective and subjective cognitive status after intensive care unit treatment for COVID-19

Purpose

Intensive care unit (ICU) survivors can experience wide-ranging and long-lasting symptoms after hospital discharge. Cognitive impairment has received increased attention in relation to the COVID-19 pandemic and can affect patients' long-term quality of life. This study aimed to investigate the prevalence of cognitive impairment using an objective neurocognitive test 6 and 12 months following ICU admission and possible predictive factors for scoring below the defined cut-off. We also explored the prevalence of subjective cognitive complaints at 12 months, including the associated factors.

Methods

This was a prospective observational study of a national cohort of COVID-19 ICU survivors during the three first pandemic waves in Norway. Data was collected by the Norwegian Intensive Care and Pandemic Registry and the study group.

Results

At the six-month follow-up, 23.1% (95% CI [18.2─28.5]) of the 273 respondents scored below the cut-off on the Mini-MoCA, indicating mild cognitive impairment. At the 12-month follow-up, the prevalence declined to 11.1% (95% CI [7.5─15.6]) in 253 respondents. Older age (OR 1.06, 95% CI [1.02─1.12]) and depression (OR 1.25, 95% CI [1.07─1.55]) were associated with cognitive impairment at six months. At 12 months, almost half of the patients reported subjective cognitive complaints. Symptoms of mental health problems and fatigue were associated with subjective cognitive complaints in our exploratory analyses.

Conclusion

Cognitive impairment declined significantly from 6 to 12 months in this cohort of COVID-19 ICU patients, while subjective cognitive complaints remained high at 12 months, perhaps attributed to a high total symptom burden.

Post-acute COVID-19 syndrome in previously hospitalized patients

INTRODUCTION

With the prolongation of the COVID-19 pandemic, more individuals are experiencing sequelae after COVID-19 infection, also known as post-acute COVID-19 syndrome (PCS). The aims of this study were to describe the prevalence and characteristics of PCS symptoms such as fatigue, anxiety, and depression and to compare these symptoms according to participant characteristics in patients who had been previously hospitalized due to COVID-19.

DESIGN

A descriptive cross-sectional study design was used.

METHODS

We included 114 individuals who had been hospitalized for COVID-19 and were discharged from the hospital at least 4 weeks before. Symptoms were assessed using the Fatigue Severity Scale, the Hospital Anxiety-Depression Scale, and the PCS symptom questionnaire developed by the authors. We used descriptive statistics, the Student's t-test, the Wilcoxon rank-sum test, and the Kruskal-Wallis test for statistical analyses.

RESULTS

The most prevalent symptoms were anxiety (66.7%), fatigue (64.0%), headache (57.9%), and concentration or memory difficulties (57.9%). Concentration or memory difficulties and sleep disturbances had the highest mean frequency. Concentration or memory difficulties were rated with the highest mean severity, and cough, loss of taste, and muscle and joint pain had the highest mean distress scores. Female participants, individuals hospitalized for more than 2 weeks, individuals discharged more than 9 months ago, unvaccinated patients, and those who tried at least one symptom relief method reported higher symptom distress.

CONCLUSION

The findings of this investigation into the frequency, severity, and distress of symptoms shed light on the identification of post-COVID symptoms in detail. To objectively evaluate and comprehend the symptom trajectories of PCS, prospective studies about the development of symptom assessment tools and studies with a longitudinal design should be conducted.

CLINICAL RELEVANCE

A substantial number of respondents reported numerous symptoms and expressed symptom distress; therefore, the development of nursing interventions and treatments to alleviate PCS symptoms is crucial.

Cannabidiol ameliorates PTSD-like symptoms by inhibiting neuroinflammation through its action on CB2 receptors in the brain of male mice

Post-traumatic stress disorder (PTSD) is a debilitating mental health disease related to traumatic experience, and its treatment outcomes are unsatisfactory. Accumulating research has indicated that cannabidiol (CBD) exhibits anti-PTSD effects, however, the underlying mechanism of CBD remains inadequately investigated. Although many studies pertaining to PTSD have primarily focused on aberrations in neuronal functioning, the present study aimed to elucidate the involvement and functionality of microglia/macrophages in PTSD while also investigated the modulatory effects of CBD on neuroinflammation associated with this condition. We constructed a modified single-prolonged stress (SPS) mice PTSD model and verified the PTSD-related behaviors by various behavioral tests (contextual freezing test, elevated plus maze test, tail suspension test and novel object recognition test). We observed a significant upregulation of Iba-1 and alteration of microglial/macrophage morphology within the prefrontal cortex and hippocampus, but not the amygdala, two weeks after the PTSD-related stress, suggesting a persistent neuroinflammatory phenotype in the PTSD-modeled group. CBD (10 mg/kg, i.p.) inhibited all PTSD-related behaviors and reversed the alterations in both microglial/macrophage quantity and morphology when administered prior to behavioral assessments. We further found increased pro-inflammatory factors, decreased PSD95 expression, and impaired synaptic density in the hippocampus of the modeled group, all of which were also restored by CBD treatment. CBD dramatically increased the level of anandamide, one of the endocannabinoids, and cannabinoid type 2 receptors (CB2Rs) transcripts in the hippocampus compared with PTSD-modeled group. Importantly, we discovered the expression of CB2Rs mRNA in Arg-1-positive cells in vivo and found that the behavioral effects of CBD were diminished by CB2Rs antagonist AM630 (1 mg/kg, i.p.) and both the behavioral and molecular effects of CBD were abolished in CB2Rs knockout mice. These findings suggest that CBD would alleviate PTSD-like behaviors in mice by suppressing PTSD-related neuroinflammation and upregulation and activation of CB2Rs may serve as one of the underlying mechanisms for this therapeutic effect. The present study offers innovative experimental evidence supporting the utilization of CBD in PTSD treatment from the perspective of its regulation of neuroinflammation, and paves the way for leveraging the endocannabinoid system to regulate neuroinflammation as a potential therapeutic approach for psychiatric disorders.