Reintroducing Consciousness in Psychopathology: Review of the Literature and Conceptual Framework

The Mind-Body Problem in the Context of Neuropsychiatric Symptoms in Patients with Coronavirus Disease 2019

Objective

This study is to determine the possible pathophysiological parameters associated with the development of anxiety and impaired consciousness in patients with acute coronavirus disease (COVID-19).

Methods

Descriptive pathophysiological and pathopsychological data was collected from 89 patients hospitalized due to COVID-19 across 7 infectious hospitals, where 14 trainees in psychiatry and neurology collected data from December 2020 to June 2021. Contingency tables and logistic regression analyses were made to reveal associations and to detect predictors of patients' states of anxiety or impaired consciousness.

Results

Anxiety and impaired consciousness were observed in 28 patients (31.50%); 22 (25.00%) presented with anxiety symptoms, and 7 (7.90%) had impaired consciousness. The degree of their association was low (Fisher's exact = 0.675 (df = 1), P = .495). Different pathophysiological mechanisms were shown to determine the development of anxiety or impaired consciousness within COVID-19. Predictors of anxiety were oxygen saturation (OR = 1.26; 95% CI, 1.04-1.54; P = .021), cardiovascular disorders (OR = 0.14; 95% CI, 0.04-0.52; P = .003), disorders of the nervous system (OR = 0.05; 95% CI, 0.01-0.84; P = .038), and urogenital system (OR = 0.13; 95% CI, 0.02-0.87; P = .035). The predictive power of the model was 80.23% (P ≤ .001). The development of impaired consciousness was associated with age (OR = 1.11; 95% CI, 1.01-1.21; P = .025) and C-reactive protein level (OR = 1.02; 95% CI, 0.99-1.04; P = .060), and the predictive power of the model was 94.52% (P ≤ .001).

Conclusion

The prevalence of psychopathological disorders associated with acute COVID-19 was high: n = 28 (31.50%) for anxiety and impaired consciousness. Moreover, a 1.00% increase in the saturation index was associated with a 1.3-fold increase in the patient's risk of developing anxiety. Thus, anxiety symptoms may be considered within a personality rather than an infectious-inflammatory response to COVID-19.

Rosiglitazone Mitigates Dexamethasone-Induced Depression in Mice via Modulating Brain Glucose Metabolism and AMPK/mTOR Signaling Pathway

Major depressive disorder (MDD) is a common, complex disease with poorly understood pathogenesis. Disruption of glucose metabolism is implicated in the pathogenesis of depression. AMP-activated protein kinase (AMPK) has been shown to regulate the activity of several kinases, including pAKT, p38MAPK, and mTOR, which are important signaling pathways in the treatment of depression. This study tested the hypothesis that rosiglitazone (RGZ) has an antidepressant impact on dexamethasone (DEXA)-induced depression by analyzing the function of the pAKT/p38MAPK/mTOR pathway and NGF through regulation of AMPK. MDD-like pathology was induced by subcutaneous administration of DEXA (20 mg/kg) for 21 days in all groups except in the normal control group, which received saline. To investigate the possible mechanism of RGZ, the protein expression of pAMPK, pAKT, p38MAPK, and 4EBP1 as well as the levels of hexokinase, pyruvate kinase, and NGF were assessed in prefrontal cortex and hippocampal samples. The activities of pAMPK and NGF increased after treatment with RGZ. The administration of RGZ also decreased the activity of mTOR as well as downregulating the downstream signaling pathways pAKT, p38MAPK, and 4EBP1. Here, we show that RGZ exerts a potent inhibitory effect on the pAKT/p38MAPK/mTOR/4EBP1 pathway and causes activation of NGF in brain cells. This study has provided sufficient evidence of the potential for RGZ to ameliorate DEXA-induced depression. A new insight has been introduced into the critical role of NGF activation in brain cells in depression. These results suggest that RGZ is a promising antidepressant for the treatment of MDD.