Researchers from the San Raffaele hospital in Milan, Italy have found that from the number of Covid-19 patients they surveyed, a significant proportion were experiencing mental illnesses. The findings of their new study, which is expected to be published in the journal Brain, Behaviour and Immunity, documented at least 402 cases of patients experiencing post-traumatic stress disorder (PTSD), depression and anxiety, among other illnesses.
What has the study found?
Considering the few preliminary studies on COVID-19 and the evidence of psychiatric manifestations of SARS and MERS, the authors hypothesised that survivors of COVID-19, “will show a high prevalence of emergent psychiatric conditions including mood disorders, anxiety disorders, PTSD, and insomnia.”
They said their preliminary data suggested that patients with COVID-19 experienced delirium, depression, anxiety and insomnia.
For their study, the authors spoke to 402 patients that survived the disease, of which 265 were male and 137 female. The subjects were aged between 18 and 87 years. A psychiatric assessment of the patients was undertaken after they were discharged with COVID-19. Overall, 55.7 per cent of them self-reported at least one psycho-pathological manifestation. At least 28 per cent said they suffered from PTSD, 31 per cent from depression, 42 per cent from anxiety, 20 per cent from obsessive-compulsive (OC) symptoms and 40 per cent from insomnia.
Who were more likely to show psycho-pathological symptoms?
The authors found that females, especially those with a previous psychiatric diagnosis, scored more on most measures. Younger patients showed higher levels of depression and sleep disturbances. The authors also found that the duration of hospitalisation inversely correlated with PTSD, depression, anxiety and symptoms of OC disorders.
In the cohort of 402, 36 patients had a pre-COVID diagnosis of major depressive illnesses, 28 had a generalised anxiety, 20 had panic attacks, five were bipolar, five had social phobia, three had eating problems and four had other illnesses. These patients suffered a more significant impact on their mental health after they recovered from COVID-19.
The findings are consistent with other coronaviruses studies, where psychiatric morbidities ranged between 10-35 per cent in the post-illness stage.
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How does COVID-19 lead to psychiatric manifestations?
There are two possible pathways for psychopathological manifestations of the disease, one is when the virus directly affects the central nervous system (CNS) and the other is indirect, via an immune response.
Significantly, the study notes that when an infection triggers the immune system it could add to the psychological stress of enduring a fatal disease and to stress-associated inflammation. Further, “cytokine storms”, which are an immune system response to coronaviruses, can also cause psychiatric symptoms in those infected.
Apart from immune system mechanisms, COVID-19 patients’ stress might be exacerbated by the fear of the illness itself, uncertainty of the future, stigma, traumatic memories of severe illness and social isolation that they experience during treatment.
What do we know about COVID-19 and the brain?
In May, researchers from the University of Cincinnati and three Italian institutions reviewed neuroimaging and neurological symptoms in patients with COVID-19 and published their findings in the journal Radiology.
Researchers investigated neurological symptoms and imaging findings in patients from three major institutions in Italy and found that out of 725 hospitalised patients with COVID-19, 59 per cent reported an altered mental state while 31 per cent experienced a stroke — two of the most common neurological symptoms. Patients also experienced headaches (12 per cent), seizures (9 per cent) and dizziness (4 per cent), among other symptoms. Altered mental status was more common in older adults.
Another study published in JAMA Neurology in April investigated hospitalised COVID-19 patients in Wuhan and found that 36.4 per cent of them showed neurologic symptoms, which were more common in patients with severe infection.
These researchers categorised the symptoms into three categories — central nervous system manifestations which include dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia (loss of full control of body movements) and seizures; peripheral nervous system manifestations which include taste and smell impairment, vision impairment and nerve pain; and skeletal muscular injury manifestations.`
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