Since the pandemic began, there has been concern that survivors may have an increased risk of neurological disorders. This concern, initially based on findings from other coronaviruses, was quickly followed by case series, emerging evidence involvement of COVID-19 in the central nervous system (CNS) and the identification of mechanisms why this could happen.
Similar concerns have been raised regarding the psychiatric sequelae of COVID-19, with evidence showing that survivors are at increased risk for mood and anxiety disorders within 3 months of infection.
In a new study, a group of health professionals Department of Psychiatry of the Oxford University used a network of electronic health records to investigate the incidence of neurological and psychiatric diagnoses in survivors within 6 months of documented clinical COVID-19 infection, and compared the risks associated with those of other health conditions. Furthermore, the researchers explored whether the severity of COVID-19 infection, represented by hospitalization, admission to the intensive care unit (ICU) and encephalopathy, impacted on these risks. Also evaluated the trajectory of risk rates (HR) throughout the 6-month period.
The data presented in this study, from a large network of electronic health records, supports predictions that adverse neurological and psychiatric outcomes have been reported to occur after COVID-19, and provide estimates of the incidence and risk of these outcomes in patients who had COVID-19 compared to matched cohorts of patients with other health conditions that occur concurrently with the disease.
“The severity of COVID-19 had a clear effect on subsequent neurological diagnoses,” the specialists indicated in their document. In general, according to your data, COVID-19 was associated with an increased risk of neurological and psychiatric outcomes, but the incidence and heart rate of these were higher in patients who had required hospitalization, and notably in those who had required admission to the ITU or had developed encephalopathy, even after an extensive propensity for other factors (age or previous cerebrovascular disease). Possible mechanisms of this association include viral invasion of the CNS, hypercoagulable states, and neural effects of the immune response. However, the incidence and relative risk of neurological and psychiatric diagnoses also increased even in COVID-19 patients who did not require hospitalization.
According to various other reports, the risk of cerebrovascular events (ischemic attack and intracranial hemorrhage) rose after COVID-19, and the incidence of ischemic stroke increased to nearly one in ten (or three out of 100 for a first accident) in patients with encephalopathy. A similar increased risk of stroke has been reported in patients who had COVID-19 compared to those with influenza.
A previous study reported preliminary evidence of an association between COVID-19 and dementia. The data from the new study support this association. Although the estimated incidence was modest across the entire COVID-19 cohort, 66% of patients older than 65 and 72% who had encephalopathy received a first dementia diagnosis within 6 months of having COVID-19. The associations between COVID-19 and cerebrovascular and neurodegenerative diagnoses have been described by the specialists in charge of the report as “worrying”.
They stated that it is not clear if COVID-19 is associated with Guillain-Barré syndrome; Their data was also equivocal, as HRs increased with COVID-19 compared to other respiratory tract infections but not influenza and increased compared to three of the other four index health events. Concerns have also been raised about Parkinsonian syndromes after COVID-19, fueled by the lethargic encephalitis epidemic that followed the 1918 influenza pandemic.
The data support this possibility, although the incidence was low and not all of them were significant. Parkinsonism may be a late outcome, in which case a clearer signal may emerge with longer follow-up.
Sick in spirit
Findings regarding anxiety and the mood disorders they were broadly consistent with previous data. They also observed a significantly increased risk of psychotic disorders. The substance use disorders and the insomnia also They were most common in COVID-19 survivors than in those who had influenza or other respiratory tract infections (except for the incidence of a first substance use disorder diagnosis after COVID-19 compared to other respiratory tract infections).
Therefore, as with neurological outcomes, The psychiatric sequelae of COVID-19 appear widespread and persist up to and probably beyond 6 months. Compared to neurological disorders, common psychiatric (mood and anxiety disorders) showed a weaker relationship with COVID-19 severity markers. This could indicate that its occurrence reflects, at least in part, the psychological and other implications of a COVID-19 diagnosis rather than being a direct manifestation of the disease.
The findings presented are robust given the sample size, the propensity score matching, and the results of the sensitivity and secondary analyzes.
In summary, Current data shows that COVID-19 is followed by significant rates of neurological and psychiatric diagnoses over the next 6 months. Services must be configured and provided with resources to meet this anticipated need, which has also been delayed in their care due to the pandemic.