Study provides a snapshot of neurological, psychiatric complications in COVID-19 patients

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A study of 153 patients treated in UK hospitals during the acute phase of the pandemic has found a range of neurological and psychiatric complications that may be linked to COVID-19.

A study of 153 patients treated in UK hospitals during the acute phase of the pandemic has found a range of neurological and psychiatric complications that may be linked to COVID-19.

A handful of small studies had earlier reported an association between COVID-19 and possible neurological complications, and a larger one involving 214 patients from Wuhan too have reported such complications in 78 patients.

Breath of complications

To investigate the breadth of COVID-19 complications that affect the brain, researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases.

Complete clinical datasets were available for 125 (82%) of 153 patients, while 114 (92%) of 125 patients with complete notification data had confirmed SARS-CoV-2 infection. The results were published in the journal The Lancet Psychiatry.

In the UK study, a team led Dr Benedict Michael from the University of Liverpool found that 62% (77 of 125 people) had broad clinical syndrome of a cerebrovascular event, of whom 57 (74%) had an ischemic stroke and nine (12%) an intracerebral haemorrhage.

Altered mental status was seen in 31% (39 of 125 people) of COVID-19 patients. This included nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis.

The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses. Psychiatric complications include psychosis, neurocognitive dementia-like syndrome, personality change, catatonia (abnormality of movement and behaviour arising from a disturbed mental state), mania, anxiety or depression, chronic fatigue syndrome, and post-traumatic stress disorder.

Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had mood disorder.

Altered mental status found in all age groups

“Altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness) was identified across all age groups, and many (49%) younger patients had this presentation,” they write. In contrast, cerebrovascular events were seen more in people older than 60 years (82%, 61 of 74 patients) while only 18% (13 of 74 patients) were younger than 60 years.

According to the authors, altered mental status is “common in patients admitted to hospital with severe infection, especially in those requiring intensive care management”. However, this is typically seen in older people and might reflect an “unmasking of latent neurocognitive degenerative disease or multiple medical comorbidities”.

“Clinicians should be alert to the possibility of patients with COVID-19 developing these complications and, conversely, of the possibility of COVID-19 in patients presenting with acute neurological and psychiatric syndromes,” they write.

The authors caution that the link between COVID-19 and new acute psychiatric or neuropsychiatric complications in younger patients will require detailed prospective longitudinal studies.

Not to be extrapolated

They caution that the “rates of neurological and psychiatric complications of COVID-19 cannot be extrapolated to mildly affected patients or patients with asymptomatic infection, especially those in the community.”

But they also add that the true extent of neurological or psychiatric symptoms may be an underestimate considering that many COVID-19 patients are managed in an ICU with sedative and paralytic medications, which can mask and contribute to complications caused by treatment. The cohort studied might “underrepresent patients with milder outpatient symptoms, such as reduced taste or smell”, they write.

Published in The Hindu on June 27, 2020

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