Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections, 2020, Rogers et al

Dolphin

Dolphin

Senior Member (Voting Rights)
Perhaps there might be something of interest in this.

Free full text:
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30203-0/fulltext

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic
Open Access
Published:May 18, 2020DOI:https://doi.org/10.1016/S2215-0366(20)30203-0
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Summary
Background
Before the COVID-19 pandemic, coronaviruses caused two noteworthy outbreaks: severe acute respiratory syndrome (SARS), starting in 2002, and Middle East respiratory syndrome (MERS), starting in 2012. We aimed to assess the psychiatric and neuropsychiatric presentations of SARS, MERS, and COVID-19.

Methods

In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases (from their inception until March 18, 2020), and medRxiv, bioRxiv, and PsyArXiv (between Jan 1, 2020, and April 10, 2020) were searched by two independent researchers for all English-language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). We excluded studies limited to neurological complications without specified neuropsychiatric presentations and those investigating the indirect effects of coronavirus infections on the mental health of people who are not infected, such as those mediated through physical distancing measures such as self-isolation or quarantine. Outcomes were psychiatric signs or symptoms; symptom severity; diagnoses based on ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition) or psychometric scales; quality of life; and employment. Both the systematic review and the meta-analysis stratified outcomes across illness stages (acute vs post-illness) for SARS and MERS. We used a random-effects model for the meta-analysis, and the meta-analytical effect size was prevalence for relevant outcomes, I2 statistics, and assessment of study quality.

Findings

1963 studies and 87 preprints were identified by the systematic search, of which 65 peer-reviewed studies and seven preprints met inclusion criteria. The number of coronavirus cases of the included studies was 3559, ranging from 1 to 997, and the mean age of participants in studies ranged from 12·2 years (SD 4·1) to 68·0 years (single case report). Studies were from China, Hong Kong, South Korea, Canada, Saudi Arabia, France, Japan, Singapore, the UK, and the USA. Follow-up time for the post-illness studies varied between 60 days and 12 years.

The systematic review revealed that during the acute illness, common symptoms among patients admitted to hospital for SARS or MERS included confusion (36 [27·9%; 95% CI 20·5–36·0] of 129 patients), depressed mood (42 [32·6%; 24·7–40·9] of 129), anxiety (46 [35·7%; 27·6–44·2] of 129), impaired memory (44 [34·1%; 26·2–42·5] of 129), and insomnia (54 [41·9%; 22·5–50·5] of 129). Steroid-induced mania and psychosis were reported in 13 (0·7%) of 1744 patients with SARS in the acute stage in one study.

In the post-illness stage, depressed mood (35 [10·5%; 95% CI 7·5–14·1] of 332 patients), insomnia (34 [12·1%; 8·6–16·3] of 280), anxiety (21 [12·3%; 7·7–17·7] of 171), irritability (28 [12·8%; 8·7–17·6] of 218), memory impairment (44 [18·9%; 14·1–24·2] of 233), fatigue (61 [19·3%; 15·1–23·9] of 316), and in one study traumatic memories (55 [30·4%; 23·9–37·3] of 181) and sleep disorder (14 [100·0%; 88·0–100·0] of 14) were frequently reported.

The meta-analysis indicated that in the post-illness stage the point prevalence of post-traumatic stress disorder was 32·2% (95% CI 23·7–42·0; 121 of 402 cases from four studies), that of depression was 14·9% (12·1–18·2; 77 of 517 cases from five studies), and that of anxiety disorders was 14·8% (11·1–19·4; 42 of 284 cases from three studies).

446 (76·9%; 95% CI 68·1–84·6) of 580 patients from six studies had returned to work at a mean follow-up time of 35·3 months (SD 40·1).

When data for patients with COVID-19 were examined (including preprint data), there was evidence for delirium (confusion in 26 [65%] of 40 intensive care unit patients and agitation in 40 [69%] of 58 intensive care unit patients in one study, and altered consciousness in 17 [21%] of 82 patients who subsequently died in another study). At discharge, 15 (33%) of 45 patients with COVID-19 who were assessed had a dysexecutive syndrome in one study. At the time of writing, there were two reports of hypoxic encephalopathy and one report of encephalitis. 68 (94%) of the 72 studies were of either low or medium quality.

Interpretation

If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term.

Funding
Wellcome Trust, UK National Institute for Health Research (NIHR), UK Medical Research Council, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London.
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I was thinking about it and if many in the ME/CFS community hadn’t been proactive in highlighting that ME/CFS is often post-viral and that lingering symptoms might be similar to post-viral fatigue syndrome/ME/CFS, there might have been more media coverage like this paper and press release.
 
IMHO you musnt blame ME people for being too pushy in media coverage :hug: that is just not the way it is, mainstream media focus is about following public interest.

If one can generalise about the mainstream media, since looking for sellable stories is a competitive business, many will consider that after so long in lock down everyone just wants to get back to normal and put COVID behind them, which is perfectly understandable and a natural healthy social response to any illness, to come back after weakness and show strength and get back to the usual pattern of subliminal microaggressions which masquerade as cheerfulness.

However a lot has changed, with our new awareness which rapid testing provides we will find this is not possible, the threat of COVID will hang around and change our behaviour re contagion and not before time. Living at these densities we have to be aware of this problem. One day something far more deadly may infect humanity and we may need to be able to lock it down effectively, which the patchy response to COVID shows we just cannot do properly at the moment.

So for now it is recovery and return to normal-which-is-not-normal stories and what-have-we-learned stories but the situation is ever changing and in short order they will be looking for new angles.

From a theatrical perspective, you sometimes have to let things fall away before bringing them back to people's attention, its just a question of neurological fatigue, there is only so much thinking people are willing to do in one go. I think the ME angle on news treatments is a matter of timing. Now there is a lull in ME coverage in favour of hope stories and then when everyone thinks it is all over there will be scope for sober retrospectives, human interest narratives and shock horror stories about how COVID is still out there and some people never escaped the nightmare. IMHO

A recent example of this was a short piece on the possibility of lung scarring in severe COVID on the BBC but it was very short, skipped over the issue of long term repercussions.

I think what matters more is that epidemiology and bioscience perspectives are now much higher on the governmental agenda and in the long term this will help ME research campaigning to be taken seriously. So while the public treatment matters, it is possibly more important how the scientific community perceive ME, not as a dead end career doom or heart sink diagnosis based on old folk tales but instead as a relevant widespread problem for human health.
 
Leila said:
Can somebody help me with language/use of medical terms here:

Why isn't it called "neurological" but (neuro)psychiatric?

What's the difference between the three terms?
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I know someone who was referred to a neuro psychiatric unit for FND / PTSD and from what I can see it was a place to say.. Even though you have these neurological symptoms they’re not actually caused by anything neurological, we know that for sure... so we can do an “education” course about your symptoms (ie the psychosomatic model), graded exercise etc. Emphasising the “psychiatry” part. Also use of anti depressants / other psychiatric drugs.
 
I found this on the UK Royal College of Psychiatrists website:
https://www.rcpsych.ac.uk/become-a-...chiatry/types-of-psychiatrist/neuropsychiatry
Neuropsychiatrist

"I have always been interested in how the brain works. I’d say psychiatry is about complex problem solving"

Neuropsychiatrists work with patients with mental disorders which in most cases originate from a brain malfunction.

Neuropsychiatry is a growing specialty combining organic (neurological) and psychological aspects of illness.

The link between the science you learn at medical school and your practice is very clear.

More than most other types of psychiatry, you’ll spend a lot of time looking at images of the brain and interpreting effects of conditions and treatments.

As a Neuropsychiatrist, you are likely to work in a multi-disciplinary setting alongside other Neuroscience clinicians, for example in a general hospital.
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I am concerned about the potential of the PTSD angle. Not in as far as it might examine purely psychiatric symptoms but because of the risk that physical symptoms arising from unexplained pathways may be put down arbritrarily to PTSD as a psychiatric phenomenon. The next move might well be "Our opponents are naive dualists, we never believed trauma was just psychiatric, so when we say PTSD we have the physical in mind too.......". This could go off in the familiar duplicitous direction.
I'd been expecting this one, as large numbers of post covid as an unexplained physical condition will ask questions and hiving sufferers off under PTSD might be a "NICE" move.
That is not to say there is no legitimate case for watching out for genuine psychiatric PTSD among post(?) Covid but not a blanket post (?)Covid =PTSD.
We should watch this one.
 
This is not a "proper" article - it is just described as a "coronavirus update". Personally, I suspect the numbers quoted are all absolute bilge, but they allegedly come from various mental health and children's charities.

Source : https://www.plymouthherald.co.uk/news/uk-world-news/live-coronavirus-local-lockdown-updates-4276532

More than a third of children and young people are experiencing increased mental health difficulties during the coronavirus lockdown, a children’s charity survey suggests.

The impacts of Covid-19 could be “catastrophic” for the wellbeing of “generation lockdown” without urgent early intervention, Barnardo’s is warning.

And Mental Health charity Mind says the "worst is yet to come” of the mental health emergency sparked by the coronavirus pandemic and the future economic fall-out, a

Many people who were previously well will develop mental health problems as a “direct consequence of the pandemic and all that follows”, according to Mind.

Two out of three (65%) adults aged 25 and over and three-quarters of young people aged 13-24 with an existing mental health problem reported worse mental health during the lockdown, its survey found.

Of adults with no previous experience of poor mental health, more than a fifth (22%) now say that their mental health is poor or very poor.
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Of adults with no previous experience of poor mental health, more than a fifth (22%) now say that their mental health is poor or very poor.
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It worries me that they may be classing low mood, loneliness, feeling miserable, frustrated, etc. because of lockdown as 'mental health problems' rather than as natural responses to a time spent alone or just with family or flatmates. I'm sure there will be people for whom it is too hard to cope with, but I suspect that might be balanced by people for whom lockdown is a welcome relief and break from having to fully function in outside the world.
 
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