The Pathogenesis of Long-Term Neuropsychiatric COVID-19 and the Role of Microglia, Mitochondria, and Persistent Neuroinflammation, 2021, Stefano et al

Full title:
Editorial: The Pathogenesis of Long-Term Neuropsychiatric COVID-19 and the Role of Microglia, Mitochondria, and Persistent Neuroinflammation: A Hypothesis (2021) Stefano et al.

Abstract:

Persistent comorbidities occur in patients who initially recover from acute coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

'Long COVID' involves the central nervous system (CNS), resulting in neuropsychiatric symptoms and signs, including cognitive impairment or 'brain fog' and chronic fatigue syndrome.

There are similarities in these persistent complications between SARS-CoV-2 and the Ebola, Zika, and influenza A viruses.

Normal CNS neuronal mitochondrial function requires high oxygen levels for oxidative phosphorylation and ATP production.

Recent studies have shown that the SARS-CoV-2 virus can hijack mitochondrial function.

Persistent changes in cognitive functioning have also been reported with other viral infections. SARS-CoV-2 infection may result in long-term effects on immune processes within the CNS by causing microglial dysfunction.

This short opinion aims to discuss the hypothesis that the pathogenesis of long-term neuropsychiatric COVID-19 involves microglia, mitochondria, and persistent neuroinflammation

Link to abstract here

 

Is it just me having problems with the term ‘neuropsychiatric’ as opposed to ‘neuropsychological’?

For me the former is suggesting more than just such as cognitive and/or sensory issues, rather straying in to the realm of mental health. Surely this should be the realm of the neurologist and the neuropsychologist rather than the psychiatrist and the psychiatric disorders oriented clinical psychologist. Unfortunately from just the abstract, even though they mention concrete neurological issues, it is hard to know if they are intending this interpretation or not.

 

Technically neuropsychology looks specifically at issues like cognitive function, the mechanics of perception, language production, taste, hunger, etc as distinct from mood or personality, though clinical psychologists may individually deal with both they are effectively very different disciplines. Unfortunately there seem to be very few neuropsychologists about, especially in areas of interest to ourselves.

 

Nervous system infections are treated by neurologists.

 

Neuropsychiatric, as opposed to psychiatric is probably most commonly used to indicate changes in mental activities associated with known metabolic, toxic, inflammatory or degenerative disorders. So it would be used for hypothyroidism, alcoholism, Alzheimer's, Parkinson's, MS. It would cover things like memory loss, inability to think clearly, as well as emotional changes or abnormal behaviours.

Perhaps paradoxically neuropsychiatric is a much more 'physical' notion than psychological. Neuropsychology has two uses, one mostly used for developmental problems in children (clinical) and the other for basic research into things like perception (non-clinical). I would not expect this study to use neuropsychological. As indicated neuropsychiatric has a much more 'physical' feel.

 

I haven't gotten to look into the details yet, but at a glance this makes me think of Jarred Younger and his research into ME and fibro. He's gotten a grant to look for neuroinflammation in ME recently (from the NIH I think?), and I read once about his idea that "hyperactive"/"angry" microglia that overreact to every little thing could be a mechanism of action in ME.

Edit: Found a link to Youngers project regarding this. It could be interesting, in my view. Hoping something interpretable comes out of it.

 

I am afraid that is just a list of the current buzz-words. I would want something more original or specific to read on.

 

First paragraph: ...."initially recover"...

The term "recover" from COVID rankles with me. Perhaps technically recovered if this virus is no longer detectable with the level of testing we have available. Or, perhaps it is definitely gone. I don't think we really know with a number of diseases that follow viruses, if the initiating infection is actually gone.

Even if medical technology is right in many situations, and the initiating disease is truly gone, it can be demoralizing to be told you've recovered, but continue to be very affected by debilitating symptoms. One's mental health comes under more intense scrutiny, and alterior motives are suspected.