Most people who are infected with the novel coronavirus will survive COVID-19. Some will be asymptomatic and might not even realize they’ve been infected. Others will need hospitalization for more severe forms of the illness. But surviving COVID-19, or clearing the virus from the system, doesn’t mean a person will make an immediate recovery. COVID-19 will last for around two weeks in most cases, at which point the virus is gone from the body. But so many people continue experiencing symptoms for several weeks after that. Plenty of survivors even continue to deal with COVID-19 several months after the virus is gone, and doctors can’t precisely explain what causes this type of chronic COVID-19 illness that’s often referred to as “Long COVID.”
Long COVID symptoms can mimic COVID-19 symptoms, such as fatigue, shortness of breath, headaches, and cognitive issues like memory loss and “brain fog.” The psychological side-effects following infection can be quite serious as well, doctors warn, with many COVID-19 patients likely to experience some form of psychiatric disorders, including long-term issues that might need treatment.
Researchers from Oxford Brookes University looked at some of the available data on psychiatric and cognitive consequences of COVID-19, publishing their work in Frontiers in Psychology.
The authors explain that COVID-19 patients experience neurological symptoms, including headache, altered consciousness, and paraesthesia (pins and needles sensation). Autopsies have revealed brain swelling and neurodegeneration. These are indications that the virus can lead to the development of “acute psychiatric symptoms and long-term neuropsychiatric sequelae of COVID-19,” similar to what happens with other viral respiratory illnesses like SARS and MERS.
The scientists analyzed various studies, identifying potential acute and long-term neuropsychiatric symptoms in COVID-19, as detailed in other studies. Here are some of the acute symptoms:
- 20-40% of patients may experience headache, dizziness, encephalopathies, anosmia (loss of smell), ageusia (loss of taste), and mood swings
- 65–69% of intensive care unit patients experience confusion and agitation
- 33% of patients had dysexecutive syndromes (emotional, motivational, and behavioral symptoms) at the time of discharge
The authors also point out that studies have shown some patients can develop a new diagnosable psychiatric disorder following the infection. The novel virus can directly impact the structure of the brain, with one study showing brain abnormalities “in the bilateral thalamic, medial temporal lobes, hippocampus, and insular regions.”
Some patients develop encephalopathy and reduced blood flow in the frontotemporal brain region after an infection. Encephalitis (inflammation of the brain) alone is linked with an increased risk of long-term neuropsychiatric symptoms, including epilepsy, bipolar disorders, psychotic disorders, anxiety disorders, cognitive problems, and dementia. The authors say that “long-term neuropsychiatric sequelae of COVID-19 are currently unknown,” but that SARS and MERS studies can provide some insight into the psychiatric disorders that can appear following an infection with the novel coronavirus.
Post-traumatic stress disorder or PTSD (55% of cases), depression (39%), pain disorder (36.4%), panic disorder (32.5%), and obsessive-compulsive disorder (15.6%) appeared in patients who survived SARS, according to one of the cited studies. Other long-term neuropsychiatric consequences of SARS and MERS included “depressed mood, insomnia, anxiety, irritability, memory impairment, and fatigue,” which appeared in 10% to 20% of patients in a different study.
The authors point out that it is also “important to understand that the neuropsychiatric manifestations, such as PTSD, depression, or anxiety, following COVID-19 infection could also be a psychological reaction to being infected, being in intensive care unit or experiencing stigma of contracting the infection. If similar proportions of long-term neuropsychiatric complications emerge following COVID-19, then we can expect a crashing wave of neuropsychiatric sequelae, which will have huge implications for management of the stretched healthcare resources in every country.”
According to early data, “cognitive domains of executive functions, attention, and memory appear to be affected by COVID-19.” The authors indicated that long-term neuropsychiatric and cognitive sequelae could include affective disorders, anxiety, fatigue, and PTSD.
PTSD has been observed in 96% of patients in a COVID-19 study from March 2020.
The authors of this latest study say that the neuropsychiatric symptoms might be the direct result of the virus impacting the regular pathophysiology of the brain, or “the psychological reactions of having contracted COVID-19 and undergoing associated medical interventions.” Physicians should conduct additional examinations to determine the nature of these problems. “Early detection and prevention of neuropsychiatric and cognitive problems should be the long-term aim of health services and governments across the world as this could present as a ‘third wave’ of the pandemic,” the authors wrote.