Signs suggestive of delirium may be common in the acute stage of the 2019 coronavirus disease (COVID-19), whereas psychiatric disorders are relatively rare in the post-illness stage, according to a systematic review and meta-analysis published in The Lancet Psychiatry.
Depression, anxiety, fatigue, and posttraumatic stress disorder, which have been observed in previous coronavirus epidemics, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), are a concern among experts. However, if infection with COVID-19 follows a similar course to that of SARS or MERS, most patients will recover without experiencing mental illness.
The current pandemic may have some psychiatric consequences, as the ramifications of quarantine, social distancing, and job loss manifest themselves. But viral infections may also infect the central nervous system, triggering neuropsychiatric syndromes that affect cognitive, affective, behavioral, and perceptual domains.
To explore the psychiatric consequences of COVID-19, Jonathan P. Rogers, PhD, of the Division of Psychiatry, University College London, United Kingdom, and colleagues, searched for English language studies with data on psychiatric and neuropsychiatric presentations in individuals with suspected or confirmed coronavirus infection. They used MEDLINE, Embase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature databases, medRxiv, bioRxiv, and PsyArXiv.
The investigators identified 65 peer-reviewed studies and 7 preprints that met inclusion criteria with a total of 3559 coronavirus cases (mean age range, 12.2±4.1 to 68.0 years). Follow-up time for the post-illness studies ranged from 60 days to 12 years. Common symptoms among patients admitted to hospital for SARS or MERS included confusion (27.9%), depressed mood (32.6%), anxiety (35.7%), impaired memory (34.1%), and insomnia (41.9%). In the post-illness stage, depressed mood (10.5%), insomnia (12.1%), anxiety (12.3%), irritability (12.8%), memory impairment (18.9%), and fatigue (19.3%) were frequently reported. Posttraumatic stress disorder occurred at levels of 32.2% in the post-illness stage, which has been a major concern with COVID-19.
For patients with COVID-19 in the intensive care unit, data showed that 65% of patients experienced delirium, 69% agitation, and 21% altered consciousness. Notably, 1 study showed that 33% of patients with COVID-19 had a dysexecutive syndrome at discharge.
However, the researchers warned, “In terms of applicability to COVID-19, conclusions must be cautious because data on the acute effects of the illness are limited and no data exist on the post-illness phase, and the higher mortality of SARS and MERS might be correlated with poorer psychiatric outcomes.” They noted that that 94% of the studies were of low or medium quality.
Study limitations could be attributed to the inclusion of preprint articles that had not yet undergone peer review and studies with very small sample sizes, as well as the exclusion of non-English language articles.
The researchers concluded, “although there are many ways in which mental health might be adversely affected by a pandemic, this review suggests, first, that most people do not suffer from a psychiatric disorder following coronavirus infection, and second, that so far there is little to suggest that common neuropsychiatric complications beyond short-term delirium are a feature.”
Disclosures: Multiple study authors reported relationships with pharmaceutical companies. Please see original paper for a full list.
Rogers JP, Chesney E, Oliver D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020. doi.org/10.1016/S2215-0366(20)30203-0.