tetano
Editor, Senior Moderator
Eur Arch Psychiatry Clin Neurosci
. 2021 Mar 12.
doi: 10.1007/s00406-021-01244-0. Online ahead of print.
Neurological and psychiatric presentations associated with COVID-19
Xudong He[SUP] 1 [/SUP], Dan Zhang[SUP] 1 [/SUP], Lei Zhang[SUP] 2 [/SUP], Xu Zheng[SUP] 1 [/SUP], Ge Zhang[SUP] 3 [/SUP], Konghan Pan[SUP] 3 [/SUP], Hong Yu[SUP] 4 [/SUP], Lisan Zhang[SUP] 1 [/SUP], Xingyue Hu[SUP] 5 [/SUP]
Affiliations
Abstract
The objective is to investigate coronavirus disease 2019 (COVID-19)-associated neurological and psychiatric effects and explore possible pathogenic mechanisms. This study included 77 patients with laboratory-confirmed COVID-19 in Wuhan, China. Neurological manifestations were evaluated by well-trained neurologists, psychologists, psychiatric presentations and biochemical changes were evaluated using the Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire-9, Brief Psychiatric Rating Scale, and electronic medical records. Eighteen (23.4%) patients presented with neurological symptoms. Patients with neurological presentations had higher urea nitrogen, cystatin C, and high-sensitivity C-reactive protein levels and lower basophil counts. Among them, patients with muscle involvement had higher urea nitrogen and cystatin C levels but lower basophil counts. In addition, patients with psychiatric presentations were older and had higher interleukin (IL)-6 and IL-10 levels and higher alkaline phosphatase, R-glutamate transferase, and urea nitrogen levels. Moreover, patients with anxiety had higher IL-6 and IL-10 levels than those without, and patients with moderate depression had higher CD8 + T cell counts and lower CD4 + /CD8 + ratios than other patients. This study indicates that the central nervous system may be influenced in patients with COVID-19, and the pathological mechanisms may be related to direct virus invasion of the central nervous system, infection-mediated overreaction of the immune system, and aberrant serum pro-inflammatory factors. In addition, basophils and cystatin C may also play important roles during these pathological processes. Our findings suggest that neurological and psychiatric presentations should be evaluated and managed in patients with COVID-19. Further studies are needed to investigate the underlying mechanisms.
Keywords: COVID-19; Neurological presentations; Psychiatric presentations; SARS-CoV-2.
. 2021 Mar 12.
doi: 10.1007/s00406-021-01244-0. Online ahead of print.
Neurological and psychiatric presentations associated with COVID-19
Xudong He[SUP] 1 [/SUP], Dan Zhang[SUP] 1 [/SUP], Lei Zhang[SUP] 2 [/SUP], Xu Zheng[SUP] 1 [/SUP], Ge Zhang[SUP] 3 [/SUP], Konghan Pan[SUP] 3 [/SUP], Hong Yu[SUP] 4 [/SUP], Lisan Zhang[SUP] 1 [/SUP], Xingyue Hu[SUP] 5 [/SUP]
Affiliations
- PMID: 33710424
- DOI: 10.1007/s00406-021-01244-0
Abstract
The objective is to investigate coronavirus disease 2019 (COVID-19)-associated neurological and psychiatric effects and explore possible pathogenic mechanisms. This study included 77 patients with laboratory-confirmed COVID-19 in Wuhan, China. Neurological manifestations were evaluated by well-trained neurologists, psychologists, psychiatric presentations and biochemical changes were evaluated using the Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire-9, Brief Psychiatric Rating Scale, and electronic medical records. Eighteen (23.4%) patients presented with neurological symptoms. Patients with neurological presentations had higher urea nitrogen, cystatin C, and high-sensitivity C-reactive protein levels and lower basophil counts. Among them, patients with muscle involvement had higher urea nitrogen and cystatin C levels but lower basophil counts. In addition, patients with psychiatric presentations were older and had higher interleukin (IL)-6 and IL-10 levels and higher alkaline phosphatase, R-glutamate transferase, and urea nitrogen levels. Moreover, patients with anxiety had higher IL-6 and IL-10 levels than those without, and patients with moderate depression had higher CD8 + T cell counts and lower CD4 + /CD8 + ratios than other patients. This study indicates that the central nervous system may be influenced in patients with COVID-19, and the pathological mechanisms may be related to direct virus invasion of the central nervous system, infection-mediated overreaction of the immune system, and aberrant serum pro-inflammatory factors. In addition, basophils and cystatin C may also play important roles during these pathological processes. Our findings suggest that neurological and psychiatric presentations should be evaluated and managed in patients with COVID-19. Further studies are needed to investigate the underlying mechanisms.
Keywords: COVID-19; Neurological presentations; Psychiatric presentations; SARS-CoV-2.