Prior Outbreaks Allude to COVID-19 Psychiatric Manifestation Risks

May 26, 2020
Rachel Lutz

Rachel is a longtime contributor to Contagion, HCP Live and MD Magazine. She frequently covers C diff, coronavirus and other infectious diseases.

Clinicians should be wary of risk for depression, anxiety, fatigue, PTSD, and, potentially, rare neuropsychiatric syndromes, in post-coronavirus patients.

Evidence suggests outbreaks can bring about psychiatric manifestations, and coronavirus 2019 (COVID-19) is likely no different, according to a paper published in The Lancet Psychiatry.

Investigators from London conducted a systematic review and meta-analysis in order to assess the psychiatric and neuropsychiatric manifestations of prior coronavirus pandemics, including SARS and MERS, to infer what might be expected for COVID-19.

They searched the Medline, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through April 10, 2020, to find relevant published articles regarding the psychiatric signs or symptoms, symptoms severity, diagnoses, quality of life, and employment.

Ultimately, 65 peer-reviewed studies and 7 pre-prints met inclusion criteria for the analysis. The investigators’ analysis involved 3559 coronavirus cases in international patients aged between 12-68 years.

The study authors said that COVID-19 may have psychiatric consequences in those infected as well as those not infected, due to “widespread anxiety, social isolation, stress in health care workers and other essential workers, and unemployment and financial difficulties,” they wrote.

However, those with the illness may experience “concern about the outcome of their illness, stigma, and amnesia or traumatic memories of severe illness.”

During the acute SARS or MERS illness, common patient symptoms for patients admitted to the hospital included depressed mood, anxiety, impaired memory, impaired concentration or attention, and insomnia, the investigators determined. Confusion was also reported by 36 of 129 patients—despite mean ages of 37 and 42 years in 1 study.

In assessing another study, investigators wrote that 1744 patients with SARS in Hong Kong were diagnosed with steroid-inducted psychotic disorders. A pair of studies reported cases of depression, anxiety disorder, acute stress reaction, psychotic depression, and deterioration of dementia among patients.

There were 5 studies that examined the experiences of SARS and MERS patients, which found that loneliness, boredom, and frustration due to isolation were prominent. These individuals were often concerned with family members who were infected, spreading the virus to others, and death; however, 2 of those studies noted “enormous gratitude felt by patients for the support they received,” investigators wrote.

Once infection resolved, investigators found depressed mood, euphoria, pressured speech, insomnia, anxiety, irritability, memory impairment, fatigue, emotional liability, traumatic memories, and sleep disorder were frequently reported.

There were 2 studies that looked into positive psychological outcomes, finding that patients gained a better perspective on life and valued their relationships, health, and every day existence more, investigators noted.

After a mean follow up of nearly 1 year, the point prevalence of anxiety disorder cases was 14.8%, investigators found. After about 22 months, the point prevalence for depression was 14.9%. After about 33 months, the point prevalence for PTSD was 32.2%.

Health-related quality of life was lower in patients after SARS infection, according to 3 studies included in the meta-analysis. After a mean follow-up time of 35.3 months, 446 of 580 patients in 6 studies had returned to work, investigators wrote.

The COVID-19 data showed evidence for delirium and altered consciousness, and after discharge, dysexecutive syndrome. Investigators also discovered 2 reports of hypoxic encephalopathy and 1 report of encephalitis.

“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,” investigators concluded. “Clinicians must be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the aftermath.”