Neurological and psychiatric presentations associated with COVID-19

• Published in: European archives of psychiatry and clinical neuroscience Vol. 272; no. 1; pp. 41 - 52
• Main Authors: He, Xudong, Zhang, Dan, Zhang, Lei, Zheng, Xu, Zhang, Ge, Pan, Konghan, Yu, Hong, Zhang, Lisan, Hu, Xingyue
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2022; Springer; Springer Nature B.V
• Subjects: Alkaline phosphatase; Anxiety; Anxiety disorders; C-reactive protein; C-Reactive Protein - analysis; CD4 antigen; CD8 antigen; Central nervous system; China - epidemiology; Coronaviruses; COVID-19; COVID-19 - physiopathology; COVID-19 - psychology; Cystatin C; Cystatin C - blood; Electronic medical records; Health aspects; Humans; Immune system; Inflammation; Interleukin 10; Interleukin 6; Interleukin-10 - blood; Leukocytes (basophilic); Lymphocytes T; Medical records; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mental Disorders - blood; Mental Disorders - epidemiology; Nervous system; Nervous System Diseases - blood; Nervous System Diseases - epidemiology; Neurosciences; Nitrogen; Original Paper; Patients; Psychiatry; T cells; Urea; Urea - blood; China; COVID-19; SARS-CoV-2; Neurological presentations; Psychiatric presentations
• ISSN: 0940-1334; 1433-8491
• DOI: 10.1007/s00406-021-01244-0

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.