What about the neurological and psychiatric effects of SARS Cov2?

The major clinical signs of SARS-CoV2 infection are respiratory-related, ranging from limited dyspnea and cough to pneumonia and acute respiratory distress syndrome in the most severe cases. Moreover, some patients develop additional acute cardiac problems and multiorgan failure. It has however been observed from the beginning of the pandemic that some patients with COVID‐19 additionally showed neurologic signs, such as headache, nausea, and vomiting. Moreover, anosmia and ageusia have been suggested to potentially result from involvement of the peripheral or central nervous system (Finsterer and Stollberger 2020). Since then, clinical data have accumulated which indicate that SARS-CoV-2 infection may be associated with neurological and neuropsychiatric illness. A recent report (July 2020) by a multidisciplinary team at UCL has classified the neurological disorders suspected to be COVID-19-related into 5 categories : (1) encephalopathies with delirium/psychosis and no distinct MRI or CSF abnormalities (2) inflammatory CNS syndromes including encephalitis, acute disseminated encephalomyelitis with haemorrhage, necrosis or myelitis (3) ischaemic strokes associated with a prothrombotic state (4) peripheral neurological disorders including Guillain-Barré syndrome and (5) miscellaneous central disorders who did not fit the former categories (Paterson, Brown et al. 2020). The authors reported that “The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease”. This report follows the publication by other groups, between March and July 2020, of neurological complications that include encephalopathy (Helms, Kremer et al. 2020), meningo-encephalitis (Moriguchi, Harii et al. 2020), ischaemic stroke (Beyrouti, Adams et al. 2020), acute necrotizing encephalopathy (Poyiadji, Shahin et al. 2020), and Guillain-Barré Syndrome (Toscano, Palmerini et al. 2020). Moreover, cases of first episode of psychosis with psychopathology relating to COVID 19  have been reported (May 2020) for 2 women who presented to the National Institute of Mental Health and Neuro Sciences, an academic psychiatric centre in Bangalore, India (Chandra, Shiva et al. 2020). Both diagnosed with Acute Polymorphic Psychosis (ICD 10), these women presented vulnerability factors –stress, in particular, which emphasize the need to “understand the confluence of vulnerability and precipitating factors in the etiology of psychosis”. The importance of resilience to stress has been emphasized in a recent publication involving researchers of the Neurex network, Prof De Quervain^[1] and Prof Domschke^[2] (Vinkers, van Amelsvoort et al. 2020).

PP

[1] Division of Cognitive Neuroscience, Department of Psychology, Department of Medicine, University of Basel, Switzerland

[2] Dept. of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

How coronaviruses gain entry into the nervous system

Coronaviruses are neurotropic and potentially neurovirulent ... read more