After a SARS-CoV-2 infection, many suffered considerable psychiatric and neurological morbidities for 6 months, especially in the seriously ill. These results of a retrospective cohort study were published in Lancet Psychiatry.
Oxford University researchers analyzed data from the TriNetX Analytics Network, including electronic health records from 81 million patients, collected primarily in the United States. Patients (n = 236,379) with a confirmed COVID-19 diagnosis and 2 incline-adjusted control cohorts of patients with another respiratory infection (n = 236,038) and influenza (n = 105,579) were screened for 24 psychiatric and neurological disorders for up to 180 days.
Patients with COVID-19 averaged 46 years old (standard deviation) [SD], 19.7) years, 55.6% were women and 57.2% were white. Most of the patients were not hospitalized (n = 190,077), 46,302 were admitted to the standard clinic, 8945 were admitted to the intensive care unit (ICU), and 6229 had encephalopathy.
After 6 months, psychiatric and neurological outcomes were observed in 33.62% (95% CI, 33.17% -34.07%) of patients with COVID-19. The patients admitted to the intensive care unit (46.42%; 95% CI, 44.78% -48.09%) or had encephalopathy (62.34%; 95% CI, 60.14% -64, 55%), had increased rates of psychiatric and neurological outcomes.
Compared to other respiratory infections, patients with COVID-19 were at an increased risk of developing all psychiatric and neurological outcomes except for the substance use disorder, with a risk of myoneural junction or muscle disease (hazard ratio) more than two-fold higher [HR]4.52; 95% CI, 1.42-1.55; P <0.0001) and Guillain-Barré syndrome (HR 2.06; 95% CI 1.43-2.96; P <0.0001).
Compared to influenza, patients with SARS-CoV-2 were at an increased risk of developing all outcomes except for Guillain-Barré syndrome and parkinsonism. The patients with COVID-19 had a more than 2-fold increased risk of myoneural junction or muscle diseases (HR 5.28; 95% CI 3.71-7.53; P <0.0001), first intracranial bleeding (HR 2 , 53; 95%) CI 1.68-3.79; P <0.0001), any intracranial hemorrhage (HR 2.44; 95% CI 1.89-3.16; P <0.0001), dementia (HR 2.33; 95% CI 1.77-3, 07; P <) 0.0001), first psychotic disorder (HR 2.16; 95% CI 1.62-2.88; P <0.0001) and any psychotic disorder (HR 2.03; 95% CI 1 , 78-2.31; P <0.0001).
In patients with COVID-19, those admitted to the intensive care unit were at increased risk for many of the psychiatric and neurological sequelae, particularly myoneural junction or muscle disease (HR 11.53; 95% CI 6.38-20.83; P <0.0001). and Guillain-Barré syndrome (HR 11.01; 95% CI 2.55-47.61; P = 0.0007). Similarly, when compared to patients not hospitalized for COVID-19, hospitalization increased the risk of the majority of diseases, particularly myoneural junction or muscle disease (HR 7.76; 95% CI 5.15-11 , 69; P <0.0001).
This study may have been limited by the scarce family history data of psychiatric and neurological disorders and there was no explanation for the predisposition.
These data showed that after 6 months, psychiatric and neurological sequelae persisted in a third of people with COVID-19, and that rate increased in patients hospitalized or admitted to intensive care.
Jonathan Rogers, MD
We spoke to Jonathan Rogers, MD, who wrote a commentary article (A Longer Look at COVID-19 and Neuropsychiatric Outcomes) about the study published in Lancet Psychiatry on April 6, 2021. Dr. Rogers, from the Department of Psychiatry at University College London, also works for the Maudsley NHS Foundation Trust in London, UK.
Dr. Rogers: “Research into the neuropsychiatric outcomes of COVID-19 has moved from single case reports in the early stages of the pandemic to case series and then to more robust epidemiological studies. This study, using real-world data from the electronic health records of more than 80 million people, marks the next level in COVID-19 research. It enables us to see the potential of COVID-19, not only during infection, but also within Communicate with neuropsychiatric symptoms in the following months.
The good news is that some of the concerns about the early pandemic of high rates of Guillain-Barré syndrome or recurrence of lethargic encephalitis have not yet been confirmed. However, this research suggests that COVID-19 is subsequently associated with a high rate of more common mental disorders. It also suggests a link with emerging psychosis and dementia, which is very worrying given the longitudinal course of these disorders.
Now that we have identified the neuropsychiatric risks of COVID-19 infection, research needs to be mobilized quickly to develop studies on pharmacological and psychological treatments. “
Taquet M, Geddes JR, Husain M, Luciano S., Harrison PJ. 6-month neurological and psychiatric outcomes in 236,379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. Published online April 6, 2021. doi: 10.1016 / S2215-0366 (21) 00084-5.
Rogers JP, David AS. A longer look at COVID-19 and neuropsychiatric outcomes. Lancet Psychiatry. Published online April 6, 2021. doi: 10.1016 / S2215-0366 (21) 00120-6
This article originally appeared on Psychiatry Advisor