ABSTRACT
Telephonebased mental health services have become available in Turkey in recent decades, including a suicide crisis intervention hotline administered by the Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, and remote substance abuse counseling services provided by the Ministry of Health and the Turkish Green Crescent Society (8,9). (32) identified 6 areas of ethical challenges for the delivery of remote mental healthcare: data security, privacy, and confidentiality;clinical safety of telepsychiatry recipients;competency and readiness of telepsychiatric practitioners;legal, regulatory, and financial concerns;informed consent for services;and social justice concerns. [...]we suggest that formal mental health care programs should include telepsychiatry training that includes competency in technical requirements, clinical assessment, communication strategies, the therapeutic relationship, consultation, liaison with other disciplines, ethical and legal aspects, and evaluation of the sociocultural characteristics of patients (36,37). Growth and success in telehealth has emerged as an unexpected silver lining of the COVID-19 pandemic and reminds us that it is critical to develop more effective mental health service delivery systems that can enhance treatment access and quality.
ABSTRACT
Cognitive impairment has recently attracted researchers as one of the possible neuropsychiatric manifestations of COVID-19, although how the infection perpetuates impairment of cognitive functions is still obscure. We presented a 29-year-old male patient with COVID-19 who developed new-onset transient attention deficit and memory problems following a SARS-CoV-2 infection. Structural neuroimaging was normal. MR-spectroscopy (MRS) of the bilateral DLPFC revealed significant for decreased levels of N-acetylaspartate (NAA), glutamate, and glutamate/glutamine ratio. After a follow-up without any medical treatment but with suggestions of memory exercises for three months a control MRS screening of DLPFC showed improved levels of NAA, glutamate, and glutamate/glutamine ratio. This report may suggest that cognitive deficits in SARS-CoV-2 infection can result from glutamatergic dysfunction with decreased NAA and glutamate levels in bilateral DLPFC.
Subject(s)
Aspartic Acid/analogs & derivatives , COVID-19/metabolism , Cognitive Dysfunction/metabolism , Glutamic Acid/metabolism , Prefrontal Cortex/metabolism , Adult , Aspartic Acid/metabolism , COVID-19/complications , COVID-19/diagnostic imaging , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/etiology , Humans , Magnetic Resonance Spectroscopy/methods , Male , Prefrontal Cortex/diagnostic imaging , Signal Transduction/physiologyABSTRACT
Despite neuropsychiatric outcomes of SARS-CoV-2 infection are now under close scrutiny, psychoneuroimmunological characteristics of COVID-19 and precise pathophysiology of neuropsychiatric manifestations of the infection are still obscure. Moreover, there still exists a shortfall in demonstrating specific clinical manifestations of the brain involvement of the virus. Here, we presented a 33-year-old female patient with COVID-19, reporting acute-onset paranoid delusions symptoms, insomnia and irritability. Cranial MRI showed an hyperintense signal in the splenium of the corpus callosum with decreased apparent diffusion coefficient, which might possibly indicate the presence of cytotoxic edema related to the brain involvement of the infection. Following the completion of SARS-CoV-2 treatment, both cytotoxic edema and psychiatric symptoms resolved. In light of this report, we suggest that either heightened immune response and direct viral infection that SARS-CoV-2 may lead to such psychiatric manifestations and neuropsychiatric monitoring should be performed in patients with COVID-19. Prompt recognition of psychiatric consequences of COVID-19 may help clinicians provide guidance for differential diagnosis and manage them accordingly.