Tryptophan catabolites, inflammation, and insulin resistance as determinants of chronic fatigue syndrome and affective symptoms in long COVID.

Critical COVID-19 disease is accompanied by depletion of plasma tryptophan (TRY) and increases in indoleamine-dioxygenase (IDO)-stimulated production of neuroactive tryptophan catabolites (TRYCATs), including kynurenine (KYN). The TRYCAT pathway has not been studied extensively in association with the physiosomatic and affective symptoms of Long COVID. In the present study, we measured serum TRY, TRYCATs, insulin resistance (using the Homeostatic Model Assessment Index 2-insulin resistance, HOMA2-IR), C-reactive protein (CRP), physiosomatic, depression, and anxiety symptoms in 90 Long COVID patients, 3-10 months after remission of acute infection. We were able to construct an endophenotypic class of severe Long COVID (22% of the patients) with very low TRY and oxygen saturation (SpO2, during acute infection), increased kynurenine, KYN/TRY ratio, CRP, and very high ratings on all symptom domains. One factor could be extracted from physiosomatic symptoms (including chronic fatigue-fibromyalgia), depression, and anxiety symptoms, indicating that all domains are manifestations of the common physio-affective phenome. Three Long COVID biomarkers (CRP, KYN/TRY, and IR) explained around 40% of the variance in the physio-affective phenome. The latter and the KYN/TRY ratio were significantly predicted by peak body temperature (PBT) and lowered SpO2 during acute infection. One validated latent vector could be extracted from the three symptom domains and a composite based on CRP, KYN/TRY, and IR (Long COVID), and PBT and SpO2 (acute COVID-19). In conclusion, the physio-affective phenome of Long COVID is a manifestation of inflammatory responses during acute and Long COVID, and lowered plasma tryptophan and increased kynurenine may contribute to these effects.

Social Interpretation Inflexibility and Functioning: Associations with Symptoms and Stress

Introduction: Interpretation inflexibility has been implicated in a range of mental health problems, including depression, social anxiety, and paranoia. Inflexible interpretation of social situations may be particularly important as it can set the stage for problems in social functioning, a symptom cutting across all three groups of disorders. Methods: This study aimed to examine the interrelations among interpretation inflexibility, social functioning impairment, and affective and psychotic symptoms. The study also explored the potential moderating effects of COVID-related preoccupation, as an example of a major stressor, on these relationships. Results: Based on a sample recruited from the general population (N = 247), interpretation inflexibility was found to be associated with social functioning impairment, with affective symptoms and paranoia as statistical mediators of the association. These relationships were magnified by ambient stress during the COVID-19 pandemic-a moderated mediation that was found only in relation to affective symptoms but not paranoia. A parallel network analysis further confirmed the moderating effects of COVID-related preoccupation on the relation between interpretation inflexibility and depression. Limitations: Measuring ambient stress with a self-report question on COVID-related preoccupation may not be representative of the amount of distress an individual experienced during the pandemic. Also, our mediation models were performed on cross-sectional data, thus not necessarily implying a feed-forward causal mediational relationship. Conclusions: These findings highlight the importance of examining social functioning as a crucial outcome, as well as the differential role of stress in modulating social interpretation flexibility with respect to affective vs. psychotic symptoms.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity.

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Anxiety and Depression during the Second Wave of the COVID-19 Pandemic: The Role of Coping Strategies.

BACKGROUND: Evidence suggests increased anxious-depressive symptoms in the general population during the COVID-19 pandemic, also in its second wave. High symptom variability across individuals suggests that risk and protective factors, including coping strategies, can play a mediating role. METHODS: General Anxiety Disorder-7, Patient Health Questionnaire-9, and Brief-COPE questionnaires were administered to people attending a COVID-19 point-of-care. Univariate and multivariate methods were used to test the association of symptoms with risk and protective factors. RESULTS: A total of 3509 participants (27.5% with moderate-severe anxiety; 12% with depressive symptoms) were recruited. Sociodemographic and lifestyle factors, including age, sex, sleep, physical activity, psychiatric treatments, parenthood, employment, and religiosity were associated with affective symptoms. Avoidant (self-distraction, venting, behavioral disengagement) and approach (emotional support, self-blame but not positive reframing and acceptance) coping strategies predicted greater anxiety. Avoidant strategies, including venting, denial, behavioral disengagement, substance use, and self-blame, and the humor strategy were associated with more severe depressive symptoms, while the planning predicted the opposite. CONCLUSIONS: Coping strategies, in addition to socio-demographic and life-habit factors, could have contributed to modulating anxious and depressive symptoms during the second-wave of the COVID-19 pandemic, thus advocating for interventions aimed at promoting positive coping strategies to reduce the psychosocial toll of the pandemic.

The relationship between health worry, work distress, and affective symptoms during the COVID-19 pandemic: The mediating role of hopelessness and helplessness.

OBJECTIVES: The COVID-19 pandemic presented both serious health threats and economic hardships, which were reflected in increased rates of mood and anxiety symptoms. We examined two separate distress domains, health worries and work distress, as predictors of mood and anxiety symptoms. Additionally, we considered whether these two domains might be uniquely associated with the development of dysfunctional beliefs, as a proposed mechanism to account for increased symptoms during the pandemic. Two separate models were considered to examine if associations remained stable through the first year of the pandemic. METHODS: Participants (N = 2152) were a representative sample of Florida adults. They completed online surveys at three waves: Wave 1 (April-May 2020), Wave 2 (May-June 2020), and Wave 3 (December-February 2021). Participants completed measures of COVID-19 health worry and work distress, anxiety, and depression. They also reported their level of hopelessness and helplessness (indices of dysfunctional beliefs). RESULTS: In an early pandemic model (Wave 1-Wave 2), health worry directly and indirectly predicted anxiety and depression via dysfunctional beliefs. In contrast, work distress only indirectly predicted both outcomes. In a longer-term model (Wave 2-Wave 3), health worry had direct and indirect effects on downstream anxiety but not depression. Pandemic work distress had no effect on depression or dysfunctional beliefs; however, it was associated with less anxiety. CONCLUSIONS: Although health worry and work distress predicted later symptoms of anxiety and depression, they appeared to operate through different pathways. These findings provide guidance for the development of more effective interventions to reduce the impact of pandemics.

Alexithymia phenomenology in psychology: innovative explanatory-functional psychological paradigm

INTRODUCTION: Alexithymia brings negative consequences on the psycho-emotional well-being and health of an individual. This narrative review attempted to explore previous research at the objective to advance understanding of psychological essence and genesis on this phenomenon. EVIDENCE ACQUISITION: On the research topic, Web of Science, Scopus, PsycInfo and PubMed original articles, dissertations and monographs were found to be included in the overview (totally, 109 publications). We presented an analysis of numerous investigations and review works with the aim to fill the existing large gap in the psychological explanation of the emergence and functioning of alexithymia. EVIDENCE SYNTHESIS: The truth is that alexithymia is still predominantly studied at the clinical-medical level. Namely, psychological roots are not considered in research or reviews at all, and no consensus on alexithymia psychological origin exists. Evidence indicated that whilst the existing research findings establish multisided relationships between alexithymia and various risk-factors, extremely little is known about its psychological origin and mechanism. CONCLUSION(S): The present overview is the first attempt to elucidate psychological essence and genesis of alexithymic symptoms and delve into presenting a disclosure and adequate explanation of the psychological mechanism of alexithymia functioning. Moreover, for the first time an innovative definition of alexithymia is given within the framework of the explanatory-functional psychological paradigm. This article is a narrative review with less rigorous methodology;nevertheless, it is useful for coherent detailed highlighting the problem posed and in cases when too much research from different scientific fields and directions is analyzed. Copyright © 2022 Edizioni Minerva Medica. All right reserved.

Study of mental health of medical staff in a specialized hospital for COVID-19 in Novi Sad

Introduction: The highly infectious novel coronavirus disease (COVID-19) emerged in Wuhan, China in late 2019 and soon became a global pandemic. COVID-19 is escalating medical staff psychological stress and creating an increasingly heavy professional burden. Fear of transmitting the virus to family, community perception of frontline workers as potential disease carriers, extreme workloads and moral dilemmas add additional stressors. In Novi Sad Clinical Centre of Vojvodina (CCV) for the past 2 years there has been a continuous struggle against the COVID-19 crisis. Both senior specialist doctors and newly hired young doctors, some without work experience, were hired immediately after completing their studies. Objective(s): To investigate the mental health of clinical first-line medical staff in COVID-19 pandemic. Method(s): This is a cross-sectional study involving CCV staff who worked in the first line of patient treatment during the COVID-19 pandemic. They were given a self-administered questionnaire which included information on demographic and socio-economic characteristics and the validated Depression, Anxiety, and Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. A total of 190 medical workers were involved. Result(s): Sixty-two (32,6%) participants screened positive for anxiety, 38 (20%) for depression, 68 (35,8%) for stress, and 22 (11,5%) for clinical concern of PTSD. The most endangered are young nurses and doctors with less than 6 months of previous work experience. Conclusion(s): In conclusion, our results suggest frontline medical staff involved in treatment of COVID-19 patients should be closely monitored as a high-risk group for depression and anxiety, and given proper training before deployment.

The associations of long-COVID symptoms, clinical characteristics and affective psychological constructs in a non-hospitalized cohort.

Objective: The effects of COVID-19, especially long-COVID, on the psychological health is incompletely understood. We aimed to evaluate the mid-term associations of the long-COVID symptoms and affective factors in a cohort of non-hospitalized patients. Method: A total of 166 patients were enrolled in this study, including 119 sedentary/non-athlete and 47 athlete subjects at the Post-COVID Outpatient Clinic of Semmelweis University. Clinical data regarding acute and long-term symptoms were obtained and detailed laboratory testing was carried out. Demographic data and psychological tests were collected. Results: We found a positive association between the level of depressive symptoms and anxiety and long-COVID symptom count, while life satisfaction and social support correlated negatively with the long-COVID symptom count. Higher haemoglobin levels and lower LDL-cholesterol were also shown to be moderating factors. A regression model showed that symptoms during acute infection, depression, age, and life satisfaction are predictors of the long-COVID symptom count. The presence of pre-existing affective or anxiety problems was also associated with higher reported long-COVID symptom count. Furthermore, we found significant association between pre-existing mental health problems and the investigated psychological constructs. Conclusion: It appears that long COVID-19 is associated with acute symptoms and mental factors. Depression and anxiety have been shown to have a negative effect on symptom perception, and also contribute to a higher number of symptoms in a non-hospitalized sample. Our study suggests bi-directional interconnection between clinical and psychological factors.

Eastern Mediterranean Health Journal [2021;Vol.27, Issue 12]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services;and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

The Impact of the COVID-19 Pandemic on the Mental Health of the General Population and the Population of Psychiatric Patients

Background: Data on the psychological consequences of social isolation imposed by the global public health threat of the COVID-19 pandemic are limited. Mentally healthy people and psychiatric patients react to stress in different ways. Goal: To examine the impact of the COVID-19 pandemic on the mental health of the general population and the population of psychiatric patients in Vojvodina. Material and Methods: The study is designed as a cross-sectional study. It was conducted during April, May and June 2020 at the end and immediately after the first wave of the COVID-19 epidemic in Serbia on the territory of Novi Sad. Participants were divided into two groups - a clinical group of patients with mental disorders and a control group composed of the healthy volunteers. A self-assessment questionnaire was used to collect data on the presence of anxiety and symptoms of depression and behavioral disorders that indicate increased levels of stress - such as insomnia, sedative abuse. Results: Anxiety, fear, panic attacks (50%), depressive symptoms (42%), sleep problems (30%) and sedative abuse (25%) were the most commonly reported psychiatric symptoms. Healthy subjects did not show a statistically significant presence of any symptoms and signs associated with mental problems. Conclusion: The results support the negative impact of the COVID-19 pandemic on the mental health of psychiatric patients. It can be expected that the most pronounced effects of the pandemic on mental health in the general population will be visible in the future.

The Impact of COVID-19 on HIV Self-Management, Affective Symptoms, and Stress in People Living with HIV in the United States.

COVID-19 has the potential to detrimentally impact HIV self-management in people living with HIV (PLHIV). Effective HIV-self management is critically important in managing symptoms as well as viral suppression. We examined the impact of the COVID-19 pandemic on HIV self-management, social support, social isolation, depressive symptoms, anxiety, and stress in PLHIV. 85 PLHIV were recruited from social media sites and completed an online survey. Data were collected between April 23 and 30, 2020. Participants reported increases in social isolation, depressive symptoms, anxiety, and stress and decreases in social support and overall HIV self-management from pre- to during the pandemic. Additionally, the Social Support domain and Chronic Nature of HIV domain of the HIV Self-Management Scale were also decreased from pre- to during the pandemic. The ability for PLHIV to maintain HIV self-management during this time is essential and HIV care providers should have plans in place to provide support.