COVID-19 and the developing brain

As of June 2022, children represent 18.9% of total cumulated cases of COVID-19 in the United States. While most children have mild symptoms, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the central and peripheral nervous system function. The most common neurological symptoms in children with COVID-19 are headache, fatigue, anosmia, dysgeusia, and myalgia. In hospitalized children, the most common symptoms are headache, encephalopathy, and seizures. Neurological symptoms are associated with a more severe disease course, and up to a third of hospitalized children with COVID-19 require intensive care intervention. A rare and feared complication is multisystem inflammatory syndrome (MIS-C), a serious condition that involves severe inflammation of different organs, including the brain. Treatment for MIS-C has not been validated and primarily consists of supportive care and immune modulation. Some children with a history of COVID-19 develop persistent symptoms, also known as long COVID. However, recent evidence suggests that long COVID symptoms appear as frequently as in children without a history of COVID-19. Similarly, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2, is associated with differences in neurodevelopmental milestones. Almost 3years into the pandemic, the evidence in children is limited. Large-scale studies with adequate pre- and post-pandemic control groups are needed to establish the associations between COVID-19 and short and long-term neurological complications. © 2023 Elsevier Inc. All rights reserved

Neuropsychiatric side of the COVID-19

The latest data shows the wide spectrum of various neuropsychiatric manifestations of COVID-19 often persisting after its acute phase. Neuropsychiatric complications of COVID-19 include various neural impairments (fatigue, headache, dizziness, anxiety, cognitive dysfunction, sleep and mood disturbances, muscle soreness, stroke, seizures, encephalitis, ataxia, myelitis, anosmia, ageusia, Guillain-Barré syndrome, and Miller Fisher syndrome) as the development of a full clinical picture of psychiatric diseases (psychotic, anxiety, and affective spectrum). Symptoms of post-COVID syndrome may persist even a year after discharge and are associated with a high risk of suicidal behavior in virus survivors. Currently, possible mechanisms of COVID-19 effect on the central nervous system include indirect (cytokine storm, hypoxia, acute respiratory distress syndrome, neuroinflammation, postinfection autoimmunity) and possible direct COVID-19-induced neuronal/vascular damage (including direct PAMP-like effect of SARS-CoV-2 components on Toll-like receptors of glia). Autoimmune and immunopathological links of COVID-19 pathogenesis also may play a role in its neuropsychiatric complications. COVID-19 is known for high rates of morbidity and mortality. Early recognition of neuropsychiatric manifestations, adequate treatment, and long-term follow-up are needed to provide efficient patient care. © 2023 Elsevier Inc. All rights reserved.

Psychiatric and neuropsychiatric issues in persons with COVID-19 infection: A case-control online study from India-Neorealist study.

Background: Many studies across the globe have evaluated the adverse mental health consequences of COVID-19 in patients who suffered from COVID-19 infection. However, a comparative study of persons who suffered from COVID-19 infection and those who witnessed the COVID-19 infection in their close relatives is lacking. Aims and Objectives: This study aims to compare the psychiatric morbidity in persons who suffered from COVID-19 infections, and those who witnessed the illness in one of their close relatives. Methods: In this cross-sectional online survey, 2,964 adult participants completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) Scale, Fear of COVID-19 Scale (FCS-19), Brief Resilient Coping Scale (BRCS), The Brief Resilience Scale (BRS) and a self-designed questionnaire to evaluate other neuropsychiatric complications. Results: Compared to the close relatives who had witnessed COVID-19 infection, participants who developed COVID-19 infection had a significantly higher prevalence of depression (34.6%), anxiety disorder (32.3%), and fear of COVID-19 infection (18.8%), which was significantly higher than that noted in close relatives. However, BRS coping score was not significantly different between the two groups. Overall, about one-third of the participants who developed COVID-19 infection had depression and one-third had anxiety disorders. One-fifth of the participants reported high fear, post-traumatic symptoms, and obsessive-compulsive symptoms, whereas one-sixth reported other neuropsychiatric manifestations. Conclusion: Patients who suffered from COVID-19 have a higher prevalence of depression, anxiety, and fear as compared to those to witnessed COVID-19 in relatives.

Association between COVID-19 and catatonia manifestation in two adolescents in Central Asia: Incidental findings or cause for alarm?

Catatonia is a rare neuropsychiatric syndrome that can accompany various medical conditions, including schizophrenia, autoimmune encephalitis, and infectious diseases. We present two cases of catatonia in males aged 12 and 17 years from Central Asia who tested positive for SARS-Cov-2 antibodies. Detailed medical assessments declined other potential precipitating factors, including schizophrenia or anti-NMDA receptor autoimmune encephalitis. FDG-PET in the younger patient demonstrated focal hypometabolism in left frontotemporal and right associative visual cortex, matching patterns previously seen in adults with catatonia. These isolated findings raise concerns about a possible causal relationship between COVID-19 infection and risk of catatonia manifestation in adolescents.

Neurological, neuropsychiatric and neurodevelopmental complications of COVID-19.

Although COVID-19 is predominantly a respiratory disease, it is known to affect multiple organ systems. In this article, we highlight the impact of SARS-CoV-2 (the coronavirus causing COVID-19) on the central nervous system as there is an urgent need to understand the longitudinal impacts of COVID-19 on brain function, behaviour and cognition. Furthermore, we address the possibility of intergenerational impacts of COVID-19 on the brain, potentially via both maternal and paternal routes. Evidence from preclinical models of earlier coronaviruses has shown direct viral infiltration across the blood-brain barrier and indirect secondary effects due to other organ pathology and inflammation. In the most severely ill patients with pneumonia requiring intensive care, there appears to be additional severe inflammatory response and associated thrombophilia with widespread organ damage, including the brain. Maternal viral (and other) infections during pregnancy can affect the offspring, with greater incidence of neurodevelopmental disorders, such as autism, schizophrenia and epilepsy. Available reports suggest possible vertical transmission of SARS-CoV-2, although longitudinal cohort studies of such offspring are needed. The impact of paternal infection on the offspring and intergenerational effects should also be considered. Research targeted at mechanistic insights into all aspects of pathogenesis, including neurological, neuropsychiatric and haematological systems alongside pulmonary pathology, will be critical in informing future therapeutic approaches. With these future challenges in mind, we highlight the importance of national and international collaborative efforts to gather the required clinical and preclinical data to effectively address the possible long-term sequelae of this global pandemic, particularly with respect to the brain and mental health.