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Background/Purpose: Pediatric Acute Lymphoblastic Leukemia (ALL) affects ~4000 young Americans each year. Steroids are essential to curative ALL treatment yet have significant neuropsychiatric side effects that decrease quality of life for patients and families. However, incidence and predisposing risk factors are not well understood. This review aims to describe the current literature on neuropsychiatric side effects of steroids in Pediatric ALL. Method(s): A precise search in PubMed and Embase was cultivated using controlled vocabulary terms (MeSH, Emtree) and keywords for the following concepts: pediatrics, steroids, side effects, cancer, and neurobehavioral manifestations. Keywords and controlled vocabulary for each subject were arranged logically and combined with other concepts by Boolean Logic, using the Boolean operator AND, resulting in 642 precise results exploring neurobehavioral side effects of steroids in children with cancer. Results (2010 to date of search) were imported into Covidence systematic review software, and reviewed by SB and AM. Result(s): Twenty-three articles met inclusion criteria. There is marked variability in research methodology and no standard measurement of neuropsychiatric symptoms. Commonly reported symptoms include mood swings, irritability, depression, anxiety, aggression, insomnia, mania, and psychosis with prevalence between 5% and 75%. Heterogeneous research methodology and descriptions of psychiatric symptoms make it difficult to determine risk factors, though dexamethasone, family psychiatric history, and younger age are consistently associated with greater risk of behavioral dysregulation. Genetic predisposition (Bcl1 polymorphism, SNPs in GR gene) may increase susceptibility to developing depression during treatment. Data suggest variable efficacy of antipsychotics, benzodiazepines, hydrocortisone, and potassium-chloride. Conclusions and Implications: Existing data about neuropsychiatric side effects of steroids in pediatric ALL is extremely heterogeneous, creating challenges for standardized assessment and treatment. The burden of these symptoms necessitates further research to identify and treat vulnerable patients. Standard measurement of these symptoms could be a first step in eventually alleviating this source of distress.
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Objective: To explore the safety of chloroquine phosphate treatment in patients with novel coronavirus pneumonia (COVID-19) and provide references for clinical safety medication. Method(s): Active monitoring for adverse events (AE) was carried out in the Third People's Hospital of Shenzhen from February to March 2020 during the treatment with chloroquine phosphate in patients with COVID-19. The causal relationship between AE and chloroquine phosphate was evaluated. Result(s): A total of 33 patients were entered in the study, including 16 males and 17 females, aged (43+/-13) years. The clinical types of COVID-19 in 26 patients (78.8%) were mild, in 7 patients (21.2%) were common. There were 7 patients (21.2%) with basic diseases, including 6 with hypertension and 1 with hypothyroidism. The treatment course of chloroquine phosphate was (8+/-3) days. During the treatment, a total of 28 cases of AE in 24 (72.7%) of the 33 patients which were probably or possibly related to chloroquine phosphate were detected. The clinical manifestations of AE included abnormal liver function (8/33, 24.2%), gastrointestinal reactions (8/33, 24.2%), neuropsychiatric system reactions (8/33, 24.2%), cardiovascular system reactions (5/33, 15.2%), eye and vision abnormality (2/33, 6.1%), and skin injury (1/33, 3.0%). The severity of AE was grade 1 or grade 2. After drug withdrawal or symptomatic treatments, all the patients' symptoms were improved and the laboratory tests results returned to normal. Conclusion(s): The adverse effects of chloroquine phosphate in the treatment of patients with COVID-19 are mild, but it is still necessary to strengthen the monitoring.Copyright © 2020 by the Chinese Medical Association.
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Background: India was one of the worst affected countries during the second wave of COVID-19 infection. The pandemic brought in a multitude of psychological problems leading to a negative impact on the mental health of affected individuals. Several studies across the globe have assessed the psychological impact of this pandemic in general and vulnerable populations with a scanty data in the assessment of those found positive for this condition. Material(s) and Method(s): This was a cross-sectional, descriptive and observational study conducted at a tertiary health care centre involved in the management of COVID-19 cases. Cases were assessed using a semi structured proforma for socio demographic and clinical details, Impact of Events Scale Revised (IES-R) and Patient Health Questionnaire- 9 S6(PHQ-9) to assess psychological impact. Descriptive and inferential statistics were used for data analysis. Result(s): A total of 60 individuals participated in the study. The mean age of the participants was 50.8 +/- 14.10 years, with a majority of males (65%). More than half (53%) of the individuals had minimal severity on IES-R while about 9% showed moderate to severe levels. About 32% had minimal depression while 25% had moderately severe or severe depression on PHQ-9 score. A significant positive correlation was observed between number of deaths due to COVID-19 infection in the family and IES-R scores. Conclusion(s): Higher levels of stress and depression were found among those found positive for COVID-19. This highlights the need for early assessment of psychological problems and timely intervention to avoid long term psychiatric sequelae to those affected by COVID-19 infection.
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The coronavirus pandemic of 2019 has resulted in extensive social regulations and affected many aspects of life. It has led to significant stress and adversely impacted mental health across the globe. The virus has been found to directly increase neuropsychiatric sequelae in those affected. Various psychosocial factors have also increased the incidence and prevalence of mental health problems worldwide. There was a need for a ramp-up of psychiatric services to support individuals in such a situation. Even after the pandemic, there is a need for improving access to mental health services for the mentally ill as well as those affected by the regulations brought about to tackle the pandemic. Telepsychiatric services are in place throughout the world in different forms and are the answer to bridging the mental health gap during and in the aftermath of the pandemic. Hence, it is important to continue developing and enhancing tele psychiatric services in different countries for supporting and treating individuals affected by the pandemic.Copyright © 2023 Bentham Science Publishers.
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Introduction: There are few reports of the effect of the COVID-19 pandemic, and subsequent lockdown, on the everyday lives of people affected by stroke. Method(s): We present a narrative of experiences of people participating in the Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) stroke study, an ongoing UK-wide, observational study of cognitive, physical and neuropsychiatric complications after stroke. Participants were recruited up to a year prior to or during the outbreak, and were in follow-up during introduction of the UK social distancing measures. During participants' 1- year follow-up we performed standardized assessments, including free text responses regarding experiences of the pandemic, encompassing many aspects of healthcare including cognition, mood and anxiety. Result(s): In our study of over 2000 stroke survivors from across the UK, we found that the COVID-19 pandemic has had an adverse effect on health, including poorer mental health and wellbeing, feelings of loneliness, poorer health related behaviours and disengagement with, or lack of access to, health services, including rehabilitation. This was most evident between March and May 2020, during which time 1 in 3 patients spontaneously reported negative effects of the pandemic during telephone followups. After the national roll out of the vaccine, participants reported barriers to resuming community activities and hesitancy and anxiety regarding the transition from self-isolation to "normal life". Conclusion(s): The pandemic has caused significant challenges for stroke survivors and their families, which, unless addressed, are likely to have substantial physical and mental health consequences, which will impact significantly on stroke survivors' recovery.
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Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neu-ropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objective(s): This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Method(s): This prospective observational study included admitted children and adolescents (4-18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Result(s): Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 +/- 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and op-positional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusion(s): The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.Copyright © 2023, Author(s).
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Background: While more than a year has passed since the COVID-19 outbreak, it is still a growing health concern. Moreover, ample consensus exists for the presence of not only a physical but also a psychological impact of the COVID-19 pandemic. Those reported as hardest hit were individuals who had been infected with COVID-19. Survivors have exhibited a higher prevalence of psychological morbidity i.e., PTSD, depression, and anxiety-as compared with the general population and health workers. Additionally, COVID-19 patients and survivors have been psychologically impacted by a staggering number of disease-related stressors. Objective(s): The study was aimed at analyzing COVID-19's impact on the psychological state of Argentinian disease survivors. Method(s): Two hundred and ninety-six COVID-19 survivors (67.2% female;Mage = 44.81;SDage = 12.16) from a major Buenos Aires hospital completed a questionnaire and a set of psychological measures-COVID-19 emotional impact, psychological sequelae, disease-related stressors, PTSD, and psychological distress. Result(s): The most impactful psychological sequelae and disease stressors revolved around having the disease awaiting test results, fear of infecting loved ones, being apart from family and friends during the disease, fear of physical sequelae and symptoms, and returning to isolation. PTSD prevalence rates were 33.8%. Survivor's psychological distress levels were moderately higher than pre-COVID-era general population levels, yet not significantly different from preCOVID-era clinical inpatients. Female gender, age, and hospital admission emerged as significant predictors of increased adverse psychological outcomes. Conclusion(s): Intervention for COVID-19 survivors is urgently needed, with particular attention to the alarming PTSD prevalence rates, as discussed in the study.Copyright © 2023 Bentham Science Publishers.
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In December 2019, the novel coronavirus strain SARS-CoV-2 caused an outbreak that quickly spread worldwide and led to the COVID-19 pandemic. COVID-19, the severe infectious disease caused by SARS-CoV-2, often presents with symptoms including fever, cough, and mental confusion and can cause the acute respiratory inflammatory disorder. Additionally, viral infection with SARS-CoV-2 is associated with mental health, neuronal degeneration, and psychiatric complications. With infection by the virus, cytokines are released by immune cells, causing acute systemic inflammation affecting the lungs. Lung damage can occur, resulting in hypoxia, brain damage, and mental health dysfunction. In addition, a cascade of inflammatory cytokines, including IL-1, IL-6, and TNF, are released, a phenomenon termed the "cytokine storm" that causes serious pathological damage to tissues and organs and mental health. This exaggerated production of cytokines leads to lymphopenia and disrupts the balance of Treg and Th17 cells, weakening the immune system. The elderly population is particularly at risk for damage associated with the "cytokine storm", which can affect neurological functions or result in death. Copyright © by BIOLIFE.
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Background: Post-intensive care syndrome (PICS) affects up to half of ICU patients and comprises neuromuscular, cognitive, and psychiatric impairments that persist up to years after discharge (Inoue, 2019). PICS is often overlooked and under-diagnosed (Rawal, 2017), without clear evidence-based strategies for management. Data supporting interventions for symptoms of anxiety, depression, and post-traumatic stress after discharge is limited (Needham, 2012). Developing high-quality, evidence-based interventions for PICS would address this critical need. Methods: Shortly before discharge, patients are recruited from our neurological ICU who have been intubated for at least 24 hours and score 24–32 on the Impact of Event Scale - Revised (which indicates likely PTSD symptoms without a true diagnosis). Baseline Beck Depression Index and Telephone Interview for Cognitive Status questionnaires are also administered to each patient. Participants are then randomly assigned either to a virtual reality exposure therapy intervention or to a control group that receives no therapeutic intervention. VRET patients are given an online 360° video of an ICU room from the perspective of an intubated patient, complete with sounds and simulated clinical scenarios (rounds, intubation, suctioning, etc.). Intervention patients have unlimited access to the videos for six months, beginning one month after discharge. Follow-up IES-R, BDI, and TICS are administered at 1, 3, and 6 months to both groups. Results/Discussion: Our IRB approved this study in March 2021. Enrollment has begun with 3–5 feasibility patients, to be followed by 30 randomized patients starting in November. Our poster features a case discussion on our first patient's experiences with VRET. Given the novelty of remote VRET for post-ICU PTSD symptoms, our results will be an important contribution with the potential to change practice. Conclusion: This will be the first remote intervention for neuropsychiatric symptoms of PICS, and has far-reaching implications for inpatient and outpatient CL psychiatrists — particularly at a time when patients have grown increasingly accustomed to virtual interventions, and when ICU survivors have multiplied due to COVID-19. Should our VRET prove successful, it will open the eyes of intensivists and CL psychiatrists to a whole realm of remote, efficient, and accessible virtual reality therapies for patients who have undergone acute care. This will improve long-term outcomes, particularly for patients who may have difficulty seeing an outpatient psychiatrist or taking medications consistently. Finally, our study will help to raise awareness of the psychiatric sequelae of acute illness, and so enhance inpatient collaboration between psychiatry and many other specialties. References: 1. Inoue S et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;(3):233-246. 2. Needham DM et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502-9. 3. Rawal G et al. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017;5(2):90-92.
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Background: The neurobiology of depression can be heterogeneous with multiple hypotheses proposed, including serotonin and neuroinflammatory pathways, each falling short of explaining the complete picture. Several reports describe the increased frequency of depression in the community following the COVID-19 pandemic and reports about neuropsychiatric sequela of the virus are emerging and the possible role of neuroinflammation. We present a patient who developed severe depression with psychotic features subsequent to his COVID-19 infection and was treated successfully with ECT following several failed medication trials. Case: A 49-year-old male with a past medical history of type II diabetes, hyperlipidemia, hypertension, chronic kidney disease, and gastroesophageal reflux disease was diagnosed with COVID-19 in January 2021. Upon initial diagnosis, neither admission nor treatment with steroids was required. He presented to the emergency department four days later with sepsis, pneumonia, and AKI secondary to COVID-19 along with the new onset of suicidal ideations with plans to cut himself and significant psychomotor features despite no previous history of mental illness or treatment. His EEG showed diffuse slow waves, consistent with encephalopathy, but no delirium was noted. He exhibited irritability, anger, anhedonia, negativism, and isolated himself in his room. He demonstrated delusional fear about his apartment exploding due to electricity disconnected for not paying his bills. He misinterpreted the blood draws as someone suspecting he has HIV. Treatment started on the medical floor and he was later transferred to the psychiatric floor. Several psychotropic medications were tried separately including citalopram 20mg, escitalopram 20mg, and bupropion (titrated to 300mg) with the addition of aripiprazole 5 mg without improvement. ECT was considered and his depression and psychosis improved following 6 treatments of bilateral ECT. He was discharged following completion of 10 ECT treatments on 300 mg of bupropion daily and 5mg olanzapine at night. Discussion: Viral infections such as HIV, Hepatitis C, and Influenza are associated with neuropsychiatric sequelae, including depression. COVID-19 infection is occasionally associated with ‘cytokine storm’ which may exacerbate neuroinflammation via increases in cytokines and possible activation of mast cells and microglia.[1] The role of elevated pro-inflammatory cytokines and glucocorticoid receptor resistance is widely studied. Interleukin-6 and CRP are the most strongly linked to depression with a high correlation for anhedonia and psychomotor retardation, prominent features of depression in our case, hinting at a possible role of neuroinflammation. [2] Psychotic features and psychomotor retardation are predictors of ECT response which matched the response to ECT in this case. References: 1. Kempuraj, Duraisamy, et al. COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist 2020: 402-414. 2. Tiemeier, Henning, et al. Inflammatory proteins and depression in the elderly. Epidemiology 2003: 103-107.
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Background: The University of Colorado (UCH) Consultation-Liaison Psychiatry (CLP) service and Psychiatric Consultation for the Medically Complex clinic (PCMC) are developing a brain health outreach program for those hospitalized with COVID. Patients with COVID have increased risk of cognitive and psychiatric sequelae due to intrinsic viral properties, hyperinflammatory state, and increased disposition to ICU level care (Inoue, 2019;Cothran, 2020). Development of a post COVID brain health program has become paramount and UCH is not alone in creation of new clinic protocols to meet the needs of this population (Rovere Querini, 2020;O'Brien, 2020). Hospitals around the globe are developing new screeners to identify patients at higher risk of neuropsychiatric sequelae and refer them to appropriate resources. Methods: The program makes use of two arms: The first assesses those discharged from the hospital using a screener developed by the UCH post-COVID hospitalization program. The second screens patients currently admitted to the hospital with COVID using psychiatric and neurocognitive screeners. Both allow patients to be referred to PCMC for evaluation and treatment. Evaluation includes psychiatric interview and additional screeners including: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and PTSD Checklist for DSM-5 (PCL-5). Additional neuropsychiatric evaluation via Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and cognitive rehabilitation referral, are available. Clinic treatment includes pharmaceuticals, individual therapy referral, or referral to the PCMC COVID Survivorship Support Group. Results: To date, 100 patients have been screened in arm 1 (outpatient outreach) and arm 2 (inpatient outreach). In arm 2, about 54% of the population identifies as female, 46% as male, 61% identified as white, and 86% spoke English. Of those in arm 2 that agreed to full participation, 26% agreed to future check-ins and 6% were seen in the clinic. There was a difference in those who did and didn't fully participate based on ethnicity, language, and insurance status;though not of statistical significance. HADs scores demonstrated different trends based on these same demographic factors, though also not statistically significant. Discussion: By using this two-armed approach, the service has been able to more effectively outreach patients and refer them to appropriate care. Though data is not complete, referral needs seem to differ based on demographic data. Conclusions: As data continues to be collected, the clinic model is expanding to outreach high risk patients for neuropsychiatric sequelae. This will strengthen our existing system, with risk of reoccurrence of similar events, and inform a new standard of care for COVID survivors. 1. Cothran, T. P., Tam, J. W.;et.al. (2020). A brewing storm: The neuropsychological sequelae of hyperinflammation due to COVID-19. Brain Behav Immun, 88, 957-958. 2. Inoue, S., Nishida, O, et.al. (2019). Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg, 6(3), 233-246. 3. O'Brien, H., Hurley, K., et.al. (2020). An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci, 1-8. 4. Rovere Querini, P., Ciceri, F., et.al. (2020). Post-COVID-19 follow-up clinic: depicting chronicity of a new disease. Acta Biomed, 91(9-s), 22-28.
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Among the long-COVID symptoms, neuropsychological sequelae are frequent after an infection by SARS-CoV-2, whatever the severity of the respiratory disease in the acute phase. These deficits seem to result from a neurological disorder, but also from psychiatric symptoms. Not only inflammatory components, which can play a major role in the genesis of the neuropsychological sequelae, but also the hypotheses of vascular systemic lesions, the neurotropism of SARS-CoV-2, or the effect of the stress and the hypothalamic–pituitary–adrenal axis (HPA) are suggested. Psychiatric complications due to SSARS-CoV-2 infection would partly explain these neuropsychological sequelae.
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Introduction: Depression was reported in 30–40% of patients at one, three, and six months following COVID-19 [1]. The host immune response to SARS-CoV-2 infection and related severe systemic inflammation seems to be the main mechanism contributing to the development of post-COVID depression. Emerging literature suggests anti-inflammatory and antiviral properties of antidepressants in the treatment of SARS-CoV-2 infection [2]. We hypothesized that post-COVID depression, triggered by infection and sustained by systemic inflammation, could particularly benefit from antidepressants. Thus, the present study aims to investigate the efficacy of SSRI in treating post-COVID depression. Methods: We included 58 adults patients who showed depressive episodes in the six months following COVID-19. We excluded patients if they showed: other psychiatric comorbidities, ongoing treatment with antidepressants or neuroleptics, somatic disease and medications known to affect mood. The severity of depression was rated at baseline and after for four weeks from the start of the treatment on the Hamilton Depression Rating Scale (HDRS) and response was considered when the patients achieved a 50% HDRS reduction after treatment. Statistical analyses to compare group means and frequencies (Student's t-test, Pearson χ2 test) were performed. To investigate changes in HDRS scores over time, repeated measures ANOVAs (according to sex, mood disorder history, and antidepressant molecule) were performed. Results: We found that 53 (91%) patients showed a clinical response to antidepressant treatment. Age, sex, mood disorder history, and hospitalization for COVID did not affect the response rate. Patients were treated with sertraline (n=26), citalopram (n=18), paroxetine (n=8), fluvoxamine (n=4), and fluoxetine (n=2). From baseline to follow-up, patients showed a significant decrease over time of HDRS score (F=618.90, p<0.001), irrespectively of sex (0.28, p=0.599), mood disorder history (F=0.04, p=0.834), and drug used (F=1.47, p=0.239). Discussion: Common knowledge highlights that among antidepressant-treated patients, response rates are moderate (40–60%). On the contrary, we observed a rapid response to the first-line antidepressants in more than 90% of patients irrespectively of clinical variables, thus suggesting a higher antidepressant response rate in post-COVID depression. The pathophysiology of post-COVID neuropsychiatric sequelae mainly entails severe systemic inflammation and subsequent neuroinflammation. In this context, we have previously found that one and three months after COVID-19, the severity of depression was predicted by the baseline systemic immune-inflammation index (SII) [3,4]. Furthermore, we found a protective effect of the IL-1β and IL-6 receptor antagonist against post-COVID depression possibly associated with their effect in dampening SII [5]. Mounting evidence suggests that antidepressants may a) decrease markers of inflammation;b) may inhibit acid sphingomyelinase preventing the infection of epithelial cells with SARS-CoV-2;c) may prevent the COVID-19 related cytokine storm by stimulating the σ-1 receptor;d) may exert antiviral effects via lysosomotropic properties;e) may inhibit platelets activation [2]. In conclusion, we hypothesized that post-COVID depression could particularly benefit from antidepressants since this molecules have anti-inflammatory and antiviral properties, pass the BBB and accumulate in the CNS, thus preventing the neuro-inflammation triggered by SARS-CoV-2 and associated with post-COVID depression. No conflict of interest
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Introduction: The COVID-19 pandemic has led to profound mental health consequences observed during acute infection and at short, medium, and long-term follow-up [1–3]. When considering long-term sequelae, a prevalent proportion of patients infected by SARS-CoV-2 experience a “Post-COVID-19 Syndrome” characterized by fatigue, depressive symptoms, sleep disturbances, and myalgia. In this context, fatigue is recognized as one of the leading complaints in COVID-19 survivors [4]. Long-term health consequences following COVID-19 and their impact on daily quality of life are largely unknown and need further investigation. Thus, questions about possible effects of mental health on fatigue, and of COVID-19 clinical severity on both, remained unanswered. We aim to predict long-term fatigue symptoms basing on clinical and psychopathological predictors through a machine learning approach. Methods: We evaluated the fatigue syndrome and the psychopathological status of 122 adult COVID-19 survivors (80 male, mean age 59.8±12.9) six months after hospital discharge for COVID-19. Clinical and psychopathological predictors were collected for the entire sample. Fatigue at six months was assessed using the Fatigue Severity Scale (FSS). Descriptive statistical analyses to compare means and frequencies were performed. To better disentangle the relationship between somatic and psychopathological predictors and the development of fatigue, we explored the effect of each predictor in affecting fatigue by implementing 5000 non-parametric bootstraps enhanced elastic net penalized logistic regression. The model's accuracy was estimated by 5-folds stratified nested cross-validations in the outer loop to define balance accuracy value (BA), class accuracies, and area under the receiver operator curve (AUC) (for a complete description of the method see [5]). Results: Six months after hospital discharge, 28%, 29%, and 24% of the total sample showed respectively depression (according to Zung Self-Rating Depression Scale), anxiety (according to State-Trait Anxiety Inventory form Y), and sleep disturbances (according to Women's Health Initiative Insomnia Rating Scale). Fatigue was present in 19% of the patients. When entering demographical, clinical, and psychopathological predictors in the elastic net penalized logistic regression, only depressive symptomatology significantly predicted the presence of fatigue at six months (Log Odds Ratio: 2.33;Standard deviation: 1.58;Lower and Upper 95% CI: -0.78 - 5.43;Variable Inclusion Probability: 96.7%). The 10-folds cross-validated elastic net model predicted fatigue with a BA of 65%, an AUC of 77%, and a specificity for the absence of fatigue of 74%, and a sensitivity for the presence of fatigue of 55%, showing good performances in excluding fatigue syndrome. Discussion: Besides confirming a high rate of long-term neuropsychiatric sequelae, our main finding is the strict association between fatigue and depression. We fear that, rather independent of pneumonia severity, major depression after COVID-19 is associated with persistent fatigue, thus worsening the burden of a non-communicable condition triggered by infection and by infection-related systemic inflammation, but then persisting on its own. Post-COVID syndrome, mainly characterized by fatigue, depression, and sleep disturbances, will affect COVID-19 survivors' daily functioning and place additional burden on the healthcare system. Clarifying the mechanisms and risk factors underlying such long-term symptomatology is essential to identify target population and to tailor specific treatment and rehabilitation interventions to foster recovery. No conflict of interest
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Introduction: The effects of COVID-19 are highly variable, with potential involvement of almost all organs and systems. While the acute and sub-acute symptoms have been well described, the possible long-term sequelae of COVID-19 have become an increasing concern [1]. One, three, and six-months follow-up studies have reported highly prevalent post COVID neuropsychiatric sequelae [2,3,4,5]. The aim of the present study is to investigate the psychopathological impact of COVID-19 in survivors at one-year follow-up, also considering the effect of possible risk factors. Methods: We prospectively evaluated the psychopathological status of 160 COVID-19 survivors one year after hospital discharge during an ongoing prospective cohort study. To keep a naturalistic study design, exclusion criteria were limited to patients under 18 years. Sociodemographic and clinical data were collected. Current psychopathology was measured using the following self-report questionnaire: Zung Self-Rating Depression Scale (ZSDS), Impact of Events Scale-Revised (IES-R), State-Trait Anxiety Inventory form Y (STAI-Y), and Fatigue Severity Score (FSS). Need of antidepressant or anxiolytic treatment in the last year was collected. Statistical analyses to compare group means and frequencies (Student's t-test, Pearson χ2 test) exploring effects of sex, psychiatric history, and hospitalization for COVID-19 were performed. Results: Overall, 77 patients (48%) scored in the clinical range in at least one psychopathological dimension among depression, anxiety, and PTSD. Females and patients with a positive previous psychiatric diagnosis showed an increased score on most measures (Table). Hospitalization for COVID-19 did not affect psychopathology. During the year after COVID-19, 25 (16%) and 23 (14%) patients started an antidepressant or anxiolytic treatment respectively.Discussion: This is the first study that investigates psychopathology in a sample of COVID-19 survivors at one-year follow-up after hospital treatment. We reported high rates of persistent psychopathology consistently with previous coronavirus outbreaks. Psychiatric consequences to SARS-CoV-2 infection can be caused by the immune-inflammatory response to the virus itself or by psychological stressors such as social isolation, concerns about infecting others, and stigma. Considering that neuropsychiatric sequelae associates with a markedly increased risk of all-cause mortality, and given the alarming prevalence of post-COVID psychopathology, we now suggest to routinely asses psychopathology of COVID-19 survivors in order to promptly diagnose emergent disorders and to treat them to reduce the disease burden and related years of life lived with disability. No conflict of interest