Microgliosis, astrogliosis and loss of aquaporin-4 polarity in frontal cortex of COVID-19 patients (preprint)

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), causing human coronavirus disease 2019 (COVID-19), not only affects the respiratory tract, but also impacts other organs including the brain. A considerable number of COVID-19 patients develop neuropsychiatric symptoms that may linger for weeks and months and contribute to \"long-COVID\". While the neurological symptoms of COVID-19 are well described, the cellular mechanisms of neurologic disorders attributed to the infection are still enigmatic. Here, we studied the effect of an infection with SARS-CoV-2 on the structure and expression of marker proteins of astrocytes and microglial cells in the frontal cortex of patients who died from COVID-19 in comparison to non-COVID-19 controls. Most of COVID-19 patients had microglial cells with retracted processes and rounded and enlarged cell bodies in both gray and white matter, as visualized by anti-Iba1 staining and confocal fluorescence microscopy. In addition, gray matter astrocytes in COVID-19 patients were frequently labeled by intense anti-GFAP staining, whereas in non-COVID-19 controls, most gray matter astrocytes expressed little GFAP. The most striking difference between astrocytes in COVID-19 patients and controls was found by anti-aquaporin-4 (AQP4) staining. In COVID-19 patients, a large number of gray matter astrocytes showed an increase in AQP4. In addition, AQP4 polarity was lost and AQP4 covered the entire cell, including the cell body and all cell processes, while in controls, AQP4 immunostaining was mainly detected in endfeet around blood vessels and did not visualize the cell body. In summary, our data suggest neuroinflammation upon SARS-CoV-2 infection including microgliosis and astrogliosis, including loss of AQP4 polarity.

The COVID-19 pandemic immediately increased the suicide rate in Kobe, Japan, especially among populations without psychiatry and primary care physician visits: Interrupted time-series analysis using a population-based database (preprint)

Background Japan has one of the lowest numbers of deaths due to coronavirus disease (COVID-19). However, the annual number of suicides increased for the first time in 2020, after a downward trend since 2007. Objective This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends in Japan following the COVID-19 pandemic. Method This quasi-experimental study used a population-based database from Hyogo Prefecture between 2012 and 2022. Interrupted time-series analyses were used to identify immediate and slope changes in the monthly number of suicides during the exposure period (2020-2022) compared with the control (2012-2019). The analysis was stratified according to the status of psychiatric department and primary care physician visits. Results: A totalof 2181 cases were included. Two-thirds of the cases were male, with a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of the patients, respectively. The level change was 4.46 (95%CI; 1.83, 7.09), 3.04 (95%CI; 1.45, 4.64), and 3.07 (95%CI; 0.60, 5.53), in the overall, no primary care physician visit, and no psychiatric visits groups, respectively, which were significant. The level change was not significant in the groups with primary care and psychiatric department visits, at 1.07 (95%CI; -0.84, 2.98) and 0.64 (95%CI; -1.05, 2.33), respectively. The slope changes were not significant in any group. Conclusion: This study suggests that visits to a medical institution may have helped prevent the rapid increase in suicides during the early stages of the COVID-19 pandemic.

A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): Study Protocol for a Multicentric Randomised Controlled Trial (preprint)

Background: Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analyzed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a medically serious suicide attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: 1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; 2) to analyze the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. Methods: An experimental, controlled, and randomized trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enroll for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. Discussion: Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments.

The Aftermath of COVID-19: Exploring Long-Term Effects on the Organ Systems (preprint)

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalized. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected with PASC and its complications. The severity and the later development of PASC symptoms is positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. Cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as a condition that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with respiratory system in long COVID-19 causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. Renal system also was impacted and result in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints were linked to PASC. Conclusions: Long COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy as well as more study to address its underlying causes and long-term effects.

Impact of immediate post SARS-CoV-2 lockdown on suicide in northern Tunisia (preprint)

Suicide is a multifactorial phenomenon influenced by pre-existing mental disorders and by the occurrence of detrimental societal changes. The stress related to the SARS-CoV-2 pandemic as well as the health prevention measures had a negative psychological impact on certain vulnerable populations. Our aim was to investigate suicidal trends and to compare suicide decedent’s profile before and after the lockdown. A descriptive and analytical cross-sectional study was conducted including all suicides that occurred in the north of Tunisia during the study period. Suicidal trends, were studied using an interrupted time series analysis while suicide decedent’s profile was compared between the study period from 24/05/2020 to 31/08/2020 and this same period of the previous five years. Interrupted Time Series Analysis showed a sporadic variation without significant peaks while the comparative study showed a significant increase, among suicide decedents after the lockdown, of individuals with a history of psychiatric disorders particularly mood disorders, suicidal attempts, alcohol and cannabis use and professional instability. We also observed an increase in suicides by hanging and precipitation against a decrease in immolations and intoxications. Our study highlights the importance of mental health promotion during health crises and of prevention especially among vulnerable people.

Two-year Follow-up of Internet-based Parent Training with Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting during the COVID-19 Pandemic (preprint)

Background: There is a lack of studies examining the long-term outcomes of internet-based parent training programs implemented in clinical settings during the COVID-19 pandemic.Objective: To study two-year outcomes of families with 3–8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors.Methods Counseling centers in Helsinki identified 50 3–8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were reported by parents at baseline, posttreatment and at 6-, 12- and 24-month follow-ups.Results The SFSW program had positive long-term effects on child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire (SDQ) total score (Cohen’s d = 0.47, p < .001), SDQ conduct scores (Cohen’s d = 0.65; p < .001) and Affective Reactivity Index (ARI) irritability scores (Cohen’s d = 0.52; p < .001) were maintained until the 24-month follow-up. Similarly, treatment effects of parenting skills measured with the Parenting Scale, including overreactivity (Cohen’s d = 0.41; p = .001) and laxness (Cohen’s d = 0.26; p = .021), were maintained until the 24-month follow-up. Parent training did not have a long-term effect on parental hostility (Cohen’s d = − 0.04; p = .70).Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting profiles, which is important to consider when developing more personalized parenting interventions.

The Outcome of the Psychological and Therapeutical Care of Hospitalized COVID-19 Patients: National African Pilot Study (preprint)

Introduction: Hospitalization in a COVID-19 unit represents a significant source of stress and psychological distress for patients. Our study aims to determine the factors of psychological distress in the therapeutic and psychosocial management of patients hospitalized with a COVID-19 infection. Methods: This cross-sectional study was carried out over 8 months at the COVID-19 zone of the CHU HASSAN II of FES. 99 patients were evaluated within days of diagnosis by psychometric scales of anxiety, depression, and post-traumatic stress. In the course of this follow-up, we found the presence of psychological impacts in these patients, and we tried to find correlating factors between the occurrence of psychiatric disorders and the set of factors related to sociodemographic data, hospitalization course and treatments taken, as well as family support. Results: 35% of patients had scores in favor of post-traumatic stress disorder, 37% of the patients had definite depression and 50% had anxiety. Post-traumatic stress, depression, and anxiety were correlated with sociodemographic factors, hospitalization, treatments received, and length of stay. Conclusion: The prevalence of anxiety-depressive disorders and post-traumatic stress disorder was high in patients with COVID-19, hence the interest in providing psychological and psychosocial care in the emergency department.

A Population-Based Cohort to Investigate the Impact of COVID-19 on Socioeconomic Inequalities in Mental Health Care in Italy (Comeh): Study Protocol (preprint)

Purpose The CoMeH cohort was established to assess the impact of the COVID-19 pandemic on the use of mental health services in Italy in the short and long term, with a particular focus on socioeconomic and/or citizenship inequalities.Methods All residents subjects for at least 2 years, aged ≥ 10 years, and assisted by an NHS general practitioner (GP) of the area of residence, in three vast catchment areas (N = 5,167,043). Primary outcomes of interest are the following indicators of mental health care services’ use: first access to any mental health care service, total number of accesses to mental health care services, the consumption of psychiatric drugs, the number of psychiatric or psychological outpatient visits, the number of residential or day care days spent in psychiatric facilities, the number of emergency and/or inpatient admissions to hospitals.Results Incident users were 3.2% of the population for Bergamo LHA, 3.5% for Rome2 LHA, and 4.4% for the Tuscany Region. The overall crude incidence rate of access to mental health care was 3.3% in the pre-COVID-19 period and 2.6% during the pandemic. Prescriptions for a mental disorder (57.2%) and ED admissions (25.1%) were the main reasons for enrollment. Compared to the general population, people with mental health conditions were older and more often female. The distribution of the incident users by deprivation index overlapped that of the population. Immigrants were younger, socioeconomically more deprived, and more often entered the study for an ED admission.Conclusion We will focus on the impact of the pandemic through the evaluation of accesses to hospitalization, emergency, outpatient visits, residential and day care services, and drug prescriptions. We will also evaluate socioeconomic inequalities through the use of census-based deprivation index and migration status. Finally, we will also analyze the impact of COVID-19 infection and outcome on the study cohort.

Increased Serum MMP-9 in Long-COVID May Reflect Activation of Microglia by SARS-CoV-2 Spike Protein (preprint)

Long-COVID is a major health concern because many patients develop chronic neuropsychiatric symptoms, but the precise pathogenesis is unknown. Matrix metalloproteinase-9 (MMP-9) can disrupt neuronal connectivity and was elevated in patients with COVID-19. MMP-9 was measured in the serum of long COVID patients and healthy controls, as well as in the supernatant fluid of cultured human SV-40 microglia, by commercial ELISA. Results were analyzed with one-way ANOVA. MMP-9 in the serum of Long-COVID patients and supernatant fluid from cultured human microglia stimulated by recombinant SARS-CoV-2 Spike protein was assayed by ELISA. MMP-9 was significantly elevated in the serum of Long-COVID patients compared to healthy controls. Moreover, cultured human microglia released MMP-9 when stimulated by Spike protein. In conclusion, MMP-9 may contribute to the development of Long-COVID and serve both as a prognostic biomarker and as target for treatment.

Creutzfeldt-Jakob Disease with Initial Typical Parkinsonism Precipitated by COVID-19? A Case Report (preprint)

Background Creutzfeldt-Jakob disease (CJD) is a rare and fatal neurodegenerative disease caused by the accumulation of PrPSc. While COVID-19-induced sporadic CJD (sCJD) with parkinsonism as the initial symptom is extremely uncommon, this report aims to raise awareness of sCJD cases that present with parkinsonism that are not associated with genetic mutations or pathological α-synuclein (α-Syn) accumulation. Case presentation This report presents the case of a 72-year-old man with probable sporadic Creutzfeldt-Jakob disease (sCJD) who initially showed symptoms of parkinsonism, which worsened rapidly after contracting COVID-19. Despite a history of responsive tremor and bradykinesia, his condition deteriorated following the viral infection, leading to rapid consciousness decline and diffuse myoclonus. Diagnostic tests, including brain MRI, cerebrospinal fluid analysis, and EEG, pointed towards prion disease. PrPSc, a marker for CJD, was detected in both the cerebrospinal fluid and skin samples using RT-QuIC, further confirming the diagnosis. Notably, skin analysis revealed PrPSc but no pathological α-synuclein deposits, ruling out typical Parkinson's disease.  Conclussion This case underscores the importance of considering sCJD in patients with parkinsonism, especially if they experience sudden neuropsychiatric symptoms, especially if they do not exhibit pathological α-Syn accumulation or have genetic mutations.

Impact of COVID-19 pandemic on incident diagnosis patterns in German refugee centres: quasi-experimental study, 2018-2023 (preprint)

The COVID-19 pandemic may have affected morbidity patterns of residents in refugee centres, but empirical evidence is scarce. We utilised linked data from a health surveillance network in German refugee centres, employing a quasi-experimental design to examine the effects of the COVID-19 pandemic on newly diagnosed medical conditions. These diagnoses were coded in on-site healthcare facilities for refugee patients. Our analysis encompasses the timeframe from October 2018 to April 2023 and includes individual-level data for 109,175 refugees. This data resulted in 76,289 patient-months across 21 refugee centres, with a total occupancy of 144,012 person-months. We employed segmented regression analyses, adjusting for time trends, socio-demographic factors, centre occupancy, and centre-specific characteristics, to evaluate the COVID-19 pandemic's impact on incident diagnosis patterns among refugees. The COVID-19 pandemic significantly altered diagnosis patterns among refugees in German centres. Notably, incidents of injuries, mental disorders, psychotherapeutic drug prescriptions, and genitourinary diseases rose, while respiratory diseases decreased, later rebounding. An 88% increase in injury-related diagnoses suggests heightened violence experiences during flight or in centres. Mental disorder diagnoses and psychotherapeutic drug prescriptions rose by 73% and 95%, reflecting pandemic-related stressors in refugee centres, highlighting the pandemic's multifaceted impact on refugee health.

Contacts with environmental biodiversity affect human health: links to allergies, physical and mental health revealed during the initial waves of the COVID-19 pandemic (preprint)

The gradual decrease in the prevalence of serious infectious diseases over the last century has been followed by increase in so called “modern” diseases, including allergies, chronic inflammatory conditions, psychiatric, and metabolic disorders. Between 2019 and 2022, public awareness of the threat of infectious diseases in humans was renewed by the global pandemic of a new type of a coronavirus, the SARS-COV-2. This public interest opened improved possibilities to test hypotheses on the factors associated with inter-individual variation in susceptibility to infectious and “modern” diseases. Based on the Hygiene hypothesis and Biodiversity hypothesis, we predicted that contacts with natural environment and wildlife in childhood and/or in adulthood can improve general health and decrease the risks of severe COVID-19 progression or prevalence of the “modern” diseases, namely the allergies. Here we report the results of an online, self-evaluating questionnaire survey conducted in the Czech Republic, where we contrasted selected health issues, and linked them to the living environment, including the level of contacts with biodiversity. In a sample of 1188 respondents, we revealed a significant effect of time spent in nature and contacts with biodiversity on physical and mental health, and incidence of allergies. This is unlike the COVID-19 progression, which was related to age, physical health, smoking, allergies, and interaction of age with smoking, but not to contacts with the natural environmental diversity. Our findings are in agreement with the Biodiversity hypothesis of allergy and, linking human and environmental health, they urge for One Health approach application.

COVID-19 Computer-aided Diagnosis through AI-assisted CT Imaging Analysis: Deploying a Medical AI System (preprint)

Computer-aided diagnosis (CAD) systems stand out as potent aids for physicians in identifying the novel Coronavirus Disease 2019 (COVID-19) through medical imaging modalities. In this paper, we showcase the integration and reliable and fast deployment of a state-of-the-art AI system designed to automatically analyze CT images, offering infection probability for the swift detection of COVID-19. The suggested system, comprising both classification and segmentation components, is anticipated to reduce physicians' detection time and enhance the overall efficiency of COVID-19 detection. We successfully surmounted various challenges, such as data discrepancy and anonymisation, testing the time-effectiveness of the model, and data security, enabling reliable and scalable deployment of the system on both cloud and edge environments. Additionally, our AI system assigns a probability of infection to each 3D CT scan and enhances explainability through anchor set similarity, facilitating timely confirmation and segregation of infected patients by physicians.

Application of Multidisciplinary Diagnosis and Treatment (MDT) Clinical Teaching Model in the Clinical Teaching of Some Undergraduates of Breast Diseases in Surgery (preprint)

Background Breast surgery, emerging as an independent discipline with a wealth of specialist cases and an extensive case resource library in medical history. Contemporary clinical teaching faces challenges with traditional methods unable to address students' theoretical strength and practical limitations. The COVID-19 pandemic further strained learning environments, limiting students' exposure to patient diagnosis and treatment. Conventional clinical teaching, organized by disciplines, often results in technical isolation and a narrow clinical perspective, impeding the development of well-rounded medical professionals. Multidisciplinary Comprehensive Diagnosis and Treatment (MDT) emerges as a patient-centric, collaborative approach involving various medical departments in clinical decision-making. Despite its success in clinical settings, the effectiveness of MDT in undergraduate medical education remains largely unexplored.Methods This study conducted at the Breast Department of the First Affiliated Hospital of Zhengzhou University, aimed to compare the learning outcomes of clinical interns under traditional and MDT teaching modes. In a randomized controlled trial with 140 participants, the MDT group received comprehensive training from diverse healthcare professionals, while the traditional group had standard teaching. Evaluation included pre-test and post-test assessments on knowledge acquisition, skill acquisition, and clinical decision-making. Longitudinal analysis and statistical tests, including t-tests and multiple regression, were employed.Results A total of 140 clinical medicine students participated, randomly assigned to MDT (n = 70) and Traditional Teaching Mode (n = 70) groups. Key baseline characteristics, such as age, gender, and completion rates, were comparable between groups. For each group’s pre- and post-test scores, MDT group means consistently surpassed Traditional Teaching Mode, with significant differences (p < 0.05).Correlation analysis showed that there were no significant variable correlations between individual performance characteristics and test scores. Post-training, significant score improvements were observed in both groups across all tests (p < 2.2e-16). Utilizing the Wilcoxon rank sum test, pre-test differences were not significant. However, post-test scores favored the MDT group significantly (p = 0.0016, 2.8e-09, 3.6e-07). For students pursuing a master's, no statistically significant differences in specialty choice were observed between groups, though a trend towards more MDT students choosing surgical specialties was noted.Conclusion This study pioneers the application of the MDT teaching method in breast cancer clinical education, comparing its efficacy against traditional teaching modes. Findings demonstrate that MDT-based breast cancer diagnosis and treatment education is more efficient and optimized, offering a transformative basis for clinical undergraduate education reform in China. The results advocate for the reconfiguration of multidisciplinary consultation clinical teaching and traditional methods, promising enhanced educational outcomes and heightened medical student knowledge.

Loneliness and mental health issues among Vietnamese migrants in Japan: A cross-sectional study (preprint)

Background: Loneliness is a major factor hindering the health of migrants. There is concern that social changes due to the COVID-19 pandemic, in addition to the acculturation gap with their host country, exacerbated loneliness among Vietnamese migrants in Japan.Therefore, this study aimed to clarify the prevalence of loneliness and examine the relationship between mental health and loneliness among Vietnamese migrants in Japan. Methods: We used a cross-sectional study design using a self-administered questionnaire. The data were collected from May 2 to June 6, 2022. The target population for this study was Vietnamese migrants living in Japan, 213 of whom were included in the analysis. The questionnaire consisted of items regarding participants' characteristics, socioeconomic status, social support, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and University of California Los Angeles 3-Item Loneliness Scale. Logistic regression analysis was performed with depressive (Patient Health Questionnaire-9 ≥ 10 points) and anxiety (Generalized Anxiety Disorder-7 ≥ 10 points) symptoms as dependent variables and loneliness (University of California Los Angeles 3-Item Loneliness Scale ≥ 6) and other socioeconomic factors as independent variables. Results: The mean age of the participants was 26.8 ± 4.4 years. The study included 112 men (52.6%) and 101 women (47.4%). Their mean years of residence in Japan was 4.4 ± 2.5 years. 53 (24.9%) had a Patient Health Questionnaire-9 score ≥ 10. 30 (14.1%) had a Generalized Anxiety Disorder-7 score ≥ 10. 81 (38%) had a University of California Los Angeles 3-Item Loneliness Scale ≥ 6. Multivariate logistic regression analysis revealed that depressive symptoms were associated with loneliness (OR: 6.06; 95% CI: 2.84–12.90). Factors associated with anxiety disorders included loneliness (OR: 12.46; 95% CI: 3.93–39.51). Conclusions: Loneliness can cause various mental disorders, and social changes due to the COVID-19 pandemic have increased loneliness over time. In this study, approximately 40% of Vietnamese migrants living in Japan were lonely, and loneliness was one of the factors contributing to their depressive and anxiety disorder symptoms. Currently, the number of Vietnamese migrants living in Japan is rapidly increasing, and reducing their loneliness may contribute to improving their mental health and wellbeing.

Exploring the Efficacy of Shirodhara as an Add-on Therapy for Alleviating Post-COVID Anxiety and Depression: A Case Study (preprint)

Background This study explores post-COVID-19 psychological challenges in a 31-year-old female patient—manifesting as Anxiety, fatigue, weakness, irritability, anger, and concentration issues. The treatment approach combines SSRI and Clonazepam medications with Shirodhara therapy using Balashwagandhadi taila, presenting a novel and comprehensive intervention strategy.Methods The patient was evaluated using recognized scales, such as HAM-A, HDRS, PHQ-9, and QOL. Additionally, monitoring serum cortisol levels served as a potential physiological marker. The integrative treatment approach addresses psychological symptoms and potential underlying physiological mechanisms.Results Significant improvement is observed across various domains, evidenced by reduced HAM-A, HDRS, and PHQ-9 scores and enhanced QOL. Post-Shirodhara therapy, a notable increase in serum cortisol levels from 3.09 ug/dL to 11.76 ug/dL, suggesting a correlation with clinical improvements.Conclusion This case underscores Shirodhara's promising role as an adjunctive therapy for post-COVID-19 Anxiety and depression. Findings advocate further exploring integrative approaches in post-viral psychological care, emphasizing addressing psychological and potential physiological aspects for holistic recovery.

Neuroleptic malignant syndrome in a patient with COVID-19 and the possible role of SARS-CoV-2 in its manifestation. Case report and overview of published cases (preprint)

Background: The manifestationof severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is more complex than that of pulmonary infection, and neuropsychiatric symptoms play a role in this complexity. In this paper, we present the case of a 29-year-old schizophrenic patient who suffered from neuroleptic malignant syndrome (NMS) that developed during coronavirus disease 2019 (COVID-19) infection, with an emphasis on the possible connection between these two conditions. Additionally, we provide an overview of published NMS cases in patients with COVID-19 or after vaccination against SARS-CoV-2. Case presentation: A 29-year-old patient treated for schizophrenia was admitted to the hospital for agitation and aggressivity; shortly after arrival at the hospital, laryngospasm and hypoxia occurred. The patient tested positive for SARS-CoV-2, and later, he developed pneumonia. After continuing restlessness, haloperidol was administered, and a few days later, neuroleptic malignant syndrome occurred. He was treated with bromocriptine and recovered. Conclusions: As SARS-CoV-2 is known to interact with angiotensin-converting enzyme 2 and DOPA-decarboxylase is known to be coexpressed with this receptor, we hypothesized that COVID-19 infection might playa substantial role in the development of NMS.

Chronic pain and post-traumatic stress in older patients with psychiatric disorders during the Covid- 19 pandemic: co-occurrence and influence of attachment and personality factors (preprint)

Objectives The Covid-19 pandemic context may have had numerous effects on the health of older patients with psychiatric disorders (PD), confronting them with a new source of stress and hindering their access to care. The aim of this study was to assess the long-term effects of the pandemic on both chronic pain (CP) and post-traumatic stress (PTS); the comorbidity of the two disorders; and to identify common psychological risk factors. Design: Medical interviews were conducted during and after (12 and 18 months later) the first lockdown. Setting: The STERACOVID longitudinal cohort study, conducted in two French hospitals. Participants: 71 patients aged 65 or over; treated in an outpatient psychiatric service; and free of major neurocognitive disorders. Measurements: Validated scales were used to assess CP; PTS; personality traits; attachment style; and coping strategies. χ² and Student's t-tests, analyses of variance and logistic regression were used to compare patients with or without CP and/or PTS, in terms of attachment styles, personality traits and coping strategies. Results CP and PTS were frequent and often co-occurring at T2. Fearful and preoccupied attachment styles and neurotic and extraverted personality traits were associated with the development of these two disorders; while coping strategies were not determinant. Conclusions Our study identified factors associated with a higher risk of developing CP and/or PTS in the pandemic context. Assessment of attachment style and personality traits in clinical routine could help identify patients who are most vulnerable to this type of stress, and prevent the development of disabling chronic conditions.

Differential associations between SARS-CoV-2 infection, perceived burden of the pandemic and mental health in the German population-based cohort for digital health research (preprint)

Introduction: Understanding the potential adverse effects of the Covid-19-pandemic remains a challenge for public mental health. In this regard, the differentiation between potential consequences of actual infection with SARS-CoV-2 and the subjective burden of the pandemic due to measures and restrictions to daily life remains elusive. Methods: Here we investigated the differential association between infection with SARS-Cov-2 and subjective burden of the pandemic in a study cohort of 7601 participants from the German population-based cohort for digital health research (DigiHero), who were recruited between March 4th and April 25th 2022. Data was collected using the online survey tool LimeSurvey between March and October 2022 in consecutive surveys, which included questionnaires on infection status and symptoms following COVID-19 as well as retrospective assessment of the subjective burden of the pandemic. Results: We observed an association of a past SARS-CoV-2 infection on deteriorated mental health related symptoms, whereas no association or interaction with burden of the pandemic occurred. The association was driven by participants with persistent symptoms 12 weeks after acute infection. On a symptom specific level, neuropsychiatric symptoms such as exhaustion and fatigue, concentration deficits as well as problems with memory function were the primary drivers of the association. Conclusion: Our findings underscore the impact of SARS-CoV-2 infections on mental health in patients suffering from ongoing symptoms 12 weeks after infection. As the association between SARS-CoV-2 infection and mental health appeared more pronounced in populations with higher vulnerability for mental disorders, increased attention should be dedicated towards these subgroups regarding the prevention of infection.

Long-term symptoms after SARS-CoV-2 infection in a cohort of people living with HIV (PLWH): a real-life study (preprint)

Background Our Hospital in Northern Italy assists 3817 people living with HIV (PLWH) and has faced the impact of COVID-19. Little is known about the impact of HIV infection on the risk of post-COVID-19 conditions (PCCs) onset. We aim to assess the incidence of PCC in PLWH and the factors associated with its occurrence.Methods We performed a retrospective, observational study including all PLWH > 18 years registered in the Brescia Health Protection Agency database, assessing SARS-CoV-2 burden, vaccination status, socio-demographic, and viro-immunological parameters from February 2020 until May 2022. Persistence of self-reported symptoms (clustered into gastrointestinal, respiratory, osteo-muscular, and neuro-behavioral symptoms) was evaluated after 3 months by a telephone-administered questionnaire. We estimated the associations between all variables and outcomes through univariate and multivariable logistic models.Results In the study period, 653 PLWH were diagnosed with SARS-CoV-2 infection (17.1%). We observed 19 (2.9%) reinfections, 71 (10.9%) hospitalizations, and 3 (0.5%) deaths. We interviewed 510/653 PLWH (78%), and 178 (PCCs prevalence 34.9%; CI95% 30.7–39.2) reported persistent symptoms. Asthenia/fatigue was the most reported symptom (60/178), followed by muscular pain (54/178). In the multivariate regression model, male sex was protective (adjusted OR = 0.64; CI95% 0.99–3.66), while hospitalization during acute infection was associated with an increased the risk of PCCs (adjusted OR = 1.9; CI95% 0.99–3.66). Notably, no viro-immunological variable modified the PCCs risk onset.Conclusions Our study highlights a substantial prevalence of PCCs among PLWH, three months post-SARS-CoV-2 infection, independent of viro-immunological features or vaccination status.