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Asian J Psychiatr ; 57: 102563, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1051426


Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.

Trastornos de Adaptación/etiología , Trastornos de Ansiedad/etiología , /terapia , Delirio/etiología , Trastorno Depresivo/etiología , Trastornos de Adaptación/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/diagnóstico , Delirio/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Resultado del Tratamiento
J Psychosom Res ; 141: 110350, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-988514


Background COVID-19 causes significant morbidity and mortality. Despite the high prevalence of delirium and delirium-related symptoms in COVID-19 patients, data and evidence-based recommendations on the pathophysiology and management of delirium are limited. Objective We conducted a rapid review of COVID-19-related delirium literature to provide a synthesis of literature on the prevalence, pathoetiology, and management of delirium in these patients. Methods Systematic searches of Medline, Embase, PsycInfo, LitCovid, WHO-COVID-19, and Web of Science electronic databases were conducted. Grey literature was also reviewed, including preprint servers, archives, and websites of relevant organizations. Search results were limited to the English language. We included literature focused on adults with COVID-19 and delirium. Papers were excluded if they did not mention signs or symptoms of delirium. Results 229 studies described prevalence, pathoetiology, and/or management of delirium in adults with COVID-19. Delirium was rarely assessed with validated tools. Delirium affected >50% of all patients with COVID-19 admitted to the ICU. The etiology of COVID-19 delirium is likely multifactorial, with some evidence of direct brain effect. Prevention remains the cornerstone of management in these patients. To date, there is no evidence to suggest specific pharmacological strategies. Discussion Delirium is common in COVID-19 and may manifest from both indirect and direct effects on the central nervous system. Further research is required to investigate contributing mechanisms. As there is limited empirical literature on delirium management in COVID-19, management with non-pharmacological measures and judicious use of pharmacotherapy is suggested.

/psicología , Delirio , Adulto , Delirio/diagnóstico , Delirio/etiología , Delirio/terapia , Humanos
Pan Afr Med J ; 35(Suppl 2): 136, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-946286


Introduction: SARS-CoV-2 is an emerging health threat outbreak. It may cause severe viral pneumonia with Acute Respiratory Distress Syndrome requiring critical care. Aim: to describe clinical features and outcomes of critically ill patients with SARS-CoV-2 infection. Methods: it was a retrospective study carried out in the medical ICU of Farhat Hached teaching hospital between March 11 and May 7, 2020. All consecutive patients with RT-PCR confirmed COVID-19 were included. Clinical characteristics and outcomes were collected by reviewing medical records. Results: during the study period, 10 critically ill patients with COVID-19 were enrolled. Mean age, 51.8±6.3 years; 8(80%), male. The most common comorbidities were; diabetes mellitus, 6(60%), obesity 2(20%), chronic kidney disease 2(20%) and hypertension 1(10%). Mean SAPS II, 23.2±1.8. The mean arterial oxygen partial pressure to fractional inspired oxygen ratio at admission was 136.2±79.7. Noninvasive mechanical ventilation was used in 4(40%) patients and 7(70%) received invasive mechanical ventilation. Tidal volume and PEEP were set respectively within the median [IQR] of, 5.7[5.6-6.3]ml/Kg and 10.7[6.5-11.7]cm H2O. Plateau pressure was monitored in the median [IQR] of 27.9 [25.9-28.5] cm H2O. Four patients received hydroxychloroquine alone and five hydroxychloroquine associated with an antiviral. Five patients developed respectively hyperactive (n=2), hypoactive (n=2) and mixed delirium (n=1). Mortality rate was at 70%. Conclusion: this study demonstrated a particular profile of COVID-19 in the critically ill as a severe presentation in aged males with comorbidities presenting with an ARDS-like and neurological impairment with poor prognosis. The only survivals seem to have benefited from noninvasive ventilatory support.

Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica/epidemiología , Neumonía Viral/epidemiología , Antivirales/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Infecciones por Coronavirus/tratamiento farmacológico , Delirio/etiología , Diabetes Mellitus/epidemiología , Femenino , Mortalidad Hospitalaria , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Pandemias , Neumonía Viral/tratamiento farmacológico , Pronóstico , Insuficiencia Renal Crónica/epidemiología , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Puntuación Fisiológica Simplificada Aguda , Túnez/epidemiología
Eur Geriatr Med ; 11(5): 857-862, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-652264


PURPOSE: To ascertain delirium prevalence and outcomes in COVID-19. METHODS: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. RESULTS: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium - 50 out of 166 points (95% CI - 83 to - 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. CONCLUSIONS: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term.

Infecciones por Coronavirus , Delirio , Pandemias , Neumonía Viral , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Cognición/fisiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Estudios Transversales , Delirio/epidemiología , Delirio/etiología , Delirio/mortalidad , Delirio/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Índice de Severidad de la Enfermedad
Neurol India ; 68(3): 560-572, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-640338


COVID-19, in most patients, presents with mild flu-like illness. Elderly patients with comorbidities, like hypertension, diabetes, or lung and cardiac disease, are more likely to have severe disease and deaths. Neurological complications are frequently reported in severely or critically ill patients with comorbidities. In COVID-19, both central and peripheral nervous systems can be affected. The SARS-CoV-2 virus causes the disease COVID-19 and has the potential to invade the brain. The SARS-CoV-2 virus enters the brain either via a hematogenous route or olfactory system. Angiotensin-converting enzyme two receptors, present on endothelial cells of cerebral vessels, are a possible viral entry point. The most severe neurological manifestations, altered sensorium (agitation, delirium, and coma), are because of hypoxic and metabolic abnormalities. Characteristic cytokine storm incites severe metabolic changes and multiple organ failure. Profound coagulopathies may manifest with ischemic or hemorrhagic stroke. Rarely, SARS-CoV-2 virus encephalitis or pictures like acute disseminated encephalomyelitis or acute necrotizing encephalopathy have been reported. Nonspecific headache is a commonly experienced neurological symptom. A new type of headache "personal protection equipment-related headache" has been described. Complete or partial anosmia and ageusia are common peripheral nervous system manifestations. Recently, many cases of Guillain-Barré syndrome in COVID-19 patients have been observed, and a postinfectious immune-mediated inflammatory process was held responsible for this. Guillain-Barré syndrome does respond to intravenous immunoglobulin. Myalgia/fatigue is also common, and elevated creatine kinase levels indicate muscle injury. Most of the reports about neurological complications are currently from China. COVID-19 pandemic is spreading to other parts of the world; the spectrum of neurological complications is likely to widen further.

Ageusia/fisiopatología , Infecciones por Coronavirus/fisiopatología , Síndrome de Liberación de Citoquinas/inmunología , Encefalitis/fisiopatología , Síndrome de Guillain-Barré/fisiopatología , Cefalea/fisiopatología , Trastornos del Olfato/fisiopatología , Neumonía Viral/fisiopatología , Accidente Cerebrovascular/fisiopatología , Ageusia/etiología , Betacoronavirus , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/etiología , Barrera Hematoencefálica , Isquemia Encefálica/sangre , Isquemia Encefálica/etiología , Isquemia Encefálica/inmunología , Isquemia Encefálica/fisiopatología , Coma/etiología , Coma/fisiopatología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Delirio/etiología , Delirio/fisiopatología , Encefalitis/etiología , Encefalitis/inmunología , Encefalomielitis Aguda Diseminada/etiología , Encefalomielitis Aguda Diseminada/inmunología , Encefalomielitis Aguda Diseminada/fisiopatología , Fatiga/etiología , Fatiga/fisiopatología , Síndrome de Guillain-Barré/etiología , Cefalea/etiología , Humanos , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/fisiopatología , Leucoencefalitis Hemorrágica Aguda/etiología , Leucoencefalitis Hemorrágica Aguda/inmunología , Leucoencefalitis Hemorrágica Aguda/fisiopatología , Mialgia/etiología , Mialgia/fisiopatología , Trastornos del Olfato/etiología , Pandemias , Equipo de Protección Personal/efectos adversos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/inmunología
Ann Phys Rehabil Med ; 63(4): 376-378, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-626203
Psychosomatics ; 61(5): 544-550, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-616923

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/terapia , Delirio/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Neumonía Viral/terapia , Agitación Psicomotora/tratamiento farmacológico , Fármacos Inductores del Sueño/uso terapéutico , Anciano , Analgésicos Opioides/efectos adversos , Azepinas/uso terapéutico , Betacoronavirus , Depresores del Sistema Nervioso Central/uso terapéutico , Clordiazepóxido/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Delirio/etiología , Delirio/fisiopatología , Delirio/psicología , Dexmedetomidina/efectos adversos , Femenino , Guanfacina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Hidromorfona/efectos adversos , Unidades de Cuidados Intensivos , Ketamina/efectos adversos , Melatonina/uso terapéutico , Midazolam/efectos adversos , Oxicodona/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Propofol/efectos adversos , Agitación Psicomotora/etiología , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/psicología , Respiración Artificial , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/etiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Traqueostomía , Triazoles/uso terapéutico , Ácido Valproico/uso terapéutico
Gen Hosp Psychiatry ; 65: 47-53, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-327315


INTRODUCTION: Neuropsychiatric manifestations of the coronavirus disease 2019 (COVID-19) have been described, including anosmia, ageusia, headache, paresthesia, encephalitis and encephalopathy. Little is known about the mechanisms by which the virus causes central nervous system (CNS) symptoms, and therefore little guidance is available regarding potential workup or management options. CASES: We present a series of four consecutive cases, seen by our psychiatry consultation service over a one-week period, each of which manifested delirium as a result of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). DISCUSSION: The four cases highlighted here all occurred in older patients with premorbid evidence of cognitive decline. Unique features seen in multiple cases included rigidity, alogia, abulia, and elevated inflammatory markers. In all four cases, a change in mental status was the presenting symptom, and three of the four cases lacked significant respiratory symptoms. In addition to discussing unique features of the cases, we discuss possible pathophysiologic explanations for COVID-19 delirium. CONCLUSIONS: Delirium should be recognized as a potential feature of infection with SARS-CoV-2 and may be the only presenting symptom. Based on the high rates of delirium demonstrated in prior studies, hospitals should consider adding mental status changes to the list of testing criteria. Further research is needed to determine if delirium in COVID-19 represents a primary encephalopathy heralding invasion of the CNS by the virus, or a secondary encephalopathy related to systemic inflammatory response or other factors.

Encefalopatías/etiología , Infecciones por Coronavirus/complicaciones , Delirio/etiología , Pandemias , Neumonía Viral , Anciano , Anciano de 80 o más Años , Encefalopatías/virología , Disfunción Cognitiva/complicaciones , Infecciones por Coronavirus/patología , Delirio/virología , Femenino , Humanos , Masculino
Anaesthesiol Intensive Ther ; 52(2): 132-138, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-291501


In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. Delirium, the detection of which takes less than two minutes, is frequently underestimated during daily routine ICU care, but it may be a prodromal symptom of infection or hypoxia associated with severe respiratory failure. During the COVID-19 pandemic, systematic delirium monitoring using validated tests (CAM-ICU or ICDSC) may be sacrificed. This is likely to be due to the fact that the main emphasis is placed on organisational issues, i.e. the lack of ventilators, setting priorities for limited mechanical ventilation options, and a shortage of personal protective equipment. Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.

Betacoronavirus , Infecciones por Coronavirus/complicaciones , Delirio/etiología , Unidades de Cuidados Intensivos , Neumonía Viral/complicaciones , Delirio/diagnóstico , Delirio/prevención & control , Delirio/psicología , Humanos , Pandemias
Crit Care ; 24(1): 176, 2020 04 28.
Artículo en Inglés | MEDLINE | ID: covidwho-133387


The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Delirium, a dangerous untoward prognostic development, serves as a barometer of systemic injury in critical illness. The early reports of 25% encephalopathy from China are likely a gross underestimation, which we know occurs whenever delirium is not monitored with a valid tool. Indeed, patients with COVID-19 are at accelerated risk for delirium due to at least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction of CNS inflammatory mediators, (3) secondary effect of other organ system failure, (4) effect of sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, and (7) other needed but unfortunate environmental factors including social isolation and quarantine without family. Given early insights into the pathobiology of the virus, as well as the emerging interventions utilized to treat the critically ill patients, delirium prevention and management will prove exceedingly challenging, especially in the intensive care unit (ICU). The main focus during the COVID-19 pandemic lies within organizational issues, i.e., lack of ventilators, shortage of personal protection equipment, resource allocation, prioritization of limited mechanical ventilation options, and end-of-life care. However, the standard of care for ICU patients, including delirium management, must remain the highest quality possible with an eye towards long-term survival and minimization of issues related to post-intensive care syndrome (PICS). This article discusses how ICU professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge and resources to limit the burden of delirium on patients by reducing modifiable risk factors despite the imposed heavy workload and difficult clinical challenges posed by the pandemic.

Betacoronavirus , Infecciones por Coronavirus/complicaciones , Delirio/terapia , Unidades de Cuidados Intensivos , Neumonía Viral/complicaciones , Infecciones por Coronavirus/epidemiología , Delirio/etiología , Humanos , Pandemias , Neumonía Viral/epidemiología , Seguridad
Age Ageing ; 49(4): 523-524, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: covidwho-116314


Common symptoms of pandemic coronavirus disease (COVID-19) include fever and cough. We describe a 94-year-old man with well-controlled schizoaffective disorder, who presented with non-specific and atypical symptoms: delirium, low-grade pyrexia and abdominal pain. He was given antibiotics for infection of unknown source, subsequently refined to treatment for community-acquired pneumonia. Despite active treatment, he deteriorated with oxygen desaturation and tachypnoea. A repeat chest X-ray showed widespread opacification. A postmortem throat swab identified COVID-19 infection. He was treated in three wards over 5 days with no infection control precautions. This has implications for the screening, assessment and isolation of frail older people to COVID-specific clinical facilities and highlights the potential for spread among healthcare professionals and other patients.

Betacoronavirus , Infecciones por Coronavirus/complicaciones , Delirio/etiología , Anciano Frágil , Fragilidad/epidemiología , Neumonía Viral/complicaciones , Anciano de 80 o más Años , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Delirio/diagnóstico , Humanos , Masculino , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Radiografía Torácica , Tomografía Computarizada por Rayos X