Biological and Psychological Factors Determining Neuropsychiatric Outcomes in COVID-19 (original) (raw)

2021, Current Psychiatry Reports

Purpose of Review We present biological and psychological factors implicated in psychiatric manifestations of SARS-CoV-2, as well as its neuroinvasive capability and immune pathophysiology. Recent Findings Preexisting mental illness leads to worse clinical outcomes in COVID-19. The presence of the virus was reported in the cerebrospinal fluid (CSF) and brain tissue post-mortem. Most common psychiatric manifestations include delirium, mood disorders, anxiety disorders, and posttraumatic stress disorder. "Long-COVID" non-syndromal presentations include "brain-fogginess," autonomic instability, fatigue, and insomnia. Summary SARS-CoV-2 infection can trigger prior vulnerabilities based on the priming of microglia and other cells, induced or perpetuated by aging and mental and physical illnesses. COVID-19 could further induce priming of neuroimmunological substrates leading to exacerbated immune response and autoimmunity targeting structures in the central nervous system (CNS), in response to minor immune activating environmental exposures, including stress, minor infections, allergens, pollutants, and traumatic brain injury. Keywords COVID-19 • SARS-CoV-2 • Neuroinflammation • Neuroinvasion • Neuropsychiatric • Priming Abbreviations ACE2 Angiotensin I-converting enzyme 2 ACEI Angiotensin-converting enzyme inhibitor ADEM Acute disseminated encephalomyelitis AHLE Acute hemorrhagic leukoencephalomyelitis ANA Antinuclear antibodies ANE Acute necrotizing encephalopathy anti-dsDNA Anti-double-stranded deoxyribonucleic acid ARBs Angiotensin receptor blockers AST Aspartate aminotransferase BBB Blood-brain barrier BMI Body mass index CBT Cognitive behavioral therapy CD Cluster of differentiation CDC Center for Disease Control and Prevention CCL2 CC motif chemokine ligand 2, also known as monocyte chemotactic protein (MCP)-1 CEC Circulating endothelial cells CNS Central nervous system CORONADO Coronavirus-SARS-CoV-2 and diabetes outcomes COVID-19 Coronavirus disease 2019 CoVs Coronaviruses Cr Creatinine CRP C-reactive protein CSF Cerebrospinal fluid CT Computed tomography CTSL Cathepsin L CVD Cardiovascular disease DCLO Diffusing capacity of the lungs for carbon monoxide DSM-IV Diagnostic and Statistical Manual of Mental Disorders, fourth edition EEG Electroencephalogram This article is part of the Topical Collection on Complex Medical-Psychiatric Issues.