Neuropsychiatric manifestations of COVID-19 and possible pathogenic mechanisms: Insights from other coronaviruses

Debanjan Banerjee, Biju Viswanath, Debanjan Banerjee, Biju Viswanath

Abstract

Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has emerged as a global public health threat. Though the fear, anxiety, and stress related to COVID-19 have been studied in depth, the direct effects of SARS-CoV-2 on the central nervous system (CNS) remain elusive. Research related to the earlier coronavirus (CoV) outbreaks (like Severe Acute Respiratory Syndrome, SARS and Middle East Respiratory Syndrome, MERS) shows the neurotropic nature of CoV and the plethora of neuropsychiatric effects that it can cause. Though the current health priorities in managing COVID-19 remain restricted to containment and targeting pulmonary symptoms, the potential acute and long-term neuropsychiatric sequelae of the infection can increase morbidity and worsen the quality of life. Emerging evidence shows neural spread of the novel coronavirus. Delirium, encephalopathy, olfactory disturbances, acute behavioral changes, headache and cerebrovascular accidents are its common neuropsychiatric complications. These are directly related to increase in peripheral immunological markers, severity of infection and case fatality rate. This narrative review synthesizes available evidence related to the neuropsychiatric manifestations of COVID-19. Also, as SARS-CoV-2 shares structural and functional similarities with its earlier congeners, this article proposes possible long-term neuropsychological sequelae and pathogenic mechanisms for the same, based on research in the other coronavirus outbreaks.

Keywords: COVID-19; Coronavirus; Neuropsychiatric; Pathogenesis; Review; Sequelae.

Conflict of interest statement

The authors report no declarations of interest.

Copyright © 2020 Elsevier B.V. All rights reserved.

References

    1. Abdelnour L., Abdalla M.E., Babiker S. COVID 19 infection presenting as motor peripheral neuropathy. J. Formos. Med. Assoc. 2020;119(6):1119–1120.
    1. Abdennour L., Zeghal C., Deme M., Puybasset L. Vol. 31. 2012. Interaction brain-lungs; pp. e101–107. (Annales francaises d'anesthesie et de reanimation). June, No. 6.
    1. Aggarwal G., Lippi G., Michael Henry B. Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): a pooled analysis of published literature. Int. J. Stroke. 2020;15(4):385–389. p.1747493020921664.
    1. Alakare J., Jurkko R., Kaukonen K.M., Saastamoinen K.P., Bäcklund T., Kaartinen J., Kolho E., Harjola V.P. Viral encephalitis associated with pandemic 2009 (H1N1) influenza A. Case Rep. 2010;2010 p.bcr0220102772.
    1. Arciniegas D.B., Anderson C.A. Viral encephalitis: neuropsychiatric and neurobehavioral aspects. Curr. Psychiatry Rep. 2004;6(5):372–379.
    1. Avula A., Nalleballe K., Narula N., Sapozhnikov S., Dandu V., Toom S., Glaser A., Elsayegh D. COVID-19 presenting as stroke. Brain Behav. Immun. 2020;87(July 2020):115–119.
    1. Banerjee D. How COVID-19 is overwhelming our mental health. Nat. India. 2020;26(March):2020. Retrieved.
    1. Beach S.R., Praschan N.C., Hogan C., Dotson S., Merideth F., Kontos N., Fricchione G.L., Smith F.A. Delirium in COVID-19: a case series and exploration of potential mechanisms for central nervous system involvement. Gen. Hosp. Psychiatry. 2020;65(July-August 2020):47–53.
    1. Bender S.J., Phillips J.M., Scott E.P., Weiss S.R. Murine coronavirus receptors are differentially expressed in the central nervous system and play virus strain-dependent roles in neuronal spread. J. Virol. 2010;84(21):11030–11044.
    1. Bohmwald K., Galvez N., Ríos M., Kalergis A.M. Neurologic alterations due to respiratory virus infections. Front. Cell. Neurosci. 2018;12:386.
    1. Chan J.F.W., Zhang A.J., Yuan S., Poon V.K.M., Chan C.C.S., Lee A.C.Y., Chan W.M., Fan Z., Tsoi H.W., Wen L., Liang R. Simulation of the clinical and pathological manifestations of Coronavirus Disease 2019 (COVID-19) in golden Syrian hamster model: implications for disease pathogenesis and transmissibility. Clin. Infect. Dis. 2020;ciaa325(March 2020)
    1. Chen J., Wang X., Zhang S., Liu B., Wu X., Wang Y., Wang X., Yang M., Sun J., Xie Y. 2020. Findings of Acute Pulmonary Embolism in COVID-19 Patients. Available at SSRN 3548771.
    1. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y., Qiu Y., Wang J., Liu Y., Wei Y., Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–513.
    1. Chen Q., Liang M., Li Y., Guo J., Fei D., Wang L., He L., Sheng C., Cai Y., Li X., Wang J. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e15–e16.
    1. Cheng S.K.W., Tsang J.S.K., Ku K.H., Wong C.W., Ng Y.K. Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: a series of 10 cases. Br. J. Psychiatry. 2004;184(4):359–360.
    1. Chilvers M.A., McKean M., Rutman A., Myint B.S., Silverman M., O’Callaghan C. The effects of coronavirus on human nasal ciliated respiratory epithelium. Eur. Respir. J. 2001;18(6):965–970.
    1. Chua S.E., Cheung V., McAlonan G.M., Cheung C., Wong J.W., Cheung E.P., Chan M.T., Wong T.K., Choy K.M., Chu C.M., Lee P.W. Stress and psychological impact on SARS patients during the outbreak. Can. J. Psychiatry. 2004;49(6):385–390.
    1. Danzi G.B., Loffi M., Galeazzi G., Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur. Heart J. 2020;41(19) 1858–1858.
    1. Desforges M., Le Coupanec A., Dubeau P., Bourgouin A., Lajoie L., Dubé M., Talbot P.J. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 2020;12(1):14.
    1. Duan L., Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):300–302.
    1. e Silva A.C.S., Moreira J.M., Romanelli R.M.C., Teixeira A.L. Zika virus challenges for neuropsychiatry. Neuropsychiatr. Dis. Treat. 2016;12:1747.
    1. Fazzini E., Fleming J., Fahn S. Cerebrospinal fluid antibodies to coronavirus in patients with Parkinson’s disease. Movement Disorders. 1992;7(2):153–158.
    1. Fischer M., Coogan A.N., Faltraco F., Thome J. COVID-19 paranoia in a patient suffering from schizophrenic psychosis–a case report. Psychiatry Res. 2020;288:113001.
    1. Fishman P.S., Gass J.S., Swoveland P.T., Lavi E., Highkin M.K. Infection of the basal ganglia by a murine coronavirus. Science. 1985;229(4716):877–879.
    1. Fu Y., Cheng Y., Wu Y. Understanding SARS-CoV-2-mediated inflammatory responses: from mechanisms to potential therapeutic tools. Virol. Sin. 2020:1–6.
    1. Fung T.S., Liu D.X. Coronavirus infection, ER stress, apoptosis and innate immunity. Front. Microbiol. 2014;5:296.
    1. Gattinoni L., Coppola S., Cressoni M., Busana M., Rossi S., Chiumello D. Covid-19 does not lead to a “typical” acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med. 2020;201(10):1299–1300. (ja)
    1. Guo Y.R., Cao Q.D., Hong Z.S., Tan Y.Y., Chen S.D., Jin H.J., Tan K.S., Wang D.Y., Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil. Med. Res. 2020;7(1):1–10.
    1. Honigsbaum M. Vol. 30. IB Tauris; 2013. (A History of the Great Influenza Pandemics: Death, Panic and Hysteria, 1830-1920).
    1. Huang K.J., Su I.J., Theron M., Wu Y.C., Lai S.K., Liu C.C., Lei H.Y. An interferon‐γ‐related cytokine storm in SARS patients. J. Med. Virol. 2005;75(2):185–194.
    1. Hui D.S., Wong K.T., Antonio G.E., Tong M., Chan D.P., Sung J.J. Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment. Hong Kong Med. J.= Xianggang yi xue za zhi. 2009;15:21.
    1. Johnson R.T. Relapsing and remitting viral diseases of the nervous system. Trends Neurosci. 1984;7(8):267–269.
    1. Karimi N., Sharifi Razavi A., Rouhani N. Frequent convulsive seizures in an adult patient with COVID-19: a case report. Iran. Red Crescent Med. J. 2020;22(3):e102828.
    1. Keith P., Day M., Perkins L., Moyer L., Hewitt K., Wells A. 2020. A Novel Treatment Approach to the Novel Coronavirus: an Argument for the Use of Therapeutic Plasma Exchange for Fulminant COVID-19.
    1. Khosravani H., Rajendram P., Notario L., Chapman M.G., Menon B.K. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke. 2020;51(6):1891–1895. pp.STROKEAHA-120.
    1. Kim J.E., Heo J.H., Kim H.O., Song S.H., Park S.S., Park T.H., Ahn J.Y., Kim M.K., Choi J.P. Neurological complications during treatment of Middle East respiratory syndrome. J. Clin. Neurol. 2017;13(3):227–233.
    1. Klok F.A., Kruip M.J.H.A., Van der Meer N.J.M., Arbous M.S., Gommers D.A.M.P.J., Kant K.M., Kaptein F.H.J., van Paassen J., Stals M.A.M., Huisman M.V., Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb. Res. 2020;191(July 2020):148–150.
    1. Koyuncu O.O., Hogue I.B., Enquist L.W. Virus infections in the nervous system. Cell Host Microbe. 2013;13(4):379–393.
    1. Lai S.L., Hsu M.T., Chen S.S. The impact of SARS on epilepsy: the experience of drug withdrawal in epileptic patients. Seizure. 2005;14(8):557–561.
    1. Lechien J.R., Chiesa-Estomba C.M., De Siati D.R., Horoi M., Le Bon S.D., Rodriguez A., Dequanter D., Blecic S., El Afia F., Distinguin L., Chekkoury-Idrissi Y. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur. Arch. Otorhinolaryngol. 2020:1–11.
    1. Li Y.C., Bai W.Z., Hashikawa T. The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID-19 patients. J. Med. Virol. 2020;92(6):552–555.
    1. Li Z., Ge J., Yang M., Feng J., Qiao M., Jiang R., Bi J., Zhan G., Xu X., Wang L., Zhou Q. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav. Immun. 2020;88(August):916–919.
    1. Liu K., Chen Y., Lin R., Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J. Infect. 2020;80(6):e14–e18.
    1. Liu S., Yang L., Zhang C., Xiang Y.T., Liu Z., Hu S., Zhang B. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e17–e18.
    1. Mao L., Jin H., Wang M., Hu Y., Chen S., He Q., Chang J., Hong C., Zhou Y., Wang D., Miao X. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–690.
    1. McAbee G.N., Brosgol Y., Pavlakis S., Agha R., Gaffoor M. Encephalitis associated with COVID-19 infection in an 11 year-old child. Pediatr. Neurol. 2020;109(94)
    1. Mehta P., McAuley D.F., Brown M., Sanchez E., Tattersall R.S., Manson J.J. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033–1034.
    1. Miller A.J., Arnold A.C. The renin–angiotensin system in cardiovascular autonomic control: recent developments and clinical implications. Clin. Auton. Res. 2019;29(2):231–243.
    1. Moein S.T., Hashemian S.M., Mansourafshar B., Khorram‐Tousi A., Tabarsi P., Doty R.L. International Forum of Allergy & Rhinology. 2020. Smell dysfunction: a biomarker for COVID‐19. April.
    1. Mori I. Transolfactory neuroinvasion by viruses threatens the human brain. Acta Virol. 2015;59(04):338–349.
    1. Moriguchi T., Harii N., Goto J., Harada D., Sugawara H., Takamino J., Ueno M., Sakata H., Kondo K., Myose N., Nakao A. A first case of Meningitis/encephalitis associated with SARS-Coronavirus-2. Int. J. Infect. Dis. 2020;94(May 2020):55–58.
    1. Ng B.Y., Lim C.T., Yeoh A., Lee W.L. Neuropsychiatric sequelae of Nipah virus encephalitis. J. Neuropsychiatry Clin. Neurosci. 2004;16(4):500–504.
    1. Okusaga O., Yolken R.H., Langenberg P., Lapidus M., Arling T.A., Dickerson F.B., Scrandis D.A., Severance E., Cabassa J.A., Balis T., Postolache T.T. Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. J. Affect. Disord. 2011;130(1–2):220–225.
    1. Oxley T.J., Mocco J., Majidi S., Kellner C.P., Shoirah H., Singh I.P., De Leacy R.A., Shigematsu T., Ladner T.R., Yaeger K.A., Skliut M. Large-vessel stroke as a presenting feature of Covid-19 in the young. N. Engl. J. Med. 2020:e60.
    1. Perlman S., Jacobsen G., Afifi A. Spread of a neurotropic murine coronavirus into the CNS via the trigeminal and olfactory nerves. Virology. 1989;170(2):556–560.
    1. Perlman S., Evans G., Afifi A.D.E.L. Effect of olfactory bulb ablation on spread of a neurotropic coronavirus into the mouse brain. J. Exp. Med. 1990;172(4):1127–1132.
    1. Poyiadji N., Shahin G., Noujaim D., Stone M., Patel S., Griffith B. COVID-19–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020:201187.
    1. Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet. 2020;395(Mar (10226)):760–762.
    1. Qiu J., Shen B., Zhao M., Wang Z., Xie B., Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen. Psychiatry. 2020;33(2)
    1. Rajkumar R.P. COVID-19 and mental health: a review of the existing literature. Asian J. Psychiatr. 2020:102066.
    1. Reinhold A.K., Rittner H.L. Barrier function in the peripheral and central nervous system—a review. Pflügers Archiv-Eur. J. Physiol. 2017;469(1):123–134.
    1. Rockx B., Kuiken T., Herfst S., Bestebroer T., Lamers M.M., Munnink B.B.O., de Meulder D., van Amerongen G., van den Brand J., Okba N.M., Schipper D. Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model. Science. 2020;368(6494):1012–1015.
    1. Rose N.R. Negative selection, epitope mimicry and autoimmunity. Curr. Opin. Immunol. 2017;49:51–55.
    1. Ruan Q., Yang K., Wang W., Jiang L., Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020:1–3.
    1. Shang L., Zhao J., Hu Y., Du R., Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet (London, England) 2020;395(10225):683.
    1. Singhal T. A review of coronavirus disease-2019 (COVID-19) Indian J. Pediatr. 2020:1–6.
    1. Sohal S., Mossammat M. COVID-19 presenting with seizures. IDCases. 2020:e00782.
    1. Sohrabi C., Alsafi Z., O’Neill N., Khan M., Kerwan A., Al-Jabir A., Iosifidis C., Agha R. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19) Int. J. Surg. 2020;76(April):71–76.
    1. Subbarao K., Roberts A. Is there an ideal animal model for SARS? Trends Microbiol. 2006;14(July (7)):299–303.
    1. Tan C.W., Low J.G.H., Wong W.H., Chua Y.Y., Goh S.L., Ng H.J. Critically ill COVID‐19 infected patients exhibit increased clot waveform analysis parameters consistent with hypercoagulability. Am. J. Hematol. 2020;(April):1–3.
    1. Troyer E.A., Kohn J.N., Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav. Immun. 2020;87(July):34–39.
    1. Vaira L.A., Deiana G., Fois A.G., Pirina P., Madeddu G., De Vito A., Babudieri S., Petrocelli M., Serra A., Bussu F., Ligas E. Objective evaluation of anosmia and ageusia in COVID‐19 patients: single‐center experience on 72 cases. Head Neck. 2020;42(6):1252–1258.
    1. Verma I.M. 2003. SARS: Fear of Global Pandemic.
    1. von Economo C.F. 1917. Encephalitis lethargica; pp. 581–583.
    1. Walls A.C., Park Y.J., Tortorici M.A., Wall A., McGuire A.T., Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;181(2):281–292.e6.
    1. Wan S., Yi Q., Fan S., Lv J., Zhang X., Guo L., Lang C., Xiao Q., Xiao K., Yi Z., Qiang M. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP) MedRxiv. 2020
    1. Wohleb E.S., McKim D.B., Sheridan J.F., Godbout J.P. Monocyte trafficking to the brain with stress and inflammation: a novel axis of immune-to-brain communication that influences mood and behavior. Front. Neurosci. 2015;8:447.
    1. World Health Organization . 2020. Coronavirus Disease 2019 (COVID-19): Situation Report; p. 143. (as on 15 June 2020)
    1. Wrapp D., Wang N., Corbett K.S., Goldsmith J.A., Hsieh C.L., Abiona O., Graham B.S., McLellan J.S. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260–1263.
    1. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242.
    1. Wu Y., Xu X., Chen Z., Duan J., Hashimoto K., Yang L., Liu C., Yang C. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav. Immun. 2020;87(July):18–22.
    1. Xie J., Tong Z., Guan X., Du B., Qiu H., Slutsky A.S. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020:1–4.
    1. Yang Y., Li W., Zhang Q., Zhang L., Cheung T., Xiang Y.T. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e19.
    1. Yang J., Zheng Y., Gou X., Pu K., Chen Z., Guo Q., Ji R., Wang H., Wang Y., Zhou Y. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int. J. Infect. Dis. 2020;94(May):91–95.
    1. Yao H., Chen J.H., Xu Y.F. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):e21.
    1. Zhang R., Wang X., Ni L., Di X., Ma B., Niu S., Liu C., Reiter R.J. COVID-19: melatonin as a potential adjuvant treatment. Life Sci. 2020:117583.
    1. Zhang W., Zhao Y., Zhang F., Wang Q., Li T., Liu Z., Wang J., Qin Y., Zhang X., Yan X., Zeng X. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the experience of clinical immunologists from China. Clin. Immunol. 2020:108393.
    1. Zhou M., Zhang X., Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front. Med. 2020:1–10.
    1. Zulkifli N.A., Sivapatham S., Guan N.C. Brief psychotic disorder in relation to coronavirus, COVID-19 outbreaks: a case report. Malaysian J. Psychiatry. 2020;29(1)

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner