Covid Awareness

NEUROPSYCHIATRIC MANIFESTATIONS OF COVID-19 AND ITS SYMPTOMS STAYING LONG TERM

This pandemic of Corona Virus has bought political and institutional, socio-economical, environmental, technological, transportation complications upon our head along with several misinterpretations. Conspiracy theories spread on the social media and major consequential factors of this disease discussed further. We do focus on physical symptoms of any disease, even in the case of this pandemic, Covid-19 we all know what aetiologies, as well as symptoms, are shown in the people affected and their respective prognosis. Fever, dry cough, tiredness, aches and pains, sore throat, diarrhoea, conjunctivitis, headache can be well known as the physical indications. But, as a psychologist or a mental health advocate, it is extremely important to know the psychiatric manifestations such as stress, anxiety, depression, frustration, uncertainties, panic behaviour etc. But another important aspect in the eyes of many researchers and psychiatrists all over the World are the Neurological and Neuro-Psychiatric symptoms.

A wide picture of neuro symptoms across this pandemic is not much explored but growing literature explains that they can play a very serious role in the lives of Corona warriors as well as their families. Few of the COVID-19 patients in Wuhan had neurological manifestations like cerebrovascular disease, impaired consciousness, and skeletal muscle injury, drowsiness, oedema, stroke, convulsions, and coma, if untreated can lead to partial or complete paralysis. This shows that there will be many patients who must be having these symptoms during and after their recovery which goes un-known and un-detected.  Similarly, there are Neuro-Psychiatric symptoms of anxiety, depression, trauma, insomnia, delirium, and suicide  that can be present till a long time even after the pandemic is over.

The pathogenesis of the neurological and neuro-psychiatric manifestations during Corona is also a major factor to understand for the clinicians in the future which includes Hypoxic Brain Injury; interaction of the COVID-19 virus spike protein with ACE-2 receptors of the cerebral capillary endothelium, resulting in damage to the endothelial lining and access to the brain; cerebral oedema; post-infectious autoimmunity; and immunomodulatory treatments. Such damage may or may not result in the people suffering from Corona depending upon their immunity, recovery rate as well as the intensity of progress, but if the damage happens surely it is a dangerous situation for the patient who is dealing with the disease.

A recent meta-analysis by Rogers et al. in Lancet Psychiatry reported the prevalence of delirium in the acute stage of COVID-19 infection which encouraged clinicians to monitor for the emergence of depression, anxiety, posttraumatic stress disorder, and other neuropsychiatric disorders post-infection. This would prove to be beneficial in providing more evidence to know their connection. In some cases research findings also show that few presenting or preliminary symptoms emerging from sensory disturbances – An area controlled by the brain and nervous systems appear before the commonly known manifestations, like Hyposmia - a decreased sense of smell, or a decreased ability to detect odours through your nose, Anosmia - the inability to smell anything, Dysgeusia - distortion of the sense of taste, ageusia - the complete lack of taste.

These all researches suggest that to look beyond just the cover picture of a cause and effect relationship along with monitoring those patients exposed to COVID-19 for neuropsychiatric sequelae is extremely supreme because those symptoms stay with the person unknowingly for a prolonged period.                  Multi-system approaches are nowadays very useful method to know the probable origins of a particular condition as it includes a holistic approach to understand bio, psycho, neuro, social, environmental, cultural and other influencing aspects that could affect a person who is tackling with such a life-threatening disease. Once, there is an awareness of the Neuropsychological link to the COVID -19 amongst the front-line health workers they can refer and transfer the cases of at-risk populations (if needed) to the mental health professionals or Neuro specialists ahead for the timely probe as they can plan appropriate testing and interventions before the situation gets too serious.