One-Third of COVID-19 Survivors May Develop a Neuropsychiatric Disorder Within Months of Infection

One-third of individuals diagnosed with COVID-19 developed a psychiatric or neurological problem within six months of their diagnosis, according to a study published Tuesday in The Lancet Psychiatry. The prevalence of a post-COVID neurologic or psychiatric diagnosis was even greater among individuals with severe illness who had required hospitalization.

“Given the size of the pandemic and the chronicity of many of the diagnoses and their consequences (for example, dementia, stroke, and intracranial hemorrhage), substantial effects on health and social care systems are likely to occur,” wrote Maxime Taque, Ph.D., of the University of Oxford and colleagues. “Our data provide important evidence indicating the scale and nature of services that might be required.”

Taque and colleagues used data from a multinational electronic health record (EHR) database to identify 236,379 patients diagnosed with COVID-19 on or after January 20, 2020, and who were still alive on December 13, 2020. This sample included 190,077 patients who did not require hospitalization and 46,302 who did (including 8,945 patients who required intensive care). For control groups, Taque and colleagues also examined the EHR records of patients diagnosed with influenza and patients diagnosed with any respiratory tract infection during the same period.

The researchers then investigated the occurrence of the following neuropsychiatric outcomes in the first 180 days after COVID-19 diagnosis: intracranial hemorrhage; ischemic stroke; Parkinson’s disease; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; neuromuscular disorders; encephalitis; dementia; psychotic disorders; mood disorders; anxiety disorders; substance use disorder; and insomnia.

Overall, 33.62% of COVID-19 patients received one of the above diagnoses within 180 days; this rate increased to 38.73% among patients who were hospitalized and 46.42% among patients admitted to intensive care. The rates of almost all these outcomes were higher in patients in the COVID-19 group compared with those in the influenza group or respiratory tract infection group. The exceptions were Parkinson’s disease and Guillain-Barré syndrome, which were similar in COVID-19 and influenza patients.

Anxiety disorders were the most common neuropsychiatric diagnoses among all patients, occurring in 17.39% of COVID-19 patients; they were followed by mood disorders in 13.66% of COVID-19 patients and substance use disorder at 6.58% of COVID-19 patients. Psychotic disorders were diagnosed in 1.40% of COVID-19 patients.

Compared with neurological disorders, the rates of mood and anxiety disorders did not significantly increase among hospitalized patients, Taque and colleagues noted. “This might indicate that their occurrence reflects, at least partly, the psychological and other implications of a COVID-19 diagnosis rather than being a direct manifestation of the illness,” they wrote.

For related information, see the Psychiatric News article “Expect a ‘Long Tail’ of Mental Health Effects From COVID-19.”

(Image: iStock/gorodenkoff)

---

APA to Sponsor Webinars on Impact of COVID-19 on MH of African Americans

Join APA for a two-part webinar series that will examine strategies and opportunities to improve the mental health of African Americans during the pandemic, while also raising awareness and building trust on the efficacy of the COVID-19 vaccine. The webinars will be held on April 8 beginning at 7 p.m. ET.

Register Now

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Medicare Beneficiaries With Mental Illness May Be More Likely to Seek Care at Emergency Department

Studies show that a relatively small proportion of the population accounts for most health spending in the United States. By some estimates, 25% of Medicare beneficiaries account for 85% of Medicare costs. A study in Psychiatric Services in Advance now suggests that high-cost Medicare patients with mental health problems may be more likely to seek help at the emergency department (ED) than patients without mental conditions.

Jeffrey B. Weilburg, M.D., of Massachusetts General Hospital (MGH) and colleagues focused their analysis on high-cost Medicare patients who were enrolled in a Medicare Case Management for High-Cost Beneficiaries Demonstration Project (CMHCB-DP) at MGH for at least 12 months. Data were obtained from the following sources: the CMHCB database; the MGH ED information system, which provided ED visit–level data; the MGH comprehensive electronic medical record, which provided a list of diagnoses, procedures, and medications; and the hospital’s electronic billing system, which provided the diagnosis codes associated with the patient’s MGH clinic, hospital inpatient, and outpatient encounters.

All codes in DSM-IV-TR or the mental disorders section of ICD-9-CM were considered as diagnoses of behavioral health conditions. The codes were sorted into 11 categories: adjustment, affective, anxiety, axis II, eating, neuropsychiatric, other, psychosis, sleep, substance abuse, and unknown.

Overall, 1,341 of 3,620 (37%) patients had a total of 2,587 ED visits during their first 12 months of enrollment in CMHCB-DP. Patients who fell into two or more behavioral health categories or had two or more prescribed psychotropics had a significantly greater tendency to make at least one ED visit, compared with patients with no behavioral health diagnosis categories or medications, and were more likely to make four or more ED visits a year. In addition, patients with a diagnosis category of psychosis, neuropsychiatric disorders, sleep disorders, or adjustment disorders were significantly more likely than those with other mental health problems to use the ED.

“Most other studies have found that medical severity and comorbidity are the most powerful predictors of ED use. Our findings suggest that this is also true for a high-cost, high-risk subpopulation,” Weilburg and colleagues wrote. “[F]uture studies are needed to address the impact of individual behavioral health diagnoses on ED use.”

For related news, see the Psychiatric Services article “Treating Patient Well-Being in a Psychiatric Emergency Room.”

(Image: iStock/MJFelt)

Follow Psychiatric News on Twitter!

Experts Recommend New Approach for Treating Neuropsychiatric Symptoms of Dementia

A panel of neurocognitive experts from the University of Michigan and Johns Hopkins University proposed in an article in the Journal of the American Geriatrics Society, an alternative method to help reduce unfavorable neuropsychiatric symptoms such as agitation—that are often associated with dementia.

“Often, more than memory loss, behavioral symptoms of dementia are among the most difficult aspects of caring for people with dementia,” said Helen Kales, M.D., lead author and a professor of psychiatry at Michigan. “These symptoms are experienced almost universally… [They] are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment.”

The approach, dubbed DICE—presented this week at APA’s annual meeting—focuses on the implementation of environmental modifications and other interventions, such as exercise, as a first-line method to alleviate neuropsychiatric symptoms.

Briefly described, the components are:

•D: Describe - Asking the caregiver, and the patient if possible, to describe the "who, what, when, and where" of situations in which problem behaviors occur and the physical and social context for them. These observations will be shared with caregivers.

•I: Investigate – Having the health provider look into all aspects of the patient's health, including dementia symptoms and current medications and sleep habits, that might be combining with physical, social, and caregiver-related factors to produce the behavior.

•C: Create – Working together, the patient's caregiver and health providers develop a plan to prevent and respond to behavioral issues, including everything from changing the patient's activities and environment to educating and supporting the caregiver.

•E: Evaluate – Giving the provider responsibility for assessing how well the plan is being followed and how it's working, or what might need to be changed.

In an interview with Psychiatric News, Kales said, “Innovative approaches are needed to support and train the front-line providers for older populations with behavioral symptoms of dementia. We believe that the DICE approach offers clinicians an evidence-informed structured clinical reasoning process that can be integrated into diverse practice settings.”

To see read more about nonpharmacological therapies for treating symptoms of neurocognitive disorders, see the Psychiatric News article, "Mindful Exercises and Meditation: Neurobiological Effects." Also, watch a Psychiatric News interview with Kales here.

Range of Neuropsychiatric Disorders Linked to Alterations in DNA

Having multiple, large “copy-number variants”— either deletions or duplications of sections of DNA—appears to significantly increase the risk for a range of neuropsychiatric disorders whose expression as a specific disorder will differ from person to person depending on other genetic and environmental factors, according to a report in the New England Journal of Medicine.


Among the disorders that may stem from these copy-number variants are autism, schizophrenia, attention-deficit/hyperactivity disorder, aggressive behaviors, epilepsy or seizures, and specific organ defects. Having more than one of the copy-number number variants significantly increases the risk for one of the disorders.

Genetic experts at more than 20 institutions and research centers analyzed the genomes of 2,312 children known to carry a copy-number variant associated with intellectual disability and congenital abnormalities. They found that among affected children, 10.1% carried a second large copy-number variant in addition to a primary genetic lesion.

“We propose that a combination of rare and disruptive variants of large effect can contribute to different phenotypic outcomes, including intellectual disability, epilepsy, autism, and schizophrenia,” the researchers stated in the article.

The report can be accessed here. For more information see Psychiatric News here and here.

(Image:negative/shutterstock.com)