A Systematic Review of Neuropsychological and Psychiatric Sequalae of COVID-19

Implications for Treatment

William Michael Vanderlind; Beth B. Rabinovitz; Iris Yi Miao; Lauren E. Oberlin; Christina Bueno-Castellano; Chaya Fridman; Abhishek Jaywant; Dora Kanellopoulos

Disclosures

Curr Opin Psychiatry. 2021;34(4):420-433. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: COVID-19 impacts multiple organ systems and is associated with high rates of morbidity and mortality. Pathogenesis of viral infection, co-morbidities, medical treatments, and psychosocial factors may contribute to COVID-19 related neuropsychological and psychiatric sequelae. This systematic review aims to synthesize available literature on psychiatric and cognitive characteristics of community-dwelling survivors of COVID-19 infection.

Recent Findings: Thirty-three studies met inclusion/exclusion criteria for review. Emerging findings link COVID-19 to cognitive deficits, particularly attention, executive function, and memory. Psychiatric symptoms occur at high rates in COVID-19 survivors, including anxiety, depression, fatigue, sleep disruption, and to a lesser extent posttraumatic stress. Symptoms appear to endure, and severity of acute illness is not directly predictive of severity of cognitive or mental health issues. The course of cognitive and psychiatric sequelae is limited by lack of longitudinal data at this time. Although heterogeneity of study design and sociocultural differences limit definitive conclusions, emerging risk factors for psychiatric symptoms include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatry history.

Summary: The extant literature elucidates treatment targets for cognitive and psychosocial interventions. Research using longitudinal, prospective study designs is needed to characterize cognitive and psychiatric functioning of COVID-19 survivors over the course of illness and across illness severity. Emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19 is warranted.

Introduction

The novel coronavirus (SARS-CoV-2) that causes coronavirus disease (COVID-19) impacts multiple organ systems.[1] Mortality rates are staggering, and morbidity trends have been the focus of numerous investigations. Persisting symptoms following infection are increasingly reported, including psychiatric symptoms and cognitive concerns,[2,3] which are likely salient contributors to morbidity and disability. Although the etiology is still largely unknown, cognitive deficits may arise from stroke, meningitis, hypoxia, and inflammatory injury[4–8] or from the invasive interventions required to treat severe illness from COVID-19.[9] Psychiatric illness may arise from a combination of biological, psychosocial, and environmental factors. Early findings on COVID-19 are consistent with existing literature on patients with severe and unexpected illness who experience psychiatric symptoms related to medical illness, functional disability, and psychosocial stressors.[10]

Here, we review the nascent literature on the neuropsychological and psychiatric sequelae of COVID-19 among community-dwelling individuals. We included studies that reported on postacute infection, including individuals who were never hospitalized and those who were previously hospitalized. We highlight trends, discuss treatment implications, and provide a roadmap for further research on long-term psychiatric and cognitive impairment after COVID-19.

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