Neurological and Psychiatric Symptoms Such As Fatigue and Depression Common in Mild COVID

Neurological and psychiatric symptoms such as fatigue and depression are common in people with Covid-19 and may be just as likely in those with mild cases, according to a new review study led by a UCL investigator.

Reviewing the evidence from 215 studies of Covid-19, the meta-analysis published in the Journal of Neurology, Neurosurgery and Psychiatry reports a wide range of ways Covid-19 can affect mental health and the brain.

Lead author Dr. Jonathan Rogers (UCL Psychiatry and South London and Maudsley NHS Foundation Trust) said: “We expected that neurological and psychiatric symptoms would be more common in severe Covid-19 cases, but instead we found that some symptoms are more common in mild cases . It seems that Covid-19 affecting mental health and the brain is the norm rather than the exception.”

The research team systematically reviewed the evidence from 215 studies of Covid-19 from 30 countries, involving a total of 105,638 people with acute symptoms of Covid-19, including data up to July 2020 (acute refers to the major stage of disease, rather than prolonged- term effects). The studies varied in the symptoms they tracked, and the research team collected data to compare how common each symptom was in the studies that tracked it.

Across the dataset, the most common neurological and psychiatric symptoms were: anosmia (loss of smell; reported by 43% of patients with Covid-19), weakness (40%), fatigue (38%), dysgeusia (loss of taste; 37%), myalgia (muscle pain; 25%), depression (23%), headache (21%), and anxiety (16%). They also identified the presence of major neurological disorders such as ischemic stroke (1.9% of cases in the dataset), hemorrhagic stroke (0.4%) and seizures (0.06%). Patients with severe Covid-19 were overrepresented in the dataset as a whole, as most studies focused on hospitalized patients, and even the out-of-hospital studies included few people with very mild or no symptoms.

But among people with symptomatic acute Covid-19 who were not hospitalized, neurological and psychiatric symptoms were still common: 55% reported fatigue, 52% loss of smell, 47% muscle pain, 45% loss of taste and 44% reported headache . The researchers say it’s still possible for such symptoms to be just as common in severe cases, because mild symptoms may not be reported by a patient in intensive care.

While this review did not investigate causal mechanisms, the researchers suggest some possible explanations. In the acute phase of the disease, inflammation has been found in the brain, which may explain some of the symptoms. Psychosocial factors related to the context of the global pandemic may play a role as acutely ill people can feel isolated when unable to see their family or friends, which may explain why depression and anxiety have been featured in some Covid-19 studies. found to be more common than other viral illnesses such as flu.

dr. Rogers said: “Many factors can contribute to neurological and psychiatric symptoms in the early stages of Covid-19 infection, including inflammation, reduced oxygen supply to the brain and psychological factors. More studies are needed to better understand these connections.”

Joint senior author Dr. Alasdair Rooney (University of Edinburgh) said: “Neurological and psychiatric symptoms are very common in people with Covid-19. With millions of people infected worldwide, even the rarer symptoms can affect significantly more people than in normal times. Mental health services and neurological rehabilitation services should be provided with resources for an increase in referrals.”

The researchers found that most studies looked at a small subset of neurological symptoms, such as fatigue or muscle pain, while often neglecting symptoms of mental illness such as depression, anxiety and post-traumatic stress disorder (PTSD), as well as stroke. and seizures, so they say more studies are needed on the full range of symptoms associated with Covid-19.

Reference: June 3, 2021, Journal of Neurology, Neurosurgery and Psychiatry.
DOI: 10.1136/jnnp-2021-326405

The study was led by researchers from UCL, the University of Edinburgh, King’s College London and Queen Mary University of London, along with co-authors in the UK, Bulgaria, Canada, India and Germany.