How COVID-19 can damage the brain

People are getting psychosis after COVID-19, prompting scientists to investigate whether the body is mistakenly attacking the brain after infection. https://www.businessinsider.com/author/marianne-guenot-ins Neurologic, psychiatric conditions common in COVID-19. Brain involvement the norm, rather than exception. https://www.cidrap.umn.edu/news-perspective/2021/06/neurologic-psychiatric-conditions-common-covid-19 https://www.youtube.com/watch?v=ATy1HXQNibk Study: A Third of COVID Patients Develop Neuropsychiatric Symptoms. Some COVID-19 patients have reported experiencing psychotic symptoms weeks after their initial infection. And now researchers say the development of these symptoms may be more common than previously thought. Study: 1 in 5 Adults Develop Pandemic-Related Mental Disorders According to new research published in JAMA Psychiatry, as many as one-third of COVID-19 patients have long-term neuropsychiatric symptoms, including psychosis and anxiety. Researchers believe that the symptoms could be the result of how the virus itself damages the brain, rather than of a lack of oxygen related to COVID-19's impact on the lungs. Up to a third of people with COVID-19 have long-term neuropsychiatric symptoms, including psychosis and anxiety. Patients may have new neuropsychiatric symptoms or worse symptoms of an existing mental illness. The virus may cause brain damage directly through inflammation or through blood clotting. Current treatment for COVID-19-related neuropsychiatric issues includes treating specific symptoms, monitoring patients, and taking a wait-and-see approach. https://www.verywellhealth.com/covid-19-psychosis-neurological-symptoms-5176173 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2778090 Psychotic-like experiences are related to COVID-19 conspiracy theory beliefs. Emphasis on perceptual abnormalities and persecutory ideation. Health concerns and low education can be liability factors for conspiracy beliefs. Illogical disease-related arguments can be related to psychotic-like experiences. https://www.sciencedirect.com/science/article/pii/S0277953621009436# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416269/ COVID and the brain: researchers zero in on how damage occurs. Growing evidence suggests that the coronavirus causes ‘brain fog’ and other neurological symptoms through multiple mechanisms. https://www.nature.com/articles/d41586-021-01693-6 https://www.nature.com/articles/d41586-020-02599-5 How COVID-19 Compromises Brain Function. https://www.cedars-sinai.org/blog/covid-19-brain-fog.html How COVID Infection May Damage the Brain and Affect Mental Illness Symptoms & Mortality Some patients develop symptoms of psychosis after getting COVID-19. It is possible that the stress of the pandemic is causing the psychiatric problems. But some scientists think it may be the virus causing the body to attack the brain. https://www.bbrfoundation.org/content/how-covid-infection-may-damage-brain-and-affect-mental-illness-symptoms-mortality Covid psychosis: Understanding how the virus can hijack the brain https://wgntv.com/news/medical-watch/covid-psychosis-understanding-how-the-virus-can-hijack-the-brain/ COVID-19: Causative Role in Psychosis, Depression, and Other Mental Health Conditions https://www.nyp.org/publications/professional-advances/psych/covid-19-causative-role-in-psychosis-depression-and-other https://chicagohealthonline.com/covid-psychosis/ 'The most terrifying thing': Some Covid-19 patients are suffering severe psychosis https://www.advisory.com/daily-briefing/2021/03/26/covid-psychosis First Covid, Then Psychosis: ‘The Most Terrifying Thing I’ve Ever Experienced’ Like a small number of Covid survivors with no previous mental illness, Ivan Agerton developed psychotic symptoms weeks after his coronavirus infection. https://www.nytimes.com/2021/03/22/health/covid-psychosis.html https://www.nytimes.com/2020/12/28/health/covid-psychosis-mental.html https://www.nationalgeographic.com/science/article/can-covid-19-alter-your-personality-heres-what-brain-research-shows https://www.hmpgloballearningnetwork.com/site/emsworld/news/1225786/post-covid-psychosis-rare-serious-virus-reaction https://www.scientificamerican.com/article/covid-can-cause-forgetfulness-psychosis-mania-or-a-stutter/ https://globalnews.ca/news/7151868/coronavirus-brain-damage-psychosis-delirium/ 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records Neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis. METHODS For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism. FINDINGS Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio [HR] 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events. INTERPRETATION Our study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings. FUNDING National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. • View related content for this article https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext