The COVID-19 SARS pandemic has passed its peak global virulence, but the effects are still being felt, with continued new infections as well as a cadre of patients who have post-acute sequelae of SARS CoV-2 infection (PASC), commonly known as “long COVID.” The World Health Organization (WHO) has defined it as “the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months without other explanation.” According to Yale Medicine, one study has estimated that 65 million people worldwide are suffering from long COVID.
Neurologic Complications Related to COVID-19
- NeurologicAdd psychiatric symptoms are associated with COVID-19:
- Anosmia (loss of smell)
- Dysgeusia (loss of taste)
- Headaches
- Impaired consciousness
- Coma
- Abnormal sleep
- Confusion
- Agitation
- Delirium
- Ataxia (loss of motor skills)
- Impaired executive function
- Seizures
In addition to psychiatric features such as depression, anxiety, hallucinations, psychosis, and suicidality, COVID-19 can also cause spinal disease, such as acute myelitis, with corresponding neurologic signs and symptoms. There have been rare cases where a patient with COVID-19 has also been diagnosed with autoimmune encephalitis. When a patient with COVID-19 presents with, or develops, severe neuropsychiatric signs and symptoms consistent with encephalitis, a thorough clinical evaluation should begin immediately, including investigation for sera and autoantibodies. As with many symptoms of COVID-19, treatment of the neuropsychiatric symptoms of COVID-19 has followed the treatment of these symptoms as they present in other circumstances where autoimmune encephalitis has been diagnosed.
Long COVID Neuropsychiatric Issues
The course of COVID-19 generally lasts from 1-6 weeks, depending on the severity of the case. However, vaccinated people have a 5-10% chance of getting long COVID thereafter and a higher rate of 15-20% for unvaccinated people. Additional risk factors associated with the risk of developing neuropsychiatric symptoms include prior history of mental illness, the severity of COVID-19, female gender, the existence of comorbidities, and elevation of inflammatory markers.
While over 200 symptoms have been associated with long COVID, the WHO identifies two neuropsychiatric symptoms, fatigue and cognitive dysfunction, as well as shortness of breath as the most common among them. Additional neuropsychiatric symptoms associated with Long COVID are depression, headaches, anxiety, sleep disturbance, psychosis, PTSD, executive dysfunction, and attention and memory deficits. These symptoms are more likely to occur in older patients, particularly those with a preexisting diagnosis of dementia.
The principal complaint of fatigue may be treated pharmacologically with stimulants along with cognitive-behavioral therapy and exercise-focused interventions.There is a growing body of data that supports the efficacy of using low-dose neuroleptics and alpha-adrenergic blockers for managing symptoms. An alternative treatment to “brain fog” is melatonin; however, this has not been clinically demonstrated to be effective. As the understanding and presentation of long COVID continues, additional treatments and interventions may prove to be effective as well.
The current treatment protocols for the neuropsychiatric symptoms of long COVID call for a combination of pharmacological and other interventions. An effective team treating a patient with long COVID should be able to offer these treatments in an integrated manner. To learn more about long COVID and its treatment, contact Washington Behavioral Medicine Associates to schedule an appointment to speak with one of our practitioners.
