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 with no 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
Numerous neurologic and 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
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 in 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.
Director, WBMA